sac
[p. 1]

2005 NHIS Questionnaire - Sample Adult
Adult Identification

AID.005_00.000

Instrument Variable Name: SADULT
Question Text:

*The sample adult person is [fill: Sample Adult name]. The next questions must be answered by this person. Probe as necessary to determine the availability of [fill: Sample Adult name].
If refused enter CTRL-R

1 Available
2 Not available
3 Physical or mental condition prohibits responding
7 Refused

Universe Text: Sample adult section has not been started or completed
Skip Instructions:

(1) [if Sample Adult = demographics.hhc.RELRESP_A]
[goto beginning of adult.asd]
[elseif Sample Adult = demographics.hhc.HHRESP]
[goto beginning of adult.asd]
[else]
[goto AIDVERF_S]
[endif]
(2) [goto callbk.ACALLBK1]
(3) [goto PROX1]
(R) [store (4) in ASTAT]
[if recontact.RCIFLAG () 1]
[goto recontact.RCI_BEGIN procedure]
[else]
[goto back.OUTCOMEB1 procedure]
[endif]

AID.010_00.000

Instrument Variable Name: PROX1
Question Text:

*Proxy interviews can be done for sample adults that have a mental or physical condition that prevents them from responding for themselves.
Is a family member or caregiver that is knowledgeable about [fill: Sample Adult name]'s health available?

1 Yes
2 No

Universe Text: The Sample adult's physical or mental condition prohibits responding
Skip Instructions:

(1) [goto PROX2]
(2) [goto PROX3]

[p. 2]

AID.015_00.000

Instrument Variable Name: PROX2
Question Text:

*Ask if necessary.
What is this person's relationship to [fill: Sample Adult name]?

1 Relative who lives in household
2 Relative who doesn't live in household
3 Other caregiver
4 Other
7 Refused
9 Don't know

Universe Text: Knowledgeable proxy is available
Skip Instructions:

(1-4) [goto AIDVERF_S]

AID.020_00.000

Instrument Variable Name: PROX3
Question Text:

*Ask if necessary.
Can a callback with someone knowledgeable about [fill: Sample Adult name]'s health be arranged?

1 Yes
2 No

Universe Text: Knowledgeable proxy is not available
Skip Instructions:

(1) [goto callbk.ACALLBK1]
(2) [store (3) in ASTAT]
[if recontact.RCIFLAG () 1]
[goto recontact.RCI_BEGIN procedure]
[else]
[goto back.OUTCOMEB1 procedure]
[endif]

AID.030_00.000

Instrument Variable Name: AIDVERF_S
Question Text:

*Please verify the following information about the sample adult before proceeding:
I have recorded your sex as [fill: Sex of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

Universe Text: Sample adult is not the person entered in HHRESP or RELRESP_A Or PROX1 = 'Yes'
Skip Instructions:

(1) [goto AIDVERF_A]
(2) [goto AIDSEX]

[p. 3]

AID.040_00.000

Instrument Variable Name: AIDSEX
Question Text:

*Ask if appropriate; otherwise, enter your best guess of the person's sex.
Are you Male or Female?

1 Male
2 Female

Universe Text: Respondent said his/her sex is not correct
Skip Instructions:

(1,2) [store AIDSEX in SEX]
[goto ERR_AIDSEX]
[reset AIDVERF_S]
[goto AIDVERF_S]

AID.045_00.000

Instrument Variable Name: AIDVERF_A
Question Text:

*Please verify the following information about the sample adult before proceeding:
I have recorded your age as [fill: Age of Sample Adult] old. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

Universe Text: Sample adult said his/her sex is correct
Skip Instructions:

(1) [goto AIDVERF_D]
(2) [goto AIDAGE]

AID.050_00.000

Instrument Variable Name: AIDAGE
Question Text:

How old are you?

000-120 Age in years
997 Refused
999 Don't know

Universe Text: Respondent said his/her age is not correct
Skip Instructions:

(0-120, Refused, Don't know)
[if AIDAGE = Refused or AIDAGE = Don't know or AIDAGE = AGE]
[reset AIDVERF_A]
[goto ERR_AIDAGE]
[else]
[store AIDAGE in AGE]
[goto AIDDOB_M]

[p. 4]

AID.055_00.000

Instrument Variable Name: AIDVERF_D
Question Text:

*Please verify the following information about the sample adult before proceeding:
I have recorded your birthday as [fill: Birthday of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

Universe Text: Sample adult said his/her age is correct
Skip Instructions:

Do not allow "Don't Know" or "Refused" as an answer.
(1) [if AGE of Sample Adult le (17)]
[goto NO_MORE]
[else]
[goto beginning of adult.asd]
[endif]
(2) [goto AIDDOB_M]

AID.060_01.000

Instrument Variable Name: AIDDOB_M
Question Text:

1 of 3
What is your birthday?
*Enter month of birth.

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: Respondent said his/her date of birth is not correct or his/her age is not correct
Skip Instructions:

(01-12, Refused, Don't know) [goto AIDDOB_D]

[p. 5]

AID.060_02.000

Instrument Variable Name: AIDDOB_D
Question Text:

2 of 3
*Enter day of birth.

01-31 Day of the month
97 Refused
99 Don't know

Universe Text: Respondent said his/her date of birth is not correct or his/her age is not correct
Skip Instructions:

(01-31,Refused,Don't know) [goto AIDDOB_Y]
If days not valid, goto ERR_AIDDOB_D

AID.060_03.000

Instrument Variable Name: AIDDOB_Y
Question Text:

3 of 3
*Enter year of birth.

1880-2020 Year of Birth

Universe Text: Respondent said his/her date of birth is not correct or his/her age is not correct
Skip Instructions:

(1880-2020, Refused, Don't know) if AIDVERF_A = No then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = No then reset AIDVERF_D to empty
goto AIDVERF_D
endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and
month = current month and day GT current day)
goto ERR1_AIDDOB_Y
endif
(if birth month = (02) and birth day = (29) and this is not a leap year)
goto ERR2_AIDDOB_Y
endif
(if AIDDOB_M = Ref or DK) or (if AIDDOB_D = Ref or DK) or (if AIDDOB_Y = Ref or DK)
goto ERR3_AIDDOB_Y
else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = No then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = No then reset AIDVERF_D to empty
goto AIDVERF_D
endif
endif
Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.
if age from AIDDOB items is ne AGE and age from AIDDOB items is valid
reset AIDVERF_A or AIDVERF_D.
goto ERR4_AIDDOB_Y
endif

[p. 1]

2005 NHIS Questionnaire - Sample Adult
Diet and Nutrition

NAC.005_00.000

Instrument Variable Name: SPSPEAK
Question Text:

(book) CAN1
First, I would like to ask about the language you use most often. In general, what language do you speak?

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

Card CAN1

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [goto CEREAL] (6) [goto OTHLANG]

NAC.006_00.000

Instrument Variable Name: OTHLANG
Question Text:

*Specify the language used most often.

7 Refused
9 Don't know
Verbatim Verbatim Response

Universe Text: Sample adults 18+ who gave other language used most often
Skip Instructions:

(allow 20,R,D) [goto CEREAL]

[p. 2]

NAC.010_00.000

Instrument Variable Name: CEREAL
Question Text:

(book) CAN2
These questions are about the different kinds of foods you ate or drank during the PAST MONTH, that is, the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else.
During the past month, how often did you eat HOT OR COLD CEREALS?
*Read if necessary: Include cereals eaten at any time of the day.

00 Never
01 1-3 times last month
02 1-2 times per week
03 3-4 times per week
04 5-6 times per week
05 1 time per day
06 2 times per day
07 3 times per day
08 4 times per day
09 5 or more times per day
97 Refused
99 Don't know

Card CAN2

0. Never
1. 1-3 times last month
2. 1-2 times per week
3. 3-4 times per week
4. 5-6 times per week
5. 1 time per day
6. 2 times per day
7. 3 times per day
8. 4 times per day
9. 5 or more times per day

Universe Text: Sample adults 18+
Skip Instructions:

(0,R,D) [goto MILK]; else [goto CERKND]

NAC.015_00.000

Instrument Variable Name: CERKND
Question Text:

(book) CAN3
*Read if necessary: During the past month . . .
When you ate cereal, which kinds did you usually eat?
*Enter one or two types. Separate with a comma.

1 Cooked cereals (such as oatmeal, cream of wheat, grits)
2 All bran cereals (such as All Bran, Fiber One, 100% Bran, or Bran Buds)
3 Cereals with some bran or fiber (such as Cheerios, Raisin Bran, Shredded Wheat, Total, Wheaties, 40% Bran flakes, Granola, Grape Nuts, Muselix, etc.)
4 Cereals with little bran or fiber (such as Corn Flakes, Honey Nut Cheerios, Froot Loops, Rice Krispies, Kix, Frosted Flakes, Special K, Cap'n Crunch, Blueberry Morning, Product 19, etc.)
5 Other
7 Refused
9 Don't know

Card CAN3
You may choose up to two.

1. Cooked cereals (such as oatmeal, cream of wheat, grits)
2. All bran cereals (such as All Bran, Fiber One, 100% Bran, or Bran Buds)
3. Cereals with some bran or fiber (such as Cheerios, Raisin Bran, Shredded Wheat, Total, Wheaties, 40% Bran Flakes, Granola, Grape Nuts, Muselix, etc.)
4. Cereals with little bran or fiber (such as Corn Flakes, Honey Nut Cheerios, Froot Loops, Rice Krispies, Kix, Frosted Flakes, Special K, Cap'n Crunch, Blueberry Morning, Product 19, etc.)
5. Other

Universe Text: Sample adults 18+ who ate cereal in the past month
Skip Instructions:

(1-5,R,D) [goto MILK]

[p. 3]

NAC.020_00.000

Instrument Variable Name: MILK
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you have MILK, either to drink or on cereal? Do NOT include small amounts of milk in coffee or tea.
*Read if necessary: Do NOT include cream or soy milk . INCLUDE skim, no-fat, low-fat, whole milk, buttermilk, and lactose-free milk. Also INCLUDE chocolate or other flavored milks.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto SODA]

NAC.030_00.000

Instrument Variable Name: SODA
Question Text:

(book) CAN2
During the past month, how often did you drink regular, carbonated SODA OR SOFT DRINKS that contain sugar? Do NOT include diet soda.
*Read if necessary: Do NOT include diet or sugar-free fruit drinks. Do NOT include juices or tea in cans. DO NOT include diet mineral water or diet flavored waters.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto FRTJUICE]

[p. 4]

NAC.040_00.000

Instrument Variable Name: FRTJUICE
Question Text:

(book) CAN2
During the past month, How often did you drink 100% FRUIT JUICE, such as orange, mango, apple, and grape juices? Do NOT count fruit drinks.
*Read if necessary: INCLUDE only 100% pure juices. Do NOT include fruit drinks with added sugar, like Kool-aid, Hi-C, lemonade, cranberry cocktail, Gatorade, Tampico, and Sunny Delight.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto FRTDRINK]

NAC.060_00.000

Instrument Variable Name: FRTDRINK
Question Text:

(book) CAN2
NOW we are going to ask about FRUIT-FLAVORED drinks WITH ADDED SUGAR. How often did you drink FRUIT-FLAVORED DRINKS with sugar (such as Kool-aid, Hi-C, lemonade, or cranberry cocktail)? Do NOT include diet drinks.
*Read if necessary: INCLUDE Gatorade and other sports drinks with added sugar. INCLUDE Tampico, Sunny Delight and Twister. Do NOT include 100% fruit juices or soda. Do NOT include yogurt drinks or carbonated water.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto FRUIT]

[p. 5]

NAC.070_00.000

Instrument Variable Name: FRUIT
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you eat FRUIT? COUNT fresh, frozen, or canned fruit. Do NOT count juices.
*Read if necessary: Include fruits such as apples, bananas, applesauce, melon, berries, fruit salad, mangos, papayas, oranges, and grapes.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto SALAD]

NAC.090_00.000

Instrument Variable Name: SALAD
Question Text:

(book) CAN2
During the past month, how often did you eat a green leafy or lettuce SALAD, with or without other vegetables?
*Read if necessary: INCLUDE spinach salads

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto FRIES]

[p. 6]

NAC.100_00.000

Instrument Variable Name: FRIES
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you eat FRENCH FRIES, home fries, or hash brown potatoes?

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto POTATO]

NAC.110_00.000

Instrument Variable Name: POTATO
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you eat other WHITE POTATOES? COUNT baked potatoes, boiled potatoes, mashed potatoes and potato salad.
*Read if necessary: Do NOT include yams or sweet potatoes. INCLUDE red-skinned and Yukon Gold potatoes.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto BEANS]

[p. 7]

NAC.120_00.000

Instrument Variable Name: BEANS
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you eat COOKED DRIED BEANS, such as refried beans, baked beans, bean soup, and pork and beans? Do NOT include green beans.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto OVEG]

NAC.130_00.000

Instrument Variable Name: OVEG
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
Not counting what you just told me about (lettuce salads, white potatoes, cooked dried beans), and not counting rice, how often did you eat OTHER VEGETABLES?
*Read if necessary: Examples of other vegetables include tomatoes, string beans, carrots, corn, sweet potatoes, cabbage, bean sprouts, collard greens, and broccoli.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto TOMSAUCE]

[p. 8]

NAC.131_00.000

Instrument Variable Name: TOMSAUCE
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you have TOMATO SAUCES such as spaghetti sauce or pizza with tomato sauce?

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto SALSA]

NAC.132_00.000

Instrument Variable Name: SALSA
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you have SALSA?

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto REDMEAT]

[p. 9]

NAC.134_00.000

Instrument Variable Name: REDMEAT
Question Text:

(book) CAN2 and CAN4
*Read if necessary: During the past month . . .
How often did you eat RED MEAT?

Card CAN2

Card CAN4

REDMEAT

Include -

Beef, veal
Pork, bacon
Lamb

Hotdogs and coldcuts made with those meats

Mixtures with those meats, like sandwiches, lasagna, stew . . .

Do NOT include -

Poultry
Fish or seafood

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto BREAD]

NAC.135_00.000

Instrument Variable Name: BREAD
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you eat WHOLE GRAIN BREAD including toast, rolls and in sandwiches? Whole grain breads include whole wheat, rye, oatmeal and pumpernickel. Do NOT include white bread.
*Read if necessary: INCLUDE cracked wheat, multi-grain and bran breads.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto DONUT]

[p. 10]

NAC.136_00.000

Instrument Variable Name: DONUT
Question Text:

(book) CAN2
During the past month, how often did you eat DOUGHNUTS, sweet rolls, Danish, muffins, or pop-tarts? Do NOT include sugar-free items.
*Read if necessary: INCLUDE low-fat kinds.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto COOKIES]

NAC.137_00.000

Instrument Variable Name: COOKIES
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you eat COOKIES, CAKE, PIE, or BROWNIES? Do NOT include sugar-free kinds.
*Read if necessary: INCLUDE low-fat kinds. Do NOT include ice cream and other frozen desserts or candy.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto CHEESE]

[p. 11]

NAC.138_00.000

Instrument Variable Name: CHEESE
Question Text:

(book) CAN2
*Read if necessary: During the past month . . .
How often did you eat any kind of CHEESE? Include cheese as a snack, cheese on burgers, sandwiches, or pizza, and cheese mixed into such foods as lasagna, enchiladas or casseroles.
*Read if necessary: Do NOT count cream cheese.

Card CAN2

Universe Text: Sample adults 18+
Skip Instructions:

(0-9,R,D) [goto VITANY]

NAC.170_00.000

Instrument Variable Name: VITANY
Question Text:

These next questions are about dietary supplements.
During the PAST 12 MONTHS, did you take any vitamin or mineral supplements of ANY kind?
*Read if necessary: INCLUDE vitamin or mineral pills, liquids, or tinctures. Do NOT include vitamin-fortified foods.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto VITMUL] (2,R,D) [goto HERBSUPP]

[p. 12]

NAC.180_00.000

Instrument Variable Name: VITMUL
Question Text:

During the PAST 12 MONTHS, did you take any MULTI-vitamins such as One-A-Day, Theragran, or Centrum, etc?
*If multi-vitamins were already mentioned, enter "1" for yes without asking.
*Read if necessary: There are a number of vitamin and mineral combinations now available. The ways in which nutrients can be combined into pill form is almost infinite. Any combination of 3 or more vitamins and minerals should be included in the MULTI-vitamin category. Combinations labeled as "stress" or "antioxidant" supplements are common and should be included as MULTI-vitamins. Do NOT include combinations of herbal or botanical substances, or combinations of just 2 nutrients (e.g., calcium with vitamin D, etc.) in this question.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who took vitamin or mineral supplements in the past 12 months
Skip Instructions:

(1) [goto VITMULM] (2,R,D) [goto BETAC]

NAC.190_00.000

Instrument Variable Name: VITMULM
Question Text:

How many months of the PAST 12 did you take MULTI-vitamins?
*Enter '12' for all 12 months.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken a multi-vitamin the past 12 months
Skip Instructions:

(1-12) [goto VITMULDN] ( R,D) [goto BETAC]

NAC.200_01.000

Instrument Variable Name: VITMULDN
Question Text:

1 of 2
During [fill1: the month/those months] about how many [fill2: DAYS/DAYS PER MONTH] did you take MULTI- vitamins?
*Enter number of days taking multi-vitamins.
*Enter '30' for all days in the month.
*Enter '95' for other.

