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ipep
[p. 1]


2004 NHIS Questionnaire - Family
Injuries and Poisoning


FIJ.010_01.000

Instrument Variable Name: FINJ3M
Question Text:
? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4:] (random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
(2,R,D) [goto FPOI3M]

FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:
*Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least was injured during the past 3 months
Skip Instructions:
(R,D) [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.


FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text:
? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons injured during the past 3 months
Skip Instructions:
(1-10,D) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]_
(11-91) [goto ERR_TFINJ3M]

[p. 2]


FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text:
? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these injuries/this injury/your injury or injuries/his injury or injuries/her injury or injuries]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:
(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM else, goto MTFINJ3M];
(2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode, goto FPOI3M]

FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text:
? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their injury episode(s)
Skip Instructions:
(1-91) [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto ERR2_MTFINJ3M; else, goto IPDATEM]
(R,D) [goto TFINJ3M for the next person with a reported injury episode if no more persons with an injury episode,; goto FPOI3M]


FIJ.020_00.000

Instrument Variable Name: FPOI3M
Question Text:
? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family poisoned by swallowing or breathing in a harmful substance such as bleach, carbon] monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFPOI3M and goto TFPOI3M; else, goto WFPOI3M]
(2,R,D) [goto FDMED12M]

FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:
*Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least one was poisoned during the past 3 months
Skip Instructions:
(R,D) [goto FDMED12M]
else, goto TFPOI3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text:
? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons poisoned during the past 3 months
Skip Instructions:
(1-10,D) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with a reported poisoning episode; if no more persons with a poisoning episode, goto FDMED12M]
(11-91) [goto ERR_TFPOI3M]

FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text:
? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:
(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM else, goto MTFPOI3M];
(2,R,D) [goto TFPOI3M for the next person with a reported poisoning episode; if no more persons with a poisoning episode, goto FDMED12M]

FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Question Text:
? [F1]
Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of those times was the poisoning serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their poisoning episode(s)
Skip Instructions:
(1-91) [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, if MTFPOI3M gt 3 and TFPOI3M eq D, goto ERR2_MTFPOI3M; else, goto IPDATEM]
(R,D) [goto TFPOI3M for the next person with a reported poisoning episode; if no more persons with a poisoning episode, goto FDMED12M]

[p. 5]


FIJ.050_01.000

Instrument Variable Name: IPDATEM
Question Text:
1 of 3
*Please hand the calendar card to the respondent.
{if only 1 injury/poisoning episode for the person}
When did [fill1: your/ALIAS's] [fill2: injury/poisoning] happen for which a medical professional was consulted?
{first of multiple injury/poisoning episodes for the person}
Now I'm going to ask a few questions about the [fill3: ^MTFINJ3M/^MTFPOI3M] times [fill4: you were/ALIAS was] [fill5: injured/poisoned] for which a medical professional was consulted. Starting with the most recent time, when did this [fill2: injury/poisoning] happen?
{second plus of multiple injury/poisoning episodes for the person}
You just told me about [fill1: your/ALIAS's] [fill6: (month, day of previous event)][fill7:most recent/second most recent/third most recent/fourth most recent [fill2: injury/poisoning]. What was the date of the [fill2: injury/poisoning] before that for which a medical professional was consulted?
*Enter 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
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1-12) [goto IPDATED]
(R) [goto IPHOW]
(D) [goto IPDATENO]

FIJ.050_02.000

Instrument Variable Name: IPDATED
Question Text:
2 of 3
*Enter day.
01-31 1-31
97 Refused
99 Don't know
Universe Text: All injury/poisoning episodes where a valid month of episode was entered
Skip Instructions:
(1-31) [goto IPDATEY]
(R) [goto IPHOW]
(D) [goto IPDATEMT]

FIJ.050_03.000

Instrument Variable Name: IPDATEY
Question Text:
3 of 3
*Enter year.
2003 2003
2004 2004
9997 Refused
9999 Don't know
Universe Text: All injury/poisoning episodes where a valid day of episode was enetered
Skip Instructions:
if IPDATEM, IPDATED and IPDATEY result in a future date; goto ERR_IPDATEY; else, if IPDATEM, IPDATED and IPDATEY result in a date prior to the start date of the 91 day reference period, goto ERR1_IPDATEY; else, goto IPHOW


