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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
(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

FR: READ LEAD-IN IF NECESSARY:

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

(1) Yes
(2) No
(7) Refused
(9) Don't know
CHDEV... Coronary heart disease?
ANGEV... Angina, also called angina pectoris?
MIEV... A heart attack (also called myocardial infarction)?
HRTEV... Any kind of heart condition or heart disease (other than the ones I just asked about)?
STREV... A stroke?
EPHEV... Emphysema?


ACN.031.010

Which of the following would you say are the symptoms that someone may be having a heart attack? I am going to read a list. Please say yes or no to each one...

(1) Yes
(2) No
(7) Refused
(9) Don't know
JAWP Pain or discomfort in the jaw, neck, or back.
WEA Feeling weak, lightheaded or faint.
CHE Chest pain or discomfort.
ARM Pain or discomfort in the arms or shoulder.
BRTH Shortness of breath.


ACN.031.020

If you thought someone was having a heart attack, what is the BEST thing to do right away?
AHADO
(1) Advise them to drive to the hospital
(2) Advise them to call their physician
(3) Call 9-1-1 (or another emergency number)
(4) Call spouse or family member
(5) Other
(7) Refused
(9) Don't know

[p. 4]


ACN.031.030

Which of the following would you say are the symptoms that someone may be having a stroke? I am going to read a list. Please say yes or no to each one...

(1) Yes
(2) No
(7) Refused
(9) Don't know
FACE Sudden numbness or weakness of face, arm, or leg, especially on one side.
SPK Sudden confusion or trouble speaking.
EYE Sudden trouble seeing in one or both eyes.
WLK Sudden trouble walking, dizziness, or loss of balance.
HEADSudden severe headache with no known cause.


ACN.031.040

Have you ever received formal training or certification in CPR for adults?
ACPR
(1) Yes
(2) No (ACN.080)
(7) Refused (ACN.080)
(9) Don't know (ACN.080)

ACN.031.050

How long ago was this?
ACPRLO
(1) 1 year or less
(2) More than 1 year, but not more than 2 years ago
(3) More than 2 years, but not more than 5 years ago
(4) More than 5 years ago
(7) Refused
(9) Don't know


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


ACN.085

Do you still have asthma?
AASSTILL
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.090

During the PAST 12 MONTHS, have you had an episode of asthma or an asthma attack?
AASMYR
(1) Yes
(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

[p. 5]


ACN.110

FR: READ LEAD-IN IF NECESSARY

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


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
(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 "96" 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. 6]


ACN.160

[ If Female, add: ]
Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

[ Else ]
Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?
DIBEV
(1) Yes
(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
AHAYFYR... Hay fever?
SINYR... Sinusitis?
CBRCHYR... Chronic bronchitis?
KIDWKYR... Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
LIVYR... Any kind of liver condition?


ACN.250

During the PAST 12 MONTHS, have you had pain, aching, stiffness or swelling in or around a joint?
JNTYR
(1) Yes
(2) No (ACN.295)
(7) Refused (ACN.295)
(9) Don't know (ACN.295)

[p. 7]


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
(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?
JNTIJLN
[ ] NUMBER:
(01-52) 1-52
(96) Entire year
(97) Refused
(99) Don't know
JNTIJLT
[ ] TIME PERIOD:
(1) Weeks
(2) Months
(6) Entire year
(7) Refused
(9) Don't know
JNTIJLM
[ ] MONTHS:
(00) Less than 1 month
(01-12) 1-12 months
(97) Refused
(99) Don't know


ACN.290

FR: SHOW FLASHCARD A4
MARK ALL THAT APPLY. ENTER 'N' FOR NO MORE

Which joints are affected?

[Card A4 depicts a human form]
CARD A4
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

JNTYRP
(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

[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
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[p. 8]


ACN.295

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

ACN.300

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.


