[p.1]
NATIONAL HEALTH INTERVIEW SURVEY (HIS) CAPI SPECIFICATIONS
2002 INSTRUMENT
HOUSEHOLD COMPOSITION
1. SCREEN HH MEMBERS
What are the names of all persons living or staying here?
Start with the name of the person, or one of the persons, who owns or rents this home.
[Else]
What is the name of the next person living or staying here?
[endif]
FR: PROBE FOR MIDDLE NAME OR MIDDLE INITIAL IF NOT REPORTED. INITIALS MAY BE ENTERED FOR EACH FIELD BUT MUST BE FOLLOWED BYA@PRESS (ENTER) TO SKIP TO LAST NAME IF NO MIDDLE NAME.
[If not the first person]
FR: IF LAST NAME IS THE SAME AS DISPLAYED, PRESS (ENTER), OTHERWISE, ENTER THE NEW LAST NAME.
[endif]
[If NAME_FNA or NAME_LNA is (D,R) go to HHC.015; Else go to HHC.020]
NAME_MNA MIDDLE NAME: __________________________________
NAME_LNA LAST NAME: __________________________________
(2) No (HHC.030)
(7) Refused (HHC.030)
(9) Don't know (HHC.030)
(2) No (HHC.040)
(7) Refused (HHC.040)
(9) Don't know (HHC.040)
[p.2]
Since (you/name) (do/does) not usually live here and (have/has) another residence elsewhere, (you/he/she) will not be included in this interview.
PRESS (P) TO PROCEED TO THE NEXT PERSON.
Is anyone else living or staying here now?
(2) No (HHC.050)
(7) Refused (HHC.050)
(9) Don't know (HHC.050)
I have listed living here (READ NAMES).
(1) Yes
(2) No
(7) Refused
(9) Don't know
Have I missed -
MISPERS2 -Any lodgers, boarders, or persons you employ who live here?
MISPERS3 -Anyone who USUALLY lives here, but is now away from home traveling or in a hospital?
MISPERS4 -Anyone else staying here?
ENTER (P) TO PROCEED.
FR: READ NAMES IF NECESSARY.
(2) No (HHC.070)
(7) Refused (HHC.090)
(9) Don't Know (HHC.090)
[p. 3]
(2) No (HHC.090)
(7) Refused (HHC.090)
(9) Don't know (HHC.090)
ENTER "N" FOR NO MORE.
[ ] TABX_1
[ ] TABX_2
[ ] TABX_3
[ ] TABX_4
[ ] TABX_5
[ ] TABX_6
[ ] TABX_7
[ ] TABX_8
[ ] TABX_9
[ ] TABX_10
(Go to HHC.090)
(2) No (HHC.100)
(7) Refused(HHC.100)
(9) Don't know(HHC.100)
(Go to HHC.010)
[p. 4]
2. GET DEMOGRAPHIC INFO - SEX, DOB/AGE, NATOR, RACE, AF
With whom am I speaking?
FR: ENTER LINE NUMBER OF THE RESPONDENT. IF MORE THAN ONE, ENTER THE NUMBER OF THE ONE YOU CONSIDER TO BE THE MAIN RESPONDENT.
{Are/Is} {you/name} male or female?
(2) Female
(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know
Age:
AGEDOB_2 [ ] Time Period
(2) Week(s)
(3) Month(s)
(4) Year(s)
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________
Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.
[p. 5]
If AGE1 =(D) and AGE2 ne (D), set AGE = AGE2, go to Check item INTWKCK1.
If AGE1 =(D) and AGE2 = (D), and AGE3 = blank, go to HHC.150
If AGE1 =(D) and AGE2 = (D), and AGE3 ne ( ), go to HHC.130
If AGE1 ne (D) and AGE2 ne (D), and AGE1 = AGE2, go to Check item INTWKCK1.
If AGE1 ne (D) and AGE2 ne (D), and AGE1 ne AGE2, and HHC.124/DOBVER = ( ), go to HHC.124
If AGE1 ne (D) and AGE2 ne (D), and AGE1 ne AGE2 and HHC.124/DOBVER ne ( ); set AGE=AGE2, go to Check item INTWKCK1
If AGE1 ne (D) and AGE2 = (D), and (AGE1 = AGE3 or AGE1 = AGE4); set AGE = AGE1; go to Check item INTWKCK1
If AGE1 ne AGE3 and AGE1 ne AGE4 and birth year = blank, go to HHC.130
If AGE1 ne AGE3 and AGE1 ne AGE4 and birth year ne ( ); set AGE = AGE1, go to
Check item INTWKCK1
I recorded {your/name's} date-of-birth as {DOB_M/DOB_BDAY/DOB_Y_P}. Is that {your/name's} correct date-of-birth?
