2007 NHIS Questionnaire - Family
Family Identification
Question Text:
Is this information correct?
2 No, correction(s) needed/more corrections needed
Skip Instructions:
if SCREENIN = 0 and I_SCRN_STATUS = S [goto EXIT(HHC)]
else [goto FIDCC13]
(2) [goto CWHAT2]
Question Text:
* Enter each number that applies. If a wrong choice, type that choice again.
1 Name
2 Age or DOB
3 Sex
4 National origin
5 Race
Skip Instructions:
(2) [goto CHG_AGEDOB_1]
(3) [goto CHG_SEX]
(4) [goto CHG_NATOR]
(5) [goto CHG_RACE]
Question Text:
Is this information correct?
2 No, correction(s) needed/more corrections needed
Skip Instructions:
if SCREENIN = 0 and I_SCRN_STATUS = S, GOTO EXIT(HHC)
else GOTO FIDCC13
(2) GOTO ERR_HHCHANGE_1
[p.2]
Question Text:
[fill: Are you/Is ALIAS] now married, widowed, divorced, separated, never married, or living with a partner?
2 Widowed
3 Divorced
4 Separated
5 Never Married
6 Living with partner
7 Refused
9 Don't know
Skip Instructions:
(2-5, R, D) [goto FIDCCI3]
(6) if LINTAL[FAMINT] = 1 [goto FIDCCI4]
else [goto COHAB1]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Is [fill: your/ALIAS's] spouse living in the household?
2 No
7 Refused
9 Don't know
Skip Instructions:
else [goto FIDCCI3]
(2,R,D) [goto FIDCCI3]
[p.3]
Question Text:
[Display all possible spouse candidates]
01-25 Person # of spouse
Skip Instructions:
(1-25,R,D) [goto FIDCCI3]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) if COHAB3[PX] = null [goto COHAB3]
else [goto FIDCCI3]
Question Text:
2 Widowed
3 Divorced
4 Separated
7 Refused
9 Don't know
Skip Instructions:
else [goto FIDCCI3]
Question Text:
[Display all possible cohabitation candidates]
01-25 Person number
Skip Instructions:
(1-25,R,D) [goto FIDCCI3]
[p.4 ]
Question Text:
2 Adoptive
3 Step
4 Foster
5 -in-law
7 Refused
9 Don't know
Skip Instructions:
if ERR_DEGREE4 = 1 [goto FIDCCI4B]
else reset DEGREE4 [goto DEGREE4] endif
else [goto FIDCCI4B]
(2-5,R,D) [goto FIDCCI4B]
Question Text:
2 Adoptive
3 Step
4 Foster
5 -in-law
7 Refused
9 Don't know
Skip Instructions:
if yes, continue the interview [goto FIDCCI4B]
else, reset DEGREE5 [goto DEGREE5] endif
else [goto FIDCCI4B]
(2-5,R,D) [goto FIDCCI4B]
[p.5 ]
Question Text:
* Enter the line number of the mother or mother-in-law.
If the mother or mother-in-law is not a household member, enter "0".
If the person has no parents present but has a legal guardian, enter "96".
* Choose mother over mother-in-law if both are present.
01-25 Person number of mother
96 Has legal guardian
97 Refused
99 Don't know
Skip Instructions:
(0,R,D) [goto FIDCCI5]
(96) [goto GUARD]
Question Text:
2 Adoptive mother
3 Step mother
4 Foster mother
5 Mother-in-law
7 Refused
9 Don't know
Skip Instructions:
if (1) [goto FIDCCI5]
elseif (2) [goto MOTHER]
elseif (3), reset MOTHERCK_A [goto MOTHERCK_A]
else [goto FIDCCI5]
(2-5,R,D) [goto FIDCCI5]
[p.6]
Question Text:
1 Relationship is correct
Skip Instructions:
if (1) [goto FIDCCI5]
elseif (2) [goto MOTHER]
elseif (3), reset MOTHERCK_A [goto MOTHERCK_A]
else [goto FIDCCI5]
(2-5,R,D) [goto FIDCCI5]
Question Text:
Is [fill: your/ALIAS's] father a household member? (Include biological (natural), adoptive, step, or foster father or father-
in-law).
* Enter the line number of the father or father-in-law.
* If the father is not a household member, enter '0'.
* If the person has no parents present but has a legal guardian, enter '96'.
* Choose father over father-in-law if both are present.
01-25 Person # of father
96 Has legal guardian
97 Refused
99 Don't know
Skip Instructions:
(0,R,D) [goto FIDCCI4]
(96) [goto GUARD]
[p.7]
Question Text:
[fill1: Are you/Is ALIAS]
2 Adoptive father
3 Step father
4 Foster father
5 Father-in-law
7 Refused
9 Don't know
Skip Instructions:
if ERRFATHERCK_A = (1) [goto FIDCCI4]
elseif (2) [goto FATHER]
elseif (3) reset FATHERCK_A
[goto FATHERCK_A] endif
else [goto FIDCCI4]
(2-5,R,D) [goto FIDCCI4]
Question Text:
1 Relationship is correct
Skip Instructions:
if ERRFATHERCK_A = (1) [goto FIDCCI4]
elseif (2) [goto FATHER]
elseif (3) reset FATHERCK_A
[goto FATHERCK_A] endif
else [goto FIDCCI4]
(2-5,R,D) [goto FIDCCI4]
Question Text:
* Enter the line number of [fill1: your/ALIAS's] gu a rdian.
* If the guardian is not a household member, enter '0'.
01-25 Person # of guardian
97 Refused
99 Don't know
(AGE(14) has no mother or father in the family.
Skip Instructions:
[p.8 ]
Question Text:
Who in the family would you say knows about the health of all the family members?
[Display all family members who not deleted and ) 17 or emancipated minors.]
* Mark all that apply, separate with commas.
2 No, does not know family member's health_
7 Refused
9 Don't know
Skip Instructions:
if SCSEL = 0 [goto FINTRO2]
else [goto KNOWSC2]
Question Text:
[Display all family members who are not deleted and )17 or emancipated minors]
* If any persons listed are not present, say:
We would like to have all adult family members who are at home take part in the interview. Are (READ NAMES) at_
home now?
* If yes, ask: Could they join us?
* If nobody is presently available, enter "96" to proceed to a callback screen.
2 Not present
Skip Instructions:
if only one PX selected [goto HLTH_BEG]
else [goto FAMRESP]
Question Text:
* Enter the line number of the person you consider to be the main respondent for this family's health questions.
Skip Instructions:
[p.1]
2007 NHIS Questionnaire - Family
Family Health Status and Limitations
Question ID: FHS.005_00.000
Question Text:
[fill1: Are/Is]
* Read names
(fill roster of persons age 0-4)
limited in the kind or amount of play activities [fill2: they/he/she] can do because of a physical, mental, or emotional
problem?
2 No
7 Refused
9 Don't know
Skip Instructions:
else, goto PLAPLYLM]
(2,R,D) [goto FSPEDEIS]
Question Text:
Who is this?
(Anyone else?)
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.2 ]
Question Text:
[fill: Do you/Does/Do any of these family members,
* Read names
(fill roster of persons less than age 18)]
receive Special Educational or Early Intervention Services?
2 No
7 Refused
9 Don't know
Skip Instructions:
else, goto PSPEDEIS]
(2,R,D) [goto FLAADL]
Question Text:
Who is this?
(Anyone else?)
2 No
7 Refused
9 Don't know
All families with two or more persons less than 18 years of age and at least one receives Special Educational or _
Early Intervention Services_
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
or behavioral problem?
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.3]
Question Text:
Because of a physical, mental, or emotional problem, [fill1: do you/does anyone in the family] need the help of other
persons with PERSONAL CARE NEEDS, such as eating, bathing, dressing, or getting around inside this home?
[fill2: Do not include family members age 2 and under.]
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FLAIADL]
Question Text:
Who is this?
(Anyone else?)
2 No
7 Refused
9 Don't know
personal care needs
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Bathing or showering?
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.4 ]
Question Text:
[fill: Do you/Does ALIAS] need the help of other persons with...
Dressing?
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
[fill: Do you/Does ALIAS] need the help of other persons with...
Eating?
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
[fill: Do you/Does ALIAS] need the help of other persons with...
Getting in or out of bed or chairs?
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.5]
Question Text:
[fill: Do you/Does ALIAS] need the help of other persons with...
Using the toilet, including getting to the toilet?
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
[fill: Do you/Does ALIAS] need the help of other persons with...
Getting around inside the home?
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Because of a physical, mental, or emotional problem, do [fill: you/any of these family members
* Read names
(fill roster of persons age 18 or older)]
need the help of other persons in handling ROUTINE NEEDS, such as everyday household chore s, doing necessary
business, shopping, or getting around for other purposes?
2 No
7 Refused
9 Don't know
Skip Instructions:
else, goto PLAIADL]
(2,R,D) [goto FLAWKNOW]
Question Text:
Who is this?
(Anyone else?)
2 No
7 Refused
9 Don't know
handling routine needs
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Does a physical, mental, or emotional problem NOW keep [fill: you/any of these family members
* Read names
(fill roster of persons age 18 or older)]
from working at a job or business?
2 No
7 Refused
9 Don't know
Skip Instructions:
else, goto PLAWKNOW]
(2,R,D) [goto FLAWKLIM]
Question Text:
Who is this?
(Anyone else?)
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
[fill: Are you limited in the kind OR amount of work you/ Is ALIAS limited in the kind OR amount of work he/she/ Are
any of these family members,
* Read names
(fill roster of persons age 18 or older)]
limited in the kind OR amount of work they] can do because of a physical, mental or emotional problem?
2 No
7 Refused
9 Don't know
mental, or emotional problem
Skip Instructions:
PLAWKLIM and goto FLAWALK; else, goto PLAWKLIM]
(2,R,D) [goto FLAWALK]
Question Text:
Who is this?
(Anyone else?)
1 Limited in work
2 Not limited in work
7 Refused
9 Don't know
or amount of work he/she can do
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Because of a health problem, [fill: do you/does anyone in the family]
have difficulty walking without using any special equipment?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FLAREMEM]
Question Text:
Who is this?
(Anyone else?)
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.9 ]
Question Text:
[fill1: Are you/Is anyone in the family] LIMITED IN ANY WAY because of difficulty remembering or because
[fill2: you/they] experience periods of confusion?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FLIMANY]
Question Text:
Who is this?
(Anyone else?)
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
[fill: Are you/ Is ALIAS/ Are any family members
* Read names
(fill roster of applicable persons)]
LIMITED IN ANY WAY in any activities because of physical, mental or emotional problems?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto LAHCC]
Question Text:
Who is this?
