[p.1]

2008 NHIS Questionnaire - Sample Child Identification

Document Version Date: 24-Apr-09

Question ID:CID.001_00.000

Instrument Variable Name:CURRES
QuestionText:

* Enter the line number of the person to whom you are speaking.

01-25 Person number of the respondent for Sample Child

UniverseText:Sample child section not started or not completed
SkipInstructions:

if CSTAT ne empty and CSTAT ne '2' THEN
if ASTAT = empty or ASTAT = '2' THEN
goto adult.aid.SADULT
elseif recontact.RCIFLAG ne '1' THEN
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif
goto back.OUTCOMEB1 procedure
endif
(01-25) if this is NOT an allowable line number
goto ERR_CURRES
elseif CURRES = a line number entered in KNOWSC2
store CURRES in CSPAVAIL and CSR ESP
goto CSRELTIV
elseif KNOWSC2 = 'Don't know' or 'Refused' or empty (no line numbers in KNOWSC2)
goto KNOAVAIL
else
goto CSPAVAIL
endif

[p.2]

Question ID:CID.010_00.000

Instrument Variable Name:CSPAVAIL
QuestionText:

The next questions are about [fill1: ALIAS of Sample Child].
Is [fill2:KNOWSC2 names] available to answer some questions about [fill3: HISHER] health?
* Enter line number of available respondent from list or enter '96' if no one is available.
* If refused enter CTRL_R.

01-25 Person # of person available to answer questions about Sample Child
96 No person available

UniverseText:Someone identified as knowledgeable about child's health and knowledgeable person(s) not entered in CURRES
SkipInstructions:

(01-25) if line number not equal one of the line numbers in KNOWSC2
goto child.cid.ERR_CSPAVAIL
else
store child.cid.CSPAVAIL in child.cid.CSRESP
goto child.cid.CSRELTIV
endif
(96) store child.cid.CSPAVAIL in child.cid.CSRESP
goto cbk.CCALLBK1
(R) store '4' in CSTAT(FAMINT)
if ASTAT = empty or ASTAT = '2' THEN
goto adult.aid.SADULT
elseif recontact.RCIFLAG ne '1' THEN
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif

Question ID:CID.030_00.000

Instrument Variable Name:CSRELTIV
QuestionText:

(book) C1
[fill1: The next questions are about [fill2: ALIAS of Sample Child].]
What is your relationship to [fill2: ALIAS of Sample Child]?

01 Parent (Biological, adoptive, or step)
02 Grandparent
03 Aunt/Uncle
04 Brother/Sister
05 Other relative
06 Legal guardian
07 Foster parent
08 Other non-relative
97 Refused
99 Don't know

UniverseText:Someone identified as knowledgeable about child's health
SkipInstructions:

(1-8,R,D) If CSRESP = demographics.hhc.RELRESP_A
goto child.chs.BWGT_LB
elseif CSRESP = demographics.hhc.HHRESP
goto child.chs.BWGT_LB
else]
goto CSPVERF_S
endif]

[p.3]

Question ID:CID.040_00.000

Instrument Variable Name:CSPVERF_S
QuestionText:

* Please verify the following information about the sample child before proceeding:
I have recorded [fill1: ALIAS of Sample Child]'s sex as [fill2: Sex of Sample Child]. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

UniverseText:Respondent is not the person entered in HHRESP or RELRESP_A.
SkipInstructions:

(1) goto CSPVERF_A
(2) goto NEWSEX

Question ID:CID.041_00.000

Instrument Variable Name:NEWSEX
QuestionText:

* Ask if appropriate; otherwise, enter your best guess of the person's sex.
Is [fill: ALIAS of Sample Child] Male or Female?

1 Male
2 Female

UniverseText Respondent said child's sex is not correct.
SkipInstructions:

(1,2) store NEWSEX in SEX
goto ERR_NEWSEX
reset CSPVERF_S
goto CSPVERF_S

Question ID:CID.042_00.000

Instrument Variable Name:CSPVERF_A
QuestionText:

* Please verify the following information about the sample child before proceeding:
I have recorded [fill1: ALIAS of Sample Child]'s age as [fill2: Age of Sample Child] old. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

UniverseText: Respondent verified child's sex
SkipInstructions:

(1) goto CSPVERF_D
(2) goto NEWAGE

[p.4]

Question ID:CID.043_00.000

Instrument Variable Name:NEWAGE
QuestionText:

How old is [fill1: ALIAS of Sample Child]?
* If age given in months, weeks, or days, convert age to appropriate year. If less than one year old, enter "0".

000-120 Age in years

UniverseText:Respondent said child's age is not correct
SkipInstructions:

(0-120, Refused, Don't know)
if NEWAGE = 'Refused' or NEWAGE = 'Don't know' or NEWAGE = AGE
reset CSPVERF_A goto ERR_NEWAGE
else
store NEWAGE in AGE
goto NEWDOB_M

Question ID:CID.044_00.000

Instrument Variable Name:CSPVERF_D
QuestionText:

* Please verify the following information about the sample child before proceeding:
I have recorded [fill1: ALIAS of Sample Child]'s birthday as [fill2: Birthday of Sample Child]. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

UniverseText:Respondent verified child's sex
SkipInstructions:

(1) if AGE of Sample Child ge '18'
goto CNO_MORE
else
goto child.chs.BWGT_LB
endif
(2) goto NEWDOB_M

[p.5]

Question ID:CID.046_01.000

Instrument Variable Name:NEWDOB_M
QuestionText:

1 of 3
What is [fill: ALIAS of Sample Child]'s birthday?
*Enter month of birth.

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December

UniverseText:Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:

(01-12, Refused, Don't know) goto NEWDOB_D

Question ID:CID.046_02.000

Instrument Variable Name:NEWDOB_D
QuestionText:

2 of 3
* Enter day of birth.

01-31 Day of the month

UniverseText:Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:

(01-31,Refused,Don't know) goto NEWDOB_Y
If days not valid, goto ERR_NEWDOB_D

[p.6]

Question ID:CID.046_03.000

Instrument Variable Name:NEWDOB_Y
QuestionText:

3 of 3
* Enter year of birth.

1880-2020 Year of birth

UniverseText:Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:

(1880-2020, Refused, Don't know) if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty
goto CSPVERF_A
elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty
goto CSPVERF_D
endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and
month = current month and day GT current day)
goto ERR1_NEWDOB_Y
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
goto ERR2_NEWDOB_Y
endif
(if NEWDOB_M = 'Ref' or 'DK') or (if NEWDOB_D = 'Ref' or 'DK') or (if NEWDOB_Y = 'Ref' or 'DK')
goto ERR3_NEWDOB_Y
else
store NEWDOB_M in DOBM
store NEWDOB_D in DOBD
store NEWDOB_Y in DOBY
if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty
goto CSPVERF_A
elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty
goto CSPVERF_D
endif
endif
Calculate age from NEWDOB_M, NEWDOB_D, and NEWDOB_Y.
if age from NEWDOB items is ne AGE and age from NEWDOB items is valid
reset CSPVERF_A or CSPVERF_D
goto ERR4_NEWDOB_Y
endif

[p.1]

Sample Child Health Status and Limitations

Question ID:CHS.010_01.000

Instrument Variable Name:BWGT_LB
QuestionText:

What was [fill: S.C. name]'s birth weight?
* Enter 'M' to record metric measurements.

01-15 1-15 pounds
97 Refused
99 Don't know
M Metric

UniverseText:Sample children LT 18
SkipInstructions:

(1-12) [goto BWGT_OZ]
(13-15) [goto ERR1_BWGT_LB]
(R,D) [goto CHGT_FT]
(M) [goto BWGT_GR]
[If NE (1-15, M, R, D) goto ERR2_BWGT_LB]

Question ID:CHS.010_02.000

Instrument Variable Name:BWGT_OZ
QuestionText:

* Enter ounces.

00-15 0-15 ounces
97 Refused
99 Don't know
Blank Blank

UniverseText:Sample children LT 18 who have a value entered for weight in pounds.
SkipInstructions:

(0-15,R,D) [goto CHGT_FT]
[if BWGT_LB = (0-15, R, D) and BWGT_OZ = (empty) go to CHGT_FT]

Question ID:CHS.011_00.000

Instrument Variable Name:BWGT_GR
QuestionText:

* Enter weight in grams

0500-5485 500-5485 grams
9997 Refused
9999 Don't know

UniverseText:Sample children LT 18 whose birth weight will be entered in metric.
SkipInstructions:

(500-5485,R,D) [goto CHGT_FT]
(5486-6900) [goto ERR_BWGT_GR]

[p.2]

Question ID:CHS.020_01.000

Instrument Variable Name:CHGT_FT
QuestionText:

How tall is [fill: S.C. name] now (without shoes)?
* If the child's height is given in inches, press 'ENTER' at feet and enter the measure in inches (36 inches maximum).
* Enter 'M' to record metric measurements.

