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[p.1]


2009 NHIS Questionnaire - Sample Adult
Adult Identification
Document Version D ate: 12-Apr-10



Question ID: AID.005_00.000

Instrument Variable name: SADULT
QuestionText:
* The sample adult person is [fill: ALIAS of Sample Adult]. The next questions must be answered by this person. Probe as necessary to determine the availability of [fill: ALIAS of Sample Adult].
* If refused enter CTRL-R
1 Available
2 Not available
3 Physical or mental condition prohibits responding
7 Refused
UniverseText: This is the Sample Adult and (the Sample Adult section has not been started or completed).
SkipInstructions:
[1]if Sample Adult = demographics.hhc.RELRESP_A
goto beginning of adult.asd
elseif Sample Adult = demographics.hhc.HHRESP
goto beginning of adult.asd
else
goto AIDVERF_S
endif
[2]goto callbk.ACALLBK1
[3]goto PROX1
[R] store '4' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif


Question ID: AID.010_00.000

Instrument Variable Name: PROX1
QuestionText:
* Proxy interviews can be done for sample adults that have a mental or physical condition that prevents them from responding for themselves.
Is a family member or caregiver that is knowledgeable about [fill: ALIAS of Sample Adult]'s health available?
1 Yes
2 No
UniverseText: The Sample Adult's physical or mental condition prohibits responding.
SkipInstructions:
[1]goto PROX2
[2]goto PROX3

[p.2]


Question ID: AID.015_00.000

Instrument Variable Name: PROX2
QuestionText:
* Ask if necessary.
What is this person's relationship to [fill: ALIAS of Sample Adult]?
1 Relative who lives in household
2 Relative who doesn't live in household
3 Other caregiver
4 Other
7 Refused
9 Don't know
UniverseText: Knowledgeable proxy is available.
SkipInstructions:
[1-4] goto AIDVERF_S

Question ID: AID.020_00.000

Instrument Variable Name: PROX3
QuestionText:
*Ask if necessary.
Can a callback with someone knowledgeable about [fill: ALIAS of Sample Adult]'s health be arranged?
1 Yes
2 No
UniverseText: Knowledgeable proxy is not available.
SkipInstructions:
[1]goto callbk.ACALLBK1
[2]store '3' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif

Question ID: AID.030_00.000

Instrument Variable Name: AIDVERF_S
QuestionText:
* Please verify the following information about the sample adult before proceeding:
I have recorded your sex as [fill: Sex of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
UniverseText: Sample Adult is not the person entered in HHRESP or RELRESP_A. Or PROX1 = 'Yes'.
SkipInstructions:
[1]goto AIDVERF_A
[2]goto AIDSEX

[p.3]

Question ID: AID.040_00.000

Instrument Variable Name:AIDSEX
QuestionText:
* Ask if appropriate; otherwise, enter your best guess of the person's sex.
Are you Male or Female?
1 Male
2 Female
UniverseText: Respondent said his/her sex is not correct.
SkipInstructions:
[1,2] store AIDSEX in SEX
goto ERR_AIDSEX
reset AIDVERF_S
goto AIDVERF_S

Question ID: AID.045_00.000

Instrument Variable Name: AIDVERF_A
QuestionText:
* Please verify the following information about the sample adult before proceeding: I have recorded your age as [fill: Age of Sample Adult] old. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
UniverseText: Sample Adult said his/her sex is correct.
SkipInstructions:
[1]goto AIDVERF_D
[2]goto AIDAGE

Question ID: AID.050_00.000

Instrument Variable Name: AIDAGE
QuestionText:
How old are you?
000-120 Age in years
997 Refused
999 Don't know
UniverseText: Respondent said his/her age is not correct
SkipInstructions:
[0-120, Refused, Don't know]
if AIDAGE = 'Refused' or AIDAGE = 'Don't know' or AIDAGE = AGE
reset AIDVERF_A
goto ERR_AIDAGE
else
store AIDAGE in AGE
goto AIDDOB_M

[p.4]

Question ID: AID.055_00.000

Instrument Variable Name: AIDVERF_D
QuestionText:
* Please verify the following information about the sample adult before proceeding:
I have recorded your birthday as [fill: Birthday of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
UniverseText: Sample Adult said his/her age is correct.
SkipInstructions:
[1]if AGE of Sample Adult le '17'
goto NO_MORE
else
goto beginning of adult.asd
endif
[2]goto AIDDOB_M

Question ID: AID.060_01.000

Instrument Variable Name: AIDDOB_M
QuestionText:
1 of 3
What is your birthday?
*Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: Respondent said his/her date of birth is not correct or his/her age is not correct
SkipInstructions:
[01-12, Refused, Don't know] goto AIDDOB_D

[p.5]

Question ID: AID.060_02.000

Instrument Variable Name: AIDDOB_D
QuestionText:
2 of 3
*Enter day of birth.
01-31 Day of the month
97 Refused
99 Don't know
UniverseText: Respondent said his/her date of birth is not correct or his/her age is not correct
SkipInstructions:
[01-31,Refused,Don't know] goto AIDDOB_Y
If days not valid, goto ERR_AIDDOB_D

Question ID: AID.060_03.000

Instrument Variable Name: AIDDOB_Y
QuestionText:
3 of 3
*Enter year of birth.
1880-2020 Year of birth
UniverseText: Respondent said his/her date of birth is not correct or his/her age is not correct
SkipInstructions:
[1880-2020, Refused, Don't know] if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
goto AIDVERF_D
endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and
month = current month and day GT current day)
goto ERR1_AIDDOB_Y
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
goto ERR2_AIDDOB_Y
endif
(if AIDDOB_M = 'Ref' or 'DK') or (if AIDDOB_D = 'Re'f or 'DK') or (if AIDDOB_Y = 'Ref' or 'DK')
goto ERR3_AIDDOB_Y
else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
goto AIDVERF_D
endif
endif
Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.
if age from AIDDOB items is ne AGE and age from AIDDOB items is valid
reset AIDVERF_A or AIDVERF_D.
goto ERR4_AIDDOB_Y
endif


[p.1]


Sample Adult-Adult Socio-Demographic


Question ID:ASD.050_00.000

Instrument Variable Name: WRKVER
QuestionText:
Earlier I recorded that in the last week you were
(Fill1: working for pay at a job or business.)
(Fill2: with a job or business but not at work.)
(Fill3: looking for work.)
(Fill4: working, but not for pay, at a family-owned job or business.)
(Fill5: not working at a job or business and not looking for work.)
Is that correct?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working or not working last week
SkipInstructions:
[1]if DOINGLW2 = 1,2,4 [goto WHOWRK]
else if DOINGLW2 = 3,5 [goto EVERWRK]
[2][go to WRKCOR]
[R,D] [go to EVERWRK]
Question ID: ASD.060_00.000

Instrument Variable Name: WRKCOR
QuestionText:
(book) A1 ? [F1]
What is your correct working status?
1 Working for pay at a job or business
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
UniverseText: Sample adults 18+ whose reported working status in the Family section was incorrect or sample adults who were not the Family Respondent and had answers of Refused of Don't know to the working status question from the
family section
SkipInstructions:
[1,4] [goto to WHOWRK]
[2,5] [goto WHYNOWK2]
[3,R,D] [goto EVERWRK]
Question ID: ASD.062_00.000

Instrument Variable Name: DOINGLW2
QuestionText:
Corrected Employment Status Last Week: (not displayed

)

1 Working for pay at a job or business
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
UniverseText: Sample adults 18+ who verified or corrected their reported working status from the family section, or who were the Family Respondent and answered Refused or Don't know to the working status question from the family section
SkipInstructions:
if DOINGLW2 = R,D [goto EVERWRK]
endif


Question ID: ASD.065_00.000

Instrument Variable Name: WHYNOWK2
QuestionText:
(Fill1: What is the main reason you did not work last week?)
(Fill2: What is the main reason you did not have a job or business last week?)
01 Taking care of house or family
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
UniverseText: Sample Adults 18+ whose corrected working status last week was not working at a job or business and not looking for work or with a job or business but not at work
SkipInstructions:
[1-10,R,D] if WRKCOR = 2 [goto WHOWRK]
else [goto EVERWRK]

[p.3]


Question ID: ASD.066_00.000

Instrument Variable Name: EVERWRK
QuestionText:
Have you ever held a job or worked at a business?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were NOT working at a job or business and not looking for work or looking for work last week or didn't know or refused to provide their employment status last week
SkipInstructions:
[1][go to WHOWRK]
[2,R,D] [go to next section]


Question ID: ASD.070_00.000

Instrument Variable Name: WHOWRK
QuestionText:
? [F1]
[If DOINGLW2 eq [1,2,4], display] For whom did you work at your MAIN job or business? (Name of company, business, organization or employer) [Else if EVERWRK eq [1]and WHYNOWK2 = 03 or AGE ge 65]Thinking about
the job you held the longest, for whom did you work? (Name of company, business, organization or employer) [Else if EVERWRK eq 1 and WHYNOWK2 ne 03 and AGE lt 65] Thinking about the job you held most recently, for whom did you work? (Name of company, business, organization, or employer)
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[90 char long,R,D] [goto KINDIND]
Question ID: ASD.080_00.000

Instrument Variable Name: KINDIND
QuestionText:
? [F1]
What kind of business or industry was this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[90 char long,R,D] [goto KINDWRK]

[p.4]


Question ID: ASD.090_00.000

Instrument Variable Name: KINDWRK
QuestionText:
? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[90 char long,R,D] [goto IMPACT]
Question ID: ASD.100_00.000

Instrument Variable Name: IMPACT
QuestionText:
? [F1]
What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates printing press.)
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[90 char long,R,D] [goto WRKCAT]


Question ID: ASD.110_00.000

Instrument Variable Name: WRKCAT
QuestionText:
(book) A2 ? [F1]
[If DOINGLW2 eq [1,2,4]] Looking at the card, which of these best describes your current job or work situation? [Else if EVERWRK eq [1]and [WHYNOWK2 eq 03 or AGE ge 65] Looking at the card, which of these best describes the job you held for the longest time?[Else if EVERWRK eq [1]and WHYNOWK2 ne 03 and AGE lt 65] Looking at the card, which of these best describes the job you held most recently?
* Read answer choices if necessary.
1 Employee of a PRIVATE company for wages
2 A FEDERAL government employee
3 A STATE government employee
4 A LOCAL government employee
5 Self-employed in OWN business, professional practice or farm
6 Working WITHOUT PAY in a family-owned business or farm
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[1-4,6,R,D] [goto LOCALLNO]
[5] [goto BUSINC]

[p.5]


Question ID: ASD.112_00.000

Instrument Variable Name: BUSINC
QuestionText:
Is this business incorporated?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who are self-employed
SkipInstructions:
[1,2,R,D] [goto LOCALLNO]


Question ID: ASD.120_00.000

Instrument Variable Name: LOCALLNO
QuestionText:
(book) A3
Thinking about [If DOINGLW2 eq [1,2,4]] this MAIN job or business [Else if EVERWRK eq [1]and [WHYNOWK2 eq 03 or AGE ge 65] your last week at the job you held the longest [Else if EVERWRK eq [1]and WHYNOWK2 ne 03 and AGE lt 65] your last week at the job you held most recently how many people work(ed) at this location?
how many people (Fill4:work/Fill5: worked) at this location?
* "People" includes both FULL- and PART-time employees; "location" refers to the street address of the workplace.
01 1-9 employees
02 10-24 employees
03 25-49 employees
04 50-99 employees
05 100-249 employees
06 250-499 employees
07 500-999 employees
08 1000 employees or more
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[1-8,R,D] [goto WRKLONGN]

[p.6]


Question ID: ASD.140_01.000

Instrument Variable Name: WRKLONGN
QuestionText:
? [F1]
1 of 2
About how long [If DOINGLW2 eq [1,2,4]] have you worked at this MAIN job or business? [Else if EVERWRK eq [1] and [WHYNOWK2 eq 03 or AGE ge 65] did you work at the job you held the longest? [Else if EVERWRK eq [1]and
WHYNOWK2 ne 03 and AGE lt 65] did you work at the job you held most recently?
001-365 1-365
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[1-365] [goto WRKLONGT]
[R,D] if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65) then [goto HOURPD]; else [goto WRKLONGH]
Question ID: ASD.140_02.000

Instrument Variable Name: WRKLONGT
QuestionText:
2 of 2
* Enter time period.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
UniverseText: Sample adults 18+ (who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked) and who gave a number entry in WRKLONGN
SkipInstructions:
[1-4] if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65) then [goto HOURPD]; else [goto WRKLONGH]
[4] if WRKLONGN gt AGE then [goto ERR_WRKLONGT]


Question ID: ASD.146_00.000

Instrument Variable Name: WRKLONGH
QuestionText:
? [F1]
[If DOINGLW2 eq 1,2,4] Is this MAIN job or business the job you have held for the longest? [Else if EVERWRK eq 1 and WHYNOWK2 ne 03 and AGE lt 65] Was your most recently held job also the job you held the longest?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ (who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business,) or (who have ever worked and are not retired and are less than 65 years of age.)
SkipInstructions:
[1,2,R,D] [goto HOURPD]