(Anyone else?)
1 Yes, limited in some other way
2 Not limited in any way
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.11 ]
Question Text:
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Skip Instructions:
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [goto LAHCC_S1]
(91) [goto LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more _
persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question Text:
What is the other impairment or problem?
Verbatim Verbatim Response
7 Refused
9 Don't know
Skip Instructions:
Question Text:
What is the other impairment or problem?
Verbatim Verbatim Response
7 Refused
9 Don't know
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had a vision problem or problem seeing?
* Enter number for time with a vision problem or problem seeing.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL01T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL01T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with vision problem or problem seeing.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
(6) [goto ERR2_LHCL01T]
if (LHCL01T = 4 and LHCL01N ) AGE) or (LHCL01T = 3 and LHCL01N ) AGE in months) or (LHCL01T = 2 and LHCL01N ) AGE in weeks), goto ERR1_LHCL01T
Question Text:
How long [fill: have you/has ALIAS] had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL02T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
(R) [store "R" in LHCL02T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with hearing problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
Skip Instructions:
(6) [goto ERR2_LHCL02T] if (LHCL02T = 4 and LHCL02N ) AGE) or (LHCL02T = 3 and LHCL02N ) AGE in months) or (LHCL02T = 2
and LHCL02N ) AGE in weeks), goto ERR1_LHCL02T
Question Text:
How long [fill: have you/has ALIAS] had a speech problem?
* Enter number for time with a speech problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL03T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL03T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with speech problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
(6) [goto ERR2_LHCL03T] if (LHCL03T = 4 and LHCL03N ) AGE) or (LHCL03T = 3 and LHCL03N ) AGE in months) or (LHCL03T = 2
and LHCL03N ) AGE in weeks), goto ERR1_LHCL03T
Question Text:
How long [fill: have you/has ALIAS] had asthma or a breathing problem?
* Enter number for time with an asthma or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL04T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL04T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with asthma or a breathing problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
entered for the "number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill1: have you/has ALIAS] had the injury that caused [fill2:your/his/her] limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL06T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL06T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with the injury that caused [fill: your/his/her] limitation.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had mental retardation?
* Enter number for time with mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL07T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with mental retardation.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had a developmental problem (e.g. cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL08T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL08T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with developmental problem (e.g. cerebral palsy).
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had a mental, emotional, or behavioral problem?
* Enter number for time with a mental, emot ional, or behavioral problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL09T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with mental, emotional, or behavioral problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
1-95, D was entered for the "number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had a bone, joint, or muscle problem?
* Enter number for time with a bone, joint, or muscle problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL10T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL10T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with bone, joint, or muscle problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had epilepsy or seizures?
* Enter number for time with epileplsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL11T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with epilepsy or seizures.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had a learning disability?
* Enter number for time with a learning disability.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL12T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
(R) [store "R" in LHCL12T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Question Text:
* Enter time period for time with learning disability.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill: have you/has ALIAS] had attention deficit/hyperactivity disorder?
* Enter number for time with attention deficit/hyperactivity disorder.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL13T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(R) [store "R" in LHCL13T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with attention deficit/hyperactivity disorder.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
95, D was entered for the "number" part of this two-part question
Skip Instructions:
Question Text:
How long [fill1: have you/has ALIAS] had [fill2: problem in LAHCC_S1]?
* Enter number for time with [fill1: problem in LAHCC_S1]?
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL90T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA] (R) [store "R" in LHCL90T and goto follow-up questions for next condition selected at LAHCC; if no more conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
Question Text:
* Enter time period for time with [fill: problem in LAHCC_S1].
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL90T]
if (LHCL90T = 4 and LHCL90N ) AGE) or (LHCL90T = 3 and LHCL90N ) AGE in months) or (LHCL90T = 2
and LHCL90N ) AGE in weeks), goto ERR1_LHCL90T
Question Text:
How long [fill1: have you/has ALIAS] had [fill2: problem in LAHCC_S2]?
* Enter number for time with [fill1: problem in LAHCC_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHCL91T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
(R) [store "R" in LHCL91T and goto follow-up questions for next condition selected at LAHCC; if no more
conditions, goto LAHCC for next person less than 18 years of age with a reported limitation; if no more persons,
goto LAHCA]
Question Text:
* Enter time period for time with [fill: problem in LAHCC_S2].
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person less than 18 years of age with a reported limitation; if no more persons, goto LAHCA]
(6) [goto ERR2_LHCL91T]
if (LHCL91T = 4 and LHCL91N ) AGE) or (LHCL91T = 3 and LHCL91N ) AGE in months) or (LHCL91T = 2
and LHCL91N ) AGE in weeks), goto ERR1_LHCL91T
[p.27 ]
Question Text:
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer_
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Skip Instructions:
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [goto LAHCA_S1]
(91) [goto LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more
persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of
age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question Text:
What is the other impairment or problem?
7 Refused
9 Don't know
Skip Instructions:
Question Text:
What is the other impairment or problem?
7 Refused
9 Don't know
Skip Instructions:
[p.29 ]
Question Text:
How long [fill: have you/has ALIAS] had a vision problem or problem seeing?
* Enter number for time with a vision problem or problem seeing.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL01T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL01T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with vision problem or problem seeing.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL01T]
if LHAL01T = 4 and LHAL01N ) AGE, goto ERR1_LHAL01T
[p.30 ]
Question Text:
How long [fill: have you/has ALIAS] had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL02T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL02T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with hearing problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL02T]
if LHAL02T = 4 and LHAL02N ) AGE, goto ERR1_LHAL02T
[p.31 ]
Question Text:
How long [fill: have you/has ALIAS] had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL03T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL03T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with arthritis or rheumatism.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL03T]
if LHAL03T = 4 and LHAL03N ) AGE, goto ERR1_LHAL03T
[p.32 ]
Question Text:
How long [fill: have you/has ALIAS] had a back or neck problem?
* Enter number for time with a back or neck problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL04T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL04T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with back or neck problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL04T]
if LHAL04T = 4 and LHAL04N ) AGE, goto ERR1_LHAL04T
[p.33 ]
Question Text:
How long [fill: have you/has ALIAS] had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone or joint injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL05T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL05T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with fracture, bone, or joint injury.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL05T]
if LHAL05T = 4 and LHAL05N ) AGE, goto ERR1_LHAL05T
[p.34 ]
Question Text:
How long [fill1: have you/has ALIAS] had the other injury that caused [fill2: your/his/her] limitation?
* Enter number for time with the injury.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL06T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL06T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with other injury that caused [fill: your/his/her] limitation.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL06T]
if LHAL06T = 4 and LHAL06N ) AGE, goto ERR1_LHAL06T
[p.35 ]
Question Text:
How long [fill: have you/has ALIAS] had a heart problem?
* Enter number for time with a heart problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL07T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL07T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with heart problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL07T]
if LHAL07T = 4 and LHAL07N ) AGE, goto ERR1_LHAL07T
[p.36 ]
Question Text:
How long [fill: have you/has ALIAS] had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL08T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL08T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with stroke problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL08T]
if LHAL08T = 4 and LHAL08N ) AGE, goto ERR1_LHAL08T
[p.37 ]
Question Text:
How long [fill: have you/has ALIAS] had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL09T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL09T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with hypertension or high blood pressure.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL09T]
if LHAL09T = 4 and LHAL09N ) AGE, goto ERR1_LHAL09T
[p.38 ]
Question Text:
How long [fill: have you/has ALIAS] had diabetes?
* Enter number for time with diabetes.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL10T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL10T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with diabetes.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL10T]
if LHAL10T = 4 and LHAL10N ) AGE, goto ERR1_LHAL10T
[p.39 ]
Question Text:
How long [fill: have you/has ALIAS] had a lung problem or breathing problem (e.g., asthma and emphysema)?
* Enter number for time with a lung problem or breathing problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL11T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL11T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with lung problem or breathing problem (e.g., asthma and emphysema).
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
entered for the "number" part of this two-part question_
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL11T]
if LHAL11T = 4 and LHAL11N ) AGE, goto ERR1_LHAL11T
[p.40 ]
Question Text:
How long [fill: have you/has ALIAS] had cancer?
* Enter number for time with cancer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL12T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL12T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with cancer.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL12T]
if LHAL12T = 4 and LHAL12N ) AGE, goto ERR1_LHAL12T
[p.41 ]
Question Text:
How long [fill: have you/has ALIAS] had mental retardation?
* Enter number for time with mental retardation.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL14T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with mental retardation.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL14T]
if LHAL14T = 4 and LHAL14N ) AGE, goto ERR1_LHAL14T
[p.42 ]
Question Text:
How long [fill: have you/has ALIAS] had a developmental problem (e.g. cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL15T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL15T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with developmental problem (e.g. cerebral palsy).
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL15T]
if LHAL15T = 4 and LHAL15N ) AGE, goto ERR1_LHAL15T
[p.43]
Question Text:
How long [fill: have you/has ALIAS] had senility?
* Enter number for time with senility.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL16T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL16T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with senility.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL16T]
if LHAL16T = 4 and LHAL16N ) AGE, goto ERR1_LHAL16T
[p.44 ]
Question Text:
How long [fill: have you/has ALIAS] had depression, anxiety, or an emotional problem?
* Enter number for time with depression, an xiety or an emotional problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL17T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with depression, anxiety, or an emotional problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
D was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL17T]
if LHAL17T = 4 and LHAL17N ) AGE, goto ERR1_LHAL17T
[p.45]
Question Text:
How long [fill: have you/has ALIAS] had a weight problem?
* Enter number for time with a weight problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL18T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL18T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with weight problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL18T]
if LHAL18T = 4 and LHAL18N ) AGE, goto ERR1_LHAL18T
[p.46 ]
Question Text:
How long [fill: have you/has ALIAS] had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL19T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL19T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with missing limb (finger, toe, or digit).
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL19T]
if LHAL19T = 4 and LHAL19N ) AGE, goto ERR1_LHAL19T
[p.47 ]
Question Text:
How long [fill: have you/has ALIAS] had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL20T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL20T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with kidney, bladder or renal problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL20T]
if LHAL20T = 4 and LHAL20N ) AGE, goto ERR1_LHAL20T
[p.48 ]
Question Text:
How long [fill: have you/has ALIAS] had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL21T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL21T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with circulation problem (including blood clots).
