[p. 1]
2006 NHIS Questionnaire -- Household Composition
Household Composition
Question Text:
Start with the name of the person, or one of the persons, who owns or rents this home.
/What is the name of the next person living or staying here?]
*Enter 999 if no more persons.
Skip Instructions:
elseif POS2 or POS3 ne 0, [goto HHRESP]
else, [goto MISPERS_MCHILD]
(allow 20,R,D) if name on fake/false name list [goto ERR2_NAME_FNAME];
else [goto NAME_MNAME]
Question Text:
*Probe for middle name or middle initial if not reported.
*Press "ENTER" to skip to last name if no middle name.
Skip Instructions:
Question Text:
*Enter Last Name.
Skip Instructions:
(allow 20, R,D) if name on fake/false name list
goto ERR2_NAME_LNAME
else if NAME_FNAME and NAME_LNAME ne D, R
Set ALIAS = NAME_FNAME( )NAME _LNAME,
goto USUALRES
else goto ALIAS
[p. 2]
Question Text:
Skip Instructions:
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto ASKURE]
Question Text:
2 No
7 Refused
8 Don't know
Skip Instructions:
(2,R,D) [goto NAME_FNAME]
Question Text:
*Enter (1) to continue to the next person.
Skip Instructions:
[p. 3]
Question Text:
[fill roster]
Have I missed any babies or small children?
2 No
7 Refused
9 Don't know
Skip Instructions:
empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
(2,R,D)
goto MISPERS_MLODGE
Question Text:
I have listed living here ...
[fill roster]
Have I missed any lodgers, boarders, or persons you employ who live here?
2 No
7 Refused
9 Don't know
Skip Instructions:
empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
(2,R,D)
goto MISPERS_MAWAY
[p. 4]
Question Text:
I have listed living here ...
[fill roster]
Have I missed anyone who USUALLY lives here, but is now away from home traveling or in a hospital?
2 No
7 Refused
9 Don't know
Skip Instructions:
empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
(2,R,D)
goto MISPERS_MELSE
Question Text:
I have listed living here ...
[fill roster]
Have I missed anyone else staying here?
2 No
7 Refused
9 Don't know
Skip Instructions:
empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
(2,R,D)
if PCNT=0, goto EXIT
else if PCNT=1 store Yes (1) in LIVEAT, goto OTHLIV
else goto LIVEAT
[p. 5]
Question Text:
*Read names if necessary.
[fill roster]
2 No
7 Refused
9 Don't know
Skip Instructions:
(2) [goto XACCESS]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto OTHLIV]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) if PCNT=1, [goto SEX]
else [goto HHRESP]
[p. 6]
Question Text:
With whom am I speaking?
*Enter the line number of the respondent. If more than one, enter the number of the one you consider to be the main respondent.
Skip Instructions:
If deleted PX [goto ERR1_HHRESP]
else if out of bound [goto ERR2_HHRESP]
else if ADC=1 [goto HHREF_A
else [goto SEX]
Question Text:
*If don't know or refused enter your best guess.
[Are you/Is ALIAS] male or female?
2 Female
Skip Instructions:
Question Text:
What is [fill: your/ALIAS's] age?
*Enter number for age.
Skip Instructions:
(R,D) [goto AGEDOB_3]
Question ID: HHC.120_02.000
Question Text:
*Enter number for age time period
2 Weeks
3 Months
4 Years
Skip Instructions:
Question Text:
And what is [fill: your/ALIAS's] date of birth?
Please give month, day, and year for the date of birth.
*Enter month of birth.
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
98 Don't know
Skip Instructions:
[p. 8]
Question Text:
*Enter day of birth
Skip Instructions:
Only allow valid days for month entered.
If days not valid, [goto ERR_AGEDOB_4]
ELSE [goto AGEDOB_5]
Question Text:
*Enter year of birth
9997 Refused
Skip Instructions:
Question Text:
I recorded [fill: your/ALIAS's] date-of-birth as [AGEDOB_3] [AGEDOB_4], [AGEDOB_5]. Is that [fill: your/ALIAS's] correct date-of-birth?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2) [goto AGEDOB_3]
Question ID: HHC.130_00.000
Question Text:
2 AGE=AGE4
3 Neither is correct
7 Refused
9 Don't know
Skip Instructions:
(3,R,D) if AGEDOB_1=R, [goto AGEGES2]
else if AGEDOB_1=D, [goto AGEGES1_NUM]
Question ID: HHC.150_01.000
Question Text:
What is your best guess of [fill: your/ALIAS's] age?
