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[p. 1]

ADULT CORE
Section I -- IDENTIFICATION

FR: THE SAMPLE ADULT PERSON IS {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}.

SADULT

(1) Available
(2) Not Available

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:

(1) Yes
(2) No

AIDVERF1 Gender = {male/female} Is it correct?
AIDVERF2 Age = {3 digit format} Is it correct?
AIDVERF3 Birthday = {spoken word format} Is it correct?

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
(7) Refused
(9) Don't know

(Go to Check Item AIDCCI2)
[Update revised sex AIDSEX in SEX]

AID.050

How old is {sample adult name}?

AIDAGE

(000-120) 0-120 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}'s birthday?

AIDDOB_M

MONTH:

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't Know

AIDDOB_D

DAY:

(01-31) 1-31
(97) Refused
(99) Don't Know

AIDDOB_Y

YEAR:

(0000-1999) 0-1999
(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]

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

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

C1_CHDEV ... Coronary heart disease?
C1_ANGEV ... Angina, also called angina pectoris?
C1_MIEV ... A heart attack (also called myocardial infarction)?
C1_HRTEV ... Any kind of heart condition or heart disease (other than the ones I just asked about)?
C1_STREV ... A stroke?
C1_EPHEV ... Emphysema?

ACN.080

FR: READ LEAD-IN IF NECESSARY:

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

AASMEV

(1) Yes (ACN.090)
(2) No (ACN.110)
(7) Refused (ACN.110)
(9) Don't know (ACN.110)

ACN.090

During the PAST 12 MONTHS, have you had an episode of asthma or asthma attack?

AASMYR

(1) Yes (ACN.100)
(2) No (ACN.110)
(7) Refused (ACN.110)
(9) Don't know (ACN.110)

ACN.100

During the PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?

AASMERYR

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

ACN.110

Have you EVER been told by a doctor or other health professional that you had .......An ulcer?
This could be a stomach, duodenal or peptic ulcer.

ULCEV

(1) Yes (ACN.120)
(2) No (ACN.130)
(7) Refused (ACN.130)
(9) Don't know (ACN.130)

[p. 4]

ACN.120

During the PAST 12 MONTHS have you had an ulcer?

ULCYR

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

ACN.130

FR: READ LEAD-IN IF NECESSARY

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)

ACN.140

What kind of cancer was it?

FR: MARK UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3, CODE _" 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 {this cancer} was first diagnosed?

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

CANAGE1 ...CANKIND1 cancer
CANAGE2 ...CANKIND2 cancer
CANAGE3 ...CANKIND3 cancer

[p. 5]

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
(999) Don't know

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

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

C2_AHAYFR ... Hay fever?
C2_SINYR ... Sinusitis?
C2_CBRCHYR ... Chronic bronchitis?
C2_KIDWKYR ... Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
C2_LIVYR ... Any kind of liver condition?

ACN.250

During the PAST 12 MONTHS, have you had pain, aching, stiffness or swelling in or around a joint?

FR: SHOW FLASHCARD A3.

Card A3
[Card A3 depicts a human figure labled as follows:]
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)

[p. 6]

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)

ACN.280

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

JNTIJL_N

[ ] NUMBER:

(01-52) 1-52
(96) Entire year
(97) Refused
(99) Don't know

JNTIJL_T

[ ] 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 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

PFA_MIG1 ... Facial ache or pain in the jaw muscles or the joint in front of the ear?
PFA_MIG2 ... Severe headache or migraine?

These next questions are about your recent health during the TWO WEEKS outlined on that calendar.

FR: HAND CALENDAR CARD.

ACN.350

Did you have a head cold or chest cold that started during those TWO WEEKS?

ACOLD2W

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

Check item ACNCCI1: If male (any age) or a female age GE (50) goto ACN.410; If female age is LT (50) goto ACN.370;

ACN.370

Are you currently pregnant?

PREGNOW

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

Check item ACNCCI11: IF SEX=2 AND AGE le 55 go to MENSYR; else go to check item ACNCCI12.

These next questions are about your hearing, vision, and teeth.

ACN.410

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
(2) Little trouble
(3) Lot of trouble
(4) Deaf
(7) Refused
(9) Don't know

[p. 8]

ACN.430

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

AVISION

(1) Yes (ACN.440)
(2) No (ACN.451)
(7) Refused (ACN.451)
(9) Don't know (ACN.451)

ACN.440

Are you blind or unable to see at all?

ABLIND

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

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

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

ACN.471

During the PAST 30 DAYS, how often did you feel...

FR: SHOW FLASHCARD A4.

(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 A4

1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time

SAD ... So sad that nothing could cheer you up?
NERVOUS ... Nervous?
RESTLESS ... Restless or fidgety
HOPELESS ... Hopeless
EFFORT ... That everything was an effort?
WORTHLS ... Worthless?

Check item ACNCCI4 :If any of the responses to ACN.471 are 1 - 3, go to ACN.530; else goto next section

ACN.530

We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?

MHAMTMO

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

(Goto next section)

[p. 9]

Section III -- HEALTH STATUS AND LIMITATION OF ACTIVITIES

Part A -- Health Indicators

If DOINGLW2 eq (1,2) goto AHS.040; If DOINGLW2 eq (3,4) goto AHS.030;
If DOINGLW2 eq (R,D) goto AHS.050

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).

BEDDAYR1

(000) None
(001-366) 1-366 Days
(397) Refused
(399) Don't know

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. 10]

Part B -- Limitation of Activities

AHS.070

Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?

SPECEQ

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

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).

AHS.091

By yourself, and without using any special equipment, how difficult is it for you to...

FR: SHOW FLASHCARD A3. [Survey indicates Card A3, it is actually Card A5]

(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 A5

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

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

FR: SHOW FLASHCARD A5.
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 A5

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

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

Card A5

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 AHS.091, AHS.141, or AHS.171 equals (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 FLASHCARD A6. 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. ENTER (N) FOR NO MORE.

Card A6
You may choose more than one

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
Other impairment/problem

AFLHCA

(1) Vision/problem seeing
(2) Hearing problem
(3) Arthritis/rheumatism
(4) Back or neck problem
(5) Fractures, bone/joint injury
(6) Other injury
(7) Heart problem
(8) Stroke problem
(9) Hypertension/high blood
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (as cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem pressure
(19) Other impairment/problem
(20) Other impairment/problem
(97) Refused
(99) Don't know

[ ]
[ ]
[ ]
[ ]
[ ]

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

AHS.201

FR: THESE SHOULD BE NAMES OF SPECIFIC CONDITIONS THAT ARE NOT ON THE CONDITION LIST.

AFLSPEC1 First condition: ___________________
AFLSPEC2 Second condition: ___________________

[p. 12]

AHS.300

How long have you had {condition AFLHCA}?

ALHCLN

[ ] NUMBER:

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

ALHCLT

[ ] TIME PERIOD:

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

(Goto next section)

[p. 13]

Section IV - HEALTH BEHAVIORS

Part A - Tobacco

These next questions are about cigarette smoking.

AHB.010

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)

AHB.040B

SMKQTTP

[ ] TIME PERIOD:

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

(Go to AHB.090)

AHB.045

Have you quit smoking since {current month in word format}?

SMKQTD

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

(Go to AHB.090)

AHB.050

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

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

CIGSDA1

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

(Go to AHB.080)

[p. 14]

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)
(99) Don't know (AHB.070)
(97) Refused (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 one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

CIGQTYR

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

[p. 15]

Part B - Physical Activity

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

AHB.090

How often do you do VIGOROUS activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases 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?

VIGNO

[ ] NUMBER:

(000) Never (AHB.110)
(001-995) 1-995 times (AHB.090B)
(996) Unable to do this type activity (AHB.110)
(997) Refused (AHB.110)
(999) Don't know (AHB.110)

AHB.090B

VIGTP

[ ] TIME PERIOD:

(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type 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.110)
(999) Don't know (AHB.108)

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. 16]

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:

(000) Never (AHB.130)
(001-995) 1-995 times (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:

(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(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 yo 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. 17]

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:

(000) Never (AHB.140)
(001-995) 1-995 times per (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:

(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this activity
(7) Refused
(9) Don't know

[p. 18]

PART C - Alcohol

These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.

AHB.140

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?

FR: IF NECESSARY, PROMPT WITH: "HOW MANY DAYS PER WEEK, PER MONTH, OR PER YEAR DID YOU DRINK?"

ALC12MNO

[ ] NUMBER:

(000) Never (AHB.190)
(001-365) 1-365 days per (AHB.160B)
(997) Refused (AHB.190)
(999) Don't know (AHB.170)

AHB.160B

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?

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

ALCAMT

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

[p. 19]

AHB.180

In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?

FR: IF NECESSARY, PROMPT WITH: HOW MANY DAYS PER WEEK, PER MONTH, OR PER YEAR DID YOU HAVE 5 OR MORE DRINKS IN A SINGLE DAY?

ALC5UPNO

[ ] NUMBER:

(000) Never/None (AHB.190)
(001-365) 1-365 days (AHB.180B)
(997) Refused (AHB.190)
(999) Don't know (AHB.190)

AHB.180B

ALC5UPTP

[ ] TIME PERIOD:

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

AHB.190

How tall are you without shoes?

AHEIGHTF

FEET:

(02-07) 2-7 Feet (AHB.190B)
(97) Refused (AHB.190B)
(99) Don't know (AHB.190B)
(M) Reported in Metric (AHB.190C)

AHB.190B

AHEIGHTI

INCHES:

(00-11) 0-11 Inches
(97) Refused
(99) Don't know

(Go to AHB.200)

FR: ENTER "M" TO RECORD METRIC MEASUREMENTS

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?

WT_LB

POUNDS:

(050-500) 50-500 pounds (Go to next section)
(997) Refused (Go to next section)
(999) Don't know (Go to next section)
(M) Reported in Metric (AHB.200B)

FR: ENTER "M" TO RECORD METRIC MEASUREMENTS

AHB.200B

WT_KG

KILOGRAMS:

(0227-2268) 22.7-226.8 kilograms
(9997) Refused
(9999) Don't Know

(Goto next section--Health Care Access and Utilization)

[p. 21]

Section V - HEALTH CARE ACCESS AND UTILIZATION

Part A - Access to Care

The next questions are about health care.

AAU.020

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 equals (1) read:]

APLKIND

What kind of place is it - a clinic, doctor's office, emergency room, or some other place?

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

(1) Clinic or health center (AAU.035)
(2) Doctor's office or HMO (AAU.035)
(3) Hospital emergency room (AAU.035)
(4) Hospital outpatient department (AAU.035)
(5) Some other place (AAU.035)
(6) Doesn't go to one place most often (AAU.037)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)

AAU.035

Is that {full name from AAU.030 APLKIND} the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?

AHCPLROU

(1) Yes (AAU.040)
(2) No (AAU.037)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)

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

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

AAU.040

At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?

AHCCHGYR

(1) Yes (AAU.050)
(2) No (AAU.061)
(7) Refused (AAU.061)
(9) 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

[p. 22]

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.

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

Part B - Dental Care

AAU.135

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.

FR: SHOW FLASHCARD A7.

Card A7

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
(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
(7) Refused
(9) Don't know

[p. 23]

Part C - Health Care Provider Contacts

AAU.141

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

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

AHCSYR1 ...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
AHCSYR2 ...An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?
AHCSYR3 ...A foot doctor?
AHCSYR4 ...A chiropractor?
AHCSYR5 ...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
AHCSYR6 ...A nurse practitioner, physician assistant, or midwife?

Check item AAUCCI2: If male goto AAU.211; If female goto 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?
...A doctor who specializes in women's health (an obstetrician/gynecologist)?

AHCSYR7

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

AAU.211

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?

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

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

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

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

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. 24]

AAU.240

FR: SHOW FLASHCARD A8.

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.)

Card A8

0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more

AHERNOY2

(00) None
(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(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) months
(97) Refused
(99) Don't know

AAU.270

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

FR: SHOW FLASHCARD A9

Card A9

1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10 -12
7. 13-15
8. 16 or more

AHCHNOY2

(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know

AAU.280

FR: SHOW FLASHCARD A8

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 DENTAL VISITS, TELEPHONE CALLS.

FR: SHOW FLASHCARD A7

Card A8

0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more

Card A7

AHCNOYR2

(00) None
(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know

[p. 25]

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 (Check item AAUCCI3)
(7) Refused (Check item AAUCCI3)
(9) Don't know (Check item AAUCCI3)

AAU.300

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during the PAST 12 MONTHS?

FR: ENTER 95 FOR 95 OR MORE TIMES.

ASRGNOYR

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

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

AAU.305

FR: SHOW FLASHCARD A7.

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 A7

AMDLONGR

(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
(7) Refused
(9) Don't know

[p. 27]

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

AAU.330

Have you EVER had chickenpox?

APOX

(1) Yes (AAU.340)
(2) No (AAU.350)
(7) Refused (AAU.350)
(9) Don't know (AAU.350)

AAU.340

Have you had chickenpox in the past 12 months?

APOX12MO

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

AAU.350

Have you EVER had hepatitis?

AHEP

(1) Yes (AAU.370)
(2) No (AAU.360)
(7) Refused (AAU.360)
(9) Don't know (AAU.360)

AAU.360

Have you ever lived with someone who had hepatitis?

AHEPLIV

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

AAU.370

Have you EVER received the hepatitis B vaccine?

FR: READ IF NECESSARY: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.

SHTHEPB

(1) Yes (AAU.380)
(2) No (end section)
(7) Refused (end section)
(9) Don't know (end section)

AAU.380

Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?

SHEPDOS

(1) Received at least 3 doses
(2) Received less than 3 doses
(7) Refused
(9) Don't know

(Goto next section)

[p. 28]

Section VI - DEMOGRAPHICS

Note: In order to obtain more citizenship information, BORNVER and BORCOR have been deleted; while USYR and USLONG have been moved to the family core section.

Check item ASDCCI2: If FSD.050 in family core equals (1-4) then go to ASD.050; If HH respondent is not the sample adult and FSD.050 eq Refuse or Don't know (7, 9) goto ASD.060.

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 DOINGLW2)
(2) No (ASD.060)
(7) Refused (DOINGLW2)
(9) Don't know (DOINGLW2)

ASD.060

FR: VERIFY OR ASK

What is your correct working status?

WRKCOR

(1) Working at a job or business
(2) With a job or business but not at work
(3) Looking for work
(4) Not working at a job or business
(7) Refused
(9) Don't know

Check item DOINGLW2: Refer to FSD.050, ASD.050, and ASD.060
DOINGLW2 represents "Corrected Employment Status Last Week", with the following values:

(1) Working at a job or business
(2) With a job or business but not at work
(3) Looking for work
(4) Not working at a job or business
(7) Refused
(9) Don't Know

If DOINGLW2 eq (1,2) goto ASD.070
If DOINGLW2 eq (3,4,R,D) goto end of section.

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

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

[p. 29]

ASD.110

FR: SHOW FLASHCARD A1

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

FR: READ IF NECESSARY

Card A1

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

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

FR: SHOW FLASHCARD A2

Card A2

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
(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

ASD.130

FR: SHOW FLASHCARD A2

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

Card A2

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

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.150)
(7) Refused (ASD.150)
(9) Don't Know (ASD.150)

Check Item:If WRKLONG1 ge AGE, goto WRKLOGN.

[p. 30]

ASD.141

Number of years exceeds current age. Please verify entry.

WRKLOGN_

(1) Make correction (ASD.140)
(2) Proceed (ASD.150)

ASD.145

Have you worked at this MAIN job or business for one year or less, or more than one year?

WRKLONG3

(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 (ACN.010)
(7) Refused (ACN.010)
(9) Don't know (ACN.010)

ASD.180

In your other jobs/businesses, do you work for an employer, are you self-employed, or both?

FR: READ IF NECESSARY: EXAMPLES OF SELF-EMPLOYMENT INCLUDE BUSINESS, PROFESSIONAL PRACTICE, OR FARM.

