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disbtest
[p.1]


2009 NHIS Questionnaire - Family Disability
Document Version Date: 30-Apr-10

Question ID: FDA.010_00.000

Instrument Variable Name: F1DFHEAR
QuestionText:
With this next set of questions, we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities. Though different, these questions may sound similar to ones I asked earlier.
[fill 1: Please answer this question for family members age 1 or older./]
[fill 2: Are you/Is anyone] deaf or [fill 3: do you/does anyone] have serious difficulty hearing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons age 1 or older and random number generator=1
SkipInstructions:
[1] If only 1 person in the family age 1 or older, store person number in P1DFHEAR and goto F1DFSEE; else,goto P1DFHEAR
[2,D,R] [goto F1DFSEE]

Question ID: FDA.020_00.000

Instrument Variable Name: P1DFHEAR
QuestionText:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is it? * Repeat if necessary: Is anyone else deaf or does anyone else have serious difficulty hearing?
(Anyone else?)
01-25 Person number
UniverseText: One or more persons are deaf or have difficulty hearing, and there is more than one person in the family age 1 or older
SkipInstructions:
goto F1DFSEE

Question ID:FDA.030_00.000

Instrument Variable Name: F1DFSEE
QuestionText:
[fill 1: Please answer this question for family members age 1 or older./]
[fill 2: Are you/Is anyone] blind or [fill 3: do you/does anyone] have serious difficulty seeing even when wearing glasses?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons age 1 or older and random number generator=1
SkipInstructions:
[1] If only 1 person in the family age 1 or older, store person number in P1DFSEE and goto F1DFCON; else, goto P1DFSEE
[2,D,R] [goto F1DFCON]

[p.2]

Question ID:FDA.040_00.000

Instrument Variable Name: P1DFSEE
QuestionText:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is it?
(Anyone else? * Repeat if necessary: Is anyone else blind or does anyone else have serious difficulty seeing even when wearing glasses?)
01-25 Person number
UniverseText: One or more persons are blind or have serious difficulty seeing, and there is more than one person in the family age 1 or older
SkipInstructions:
goto F1DFCON

Question ID: FDA.050_00.000

Instrument Variable Name: F1DFCON
QuestionText:
[fill 1: Please answer this question for family members age 5 or older./]
Because of a physical, mental, or emotional condition, [fill 2: do you/does anyone] have serious difficulty concentrating, remembering, or making decisions?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons age 5 or older and random number generator=1
SkipInstructions:
[1] If only 1 person in the family age 5 or older, store person number in P1DFCON and goto F1DFWALK; else, goto P1DFCON
[2,D,R] [goto F1DFWALK]

Question ID: FDA.060_00.000

Instrument Variable Name:P1DFCON
QuestionText:
* Ask or verify. Enter applicable line number(s),separate with commas.
Who is it?
(Anyone else? * Repeat if necessary: Does anyone else have serious difficulty concentrating, remembering, or making decisions?)
01-25 Person number
UniverseText: One or more persons have serious difficulty concentrating, remembering, or making decisions, and there is more
than one person age 5 or older
SkipInstructions:
goto F1DFWALK

[p.3]

Question ID: FDA.070_00.000

Instrument Variable Name: F1DFWALK
QuestionText:
[fill 1: Please answer this question for family members age 5 or older./ ]
[fill 2: Do you/Does anyone] have serious difficulty walking or climbing stairs?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with one or more persons age 5 or older and random number generator=1
SkipInstructions:
[1] If only 1 person in the family age 5 or older, store person number in P1DFWALK and goto F1DFDRES; else, goto P1DFWALK
[2,D,R] [goto F1DFDRES]

Question ID: FDA.080_00.000

Instrument Variable Name: P1DFWALK
QuestionText:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is it?
(Anyone else? * Repeat if necessary: Does anyone else have serious difficulty walking or climbing stairs?)
01-25 Person number
UniverseText:One or more persons have serious difficulty walking or climbing stairs, and there is more than one person age 5 or older
SkipInstructions:
goto F1DFDRES