00-07 0-7 feet
97 Refused
99 Don't know
M Metric

UniverseText:Sample children 12+
SkipInstructions:

(empty) [goto CHGT_IN]
(0-7) [goto CHGT_IN]
(R,D) [goto CWGT_LB]
(M) [goto CHGT_M]
[If NE (0-7, M, R, D) go to ERR_CHGT_FT]

Question ID:CHS.020_02.000

Instrument Variable Name:CHGT_IN
QuestionText:

* Enter inches.

00-36 0-36 inches
97 Refused
99 Don't know

UniverseText:Sample children 12+ whose height in feet is 0-7 or is left empty.
SkipInstructions:

(0-36) [goto CWGT_LB]
[If both CHGT_FT and CHGT_IN are either (empty) or (0), display ERR1_CHGT_IN]
[If CHGT_FT = (0-7) and CHGT_IN is GE (12) display ERR2_CHGT_IN]

Question ID:CHS.021_01.000

Instrument Variable Name:CHGT_M
QuestionText:

* Enter height in metric.
* If the child's height is given in centimeters, press 'ENTER' at meters and enter the measure in centimeters (241 centimeters maximum).

0-2 0-2 meters
7 Refused
9 Don't know
Blank Blank

UniverseText:Sample children 12+ whose current height will be entered in metric.
SkipInstructions:

(0-2) [goto CHGT_CM]
(R,D) [goto CWGT_LB]
(empty) [go to CHGT_CM]

Question ID:CHS.021_02.000

Instrument Variable Name:CHGT_CM
QuestionText:

* Enter centimeters

000-241 0-241 centimeters
Blank Blank

UniverseText:Sample children 12+ whose weight will be entered in metric, and who entered "0-2" for height in meters or left it empty.
SkipInstructions:

(0-241) [goto CWGT_LB]
[if CHGT_M = (empty, 0) and CHGT_CM = (empty, 0) go to ERR1_CHGT_CM]
[if CHGT_M = 2 and CHGT_CM GT 41 goto ERR2_CHGT_CM]
[if CHGT_M = 1 and CHGT_CM GT 141 goto ERR2_CHGT_CM]

Question ID:CHS.022_00.000

Instrument Variable Name:CWGT_LB
QuestionText:

How much does [fill: S.C. name] weigh now (without shoes)?
* Enter 'M' to record metric measurements.
* Enter '500' if 500 pounds or more.

001-500 1-500 pounds
997 Refused
999 Don't know
M Metric

UniverseText:Sample children 12+
SkipInstructions:

(1-500,R,D) [if age ge (2) goto ADD_1, else, goto ADD1_2]
(M) [goto CWGT_KG]
[if = (501-999) goto ERR1_CWGT_LB]
[if NE (1-999, M, R, D) goto ERR2_CWGT_KG]

Question ID:CHS.023_00.000

Instrument Variable Name:CWGT_KG
QuestionText:

* Enter weight in kilograms.

002-226 2-226 kilograms

UniverseText:Sample children 12+ whose weight will be entered in metric.
SkipInstructions:

(2-226) [if AGE ge (2) goto ADD_1; else goto ADD1_2]
[if CWGT_KG GT 226 goto ERR_CWGT_KG]

[p.4]

Question ID:CHS.031_02.000

Instrument Variable Name:ADD1_2
QuestionText:

Has a doctor or health professional ever told you that [fill: S.C. name] had...
Mental Retardation?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto ADD1_3]

Question ID:CHS.031_03.000

Instrument Variable Name:ADD1_3
QuestionText:

* Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had...
Any other developmental delay?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children
SkipInstructions:

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

Question ID:CHS.032_01.000

Instrument Variable Name:ADD_1
QuestionText:

Has a doctor or health professional ever told you that [fill: S.C. name] had...
Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 2-17
SkipInstructions:

(1,2,R,D) [go to ADD_2]

[p.5]

Question ID:CHS.032_02.000

Instrument Variable Name:ADD_2
QuestionText:

* Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had...
Mental Retardation?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 2-17
SkipInstructions:

(1,2,R,D) [go to ADD_3]

Question ID:CHS.032_03.000

Instrument Variable Name:ADD_3
QuestionText:

* Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had...
Any other developmental delay?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 2-17
SkipInstructions:

(1,2,R,D) [go to CONDL]

[p.6]

Question ID:CHS.060_00.000

Instrument Variable Name:CONDL
QuestionText:

(book) C2 ?[F1]
Looking at this list, has a doctor or health professional ever told you that [fill: SC name] had any of these conditions?
*Read if necessary.
Down syndrome
Cerebral palsy
Muscular dystrophy
Cystic fibrosis
Sickle cell anemia
Autism
Diabetes
Arthritis
Congenital heart disease
Other heart condition

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto CONDL1] (2,R,D) [goto CPOX]

Question ID:CHS.061_00.000

Instrument Variable Name:CONDL1
QuestionText:

(book) C2 ?[F1]
Which ones?
* Enter all that apply, separate with commas.

01 Down syndrome
02 Cerebral palsy
03 Muscular dystrophy
04 Cystic fibrosis
05 Sickle cell anemia
06 Autism
07 Diabetes
08 Arthritis
09 Congenital heart disease
10 Other heart condition

UniverseText:Sample children LT 18 and CONDL=1
SkipInstructions:

(1-10,R,D) [go to CPOX]
[If (0) and (1-10) go to ERR_CONDL]

[p.7]

Question ID:CHS.070_00.000

Instrument Variable Name:CPOX
QuestionText:

Has [fill: S.C. Name] EVER had chickenpox?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [go to CPOX12MO]
(2,R,D) [go to CASHMEV]

Question ID:CHS.072_00.000

Instrument Variable Name:CPOX12MO
QuestionText:

Has [fill: S.C. name] had chickenpox DURING THE PAST 12 MONTHS?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 who have had chickenpox
SkipInstructions:

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

Question ID:CHS.080_00.000

Instrument Variable Name:CASHMEV
QuestionText:

Has a doctor or other health professional EVER told you that [fill: S.C. name] had asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [go to CASSTILL]
(2,R,D) [if AGE LE 2 go to CCONDT1_1; if AGE GT 2 go to CCONDT_1]

Question ID:CHS.085_00.000

Instrument Variable Name:CASSTILL
QuestionText:

Does [fill: S.C. name] still have asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:

(1,2,R,D) [go to CASHYR]

[p.8]

Question ID:CHS.090_00.000

Instrument Variable Name:CASHYR
QuestionText:

The following questions are about [fill: S.C. name]'s asthma DURING THE PAST 12 MONTHS.
DURING THE PAST 12 MONTHS, has [fill: SC name] had an episode of asthma or an asthma attack?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:

(1) [go to CASMERYR]
(2,R,D) [if CASSTILL = 1 go to CWZPIN; if CASSTILL = 2, R, D and AGE LE 2 go to CCONDT1_1; else go
to CCONDT_1]

Question ID:CHS.100_00.000

Instrument Variable Name:CASMERYR
QuestionText:

DURING THE PAST 12 MONTHS, did [fill1: S.C. name] have to visit an emergency room or urgent care center because of [fill2: his/her] asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 who has had an episode of asthma or an asthma attack in the past 12 months
SkipInstructions:

(1,2,R,D) [CASMHSP]

Question ID:CHS.100_00.010

Instrument Variable Name:CASMHSP
QuestionText:

DURING THE PAST 12 MONTHS, has [fill: S.C. name] stayed overnight in a hospital because of asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who had episode of asthma in past year
SkipInstructions:

(1) [goto CASMMC]
(2,R,D) [go to CWZMSWK]

[p.9]

Question ID:CHS.100_00.020

Instrument Variable Name:CASMMC
QuestionText:

After (the last time) [fill: SC name] left the hospital, did a health professional talk with you about long term management of [fill: his/her] asthma?