WRKCATOT

(1) Employee only (ACN.010)
(2) Self-employed only (ASD.190)
(3) Both (ACN.010)
(7) Refused (ACN.010)
(9) Don't know (ACN.010)

ASD.190

Is this business incorporated?

BUSINC

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

(Goto next section)

[p. 31]

Section VII - AIDS

Now, I am going to ask about giving blood donations to a blood bank such as the American Red Cross.

ADS.010

Have you donated 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 HIV, (the virus that causes AIDS).

[If ADS.010 equals (1) read:]
Except for tests you may have had as part of blood donations, have you ever been tested for HIV?

[Else read:]
Have you ever been tested for HIV?

HIVTST

(1) Yes (ADS.060)
(2) No (ADS.050)
(7) Refused (ADS.110)
(9) Don't know (ADS.110)

ADS.050

I am going to show you a list of reasons why some people have not been tested for HIV, (the virus that causes AIDS). Which one of these would you say is the MAIN reason why you have not been tested?

FR: SHOW FLASHCARD A10.

Card A10

1. It's unlikely you've been exposed to HIV
2. You were afraid to find out if you were HIV positive (that you had HIV)
3. You didn't want to think about HIV or about being HIV positive
4. You were worried your name would be reported to the government if you tested positive
5. You didn't know where to get tested
6. Some other reason

WHYTST

(01) It's unlikely you've been exposed to HIV (ASD.110)
(02) You were afraid to find out if you were HIV positive (that you had HIV) (ASD.110)
(03) You didn't want to think about HIV or about being HIV positive; (ASD.110)
(04) You were worried your name would be reported to the government if you tested positive (ASD.110)
(05) You didn't know where to get tested (ASD.110)
(06) Some other reason (ASD.055)
(07) No particular reason (ASD.110)
(97) Refused (ASD.110)
(99) Don't Know (ASD.110)

ADS.055

What was the main reason why you have not been tested?.

WHYSPEC ________________________________

[p. 32]

ADS.060

[If ADS.020 equals (1) read:]
Not including blood donations, in what month and year was your last test for HIV, (the virus that causes AIDS)?

[Else read:]
In what month and year was your last test for HIV, (the virus that causes AIDS)?

FR: Enter "T" for Time Period (ADS.061)

TST12M_M

[ ] MONTH:

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Refused (ADS.060B)
(99) Don't know (ADS.060B)

ADS.060B

TST12M_Y

[ ] YEAR:

(1880-2030) 1880-2030 (ADS.065)
(97) Refused (ADS.061)
(99) Don't know (ADS.061)

ADS.061

Was it:

TIMETST

(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
(4) More than 2 years, but not more than 5 years ago
(5) More than 5 years ago
(7) Refused
(9) Don't know

[p. 33]

ADS.065

FR: SHOW FLASHCARD A11.

I am going to show you a list of reasons why some people have been tested for HIV, (the virus that causes AIDS).

[If ADS.020 equals (1) read:]
Not including your blood donations, which of these would you say was the MAIN reason for your last HIV test?

[Else read:]
Which of these would you say was the MAIN reason for your last HIV test?

Card A11

1. Someone suggested you should be tested
2. You might have been exposed through sex or drug use
3. You just wanted to find out if you were infected or not
4. You were concerned you could give HIV to someone
5. You wanted medical care or new treatments if you tested positive
6. You were pregnant
7. It was part of a routine medical check-up
8. It was required
9. Some other reason

REATST

(01 )Someone suggested you should be tested; (ADS.066)
(02) You might have been exposed through sex or drug use; (ADS.070)
(03) You just wanted to find out if you were infected or not; (ADS.070)
(04) You were concerned you could give HIV to someone; (ADS.070)
(05) You wanted medical care or new treatments if you tested positive; (ADS.070)
(06) You were pregnant; (ADS.070)
(07) It was part of a routine medical check-up; (ADS.070)
(08) It was required; or (ADS.068)
(09) Some other reason. (ADS.069)
(10) No particular reason (ADS.070)
(97) Refused(ADS.070)
(99) Don't know (ADS.070)

ADS.066

Who suggested you should be tested - a doctor, a sex partner, someone at the health department, or someone else?

REASWHO

(1) Doctor (ADS.070)
(2) Sex partner (ADS.070)
(3) Someone at health department (ADS.070)
(4) Someone else (ADS.067)
(7) Refused (ADS.070)
(9) Don't know (ADS.070)

ADS.067

Who suggested you should be tested?

WHOSPEC _____________________________________ (ADS.070)

ADS.068

Why were you required to get your last HIV test?

WHYREQ

(01) Insurance
(02) Military
(03) Jail
(04) Hospitalization
(05) Employment
(06) Immigration
(07) Other
(97) Refused
(99) Don't know

(Go to ADS.070)

ADS.069

What was the main reason for your last HIV test?

REASPEC _____________________________________

[p. 34]

ADS.070

FR: SHOW FLASHCARD A12.

[If ADS.010 equals (1) read:]
Not including your blood donations, where did you have your last HIV test?

[Else read:]
Where did you have your last HIV test?

Card A12

1. Private doctor/HMO
2. AIDS clinic/counseling/testing site
3. Hospital, emergency room, outpatient clinic
4. Other type of clinic
5. Public health department
6. At home
7. Drug treatment facility
8. Military induction or military service site
9. Immigration site
10. In a correctional facility (jail or prison)
11. Other location

LASTST_C

(01) Private doctor/HMO (ADS.080)
(02) AIDS clinic/counseling/testing site (ADS.080)
(03) Hospital, emergency room, outpatient clinic (ADS.080)
(04) Other type of clinic (ADS.072)
(05) Public health department (ADS.080)
(06) At home (ADS.074)
(07) Drug treatment facility (ADS.080)
(08) Military induction or military service site (ADS.080)
(09) Immigration site (ADS.080)
(10) In a correctional facility (jail or prison) (ADS.080)
(11) Other location (ADS.076)
(97) Refused (ADS.080)
(99) Don't know/not sure (ADS.080)

ADS.072

What type of clinic did you go to for your last HIV test?

CLINTYP

(01) Family planning clinic (ADS.080)
(02) Prenatal clinic (ADS.080)
(03) Tuberculosis clinic (ADS.080)
(04) STD clinic (ADS.080)
(05) Community health clinic (ADS.080)
(06) Clinic run by employer or insurance company (ADS.080)
(07) Other (ADS.080)
(97) Refused (ADS.080)
(99) Don't know(ADS.080)

(Go to ADS.080)

ADS.074

Was this test administered by a nurse or other health worker, or did you use a self-sampling kit?

WHOADM

(1) Nurse or health worker (ADS.080)
(2) Self-sampling kit (ADS.080)
(7) Refused (ADS.080)
(9) Don't know (ADS.080)

(Go to ADS.080)

ADS.076

Where did you have your last HIV test?

FR: THIS SHOULD BE A SPECIFIC LOCATION THAT IS NOT ON THE LIST.

LASTSPEC ______________________________

ADS.080

The last time you were tested, did you have to give your first and last names?

GIVNAM

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

[p. 35]

ADS.110

[If ADS.040 equals (1) read:]
Do you expect to have another test for HIV in the next 12 months, not including blood donations?

[Else, read:]
Do you expect to have a test for HIV in the next 12 months, not including blood donations?

EXTST12M

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

ADS.140

What are your chances of GETTING HIV, (the virus that causes AIDS)? Would you say high, medium, low, or none?

CHNSADS

(1) High
(2) Medium
(3) Low
(4) None
(5) Already have HIV or AIDS
(7) Refused
(9) Don't know

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.

FR: SHOW FLASHCARD A13.

(a) You have hemophilia and have received clotting factor concentrations.
(b) You are a man who has had sex with other men, even just one time.
(c) You have taken street drugs by needle, even just one time.
(d) You have traded sex for money or drugs, even just one time.
(e) You have tested positive for HIV, the virus that causes AIDS.
(f) You have had sex (even just one time) with someone who would answer "yes" to any of these statements

Card A13

a. You have hemophilia and have received clotting factor concentrations
b. You are a man who has had sex with other men, even just one time
c. You have taken street drugs by needle, even just one time
d. You have traded sex for money or drugs, even just one time
e. You have tested positive for HIV, the virus that causes AIDS
f. You have had sex (even just one time) with someone who would answer "yes" to any of these statements

STMTRU

(1) Yes, at least one statement is true
(2) No, none of these statements are true
(7) Refused
(9) Don't know

Check item: [If AGE gt or eq (50) goto ADS.200] [else goto ADS.160]

The next questions are about other sexually transmitted diseases or STDs. STDs are also known as venereal diseases or VD. Examples of STDs are gonorrhea, chlamydia (CLUH-MIH-DEE-UH), syphilis, herpes, and genital warts.

[p. 36]

ADS.160

In the past five years, have you had an STD other than HIV or AIDS?

FR: IF ASKED, TELL RESPONDENT TO INCLUDE NEWLY CONTRACTED STDs AND RECURRING FLARE-UPS OF PREVIOUSLY CONTRACTED STDs.

STD

(1) Yes (ADS.170)
(2) No(ADS.200)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)

ADS.170

The last time you had an STD other than HIV or AIDS, did you see a doctor or other health professional to get it checked?

STDDOC

(1) Yes (ADS.180)
(2) No (ADS.200)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)

ADS.180

Where did you go to be checked?

FR: READ ANSWER CHOICES ONLY IF NECESSARY.

STDWHER

(1) Private doctor (ADS.200)
(2) Family planning clinic (ADS.200)
(3) STD clinic (ADS.200)
(4) Emergency room (ADS.200)
(5) Health department (ADS.200)
(6) Some other place (ADS.190)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)

ADS.190

Where did you go to be checked?

STDWOTH ____________________________

The next questions are about tuberculosis, or TB.

ADS.200

Have you ever heard of tuberculosis?

TBHRD

(1) Yes (ADS.210)
(2) No (end of section)
(7) Refused (end of section)
(9) Don't Know (end of section)

ADS.210

Have you ever personally known anyone who had TB?

TBKNOW

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

ADS.220

How much do you know about TB - a lot, some, a little, or nothing?

(1) A lot (ADS.230)
(2) Some (ADS.230)
(3) A little (ADS.230)
(4) Nothing (ADS.250)
(7) Refused (end of section)
(9) Don't know (end of section)

[p. 37]

ADS.230

How is TB spread? (PROBE: Can TB be spread in any other way?)

FR: SHOW FLASHCARD A14. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.

Card A14

1. Breathing the air around a person who is sick with TB
2. Sharing eating/drinking utensils
3. Through semen or vaginal secretions shared during sexual intercourse
4. From smoking
5. From mosquito or other insect bites
6. Other

TBSPRD

(1) Breathing the air around a person who is sick with TB
(2) Sharing eating / drinking utensils
(3) Through semen or vaginal secretions shared during sexual intercourse
(4) From smoking
(5) From mosquito or other insect bites
(6) Other
(7) Refused
(9) Don't know

ADS.240

As far as you know, can TB be cured?

TBCURED

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

ADS.250

What are your chances of getting TB? Would you say high, medium, low, or none?

TBCHANC

(1) High
(2) Medium
(3) Low
(4) None
(5) Already have TB
(7) Refused
(9) Don't Know

ADS.260

Have you ever spent more than 24 hours living on the streets, in a shelter, or in a jail or prison?

HOMELESS

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

ADS.270

[If ADS.250 equals (5) read:]
If a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?

[Else, read:]]
If you or a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?

TBSHAME

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

Adult_End

(goto next section)

CANCER 2000 MODULE

SECTION B - HISPANIC ACCULTURATION

Check item NABCCI01: Refer to Household Composition, Basic Module. ORIGIN/HHC.170 "Does {person} consider {self} Hispanic/Latino?"

[If ORIGIN/HHC.170 is not = 1, then go to END_NAB.]

NAB.010

I am going to ask you about health concerns, such as smoking, diet, and disease. First, I would like to ask a few questions about which language you use most often.

FR: SHOW CARD CAN1.

In general, which language do you SPEAK?

Card CAN1

1. Only Spanish
2. Mostly Spanish
3. Spanish and English about the same
4. Mostly English
5. Only English
6. Other Language

SPSPEAK

(1) Only Spanish
(2) Mostly Spanish
(3) Spanish and English about the same
(4) Mostly English
(5) Only English
(6) Other Language
(7) Refused
(9) Don't know

NAB.020

FR: SHOW CARD CAN1.

Which language did you use as a child?

Card CAN1

1. Only Spanish
2. Mostly Spanish
3. Spanish and English about the same
4. Mostly English
5. Only English
6. Other Language

SPCHILD

(1) Only Spanish
(2) Mostly Spanish
(3) Spanish and English about the same
(4) Mostly English
(5) Only English
(6) Other Language
(7) Refused
(9) Don't know

[If SPSPEAK and SPCHILD = 6, then go to END_NAB]

[p. 2]

NAB.030

FR: SHOW CARD CAN2.

In general, which language do you READ better?

Card CAN2

1. Only Spanish
2. Spanish better than English
3. Spanish and English about the same
4. English better than Spanish
5. Only English
6. Don't read

SPREAD

(1) Only Spanish
(2) Spanish better than English
(3) Spanish and English about the same
(4) English better than Spanish
(5) Only English
(6) Don't read
(7) Refused
(9) Don't know

NAB.040

FR: SHOW CARD CAN3.

Which language do you usually speak at home?
Would you say (READ CATEGORIES)?

Card CAN3

1. Only Spanish
2. More Spanish than English
3. Spanish and English about the same
4. More English than Spanish
5. Only English

SP1_HOME

(1) Only Spanish
(2) More Spanish than English
(3) Spanish and English about the same
(4) More English than Spanish
(5) Only English
(7) Refused
(9) Don't Know

NAB.050

FR: SHOW CARD CAN3.

Which language do you usually speak with your friends?Would you say (READ CATEGORIES)?

Card CAN3

1. Only Spanish
2. More Spanish than English
3. Spanish and English about the same
4. More English than Spanish
5. Only English

SP1_FRND

(1) Only Spanish
(2) More Spanish than English
(3) Spanish and English about the same
(4) More English than Spanish
(5) Only English
(7) Refused
(9) Don't Know

NAB.060

FR: SHOW CARD CAN3.

In which language do you usually think? Would you say (READ CATEGORIES)?

Card CAN3

1. Only Spanish
2. More Spanish than English
3. Spanish and English about the same
4. More English than Spanish
5. Only English

SP2_THNK

(1) Only Spanish
(2) More Spanish than English
(3) Spanish and English about the same
(4) More English than Spanish
(5) Only English
(7) Refused
(9) Don't know

[p. 3]

NAB.070

FR: SHOW CARD CAN3.

In which language are the T.V. programs you usually watch? Would you say (READ CATEGORIES)?

Card CAN3

1. Only Spanish
2. More Spanish than English
3. Spanish and English about the same
4. More English than Spanish
5. Only English

SP2_TV

(1) Only Spanish
(2) More Spanish than English
(3) Spanish and English about the same
(4) More English than Spanish
(5) Only English
(7) Refused
(9) Don't know

NAB.080

FR: SHOW CARD CAN3.

In which language are the radio programs you usually listen to?
Would you say (READ CATEGORIES)?

Card CAN3

1. Only Spanish
2. More Spanish than English
3. Spanish and English about the same
4. More English than Spanish
5. Only English

SP2_RDIO

(1) Only Spanish
(2) More Spanish than English
(3) Spanish and English about the same
(4) More English than Spanish
(5) Only English
(7) Refused
(9) Don't know

NAB.090

In what state or country was your father born?