During the PAST THREE MONTHS, did you have.... Neck pain?
PAINECK
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.310

FR: READ LEAD-IN IF NECESSARY

During the PAST THREE MONTHS, did you have...Low back pain?
PAINLB
(1) Yes
(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

FR: READ LEAD-IN IF NECESSARY

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

(1) Yes
(2) No
(7) Refused
(9) Don't know
PAINFACE... Facial ache or pain in the jaw muscles or the joint in front of the ear?
AMIGR... Severe headache or migraine?

ACN.350

FR: HAND CALENDAR CARD.

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


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

[p. 9]


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


ACN.410

These next questions are about your hearing, vision, and teeth.
Have you ever worn a hearing aid?
HEARAID
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.420

Which statement best describes your hearing (without a hearing aid): good, a little trouble, a lot of trouble, deaf?
AHEARST
(1) Good
(2) Little trouble
(3) Lot of trouble
(4) Deaf
(7) Refused
(9) Don't know


ACN.430

Do you have any trouble seeing, even when wearing glasses or contact lenses?
AVISION
(1) Yes
(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

FR: SHOW FLASHCARD A6.
During the PAST 30 DAYS, how often did you feel...

(1) ALL of the time
(2) MOST of the time
(3) SOME of the time
(4) A LITTLE of the time
(5) NONE of the time
(7) Refused
(9) Don't know
CARD A6
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?
NER... Nervous?
RES... Restless or fidgety?
HPL... Hopeless?
AEF... That everything was an effort?
WRL... Worthless?

[p. 10]



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


ACN.530.020

How often do you get the social and emotional support you need? Would you say always, usually, sometimes, rarely, or never?
AEMOFT
(1) Always
(2) Usually
(3) Sometimes
(4) Rarely
(5) Never
(7) Refused
(9) Don't know


ACN.530.030

In general, how satisfied are you with your life? Would you say very satisfied, satisfied, dissatisfied, or very dissatisfied?
AEMSAT
(1) Very satisfied
(2) Satisfied
(3) Dissatisfied
(4) Very dissatisfied
(7) Refused
(9) Don't know


ACN.530.040

FR: SHOW FLASHCARD A6

I have another question about feelings you may have experienced over the past 30 days. During the past 30 days, how often did you feel happy?
CARD A6
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
HAP
(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


ACN.530.050
The next questions are about various activities you may have participated in. DURING THE PAST 2 WEEKS, did you...

(1) Yes
(2) No
(7) Refused
(9) Don't know
GET Get together socially with friends or neighbors?
TEL Talk with friends or neighbors on the telephone?
RELG Get together with ANY relatives not including those living with you?
REL Talk with ANY relatives on the telephone not including those living with you?
WORS Go to church, temple, or another place of worship for services or other activities?
GRP Go to a show or movie, sports event, club meeting, class or other group event?
EAT Go out to eat at a restaurant?

(Goto next section)
[p. 11]


Section III -- HEALTH STATUS AND LIMITATION OF ACTIVITIES

Part A -- Health Indicators


If DOINGLW2 eq (1,2,4) and if EVERWRK ne (2,R,D) goto AHS.040;
If DOINGLW2 eq (3) and if EVERWRK ne (2,R,D) goto AHS.030;
If DOINGLW2 eq (R,D) or EVERWRK eq (2,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
(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
(0) None
(1-366) 1-366 Days
(997) Refused
(999) Don't know


AHS.050

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

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

FR: SHOW FLASHCARD A7.

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 A7
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 A7.

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 A7
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

FR: SHOW FLASHCARD A7.

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 A7
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

[IF 3 OR LESS CONDITIONS MENTIONED]
What condition or health problem causes you to have difficulty with (names of up to 3 specified activities/these activities)?

[Else]
What condition or health problem causes you to have difficulty with these activities ?