01-30 1-30 days
95 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken a multi-vitamin at least one month in the last year
Skip Instructions:

(1-29) [goto VITMULDT]
(30) store '2' in VITMULDT [goto BETAC] (95) store '3' in VITMULDT [goto BETAC]
(R,D) store 'R', 'D' in VITMULDT [goto BETAC]

[p. 13]

NAC.200_02.000

Instrument Variable Name: VITMULDT
Question Text:

2 of 2
*Enter time period for days taking multi-vitamins.

1 Days per week
2 Days per month
3 Other
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have taken a multi-vitamin at least one day a month in the last year
Skip Instructions:

VITMULDT='1' AND ( If VITMULDN ge 8 AND le 29), then goto ERR1_VITMULDT.
else
(1-3,R,D) [goto BETAC]

NAC.210_00.000

Instrument Variable Name: BETAC
Question Text:

The next questions are about any INDIVIDUAL vitamin or mineral supplements you may take.
During the PAST 12 MONTHS, did you take any beta carotene (BAY-tuh KAR-uh-teen)? [fill1: Do NOT include any beta carotene in the MULTI-vitamins you told me about.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever taken vitamins or mineral supplements
Skip Instructions:

(1) [goto BETACM] (2,R,D) [goto VITE]

NAC.220_00.000

Instrument Variable Name: BETACM
Question Text:

How many months of the PAST 12 MONTHS did you take beta carotene?
*Enter '12' for all 12 months.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken beta carotene in the past 12 months
Skip Instructions:

(1-12) [goto BETACDN] (R,D) [goto VITE]

[p. 14]

NAC.230_01.000

Instrument Variable Name: BETACDN
Question Text:

1 of 2
During [fill1: the month/those months] about how many [fill2: DAYS/DAYS PER MONTH] did you take beta carotene?
*Enter number of days taking beta carotene.
*Enter '30' for all days in the month.
*Enter '95' for other.

01-30 1-30 days
95 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken beta carotene at least one month in the last year
Skip Instructions:

(1-29) [goto BETACDT]
(30) store '2' in BETACDT [goto VITE] (95) store '3' in BETACDT [goto VITE]
(R,D) store 'R', 'D' in BETACDT [goto VITE]

NAC.230_02.000

Instrument Variable Name: BETACDT
Question Text:

2 of 2
*Enter time period for days taking beta carotene. (Probe as necessary for a 'don't know' answer)

1 Days per week
2 Days per month
3 Other
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have taken beta carotene at least one day a month in the last year
Skip Instructions:

BETACDT='1' AND ( If BETACDN ge 8 AND le 29), then goto ERR1_BETACDT.
else
(1-3,R,D)[ goto VITE]

NAC.270_00.000

Instrument Variable Name: VITE
Question Text:

During the PAST 12 MONTHS, did you take any vitamin E? [fill1: Do NOT include any vitamin E in the MULTI-vitamins you told me about.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever taken vitamins or mineral supplements
Skip Instructions:

(1) [goto VITEM] (2,R,D) [goto CALC]

[p. 15]

NAC.280_00.000

Instrument Variable Name: VITEM
Question Text:

How many months of the PAST 12 did you take vitamin E?
*Enter '12' for all 12 months.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken vitamin E in the past 12 months
Skip Instructions:

(1-12) [goto VITEDN] (R,D) [goto CALC]

NAC.290_01.000

Instrument Variable Name: VITEDN
Question Text:

1 of 2
During [fill1: the month/those months] about how many [fill2: DAYS/DAYS PER MONTH] did you take vitamin E?
*Enter number of days taking vitamin E.
*Enter '30' for all days in the month.
*Enter '95' for other.

01-30 1-30 days
95 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken vitamin E at least one month in the last year
Skip Instructions:

(1-29) [goto VITEDT]
(30) store '2' in VITEDT [goto CALC] (95) store '3' in VITEDT [goto CALC]
(R,D) store 'R', 'D' in VITEDT [goto CALC]

NAC.290_02.000

Instrument Variable Name: VITEDT
Question Text:

2 of 2
*Enter time period for days taking vitamin E.

1 Days per week
2 Days per month
3 Other
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have taken vitamin E at least one day a month in the last year
Skip Instructions:

VITEDT='1' AND ( If VITEDN ge 8 AND le 29), then goto ERR1_VITEDT.
else
(1-3,R,D) [goto CALC]

[p. 16]

NAC.300_00.000

Instrument Variable Name: CALC
Question Text:

During the PAST 12 MONTHS, did you take any calcium? [fill1: Do NOT include any calcium in the MULTI-vitamins you told me about.]
*Read if necessary: Include Tums. Do NOT include milk or calcium-fortified orange juice.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever taken vitamins or mineral supplements
Skip Instructions:

(1) [goto CALCM] (2,R,D) [goto SELN]

NAC.310_00.000

Instrument Variable Name: CALCM
Question Text:

How many months of the PAST 12 did you take calcium?
*Enter '12' for all 12 months.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken calcium in the past 12 months
Skip Instructions:

(1-12) [goto CALCDN] (R,D) [goto SELN]

NAC.320_01.000

Instrument Variable Name: CALCDN
Question Text:

1 of 2
During [fill1: the month/those months] about how many [fill2: DAYS/DAYS PER MONTH] did you take calcium?
*Enter number of days taking calcium.
*Enter '30' for all days in the month.
*Enter '95' for other.

01-30 1-30 days
95 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken calcium at least one month in the last year
Skip Instructions:

(1-29) [goto CALCDT]
(30) store '2' in CALCDT [goto SELN] (95) store '3' in CALCDT [goto SELN]
(R,D) store 'R', 'D' in CALCDT [goto SELN]

[p. 17]

NAC.320_02.000

Instrument Variable Name: CALCDT
Question Text:

2 of 2
*Enter time period for days taking calcium.

1 Days per week
2 Days per month
3 Other
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have taken calcium at least one day a month in the last year
Skip Instructions:

CALCDT='1' AND ( If CALCDN ge 8 AND le 29), then goto ERR1_CALCDT.
else
(1-3,R,D) [goto SELN]

NAC.360_00.000

Instrument Variable Name: SELN
Question Text:

During the PAST 12 MONTHS, did you take selenium? [fill1: Do NOT include any selenium in the MULTI-vitamins you told me about.]

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever taken vitamins or mineral supplements
Skip Instructions:

(1) [goto SELNM] (2,R,D) [goto HERBSUPP]

NAC.370_00.000

Instrument Variable Name: SELNM
Question Text:

How many months of the PAST 12 did you take selenium?
*Enter '12' for all 12 months.

01-12 1-12 months
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken selenium in the past 12 months
Skip Instructions:

(1-12) [goto SELNDN] (R,D) [goto HERBSUPP]

[p. 18]

NAC.380_01.000

Instrument Variable Name: SELNDN
Question Text:

1 of 2
During [fill1: the month/those months] about how many [fill2: DAYS/DAYS PER MONTH] did you take selenium?
*Enter number of days taking selenium.
*Enter '30' for all days in the month.
*Enter '95' for other.

01-30 1-30 days
95 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken selenium at least one month in the last year
Skip Instructions:

(1-29) [goto SELNDT]
(30) store '2' in SELNDT [goto HERBSUPP] (95) store '3' in SELNDT [goto HERBSUPP]
(R,D) store 'R', 'D' in SELNDT [goto HERBSUPP]

NAC.380_02.000

Instrument Variable Name: SELNDT
Question Text:

2 of 2
*Enter time period for days taking selenium.

1 Days per week
2 Days per month
3 Other
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have taken selenium at least one day a month in the last year
Skip Instructions:

SELNDT='1' AND ( If SELNDN ge 8 AND le 29), then goto ERR1_SELNDT.
else
(1-3,R,D) [goto HERBSUPP]

[p. 19]

NAC.390_00.000

Instrument Variable Name: HERBSUPP
Question Text:

(book) CAN5
This next question is about herbal supplements. During the PAST 12 MONTHS, did you take any MIXED or single herbal or botanical supplements?
*Read if necessary: Include pills, capsules, liquid tinctures and extracts. Do NOT include teas or food. Do not include garlic or ginger used in cooking.

Card CAN5

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [goto CHOLEST]

NAC.435_00.000

Instrument Variable Name: CHOLEST
Question Text:

People may take medication to lower their cholesterol level. Do you now take medication regularly, that is, at least 3 times a week, to lower your cholesterol?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto CHOLMTHS] (2,R,D) [goto PAINMEDS]

NAC.437_00.000

Instrument Variable Name: CHOLMTHS
Question Text:

Have you taken medication to lower your cholesterol regularly for the last 3 months?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who take cholesterol medicine regularly
Skip Instructions:

(1,2,R,D) [goto PAINMEDS]

[p. 20]

NAC.440_00.000

Instrument Variable Name: PAINMEDS
Question Text:

(book) CAN6
People may take medication to treat pain, headache, or arthritis; to relax muscles; or to prevent heart attacks and other diseases.
Typical medications are shown on this card:
Note that this list does NOT include Tylenol. Do you now take any of these medications regularly, that is, at least 3 times a week?
*Read list only if necessary.
Aspirin, Advil, Aleve, Bayer, Bufferin, Celecoxib, Excedrin, Ibuprofen, Motrin, Naprosyn (Naproxen), Nuprin, Vioxx

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto PAINMTHS] (2,R,D) if SEX=1 [goto PROPECIA]; else [goto next section]

NAC.442_00.000

Instrument Variable Name: PAINMTHS
Question Text:

(book) CAN6
Have you taken any of these kinds of medications regularly for the last 3 months?

Card CAN6

Aspirin
Advil
Aleve
Bayer
Bufferin
Celecoxib
Excedrin
Ibuprofen
Motrin
Naprosyn (Naproxen)
Nuprin
Vioxx

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who take pain medication regularly
Skip Instructions:

(1) [goto PAINKIND] (2,R,D) if SEX=1 [goto PROPECIA]; else [goto next section]

NAC.450_00.000

Instrument Variable Name: PAINKIND
Question Text:

Can you tell me the names of these medications?
*Enter all that apply, separate with commas.

01 Aspirin
02 Advil
03 Aleve
04 Bayer
05 Bufferin
06 Celecoxib
07 Excedrin
08 Ibuprofen
09 Motrin
10 Naprosyn (Naproxen)
11 Nuprin
12 Vioxx
13 Other (specify)
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have taken pain medication regularly for the past 3 months
Skip Instructions:

(1-12,R,D) if SEX=1 [goto PROPECIA]; else [goto next section] (13) [goto OTHPAIN]

NAC.455_00.000

Instrument Variable Name: OTHPAIN
Question Text:

*Enter the specified pain medication(s)

7 Refused
9 Don't know
Verbatim Verbatim Response

Universe Text: Sample adults age 18+ who named other type of pain medication
Skip Instructions:

(allow 50,R,D) if SEX=1 [goto PROPECIA]; else [goto next section]

NAC.460_00.000

Instrument Variable Name: PROPECIA
Question Text:

Some men take medications such as Propecia (pro-PEE-she-ah), Proscar (PRAHS-car) or Finasteride (fin-AS-tur-eyed) for hair loss or for problems with their prostate gland. Do you now take any of these medications regularly, that is, at least 3 times a week?

Male sample adults 18+

Universe Text: Male sample adults 18+
Skip Instructions:

(1) [goto PROPMTHS] (2,R,D) [goto next section]

[p. 22]

NAC.470_00.000

Instrument Variable Name: PROPMTHS
Question Text:

Have you taken Propecia, Proscar or Finasteride regularly for the last 3 months?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Male sample adults 18+ who take Propecia regularly
Skip Instructions:

(1,2,R,D) [goto next section]

[p. 1]

2005 NHIS Questionnaire - Sample Adult
Physical Activity

NAD.010_00.000

Instrument Variable Name: AD11
Question Text:

The next questions are about walking. First I will ask about walking for transportation, that is walking to get some place. PLEASE INCLUDE ALL WALKS THAT INVOLVED AN ERRAND OR TO GET SOME PLACE. I will ask you separately about walking for other reasons like relaxation or exercise. During the PAST SEVEN DAYS, did you walk to get to some place that took you AT LEAST 10 MINUTES?

1 Yes
2 No
3 Unable to walk
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto AD12] (2,R,D) [goto AD14] (3) [goto MOVE1]

NAD.011_00.000

Instrument Variable Name: AD12
Question Text:

During the PAST SEVEN DAYS, ON HOW MANY DAYS did you walk for at least ten minutes at a time to get some place such as work, school, a store, or restaurant?
*Enter '7' for all days per week.

01-07 1-7 days
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have walked for transportation in the past 7 days
Skip Instructions:

(1-7) [goto AD13NO] (R,D) [goto AD14]

NAD.012_01.000

Instrument Variable Name: AD13NO
Question Text:

1 of 2
[fill1: How much time did you spend walking to get from place to place on that day?/
How much time did you usually spend on one of those days walking to get from place to place?]
*Enter number for length of walk for transportation.

001-995 1-995
997 Refused
999 Don't know

Universe Text: Sample adults 18+ who have walked for transportation at least one day in the past week
Skip Instructions:

(1-995)[goto AD13TP] [If AD13NO= 'R', 'D' store 'R', 'D' in AD13TP]
(R,D)[goto AD14]

NAD.012_02.000

Instrument Variable Name: AD13TP
Question Text:

2 of 2
*Enter time period for length of walking for transportation.

1 Minutes
2 Hours
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have walked for transportation at least one day in the past week and gave a number for the first part of this two-part question
Skip Instructions:

If AD13N0 gt (24) and AD13TP eq (2) goto ERR1_ AD13TP
(IF AD13NO gt (90) and AD13TP eq (1) ) or ( if AD13NO gt (2) and AD13TP eq (2) ) goto ERR2_ AD13TP
(1,2,R,D)goto AD14
If AD13NO= 'R', 'D' store 'R', 'D' in AD13TP

NAD.013_00.000

Instrument Variable Name: AD14
Question Text:

Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. During the PAST SEVEN DAYS, DID YOU WALK FOR AT LEAST TEN MINUTES AT A TIME for any of these reasons? Please do not include any walking that you already told me about.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are able to walk
Skip Instructions:

(1) [goto AD15] (2,R,D) [goto MOVE1]

NAD.014_00.000

Instrument Variable Name: AD15
Question Text:

During the past seven days, on how many days did you walk for at least ten minutes at a time for fun, relaxation, exercise or to walk the dog?
*Enter '7' for all days per week.

01-07 1-7 days
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have walked for leisure in the past 7 days
Skip Instructions:

(1-7) [goto AD16NO] (R,D) [goto MOVE1]

[p. 3]

NAD.015_01.000

Instrument Variable Name: AD16NO
Question Text:

1 of 2
[fill1: How much time did you spend walking on that day for FUN, RELAXATION, OR EXERCISE?/
fill2: How much time did you usually spend on one of those days walking for FUN, RELAXATION, OR EXERCISE?]
*Enter number for length of walk for fun, relaxation, or exercise.

001-995 1-995
997 Refused
999 Don't know

Universe Text: Sample Adults 18+ who have walked for leisure at least one day in the past week.
Skip Instructions:

If AD16N0 gt (24) and AD16TP eq (2) goto ERR1_ AD16TP
(IF AD16NO gt (90) and AD16TP eq (1) ) or ( if AD16NO gt (2) and AD16TP eq (2) ) goto ERR2_ AD16TP
(1-995)[goto AD16TP]
(R,D)[goto MOVE1]
[If AD16NO= 'R', 'D' store 'R', 'D' in AD16TP]

NAD.015_02.000

Instrument Variable Name: AD16TP
Question Text:

2 of 2
*Enter time period for length of walking for fun, relaxation, or exercise.

1 Minutes
2 Hours
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have walked for leisure at least one day in the past week and gave a number for the first part of this two-part question
Skip Instructions:

(1,2,R,D)goto MOVE1
[If AD16NO= 'R', 'D' store 'R', 'D' in AD16TP]

[p. 4]

NAD.020_00.000

Instrument Variable Name: MOVE1
Question Text:

(book) CAN7
Which one of the following BEST describes your usual daily activities related to moving around? Do NOT include exercises, sports, or physically active hobbies done in your leisure time.
Do you (read categories below):
*Read if necessary: Pick the one you do MOST often
*If respondent is bedridden, enter '1'

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

Card CAN7

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-3,R,D) [goto LIFT]

NAD.030_00.000

Instrument Variable Name: LIFT
Question Text:

(book) CAN8
Which one of the following BEST describes your usual daily activities related to lifting or carrying things? Do NOT include activities done in your leisure time.
Do you (read categories 1-4 below):
*Read if necessary: Pick the one you do MOST often.