(2) No (HHC.128)
(7) Refused (Check item INTWKCK1)
(9) Don't know (Check item INTWKCK1)
ASK IF NECESSARY:
What is {your/name's} correct date-of-birth?
(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know
DOB_BDAY DAY: ______________
DOB_Y_P YEAR: ______________
[p. 6]
[If AGE3 = (0)]
[Else]
(1) {AGE3} year(s) old? (Check item INTWKCK1)
[endif]
(2) {AGE4} year(s) old? (Check item INTWKCK1)
(N) Neither is correct (HHC.150)
(7) Refused (HHC.150)
(9) Don't know (HHC.150)
[If answer is (1, 2); update AGE accordingly, go to HHC.170]
What is your best guess of {your/name's} age?
AGEGES12 [ ] Time Period
(4) Year(s) (Check item)
(C) Compute from range (HHC.160)
(7) Refused (HHC.152)
(9) Don't Know (HHC.152)
Could you please tell me if {you/name} {are/is} at least 18 years old?
(2) 18 or older (HHC.154)
(7) Refused (HHC.156)
(9) Don't know (HHC.156)
ENTER "0" IF LESS THAN 1 YEAR OLD.
[p. 7]
First/lower:
AGERNG_3 [ ] Time period
(4) Year (s)
Last/higher:
AGERNG_4 [ ] Time period
(4) Year (s)
(2) [fill BYY2]
(7) Refused
(9) Don't Know
(N) Neither is correct
Else go to HHC.170.
(2) No (HHC.170)
(Go to Check item HHCCCI5)
[p. 8]
{Do/Does} (you/name's) consider {yourself/himself/herself} to be Hispanic, or Latino?
FR: READ IF NECESSARY:
You may choose more than one
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
Other Latin American
Other Hispanic/Latino
(Where did {your/name's} ancestors come from?)
(1) Yes (HHC.180)
(2) No (HHC.200)
(7) Refused (HHC.200)
(9) Don't know (HHC.200)
Please give me the number of the group that represents {your/name's} Hispanic origin or ancestry.
FR: IF A NONHISPANIC GROUP IS NAMED, PRESS "F1" TO RETURN TO ORIGIN AND CHANGE THE ANSWER FROM "YES" TO "NO". ENTER EACH NUMBER THAT APPLIES. ENTER (N) FOR NO MORE.
You may choose more than one
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino
(2) Cuban/Cuban American (HHC.200)
(3) Dominican (Republic) (HHC.200)
(4) Mexican (HHC.200)
(5) Mexican American (HHC.200)
(6) Central or South American (HHC.200)
(7) Other Latin American (HHC.190)
(8) Other Hispanic/Latino (HHC.195)
(97) Refused (HHC.200)
(99) Don't know (HHC.200)
[ ] HISPAN_2
[ ] HISPAN_3
[ ] HISPAN_4
[ ] HISPAN_5
FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRESS F1 TO RETURN TO HISPAN SCREEN AND CORRECT ENTRY.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
FR: SPECIFY THE OTHER LATIN AMERICAN
FR: IF ANY OF THE FOLLOWING ARE MENTIONED, PRES S F1 TO RETURN TO HISPAN SCREEN AND CORRECT ENTRY.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
FR: SPECIFY THE OTHER HISPANIC OR LATINO.
[p. 10]
HHC.200
You may choose more than one.
2. Black/African American
3. Indian (American)
4. Alaska Native
5. Native Hawaiian
6. Guamanian
7. Samoan
8. Other Pacific Islander
9. Asian Indian
10. Chinese
11. Filipino
12. Japanese
13. Korean
14. Vietnamese
15. Other Asian
Please select 1 or more of these categories.
FR: ENTER (N) FOR NO MORE.
(2) Black/African American
(3) Indian (American)
(4) Alaska Natives
(5) Native Hawaiian
(6) Guamanian
(7) Samoan
(8) Other Pacific Islander (HHC.210)
(9) Asian Indian
(10) Chinese
(11) Filipino
(12) Japanese
(13) Korean
(14) Vietnamese
(15) Other Asian (HHC.212)
(16) Some other race (HHC.214)
(97) Refused (Check Item HHCCCI4)
(99) Don't know (Check Item HHCCCI4)
[ ] RACE2
[ ] RACE3
[ ] RACE4
[ ] RACE5
(Go to Check Item HHCCCI4)
HHC.210
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
FR: SPECIFY OTHER PACIFIC ISLANDER
HHC.212
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
FR: SPECIFY THE OTHER ASIAN
HHC.214
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
FR: SPECIFY THE OTHER RACE
[List all mentioned race codes and descriptions in RACE1 - RACE5; If RACE1 - RACE5 = 8,15,16 fill RACSPY1 and/or RACSPY2 and/or RACSPY3 IN THE ORDER IN WHICH THE RESPONDENT GAVE THEM]
(97) Refused
(99) Don't know
HHC.230 HHC.232
Is anyone in the household now on full-time active duty with the armed forces?