FR: SHOW FLASHCARD A8. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (M) FOR CONDITIONS NOT ON THE FLASHCARD. ENTER (N) FOR NO MORE.
CARD A8
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
AFLHCA1a
(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 pressure
(10) Diabetes
(11) Lung/breathing problem (e.g. asthma and emphysema)
(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
(97) Refused
(99) Don't know
(M) More conditions (AHS.205)

AHS.205

AFLHCA1b
(19) Missing limbs (fingers, toes or digits), amputee
(20) Kidney, bladder or renal problems
(21) circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendinitis
(25) Epilepsy, seizures
(26) Multiple Sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (myelitis), paralysis, para/quadriplegia
(28) Parkinson's disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves' disease, gout
(34) Knee problems [(not arthritis (03), not joint injury (05)]
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (specify one)
(37) Other impairment/problem (specify one)
(97) Refused
(99) Don't know


If answers = 1-37 then go to AHS.300; Else go to end of section.

AHS.300

How long have you had (condition AFLHCA)?
ALHCLN1
[ ] NUMBER:
(01-94) 1-94
(95) 95+
(96) Since birth
(97) Refused
(99) Don't know
ALHCLT1
[ ] TIME PERIOD:
(1) Days
(2) Weeks
(3) Months
(4) Years
(6) Since birth
(7) Refused
(9) Don't know
ALHCLY1
[ ] YEARS:
(00) Less than 1 year
(01-84) 1-84 years
(85) 85+ years
(97) Refused
(99) Don't know

[AHS.300 - AHS.336 are asked for each condition reported in AHS.200 and AHS.205]

(Goto next section)
[p. 15]


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
(2) No (AHB.085)
(7) Refused (AHB.085)
(9) Don't know (AHB.085)


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
(94) 95 years or older
(95) 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
(95) 95+
(97) Refused (AHB.085)
(99) Don't know (AHB.045)
SMKQTTP
[ ] TIME PERIOD:
(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know


AHB.045

Have you quit smoking since (current month, 1 year ago)?
SMKQTD
(1) Yes
(2) No
(7) Refused
(9) Don't know

(Go to AHB.085)
[p. 16]


AHB.050

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

FR: IF LESS THAN 1, ENTER "1"
CIGSDA1
(01-94) 1-94 cigarettes
(95) 95+ cigarettes
(97) Refused
(99) Don't know

(Go to AHB.080)

AHB.060

On how many of the PAST 30 DAYS did you smoke a cigarette?
CIGDAMO
(00) None (AHB.080)
(1-30) 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 more than one day BECAUSE YOU WERE TRYING TO QUIT SMOKING?
CIGQTYR
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 17]

Part B - Physical Activity


The next questions are about physical activities (exercises, 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
(996) Unable to do this type activity (AHB.110)
(997) Refused (AHB.110)
(999) Don't know (AHB.110)
VIGTP
[ ] TIME PERIOD:
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) Don't know

AHB.100

About how long do you do these vigorous activities each time?
VIGLNGNO
[ ] NUMBER:
(001-995) 1-995
(997) Refused (AHB.110)
(999) Don't know (AHB.108)
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. 18]


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
(996) Unable to do this type activity (AHB.130)
(997) Refused (AHB.130)
(999) Don't know (AHB.130)
MODTP
[ ] TIME PERIOD:
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) Don't know

AHB.120

About how long do you do these light or moderate activities each time?
MODLNGNO
[ ] NUMBER:
(001-995) 1-995
(997) Refused (AHB.130)
(999) Don't know (AHB.128)
MODLNGTP
[ ] TIME PERIOD:
(1) Minutes (AHB.130)
(2) Hours (AHB.130)
(7) Refused
(9) Don't know

AHB.128

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

[p. 19]


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
(996) Unable to do this type activity (AHB.140)
(997) Refused (AHB.140)
(999) Don't know (AHB.140)
STRNGTP
[ ] TIME PERIOD:
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this activity
(7) Refused
(9) Don't know


AHB.130.010

How often do you do physical activities designed to STRETCH your muscles such as yoga, or exercises like bending side-to-side, toe touches, and leg stretches?

FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES
STRTCHNO
[ ] NUMBER:
(000) Never (AHB.140)
(001-995) 1-995
(996) Unable to do this type activity (AHB.140)
(997) Refused (AHB.140)
(999) Don't know (AHB.140)
STRTCHTP
[ ] TIME PERIOD:
(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this activity
(7) Refused
(9) Don't know

AHB.130.020

About how long do you do these stretching activities each time?
STRCHLNO
[ ] NUMBER:
(001-995) 1-995
(997) Refused
(999) Don't know
STRCHLTP
[ ] TIME PERIOD:
(1) Minutes
(2) Hours
(7) Refused
(9) Don't know

[p. 21]

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
(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
(997) Refused (AHB.190)
(999) Don't know (AHB.170)
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. 22]


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
(997) Refused (AHB.190)
(999) Don't know (AHB.190)
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

[p. 23]


AHB.200

How much do you weigh without shoes?
AWEIGHTP
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. 24]


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:]
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?
APLKIND
(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.050.010; 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.050.010)
(7) Refused (AAU.050.010)
(9) Don't know (AAU.050.010)

AAU.050

Was this change for a reason related to health insurance?
AHCCHGHI
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.050.010

Including all types of health care providers, is there a particular doctor, nurse or other health professional that you see most often? (Do not include psychiatrists and other mental health professionals)
AQHP2
(1) Yes (AAU.050.020)
(2) No (AAU_CCI2)
(7) Refused (AAU_CCI2)
(9) Don't know (AAU_CCI2)

AAU.050.020

What kind of health professional do you see most often-- a doctor, or nurse or some other health professional.
AQHPKND2
(1) Doctor
(2) Nurse
(3) Nurse Practitioner
(4) Physician Assistant
(5) Chiropractor
(6) Other (AAU.050.030)
(7) Refused
(9) Don't know

(Goto AAU_CCI2)

AAU.050.030

FR: SPECIFY KIND OF HEALTH PROFESSIONAL. THIS SHOULD BE A TYPE OF HEALTH PROFESSIONAL THAT IS NOT ON THE LIST.
AQHPSPEC Health Professional: _________________________________


Check item AAU_CCI2:If AQHPKND2 ge (1) and AQHPKND2 le (6); goto AQHPVI2.
If AHCPLKND ge (1) and AHCPLKND le (5); goto AQHPVI2.
If APLKIND ge (1) and APLKIND le (5); goto AQHPVI2.
Else, goto AHCDLY.

AAU.050.040

DURING THE PAST 12 MONTHS, did you go to this (fill from kind of provider-- taken from AQHPKND2, AHCPLKND, OR APLKIND)?
AQHPVI2
(1) Yes (AAU.050.090)
(2) No (AAU.061)
(7) Refused (AAU.061)
(9) Don't know (AAU.061)


AAU.050.090

DURING THE PAST 12 MONTHS, has your (fill from kind of provider-- taken from AQHPKND2, AHCPLKND, OR APLKIND) asked you about or given you advice regarding...

(1) Yes
(2) No
(7) Refused
(9) Don't know
AHDIET...diet and nutrition?
AHPA...physical activity or exercise?

[p. 26]


Check item AAU_CCI3: Females - all those who averaged 7 or more drinks per week over the past year and/or who consumed at least 3 drinks on days that they drank and/or who had 5 or more drinks in a single day at least twice in the past year.

Males - all those who averaged 14 or more drinks per week over the past year and/or who
consumed at least 4 drinks on days that they drank and/or who had 5 or more drinks in a
single day at least twice over the past year.

[Else go to Check Item AAUCCI4]
(Note: During post editing, the universe was modified for ease of interpretation and to be consistent with the 2010 Healthy People Objectives (26-13.))