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

Card CAN8

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-6,R,D) [goto to SITWDAY]

[p. 5]

NAD.040_00.000

Instrument Variable Name: SITWDAY
Question Text:

[Fill1:Outside of work, how/ Fill2: How ] many hours do you spend per day during the WEEKDAYS sitting?
*Read if necessary: Include watching television or videos, working on the computer, playing video games, using the Internet, knitting, sewing, reading, fishing, taking long drives, watching ball games or doing other sitting activities.
*If person is bedridden, include only waking hours lying down

00 None
01-24 1-24 hours
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0-24,R,D) [goto SITWEND]

NAD.050_00.000

Instrument Variable Name: SITWEND
Question Text:

[Fill1: Outside of work, how / How] many hours do you spend per day during the WEEKEND sitting?
*Read if necessary: Include watching television or videos, working on the computer, playing video games, using the Internet, knitting, sewing, reading, fishing, taking long drives, watching ball games or doing other sitting activities. Weekend means any days off, not necessarily Saturday and Sunday.
*If person is bedridden, include only waking hours lying down.

00 None
01-24 01-24 hours
97 Refused
99 Don't know

Universe Text: Sample adults age 18+
Skip Instructions:

(0-24,R,D) if AMDLONG eq (1,2) [goto MDEXER]; else if AMDLONG eq (0,3,4,5,R,D) [goto next section]

NAD.060_00.000

Instrument Variable Name: MDEXER
Question Text:

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

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

Universe Text: Sample adults 18+ who have seen a doctor or other health professional in the PAST 12 MONTHS
Skip Instructions:

(1-3,R,D) [goto next section]

[p. 1]

2005 NHIS Questionnaire - Sample Adult
Tobacco

NAE.010_00.000

Instrument Variable Name: MENTHOLF
Question Text:

Earlier you said you used to smoke cigarettes. Think back to the 12 months BEFORE you quit smoking. During that time, was your usual cigarette brand menthol or non-menthol?

1 Menthol
2 Non menthol
3 No usual type
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and gave a valid number and time period answer for time quitting smoking
Skip Instructions:

(1-3,R,D) [goto NUMCIG]

NAE.015_00.000

Instrument Variable Name: NUMCIG
Question Text:

Thinking back over the years you have smoked regularly, about how many cigarettes did you usually smoke each day?
*Read if necessary.
1 pack equals 20 cigarettes.
*Enter '95' if varied.
*Enter '96' if never smoked cigarettes regularly.

01-94 1-94 cigarettes
95 Varied
96 Never smoked cigarettes regularly
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who are former smokers and gave a valid number and time period answer for time quitting smoking
Skip Instructions:

(1-94,96,R,D) if SMKQTNO and SMKQTTP LE 2 years ago [goto FE1A_1]; else
if AMDLONG=1,2,R,D or ADENLONG = 1,2,R,D [goto MDTOB1A]; else if
AMDLONG=0,3,4,5 or ADENLONG = 0,3,4,5 [goto PIPEEV]
(95) [goto NUMCVAR]

NAE.017_00.000

Instrument Variable Name: NUMCVAR
Question Text:

What is the average number of cigarettes that you smoked daily during the longest period that you smoked?
*Read if necessary: 1 pack equals 20 cigarettes.

01-94 1-94 cigarettes
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who said number of cigarettes smoked daily varied
Skip Instructions:

(1-94,R,D) if SMKQTNO and SMKQTTP LE 2 years ago [goto FE1A_1]; else if AMDLONG=1,2,R,D or ADENLONG = 1,2,R,D [goto MDTOB1A]; AMDLONG=0,3,4,5 or ADENLONG = 0,3,4,5 [goto PIPEEV]

[p. 2]

NAE.020_01.000

Instrument Variable Name: FE1A_1
Question Text:

Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine gum?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1A_2]

NAE.020_02.000

Instrument Variable Name: FE1A_2
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine patch?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1A_3]

NAE.020_03.000

Instrument Variable Name: FE1A_3
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
Any of these other nicotine products---nasal spray, inhaler, lozenge or tablet?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1A_4]

[p. 3]

NAE.020_04.000

Instrument Variable Name: FE1A_4
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A prescription pill, such as Zyban, Buproprion, or Wellbutrin?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1B_1]

NAE.025_01.000

Instrument Variable Name: FE1B_1
Question Text:

Thinking back to when you stopped smoking completely, did you use ANY of the following:
A telephone help line or quit line?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1B_2]

NAE.025_02.000

Instrument Variable Name: FE1B_2
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
A stop smoking clinic, class, or support group?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1B_3]

[p. 4]

NAE.025_03.000

Instrument Variable Name: FE1B_3
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
One-on-one counseling?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1B_4]

NAE.025_04.000

Instrument Variable Name: FE1B_4
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
Help or support from friends or family?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1B_5]

NAE.025_05.000

Instrument Variable Name: FE1B_5
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
The Internet or World Wide Web?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1B_6]

[p. 5]

NAE.025_06.000

Instrument Variable Name: FE1B_6
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
Books, pamphlets, videos, or other materials?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) [goto FE1B_7]

NAE.025_07.000

Instrument Variable Name: FE1B_7
Question Text:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
Acupuncture or hypnosis?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:

(1,2,R,D) if AMDLONG=1,2,R,D or ADENLONG = 1,2,R,D [goto MDTOB1A]; else
if AMDLONG=0,3,4,5 or ADENLONG = 0,3,4,5 [goto PIPEEV]

NAE.060_00.000

Instrument Variable Name: MENTHOL
Question Text:

Earlier you said you smoke cigarettes.
Is your usual cigarette brand menthol or non-menthol?

1 Menthol
2 Non menthol
3 No usual type
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers
Skip Instructions:

(1-3,R,D) if CIGQTYR=1 [goto CE1A_1]; else [goto CSQEV]

[p. 6]

NAE.075_00.000

Instrument Variable Name: CSQEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers
Skip Instructions:

(1,2,R,D) [goto COMPQT]

NAE.080_01.000

Instrument Variable Name: CE1A_1
Question Text:

Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A nicotine gum?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1A_2]

NAE.080_02.000

Instrument Variable Name: CE1A_2
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A nicotine patch?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1A_3]

[p. 7]

NAE.080_03.000

Instrument Variable Name: CE1A_3
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
Any of these other nicotine products---nasal spray, inhaler, lozenge or tablet?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1A_4]

NAE.080_04.000

Instrument Variable Name: CE1A_4
Question Text:

*Read if necessary.
Thinking back to when tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A prescription pill, such as Zyban, Buproprion, or Wellbutrin?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1B_1]

NAE.085_01.000

Instrument Variable Name: CE1B_1
Question Text:

Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
A telephone help line or quit line?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1B_2]

[p. 8]

NAE.085_02.000

Instrument Variable Name: CE1B_2
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
A stop smoking clinic, class, or support group?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1B_3]

NAE.085_03.000

Instrument Variable Name: CE1B_3
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
One-on-one counseling?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1B_4]

NAE.085_04.000

Instrument Variable Name: CE1B_4
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
Help or support from friends or family?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1B_5]

[p. 9]

NAE.085_05.000

Instrument Variable Name: CE1B_5
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
The Internet or World Wide Web?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1B_6]

NAE.085_06.000

Instrument Variable Name: CE1B_6
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
Books, pamphlets, videos, or other materials?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto CE1B_7]

NAE.085_07.000

Instrument Variable Name: CE1B_7
Question Text:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
Acupuncture or hypnosis?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:

(1,2,R,D) [goto QWANT]

[p. 10]

NAE.100_00.000

Instrument Variable Name: QWANT
Question Text:

Would you like to completely quit smoking cigarettes?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are current smokers
Skip Instructions:

(1,2,R,D) if AMDLONG=1,2, R,D or ADENLONG = 1,2,R,D [goto MDTOB1A]; else if AMDLONG=0,3,4,5 or ADENLONG =0,3,4,5 [goto PIPEEV]

NAE.130_00.000

Instrument Variable Name: MDTOB1A
Question Text:

[fill1: These questions are about tobacco use.]
In the PAST 12 MONTHS, has a medical doctor, dentist, or other health professional ASKED you about whether you smoke cigarettes or use other kinds of tobacco?

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have seen a doctor or other health care professional in the past year
Skip Instructions:

(1,R,D) if SMKNOW=1,2 or SMKNOW=3 and SMKQTNO and SMKQTTP LE 1 year ago [goto MDTOB2]; else [goto PIPEEV] (2) [goto MDTOB1B] (3) [goto PIPEEV]

NAE.131_00.000

Instrument Variable Name: MDTOB1B
Question Text:

Was this because the doctor, dentist, or other health professional already knew whether or not you smoke or use tobacco?

1 Yes
2 No
3 Varies from doctor to doctor
7 Refused
9 Don't know

Universe Text: Sample adults 18+ whose doctor did not ask them about smoking habits in the past 12 months
Skip Instructions:

(1,2,3,R,D) if SMKNOW=1,2 or SMKNOW=3 and SMKQTNO and SMKQTTP LE 1 year ago [goto MDTOB2]; else [goto PIPEEV]

[p. 11]

NAE.135_00.000

Instrument Variable Name: MDTOB2
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have seen a doctor or other health professional in the past year and are current smokers or former smokers who have quit in the past 12 months
Skip Instructions:

(1) [goto HPTOB2] (2,R,D) [goto PIPEEV]

NAE.137_00.000

Instrument Variable Name: HPTOB2
Question Text:

(book) CAN9
In the PAST 12 MONTHS, which health professional(s) advised you to quit smoking or quit using other kinds of tobacco?
*Enter all that apply, separate with commas.

1 Medical doctor
2 Dentist
3 Nurse
4 Dental Hygienist
5 Other health professional (specify)
7 Refused
9 Don't know

Card CAN9

1. Medical doctor
2. Dentist
3. Nurse
4. Dental Hygienist
5. Other health professional

Universe Text: Sample adults 18+ whose doctor or other health professional advised them to quit smoking or using other kinds of tobacco in the past 12 months
Skip Instructions:

(1-4,R,D) [goto PIPEEV] (5) [goto HPTOTH]

NAE.138_00.000

Instrument Variable Name: HPTOTH
Question Text:

*Enter other health professional.

7 Refused
9 Don't know
verbatim Verbatim response

Universe Text: Sample adults 18+ who were advised to quit using tobacco by other health professional
Skip Instructions:

(allow 20,R,D) [goto PIPEEV]

[p. 12]

NAE.140_00.000

Instrument Variable Name: PIPEEV
Question Text:

[fill1: These questions are about tobacco use.]
Have you ever smoked tobacco in a pipe EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto PIPEEV50) (2,R,D) [goto CIGEV1)

NAE.142_00.000

Instrument Variable Name: PIPEEV50
Question Text:

Have you smoked a pipe at least 50 times in your entire life?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever smoked a pipe
Skip Instructions:

(1,2,R,D) [goto PIPECUR]

NAE.144_00.000

Instrument Variable Name: PIPECUR
Question Text:

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

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

Universe Text: Sample adults 18+ who have ever smoked a pipe
Skip Instructions:

(1-3,R,D) [goto CIGEV1]

NAE.146_00.000

Instrument Variable Name: CIGEV1
Question Text:

Have you ever smoked a cigar EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto CIGEV50] (2,R,D) [goto SNUFFEV]

[p. 13]

NAE.148_00.000

Instrument Variable Name: CIGEV50
Question Text:

Have you smoked at least 50 cigars in your entire life?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever smoked a cigar
Skip Instructions:

(1,2,R,D) [goto CIGCUR]

NAE.150_00.000

Instrument Variable Name: CIGCUR
Question Text:

Do you now smoke a cigar every day, some days, or not at all?

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

Universe Text: Sample adults 18+ who have ever smoked a cigar
Skip Instructions:

(1,3) [goto SNUFFEV] (2,R,D) [goto CIG30D]

NAE.152_00.000

Instrument Variable Name: CIG30D
Question Text:

On how many of the PAST 30 DAYS have you smoked a cigar?
*Enter '0' for none.
*Enter '30' for all days in the month.

00 None
01-30 1-30 days
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who smoke a cigar some days or refused or don't know current cigar smoking status
Skip Instructions:

(0-30,R,D) [goto SNUFFEV]

NAE.154_00.000

Instrument Variable Name: SNUFFEV
Question Text:

Have you EVER used snuff, such as Skoal, Skoal Bandits, or Copenhagen, EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto SNUFEV20) (2,R,D) [goto CHEWEV)

[p. 14]

NAE.156_00.000

Instrument Variable Name: SNUFEV20
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever used snuff
Skip Instructions:

(1,2,R,D) [goto SNUFFCUR]

NAE.158_00.000

Instrument Variable Name: SNUFFCUR
Question Text:

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

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

Universe Text: Sample adults 18+ who have ever used snuff
Skip Instructions:

(1-3,R,D) [goto CHEWEV]

NAE.160_00.000

Instrument Variable Name: CHEWEV
Question Text:

Have you EVER used chewing tobacco, such as Redman, Levi Garrett, or Beechnut EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto CHEWEV20) (2,R,D) [goto BIDISEV]

NAE.162_00.000

Instrument Variable Name: CHEWEV20
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever used chewing tobacco
Skip Instructions:

(1,2,R,D) [goto CHEWCUR]

[p. 15]

NAE.164_00.000

Instrument Variable Name: CHEWCUR
Question Text:

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

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

Universe Text: Sample adults 18+ who have ever used chewing tobacco
Skip Instructions:

(1-3,R,D) [goto BIDISEV]

NAE.166_00.000

Instrument Variable Name: BIDISEV
Question Text:

Have you ever smoked a bidi (bee-dee) EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-3,R,D)[goto LIVINTRO]

NAE.168_00.000

Instrument Variable Name: BIDIEV20
Question Text:

Have you smoked a bidi at least 20 times in your entire life?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever smoked a bidi
Skip Instructions:

(1,2,R,D) [goto BIDISCUR]

NAE.170_00.000

Instrument Variable Name: BIDISCUR
Question Text:

Do you now smoke a bidi every day, some days, or not at all?

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

Universe Text: Sample adults 18+ who have ever smoked a bidi
Skip Instructions:

(1-3,R,D)[goto LIVINTRO]

[p. 16]

NAE.173_00.000

Instrument Variable Name: LIVINTRO
Question Text:

In a usual week, does ANYONE who lives here, including yourself, smoke cigarettes, cigars, or pipes anywhere inside this home?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto LIVSMOKE]
(2,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section

NAE.174_00.000

Instrument Variable Name: LIVSMOKE
Question Text:

In a usual week, how many people WHO LIVE here, including yourself, smoke cigarettes, cigars, or pipes anywhere INSIDE this home?
*Enter '0' for none.
*Enter '96' for 96 or more smokers.

00 None
01-95 01-95 persons
96 96+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have people living in the home that smoke in a usual week
Skip Instructions:

(1-96) [goto LVDYSMOK]
(0,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section

NAE.176_00.000

Instrument Variable Name: LVDYSMOK
Question Text:

Usually, about how many days per week do people WHO LIVE here smoke anywhere INSIDE this home?
*Enter '0' for less than 1 day per week/rarely/none
*Enter '7' for all days per week

00 Less than one day per week/rarely/none
01-07 01-07 days
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have at least one resident smoking inside the home
Skip Instructions:

(0-7,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section

[p. 17]

NAE.190_00.000

Instrument Variable Name: LIVEBTH
Question Text:

Have you given birth to a live born infant within the past 5 years?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults age 18-49
Skip Instructions:

(1) if SMKEV=1 [goto SMKPREG]; else [goto next section] (2,R,D) [goto next section]

NAE.200_00.000

Instrument Variable Name: SMKPREG
Question Text:

Were you smoking cigarettes when you became pregnant with your last child?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and have had a live birth in the past 5 years
Skip Instructions:

(1,2,R,D) [goto SMKLST]

NAE.210_00.000

Instrument Variable Name: SMKLST
Question Text:

Did you smoke cigarettes at any time during your pregnancy with your last child?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and have had a live birth in the past 5 years
Skip Instructions:

(1) [goto QUTWK] (2,R,D) [goto next section]

NAE.220_00.000

Instrument Variable Name: QUTWK
Question Text:

Did you quit smoking for 7 days or longer during your pregnancy with your last child?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last pregnancy
Skip Instructions:

(1) [goto MTHQUIT] (2,R,D) [goto next section]

[p. 18]

NAE.230_00.000

Instrument Variable Name: MTHQUIT
Question Text:

In what month of your pregnancy did you quit for 7 days or longer?