Question ID: FDA.090_00.000

Instrument Variable Name: F1DFDRES
QuestionText:
[fill 1: Please answer this question for family members age 5 or older./ ]
[fill 2: Do you/Does anyone] have difficulty dressing or bathing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:All families with one or more persons age 5 or older and random number generator=1
SkipInstructions:
[1] If only 1 person in the family age 5 or older, store person number in P1DFDRES and goto F1DFERR; else,goto P1DFDRES
[2,D,R] [goto F1DFERR]

[p.4]

Question ID: FDA.100_00.000

Instrument Variable Name: P1DFDRES
QuestionText:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is it?
(Anyone else? * Repeat if necessary: Does anyone else have difficulty dressing or bathing?)
01-25 Person number
UniverseText:One or more persons have difficulty dressing or bathing, and there is more than one person age 5 or older
SkipInstructions:
goto F1DFERR

Question ID: FDA.110_00.000

Instrument Variable Name: F1DFERR
QuestionText:
[fill 1: Please answer this question for family members age 15 or older./]
Because of a physical, mental, or emotional condition, [fill 2: do you/does anyone] have difficulty doing errands alone such as visiting a doctor's office or shopping?
1 Yes
2 No
7 Refused
8 Not acertained
9 Don't know
UniverseText: All families with one or more persons age 15 or older and random number generator=1
SkipInstructions:
[1] If only 1 person in the family age 15 or older, store person number in P1DFERR and goto end of section; else, goto P1DFERR
[2,D,R] [goto end of section]

Question ID: FDA.120_00.000

Instrument Variable Name: P1DFERR
QuestionText:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who is it?
(Anyone else? * Repeat if necessary: Does anyone else have difficulty doing errands alone such as visiting a doctor's office or shopping?
01-25 Person number
UniverseText: One or more persons have difficulty doing errands alone, and there is more than one person age 15 or older
SkipInstructions:
goto end of section

[p.1]


2009 NHIS Questionnaire - Family Disability: Version 2

Question ID: FDB.020_00.000

Instrument Variable Name: P2DFHEAR
QuestionText:
With this next set of questions, we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities. Though different, these questions may sound similar to ones I asked
earlier.
[fill 1: Are you/Is ALIAS] deaf or [fill 2: do you/does ALIAS] have serious difficulty hearing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:All persons age 1 or older and random number generator=2
SkipInstructions:
[1,2,D,R] goto P2DFSEE

Question ID: FDB.040_00.000

Instrument Variable Name: P2DFSEE
QuestionText:
[fill 1: Are you/Is ALIAS] blind or [fill 2: do you/does ALIAS] have serious difficulty seeing even when wearing glasses?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 1 or older and random number generator=2
SkipInstructions:
[1,2,D,R] goto P2DFCON

Question ID: FDB.060_00.000

Instrument Variable Name: P2DFCON
QuestionText:
Because of a physical, mental, or emotional condition, [fill: do you/does ALIAS] have serious difficulty concentrating,
remembering, or making decisions?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 5 or older and random number generator=2
SkipInstructions:
[1,2,D,R] goto P2DFWALK

[p.2]

Question ID: FDB.080_00.000

Instrument Variable Name: P2DFWALK
QuestionText:
[fill: Do you/Does ALIAS] have serious difficulty walking or climbing stairs?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 5 or older and random number generator=2
SkipInstructions:
[1,2,D,R] goto P2DFDRES

Question ID:FDB.100_00.000

Instrument Variable Name: P2DFDRES
QuestionText:
[fill: Do you/Does ALIAS] have difficulty dressing or bathing?
1 Yes
2 No
7 Refused
9 Don' know
UniverseText: All persons age 5 or older and random number generator=2
SkipInstructions:
[1,2,D,R] goto P2DFERR

Question ID: FDB.120_00.000

Instrument Variable Name: P2DFERR
QuestionText:
Because of a physical, mental, or emotional condition, [fill: do you/does ALIAS] have difficulty doing errands alone such as visiting a doctor's office or shopping?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 15 or older and random number generator=2
SkipInstructions:
[1,2,D,R] if no more persons age 1 or older, goto end of section; else return to P2DFHEAR for next person age 1 or older