[p.7]


Question ID: ASD.150_00.000

Instrument Variable Name: HOURPD
QuestionText:
[If DOINGLW2 eq [1,2,4]] Are you paid by the hour at this MAIN job or business? [Else if EVERWRK eq [1]and[WHYNOWK2 eq 03 or AGE ge 65] Were you paid by the hour on the job you held the longest? [Else if EVERWRK eq[1]and WHYNOWK2 ne 03 and AGE lt 65] Were you paid by the hour on the job you held most recently?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[1,2,R,D] [goto PDSICK]


Question ID: ASD.160_00.000

Instrument Variable Name: PDSICK
QuestionText:
[If DOINGLW2 eq [1,2,4]] Do you have paid sick leave on this MAIN job or business? [Else if EVERWRK eq [1] and
[WHYNOWK2 eq 03 or AGE ge 65] Did you ever have paid sick leave on the job you held the longest?
[Else if EVERWRK eq [1]and WHYNOWK2 ne 03 and AGE lt 65] Did you ever have paid sick leave on the job you held most
recently?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:
[1,2,R,D] if DOINGLW2 = 1,2,4 then [goto ONEJOB];
else [goto next section]


Question ID: ASD.170_00.000

Instrument Variable Name: ONEJOB
QuestionText:
Do you have more than one job or business?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business
SkipInstructions:
[1,2,R,D] [goto next section]

[p.1]


Sample Adult - Adult Conditions


Question ID: ACN.010_00.000

Instrument Variable Name: HYPEV
QuestionText:
Now I am going to ask you about certain medical conditions.
Have you EVER been t old by a doctor or other health professional that you had
... Hypertension, also called high blood pressure?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto HYPDIFV]
[2,R,D] [goto CHDEV]




Question ID: ACN.020_00.000

Instrument Variable Name: HYPDIFV
QuestionText:
Were you told on two or more DIFFERENT visits that you had hypertension, also called high blood pressure?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were told they had hypertension
SkipInstructions:
[1,2,R,D] [goto CHDEV]


Question ID: ACN.031_01.000

Instrument Variable Name: CHDEV
QuestionText:
Have you EVER been t old by a doctor or other health professional that you had
... Coronary heart disease?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto ANGEV]

[p.2]


Question ID: ACN.031_02.000

Instrument Variable Name: ANGEV
QuestionText:
* Read lead-in if necessary:
Have you EVER been told by a doctor or other health professional that you had
... Angina, also called angina pectoris?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto MIEV]


Question ID: ACN.031_03.000

Instrument Variable Name: MIEV
QuestionText:
* Read lead-in if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A heart attack (also called myocardial infarction)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto HRTEV]


Question ID: ACN.031_04.000

Instrument Variable Name: HRTEV
QuestionText:
* Read lead-in if necessary:
Have you EVER been told by a doctor or other health professional that you had...Any kind of heart condition or heart disease (other than the ones I just asked about)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto STREV]

[p.3]


Question ID: ACN.031_05.000

Instrument Variable Name: STREV
QuestionText:
* Read lead-in if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A stroke?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto EPHEV]


Question ID: ACN.031_06.000

Instrument Variable Name: EPHEV
QuestionText:
* Read lead-in if necessary:
Have you EVER been told by a doctor or other health professional that you had...Emphysema?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto FACE]


Question ID: ACN.032_00.010

Instrument Variable Name: FACE
QuestionText:
Which of the following would you say are the symptoms that someone may be having a stroke? I am going to read a list.
Please say yes or no to each one.
Sudden numbness or weakness of face, arm, or leg, especially on one side.
1 Yes
2 No
7 Refused
9 Don't Know
UniverseText: Sample Adults 18+
SkipInstructions:
[1,2,R,D] [goto SPEAKING]

[p.4]


Question ID: ACN.032_00.020

Instrument Variable Name: SPEAKING
QuestionText:
Which of the following would you say are the symptoms that someone may be having a stroke? I am going to read a list.
Please say yes or no to each one.
Sudden confusion or trouble speaking.
1 Yes
2 No
7 Refused
9 Don't Know
UniverseText: Sample Adults 18+
SkipInstructions:
[1,2,R,D] [goto EYE]


Question ID: ACN.032_00.030

Instrument Variable Name: EYE
QuestionText:
Which of the following would you say are the symptoms that someone may be having a stroke? I am going to read a list.
Please say yes or no to each one.
Sudden trouble seeing in one or both eyes.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1,2,R,D ] [goto WALKING]


Question ID: ACN.032_00.040

Instrument Variable Name: WALKING
QuestionText:
Which of the following would you say are the symptoms that someone may be having a stroke? I am going to read a list.
Please say yes or no to each one.
Sudden trouble walking, dizziness, or loss of balance.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1,2,R,D ] [goto HEADACHE]

[p.5]


Question ID: ACN.032_00.050

Instrument Variable Name: HEADACHE
QuestionText:
Which of the following would you say are the symptoms that someone may be having a stroke? I am going to read a list.
Please say yes or no to each one.
Sudden severe headache with no known cause.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1,2,R,D ] [goto ASTDO]


Question ID: ACN.032_00.060

Instrument Variable Name: ASTDO
QuestionText:
(book) A4
If you thought someone was having a stroke, what is the BEST thing to do right away?
Please give me a number from the card.
1 Advise them to drive to the hospital
2 Advise them to call their physician
3 Call 9-1-1 (or another emergency number)
4 Call spouse or family member
5 Other
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1-5,7,9] [goto AASMEV]


Question ID: ACN.080_00.000

Instrument Variable Name: AASMEV
QuestionText:
Have you EVER been told by a doctor or other health professional that you had asthma?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto AASSTILL]
[2,R,D] [goto ULCEV]

[p.6]


Question ID: ACN.085_00.000

Instrument Variable Name: AASSTILL
QuestionText:
Do you still have asthma?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were ever told they have asthma
SkipInstructions:
[1,2,R,D] [go to AASMYR]




Question ID: ACN.090_00.000

Instrument Variable Name: AASMYR
QuestionText:
DURING THE PAST 12 MONTHS, have you had an episode of asthma or an asthma attack?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were ever told they had asthma
SkipInstructions:
[1][goto AASMERYR]
[2,R,D] [ go to ULCEV]


Question ID: ACN.100_00.000

Instrument Variable Name: AASMERYR
QuestionText:
DURING THE PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with asthma episode/attack in past 12 months
SkipInstructions:
[1,2,R,D] [goto ULCEV]


Question ID: ACN.110_00.000

Instrument Variable Name: ULCEV
QuestionText:
Have you EVER been told by a doctor or other health professional that you had...An ulcer? This could be a stomach, duodenal or peptic ulcer

.

1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto ULCYR]
[2,R,D][goto CANEV]

[p.7]


Question ID: ACN.120_00.000

Instrument Variable Name: ULCYR
QuestionText:
DURING THE PAST 12 MONTHS have you had an ulcer?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were ever told they had an ulcer
SkipInstructions:
[1,2,R,D] [goto CANEV]


Question ID: ACN.130_00.000

Instrument Variable Name: CANEV
QuestionText:
Have you EVER been told by a doctor or other health professional that you had...Cancer or a malignancy of any kind?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto CANKIND_1]
[2,R,D] [goto DIBEV]

[p.8]


Question ID: ACN.140_00.001

Instrument Variable Name: CANKIND_1
QuestionText:
What kind of cancer was it?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:
[1-30,R,D][goto CANAGE_1]
IF SEX=1 (MALE) and No. [6,18,29] selected goto ERR1_CANKIND_1
IF SEX=2 (FEMALE) and No. [20,26] selected goto ERR2_CANKIND_1
Question ID: ACN.140_00.002

Instrument Variable Name: CANKIND_2
QuestionText:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who either provided an age for one kind of cancer or didn't know how old they were when first diagnosed with that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_1.
SkipInstructions:
[1-30,R,D][goto CANAGE_2]
[96] goto DIBEV
IF SEX=1 (MALE) and No. [6,18,29] selected goto ERR1_CANKIND_2
IF SEX=2 (FEMALE) and No. [20,26] selected goto ERR2_CANKIND_2
Question ID: ACN.140_00.003

Instrument Variable Name: CANKIND_3
QuestionText:
* Enter code for the third kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who either provided an age for a second kind of cancer or didn't know how old they were when first diagnosed that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_2.
SkipInstructions:
[1-30,R,D][goto CANAGE_3]
[96] [goto DIBEV]
IF SEX=1 (MALE) and No. [6,18,29] selected goto ERR1_CANKIND_3
IF SEX=2 (FEMALE) and No. [20,26] selected goto ERR2_CANKIND_3
Question ID: ACN.140_00.004

Instrument Variable Name: CANKIND_4
QuestionText:
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
95 More than three kinds
96 No more
UniverseText: Sample adults 18+ who either provided an age for a third kind of cancer or didn't know how old they were when first diagnosed that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_3
SkipInstructions:
[95,96] [goto DIBEV]


Question ID: ACN.150_00.001

Instrument Variable Name: CANAGE_1
QuestionText:
How old were you when [fill: CANKIND_1 /this cancer] was first diagnosed?
001-100 1-100 years
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:
[1-100, D] [goto CANKIND_2]
[R] and [R] at CANKIND_1 [goto DIBEV]
[R] and CANKIND_1 NE [R] [goto CANKIND_2]
If number in CANAGE_1 greater than person years old (AGE) goto ERR_ CANAGE_1
Question ID: ACN.150_00.002

Instrument Variable Name: CANAGE_2
QuestionText:
How old were you when [fill: CANKIND_2/this cancer] was first diagnosed?
001-100 1-100 years
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:
1-100, D] [goto CANKIND_3]
[R] and [R] at CANKIND_2 [goto DIBEV]
[R] and CANKIND_2 NE [R] [goto CANKIND_3]
If number in CANAGE_2 greater than person years old (AGE) goto ERR_ CANAGE_2
Question ID: ACN.150_00.003

Instrument Variable Name: CANAGE_3
QuestionText:
How old were you when [fill: CANKIND_3/this cancer ] was first diagnosed?
001-100 1-100 years
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:
[1-100, D] [goto CANKIND_4]
[R] and [R] at CANKIND_3 [goto DIBEV]
[R] and CANKIND_3 NE [R] [goto CANKIND_4]
If number in CANAGE_3 greater than person years old (AGE) goto ERR_ CANAGE_3


Question ID: ACN.160_00.000

Instrument Variable Name: DIBEV
QuestionText:
[fill: Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or
sugar diabetes?/Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?]
1 Yes
2 No
3 Borderline
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto DIBAGE]
[2,3,R,D] [goto DIBPRE1]


Question ID: ACN.165_00.000

Instrument Variable Name: DIBPRE1
QuestionText:
Have you EVER been told by a doctor or other health professional that you have any of the following: prediabetes,
impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were never told they had diabetes, or who refused or said don't know to having been told they had diabetes
SkipInstructions:
[1][goto INSLN]
[2,R,D] [goto AHAYFYR]

[p.13]


Question ID: ACN.170_00.000

Instrument Variable Name: DIBAGE
QuestionText:
How old were you when a doctor FIRST told you that you had diabetes or sugar diabetes?
01-84 1-84 years
85 85+ years
97 Refused
99 Don't know
UniverseText:Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy)
SkipInstructions:
[1-100 R,D] [goto INSLN]


Question ID: ACN.180_00.000

Instrument Variable Name:INSLN
QuestionText:
Are you NOW taking insulin?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were ever told they had diabetes or prediabetic condition (other than during pregnancy)
SkipInstructions:
[1,2,R,D] [goto DIBPILL]


Question ID: ACN.190_00.000

Instrument Variable Name: DIBPILL
QuestionText:
Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were ever told they had diabetes or prediabetic condition (other than during pregnancy)
SkipInstructions:
[1,2,R,D] else goto AHAYFYR


Question ID: ACN.201_01.000

Instrument Variable Name: AHAYFYR
QuestionText:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had...Hay fever?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto SINYR]

[p.14]


Question ID: ACN.201_02.000

Instrument Variable Name: SINYR
QuestionText:
* Read lead-in if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had...Sinusitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto CBRCHYR]


Question ID: ACN.201_03.000

Instrument Variable Name: CBRCHYR
QuestionText:
* Read lead-in if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had...Chronic bronchitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto KIDWKYR]


Question ID: ACN.201_04.000

Instrument Variable Name: KIDWKYR
QuestionText:
* Read lead-in if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had.....Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto LIVYR]

[p.15]


Question ID: ACN.201_05.000

Instrument Variable Name: LIVYR
QuestionText:
* Read lead-in if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had......Any kind of liver condition?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto JNTSYMP]


Question ID: ACN.250_00.000

Instrument Variable Name: JNTSYMP
QuestionText:
The next questions refer to your joints. Please do NOT include the back or neck. DURING THE PAST 30 DAYS, have you had any symptoms of pain, aching, or stiffness in or around a joint?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto JMTHP]
[2,R,D] [goto ARTH]

[p.16]