BIRFATH

(1) Alabama
(2) Alaska
(3) Arizona
(4) Arkansas
(5) California
(6) Colorado
(7) Connecticut
(8) Delaware
(9) Dist. Of Columbia
(10) Florida
(11) Georgia
(12) Hawaii
(13) Idaho
(14) Illinois
(15) Indiana
(16) Iowa
(17) Kansas
(18) Kentucky
(19) Louisiana
(20) Maine
(21) Maryland
(22) Massachusetts
(23) Michigan
(24) Minnesota
(25) Mississippi
(26) Missouri
(27) Montana
(28) Nebraska
(29) Nevada
(30) New Hampshire
(31) New Jersey
(32) New Mexico
(33) New York
(34) North Carolina
(35) North Dakota
(36) Ohio
(37) Oklahoma
(38) Oregon
(39) Pennsylvania
(40) Rhode Island
(41) South Carolina
(42) South Dakota
(43) Tennessee
(44) Texas
(45) Utah
(46) Vermont
(47) Virginia
(48) Washington
(49) West Virginia
(50) Wisconsin
(51) Wyoming
(57) U.S.(state unknown)
(60-696) Other listed location
(995) Not in U.S., country unknown
(996) Not in U.S., country not listed
(997) Refused
(999) Don't Know

[p. 4]

NAB.100

In what state or country was your mother born?

BIRMOTH

Check item END_NAB: Go to next section - Diet and Nutrition

[p. 5]

SECTION C - DIET AND NUTRITION

NAC.010

These questions are about the different kinds of foods you USUALLY ate or drank during the PAST MONTH, that is, the past 30 days.

How many times per day, week, or month did you USUALLY eat cold cereals?

FR: IF RESPONDENT ANSWERS "EVERY DAY", PROBE FOR HOW MANY TIMES PER DAY.

COLDCNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

COLDCTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.020

How many times per day, week, or month did you use milk, either to drink or on cold cereal?

FR: READ IF NECESSARY:

Do NOT include small amounts of milk in coffee or tea. DO include chocolate or other flavored milks.

MILKNO

[ ] NUMBER times per

(0)Never (MILKTP = 1; go to NAC.030)
(01-94) 1-94
(95)95+
(97)Refused (MILKTP = 7; go to NAC.021)
(99)Don't know (MILKTP = 9; go to NAC.021)

MILKTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 6]

NAC.021

FR: SHOW CARD CAN4

What kind of milk did you usually use?

FR: READ IF NECESSARY:

Pick the one you use most often.

Card CAN4

1. Whole milk
2. 2% fat
3. 1% fat
4. l/2% milk
5. Non-fat or skim milk

MILKKND

(1) Whole milk
(2) 2% milk
(3) 1% milk
(4) 1/2 % milk
(5) Non-fat or skim milk
(6) Other
(7) Refused
(9) Don't know

NAC.030

How many times per day, week, or month did you USUALLY eat bacon or sausage, not including low-fat, light, or turkey varieties?

HELP: Bacon and sausage are meat products.Do NOT include vegetarian substitutes here.

BACONNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

BACONTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 7]

NAC.040

How many times per day, week, or month did you USUALLY eat hotdogs made of beef or pork?

HTDOGNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

HTDOGTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.050

How many time per day, week, or month did you USUALLY eat whole grain bread including toast, rolls and in sandwiches? Whole grain breads include whole wheat, rye, oatmeal, and pumpernickel.

FR: READ IF NECESSARY:

Include cracked wheat, multi-grain, and bran breads.

BREADNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

BREADTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 8]

NAC.060

How often did you DRINK 100% fruit juice, such as orange, grapefruit, apple, and grape juices?
Do NOT count fruit drinks such as Kool-Aid, lemonade, cranberry juice cocktail, Hi-C, and Tang.

JUICENO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

JUICETP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.070

How often did you eat FRUIT? COUNT fresh, frozen, or canned fruit. Do NOT count juices.

FRUITNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

FRUITTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 9]

NAC.080

How often did you use regular fat salad dressing or mayonnaise, including on salad and sandwiches?

FR: READ IF NECESSARY:

Do NOT include low-fat, light, or diet dressings. Include salad dressing used as dip.

DRESSNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

DRESSTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.090

How often did you eat lettuce or green leafy SALAD, with or without other vegetables?

SALADNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

SALADTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 10]

NAC.100

How often did you EAT french fries, home fries, or hash brown potatoes?

FRIESNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

FRIESTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.110

How often did you EAT other WHITE potatoes? COUNT baked potatoes, boiled potatoes, mashed potatoes and potato salad.

FR: READ IF NECESSARY:

Do NOT include yams or sweet potatoes. Include red-skinned and Yukon Gold potatoes.

POTATNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

POTATTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 11]

NAC.120

How often did you EAT cooked dried beans, such as refried beans, baked beans, bean soup, and pork and beans?

BEANSNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

BEANSTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.130

Not counting what you just told me about (lettuce salads, white potatoes, cooked dried beans), and not counting rice, how often did you usually eat OTHER vegetables?

FR: READ IF NECESSARY:

Examples of other vegetables include tomatoes, string beans, carrots, corn, sweet potatoes, cabbage, bean sprouts, collard greens, and broccoli.

HELP: COUNT any form of the vegetables (raw, cooked, canned, or frozen).

OVEGNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

OVEGTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 12]

NAC.140

How many times per day, week, or month did you USUALLY eat any kind of pasta? COUNT spaghetti, noodles, macaroni and cheese, pasta salad, and any other kind of pasta.

HELP: Include tortellini, manicotti, lasagna, rice noodles, soba, etc.

PASTANO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

PASTATP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.150

How many times per day, week, or month did you USUALLY eat peanuts, walnuts, seeds, or other nuts, not including nut butters?

HELP: DO NOT include peanut butter, other nut butters, soy nuts, or nuts in cakes, cookies, and pastries.

PNUTNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

PNUTTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

[p. 13]

NAC.160

How many times per day, week, or month did you USUALLY eat regular fat potato chips, tortilla chips, or corn chips? Do NOT include low-fat chips.

HELP: Do NOT include non-fat baked chips. Salt content does not matter.

CHIPSNO

[ ] NUMBER times per

(0)Never
(01-94) 1-94
(95)95+
(97)Refused
(99)Don't know

CHIPSTP

[ ] TIME PERIOD

(1) Day
(2) Week
(3) Month
(4) Year
(7) Refused
(9) Don't know

NAC.170

These next questions are about dietary supplements.
During the PAST 12 MONTHS, did you take any vitamin or mineral supplements of ANY kind?

FR: READ IF NECESSARY:

Include vitamin or mineral pills, liquids, or tinctures. Do NOT include vitamin-fortified foods.

VITANY

(1) Yes (NAC.180)
(2) No (NAC.330)
(7) Refused (NAC.330)
(9) Don't know (NAC.330)

[p. 14]

NAC.180

During the PAST 12 MONTHS, did you take any MULTI-vitamins such as One-A-Day, Theragran, or Centrum, etc.?

FR: IF MULTI-VITAMINS WERE ALREADY MENTIONED, ENTER "1" FOR YES WITHOUT ASKING.
FR: READ IF NECESSARY:

There are a number of vitamin and mineral combinations now available. The ways in which nutrients can be combined into pill form is almost infinite. Any combination of 3 or more vitamins and minerals should be included in the MULTI-vitamin category. Combinations labeled as "stress" or "antioxidant" supplements are common and should be included as MULTI-vitamins. Do NOT include combinations of herbal or botanical substances, or combinations of just 2 nutrients (e.g.,calcium with vitamin D, etc.) in this question.

VITMUL

(1) Yes (NAC.190)
(2) No (NAC.210)
(7) Refused (NAC.210)
(9) Don't know (NAC.210)

NAC.190

How many months of the PAST 12 did you take MULTI-vitamins?

VITMULM

(12) All of them (NAC.200)
(01-12) Number of months (NAC.200)
(97) Refused (NAC.210)
(99) Don't know (NAC.210)

NAC.200

During {the/those} month(s), about how many {DAYS/DAYS PER MONTH} did you take MULTI-vitamins?

VITMULD1

[ ] NUMBER

(01-30) 1-30 days
(30) All of them
(96) Other
(97) Refused
(99) Don't Know

VITMULD2

[ ] TIME PERIOD

(1) Days per week
(2) Days per month
(6) Other
(7) Refused
(9) Don't know

[p. 15]

NAC.210

The next questions are about any INDIVIDUAL vitamin or mineral supplements you may take.

During the PAST 12 MONTHS, did you take any vitamin A?

FR: READ IF NECESSARY:

Do NOT include any Vitamin A in the MULTI-vitamins you told me about.

VITA

(1) Yes (NAC.220)
(2) No (NAC.240)
(7) Refused (NAC.240)
(9) Don't know (NAC.240)

NAC.220

How many months of the PAST 12 MONTHS did you take vitamin A?

VITAM

(12) All of them (NAC.230)
(01-12) Number of months (NAC.230)
(97) Refused (NAC.240)
(99) Don't know (NAC.240)

NAC.230

During {the/those} month(s), about how many {DAYS/DAYS PER MONTH} did you take vitamin A?

VITADNO

[ ] NUMBER

(01-30) 01-30 days
(30)All of them
(96) Other
(97) Refused
(99) Don't know

VITADTP

[ ] TIME PERIOD

(1) Days per week
(2) Days per month
(6) Other
(7) Refused
(9) Don't know

NAC.240

During the PAST 12 MONTHS, did you take any vitamin C?

FR: READ IF NECESSARY:

Do NOT include any vitamin C in the MULTI-vitamins you told me about.
Do NOT include vitamin C fortified drinks.

VITC

(1) Yes (NAC.250)
(2) No (NAC.270)
(7) Refused (NAC.270)
(9) Don't know (NAC.270)

[p. 16]

NAC.250

How many months of the PAST 12 did you take vitamin C?

VITCM

(12) All of them (NAC.260)
(01-12) Number of months (NAC.260)
(97) Refused (NAC.270)
(99) Don't know (NAC.270)

NAC.260

During {the/those} month(s), about how many {DAYS/DAYS PER MONTH} did you take vitamin C?

VITCDNO

[ ] NUMBER

(01-30) 01-30 days
(30) All of them
(96) Other
(97) Refused
(99) Don't know

VITCDTP

[ ] TIME PERIOD

(1) Days per week
(2) Days per month
(6) Other
(7) Refused
(9) Don't know

NAC.270

During the PAST 12 MONTHS, did you take any vitamin E?

FR: READ IF NECESSARY:

Do NOT include any vitamin E in the MULT-vitamins you told me about.

VITE

(1) Yes (NAC.280)
(2) No (NAC.300)
(7) Refused (NAC.300)
(9) Don't know (NAC.300)

NAC.280

How many months of the PAST 12 did you take vitamin E?

VITEM

(12) All of them (NAC.290)
(01-12) Number of months (NAC.290)
(97) Refused (NAC.300)
(99) Don't know (NAC.300)

[p. 17]

NAC.290

During {the/those} month(s), about how many {DAYS/DAYS PER MONTH} did you take vitamin E?

VITEDNO

[ ] NUMBER

(01-30) 1-30 days
(30) All of them
(96) Other
(97) Refused
(99) Don't know

VITEDTP

[ ] TIME PERIOD

(1) Days per week
(2) Days per month
(6) Other
(7) Refused
(9) Don't know

NAC.300

During the PAST 12 MONTHS, did you take calcium?

FR: READ IF NECESSARY:

Do NOT include any calcium in the MULTI-vitamins you told me about.
Include Tums. Do NOT include milk or calcium-fortified orange juice.

CALC

(1) Yes (NAC.310)
(2) No (NAC.330)
(7) Refused (NAC.330)
(9) Don't know (NAC.330)

NAC.310

How many months of the PAST 12 did you take calcium?

CALCM

(12) All of them (NAC.320)
(01-12) Number of months (NAC.320)
(97) Refused (NAC.330)
(99) Don't know (NAC.330)

[p. 18]

NAC.320

During {the/those} month(s), about how many {DAYS/DAYS PER MONTH} did you take calcium?

CALCDNO

[ ] NUMBER

(01-30) 1-30 days
(30) All of them
(96) Other
(97) Refused
(99) Don't know

CALCDTP

[ ] TIME PERIOD

(1) Days per week
(2) Days per month
(6) Other
(7) Refused
(9) Don't know

NAC.330

These next questions are about herbal supplements.
During the PAST 12 MONTHS, did you take any MIXED or single herbal or botanical supplements.

FR: READ IF NECESSARY:

Include pills, capsules, liquid tinctures and extracts. Do NOT include teas or food. Do NOT include garlic or ginger used in cooking.

HERBSUPP

(1) Yes (NAC.340)
(2) No (NAC.370)
(7) Refused (NAC.370)
(9) Don't know (NAC.370)

NAC.340

FR: SHOW CARD CAN5.

Which ones?

FR: MARK ALL THAT APPLY. ENTER THE NUMBER OF EACH ITEM MENTIONED.
ENTER (N) FOR NO MORE.

Card CAN5

1. Aloe
2. Astragalus
3. Bilberry
4. Cascara Sagrada
5. Cat's Claw
6. Cayenne
7. Cranberry
8. Dong Quai
9. Echinacea
10. Evening primrose oil
11. Feverfew
12. Garlic pills
13. Ginger pills
14. Ginkgo (biloba)
15. Ginseng (Amer., Asian)
16. Ginseng (Siberian)
17. Goldenseal
18. Grapeseed extract
19. Kava Kava
20. Lecithin
21. Melatonin
22. Milk Thistle
23: Saw Palmetto
24. St. John's Wort
25. Valerian
26. Another herbal supplement

HERB_ALO (1) Aloe
HERB_AST (2) Astragalus
HERB_BIL (3) Bilberry
HERB_CAS (4) Cascara Sagrada
HERB_CAT (5) Cat's Claw
HERB_CAY (6) Cayenne
HERB_CRA (7) Cranberry
HERB_DON (8) Dong Quai
HERB_ECH (9) Echinacea
HERB_EVE (10) Evening primrose oil
HERB_FEV (11) Feverfew
HERB_GAR (12) Garlic pills
HERB_GIG (13) Ginger pills
HERB_GIK (14) Ginkgo (biloba)
HERB_GIA (15) Ginseng(Amer, Asian)
HERB_GIS (16) Ginseng (Siberian)
HERB_GOL (17) Goldenseal
HERB_GRA (18) Grapeseed extract
HERB_KAV (19) Kava Kava
HERB_LEC (20) Lecithin
HERB_MEL (21) Melatonin
HERB_MIL (22) Milk Thistle
HERB_SAW (23) Saw Palmetto
HERB_JOH (24) St. John's Wort
HERB_VAL (25) Valerian
HERB_OTH (26) Another herbal supplement

(97) Refused
(99) Don't know

NAC.350

How many months of the PAST 12 did you take herbal supplements?

HERBM

(12) All of them (NAC.360)
(01-12) Number of months (NAC.360)
(97) Refused (NAC.370)
(99) Don't know (NAC.370)

NAC.360

During {the/those} month(s), about how many {DAYS/DAYS PER MONTH} did you take herbal supplements?

HERBDNO

[ ] NUMBER

(01-30) 1-30 days
(30) All of them
(96) Other
(97) Refused
(99) Don't know

HERBDTP

[ ] TIME PERIOD

(1) Days per week
(2) Days per month
(6) Other
(7) Refused
(9) Don't know

[p. 20]

NAC.370

During the PAST 12 MONTHS, has a doctor or other health professional talked with you about your diet and eating habits?

MDTALK

(1) Yes
(2) No
(3) Did not see a doctor in the PAST 12 MONTHS
(7) Refused
(9) Don't know

Check item END NAC: Go to the next section -- Section D: Physical Activity.

[p. 21]

SECTION D - PHYSICAL ACTIVITY

Refer to Adult Core, Basic Module.

FLWALK/AHS.091, "By yourself, and without using any special equipment, how difficult is it for you to...Walk a quarter of a mile - about 3 city blocks?"

(0) Not at all difficult (NAD.010)
(1) Only a little difficult (NAD.010)
(2) Somewhat difficult (NAD.010)
(3) Very difficult (NAD.010)
(4) Can't do at all (NAD.020)
(6) Do not do this activity (NAD.020)
(7) Refused (NAD.010)
(9) Don't know (NAD.010)

NAD.010

These next questions are about physical activity.
Do you usually walk or bike to work, school, or to do errands?