01 First
02 Second
03 Third
04 Fourth
05 Fifth
06 Sixth
07 Seventh
08 Eighth
09 Ninth
97 Refused
99 Don't know

Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last pregnancy, but quit for 7 days or longer
Skip Instructions:

(1-9,R,D) [goto STSMOK]

NAE.240_00.000

Instrument Variable Name: STSMOK
Question Text:

Did you start smoking again during the pregnancy or did you stay off cigarettes for the rest of the pregnancy?

1 Stayed off rest of pregnancy
2 Started again
3 Never started again
7 Refused
9 Don't know

Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last pregnancy, but quit for 7 days or longer
Skip Instructions:

(1-3,R,D) [goto next section]

[p. 1]

2005 NHIS Questionnaire - Sample Adult
Cancer Screening

NAF.010_00.000

Instrument Variable Name: SUN1HR
Question Text:

(book) CAN10
Now, we are going to ask you about your skin's reaction to the sun. After several months of not being in the sun very much, if you went out in the sun for an hour without sunscreen, a hat, or protective clothing, which one of these best describes what would happen to your skin?
*Read if necessary: Even if you did not go out in the sun, what would happen if you did? Use the most recent experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more.

01 Get a severe sunburn with blisters
02 Have a moderate sunburn with peeling
03 Burn mildly with some or no darkening/tanning
04 Turn darker without sunburn
05 Nothing would happen to my skin
06 Do not go out in the sun
07 Other
97 Refused
99 Don't know

Card CAN10

1. Get a severe sunburn with blisters
2. Have a moderate sunburn with peeling
3. Burn mildly with some or no darkening/tanning
4. Turn darker without sunburn
5. Nothing would happen to my skin

Universe Text: Sample adults 18+
Skip Instructions:

(1-7,R,D) [goto SUNTAN]

NAF.015_00.000

Instrument Variable Name: SUNTAN
Question Text:

(book) CAN11
Next, consider that you were out in the sun repeatedly, such as every day for two weeks, without sunscreen, a hat, or protective clothing . Which one of these best describes what your skin would LOOK like?
*Read if necessary: Even if you did not go out in the sun, what would happen if you did? Use the most recent experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more.

01 Very dark or deeply tanned
02 Dark/Moderately tanned
03 A little dark/mildly tanned
04 Freckled but still light skinned
05 Burned repeatedly with little or no darkening or tanning---still light skinned
06 Don't go out in the sun
07 Other
97 Refused
99 Don't know

Card CAN11

1. Very dark or deeply tanned
2. Dark/Moderately tanned
3. A little dark/Mildly tanned
4. Freckled but still light skinned
5. Burned repeatedly with little or no darkening or tanning--still light skinned

Universe Text: Sample adults 18+
Skip Instructions:

(1-7,R,D) [goto SUN1_SHA]

[p. 2]

NAF.020_00.000

Instrument Variable Name: SUN1_SHA
Question Text:

(book) CAN12
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Stay in the shade? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

Card CAN12

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-6,R,D) [goto SUN1_CAP]

NAF.022_00.000

Instrument Variable Name: SUN1_CAP
Question Text:

(book) CAN12
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a baseball cap or sun visor? Would you say (Read categories 1-5). . .
SUN1_CAP

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

Card CAN12

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-6,R,D) [goto SUN1_HAT]

[p. 3]

NAF.023_00.000

Instrument Variable Name: SUN1_HAT
Question Text:

(book) CAN12 and CAN13
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a hat that shades your face, ears AND neck such as a hat with a wide brim all around? Would you say (Read categories 1-5). . .
*Do not include visors, baseball caps, or hats that do not shade the face, ears and neck. Include safari hats.

Card CAN12

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

Card CAN13
Flashcard CAN13 shows images of different kinds of hats that shade the face, ears, and neck (e.g., sunhat, cowboy hat, safari hat).

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-6,R,D) [goto SUN2_LGS]

NAF.024_00.000

Instrument Variable Name: SUN2_LGS
Question Text:

(book) CAN12
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a long sleeved shirt? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

Card CAN12

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-6,R,D) [goto SUN2_LGP]

[p. 4]

NAF.025_00.000

Instrument Variable Name: SUN2_LGP
Question Text:

(book) CAN12
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear long pants or other clothing that reaches your ankles? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

Card CAN12

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-6,R,D) [goto SUN2_SCR]

NAF.026_00.000

Instrument Variable Name: SUN2_SCR
Question Text:

(book) CAN12
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Use sunscreen? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

Card CAN12

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-4) [goto SPF] (5,6,R,D) [goto NBURN]

[p. 5]

NAF.027_00.000

Instrument Variable Name: SPF
Question Text:

What is the SPF number of the sunscreen you use MOST often?
*Read if necessary: If you use more than one or different ones, pick the one used most often.
*Enter '96' if unable to pick the one used most often.

01-50 1-50
96 More than one, different ones, other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who use sunscreen at least rarely
Skip Instructions:

(1-50) [goto NBURN] (96, R, D) [goto SPFSCALE]

NAF.028_00.000

Instrument Variable Name: SPFSCALE
Question Text:

Is the SPF usually 1-14 or 15-50?

1 1-14
2 15-50
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who answered more than one, different ones, or other to SPF number, or did not know or refused to say the SPF
Skip Instructions:

(1,2,R,D) [goto NBURN]

NAF.030_00.000

Instrument Variable Name: NBURN
Question Text:

DURING THE PAST 12 MONTHS, how many times have you had a sunburn?
*Read if necessary: By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more. Also include burns from sunlamps and other indoor tanning devices.
*Enter '0' for none.

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

Universe Text: Sample adults 18+
Skip Instructions:

(0-365,R,D) [goto SNNUM]

[p. 6]

NAF.033_00.000

Instrument Variable Name: SNNUM
Question Text:

DURING THE PAST 12 MONTHS, how many times have you used any of the following indoor tanning devices---a sunlamp, sunbed or tanning booth EVEN ONE TIME? Do NOT include times you have gotten a spray-on tan.
*Enter '0' for none.

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

Universe Text: Sample adults 18+
Skip Instructions:

(000-365,R,D) [goto SKNX]

NAF.040_00.000

Instrument Variable Name: SKNX
Question Text:

Now we are going to ask you about medical tests and exams that check for cancer. Have you EVER had all of your skin from head to toe checked for cancer either by a dermatologist or some other kind of doctor?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto RSKX1_MT] (2,R,D) [if SEX=2 goto MENSTAGE; else if SEX=1 and AGE=18-39, goto Genetic Testing; else goto PSAHRD]

[p. 7]

NAF.050_01.000

Instrument Variable Name: RSKX1_MT
Question Text:

1 of 2
When did you have your MOST RECENT skin exam to check for cancer?
*Enter month of last skin exam.
*Enter '96' to go to the number and time period format.

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

Universe Text: Sample adults 18+ who have had a skin exam
Skip Instructions:

(1-12,D) [goto RSKX1_YR] (R) store "R' in RSKX1_YR [goto RSKX2] (96) store "96" in RSKX1_YR [goto RSKX1N]

NAF.050_02.000

Instrument Variable Name: RSKX1_YR
Question Text:

2 of 2
*Enter year of last skin exam.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Sample adults age 18+ who answered month of last skin exam or didn't know month of last skin exam
Skip Instructions:

(valid year) if RSKX1_MT=1-12 [goto SKINREAS]; else if RSKX1_MT=D [goto RSKX2] (R,D) [goto RSKX2] IF RSKX1_MT and RSKX1_YR = a future date [goto ERR1_RSKX1_YR] IF RSKX1_MT and RSKX1_YR = a date prior to birth date [goto ERR2_RSKX1_YR]

[p. 8]

NAF.055_01.000

Instrument Variable Name: RSKX1N
Question Text:

1 of 2
When did you have your MOST RECENT skin exam?
*Enter number for time since last skin exam.
*Enter '95' for 95 or more.

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

Universe Text: Sample adults 18+ who selected number and time period format for most recent skin exam
Skip Instructions:

(1-95) [goto RSKX1T] (R,D) store "R,D" in RSKX1T [goto RSKX2]

NAF.055_02.000

Instrument Variable Name: RSKX1T
Question Text:

2 of 2
*Enter time period for time since most recent skin exam.

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

Universe Text: Sample adults 18+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto SKINREAS]; (4) if RSKX1N and RSKX1T GT 5 years from system date, fill "5" in RSKX2 [goto SKINREAS]; else [goto RSKX2] (R,D) [goto RSKX2] IF [RSKX1N = Number greater than person years old and RSKX1T= 4]] goto ERR1_RSKX1T

NAF.060_00.000

Instrument Variable Name: RSKX2
Question Text:

(book) CAN14
Was it (read answer categories):

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

Card CAN14

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

Universe Text: Sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last skin exam was over 5 years ago)
Skip Instructions:

(1-5,R,D) [goto SKINREAS]

[p. 9]

NAF.070_00.000

Instrument Variable Name: SKINREAS
Question Text:

What was the MAIN reason you had this skin exam -- was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have had a skin exam
Skip Instructions:

(1-3,R,D) [f SEX=2 goto MENSTAGE; else if SEX=1 and AGE=18-39, goto Genetic Testing; else goto PSAHRD]

NAF.080_00.000

Instrument Variable Name: MENSTAGE
Question Text:

The following questions are about women's health. How old were you when your periods or menstrual cycles started?
*Enter '0' for haven't started.

00 Haven't started
06-60 6-60 years
97 Refused
99 Don't know

Universe Text: Female sample adults 18+
Skip Instructions:

(0,6-60,R,D) [goto BCONTROL]

NAF.090_00.000

Instrument Variable Name: BCONTROL
Question Text:

(book) CAN15
Have you EVER used any of the following birth control methods?
*Enter all that apply, separate with commas.

0 None
1 Oral Contraception (birth control pills)
2 Patch
3 Ring
4 Injection
5 IUD (Intrauterine Device)
6 Implant
7 Refused
9 Don't know

Card CAN15
You may choose more than one.

1. Oral Contraception (birth control pills)
2. Patch
3. Ring
4. Injection
5. IUD (Intrauterine Device)
6. Implant

Universe Text: Female sample adults 18+
Skip Instructions:

(1-6) [goto BCNO] (0,R,D) if LIVEBTH=1 store '1' in BIRTHEV [goto BIRTHNUM]; else [goto BIRTHEV]

[p. 10]

NAF.100_01.000

Instrument Variable Name: BCNO
Question Text:

1 of 2
Altogether, about how long did you use birth control?
*Enter number for time using birth control.
*Enter '95' for 95 or more.

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

Universe Text: Female sample adults 18+ who have ever used birth control
Skip Instructions:

(1-95) [goto BCTP] (R,D) store "R,D" in BCTP, if LIVEBTH=1 store '1' in BIRTHEV [goto BIRTHNUM]; else [goto BIRTHEV]

NAF.100_02.000

Instrument Variable Name: BCTP
Question Text:

2 of 2
*Enter time period for time using birth control.

1 Weeks
2 Months
3 Years
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have entered a number for time using birth control
Skip Instructions:

(1-3,R,D) if LIVEBTH=1 store '1' in BIRTHEV [goto BIRTHNUM]; else [goto BIRTHEV]
if [BCNO = Number greater than person years old and BCTP= 3]] goto
ERR1_BCTP

NAF.110_00.000

Instrument Variable Name: BIRTHEV
Question Text:

*If the respondent mentioned having a biological child in the core, enter '1' for yes (and don't ask question).
Have you EVER given birth to a live born infant?
*Read if necessary.
A live born infant is an infant born alive.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who did not already answer they had a live birth
Skip Instructions:

(1) [goto BIRTHNUM] (2,R,D) [goto PAPHAD]

[p. 11]

NAF.111_00.000

Instrument Variable Name: BIRTHNUM
Question Text:

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

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

Universe Text: Female sample adults 18+ who have ever had a live born infant
Skip Instructions:

(1-25,R,D) [goto BIRTHAGE]

NAF.120_00.000

Instrument Variable Name: BIRTHAGE
Question Text:

How old were you when your [fill1: child/first child] was born?

06-60 6-60 years
97 Refused
99 Don't know

Universe Text: Female sample adults 18+ who have ever had a live born infant
Skip Instructions:

(6-60,R) [goto PAPHAD] (D) [goto BIRTHAG2]; if BIRTHAGE GE AGE [goto ERR1_BIRTHAGE]

NAF.121_00.000

Instrument Variable Name: BIRTHAG2
Question Text:

What year was your [fill1: child/first child] born?

1890-2006 1890-2006
9997 Refused
9999 Don't know

Universe Text: Female sample adults 18+ who didn't know their age at first's child's birth
Skip Instructions:

(1890-2007,R,D) [goto PAPHAD]

NAF.130_00.000

Instrument Variable Name: PAPHAD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+
Skip Instructions:

(1) [goto PAP6YR] (2) [goto PAPNOT] (R,D) [goto HYST]

[p. 12]

NAF.140_00.000

Instrument Variable Name: PAP6YR
Question Text:

How many Pap smears have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more exams.

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

Universe Text: Female sample adults 18+ who have ever had a Pap smear
Skip Instructions:

(0-95,R,D) [goto RPAP1_MT]

NAF.150_01.000

Instrument Variable Name: RPAP1_MT
Question Text:

1 of 2
*Enter month of last Pap smear test.
*Enter '96' to go to number and time period format.

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

Universe Text: Female sample adults 18+ who have ever had a Pap smear
Skip Instructions:

(1-12,D) [goto RPAP1_YR] (R) store "R' in RPAP1_YR [goto RPAP2] (96) store "96" in RPAP1_YR [goto RPAP1N]

[p. 13]

NAF.150_02.000

Instrument Variable Name: RPAP1_YR
Question Text:

2 of 2
*Enter year of last Pap smear test.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Female sample adults age 18+ who answered month of last Pap smear test or didn't know month of last Pap smear test
Skip Instructions:

(valid year) if RPAP1_MT=1-12 [goto PAPREAS]; else if RPAP1_MT=D [goto RPAP2] (R,D) [goto RPAP2]
IF RPAP1_MT and RPAP1_YR = a future date [goto ERR1_RPAP1_YR]
IF RPAP1_MT and RPAP1_YR = a date prior to birth date [goto ERR2_RPAP1_YR]

NAF.160_01.000

Instrument Variable Name: RPAP1N
Question Text:

1 of 2
When did you have your MOST RECENT Pap smear test?
*Enter number for time since last Pap smear test.
*Enter '95' for 95 or more.

01-94 1-94
95 95+
97 Refused

Universe Text: Female sample adults 18+ who selected number and time period format for most recent Pap smear test from the initial month screen
Skip Instructions:

(1-95) [goto RPAP1T] (R,D) store "R,D" in RPAP1T [goto RPAP2]

NAF.160_02.000

Instrument Variable Name: RPAP1T
Question Text:

2 of 2
*Enter time period for time since most recent Pap smear test.

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

Universe Text: Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto PAPREAS];
(4) if RPAP1N and RPAP1T GT 5 years from system, fill "5" in RPAP2 [goto PAPREAS]; else [goto RPAP2]
(R,D) [goto RPAP2]
IF [RPAPIN = Number greater than person years old and RPAP1T= 4]] goto ERR1_RPAP1T

[p. 14]

NAF.165_00.000

Instrument Variable Name: RPAP2
Question Text:

(book) CAN14
Was it:
*Read answer categories.

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

Card CAN14

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

Universe Text: Female sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last Pap smear test was over 5 years ago)
Skip Instructions:

(1-5,R,D) [goto PAPREAS]

NAF.170_00.000

Instrument Variable Name: PAPREAS
Question Text:

What was the MAIN reason you had this Pap smear - was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have ever had a Pap smear
Skip Instructions:

(1-3,R,D) [goto PAPNMR]

NAF.180_00.000

Instrument Variable Name: PAPABN
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have ever had a Pap smear
Skip Instructions:

(1) [goto PAPADDE] (2,R,D) if last Pap smear was 3 years or less [goto MDRECPAP]; else if last PAP smear was more than 3 years ago [goto PAPNOT] else if RPAP2=R,D, [goto MDRECPAP]

[p. 15]

NAF.190_00.000

Instrument Variable Name: PAPADDE
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have had an abnormal Pap smear
Skip Instructions:

(1,2,R,D) [goto PAPTRT]

NAF.200_00.000

Instrument Variable Name: PAPTRT
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have had an abnormal Pap smear
Skip Instructions:

(1,2,R,D) if last Pap smear was more than 3 years ago [goto PAPNOT] else [goto MDRECPAP]

NAF.210_00.000

Instrument Variable Name: PAPNOT
Question Text:

(book) CAN16
What is the most important reason you have [Fill1: NEVER had a Pap smear/NOT had a Pap smear in the LAST 3 YEARS]?