Question ID: ACN.260_00.000

Instrument Variable Name: JMTHP
QuestionText:
(book) A5
Which joints are affected?
* Enter all that apply, separate with commas.
01 Shoulder-right
02 Shoulder-left
03 Elbow-right
04 Elbow-left
05 Hip-right
06 Hip-left
07 Wrist-right
08 Wrist-left
09 Knee-right
10 Knee-left
11 Ankle-right
12 Ankle-left
13 Toes-right
14 Toes-left
15 Fingers/thumb-right
16 Fingers/thumb-left
17 Other joint not listed
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had joint pain in the past 30 days
SkipInstructions:
[1-17,R,D] [goto JNTPN]


Question ID: ACN.265_00.010

Instrument Variable Name: JNTPN
QuestionText:
Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication. DURING THE PAST 30 DAYS, how bad was your joint pain ON AVERAGE? Please answer on a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be.
00-10 00-10
97 Refused
99 Don't know
UniverseText: Sample adults GE 18 years who have had any symptoms of pain, aching, or stiffness in or around a joint during the past 30 days
SkipInstructions:
[0-10,R,D] [goto JNTCHR]

[p.17]


Question ID:ACN.270_00.000

Instrument Variable Name: JNTCHR
QuestionText:
Did your joint symptoms FIRST begin more than 3 months ago?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with joint pain
SkipInstructions:
[1,2,R,D] [goto JNTHP]




Question ID: ACN.280_00.000

Instrument Variable Name: JNTHP
QuestionText:
Have you EVER seen a doctor or other health professional for these
joint symptoms?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with joint pain
SkipInstructions:
[1,2,R,D] [goto ARTH]


Question ID: ACN.290_00.000

Instrument Variable Name: ARTH
QuestionText:
Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia (fy-bro-my-AL-jee-uh)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
([1]or JNTSYMP eq [1]) [goto ARTHWT];
else ([2,R,D] and JNTSYMP ne 1) [goto PAINECK]


Question ID: ACN.290_00.010

Instrument Variable Name: ARTHWT
QuestionText:
Has a doctor or other health professional EVER suggested losing weight to help your arthritis or joint symptoms?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a joint
SkipInstructions:
[1,2,R,D] [goto ARTHPH]

[p.18]


Question ID: ACN.290_00.020

Instrument Variable Name: ARTHPH
QuestionText:
Has a doctor or other health professional EVER suggested physical activity or exercise to help your arthritis or joint symptoms?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a joint
SkipInstructions:
[1,2,R,D] [goto ARTHCLS]


Question ID: ACN.290_00.030

Instrument Variable Name: ARTHCLS
QuestionText:
Have you EVER taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?
1 Yes
2 No
7 Refused
8 Not asc0ertained
9 Don't know
UniverseText: Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a joint
SkipInstructions:
[1,2,R,D] [goto ARTHLMT]


Question ID: ACN.295_00.000

Instrument Variable Name: ARTHLMT
QuestionText:
Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with joint pain or arthritis
SkipInstructions:
[1,2,R,D] [goto ARTHWRK]

[p.19]


Question ID: ACN.295_00.010

Instrument Variable Name: ARTHWRK
QuestionText:
In this next question we are referring to work for pay.
Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a joint
SkipInstructions:
[1,2,R,D] [goto PAINECK]


Question ID: ACN.300_00.000

Instrument Variable Name: PAINECK
QuestionText:
The following questions are about pain you may have experienced in the PAST THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor.During the PAST THREE MONTHS, did you have ... Neck pain?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto PAINLB]


Question ID: ACN.310_00.000

Instrument Variable Name: PAINLB
QuestionText:
* Read lead-in if necessary.
During the PAST THREE MONTHS, did you have
... Low back pain?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto PAINLEG]
[2,R,D] [goto PAINFACE]

[p.20]


Question ID: ACN.320_00.000

Instrument Variable Name: PAINLEG
QuestionText:
Did this pain spread down either leg to areas below the knees?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with low back pain in the past 3 months
SkipInstructions:
[1,2,R,D] [goto PAINFACE]




Question ID: ACN.331_01.000

Instrument Variable Name: PAINFACE
QuestionText:
During the PAST THREE MONTHS, did you have
... Facial ache or pain in the jaw muscles or the joint in front of the ear?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto AMIGR]


Question ID: ACN.331_02.000

Instrument Variable Name: AMIGR
QuestionText:
* Read lead-in if necessary:
During the PAST THREE MONTHS, did you have
...Severe headache or migraine?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][goto ACOLD2W]



[p.21]


Question ID: ACN.350_00.000

Instrument Variable Name: ACOLD2W
QuestionText:
* Hand calendar card
These next questions are about your recent health during the TWO WEEKS outlined on that calendar. Did you 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 adults 18+
SkipInstructions:
[1,2,R,D] [goto AINTIL2W]


Question ID: ACN.360_00.000

Instrument Variable Name: AINTIL2W
QuestionText:
Did you 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 adults 18+
SkipInstructions:
[1,2,R,D] if SEX=2 and AGE 18-49 [goto PREGNOW]; else [goto HRAIDNOW]


Question ID: ACN.370_00.000

Instrument Variable Name: PREGNOW
QuestionText:
Are you currently pregnant?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Female sample adults 18-49 years of age
SkipInstructions:
[1,2,R,D] [goto HRAIDNOW]

[p.22]


Question ID: ACN.400_00.000

Instrument Variable Name: HRAIDNOW
QuestionText:
These next questions are about your hearing, vision, and teeth.
Do you now use a hearing aid(s)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto AHEARST1]
[2,R,D] [goto HRAIDEV]


Question ID: ACN.410_00.000

Instrument Variable Name: HRAIDEV
QuestionText:
Have you ever used a hearing aid(s) in the past?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not now use a hearing aid or REF/DK whether they now use a hearing aid
SkipInstructions:
[1,2,R,D][goto AHEARST1]


Question ID: ACN.420_00.000

Instrument Variable Name: AHEARST1
QuestionText:
WITHOUT the use of hearing aids or other listening devices, is your hearing excellent, good, a little trouble hearing, moderate trouble, a lot of trouble, or are you 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 adults 18+
SkipInstructions:
[1-6,R,D] [goto AVISION]

[p.23]


Question ID: ACN.430_00.000

Instrument Variable Name: AVISION
QuestionText:
Do you have any trouble seeing, even when wearing glasses or contact lenses?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto ABLIND]
[2,R,D] [goto LUPPRT]


Question ID: ACN.440_00.000

Instrument Variable Name: ABLIND
QuestionText:
Are you blind or unable to see at all?
Instrument Variable Name: ABLIND
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have trouble seeing even when wearing glasses/contact lenses
SkipInstructions:
[1,2,R,D] [goto LUPPRT]


Question ID: ACN.451_00.000

Instrument Variable Name: LUPPRT
QuestionText:
Have you lost all of your upper and lower natural (permanent) teeth?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][goto MHSAD_CK]


Question ID: CAN.470_00.000

Instrument Variable name: MHSAD_CK
QuestionText:
Now I am going to ask you some questions about feelings you may have experienced over the past 30 days.
1 Enter 1 to continue
UniverseText: Sample adults 18+
SkipInstructions:
[1] [goto SAD]

[p.24]


Question ID: ACN.471_01.000

Instrument Variable Name: SAD
QuestionText:
(book) A6
During the PAST 30 DAYS, how often did you feel
... So sad that nothing could cheer you up?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-5,R,D] [goto NERVOUS]




Question ID: ACN.471_02.000

Instrument Variable Name: NERVOUS
QuestionText:
(book) A6
* Read lead-in if necessary:
During the PAST 30 DAYS, how often did you feel
... Nervous?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-5,R,D] [goto RESTLESS]

[p.25]


Question ID: ACN.471_03.000

Instrument Variable Name: RESTLESS
QuestionText:
(book) A6
* Read lead-in if necessary:
During the PAST 30 DAYS, how often did you feel
... Restless or fidgety?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-5,R,D] [goto HOPELESS]




Question ID: ACN.471_04.000

Instrument Variable Name: HOPELESS
QuestionText:
(book) A6
* Read lead-in if necessary:
During the PAST 30 DAYS, how often did you feel
... Hopeless?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-5,R,D] [goto EFFORT]

[p.26]


Question ID: ACN.471_05.000

Instrument Variable Name: EFFORT
QuestionText:
(book) A6
* Read lead-in if necessary:
During the PAST 30 DAYS, how often did you feel
...That everything was an effort?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-5,R,D] [goto WORTHLS]


Question ID: ACN.471_06.000

Instrument Variable Name: WORTHLS
QuestionText:
(book) A6
* Read lead-in if necessary:
During the PAST 30 DAYS, how often did you feel
...Worthless?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
If SAD eq [1-3] or NERVOUS eq [1-3] or RESTLESS eq [1-3] or HOPELESS eq [1-3] or EFFORT eq [1-3] or WORTHLS eq [1-3] [goto MHAMTMO]; else [goto next section]

[p.27]


Question ID: ACN.530_00.000

Instrument Variable Name: MHAMTMO
QuestionText:
We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?
1 A lot
2 Some
3 A little
4 Not at all
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who at least some of the time have felt sad, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless, in the past 30 days
SkipInstructions:
[1-4,R,D] [goto next section]

[p.1]


Sample Adult - Adult Health Status and Limitations


Question ID: AHS.030_00.000

Instrument Variable Name: WRKLYR2
QuestionText:
Although you did not work last week, did you have a job or business at any time in the PAST 12 MONTHS?
0 Had job last week
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were looking for work or who were not working at a job or business AND who were not looking for work in the last week
SkipInstructions:
[1][goto WKDAYR]
[2,R,D] [goto BEDDAYR]


Question ID: AHS.040_00.000

Instrument Variable Name: WKDAYR
QuestionText:
During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did you miss work at a job or business because of illness or injury (do not include maternity leave)?
* Enter '0' for None.
000 None
001-366 1-366 days
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who worked or had a job or business with or without pay in the last week or who had a job or business in the past 12 months
SkipInstructions:
[0-366,R,D] [goto BEDDAYR]
[120-366] [goto ERR_WKDAYR]


Question ID: AHS.050_00.000

Instrument Variable Name: BEDDAYR
QuestionText:
During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did illness or injury keep you in bed more than half of the day (include days while an overnight patient in a hospital)?
* Enter '0' for None.
000 None
001-366 1-366 days
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-366,R,D] [goto AHSTATYR]
[120-366] [goto ERR_BEDDAYR]

[p.2]


Question ID: AHS.060_00.000

Instrument Variable Name: AHSTATYR
QuestionText:
Compared with 12 MONTHS AGO, would you say your health is better, worse, or about the same?
1 Better
2 Worse
3 About the same
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-3,R,D] [goto SPECEQ]


Question ID: AHS.070_00.000

Instrument Variable Name: SPECEQ
QuestionText:
Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto FLWALK]


Question ID: AHS.091_01.000

Instrument Variable Name: FLWALK
QuestionText:
(book) A7
The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or emotional problem or illness (not including pregnancy).

By yourself, and without using any special equipment, how difficult is it for you to.....Walk a quarter of a mile - about 3 city blocks?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLCLIMB]

[p.3]


Question ID: AHS.091_02.000

Instrument Variable Name: FLCLIMB
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to.....Walk up 10 steps without resting?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLSTAND]


Question ID: AHS.091_03.000

Instrument Variable Name: FLSTAND
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to.....Stand or be on your feet for about 2 hours?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLSIT]

[p.4]


Question ID: AHS.091_04.000

Instrument Variable Name: FLSIT
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to.....Sit for about 2 hours?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLSTOOP]


Question ID: AHS.091_05.000

Instrument Variable Name: FLSTOOP
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to.....Stoop, bend, or kneel?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLREACH]

[p.5]


Question ID: AHS.091_06.000

Instrument Variable Name: FLREACH
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to.....Reach up over your head?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLGRASP]


Question ID: AHS.141_01.000

Instrument Variable Name: FLGRASP
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to.....Use your fingers to grasp or handle small objects?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLCARRY]

[p.6]


Question ID: AHS.141_02.000

Instrument Variable Name: FLCARRY
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to......Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLPUSH]


Question ID: AHS.141_03.000

Instrument Variable Name: FLPUSH
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to......Push or pull large objects like a living room chair?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLSHOP]


Question ID: AHS.171_01.000

Instrument Variable Name: FLSHOP
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to......Go out to things like shopping, movies, or sporting events?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLSOCL]


Question ID: AHS.171_02.000

Instrument Variable Name:FLSOCL
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to.....Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-4,6,R,D] [goto FLRELAX]

[p.8]


Question ID: AHS.171_03.000

Instrument Variable Name: FLRELAX
QuestionText:
(book) A7
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to......Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-4 or FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND= 1-4 or FLSIT= 1-4 or FLSTOOP= 1-4 or FLREACH= 1-4 or FLGRASP= 1-4 or FLCARRY= 1-4 or FLPUSH= 1-4 or FLSHOP= 1-4 or FLSOCL= 1-4][goto AFLHCA]
Else goto SMKEV (next section)

[p.9]