FIJ.051_01.000

Instrument Variable Name: IPDATENO
Question Text:
1 of 2
Can you tell me approximately how long ago [fill1: your/ALIAS's] [fill2: injury/poisoning] happened?
*Enter number for time since event.
01-91 1-91
97 Refused
99 Don't know
Universe Text: All injury/poisoning episodes where don't know was entered for month of episode
Skip Instructions:
(1-91) [goto IPDATETP]
(R,D) [goto IPHOW]

FIJ.051_02.000

Instrument Variable Name: IPDATETP
Question Text:
2 of 2
*Enter number for time period since event.
^IPDATENO...
1 Days
2 Weeks
3 Months
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes where don't know was entered for month of episode and 1-91 was entered for the "number" part of this two-part question
Skip Instructions:
goto IPHOW

FIJ.052_00.000

Instrument Variable Name: IPDATEMT
Question Text:
(book) F3? [F1]
Was this in the beginning of [fill: ^IPDATEM (text)], the middle of [fill: ^IPDATEM (text)], or the end of [fill:^IPDATEM (text)]?
1 Beginning
2 Middle
3 End
7 Refused
9 Don't know

[Flashcard F3 shows numbers 1-31 displayed in a grid, simulating a calendar. The boxes numbers 1-20 are displayed in are white; the boxes numbers 21-31 are displayed in are gray.]
Card F3
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20

21
22 23 24 25 26 27 28
29 30 31

Universe Text: All injury/poisoning episodes where don't know was entered for day of episode
Skip Instructions:
gotoIPHOW


FIJ.060_00.000

Instrument Variable Name: IPHOW
Question Text:
? [F1]
[fill1: How did [fill2: your/ALIAS's] [fill3: injury/poisoning] on [fill4: ^IPDATEM ^IPDATED (starting with most
recent if multiple)] happen?/How did this [fill3: injury/poisoning] happen?] Please describe fully the circumstances or
events leading to the [fill3: injury/poisoning], and any objects, substances, or other people involved.
*Enter the verbatim response, probing for as much detail as possible, including specifically what the person was doing at the time and all circumstances surrounding the event. Record all volunteered information.
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(verbatim) [if an injury episode, goto ICAUS; else, if a poisoning episode, goto PPCC]
(R) [if an injury episode, fill "R" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]
(D) [if an injury episode, fill "D" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]

[p. 8]


FIJ.065_00.000

Instrument Variable Name: ICAUS
Question Text:
? [F1]
*Do not read.
*Enter the number which best describes the cause of the person's injury from the list below.
01 In a motor vehicle
02 On a bike, scooter, skateboard, skates, skis, horse, etc.
03 Pedestrian who was struck by a vehicle such as a car or bicycle
04 In a boat, train, or plane
05 Fall
06 Burned or scalded by substances such as hot objects or liquids, fire, or chemicals
07 Other
97 Refused
99 Don't know
Universe Text: All injury episodes for which a medical professional was consulted and don't know or refused was not entered at IPHOW
Skip Instructions:
goto IJBODY

[p. 9]


FIJ.070_00.000

Instrument Variable Name: IJBODY
Question Text:
(book) F4
*Enter up to 4 responses, separate with commas.
*Ask or verify.
In this injury, what parts of [fill: your/ALIAS's] body were hurt?
01 Ankle
02 Back
03 Buttocks
04 Chest
05 Ear
06 Elbow
07 Eye
08 Face
09 Finger/thumb
10 Foot
11 Forearm
12 Groin
13 Hand
14 Head (not face)
15 Hip
16 Jaw
17 Knee
18 Lower leg
19 Mouth
20 Neck
21 Nose
22 Shoulder
23 Stomach
24 Teeth
25 Thigh
26 Toe
27 Upper arm
28 Wrist
29 Other, specify
97 Refused
99 Don't know

[Flashcard F4 depicts the front, back, and face of a person. They are labeled as follows]
Card F4
You may choose up to four.