1 Yes
2 No
3 Still in the hospital
7 Refused
9 Don't know

UniverseText:Sample child LT 18 in hospital overnight b/c of asthma, past year
SkipInstructions:

(1,2,3,R,D) [go to CWZMSWK]

Question ID:CHS.100_00.030

Instrument Variable Name:CWZMSWK
QuestionText:

DURING THE PAST 12 MONTHS, that is since [12-month ref. date], HOW MANY DAYS of [fill1: daycare or preschool/fill2: school/fill3: school or work] did [fill: SC name] miss because of [fill: his/her] asthma?
*Enter 995 if child home schooled.
*Enter 996 if child did not go to [fill1: daycare or preschool/fill2: school/fill3: school or work].

000-365 000-365 days
995 Child was home schooled
996 child did not go to day care, preschool, school, or work
997 Refused
999 Don't know

UniverseText:Sample child LT 18 who had episode of asthma in past year
SkipInstructions:

(000-100,995,996,R,D) [go to CWZPIN]
(101-365) [go to ERR1_CWZMSWK]
(366-994) [go to ERR2_CWZMSWK]

Question ID:CHS.100_00.040

Instrument Variable Name:CWZPIN
QuestionText:

Has [fill: SC name] EVER used a PRESCRIPTION inhaler?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or asthma attack in past 12 months
SkipInstructions:

(1) [goto CASMINST]
(2,D,R) [go to CASMED]

[p.10]

Question ID:CHS.100_00.050

Instrument Variable Name:CASMINST
QuestionText:

Has a health professional shown [fill: SC name] how to use [fill: his/her] inhaler? (This includes showing parents for young children.)

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who have ever used prescription inhaler
SkipInstructions:

(1,2,R,D) [go to CASMPMED]

Question ID:CHS.100_00.060

Instrument Variable Name:CASMPMED
QuestionText:

Now I'm going to ask you about two different kinds of ASTHMA medicine. One is for quick relief. The other does not give quick relief but protects your lungs AND PREVENTS SYMPTOMS OVER THE LONG TERM.
DURING THE PAST 3 MONTHS, has [fill: SC name] used the kind of PRESCRIPTION inhaler THAT YOU
BREATHE IN THROUGH YOUR MOUTH, that gives QUICK relief from asthma symptoms?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who have ever used prescription inhaler
SkipInstructions:

(1) [goto CASMCAN]
(2,D,R) [go to CASMED]

Question ID:CHS.100_00.070

Instrument Variable Name:CASMCAN
QuestionText:

DURING THE PAST 3 MONTHS did [fill: SC name] use more than three canisters of this type of inhaler?

1 Yes
2 No
7 Refused
9 Don't Know

UniverseText:Sample child LT 18 who have used quick relief inhaler,past 3m
SkipInstructions:

(1,2,D,R) [go to CASMED]

[p.11]

Question ID:CHS.100_00.080

Instrument Variable Name:CASMED
QuestionText:

Has [fill: SC name] EVER taken the preventive kind of ASTHMA medicine used everyday to protect [fill: his/her] lungs and keep [fill: him/her] from having attacks? Include both oral medicine and inhalers. This is different from inhalers used for quick relief.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or who had asthma attack in the past 12 months
SkipInstructions:

(1) [go to CASMDTP] (2,R,D) [goto CASWMP]

Question ID:CHS.100_00.090

Instrument Variable Name:CASMDTP
QuestionText:

Is [fill: SC name] NOW taking this medication (that protects [fill: his/her] lungs) daily or almost daily?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who have ever taken preventive asthma medicine
SkipInstructions:

(1,2,D,R) [go to CASWMP]

Question ID:CHS.100_00.100

Instrument Variable Name:CASWMP
QuestionText:

An asthma action plan is a printed form that tells when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room.
Has a doctor or other health professional EVER given [fill: SC name] an asthma action plan?
*Read if necessary: Include nurses and asthma educators.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or who had an asthma attack in the past 12 months
SkipInstructions:

(1,2,D,R) [go to CASCLASS]

[p.12]

Question ID:CHS.100_00.110

Instrument Variable Name:CASCLASS
QuestionText:

Has [fill: SC name] ever taken a course or class on how to manage [fill: his/her] asthma?
*Include adult(s) who took a course for the child's asthma.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or have had asthma attack in the past 12 months.
SkipInstructions:

(1,2,D,R) [go to CAS_REC]

Question ID:CHS.100_00.116

Instrument Variable Name:CAS_REC
QuestionText:

Has a doctor or other health professional EVER taught [fill: SC name] or [fill: his/her] parent or guardian
...how to recognize early signs or symptoms of an asthma episode

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or who have had asthma attack in the past 12 months.
SkipInstructions:

(1,2,D,R) [go to CAS_RES]

Question ID:CHS.100_00.117

Instrument Variable Name:CAS_RES
QuestionText:

*Read if necessary: Has a doctor or other health professional EVER taught [fill: SC name] or [fill: his/her] parent or guardian ...how to respond to episodes of asthma

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or who have had asthma attack in the past 12 months.
SkipInstructions:

(1,2,D,R) [go to CAS_MON]

[p.13]

Question ID:CHS.100_00.118

Instrument Variable Name: CAS_MON
QuestionText:

*Read if necessary: Has a doctor or other health professional EVER taught [fill: SC name] or [fill: his/her] parent or guardian ...how to monitor peak flow for daily therapy

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or who have had asthma attack in the past 12 months
SkipInstructions:

(1,2,D,R) [go to CAPENVLN]

Question ID:CHS.100_00.130

Instrument Variable Name:CAPENVLN
QuestionText:

Has a doctor or other health professional EVER advised you to change things in [fill: SC name]'s home, school, or work to improve [fill: his/her] asthma?

1 Yes
2 No
3 Was told no changes needed
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who still have asthma or who have had an asthma attack in the past 12 months
SkipInstructions:

(1) [goto CAPENVDO]
(2,3,R,D) [if AGE LE 2 go to CCONDT1_1; else go to CCONDT_1]

Question ID:CHS.100_00.140

Instrument Variable Name:CAPENVDO
QuestionText:

How much of this advice did you follow? Would you say none, a little, some, most, or all?

0 None
1 A little
2 Some
3 Most
4 All
7 Refused
9 Don't know

UniverseText:Sample child LT 18 who been told to change things because of asthma
SkipInstructions:

(0-4,R,D) [if AGE LE 2 go to CCONDT1_1; else go to CCONDT_1]

[p.14]

Question ID:CHS.111_01.000

Instrument Variable Name:CCONDT1_1
QuestionText:

DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Hay fever?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CCONDT1_2]

Question ID:CHS.111_02.000

Instrument Variable Name:CCONDT1_2
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Any kind of respiratory allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CCONDT1_3]

Question ID:CHS.111_03.000

Instrument Variable Name:CCONDT1_3
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Any kind of food or digestive allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CCONDT1_4]

[p.15]

Question ID:CHS.111_04.000

Instrument Variable Name:CCONDT1_4
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Eczema or any kind of skin allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CCONDT1_5]

Question ID:CHS.111_05.000

Instrument Variable Name:CCONDT1_5
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Frequent or repeated diarrhea or colitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CCONDT1_6]

Question ID:CHS.111_06.000

Instrument Variable Name:CCONDT1_6
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Anemia?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CCONDT1_8]

[p.16]

Question ID:CHS.111_08.000

Instrument Variable Name:CCONDT1_8
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Three or more ear infections?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CCONDT1_9]

Question ID:CHS.111_09.000

Instrument Variable Name:CCONDT1_9
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Seizures?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LE 2
SkipInstructions:

(1,2,R,D) [go to CHSTATYR]

Question ID:CHS.115_01.000

Instrument Variable Name:CCONDT_1
QuestionText:

DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Hay fever?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_2]

[p.17]

Question ID:CHS.115_02.000

Instrument Variable Name:CCONDT_2
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Any kind of respiratory allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_3]

Question ID:CHS.115_03.000

Instrument Variable Name:CCONDT_3
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Any kind of food or digestive allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_4]

Question ID:CHS.115_04.000

Instrument Variable Name:CCONDT_4
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Eczema or any kind of skin allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_5]

[p.18]

Question ID:CHS.115_05.000

Instrument Variable Name:CCONDT_5
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Frequent or repeated diarrhea or colitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_6]

Question ID:CHS.115_06.000

Instrument Variable Name:CCONDT_6
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Anemia?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_7]

Question ID:CHS.115_07.000

Instrument Variable Name:CCONDT_7
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Frequent or severe headaches, including migraines?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_8]

[p.19]

Question ID:CHS.115_08.000

Instrument Variable Name:CCONDT_8
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Three or more ear infections?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_9]

Question ID:CHS.115_09.000

Instrument Variable Name:CCONDT_9
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Seizures?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CCONDT_10]

Question ID:CHS.115_10.000

Instrument Variable Name:CCONDT_10
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: S.C. name] had any of the following conditions...
Stuttering or stammering?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children = 3-17
SkipInstructions:

(1,2,R,D) [go to CHSTATYR]

[p.20]

Question ID:CHS.210_00.000

Instrument Variable Name:CHSTATYR
QuestionText:

Compared with 12 months ago, would you say [fill: S.C. name]'s health is now better, worse, or about the same?