Question ID: AHS.200_00.000

Instrument Variable Name: AFLHCA
QuestionText:
(book) A8
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for all that apply, separate with commas.
* Do not probe, except to clarify answer.
01 Vision/problem seeing
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
UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile; walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10 pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or relaxing at home (reading/sewing).
SkipInstructions:
[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order
[13] store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
[90] [goto AFLHCA_S1]
[91] [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
[R,D] [goto SMKEV (next section)]

[p.10]


Question ID: AHS.201_90.000

Instrument Variable Name: AFLHCA_S1
QuestionText:
* Enter other impairment/problem.
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least one condition not listed in AFLHCA
SkipInstructions:
[50 chars][goto AHCL90N]
(ENTER) only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N],in numericalorder, as specified in AFLHCA

Question ID: AHS.201_91.000

Instrument Variable Name: AFLHCA_S2
QuestionText:
* Enter other impairment/problem.
Verbatim Verbatim Response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more than one condition that is not listed in AFLHCA
SkipInstructions:
[50 chars][goto AHCL91N]
(ENTER) only with no description [goto ERR1_AFLHCA_S1]

[p.11]


Question ID: AHS.300_01.000

Instrument Variable Name: AHCL01N
QuestionText:
1 of 2
How long have you had a vision problem or problem seeing?
* Enter number for time with your vision problem or problem seeing..
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a vision problem or problem seeing
SkipInstructions:
[1-95,D][goto AHCL01T]
[R][store "R" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.300_02.000

Instrument Variable Name: AHCL01T
QuestionText:
2 of 2
* Enter time period for time with vision problem or problem seeing.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL01T
[if [AHCL01N = Number greater than person years old and AHCL01T= 4]] goto
ERR1_AHCL01T

[p.12]


Question ID: AHS.301_01.000

Instrument Variable Name: AHCL02N
QuestionText:
1 of 2
How long have you had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a hearing problem
SkipInstructions:
[1-95,D][goto AHCL02T]
[R][store "R" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.301_02.000

Instrument Variable Name: AHCL02T
QuestionText:
2 of 2
* Enter time period for time with hearing problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL02T
[if [AHCL02N = Number greater than person years old and AHCL02T= 4]] goto
ERR1_AHCL02T

[p.13]


Question ID: AHS.302_01.000

Instrument Variable Name: AHCL03N
QuestionText:
1 of 2
How long have you had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to arthritis or rheumatism
SkipInstructions:
[1-95,D][goto AHCL03T]
[R][store "R" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.302_02.000

Instrument Variable Name: AHCL03T
QuestionText:
2 of 2
* Enter time period for time with arthritis or rheumatism.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL03T
[if [AHCL03N = Number greater than person years old and AHCL03T= 4]] goto
ERR1_AHCL03T

[p.14]


Question ID: AHS.303_01.000

Instrument Variable Name: AHCL04N
QuestionText:
1 of 2
How long have you had a back or neck problem?
* Enter number for time with back or neck problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a back or neck problem
SkipInstructions:
[1-95,D][goto AHCL04T]
[R][store "R" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.303_02.000

Instrument Variable Name: AHCL04T
QuestionText:
2 of 2
* Enter time period for time with back or neck problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL04T
[if [AHCL04N = Number greater than person years old and AHCL04T= 4]] goto
ERR1_AHCL04T

[p.15]


Question ID: AHS.304_01.000

Instrument Variable Name: AHCL05N
QuestionText:
1 of 2
How long have you 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.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a fracture, bone, or joint injury
SkipInstructions:
[1-95,D][goto AHCL05T]
[R][store "R" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.304_02.000

Instrument Variable Name: AHCL05T
QuestionText:
2 of 2
* Enter time period for time with fracture, bone, or joint injury.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL05T
[if [AHCL05N = Number greater than person years old and AHCL05T= 4]] goto
ERR1_AHCL05T

[p.16]


Question ID: AHS.305_01.000

Instrument Variable Name: AHCL06N
QuestionText:
1 of 2
How long have you had the (fill: other) injury that caused your limitation?
* Enter number for time with injury that caused your limitation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to an injury other than a fracture, bone, or joint injury
SkipInstructions:
[1-95,D][goto AHCL06T]
[R][store "R" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.305_02.000

Instrument Variable Name: AHCL06T
QuestionText:
2 of 2
* Enter time period for time with (fill: other) injury.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL06T
[if [AHCL06N = Number greater than person years old and AHCL06T= 4]] goto
ERR1_AHCL06T

[p.17]


Question ID: AHS.306_01.000

Instrument Variable Name: AHCL07N
QuestionText:
1 of 2
How long have you had a heart problem?
* Enter number for time with a heart problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a heart problem
SkipInstructions:
[1-95,D][goto AHCL07T]
[R][store "R" in AHCL07T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL07T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.306_02.000

Instrument Variable Name: AHCL07T
QuestionText:
2 of 2
* Enter time period for time with heart problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL07T
[if [AHCL07N = Number greater than person years old and AHCL07T= 4]] goto
ERR1_AHCL07T

[p.18]


Question ID: AHS.307_01.000

Instrument Variable Name: AHCL08N
QuestionText:
1 of 2
How long have you had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a stroke problem
SkipInstructions:
[1-95,D][goto AHCL08T]
[R][store "R" in AHCL08T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL08T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.307_02.000

Instrument Variable Name: AHCL08T
QuestionText:
2 of 2
* Enter time period for time with stroke problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL08T
[if [AHCL08N = Number greater than person years old and AHCL08T= 4]] goto
ERR1_AHCL08T

[p.19]


Question ID: AHS.308_01.000

Instrument Variable Name: AHCL09N
QuestionText:
1 of 2
How long have you 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

.

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to hypertension or high blood pressure
SkipInstructions:
[1-95,D][goto AHCL09T]
[R][store "R" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.308_02.000

Instrument Variable Name: AHCL09T
QuestionText:
2 of 2
* Enter time period for time with hypertension or high blood pressure.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL09T
[if [AHCL09N = Number greater than person years old and AHCL09T= 4]] goto
ERR1_AHCL09T

[p.20]


Question ID: AHS.309_01.000

Instrument Variable Name: AHCL10N
QuestionText:
1 of 2
How long have
I you had diabetes?
* Enter number for time with diabetes.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to diabetes
SkipInstructions:
[1-95,D][goto AHCL10T]
[R][store "R" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.309_02.000

Instrument Variable Name: AHCL10T
QuestionText:
2 of 2
* Enter time period for time with diabetes.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL10T
[if [AHCL10N = Number greater than person years old and AHCL10T= 4]] goto
ERR1_AHCL10T

[p.21]


Question ID: AHS.310_01.000

Instrument Variable Name: AHCL11N
QuestionText:
1 of 2
How long have you had a lung or breathing problem (e.g. asthma and emphysema)?
* Enter number for time with a lung or breathing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a lung or breathing problem
SkipInstructions:
[1-95,D][goto AHCL11T]
[R][store "R" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.310_02.000

Instrument Variable Name: AHCL11T
QuestionText:
2 of 2
* Enter time period for time with lung or breathing problem (e.g. asthma and emphysema).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL11T
[if [AHCL11N = Number greater than person years old and AHCL11T= 4]] goto
ERR1_AHCL11T

[p.22]


Question ID: AHS.311_01.000

Instrument Variable Name: AHCL12N
QuestionText:
1 of 2
How long have you had cancer?
* Enter number for time with cancer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to cancer
SkipInstructions:
[1-95,D][goto AHCL12T]
[R][store "R" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.311_02.000

Instrument Variable Name: AHCL12T
QuestionText:
2 of 2
* Enter time period for time with cancer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL12T
[if [AHCL12N = Number greater than person years old and AHCL12T= 4]] goto
ERR1_AHCL12T

[p.23]


Question ID: AHS.313_01.000

Instrument Variable Name: AHCL14N
QuestionText:
1 of 2
How long have you had mental retardation?
* Enter number for time with mental retardation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to mental retardation
SkipInstructions:
[1-95,D][goto AHCL14T]
[R][store "R" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.313_02.000

Instrument Variable Name: AHCL14T
QuestionText:
2 of 2
* Enter time period for time with mental retardation.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL14T
[if [AHCL14N = Number greater than person years old and AHCL14T= 4]] goto
ERR1_AHCL14T

[p.24]


Question ID: AHS.314_01.000

Instrument Variable Name: AHCL15N
QuestionText:
1 of 2
How long have you 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.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a developmental problem
SkipInstructions:
[1-95,D][goto AHCL15T]
[R][store "R" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.314_02.000

Instrument Variable Name: AHCL15T
QuestionText:
2 of 2
* Enter time period for time with developmental problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL15T
[if [AHCL15N = Number greater than person years old and AHCL15T= 4]] goto
ERR1_AHCL15T

[p.25]


Question ID: AHS.315_01.000

Instrument Variable Name: AHCL16N
QuestionText:
1 of 2
How long have you had senility?
* Enter number for time with senility.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to senility
SkipInstructions:
[1-95,D][goto AHCL16T]
[R][store "R" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.315_02.000

Instrument Variable Name: AHCL16T
QuestionText:
2 of 2
* Enter time period for time with senility.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL16T
[if [AHCL16N = Number greater than person years old and AHCL16T= 4]] goto
ERR1_AHCL16T

[p.26]


Question ID: AHS.316_01.000

Instrument Variable Name: AHCL17N
QuestionText:
1 of 2
How long have you had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety, or an emotional problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to depression, anxiety, or an emotional problem
SkipInstructions:
[1-95,D][goto AHCL17T]
[R][store "R" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.316_02.000

Instrument Variable Name: AHCL17T
QuestionText:
2 of 2
* Enter time period for time with depression, anxiety, or emotional problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL17T
[if [AHCL17N = Number greater than person years old and AHCL17T= 4]] goto
ERR1_AHCL17T

[p.18]


Question ID: AHS.317_01.000

Instrument Variable Name: AHCL18N
QuestionText:
1 of 2
How long have you had a weight problem?
* Enter number for time with a weight problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don'tknow
UniverseText: Sample adults 18+ who had difficulty due to a weight problem
SkipInstructions:
[1-95,D][goto AHCL18T]
[R][store "R" in AHCL18T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL18T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.317_02.000

Instrument Variable Name: AHCL18T
QuestionText:
2 of 2
* Enter time period for time with weight problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL18T
[if [AHCL18N = Number greater than person years old and AHCL18T= 4]] goto
ERR1_AHCL18T

[p.28]


Question ID: AHS.318_01.000

Instrument Variable Name: AHCL19N
QuestionText:
1 of 2
How long have you 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.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a missing limb
SkipInstructions:
[1-95,D][goto AHCL19T]
[R][store "R" in AHCL19T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL19T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.318_02.000

Instrument Variable Name: AHCL19T
QuestionText:
2 of 2
* Enter time period for time with missing limb.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL19T
[if [AHCL19N = Number greater than person years old and AHCL19T= 4]] goto
ERR1_AHCL19T

[p.29]

Question ID: AHS.319_01.000

Instrument Variable Name: AHCL20N
QuestionText:
1 of 2
How long have you 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.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText:S ample adults 18+ who had difficulty due to a kidney, bladder or renal problem
SkipInstructions:
[1-95,D][goto AHCL20T]
[R][store "R" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.319_02.000

Instrument Variable Name: AHCL20T
QuestionText:
2 of 2
* Enter time period for time with kidney, bladder or renal problem

.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL20T
[if [AHCL20N = Number greater than person years old and AHCL20T= 4]] goto
ERR1_AHCL20T

[p.30]


Question ID: AHS.320_01.000

Instrument Variable Name: AHCL21N
QuestionText:
1 of 2
How long have you 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.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a circulation problem
SkipInstructions:
[1-95,D][goto AHCL21T]
[R][store "R" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.320_02.000

Instrument Variable Name: AHCL21T
QuestionText:
2 of 2
* Enter time period for time with circulation problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL21T
[if [AHCL21N = Number greater than person years old and AHCL21T= 4]] goto
ERR1_AHCL21T

[p.22]


Question ID: AHS.321_01.000

Instrument Variable Name: AHCL22N
QuestionText:
1 of 2
How long have you 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.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to benign tumors or cysts
SkipInstructions:
[1-95,D][goto AHCL22T]
[R][store "R" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]


Question ID: AHS.321_02.000

Instrument Variable Name: AHCL22T
QuestionText:
2 of 2
* Enter time period for time with benign tumors or cysts.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL22T
[if [AHCL22N = Number greater than person years old and AHCL22T= 4]] goto
ERR1_AHCL22T

[p.32]

Question ID: AHS.322_01.000

Instrument Variable Name: AHCL23N
QuestionText:
1 of 2
How long have you had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to fibromyalgia or lupus
SkipInstructions:
[1-95,D][goto AHCL23T]
[R][store "R" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.322_02.000

Instrument Variable Name:AHCL23T
QuestionText:
2 of 2
* Enter time period for time with fibromyalgia or lupus.
1 Day (s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL23T
[if [AHCL23N = Number greater than person years old and AHCL23T= 4]] goto
ERR1_AHCL23T

[p.33]

Question ID: AHS.323_01.000

Instrument Variable Name: AHCL24N
QuestionText:
1 of 2
How long have you had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to osteoporosis or tendinitis
SkipInstructions:
[1-95,D][goto AHCL24T]
[R][store "R" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.323_02.000