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL21T]
if LHAL21T = 4 and LHAL21N ) AGE, goto ERR1_LHAL21T
[p.49 ]
Question Text:
How long [fill: have you/has ALIAS] had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL22T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL22T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with benign tumors or cysts.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL22T]
if LHAL22T = 4 and LHAL22N ) AGE, goto ERR1_LHAL22T
[p.50 ]
Question Text:
How long [fill: have you/has ALIAS] had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL23T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with fibromyalgia or lupus.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL23T]
if LHAL23T = 4 and LHAL23N ) AGE, goto ERR1_LHAL23T
[p.51] 51 of 65
Question Text:
How long [fill: have you/has ALIAS] had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL24T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL24T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with osteoporosis or tendinitis.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
Skip Instructions:
(6) [goto ERR2_LHAL24T] if LHAL24T = 4 and LHAL24N ) AGE, goto ERR1_LHAL24T
[p.52 ]
Question Text:
How long [fill: have you/has ALIAS] had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL25T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL25T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with epilepsy or seizures.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
[p.53 ]
Question Text:
How long [fill: have you/has ALIAS] had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclero sis (MS) or muscular dtstrophy (MD)?
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL26T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with multiple sclerosis (MS) or muscular dystrophy (MD).
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
95, D was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL26T]
if LHAL26T = 4 and LHAL26N ) AGE, goto ERR1_LHAL26T
[p.54 ]
Question Text:
How long [fill: have you/has ALIAS] had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis ) paralysis or para/quadriplegia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL27T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
[p.55 ]
Question Text:
How long [fill: have you/has ALIAS] had Parkinson's disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL28T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL28T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with Parkinson's disease or tremors.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
(6) [goto ERR2_LHAL28T]
if LHAL28T = 4 and LHAL28N ) AGE, goto ERR1_LHAL28T
[p.56 ]
Question Text:
How long [fill: have you/has ALIAS] had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerve damage.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
syndrome
Skip Instructions:
(96) [fill "6" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL29T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with nerve damage (including carpal tunnel syndrome).
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
syndrome, and 1-95, D was entered for the "number" part of this two-part question
Skip Instructions:
[p.57]
Question Text:
How long [fill: have you/has ALIAS] had a hernia?
* Enter number for time with a hernia.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL30T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with hernia.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL30T]
if LHAL30T = 4 and LHAL30N ) AGE, goto ERR1_LHAL30T
[p.58 ]
Question Text:
How long [fill: have you/has ALIAS] had an ulcer?
* Enter number for time with an ulcer.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL31T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with ulcer.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL31T]
if LHAL31T = 4 and LHAL31N ) AGE, goto ERR1_LHAL31T
[p.59]
Question Text:
How long [fill: have you/has ALIAS] had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL32T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with varicose veins or hemorrhoids.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL32T]
if LHAL32T = 4 and LHAL32N ) AGE, goto ERR1_LHAL32T
[p.60 ]
Question Text:
How long [fill: have you/has ALIAS] had a thyroid problem, Grave's disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(R) [store "R" in LHAL33T and goto follow-up questions for next condition selected at LAHCA; if no more conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
Question Text:
* Enter time period for time with thyroid problem, Grave's disease or gout.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
95, D was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL33T]
if LHAL33T = 4 and LHAL33N ) AGE, goto ERR1_LHAL33T
[p.61 ]
Question Text:
How long [fill: have you/has ALIAS] had a knee problem?
* Enter number for time with a knee problem.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL34T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL34T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with knee problem.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
"number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL34T]
if LHAL34T = 4 and LHAL34N ) AGE, goto ERR1_LHAL34T
[p.62]
Question Text:
How long [fill: have you/has ALIAS] had migraine headaches?
* Enter number for time with migrane headaches.
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL35T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with migraine headaches.
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
the "number" part of this two-part question
Skip Instructions:
[p.63]
Question Text:
How long [fill1: have you/has ALIAS] had [fill2: LAHCA_S1]?
* Enter number for time with [fill1: LAHCA_S1].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL90T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL90T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with [fill: LAHCA_S1].
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL90T]
if LHAL90T = 4 and LHAL90N ) AGE, goto ERR1_LHAL90T
[p.64]
Question Text:
How long [fill1: have you/has ALIAS] had [fill2: LAHCA_S2]?
* Enter number for time with [fill1: LAHCA_S2].
* Enter '95' for 95 or more.
* Enter '96' if since birth.
95 95+
96 Since birth
97 Refused
99 Don't know
Skip Instructions:
(96) [fill "6" in LHAL91T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
(R) [store "R" in LHAL91T and goto follow-up questions for next condition selected at LAHCA; if no more
conditions, goto LAHCA for next person 18 years of age or older with a reported limitation; if no more persons,
goto PHSTAT]
Question Text:
* Enter time period for time with [fill: LAHCA_S2].
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
was entered for the "number" part of this two-part question
Skip Instructions:
for next person 18 years of age or older with a reported limitation; if no more persons, goto PHSTAT]
(6) [goto ERR2_LHAL91T]
if LHAL91T = 4 and LHAL91N ) AGE, goto ERR1_LHAL91T
[p.65 ]
Question Text:
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know
Skip Instructions:
[p. 1]
2007 NHIS Questionnaire - Family
Family Access to Health Care and Utilization
Question Text:
The following questions are about the use of health care. Do not include dental care.
DURING THE PAST 12 MONTHS, [fill: have you delayed seeking medical care/has medical care been delayed for
anyone in the family] because of worry about the cost?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FNMED12M]
Question Text:
For which family member was medical care delayed?
(Anyone else?)
2 No
7 Refused
9 Don't know
the past 12 months
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
DURING THE PAST 12 MONTHS, was there any time when [fill1: you/someone in the family] needed medical care, but
did not get it because [fill2: you/the family] couldn't afford it?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FHOSPYR]
Question Text:
Who didn't get needed care?
(Anyone else?)
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
[fill1: were you/Including all infants born in a hospital, has anyone in the family] been hospitalized OVERNIGHT in the past 12 months? Do not include an overnight stay in the emergency room.
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Who was in a hospital overnight?
(Anyone else?)
2 No
7 Refused
9 Don't know
(excluding ER)
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.3 ]
Question Text:
How many different times did [fill: you/ALIAS] stay in any hospital overnight or longer DURING THE PAST 12 MONTHS?
997 Refused
999 Don't know
Skip Instructions:
(11-365) [goto ERR_HOSPNO]
(R,D) [goto HPNITE]
Question Text:
Altogether how many nights [fill: were you/was ALIAS] in the hospital DURING THE PAST 12 MONTHS?
997 Refused
999 Don't know
Skip Instructions:
if HOSPNO gt HPNITE, goto ERR2_HPNITE
[p.4 ]
Question Text:
* Hand calendar card.
These next questions are about health care received during the 2 WEEKS outlined on that calendar. Include care from
ALL types of medical doctors, such as dermatologists, psychiatrists, ophthalmologists, and general practitioners. Also include care from OTHER health professionals such as nurses, physical therapists, and chiropractors.
Do not include dental care. Do not include care while an overnight patient in a hospital.
During those 2 WEEKS, did [fill: you/anyone in the family] receive care AT HOME from a nurse or other health care professional?
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Who received care at home?
(Anyone else?)
2 No
7 Refused
9 Don't know
the past 2 weeks (excluding dental care)
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.5 ]
Question Text:
* Enter '50' for 50 or more visits.
97 Refused
99 Don't know
care)
Skip Instructions:
(15-50) [goto ERR_PHCPHMN2W]
Question Text:
doctor, nurse, or other health care professional?
Do not include phone calls to make appointments, for billing questions or for prescription refills.
2 No
7 Refused
9 Don't know
Skip Instructions:
PHCPH2W]
(2,R,D) [goto FHCDV2W]
Question Text:
Who was the phone call about?
(Anyone else?)
2 No
7 Refused
9 Don't know
during the past 2 weeks (excluding calls for appointments, billing questions, or prescription medicines)
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.6 ]
Question Text:
* Enter '50' for 50 or more phone calls.
97 Refused
99 Don't know
during the past 2 weeks (excluding calls for appointments, billing questions, or prescription refills)
Skip Instructions:
(15-50) [goto ERR_PHCPHN2W]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto F10DVYR]
Question Text:
Who received care?
(Anyone else?)
2 No
7 Refused
9 Don't know
emergency room, or some other place during the past 2 weeks (excluding visits during overnight hospital stays)
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.7 ]
Question Text:
* Enter '50' for 50 or more visits.
97 Refused
99 Don't know
Skip Instructions:
(15-50) [goto ERR_PHCDVN2W]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Who received care 10 or more times? (Anyone else?)
2 No
7 Refused
9 Don't know
professional during the past 12 months (excluding telephone calls)
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
2007 NHIS Questionnaire - Family
Family Health Insurance
Question Text:
The next questions are about health insurance. Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide Medical care or help pay medical bills.
[fill:Are you/Is anyone in the family] covered by any kind of health insurance or some other kind of health care plan?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2) [if AGE ge 65, goto MCAREPRB; else, goto MCAIDPRB]
Question Text:
What kind of health insurance or health care coverage [fill: do you/does ALIAS] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized.
* Enter all that apply, separate with commas.
02 Medicare
03 Medi-Gap
04 Medicaid
05 SCHIP (CHIP/Children's Health Insurance Program)
06 Military health care (TRICARE/VA/CHAMP-VA)
07 Indian Health Service
08 State-sponsored health plan
09 Other government program
10 Single service plan (e.g., dental, vision, prescriptions)
11 No coverage of any type
97 Refused
99 Don't know
Skip Instructions:
(1-10) [if AGE ge 65 and HIKIND ne 2, goto MCAREPRB; else, if HIKIND ne 10 goto SINCOV; else, goto _HICHANGE]
(11) [if HIKIND = 1-10, goto ERR_HIKIND; else, if AGE ge 65 goto MCAREPRB; else, goto MCAIDPRB]
[p.2 ]
Question Text:
People covered by Medicare have a card that looks like this.
[fill: Are you/Is ALIAS] covered by Medicare?
2 No
7 Refused
9 Don't know
those persons at HIKIND
Skip Instructions:
Question Text:
* Refer to flashcard F14 for state Medicaid names.
There is a program called Medicaid that pays for health care for persons in need. In this State it is also called (* fill State name). [fill: Are you/Is ALIAS] covered by Medicaid?
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
2 No
7 Refused
9 Don't know
HIKIND
Skip Instructions:
[p.3 ]
Question Text:
fill3: ^HIKIND] / not covered by health insurance.] Is this correct?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2) [goto ERR_HICHANGE]
Question Text:
Earlier I recorded that ALIAS is covered by Medicare. May I please see ALIAS's Medicare card to determine the type of
coverage?
{if subject eq respondent}:
* Read if necessary.