Head
Shoulder
Chest
Elbow
Stomach
Wrist
Groin
Finger/Thumb
Knee
Lower leg
Ankle
Toe

Neck
Upper arm
Back
Forearm
Buttocks
Hip
Hand
Thigh
Foot

Eye
Ear
Nose
Mouth
Teeth
Jaw
Universe Text: All injury episodes for which a medical professional was consulted
Skip Instructions:
(1-28) [goto IJTYPE1]
(29) [goto IJBODYOS]
(R,D) [goto IPEV]

FIJ.071_00.000

Instrument Variable Name: IJBODYOS
Question Text:
*Read if necessary.
What other parts of the body were hurt?
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All injury episodes where some "other" part of the body was hurt
Skip Instructions:
goto IJTYPE1


FIJ.072_00.000

Instrument Variable Name: IJTYPE1
Question Text:
(book) F5
*Enter up to 2 responses, separate with a comma.
*Ask or verify.
In what way was [fill1: your/ALIAS's] [fill2: first entry--^IJBODY (text or ^IJBODYOS] hurt?)
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
Card F5
You may choose up to two.

1. Broken bone or fracture
2. Sprain, strain, or twist
3. Cut
4. Scrape
5. Bruise
6. Burn
7. Insect bite
8. Animal bite
9. Other (specify)
Universe Text: All injury episodes where at least one part of the body was hurt
Skip Instructions:
(1-8,D) [goto IJTYPE2 for next body part entered at IJBODY; if no more body parts, goto IPEV]
(9) [goto IJTYP1OS]
(R) [goto IPEV]

FIJ.073_00.000

Instrument Variable Name: IJTYP1OS
Question Text:
? [F1]
*Read if necessary.
How was [fill1: your/ALIAS's] [fill2: first entry -- ^IJBODY (text) or ^IJBODYOS hurt?]
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All injury episodes where the first body part was hurt in some "other" way
Skip Instructions:
goto IJTYPE2 for next body part; if no more body parts, goto IPEV

[p. 11]


FIJ.074_00.000

Instrument Variable Name: IJTYPE2
Question Text:
(book) F5
*Enter up to 2 responses, separate with a comma.
*Ask or verify.
In what way was [fill1: your/ALIAS's] [fill2: second entry--^IJBODY (text or ^IJBODYOS] hurt?)
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
Card F5
You may choose up to two.

1. Broken bone or fracture
2. Sprain, strain, or twist
3. Cut
4. Scrape
5. Bruise
6. Burn
7. Insect bite
8. Animal bite
9. Other (specify)
Universe Text: All injury episodes where at least two body parts were hurt and the type of injury or don't know was entered for the first body part at IJTYPE1
Skip Instructions:
(1-8,D) [goto IJTYPE3 for next body part entered at IJBODY; if no more body parts, goto IPEV]
(9) [goto IJTYP2OS]
(R) [goto IPEV]

FIJ.075_00.000

Instrument Variable Name: IJTYP2OS
Question Text:
*Read if necessary.
How else was [fill1: your/ALIAS's [fill2: second entry -- ^IJBODY (text) or ^IJBODYOS] hurt?]
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All injury episodes where the second body part was hurt in some "other" way
Skip Instructions:
goto IJTYPE3 for next body part; if no more body parts, goto IPEV

[p. 12]


FIJ.076_00.000

Instrument Variable Name: IJTYPE3
Question Text:
(book) F5
*Enter up to 2 responses, separate with a comma.
*Ask or verify.
In what way was [fill1: your/ALIAS's] [fill2: third entry--^IJBODY (text) or ^IJBODYOS] hurt?
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
Card F5
You may choose up to two.