WALK

(1) Yes
(2) No
(3) Unable to walk or bike
(7) Refused
(9) Don't know

NAD.020

FR: SHOW CARD CAN6.

Which one of the following BEST describes your usual daily activities related to moving around? Do NOT include exercises, sports, or physically active hobbies done in your leisure time.

HELP: DAILY activities may include work, housework if you are a homemaker, going to and attending classes if you are a student, and what you normally do throughout a typical day if you are retired or unemployed.
LEISURE activities include exercises, sports, or physically active hobbies that you do in your leisure time.

FR: IF RESPONDENT IS BEDRIDDEN, ENTER '1'.
FR: READ IF NECESSARY:

Pick the one you do MOST often.
Do you (READ CATEGORIES BELOW)...

Card CAN6

1. You SIT during MOST of the day
2. You STAND during MOST of the day
3. You WALK AROUND most of the day

MOVE1

(1) ... SIT during MOST of the day?
(2) ... STAND during MOST of the day?
(3) ... WALK AROUND MOST of the day?
(7) Refused
(9) Don't know

[p. 22]

NAD.030

FR: SHOW CARD CAN7.

Which one of the following BEST describes your usual daily activities related to lifting or carrying things? Do NOT include activities done in your leisure time.

HELP: DAILY activities may include work, housework if you are a homemaker, going to and attending classes if you are a student, and what you normally do throughout a typical day if you are retired or unemployed. LEISURE activities include exercises, sports, or physically active hobbies that you do in your leisure time.

FR: READ IF NECESSARY:

Pick the one you do MOST often.
Do you (READ CATEGORIES 1-4 BELOW).

Card CAN7

1. You Do NOT lift or carry things very often
2. You LIFT or carry LIGHT loads
3. You LIFT or carry MODERATE loads
4. You LIFT or carry HEAVY loads

LIFT

(1) ... NOT lift or carry things very often?
(2) ... LIFT or carry LIGHT loads?
(3) ... LIFT or carry MODERATE loads?
(4) ... LIFT or carry HEAVY loads?
(5) ... Unable to lift or carry loads?
(6) Other
(7) Refused
(9) Don't know

Refer to Family Core, Basic Module.

DOINGLW/FSD.050 "Which of the following were you doing LAST WEEK:"

(1) Working at a job or business
(2) With a job or business but not at work.
(3) Looking for work
(4) Not working at a job or business
(7) Refused
(9) Don't know

[For the next two questions, if DOINGLW = 1 or 2 fill {Outside of work, how}; Else fill {How}.]

NAD.040

{Outside of work, how/How} many hours do you spend per day during the WEEKDAYS sitting?

SITWDAY

(00-24) 0-24 hours per day
(97)Refused
(99)Don't know

NAD.050

{Outside of work, how/How} many hours do you spend per day during the WEEKEND sitting?

FR: READ IF NECESSARY:

Include watching television or videos, working on the computer, playing video games, using the Internet, knitting, sewing, reading, fishing, taking long drives, watching ball games or doing other sitting activities. Weekend means any days off, not necessarily Saturday and Sunday.

FR: IF PERSON IS BEDRIDDEN, INCLUDE ONLY WAKING HOURS LYING DOWN.

SITWEND

(00-24) 0-24 hours per day
(97) Refused
(99) Don't know

Refer to Adult Core, Basic Module.

AMDLONGR/AAU.305 "About how long has it been since you last saw or talked to a doctor or other health care professional about your own health?"

(0) Never
(1) 6 months or less
(2) More than 6 months but not more than 1 year ago
(3,4,5) More than 1 year
(7) Refused
(9) Don't know

[If AMDLONGR is not = 1 or 2, then store '3' in MDEXER and go to END_NAD.]

NAD.060

During the PAST 12 MONTHS, did a doctor or other health professional RECOMMEND that you BEGIN or CONTINUE to do any type of exercise or physical activity?

MDEXER

(1) Yes
(2) No
(3) Did not see a doctor in the PAST 12 MONTHS
(7) Refused
(9) Don't know

Check item END_NAD: Go to the next section - Section E: Tobacco

[p. 24]

SECTION E - TOBACCO

Check item NAECCI01: Refer to Adult Core, Basic Module.

SMKEV/AHB.010, "Have you smoked at least 100 cigarettes in your ENTIRE LIFE?"

[If SMKEV is not = 1, then go to Check Item NAECCI11]

Check item NAECCI03: Refer to Adult Core, Basic Module.

SMKNOW/AHB.030, "Do you now smoke cigarettes every day, some days, or not at all?"

[If SMKNOW is not = 3, then go to NAE.050]

NAE.010

Earlier you said that you used to smoke cigarettes.
Did you ever USE or SWITCH to a lower tar and nicotine cigarette to reduce your health risk?

FSSWITC

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

NAE.020

FR: SHOW CARD CAN8.

When you stopped smoking completely, which of these methods did you use?

FR: MARK ALL THAT APPLY. ENTER THE NUMBER '1' FOR EACH ITEM MENTIONED. ENTER (N) FOR NO MORE.
PROBE: "Anything else?"

Card CAN8

1. Stopped all at once ("cold turkey")
2. Gradually decreased the number of cigarettes smoked in a day
3. Instructions in a pamphlet or book
4. One-on-one counseling
5. Stop smoking clinic or program
6. Nicotine patch
7. Nicotine containing gum (such as "Nicorette")
8. Nicotine nasal spray
9. Nicotine inhaler
10. Zyban/Buproprion/Wellbutrin medication
11. Switched to chewing tobacco or snuff
12. Any other method

NAE.020 FSQSTOP Stopped all at once ("cold turkey")
NAE.021 FSQDECR Gradually decreased the number of cigarettes smoked in a day
NAE.022 FSQBOOK Instructions in a pamphlet or book
NAE.023 FSQCOUN One-on-one counseling
NAE.024 FSQCLIN Stop-smoking clinic or program
NAE.025 FSQPATC Nicotine patch
NAE.026 FSQGUM Nicotine containing gum (such as "Nicorette)
NAE.027 FSQSPRY Nicotine nasal spray
NAE.028 FSQINHA Nicotine inhaler
NAE.029 FSQZYB Zyban/Buproprion/Wellbutrin medication
NAE.030 FSQSWIT Switched to chewing tobacco or snuff
NAE.031 FSQOTHAny other method

[p. 25]

NAE.040

In your WHOLE LIFE, including the last time, how many times did you stop smoking for one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

FSQUITN

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

[Go to Check Item NAECCI11]

NAE.050

Did you EVER USE or SWITCH to a lower tar and nicotine cigarette to reduce your health risk?

CSSWITC

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

NAE.060

Have you EVER stopped smoking for one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

CSQEV

(1) Yes (NAE.070)
(2) No (NAE.100)
(7) Refused (NAE.070)
(9) Don't know (NAE.070)

NAE.070

In your WHOLE LIFE, how many times have you stopped smoking for one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

CSQ12

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

[p. 26]

NAE.080

FR: SHOW CARD CAN8.

The LAST TIME you stopped smoking, which of these methods did you use?

FR: MARK ALL THAT APPLY. ENTER THE NUMBER '1' FOR EACH ITEM MENTIONED.
ENTER (N) FOR NO MORE.
PROBE: "Anything else?"

Card CAN8

NAE.080 CSQSTOP Stopped all at once ("cold turkey")
NAE.081 CSQDECR Gradually decreased the number of cigarettes smoked in a day
NAE.082 CSQBOOK Instructions in a pamphlet or book
NAE.083 CSQCOUN One-on-one counseling
NAE.084 CSQCLIN Stop-smoking clinic or program
NAE.085 CSQPATC Nicotine patch
NAE.086 CSQGUM Nicotine containing gum (such as "Nicorette")
NAE.087 CSQSPRY Nicotine nasal spray
NAE.088 CSQINHA Nicotine inhaler
NAE.089 CSQZYB Zyban /Buproprion/Wellbutrin medication
NAE.090 CSQSWIT Switched to chewing tobacco or snuff
NAE.091 CSQOTH Any other method

NAE.100

Would you like to completely quit smoking cigarettes?

QWANT

(1) Yes (NAE.110)
(2) No (NAE.150)
(7) Refused (NAE.110)
(9) Don't know (NAE.110)

NAE.110

Are you seriously considering quitting smoking within the NEXT 6 MONTHS?

CSQ6M

(1) Yes (NAE.120)
(2) No (NAE.150)
(7) Refused (NAE.150)
(9) Don't know (NAE.150)

NAE.120

Are you planning to quit smoking within the NEXT 30 DAYS?

CSQ30D

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

Check Item NAECCI11: Refer to Adult Core, Basic Module.
AMDLONGR/AAU.305, "Time since last saw/talked to health professional"
IF AMDLONGR is not = 1 or 2, then store '5' in NAE.130 and go to NAE.140.

[p. 26]

NAE.130

The following questions are about cigarette smoking.

In the PAST 12 MONTHS has a medical doctor or other health
professional ASKED you about whether you smoke cigarettes or use
other kinds of tobacco?

MDTOB1

(1) Yes (Check item NAECCI12)
(2) No (Check item NAECCI12)
(3) My doctor doesn't ask as {he/she} knows I DO smoke or use tobacco (Check item NAECCI12)
(4) My doctor doesn't ask as {he/she} knows I DON'T use tobacco (NAE.140)
(5) Did not see a doctor in the past 12 months (NAE.140)
(7) Refused (Check item NAECCI12)
(9) Don't know (Check item NAECCI12)

Check item NAECCI12: If never smoked or if quit more than a year ago, then go to NAE.140.

NAE.135

In the PAST 12 MONTHS has a medical doctor or other health professional ADVISED you to quit smoking or quit using other kinds of tobacco?

MDTOB2

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

NAE.140-142

Have you EVER smoked . . .

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

NAE.140 EVPIPE ... A pipe?
NAE.141 EVCIGAR ... A cigar?

HELP: Include small, thin, cigars called 'cigarillos', 'puritos' or 'chicos', that are wrapped in tobacco leaf rather than paper, and are made by machine or handrolled.

NAE.142 EVBIDI... A bidi?

HELP: A bidi is a flavored cigarette from India.

NAE.143-144

Have you EVER used . . .

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

NAE.143 EVSNUFF ... Snuff?
NAE.144 EVCHEW ... Chewing tobacco?

[If EVEPIPE is not = 1, then go to Check item NAECCI13]

NAE.150

Have you smoked a pipe at least 50 times in your ENTIRE LIFE?

PIPE50

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

NAE.151

Do you NOW smoke a pipe every day, some days, or not at all?

PIPEED

(1) Every day
(2) Some days
(3) Not at all
(7) Refused
(9) Don't know

Check item NAECCI13: If EVCIGAR is not = 1, then go to Check item NAECCI14.

NAE.160

Have you smoked at least 50 cigars in your ENTIRE LIFE?

CIGAR50

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

NAE.161

Do you NOW smoke cigars every day, some days, or not at all?

CIGARED

(1) Every day (Check item NAECCI14)
(2) Some days (NAE.162)
(3) Not at all (Check item NAECCI14)
(7) Refused (NAE.162)
(9) Don't know (NAE.162)

NAE.162

On how many of the PAST 30 DAYS have you smoked a cigar?

CIG30D

(0)None
(01-30) 1-30 days
(97) Refused
(99) Don't know

Check item NAECCI14: If EVBIDI is not = 1, then go to Check item NAECCI15.

NAE.170

Have you smoked bidis least 20 times in your ENTIRE LIFE?

BIDI20

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

[p. 29]

NAE.171

Do you NOW smoke bidis every day, some days, or not at all?

BIDIED

(1) Every day
(2) Some days
(3) Not at all
(7) Refused
(9) Don't know

Check item NAECCI15: If EVSNUFF is not = 1, then go to Check item NAECCI16. NAE.180Have you used snuff, (such as Skoal, Skoal Bandits, or Copenhagen) at least 20 times in your ENTIRE LIFE?

NAE.180

Have you used snuff, (such as Skoal, Skoal Bandits, or Copenhagen) at least 20 times in your ENTIRE LIFE?

SNUFF20

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

NAE.181

Do you now use snuff every day, some days, or not at all?

SNUFFED

(1) Every day
(2) Some days
(3) Not at all
(7) Refused
(9) Don't know

Check item NAECCI16: If EVCHEW is not = 1, then go to NAE.200

NAE.190

Have you used chewing tobacco, (such as Redman, Levi Garrett, or Beechnut) at least 20 times in your ENTIRE LIFE?

CHEW20

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

NAE.191

Do you NOW use chewing tobacco every day, some days, or not at all?

CHEWED

(1) Every day
(2) Some days
(3) Not at all
(7) Refused
(9) Don't know

NAE.200

During the PAST WEEK, how many days did ANYONE smoke cigarettes, cigars, or pipes ANYWHERE INSIDE your home?

SMHOME

(00) Less than 1 day per week/Rarely/None
(01-07) 1-7 days per week
(97) Refused
(99) Don't know

[p. 30]

Check item NAECCI17: Refer to Adult Core, Basic Module.
DOINGLW/FSD.050 "Which of the following were you doing last week?"

(1) Working at a job or business (Check item NAECCI18)
(2) With a job or business but not at work (Check item NAECCI18)
(3) Looking for work (NAE.260)
(4) Not working at a job or business (NAE.260)
(7) Refused (NAE.260)
(9) Don't Know (NAE.260)

Check item NAECCI18: Refer to Adult Core, Basic Module.
WRKCAT/ASD.110 "Looking at the card, which of these best describes your current job or work situation?"

(1) Private business (NAE.210)
(2) Federal employee (NAE.210)
(3) State government employee (NAE.210)
(4) Local government employee (NAE.210)
(5) Self employed in own business, professional practice, or farm (NAE.260)
(6) Working without pay in family business or farm (NAE.260)
(7) Refused (NAE.260)
(9) Don't Know (NAE.260)

NAE.210

FR: SHOW CARD CAN9.

The next questions are about smoking where you work.
Which of these BEST describes the area in which you work most of the time?

Card CAN9

1. Work mainly indoors
2. Work mainly outdoors
3. Travel to different buildings or sites
4. In a motor vehicle
5. Some other area

AREAWRK

(1) Work mainly indoors (NAE.220)
(2) Work mainly outdoors NAE.260)
(3) Travel to different buildings or sites (NAE.260)
(4) In a motor vehicle (NAE.260)
(5) Some other area (NAE.260)
(7) Refused (NAE.260)
(9) Don't know (NAE.260)

NAE.220

As far as you know, has anyone smoked in your work area in the LAST WEEK?

SMAREA

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

[p. 31]

NAE.230

Does your employer have an official policy that restricts smoking in any way?

SMPOL

(1) Yes (NAE.240)
(2) No (NAE.260)
(7) Refused (NAE.260)
(9) Don't know (NAE.260)

NAE.240

FR: SHOW CARD CAN10.

Which of these BEST describes your employer's smoking policy for indoor public or common areas, such as lobbies, rest rooms, and lunch rooms?

Card CAN10

1. Not allowed in ANY indoor public or common areas
2. Allowed in SOME indoor public or common areas
3. Allowed in ALL indoor public or common areas

SMPOLP

(1) Not allowed in ANY indoor public or common areas
(2) Allowed in SOME indoor public or common areas
(3) Allowed in ALL indoor public or common areas
(7) Refused
(9) Don't Know

NAE.250

FR: SHOW CARD CAN11.

Which of these BEST describes your employer's smoking policy for work areas?

Card CAN11

1. Not allowed in ANY work areas
2. Allowed in SOME work areas
3. Allowed in ALL work areas

SMPOLW

(1) Not allowed in ANY work areas
(2) Allowed in SOME work areas
(3) Allowed in ALL work areas
(7) Refused
(9) Don't Know

NAE.260

FR: SHOW CARD CAN12

Which BEST describes your opinion about smoking in indoor public places? Smoking should be...