What type of Medicare coverage do you have? Is it Part A - hospital insurance, Part B - medical insurance, or both?
* Fill in appropriate coverage type below.
2 Part B - Medical only
3 Both Part A and Part B
7 Refused
9 Don't know
Skip Instructions:
(R,D) [prefill MCCARD with a "2" and goto MCCHOICE]
Question Text:
2 No
Skip Instructions:
[p.4 ]
Question Text:
Medicare Advantage is the new name for Medicare Plus Choice plans. [fill: Are you/Is ALIAS] enrolled in a Medicare
Advantage plan?
2 No
7 Refused
9 Don't know
B coverage
Skip Instructions:
Question Text:
[fill: Are you/Is ALIAS] under a Medicare managed care arrangement, such as an HMO, that is, a Health Maintenance Organization? (With an HMO, you must generally receive care from HMO doctors, otherwise the expense is not covered unless you were referred by the HMO or there was a medical emergency).
2 No
7 Refused
9 Don't know
B coverage
Skip Instructions:
(2,R,D) [goto MCREF]
Question Text:
What is the name of the HMO?
* Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
B coverage, and are enrolled under a Medicare managed care arrangement
Skip Instructions:
[p.5 ]
Question Text:
? [F1]
Under [fill1: your/ALIAS's] Medicare plan, if [fill2: you need/he needs/she needs] to go to a different doctor or place for
special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.
2 No
7 Refused
9 Don't know
B coverage
Skip Instructions:
Question Text:
premium to receive a more comprehensive health benefit plan?
2 No
7 Refused
9 Don't know
B coverage
Skip Instructions:
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.6 ]
Question Text:
* Refer to flashcard F14 for state Medicaid names.
The next questions are about Medicaid coverage. In this State it is also called (* fill State Name). [fill1: You are/ALIAS
is] listed as having Medicaid coverage. Can [fill2: you/ALIAS] go to ANY doctor who will accept Medicaid or MUST
[fill3: you/he/she] choose from a book or list of doctors or is a doctor assigned?
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know
Skip Instructions:
(2) [goto MACHMD1]
(3) [goto MACHMD2]
Question Text:
What is the name of the health plan that provided the book or list?
*Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
Question Text:
What is the name of the health plan that assigned the doctor?
*Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
Question Text:
* Do not read. Was the Health Plan name obtained from a Health Plan Card or something with the Health Plan name on it?
2 No
Skip Instructions:
Question Text:
[fill2: you/he/she] must go to for all of [fill3: your/his/her] routine care? Do not include emergency care or care from a
specialist [fill4: you were/he was/she was] referred to.
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Under [fill1: your/ALIAS's] Medicaid plan, if [fill2: you need/he needs/she needs] to go to a different doctor or place for
special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.8 ]
Question Text:
* Enter all that apply, separate with commas.
You mentioned that [fill1: you have/ALIAS has] a single-service plan - that is, an insurance plan that provides one specific type of coverage. What type of service or care does [fill2: your/ALIAS's] single service plan or plans pay for?
02 AIDS care
03 Cancer treatment
04 Catastrophic care
05 Dental care
06 Disability insurance
07 Hospice care
08 Hospitalization only
09 Long-term care
10 Prescriptions
11 Vision care
12 Other (specify)
97 Refused
99 Don't know
Skip Instructions:
(12) [goto SSOTHER]
Question Text:
7 Refused
9 Don't know
Skip Instructions:
[p.9 ]
Question Text:
through work, purchased directly, or through a state or local government program or community program.
[fill2: We have the following persons listed as being covered by such plans:
* Read names.
(display roster of eligible persons)]
* Enter 1 to continue
1 Continue
Skip Instructions:
Question Text:
name of the first plan?
Do NOT include plans that only provide extra cash while in the hospital or plans that pay for only one type of service,
such as nursing home care, accidents, or dental care.
* Read if necessary: Do you have your health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
(R,D) [prefill PCARD1 with a "2" and goto HIPNAM1B]
Question Text:
2 No
Skip Instructions:
Question Text:
Which family members are covered by this plan?
* Indicate each family member covered by this plan.
2 No
7 Refused
9 Don't know
HIPNAM1
Skip Instructions:
goto MORPLAN NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Are there any more private health insurance plans?
2 No
7 Refused
9 Don't know
at HIPNAM1B
Skip Instructions:
(2,R,D) [if no persons selected at HIPNAM1B, goto FHICCI8; else, if persons selected at HIPNAM1B, but not all persons with HIKIND = 1 or 3 selected at HIPNAM1B, goto HIVER1]
Question Text:
*Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
(R,D) [prefill PCARD2 with a "2" and goto HIPNAM2B]
Question Text:
2 No
Skip Instructions:
Question Text:
Which family members are covered by that plan?
* Indicate each family member covered by this plan.
2 No
7 Refused
9 Don't know
HIPNAM2
Skip Instructions:
Question Text:
Are there any more private health insurance plans?
2 No
7 Refused
9 Don't know
at HIPNAM2B
Skip Instructions:
(2,R,D) [if persons selected at HIPNAM2B or HIPNAM1B, but not all persons with HIKIND eq 1 or 3 selected at HIPNAM2B or HIPNAM1B, goto HIVER1; else, goto FHICCI8]
[p.12]
Question Text:
*Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
(R,D) [prefill PCARD3 with a "2" and goto HIPNAM3B]
Question Text:
2 No
Skip Instructions:
Question ID: FHI.176_00.000
Instrument Variable Name: HIPNAM3B
Question Text:
Which family members are covered by that plan?
* Indicate each family member covered by this plan.
2 No
7 Refused
9 Don't know
HIPNAM3
Skip Instructions:
HIKIND eq 1 or 3 selected at HIPNAM1B or HIPNAM2B, goto HIVER1; else, if HIPNAM3 eq R or D and persons selected at HIPNAM1B or HIPNAM2B, and all persons with HIKIND eq 1 or 3 selected at HIPNAM1B or HIPNAM2B, goto FHICCI8; else, if HIPNAM3 eq R or D and persons not selected at HIPNAM1B and HIPNAM2B, goto FHICCI8; else, if the health plan name was entered at HIPNAM3, goto ORPLAN3]
goto MORPLAN3
[p.13 ]
Question Text:
Are there any more private health insurance plans?
2 No
7 Refused
9 Don't know
at HIPNAM3B
Skip Instructions:
(2,R,D) [if persons selected at HIPNAM1B or HIPNAM2B or HIPNAM3B, but not all persons with HIKIND eq 1 or 3 selected at HIPNAM1B or HIPNAM2B or HIPNAM3B, goto HIVER1; else, goto FHICCI8]
Question Text:
*Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
(R,D) [prefill PCARD4 with a "2" and goto HIPNAM4B]
Question Text:
2 No
Skip Instructions:
[p.14] 14 of 29
Question Text:
Which family members are covered by that plan?
* Indicate each family member covered by this plan.
2 No
7 Refused
9 Don't know
HIPNAM4
Skip Instructions:
Question Text:
[fill1: You are/ALIAS is] listed as having private insurance but [fill2: were/was] not mentioned as being covered by any
of the plans we just discussed. [fill3: Are you/Is ALIAS] covered by private insurance?
2 No
7 Refused
9 Don't know
reported plans
Skip Instructions:
(2,R,D) [goto ERR_HIVER1]
[p.15 ]
Question Text:
* Enter all that apply, separate with commas.
Is [fill: your/ALIAS's] health insurance plan the same as one of those already mentioned?
2 2nd plan mentioned (^HIPNAM2)
3 3rd plan mentioned (^HIPNAM3)
4 4th plan mentioned (^HIPNAM4)
5 Some other plan not already mentioned
7 Refused
9 Don't know
covered by any of the reported plans
Skip Instructions:
Question Text:
* Enter 1 to continue
1 Continue
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.
[p.16 ]
Question Text:
Health insurance plans are usually obtained in one person's name even if other family members are covered. That person
is called the policyholder. In whose name is this plan?
* Enter line number of family member (from list below) in whose name this plan is held.
* Enter 0 if the policyholder is not on the family roster."
01-25 Two-digit person number
97 Refused
99 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
Question Text:
Which one of these categories best describes how this plan was obtained?
02 Through union
03 Through workplace, but don't know if employer or union
04 Through workplace, self-employed or professional association
05 Purchased directly
06 Through a state/local government or community program
07 Other, specify
97 Refused
99 Don't know
Skip Instructions:
(7) [goto PLNWKSP] NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
Question Text:
How was this plan obtained?
7 Refused
9 Don't know
Skip Instructions:
Question Text:
* Enter all that apply, separate with commas.
Who pays for this health insurance plan?
* If government program is reported, probe for Medicare or Medicaid or SCHIP before entering code 7. If government is
the employer, enter code 2.
02 Employer or union
03 Someone outside the household
04 Medicare
05 Medicaid
06 Children's Health Insurance Program (CHIP/SCHIP)
07 State or local government or community program
97 Refused
99 Don't know
Skip Instructions:
(2-7,R,D) [if PLNPAY=1, goto HICOSTN; else, goto PLNMGD]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
[p.18 ]
Question Text:
How much [fill1: do you/does your family] currently spend for health insurance premiums for [fill2: ^HIPNAM1/^HIPNAM2/^HIPNAM3/^HIPNAM4/Plan 1/Plan 2/Plan 3/Plan 4]? Please include payroll deductions for premiums.
*Enter dollar amount for premium payments.
99997 Refused
99999 Don't know
Skip Instructions:
(R) [store "R" in HICOSTT and goto PLNMGD]
(D) [store "D" in HICOSTT and goto PLNMGD]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
Question Text:
* Enter time period for premium payments.
02 Once every 2 weeks
03 Once a month
04 Twice a month
05 Every 2 months
06 Quarterly (every 3 months)
07 Once a year
08 Twice a year
97 Refused
99 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
[p.19 ]
Question Text:
Is [fill: ^HIPNAM1/^HIPNAM2/^HIPNAM3/^HIPNAM4/Plan 1/Plan 2/Plan 3/Plan 4] an HMO (Health Maintenance
Organization), an IPA (Individual Practice Association), a PPO (Preferred Provider Organization), a POS (Point-Of-
Service), fee-for-service, or indemnity or is it some other kind of plan?
2 PPO
3 POS_
4 Fee-for-service/indemnity
5 Other
7 Refused
9 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
Question Text:
[If only one person covered by this plan:]
Is the annual deductible for medical care for this plan less than $1,100 or $1,100 or more? If there is a separate deductible
for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
[If two or more persons in the family are covered by this plan:]
Is the family annual deductible for medical care for this plan less than $2,200 or $2,200 or more? If there is a separate
deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
2 [$1,100/$2,200] or more
7 Refused
9 Don't know
Skip Instructions:
2 [goto HSAHRA]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.