1. Broken bone or fracture
2. Sprain, strain, or twist
3. Cut
4. Scrape
5. Bruise
6. Burn
7. Insect bite
8. Animal bite
9. Other (specify)
Universe Text: All injury episodes where at least three body parts were hurt and type of injury or don't know was entered for the second body part at IJTYPE2
Skip Instructions:
(1-8,D) [goto IJTYPE4 for next body part entered at IJBODY; if no more body parts, goto IPEV]
(9) [goto IJTYP3OS]
(R) [goto IPEV]

FIJ.077_00.000

Instrument Variable Name: IJTYP3OS
Question Text:
*Read if necessary.
How else was [fill1: your/ALIAS's [fill2: third entry -- ^IJBODY (text) or ^IJBODYOS] hurt?]
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All injury episodes where the third body part was hurt in some "other" way
Skip Instructions:
goto IJTYPE4 for next body part; if no more body parts, goto IPEV

[p. 13]


FIJ.078_00.000

Instrument Variable Name: IJTYPE4
Question Text:
(book) F5
*Enter up to 2 responses, separate with a comma.
*Ask or verify.
In what way was [fill1: your/ALIAS's] [fill2: fourth entry--^IJBODY (text or ^IJBODYOS] hurt?)
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
Card F5
You may choose up to two.

1. Broken bone or fracture
2. Sprain, strain, or twist
3. Cut
4. Scrape
5. Bruise
6. Burn
7. Insect bite
8. Animal bite
9. Other (specify)
Universe Text: All injury episodes where four body parts were hurt and type of injury or don't know was entered for the third body part at IJTYPE3
Skip Instructions:
(1-8,R,D) [goto IPEV]
(9) [goto IJTYP4OS]

FIJ.079_00.000

Instrument Variable Name: IJTYP4OS
Question Text:
*Read if necessary.
How else was [fill1: your/ALIAS's [fill2: fourth entry -- ^IJBODY (text) or ^IJBODYOS] hurt?]
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All injury episodes where the fourth body part was hurt in some "other" way
Skip Instructions:
if a poisoning episode, goto PPCC; else, goto IPEV


FIJ.080_01.000

Instrument Variable Name: PPCC
Question Text:
Did [fill: you/ALIAS get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this poisoning from..]
A phone call to a poison control center?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1,2,D) [goto IPEV]
(R) [goto IPHOSP]

[p. 14]


FIJ.080_02.000

Instrument Variable Name: IPEV
Question Text:
*Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]?
An emergency vehicle, such as an ambulance or fire truck
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1,2,D) [goto IPER]
(R) [goto IPHOSP]


FIJ.080_03.000

Instrument Variable Name: IPER
Question Text:
*Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]?
A visit to an emergency room
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1,2,D) [goto IPDO]
(R) [goto IPHOSP]


FIJ.080_04.000

Instrument Variable Name: IPDO
Question Text:
? [F1]
*Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]?
A visit to a doctor's office or other health clinic
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1,2,D) [goto IPPCHCP]
(R) [goto IPHOSP]

[p. 15]


FIJ.080_05.000

Instrument Variable Name: IPPCHCP
Question Text:
? [F1]
*Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]?
A phone call to a doctor, nurse, or other health care professional
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1,2,D) [goto IPOTH]
(R) [goto IPHOSP]


FIJ.080_06.000

Instrument Variable Name: IPOTH
Question Text:
*Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2: injury/poisoning]?
Any place else?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1) [goto IPOTHOS]
if [MTFINJ3M= 01-91 and IPEV=2] goto IPVER
(2) [if poisoning and episode and PPCC eq 2 and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2, goto IPVER; else if an injury episode and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2, goto IPVER; else goto IPHOSP]
(R,D) [goto IPHOSP]


FIJ.081_00.000

Instrument Variable Name: IPOTHOS
Question Text:
*Read lead-in if necessary.
Where else did [fill1: you/ALIAS get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:] injury/poisoning]?
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All injury/poisoning episodes where medical advice, treatment, or follow-up care was received from some "other" place
Skip Instructions:
goto IPHOSP

[p. 16]

FIJ.082_00.000

Instrument Variable Name: IPVER
Question Text:
*Please verify.
[fill1: You/ALIAS DID NOT receive any medical advice, treatment, or follow-up for this [fill2: injury/poisoning].]Is that correct?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted, but no source of medical advice, treatment, or follow-up care was selected
Skip Instructions:
(1)[if the person has more injury/poisoning episodes, goto IPDATEM else, if the person does not have more; injury poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an injury/poisoning; else, if no more/family members with an injury/poisoning, go to FPOI3M/FDMED12M]
(2) [if a poisoning episode, goto PPCC for new entries; else, if an injury episode, goto IPEV for new entries]


