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[p. 1]

ADULT CORE
Section I -- IDENTIFICATION

FR: THE SAMPLE PERSON IS {FILL SAMPLE ADULT NAME}. THE NEXT QUESTIONS MUST BE ANSWERED BY THIS PERSON - NO PROXIES ARE PERMITTED. PROBE AS NECESSARY TO DETERMINE THE AVAILABILITY OF {SAMPLE ADULT NAME}. NO EMANCIPATED MINORS ARE PERMITTED.

SADULT

(1) Available
(2) Not Available (arrange callback)

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 ABOUT THE SAMPLE ADULT BEFORE PROCEEDING:

AIDVERF_S

Gender = {male/female} Is it correct?
(1) Yes
(2) No

AIDVERF_A

Age = {3 digit format} Is it correct?
(1) Yes
(2) No

AIDVERF_D

Birthday = {word format} Is it correct?
(1) Yes
(2) No

Check Item AIDCCI2 : If AIDVERF_S = (2) go to AID.040; If AIDVERF_A = (2) go to AID.050;
If AIDVERF_D = (2) go to AID.060; Else go to ACN.010. If no changes or when changes complete, go to next section -- Conditions

AID.040

FR: ASK IF APPROPRIATE; OTHERWISE, ENTER YOUR BEST GUESS OF THE PERSON'S SEX.

Is {sample adult name} male or female?

AIDSEX

(1) Male
(2) Female
(Go to Check Item AIDCCI2)
[Update revised sex AIDSEX in SEX]

AID.050

How old is {sample adult name}?

AIDAGE

(00-99) 0-99 years old
(997) Refused
(999) Don't Know(Go to Check Item AIDCCI2)

[Update revised age AIDAGE in AGE]

[p. 2]

AID.060

What is {sample adult name} 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)Don't Know

AIDDOB_Y

YEAR:
(1900-1997) 1900-1997
(9997)Refused
(9999)Don't Know(Go to Check Item AIDCCI2)

[Update revised birthdate in DOB_M, DOB_BDAY, and DOB_Y_P]
[Note: Variables in the AID section are used to verify information collected from the family
respondent. They do no exist as separate variables in the analytic file.]
(Go to next section -- Conditions)

[p. 3]

ADULT CORE
Section II -- CONDITIONS

ACN.010

Now I am going to ask you about certain medical conditions.
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) Don't know (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) Don't know

[The next 8 questions are periodic heart disease questions.]

ACN.020.010

Was any medication ever prescribed by a doctor to help you lower your blood pressure?

HYPMEDEV

(1) Yes (ACN.020.020)
(2) No (ACN.020.030)
(7) Refused (ACN.020.030)
(9) Don't know (ACN.020.030)

ACN.020.020

Are you NOW taking prescribed medicine for your high blood pressure?

HYPMED

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.020.030

About how long has it been since you had your blood pressure checked by a doctor, nurse, or
health professional?

ACN.020.030A

[ ] NUMBER

HYBPCKNO

(00) Never (ACN.020.050)
(01-94) 1-94 (ACN.020.030B)
(95) 95+ (ACN.020.030B)
(97) Refused (ACN.020.050)
(99) Don't know (ACN.020.050)

ACN.020.030B

[ ] TIME PERIOD

HYBPCKTP

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know

[p. 4]

ACN.020.040

At that time, were you told that your blood pressure was high, normal, or low?

HYBPLEV

(1) Not told
(2) High
(3) Normal
(4) Low
(5) Borderline
(7) Refused
(9) Don't know

*ACN.020.050

Have you ever been told by a doctor or health professional that your blood cholesterol level was high?

CLHI

(1) Yes (ACN.020.060)
(2) No (ACN.031)
(7) Refused (ACN.031)
(9) Don't know (ACN.031)

*ACN.020.060

Was any medication ever prescribed by a doctor to help lower your cholesterol level?

CLMEDEV

(1) Yes (ACN.020.070)
(2) No (ACN.031)
(7) Refused (ACN.031)
(9) Don't know (ACN.031)

*ACN.020.070

Are you now taking prescribed medication to lower your cholesterol?

CLMED

(1) Yes
(2) No
(7) Refused
(9) Don't know

*ACN.020.080

About how long has it been since you had your blood cholesterol checked by a doctor or other health professional?

CLCK_NO

[ ] NUMBER
(00) Never
(01-94) 1-94
(95) 95+
(97) Refused
(99) Don't know

CLCK_TP

[ ] TIME PERIOD
(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know

[End of periodic heart disease questions.]

*Cholesterol questions were inadvertently asked for only a subgroup of the population (people with high blood pressure).

Therefore, data from these questions are not being released.

[p. 5]

ACN.031

Have you EVER been told by a doctor or other health professional that you had ...
(1) Yes
(2) No
(7) Refused
(9) Don't know

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?

[ The next 2 questions are periodic heart disease questions. ]

[ If MIEV = (1) go to ACN.031.010; Else go to ACN.031.020 ]

ACN.031.010

How old were you when you were first told you had a heart attack?

C1MIAGE

(001-100) 1-100 Age (ACN.031D)
(997) Refused (ACN.031D)
(999) Don't know (ACN.031D)

ACN.031.020

Have you EVER been told by a doctor or other health professional that you had...
(1) Yes
(2) No
(7) Refused
(9) Don't know

CON...Congestive heart failure?
OST...Osteoporosis?
PAR...Parkinson's Disease?

[ End of periodic heart disease questions. ]

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.100.070)
(7) Refused (ACN.100.070)
(9) Don't know (ACN.100.070)

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.100.060)
(7) Refused (ACN.100.060)
(9) Don't know (ACN.100.060)

[p. 6]

ACN.100During 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) Don't know

[ The next 15 questions are periodic asthma questions. ]

ACN.100.010

During the past 12 months, have you have to stay overnight in the hospital because of asthma?

AASMHOS

(1) Yes (ACN.100.020)
(2) No (ACN.100.030)
(7) Refused (ACN.100.030)
(9) Don't know (ACN.100.030)

ACN.100.020

During the past 12 months, how many times did you stay overnight in the hospital because of
asthma?

AASHONT

(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13+
(7) Refused
(9) Don't know

ACN.100.030
During the past 12 months, have you used over-the-counter medications for your asthma?

AASMOTC

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.100.040

During the PAST 3 MONTHS, have you used prescription inhalers (Do not include over-the-
counter inhalers like Primatene Mist)?

AASMPMED

(1) Yes (ACN.100.050)
(2) No (ACN.100.060)
(7) Refused (ACN.100.060)
(9) Don't know (ACN.100.060)

ACN.100.050

During the past 3 months, that is since {fill date 3 months prior with the same date}, how many
canisters of prescription inhalers did you use? Do not include over-the-counter inhalers like
Primatene Mist.

AASMCAN

(01-94) 1-94
(97) Refused
(99) Don't know

ACN.100.060

Have you ever taken a course or class on how to manage asthma yourself?

AASCLASS

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.100.070

During the past 12 months, have you had a wheezing or whistling sound in your chest?

AWZ

(1) Yes (ACN.100.080)
(2) No (ACN.110)
(7) Refused (ACN.110)
(9) Don't know (ACN.110)

[p. 7]

ACN.100.080

How many attacks of wheezing or whistling have you had in your chest during the past 12 months?

AWZNUM

(01-94) 1-94 attacks
(95) 95+ attacks
(97) Refused
(99) Don't know

ACN.100.090

During the past 12 months, has your sleep been disturbed due to wheezing or whistling?

AWZSLP

(1) Yes (ACN.100.100)
(2) No (ACN.100.110)
(7) Refused (ACN.100.110)
(9) Don't know (ACN.100.110)

ACN.100.100

During the past 12 months, how often on average, has your sleep been disturbed due to wheezing
or whistling?

AWZSPL

(1) Less than 1 per week
(2) 1 per week
(3) More than 1 per week
(7) Refused
(9) Don't know

ACN.100.110

During past 12 months, has your chest sounded wheezy during or after exercise or physical
activity?

AWZEX

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.100.120

During the past 12 months, has wheezing ever been severe enough to limit your speech to only 1 or 2 words at at time between breaths?

AWZSPC

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.100.130

During the past 12 months, how many times have you gone to the doctor's office or the hospital
emergency room for one or more or these attacks of wheezing or whistling?

AWZERYR

(000) Never
(001-365) 1-365 times
(997) Refused
(999) Don't know

ACN.100.140

FR: SHOW CARD A1
During the past 12 months, how much did you limit your usual activities due to wheezing or
whistling? Would you say: not at all, a little, a fair amount, a moderate amount, or a lot?

Card A1

1. Not at all
2. A little
3. A fair amount
4. A moderate amount
5. A lot

AWZLA

(1) Not at all (ACN.110)
(2) A little (ACN.100.150)
(3) A fair amount (ACN.100.150)
(4) A moderate amount (ACN.100.150)
(5) A lot (ACN.100.150)
(7) Refused (ACN.100.150)
(9) Don't know (ACN.100.150)

ACN.100.150

During the past 12 months, how many days of work/school did you miss due to wheezing or
whistling?

AWZMSWK

(0) Zero
(1) 1-7
(2) 8-30
(3) 31+
(4) Does not (work/go to school)
(7) Refused
(9) Don't know

[ End of the periodic asthma questions. ]

[p. 8]

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.110.010)
(2) No (ACN.120.010)
(7) Refused (ACN.120.010)
(9) Don't know (ACN.120.010)

[ This next question is a periodic ulcer question. ]

ACN.110.010

How old were you when you were first told had an ulcer?

ULCAGE

(001-100) 1-100 years
(997) Refused
(999) Don't know

[ End of the periodic ulcer question. ]

ACN.120
During the PAST 12 MONTHS have you had an ulcer?

ULCYR

(1) Yes
(2) No
(7) Refused
(9) Don't know

[ The next 3 questions are periodic ulcer questions. ]

ACN.120.010

Have you EVER been told be a doctor or other health professional that you had Crohn's disease or ulcerative colitis?