1 Better
2 Worse
3 About the same
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1-3,R,D) [if AGE le (4) goto CCOLD2W; else goto SCHDAYR]

Question ID:CHS.220_00.000

Instrument Variable Name:SCHDAYR
QuestionText:

DURING THE PAST 12 MONTHS, that is, since [fill1: 12-month ref. date], about how many days did [fill2: S.C. name] miss school because of illness or injury?
* Enter '996' if child did not go to school in the past 12 months.

000 None
001-240 1-240 days
996 Did not go to school
997 Refused
999 Don't know

UniverseText:Sample children 5-17
SkipInstructions:

(0-99,996,R,D) [goto CCOLD2W]
(100-240) [go to ERR1_SCHDAYR]
(241-995) [goto ERR2_SCHDAYR]

Question ID:CHS.230_00.000

Instrument Variable Name:CCOLD2W
QuestionText:

* Hand calendar card.
These next questions are about [fill: S.C name]'s recent health during the 2 weeks outlined on that calendar. Did [fill: SC name] have a head cold or chest cold that started during those two weeks?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CINTIL2W]

[p.21]

Question ID:CHS.240_00.000

Instrument Variable Name:CINTIL2W
QuestionText:

Did [fill: S.C. name] have a stomach or intestinal illness with vomiting or diarrhea that started during those two weeks?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHEARST1]

Question ID:CHS.250_00.000

Instrument Variable Name: CHEARST1
QuestionText:

Which statement best describes [fill: SC name]'s hearing without a hearing aid: Excellent, good, a little trouble hearing, moderate trouble, a lot of trouble, or is [fill: SC's name] deaf?

1 Excellent
2 Good
3 A little trouble hearing
4 Moderate trouble
5 A lot of trouble
6 Deaf
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1-6,R,D) [go to CVISION]

Question ID:CHS.260_00.000

Instrument Variable Name:CVISION
QuestionText:

Does [fill1: S.C. name] have any trouble seeing [fill2: , even when wearing glasses or contact lenses]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto CBLIND]
(2,R,D) [if AGE LT 6 go to CVISTST; if AGE = 6-17 go to CVISGLAS]

[p.22]

Question ID:CHS.270_00.000

Instrument Variable Name:CBLIND
QuestionText:

Is [fill: S.C. name] blind or unable to see at all?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 having trouble seeing
SkipInstructions:

(1) [if AGE LT 6 go to IHSPEQ; else if AGE = 6-17 go to CVISACT]
(2, R, D) [if AGE LT 6 go to CVISTST; else if AGE = 6-17 go to CVISGLAS]

Question ID:CHS.270_00.010

Instrument Variable Name:CVISTST
QuestionText:

Has [fill: SC name] EVER had [fill: his/her] vision tested by a doctor or other health professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 6 who is not blind
SkipInstructions:

(1) [goto CVISLT]
(2,R,D) [go to IHSPEQ]

Question ID:CHS.270_00.020

Instrument Variable Name:CVISLT
QuestionText:

When was [fill: his/her] vision last tested?

1 In the last 12 months
2 In the last 13-24 months
3 Over 24 months
7 Refused
9 Don't know

UniverseText:Sample children LT 6 ever had vision tested
SkipInstructions:

(1-3,R,D) [go to IHSPEQ]

[p.23]

Question ID:CHS.270_00.025

Instrument Variable Name:CVISGLAS
QuestionText:

Does [fill: SC name] wear eyeglasses or contact lenses?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 6-17 years who are not blind
SkipInstructions:

(1) [goto CVISDIST]
(2,R,D) [go to CVISACT]

Question ID:CHS.270_00.030

Instrument Variable Name:CVISDIST
QuestionText:

Does [fill: SC name] wear eyeglasses or contact lenses to read road and street signs, see the blackboard, play sports, watch TV, or see things in the distance?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 6-17 years who wear glasses or contact lenses
SkipInstructions:

(1,2,R,D) [go to CVISREAD]

Question ID:CHS.270_00.035

Instrument Variable Name:CVISREAD
QuestionText:

Does [fill: SC name] wear eyeglasses or contact lenses to read books, write, play hand-held games, or do other things that require [fill: her/him] to see well up close?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 6-17 years who wear glasses or contact lenses
SkipInstructions:

(1,2,R,D) [AGE GE 6 go to CVISACT;
else go to IHSPEQ]

Question ID:CHS.270_00.040

Instrument Variable Name:CVISACT
QuestionText:

Does [fill: SC name] participate in sports, hobbies, or other activities that can cause eye injury? This includes activities such as baseball, basketball, soccer and mowing the lawn.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 6-17
SkipInstructions:

(1) [go to CVISPROT] (2,R,D) [go to IHSPEQ]

[p.24]

Question ID:CHS.270_00.050

Instrument Variable Name:CVISPROT
QuestionText:

When doing these activities, on average, does [fill: he/she] wear eye protection always, most of the time, some of the time, or none of the time?

1 Always
2 Most of the time
3 Some of the time
4 None of the time
7 Refused
9 Don't know

UniverseText:Sample children 6-17 participate in sports that cause eye injuries
SkipInstructions:

(1-4,R,D) [go to IHSPEQ]

Question ID:CHS.290_00.000

Instrument Variable Name:IHSPEQ
QuestionText:

Does [fill1: S.C. name] have any impairment or health problem that requires [fill2: him/her] to use special equipment, such as a brace, a wheelchair, or a hearing aid (excluding ordinary eyeglasses or corrective shoes)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

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

Question ID:CHS.300_00.000

Instrument Variable Name:IHMOB
QuestionText:

Does [fill1: S.C. name] have an impairment or health problem that limits [fill2: his/her] ability to (crawl), walk, run, or play?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto IHMOBYR]
(2,R,D) [goto PROBRX]

[p.25]

Question ID:CHS.310_00.000

Instrument Variable Name:IHMOBYR
QuestionText:

Is this an impairment or health problem that has lasted, or is expected to last, 12 months or longer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 that have limited ability to crawl, walk, run, or play
SkipInstructions:

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

Question ID:CHS.311_00.000

Instrument Variable Name:PROBRX
QuestionText:

Does [fill1: S.C. name] NOW have a problem for which [fill2: he/she] has regularly taken prescription medication for at least three months?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [if AGE LE (1) go to CUSUALPL;
if AGE GE (3) go to LEARND;
if AGE = (2) and SEX = (1) go to CMHAGM11_1;
if AGE = (2) and SEX = (2) go to CMHAGF11_1]

Question ID:CHS.312_00.000

Instrument Variable Name:LEARND
QuestionText:

Has a representative from a school or a health professional ever told you that [fill: S.C. name] had a learning disability?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 3-17
SkipInstructions:

(1,2,R,D) [if AGE GT 3 go to CUSUALPL;
if AGE = 3 and SEX = 1 go to CMHAGM11_1;
if AGE = 3 and SEX = 2 go to CMHAGF11_1]

[p.26]

Question ID:CHS.321_01.000

Instrument Variable Name:CMHAGM11_1
QuestionText:

(book) C3
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
HE:
Has been uncooperative?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Male sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CMHAGM11_2]

Question ID:CHS.321_02.000

Instrument Variable Name:CMHAGM11_2
QuestionText:

(book) C3
* Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
HE:
Has trouble getting to sleep?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Male sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CMHAGM11_3]

Question ID:CHS.321_03.000

Instrument Variable Name:CMHAGM11_3
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Male sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CMHAGM11_4]

Question ID:CHS.321_04.000

Instrument Variable Name:CMHAGM11_4
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Male sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CUSUALPL]

[p.28]

Question ID:CHS.361_01.000

Instrument Variable Name:CMHAGF11_1
QuestionText:

(book) C3
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES
TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
SHE:
Has temper tantrums or a hot temper?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Female sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CMHAGF11_2]

Question ID:CHS.361_02.000

Instrument Variable Name:CMHAGF11_2
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Female sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CMHAGF11_3]

Question ID:CHS.361_03.000

Instrument Variable Name:CMHAGF11_3
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Female sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CMHAGF11_4]

Question ID:CHS.361_04.000

Instrument Variable Name:CMHAGF11_4
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText:Female sample children 2-3
SkipInstructions:

(0-2,R,D) [go to CUSUALPL]

[p.1]

Sample Child Access to Health Care and Utilization

Question ID:CAU.020_00.000

Instrument Variable Name:CUSUALPL
QuestionText:

The next questions are about health care.
Is there a place that [fill1: alias] USUALLY goes when [fill2: he/she] is sick or you need advice
about [fill3: his/her] health?