FIJ.090_00.000

Instrument Variable Name: IPHOSP
Question Text:
? [F1]
[fill1: Were you/Was ALIAS] hospitalized for at least one night as a result of this [fill2: injury/poisoning]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1) [goto IPIHNO]
(2,R,D) [if an injury episode, goto IMTRAF if a poisoning episode, goto PPOIS]


FIJ.091_00.000

Instrument Variable Name: IPIHNO
Question Text:
? [F1]
How many nights [fill: were you/was ALIAS] in the hospital?
*If still in hospital, ask how many nights up to today.
*Enter '95' for 95 or more nights.
01-94 1-94 nights
95 95+ nights
97 Refused
99 Don't know
Universe Text: All injury/poisoning episodes for which a medical professional was consulted and resulted in hospitalization
Skip Instructions:
(1-60,R,D) [if ICAUS eq 1-3, goto IMTRAF; else, if ICAUS eq 4-7,R,D, goto IPWHAT; else, if ICAUS eq 5, goto IFALL]
(61-95) [goto ERR_IPIHNO]

[p. 17]


FIJ.109_00.000

Instrument Variable Name: IMTRAF
Question Text:
? [F1]
*Ask or verify.
Did this accident occur on a public highway, street, or road?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All medically-consulted injury episodes that occurred while in a motor vehicle on a bike, scooter, skateboard, skates,; skis, horse, etc.; or as a pedestrian who was struck by a vehicle such as a car or bicycle
Skip Instructions:
goto IMVWHO


FIJ.110_00.000

Instrument Variable Name: IMVWHO
Question Text:
*Read all categories.
*Ask or verify.
[fill: Were you/Was ALIAS] injured as:
*Read answer categories.
1 The driver of a motor vehicle
2 A passenger in a motor vehicle
3 A pedestrian
4 A bicycle rider or tricycle rider
5 The rider of a scooter, skateboard, skates, or other non-motorized vehicle
7 Refused
9 Don't know
Universe Text: All medically-consulted injury episodes that occurred while in a motor vehicle on a bike, scooter, skateboard, skates,; skis, horse, etc.; or as a pedestrian who was struck by a vehicle such as a car or bicycle
Skip Instructions:
(1,2) [goto IMVTYP]
(4,5) [goto IHELMT]
(3,R,D) [goto IPWHAT]

[p. 18]


FIJ.111_00.000

Instrument Variable Name: IMVTYP
Question Text:
(book) F6? [F1]
*Ask or verify.
What type of vehicle [fill: were you/was ALIAS] in?
01 Passenger car
02 Passenger truck, such as a pickup truck, van, or SUV
03 Bus
04 Large commercial truck, such as a semi-truck, big rig, or 18 wheeler
05 Motorcycle (including mopeds and minibikes)
06 All terrain vehicle or ski/snow-mobile
07 Farm equipment (such as a tractor)
08 Industrial or construction vehicle
09 Other
97 Refused
99 Don't know
Card F6
1. Passenger car
2. Passenger truck, such as a pickup truck, van, or SUV
3. Bus
4. Large commercial truck, such as a semi-truck, big rig, or 18-wheeler
5. Motorcycle (including mopeds, minibikes)
6. All terrain vehicle or ski/snow-mobile
7. Farm equipment (such as a tractor)
8. Industrial or construction vehicle
9. Other
Universe Text: All medically-consulted injury episodes that occurred while a driver or passenger of a vehicle
Skip Instructions:
(1,2,4) [goto ISBELT]
(5,6) [goto IHELMT]
(3,7,8,9,R,D) [goto IPWHAT]


FIJ.112_00.000

Instrument Variable Name: ISBELT
Question Text:
? [F1]
*Ask or verify.
[fill: Were you/Was ALIAS restrained at the time of the accident?]
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All medically-consulted injury episodes that occurred while a driver or passenger of a car or truck
Skip Instructions:
goto IPWHAT

[p. 19]


FIJ.113_00.000

Instrument Variable Name: IHELMT
Question Text:
? [F1]
*Ask or verify.
[fill: Were you/Was ALIAS wearing a helmet at the time of the accident?]
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All medically-consulted injury episodes that occurred while riding a bicycle, tricycle, scooter, skateboard, skates, or other nonmotorized vehicle; a motorcycle; or an all terrain vehicle or ski/snow-mobile
Skip Instructions:
goto IPWHAT


FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:
(book) F7
*Enter up to 2 responses, separate with a comma.
*Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Card F7
You may choose up to two.