[p.20
Question Text:
With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are
sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care
accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts.
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
Question Text:
2 Select from group/list
7 Refused
9 Don't know
Skip Instructions:
(2) [goto MGPYMD]
(R,D) [goto MGPREF]
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.
Question Text:
select list at a lower cost?
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.
[p.21 ]
Question Text:
^HIPNAM1/^HIPNAM2/^HIPNAM3/^ HIPNAM4/Plan 1/Plan 2/Plan 3/Plan 4] pay for any or part of the cost?
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.
Question Text:
When [fill1: you need/ALIAS needs/the family members with this plan need] to go to a different doctor or place for
special care, [fill2: do you/does ALIAS/do they] need approval or a referral? Do not include emergency care.
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a
family. Information on up to 4 plans per family is collected.
Question Text:
medicines prescribed by a doctor?
* Read if necessary: Does this plan have a drug benefit?
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: Detailed questions about private health insurance plans are looped through for each plan mentioned in a family. Information on up to 4 plans per family is collected.
[p.22 ]
Question Text:
is the name of the plan?
* Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
Question Text:
[fill3: you/he/she] choose from a book or list of doctors or is the doctor assigned?
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know
Skip Instructions:
Question Text:
[fill2: you/he/she] must go to for all of [fill3: your/his/her] routine care? Do not include emergency care or care from a
specialist [fill4: you were/he was/she was] referred to.
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.23 ]
Question Text:
Under [fill1: ^STNAME1/this SCHIP plan], if [fill2: you need/ALIAS needs] to go to a different doctor or place for
special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
* Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
Question Text:
MUST [fill3: you/he/she] choose from a book or list of doctors or is the doctor assigned?
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know
Skip Instructions:
[p.24 ] 24 of 29
Question Text:
[fill2: you/he/she] must go to for all of [fill3: your/his/her] routine care? Do not include emergency care or care from a
specialist [fill4: you were/he was/she was] referred to.
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Under [fill1:^STNAME2/this state sponsored plan], if [fill2: you need/ALIAS needs] to go to a different doctor or place
for special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
* Read if necessary: Do you have a health plan card or something with the plan name on it?
7 Refused
9 Don't know
Skip Instructions:
[p.25 ]
Question Text:
or MUST [fill3:you/he/she] choose from a book or list of doctors or is the doctor assigned?
2 Select from book/list
3 Doctor is assigned
7 Refused
9 Don't know
Skip Instructions:
Question Text:
[fill2: you/he/she] must go to for all of [fill3: your/his/her] routine care? Do not include emergency care or care from a
specialist [fill4: you were/he was/she was] referred to.
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Under [fill1:^ STNAME3/this other government plan], if [fill2: you need/ALIAS needs] to go to a different doctor or
place for special care, [fill3: do you/does he/does she] need approval or a referral? Do not include emergency care.
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.26 ]
Question Text:
* Enter all that apply, separate with commas.
Earlier I recorded that [fill1: you are/ALIAS is] covered by military health care. What types of military health care [fill2:
are you/is ALIAS] covered by?
2 VA
3 CHAMP-VA
4 Other military coverage (specify)
7 Refused
9 Don't know
Skip Instructions:
(2,3,R,D) [repeat question for next person with military health care; else, goto HILAST]
(4) [goto MILSPCOT]
Question Text:
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Is [fill: your/ALIAS's] TRICARE plan, TRICARE prime, TRICARE Extra, TRICARE Standard or TRICARE for Life?
2 TRICARE Extra
3 TRICARE Standard
4 TRICARE for life
5 TRICARE other (specify)
7 Refused
9 Don't know
Skip Instructions:
Question Text:
7 Refused
9 Don't know
Skip Instructions:
Question Text:
Not including Single Service Plans, about how long has it been since [fill: you/ALIAS] last had health care coverage?
2 More than 6 months, but not more than 1 year ago
3 More than 1 year, but not more than 3 years ago
4 More than 3 years
5 Never
7 Refused
9 Don't know
Skip Instructions:
Question Text:
[fill1: Which of these are reasons [fill2: you/ALIAS] stopped being covered?/Which of these are reasons [fill3:you
do/ALIAS does] not have health insurance?]
* Enter up to 5 reasons, separate with commas.
02 Got divorced or separated/death of spouse or parent
03 Became ineligible because of age/left school
04 Employer does not offer coverage/or not eligible for coverage
05 Cost is too high
06 Insurance company refused coverage
07 Medicaid/Medical plan stopped after pregnancy
08 Lost Medicaid/Medical plan because of new job or increase in income
09 Lost Medicaid (other)
10 Other (specify)
97 Refused
99 Don't know
Skip Instructions:
(10) [goto HISTOPOT]
Question Text:
* Other reason for not having coverage
7 Refused
9 Don't know
Skip Instructions:
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto HCSPFYR]
Question Text:
* If less than 1 month, enter '1'.
97 Refused
99 Don't know
the past 12 months
Skip Instructions:
HCSPFYR
[p. 29]
Question Text:
The next question is about money that [fill1: you have/your family has] spent out of pocket on medical care. We do NOT
want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for. In the
PAST 12 MONTHS, about how much did [fill2: you/your family] spend for medical care and dental care?
1 Less than $500
2 $500 - $1,999_
3 $2,000 - $2,999
4 $3,000 - $4,999
5 $5,000 or more
7 Refused
9 Don't know
Skip Instructions:
Question Text:
offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the
year to reimburse themselves for their out-of-pocket expenses for health care. With this type of account, any money
remaining in the account at the end of the year, following a short grace period, is lost to the employee.
2 No
7 Refused
9 Don't know
Skip Instructions:
2007 NHIS Questionnaire - Family
Family Socio-Demographic
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2) [goto PLBORN2]
(R,D) [goto CITIZEN]
[p.2]
Question Text:
02 Alaska
03 Arizona
04 Arkansas
05 California
06 Colorado
07 Connecticut
08 Delaware
09 District of Columbia
10 Florida
11 Georgia
12 Hawaii
13 Idaho
14 Illinois
15 Indiana
16 Iowa
17 Kansas
18 Kentucky
19 Louisiana
20 Maine
21 Maryland
22 Massachusetts
23 Michigan
24 Minnesota
25 Mississippi
26 Missouri
27 Montana
28 Nebraska
29 Nevada
30 New Hampshire
31 New Jersey
32 New Mexico
33 New York
34 North Carolina
35 North Dakota
36 Ohio
37 Oklahoma
38 Oregon
39 Pennsylvania
40 Rhode Island
41 South Carolina
42 South Dakota
43 Tennessee
44 Texas
45 Utah
46 Vermont
47 Virginia
49 West Virginia
50 Wisconsin
51 Wyoming
57 United States (state unknown)
Skip Instructions:
[p.4 ]
Question Text:
* Please record country of birth. If country not found, type "ZZ"
06 1 AM SAMOA