AAU.050.120

DURING THE PAST 12 MONTHS, has your (fill from kind of provider-- taken from AQHPKND2, AHCPLKND, OR APLKIND) advised you to reduce your alcohol consumption or recommended you participate in a program to help you reduce your alcohol consumption?
AALCHLP
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check item AAU_CCI4: If SMKNOW eq (1) or SMKNOW eq (2); goto AHCQSMK.
If SMKQT@NO eq (1) and SMKQT@TP eq (4); goto AHCQSMK.
If SMKQT@NO ge (1) and SMKQT@NO le (12) and SMKQT@TP eq (3); goto
AHCQSMK.
If SMKQT@NO ge (1) and SMKQT@NO le (52) and SMKQT@TP eq (2); goto
AHCQSMK.
If SMKQT@NO ge (1) and SMKQT@NO le (95) and SMKQT@TP eq (1); goto
AHCQSMK.
If SMQTD eq (1); goto AHCQSMK.
Else, goto AAU_CCI5 .
(NOTE: DURING POST EDITING, THE VARIABLE SMQTD WAS EXCLUDED FROM THE UNIVERSE BECAUSE IT WILL BE DELETED FROM THE SURVEY INSTRUMENT IN 2004.)

AAU.050.130

DURING THE PAST 12 MONTHS, has your (fill from kind of provider-- taken from AQHPKND2, AHCPLKND, OR APLKIND) advised you to quit smoking?
AHCQSMK
(1) Yes (AAU.050.140)
(2) No (AAU_CCI5)
(7) Refused (AAU_CCI5)
(9) Don't know (AAU_CCI5)

AAU.050.140

Did your (fill from kind of provider-- taken from AQHPKND2, AHCPLKND, OR APLKIND) give you help to quit smoking?

FR: READ IF NECESSARY:

Help would include recommending a program to help you quit smoking, counseling, quitting tips, nicotine gum, patch, spray or inhaler, or the non-nicotine medication called Zyban.
AHCHELP
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check item AAU_CCI5: If female and AGE ge (45) and AGE le (57) go to AHCMENO.
Else, goto AHCDLY.

AAU.050.150

DURING THE PAST 12 MONTHS, has your (fill from kind of provider-- taken from AQHPKND2, AHCPLKND, OR APLKIND) given you advice about options for managing menopause?
AHCMENO
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.061

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

(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCDLYR1...You couldn't get through on the telephone.
AHCDLYR2...You couldn't get an appointment soon enough.
AHCDLYR3...Once you get there, you have to wait too long to see the doctor.
AHCDLYR4...The (clinic/doctor's office) wasn't open when you could get there.
AHCDLYR5...You didn't have transportation.


AAU.061.010

Did you delay, have trouble, or were you unable to get care from a HOSPITAL EMERGENCY ROOM DURING THE PAST 12 MONTHS?
AHCDIFER
(1) Yes (AAU.061.020)
(2) No (AAU.111)
(3) Did not need emergency care (AAU.111)
(7) Refused (AAU.111)
(9) Don't know (AAU.111)

AAU.061.020

What were the reasons you delayed or had trouble getting care from a HOSPITAL EMERGENCY ROOM?

FR: SHOW FLASHCARD A9.

MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
CARD A9
You may choose more than one.

1. Not sure needed emergency room care/wanted advice from health care provider/plan first
2. Could not take time off from work
3. Did not have child care
4. Did not have transportation
5. Ambulance did not arrive at home/pickup point quickly enough
6. Did not have health insurance
7. Emergency room costs too much
8. Did not have money for co-payment
9. Health plan requires pre-authorization
10. Concerned that health plan would not pay
11. Long wait
12. Sent to another part of the hospital for care
13. Other
AHCERR01 (1) Not sure needed emergency room care/wanted advice from health care provider/plan first.
AHCERR02 (2) Could not take time off from work
AHCERR03 (3) Did not have child care
AHCERR04 (4) Did not have transportation
AHCERR05 (5) Ambulance did not arrive at home/pick up point quickly enough
AHCERR06 (6) Did not have health insurance
AHCERR07 (7) Emergency room costs too much
AHCERR08 (8) Did not have money for co-payment
AHCERR09 (9) Health plan requires pre-authorization
AHCERR10 (10) Concerned that health plan would not pay
AHCERR11 (11) Long Wait
AHCERR12 (12) Sent to another part of the hospital for care
AHCERR13 (13) Other (specify) (AAU.061.030)
(97) Refused
(99) Don't know
(Goto AAU.111)