Card CAN12

1. Not allowed in ANY indoor public places
2. Allowed ONLY in smoking areas
3. Allowed in ALL indoor public places

NOSMOK

(1) NOT allowed in ANY indoor public places
(2) Allowed ONLY in smoking areas
(3) Allowed in ALL indoor public places
(7) Refused
(9) Don't Know

[p. 32]

NAE.270

FR: SHOW CARD CAN13

Now, I am going to read a list of statements about cigarette smoking. After I read each one, please tell me whether you agree, disagree or have no opinion.
The smoke from other people's cigarettes is harmful to you.

Card CAN13

1. Agree
2. Disagree
3. Have no opinion

SMHARM

(1) Agree
(2) Disagree
(3) Have no opinion
(7) Refused
(9) Don't Know

NAE.280

FR: SHOW CARD CAN13

To help prevent smoking in young people, the price of cigarettes should be increased by at least $1.50 per pack.

Card CAN13

1. Agree
2. Disagree
3. Have no opinion

INCR150

(1) Agree
(2) Disagree
(3) Have no opinion
(7) Refused
(9) Don't Know

Check item END_NAE: Go to the next section, Section F -- Cancer Screening

[p. 33]

SECTION F - CANCER SCREENING

Check item NAFCCI01: Refer to Household Composition, Basic Module.

SEX/HHC.110 "{Are/Is} {you/name} male or female?"

(1) Male
(2) Female

NAF.010

Now, we are going to ask you about cancer prevention. The next few questions are about the time you spend in the sun.

FR: SHOW CARD CAN14

After several months of not being in the sun, if you went out in the sun without sunscreen, a hat, or protective clothing, for an hour, which one of these would happen to your skin? (READ CATEGORIES 1-5)

FR: READ IF NECESSARY:

Even if you do not go out in the sun, what would happen if you did?

FR: READ IF NECESSARY:

By "sunburn" we mean your skin turns pink or red or hurts for 12 hours or more.

HELP: If asked how much skin needs to be burned, include: "a burn on even a small part of your body".

Card CAN14

1. Get a severe sunburn with blisters
2. Have a severe sunburn for a few days with peeling
3. Burn mildly with some or no tanning
4. Turn darker without sunburn
5. Say that nothing would happen

SUN1HR

(01) Get a severe sunburn with blisters
(02) Have a severe sunburn for a few days with peeling
(03) Burn mildly with some or no tanning
(04) Turn darker without sunburn
(05) Say that nothing would happen
(06) Do not go out in the sun
(07) Other
(97) Refused
(99) Don't know

[p. 34]

NAF.015

FR: SHOW CARD CAN15

If you were out in the sun for a long time repeatedly (such as every day for two weeks), which one of these things would happen to your skin? Get...

Further clarification of question on long-term sun exposure:
-Even if you do not go out in the sun, what would happen if you did?
-By "sunburn", we mean your skin turns pink or red or hurts for 12 hours or more.
-If asked how much skin needs to be burned, include: "a burn on even a small part of your body".

Card CAN15

1. Get very dark and deeply tanned
2. Moderately tanned
3. Mildly tanned
4. Only freckled or no suntan at all
5. Repeated sunburns

SUNTAN

(01) Get very dark and deeply tanned
(02) Moderately tanned
(03) Mildly tanned
(04) Only freckled or no suntan at all
(05) Repeated sunburns
(06) Don't go out in the sun
(07) Other
(97) Refused
(99) Don't know

NAF.021-024

FR: SHOW CARD CAN16.

When you go outside on a very sunny day, for more than one hour, how often do you . . .

Card CAN16

1. Always
2. Most of the time
3. Sometimes
4. Rarely
5. Never

NAF.021

...Stay in the shade? Would you say (READ CATEGORIES 1-5)?

SUN1_SHA

(1) ALWAYS
(2) MOST OF THE TIME
(3) SOMETIMES
(4) RARELY
(5) NEVER
(6) DON'T GO OUT IN SUN
(7) Refused
(9) Don't Know

[p. 35]

NAF.022

...Wear a hat that shades your face, ears AND neck?
Would you say (READ CATEGORIES 1-5)?

HELP: Include any wide-brimmed hat that shades your face, ears and neck from the sun.

FR: READ IF NECESSARY

Do NOT include visors, baseball caps, or hats that do not shade the ears and neck.

SUN1_HAT

(1) ALWAYS
(2) MOST OF THE TIME
(3) SOMETIMES
(4) RARELY
(5) NEVER
(6) DON'T GO OUT IN SUN
(7) Refused
(9) Don't Know

NAF.023

...Wear a long sleeved shirt? Would you say (READ CATEGORIES 1-5)?

SUN2_LGS

(1) ALWAYS
(2) MOST OF THE TIME
(3) SOMETIMES
(4) RARELY
(5) NEVER
(6) DON'T GO OUT IN SUN
(7) Refused
(9) Don't Know

NAF.024

...Use sunscreen? Would you say(READ CATEGORIES 1-5)?

SUN2_SCR

(1) ALWAYS
(2) MOST OF THE TIME
(3) SOMETIMES
(4) RARELY
(5) NEVER
(6) DON'T GO OUT IN SUN
(7) Refused
(9) Don't Know

[If SUN2_SCR is = 5-9, then go to NAF.030]

NAF.025

What is the SPF number do you use most often?

SPF

(1-50) SPF 1-50
(96)More than one, different ones, other
(97)Refused
(99)Don't know

[If SUN1_SHA/NAF.021 and SUN1_HAT/NAF.022 and SUN2_LGS/NAF.023 and SUN2_SCR/NAF.024 are all = 6, then go to NAF.040]

NAF.030

How many times in the PAST YEAR have you had a sunburn?

NBURN

(000)None
(001-365) 1-365 times
(997)Refused
(999)Don't know

NAF.040

Have you EVER had all of your skin from head to toe checked for cancer either by a dermatologist or some other kind of doctor?

SKNX

(1) Yes (NAF.050)
(2) No (Check item NAFCCI03)
(7) Refused (Check item NAFCCI03)
(9) Don't know (Check item NAFCCI03)

NAF.050-055

When did you have your MOST RECENT skin exam?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

NAF.050

Month:

RSKX1_MT

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Don't know
(99) Refused
(T) Time Period (NAF.055)

Year:

RSKX1_YR

(1950-2000) 1950-2000 (NAF.070)
(9997) Don't know (NAF.060)
(9999) Refused (NAF.060)

NAF.055

[ ] NUMBER

RSKX1_NO

(01-94) 1-94 (RSKX1_TP/NAF.055)
(95)95+ (RSKX1_TP/NAF.055)
(97)Refused (NAF.060)
(99)Don't know (NAF.060)

[ ] TIME PERIOD

RSKX1_TP

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

[Go to NAF.070]

NAF.060

FR: SHOW CARD CAN17

Was it: (READ CATEGORIES BELOW)

Card CAN17

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

RSKX2

(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

NAF.070

FR: SHOW CARD CAN18.

What was the MAIN reason you had this skin exam?

Card CAN18

1. Part of a routine exam/screening test
2. Because of a specific skin problem
3. Followup to a previous skin problem
4. Family history

SKNXREAS

(1) Part of a routine physical exam/screening test
(2) Because of a specific skin problem
(3) Followup to a previous skin problem
(4) Family history
(5) Other
(7) Refused
(9) Don't know

Check item NAFCCI03: Refer to Household Composition, Basic Module.
SEX/HHC.110 and AGE/HHC.120.
(1) Male 18-39 (under 30) (END_NAF)
(2) Male 40+ (Check Item NAFCCI09)
(3) Female (NAF.080)

NAF.080

The following questions are about women's health.
How old were you when your periods or menstrual cycles started?

MENSTAGE

(00)Haven't started
(08-60) 8-60 years
(7)Refused
(9)Don't know

NAF.090

Have you EVER used birth control pills?

BCEVUSE

(1) Yes (NAF.100)
(2) No (NAF.110)
(7) Refused (NAF.110)
(9) Don't know (NAF.110)

[p. 38]

NAF.100

Altogether, about how long did you take birth control pills?

BC_NO

[ ] Number

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

BC_TP

[ ] Time Period

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

NAF.110

FR: IF THE RESPONDENT MENTIONED HAVING A BIOLOGICAL CHILD IN THE CORE, ENTER (1) FOR YES.

Have you EVER given birth to a live born infant?

FR: READ IF NECESSARY:

A live born infant is an infant born alive.

BIRTHEV

(1) Yes (NAF.111)
(2) No (NAF.130)
(7) Refused (NAF.130)
(9) Don't know (NAF.130)

NAF.111

What is the total number of live births (live born children) you have had?

BIRTHNUM

(01-25) 1-25 Live births
(97) Refused
(99) Don't know

NAF.120

How old were you when your {child/first child} was born?

BIRTHAGE

(08-60) 8-60 years (NAF.130)
(97) Refused (NAF.130)
(99) Don't know (NAF.121)

NAF.121

What year was your first child born?

BIRTHAG2

(1890-2000) 1890-2000
(9997) Refused
(9999) Don't know

[p. 39]

NAF.130

Have you EVER HAD a Pap smear test?
A Pap smear is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.

PAPHAD

(1) Yes (NAF.140)
(2) No (NAF.220)
(7) Refused (NAF.220)
(9) Don't know (NAF.220)

NAF.140

How many Pap smears have you had in the LAST 6 YEARS?

PAP6YR

(0) None
(01-94) 1-94 times
(95) 95+ times
(97) Refused
(99) Don't know

NAF.150

When did you have your MOST RECENT Pap smear test?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RPAP1_MT

RPAP1_YR

(1950-2000) 1950-2000 (NAF.170)
(9997) Don't know (NAF.160)
(9999) Refused (NAF.160)

When did you have your MOST RECENT Pap smear test?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RPAP1_NO

(01-94) 1-94 (RPAP1_TP/NAF.150)
(95) 95+ (RPAP1_TP/NAF.150)
(97) Don't know (NAF.160)
(99) Refused (NAF.160)

[ ] Time Period

RPAP1_TP

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

[Go to NAF.170]

NAF.160

FR: SHOW CARD CAN19

Was it: (READ CATEGORIES BELOW)

Card CAN19

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

RPAPCA

NAF.170

FR: SHOW CARD CAN20.

What was the MAIN reason you had this Pap smear?

Card CAN20

1. Part of a routine physical or pregnancy exam
2. Because of a specific gynecological problem
3. Followup to a previous gynecological exam

PAPREAS

(1) Part of a routine physical or pregnancy exam
(2) Because of a specific gynecological problem
(3) Followup to a previous gynecological exam
(4) Other
(7) Refused
(9) Don't know

NAF.180

Have you EVER had a Pap smear where the results were NOT normal?

PAPABN

(1) Yes (NAF.190)
(2) No (Check item NAFCCI04)
(7) Refused (Check item NAFCCI04)
(9) Don't know (Check item NAFCCI04)

NAF.190

Because of these results, did you have any additional exams or tests?

PAPADDE

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

NAF.200

Because of these results, did you have surgery or other treatment?

PAPTRT

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

[If pap smear in last three years or Don't know or Refused then go to NAF.220]

NAF.210

FR: SHOW CARD CAN21.

What is the most important reason you have {NEVER had a Pap smear /NOT had a Pap smear in the LAST 3 YEARS}?

Card CAN21

1. No reason/never thought of it
2. Didn't need it/didn't know I needed this type of test
3. Doctor didn't order it/didn't say I needed it
4. Haven't had any problems
5. Put if off/didn't get around to it
6. Too expensive/no insurance/cost
7. Too painful, unpleasant, or embarrassing
8. Had hysterectomy
9. Don't have doctor

PAPNOT

(01) No reason/never thought about it. (NAF.215)
(02) Didn't need/ didn't know I needed this type of test (NAF.215)
(03) Doctor didn't order it/ didn't say I needed it (NAF.220)
(04) Haven't had any problems (NAF.215)
(05) Put it off/ didn't get around to it (NAF.215)
(06) Too expensive/no insurance/cost (NAF.215)
(07) Too painful, unpleasant, or embarrassing (NAF.215)
(08) Had hysterectomy (NAF.221)
(09) Don't have doctor (NAF.220)
(10) Other (NAF.215)
(97) Refused (NAF.215)
(99) Don't know (NAF.215)

NAF.215

In the PAST YEAR, has a doctor or other health professional RECOMMENDED that you have a Pap smear?

MDRECPAP

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

NAF.220

Have you had a hysterectomy?

HYST

(1) Yes (NAF.221)
(2) No (Check item NAFCCI05)
(7) Refused (Check item NAFCCI05)
(9) Don't know (Check item NAFCCI05)

[p. 42]

NAF.221

When was your hysterectomy?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RHYST1_M

RHYSTI_Y

(1950-2000) 1950-2000 (Check item NAFCCI05)
(9997) Don't know (NAF.223)
(9999) Refused (NAF.223)

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RHYST1_N

(01-94) 1-94 (RHYST1_T/NAF.221)
(95) 95+ (RHYST1_T/NAF.221)
(97) Refused (NAF.223)
(99) Don't know (NAF.223)

[ ] Time Period

RHYST1_T

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

[Go to Check item NAFCCI05]

NAF.223

FR: SHOW CARD CAN22

Was it: (READ CATEGORIES BELOW)

Card CAN22

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

RHYST2

Check item NAFCCI05: Refer to Household Composition, Basic Module.
AGE/HHC.120 "What is {name/your} age...?"
(1)Female 18-29 (under 30) (Check item NAFCCI07)
(2)Female 30+ (NAF.230)

[p. 43]

NAF.230

Have you EVER HAD a mammogram?

FR: READ IF NECESSARY:

A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.

MAMHAD

(1) Yes (NAF.240)
(2) No (Check item NAFCCI06)
(7) Refused (Check item NAFCCI06)
(9) Don't know (Check item NAFCCI06)

NAF.240

FR: SHOW CARD CAN23

About how old were you when you had your first mammogram?
Were you: (READ CATEGORIES BELOW)

Card CAN23

1. Under 30 years
2. 30-39
3. 40-49
4. 50-59
5. 60 years or older

MAMAGE

(1) Under 30 years
(2) 30 to 39
(3) 40 to 49
(4) 50 to 59
(5) 60 years or older
(7) Refused
(9) Don't know

NAF.250

How many mammograms have you had in the LAST 6 YEARS?

MAM6YR

(00) None
(01-94) 1-94 times
(95) 95+
(97) Refused
(99) Don't know

[p. 44]

NAF.260

When did you have your MOST RECENT mammogram?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RMAM1_MT

RMAM1_YR

(1950-2000) 1950-2000 (NAF.280)
(9997) Don't know (NAF.270)
(9999) Refused (NAF.270)

When did you have your MOST RECENT mammogram?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RMAM1_NO

(01-94) 1-94 (RMAM1_TP/NAF.260)
(95) 95+ (RMAM1_TP/NAF.260)
(97) Refused (NAF.270)
(99) Don't know (NAF.270)

[ ] Time Period

RMAM1_TP

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

[Go to NAF.280]

NAF.270

FR: SHOW CARD CAN24

Was it: (READ CATEGORIES BELOW)

Card CAN24

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

RMAMCA

(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

[p. 45]

NAF.280

Where was this mammogram done? Was it a (READ CATEGORIES 1-5 BELOW):

MAMWHER

(1) Mammogram van?
(2) Independent X-ray or radiology center?
(3) Clinic/health center, not in a hospital?
(4) Private doctor's office?
(5) Hospital?
(6) Other place?
(7) Refused
(9) Don't know

NAF.290

How much did you pay for this mammogram. Was it NONE, PART, or ALL of the cost?

MAMPAY

(1) I paid NONE of the cost (NAF.300)
(2) I paid PART of the cost (NAF.300)
(3) I paid ALL of the cost (NAF.305)
(7) Refused (NAF.300)
(9) Don't know (NAF.300)

NAF.300-304

Which of the following sources paid for {some/all} of the cost of this mammogram?

FR: MARK ALL THAT APPLY. ENTER THE NUMBER OF EACH ITEM MENTIONED;
ENTER (N) FOR NO MORE.