1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,3) [go to CPLKIND]
(2,R,D) [go to CHCPLKND]

Question ID:CAU.030_00.000

Instrument Variable Name:CPLKIND
QuestionText:

[fill1: What kind of place is it / What kind of place does [fill2: alias] go to most often] - a clinic, doctor's office, emergency room, or some other place?

1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know

UniverseText:Sample children LT 18 with one or more usual places to go when sick or need health advice
SkipInstructions:

(1-5) [go to CHCPLROU]
(6,R,D) [go to CHCPLKND]

Question ID:CAU.035_00.000

Instrument Variable Name:CHCPLROU
QuestionText:

Is that [fill1: CPLKIND/CAU.030] the same place [fill2: alias] USUALLY goes when [fill3: he/she] needs routine or preventive care, such as a physical examination or (well baby/child) check-up?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 with one or more usual places to go when sick or need health advice who reported that place as a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some other place
SkipInstructions:

(1) [go to CHCCHGYR]
(2,R,D) [go to CHCPLKND]

[p.2]

Question ID:CAU.037_00.000

Instrument Variable Name:CHCPLKND
QuestionText:

What kind of place does [fill1: alias] USUALLY go to when [fill2: he/she] needs routine or preventive care, such as a physical examination or (well baby/child) check-up?

0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know

UniverseText:Sample children LT 18 who do not have a usual source of sick care; who Ref/NA/DK if have a usual source of sick care; who have a usual source of sick care but does not go to one place most often; who have a usual source of sick care but Ref/NA/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source of sick care but Ref/NA/DK if it is same place as usual source of routine/preventive care.
SkipInstructions:

(0-6,R,D) [ if CUSUALPL=2,R,D goto CHCDLYR_1; else goto CHCCHGYR]

Question ID:CAU.040_00.000

Instrument Variable Name:CHCCHGYR
QuestionText:

At any time IN THE PAST 12 MONTHS did you CHANGE the place(s) to which [fill: alias] USUALLY goes for health care?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 with one or more place to go when sick/need advice [or who reported same place as usual source of routine/preventive care]
SkipInstructions:

(1) [go to CHCCHGHI]
(2,R,D) [goto to CHCDLYR1_1]

Question ID:CAU.050_00.000

Instrument Variable Name:CHCCHGHI
QuestionText:

Was this change for a reason related to health insurance?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 that have changed their usual place of health care in the past 12 months
SkipInstructions:

(1,2,R,D) [goto CHCDLYR1_1]

[p.3]

Question ID:CAU.080_01.000

Instrument Variable Name:CHCDLYR1_1
QuestionText:

There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS...
You couldn't get through on the telephone.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCDLYR1_2]

Question ID:CAU.080_02.000

Instrument Variable Name:CHCDLYR1_2
QuestionText:

* Read if necessary.
There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS...
You couldn't get an appointment for [fill: alias] soon enough.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCDLYR1_3]

Question ID:CAU.080_03.000

Instrument Variable Name:CHCDLYR1_3
QuestionText:

* Read if necessary.
There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS...
Once you get there, [fill: alias] has to wait too long to see the doctor.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCDLYR1_4]

[p.4]

Question ID:CAU.080_04.000

Instrument Variable Name:CHCDLYR1_4
QuestionText:

* Read if necessary.
There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS...
The (clinic/doctor's office) wasn't open when you could get there.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCDLYR1_5]

Question ID:CAU.080_05.000

Instrument Variable Name:CHCDLYR1_5
QuestionText:

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [if AGE GE (2) goto CHCAFYR1_1; else goto CHCAFYR]

Question ID:CAU.130_00.000

Instrument Variable Name:CHCAFYR
QuestionText:

DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it... Prescription medicines?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 2
SkipInstructions:

(1,2,R,D) [if AGE LT 1 goto CHCSYR1_2; else goto CDENLONG]

[p.5]

Question ID:CAU.135_01.000

Instrument Variable Name:CHCAFYR1_1
QuestionText:

DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it... Prescription medicines?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCAFYR1_2]

Question ID:CAU.135_02.000

Instrument Variable Name:CHCAFYR1_2
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it... Mental health care or counseling?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCAFYR1_3]

Question ID:CAU.135_03.000

Instrument Variable Name:CHCAFYR1_3
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it...Dental care (including check-ups)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCAFYR1_4]

[p.6]

Question ID:CAU.135_04.000

Instrument Variable Name:CHCAFYR1_4
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it...Eyeglasses?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

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

Question ID:CAU.160_00.000

Instrument Variable Name:CDENLONG
QuestionText:

(book) C4
About how long has it been since [fill: alias] last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

0 Never
1 6 months or less
2 More than 6 months, but not more than 1 year ago
3 More than 1 year, but not more than 2 years ago
4 More than 2 years, but not more than 5 years ago
5 More than 5 years ago
7 Refused
9 Don't know

UniverseText:Sample children GE 1
SkipInstructions:

(0-5,R,D) [if AGE GE (2) goto CHCSYR_1; else go to CHCSYR1_2]

Question ID:CAU.170_01.000

Instrument Variable Name:CHCSYR1_2
QuestionText:

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR1_3]

[p.7]

Question ID:CAU.170_02.000

Instrument Variable Name:CHCSYR1_3
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? A foot doctor?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR1_5]

Question ID:CAU.170_03.000

Instrument Variable Name:CHCSYR1_5
QuestionText:

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR1_6]

Question ID:CAU.170_04.000

Instrument Variable Name:CHCSYR1_6
QuestionText:

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR8]

[p.8]

Question ID:CAU.175_01.000

Instrument Variable Name:CHCSYR_1
QuestionText:

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_2]

Question ID:CAU.175_02.000

Instrument Variable Name:CHCSYR_2
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the following health care providers about [fill2: alias]'s health?
An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_3]

Question ID:CAU.175_03.000

Instrument Variable Name:CHCSYR_3
QuestionText:

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_4]

[p.9]

Question ID:CAU.175_04.000

Instrument Variable Name:CHCSYR_4
QuestionText:

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_5]

Question ID:CAU.175_05.000

Instrument Variable Name:CHCSYR_5
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_6]

Question ID:CAU.175_06.000

Instrument Variable Name:CHCSYR_6
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A nurse practitioner, physician assistant or midwife?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 2
SkipInstructions:

(1,2,R,D) [if SEX eq (2) and AGE GE 15 goto CHCSYR7; else goto CHCSYR8]

[p.10]

Question ID:CAU.230_00.000

Instrument Variable Name:CHCSYR7
QuestionText:

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to a doctor who specializes in women's health (an obstetrician/gynecologist) about [fill2: alias]'s health?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children GE 15 who are female
SkipInstructions:

(1,2,R,D) [goto CHCSYR8_1]

Question ID:CAU.240_01.000

Instrument Variable Name:CHCSYR8_1
QuestionText:

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to the following about [fill2: alias]'s health? A medical doctor who specializes in a particular medical disease or problem (fill3:other than obstetrician/ gynecologist, psychiatrist or ophthalmologist? /fill4: other than psychiatrist or ophthalmologist)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCSYR8_2]

Question ID:CAU.240_02.000

Instrument Variable Name:CHCSYR8_2
QuestionText:

* Read if necessary.
DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to the following about [fill2: alias]'s health?
A general doctor who treats a variety of illnesses (a doctor in general practice, pediatrics, family medicine, or internal medicine)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto CHCSYR10]
(2,R,D) [goto CHPEXYR]

[p.11]

Question ID:CAU.260_00.000

Instrument Variable Name:CHCSYR10
QuestionText:

Does that doctor treat children and adults (a doctor in general practice or family medicine)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 who have seen or talked to a general doctor during the past 12 months
SkipInstructions:

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

Question ID:CAU.265_00.000

Instrument Variable Name:CHCSYREM
QuestionText:

Did you see or talk to this general doctor because of an emotional or behavioral problem that [fill1: alias] may have?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 who have seen a general doctor in the past 12 months
SkipInstructions:

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

Question ID:CAU.270_00.000

Instrument Variable Name:CHPEXYR
QuestionText:

DURING THE PAST 12 MONTHS, did [fill1: alias] receive a well-child check-up, that is a general check-up, when [fill2: he/she] was not sick or injured?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT18
SkipInstructions:

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

[p.12]

Question ID:CAU.280_00.000

Instrument Variable Name:CHERNOYR
QuestionText:

(book) C5
DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] gone to a HOSPITAL EMERGENCY
ROOM about [fill2: his/her] health? (This includes emergency room visits that resulted in a hospital admission.)