ULCCOLEV

(1) Yes (ACN.120.020)
(2) No (ACN.130)
(7) Refused (ACN.130)
(9) Don't know (ACN.130)

ACN.120.020

How old were you when you were first told you had Crohn's disease or ulcerative colitis?

ULCCLAGE

(001-100) 1-100 years
(997) Refused
(999) Don't know

ACN.120.030

During the past 12 months have you had symptoms of Crohn's disease or ulcerative colitis?

ULCCOLYR

(1) Yes
(2) No
(7) Refused
(9) Don't know
[ End of periodic ulcer questions. ]

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) Don't know (ACN.160)

[p. 9]

ACN.140

What kind of cancer was it?
FR:_MARK UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3, CODE ?'
(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 (Don't know what kind)
(24) Soft Tissue (muscle or fat)
(25) Stomach
(26) Testis
(27) Throat - pharynx
(28) Thyroid
(29) Uterus
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know
[ ]
[ ]
[ ]
[ ]

ACN.150

How old were you when cancer was first diagnosed?

CANAGE1

(001-100) 1-100 years
(997)Refused
(999)Don't know

CANAGE2

(001-100) 1-100 years
(997)Refused
(999)Don't know

CANAGE3

(001-100) 1-100 years
(997)Refused
(999)Don't know

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) Don't know (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 (ACN.180)
(999) Don't know (ACN.180)
[Respondent Age in DIBAGE (ACN.170) LE "1" then go to ACN.170.010; Else go to
ACN.180. ]

[p. 10]

[ The next 2 questions are periodic diabetes diagnosis questions. ]
ACN.170.010
Was your diabetes diagnosed in the last 12 months?

DIB12MO

(1) Yes (ACN.170.020)
(2) No (ACN.180)
(7) Refused (ACN.180)
(9) Don't know (ACN.180)

ACN.170.020

When was it diagnosed?

DIB3MO

(1) 3 months ago or less
(2) More than 3 months ago but not more than 6 months ago
(3) More than 6 months ago but not more than 9 months ago
(4) More than 9 months ago but not more than 12 months ago
(7) Refused
(9) Don't know
[ End of periodic diabetes diagnosis questions. ]

ACN.180

Are you NOW taking insulin?

INSLN

(1) Yes
(2) No
(7) Refused
(9) Don't know

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) Don't know

[ The next 5 questions are periodic diabetes questions. ]

ACN.190.010
Have you ever taken a course or class on how to manage diabetes yourself?

DIBCLASS

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.190.020

Have you ever heard of glycosylated hemoglobin [gli-KOS-ilated he-mo-glo-bin] or hemoglobin "A one C"?

DIBA1CKN

(1) Yes (ACN.190.030)
(2) No (ACN.190.040)
(7) Refused (ACN.190.040)
(9) Don't know (ACN.190.040)

ACN.190.030

During the past 12 months, how many times has a doctor, nurse, or other health professional
checked you for glycosylated hemoglobin [gli-KOS-ilated he-mo-glo-bin] or hemoglobin "A one
C"?

DIBA1CCK

(00) Zero
(01-52) 1-52
(53) 53+ times
(97) Refused
(99) Don't know

[p. 11]

ACN.190.040

During the past 12 months, how many times has a health professional checked your feet for any
sores or irritations?

DIBFTCK

(00) Zero
(01-52) 1-52
(53) 53+ times
(97) Refused
(99) Don't know

ACN.190.050

When was the last time you had an eye exam in which the pupils were dilated? This would have
made you temporarily sensitive to bright light.

DIBEYCKL

(1) Less than 1 month
(2) 1 to 12 months
(3) 13 to 24 months
(4) More than 2 years
(5) Never
(7) Refused
(9) Don't Know

[ End of the periodic diabetes questions. ]

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) Don't know

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?

[ This next question is a periodic condition question. ]

ACN.201.010

During the PAST 12 MONTHS, have you been told by a doctor or other health professional that
you had...

KSTYR...kidney stones?
CTSYR...carpal tunnel syndrome?

ACN.250

FR: SHOW CARD A2
During the PAST 12 MONTHS, have you had pain, aching, stiffness or swelling in or around a
joint?

Card A2
Front
Shoulders

(1) Right
(2) Left

Elbows

(3) Right
(4) Left

Hips

(5) Right
(6) Left

Wrists

(7) Right
(8) Left

Knees

(9) Right
(10) Left

Ankles

(11) Right
(12) Left

Toes

(13) Right
(14) Left

Back
Shoulders

(1) Right
(2) Left

Fingers, Thumb

(15) Right
(16) Left

Knees

(9) Right
(10) Left

( ) = joint

JNTYR

(1) Yes (ACN.260)
(2) No (ACN.300)
(7) Refused (ACN.300)
(9) Don't know (ACN.300)

ACN.260

Were these symptoms present on MOST DAYS FOR AT LEAST ONE MONTH?

JNTMO

(1) Yes
(2) No
(7) Refused
(9) Don't know

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) Don't know (ACN.290)

[p. 12]

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) Don't know

JNTIJLT

[ ] TIME PERIOD
(1) Weeks
(2) Months
(6) Entire year
(7) Refused
(9) Don't know

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) Don't know
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

[The next 3 questions are periodic joint problem questions.]

ACN.290.010

Did a doctor ever tell you that any of the following conditions were responsible for your joint symptoms...

(1) Yes
(2) No
(7) Refused
(9) Don't know

JNT_RH...Rheumatoid arthritis?
JNT_OST...Osteo- or degenerative arthritis?
JNT_GOUT...Gout?
JNT_BURS...Bursitis or tendinitis?
JNT_OC...Other condition?

[p. 13]

ACN.290.020

During the past 12 months have you taken any prescribed medication containing steroids, like Prednisone? Do not include use of steroid cremes.

JTSTERYR

(1) Yes (ACN.029.030)
(2) No (ACN.300)
(7) Refused (ACN.300)
(9) Don't know (ACN.300)

ACN.290.030

Did you take this medicine daily more than 30 days?

JTSTERMO

(1) Yes
(2) No
(7) Refused
(9) Don't know

[ End of periodic joint problem questions. ]

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) Don't know

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) Don't know (ACN.331)

ACN.320

Did this pain spread down either leg to areas below the knees?

PAINLEG

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.331

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

(1) Yes
(2) No
(7) Refused
(9) Don't know

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 (ACN.350.010)
(2) No (ACN.360)
(7) Refused (ACN.360)
(9) Don't know (ACN.360)

ACN.350.010

Did you see a doctor for this?

ACLD2WMD

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.360

Did you have a stomach or intestinal illness with vomiting or diarrhea that started during those TWO WEEKS?

AINTIL2W

(1) Yes (ACN.360.010)
(2) No (ACNCCI1)
(7) Refused (ACNCCI1)
(9) Don't know (ACNCCI1)

ACN.360.010

Did you see a doctor for this?

AINTILMD

(1) Yes
(2) No
(7) Refused
(9) Don't know

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.370.010

ACN.370

Are you currently pregnant?

PREGNOW

(1) Yes (ACN.410)
(2) No (ACN.370.010)
(7) Refused (ACN.370.010)
(9) Don't know (ACN.370.010)

[ The next 20 questions are periodic menopause and hormone replacement therapy questions]

ACN.370.010

Have you had a natural menstrual period in the past 12 months?

MNYR

(1) Yes (ACN.370.020)
(2) No (ACN.370.050)
(3) Never had a menstrual period (ACN.370.070)
(7) Refused (ACN.370.070)
(9) Don't know (ACN.370.070)

ACN.370.020

Have you had a natural menstrual period in the past 3 months?

MN3MO

(1) Yes (ACN.370.030)
(2) No (ACN.370.050)
(7) Refused (ACN.370.070)
(9) Don't know (ACN.370.070)

ACN.370.030

Compared with 12 months ago, is the length of time between your periods more regular, less regular, or about the same?

MNREG

(1) More regular
(2) Less regular
(3) About the same
(7) Refused
(9) Don't know

[p. 15]

ACN.370.040

Compared with 12 months ago, is your menstrual flow lighter, about the same, heavier, more variable or has it stopped?

MNFLOW

(1) Lighter
(2) About the same
(3) Heavier
(4) More variable
(5) Has it stopped
(7) Refused
(9) Don't know

ACN.370.050

About how old were you when you had your last period?

MNAGE

(1-100) 1-100 years (ACN.370.070)
(997) Refused (ACN.370.060)
(999) Don't know (ACN.370.060)

ACN.370.060

FR: SHOW CARD A3
Were you younger than 20, 20-29, 30-39, 40-44, 45-49, 50-54, or 55 or older ?

Card A3

1. Younger than 20
2. 20-29
3. 30-39
4. 40-44
5. 4549
6. 50-54
7. 55 or older

MNAGE2

(01) Younger than 20
(02) 20-29
(03) 30-39
(04) 40-44
(05) 45-49
(06) 50-54
(07) 55 or older
(97) Refused
(99) Don't know

ACN.370.070

Have you had a hysterectomy?

MNHYST

(1) Yes (ACN.370.080)
(2) No (ACN.370.090)
(7) Refused (ACN.370.090)
(9) Don't know (ACN.370.090)

ACN.370.080

How old were you when you had your hysterectomy?

MNHYSAGE

(1-100) 1-100 years
(997) Refused
(999) Don't know

ACN.370.090

Have you had both of your ovaries removed during any surgical procedure?

MNOVAR

(1) Yes (ACN.370.100)
(2) No (ACN.370.110)
(7) Refused (ACN.370.110)
(9) Don't know (ACN.370.110)

ACN.370.100

How old were you when you had your ovaries [second ovary] removed?

OVARYAGE

(1-100) 1-100 years
(997) Refused
(999) Don't know

[ If AGE gt 39 or MNREG=2 or MNFLOW=1, go to ACN.370.110; Else go to ACN.410. ]

ACN.370.110

Are you now experiencing symptoms of menopause like hot-flashes?

MNHTFLSH

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.370.120
Has your doctor ever discussed the benefits and risks of hormone replacement therapy with you?