On, down, from, or into:
1. Stairs, steps, or escalator
2. Floor or level ground
3. Curb (including sidewalk)
4. Ladder or scaffolding
5. Playground equipment
6. Sports field, court, or rink
7. Building or other structure
8. Chair, bed, sofa, or other furniture
9. Bathtub, shower, toilet, or commode
10. Hole or other opening
11. Other
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IFALLWHY

[p. 20]


FIJ.131_00.000

Instrument Variable Name: IFALLWHY
Question Text:
(book) F8
*Ask or verify.
What caused [fill: you/ALIAS] to fall?
1 Slipping or tripping
2 Jumping or diving
3 Bumping into an object or another person
4 Being shoved or pushed by another person
5 Losing balance or having dizziness (becoming faint or having a seizure)
6 Other
7 Refused
9 Don't know
Card F8
1. Slipping or tripping
2. Jumping or diving
3. Bumping into an object or another person
4. Being shoved or pushed by another person
5. Losing balance or having dizziness becoming faint or having a seizure)
6. Other
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IPWHAT


FIJ.140_00.000

Instrument Variable Name: PPOIS
Question Text:
(book) F9? [F1]
*Ask or verify.
What did [fill: your/ALIAS's] poisoning result from?
1 Swallowing a drug or medical substance mistakenly or in overdose
2 Swallowing or touching a harmful solid or liquid substance
3 Inhaling harmful gases or vapors
4 Eating a poisonous plant or other substance mistaken for food
5 Being bitten by a poisonous animal
6 Other, please specify
7 Refused
9 Don't know
Card F9
1. Swallowing a drug or medical substance mistakenly or in overdose
2. Swallowing or touching a harmful solid or liquid substance
3. Inhaling harmful gases or vapors
4. Eating a poisonous plant or other substance mistaken for food
5. Being bitten by a poisonous animal
6. Other (specify)
Universe Text: All poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1-5,R,D) [goto IPWHAT]
(6) [goto PPOISOS]

FIJ.141_00.000

Instrument Variable Name: PPOISOS
Question Text:
*Read if necessary.
How did [fill: your/ALIAS's] poisoning occur?
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All medically-consulted poisoning episodes where the poisoning resulted from some "other" reason
Skip Instructions:
goto IPWHAT

[p. 21]


FIJ.150_00.000

Instrument Variable Name: IPWHAT
Question Text:
(book) F10? [F1]
*Enter up to 2 responses, separate with a comma.
*Ask or verify.
What activity [fill1: were you/was ALIAS involved in at the time of the [fill2: injury/poisoning]?]
01 Driving or riding in a motor vehicle
02 Working at a paid job
03 Working around the house or yard
04 Attending school
05 Unpaid work (such as volunteer work)
06 Sports and exercise
07 Leisure activity (excluding sports)
08 Sleeping, resting, eating, or drinking
09 Cooking
10 Being cared for (hands-on care from other person)
11 Other, please specify
97 Refused
99 Don't know
Card F10
You may choose up to two.