00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(0-8,R,D) [goto CHCHYR]

Question ID:CAU.290_00.000

Instrument Variable Name:CHCHYR
QuestionText:

DURING THE PAST 12 MONTHS, did [fill1: alias] receive care AT HOME from a nurse or other health care professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto CHCHMOYR]
(2,R,D) [goto CHCNOYR]

Question ID:CAU.300_00.000

Instrument Variable Name:CHCHMOYR
QuestionText:

DURING THE PAST 12 MONTHS, how many months did [fill: alias] receive care AT HOME from a health care professional?

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

UniverseText:Sample children LT 18 that have received home care from health professional during the past 12 months
SkipInstructions:

(01-12,R,D) [goto CHCHNOYR]

[p.13]

Question ID:CAU.310_00.000

Instrument Variable Name:CHCHNOYR
QuestionText:

(book) C6
What was the total number of home visits received for [fill1: alias] during [fill2: that month/those months]?

01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

UniverseText:Sample children LT 18 that have received home care from health professional during the past 12 months
SkipInstructions:

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

Question ID:CAU.320_00.000

Instrument Variable Name:CHCNOYR
QuestionText:

(book) C5
DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] seen a doctor or other health care
professional about [fill2: his/her] health at A DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times [fill1: alias] was hospitalized overnight, visits to hospital emergency rooms, home visits, dental visits or telephone calls

00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

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

[p.14]

Question ID:CAU.330_00.000

Instrument Variable Name:CSRGYR
QuestionText:

DURING THE PAST 12 MONTHS has [fill1: alias] had SURGERY or other surgical procedures either as an inpatient or outpatient?
* Read if necessary.
This includes both major surgery and minor procedures such as setting bones or removing growths.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto CSRGNOYR]
(2,R,D) [goto CMDLONG]

Question ID:CAU.340_00.000

Instrument Variable Name:CSRGNOYR
QuestionText:

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES has [fill1: alias] had surgery DURING THE PAST 12 MONTHS?
* Enter '95' for 95 or more times.

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

UniverseText:Sample children LT 18 that have undergone surgery during the past 12 months
SkipInstructions:

(1-10,R,D) [goto CMDLONG]
(11-95) [goto ERR_CMDLONG]

Question ID:CAU.345_00.000

Instrument Variable Name:CMDLONG
QuestionText:

(book) C4
About how long has it been since anyone in the family last saw or talked to a doctor or other health care professional about [fill1: alias]'s health? Include doctors seen while [fill2: he/she] was a patient in a hospital.

UniverseText:Sample children LT 18
SkipInstructions:

(0-5, R,D) [if AGE=14-17 go to CSNLAMP; else go to COCOND]

[p.15]

Question ID:CAU.350_00.010

Instrument Variable Name:CSNLAMP
QuestionText:

During the PAST 12 MONTHS, has [fill1: SC name] used any of the following indoor tanning devices - a sunlamp, sunbed, or tanning booth EVEN ONE TIME? Do NOT include a spray-on tan.

1 Yes
2 No
7 Refused
9 Don't Know

UniverseText:Sample children 14-17
SkipInstructions:

(1) [goto CSNNUM] (2,R,D) [goto COCOND]

Question ID:CAU.350_00.020

Instrument Variable Name:CSNNUM
QuestionText:

During the PAST 12 MONTHS, how many times has [fill1: SC name] used the following indoor tanning devices - a sunlamp, sunbed, or tanning booth? Do NOT include times [fill1: SC name] has gotten a spray-on tan

001-365 Number of tans
997 Refused
999 Don't know

UniverseText:Sample children 14-17 who have used an indoor tanning device in the past 12 months
SkipInstructions:

(1-99,R,D) [goto COCOND];
(100-365) [goto ERR1_CSNNUM]

[p.1]

Question ID:COH.010_00.000

Instrument Variable Name:COCOND
QuestionText:

How would you describe the condition of [fill: S.C. name]'s mouth and teeth? Would you say very good, good, fair or poor?

1 Very good
2 Good
3 Fair
4 Poor
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1-4,R,D) [go to COBTWS]

Question ID:COH.020_00.000

Instrument Variable Name:COBTWS
QuestionText:

Would you say the condition of [fill: SC name]'s mouth and teeth is better than, the same as or not as good as other people [fill: her or his] age?

1 Better
2 Same
3 Not as good
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1-3,R,D) [if AGE GE 5 go to COEMB;
if AGE LT 1 goto COPROB_2;
else go to COPROB_1]

Question ID:COH.030_00.000

Instrument Variable Name:COEMB
QuestionText:

DURING THE PAST 6 MONTHS, how often was [fill: she/he] self-conscious or embarrassed because of [fill: her/his] teeth or mouth? Would you say often, sometimes, rarely or never?

1 Often
2 Sometimes
3 Rarely
4 Never
7 Refused
9 Don't know

UniverseText:Sample children 5-17
SkipInstructions:

(1-4,R,D) [if CDENLONG = 1 go to COREAS_1;
if AGE LE 15 and CDENLONG NE 1 go to COPROB_1;
if AGE GE 16 and CDENLONG NE 1 go to COREAS_4;
else goto COPROB_1]

[p.2]

Question ID:COH.040_01.000

Instrument Variable Name:COREAS_1
QuestionText:

I am going to read you a list of reasons people get dental care. Please tell me how many hours of school [fill: SC name] has missed IN THE PAST 6 MONTHS for each one....For emergency dental care where [fill: SC name] saw the dentist within 24 hours or as soon as was possible
*If [SC name] did not miss any school enter '1'.
*Probe if necessary.

01 None to less than 1 hour
02 1 hour, less than 3 hours
03 3 hours, less than 5 hours
04 5 hours, less than 7 hours
05 7 or more hours
06 Doesn't go to school
07 Did not have this type of dental care
97 Refused
99 Don't know

UniverseText:Sample children 5-17, seen a dentist, past 6 mos
SkipInstructions:

(1-7,R,D) [go to COREAS_2]

Question ID:COH.040_02.000

Instrument Variable Name:COREAS_2
QuestionText:

*Read if necessary: I am going to read you a list of reasons people get dental care. Please tell me how many hours of school [fill: SC name] has missed IN THE PAST 6 MONTHS for each one....For planned routine dental or orthodontic care
*If [SC name] did not miss any school enter '1'.
*Probe if necessary.

UniverseText:Sample children 5-17, seen a dentist, past 6 mos
SkipInstructions:

(1-7,R,D) [go to COREAS_3]

[p.3]

Question ID:COH.040_03.000

Instrument Variable Name:COREAS_3
QuestionText:

*Read if necessary: I am going to read you a list of reasons people get dental care. Please tell me how many hours of school [fill: SC name] has missed IN THE PAST 6 MONTHS for each one.
...For tooth whitening or other cosmetic procedures
*If [SC name] did not miss any school enter '1'.
*Probe if necessary.

01 None or less than 1 hour
02 1 hour, less than 3 hours
03 3 hours, less than 5 hours
04 5 hours, less than 7 hours
05 7 or more hours
06 Doesn't go to school
07 did not have this type of dental care
97 Refused
99 Don't know

UniverseText:Sample children 5-17, seen a dentist, past 6 mos
SkipInstructions:

(1-7,R,D) [if AGE GE 16 go to COREAS_4;
else go to COPROB_1]

Question ID:COH.040_04.000

Instrument Variable Name:COREAS_4
QuestionText:

Please tell me how many hours of school [fill: SC name] has missed IN THE PAST 6 MONTHS....For taking someone else to a dental appointment
*If [SC name] did not miss any school enter '1'.
*Probe if necessary.