*If the respondent give a range of ages, enter "C" to continue to the screen that will compute an age.
*If the respondent does not know the age, enter your best estimate of the person's age.
997 Refused
999 Don't know
C Compute from range
Skip Instructions:
else if outside range, [goto ERR_AGEGES1_NUMB]
(C) [goto AGERNG_N1]
(R,D) [goto AGEGES2]
Question ID: HHC.150_02.000
Question Text:
*Enter time period for age guess.
4 Year(s)
Skip Instructions:
else [goto INTWKCK1]
Question ID: HHC.152_00.000
Question Text:
Could you please tell me if [fill: you are/ALIAS is] at least 18 years old?
2 18 or older
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto GREAT18]
Question ID: HHC.154_00.000
Question Text:
*Enter age "0" to 17
*Enter "0" if less than 1 year old.
001 lt 17 1 to 17 years of age
Skip Instructions:
else, [goto INTWKCK1]
Question ID: HHC.156_00.000
Question Text:
*Enter age 18 or greater
Skip Instructions:
else, [goto INTWKCK1]
Question ID: HHC.160_01.000
Question Text:
*Enter lower age of the range in months or years.
Skip Instructions:
Question ID: HHC.160_02.000
Question Text:
*Enter lower age time period.
4 Year(s)
Skip Instructions:
Question ID: HHC.160_03.000
Question Text:
*Enter higher age of the range in months or years.
Skip Instructions:
Question ID: HHC.160_04.000
Question Text:
*Enter higher age time period
4 Year(s)
Skip Instructions:
(3,4) if AGEDOB_5=Don't know, [goto YEARPIC]
else, [goto INTWKCK1]
Question ID: HHC.165_01.000
Question Text:
2 High guess for year born
3 Neither is correct
7 Refused
9 Don't know
Skip Instructions:
else, [goto INTWKCK1]
Question ID: HHC.165_03.000
Question Text:
2 No
Skip Instructions:
then, [goto AGEDOB_1 to collect information about the next person in roster]
else, [goto NATOR]
(2) [goto AGEDOB_1 to collect information about the next person in roster]
else, [goto NATOR]
[p. 13]
Question Text:
[fill1: Do you/Does ALIAS] consider [fill2: yourself/himself/herself] to be Hispanic or Latino?
*Read if necessary.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
Other Latin American
Other Hispanic/Latino
Where did [your/ALIAS's] ancestors come from?
You may choose more than one.
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino/Spanish
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto NATOR for next person in roster]
else [goto RACE]
Question Text:
Please give me the number of the group that represents [fill: your/ALIAS's] Hispanic origin or ancestry.
You may choose up to five (5), if applicable
*If a nonhispanic group is named, backup to previous screen and change answer from "yes" to "no".
Enter all that apply, separate with commas.
02 Cuban/Cuban American
03 Dominican (Republic)
04 Mexican
05 Mexican American
06 Central or South American
07 Other Latin American
08 Other Hispanic/Latino/Spanish
97 Refused
99 Don't know
You may choose more than one.
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino/Spanish
Skip Instructions:
(7) [goto HIS_SP2]
(8) [goto HIS_SP3]
Question ID: HHC.190_00.000
Question Text:
*If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
*(F1) For a list of Central or South American countries.
*Specify the other Latin American.
Skip Instructions:
else [goto RACE]
Question ID: HHC.195_00.000
Question Text:
*If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
*(F1) For a list of Central or South American countries.
*Specify the other Hispanic/Latino.
Skip Instructions:
else [goto RACE]
[p. 15]
Question Text:
What race or races [fill1: Do you/Does ALIAS] consider [fill2: yourself/himself/herself] to be? Please select 1 or more of these categories.
*Enter all that apply, separate with commas.
02 Black/African American
03 Indian (American)
04 Alaska Native
05 Native Hawaiin
06 Guamanian
07 Samoan
08 Other Pacific Islander
09 Asian Indian
10 Chinese
11 Filipino
12 Japanese
13 Korean
14 Vietnamese
15 Other Asian
16 Some other race
97 Refused
99 Don't know
You may choose more than one.