AAU.061.030

FR: ENTER SPECIFIED REASON FOR DELAY OR TROUBLE GETTING EMERGENCY MEDICAL CARE.
AHCESPEC_____________________________________


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

[p. 29]

Part B - Dental Care


AAU.135

FR: SHOW FLASHCARD A10.

About how long has it been since you last saw or talked to a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
CARD A10
0. Never
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
ADNLONG2
(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. 30]

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 AAUCCI7: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. 31]


AAU.240

FR: SHOW FLASHCARD A11.

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 A11
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 A12
CARD A12
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 A11

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, DENTAL VISITS, OR TELEPHONE CALLS.

FR: SHOW FLASHCARD A11
CARD A11
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
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. 32]


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 AAUCCI8)
(7) Refused (Check item AAUCCI8)
(9) Don't know (Check item AAUCCI8)


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 AAUCCI8: 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 A10.
About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.
CARD A10
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
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. 33]

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 shot? This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.
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. 34]


Section VI - DEMOGRAPHICS


Check item ASDCCI2 :If DOINGLW in family core equals (1-5) then go to WRKVER; If HH respondent is not the sample adult and DOINGLW eq (7, 9) goto WRKCOR.

ASD.050

Earlier I recorded that in the last week you were (Fill answer code description from DOINGLW). Is that correct?
WRKVER
(1) Yes
(2) No
(7) Refused
(9) Don't know

If WRKVER eq (2) goto WRKCOR
else if DOINGLW eq (1, 2, 4) goto WHOWRK
else if DOINGLW eq (3, 5) goto EVERWRK

ASD.060

FR: VERIFY OR ASK

What is your correct working status?
WRKCOR
(1) Working for pay at a job or business
(2) With a job or business but not at work
(3) Looking for work
(4) Working, but not for pay, at a job or business
(5) Not working at a job or business
(7) Refused
(9) Don't know

NOTE: At this point, information from DOINGLW in FSD and WRKCOR is used to create DOINGLW1. "Corrected Employment Status Last Week", with the following values:
(1) Working for pay at a job or business
(2) With a job or business but not at work
(3) Looking for work
(4) Working, but not for pay, at a job or business
(5) Not working at a job or business AND not looking for work
(7) Refused
(9) Don't Know

If DOINGLW1 eq (2, 5) goto WHYNOWK2
else If DOINGLW1 eq (1, 4) goto WHOWRK
else If DOINGLW1 eq (3) goto EVERWRK
else goto next section

[p. 35]

ASD.065

What is the main reason you did not work last week?
WHYNOWK2
(1) Taking care of house or family
(2) Going to school
(3) Retired
(4) On a planned vacation from work
(5) On family or maternity leave
(6) Unable to work for health reasons
(7) On layoff
(8) Disabled
(9) Have job/contract; off season
(10) Other
(97) Refused
(99) Don't know

If DOINGLW1 eq (2) goto WHOWRK; else
If DOINGLW1 eq (5) goto EVERWRK

NOTE: At this point, information from WHYNOWRK in FSD and WHYNOWK2 is used to create WHYNOWK1 .

ASD.066

Have you ever held a job or worked at a business?
EVERWRK
(1) Yes
(2) No
(7) Refused
(9) Don't know

If EVERWRK eq (1) or DOINGLW1 eq (1, 2, 4) goto WHOWRK; else goto next section.