[else]
[If total number of adults aged 18 to 64 eq (1) and a HH respondent]
Are you now on full-time active duty with the Armed Forces?
[else]
Is {name} now on full-time active duty with the Armed Forces?
(2) No (HHC.240)
(7) Refused(HHC.240)
(9) Don't know (HHC.240)
FR: ENTER LINE NUMBERS AS APPROPRIATE. ENTER (N) FOR NO MORE.
[p. 13]
3. SELECT HHREF
PRESS SHIFT F1 TO SEE FULL ROSTER INFORMATION.
(2) No, select another person (HH_REF)
(2) No, select another (HHREF_A)
[p. 14]
4. RELATIONSHIP TO HHREF
What is {your/PX-name's} relationship to {you/RP-name}?
3. Unmarried Partner
4. Child (biological/adoptive/in-law/step/foster)
5. Child of Partner
6. Grandchild
7. Parent (biological/adoptive/in-law/step/foster)
8. Brother/Sister (biological/adoptive/in-law/step/foster)
9. Grandparent (Grandmother/Grandfather)
10. Aunt/Uncle
11. Niece/Nephew
12. Other relative
13. Housemate/Roommate
14. Roomer/Boarder
15. Other nonrelative
16. Legal Guardian
17. Ward
(3) Unmarried partner
(4) Child (biological/adoptive/in-law/step/foster)(HHC.270)
(5) Child of partner
(6) Grandchild
(7) Parent (biological/ adoptive/in-law/ step/ foster)(HHC.280)
(8) Brother/sister (biological/adoptive/ in-law/ step/ foster)(HHC.290)
(9) Grandparent (grandmother/grandfather)
(10) Aunt/uncle
(11) Niece/nephew
(12) Other relative
(13) Housemate/Roommate
(14) Roomer/Boarder
(15) Other nonrelative
(16) Legal guardian
(17) Ward
(97) Refused
(99) Don't know
[Go to HHC.260 for obtaining the relationship of next person in the household. If no more persons in the household, go to Check Item HHCCC18]
I have recorded that:
Line #NAME.
Are {your/} spouses or unmarried partners {/of Reference Person name}.
Which is correct?
[p. 15]
(2) Adoptive {son/daughter}
(3) Step {son/daughter}
(4) Foster {son/daughter}
(5) {son/daughter}-in-law
(7) Refused
(9) Don't know
There are only {1-11} years age difference between {you/them}. Is this relationship correct?
(2) No, change relationship (HHC.270)
(2) Adoptive {mother/father}
(3) Step {mother/father}
(4) Foster {mother/father}
(5) {mother/father}-in-law
(7) Refused
(9) Don't know
(2) No, change relationship (HHC.280)
[p. 16]
(2) Half {brother/sister}
(3) Adopted {brother/sister}
(4) Step {brother/sister}
(5) Foster {brother/sister}
(6) {brother/sister}-in-law
(7) Refused
(9) Don't know
5.ASSIGN FAMILY NUMBER
FR: DO NEW FAMILY NUMBERS NEED TO BE ASSIGNED TO ANY HOUSEHOLD MEMBERS?
(2) No, all are in family "2" (END_HHC)
Name
Family #
[fill NAME]
[Store new family # in FMX (family number)]
Count the number of persons in each family.
(Go to next section -- Family Relationship and Verification of Demographic Information).
RECONTACT INFORMATION
RCI.010
ENTER 7 or 9 FOR ANY PARTS OF NAME REFUSED OR NOT KNOWN.
IF THERE IS NO MIDDLE INITIAL, LEAVE BLANK.
NAMVER_M Middle initial of {subject name}:________________________
NAMVER_L Last name of {subject name}:___________________________
(9) Don=t know
RCI.020
(2) Present for some questions
(3) Not present
RCI.030
(2) No (Check item RCICCI1)
(7) Refused (Check item RCICCI1)
(9)Don=t Know (Check item RCICCI1)
RCI.040
(7) Refused
(9) Don=t Know
If female and (never married or age is under 14), then go to RCI.060.
RCI.050
(S) Same as current last name (displayed above)
(7) Refused
(9) Don=t Know
RCI.060
(S) Same as current last name (displayed above)
(7) Refused
(9) Don=t Know
We also need {subject name}'s Social Security Number. The National Center for Health Statistics will use {subject name}=s Social Security Number to conduct health-related research by linking your survey data with vital statistics and other records. We may also use it if we need to recontact you or your family. Except for these purposes, the National Center for Health Statistics will not release {subject name}'s SSN to anyone, including any government agency. Providing this information is voluntary and is collected under the authority of the Public Health Service Act. There will be no effect on {subject name}'s benefits if you do not provide it.