MNHMRPMD

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.370.130

Estrogen is a female hormone that may be taken after a hysterectomy or during or after menopause.
Have you ever taken medication containing estrogen (like Premarin) for any reason? (Do not include birth control pills).

MNESTEV

(1) Yes (ACN.370.140)
(2) No (ACN.410)
(7) Refused (ACN.410)
(9) Don't know (ACN.410)

ACN.370.140

How old were you when you first started taking estrogen?

MNESTAGE

(001-100) 1-100 years
(997) Refused
(999) Don't know

ACN.370.150

Are you taking medication containing estrogen now?

MNESTNOW

(1) Yes (ACN.370.160)
(2) No (ACN.370.160)
(7) Refused (ACN.370.170)
(9) Don't know (ACN.370.170)

ACN.370.160

Altogether, about how long have you taken estrogen? Include any breaks in usage that lasted less than 30 days.

ACN.370.160A

[ ] NUMBER

MNESTL_N

(01-94) 1-94 (ACN.370.160B)
(95) 95+ (ACN.370.160B)
(97) Refused (ACN.370.170)
(99) Don't know (ACN.370.170)

ACN.370.160B

[ ] TIME PERIOD

MNEDTL_T

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know

ACN.370.170

Progestin is a female hormone that may be taken in addition to estrogen therapy. Have you ever
taken medication containing progestin (like Provera) for any reason? (Do not include birth control pills).

MNPGSEV

(1) Yes (ACN.370.180)
(2) No (ACN.410)
(7) Refused (ACN.410)
(9) Don't know (ACN.410)

[p. 17]

ACN.370.180

How old were you when you first started taking progestin?

MNPGSAGE

(001-100) 1-100 years
(997) Refused
(999) Don't know

ACN.370.190

Are you taking medication containing progestin now?

MNPGSNOW

(1) Yes (ACN.370.200A)
(2) No (ACN.370.200A)
(7) Refused (ACN.410)
(9) Don't know (ACN.410)

ACN.370.200

Altogether, about how long have you taken progestin? Include any breaks in usage that lasted
less than 30 days.

ACN.370.200A

[ ] NUMBER

MNPGSL_N

(01-94) 1-94
(95) 95+
(97) Refused
(99) Don't know

ACN.370.200B

[ ] TIME PERIOD

MNPGSL_T

(1) Days
(2) Months
(3) Years
(4) Less than one month
(7) Refused
(9) Don't know

[ End of periodic menopause and hormone replacement therapy questions. ]

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) Don't know

ACN.420

Which statement best describes your hearing without a hearing aid: good, a little trouble, a lot of
trouble, deaf?

AHEARST

(1) Good (ACN.420.100)
(2) Little trouble (ACN.420.010)
(3) Lot of trouble (ACN.420.010)
(4) Deaf (ACN.420.050)
(7) Refused (ACN.420.100)
(9) Don't know (ACN.420.100)

[ The next 9 questions are periodic hearing questions. ]

ACN.420.010

Which statement best describes your hearing in your LEFT ear (without a hearing aid): good, a little trouble, a lot of trouble, deaf?

HEARLFT

(1) Good (ACN.420.030)
(2) Little trouble (ACN.420.030)
(3) Lot of trouble (ACN.420.030)
(4) Deaf (ACN.420.020)
(7) Refused (ACN.420.030)
(9) Don't know (ACN.420.030)

[p. 18]

ACN.420.020

How old were you when you began to have hearing loss in your LEFT ear?

HEARLAGE

(1) At birth
(2) Less than 3 years old
(3) Over 3 but less than 19 years old
(4) 19 and over but less than 45 years old
(5) 45 and over but less than 65 years old
(6) 65 and over
(7) Refused
(9) Don't know

ACN.420.030

Which statement best describes your hearing in your RIGHT ear (without a hearing aid): good, a little trouble, a lot of trouble, deaf?

HEARRGT

(1) Good (ACN.420.060)
(2) Little trouble (ACN.420.060)
(3) Lot of trouble (ACN.420.060)
(4) Deaf (ACN.420.040)
(7) Refused (ACN.420.060)
(9) Don't know (ACN.420.060)

ACN.420.040

How old were you when you began to have hearing loss in your RIGHT ear?

HEARRAGE

ACN.420.050

How old were you when you began to have hearing loss ?

HEARDAGE

ACN.420.060

(Without a hearing aid) Can you usually HEAR AND UNDERSTAND what a person says without seeing his/her face if that person WHISPERS to you from across a quiet room?

HEARWHIS

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.420.070

(Without a hearing aid) Can you usually HEAR AND UNDERSTAND what a person says without seeing his/her face if that person TALKS IN A NORMAL VOICE to you from across a quiet room?

HEARVOIC

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.420.080

(Without a hearing aid) Can you usually HEAR AND UNDERSTAND what a person says without seeing his/her face if that person SHOUTS to you from across a quiet room?

HEARSHT

(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 19]

ACN.420.090

(Without a hearing aid) Can you usually HEAR AND UNDERSTAND what a person says without seeing his/her face if that person SPEAKS LOUDLY into your better ear?

HEARSKLD

(1) Yes
(2) No
(7) Refused
(9) Don't know

[ End of periodic hearing questions. ]

[ The next 3 questions are periodic eyesight questions. ]

ACN.420.100

These next questions are about your eyesight. Do you now have cataracts?

AVISCAT

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.420.110

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

AVISGLAU

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.420.120

Have you EVER been told by doctor or other health professional that you had.. Macular degeneration?

AVISMACD

(1) Yes
(2) No
(7) Refused
(9) Don't know

[ End of periodic eyesight questions. ]

ACN.430

Do you have any trouble seeing, even when wearing glasses or contact lenses?

AVISION

(1) Yes (ACN.440)
(2) No (ACN.440.010)
(7) Refused (ACN.440.010)
(9) Don't know (ACN.440.010)

ACN.440

Are you blind or unable to see at all?

ABLIND

(1) Yes (ACN.451)
(2) No (ACN.440.010)
(7) Refused (ACN.440.010)
(9) Don't know (ACN.440.010)
[ The next question is a periodic eyesight question. ]

[p. 20]

ACN.440.010

FR: SHOW CARD A4
Even when wearing glasses or contact lenses, because of your eyesight, how difficult is it for
you...
(0) Not at all difficult
(1) Only a little difficult
(2) Some what difficult
(3) Very difficult
(4) Can't do at all
(7) Refused
(9) Don't know

Card A4

0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all

NWS...To read ordinary print in newspapers?
CLS...To do work or hobbies that require you to see well up close such as cooking, sewing, fixing things around the house, or using hand tools?
NIT...To go down steps, stairs or curbs in dim light or at night?
DRV...To drive during daytime in familiar places?
PER...To notice objects off to the side while you are walking along?
CRD...Finding something on a crowded shelf?

ACN.451

Have you lost all of your upper and lower natural (permanent) teeth?

LUPPRT

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.471

FR: SHOW CARD A5
Now I am going to ask you some questions about felings you may have experienced over the
PAST 30 DAYS.
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) Don't know

Card A5

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?

[If any of the responses are 1 - 3, then go to ACN.471.010; Else, go to the ACN.530.]
[ The next 3 questions are periodic general mental health questions. ]

[p. 21]

ACN.471.010

Thinking about the feelings I just asked about: altogether, did you have them MORE often during the past 30 days than is usual for you, LESS often, or about the same as usual?

MHFEMO

(1) More often (ACN.471.020)
(2) Less often (ACN.471.030)
(3) About the same (ACN.530)
(7) Refused (ACN.530)
(9) Don't know (ACN.530)

ACN.471.020

Is that a LOT more, SOMEWHAT, or only a LITTLE more often than usual?

MHFEMOMR

(1) A lot more (ACN.530)
(2) Somewhat more (ACN.530)
(3) A little more (ACN.530)
(7) Refused (ACN.530)
(9) Don't know (ACN.530)

ACN.471.030

Is that a LOT less, SOMEWHAT, or only a LITTLE less often than usual?

MHFEMOLS

(1) A lot less
(2) Somewhat less
(3) A little less
(7) Refused
(9) Don't know
[ End of periodic general mental health questions. ]

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 (ACN.530.010)
(2) Some (ACN.530.010)
(3) A little (ACN.530.010)
(4) Not at all (ACN.530.030)
(7) Refused (ACN.530.030)
(9) Don't know (ACN.530.030)

[The remaining 65 questions are periodic mental health questions. ]

ACN.530.010

During the past 30 days, HOW MANY DAYS were you TOTALLY UNABLE to (work or) carry out your usual activities because of these feelings?

MHFENWK

(01-29) 1-29 Days (ACN.530.020)
(30) 30 Days (ACN.530.030)
(97) Refused (ACN.530.020)
(99) Don't know (ACN.530.020)

ACN.530.020

Besides [that day/those (number) days] when you were UNABLE to carry out your usual activities, how many days out of the past 30 did you have to CUT DOWN on what you did because of these feelings?

MHFECDA

(00-30) 0-30 Days
(97) Refused
(99) Don't know

ACN.530.030

During the past 12 months, was there ever a time when you felt sad, blue or depressed for two weeks or more in a row?

MHDSAD2W

(1) Yes (ACN.530.040)
(2) No (ACN.530.230)
(3) Volunteered: "I was on medication/anti-depressants" (ACN.530.230)
(7) Refused (ACN.530.230)
(9) Don't know (ACN.530.230)

[p. 22]

For the next few questions, please think of the two-week period during the past 12 months when these feelings were the worst.

ACN.530.040

During that time did the feelings of being sad, blue, or depressed usually last all day long, most of the day, about half of the day or less than half of the day?

MHDSADDY

(1) All day long (ACN.530.050)
(2) Most of the day (ACN.530.050)
(3) About half of the day (ACN.530.050)
(4) Less than half of the day (ACN.530.230)
(7) Refused (ACN.530.230)
(9) Don't know (ACN.530.230)

ACN.530.050

During those two weeks, did you feel this way every day, almost every day, or less often?