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

Card CAN16

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

Universe Text: Female sample adults 18+ who have never had a Pap smear, or who have not had a Pap smear in the last 3 years
Skip Instructions:

(1,2,4-7,10,R,D) [goto MDRECPAP] (3,9) [goto HYST] (8) [goto RHYS1_MT]

[p. 16]

NAF.215_00.000

Instrument Variable Name: MDRECPAP
Question Text:

Fill1 (IF PAPHAD=1 and most recent screening exam LE 3 years from system date)
"Was your most recent Pap smear recommended by a doctor or other health professional?"
Else (IF PAPHAD=2, or PAPHAD GT 3 years from system date or RPAP2=R,D)
"In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a PAP smear?"

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who had a doctor, who didn't answer that her doctor didn't recommend a Pap Smear, who haven't had a hysterectomy, and gave a reason for not having Pap test ever/in the last 3 years
Skip Instructions:

(1,2,R,D) if PAPNOT=8 store "1" in HYST [goto RHYS1_MT]; else [goto HYST]

NAF.220_00.000

Instrument Variable Name: HYST
Question Text:

Have you had a hysterectomy?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have not already indicated they have had a hysterectomy
Skip Instructions:

(1) [goto RHYS1_MT] (2,R,D) if age 18-29 [goto Genetic Testing]; else [goto MAMHAD]

[p. 17]

NAF.221_01.000

Instrument Variable Name: RHYS1_MT
Question Text:

1 of 2
When was your hysterectomy?
*Enter month of hysterectomy.
*Enter '96' to go to number and time period format.

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

Universe Text: Female sample adults 18+ who have ever had a hysterectomy
Skip Instructions:

(1-12,D) [goto RHYS1_YR] (R) store "R' in RHYS1_YR [goto RHYS2] (96) store "96" in RHYS1_YR [goto RHYS1N]

NAF.221_02.000

Instrument Variable Name: RHYS1_YR
Question Text:

2 of 2
*Enter year of hysterectomy.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Female sample adults age 18+ who answered month of hysterectomy or didn't know month of hysterectomy
Skip Instructions:

(valid year) if RHYS1_MT=1-12 [goto MAMHAD if AGE GE 30; else goto next section]; else if RHYS1_MT=D [goto RHYS2] (R,D) [goto RHYS2]
IF RHYS1_MT and RHYS1_YR = a future date [goto ERR1_RHYS1_YR]
IF RHYS1_MT and RHYS1_YR = a date prior to birth date [goto ERR2_RHYS1_YR]

[p. 18]

NAF.222_01.000

Instrument Variable Name: RHYS1N
Question Text:

1 of 2
When was your hysterectomy?
*Enter number for time since hysterectomy.
*Enter '95' for 95 or more.

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

Universe Text: Female sample adults 18+ who selected number and time period format for hysterectomy from the initial month screen
Skip Instructions:

(1-95) [goto RHYS1T] (R,D) store "R,D" in RHYS1T [goto RHYS2]

NAF.222_02.000

Instrument Variable Name: RHYS1T
Question Text:

2 of 2
*Enter time period for time since hysterectomy.

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

Universe Text: Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) if age GE 30 [goto MAMHAD]; else [goto next section]
(4) if RHYS1N and RHYS1T GT 5 years from system date fill "5" in RHYS2 [goto MAMHAD if AGE GE 30, else goto next section]; else [goto RHYS2] (R,D) [goto RHYS2]
IF [RHYS1N = Number greater than person years old and RHYS1T= 4]] goto ERR1_RHYS1T

[p. 19]

NAF.225_00.000

Instrument Variable Name: RHYS2
Question Text:

(book) CAN14
Was it:
*Read answer categories.

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

Card CAN14

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

Universe Text: Female sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose hysterectomy was over 5 years ago)
Skip Instructions:

(1-5,R,D) if AGE GE 30 [goto MAMHAD]; else [goto Genetic Testing]

NAF.230_00.000

Instrument Variable Name: MAMHAD
Question Text:

Have you EVER HAD a mammogram?
*Read if necessary. A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults age 30+
Skip Instructions:

(1) [goto MAMAGE] (2) [goto MAMNOT] (R,D) [goto CBEHAD]

NAF.240_00.000

Instrument Variable Name: MAMAGE
Question Text:

(book) CAN17
About how old were you when you had your first mammogram? Were you:
*Read answer categories.

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

Card CAN17

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

Universe Text: Female sample adults age 30+ who have ever had a mammogram
Skip Instructions:

(1-5,R,D) [goto MAM6YR]

[p. 20]

NAF.250_00.000

Instrument Variable Name: MAM6YR
Question Text:

How many mammograms have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more mammograms.

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

Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:

(0-95,R,D) [goto RMAM1_MT]

NAF.260_01.000

Instrument Variable Name: RMAM1_MT
Question Text:

1 of 2
The next few questions are about your recent mammograms. When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and time period format.

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

Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:

(1-12,D) [goto RMAM1_YR] (R) store "R' in RMAM1_YR [goto RMAM2] (96) store "96" in RMAM1_YR
[goto RMAM1N]

[p. 21]

NAF.260_02.000

Instrument Variable Name: RMAM1_YR
Question Text:

2 of 2
*Enter year of last mammogram.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Female sample adults age 30+ who answered month of last mammogram or didn't know month of last mammogram
Skip Instructions:

(valid year) if RMAM1_MT=1-12 [goto MAMWHER]; else if RMAM1_MT=D [goto RMAM2] (R,D) [goto RMAM2] IF RMAM1_MT and RMAM1_YR = a future date [goto ERR1_RMAM1_YR] IF RMAM1_MT and RMAM1_YR = a date prior to birth date [goto ERR2_RMAM1_YR]

NAF.270_01.000

Instrument Variable Name: RMAM1N
Question Text:

1 of 2
When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.

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

Universe Text: Female sample adults 30+ who selected number and time period format for most recent mammogram from the initial month screen
Skip Instructions:

(1-95) [goto RMAM1T] (R,D) store "R,D" in RMAM1T [goto RMAM2]

NAF.270_02.000

Instrument Variable Name: RMAM1T
Question Text:

2 of 2
*Enter time period for time since most recent mammogram.

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

Universe Text: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto MAMWHER]; (4) if RMAM1N and RMAM1T GT 5 years from system date, fill "5" in RMAM2 [goto MAMWHER]; else [goto RMAM2] (R,D) [goto RMAM2]
IF [RMAM1N = Number greater than person years old and RMAM1T= 4]] goto ERR1_RMAM1T

[p. 22]

NAF.275_00.000

Instrument Variable Name: RMAM2
Question Text:

(book) CAN14
Was it:
*Read answer categories.

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

Card CAN14

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

Universe Text: Female sample adults 30+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last mammogram was over 5 years ago)
Skip Instructions:

(1-5,R,D) [goto MAMWHER]

NAF.310_00.000

Instrument Variable Name: MAMREAS
Question Text:

What was the MAIN reason you had this mammogram -- was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:

(1-3,R,D) [goto MAMNMR]

NAF.320_00.000

Instrument Variable Name: MAMABN
Question Text:

Have you EVER had a mammogram where they needed to examine you further by taking more pictures, doing a biopsy, or having you see a physician?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:

(1) [goto MAMCAN] (2,R,D) [goto LUMPEV]

[p. 23]

NAF.340_00.000

Instrument Variable Name: MAMCAN
Question Text:

As a result of these additional tests after your [fill1: mammogram/mammograms] were you diagnosed with cancer?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 30+ who have needed follow-up after a mammogram
Skip Instructions:

(1,2,R,D) [goto LUMPEV]

NAF.350_00.000

Instrument Variable Name: LUMPEV
Question Text:

Have you EVER HAD an operation to remove a lump from your breast that was found not to be cancer?

1 Yes
2 No
3 Lump removed was cancerous
7 Refused
9 Don't know

Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:

(1) [goto LUMPNUM] (2,3,R,D) if MAMHAD=2 or last mammogram was more than 2 years ago [goto MAMNOT] else [goto MDRECMAM]

NAF.351_00.000

Instrument Variable Name: LUMPNUM
Question Text:

How many of these operations have you had?

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

Universe Text: Female sample adults 30+ who have had a lump removed that was not cancerous
Skip Instructions:

(1-20,R,D) if MAMHAD=2 or last mammogram was more than 2 years ago [goto MAMNOT] else [goto MDRECMAM]

[p. 24]

NAF.360_00.000

Instrument Variable Name: MAMNOT
Question Text:

(book) CAN18
What is the most important reason why you have [fill1: NEVER had a mammogram/NOT had a mammogram in the PAST 2 YEARS]?

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

Card CAN18

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

Universe Text: Female sample adults 30+ who have never had a mammogram or had a last mammogram more than 2 years ago
Skip Instructions:

(1-2,4-8,10,R,D) [goto MDRECMAM] (3,9) [goto MEDHRT]

NAF.370_00.000

Instrument Variable Name: MDRECMAM
Question Text:

Fill1 (IF MAMHAD=1 and most recent screening exam LE 2 years from system date)
[Was your most recent mammogram recommended by a doctor or other health professional?]
Else (IF MAMHAD=2, or MAMHAD GT 2 years from system date or RMAM2=R,D)
[In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a mammogram?]

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

Universe Text: Female sample adults 30+ who have a doctor and had a mammogram in the past 2 years
Skip Instructions:

(1,2,3,R,D) [goto MEDHRT]

NAF.380_01.000

Instrument Variable Name: MEDHRT
Question Text:

Are you currently taking any of the following medications?
Hormone replacement therapy?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 30+
Skip Instructions:

(1,2,R,D) [goto MEDTAMX]

[p. 25]

NAF.380_02.000

Instrument Variable Name: MEDTAMX
Question Text:

*Read if necessary.
Are you currently taking any of the following medications?
Tamoxifen, also known as Nolvadex?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 30+
Skip Instructions:

(1,2,R,D) [goto MEDRALX]

NAF.380_03.000

Instrument Variable Name: MEDRALX
Question Text:

*Read if necessary.
Are you currently taking any of the following medications?
Raloxifen, also known as Evista?
*Pronunciation guide: rah-LOX-ih-fen

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 30+
Skip Instructions:

(1,2,R,D) [goto MEDBC]

NAF.380_04.000

Instrument Variable Name: MEDBC
Question Text:

[fill 1: if AGE GE 30 : *Read lead in if necessary.]
Are you currently taking any of the following medications?
Birth control pills, birth control implants, or birth control shots?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ and never taken birth control
Skip Instructions:

(1,2,R,D) if MEDTAXMD eq 1 [goto TAMMAIN]; else [goto CBEHAD]

[p. 26]

NAF.385_00.000

Instrument Variable Name: TAMMAIN
Question Text:

What is the main reason you are taking tamoxifen?

1 As part of my treatment for breast cancer
2 To reduce the chance I may develop breast cancer
3 Other
7 Refused
9 Don't know

Universe Text: Female sample adults 30+ who are currently taking tamoxifen
Skip Instructions:

(1-3,R,D) [goto CBEHAD]

NAF.390_00.000

Instrument Variable Name: CBEHAD
Question Text:

Have you EVER HAD a breast exam done by a doctor or other health professional to check for lumps or other signs of breast cancer?
*Read if necessary.
A breast exam is when the breasts are felt by a doctor or other health professional to check for lumps or other signs of breast cancer.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 30+
Skip Instructions:

(1) [goto RCBE1_MT] (2,R,D) if AGE GE 40 [goto CREHAD]; else [goto Genetic Testing]

[p. 27]

NAF.400_01.000

Instrument Variable Name: RCBE1_MT
Question Text:

1 of 2
When did you have your MOST RECENT breast exam?
*Enter month of last breast exam.
*Enter '96' to go to number and time period format.

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

Universe Text: Female sample adults 30+ who have ever had a breast exam
Skip Instructions:

(1-12,D) [goto RCBE1_YR] (R) store "R' in RCBE1_YR [goto RCBE2] (96) store "96" in RCBE1_YR [goto RCBE1N]

NAF.400_02.000

Instrument Variable Name: RCBE1_YR
Question Text:

2 of 2
*Enter year of last breast exam.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Female sample adults age 30+ who answered month of last breast exam or didn't know month of last breast exam
Skip Instructions:

(valid year) if RCBE1_MT=1-12 [goto CREHAD if AGE GE 40; else goto next section]; else if RCBE1_MT=D
[goto RCBE2] (R,D) [goto RCBE2]
IF RCBE1_MT and RCBE1_YR = a future date [goto ERR1_RCBE1_YR]
IF RCBE1_MT and RCBE1_YR = a date prior to birth date [goto ERR2_RCBE1_YR]

[p. 28]

NAF.410_01.000

Instrument Variable Name: RCBE1N
Question Text:

1 of 2
When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.

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

Universe Text: Female sample adults 30+ who selected number and time period format for most recent breast exam from the initial month screen
Skip Instructions:

(1-95) [goto RCBE1T] (R,D) store "R,D" in RCBE1T [goto RCBE2]

NAF.410_02.000

Instrument Variable Name: RCBE1T
Question Text:

2 of 2
*Enter time period for time since most recent breast exam.

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

Universe Text: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto CREHAD if AGE GE 40; else goto next section];
(4) if RCBE1N and RCBE1T GT 5 years from system date, fill "5" in RCBE2 [goto CREHAD if AGE GE 40; else goto next section]; else [goto RCBE2] (R,D) [goto RCBE2]
IF [RCBEIN = Number greater than person years old and RCBE1T= 4]] goto ERR1_RCBE1T

[p. 29]

NAF.415_00.000

Instrument Variable Name: RCBE2
Question Text:

(book) CAN14
Was it:
*Read answer categories.

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

Card CAN14

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

(1-5,R,D) [goto CREHAD if AGE GE 40; else goto Genetic Testing]

NAF.430_00.000

Instrument Variable Name: PSAHAD
Question Text:

The following questions are about men's health.
Have you EVER HAD a PSA test? *Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Male sample adults 40+
Skip Instructions:

(1) [goto PSAAGE1] (2,R,D) [goto CREHAD]

[p. 30]

NAF.440_00.000

Instrument Variable Name: PSAAGE1
Question Text:

(book) CAN19
How old were you when you had your first PSA test? Were you:
*Read answer categories.

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

Card CAN19

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

Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:

(1-8,R,D) [goto PSA5YR]

NAF.450_00.000

Instrument Variable Name: PSA5YR
Question Text:

How many PSA tests have you had in the LAST 5 years?
*Enter '0' for none.
*Enter '95" for 95 or more PSA tests.

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

Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:

(0-95,R,D) [goto RPSA1_MT]

[p. 31]

NAF.460_01.000

Instrument Variable Name: RPSA1_MT
Question Text:

1 of 2
The next few questions are about your recent PSA tests. When did you have your MOST RECENT PSA test?
*Enter month of last PSA test.
*Enter '96' to go to number and time period format.

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

Universe Text: Male sample adults 40+ who have ever had a PSA test
Skip Instructions:

(1-12,D) [goto RPSA1_YR] (R) store "R' in RPSA1_YR [goto RPSA2] (96) store "96" in RPSA1_YR [goto RPSA1N]

NAF.460_02.000

Instrument Variable Name: RPSA1_YR
Question Text:

2 of 2
*Enter year of last PSA test.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Male sample adults 40+ who answered month of last PSA test or didn't know month of last PSA test
Skip Instructions:

(valid year) if RPSA1_MT=1-12 [goto PSAREAS]; else if RPSA1_MT=D [goto RPSA2] (R,D) [goto RPSA2]
IF RPSA1_MT and RPSA1_YR = a future date [goto ERR1_RPSA1_YR]
IF RPSA1_MT and RPSA1_YR = a date prior to birth date [goto ERR2_RPSA1_YR]

[p. 32]

NAF.470_01.000

Instrument Variable Name: RPSA1N
Question Text:

1 of 2
When did you have your MOST RECENT PSA test?
*Enter number for time since last PSA test.
*Enter '95' for 95 or more.

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

Universe Text: Male sample adults 40+ who selected number and time period format for most recent PSA test from the initial month screen
Skip Instructions:

(1-95) [goto RPSA1T] (R,D) store "R,D" in RPSA1T [goto RPSA2]

NAF.470_02.000

Instrument Variable Name: RPSA1T
Question Text:

2 of 2
*Enter time period for time since most recent PSA test.

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

Universe Text: Male sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto PSAREAS]; (4) if RPSA1N and RPSA1T GT 5 years from system date, fill "5" in RPSA2 [goto PSAREAS]; else [goto RPSA2] (R,D) [goto RPSA2]
IF [RPSA1N = Number greater than person years old and RPSA1T= 4]] goto ERR1_RPSA1T

[p. 33]

NAF.475_00.000

Instrument Variable Name: RPSA2
Question Text:

(book) CAN14
Was it:
*Read answer categories.