FR: READ IF NECESSARY:
The Public Health Service Act is title 42, United States Code, section 242k.
RCI.070
FR: ENTER (N) IF NO SOCIAL SECURITY NUMBER.
(999999997) Refused
(999999999) Don=t Know
RCI.075
YOU MIGHT WANT TO ENTER H TO READ SSN HELP SCREEN.
(1) Yes (RCI.070)
(2) No (Check Item RCICCI2)
RCI.080
(2) from Records
RCI.090
(2) Self - telephone
(3) Proxy - in person
(4) Proxy - telephone
The United States Public Health Service may wish to contact {you/your family} again to obtain additional health related information.
@ENTER (P) TO PROCEED
RCI.091
(2) No (RCI.092)
(7) Refused (RCI.096)
(9) Don=t Know (RCI.096)
RCI.092
(7) Refused (RCI.096)
(9) Don=t Know (RCI.096)
RCI.093
FR: SPECIFY NAME AND RELATIONSHIP AND/OR OTHER VERBATIM RESPONSE. RECORD UP TO FOUR LINES OF INFORMATION. ENTER (N) WHEN ALL ENTRIES HAVE BEEN MADE.
TELST_B ____________________________________
TELST_C ____________________________________
TELST_D ____________________________________
(9) Don=t Know
RCI.096
(2) No (RCI.100)
(7) Refused (RCI.100)
(9) Don=t Know (RCI.100)
RCI.097
FR: PROBE FOR MONTH AND YEAR.
MVTIME_Y YEAR: ________________
(9) Don=t Know
RCI.098
FR: PROBE FOR AS MUCH DETAIL AS RESPONDENT CAN PROVIDEC LOCATION, SPECIFIC ADDRESS IF POSSIBLE (STREET ADDRESS, APT #, CITY, STATE, ZIP]. RECORD UP TO FOUR LINES OF ADDRESS INFORMATION. ENTER (N) WHEN ALL ENTRIES HAVE BEEN MADE.
MVINFO_B ___________________________________________________
MVINFO_C ___________________________________________________
MVINFO_D ___________________________________________________
(9) Don=t Know
RCI.100
Please give me the names of persons not currently living in the household.
FIRST CONTACT PERSON'S NAME:
CP1NAME_M Middle Initial:___________________________________
CP1NAME_L Last Name:___________________________________
(9) Don=t Know
RCI.110
FR: READ IF NECCESSARY:
If there is more than one address, please give us the address used most often.
CP1ADDR2 ____________________________________________________
CP1ADDR3 City: ______________________________________________
CP1ADDR4 State: ____
CP1ADDR5 Zip: ________ -
CP1ADDR6 Zip: ______
(9) Don=t Know
RCI.120
FR: ENTER THE AREA CODE AND THE NUMBER OR ENTER (N) IF NO PHONE.
CP1TELN2 ______
(9999999997) Refused
(9999999999) Don=t Know
RCI.130
(2) Unmarried partner not living in HH
(3) Child
(4) Grandchild
(5) Parent (mother or father)
(6) Brother or sister
(7) Grandparent
(8) Other relative
(9) Legal Guardian
(10) Friend
(11) Co-worker
(12) Neighbor
(13) Other
(97) Refused
(99) Don=t Know
Please give us the name, address, and telephone number of the second relative or friend who would also know where you could be reached in case we have trouble reaching you. Again, this should be someone who is not currently living in the household.
RCI.140
CP2NAME_M Middle Initial:_____________________________________
CP2NAME_L Last Name:_______________________________________
(9) Don=t Know
RCI.150
FR: READ IF NECESSARY:
If there is more than one address, please give us the address used most often.
CP2ADDR2 ____________________________________________________
CP2ADDR3 City: _______________________________________________
CP2ADDR4 State: _____
CP2ADDR5 Zip: _________ -
CP2ADDR6 Zip: _______
(9) Don=t Know
RCI.160
FR: ENTER THE AREA CODE AND THE NUMBER OR ENTER (N) IF NO PHONE.
CP2TELN2 _______
(9999999997) Refused
(9999999999) Don=t Know
RCI.170
(2) Unmarried partner not living in HH
(3) Child
(4) Grandchild
(5) Parent (mother or father)
(6) Brother or sister
(7) Grandparent
(8) Other relative
(9) Legal Guardian
(10) Friend
(11) Co-worker
(12) Neighbor
(13) Other
(97) Refused
(99) Don=t Know
RCI.172
FR: PROBE FOR DETAIL (FOR EXAMPLE EVENINGS, WEEKENDS, WORK TELEPHONE NUMBER, ETC.) RECORD UP TO FOUR LINES OF INFORMATION. ENTER (N) WHEN ALL ENTRIES HAVE BEEN MADE.
_____________
_____________
_____________
(7) Refused
(9) Don=t Know
hh