Instrument Variable Name:AHCL24T
QuestionText:
2 of 2
* Enter time period for time with osteoporosis or tendinitis.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL24T
[if [AHCL24N = Number greater than person years old and AHCL24T= 4]] goto
ERR1_AHCL24T

[p.34]

Question ID: AHS.324_01.000

Instrument Variable Name: AHCL25N
QuestionText:
1 of 2
How long have you had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to epilepsy or seizures
SkipInstructions:
[1-95,D][goto AHCL25T]
[R][store "R" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID:AHS.324_02.000

Instrument Variable Name: AHCL25T
QuestionText:
2 of 2
* Enter time period for time with epilepsy or seizures.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL25T
[if [AHCL25N = Number greater than person years old and AHCL25T= 4]] goto
ERR1_AHCL25T

[p.35]

Question ID: AHS.325_01.000

Instrument Variable Name: AHCL26N
QuestionText:
1 of 2
How long have you had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclerosis (MS) or muscular dystrophy (MD).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to multiple sclerosis or muscular dystrophy
SkipInstructions:
[1-95,D][goto AHCL26T]
[R][store "R" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.325_02.000

Instrument Variable Name: AHCL26T
QuestionText:
2 of 2
* Enter time period for time with multiple sclerosis or muscular dystrophy.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL26T
[if [AHCL26N = Number greater than person years old and AHCL26T= 4]] goto
ERR1_AHCL26T

[p.36]

Question ID: AHS.326_01.000

Instrument Variable Name: AHCL27N
QuestionText:
1 of 2
How long have you 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.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to polio(myelitis), paralysis or para/quadriplegia
SkipInstructions:
[1-95,D][goto AHCL27T]
[R][store "R" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.326_02.000

Instrument Variable Name: AHCL27T
QuestionText:
2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL27T
[if [AHCL27N = Number greater than person years old and AHCL27T= 4]] goto
ERR1_AHCL27T

[p.37]

Question ID: AHS.327_01.000

Instrument Variable Name: AHCL28N
QuestionText:
1 of 2
How long have you 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.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to Parkinson's disease or tremors
SkipInstructions:
[1-95,D][goto AHCL28T]
[R][store "R" in AHCL28T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL28T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.327_02.000

Instrument Variable Name: AHCL28T
QuestionText:
2 of 2
* Enter time period for time with Parkinson's disease or tremors.
1 Day(s)
2 Week(s)
3 Month (s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL28T
[if [AHCL28N = Number greater than person years old and AHCL28T= 4]] goto
ERR1_AHCL28T

[p.38]

Question ID: AHS.328_01.000

Instrument Variable Name: AHCL29N
QuestionText:
1 of 2
How long have you had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerve damage (including carpal tunnel syndrome).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to nerve damage
SkipInstructions:
[1-95,D][goto AHCL29T]
[R][store "R" in AHCL29T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL29T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.328_02.000

Instrument Variable Name: AHCL29T
QuestionText:
2 of 2
* Enter time period for time with nerve damage

.

1 Day(s)
2 Week(s)
3 Month (s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL29T
[if [AHCL29N = Number greater than person years old and AHCL29T= 4]] goto
ERR1_AHCL29T

[p.39]

Question ID: AHS.329_01.000

Instrument Variable Name: AHCL30N
QuestionText:
1 of 2
How long have you had a hernia?
* Enter number for time with a hernia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a hernia
SkipInstructions:
[1-95,D][goto AHCL30T]
[R][store "R" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID:AHS.329_02.000

Instrument Variable Name: AHCL30T
QuestionText:
2 of 2
* Enter time period for time with hernia.
1 Day(s)
2 Week(s)
3 Month(s
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL30T
[if [AHCL30N = Number greater than person years old and AHCL30T= 4]] goto
ERR1_AHCL30T

[p.40]

Question ID: AHS.330_01.000

Instrument Variable Name: AHCL31N
QuestionText:
1 of 2
How long have you had an ulcer?
* Enter number for time with an ulcer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to an ulcer
SkipInstructions:
[1-95,D][goto AHCL31T]
[R][store "R" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID:AHS.330_02.000

Instrument Variable Name:AHCL31T
QuestionText:
2 of 2
* Enter time period for time with ulcer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL31T
[if [AHCL31N = Number greater than person years old and AHCL31T= 4]] goto
ERR1_AHCL31T

[p.41]

Question ID: AHS.331_01.000

Instrument Variable Name: AHCL32N
QuestionText:
1 of 2
How long have you 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.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to varicose veins or hemorrhoids
SkipInstructions:
[1-95,D][goto AHCL32T]
[R][store "R" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.331_02.000

Instrument Variable Name:AHCL32T
QuestionText:
2 of 2
* Enter time period for time with varicose veins or hemorrhoids.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL32T
[if [AHCL32N = Number greater than person years old and AHCL32T= 4]] goto
ERR1_AHCL32T

[p.42]

Question ID:AHS.332_01.000

Instrument Variable Name:AHCL33N
QuestionText:
1 of 2
How long have you 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.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
SkipInstructions:
[1-95,D][goto AHCL33T]
[R][store "R" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.332_02.000

Instrument Variable Name: AHCL33T
QuestionText:
2 of 2
* Enter time period for time with thyroid problem, Grave's disease or gout.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL33T
[if [AHCL33N = Number greater than person years old and AHCL33T= 4]] goto
ERR1_AHCL33T

[p.43]

Question ID: AHS.333_01.000

Instrument Variable Name: AHCL34N
QuestionText:
1 of 2
How long have you had a knee problem?
* Enter number for time with a knee problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a knee problem
SkipInstructions:
[1-95,D][goto AHCL34T]
[R][store "R" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.333_02.000

Instrument Variable Name: AHCL34T
QuestionText:
2 of 2
* Enter time period for time with knee problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL34T
[if [AHCL34N = Number greater than person years old and AHCL34T= 4]] goto
ERR1_AHCL34T

[p.44]

Question ID: AHS.334_01.000

Instrument Variable Name: AHCL35N
QuestionText:
1 of 2
How long have you had migraine headaches?
* Enter number for time with migraine headaches.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to migraine headaches
SkipInstructions:
[1-95,D][goto AHCL35T]
[R][store "R" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.334_02.000

Instrument Variable Name: AHCL35T
QuestionText:
2 of 2
* Enter time period for time with migraine headaches.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText:Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL35T
[if [AHCL35N = Number greater than person years old and AHCL35T= 4]] goto
ERR1_AHCL35T

[p.45]


Question ID: AHS.335_01.000

Instrument Variable Name: AHCL90N
QuestionText:
1 of 2
How long have you had {problem in AFLHCA90}?
* Enter number for time with {problem in AFLHCA90}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA90}
SkipInstructions:
[1-95,D][goto AHCL90T]
[R][store "R" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[96][store "6" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.335_02.000

Instrument Variable Name: AHCL90T
QuestionText:
2 of 2
* Enter time period for time with {problem in AFLHCA90}.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][[if 91 selected in AFLHCA goto AFLHCA_S2]
Else goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL90T
[if [AHCL90N = Number greater than person years old and AHCL90T= 4]] goto
ERR1_AHCL90T

[p.46]


Question ID: AHS.336_01.000

Instrument Variable Name: AHCL91N
QuestionText:
1 of 2
How long have you had {problem in AFLHCA91}?
* Enter number for time with {problem in AFLHCA91}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA91}
SkipInstructions:
[1-95,D][goto AHCL91T]
[R][store "R" in AHCL91T] [goto SMKEV (next section)]
[96][store "6" in AHCL91T] [goto SMKEV (next section)]
Question ID: AHS.336_02.000

Instrument Variable Name: AHCL91T
QuestionText:
2 of 2
* Enter time period for time with {problem in AFLHCA91}.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions:
[1- 4, R,D][goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
[6] goto ERR2_AHCL91T
[if [AHCL91N = Number greater than person years old and AHCL91T= 4]] goto
ERR1_AHCL91T

[p.1]


Sample Adult Adult Health Behaviors


Question ID: AHB.010_00.000

Instrument Variable Name: SMKEV
QuestionText:
These next questions are about cigarette smoking.
Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto SMKREG]
[2,R,D][goto VIGNO]




Question ID: AHB.020_00.000

Instrument Variable Name: SMKREG
QuestionText:
How old were you when you FIRST started to smoke fairly regularly?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years old or older.
* Enter '96' if never smoked regularly.
06-84 6-84 years
85 85 years or older
96 Never smoked regularly
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions:
[6-95,96,R,D] [goto SMKNOW]
[If SMKREG gt AGE and SMKREG ne [96], goto E RR_SMKREG


Question ID: AHB.030_00.000

Instrument Variable Name: SMKNOW
QuestionText:
Do you NOW smoke cigarettes every day, some days or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions:
[1][goto CIGSDA1]
[2][goto CIGDAMO]
[3][goto SMKQTNO]
[R,D] [goto VIGNO]

[p.2]


Question ID: AHB.040_01.000

Instrument Variable Name: SMKQTNO
QuestionText:
1 of 2
How long has it been since you quit smoking cigarettes?
* Enter number for time since quit smoking.
* Enter '95' for 95 years old or older.
01-94 1-94
95 95+
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who quit smoking
SkipInstructions:
[1-95] [goto SMKQTTP]
[R,D] [goto VIGNO]


Question ID: AHB.040_02.000

Instrument Variable Name: SMKQTTP
QuestionText:
2 of 2
* Enter time period for time since quit smoking.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who quit smoking
SkipInstructions:
[1-4] [goto VIGNO]
[4][if SMKQTNO gt (AGE - [15]), goto ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), goto ERR2_SMKQTTP


Question ID: AHB.050_00.000

Instrument Variable Name: CIGSDA1
QuestionText:
On the average, how many cigarettes do you now smoke a day?
* Enter '1' if less than 1 cigarette.
* Enter '95' if 95 or more cigarettes.
01-94 1-94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who are current every day smokers
SkipInstructions:
[1-95,R,D] [goto CIGQTYR]

[p.3]


Question ID: AHB.060_00.000

Instrument Variable Name: CIGDAMO
QuestionText:
On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.
00 None
01-30 1-30 days
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who are current some day smokers
SkipInstructions:
[0][goto CIGQTYR]
[1-30,R,D] [goto CIGSDA2]


Question ID: AHB.070_00.000

Instrument Variable Name: CIGSDA2
QuestionText:
On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?
* Enter '1' if less than 1.
* Enter '95' if 95 or more cigarettes.
01-94 1-94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who are current some day smokers
SkipInstructions:
[1-95,R,D] [goto CIGQTYR]


Question ID: AHB.080_00.000

Instrument Variable Name: CIGQTYR
QuestionText:
During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO QUIT SMOKING?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who are every day or someday smokers
SkipInstructions:
[1,2,R,D] [goto VIGNO]

[p.4]


Question ID: AHB.090_01.000

Instrument Variable Name: VIGNO
QuestionText:
1 of 2
The next questions are about physical activities (exercise, sports, physically active hobbies...) that you may do in your
LEISURE time.
How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10 MINUTES that cause HEAVY
sweating or LARGE increases in breathing or heart rate?
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for vigorous leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0,996,R,D][goto MODNO]
[1-995][goto VIGTP]


Question ID: AHB.090_02.000

Instrument Variable Name: VIGTP
QuestionText:
2 of 2
* Enter time period for vigorous leisure-time physical activities

.