06 2 BAKER ISLAND
06 3 GUAM
06 4 HOWLAND ISLAND
06 5 JARVIS ISLAND
06 6 JOHNSTON ATOLL
06 7 KINGMAN REEF
06 8 MANUA ISLANDS
06 9 MIDWAY ISLANDS
07 0 NAVASSA ISLAND
07 1 NORTHERN MARIANAS
07 2 PALMYRA ATOLL
07 3 PUERTO RICO
07 4 ROTA
07 5 SAIPAN
07 6 SAND ISLAND
07 7 ST CROIX
07 8 ST JOHN
07 9 ST THOMAS
08 0 TINIAN
08 1 US OUTLYING AREA
08 2 US VIRGIN ISLANDS
08 3 USVI
08 4 VIRGIN ISLANDS
08 5 WAKE ISLAND
10 0 ABROAD
10 1 ABU DHABI
10 2 ADEN
10 3 AFGHANISTAN
10 4 AFRICA
10 5 ALBANIA
10 6 ALBERTA
10 7 ALGERIA
10 8 ALGIERS
10 9 ALSACE-LORRAINE
11 0 AMSTERDAM
11 1 ANEGADA
11 2 ANGOLA
11 3 ANGUILLA
11 4 ANGUILLA BWI
11 5 ANOJOUAN
11 6 ANTARCTICA
11 7 ANTIGUA
11 8 ANTIGUA and BARBUDA
11 9 ANTIGUA WI
12 1 ARAB PALESTINE
12 2 ARABIA
12 3 ARGENTINA
12 4 ARMENIA
12 5 ARUBA
12 6 ARUBA DWI
12 7 ARUBA NETHERLANDS
12 8 ASCENSION ISLAND
12 9 ASIA
13 0 ASIA MINOR
13 1 ASSAM
13 2 AT SEA
13 3 AUSTRALIA
13 4 AUSTRIA
13 5 AUSTRIA-HUNGARY
13 6 AZERBAIJAN
13 7 AZORES ISLANDS
13 8 BAHAMAS
13 9 BAHAMAS UK
14 0 BAHRAIN
14 1 BAJA CAL
14 2 BAJA CAL SUR
14 3 BALBOA
14 4 BANGLADESH
14 5 BARBADOS
14 6 BARBUDA
14 7 BAVARIA
14 8 BELARUS
14 9 BELFAST
15 0 BELGIAN CONGO
15 1 BELGIUM
15 2 BELIZE
15 3 BENIN
15 4 BERLIN
15 5 BERMUDA
15 6 BESSARABIA
15 7 BHUTAN
15 8 BOHEMIA
15 9 BOLIVIA
16 0 BONAIRE
16 1 BORNEO
16 2 BOSNIA
16 3 BOSNIA and HERZEGOVINA
16 4 BOTSWANA
16 5 BRASIL
16 6 BRAZIL
16 7 BRAZZAVILLE
16 8 BREMEN
16 9 BRITAIN
17 0 BRITISH COLUMBIA
17 1 BRITISH EAST AFRICA
17 3 BRITISH GUYANA
17 4 BRITISH HONDURAS
17 5 BRITISH HONG KONG
17 6 BRITISH ISLES
17 7 BRITISH VI
17 8 BRITISH VIRGIN IS
17 9 BRITISH WEST INDIES
18 0 BRITISH WI
18 1 BRUNEI
18 2 BULGARIA
18 3 BURKINA FASO
18 4 BURMA
18 5 BURUNDI
18 6 BWI
18 7 BYELARUS
18 8 BYELORUSSIA
18 9 CAICOS ISLANDS
19 0 CAM PHA
19 1 CAM RANH
19 2 CAMBODIA
19 3 CAMEROON
19 4 CAN THO
19 5 CANADA
19 6 CANAL ZONE
19 7 CANARY ISLANDS
19 8 CANTON and ENDERBURY IS
19 9 CANTON ISLAND
20 0 CAPE VERDE
20 1 CARIBBEAN
20 2 CAYMAN ISLANDS
20 3 CENTRAL AFRICA
20 4 CENTRAL AFRICAN REP
20 5 CENTRAL AMERICA
20 6 CEYLON
20 7 CHAD
20 8 CHANNEL ISLANDS
20 9 CHIAPAS
21 0 CHIHUAHUA
21 1 CHILE
21 2 CHINA
21 3 CHINA HONG KONG
21 4 CHRISTMAS ISLAND
21 5 CHRISTMAS ISLAND, INDIAN OCEAN
21 6 COAHUILA
21 7 COLIMA
21 8 COLOMBIA
21 9 COMOROS
22 0 CONGO
22 1 COOK ISLANDS
22 2 CORAL SEA ISLANDS
22 3 CORK
22 5 COSTA RICA
22 6 COTE D'IVORIE
22 7 CRETE
22 8 CRIMEA
22 9 CRISTOBAL
23 0 CROATIA
23 1 CUBA
23 2 CURACAO
23 3 CYPRUS
23 4 CZ
23 5 CZECH REPUBLIC
23 6 CZECHOSLOVAKIA
23 7 DA LAT
23 8 DA NANG
23 9 DAKAR
24 0 DANZIG
24 1 DELHI
24 2 DEMO PEOPLE'S REP OF KOREA
24 3 DEMO REP OF CONGO
24 4 DENMARK
24 5 DISTRITO FEDERAL
24 6 DJIBOUTI
24 7 DOM REP
24 8 DOMINICA
24 9 DOMINICA BWI
25 0 DOMINICA WI
25 1 DOMINICAN REPUBLIC
25 2 DUBAI
25 3 DUBLIN
25 4 DURANGO
25 5 DUTCH EAST INDIES
25 6 DUTCH GUIANA
25 7 DUTCH INDONESIA
25 8 DUTCH NEW GUINEA
25 9 EAST PAKISTAN
26 0 EAST PRUSSIA
26 1 EASTER ISLAND
26 2 EASTERN AFRICA
26 3 ECUADOR
26 4 EGYPT
26 5 EIRE
26 6 EL SALVADOR
26 7 ENGLAND
26 8 EQUATORIAL GUINEA
26 9 ERITREA
27 0 ESPANA
27 1 ESTONIA
27 2 ETHIOPIA
27 3 EUROPA ISLAND
27 4 EUROPE
27 5 FALKLAND ISLANDS
27 7 FEDERAL DISTRICT
27 8 FEDERAL REPUBLIC OF YUGOSLAVIA
27 9 FEDERATED STATES OF MICRONESIA
28 0 FIJI
28 1 FILIPINES
28 2 FINLAND
28 3 FOREIGN COUNTRY
28 4 FORMOSA
28 5 FRANCE
28 6 FRANKFURT
28 7 FRENCH GUIANA
28 8 FRENCH MOROCCO
28 9 FRENCH POLYNESIA
29 0 GABON
29 1 GALAPAGOS ISLANDS
29 2 GALWAY
29 3 GAMBIA
29 4 GAZA STRIP
29 5 GEORGIA
29 6 GERMANY
29 7 GHANA
29 8 GIA DINH
29 9 GIBRALTER
30 0 GLORIOSO ISLANDS
30 1 GOA
30 2 GRAND BAHAMA
30 3 GRAND CAYMAN
30 4 GRAND TURK
30 5 GREAT BRITAIN
30 6 GREAT COMORE
30 7 GREECE
30 8 GREENLAND
30 9 GRENADA
31 0 GUADALAJARA
31 1 GUADELOUPE
31 2 GUANAJUATO
31 3 GUATEMALA
31 4 GUERNSEY
31 5 GUERRERO
31 6 GUIANA
31 7 GUINEA
31 8 GUINEA-BISSAU
31 9 GUYANA
32 0 HA DONG
32 1 HAI PHONG
32 2 HAITI
32 3 HAMBURG
32 4 HANOI
32 5 HANOVER
32 6 HAVANA
32 7 HEARD and MCDONALD ISLANDS
32 9 HESSE
33 0 HIDALGO
33 1 HIGH SEAS
33 2 HOLLAND
33 3 HONDURAS
33 4 HONG KONG
33 5 HUNGARY
33 6 HYDERABAD
33 7 ICELAND
33 8 INDIA
33 9 INDONESIA
34 0 INTERNATIONAL WATERS
34 1 IRAN
34 2 IRAQ
34 3 IRELAND
34 4 IRIAN JAYA
34 5 IRISH REPUBLIC
34 6 ISLE OF MAN
34 7 ISRAEL
34 8 ITALY
34 9 IVORY COAST
35 0 JALISCO
35 1 JAMAICA
35 2 JAN MEYAN
35 3 JAPAN
35 4 JAVA
35 5 JERSEY
35 6 JIBUTI
35 7 JORDAN
35 8 JUAN DE NOVA ISLAND
35 9 JUGOSLAVIA
36 0 KALININGRAD
36 1 KAMPUCHEA
36 2 KASHMIR
36 3 KAZAKHSTAN
36 4 KENYA
365 KHANH HUNG
36 6 KINSHASA
36 7 KIRIBATI
36 8 KOREA
36 9 KORO ISLAND
37 0 KUWAIT
37 1 KWAJALEIN
37 2 KWANTUNG
37 3 KYRGYZSTAN
37 4 LABRADOR
37 5 LABUAN
37 6 LAOS
37 7 LATAKIA
37 8 LATIN AMERICA
37 9 LATVIA
38 1 LEEWARD ISLANDS
38 2 LESOTHO
38 3 LIBERIA
38 4 LIBYA
38 5 LIECHTENSTEIN
38 6 LITHUANIA
38 7 LOAS
38 8 LONDONDERRY
38 9 LONG XUYEN
39 0 LORRAINE
39 1 LUBECK
39 2 LUXEMBOURG
39 3 MACAO
39 4 MACAU
39 5 MACEDONIA
39 6 MADAGASCAR
39 7 MADEIRA ISLANDS
39 8 MAINLAND CHINA
39 9 MAJORCA
40 0 MALAGASY REPUBLIC
40 1 MALAWI
40 2 MALAYSIA
40 3 MALDIVES
40 4 MALI
40 5 MALLORCA
40 6 MALTA
40 7 MACHURIA
40 8 MANICA
40 9 MANILA
41 0 MANITOBA
41 1 MARSHALL ISLANDS
41 2 MARTINIQUE
41 3 MAURITANIA
41 4 MAURITIUS
41 5 MAYOTTE ISLAND
41 6 MELANESIA
41 7 MEXICO
41 8 MICHOACAN
41 9 MICRONESIA
42 0 MIDDLE EAST
42 1 MOLDAVIA
42 2 MOLDOVA
42 3 MONACO
42 4 MONAGAS
42 5 MONGOLIA
42 6 MONTENEGRO
42 7 MONTSERRAT
42 8 MORELOS
42 9 MOROCCO
43 0 MOZAMBIQUE
43 1 MY THO
43 3 NAM DINH
43 4 NAMIBIA
43 5 NAURU
43 6 NAYARIT
43 7 NEPAL
43 8 NETHERLANDS
43 9 NETH. ANTILLES
44 0 NETH. EAST INDIES
44 1 NEVIS ISLAND
44 2 NEW BRUNSWICK
44 3 NEW CALEDONIA
44 4 NEW GUINEA
44 5 NEW HEBRIDES
44 6 NEW SOUTH WALES
44 7 NEW ZEALAND
44 8 NEWFOUNDLAND
44 9 NHA TRANG
45 0 NICARAGUA
45 1 NIGER
45 2 NIGERIA
45 3 NIUE ISLAND
45 4 NORFOLK ISLAND
45 5 NORTH AFRICA
45 6 NORTH AMERICA
45 7 NORTH KOREA
45 8 NORTH VIETNAM
45 9 NORTHERN IRELAND
46 0 NORTHERN TERRITORY
46 1 NORWAY
46 2 NOVA SCOTIA
46 3 NUEVO LEON
46 4 OAXACA
46 5 OCEANIA
46 6 OKINAWA
46 7 OMAN
46 8 ONTARIO
46 9 OVERSEAS
47 0 PAKISTAN
47 1 PALAU
47 2 PALESTINE
47 3 PANAMA
47 4 PANAMA CANAL ZONE
47 5 PAPUA NEW GUINEA
47 6 PARACEL ISLANDS
47 7 PARAGUAY
47 8 PELAGOSA
47 9 PEOPLE'S REP. OF CHINA
48 0 PEOPLE'S REP. OF CONGO
48 1 PERSIA
48 2 PERU
48 3 PHAN THIET
48 5 PITCAIRN ISLAND
48 6 POLAND
48 7 POLYNESIA
48 8 PONAPE
48 9 PORTUGAL
49 0 PORTUGUESE INDIA
49 1 PRINCE EDWARD ISLAND
49 2 PRINCIPE ISLAND
49 4 PRUSSIA
49 5 PUEBLA
49 6 PUNJAB
49 7 PUNJAB, INDIA
49 8 PUNJAB, PAKISTAN
49 9 QATAR
50 0 QUANG LONG
50 1 QUEBEC
50 2 QUEENSLAND
50 3 QUERETARO
50 4 QUI NHON
50 5 RACH GIA
50 6 RAJASTHAN
50 7 RED CHINA
50 8 REPUBLIC OF CHINA
50 9 REPUBLIC OF CYPRUS
51 0 REPUBLIC OF IRELAND
51 1 REPUBLIC OF KOREA
51 2 REPUBLIC OF PANAMA
51 3 REP. OF PHILIPPINES
51 4 REP. OF SOUTH AFRICA
51 5 REPUBLICA DOMINICANA
51 6 REUNION ISLAND
51 7 RHODESIA
51 8 ROC
51 9 ROK
52 0 ROMANIA
52 1 ROTTERDAM
52 2 RUMANIA
52 3 RUSSIA
52 4 RUSSIAN FEDERATION
52 5 RWANDA
52 6 SAIGON
52 7 SALVADOR
52 8 SAMOA
52 9 SAN ANDRES
53 0 SAN LUIS POTOSI
53 1 SAN MARINO
53 2 SAN SALVADOR
53 3 SAO TOME ISLAND
53 4 SAO TOME and PRINCIPE
53 5 SARAWAK
53 6 SASKATCHEWAN
53 8 SAXONY
53 9 SCOTLAND
54 0 SENEGAL
54 1 SEOUL
54 2 SERBIA
54 3 SEYCHELLES
54 4 SHANGHAI
54 5 SHARJAH
54 6 SIBERIA
54 7 SICILY
54 8 SIERRA LEONE
54 9 SIKKIM
55 0 SINALOA
55 1 SINGAPORE
55 2 SLAVONIA
55 3 SLOVAK REPUBLIC
55 4 SLOVAKIA
55 5 SLOVENIA
55 6 SOLOMAN ISLANDS
55 7 SOMALIA
55 8 SONORA
55 9 SOUTH AFRICA