2. Black/African American
3. Indian (American)
4. Alaska Native
5. Native Hawaiian
6. Guamanian
7. Samoan
8. Other Pacific Islander
9. Asian Indian
10. Chinese
11. Filipino
12. Japanese
13. Korean
14. Vietnamese
15. Other Asian
Skip Instructions:
else [goto NOWAF_A]
(8) [goto RAC_SP1]
(15) [goto RAC_SP2]
(16) [goto RAC_SP3]
(R,D) [goto RACE, for the next person in roster]
else [goto NOWAF_A]
Question ID: HHC.210_00.000
Question Text:
REM *If any of the following are mentioned, go back to RACE screen to correct.
*If the respondent's answer could not be found, clear entry, type 'ZZ'.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
*If the respondent's answer could not be found, type 'ZZ' to enable you to type an entry.
Skip Instructions:
If 'ZZ' entered [goto RAC_SP1A]
then [goto RACE for next person on the roster]
else [goto NOWAF_A]
Question ID: HHC.212_00.000
Question Text:
*If any of the following are mentioned, backup to previous item and correct the entry.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
uamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
*If the respondent's answer could not be found, type 'ZZ' to enable you to type an entry.
Skip Instructions:
then [goto RACE] for next person on the roster
else [goto NOWAF_A]
Question ID: HHC.214_00.000
Question Text:
*If any of the following are mentioned, backup to previous item and correct the entry.
White
Black/African American
Indian (American)
Alaska Native
Native Hawaiian
Guamanian
Samoan
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
*If the respondent's answer could not be found, type 'ZZ' to enable you to type an entry.
Skip Instructions:
else [goto NOWAF_A]
Question ID: HHC.220_00.000
Question Text:
02 Black/African American
03 Indian (American)
04 Alaska Native
05 Native Hawaiian
06 Guamanian
07 Samoan
08 Other Pacific Islander
09 Asian Indian
10 Chinese
11 Filipino
12 Japanese
13 Korean
14 Vietnamese
15 Other Asian
16 Other race
97 Refused
99 Don't know
Skip Instructions:
else, [goto ERR_MLTRAC]
[p. 18]
Question Text:
[display eligible persons]
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) if POS2 or POS3 ne 0, [goto ADC]
else [goto HHREF_A]
if NOWAF_A eq (1) and ADULTCNT eq (1) [goto EXIT]
else [goto NOWAF2_B]
Question ID: HHC.230_03.000
Question Text:
*Enter line numbers as appropriate.
*Enter all that apply, separate with commas.
2 Not Armed Forces
7 Refused
Skip Instructions:
else if POS2 and POS3 ne 0 [goto ADC]
else [goto HHREF_A]
Invalid person # selected [goto ERR_NOWWAF2_B]
Question Text:
*Enter (1) to proceed.
Skip Instructions:
[p. 19]
Question Text:
[Display all non-deleted household members ge 14 years of age]
*Press shift F1 to see full roster information.
2 No
Skip Instructions:
(2) [goto HHREF_B]
Question ID: HHC.250_02.000
Question Text:
*Enter the line number of the Household Reference person.
2 No
Skip Instructions:
[p. 20]
Question Text:
What is [fill1: your/ALIAS's] relationship to [fill2: Reference Person's name/you]
02 Spouse (husband/wife)
03 Unmarried Partner
04 Child (biological/adoptive/in-law/step/foster)
05 Child of partner
06 Grandchild
07 Parent (biological/adoptive/in-law/step/foster)
08 Brother/sister (biological/adoptive/in-law/step/foster)
09 Grandparent (Grandmother/Grandfather)
10 Aunt/Uncle
11 Niece/Nephew
12 Other relative
13 Housemate/roommate
14 Roomer/Boarder
15 Other nonrelative
16 Legal guardian
17 Ward
97 Refused
99 Don't know
3. Unmarried Partner
4. Child (biological/adoptive/in-law/step/foster)
5. Child of Partner
6. Grandchild
7. Parent (biological/adoptive/in-law/step/foster)
8. Brother/Sister (biological/adoptive/in-law/step/foster)
9. Grandparent (Grandmother/Grandfather)
10. Aunt/Uncle
11. Niece/Nephew