01 None or less than 1 hour
02 1 hour, less than 3 hours
03 3 hours, less than 5 hours
04 5 hours, less than 7 hours
05 7 or more hours
06 Doesn't go to school
07 Did not have this type of dental care
97 Refused
99 Don't know

UniverseText:Sample children 16-17, seen a dentist, past 6 mos
SkipInstructions:

(1-7,R,D) [go to COPROB_1]

[p.4]

Question ID:COH.050_01.000

Instrument Variable Name:COPROB_01
QuestionText:

DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....A toothache or sensitive teeth
* Read if necessary. Do not include pain from getting new teeth (teething pain).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children 1-17
SkipInstructions:

(1,2,R,D) [go to COPROB_02]

Question ID:COH.050_02.000

Instrument Variable Name:COPROB_02
QuestionText:

DURING THE PAST 6 MONTHS, has [fill: S.C. name] had any of the following problems? Please say yes or no to each....Pain in [fill: her/his] jaw joint

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [go to COPROB_03]

Question ID:COH.050_03.000

Instrument Variable Name:COPROB_03
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Sores in [fill: her/his] mouth

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [go to COPROB_04]

[p.5]

Question ID:COH.050_04.000

Instrument Variable Name:COPROB_04
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Bleeding gums

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) if AGE=1-17 [go to COPROB_05];
else [goto COPROB_11]

Question ID:COH.050_05.000

Instrument Variable Name:COPROB_05
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Crooked teeth

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [go to COPROB_06]

Question ID:COH.050_06.000

Instrument Variable Name:COPROB_06
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Broken or missing teeth other than losing baby teeth

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [go to COPROB_07]

[p.6]

Question ID:COH.050_07.000

Instrument Variable Name:COPROB_07
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Stained or discolored teeth

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2,R,D) [go to COPROB_08]

Question ID:COH.050_08.000

Instrument Variable Name:COPROB_08
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Loose teeth not due to an injury or losing baby teeth

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [go to COPROB_09]

Question ID:COH.050_09.000

Instrument Variable Name:COPROB_09
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Decayed teeth or cavities

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [go to COPROB_10]

[p.7]

Question ID:COH.050_10.000

Instrument Variable Name:COPROB_10
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Broken or missing fillings

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [go to COPROB_11]

Question ID:COH.050_11.000

Instrument Variable Name:COPROB_11
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Bad breath

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [go to COPROB_12]

Question ID:COH.050_12.000

Instrument Variable Name:COPROB_12
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, has [fill S.C. name] had any of the following problems? Please say yes or no to each....Dry mouth

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1,2, R,D) [if [COPROB_01 =1 or COPROB_02 =1 or COPROB_03 =1 or COPROB_04 =1 or COPROB_05 =1
or COPROB_06 =1 or COPROB_07 =1 or COPROB_08 =1 or COPROB_09 =1 or COPROB_10 =1 or
COPROB_11 =1 or COPROB_12 =1 go to CODENT1;
else [go to next section]

[p.8]

Question ID:COH.060_00.000

Instrument Variable Name:CODENT1
QuestionText:

DURING THE PAST 6 MONTHS did [fill S.C. name] see a dentist or a medical doctor for any of the problems with [fill: her or his] mouth or teeth?
*Read if necessary: Include all types of dentists such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 have at least one problem mouth or teeth
SkipInstructions:

(1) [go to CODENT2]
(2) [go to CONODEN_1]
(R,D) [go to COINT_1]

Question ID:COH.070_00.000

Instrument Variable Name:CODENT2
QuestionText:

Which one did [fill S. C. name] see - a dentist or a medical doctor?
*Code as dentist: orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

1 Dentist
2 Medical doctor
3 Both
7 Refused
9 Don't know

UniverseText:Sample children LT 18 who have seen a doctor or dentist for mouth or teeth problem
SkipInstructions:

(1,3,R,D) [go to COINT_1] (2) [go to CONODEN_1]

Question ID:COH.080_01.000

Instrument Variable Name:CONODEN_1
QuestionText:

DURING THE PAST 6 MONTHS, why didn't [fill: SC name] see a dentist for the problems with [fill: his/her] mouth or teeth? Please say yes or no to each....You didn't think it was important

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 didn't see a dentist for problem with mouth or teeth
SkipInstructions:

(1,2,R,D) [go to CONODEN_2]

[p.9]

Question ID:COH.080_02.000

Instrument Variable Name:CONODEN_2
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, why didn't [fill: SC name] see a dentist for the problems with [fill: his/her] mouth or teeth? Please say yes or no to each....The problem went away

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 didn't see a dentist for problem with mouth or teeth
SkipInstructions:

(1,2, R,D) [go to CONODEN_3]

Question ID:COH.080_03.000

Instrument Variable Name:CONODEN_3
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, why didn't [fill: SC name] see a dentist for the problems with [fill: his/her] mouth or teeth? Please say yes or no to each.
...You couldn't afford treatments or [fill S.C. name] didn't have insurance

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 didn't see a dentist for problem with mouth or teeth
SkipInstructions:

(1,2, R,D) [go to CONODEN_4]

Question ID:COH.080_04.000

Instrument Variable Name:CONODEN_4
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, why didn't [fill: SC name] see a dentist for the problems with [fill: his/her] mouth or teeth? Please say yes or no to each ...No transportation was available

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 didn't see a dentist for problem with mouth or teeth
SkipInstructions:

(1,2, R,D) [go to CONODEN_5]

[p.10]

Question ID:COH.080_05.000

Instrument Variable Name:CONODEN_5
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, why didn't [fill: SC name] see a dentist for the problems with [fill: his/her] mouth or teeth? Please say yes or no to each....[fill S. C. name] was afraid to see a dentist

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 didn't see a dentist for problem with mouth or teeth
SkipInstructions:

(1,2,R,D) [go to CONODEN_6]

Question ID:COH.080_06.000

Instrument Variable Name:CONODEN_6
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, why didn't [fill: SC name] see a dentist for the problems with [fill: his/her] mouth or teeth? Please say yes or no to each....[fill: SC name] was waiting for an appointment

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 didn't see a dentist for problem with mouth or teeth
SkipInstructions:

(1,2,R,D) [go to CONODEN_7]

Question ID:COH.080_07.000

Instrument Variable Name:CONODEN_7
QuestionText:

*Read if necessary: DURING THE PAST 6 MONTHS, why didn't [fill: SC name] see a dentist for the problems with [fill: his/her] mouth or teeth? Please say yes or no to each....You didn't think a dentist could fix the problem

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 didn't see a dentist for problem with mouth or teeth
SkipInstructions:

(1,2,R,D) [if AGE=5-17 go to COINT_1,
else if AGE LT 5 go to COINT_3]

[p.11]

Question ID:COH.090_01.000

Instrument Variable Name:COINT_1
QuestionText:

Did the problems with [fill S. C. name]'s mouth or teeth interfere with any of the following? Please say yes or no to each....School or school activities

1 Yes
2 No
3 Doesn't go to school
7 Refused
9 Don't know

UniverseText:Sample children 5-17 have at least one problem mouth or teeth
SkipInstructions:

(1-3,R,D) [if AGE = 14-17 go to COINT_2; else go to COINT_3]

Question ID:COH.090_02.000

Instrument Variable Name:COINT_2
QuestionText:

*Read if necessary: Did the problems with [fill S. C. name]'s mouth or teeth interfere with any of the following? Please say yes or no to each....Work

1 Yes
2 No
3 Doesn't work
7 Refused
9 Don't know

UniverseText:Sample children 14-17 have at least one problem with mouth or teeth
SkipInstructions:

(1-3, R,D) [go to COINT_3]

Question ID:COH.090_03.000

Instrument Variable Name:COINT_3
QuestionText:

*Read if necessary: Did the problems with [fill S. C. name]'s mouth or teeth interfere with any of the following? Please say yes or no to each....Eating

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 have at least one problem with mouth or teeth
SkipInstructions:

(1,2,R,D) [go to COINT_4]

[p.12]

Question ID:COH.090_04.000

Instrument Variable Name:COINT_4
QuestionText:

*Read if necessary: Did the problems with [fill S. C. name]'s mouth or teeth interfere with any of the following? Please say yes or no to each....Sleeping