MHDSADLO

(1) Every day (ACN.530.060)
(2) Almost every day (ACN.530.060)
(3) Less often (ACN.530.230)
(7) Refused (ACN.530.230)
(9) Don't know (ACN.530.230)

ACN.530.060

During those two weeks, did you lose interest in most things?

MHDSADLI

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.070

Thinking about those same two weeks, did you feel more tired out or low on energy than is usual for you?

MHDSADTD

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.080

Did you gain or lose weight without trying, or did you stay about the same?

MHDSADWT

(1) Gain (ACN.530.090)
(2) Lose (ACN.530.090)
(3) Volunteered "both gained and lost weight" (ACN.530.090)
(4) Stay about the same (ACN.530.120)
(5) Volunteered "was on a diet" (ACN.530.120)
(7) Refused (ACN.530.120)
(9) Don't know (ACN.530.120)

ACN.530.090

About how much did [you gain/you lose/your weight change]?

MHDSADWC

(001-500) 1-500 Pounds (ACN.530.120)
(997) Refused (ACN.530.120)
(999) Don't know (ACN.530.110)

ACN.530.110

Did your weight change by 10 pounds or more?

MHDSADLB

(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 23]

ACN.530.120

During those two weeks, did you have more trouble falling asleep than you usually do?

MHDSADSP

(1) Yes (ACN.530.130)
(2) No (ACN.530.140)
(7) Refused (ACN.530.140)
(9) Don't know (ACN.530.140)

ACN.530.130

Did that happen every night, nearly every night, or less often during those two weeks?

MHDSADNT

(1) Every night
(2) Nearly every night
(3) Less often
(7) Refused
(9) Don't know

ACN.530.140

During those two weeks, did you have a lot more trouble concentrating than usual?

MHDSADCN

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.150

People sometimes feel down on themselves, no good, or worthless. During that two week period, did you feel this way?

MHDSADWR

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.160

Did you think a lot about death -- either your own, someone else's, or death in general during those two weeks?

MHDSADDE

(1) Yes
(2) No
(7) Refused
(9) Don't know

Check item MHDSADDE_CK1: If any response ACN.530.060=1, ACN.530.070=1, ACN.530.090=10-500, ACN.530.110=1, ACN.530.130=1 or 2, ACN.530.140=1, ACN.530.150=1, ACN530.160 =1, go to ACN.530.170; Else go ACN.530.410.

To review, you had two weeks in a row during the past 12 months when you were sad, blue, or depressed and also had some other feelings or problems like:

FR: READ UP TO THE FIRST THREE "YES" RESPONSES TO MHDSALI, MHDSADTD, MHDSADLB, MHDSASNT, MHDSADCN, MHDSASWR, MHDSADDE).

ACN.530.170

About how many weeks altogether did you feel this way during the past 12 months?

MHDSADWY

(02-52) Number of weeks
(96) Entire year
(97) Refused
(99) Don't know

[p. 24]

ACN.530.180

Think about the most recent time when you had two weeks in a row when you felt this way. What month and year was this?

ACN.530.180A

Month:

MHDSAD_M

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December

ACN.530.180B

Year:

MHDSAD_Y

(1998-2000) 1998-2000
(9997) Refused
(9999) Don't know

ACN.530.190

Did you tell a doctor about these problems? (By "doctor" I mean either a medical doctor or osteopath, or a student in training to be either a medical doctor or osteopath.)

MHDSADMD

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.200

Did you tell any other health professional (such as a psychologist, social worker, counselor, nurse, clergy, or other helping professional)?

MHDSADHP

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.210

Did you take medication or use drugs or alcohol more than once for these problems?

MHDSADAC

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.220

How much did these problems interfere with your life or activities--a lot, some, a little or not at all?

MHDSADIA

(1) A lot
(2) Some
(3) A little
(4) Not at all
(7) Refused
(9) Don't know

(Go to ACN.530.410)

ACN.530.230

During the past 12 months, was there ever a time lasting two weeks or more when you lost interest in most things like hobbies, work, or activities that usually give you pleasure?

MHDINT2W

(1) Yes (ACN.530.240)
(2) No (ACN.530.410)
(3) Volunteered: "I was on medication/anti-depressants" (ACN.530.410)
(7) Refused (ACN.530.410)
(9) Don't know (ACN.530.410)

[p. 25]

ACN.530.240

For the next few questions, please think of the two week period during the past 12 months when you had the most complete loss of interest in things.

During that two week period, did the loss of interest usually last all day long, most of the day, about half the day, or less than half the day?

MHDINTDY

(1) All day long (ACN.530.250)
(2) Most of the day (ACN.530.250)
(3) About half of the day (ACN.530.250)
(4) Less than half of the day (ACN.530.410)
(7) Refused (ACN.530.410)
(9) Don't know (ACN.530.410)

ACN.530.250

During those two weeks, did you feel this way every day, almost every day, or less often?

MHDINTLO

(1) Every day (ACN.530.260)
(2) Almost every day (ACN.530.260)
(3) Less often (ACN.530.410)
(7) Refused (ACN.530.410)
(9) Don't know (ACN.530.410)

ACN.530.260

During those two weeks, did you feel more tired out or low on energy than usual for you?

MHDINTTD

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.270

Did you gain or lose weight without trying, or did you stay about the same?

MHDINTWT

(1) Gain (ACN.530.280)
(2) Lose (ACN.530.280)
(3) Volunteered "both gained and lost weight" (ACN.530.280)
(4) Stay about the same (ACN.530.300)
(5) Volunteered "was on a diet" (ACN.530.300)
(7) Refused (ACN.530.300)
(9) Don't know (ACN.530.300)

ACN.530.280

About how much did [you gain/you lose/your weight change]?

MHDINTWC

(001-500) Pounds (ACN.530.300)
(997) Refused (ACN.530.300)
(999) Don't know (ACN.530.290)

ACN.530.290

Did your weight change by 10 pounds or more?

MHDINTLB

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.300

During those same two weeks, did you have more trouble falling asleep than you usually do?

MHDINTSP

(1) Yes (ACN.530.310)
(2) No (ACN.530.320)
(7) Refused (ACN.530.320)
(9) Don't know (ACN.530.320)

ACN.530.310

Did that happen every night, nearly every night, or less often during those two weeks?

MHDINTNT

(1) Every night
(2) Nearly every night
(3) Less often
(7) Refused
(9) Don't know

[p. 26]

ACN.530.320

During those two weeks, did you have a lot more trouble concentrating than usual?

MHDINTCN

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.330

People sometimes feel down on themselves, no good, or worthless. During that two week period, did you feel this way?

MHDINTWR

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.340

Did you think a lot about death--either your own, someone else's, or death in general during those two weeks?

MHDINTDE

(1) Yes
(2) No
(7) Refused
(9) Don't know

Check item MHDINTDE_CK1: If any response to ACN.530.260=1, ACN.530.280=10-500, ACN530.290=1, ACN.530.310=1 or 2, ACN.530.320=1, ACN.530.330=1, ACN.530.340 =1, go to ACN.530.350; Else go to ACN.530.410.

To review, you had two weeks in a row during the past 12 months when you lost interest in most things and also had some other feelings or problems like:

FR: READ UP TO THE FIRST THREE "Yes" RESPONSES TO MHDINTTD, MHDINTLB, MHDINTNT, MHDINTCN, MHDINTWR, MHDINTDE).

ACN.530.350

About how many weeks altogether did you feel this way during the past 12 months?

MHDINTWY

(02-52) Number of weeks
(96) Entire year
(97) Refused
(99) Don't know

ACN.530.360

Think about this most recent time when you had two weeks in a row when you felt this way. In what month and year was this?

ACN.530.360A

Month:

MHDINT_M

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December

ACN.530.360B

Year:

MHDINT_Y

(1998-2000) 1998-2000
(9997) Refused
(9999) Don't know

[p. 27]

ACN.530.370

Did you tell a doctor about these problems? (By "doctor" I mean either a medical doctor or osteopath, or a student in training to be either a medical doctor or osteopath.)

MHDINTMD

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.380

Did you tell any other health professional (such as a psychologist, social worker, counselor, nurse, clergy, or other helping professional)?

MHDINTHP

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.390

Did you take medication or use drugs or alcohol more than once for these problems?

MHDINTAC

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.400

How much did these problems interfere with your life or activities -- a lot, some, a little or not at all?

MHDINTIA

(1) A lot
(2) Some
(3) A little
(4) Not at all
(7) Refused
(9) Don't know

ACN.530.410

During the past 12 months, did you ever have a period lasting one month or longer when most of the time you felt worried, tense or anxious?

MHAXEVYR

(1) Yes (ACN.530.430)
(2) No (ACN.530.420)
(7) Refused (ACN.530.420)
(9) Don't know (ACN.530.420)

ACN.530.420

People differ a lot in how much they worry about things. Did you have a time in the past 12 months when you worried a lot more than most people would in your situation?

MHAXMO

(1) Yes (ACN.530.430)
(2) No (ACN.530.590)
(7) Refused (ACN.530.590)
(9) Don't know (ACN.530.590)

ACN.530.430

Has that period ended or is it still going on?

MHAXL

(1) Ended (ACN.530.440)
(2) Still going on (ACN.530.450)
(7) Refused (ACN.530.450)
(9) Don't know (ACN.530.450)

ACN.530.440

How many months or years did it go on before it ended?

ACN.530.440A

[ ] NUMBER:

MHAXEN_N

(01-94) 1-94 (ACN.530.440B)
(95) 95+ (ACN.530.440B)
(96) Volunteered "All my life/as long as I can remember" (ACN.530.440B)
(97) Refused (ACN.530.451)
(99) Don't know (ACN.530.451)

ACN.530.440B

[ ] TIME PERIOD:

MHAXEN_T

(1) Months (Check Item MHAXWST.CK)
(2) Years (Check Item MHAXWST.CK)
(6) Volunteered "All my life/as long as I can remember" (Check Item MHAXWST.CK)
(7) Refused (ACN.530.451)
(9) Don't know (ACN530.451)

ACN.530.450

How many months or years has it been going on?