12. Other relative
13. Housemate/Roommate
14. Roomer/Boarder
15. Other non-relative
16. Legal Guardian
17. Ward
Skip Instructions:
(2,3) if selected for more than one PX [goto ERR4_RPREL]
else if age lt 14 [goto ERR1_RPREL]
(4) [goto DEGREE1]
(5) if loop is completed and no PX has RPREL=3 [goto ERR5_RPREL] endif
(6) if AGEDIFF lt 25 [goto ERR2_RPREL] endif
(7) [goto DEGREE2]
(8) [goto DEGREE3]
(9) if AGEDIFF lt 25 [goto ERR3_RPREL] endif
(10-17,R,D) end loop
if UNRELTAL gt 1 [GOTO FAMNUM]
else [goto HHCHANGE]
Question ID: HHC.260_01.000
Question Text:
What is [fill1: your/ALIAS's] relationship to [fill2: Reference Person's name/you]
3. Unmarried Partner
4. Child (biological/adoptive/in-law/step/foster)
5. Child of Partner
6. Grandchild
7. Parent (biological/adoptive/in-law/step/foster)
8. Brother/Sister (biological/adoptive/in-law/step/foster)
9. Grandparent (Grandmother/Grandfather)
10. Aunt/Uncle
11. Niece/Nephew
12. Other relative
13. Housemate/Roommate
14. Roomer/Boarder
15. Other non-relative
16. Legal Guardian
17. Ward
Skip Instructions:
(2,3) if selected for more than one PX [goto ERR4_RPREL]
else if age lt 14 [goto ERR1_RPREL]
(4) [goto DEGREE1]
(5) if loop is completed and no PX has RPREL=3 [goto ERR5_RPREL] endif
(6) if AGEDIFF lt 25 [goto ERR2_RPREL] endif
(7) [goto DEGREE2]
(8) [goto DEGREE3]
(9) if AGEDIFF lt 25 [goto ERR3_RPREL] endif
(10-17,R,D) end loop
if UNRELTAL gt 1 [GOTO FAMNUM]
else [goto HHCHANGE]
Question Text:
2 Adoptive {son/daughter}
3 Step {son/daughter]
4 Foster {son/daughter}
5 {son/daughter]-in-law
7 Refused
Refused
9 Don't know
Skip Instructions:
else [goto RPREL]
(2-5,R,D) [goto RPREL]
[p. 22]
Question Text:
2 Adoptive {mother/father}
3 Step {mother/father]
4 Foster {mother/father}
5 {mother/father]-in-law
7 Refused
9 Don't know
Skip Instructions:
else if additional PX's remain [goto RPREL]
else if UNRELTAL gt 1 [goto FAMNUM]
else [goto HHCHANGE]
(2-5,R,D) if additional PX's remain [goto RPREL]
else if UNRELTAL gt 1 [goto FAMNUM]
else [goto HHCHANGE]
Question Text:
2 Half {brother/sister}
3 Adopted {brother/sister}
4 Step {brother/sister]
5 Foster {brother/sister}
6 {brother/sister]-in-law
7 Refused
9 Don't know
Skip Instructions:
[p. 1]
2006 NHIS Questionnaire - Recontact
Recontact
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2, R, D) if TELENUM = N or TELECHG = R,D [goto RNOSERV]
else if TELECHK = 1,R,D or TELECHG ne R,D, empty [go to TELDIRC]
Question Text:
97 Refused
99 Don't know
Skip Instructions:
else if TELECHK = 1,R,D or TELECHG ne R,D, empty [goto VCELNUM]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2) goto TELDIRC
[p. 2]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
elseif TELENUM = N or TELECHG = R,D [go to RNOSERV]
(2,R,D) [goto RNOSERV]
Question Text:
*Read if necessary.
Home telephone refers to the phone that is not your cell phone.
9999999997 Refused
9999999999 Don't know
Skip Instructions:
(R,D) [goto RNOSERV]
(0 - 1999999999) [goto ERR_TELHOME]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto RNOSERV]
[p. 3]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2, R,D) goto [MOVE]
Question Text:
997 Refused
999 Don't know
Skip Instructions:
(R,D) [goto MOVE]
Question Text:
2 Week(s)
3 Month(s)
7 Refused
9 Don't know
Skip Instructions:
(2) if RHOWL1_1 gt 52, [goto ERR1_RHOWL1_2]
(3) if RHOWL1_1 gt 12, [goto ERR2_RHOWL1_2]
[p. 4]
Question Text:
*Enter number for time without service due to weather/natural disasters.
*Enter '0' for none.
997 Refused
999 Don't know
Skip Instructions:
(0,R,D) [goto MOVE]
Question Text:
1 Day(s)
2 Week(s)
3 Month(s)
7 Refused
9 Don't know
Skip Instructions:
(2) if RHOWL2_1 gt 52, [goto ERR1_RHOWL2_2]
(3) if RHOWL2_1 gt 12, [goto ERR2_RHOWL2_2]