NAF.300 MAMP_PRI (1) Private health insurance
NAF.301 MAMP_CAR (2) Medicare
NAF.302 MAMP_AID (3) Medicaid
NAF.303 MAMP_FRE (4) Free Clinic
NAF.304 MAMP_OTH (5) Other source

NAF.305

Was this mammogram provided through a special low-cost program?

MAMLOCST

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

NAF.310

FR: SHOW CARD CAN25.

What was the MAIN reason you had this mammogram?

Card CAN25

1. Part of a routine physical exam/screening test
2. Because of a specific breast problem
3. Followup to a previously identified breast problem
4. Baseline or initial mammogram
5. Family history

MAMREAS

(1) Part of a routine physical exam/screening test
(2) Because of a specific breast problem
(3) Followup to a previously identified breast problem
(4) Baseline or initial mammogram
(5) Family history
(6) Other
(7) Refused
(9) Don't know

[p. 46]

NAF.320

Have you EVER had a mammogram where the results were not normal?

MAMABN

(1) Yes (NAF.330)
(2) No (NAF.350)
(7) Refused (NAF.350)
(9) Don't know (NAF.350)

NAF.331-337

Because of these results, what additional tests or surgery did you have?

FR: MARK ALL THAT APPLY. ENTER THE NUMBER FOR EACH ITEM MENTIONED. TYPE N FOR "NO MORE".
PROBE: "Anything else?"

NAF.331 MAMT_NON (0) None
NAF.332 MAMT_OTH (1) Another mammogram
NAF.333 MAMT_ULT (2) Ultrasound
NAF.334 MAMT_CBE (3) Clinical breast exam
NAF.335 MAMT_BIO (4) Needle biopsy
NAF.336 MAMT_TUM (5) Tumor/ lump removed/ lumpectomy
NAF.337 MAMT_BRE (6) Breast removed/ mastectomy

[If no additional tests or surgery, then go to NAF.350]

NAF.340

Did the surgery or additional tests indicate that you had cancer?

MAMCAN

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

NAF.350

Have you ever had an operation to remove a lump from your breast that was found to be NONCANCEROUS?

LUMPEV

(1) Yes (NAF.351)
(2) No (Check item NAFCCI06)
(3) Lump removed was cancerous (Check item NAFCCI06)
(7) Refused (Check item NAFCCI06)
(9) Don't know (Check item NAFCCCI06)

NAF.351

How many of these operations have you had?

LUMPNUM

(01-20) 1-20 Operations
(97)Refused
(99)Don't know

[p. 47]

Check item NAFCCI06: Refer to:
MAMHAD/NAF.230, Have had a mammogram.
RMAM1/NAF.260, Date of last mammogram in month, year or time ago
RMAM2/NAF.270, Date of last mammogram in time categories.
(1) Have NEVER had a mammogram (NAF.360)
(2) Have NOT had a mammogram in the last 2 years (NAF.360)
(3) HAVE HAD a mammogram in the last 2 years (Check item NAFCCI07)
(7) Refused (NAF.370)
(9) Don't Know (NAF.370)

NAF.360

FR: SHOW CARD CAN26

What is the most important reason why you have {NEVER had/ NOT had} a mammogram in the PAST 2 YEARS)?

Card CAN26

MAMNOT

(01) No reason/never thought of it. (NAF.370)
(02) Didn't need it/ didn't know I needed this type of test (NAF.370)
(03) Doctor didn't order it/ didn't say I needed it (Check item NAFCCIO7)
(04) Haven't had any problems (NAF.370)
(05) Put it off/ Didn't get around to it (NAF.370)
(06) Too expensive/no insurance/cost (NAF.370)
(07) Too painful, unpleasant or embarrassing (NAF.370)
(08) I'm too young (NAF.370)
(09) Don't have doctor (Check item NAFCCI07)
(10) Other reason (NAF.370)
(97) Refused (NAF.370)
(99) Don't know (NAF.370)

NAF.370

In the PAST YEAR, has a doctor or other health professional RECOMMENDED that you have a mammogram?

MDRECMAM

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

Check item NAFCCI07: Refer to Household Composition, Basic Module.
AGE/HHC.120 "What is {name/your} age...?"
(1) Female 18-39 (under 40) (Check item NAFCCI08)
(2) Female 40+ (NAF.380)

NAF.380-383

Are you currently taking any of the following medications?

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

NAF.380 MED_HRT (1) Hormone replacement therapy
NAF.381 MED_TAMX (2) Tamoxifen
NAF.382 MED_RALX (3) Raloxifen
NAF.383 MED_BC (4) Birth control implants, pills, or shots

[p. 48]

Check item NAFCCI08: Refer to Household Composition, Basic Module.
AGE, HHC.120 "What is {name/your} age...?"
(1)Female 18-29 (under 30) (END_NAF)
(2)Female 30+ (NAF.390)

NAF.390

Have you EVER HAD a breast exam done by a doctor or other health professional to check for lumps or other signs of breast cancer?

FR: READ IF NECESSARY:

A clinical breast exam is when the breasts are felt by a doctor or other health professional to check for lumps or other signs of breast cancer.

CBEHAD

(1) Yes (NAF.400)
(2) No (Check item NAFCCI09)
(7) Refused (Check item NAFCCI09)
(9) Don't know (Check item NAFCCI09)

NAF.400

When did you have your MOST RECENT breast exam?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RCBE1_MT

RCBE1_YR

(1950-2000) 1950-2000 (Check item NAFCCI09)
(9997) Don't know (NAF.410)
(9999) Refused (NAF.410)

When did you have your MOST RECENT breast exam?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RCBE1_NO

(01-94) 1-94 (RCBE1_TP/NAF.400)
(95) 95+(RCBE1_TP/NAF.400)
(97) Refused (NAF.410)
(99) Don't know (NAF.410)

[ ] Time Period

RCBE1_TP

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

[Go to Check item NAFCCI09]

NAF.410

FR: SHOW CARD CAN27

Was it: (READ CATEGORIES BELOW)

Card CAN27

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

RCBE2

Check item NAFCCI09: Refer to Household Composition, Basic Module.
SEX/HHC.110 "{Are/Is} {you/name} male or female?" and AGE/HHC.120 "What is {name/your} age...?"
(1) Male, 18-39 (under 40) (END_NAF)
(2) Male, 40+ (NAF.420)
(3) Female (Check item NAFCCI10)

NAF.420

The following questions are about men's health.
Have you EVER HEARD OF a PSA or prostate-specific antigen test?

FR: READ IF NECESSARY:

A PSA test is a blood test to detect prostate cancer.

PSAHRD

(1) Yes (NAF.430)
(2) No (Check item NAFCCI10)
(7) Refused (NAF.430)
(9) Don't know (Check item NAFCCI10)

NAF.430

Have you EVER HAD a PSA test?

PSAHAD

(1) Yes (NAF.440)
(2) No (Check item NAFCCI10)
(7) Refused (Check item NAFCCI10)
(9) Don't know (Check item NAFCCI10)

NAF.440

FR: SHOW CARD CAN28.

How old were you when you had your first PSA test? Were you...
Were you (READ CATEGORIES BELOW):

Card CAN28

1. Under 40 years
2. 40-44
3. 45-49
4. 50-54
5. 55-59
6. 60-64
7. 65-69
8. 70 years or older

PSAAGE1

(01) Under 40 years?
(02) 40 - 44?
(03) 45 - 49?
(04) 50 - 54?
(05) 55 - 59?
(06) 60 - 64?
(07) 65 - 69?
(08) 70 years or older?
(97) Refused
(99) Don't know

[p. 49]

NAF.450

How many PSA tests have you had in the LAST 5 YEARS?

PSA5YR

(00) None
(01-94) 1-94
(95) 95+
(97) Refused
(99) Don't know

NAF.460

When did you have your MOST RECENT PSA test?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RPSA1_MT

RPSA1_YR

(1950-2000) 1950-2000 (NAF.480)
(9997)Don't know (NAF.470)
(9999)Refused (NAF.470)

When did you have your MOST RECENT PSA test?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RPSA1_NO

(01-94) 1-94 (RPSA1_TP/NAF.460)
(95) 95+ (RPSA1_TP/NAF.460)
(97) Refused (NAF.470)
(99) Don't know (NAF.470)

[ ] Time Period

RPSA1_TP

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

[Go to NAF.480]

NAF.470

FR: SHOW CARD CAN29.

Was it: (READ CATEGORIES BELOW)

Card CAN29

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

(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

NAF.480

What was the MAIN reason you had this PSA test?

FR: SHOW CARD CAN30.

Card CAN30

1. Part of a routine physical exam/screening test
2. Because of a specific problem
3. Followup test for an earlier exam
4. Family history

PSAREAS

(1) Part of a routine physical exam/screening test
(2) Because of a specific problem
(3) Followup test for an earlier exam
(4) Family history
(5) Other
(7) Refused
(9) Don't know

NAF.490

Who first suggested the PSA test: you, your doctor, or someone else?

PSASUGG

(1) I did
(2) My doctor
(3) Someone else
(7) Refused
(9) Don't know

NAF.500

Did the doctor discuss the advantages and disadvantages of this test with you before doing it?

PSADISC

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

NAF.510

Have you EVER had a PSA test where the results were NOT normal?

PSAABN

(1) Yes (NAF.520)
(2) No (Check item NAFCCI10)
(7) Refused (Check item NAFCCI10)
(9) Don't know (Check item NAFCCI10)

NAF.520-524

Because of these results, what additional tests or surgery did you have?

FR: MARK ALL THAT APPLY. ENTER THE NUMBER AT EACH ITEM MENTIONED.
ENTER (N) FOR NO MORE.
PROBE: "Anything else?"

NAF.520 PSAT_NON (0) None
NAF.521 PSAT_OTH (1) Another PSA
NAF.522 PSAT_BIO (2) Biopsy
NAF.523 PSAT_ULT (3) Ultrasound
NAF.524 PSAT_MRI (4) MRI

[If no additional tests or surgery, then go to Check item NAFCCI10]

NAF.530

Did the PSA test, surgery, or other test indicate that you had cancer?

PSACAN

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

Check item NAFCCI10:Refer to Household Composition, Basic Module.
AGE/HHC.120 "What is {name/your} age...?"
(1) Age 18-39 (under 40) (END_NAF)
(2) Age 40+ (NAF.540)

NAF.540

Have you EVER HAD a sigmoidoscopy, colonoscopy, or proctoscopy?
These are exams in which a health care professional inserts a tube into the rectum to look for signs of cancer or other problems.
PRONUNCIATION GUIDE:
sigmoid-OS-copy, colon-OS-copy, proc-TOS-copy

FR: READ IF NECESSARY:

A SIGMOIDOSCOPY is an exam in which a health care professional inserts a flexible tube into the rectum and lower part of the colon to look for signs of cancer or other problems. A COLONOSCOPY is a SIMILAR exam but uses a longer tube to examine the entire colon. Before a colonoscopy is done, you are usually given medication through a needle in your arm to make you sleepy. A PROCTOSCOPY is an older exam that used a rigid tube.

CREHAD

(1) Yes (NAF.550)
(2) No (Check item NAFCCI11)
(7) Refused (Check item NAFCCI11)
(9) Don't know (Check item NAFCCI11)

[p. 53]

NAF.550

How many sigmoidoscopy, colonoscopy, or proctoscopy exams have you had in the LAST 10 YEARS?

CRE10YR

(0) None
(1-94) 1-94
(95) 95+ times
(97) Refused
(99) Don't know

NAF.560

When did you have your MOST RECENT exam?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RCRE1_MT

RCRE1_YR

(1950-2000) 1950-2000 (NAF.580)
(9997) Don't know (NAF.570)
(9999) Refused (NAF.570)

When did you have your MOST RECENT exam?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RCRE1_NO

(01-94) 1-94 (RCRE1_TP/NAF.560)
(95) 95+(RCRE1_TP/NAF.560)
(97) Refused (NAF.570)
(99) Don't know (NAF.570)

[ ] Time Period

RCRE1_TP

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

[Go to NAF.580]

[p. 54]

NAF.570

FR: SHOW CARD CAN31.

Was it: (READ CATEGORIES BELOW)

Card CAN31

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. More than 5 years but not more than 10 years
6. Over 10 years ago

RCRE2

(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) More than 5 years but not more than 10 years?
(6) Over 10 years ago?
(7) Refused
(9) Don't know

NAF.580

What was this MOST RECENT exam called: a sigmoidoscopy, colonoscopy, proctoscopy or something else?
PRONUNCIATION GUIDE:
sigmoid-OS-copy, colon-OS-copy, proc-TOS-copy

FR: READ IF NECESSARY

A SIGMOIDOSCOPY is an exam in which a health care professional inserts a flexible tube into the rectum and lower part of the colon to look for signs of cancer or other problems. A COLONOSCOPY is a SIMILAR exam but uses a longer tube to examine the entire colon. Before a colonoscopy is done, you are usually given medication through a needle in your arm to make you sleepy. A PROCTOSCOPY is an older exam that used a rigid tube.

CRENAM

(1) Sigmoidoscopy
(2) Colonoscopy
(3) Proctoscopy
(4) Something else
(7) Refused
(9) Don't know

NAF.590

FR: SHOW CARD CAN32.

What was the MAIN reason you had this exam?

Card CAN32

1. Part of a routine physical exam/screening test
2. Because of a specific problem
3. Followup test of an earlier test or screening exam (Fecal Occult Blood Test or sigmoidoscopy)
4. Family history

CREREAS

(1) Part of a routine physical exam/screening test
(2) Because of a specific problem
(3) Followup test of an earlier test or screening exam (Fecal Occult Blood Test or sigmoidoscopy)
(4) Family history
(5) Other
(7) Refused
(9) Don't know

[p. 55]

Check item NAFCCI11: Refer to CREHAD, RCRE1, RCRE2.
CREHAD/NAF.540, Have had a colorectal exam,
RCRE1/NAF.560, Date of last colorectal exam in month, year or time ago
RCRE2/NAF.570, Date of last colorectal exam in time categories.
(1) Have NEVER had a sigmoidoscopy/colonoscopy (NAF.600)
(2) Have NOT had a sigmoidoscopy/colonoscopy in the last 10 years (NAF.600)
(3) HAVE HAD a sigmoidoscopy/colonoscopy 3 in the last 10 years (NAF.620)
(7) Refused (NAF.620)
(9) Don't Know (NAF.620)

NAF.600

FR: SHOW CARD CAN33

What is the most important reason you have [NEVER had/NOT had} one of these exams in the LAST 10 YEARS]?

Card CAN33

CRENOT

(01) No reason/never thought about it (Check item NAFCCI12)
(02) Didn't need it/didn't know I needed this type of test (Check item NAFCCI12)
(03) Doctor didn't order it/ didn't say I needed it (NAF.620)
(04) Haven't had any problems (Check item NAFCCI12)
(05) Put it off/ didn't get around to it (Check item NAFCCI12)
(06) Too expensive/no insurance/cost (Check item NAFCCI12)
(07) Too painful, unpleasant, or embarrassing (Check item NAFCCI12)
(08) Had another type of colorectal exam (Check item NAFCCI12)
(09) Don't have doctor (NAF.620)
(10) Other (Check item NAFCCI12)
(97) Refused (Check item NAFCCI12)
(99) Don't know (Check item NAFCCI12)

Check item NAFCCI12: If AMDLONGR/AAU.305 is not = 1 or 2, then store '3' in CREREC and go to NAF.620

NAF.610

In the PAST YEAR has a doctor or other health professional RECOMMENDED that you have a sigmoidoscopy or colonoscopy?

CREREC

(1) Yes
(2) No
(3) No doctor visit in past twelve months
(7) Refused
(9) Don't know

[p. 56]

NAF.620

The following questions are about the blood stool or occult blood test, a test to determine whether you have blood in your stool or bowel movement.

The blood stool test can be done at home using a kit. You smear a small amount of stool on cards at home and send the cards back to the doctor or lab.

Have you EVER HAD a blood stool test, using a HOME test kit?