56 0 SOUTH AMERICA
56 1 SOUTH AUSTRALIA
56 2 SOUTH KOREA
56 3 SOUTH VIETNAM
56 4 SOUTH WALES
56 5 SOUTH YEMEN
56 6 SOUTHEAST ASIA
56 7 SOUTHERN AFRICA
56 8 SOUTHERN RHODESIA
56 9 SOVIET UNION
57 0 SPAIN
57 1 SPRATLEY ISLANDS
57 2 SRI LANKA
57 3 ST BARTHELEMY
57 4 ST BARTS
57 5 ST CHRISTOPHER
57 6 ST CHRISTOPHER-NEVIS
57 7 ST EUSTATIUS
57 8 ST HELENA
57 9 ST KITTS
58 0 ST KITTS-NEVIS
58 1 ST LUCIA
58 2 ST MAARTEN
58 3 ST MARTIN
58 4 ST PIERRE and MIQUELON
58 5 ST VINCENT
58 6 ST VINCENT and THE GRENADINES
58 7 SUDAN
58 8 SUMATRA
59 0 SURINAME
59 1 SVALBARD
59 2 SWAZILAND
59 3 SWEDEN
59 4 SWITZERLAND
59 5 SYRIA
59 6 SYRIAN ARAB REP
59 7 TABASCO
59 8 TADZHIK
59 9 TAHITI
60 0 TAIWAN
60 1 TAIWAN ROC
60 2 TAJIKISTAN
60 3 TAMAULIPAS
60 4 TANGANYIKA
60 5 TANGIER
60 6 TANZANIA
60 7 TASMANIA
60 8 THAILAND
60 9 THANH HOA
61 0 THE GRENADINES
61 1 TIBET
61 2 TIJUANA
61 3 TLAXCALA
61 4 TOBAGO
61 5 TOGO
61 6 TOGOLAND
61 7 TOKELAU
61 8 TONGA
61 9 TORTOISE ISLANDS
62 0 TORTOLA
62 1 TRANSVAAL
62 2 TRANSYLVANIA
62 3 TRIESTE
62 4 TRINIDAD
62 5 TRINIDAD and TOBAGO
62 6 TRIPOLI
62 7 TROMELIN ISLAND
62 8 TRUK
62 9 TUNIS
63 0 TUNISIA
63 1 TURKEY
63 2 TURKMENISTAN
63 3 TURKS and CAICOS IS
63 4 TURK ISLANDS
63 5 TUVALU
63 6 TUY HOA
63 7 UGANDA
63 8 UK
63 9 UKRAINE
64 0 UKRAINIA
64 2 UNION OF SOUTH AFRICA
64 3 UNION OF SOVIET SOCIALIST REPUBLICS
64 4 UNITED ARAB EMIRATES
64 5 UNITED KINGDOM
64 6 UPPER VOLTA
64 7 URUGUAY
64 8 USSR
64 9 USBEKISTAN
65 0 VANCOUVER
65 1 VANUATU
65 2 VATICAN CITY
65 3 VENEZUELA
65 4 VERACRUZ
65 5 VICTORIA
65 6 VIETNAM
65 7 VINH LONG
65 8 VUNG TAU
65 9 WALES
66 0 WALLIS and FUTUNA ISLANDS
66 1 WEST AFRICA
66 2 WEST BANK
66 3 WEST BENGAL
66 4 WEST INDIES
66 5 WEST PAKISTAN
66 6 WESTERN AUSTRALIA
66 7 WESTERN SAHARA
66 8 WESTERN SAMOA
66 9 WHITE RUSSIA
67 0 WINDWARD ISLANDS
67 1 WINNIPEG
67 2 WURZBERG
67 3 YAP
67 4 YAR
67 5 YEMEN
67 6 YEMEN ARAB REPUBLIC
67 7 YEREVAN
67 8 YUCATAN
67 9 YUGOSLAVIA
68 0 YUKON TERRITORY
68 1 ZACATECAS
68 2 ZADAR
68 3 ZAIRE
68 4 ZAMBIA
68 5 ZANZIBAR
68 6 ZIMBABWE
68 7 ZURICH
68 8 ANDORRA
68 9 BRITISH INDIAN OCEAN TERRITORY
69 0 DEUTSCHLAND
69 1 FRENCH SOUTHERN AND ANTARCTIC LANDS
69 2 GRENADINES, THE
69 4 MYANMAR
69 5 NORTHWEST TERRITORY
69 6 NUNAVUT TERRITORY
996 Country not listed
997 Refused
999 Don't know
Skip Instructions:
(100-696,996,R,D) [goto USYR]
Question Text:
Earlier I recorded [fill1: your/ALIAS's] date of birth as [fill2: AGEDOB@3(text version) AGEDOB@4, AGEDOB@5].
In what year did [fill3: you/ALIAS] come to the United States to stay?
1880-Current 1880-Current Year
9997 Refused
9999 Don't know
Skip Instructions:
(R,D) [goto USLONG]
NOTE: The "*Read if necessary...Earlier I recorded..." portion of this question is included for persons with
complete date of birth information.
Question Text:
* Read if necessary: Earlier I recorded that [fill2: you are/ALIAS is] [fill3: AGE] years old.
*Enter '95' for 95 or more years.
*If less than 1 year given as a response, code the answer as '0'.
95 95+ years
97 Refused
99 Don't know
Skip Instructions:
(R,D) [goto CITIZEN]
[p.17 ]
Question Text:
[fill: Are you/Is ALIAS] a CITIZEN of the United States?
2 Yes, born in Puerto Rico, Guam, American Virgin Islands, or other U.S. territory
3 Yes, born abroad to American parent(s)
4 Yes, U.S. citizen by naturalization
5 No, not a citizen of the United States
7 Refused
9 Don't know
Skip Instructions:
(2) [if (PLBORN eq 2 or PLBORN eq R), goto ERR2_CITIZEN; else, goto HEADST]
(R,D) [goto HEADST]
Question Text:
Is [fill: ALIAS] now attending Head Start?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [ goto HEADSTEV]
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.18 ]
Question Text:
What is the HIGHEST level of school [fill: you have/ALIAS has] completed or the highest degree [fill: you have/ALIAS
has] received? Please tell me the number from the card.
* Enter highest level of school completed.
01 1st grade
02 2nd grade
03 3rd grade
04 4th grade
05 5th grade
06 6th grade
07 7th grade
08 8th grade
09 9th grade
10 10th grade
11 11th grade
12 12th grade, no diploma
13 GED or equivalent
14 High School Graduate
15 Some college, no degree
16 Associate degree: occupational, technical, or vocational program
17 Associate degree: academic program
18 Bachelor's degree (Example: BA, AB, BS, BBA)
19 Master's degree (Example: MA, MS, MEng, MEd, MBA)
20 Professional School degree (Example: MD, DDS, DVM, JD)
21 Doctoral degree (Example: PhD, EdD)
96 Child under 5 years old
97 Refused
99 Don't know
Skip Instructions:
[p.19 ]
Question Text:
*Read names
(fill roster of people ge 18 years of age)]
ever been hono rably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard?
2 No
7 Refused
9 Don't know
Skip Instructions:
goto PMILTRY]
(2,R,D) [goto DOINGLW]
Question Text:
Who was this?
* Indicate each family member with honorable discharge.
2 No
7 Refused
9 Don't know
active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.20 ]
Question Text:
The next few questions are about employment status.
Which of the following [fill: were you/was ALIAS] doing last week?
* Read answer categories.
2 With a job or business but not at work
3 Looking for work
4 Working, but not for pay, at a family-owned job or business_
5 Not working at a job or business and not looking for work
7 Refused
9 Don't know
Skip Instructions:
(2,5) [goto WHYNOWRK]
(3,R,D) [goto WRKLYR]
NOTE: A flashcard was added to this question in quarter 3 of 2005.
Question Text:
What is the main reason [fill1: you/ALIAS] did not [fill2: work last week/have a job or business last week]?
02 Going to school
03 Retired
04 On a planned vacation from work
05 On family or maternity leave
06 Temporarily unable to work for health reasons
07 Have job/contract and off-season
08 On layoff
09 Disabled
10 Other
97 Refused
99 Don't know
or business and not looking for work
Skip Instructions:
(4-7) [goto WRKHRS]
[p.21 ] 21 of 22
Question Text:
How many hours [fill: did you work LAST WEEK at ALL jobs or businesses/did ALIAS work LAST WEEK at ALL jobs
or businesses/do you USUALLY work at ALL jobs or businesses/does ALIAS USUALLY work at ALL jobs or
businesses]?
997 Refused
999 Don't know
a job or business last week, or on a planned vacation from work, or on family or maternity leave, or temporarily
unable to work for health reasons, or have a job/contract and off-season
Skip Instructions:
(35-94) [goto WRKLYR]
(95-168) [goto ERR1_WRKHRS]
Question Text:
[fill: Do you/Does ALIAS] USUALLY work 35 hours or more per week in total at ALL jobs or businesses?
2 No
7 Refused
9 Don't know
how many hours they worked last week
Skip Instructions:
NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from DOINGLW
to WRKFTALL for each eligible person, then proceeds to WRKLYR.
Question Text:
Did [fill1: you/ALIAS] work for pay at any time in [fill2: last calendar year in 4-digit format]?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto HIEMPOF]
[p.22 ]
Question Text:
* If less than one month, enter '1'.
02-12 2-12 months
97 Refused
99 Don't know
Skip Instructions:
Question Text:
What is your best estimate of [fill1: your/ALIAS's] earnings before taxes and deductions from ALL jobs and businesses in
[fill2: last calendar year in 4-digit format]?
Include hourly wages, salaries, tips and commissions.
* Enter '999,995' if the reported income is greater than $999,995.
999995 $999,995+
999997 Refused
999999 Don't know
Skip Instructions:
Question Text:
your/ALIAS's] workplace?