ACN.530.450A

[ ] NUMBER:

MHAXLN_N

(01-94) 1-94 (ACN.530.450B)
(95) 95+ (ACN.530.450B)
(96) Volunteered "All my life/as long as I can remember" (ACN.530.450B)
(97) Refused (ACN.530.451)
(99) Don't know (ACN.530.451)

ACN.530.450B

[ ] TIME PERIOD:

MHAXLN_T

(1) Months (Check Item MHAXWST_CK)
(2) Years (Check Item MHAXWST_CK)
(6) Volunteered "All my life/as long as I can remember" (Check Item MHAXWST_CK)
(7) Refused (ACN.530.451)
(9) Don't know (ACN.530.451)

ACN.530.451

[Did it last/Has it been] at least 6 months?

MHAX6MO

(1) Yes
(2) No
(7) Refused
(9) Don't know

Check item MHAXWST_CK: If ACN.530.440 is equal or greater than 6 months or ACN.530.450 is equal or greater than 6 months or ACN.530.451=1 go to ACN.530.460; Else go to ACN.530.590.

ACN.530.460

During that period, {has your worry been/was your worry} stronger than in other people?

MHAXWST

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.470

[Did/do] you worry most days?

MHAXWDYS

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.480

[Did/do] you usually worry about one particular thing, such as your job security or the failing health of a loved one, or more than one thing?

MHAXWI

(1) One thing
(2) More than one thing
(7) Refused
(9) Don't know

[p. 29]

ACN.530.490

[Did/do] you find it difficult to stop worrying?

MHAXDST

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.500

[Did/do] you ever have different worries on your mind at the same time?

MHAXW2

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.510

How often [was/is] your worry so strong that you [couldn't/can't] put it out of your mind no matter how hard you [tried/try]--often, sometimes, rarely or never?

MHAXWSTR

(1) Often
(2) Sometimes
(3) Rarely
(4) Never
(7) Refused
(9) Don't know

ACN.530.520

How often [did/do] you find it difficult to control your worry - often, sometimes, rarely or never?

MHAXWCNT

(1) Often
(2) Sometimes
(3) Rarely
(4) Never
(7) Refused
(9) Don't know

ACN.530.530

What sorts of things [did/do] you mainly worry about?

MHAXWHAT _________________________________________________

ACN.530.540

When you [are/were] worried or anxious, [are/were] you also...

(1) Yes
(2) No
(7) Refused
(9) Don't know

MHAX_RST ...Restless?
MHAX_EDG ...[Are/Were] you keyed up or on the edge?
MHAX_IRR ...[Are/Were] you more irritable than usual?
MHAX_HTP ...[Does/Did] your heart pound or race?
MHAX_WTD ...[Are/Were] you easily tired?
MHAX_WSP ...[Do/Did] you have trouble falling asleep or staying asleep?
MHAX_WLH ...[Do/Did] you feel dizzy or lightheaded?

Check item ACNCCI3: If any ACN.530.540=1, go to ACN.530.550; Else go to ACN.530.590.

ACN.530.550

Did you tell a doctor about your worry or about the problems it was causing? (By "doctor" I mean either a medical doctor or osteopath, or a student in training to be either a medical doctor or osteopath.)

MHAXWMD

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.560

Did you tell any other health professional (such as a psychologist, social worker, counselor, nurse, clergy, or other helping professional)?

MHAXWHP

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.570

Did you take medication or use drugs or alcohol more than once for the worry or the problems it was causing?

MHAXWAC

(1) Yes
(2) No
(7) Refused
(9) Don't know

ACN.530.580

How much [did/does] the worry or anxiety interfere with your life or activities--a lot, some, a little or not at all?

MHAXWITF

(1) A lot
(2) Some
(3) A little
(4) Not at all
(7) Refused
(9) Don't know

ACN.530.590

During the past 12 months, did you ever have a spell or an attack when all of a sudden you felt frightened, anxious, or very uneasy?

MHPEVYR

(1) Yes (ACN.530.600)
(2) No (AHS.010)
(7) Refused (AHS.010)
(9) Don't know (AHS.010)

ACN.530.600

Did any of these attacks occur when you were in a life-threatening situation?

MHPLFTH

(1) Yes (ACN.530.610)
(2) No (ACN.530.620)
(3) Volunteered "wasn't in a life-threatening situation" (ACN.530.620)
(7) Refused (ACN.530.620)
(9) Don't know (ACN.530.620)

ACN.530.610

Did any of these attacks occur when you were not in a life-threatening situation?

MHPNLFTH

(1) Yes (ACN.530.620)
(2) No (AHS.010)
(7) Refused (AHS.010)
(9) Don't know (AHS.010)

ACN.530.620

About how many attacks did you have in the past 12 months?

MHPANYR

(001-994) 1-994 Attacks
(995) 995+ Attacks
(997) Refused
(999) Don't know

ACN.530.630

In what month and year did you have the most recent attack?

ACN.530.630A

Month:

MHPANDT1

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December

ACN.530.630B

Year:

MHPANDT2

(1998-2000) 1998-2000
(9997) Refused
(9999) Don't know

ACN.530.640

Did [this attack/all of these attacks] happen in a situation when you were not in danger or not the center of attention?

MHPNODAN

(1) Yes (ACN.530.650)
(2) No (AHS.010)
(7) Refused (AHS.010)
(9) Don't know (AHS.010)

ACN.530.650

When you have attacks...

(1) Yes
(2) No
(7) Refused
(9) Don't know

MHPA_AHP ...Does your heart pound?
MHPA_CST ...Do you have chest tightness, pain, or discomfort in your chest or stomach?
MHPA_SWT ...Do you sweat?
MHPA_SHK ...Do you tremble or shake?
MHPA_FLA ...Do you have hot flashes or chills?
MHPA_UNR ...Do you, or things around you, seem unreal?

[ End of the periodic mental health questions.]

(Go to next section--Health Status and Limitation of Activities)

[p. 32]

Section III -- HEALTH STATUS AND LIMITATION OF ACTIVITIES

Part A -- Health Indicators

[If FSD.050/DOINGLW ne (1) go to AHS.030; Else assign (0) to AHS,030/WRKLYR2 and go to AHS.040]

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) Don't Know (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) Don't Know

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) Don't Know

(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) Don't Know

[p. 33]

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) Don't Know

AHS.091

FR: SHOW CARD A4.

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).

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) Don't Know

Card A4

0. Not at all difficult
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) Don't Know

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?

AHS.171

FR: SHOW CARD A6.
FR: READ LEAD-IN IF NECESSARY:

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
(6) DO NOT DO THIS ACTIVITY
(7) Refused
(9) Don't Know

Card A6

0. Not at all difficult
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...)

Check item AHSCCI3 :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 A7. 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 A7

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
(97) Refused
(99) Don't Know

[ ]
[ ]
[ ]
[ ]
[ ]

[If answers = (1) - (12) and (14) - (18) then go to AHS.300; if answer = (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 _______________

[p. 35]

AHS.300

How long have you had {name the first condition AFLHCA1}?

AFLHCLN

[ ] NUMBER

(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) Don't Know

AFLHCLT

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) Don't Know

AHS.301

How long have you had {name the second condition AFLHCA2}?

AFLHCLN2

[ ] NUMBER

(01-94) 1-94
(95)95+
(96)Since birth
(97) Refused
(99) Don't Know

AFLHCLT2

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) Don't Know

AHS.302

How long have you had {name the third condition AFLHCA3}?

AFLHCLN3

[ ] NUMBER

(01-94) 1-94
(95)95+
(96)Since birth
(97) Refused
(99) Don't Know

AFLHCLT3

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) Don't Know

AHS.303

How long have you had {name the fourth condition AFLHCA4}?

AFLHCLN4

[ ] NUMBER

(01-94) 1-94
(95)95+
(96)Since birth
(97) Refused
(99) Don't Know

AFLHCLT4

[ ]TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) Don't Know

AHS.304

How long have you had {name the fifth condition AFLHCA5}?

AFLHCLN5

[ ] NUMBER

(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) Don't Know

AFLHCLT5

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) Don't Know

(Go to next section -- Health Behaviors)

[p. 37]

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) Don't Know (AHB.090)

AHB.020

How old were you when you FIRST started to smoke fairly regularly?

FR: IF LESS THAN 6 YEARS OLD, ENTER "6"

SMKREG

(06-94) 6-94 years of age
(95)95 years or older
(96)Never smoked regularly
(97)Refused
(99)Don't Know

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) Don't Know (AHB.060)

AHB.040

How long has it been since you quit smoking cigarettes?

SMKQTNO

[ ] NUMBER

(01-94) 1-94 (AHB.040B)
(95)95+ (AHB.040B)
(97) Refused (AHB.090)
(99) Don't Know (AHB.045)

SMKQTTP

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't Know

(AHB.090)

AHB.045

Have you quit smoking since {current month, 1 year ago}?

SMKQTD

(1) Yes
(2) No
(7) Refused
(9) Don't Know

(AHB.090)

[p. 38]

AHB.050

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

FR: IF LESS THAN "1", ENTER "1"

CIGSDA1

(01-94) 1-94 cigarettes
(95)95+ cigarettes
(97) Refused
(99) Don't Know

(AHB.080)

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) Don't Know (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) Don't Know

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) Don't Know

[p. 39]

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 (AHB.110)
(001-995) 1-995 times (AHB.090B)
(996) Unable to do this type of activity (AHB.110)
(997) Refused (AHB.110)
(999) Don't Know (AHB.110)

AHB.090B

VIGTP

[ ] TIME PERIOD

(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this activity
(7) Refused
(9) Don't Know

AHB.100

About how long do you do these vigorous activities each time?

VIGLNGNO

[ ] NUMBER

(001-995) 1-995 (AHB.100B)
(997) Refused (AHB.108)
(999) Don't Know (AHB.110)

AHB.100B

VIGLNGTP

[ ] TIME PERIOD

(1) Minutes (AHB.110)
(2) Hours (AHB.110)
(7) Refused (AHB.110)
(9) Don't know (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. 40]

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?

FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?