0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:
[1-4] goto VIGLNGNO
[if (VIGNO gt [4]and VIGTP eq [1]) or
(VIGNO gt [28] and VIGTP eq [2]) or
(VIGNO gt [31] and VIGTP eq [3]) or
(VIGNO gt [365] and VIGTP eq [4]) goto ERR1_VIGTP]

[p.5]


Question ID: AHB.100_01.000

Instrument Variable Name: VIGLNGNO
QuestionText:
1 of 2
About how long do you do these vigorous leisure-time physical activities each time?
* Enter number for length of vigorous leisure-time physical activities.
001-995 1-995
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:
[1-995][goto VIGLNGTP]
[R,D][goto MODNO]


Question ID: AHB.100_02.000

Instrument Variable Name: VIGLNGTP
QuestionText:
2 of 2
* Enter time period for length of vigorous leisure-time physical activities.
1 Minutes
2 Hours
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:
[1,2] goto MODNO
if VIGLNGNO lt [10] and VIGLNGTP eq [1]goto ERR1_VIGLNGTP;
if (VIGLNGNO gt [90] and VIGLNGTP eq [1]) or if VIGLNGNO gt [2]and VIGLNGTP eq [2]goto
ERR2_VIGLNGTP

[p.6]


Question ID: AHB.110_01.000

Instrument Variable Name: MODNO
QuestionText:
How often do you do LIGHT OR MODERATE LEISURE-TIME physical activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?
* If necessary, prompt with: How many times per day, per week, per month, or per year do you do these activities?
* Enter number of light or moderate leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-995][goto MODTP]
[0, 996, R,D][goto STRNGNO]


Question ID: AHB.110_02.000

Instrument Variable Name: MODTP
QuestionText:
2 of 2
* Enter time period for light or moderate leisure-time physical activities
0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:
[1-4] goto MODLNGNO
[if (MODNO gt [4]and MODTP eq [1]) or
(MODNO gt [28] and MODTP eq [2]) or
(MODNO gt [31] and MODTP eq [3]) or
(MODNO gt [365] and MODTP eq [4])] goto ERR_MODNO

[p.7]


Question ID: AHB.120_01.000

Instrument Variable Name: MODLNGNO
QuestionText:
1 of 2
About how long do you do these light or moderate leisure-time physical activities each time?
* Enter number for length of light or moderate leisure-time physical activities.
001-995 1-995
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:
[1-995][goto MODLNGTP]
[R,D][goto STRNGNO]


Question ID: AHB.120_02.000

Instrument Variable Name: MODLNGTP
QuestionText:
2 of 2
* Enter time period for length of light or moderate leisure-time physical activities.
1 Minutes
2 Hours
7 Refused
9 Don't know
UniverseText:Sample adults 18+ who do light or moderate activities
SkipInstructions:
[1,2] goto STRNGNO
if MODLNGNO lt [10] and MODLNGTP eq [1]goto ERR1_MODLNGTP
if MODLNGNO gt [90] and MODLNGTP eq [1]or if MODLNGNO gt [2]and MODLNGTP eq [2]goto
ERR2_MODLNGTP

[p.8]


Question ID: AHB.130_01.000

Instrument Variable Name:STRNGNO
QuestionText:
How often do you do LEISURE-TIME physical activities specifically designed to STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for strengthening activities.
* Enter '0' for Never.
* Enter '996' for Unable to do this type activity
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-995][goto STRNGTP]
[0, 996,R,D][goto ALC1YR]


Question ID: AHB.130_02.000

Instrument Variable Name: STRNGTP
QuestionText:
2 of 2
* Enter time period for strengthening activities
0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do strengthening activities
SkipInstructions:
[1-4] goto ALC1YR
[If (STRNGNO gt [4]and STRNGTP = [1]) or (STRNGNO gt [28] and STRNGTP = [2]) or (STRNGNO gt [31] and STRNGTP = [3]) or (STRNGNO gt [365] and STRNGTP = [4]) goto
ERR_STRNGTP]

[p.9]


Question ID: AHB.140_00.000

Instrument Variable Name: ALC1YR
QuestionText:
These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.
In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto ALC12MNO]
[2,R,D] [goto ALCLIFE]


Question ID: AHB.150_00.000

Instrument Variable Name: ALCLIFE
QuestionText:
In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did or refused to answer
SkipInstructions:
[1][goto ALC12MNO]
[2,R,D] [goto AHGT_FT]


Question ID: AHB.160_01.000

Instrument Variable Name: ALC12MNO
QuestionText:
1 of 2
In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcoholic beverages were consumed in the past year.
*Enter '0' for Never.
000 Never
001-365 1-365 days
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks in their entire life
SkipInstructions:
[1-365][goto ALC12MTP]
[0,R,D][goto AHGT_FT]

[p.10]


Question ID: AHB.160_02.000

Instrument Variable Name: ALC12MTP
QuestionText:
2 of 2
* Enter time period for how often alcoholic beverages were consumed in the past year.
0 Never/None
1 Week
2 Month
3 Year
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who drank at least once in the past year
SkipInstructions:
[1-3] [goto ALCAMT]
[If (ALC12MNO gt [7] and ALC12MTP = [1]) or (ALC12MNO gt [31] and ALC12MTP = [2]) or(ALC12MNO gt [365] and ALC12MTP = [3]) goto ERR_ALC12MTP]


Question ID: AHB.170_00.000

Instrument Variable Name: ALCAMT
QuestionText:
In the PAST YEAR, on those days that you drank alcoholic
beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.
01-94 1-94 drinks
95 95+ drinks
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions:
[1-95,R,D] [goto ALC5UPNO]
[10-95][goto ERR_ALCAMT]

[p.11]


Question ID: AHB.180_01.000

Instrument Variable Name: ALC5UPNO
QuestionText:
1 of 2
In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have 5 or more drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.
000 Never/None
001-365 1-365 days
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions:
[1-365][goto ALC5UPTP]
[0,R,D][goto AHGT_FT]


Question ID: AHB.180_02.000

Instrument Variable Name: ALC5UPTP
QuestionText:
2 of 2
* Enter time period for days per week, per month or per year.
0 Never/None
1 Per week
2 Per month
3 Per year
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have had 5+ drinks in one day at least once in the past year
SkipInstructions:
[1-3]goto AHGT_FT
[If (ALC5UPNO gt [7] and ALC5UPTP = [1]) or
(ALC5UPNO gt [31] and ALC5UPTP = [2]) or
(ALC5UPNO gt [365] and ALC5UPTP = [3]) goto ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP) lt number of days per
year with 5 or more drinks (calculated from ALC5UPNO and ALC5UPTP)] goto ERR2_ALC5UPTP]

[p.12]


Question ID: AHB.190_01.000

Instrument Variable Name: AHGT_FT
QuestionText:
How tall are you without shoes?
* Enter "M" to record metric measurements
02-07 2-7 feet
97 Refused
99 Don't know
M Metric
UniverseText: Sample adults 18+
SkipInstructions:
[2-7] [goto AHGT_IN]
[R,D] [goto AWGT_LB]
[M] [goto AHGT_M]
[if AHGT_FT NE [2-7,D,R,M] goto ERR1_AHGT_FT]
[if AHGT_FT = [2,3] goto ERR2_AHGT_FT]




Question ID: AHB.190_02.000

Instrument Variable Name: AHGT_IN
QuestionText:
How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.
00-11 0-11 inches
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who answered their height in feet
SkipInstructions:
[0-11,R,D] [goto AWGT_LB]
(empty) [goto ERR_AHGT_IN]


Question ID: AHB.190_03.000

Instrument Variable Name: AHGT_M
QuestionText:
How tall are you without shoes?
* Enter height in metric.
0-2 0-2 Meters
7 Refused
9 Don't know
UniverseText:Sample adults 18+ who choose to give their height in metric measurements
SkipInstructions:
[0-2] [goto AHGT_CM]
[R,D] [goto AWGT_LB]
(empty) [goto ERR_AHGT_M]

[p.13]


Question ID: AHB.190_04.000

Instrument Variable Name: AHGT_CM
QuestionText:
*Enter centimeters.
000-241 0-241 Centimeters
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who answered their height in meters
SkipInstructions:
[0-241,R,D] goto AWGT_LB
[If AHGT_M eq [2]and AHGT_CM gt [41] or AHGT_M eq [1]and AHGT_CM gt [141]] goto
ERR1_AHGT_CM]
[ ] goto ERR2_AHGT_CM
[If AHGT_M eq [1]and AHGT_CM lt [20] or AHGT_M eq [0] and AHGT_CM lt
[120]] goto ERR3_AHGT_CM]


Question ID: AHB.200_01.000

Instrument Variable Name: AWGT_LB
QuestionText:
How much do you weigh without shoes?
* Enter "M" to record metric measurements
* Enter '500' for 500 pounds or more
050-500 50-500 pounds
997 Refused
999 Don't know
M Metric
UniverseText: Sample adults 18+
SkipInstructions:
[50-500] [goto SLEEP]
[if AWGT_LB lt [50] or gt [500] goto ERR_AWGT_LB
[R,D][goto SLEEP]
[M] [goto AWGT_KG]


Question ID: AHB.200_02.000

Instrument Variable Name: AWGT_KG
QuestionText:
How much do you weigh without shoes?
* Enter weight in kilograms
022-226 22-226 Kilograms
997 Refused
999 Don't know
UniverseText:Sample adults 18+ who choose to give their weight in metric measurements
SkipInstructions:
[22-226,R,D] [goto SLEEP]
[If AWGT_KG lt [22] or K gt [226]goto ERR_AWGT_KG]

[p.14]


Question ID: AHB.210_00.000

Instrument Variable Name: SLEEP
QuestionText:
On average, how many hours of sleep do you get in a 24-hour period?
* Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more UP to the next whole hour and dropping 29 or fewer minutes.
01-24 1-24 hours
97 Refused
99 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-24,R,D] [goto next section]
[If SLEEP eq [1-5] goto ERR_SLEEP]

[p.1]


Sample Adult Access to Health Care and Utilization


Question ID: AAU.020_00.000

Instrument Variable Name: AUSUALPL
QuestionText:
Is there a place that you USUALLY go to when you are sick or need advice about your health?
1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-3] [goto APLKIND]
[2,R,D] [goto AHCPLKND]


Question ID: AAU.030_00.000

Instrument Variable Name: APLKIND
QuestionText:
[Fill1: What kind of place is it - a clinic, doctor's office, emergency room, or some other place?
[Fill2: What kind of place do you 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 adults 18+ with 1+ usual place(s) to go when sick/need health advice
SkipInstructions:
[1-5] [go to AHCPLROU]
[6,R,D] [go to AHCPLKND]


Question ID: AAU.035_00.000

Instrument Variable Name: AHCPLROU
QuestionText:
Is that {fill: place from (APLKIND)} the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults aged 18+ years having a clinic or health center, doctor's office or HMO, hospital emergency room,
hospital outpatient department, or some other place that they usually go to when they are sick or need advice about their health
SkipInstructions:
[1][goto AHCCHGYR]
[2,R,D] [go to AHCPLKND]

[p.2]


Question ID: AAU.037_00.000

Instrument Variable Name: AHCPLKND
QuestionText:
What kind of place do you USUALLY go to when you need routine or preventive care, such as a physical examination or
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 Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a usual source of sick care; who have a usual source of sick care but do not go to one place most often or Ref/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/DK if it is same place as usual source of routine/preventive care.
SkipInstructions:
[0-6,R,D] if AUSUALPL = 2,R,D goto AHCDLY_1
ELSE goto AHCCHGYR


Question ID: AAU.040_00.000

Instrument Variable Name: AHCCHGYR
QuestionText:
At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who reported same place as usual source of routine/preventive care]
SkipInstructions:
[1][goto AHCCHGHI]
[2,R,D][goto AHCDLY_1]


Question ID: AAU.050_00.000

Instrument Variable Name:AHCCHGHI
QuestionText:
Was this change for a reason related to health insurance?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who CHANGED their USUAL place for health care in past 12 months
SkipInstructions:
[1,2,R,D][goto AHCDLY_1]

[p.3]


Question ID: AAU.061_01.000

Instrument Variable Name: AHCDLY_1
QuestionText:
There are many reasons people delay getting medical care.
Have you delayed getting care 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 adults 18+
SkipInstructions:
[1,2,R,D][goto AHCDLY_2]


Question ID: AAU.061_02.000

Instrument Variable Name: AHCDLY_2
QuestionText:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?...You couldn't get an appointment soon enough.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][goto AHCDLY_3]


Question ID: AAU.061_03.000

Instrument Variable Name: AHCDLY_3
QuestionText:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?...Once you get there, you have to wait too long to see the doctor.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][goto AHCDLY_4]

[p.4]


Question ID: AAU.061_04.000

Instrument Variable Name: AHCDLY_4
QuestionText:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care 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 adults 18+
SkipInstructions:
[1,2,R,D][goto AHCDLY_5]


Question ID:AAU.061_05.000

Instrument Variable Name:AHCDLY_5
QuestionText:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?...You didn't have transportation.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][goto AHCAFY_1]


Question ID: AAU.111_01.000

Instrument Variable Name: AHCAFY_1
QuestionText:
DURING THE PAST 12 MONTHS, was there any time when you 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 adults 18+
SkipInstructions:
[1,2,R,D][goto AHCAFY_2]

[p.5]


Question ID: AAU.111_02.000

Instrument Variable Name:AHCAFY_2
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you 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 adults 18+
SkipInstructions:
[1,2,R,D][goto AHCAFY_3]


Question ID: AAU.111_03.000

Instrument Variable Name:AHCAFY_3
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you 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 adults 18+
SkipInstructions:
[1,2,R,D][goto AHCAFY_4]


Question ID:AAU.111_04.000

Instrument Variable Name:AHCAFY_4
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you 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 adults 18+
SkipInstructions:
[1,2,R,D][goto ADENLONG]

[p.6]


Question ID: AAU.135_00.000

Instrument Variable Name: ADENLONG
QuestionText:
(book) A9
About how long has it been since you 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 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[0-5,R,D][ goto AHCSY1_1]


Question ID:AAU.141_01.000

Instrument Variable Name:AHCSY1_1
QuestionText:
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own 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 adults 18+
SkipInstructions:
[1,2,R,D][ goto AHCSY1_2]


Question ID:AAU.141_02.000

Instrument Variable Name: AHCSY1_2
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?...An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[1,2,R,D][ goto AHCSY1_3]

[p.7]


Question ID: AAU.141_03.000

Instrument Variable Name:AHCSY1_3
QuestionText:
* Read Lead-in if Necessary.
During the past 12 months,that is since {12 months ref.date}, have you seen or talked to any of the following health care providers about our own health?....A foot doctor.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][ goto AHCSY1_4]