ASD.070

[If DOINGLW1 eq (1) or DOINGLW1 eq (2) or DOINGLW1 eq (4)]
For whom did you work at your MAIN job or business? (Name of company, business, organization, or employer)

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Thinking about the job you held the longest, for whom did you work? (Name of company, business, organization, or employer)

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Thinking about the job you held most recently, for whom did you work? (Name of company, business, organization, or employer)
WHOWRK Job or Business: ________________
(7) Refused
(9) Don't know

ASD.080

What kind of business or industry is this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)
KINDIND Kind of Business: ________________
(7) Refused
(9) Don't know

ASD.090

What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)
KINDWRK Kind of Work: ____________________
(7) Refused
(9) Don't know

[p. 36]

ASD.100

What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates printing press.)
IMPACT Activities: ___________________
(7) Refused
(9) Don't know


ASD.110

FR: SHOW FLASHCARD A1

[If DOINGLW1 eq (1) or DOINGLW1 eq (2) or DOINGLW1 eq (4)]
Looking at the card, which of these best describes your current job or work situation?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Looking at the card, which of these best describes the job you held for the longest time?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Looking at the card, which of these best describes the job you held most recently?

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

If WRKCAT eq (1, 2, 3, 4, 6, 7-9) goto LOCALL1;
else If WRKCAT eq (5) goto BUSINC
ASD.112

Is this business incorporated?
BUSINC
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 37]


ASD.120

FR: SHOW FLASHCARD A2

Thinking about

[If DOINGLW1 eq (1) or DOINGLW1 eq (2) or DOINGLW1 eq (4)]
this MAIN job or business,

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
your last week at the job you held the longest,

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
your last week at the job you held most recently, how many people work(ed) at this location?

NOTE TO FR: "People" includes both full- and part-time employees;
"location" refers to the street address of the workplace.
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
LOCALL1
(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

Goto WRKLONG1
ASD.140

About how long

[If DOINGLW1 eq (1) or DOINGLW1 eq (2) or DOINGLW1 eq (4)]
have you worked at this MAIN job or business?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
did you work at the job you held the longest?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
did you work at the job you held most recently?
WRKLONG1
NUMBER:
(001-365) 1-365
(997) Refused
(999) Don't know

If WRKLONG1 eq (997, 999) goto HOURPD;
else if WRKLONG1 eq (001-365) goto WRKLONG2
WRKLONG2
TIME PERIOD:
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
(7) Refused
(9) Don't Know

[p. 38]

Check Item: If WRKLONG1 ge AGE, goto WRKLOGN_.
ASD.141

Number of years exceeds current age. Please verify entry.
WRKLOGN_EDIT
(1) Make correction
(2) Proceed

Goto HOURPD


ASD.150

[If DOINGLW1 eq (1) or DOINGLW1 eq (2) or DOINGLW1 eq (4)]
Are you paid by the hour at this MAIN job or business?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Were you paid by the hour at the job you held the longest?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Were you paid by the hour on the job you held most recently?
HOURPD
(1) Yes
(2) No
(7) Refused
(9) Don't know

Goto PDSICK

ASD.160

[If DOINGLW1 eq (1) or DOINGLW1 eq (2) or DOINGLW1 eq (4)]
Do you have paid sick leave on this MAIN job or business?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Did you ever have paid sick leave on the job you held the longest?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Did you ever have paid sick leave on the job you held most recently?
PDSICK
(1) Yes
(2) No
(7) Refused
(9) Don't know

If DOINGLW1 eq (1, 2, 4) goto ONEJOB;
else goto the end of section.
ASD.170

Do you have more than one job or business?
ONEJOB
(1) Yes
(2) No
(7) Refused
(9) Don't know

(Goto next section)

[p. 39]


Section VII - AIDS


ADS.010

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

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

FR: SHOW FLASHCARD A13.