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

Card CAN14

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

Universe Text: Male sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last PSA test was over 5 years ago)
Skip Instructions:

(1-5,R,D) [goto PSAREAS]

NAF.480_00.000

Instrument Variable Name: PSAREAS
Question Text:

What was the MAIN reason you had this PSA test - was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:

(1-3,R,D) [goto PSANMR]

NAF.540_00.000

Instrument Variable Name: CREHAD
Question Text:

Have you EVER HAD a sigmoidoscopy, colonoscopy, or proctoscopy? These are exams in which a health care professional inserts a tube into the rectum to look for signs of cancer or other problems.
*Read if necessary. A proctoscopy is an older exam that used a rigid tube.
*Pronunciation guide: sigmoid-OS-copy, colon-OS-copy, proc-TOS-copy.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 40+
Skip Instructions:

(1) [goto CRE10YR] (2) [goto CRENOT] (R,D) [goto HFOBHAD]

[p. 34]

NAF.550_00.000

Instrument Variable Name: CRE10YR
Question Text:

How many of these exams have you had in the LAST 10 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more exams.

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

Universe Text: Sample adults 40+ who have had a colorectal exam
Skip Instructions:

(0-95,R,D) [goto RCRE1_MT]

NAF.560_01.000

Instrument Variable Name: RCRE1_MT
Question Text:

1 of 2
When did you have your MOST RECENT exam?
*Enter month of last exam.
*Enter '96' to go to number and time period format.

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

Universe Text: Sample adults 40+ who have ever had a colorectal exam
Skip Instructions:

(1-12,D) [goto RCRE1_YR] (R) store "R' in RCRE1_YR [goto RCRE2] (96) store "96" in RCRE1_YR [goto RCRE1N]

[p. 35]

NAF.560_02.000

Instrument Variable Name: RCRE1_YR
Question Text:

2 of 2
*Enter year of last colorectal exam.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Sample adults age 40+ who answered month of last colorectal exam or didn't know month of last colorectal exam
Skip Instructions:

(valid year) if RCRE1_MT=1-12 [goto CRENAM]; else if RCRE1_MT=D [goto RCRE2] (R,D) [goto RCRE2]
IF RCRE1_MT and RCRE1_YR = a future date [goto ERR1_RCRE1_YR]
IF RCRE1_MT and RCRE1_YR = a date prior to birth date [goto ERR2_RCRE1_YR]

NAF.570_01.000

Instrument Variable Name: RCRE1N
Question Text:

1 of 2
When did you have your MOST RECENT exam?
*Enter number for time since last exam.
*Enter '95' for 95 or more.

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

Universe Text: Sample adults 40+ who selected number and time period format for most recent colorectal exam from the initial month screen
Skip Instructions:

(1-95) [goto RCRE1T] (R,D) store "R,D" in RCRE1T [goto RCRE2]

NAF.570_02.000

Instrument Variable Name: RCRE1T
Question Text:

2 of 2
*Enter time period for time since most recent exam.

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

Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto CRENAM]; (4) if RCRE1N and RCRE1T GT 5 years from system date but LE 10 years from system data, fill "5" in RCRE2; if RCRE1N and RCRE1T GT 10 years from system date, fill "6" in RCRE2 [goto CRENAM]; else [goto RCRE2] (R,D) [goto RCRE2]
IF [RCRE1N = Number greater than person years old and RCRE1T= 4]] goto ERR1_RCRE1T

[p. 36]

NAF.575_00.000

Instrument Variable Name: RCRE2
Question Text:

(book) CAN20
Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 years
6 Over 10 years ago
7 Refused
9 Don't know

Card CAN20

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

Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last colorectal exam was over 5 years ago)
Skip Instructions:

(1-6,R,D) [goto CRENAM]

NAF.580_00.000

Instrument Variable Name: CRENAM
Question Text:

(book) CAN21
For a SIGMOIDOSCOPY, a flexible tube is inserted into the rectum to look for problems. A COLONOSCOPY is SIMILAR, but uses a longer tube, and you are usually given medication through a needle in your arm to make you sleepy, and told to have someone else drive you home. A PROCTOSCOPY is an older exam that used a rigid tube.
Was this MOST RECENT exam a sigmoidoscopy, colonoscopy, proctoscopy or something else?
Pronunciation guide: sigmoid-OS-copy, colon-OS-copy, proc-TOS-copy.

Card CAN21

With the sigmoidoscopy (SIG) -

- You are awake
- You are able to drive yourself home
- You are able to resume your normal activities

With the colonoscopy (COL) -

- You are given medicine through a needle in your arm to make you sleepy
- You need someone to drive you home
- You may

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

Universe Text: Sample adults 40+ who have had a colorectal exam
Skip Instructions:

(1-4,R,D) [goto CREREAS]

[p. 37]

NAF.590_00.000

Instrument Variable Name: CREREAS
Question Text:

What was the MAIN reason you had this exam - was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who have had a colorectal exam
Skip Instructions:

(1-3,R,D) if CREHAD=2 or last exam was more than 10 years ago [goto CRENOT] else [goto CREREC]

NAF.600_00.000

Instrument Variable Name: CRENOT
Question Text:

(book) CAN22
What is the most important reason you have [fill1: NEVER had one of these exams/NOT had one of these exams in the LAST 10 YEARS]?

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

Card CAN22

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

Universe Text: (1-2,4-8,10,R,D) [goto CREREC] (3,9) [goto HFOBHAD]
Skip Instructions:

(1-2,4-8,10,R,D) [goto CREREC] (3,9) [goto HFOBHAD]

[p. 38]

NAF.610_00.000

Instrument Variable Name: CREREC
Question Text:

Fill1 (IF CREHAD=1 and most recent screening exam LE 10 years from system date)
Was your most recent test recommended by a doctor or other health professional?
Else (IF CREHAD=2, or CREHAD GT 10 years from system date or RCRE2=R,D)
In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a sigmoidoscopy or colonoscopy?

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who have a doctor or had a colorectal exam in the past 10 years or refused or didn't know date of most recent colorectal exam
Skip Instructions:

(1,2,R,D) [goto HFOBHAD]

NAF.620_00.000

Instrument Variable Name: HFOBHAD
Question Text:

The following questions are about the blood stool or occult blood test, a test to determine whether you have blood in your stool or bowel movement. The blood stool test can be done at home using a kit. You smear a small amount of stool on cards at home and send the cards back to the doctor or lab.
Have you EVER HAD a blood stool test, using a HOME test kit?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 40+
Skip Instructions:

(1) [goto HFOB3YR] (2) [goto HFOBNOT] (R,D) [goto FOBHAD]

NAF.630_00.000

Instrument Variable Name: HFOB3YR
Question Text:

How many HOME blood stool tests have you had in the LAST 3 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more exams.

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

Universe Text: Sample adults 40+ who have had a home blood stool test
Skip Instructions:

(0-95,R,D) [goto RHFO1_MT]

[p. 39]

NAF.640_01.000

Instrument Variable Name: RHFO1_MT
Question Text:

1 of 2
When did you have your MOST RECENT blood stool test using a kit at home?
*Enter month of last test.
*Enter '96' to go to number and time period format.

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

Universe Text: Sample adults 40+ who have ever had a home blood stool test
Skip Instructions:

(1-12,D) [goto RHFO1_YR] (R) store "R' in RHFO1_YR [goto RHFO2] (96) store "96" in RHFO1_YR [goto RHFO1N]

NAF.640_02.000

Instrument Variable Name: RHFO1_YR
Question Text:

2 of 2
*Enter year of last home blood stool test.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Sample adults age 40+ who answered month of last home blood stool test or didn't know month of last test
Skip Instructions:

(valid year) if RHFO1_MT=1-12 [goto HFOBREAS]; else if RHFO1_MT=D [goto RHFO2] (R,D) [goto RHFO2]
IF RHFO1_MT and RHFO1_YR = a future date [goto ERR1_RHFO1_YR]
IF RHFO1_MT and RHFO1_YR = a date prior to birth date [goto ERR2_RHFO1_YR]

[p. 40]

NAF.650_01.000

Instrument Variable Name: RHFO1N
Question Text:

1 of 2
When did you have your MOST RECENT blood stool test using a kit at home?
*Enter number for time since last test.
*Enter '95' for 95 or more.

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

Universe Text: Sample adults 40+ who selected number and time period format for most recent home blood stool test from the initial month screen
Skip Instructions:

(1-95) [goto RHFO1T] (R,D) store "R,D" in RHFO1T [goto RHFO2]

NAF.650_02.000

Instrument Variable Name: RHFO1T
Question Text:

2 of 2
*Enter time period for time since most recent home blood stool test.

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

Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto HFOBREAS]; (4) if RHFO1N and RHFO1T GT 5 years from system date but LE 10 years from system data, fill "5" in RHFO2; if RHFO1N and RHFO1T GT 10 years from system date, fill "6" in RHFO2 [goto HFOBREAS]; else [goto RHFO2] (R,D) [goto RHFO2] IF [RHFO1N = Number greater than person years old and RHFO1T= 4]] goto ERR1_RHFO1T

[p. 41]

NAF.655_00.000

Instrument Variable Name: RHFO2
Question Text:

(book) CAN20
Was it:
*Read answer categories.

Card CAN20

Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last home blood stool test was over 5 years ago)
Skip Instructions:

(1-6,R,D) [goto HFOBREAS]

NAF.660_00.000

Instrument Variable Name: HFOBREAS
Question Text:

What was the MAIN reason you had this exam - was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who have had a home blood stool test
Skip Instructions:

(1-3,R,D) [goto HFOBABN]

NAF.670_00.000

Instrument Variable Name: HFOBABN
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 40+ who have ever had a home blood stool test
Skip Instructions:

(1) [goto HFOREC] (2,R,D) if home blood stool test was 1 year ago or less [goto MDHFOB]; else if last home blood stool test was more than 11 years ago [goto HFOBNOT]

[p. 42]

NAF.672_00.000

Instrument Variable Name: HFOREC
Question Text:

Was this your most recent test?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who have had an abnormal home blood stool test
Skip Instructions:

(1) [goto HFOBTEST] (2,R,D) if home blood stool test was 1 years ago or less [goto MDHFOB]; else if last home blood stool test was more than 1 years ago [goto HFOBNOT]

NAF.680_00.000

Instrument Variable Name: HFOBTEST
Question Text:

Because of these results, what additional tests or surgery did you have?
*Enter all that apply, separate with commas.

0 None
1 Another Fecal Occult Blood Test
2 Sigmoidoscopy
3 Colonoscopy
4 Barium enema
5 Surgery
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who had surgery as a result of most recent home blood stool test
Skip Instructions:

(0-5,R,D) if home blood stool test was 1 year agoor less [goto MDHFOB]; else if last home blood stool test was more than 1 year ago [goto HFOBNOT]

[p. 43]

NAF.690_00.000

Instrument Variable Name: HFOBNOT
Question Text:

(book) CAN22
What is the most important reason you have [fill1: NEVER had a HOME blood stool test/NOT had a HOME blood stool test in the LAST YEAR]?

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

Card CAN22

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

Universe Text:
Skip Instructions:

(1,2,4-8,10,R,D) [goto MDHFOB] (3,9) [goto FOBHAD]

NAF.700_00.000

Instrument Variable Name: MDHFOB
Question Text:

IFill1 (IF HFOBHAD=1 and most recent screening exam LE 1 year from system date)
Was your most recent HOME blood stool test recommended by a doctor or other health professional?
Else (IF HFOBHAD=2, or HFOBHAD GT 1 year from system date or RHFO2=R,D)
In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a HOME blood stool test?

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who have a doctor and had a home blood stool test in the past 10 years
Skip Instructions:

(1-3,R,D) [goto FOBHAD]

NAF.710_00.000

Instrument Variable Name: FOBHAD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 40+
Skip Instructions:

(1) [goto RFOB1_MT]
(2, R, D) [goto Genetic Test]

[p. 44]

NAF.720_01.000

Instrument Variable Name: RFOB1_MT
Question Text:

1 of 2
When did you have your MOST recent OFFICE blood stool test?
*Enter month of last test.
*Enter '96' to go to number and time period format.

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

Universe Text: Sample adults 40+ who have ever had a office blood stool test
Skip Instructions:

(1-12,D) [goto RFOB1_YR] (R) store "R' in RFOB1_YR [goto RFOB2] (96) store "96" in RFOB1_YR [goto RFOB1N]

NAF.720_02.000

Instrument Variable Name: RFOB1_YR
Question Text:

*Enter year of last office blood stool test.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Sample adults 40+ who answered month of last office blood stool test or didn't know month of last office blood stool test
Skip Instructions:

(valid year) if RFOB1_MT=1-12 [goto next section]; else if RFOB1_MT=D [goto RFOB2] (R,D) [goto RFOB2]
IF RFOB1_MT and RFOB1_YR = a future date [goto ERR1_RFOB1_YR]
IF RFOB1_MT and RFOB1_YR = a date prior to birth date [goto ERR2_RFOB1_YR]

[p. 45]

NAF.730_01.000

Instrument Variable Name: RFOB1N
Question Text:

1 of 2
When did you have your MOST recent OFFICE blood stool test?
*Enter number for time since last test.
*Enter '95' for 95 or more.

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

Universe Text: Sample adults 40+ who selected number and time period format for most recent office blood stool test from the initial month screen
Skip Instructions:

(1-95) [goto RFOB1T] (R,D) store "R,D" in RFOB1T [goto RFOB2]

NAF.730_02.000

Instrument Variable Name: RFOB1T
Question Text:

2 of 2
*Enter time period for time since most recent office blood stool test.

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

Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:

(1-3) [goto next section]; (4) if RFOB1N and RFOB1T GT 5 years from system date but LE 10 years from system data, fill "5" in RFOB2; if RFOB1N and RFOB1T GT 10 years from system date, fill "6" in RFOB2 [goto next section]; else [goto RFOB2] (R,D) [goto RFOB2]
IF [RFOB1N = Number greater than person years old and RFOB1T= 4]] goto ERR1_RFOB1T

[p. 46]

NAF.735_00.000

Instrument Variable Name: RFOB2
Question Text:

(book) CAN20
Was it:
*Read answer categories.

Card CAN20

Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last office blood stool test was over 5 years ago)
Skip Instructions:

(1-6,R,D) [goto next section]

[p. 1]

2005 NHIS Questionnaire - Sample Adult
Genetic Testing

NAG.010_00.000

Instrument Variable Name: GTHEARD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto GTPOSS] (2,R,D) [goto GTCCOM]

NAG.020_00.000

Instrument Variable Name: GTPOSS
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever heard of genetic testing
Skip Instructions:

(1) [goto GTADVISE] (2,R,D) [goto GTGRISK]

NAG.025_00.000

Instrument Variable Name: GTADVISE
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who discussed getting genetic test with doctor or other health professional
Skip Instructions:

(1,2,R,D) [goto GTGRISK]

[p. 2]

NAG.030_00.000

Instrument Variable Name: GTGRISK
Question Text:

Have you EVER HAD a genetic test to determine if you are at greater risk of developing cancer in the FUTURE?
*Read if necessary. This does not include any test to see whether you had cancer in the PAST or have cancer NOW.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever heard of a genetic test
Skip Instructions:

(1) [if SEX=1 goto GTCOL; else goto GTBRE] (2,R,D) [goto GTCCOM]

NAG.040_01.000

Instrument Variable Name: GTBRE
Question Text:

Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Breast?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have ever had a genetic test
Skip Instructions:

(1,2,R,D) [goto GTOVA]

NAG.040_02.000

Instrument Variable Name: GTOVA
Question Text:

*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Ovarian?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+ who have ever had a genetic test
Skip Instructions:

(1,2,R,D) [goto GTCOL]

[p. 3]

NAG.040_03.000

Instrument Variable Name: GTCOL
Question Text:

Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Colon or rectal?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:

(1,2,R,D) [goto GTOTH]

NAG.040_04.000

Instrument Variable Name: GTOTH
Question Text:

*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Another type of cancer?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:

(1) [goto GTRSKOTH] (2,R,D) [goto GTRSK_MT]

NAG.044_00.000

Instrument Variable Name: GTRSKOTH
Question Text:

*Specify other test for genetic risk of cancer.

7 Refused
9 Don't know
verbatim Verbatim response

Universe Text: Male sample adutls 18+ who have had a genetic test for another type of cancer
Skip Instructions:

(allow 20,R,D) [goto GTRSK_MT]

[p. 4]

NAG.050_01.000

Instrument Variable Name: GTRSK_MT
Question Text:

1 of 2
When did you have this genetic test done?
*Enter month of genetic test.
*Enter '96' to go to number and time period format.

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

Universe Text: Sample adults 18+ who have had a genetic test for cancer
Skip Instructions:

(1-12,D) [goto GTRSK_YR] (R) store "R' in GTRSK_YR [goto GTINSURE ] (96) store "9996" in GTRSK_YR [goto GTRSKN]

NAG.050_02.000

Instrument Variable Name: GTRSK_YR
Question Text:

2 of 2
*Enter year of genetic test.