HFOBHAD

(1) Yes (NAF.630)
(2) No (Check item NAFCCI13)
(7) Refused (Check item NAFCCI13)
(9) Don't know (Check item NAFCCI13)

NAF.630

How many HOME blood stool tests have you had in the LAST 3 YEARS?

FR: IF GREATER THEN 95, ENTER `95'

HFOB3YR

(00) None
(01-94) 1-94
(95) 95+ times
(97) Refused
(99) Don't know

[p. 57]

NAF.640

When did you have your MOST RECENT HOME blood stool test?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RHFOB1_M

RHFOB1_Y

(1950-2000) 1950-2000 (NAF.660)
(9997) Don't know (NAF.650)
(9999) Refused (NAF.650)

When did you have your MOST RECENT HOME blood stool test?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RHFOB1_N

(01-94) 1-94 (RHFOB1_T/NAF.640)
(95) 95+ (RHFOB1_T/NAF.640)
(97) Refused (NAF.650)
(99) Don't know (NAF.650)

[ ] Time Period

RHFOB1_T

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

[Go to NAF.660]

NAF.650

FR: SHOW CARD CAN34

Was it: (READ CATEGORIES BELOW)

Card CAN34

1. A year ago or less
2. More than 1 year but not more 2 years
3. More than 2 years but not more 3 years
4. More than 3 years but not more 5 years
5. More than 5 years but not more 10 years
6. Over 10 years ago

RHFOB2

NAF.660

FR: SHOW CARD CAN35.

What was the MAIN reason you had this exam?

Card CAN35

1. Part of a routine physical exam/screening test
2. Because of a specific problem
3. Followup test of an earlier test or screening exam
4. Family history

HFOBREAS

(1) Part of a routine physical exam/screening test
(2) Because of a specific problem
(3) Followup test of an earlier test or screening exam
(4) Family history
(5) Other
(7) Refused
(9) Don't know

NAF.670

Have you EVER had a HOME blood stool test where the results were NOT normal?

HFOBABN

(1) Yes (NAF.680)
(2) No (Check item NAFCCI13)
(7) Refused (Check item NAFCCI13)
(9) Don't know (Check item NAFCC13)

NAF.680

Because of these results, what additional tests or surgery did you have?

FR: MARK ALL THAT APPLY. ENTER THE NUMBER AT EACH ITEM MENTIONED.
ENTER (N) FOR NO MORE.
PROBE: "Anything else?"

NAF.680 HFOB_NON (0) None
NAF.681 HFOB_OTH (1) Another Fecal Occult Blood Test
NAF.682 HFOB_SIG (2) Sigmoidoscopy
NAF.683 HFOB_COL (3) Colonoscopy
NAF.684 HFOB_BAR (4) Barium enema
NAF.685 HFOB_SUR (5) Surgery

[p. 59]

Check item NAFCCI13: Refer to HFOBHAD, RHFOB1, RHFOB2.
Refer to HFOBHAD/NAF.620, Have had a home blood stool test.
RHFOB1/NAF.640, Date of last home blood stool test in month, year or time ago
RHFOB2/NAF.650, Date of last home blood stool test in time categories.
(1) Have NEVER had a home blood stool test (NAF.690)
(2) Have NOT had a home blood stool test in the last year (NAF.690)
(3) HAVE HAD a home blood stool test in the last year (NAF.710)
(7) Refused (NAF.710)
(9) Don't Know (NAF.710)

NAF.690

FR: SHOW CARD CAN36.

What is the most important reason you have {NEVER had /NOT had a HOME blood stool test in the PAST YEAR}?

Card CAN36

1. No reason/never thought of it
2. Didn't need it/didn't know I needed this type of test
3. Doctor didn't order it/ didn't say I needed it
4. Haven't had any problems
5. Put if off/didn't get around to it
6. Too expensive/no insurance/cost
7. Too painful, unpleasant, or embarrassing
8. Had another type of colorectal exam
9. Don't have doctor

HFOBNOT

(01) No reason/never thought about it. (Check item NAFCCI14)
(02) Didn't need/ didn't know I needed this type of test. (Check item NAFCCI14)
(03) Doctor didn't order it/didn't say I needed it. (NAF.710)
(04) Haven't had any problems(Check item NAFCCI14)
(05) Put it off/ didn't get around to it (Check item NAFCCI14)
(06) Too expensive/no insurance/cost (Check item NAFCCI14)
(07) Too painful, unpleasant, or embarrassing (Check item NAFCCI14)
(08) Had another type of colorectal exam (Check item NAFCCI14)
(09) Don't have doctor (NAF.710)
(10) Other (Check item NAFCCI14)
(97) Refused(Check item NAFCCI14)
(99) Don't know (Check item NAFCCI14)

Check item NAFCCI14: Refer to Adult Core, Basic Module.
AMDLONGR/AAU.305 "About how long has it been since you last saw or talked to a doctor or other health care professional about your own health?"
If AMDLONGR/AAU.305 is not = 1 or 2 then, store '3' in NAF.700 and go to NAF.710.

NAF.700

In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a HOME blood stool test?

MDHFOB

(1) Yes
(2) No
(3) Did not go to doctor in past 12 months
(7) Refused
(9) Don't know

[p. 60]

NAF.710

Have you EVER HAD a blood stool test in which your doctor or other health care professional collected a stool sample during an office visit?

FOBHAD

(1) Yes (NAF.720)
(2) No (END_NAF)
(7) Refused (END_NAF)
(9) Don't know (END_NAF)

NAF.720

When did you have your MOST recent OFFICE blood stool test?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RFOB1_MT

RFOB1_YR

(1950-2000) 1950-2000 (END_NAF)
(9997) Don't know (NAF.730)
(9999) Refused (NAF.730)

When did you have your MOST recent OFFICE blood stool test?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RFOB1_NO

(01-94) 1-94 (RFOB1_TP/NAF.720)
(95) 95+ (RFOB1_TP/NAF.720)
(97) Refused (NAF.730)
(99) Don't know (NAF.730)

[ ] Time Period

RFOB1_TP

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

[Go to END_NAF]

NAF.730

FR: SHOW CARD CAN37

Was it: (READ CATEGORIES BELOW)

Card CAN37

RFOB2

(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) More than 5 years but not more than 10 years
(6) Over 10 years ago
(7) Refused
(9) Don't know

Check item END_NAF: Go to the next section - Section G: Genetic Testing

[p. 62]

SECTION G - GENETIC TESTING

The following questions refer to "genetic testing for cancer risk." That is, testing your blood to see if you carry genes which may predict a greater chance of developing cancer at some point in your life. This does NOT include tests to determine if you have cancer now.

NAG.010

Have you EVER HEARD of genetic testing to determine if a person is at greater risk of developing cancer?

GTHEARD

(1) Yes (NAG.020)
(2) No (NAG.160)
(7) Refused (NAG.160)
(9) Don't know (NAG.160)

NAG.020

Have you EVER DISCUSSED the possibility of getting a genetic test for cancer risk with a doctor or other health professional?

GTPOSS

(1) Yes (NAG.025)
(2) No (NAG.030)
(7) Refused (NAG.030)
(9) Don't know (NAG.030)

NAG.025

Did the doctor or other health professional ADVISE you to have such a test?

GTADVISE

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

NAG.030

Have you ever HAD a genetic test to determine if you are at greater risk of developing cancer in the FUTURE?

FR: READ IF NECESSARY:

This does not include any test to see whether you had cancer in the PAST or have cancer NOW.

GTGRISK

(1) Yes (Check item NAGCCI01)
(2) No (NAG.160)
(7) Refused (NAG.160)
(9) Don't know (NAG.160)

Check item NAGCCI01: Refer to Household Composition, Basic Module.
SEX/HHC.110 "{Are/Is} {you/name} male or female?"
(1) Male
(2) Female

[p. 63]

NAG.040

Please think about your MOST RECENT genetic test for cancer risk.
Which kinds of cancer was it for: (READ EACH CANCER TYPE LISTED BELOW)

NAG.040

Breast?

GT_BRE

(1) Yes
(2) No
(3) Male, not applicable
(7) Refused
(9) Don't know

NAG.041

Ovarian?

GT_OVA

(1) Yes
(2) No
(3) Male, not applicable
(7) Refused
(9) Don't know

NAG.042

Colon or rectal?

GT_COL

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

NAG.043

Another cancer?

GT_OTH

(1) Yes (NAG.044)
(2) No (NAG.050)
(7) Refused (NAG.050)
(9) Don't know (NAG.050)

NAG.044

FR: SPECIFY OTHER TEST FOR GENETIC RISK OF CANCER:

GTRSKOTH Other Specify: ______________________________________

NAG.050

When did you have this genetic test done?

FR: ENTER "96" TO USE TIME PERIOD FORMAT.

GTRSK_MT MONTH: __________________________________________

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Refused
(96) Time period format (NAG.055)
(99) Don't Know

GTRSK_YR YEAR: _____________________________________________

(1950-2001) 1950-2001 (NAG.060)
(9996) Time period format (NAG.055)
(9997) Refused (NAG.060)
(9999) Don't Know (NAG.060)

NAG.055

When did you have this genetic test done?

FR: IF GREATER THAN "96", ENTER "96".

GTRSKBNO

[ ] Number

(01-95) 1-95
(96)96+
(97)Refused
(99)Don't know

GTRSKBTP

[ ] Time Period

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

NAG.060

Before the test was given, did you sign a consent form in which you agreed to take the test?

GTCONSNT

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

NAG.070

Was this genetic test done as part of a research study?

GTRSRCH

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

NAG.080

FR: SHOW CARD CAN38

Who ordered the genetic test for cancer?

Card CAN38

1. Surgeon
2. Gastroenterologist
3. Gynecologist
4. Dermatologist
5. Medical Geneticist
6. Internal medicine or family practice physician
7. Genetic counseler
8. Oncologist
9. Pediatrician
10. Some other doctor

GTDOCT

(01) Surgeon
(02) Gastroenterologist
(03) Gynecologist
(04) Dermatologist
(05) Medical Geneticist
(06) Internal medicine or family practice physician
(07) Genetic counselor
(08) Oncologist
(09) Pediatrician
(10) Some other doctor
(97) Refused
(99) Don't Know kind of doctor

[p. 64]

NAG.090

This question refers to the confidentiality of genetic tests results in your medical records.
Do you believe that your test results will remain confidential?

GTCONF

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

NAG.100

Did you receive the results of the genetic test?

GTRESULT

(1) Yes (NAG.110)
(2) No (NAG.130)
(7) Refused (NAG.130)
(9) Don't know (NAG.130)

NAG.110

How did you receive the results? Was it by telephone, in person, or by mail?

GTRESHOW

(1) By telephone
(2) In person
(3) By mail
(7) Refused
(9) Don't know

NAG.120

How confident are you that your test results are accurate? Would you say very confident, somewhat confident, not very confident, or not confident at all?

GTACCURA

(1) Very confident
(2) Somewhat confident
(3) Not very confident
(4) Not confident at all
(7) Refused
(9) Don't know

NAG.130

Did you receive any genetic counseling about your test for cancer risk?

FR: READ IF NECESSARY:

By genetic counseling, I mean a thorough discussion of the advantages and disadvantages of testing that includes an explanation of what the test can and cannot tell you.

GTCOUNC

(1) Yes (NAG.140)
(2) No (NAG.150)
(7) Refused (NAG.150)
(9) Don't know (NAG.150)

[p. 66]

NAG.140

When did you receive this genetic counseling? Was it: (READ CATEGORIES BELOW)

GTCWHEN

(1) Before or on the day you took the test
(2) After the day you took the test
(3) Both before and after you took the test
(7) Refused
(9) Don't know

NAG.150

Do you believe that getting a genetic test for cancer risk has or will affect your health insurance coverage?

FR: READ IF NECESSARY:

Effects include losing your health insurance coverage or not being eligible for health insurance if you change jobs or move.

GTINSURE

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

NAG.160

Would you say your risk of getting cancer in the future is low, medium, or high?
For a cancer survivor, this means getting another cancer in the future defined as a new cancer in a different organ. It can also mean a new cancer in another part of the same organ, such as another primary breast cancer in the opposite breast.

GTCRISK

(1) Low
(2) Medium
(3) High
(7) Refused
(9) Don't know

NAG.170

Thinking only of your blood relatives, do you feel that the amount of cancer in your family is low, medium, or high?
DO NOT include family members related only through marriage such as stepfather, stepsister etc... or family members who were adopted.

GTFRISK

(1)Low
(2)Medium
(3)High
(7)Refused
(9)Don't know

Check item END_NAG: Go to next section, Section H -- Family History.

[p. 67]

Section H - Family History

NAH.010

We would like to ask you a few questions about your family history of cancer. Did your BIOLOGICAL FATHER EVER have cancer of any kind?

FHFCAN

(1) Yes (NAH.020)
(2) No (NAH.040)
(3) Adopted or don't know biological father (NAH.040)
(7) Refused (NAH.040)
(9) Don't know (NAH.040)

NAH.020

What kind of cancer did your father have?

FR: ENTER UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3 KINDS, ENTER "96" IN THE FOURTH ANSWER SPACE. ENTER (N) FOR NO MORE.

FHFTYP

(1) Bladder
(2) Blood
(3) Bone
(4) Brain
(5) Breast
(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
(19) Pancreas
(20) Prostate
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't Know what kind)
(24) Soft Tissue (muscle/fat)
(25) Stomach
(26) Testis
(27) Throat -pharynx
(28) Thyroid
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know

____ (Father Cancer Type 1)
____ (Father Cancer Type 2)
____ (Father Cancer Type 3)
____ (N or 96)

NAH.030

Was your biological father under 50 years of age when ...

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

FHFAGE

...(Father Cancer Type 1) was first diagnosed?
...(Father Cancer Type 2) was first diagnosed?
...(Father Cancer Type 3) was first diagnosed?

NAH.040

Did your BIOLOGICAL MOTHER EVER have cancer of any kind?

FHMCAN

(1) Yes (NAH.050)
(2) No (NAH.070)
(3) Adopted or don't know biological mother (NAH.070)
(7) Refused (NAH.070)
(9) Don't know (NAH.070)

[p. 68]

NAH.050

What kind of cancer did your mother have?

FR: ENTER UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3 KINDS, ENTER "96" IN THE FOURTH ANSWER SPACE. ENTER (N) FOR NO MORE.

FHMTYP

(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
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't Know what kind)
(24) Soft Tissue (muscle/fat)
(25) Stomach
(27) Throat -pharynx
(28) Thyroid
(29) Uterus
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know

____ (Mother Cancer Type 1)
____ (Mother Cancer Type 2)
____ (Mother Cancer Type 3)
____ (N or 96)

NAH.060

Was your biological mother under 50 years of age when ...

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

FHMAGE

...(Mother Cancer Type 1) was first diagnosed?
...(Mother Cancer Type 2) was first diagnosed?
...(Mother Cancer Type 3) was first diagnosed?

NAH.070

FULL BROTHERS have the same biological mother and father as you.
How many FULL BROTHERS do you have? Please include any who are alive and those who may have died.

FHBNUM

(00) None (NAH.100)
(01-20) 1-20 brothers (NAH.080)
(21) 21+ brothers (NAH.080)
(97) Refused (NAH.100)
(99) Don't know (NAH.100)

[p. 69]

NAH.080

FR: IF ONLY ONE BROTHER, ASK:

Did your brother EVER have cancer of any kind?

(00) Brother has not had any kind of cancer (NAH.100)
(01) Brother has had cancer (NAH.090)
(97) Refused (NAH.100)
(99) Don't know (NAH.100)

FR: IF MORE THAN ONE BROTHER, ASK:

How many of your BROTHERS have EVER had cancer of any kind?

FHBCAN

(00) None (NAH.100)
(01-20) 1-20 brothers (NAH.090)
(21) 21+ brothers (NAH.090)
(97) Refused (NAH.100)
(99) Don't know (NAH.100)

NAH.090

What kinds of cancer did your brother(s) have?

FR: ENTER UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3 KINDS, ENTER "96" IN THE FOURTH ANSWER SPACE. ENTER (N) FOR NO MORE.