MODNO

[ ] NUMBER OF TIMES per

(000) Never (AHB.130)
(001-995) 1-995 (AHB.110B)
(996) Unable to do this type activity (AHB.130)
(997) Refused (AHB.130)
(999) Don't Know (AHB.130)

AHB.110B

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
(9) Don't know

AHB.120

About how long do you do these light or moderate activities each time?

MODLNGNO

[ ] NUMBER

(001-995) 1-995 (AHB.120B)
(997) Refused (AHB.130)
(999) Don't Know (AHB.128)

AHB.120B

MODLNGTP

[ ] TIME PERIOD

(1) Minutes (AHB.130)
(2) Hours (AHB.130)
(7) Refused
(9) Don't know

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) Don't Know

[p. 41]

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.)

FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?

STRNGNO

[ ] NUMBER OF TIMES per

(000) Never (AHB.140)
(001-995) 1-995(AHB.130B)
(996) Unable to do this type activity (AHB.140)
(997) Refused (AHB.140)
(999) Don't Know (AHB.140)

AHB.130B

STRNGTP

[ ] TIME PERIOD

(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) Don't Know

[p. 42]

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) Don't Know (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) Don't Know (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) Don't Know

ALC12MTP

[ ] TIME PERIOD

(0) Never/None (AHB.190)
(1) Week (AHB.170)
(2) Month (AHB.170)
(3) Year (AHB.170)
(7) Refused (AHB.190)
(9) Don't Know (AHB.170)

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) Don't Know

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) Don't Know

ALC5UPTP

[ ] TIME PERIOD

(0) Never/None
(1) Week
(2) Month
(3) Year
(7) Refused
(9) Don't Know

[p. 43]

AHB.190

How tall are you without shoes?

FR: ALLOW RESPONSES IN METRIC IF VOLUNTEERED.

AHEIGHTF

Feet __________

(02-07) 2-7 feet
(97) Refused
(99) Don't Know
(M) Reported in metric

AHB.190B

AHEIGHTI

Inches __________

(00-11) 0-11 inches
(97) Refused
(99) Don't Know(AHB.200)

AHB.190C

AHEIGHTM

Meters __________

(0-2) 0-2 meters
(7) Refused
(9) Don't Know

AHB.190D

AHEIGHTC

Centimeters __________

(000-241) 0-241 centimeters
(997) Refused
(999) Don't Know

AHB.200

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) Don't Know
(M) Reported in metric

(Go to next section)

AHB.200B

WT_KG

Kilograms __________

(0227-2268) 22.7-226.8 kilograms

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

[p. 44]

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) Don't Know (AAU.037)

AAU.030

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

[If AAU.020 = (3) read:]
What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?

APLKIND

(1) Clinic or health center (AAU.030.010)
(2) Doctor's office or HMO (AAU.030.010)
(3) Hospital emergency room (AAU.030.010)
(4) Hospital outpatient department (AAU.030.010)
(5) Some other place (AAU.030.010)
(6) Doesn't go to one place most often (AAU.037)
(7) Refused (AAU.037)
(9) Don't Know (AAU.037)

[The next question is a periodic access to health care question]

AAU.030.010

How long have you been going to this {fill place from AAU.030 APLKIND} for health care?

AQUSL

(1) 1 year or less
(2) More than 1 year but not more than 3 years
(3) More than 3 years
(4) Hasn't been there yet
(7) Refused
(9) Don't know

[End of the periodic access to health care question]

AAU.035

Is that {fill 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.037.010)
(2) No (AAU.037)
(7) Refused (AAU.037)
(9) Don't Know (AAU.037)

[p. 45]

AAU.037

What kind of place do you USUALLY 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
(6) Doesn't go to one place most often
(7) Refused
(9) Don't Know

[The next 16 questions are periodic access to health care questions]

AAU.037.010

Is there a particular doctor, nurse, or other health professional that you usually see when you get health care?

AQHP

(1) Yes (AAU.037.020)
(2) No (Check Item AAUCCI1)
(7) Refused (Check Item AAUCCI1)
(9) Don't know (Check Item AAUCCI1)

AAU.037.020

FR: READ ANSWER CATEGORIES BELOW IF NECESSARY

What kind of health professional do you usually see--a doctor or nurse or some other health professional?

AQHPKIND

(1) Doctor (Check Item AAUCCI0)
(2) Nurse (Check Item AAUCCI1)
(3) Nurse Practitioner (Check Item AAUCCI1)
(4) Physician's assistant (Check Item AAUCCI1)
(5) Chiropractor (Check Item AAUCCI1)
(6) Other (AAU.037.021)
(7) Refused (Check Item AAUCCI1)
(9) Don't know (Check Item AAUCCI1)

AAU.037.021

FR: SPECIFIC KIND OF HEALTH PROFESSIONAL. THIS SHOULD BE A TYPE OF HEALTH PROFESSIONAL THAT IS NOT ON THE HEALTH PROFESSIONAL LIST.

AQHPSPEC Health Professional: ____________________

Check item AAUCCI0: If Sex is female go to AAU.037.030; Else go to AAU.037.031.

AAU.037.030

Does this doctor specialize in women's reproductive health (an obstetrician/gynecologist)?

AQMDGYN

(1) Yes (Check Item AAUCCI1)
(2) No (AAU.037.031)
(7) Refused (AAU.037.031)
(9) Don't know (AAU.037.031)

[p. 46]

AAU.037.031

Which of the following best describes this doctor? A general doctor who treats a variety of illnesses; a doctor who specializes in a particular medical disease or problem?

AQMDGS

(1) General doctor treats a variety of illnesses (AAU.037.032)
(2) Doctor who specializes in a particular medical disease or problem (Other than obstetrician/gynecologist) (Check Item AAUCCI1)
(3) Some other kind of doctor (Check Item AAUCCI1)
(7) Refused (Check Item AAUCCI1)
(9) Don't know (Check Item AAUCCI1)

AAU.037.032

Does this doctor treat children and adults?

AQMDCA

(1) Yes
(2) No
(7) Refused
(9) Don't know

Check item AAUCCI1: If AAU.030 = 1-5, or AAU.037 = 1-5, or AAU.037.020 = 1-6, go to AAU.037.040; Else go to AAU.037.051.

AAU.037.040

These next questions refer to the {fill from kind of provider- - taken from APLKIND/AAU.030 or AHCPLKND/AAU.037 , or AQHPKIND/AAU.037.020, in that order} that you usually go to if you are sick or need advice about your health.

During the PAST 12 MONTHS, did you go to this {fill from kind of provider- - taken from AAU.030, or AAU.037, or AAU.037.020 in that order}?

AQHPVI

(1) Yes
(2) No
(7) Refused
(9) Don't know

AAU.037.050

We want to know your rating of this {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order}. Use any number on a scale of 0 to 10, where 0 is the worst and 10 is the best.
How would you rate this {fill from kind of provider- - taken from AAU.030, or AAU.037.020, or AAU.037 in that order}?

AQHPRAT

(00-10) 0-10 (AAU.037.130)
(97) Refused (AAU.037.130)
(99) Don't know (AAU.037.130)

[p. 47]

AAU.037.051

FR: SHOW CARD A8

What is the main reason you do not have a usual source of health care?

Card A8

1. Seldom or never gets sick
2. Recently moved into the area
3. Don't know where to go for care
4. Usual source of medical care in this area is no longer available
5. Can't find a provider who speaks my language
6. Likes to go to different places for health care needs
7. Just changed insurance plans
8. Don't use doctors/treat myself
9. Cost of medical care
10. Other reason

AQWHYNOT

(01) Seldom or never gets sick
(02) Recently moved into the area
(03) Don't know where to go for care
(04) Usual source of medical care in this area is no longer available
(05) Can't find provider who speaks my language
(06) Likes to go to different places for healthcare needs
(07) Just changed insurance plans
(08) Don't use doctors/treat myself
(09) Cost of medical care
(10) Other reason
(97) Refused
(99) Don't know

(Go to Check Item AAUCCI1A)

AAU.037.130

Does this {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order} have office hours at night or on weekends?

AQHPNHR

(1) Yes
(2) No
(7) Refused
(9) Don't know

AAU.037.140

When you are SICK and your {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order} is closed, can you get advice from a doctor or nurse quickly over the phone?

AQHPTEL

(1) Yes
(2) No
(3) Provider open 24 hours
(7) Refused
(9) Don't know

AAU.037.150

When you are SICK and need to see a doctor or health professional soon, how long do you usually have to wait to get an appointment at/with this {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order}?

AQHPSINJ

(1) No appointment necessary
(2) A day or two
(3) More than 2 days, but not more than 1 week
(4) More than 1 week, but not more than 2 weeks
(5) More than 2 weeks, but not more than 1 month
(6) More than 1 month
(7) Refused
(9) Don't know

[p. 48]

AAU.037.160

During the PAST 12 MONTHS, when you needed REGULAR OR ROUTINE CARE, including routine care for any ongoing health problems, how long did you usually have to wait to get an appointment at/with this {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order}?

AQHPRT

(0) No appointment necessary (AAU.037.220)
(1) Scheduled appointment well in advance (AAU.037.170)
(2) A day or two (AAU.037.170)
(3) More than 2 days, but not more than 1 week (AAU.037.170)
(4) More than 1 week, but not more than 2 weeks (AAU.037.170)
(5) More than 2 weeks, but not more than 1 month (AAU.037.170)
(6) More than 1 month (AAU.037.170)
(7) Refused (AAU.037.220)
(9) Don't know (AAU.037.220)

AAU.037.170

When you have an appointment, how long do you usually have to wait in the waiting room (at/for) this {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order)?

AQHPWAIT

(1) 30 minutes or less
(2) More than 30 min, but not more than 1 hour
(3) More than an hour
(7) Refused
(9) Don't know

AAU.037.220

We want to know your rating of this {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order}'s professional staff. Use any number on a scale from 0 to 10, where 0 is the worst professional staff possible, and 10 is the best professional staff possible. How would you rate the professional staff?

AQUSCSAT

_____ (0-10)
(96) No professional staff/provider works alone
(97) Refused
(99) Don't know

AAU.037.230

Does this {fill from kind of provider-- taken from AAU.030, or AAU.037.020, or AAU.037 in that order} usually ask about prescription medications and treatments that other doctors may have given you?