2 No
7 Refused
9 Don't know
not at work, or working, but not for pay, at a family-owned job or business
Skip Instructions:
NOTE ON QUESTIONNAIRE FLOW: The instrument cycles through the appropriate questions from WRKLYR
to HIEMPOF for each eligible person, then proceeds to INTROINC.
[p.1 ]
2007 NHIS Questionnaire - Family
Family Income
Question Text:
The next questions are about [fill1: your total/your total family] income in [fill2: last calendar year in 4-digit format]
BEFORE TAXES.
Income is important in analyzing the health information we collect. For example, with this information, we can learn
whether persons in one income group use certain types of medical services more or less often than those in another group.
Please be assured that, like all other information you have provided, these answers will be kept strictly confidential.
1 Enter 1 to continue
Skip Instructions:
Question Text:
[fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from wages and salaries?]
[fill3: When answering these questions, please remember that by "combined ," I mean your income PLUS
the income of all family members living in this household (including cohabiting partners, and armed forces members
living at home).
Did any family members 18 and older, that is * Read names
(fill roster of people ge 18 years of age)
receive income in [fill2: last calendar year in 4-digit format] from...wages and salaries?]
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FSEINC]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income.
2 No
7 Refused
9 Don't know
salaries in the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
farm income?/ Did ALIAS receive income in [fill2: last calendar year in 4-digit format] from self-employment including
business and farm income?/Did any family members 18 and older, that is
*Read names
(fill roster of people ge 18 years of age)
receive income in [fill2: last calendar year in 4-digit format] from...self-employment including business and farm income?]
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FSSRR]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income.
2 No
7 Refused
9 Don't know
employment in the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Did [fill1: you/any family members living here] receive income in [fill2: last calendar year in 4-digit format] from Social
Security or Railroad Retirement?
* Read if necessary: Social Security checks are either automatically deposited in the bank or mailed to arrive on the third
of every month.
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FPENS]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income.
2 No
7 Refused
9 Don't know
Retirement in the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Social Security or Railroad Retirement income received as a disability benefit?
2 No
7 Refused
9 Don't know
the last calendar year
Skip Instructions:
person number in PSSRRDB and goto PSSRRD; else, goto PSSRRDB]
(2,R,D) [goto FPENS]
Question Text:
Who received Social Security or Railroad Retirement as a disability benefit?
(Anyone else?)
2 No
7 Refused
9 Don't know
Railroad Retirement in the last calendar year and at least one received the income as a disability benefit
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
2 No
7 Refused
9 Don't know
benefit in the last calendar year
Skip Instructions:
Question Text:
disability pension [fill3: other than Social Security or Railroad Retirement]?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FOPENS]
Question Text:
Who received this?
(Anyone else?)
*Indicate each family member with this income.
2 No
7 Refused
9 Don't know
Security or Railroad Retirement) in the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Social Security or Railroad Retirement/than a disability pension/than Social Security, Railroad Retirement, or a disability
pension]?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FSSI]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income.
2 No
7 Refused
9 Don't know
the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.7 ]
Question Text:
Did [fill: you/any family members] receive Supplemental Security Income (SSI)?
* Read if necessary: Federal SSI checks are either automatically deposited in the bank or mailed to arrive on the first of
every month.
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FTANF]
Question Text:
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.
2 No
7 Refused
9 Don't know
calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
[p.8 ]
Question Text:
At any time during [fill1: last calendar year in 4-digit format], even for one month, did [fill2: you/any family members
living here] receive any CASH assistance from a state or county welfare program, such as (* fill specific program name)?
* Please do not include food stamps, SSI, energy assistance, or medical assistance payments.
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FOWBEN]
Question Text:
Who in the family received this?
(Anyone else?)
*Indicate each family member with this income.
2 No
7 Refused
9 Don't know
program in the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
OTHER kind of welfare assistance such as help with getting a job, placement in education or job training programs, or
help with transportation or child care?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FINTRST]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income.
2 No
7 Refused
9 Don't know
assistance in the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
IRAs or certificates of deposit, money market funds, treasury notes, bonds, or any other investments that earn interest?
* Do not include dividends
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FDIVD]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income.
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.10 ] 10 of 17
Question Text:
income from property, royalties, estates or trusts?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FCHLDSP]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income.
2 No
7 Refused
9 Don't know
year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Did [fill: you/any family members living here] receive income from child support?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FINCOT]
Question Text:
Who received this?
(Anyone else?)
* Indicate which child in the family this is for. If that child is no longer residing with this family, enter line number of
custodial parent.
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
family/others, VA payments, Worker's Compensation, or unemployment compensation?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FINCTOT]
Question Text:
Who received this?
(Anyone else?)
* Indicate each family member with this income
2 No
7 Refused
9 Don't know
year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.12 ]
Question Text:
members living in this household.]
What is your best estimate of [fill2: your total income/the total income of all family members] from all sources, before
taxes, in [fill3: last calendar year in 4 digit format]?
* Enter ?999,995' if the reported income is greater than $999,995.
999995 $999,995+
999997 Refused
999999 Don't know
Skip Instructions:
(1000-250000) goto HOUSEOWN _
(250001-999995) goto ERR2_FINCTOT_
(D,R) goto FINC50_
Question Text:
2 $50,000 or more
7 Refused
9 Don't know
Skip Instructions:
(2) [goto FINC100]
(R,D) [HOUSEOWN]
Question Text:
2 $35,000 or more
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto HOUSEOWN]
Question Text:
on poverty threshold] or more?
2 [$9,500/$12,000/$15,000/$19,000/$22,500/$25,500/$29,000] or more
7 Refused
9 Don't know
Skip Instructions:
Question Text:
2 $100,000 or more
7 Refused
9 Don't know
Skip Instructions:
Question Text:
2 $75,000 or more
7 Refused
9 Don't know
Skip Instructions:
Question Text:
in your family]?
2 Rented
3 Other arrangement
7 Refused
9 Don't know
Skip Instructions:
(2) [goto FGAH]
[p.14 ]
Question Text:
[fill: Are you/Is anyone in your family] paying lower rent because the Federal, State, or local government is paying part of
the cost?
2 No
7 Refused
9 Don't know
Skip Instructions:
Question Text:
members living here EVER applied for Supplemental Security Income (SSI)? This includes people who applied for
benefits, even if the claim was denied.]
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FSDAPL]
Question Text:
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for SSI benefits.
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p. 15]
Question Text:
family members living here EVER applied for disability benefits from Social Security? This includes people who applied
for benefits, even if the claim was denied.]
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto TANFMYR]
Question Text:
Who in the family applied for it?
(Anyone else?)
* Indicate each family member who applied for Social Security Disability benefits.
2 No
7 Refused
9 Don't know
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the
respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
Earlier I recorded that [fill1: you/ALIAS] received cash assistance from programs such as welfare or public assistance in
[fill2: last calendar year in 4-digit format]. During [fill2: last calendar year in 4-digit format], about how many months
did [fill1: you/ALIAS] receive this assistance?
*Enter '1' if less than one month.
97 Refused
99 Don't know
Skip Instructions:
[p.16 ]
Question Text:
[fill1: Were you/Was anyone in the family] authorized to receive food stamps (which includes a food stamp card or
voucher, or cash grants from the state for food) at anytime during [fill2: last calendar year in 4-digit format]?
*An authorized person is one whose name appears on a certification card.
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FINWIC]
Question Text:
Who was authorized to receive food stamps?
* Indicate family members who were authorized to receive food stamps.
2 No
7 Refused
9 Don't know
year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
Question Text:
receive food stamps?
* Enter '1' if less than 1 month
97 Refused
99 Don't know
Skip Instructions:
[p.17 ]
Question Text:
At any time during [fill1: last calendar year in 4-digit format] did [fill2: you/anyone in your family] receive benefits from
the WIC program, that is, the Women, Infants and Children program?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2,R,D) [goto FMSSN]
Question Text:
Who in the family received this?
(Anyone else?)
* Indicate family members who were authorized to receive WIC benefits.
2 No
7 Refused
9 Don't know
of 0-5, and at least one received WIC benefits in the last calendar year
Skip Instructions:
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.
[p.1 ]
2007 NHIS Questionnaire - Family
Coverage
Question Text:
* Enter the area code and the number, or enter "N" if no phone.
9999999997 Refused
9999999999 Don't know
N No phone
Skip Instructions:
(0-1999999999) GOTO ERR_TELENUM_
(N) GOTO HOWLONG_1
Question Text:
Is there at least one telephone INSIDE your home that is currently working and is not a cell phone?
2 No
7 Refused
9 Don't know
Skip Instructions:
(2) goto RH1LNGDY_1
Question Text:
PAST 12 MONTHS? Do not include interruptions of phone service due to weather or natural disasters.
2 No
7 Refused
9 Don't know
information)
Skip Instructions:
(2, Refused, Don't know) goto TELCEL
[p.2]
Question Text:
Not including cell phones, how long were you or your family without telephone service in the PAST 12 MONTHS?
* Enter number for time without telephone service.
* If less than one week, enter '0'.
001-365 1-365
997 Refused
999 Don't know
service for one week or more during the past 12 months.
Skip Instructions:
(0,Refused, Don't know) goto TELCEL
Question Text:
* Enter time period for time without telephone service.
2 Week(s)
3 Months(s)
7 Refused
9 Don't know
Skip Instructions:
(2) if RH1LNGDY_1 gt '52' goto ERR2_RH1LNGDY_2 else goto TELCEL
(3) if RH1LNGDY_1 gt '12' goto ERR3_RH1LNGDY_2 else goto TELCEL
Question Text:
2 No
7 Refused
9 Don't know
Skip Instructions:
(2, Refused, Don't know) if CURWRK = '1' and RNOSERV = '1'
goto CELLOUT
elseif POS2 = '0'
goto hhc.NAME_FNAME
else
goto hhc.ADC
[p.3]
Question Text:
97 Refused
99 Don't know
Skip Instructions:
goto CELLOUT
elseif CURWRK = '1' and RNOSERV = '2', 'Refused', or 'Don't know'
goto PHONEUSE
elseif POS2 = '0'
goto hhc.NAME_FNAME
else
goto hhc.ADC
Question Text:
2 No
7 Refused
9 Don't know
working land-line that was out of service in the past 12 months, or who have a least one working cell phone or
Refused or Don't know number of working cell phones and have current working land-line that was out of service
in the past 12 months
Skip Instructions:
elseif POS2 = '0' goto hhc.NAME_FNAME
else goto hhc.ADC
[p.4]
Question Text:
*Read categories below.
2 Some received on cell phones and some on regular phones
3 Very few or none on cell phones
7 Refused
9 Don't know
Skip Instructions:
goto hhc.NAME_FNAME else goto hhc.ADC