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?
CARD A13
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. You don't like needles
7. You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
8. Some other reason
9. No particular reason
WHYTST
(01) It's unlikely you've been exposed to HIV; (ADS.110)
(02) You were afraid to find out if you were HIV positive (that you had HIV); (ADS.110)
(03) You didn't want to think about HIV or about being HIV positive; (ADS.110)
(04) You were worried your name would be reported to the government if you tested positive; (ADS.110)
(05) You didn't know where to get tested; (ADS.110)
(06) You don't like needles; (ADS.110)
(07) You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection; (ADS.110)
(08) Some other reason; (ADS.055)
(09) No particular reason; (ADS.110)
(97) Refused; (ADS.110)
(99) Don't Know; (ADS.110)

ADS.055

What was the main reason why you have not been tested?.
WHYSPECMain reason:_____________________________(ADS.110)

[p. 40]


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.061)
(99) Don't know
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 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. 41]


ADS.065

FR: SHOW FLASHCARD A14.

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 A14
1. Someone suggested you should be tested
2. You might have been exposed through sex or drug use
3. You might have been exposed through your work or at work
4. You just wanted to find out if you were infected or not
5. For part of a routine medical check-up, or for hospitalization or surgical procedure
6. You were sick or had a medical problem
7. You were pregnant or delivered a baby
8. For health or life insurance coverage
9. For military induction, separation, or military service
10. For immigration
11. For marriage license or to get married
12. You were concerned you could give HIV to someone
13. You wanted medical care or new treatments if you tested positive
14. Some other reason
15. No particular reason
REATST_C
(01 )Someone suggested you should be tested; (ADS.066)
(02) You might have been exposed through sex or drug use; (ADS.070)
(03) You might have been exposed through your work or at work; (ADS.070)
(04) You just wanted to find out if you were infected or not; (ADS.070)
(05) For part of a routine medical check-up, or for hospitalization or surgical procedure; (ADS.070)
(06) You were sick or had a medical problem; (ADS.070)
(07) You were pregnant or delivered a baby; (ADS.070)
(08) For health or life insurance coverage; (ADS.070)
(09) For military induction, separation, or military service; (ADS.070)
(10) For immigration; (ADS.070)
(11) For marriage license or to get married; (ADS.070)
(12) You were concerned you could give HIV to someone; (ADS.070)
(13) You wanted medical care or new treatments if you tested positive; (ADS.070)
(14) Some other reason. (ADS.069)
(15) 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, nurse or other health care professional, a sex partner, someone at the health department, or someone else?
REASWHOR
(1) Doctor, nurse or other health care professional (ADS.070)
(2) Sex partner (ADS.070)
(3) Someone at health department (ADS.070)
(4) Family member or friend (ADS.070)
(5) Other (ADS.067)
(7) Refused (ADS.070)
(9) Don't know (ADS.070)

ADS.067

Who suggested you should be tested?
WHOSPEC Who: _______________________(ADS.070)


ADS.069

What was the main reason for your last HIV test?
REASPEC Main reason: _____________________________________

[p. 42]


ADS.070

FR: SHOW FLASHCARD A15.

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 A15
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_C
(01) Family planning clinic
(02) Prenatal clinic
(03) Tuberculosis clinic
(04) STD clinic
(05) Community health clinic
(06) Clinic run by employer or insurance company
(07) Other
(97) Refused
(99) Don't know

(Goto 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
(2) Self-sampling kit
(7) Refused
(9) Don't know

(Goto 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 Location: ______________________________

[p. 43]


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


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


ADS.150

FR: SHOW FLASHCARD A16.

Tell me if ANY of these statements is true for YOU. Do NOT tell me WHICH statement or statements are true for you. Just IF ANY of them are.

(a) You have hemophilia and have received clotting factor concentrations.
(b) You are a man who has had sex with 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 A16
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 ge or eq (50) goto ADS.200; else goto ADS.160

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.

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)

[p. 44]


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 Location: ____________________________


ADS.200

The next questions are about tuberculosis, or TB.

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?
TB
(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)


ADS.230

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

FR: SHOW FLASHCARD A17. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
CARD A17
You may choose more than one.

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

[p. 45]


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

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