AQPREMED

(1) Yes
(2) No
(7) Refused
(9) Don't Know

[End of periodic access to health care questions]

Check Item AAUCCI1A: If AAU.020 = 2,7, or 9 go to AAU.061; Else go to AAU.040.

[p. 49]

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) Don't Know (AAU.061)

AAU.050

Was this change for a reason related to health insurance?

AHCCHGHI

(1) Yes
(2) No
(7) Refused
(9) Don't Know

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) Don't Know

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.
AHCDLYR5 You didn't have transportation.

[The next 13 questions are periodic cancer screening questions.]

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) Don't Know

AHCAFYR1 Prescription medicines
AHCAFYR2 Mental health care or counseling
AHCAFYR3 Dental care (including check-ups)
AHCAFYR4 Eyeglasses

Check Item AAUCCI2 If SEX= (1) (male) go to Check item AAUCCI4; Else if SEX= (2) (female) go to AAU.111.010.

[The next 13 questions are periodic cancer screening questions.]

AAU.111.010

Have you ever had a Pap smear test?

FR: 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.

PAP

(1) Yes (AAU.111.011)
(2) No (AAU.111.030)
(7) Refused (AAU.111.030)
(9) Don't know (AAU.111.030)

[p. 50]

AAU.111.011

When did you have your most recent Pap smear test?

RPAP1NO

[ ] NUMBER

(01-94) 01-94 (AAU.111.030)
(95) 95+ (AAU.111.030)
(97) Refused (AAU.111.020)
(99) Don't know (AAU.111.020)

RPAP1TP

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know

AAU.111.020

FR: SHOW CARD A9

Was it a year ago or less, more than 1 year but not more than 2 years, more than 2 years but not more than 3 years, more than 3 years but not more than 5 years, or over 5 years ago?

Card A9

1. A year ago or less
2. More than 1 year, but not more than 2 years
3. More than 2 years, but not more than 3 years
4. More than 3 years, but not more than 5 years
5. Over 5 years ago

RPAP2

(1) A year ago or less
(2) More than 1 year but not more than 2 years
(3) More than 2 years but not more than 3 years
(4) More than 3 years but not more than 5 years
(5) Over 5 years ago
(7) Refused
(9) Don't know

AAU.111.030

A breast physical exam is when the breast is felt for lumps by a doctor or other health professional. Have you ever had a breast physical exam?

BEX

(1) Yes (AAU.111.031)
(2) No (Check Item AAUCCI3)
(7) Refused (Check Item AAUCCI3)
(9) Don't know (Check Item AAUCCI3)

[p. 51]

AAU.111.031

When did you have your most recent breast physical exam?

RBEX1NO

[ ] NUMBER

(01-94) 01-94 (Check Item AAUCCI3)
(95) 95+ (Check Item AAUCCI3)
(97) Refused (AAU.111.040)
(99) Don't know (AAU.111.040)

RBEX1TP

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know

AAU.111.040

FR: SHOW CARD A9

Was it a year ago or less, more than 1 year but not more than 2 years, more than 2 years but not more than 3 years, more than 3 years but not more than 5 years, or over 5 years ago?

Card A9

1. A year ago or less
2. More than 1 year, but not more than 2 years
3. More than 2 years, but not more than 3 years
4. More than 3 years, but not more than 5 years
5. Over 5 years ago

RBEX2

(1) A year ago or less
(2) More than 1 yr but not more than 2 yrs
(3) More than 2 yrs but not more than 3 yrs
(4) More than 3 yrs but not more than 5 yrs
(5) Over 5 years ago
(7) Refused
(9) Don't know

Check item AAUCCI3 Under age 30 go to AAU.135; Age 30 or over go to AAU.111.050

AAU.111.050

A mammogram is an x-ray taken only of the breast by a machine that presses the breast against a plate. Have you ever had a mammogram?

MAM

(1) Yes (AAU.111.051)
(2) No (AAU.135)
(7) Refused (AAU.135)
(9) Don't know (AAU.135)

[p. 52]

AAU.111.051

When did you have your most recent mammogram?

RMAM1NO

[ ] NUMBER

(01-94) 01-94 (AAU.135)
(95) 95+ (AAU.135)
(97) Refused (AAU.111.060)
(99) Don't know (AAU.111.060)

RMAM1TP

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know

AAU.111.060

FR: SHOW CARD A9

Was it a year ago or less, more than 1 year but not more than 2 years, more than 2 years but not more than 3 years, more than 3 years but not more than 5 years, or over 5 years ago?

Card A9

1. A year ago or less
2. More than 1 year, but not more than 2 years
3. More than 2 years, but not more than 3 years
4. More than 3 years, but not more than 5 years
5. Over 5 years ago

RMAM2

(Go to AAU.135)

Check Item AAUCCI4 If age lt (40) go to AAU.135; Else if Age is ge (40) go to AAU.111.070.

AAU.111.070

The PSA test is a blood test used to detect prostate cancer. Have you ever heard of a PSA test?

PSAHRD

(1) Yes (AAU.111.080)
(2) No (AAU.135)
(7) Refused (AAU.135)
(9) Don't know (AAU.135)

AAU.111.080

Have you ever had one?

PSAEV

(1) Yes (AAU.111.081)
(2) No(AAU.135)
(7) Refused (AAU.135)
(9) Don't know (AAU.135)

[p. 53]

AAU.111.081

When did you have your most recent PSA test?

RPSA1NO

[ ] NUMBER

(01-94) 01-94 (AAU.135)
(95) 95+ (AAU.135)
(97) Refused (AAU.111.090)
(99) Don't know (AAU.111.090)

RPSA1TP

[ ] TIME PERIOD

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know

AAU.111.090

FR: SHOW CARD A9

Was it a year ago or less, more than 1 year but not more than 2 years, more than 2 years but not more than 3 years, more than 3 years but not more than 5 years, or over 5 years ago?

Card A9

1. A year ago or less
2. More than 1 year, but not more than 2 years
3. More than 2 years, but not more than 3 years
4. More than 3 years, but not more than 5 years
5. Over 5 years ago

RPSA2

[End of the periodic cancer screening questions.]

[p. 54]

Part B - Dental Care

AAU.135

FR: SHOW CARD A10.

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 A10

0. 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 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago

ADNLONGR

(0) Never (AAU.135.020)
(1) 6 months or less (AAU.135.010)
(2) More than 6 months, but not more than 1 year ago (AAU.135.010)
(3) More than 1 year, but not more than 2 years ago (AAU.135.020)
(4) More than 2 years, but not more than 5 years ago (AAU.135.020)
(5) More than 5 years ago (AAU.135.020)
(7) Refused (Check Item AAUCCI5)
(9) Don't Know (Check Item AAUCCI5)

[The next 8 questions are the periodic dental questions]

AAU.135.010

FR: SHOW CARD A11

What was the MAIN REASON that you last went to the dentist?

Card A11

1. Went in on own for check-up, examination, or cleaning
2. Was called in by the dentist for check-up, examination, or cleaning
3. Something was wrong, bothering, or hurting you
4. Went for treatment of a condition that dentist discovered at earlier check-up or examination
5. Other

ADENREAS

(1) Went in on own for checkup, examination, or cleaning (AAU.135.030)
(2) Was called in by the dentist for checkup, examination, or cleaning (AAU.135.030)
(3) Something was wrong, bothering, or hurting you (AAU.135.030)
(4) Went for treatment of a condition that dentist discovered at earlier checkup or examination (AAU.135.030)
(5) Other (AAU.135.011)
(7) Refused (AAU.135.030)
(9) Don't know (AAU.135.030)

AAU.135.011

FR: SPECIFY OTHER REASON FOR DENTAL VISIT. THIS SHOULD BE A REASON THAT IS NOT ON THE DENTAL REASON LIST.

AREASPEC

Dental reason: _______________

(Go to AAU.135.030)

[p. 55]

AAU.135.020

FR: SHOW CARD A12

[If AAU.135 = 0 read :]
What are the reasons that you have never gone to the dentist?

[Else read:]
What are the reasons that you have not visited a dentist in over 12 months?
Reason no dental visit...

Card A12

1. Afraid
2. Nervous
3. Needles
4. Cost
5. Don't know dentist
6. Dentist too far
7. Can't get there
8. No problems
9. No teeth
10. Not important
11. Didn't think of it
12. Other

ADENNOVS

(01) Afraid (Check Item AAUCCI5)
(02) Nervous (Check Item AAUCCI5)
(03) Needles (Check Item AAUCCI5)
(04) Cost/no insurance (Check Item AAUCCI5)
(05) Don't know dentist (Check Item AAUCCI5)
(06) Dentist too far (Check Item AAUCCI5)
(07) Can't get there (Check Item AAUCCI5)
(08) No problems (Check Item AAUCCI5)
(09) No teeth (Check Item AAUCCI5)
(10) Not important (Check Item AAUCCI5)
(11) Didn't think of it (Check Item AAUCCI5)
(12) Other (AAU.135.021)
(97) Refused (Check Item AAUCCI5)
(99) Don't know (Check Item AAUCCI5)

[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

AAU.135.021

FR: SPECIFY OTHER REASON FOR NO DENTAL VISITS. THIS SHOULD BE A REASON THAT IS NOT ON THE NO DENTAL REASON LIST.

ANOVSPEC

No dental reason _______________

(Go to Check Item AAUCCI5)

AAU.135.030

During the PAST 12 MONTHS, that is, since {fill 12-month date} a year ago, about how many visits did you make to a dentist?

ADENVIS

(01-94) 1-94 visits
(95) 95+ visits
(97) Refused
(99) Don't know

AAU.135.040

These next questions are about dental care received during the 2 weeks beginning Monday, {fill beginning date} and ending this past Sunday {fill ending date}.

During those 2 WEEKS did you go to a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

ADEN2W

(1) Yes (AAU.135.050)
(2) No (Go to Check Item AAUCCI5)
(7) Refused (Check Item AAUCCI5)
(9) Don't know (Check Item AAUCCI5)

[p. 56]

AAU.135.050

During those 2 weeks, how many times did you go to a dentist?