Question ID:AAU.141_04.000

Instrument Variable Name: AHCSY1_4
QuestionText:
*Read lead-in if Necessary.
During the past 12 months, that is since {12 month ref. date} have you seen or talked to any of the following health care providers about your own health?....A chiropractor.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][ goto AHCSY1_5]


Question ID: AAU.141_05.000

Instrument Variable Name: AHCSY1_5
QuestionText:
* Read Lead-in if Necessary.
During the past 12 months, that is since {12 month ref date} have you seen or talked to any of the following health care providers about your own health?
...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[1,2,R,D][ goto AHCSY1_6]

[p.6]


Question ID:AAU.141_06.000

Instrument Variable Name:AHCSY1_6
QuestionText:
* Read Lead-in if Necessary.
During the past 12 months, that is since {12 month ref date} have you seen or talked to any of the following health care providers about your own health?...A nurse practitioner, physician assistant, or midwife.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D][if SEX=1goto AHCSY8_8; else if SEX=2 goto AHCSYR7]


Question ID: AAU.200_00.000

Instrument Variable Name:AHCSYR7
QuestionText:
* Read lead-in if necessary
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?...A doctor who specializes in women's health (an obstetrician/gynecologist).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample female adults aged 18+ years
SkipInstructions:
[1,2,R,D] [go to AHCSY8_ 8]


Question ID: AAU.211_01.000

Instrument Variable Name:AHCSY8_ 8
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health? ...A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist, or ophthalmologist).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[1,2,R,D] [go to AHCSY8_ 9]

[p.9]


Question ID:AAU.211_02.000

Instrument Variable Name: AHCSY8_ 9
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health? ...A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[1][goto AHCSYR10]
[2,R,D] [goto AHERNOYR]


Question ID:AAU.230_00.000

Instrument Variable Name:AHCSYR10
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 adults 18+ who have seen or talked to a general doctor during the past 12 months
SkipInstructions:
[1,2,R,D] [go to AHERNOYR]


Question ID:AAU.240_00.000

Instrument Variable Name:AHERNOYR
QuestionText:
(book) A10
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own 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 adults 18+
SkipInstructions:
[0 - 8,R,D] [go to AHCHYR]

[p.10]


Question ID: AAU.250_00.000

Instrument Variable Name: AHCHYR
QuestionText:
DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto AHCHMOYR]
[2,R,D][goto AHCNOYR]


Question ID: AAU.260_00.000

Instrument Variable Name: AHCHMOYR
QuestionText:
During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?
01-12 01-12 months
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions:
[1-12,R,D][goto AHCHNOYR]


Question ID:AAU.270_00.000

Instrument Variable Name: AHCHNOYR
QuestionText:
(book) 11
What was the total number of home visits received during {Fill1: that month/Fill2: 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 adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions:
[1-8,R,D][goto AHCNOYR]

[p.11]


Question ID: AAU.280_00.000

Instrument Variable Name: AHCNOYR
QuestionText:
(book) A10
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? DO NOT INCLUDE TIMES YOU WERE 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 adults 18+
SkipInstructions:
[0-8,R,D][goto ASRGYR]


Question ID:AAU.290_00.000

Instrument Variable Name: ASRGYR
QuestionText:
DURING THE PAST 12 MONTHS, have you 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 adults 18+
SkipInstructions:
[1][goto ASRGNOYR]
[2,R,D] [goto AMDLONG]

[p.12]


Question ID: AAU.300_00.000

Instrument Variable Name: ASRGNOYR
QuestionText:
Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you 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 adults 18+ who had surgery or surgical procedures during past 12 months
SkipInstructions:
[1-95,R,D] [goto AMDLONG]
[11-95] [goto ERR_ASGYR]


Question ID:AAU.305_00.000

Instrument Variable Name: AMDLONG
QuestionText:
(book) A9 ? [F1]
About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.
0 Never
1 6 months or less
2 More than 6 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[0-5,R,D] [goto HIT1]


Question ID:AAU.305_00.010

Instrument Variable Name:HIT1
QuestionText:
Have you ever used computers for any of the following?
Looked up health information on the Internet
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1][goto HIT2]
[2,D,R] [goto HIT3]

[p.13]


Question ID:AAU.305_00.020

Instrument Variable Name: HIT2
QuestionText:
Did you look up health information on the Internet in the past 12 months?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+ who have ever looked up health information on the Internet
SkipInstructions:
[1,2,D,R] [goto HIT3]


Question ID:AAU.305_00.030

Instrument Variable Name: HIT3
QuestionText:
Have you ever used online chat groups to learn about health topics?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1][goto HIT4]
[2,D,R] [goto HIT5]


Question ID: AAU.305_00.040

Instrument Variable Name:HIT4
QuestionText:
Did you use online chat groups to learn about health topics in the past 12 months?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+ who have ever used online chat groups to learn about health topics
SkipInstructions:
[1,2,D,R] [goto HIT5]


Question ID: AAU.305_00.050

Instrument Variable Name: HIT5
QuestionText:
Refilled a prescription on the internet
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1][goto HIT6]
[2,D,R] [goto HIT7]

[p.14]


Question ID: AAU.305_00.060

Instrument Variable Name: HIT6
QuestionText:
Did you refill a prescription on the Internet in the past 12 months?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+ who ever refilled a prescription on the internet
SkipInstructions:
[1,2,D,R] [goto HIT7]


Question ID: AAU.305_00.070

Instrument Variable Name: HIT7
QuestionText:
Scheduled an appointment with a health care provider using the Internet
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1][goto HIT8]
[2,D,R] [goto HIT9]


Question ID: AAU.305_00.080

Instrument Variable Name: HIT8
QuestionText:
Did you schedule an appointment with a health care provider using the Internet in the past 12 months?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+ who ever scheduled an appointment with a health care provider using the Internet
SkipInstructions:
[1,2,D,R] [goto HIT9]


Question ID: AAU.305_00.090

Instrument Variable Name: HIT9
QuestionText:
Communicated with a health care provider over e-mail
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+
SkipInstructions:
[1][goto HIT10]
[2,D,R] [goto SHTFLUYR]

[p.15]


Question ID:AAU.305_00.100

Instrument Variable Name: HIT10
QuestionText:
Did you communicate with a health care provider over e-mail in the past 12 months?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Adults 18+ who ever communicated with a health care provider over e-mail
SkipInstructions:
[1,2,D,R] [goto SHTFLUYR]


Question ID: AAU.310_00.000

Instrument Variable Name: SHTFLUYR
QuestionText:
The next questions are about seasonal or regular flu vaccination. Please do not include H1N1 or swine flu vaccination.
DURING THE PAST 12 MONTHS, have you 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 adults 18+
SkipInstructions:
[1][goto ASHFLU_M] [2,R,D] [ goto SPRFLUYR ]


Question ID:AAU.312_01.000

Instrument Variable Name: ASHFLU_M
QuestionText:
1 of 2
During what month and year did you receive your 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 adults 18+ who have had a flu shot
SkipInstructions:
[1-12,D] [ goto ASHFLU_Y] [R] [goto SPRFLUYR]

[p.16]


Question ID: AAU.312_02.000

Instrument Variable Name: ASHFLU_Y
QuestionText:
2 of 2
*Enter year of most recent flu shot.
Year Year
9997 Refused
9999 Don't know
UniverseText: Sample adults 18+ who gave a month for their last flushot or who didn't know the month
SkipInstructions:
[valid year,R,D] [goto SPRFLUYR]
[If ASHFLU_M and ASHFLU_Y = a future date] goto ERR1_ASHFLU_Y
[If ASHFLU_M and ASHFLU_Y = a date prior to birth] goto ERR2_ASHFLU_Y
[If ASHFLU_M and ASHFLU_Y = a date before 12 months ago] goto ERR3_ASHFLU_Y


Question ID: AAU.315_00.000

Instrument Variable Name: SPRFLUYR
QuestionText:
DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health professional? A health professional may have let you spray it. 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 adults 18+
SkipInstructions:
[1][goto ASPFLU_M]
[if SHTFLUYR =1 and SPRFLUYR=1] goto ERR1_SPRFLUYR
[if AGE GE 50] goto ERR2_SPRFLUYR
[2,D,R] [goto SHTPNUYR]

[p.17]


Question ID:AAU.318_01.000

Instrument Variable Name: ASPFLU_M
QuestionText:
1 of 2
During what month and year did you receive your 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 adults 18+ who have had a flu nasal vaccine
SkipInstructions:
[1-12,D] [ goto ASPFLU_Y] [R] [goto SHTPNUYR]


Question ID: AAU.318_02.000

Instrument Variable Name: ASPFLU_Y
QuestionText:
2 of 2
*Enter year of most recent flu nasal spray.
Year Year
9997 Refused
9999 Don't know
UniverseText: Sample adults 18+ who gave a month for their flu nasal vaccine or who didn't know the month
SkipInstructions:
[valid year, R,D] [goto SHTPNUYR]
[If ASPFLU_M and ASPFLU_Y = a future date] goto ERR1_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date prior to birth] goto ERR2_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date before 12 months ago] goto ERR3_ASPFLU_Y


Question ID: AAU.320_00.000

Instrument Variable Name: SHTPNUYR
QuestionText:
Have you EVER had a pneumonia shot?
This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the
pneumococcal vaccine

.

1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto APOX]

[p.18]


Question ID: AAU.330_00.000

Instrument Variable Name: APOX
QuestionText:
Have you EVER had chickenpox?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto APOX12MO]
[2,R,D] [goto AHEP]


Question ID: AAU.340_00.000

Instrument Variable Name: APOX12MO
QuestionText:
Have you had chickenpox in the PAST 12 MONTHS?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have ever had chickenpox
SkipInstructions:
[1,2,R,D] [goto AHEP]


Question ID: AAU.350_00.000

Instrument Variable Name: AHEP
QuestionText:
Have you EVER had hepatitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto SHTHEPB]
[2,R,D] [goto AHEPLIV]


Question ID: AAU.360_00.000

Instrument Variable Name: AHEPLIV
QuestionText:
Have you ever lived with someone who had hepatitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
SkipInstructions:
[1,2,R,D] [goto SHTHEPB]

[p.19]


Question ID: AAU.370_00.000

Instrument Variable Name: SHTHEPB
QuestionText:
Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto SHEPDOS]
[2,R,D] [goto SHTHEPA]


Question ID: AAU.380_00.000

Instrument Variable Name: SHEPDOS
QuestionText:
Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?
1 Received at least 3 doses
2 Received less than 3 doses
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have ever received the Hepatitis B vaccine
SkipInstructions:
[1,2,R,D] [goto SHTHEPA]


Question ID: AAU.390_00.010

Instrument Variable Name: SHTHEPA
QuestionText:
The hepatitis A vaccine is given as a two dose series routinely to some children starting at 1 year of age, and to some adults and people who travel outside the United States. Although it can be given as a combination vaccine with hepatitis
B, it is different from the hepatitis B shot, and has only been available since 1995. Have you ever received the hepatitis A
vaccine?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1]goto SHEPANUM
[2,R,D] if AGE GE 50 goto SHINGLES
else goto SHTTD

[p.20]


Question ID: AAU.400_00.010

Instrument Variable Name: SHEPANUM
QuestionText:
How many hepatitis A shots did you receive?
*Enter '96' if all shots were received
01-95 01-95 shots
96 Received all shots
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have had a hepatitis A vaccine
SkipInstructions:
[1-95,96,R,D] if AGE GE 50 goto SHINGLES
elseif AGE LT 50 goto SHTTD


Question ID: AAU.410_00.010

Instrument Variable Name: SHINGLES
QuestionText:
Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is generally on one side of the body or face. Shingles is caused by the chicken pox virus. A vaccine for shingles has been available since
May 2006. Have you ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 50+
SkipInstructions:
[1,2,R,D] goto SHTTD


Question ID: AAU.420_00.010

Instrument Variable Name: SHTTD
QuestionText:
Have you received a tetanus shot in the past 10 years?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1]goto SHTTD05
[2,R,D] and AGE GT 64 [goto LIVEV]
Else if [2,R,D] and AGE LT 65 {goto HPVHRD]

[p.21]


Question ID: AAU.430_00.010

Instrument Variable Name: SHTTD05
QuestionText:
Was your most recent tetanus shot given in 2005 or later?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have had a tetanus shot in the past 10 years
SkipInstructions:
[1,R] if AGE le 64 goto SHTTDAP
elseif AGE gt 64 goto LIVEV
[2,D] if AGE le 64 goto HPVHRD
elseif AGE gt 64 goto LIVEV


Question ID: AAU.440_00.010

Instrument Variable Name: SHTTDAP
QuestionText:
There are currently two types of tetanus shots available today. One is the Td or tetanus-diphtheria vaccine and the other is called Tdap or Adacel (trademark). They are similar except the Tdap shot also includes a pertussis (per-TUH-sis) or
whooping cough vaccine. Thinking back to your most recent tetanus shot, did the doctor tell you the vaccine included the pertussis or whooping cough vaccine? The shot is often called Tdap or ADACEL (trademark).
1 Yes-included pertussis
2 No-did not include pertussis
3 Doctor did not say
7 Refused
9 Don't know
UniverseText: Sample adults LT 65 who have had a tetanus shot in 2005 or beyond or refused to say if they had a tetanus shot in 2005 or beyond
SkipInstructions:
[1-3,R,D] [goto HPVHRD]