FHBTYP

(1) Bladder
(2) Blood
(3) Bone
(4) Brain
(5) Breast
(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
(19) Pancreas
(20) Prostate
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't Know what kind)
(24) Soft Tissue (muscle/fat)
(25) Stomach
(26) Testis
(27) Throat -pharynx
(28) Thyroid
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know

____ (Brother Cancer Type 1)
____ (Brother Cancer Type 2)
____ (Brother Cancer Type 3)
____ (N or 96)

NAH.091

How many of your brothers have had {Brother Cancer Type 1} cancer?

FHBMAN1

(01-20) 1-20 brothers (NAH.092)
(21) 21+ brothers (NAH.092)
(97) Refused (NAH.093)
(99) Don't know (NAH.093)

[p. 70]

NAH.092

FR: IF ONE BROTHER HAD {BROTHER CANCER TYPE 1} CANCER, ASK:

Was your brother under 50 years of age when {Brother Cancer Type 1} cancer was first diagnosed?

(00) Brother not under 50 years of age (NAH.093)
(01) Brother was under 50 (NAH.093)
(97) Refused (NAH.093)
(99) Don't know (NAH.093)

FR: IF TWO OR MORE BROTHERS HAD {BROTHER CANCER TYPE 1} CANCER, ASK:

How many of these brothers were under 50 years of age when {BROTHER CANCER TYPE 1} cancer was first diagnosed?

FHBAGE1

(00) None diagnosed under 50 years
(01-20) 1-20 brothers
(21) 21+ brothers
(97) Refused
(99) Don't know

NAH.093

How many of your brothers have had {Brother Cancer Type 2} cancer?

FHBMAN2

(01-20) 1-20 brothers (NAH.094)
(21) 21+ brothers (NAH.094)
(97) Refused (NAH.095)
(99) Don't know (NAH.095)

NAH.094

FR: IF ONE BROTHER HAD {BROTHER CANCER TYPE 2} CANCER, ASK:

Was your brother under 50 years of age when {Brother Cancer Type 2} cancer was first diagnosed?

(00) Brother not under 50 years of age (NAH.095)
(01) Brother was under 50 (NAH.095)
(97) Refused (NAH.095)
(99) Don't know (NAH.095)

FR: IF TWO OR MORE BROTHERS HAD {BROTHER CANCER TYPE 2} CANCER, ASK:

How many of these brothers were under 50 years of age when {BROTHER CANCER TYPE 2} cancer was first diagnosed?

FHBAGE2

(00) None diagnosed under 50 years
(01-20) 1-20 brothers
(21) 21+ brothers
(97) Refused
(99) Don't know

NAH.095

How many of your brothers have had {Brother Cancer Type 3} cancer?

FHBMAN3

(01-20) 1-20 brothers (NAH.096)
(21) 21+ brothers (NAH.096)
(97) Refused (NAH.100)
(99) Don't know (NAH.100)

[p. 71]

NAH.096

FR: IF ONE BROTHER HAD {BROTHER CANCER TYPE 3} CANCER, ASK:

Was your brother under 50 years of age when {Brother Cancer Type 3} cancer was first diagnosed?

(00) Brother not under 50 years of age (NAH.100)
(01) Brother was under 50 (NAH.100)
(97) Refused (NAH.100)
(99) Don't know (NAH.100)

FR: IF TWO OR MORE BROTHERS HAD {BROTHER CANCER TYPE 3} CANCER, ASK:

How many of these brothers were under 50 years of age when {BROTHER CANCER TYPE 3} cancer was first diagnosed?

FHBAGE3

(00) None diagnosed under 50 years
(01-20) 1-20 brothers
(21) 21+ brothers
(97) Refused
(99) Don't know

NAH.100

FULL SISTERS have the same biological mother and father as you.
How many FULL SISTERS do you have? Please include any who are alive and those who may have died.

FHSNUM

(00) None (NAH.130)
(1-20) 1-20 sisters (NAH.110)
(21) 21 + sisters (NAH.110)
(97) Refused (NAH.130)
(99) Don't know (NAH.130)

NAH.110

FR: IF ONLY ONE SISTER, ASK:

Did your sister EVER have cancer of any kind?

(00) Sister has not had any kind of cancer (NAH.130)
(01) Sister has had cancer (NAH.120)
(97) Refused (NAH.130)
(99) Don't know (NAH.130)

FR: IF MORE THAN ONE SISTER, ASK:

How many of your SISTERS have EVER had cancer of any kind?

FHSCAN

(00) None (NAH.130)
(01-20) 1-20 sisters (NAH.120)
(21) 21+ sisters (NAH.120)
(97) Refused (NAH.130)
(99) Don't know (NAH.130)

[p. 72]

NAH.120

What kinds of cancer did your sister(s) have?

FR: ENTER UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3 KINDS, ENTER "96" IN THE FOURTH ANSWER SPACE. ENTER (N) FOR NO MORE.

FHSTYP

(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
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't Know what kind)
(24) Soft Tissue (muscle/fat)
(25) Stomach
(27) Throat -pharynx
(28) Thyroid
(29) Uterus
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know

____ (Sister Cancer Type 1)
____ (Sister Cancer Type 2)
____ (Sister Cancer Type 3)
____ (N or 96)

NAH.121

How many of your sisters have had {Sister Cancer Type 1} cancer?

FHSMAN1

(01-20) 1-20 sisters (NAH.122)
(21) 21+ sisters (NAH.122)
(97) Refused (NAH.123)
(99) Don't know (NAH.123)

NAH.122

FR: IF ONE SISTER HAD {SISTER CANCER TYPE 1} CANCER, ASK:

Was your sister under 50 years of age when {Sister Cancer Type 1} cancer was first diagnosed?

(00) Sister not under 50 years of age (NAH.123)
(01) Sister was under 50 (NAH.123)
(97) Refused (NAH.123)
(99) Don't know (NAH.123)

FR: IF TWO OR MORE SISTERS HAD {SISTER CANCER TYPE 1} CANCER, ASK:

How many of these sisters were under 50 years of age when {SISTER CANCER TYPE 1} cancer was first diagnosed?

FHSAGE1

(00) None diagnosed under 50 years
(01-20) 1-20 sisters
(21) 21+ sisters
(97) Refused
(99) Don't know

NAH.123

How many of your sisters have had {SISTER CANCER TYPE 2} cancer?

FHSMAN2

(01-20) 1-20 sisters (NAH.124)
(21) 21+ sisters (NAH.124)
(97) Refused (NAH.125)
(99) Don't know (NAH.125)

[p. 73]

NAH.124

FR: IF ONE SISTER HAD {SISTER CANCER TYPE 2} CANCER, ASK:

Was your sister under 50 years of age when {SISTER CANCER TYPE 2} cancer was first diagnosed?

(00) Sister not under 50 years of age (NAH.125)
(01) Sister was under 50 (NAH.125)
(97) Refused (NAH.125)
(99) Don't know (NAH.125)

FR: IF TWO OR MORE SISTERS HAD {SISTER CANCER TYPE 2} CANCER, ASK:

How many of these sisters were under 50 years of age when {SISTER CANCER TYPE 2} cancer was first diagnosed?

FHSAGE2

(00) None diagnosed under 50 years
(1-20) 1-20 sisters
(21) 21+ sisters
(97) Refused
(99) Don't know

NAH.125

How many of your sisters have had {SISTER CANCER TYPE 3} cancer?

FHSMAN3

(01-20) 1-20 sisters (NAH.126)
(21) 21+ sisters (NAH.126)
(97) Refused (NAH.130)
(99) Don't know (NAH.130)

NAH.126

FR: IF ONE SISTER HAD {SISTER CANCER TYPE 3} CANCER, ASK:

Was your sister under 50 years of age when {Sister Cancer Type 3} cancer was first diagnosed?

(00) Sister not under 50 years of age (NAH.130)
(01) Sister was under 50 (NAH.130)
(97) Refused (NAH.130)
(99) Don't know (NAH.130)

FR: IF TWO OR MORE SISTERS HAD {SISTER CANCER TYPE 3} CANCER, ASK:

How many of these sisters were under 50 years of age when {SISTER CANCER TYPE 3} cancer was first diagnosed?

FHSAGE3

(00) None diagnosed under 50 years
(01-20) 1-20 sisters
(21) 21+ sisters
(97) Refused
(99) Don't know

[p. 74]

NAH.130

How many BIOLOGICAL SONS do you have? Please include any who are alive and those who may have died.

FHNNUM

(00) No sons (NAH.160)
(01-20) 1-20 sons (NAH.140)
(21) 21+ sons (NAH.140)
(96) No biological children (Check item END_NAH)
(97) Refused (NAH.160)
(99) Don't know (NAH.160)

NAH.140

FR: IF ONLY ONE SON, ASK:

Did your SON EVER have cancer of any kind?

(00) Son has not had any kind of cancer (NAH.160)
(01) Son has had cancer (NAH.150)
(97) Refused (NAH.160)
(99) Don't know (NAH.160)

FR: IF TWO OR MORE SONS, ASK:

How many of your SONS have EVER had cancer of any kind?

FHNCAN

(00) None (NAH.160)
(01-20) 1-20 sons (NAH.150)
(21) 21+ sons (NAH.150)
(97) Refused (NAH.160)
(99) Don't know (NAH.160)

NAH.150

What kinds of cancer did your son(s) have?

FR: ENTER UP TO 2 KINDS. IF RESPONDENT OFFERS MORE THAN 2 KINDS, ENTER "96" IN THE THIRD ANSWER SPACE.ENTER (N) FOR NO MORE.

FHNTYP

(1) Bladder
(2) Blood
(3) Bone
(4) Brain
(5) Breast
(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
(19) Pancreas
(20) Prostate
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't Know what kind)
(24) Soft Tissue (muscle/fat)
(25) Stomach
(26) Testis
(27) Throat -pharynx
(28) Thyroid
(30) Other
(96) More than 2 kinds
(97) Refused
(99) Don't know

____ (Son Cancer Type 1)
____ (Son Cancer Type 2)
____ (N or 96)

NAH.151

How many of your sons have had {SON CANCER TYPE 1} cancer?

FHNMAN1

(01-20) 1-20 sons (NAH.152)
(21) 21+ sons (NAH.152)
(97) Refused (NAH.153)
(99) Don't know (NAH.153)

[p. 75]

NAH.152

FR: IF ONE SON HAD {SON CANCER TYPE 1} CANCER, ASK:

Was your son under 50 years of age when {SON CANCER TYPE 1} cancer was first diagnosed?

(00) Son not under 50 years of age (NAH.153)
(01) Son was under 50 (NAH.153)
(97) Refused (NAH.153)
(99) Don't know (NAH.153)

FR: IF TWO OR MORE SONS HAD (SON CANCER TYPE 1) CANCER, ASK:

How many of these sons were under 50 years of age when {SON CANCER TYPE 1} cancer was first diagnosed?

FHNAGE1

(00) None diagnosed under 50 years
(01-20) 1-20 sons
(21) 21+ sons
(97) Refused
(99) Don't know

NAH.153

How many of your sons have had {SON CANCER TYPE 2} cancer?

FHNMAN2

(01-20) 1-20 sons (NAH.154)
(21) 21+ sons (NAH.154)
(97) Refused (NAH.160)
(99) Don't know (NAH.160)

NAH.154

FR: IF ONE SON HAD {SON CANCER TYPE 2} CANCER, ASK:

Was your son under 50 years of age when {SON CANCER TYPE 2} cancer was first diagnosed?

(00) Son not under 50 years of age (NAH.160)
(01) Son was under 50 (NAH.160)
(97) Refused (NAH.160)
(99) Don't know (NAH.160)

FR: IF TWO OR MORE SONS HAD {SON CANCER TYPE 2} CANCER, ASK:

How many of these sons were under 50 years of age when {SON CANCER TYPE 2} cancer was first diagnosed?

FHNAGE2

(00) None diagnosed under 50 years
(01-20) 1-20 sons
(21) 21+ sons
(97) Refused
(99) Don't know

[p. 76]

NAH.160

How many BIOLOGICAL DAUGHTERS do you have? Please include any who are alive and those who may have died.

FHDNUM

(00) No daughters (Check item END_NAH)
(01-20) 1-20 daughters (NAH.170)
(21) 21+ daughters (NAH.170)
(96) No biological children (Check item END_NAH)
(97) Refused (Check item END_NAH)
(99) Don't know (Check item END_NAH)

NAH.170

FR: IF ONLY ONE DAUGHTER, ASK:

Did your DAUGHTER EVER have cancer of any kind?

(00) Daughter has not had any kind of cancer (Check item END_NAH)
(01) Daughter has had cancer (NAH.180)
(97) Refused (Check item END_NAH)
(99) Don't know (Check item END_NAH)

FR: IF TWO OR MORE DAUGHTERS, ASK:

How many of your DAUGHTERS have EVER had cancer of any kind?

FHDCAN

(00) None (Check item END_NAH)
(01-20) 1-20 daughters (NAH.180)
(21) 21+ daughters (NAH.180)
(97) Refused (Check item END_NAH)
(99) Don't know (Check item END_NAH)

NAH.180

What kinds of cancer did your daughter(s) have?

FR: ENTER UP TO 2 KINDS. IF RESPONDENT OFFERS MORE THAN 2 KINDS, ENTER "96" IN THE THIRD ANSWER SPACE.ENTER (N) FOR NO MORE.

FHDTYP

(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
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't Know what kind)
(24) Soft Tissue (muscle/fat)
(25) Stomach
(27) Throat -pharynx
(28) Thyroid
(29) Uterus
(30) Other
(96) More than 2 kinds
(97) Refused
(99) Don't know

____ (Daughter Cancer Type 1)
____ (Daughter Cancer Type 2)
____ (N or 96)

NAH.190

How many of your daughters have had {DAUGHTER CANCER TYPE 1} cancer?

FHDMAN1

(01-20) 1-20 daughters (NAH.191)
(21) 21+ daughters (NAH.191)
(97) Refused (NAH.192)
(99) Don't know (NAH.192)

[p. 77]

NAH.191

FR: IF ONE DAUGHTER HAD {DAUGHTER CANCER TYPE 1} CANCER, ASK:

Was your daughter under 50 years of age when {DAUGHTER CANCER TYPE 1} cancer was first diagnosed?

(00) Daughter not under 50 years of age (NAH.192)
(01) Daughter was under 50 (NAH.192)
(97) Refused (NAH.192)
(99) Don't know (NAH.192)

FR: IF TWO OR MORE DAUGHTERS HAD (DAUGHTER CANCER TYPE 1) CANCER, ASK:

How many of these daughters were under 50 years of age when {DAUGHTER CANCER TYPE 1} cancer was first diagnosed?

FHDAGE1

(00) None diagnosed under 50 years
(01-20) 1-20 daughters
(21) 21+ daughters
(97) Refused
(99) Don't know

NAH.192

How many daughters have had {Daughter Cancer Type 2} cancer?

FHDMAN2

(01-20) 1-20 daughters (NAH.193)
(21) 21+ daughters (NAH.193)
(97) Refused (Check item END_NAH)
(99) Don't know (Check item END_NAH)

NAH.193

FR: IF ONE DAUGHTER HAD {DAUGHTER CANCER TYPE 2} CANCER, ASK:

Was your daughter under 50 years of age when {DAUGHTER CANCER TYPE 2} cancer was first diagnosed?

(00) Daughter not under 50 years of age (END_NAH)
(01) Daughter was under 50 (END_NAH)
(97) Refused (END_NAH)
(99) Don't know (END_NAH)

FR: IF TWO OR MORE DAUGHTERS HAD (DAUGHTER CANCER TYPE 2) CANCER, ASK:

How many of your daughters were under 50 years of age when {DAUGHTER CANCER TYPE 2} cancer was first diagnosed?

FHDAGE2

(00)None diagnosed under 50 years
(01-20) 1-20 daughters
(21) 21+ daughters
(97) Refused
(99) Don't know

Check item END NAH: Go to the next section.

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