ADEN2WNO

(01-40) 1-40 two week dental visits
(97) Refused
(99) Don't know

Check item AAUCCI5: Does this sample adult have private health insurance coverage? If private*=1 then go to AAU.135.060; Else go to AAU.141.

(*This recode is based on responses to FHI.070 as well as responses to FHI.160, FHI.172, FHI.175, FHI.178, FHI.250, and FHI.280)

AAU.135.060

Earlier it was mentioned that you are covered by {fill name (s) of private health plan (s)}.
[If respondent has one plan, read:]

Does this plan pay for any part of the cost for dental care?
[Else read:]

Do any of these plans pay for any part of the cost for dental care?

ADENINS

(1) Yes
(2) No
(7) Refused
(9) Don't know

[End of the periodic dental questions]

[p. 57]

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) Don't know

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 AAUCCI5A: If male then go to AAU.211; Else go to AAU.200.

AAU.200

FR: READ LEAD-IN IF NECESSARY:

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) Don't Know

AHCSYR7 .... A doctor who specializes in women's health (an obstetrician/gynecologist)?

AAU.211

AHCSYR8 ... A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist, or ophthalmologist)?

(1) Yes (AAU.230)
(2) No (AAU.240)
(7) Refused (AAU.240)
(9) Don't Know (AAU.240)

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) Don't Know

[p. 58]

AAU.240

FR: SHOW CARD A13.

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.)

AHERNOYR

(0) None (AAU.250)
(1) 1 (AAU.240.010)
(2) 2-3 (AAU.240.010)
(3) 4-9 (AAU.240.010)
(4) 10-12 (AAU.240.010)
(5) 13 or more (AAU.240.010)
(7) Refused (AAU.250)
(9) Don't Know (AAU.250)

[This question is a periodic health care provider contact question]

AAU.240.010

FR: SHOW CARD A14

What was the main reason you last went to the emergency room?

AHERREAS

(01) You don't need an appointment there
(02) Didn't know where else to go
(03) They won't turn anyone away
(04) No other place was open at that time
(05) A doctor said to go there
(06) It was a life or death situation requiring immediate attention
(07) Other reason
(97) Refused
(99) Don't know

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) Don't Know (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
(97) Refused
(99) Don't Know

AAU.270

FR: SHOW CARD A15.

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

Card A15

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

AHCHNOYR

(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) Don't Know

[p. 59]

AAU.280

FR: SHOW CARD A13.

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.

Card A13

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

AHCNOYR

(0) None
(1) 1
(2) 2-3
(3) 4-9
(4) 10-12
(5) 13 or more
(7) Refused
(9) Don't Know

AAU.290

During the PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or outpatient?

FR: READ IF NECESSARY:

This includes both major surgery and minor procedures such as setting bones or removing growths.

ASRGYR

(1) Yes (AAU.300)
(2) No (AAU.300.010)
(7) Refused (AAU.300.010)
(9) Don't Know (AAU.300.010)

AAU.300

FR: ENTER 95 FOR 95 OR MORE TIMES.

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) Don't Know

[The next 2 question are periodic access to health care questions.]

AAU.300.010

Have you taken any prescription medication during the last 3 months?

APMED3MO

(1) Yes (AAU.300.020)
(2) No (Check item AAUCCI5B)
(7) Refused (Check item AAUCCI5B)
(9) Don't Know (Check item AAUCCI5B)

AAU.300.020

Have you been taking any of these prescription medications regularly for at least 3 months?

APMEDREG

(1) Yes
(2) No
(7) Refused
(9) Don't Know

[End of the periodic access to health care questions.]

Check item AAUCCI5B: 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 go to AAU.305.

[p. 60]

AAU.305

FR: SHOW CARD A10

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.

Card A10

AMDLONGR

(0) Never (AAU.310)
(1) 6 months or less (AAU.305.010)
(2) More than 6 months but not more than 1 year ago (AAU.305.010)
(3) More than 1 year, but not more than 2 years ago (AAU.310)
(4) More than 2 years, but not more than 5 years ago (AAU.310)
(5) More than 5 years ago (AAU.310)
(7) Refused (AAU.305.010)
(9) Don't Know (AAU.305.010)

[This next question is a periodic access to health care question.]

AAU.305.010

We want to know your rating of all your health care during the PAST 12 MONTHS from ALL DOCTORS AND OTHER HEALTH PROFESSIONALS. Use any number on a scale from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible. How would you rate your health care?

AQOVHC

(00-10) 0-10
(97) Refused
(99) Don't know

[End of the periodic access to health care question.]

[p. 61]

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) Don't Know

AAU.320

Have you EVER had a pneumonia vaccination, sometimes called a pneumonia shot? 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) Don't Know

[This next question is a periodic immunization question.]

AAU.320.010

During the past 10 years, have you had a tetanus shot?

SHTTETYR

(1) Yes
(2) No
(7) Refused
(9) Don't know

[This question is a periodic alternative health question.]

AAU.320.020

People may also use alternative health care services. I'd like to ask you about your use of some alternative kinds of therapies and treatments. During the PAST 12 MONTHS have you used...?

(1) Yes
(2) No
(7) Refused
(9) Don't know

AHCACU ...acupuncture
AHCREL ...relaxation techniques
AHCMT ...massage therapy
AHCIMA ....imagery
AHCSPI ....spiritual healing/prayer
AHCLSD ....lifestyle diets
AHCHM ....herbal medicine
AHCHOME ...homeopathic treatment
AHCENE ....energy healing
AHCBIO ....biofeedback
AHCHYP ....hypnosis
AHCOTH ....other alternative therapy or treatment

[If AHCOTH = (1) go to AAU.320.030]

[p. 62]

AAU.320.030

FR: SPECIFY UP TO FIVE OTHER ALTERNATIVE THERAPIES OR TREATMENTS. ENTER (N) FOR NO MORE.

You have mentioned that you use "other"alternative therapy or treatment...please specify up to five

FR: SPECIFY THE FIRST OTHER ALTERNATIVE THERAPY OR TREATMENT

ALTH1 Specify: _____________________

FR: SPECIFY THE SECOND OTHER ALTERNATIVE THERAPY OR TREATMENT

ALTH2 Specify: _____________________

FR: SPECIFY THE THIRD OTHER ALTERNATIVE THERAPY OR TREATMENT

ALTH3 Specify: _____________________

FR: SPECIFY THE FOURTH OTHER ALTERNATIVE THERAPY OR TREATMENT

ALTH4 Specify: _____________________

FR: SPECIFY THE FIFTH OTHER ALTERNATIVE THERAPY OR TREATMENT

ALTH5 Specify: _____________________

(Go to next section -- Demographics)

[p. 63]

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) Don't Know (ADS.010)

Check item ASDCCI3: 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) Don't Know (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) Don't Know

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) Don't Know

ASD.090

What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)

KINDWRK

Kind of Work: __________
(7) Refused
(9) Don't Know

[p. 64]

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) Don't Know

ASD.110

FR: SHOW CARD A16.

Looking at the card, which of these best describes your current job or work situation?

Card A16

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

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) Don't Know

ASD.120

FR: SHOW CARD A17.

Thinking about this MAIN job or business, how many people are employed there full and part time, including employees at all locations?

Card A17

1. 1-9 employees
2. 10-24 employees
3. 25-49 employees
4. 50-99 employees
5. 100-249 employees
6. 250-499 employees
7. 500-999 employees
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) Don't Know (ASD.130)

ASD.130

FR: SHOW CARD A17.

Thinking about the particular location or facility where you worked last week, how many people are employed there full and part time?

Card A17

1. 1-9 employees
2. 10-24 employees
3. 25-49 employees
4. 50-99 employees
5. 100-249 employees
6. 250-499 employees
7. 500-999 employees
8. 1000 employees or more

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) Don't Know

[p. 65]

ASD.140

About how long have you worked at this MAIN job or business?

WRKLONG1

[ ] NUMBER

(001-365) 1-365
(997) Refused (ASD.150)
(999) Don't Know (ASD.145)

WRKLONG2

[ ] TIME PERIOD

(1) Day(s) (ASD.150)
(2) Week(s) (ASD.150)
(3) Month(s) (ASD.150)
(4) Year(s) (ASD.140 if WRKLONG1 = AGE; Else ASD.150)
(7) Refused (ASD.150)
(9) Don't Know (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) Don't Know

ASD.150

Are you paid by the hour on this MAIN job or business?

HOURPD

(1) Yes
(2) No
(7) Refused
(9) Don't Know

ASD.160

Do you have paid sick leave on this MAIN job or business?

PDSICK

(1) Yes
(2) No
(7) Refused
(9) Don't Know

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) Don't Know (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) Don't Know (ADS.010)

ASD.190

Is this business incorporated?

BUSINC

(1) Yes
(2) No
(7) Refused
(9) Don't Know

(Go to next section --AIDS)

[p. 66]

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) Don't Know (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) Don't Know

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 = (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) Don't Know (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) Don't Know (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 = (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

[ ] MONTH:

(1) Yes (ADS.065)
(2) No (ADS.110)
(7) Refused (ADS.110)
(9) Don't Know (ADS.110)

ADS.065

FR: SHOW CARD A18

[If ADS.020 = (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?

Card A18

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 (Specify)

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) Don't Know(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.

REASPEC2 Second reason: _______________

ADS.070

[If ADS.020 = (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) Don't Know (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) Don't Know (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) Don't Know

[p. 69]

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) Don't Know

ADS.110

[If ADS.040 = (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) Don't Know (ADS.140)

[p. 70]

ADS.120

I am going to read some reasons people might have the test for the AIDS virus infection.

FR: SHOW CARD A19.

Tell me which of these statements explain WHY YOU expect to have the test in the next 12 months?
(Anything else?)

Card A19

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

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) Don't Know (ADS.130)

[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

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. 71]

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) Don't Know (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) Don't Know

FR: SHOW CARD A20.

Card A20

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) Don't Know

(Go to next section)

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