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 have at least one problem with mouth or teeth
SkipInstructions:

(1,2, R,D) [go to COINT_5]

Question ID:COH.090_05.000

Instrument Variable Name:COINT_5
QuestionText:

*Read if necessary: Did the problems with [fill S. C. name]'s mouth or teeth interfere with any of the following? Please say yes or no to each....Social activities such as going out or being with other people

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 have at least one problem with mouth or teeth
SkipInstructions:

(1,2,R,D) [go to COINT_6]

Question ID:COH.090_06.000

Instrument Variable Name:COINT_6
QuestionText:

*Read if necessary: Did the problems with [fill S. C. name]'s mouth or teeth interfere with any of the following? Please say yes or no to each....[fill S. C. name] 's usual activities at home

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18 have at least one problem with mouth or teeth
SkipInstructions:

(1,2, R,D) [if AGE GE 4 go to CMHCOPY;
else go to CSHFLUYR]

[p.1]

Sample Child Mental Health Brief Questionnaire

Question ID:CMB.010_00.000

Instrument Variable Name:CMHCOPY
QuestionText:

* The following statements are not to be read to the respondent. They are displayed and included here for legal reasons.
* The next 6 items contained in CMHMF_1 through CMHDIFF are included in this survey with permission as indicated below.
* The SDQ questions are copyrighted by Robert Goodman, Ph.D., FRCPSYCH, MRCP. State and local agencies may use these questions without charge and without seeking separate permission provided the wording is not modified, all the questions are retained, and Dr. Goodman's copyright is acknowledged.
* Enter 1 to Continue.

1 Enter 1 to continue

UniverseText:Sample children GE 4
SkipInstructions:

(1) [goto CMHMF_1]

Question ID:CMB.030_00.000

Instrument Variable Name:CMHDIFF
QuestionText:

(book) C7
Overall, do you think that [fill1: SC name] has difficulties in any of the following areas: emotions, concentration, behavior, or being able to get along with other people?

1 No
2 Yes, minor difficulties
3 Yes, definite difficulties
4 Yes, severe difficulties
7 Refused
9 Don't know

UniverseText:Sample children GE 4
SkipInstructions:

(1-4,R,D) [goto next section]

[p.1]

Sample Child Influenza Immunization

Question ID:CFI.010_00.000

Instrument Variable Name:CSHFLUYR
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: SC name} had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: A flu shot is injected in the arm. Do not include an influenza vaccine sprayed in the nose.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto CSHFLU_M] (2,R,D) [ goto CSPFLUYR ]

Question ID:CFI.015_01.000

Instrument Variable Name:CSHFLU_M
QuestionText:

1 of 2
During what month and year did {fill1: SC name} receive {fill2: his/her} most recent flu shot?

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

UniverseText:Sample children LT 18 who have had a flu shot
SkipInstructions:

(1-12,D) [ goto CSHFLU_Y] (R) [goto CSPFLUYR]

Question ID:CFI.015_02.000

Instrument Variable Name:CSHFLU_Y
QuestionText:

*Enter year of most recent flu shot.
2 of 2

Year Year
9997 Refused
9999 Don't know

UniverseText:Sample children LT 18 who gave a month for their last flu shot or who didn't know the month
SkipInstructions:

(valid year,R,D) [goto CSPFLUYR]
[If CSHFLU_M and CSHFLU_Y = a future date] goto ERR1_CSHFLU_Y]
[If CSHFLU_M and CSHFLU_Y = a date prior to birth] goto ERR2_CSHFLU_Y]
[If CSHFLU_M and CSHFLU_Y = a date prior to 12 months ago] goto ERR3_CSHFLU_Y]

[p.2]

Question ID:CFI.020_00.000

Instrument Variable Name:CSPFLUYR
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: SC name} had a flu vaccine sprayed in {fill2: his/her} nose by a doctor or other health professional? This vaccine is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: This influenza vaccine is called FluMist (trademark).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample children LT 18
SkipInstructions:

(1) [goto CSPFLU_M] (2,R,D) [goto next section]
[if CSHFLUYR =1 and CSPFLUYR=1] goto ERR_CSPFLUYR

Question ID:CFI.025_01.000

Instrument Variable Name:CSPFLU_M
QuestionText:

1 of 2
During what month and year did {fill1: SC name} receive {his/her} most recent flu nasal spray?

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

UniverseText:Sample children LT 18 who have had a flu nasal vaccine
SkipInstructions:

(1-12,D) [ goto CSPFLU_Y] (R) [goto next section]

[p.3]

Question ID:CFI.025_02.000

Instrument Variable Name:CSPFLU_Y
QuestionText:

2 of 2
*Enter year of most recent flu nasal spray.

Year Year
9997 Refused
9999 Don't know

UniverseText:Sample children 18+ who gave a month for their flu nasal vaccine or who didn't know the month
SkipInstructions:

(valid year,R,D) [goto next section]
[If CSPFLU_M and CSPFLU_Y = a future date] goto ERR1_CSPFLU_Y]
[If CSPFLU_M and CSPFLU_Y = a date prior to birth] goto ERR2_CSPFLU_Y]
[If CSPFLU_M and CSPFLU_Y = a date prior to 12 months ago] goto ERR3_CSPFLU_Y]

[p.1]

Sample Child HPV

Question ID:CHP.010_00.000

Instrument Variable Name:CHPVHRD
QuestionText:

A vaccine to prevent the human papilloma virus (pap-uh-LOW-muh-vi-rus) or HPV infection is available and is called the HPV shot, cervical cancer vaccine, or GARDASIL®. Before this survey, have you ever heard of the HPV shot or cervical cancer vaccine?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Female sample children 8+
SkipInstructions:

(1,2,R,D) goto CSHTHPV

Question ID:CHP.020_00.000

Instrument Variable Name:CSHTHPV
QuestionText:

Did [fill: SC name] ever receive the HPV shot or cervical cancer vaccine?

1 Yes
2 No
3 Doctor refused when asked
7 Refused
9 Don't know

UniverseText:Female sample children 8+
SkipInstructions:

(1) goto CSHHPVDS
(2,R,D) goto CHPVREC
(3) goto next section

Question ID:CHP.030_00.000

Instrument Variable Name:CSHHPVDS
QuestionText:

How many HPV shots did [fill: SC name] receive?
* Enter '96' for all shots

01-50 1-50 shots
96 All shots
97 Refused
99 Don't know

UniverseText:Female sample children 8+ who have received the HPV vaccine or shot
SkipInstructions:

(1-50,96,R,D) goto next section
(51-95) goto ERR_CSHHPVDS

[p.2]

Question ID:CHP.040_00.000

Instrument Variable Name:CHPVREC
QuestionText:

If [fill: SC name]'s doctor recommended the HPV vaccine, would you have her get it?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Female sample children 8+ who have not received an HPV vaccine or shot or refused to say/said don't know if received vaccine or shot
SkipInstructions:

(1) goto CHPVCOST
(2,D) goto CHPVNOT
(R) goto next section

Question ID:CHP.050_00.000

Instrument Variable Name:CHPVNOT
QuestionText:

What is the MAIN reason you would NOT want [fill: SC name] to get the vaccine?

01 Does not need vaccine
02 Not sexually active
03 Too expensive
04 Too young for vaccine
05 Doctor didn't recommend it
06 Worried about safety of vaccine
07 Don't know where to get vaccine
08 My spouse/family member is against it
09 Don't know enough about vaccine
10 Already has HPV
11 Other
97 Refused
99 Don't know

UniverseText:Female sample children 8+ who would not get the HPV vaccine if her doctor recommended it or who said don't know to this information
SkipInstructions:

(1,2,4-11,R,D) goto next section
(3) goto CHPVLOC

Question ID:CHP.060_00.000

Instrument Variable Name:CHPVCOST
QuestionText:

The cost of the vaccine may be about $360-$500. Would you have [fill: SC name] get the vaccine if you had to pay this amount?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Female sample children age 8+ whose respondent would be interested in getting the HPV vaccine for her
SkipInstructions:

(1,R,D) goto next section
(2) goto CHPVLOC

[p.3]

Question ID:CHP.070_00.000

Instrument Variable Name:CHPVLOC
QuestionText:

If [fill: SC name] could get the vaccine free or at a much lower cost, would you have her get it?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Female sample children age 8+ whose respondent would not pay $360-$500 for the HPV vaccine or for whom the main reason not to get the vaccine was because it was too expensive
SkipInstructions:

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

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