1. Driving or riding in a motor vehicle
2. Working at a paid job
3. Working around the house or yard
4. Attending school
5. Unpaid work (such as volunteer work)
6. Sports and exercise
7. Leisure activity (excluding sports)
8. Sleeping, resting, eating, or drinking
9. Cooking
10. Being cared for (hands-on care from other person)
11. Other (specify)
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
(1-10,R,D) [goto IPWHER]
(11) [goto IPWHATOT]

FIJ.151_00.000

Instrument Variable Name: IPWHATOT
Question Text:
*Read if necessary.
What other activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: injury/poisoning]?
7 Refused
9 Don't know
Verbatim Verbatim response
Universe Text: All medically-consulted injury/poisoning episodes that occurred in some "other" place
Skip Instructions:
goto IPWHER

[p. 22]


FIJ.160_00.000

Instrument Variable Name: IPWHER
Question Text:
(book) F11? [F1]
*Enter up to 2 responses, separate with a comma.
*Ask or verify.
Where [fill1: were you/was ALIAS] when the [fill2: injury/poisoning] happened?
01 Home (inside)
02 Home (outside)
03 School (not residential)
04 Child care center or preschool
05 Residential institution (excluding hospital)
06 Health care facility (including hospital)
07 Street or highway
08 Sidewalk
09 Parking lot
10 Sport facility, athletic field, or playground
11 Shopping center, restaurant, store, bank, gas station, or other place of business
12 Farm
13 Park or recreation area (include bike or og path)j
14 River, lake, stream, or ocean
15 Industrial or construction area
16 Other public building
17 Other
97 Refused
99 Don't know
Card F11
You may choose up to two.

1. Home (inside)
2. Home (outside)
3. School (not residential)
4. Child care center or preschool
5. Residential institution (excluding hospital)
6. Health care facility (including hospital)
7. Street or highway
8. Sidewalk
9. Parking lot
10. Sport facility, athletic field, or playground
11. Shopping center, restaurant, store, bank, gas station, or other place of business
12. Farm
13. Park or recreation area (including bike or jog path)
14. River, lake, stream, or ocean
15. Industrial or construction area
16. Other public building
17. Other
Universe Text: All injury/poisoning episodes for which a medical professional was consulted
Skip Instructions:
if AGE lt 5 and the person has more injury /poisoning episodes, goto IPDATEM else, if AGE lt 5 and the person does not have more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an injury poisoning episode; else, if AGE lt 5 and no more family members with an injury/poisoning, goto FPOI3M/FDMED12M; else, if AGE ge 13, goto IPEMP; else, if AGE ge 5 and AGE le 12, goto IPSTU


FIJ.170_00.000

Instrument Variable Name: IPEMP
Question Text:
? [F1]
At the time of this [fill1: injury/poisoning], [fill2: were you/was ALIAS employed full-time, part-time, or not employed?]
1 Full-time
2 Part-time
3 Not employed
7 Refused
9 Don't know
Universe Text: All medically-consulted injury/poisoning episodes for persons 13 years of age or older
Skip Instructions:
(1,2) [goto IPWKLS]
(3,R,D) [goto IPSTU]

[p. 23]


FIJ.171_00.000

Instrument Variable Name: IPWKLS
Question Text:
As a result of this [fill1: injury/poisoning], how many days of work did [fill2: you/ALIAS] miss?
1 None
2 Less than one day
3 One to five days
4 Six or more days
7 Refused
9 Don't know
Universe Text: All medically-consulted injury/poisoning episodes for persons 13 years of age or older who were employed at the time of the episode
Skip Instructions:
goto IPSTU


FIJ.180_00.000

Instrument Variable Name: IPSTU
Question Text:
? [F1]
At the time of this [fill1: injury/poisoning], [fill2: were you/was ALIAS] a full-time student, part-time student or not a student?
1 Full-time
2 Part-time
3 Not a student
7 Refused
9 Don't know
Universe Text: All medically-consulted injury/poisoning episodes for persons 5 years of age or older
Skip Instructions:
(1,2) [goto IPSCLS]
(3,R,D) [goto FDMED12M]


FIJ.181_00.000

Instrument Variable Name: IPSCLS
Question Text:
As a result of this [fill1: injury/poisoning], how many days of school did [fill2: you/ALIAS] miss?
1 None
2 Less than one day
3 One to five days
4 Six or more days
7 Refused
9 Don't know
Universe Text: All medically-consulted injury/poisoning episodes for persons 5 years of age or older who were students at the time of the episode
Skip Instructions:
if the person has more injury/poisoning episodes, goto IPDATEM else, if the person does not have more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an injury/poisoning episode; else, if no more family members with an injury/poisoning episode, goto FPOI3M/FDMED12M


ipep