1880-2006 1880-2006
9996 Time period format
9997 Refused
9999 Don't know

Universe Text: Sample adults 18+ who gave a month for their genetic test date or who didn't know the month
Skip Instructions:

(valid year),R,D [goto GTINSURE] IF GTRSK_MT and GTRSK_YR = a future date [goto ERR1_GTRSK_YR]
IF GTRSK_MT and GTRSK_YR = a date prior to birth date [goto ERR2_GTRSK_YR]

[p. 5]

NAG.055_01.000

Instrument Variable Name: GTRSKN
Question Text:

1 of 2
When did you have this genetic test done?
*Enter number for time since genetic test.
*Enter '95' for 95 or more.

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

Universe Text: Sample adults 18+ who requested the time period format at GTRSK_MT
Skip Instructions:

(1-95) [goto GTRSKT]; (R,D) [store 'R,D" in GTRSKT, goto GTINSURE]

NAG.055_02.000

Instrument Variable Name: GTRSKT
Question Text:

2 of 2
*Enter time period for time since genetic test.

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

Universe Text: Sample adults 18+ who answered 1-95 for the number part of this 2-part question
Skip Instructions:

(1-4,R,D) [goto GTINSURE] [if [GTRSKN = number greater than person years old and GTRSKT=4]] goto ERR1_GTRSKT

NAG.060_00.000

Instrument Variable Name: GTINSURE
Question Text:

Do you believe that getting a genetic test for cancer risk has or will affect your health insurance coverage?
*Read if necessary. Effects include losing your health insurance coverage or not being eligible for health insurance if you change jobs or move.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have had a genetic test for cancer.
Skip Instructions:

(1,2,D,R) [goto GTCCOM]

[p. 6]

NAG.070_00.000

Instrument Variable Name: GTCCOM
Question Text:

Compared to the average {man/woman} your age, would you say that you are more likely to get cancer, less likely, or about as likely?
*Read if necessary.
For a cancer survivor, this means getting another cancer in the future.

1 More likely to get cancer
2 Less likely
3 About as likely
7 Refused
9 Don't know

Universe Text: Sample adults age 18+
Skip Instructions:

(1,2,3,R,D) [goto GTCCLOM]

NAG.080_00.000

Instrument Variable Name: GTCCLOM
Question Text:

Compared to the average {man/woman} your age, would you say that you are more likely to get colon or rectal cancer, less likely, or about as likely?
*Read if necessary.
For a cancer survivor, this means getting another cancer in the future.

1 More likely to get colon or rectal cancer
2 Less likely
3 About as likely
7 Refused
9 Don't know

Universe Text: Sample adults age 18+
Skip Instructions:

(1,2,3,R,D) [if SEX=1 goto next section; else if SEX=2 goto GTCBOM]

NAG.090_00.000

Instrument Variable Name: GTCBOM
Question Text:

Compared to the average woman your age, would you say that you are more likely to get breast cancer, less likely, or about as likely?
*Read if necessary.
For a cancer survivor, this means getting another cancer in the future.

1 More likely to get breast cancer
2 Less likely
3 About as likely
7 Refuse
9 Don't know

Universe Text: Female sample adult age 18+
Skip Instructions:

(1,2,3,R,D) [goto next section]

[p. 1]

2005 NHIS Questionnaire - Sample Adult
Family History

NAH.010_00.000

Instrument Variable Name: FHFCAN
Question Text:

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

1 Yes
2 No
3 Adopted or don't know biological father
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto FHFTYP_1]
(2,3,R,D) [goto FHMCAN]

[p. 2]

NAH.020_00.001

Instrument Variable Name: FHFTYP_1
Question Text:

What kind of cancer did your father have?
*Enter code for the first kind of cancer.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose father ever had cancer
Skip Instructions:

(1-5,7-17,19-28,30,RF,DK) goto FHFAGE1
(6,18,29) goto ERR_FHFTYP_1

[p. 3]

NAH.020_00.002

Instrument Variable Name: FHFTYP_2
Question Text:

*Enter code for the second kind of cancer.
*Enter '96' for no more.

Universe Text: Sample adults 18+ who either provided an age range for a first kind of cancer or didn't know how old father was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to give first kind of cancer
Skip Instructions:

(1-5,7-17,19-28,30,R,D) if FHFTYP_2 = FHFTYP_1 [goto ERR2_FHFTYP_2]; else [goto FHFAGE2]
(96) [goto FHMCAN]
(6,18,29) [goto ERR1_FHFTYP_2]

[p. 4]

NAH.020_00.003

Instrument Variable Name: FHFTYP_3
Question Text:

*Enter code for the third kind of cancer.
*Enter '96' for no more.

Universe Text: Sample adults 18+ who either provided an age range for a second kind of cancer or didn't know how old father was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to give a second type of cancer
Skip Instructions:

(1-5,7-17,19-28,30,R,D) if FHFTYP_3 = FHFTYP_1 or FHFTYP_2 [goto ERR2_FHFTYP_3]; else [goto FHFAGE3]
(96) [goto FHMCAN]
(6,18,29) [goto ERR1_FHFTYP_3]

[p. 5]

NAH.020_00.004

Instrument Variable Name: FHFTYP_4
Question Text:

*Enter '95' if respondent offers more than 3 kinds of cancer.
*Enter '96' for no more.

95 More than 3 kinds
96 No more

Universe Text: Sample adults 18+ who either provided an age range for a third kind of cancer or didn't know how old father was when first diagnosed that kind of cancer or else refused to provide an age range but had not refused to give a third kind of cancer
Skip Instructions:

(95,96) [goto FHMCAN]
(1-30) [goto ERR_FHFTYP_4]

NAH.030_00.001

Instrument Variable Name: FHFAGE1
Question Text:

Was your biological father under 50 years of age when [Fill: FHFTYP_1] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who selected a first kind of cancer for father or refused to answer or didn't know kind of cancer
Skip Instructions:

(1,2,D) [goto FHFTYP_2]
(R) and (R) at FHFTYP_1 [goto FHMCAN]
(R) and FHFTYP_1 NE (R) [goto FHFTYP_2]

NAH.030_00.002

Instrument Variable Name: FHFAGE2
Question Text:

Was your biological father under 50 years of age when [Fill: FHFTYP_2] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who selected a second kind of cancer for father or refused to answer or didn't know kind of cancer
Skip Instructions:

(1,2,D) [goto FHFTYP_3]
(R) and (R) at FHFTYP_2 [goto FHMCAN]
(R) and FHFTYP_2 NE (R) [goto FHFTYP_3]

NAH.030_00.003

Instrument Variable Name: FHFAGE3
Question Text:

Was your biological father under 50 years of age when [Fill: FHFTYP_3] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who selected a third kind of cancer for father or refused to answer or didn't know kind of cancer
Skip Instructions:

(1,2,D) [goto FHFTYP_4]
(R) and (R) at FHFTYP_3 [goto FHMCAN]
(R) and FHFTYP_3 NE (R) [goto FHFTYP_4]

NAH.040_00.000

Instrument Variable Name: FHMCAN
Question Text:

Did your BIOLOGICAL MOTHER EVER have cancer of any kind?

1 Yes
2 No
3 Adopted or don't know biological mother
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [goto FHMTYP_1]
(2,3,R,D) [goto FHBNUM]

[p. 7]

NAH.050_00.001

Instrument Variable Name: FHMTYP_1
Question Text:

What kind of cancer did your mother have?
*Enter code for the first kind of cancer.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose mother ever had cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) [goto FHMAGE1]
(20,26) [goto ERR_FHMTYP_1]

[p. 8]

NAH.050_00.002

Instrument Variable Name: FHMTYP_2
Question Text:

*Enter code for the second kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who either provided an age range for a first kind of cancer or didn't know how old mother was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer a first kind of cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) if FHMTYP_2 = FHMTYP_1 [goto ERR2_FHMTYP_2]; else [goto FHMAGE2]
(96) [goto FHBNUM]
(20,26) [goto ERR1_FHMTYP_2]

[p. 9]

NAH.050_00.003

Instrument Variable Name: FHMTYP_3
Question Text:

*Enter code for the third kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who either provided an age range for a second kind of cancer or didn't know how old mother was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer a second kind of cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) if FHMTYP_3 = FHMTYP_1 or FHMTYP_2 [goto ERR2_FHMTYP_3]; else [goto FHMAGE3]
(96) [goto FHBNUM]
(20,26) [goto ERR1_FHMTYP_3]

[p. 10]

NAH.050_00.004

Instrument Variable Name: FHMTYP_4
Question Text:

*Enter '95' if respondent offers more than 3 kinds of cancer.
*Enter '96' for no more.

95 More than 3 kinds
96 No more

Universe Text: Sample adults 18+ who either provided an age range for a third kind of cancer or didn't know how old mother was when first diagnosed with that kind of cancer or else refused to provide an age range but had not refused to answer a third kind of cancer
Skip Instructions:

(95,96) [goto FHBNUM]
(1-30) [goto ERR_FHMTYP_4]

NAH.060_00.001

Instrument Variable Name: FHMAGE1
Question Text:

Was your biological mother under 50 years of age when [Fill: FHMTYP_1] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who selected a first kind of cancer for mother or refused to answer or didn't know kind of cancer
Skip Instructions:

(1,2,D) [goto FHFMYP_2]
(R) and (R) at FHMTYP_1 [goto FHBCAN]
(R) and FHMTYP_1 NE (R) [goto FHMTYP_2]

NAH.060_00.002

Instrument Variable Name: FHMAGE2
Question Text:

Was your biological mother under 50 years of age when [Fill: FHMTYP_2] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who selected a second kind of cancer for mother or refused to answer or didn't know kind of cancer
Skip Instructions:

(1,2,D) [goto FHMTYP_3]
(R) and (R) at FHMTYP_2 [goto FHBCAN]
(R) and FHMTYP_2 NE (R) [goto FHMTYP_3]

NAH.060_00.003

Instrument Variable Name: FHMAGE3
Question Text:

Was your biological mother under 50 years of age when [Fill: FHMTYP_3] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who selected a third kind of cancer for mother or refused to answer or didn't know kind of cancer
Skip Instructions:

(1,2,D) [goto FHMTYP_4]
(R) and (R) at FHMTYP_3 [goto FHBNUM]
(R) and FHMTYP_3 NE (R) [goto FHMTYP_4]]

NAH.070_00.000

Instrument Variable Name: FHBNUM
Question Text:

FULL BROTHERS have the same biological mother and father as you. How many FULL BROTHERS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more brothers.

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0,R,D) [goto FHSNUM]
(1-21)[goto FHBCAN]

[p. 12]

NAH.080_00.000

Instrument Variable Name: FHBCAN
Question Text:

[Fill1: Did your BROTHER EVER have cancer of any kind?
*Enter '0' if brother has not had any kind of cancer.
*Enter '1' if brother has had cancer.]
[Fill2: How many of your BROTHERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have at least one full brother
Skip Instructions:

(0,R,D) [goto FHSNUM]
(1-21) if FHBCAN GT FHBNUM [goto ERR_FHBCAN]; else [goto FHBTYP_1]

[p. 13]

NAH.090_00.001

Instrument Variable Name: FHBTYP_1
Question Text:

What kinds of cancer did your [Fill1: brother/Fill2: brothers] have?
*Enter code for the first kind of cancer.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose brother(s) ever had cancer
Skip Instructions:

(1-5,7-17,19-28,30,R,D) if FHBCAN = 1 [goto FHBAGE1]; else [goto FHBMAN1]
(6,18,29) [goto ERR_FHBTYP_1]

[p. 14]

NAH.090_00.002

Instrument Variable Name: FHBTYP_2
Question Text:

*Enter code for the second kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who provided age range for brother(s) diagnosed with the first kind of cancer or didn't know how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:

(1-5,7-17,19-28,30,R,D) if FHBTYP_2 = FHBTYP_1 [goto ERR2_FHBTYP_2]; elseif FHBCAN = '1' [goto FHBAGE2]; else [goto FHBMAN2]
(96) [goto FHSNUM]
(6,18,29) [goto ERR1_FHBTYP_2]

[p. 15]

NAH.090_00.003

Instrument Variable Name: FHBTYP_3
Question Text:

*Enter code for the third kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who provided age range for brother(s) diagnosed with the second kind of cancer or didn't know how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:

(1-5,7-17,19-28,30,R,D) if FHBTYP_3 = FHBTYP_1 or FHBTYP_2 [goto ERR2_FHBTYP_3]; elseif FHBCAN = '1' [goto FHBAGE3]; else [goto FHBMAN3]
(96) [goto FHSNUM]
(6,18,29) [goto ERR1_FHBTYP_3]

[p. 16]

NAH.090_00.004

Instrument Variable Name: FHBTYP_4
Question Text:

*Enter '95' if respondent offers more than 3 kinds of cancer.
*Enter '96' for no more.

95 More than 3 kinds
96 No more

Universe Text: Sample adults 18+ who provided age range for brother(s) diagnosed with the third kind of cancer or didn't know how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the third kind of cancer
Skip Instructions:

(95,96) [goto FHSNUM]
(1-30) goto [ERR_FHBTYP_4]

NAH.091_00.000

Instrument Variable Name: FHBMAN1
Question Text:

How many brothers have had [Fill: FHBTYP_1]?
*Enter '21' for 21 or more brothers.

01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have brothers with a first kind of cancer
Skip Instructions:

(1-21) if FHBMAN1 GT FHBCAN [goto ERR_FHBMAN1]; else [goto FHBAGE1]
(R,D) [goto FHBAGE1]

[p. 17]

NAH.092_00.000

Instrument Variable Name: FHBAGE1
Question Text:

[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_1] was first diagnosed?
*Enter '0' if brother was not under 50.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose brother(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:

(0-21) if FHBMAN1 NE 'Refused' and FHBMAN1 NE D and FHBAGE1 GT FHBMAN1 [goto ERR1_FHBAGE1]; elseif FHBMAN1 = R or FHBMAN1 = D and FHBAGE1 GT FHBCAN [goto ERR2_FHBAGE1]; else [goto FHBTYP_2]
(D) [goto FHBTYP_2]
(R) and (R) at FHBTYP_1 [goto FHSNUM]
(R) and FHBTYP_1 NE (R) [goto FHBTYP_2]

NAH.093_00.000

Instrument Variable Name: FHBMAN2
Question Text:

How many brothers have had [Fill: FHBTYP_2]?
*Enter '21' for 21 or more brothers.

01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have brothers with a second kind of cancer
Skip Instructions:

(1-21) if FHBMAN2 GT FHBCAN [goto ERR_FHBMAN2]; else [goto FHBAGE2]
(R,D) [goto FHBAGE2]

[p. 18]

NAH.094_00.000

Instrument Variable Name: FHBAGE2
Question Text:

[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_2] was first diagnosed?
*Enter '0' if brother was not under 50.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose brother(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:

(0-21) if FHBMAN2 NE R and FHBMAN2 ne D' and FHBAGE2 GT FHBMAN2 [goto ERR1_FHBAGE2]; elseif (FHBMAN2 = R or FHBMAN2 = D) and FHBAGE2 GT FHBCAN [goto ERR2_FHBAGE2]; else [goto FHBTYP_3]
(D) [goto FHBTYP_3]
(R) and (R) at FHBTYP_2 [goto FHSNUM]
(R) and FHBTYP_2 NE (R) [goto FHBTYP_3]

NAH.095_00.000

Instrument Variable Name: FHBMAN3
Question Text:

How many brothers have had [Fill: FHBTYP_3]?
*Enter '21' for 21 or more brothers.

01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have brothers with a third kind of cancer
Skip Instructions:

(1-21) if FHBMAN3 GT FHBCAN [goto ERR_FHBMAN3]; else [goto FHBAGE3]
(R,D) [goto FHBAGE3]

[p. 19]

NAH.096_00.000

Instrument Variable Name: FHBAGE3
Question Text:

[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' if brother was not under 50.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose brother(s) had a third kind of cancer or refused or didn't know name of third kind of cancer
Skip Instructions:

(0-21) if FHBMAN3 NE R and FHBMAN3 NE D and FHBAGE3 GT FHBMAN3 [goto ERR1_FHBAGE3]; elseif (FHBMAN3 = R or FHBMAN3 = D) and FHBAGE3 GT FHBCAN [goto ERR2_FHBAGE3]; else [goto FHBTYP_4]
(D) [goto FHBTYP_4]
(R) and (R) at FHBTYP_3 [goto FHSNUM]
(R) and FHBTYP_3 NE (R) [goto FHBTYP_4]

NAH.100_00.000

Instrument Variable Name: FHSNUM
Question Text:

FULL SISTERS have the same biological mother and father as you. How many FULL SISTERS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more sisters.

00 None
1-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0,R,D) [goto FHNNUM]
(1-21) [goto FHSCAN]

[p. 20]

NAH.110_00.000

Instrument Variable Name: FHSCAN
Question Text:

[Fill1: Did your SISTER EVER have cancer of any kind?
*Enter '0' if sister has not had any kind of cancer.
*Enter '1' if sister has had cancer.]
[Fill2: How many of your SISTERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have at least one full sister
Skip Instructions:

(0,R,D) [goto FHNNUM]
(1-21) if FHSCAN gt FHSNUM [goto ERR_FHSCAN]; else [goto FHSTYP_1]

[p. 21]

NAH.120_00.001

Instrument Variable Name: FHSTYP_1
Question Text:

What kind of cancer did your [Fill1: sister/Fill2: sisters] have?
*Enter code for the first kind of cancer.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose sister(s) ever had cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) if FHSCAN = 1 [goto FHSAGE1]; else [goto FHSMAN1]
(20,26) [goto ERR_FHSTYP_1]

[p. 22]

NAH.120_00.002

Instrument Variable Name: FHSTYP_2
Question Text:

*Enter code for the second kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who provided age range for sister(s) diagnosed with the first kind of cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) if FHSTYP_2 = FHSTYP_1 [goto ERR2_FHSTYP_2]; elseif FHSCAN = 1 [goto FHSAGE2]; else [goto FHSMAN2]
(96) [goto FHNNUM]
(20,26) [goto ERR1_FHSTYP_2]

[p. 23]

NAH.120_00.003

Instrument Variable Name: FHSTYP_3
Question Text:

*Enter code for the third kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who provided age range for sister(s) diagnosed with the second kind of cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) if FHSTYP_2 = FHSTYP_1 or FHSTYP_2 [goto ERR2_FHSTYP_3]; elseif FHSCAN = 1 [goto FHSAGE3]; else [goto FHSMAN3]
(96) [goto FHNNUM]
(20,26) [goto ERR1_FHSTYP_3]

[p. 24]

NAH.120_00.004

Instrument Variable Name: FHSTYP_4
Question Text:

*Enter '95' if respondent offers more than 3 kinds of cancer.
*Enter '96' for no more.

95 More than 3 kinds
96 No more

Universe Text: Sample adults 18+ who provided age range for sister(s) diagnosed with the third kind of cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the third kind of cancer
Skip Instructions:

(95,96) [goto FHNNUM]
(1-30) [goto ERR_FHSTYP_4]

NAH.121_00.000

Instrument Variable Name: FHSMAN1
Question Text:

How many sisters have had [Fill: FHSTYP_1]?
*Enter '21' for 21 or more sisters.

01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have sisters with a first kind of cancer
Skip Instructions:

(1-21) if FHSMAN1 GT FHSCAN [goto ERR_FHSMAN1]; else [goto FHSAGE1]
(R,D) [goto FHSAGE1]

NAH.122_00.000

Instrument Variable Name: FHSAGE1
Question Text:

[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_1] was first diagnosed?
*Enter '0' if sister was not under 50.
*Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose sister(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:

(0-21) if FHSMAN1 NE R and FHSMAN1 NE D and FHSAGE1 GT FHSMAN1 [goto ERR1_FHSAGE1]; elseif (FHSMAN1 = 'Refused' or FHSMAN1 = D) and FHSAGE1 GT FHSCAN [goto ERR2_FHSAGE1]; else [goto FHSTYP_2]
(D) [goto FHSTYP_2]
(R) and (R) at FHSTYP_1 [goto FHNNUM]
(R) and FHSTYP_1 NE (R) [goto FHSTYP_2]

[p. 25]

NAH.123_00.000

Instrument Variable Name: FHSMAN2
Question Text:

How many sisters have had [Fill: FHSTYP_2]?
*Enter '21' for 21 or more sisters.

01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have sisters with a second kind of cancer
Skip Instructions:

(1-21) if FHSMAN2 GT FHSCAN [goto ERR_FHSMAN2]; else [goto FHSAGE2]
(R,D) [goto FHSAGE2]

NAH.124_00.000

Instrument Variable Name: FHSAGE2
Question Text:

[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_2] was first diagnosed?
*Enter '0' if sister was not under 50.
*Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose sister(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:

(0-21) if FHSMAN2 NE R and FHSMAN2 NE D and FHSAGE2 GT FHSMAN2 [goto ERR1_FHSAGE2]; elseif (FHSMAN2 = R or FHSMAN2 = D) and FHSAGE2 GT FHSCAN [goto ERR2_FHSAGE2]; else [goto FHSTYP_3]
(D) [goto FHSTYP_3]
(R) and (R) at FHSTYP_2 [goto FHNNUM]
(R) and FHSTYP_2 NE (R) [goto FHSTYP_3]

[p. 26]

NAH.125_00.000

Instrument Variable Name: FHSMAN3
Question Text:

How many sisters have had [Fill1: FHSTYP_3]?
*Enter '21' for 21 or more sisters.

01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have sisters with a third kind of cancer
Skip Instructions:

(1-21) if FHSMAN3 GT FHSCAN [goto ERR_FHSMAN3]; else [goto FHSAGE3]
(R,D) [goto FHSAGE3]

NAH.126_00.000

Instrument Variable Name: FHSAGE3
Question Text:

[Fill1: Was your sister under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' if sister was not under 50.
*Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose sister(s) had a third kind of cancer or refused or didn't know name of third kind of cancer
Skip Instructions:

(0-21) if FHSAGE3 GT FHSMAN3 [goto ERR_FHSAGE3]; elseif (FHSMAN3 = R or FHSMAN3 = D) and FHSAGE3 GT FHSCAN [goto ERR2_FHSAGE3]; else [goto FHSTYP_4]
(D) [goto FHSTYP_4]
(R) and (R) at FHSTYP_3 [goto FHNNUM]
(R) and FHSTYP_3 NE (R) [goto FHSTYP_4]

[p. 27]

NAH.130_00.000

Instrument Variable Name: FHNNUM
Question Text:

How many BIOLOGICAL SONS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more biological sons.
*Enter '96' for no biological children.

00 None
01-20 1-20 sons
21 21+
96 No biological children
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0,R,D) [goto FHDNUM]
(1-21)[goto FHNCAN]
(22-95) [goto ERR_FHNNUM]
(96) [goto next section]

NAH.140_00.000

Instrument Variable Name: FHNCAN
Question Text:

[Fill1: Did your SON EVER have cancer of any kind?
*Enter '0' if son has not had any kind of cancer.
*Enter '1' if son has had cancer.]
[Fill2: How many of your SONS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]

00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have at least one biological son
Skip Instructions:

(0,R,D) [goto FHDNUM]
(1-21) if FHNCAN gt FHNNUM [goto ERR_FHNCAN]; else [goto FHNTYP_1]

[p. 28]

NAH.150_00.001

Instrument Variable Name: FHNTYP_1
Question Text:

What kinds of cancer did your [Fill1: son/Fill2: sons] have?
*Enter code for the first kind of cancer.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose sons(s) ever had cancer
Skip Instructions:

(1-5,7-17,19-28,30,R,D) if FHNCAN = 1 [goto FHNAGE1]; else [goto FHNMAN1]
(6,18,29) [goto ERR_FHNTYP_1]

[p. 29]

NAH.150_00.002

Instrument Variable Name: FHNTYP_2
Question Text:

*Enter code for the second kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who provided age range for son(s) diagnosed with the first kind of cancer or didn't know how old sons(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:

(1-5,7-17,19-28,30,R,D) if FHNTYP_2 = FHNTYP_1 [goto ERR2_FHNTYP_2]; elseif FHNCAN = 1 [goto FHNAGE2]; else [goto FHNMAN2]
(96) goto [FHDNUM] (6,18,29) [goto ERR1_FHNTYP_2]

[p. 30]

NAH.150_00.003

Instrument Variable Name: FHNTYP_3
Question Text:

*Enter '95' if respondent offers more than 2 kinds of cancer.
*Enter '96' for no more.

95 More than 2 kinds
96 No more

Universe Text: Sample adults 18+ who provided age range for son(s) diagnosed with the second kind of cancer or didn't know how old son(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:

(95,96) [goto FHDNUM]
(1-30) [goto ERR_FHNTYP_3]

NAH.151_00.000

Instrument Variable Name: FHNMAN1
Question Text:

How many sons have had [Fill1: FHNTYP_1]?
*Enter '21' for 21 or more sons.

01-20 1-20 sons
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have sons with a first kind of cancer
Skip Instructions:

(1-21) if FHNMAN1 GT FHNCAN [goto ERR_FHNMAN1]; else [goto FHNAGE1] (R,D) [goto FHNAGE1]

[p. 31]

NAH.152_00.000

Instrument Variable Name: FHNAGE1
Question Text:

[Fill1: Was your son under 50 years of age when [Fill3: FHNTYP_1] was first diagnosed?
*Enter '0' if son was not under 50.
*Enter '1' if son was under 50.]
[Fill2: How many of these sons were under 50 years of age when [Fill3: FHNTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]

00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose son(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:

(0-21) if FHNMAN1 NE R and FHNMAN1 NE D and FHNAGE1 GT FHNMAN1 [goto ERR2_FHNAGE1]; elseif (FHNMAN1 = R or FHNMAN1 = D) and FHNAGE1 GT FHNCAN [goto ERR3_FHNAGE1]; elseif AGE LE 55 and FHNMAN1 NE 'Refused' and FHNMAN1 NE 'Don't know' and FHNAGE1 LT FHNMAN1 [goto
ERR1_FHNAGE1]; elseif AGE LE 55 and(FHNMAN1 = R or FHNMAN1 = D) and FHNAGE1 = 0 [goto ERR1_FHNAGE1] else [goto FHNTYP_2] (D) [goto FHNTYP_2]
(R) and (R) at FHNTYP_1 [goto FHDNUM]
(R) and FHNTYP_1 NE (R) [goto FHNTYP_2]

NAH.153_00.000

Instrument Variable Name: FHNMAN2
Question Text:

How many sons have had [Fill: FHNTYP_2]?
*Enter '21' for 21 or more sons.

01-20 1-20 sons
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have sons with a second kind of cancer
Skip Instructions:

(1-21) if FHNMAN2 GT FHNCAN [goto ERR_FHNMAN2]; else [goto FHNAGE2]
(R,D) [goto FHNAGE2]

[p. 32]

NAH.154_00.000

Instrument Variable Name: FHNAGE2
Question Text:

[Fill1: Was your son under 50 years of age when [Fill3: FHNTYP_2] was first diagnosed?
*Enter '0' if son was not under 50.
*Enter '1' if son was under 50.]
[Fill2: How many of these sons were under 50 years of age when [Fill3: FHNTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]

00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose sons(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:

(0-21) if FHNMAN2 NE R and FHNMAN2 NE D and FHNAGE2 GT FHNMAN2 [goto ERR2_FHNAGE2]; elseif (FHNMAN2 = R or FHNMAN2 = D) and FHNAGE2 GT FHNCAN [goto ERR3_FHNAGE2]; elseif AGE LE '55' and FHNMAN2 NE R and FHNMAN2 NE D and FHNAGE2 LT FHNMAN1 [goto ERR1_FHNAGE2]; elseif AGE LE '55' and (FHNMAN2 = R or FHNMAN2 = D) and FHNAGE2 = 0 [goto ERR1_FHNAGE2]; else [goto FHNTYP_3]
(D) [goto FHNTYP_3]
(R) and (R) at FHNTYP_2 [goto FHDNUM]
(R) and FHNTYP_2 NE (R) [goto FHNTYP_3]

NAH.160_00.000

Instrument Variable Name: FHDNUM
Question Text:

How many BIOLOGICAL DAUGHTERS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more biological daughters.

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who did not say they did not have any biological children at the 'number of biological sons' question
Skip Instructions:

(0,R,D) [goto next section]
(1-21) goto [FHDCAN]

[p. 33]

NAH.170_00.000

Instrument Variable Name: FHDCAN
Question Text:

[Fill1: Did your DAUGHTER EVER have cancer of any kind?
*Enter '0' if daughter has not had any kind of cancer.
*Enter '1' if daughter has had cancer.]
[Fill2: How many of your DAUGHTERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have at least one biological daughter
Skip Instructions:

(0,R,D) [goto next section]
(1-21) if FHDCAN gt FHDNUM [goto ERR_FHDCAN]; else [goto FHDTYP_1]

[p. 34]

NAH.180_00.001

Instrument Variable Name: FHDTYP_1
Question Text:

What kinds of cancer did your [Fill1: daughter/Fill2: daughters] have?
*Enter code for the first kind of cancer.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose daughter(s) ever had cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) if FHDCAN = 1 [goto FHDAGE1]; else [goto FHDMAN1]
(20,26) [goto ERR_FHDTYP_1]

[p. 35]

NAH.180_00.002

Instrument Variable Name: FHDTYP_2
Question Text:

*Enter code for the second kind of cancer.
*Enter '96' for no more.

01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 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 (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat-pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who provided age range for daughter(s) diagnosed with the first kind of cancer or didn't know how old daughter(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:

(1-19,21-25,27-30,R,D) if FHDTYP_2 = FHDTYP_1 [goto ERR2_FHDTYP_2]; elseif FHDCAN = 1 [goto FHDAGE2]; else [goto FHDMAN2]
(96) [goto next section]
(20,26) [goto ERR_FHDTYP_2]

[p. 36]

NAH.180_00.003

Instrument Variable Name: FHDTYP_3
Question Text:

*Enter '95' if respondent offers more than 2 kinds of cancer.
*Enter '96' for no more.

95 More than 2 kinds
96 No more

Universe Text: Sample adults 18+ who provided age range for daughter(s) diagnosed with the second kind of cancer or didn't know how old daughter(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:

(95,96) [goto next section]
(1-30) [goto ERR_FHDTYP_3]

NAH.190_00.000

Instrument Variable Name: FHDMAN1
Question Text:

How many daughters have had [Fill: FHDTYP_1]?
*Enter '21' for 21 or more daughters.

01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have daughters with a first kind of cancer
Skip Instructions:

(1-21) if FHDMAN1 GT FHDCAN [goto ERR_FHDMAN1]; else [goto FHDAGE1]
(R,D) [goto FHDAGE1]

[p. 37]

NAH.191_00.000

Instrument Variable Name: FHDAGE1
Question Text:

[Fill1: Was your daughter under 50 years of age when [Fill3: FHDTYP_1] was first diagnosed?
*Enter '0' if daughter was not under 50.
*Enter '1' if daughter was under 50.]
[Fill2: How many of these daughters were under 50 years of age when [Fill3: FHDTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose daughter(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:

(0-21) if FHDMAN1 NE R and FHDMAN1 NE D and FHDAGE1 GT FHDMAN1 [goto ERR2_FHDAGE1]; elseif (FHDMAN1 = R or FHDMAN1 = D) and FHDAGE1 GT FHDCAN [goto ERR3_FHDAGE1]; elseif AGE LE '55' and FHDMAN1 NE R and FHDMAN1 NE D and FHDAGE1 LT FHDMAN1 [goto ERR1_FHDAGE1]; elseif AGE LE '55' and (FHDMAN1 = R or FHDMAN1 = D) and FHDAGE1 = 0 [goto ERR1_FHDAGE1]; else [goto FHDTYP_2]
(D) [goto FHDTYP_2]
(R) and (R) at FHDTYP_1 [goto next section]
(R) and FHDTYP_1 NE (R) [goto FHDTYP_2]

NAH.192_00.000

Instrument Variable Name: FHDMAN2
Question Text:

How many daughters have had [Fill: FHDTYP_2]?
*Enter '21' for 21 or more daughters.

01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have daughters with a second kind of cancer
Skip Instructions:

(1-21) if FHDMAN2 GT FHDCAN [goto ERR_FHDMAN2]; else [goto FHDAGE2]
(R,D) [goto FHDAGE2]

[p. 38]

NAH.193_00.000

Instrument Variable Name: FHDAGE2
Question Text:

[Fill1: Was your daughter under 50 years of age when [Fill3: FHDTYP_2] was first diagnosed?
*Enter '0' if daughter was not under 50.
*Enter '1' if daughter was under 50.]
[Fill2: How many of these daughters were under 50 years of age when [Fill3: FHDTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

Universe Text: Sample adults 18+ whose daughter(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:

(0-21)if FHDMAN2 NE R and FHDMAN2 NE D and FHDAGE2 GT FHDMAN2 [goto ERR2_FHDAGE2]; elseif (FHDMAN2 = R or FHDMAN2 = D) and FHDAGE2 GT FHDCAN [goto ERR3_FHDAGE2]; elseif AGE LE '55' and FHDMAN2 NE R and FHDMAN2 NE D and FHDAGE2 LT FHDMAN2 [goto ERR1_FHDAGE2]; elseif AGE LE '55' and (FHDMAN2 = R or FHDMAN2 = D) and FHDAGE2 = 0 [goto ERR1_FHDAGE2]; else [goto FHDTYP_3]
(D) [goto FHDTYP_3]
(R) and (R) at FHDTYP_2 [goto next section]
(R) and FHDTYP_2 NE (R) [goto FHDTYP_3]

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