Question ID: AAU.442_00.010

Instrument Variable Name: HPVHRD
QuestionText:
Have you ever heard of HPV? HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults LE 64
SkipInstructions:
[1,2,R,D] goto SHHPVHRD

[p.22]


Question ID: AAU.444_00.010

Instrument Variable Name: SHHPVHRD
QuestionText:
A vaccine to prevent 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: Sample adults age LE 64
SkipInstructions:
[1,2,R,D] if SEX=2 [goto SHTHPV],
[1,2,R,D] if SEX=1 [goto LIVEV]


Question ID: AAU.446_00.010

Instrument Variable Name: SHTHPV
QuestionText:
Have you ever received the HPV shot or cervical cancer vaccine?
1 Yes
2 No
3 Doctor refused when asked
7 Refused
UniverseText: Female sample adults age LE 64
SkipInstructions:
[1][goto SHHPVDOS]
[2,3,R,D] [goto LIVEV]


Question ID: AAU.448_00.010

Instrument Variable Name:SHHPVDOS
QuestionText:
How many HPV shots did you receive?
* Enter '96' for all shots
01-50 1-50 shots
96 All shots
97 Refused
99 Don't know
UniverseText: Female sample adults age LE 64 who have had a HPV shot
SkipInstructions:
[1-50,96,R,D] [goto LIVEV]
[51-95] [goto ERR_SHHPVDOS]

[p.23]


Question ID: AAU.450_00.010

Instrument Variable Name: LIVEV
QuestionText:
Has a doctor or other health professional ever told you that you had any kind of chronic, or long-term liver condition?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto TRAVEL]


Question ID: AAU.460_00.010

Instrument Variable Name: TRAVEL
QuestionText:
Have you ever traveled outside of the United States to countries other than Europe, Japan, Australia, New Zealand or Canada, since 1995?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto WRKHLTH]


Question ID:AAU.465_00.010

Instrument Variable Name:WRKHLTH
QuestionText:
Do you currently volunteer or work in a hospital, medical clinic, doctor's office, dentist's office, nursing home or some other health-care facility? This includes part-time and unpaid work in a health care facility as well as professional nursing care provided in the home.
*Read if necessary: This includes non-health care professionals, such as administrative staff, who work in a health-care
facility.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto WRKDIR] [2,R,D] goto next section

[p.24]


Question ID:AAU.470_00.010

Instrument Variable Name:WRKDIR
QuestionText:
Do you provide direct patient care as part of your routine work? By direct patient care we mean physical or hands on contact with patients.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who work or volunteer in a health-care setting
SkipInstructions:
[1,2,R,D] goto next section

[p.1]


Sample Adult -AIDS Knowledge and Attitudes


Question ID: ADS.010_00.000

Instrument Variable Name: BLDGV
QuestionText:
Now, I am going t o ask about giving blood donations to a blood bank such as the American Red Cross.
Have you donated blood since March 1985?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[1][goto BLDG12M]
[2,R,D] [goto HIVTST]




Question ID: ADS.020_00.000

Instrument Variable Name: BLDG12M
QuestionText:
During the PAST 12 MONTHS, that is, since [fill: 12-month ref. Date], have you donated blood?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have given blood since March 1985
SkipInstructions:
[1,2,R,D] [goto HIVTST]


Question ID: ADS.040_00.000

Instrument Variable Name: HIVTST
QuestionText:
The next questions are about the test for HIV (the virus that causes AIDS).[fill: Except for tests you may have had as part of blood donations, have you ever been tested for HIV?/Have you ever been tested for HIV?]
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto TST12M_M]
[2][goto WHYTST]
[R,D] [goto EXTST12M]

[p.2]


Question ID: ADS.050_00.000

Instrument Variable Name: WHYTST
QuestionText:
(book) A12
I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes AIDS).
Which one of these would you say is the MAIN reason why you have not been tested?
01 It's unlikely you've been exposed to HIV
02 You were afraid to find out if you were HIV positive (that you had HIV)
03 You didn't want to think about HIV or about being HIV positive
04 You were worried your name would be reported to the government if you tested positive
05 You didn't know where to get tested
06 You don't like needles
07 You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
08 Some other reason
09 No particular reason
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have not been tested for HIV
SkipInstructions:
[1-7,9,R,D] [goto EXTST12M]
[8] [goto WHYSPEC]


Question ID: ADS.055_00.000

Instrument Variable Name: WHYSPEC
QuestionText:
What was the main reason why you have not been tested?
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with some other reason for no HIV test
SkipInstructions:
[20 char long] [goto EXTST12M]

[p.3]


Question ID: ADS.060_01.000

Instrument Variable Name: TST12M_M
QuestionText:
1 of 2
[fill: Not including blood donations, in what month and year was your last test for HIV (the virus that causes AIDS)?/In what month and year was your last test for HIV, (the virus that causes AIDS)?]
* Enter month of last HIV test.
* Enter "96" to go to the time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV/AIDS
SkipInstructions:
[R,96] [goto TIMETST]
[1-12,D] [goto TST12M_Y]


Question ID: ADS.060_02.000

Instrument Variable Name: TST12M_Y
QuestionText:
2 of 2
* Enter year of last HIV test.
1985-2009 1985-2009
9996 Time period format
9997 Refused
9999 Don't know
UniverseText: Sample adults 18+ who gave a month for their last HIV test or who didn't know the month
SkipInstructions:
[1880-2030] [goto REATST]
[R,D] [goto TIMETST]
[if TST12M_M and TST12M_Y = a future date] goto ERR1_TST12M_Y
[if TST12M_M and TST12M_Y = a date prior to birth date] goto ERR2_TST12M_Y


Question ID: ADS.061_00.000

Instrument Variable Name: TIMETST
QuestionText:
Was it:
* Read answer categories.
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 adults 18+ who have been tested for HIV, who refused or requested the time period format at TEST12M_M, or refused or don't know the year of their last HIV test.
SkipInstructions:
[1-5,R,D] [goto REATST]


Question ID:ADS.065_00.000

Instrument Variable Name: REATST
QuestionText:
(book) A13
I am going to show you a list of reasons why some people have been tested for HIV (the virus that causes AIDS).
[fill: Not including your blood donations, which of these would you say was the MAIN reason for your last HIV test?/Which of these would you say was the MAIN reason for your last HIV test?]
01 Someone suggested you should be tested
02 You might have been exposed through sex or drug use
03 You might have been exposed through your work or at work
04 You just wanted to find out if you were infected or not
05 For part of a routine medical check-up, or for hospitalization or surgical procedure
06 You were sick or had a medical problem
07 You were pregnant or delivered a baby
08 For health or life insurance coverage
09 For military induction, separation, or military service
10 For immigration
11 For marriage license or to get married
12 You were concerned you could give HIV to someone
13 You wanted medical care or new treatments if you tested positive
14 Some other reason
15 No particular reason
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV SkipInstructions:
[1][goto REASWHO]
[2-13,15,R,D] [goto LASTST]
[14] [goto REASPEC]

[p.5]


Question ID: ADS.066_00.000

Instrument Variable Name: REASWHO
QuestionText:
Who suggested you should be tested - a doctor, nurse or other health care professional, a sex partner, someone at the health department, or someone else?
1 Doctor, nurse or other health care professional
2 Sex partner
3 Someone at health department
4 Family member or friend
5 Other
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV because someone suggested it
SkipInstructions:
[1-4,R,D] [goto LASTST]
[5] [goto WHOSPEC]


Question ID: ADS.067_00.000

Instrument Variable Name:WHOSPEC
QuestionText:
Who suggested you should be tested?
Verbatim Verbatim Response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV because someone not listed in REASWHO suggested it
SkipInstructions:
[20 char long] [goto LASTST]


Question ID: ADS.069_00.000

Instrument Variable Name: REASPEC
QuestionText:
What was the main reason for your last HIV test?
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV for some reason not listed in REATST
SkipInstructions:
[20 char long][goto LASTST]

[p.6]


Question ID: ADS.070_00.000

Instrument Variable Name: LASTST
QuestionText:
(book) A14
[fill: Not including your blood donations, where did you have your last HIV test?/Where did you have your last HIV test?]
01 Private doctor/HMO
02 AIDS clinic/counseling/testing site
03 Hospital, emergency room, outpatient clinic
04 Other type of clinic
05 Public health department
06 At home
07 Drug treatment facility
08 Military induction or military service site
09 Immigration site
10 In a correctional facility (jail or prison)
11 Other location
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV
SkipInstructions:
[1-3,5,7-10,R,D] [goto GIVNAM]
[4][goto CLINTYP]
[6] [goto WHOADM]
[11] [goto LASTSPEC]


Question ID: ADS.072_00.000

Instrument Variable Name: CLINTYP
QuestionText:
What type of clinic did you go to for your last HIV test?
01 Family planning clinic
02 Prenatal clinic
03 Tuberculosis clinic
04 STD clinic
05 Community health clinic
06 Clinic run by employer or insurance company
07 Other
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV at another type of clinic
SkipInstructions:
[1-7,R,D] [goto GIVNAM]

[p.7]


Question ID: ADS.074_00.000

Instrument Variable Name: WHOADM
QuestionText:
Was this test administered by a nurse or other health worker, or did you use a self-sampling kit?
1 Nurse or health worker
2 Self-sampling kit
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV at home
SkipInstructions:
[1,2,R,D] [goto GIVNAM]


Question ID: ADS.076_00.000

Instrument Variable Name: LASTSPEC
QuestionText:
Where did you have your last HIV test?
* This should be a specific location that is not on the list.
Verbatim response Verbatim
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were tested at another location
SkipInstructions:
[20 char long][goto GIVNAM]




Question ID: ADS.080_00.000

Instrument Variable Name: GIVNAM
QuestionText:
The last time you were tested, did you have to give your first and last names?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have been tested for HIV
SkipInstructions:
[1,2,R,D] [goto EXTST12M]


Question ID:ADS.110_00.000

Instrument Variable Name: EXTST12M
QuestionText:
[fill: Do you expect to have another test for HIV in the next 12 months, not including blood donations?/Do you expect to have a test for HIV in the next 12 months, not including blood donations?]
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto CHNSADS]

[p.8]


Question ID: ADS.140_00.000

Instrument Variable Name: CHNSADS
QuestionText:
What are your chances of GETTING HIV (the virus that causes AIDS)?
Would you say high, medium, low, or none?
1 High
2 Medium
3 Low
4 None
5 Already have HIV or AIDS
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1-5,R,D] [goto STMTRU]


Question ID: ADS.150_00.000

Instrument Variable Name: STMTRU
QuestionText:
(book) A15
Tell me if ANY of these statements is true for YOU. Do NOT tell me WHICH Statement or statements are true for you.
Just IF ANY of them are.
* Read if necessary.
(a) You have hemophilia and have received clotting factor concentrations.
(b) You are a man who has had sex with other men, even just one time.
(c ) You have taken street drugs by needle, even just one time.
(d) You have traded sex for money or drugs, even just one time.
(e) You have tested positive for HIV (the virus that causes AIDS).
(f) You have had sex (even just one time) with someone who would answer "yes" to any of these statements.
1 Yes, at least one statement is true
2 No, none of these statements are true
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1,2,R,D] [If AGE GE [50] [go to TBHRD] else [go to STD]]

[p.9]


Question ID: ADS.160_00.000

Instrument Variable Name: STD
QuestionText:
The next questions are about other sexually transmitted diseases or STDs. STDs are also known as venereal diseases or VD. Examples of STDs are gonorrhea, Chlamydia (CLUH-MIH-DEE-UH), syphilis, herpes, and genital warts.
In the past five years, have you had an STD other than HIV or AIDS?
* If asked, tell respondent to include newly contracted STDs and recurring flare-ups of previously contracted STDs.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18-49
SkipInstructions:
[1][goto STDDOC]
[2,R,D] [goto TBHRD]


Question ID:ADS.170_00.000

Instrument Variable Name: STDDOC
QuestionText:
The last time you had an STD other than HIV or AIDS, did you see a doctor or other health professional to get it checked?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18 - 49 who have had an STD other than HIV or AIDS in the past 5 years
SkipInstructions:
[1][goto STDWHER]
[2,R,D] [goto TBHRD]


Question ID: ADS.180_00.000

Instrument Variable Name STDWHER
QuestionText:
Where did you go to be checked?
* Read answer choices only if necessary.
1 Private doctor
2 Family planning clinic
3 STD clinic
4 Emergency room
5 Health department
6 Some other place
7 Refused
9 Don't know
UniverseText: Sample adults 18-49 who have had an STD other than HIV or AIDS who saw a doctor or other health professional
SkipInstructions:
[1-5,R,D] [goto TBHRD]
[6] [goto STDWOTH]

[p.10]


Question ID:ADS.190_00.000

Instrument Variable Name: STDWOTH
QuestionText:
Where did you go to be checked?
Verbatim Verbatim response
7 Refused
9 Don't know
UniverseText: Sample adults 18-49 who have had an STD other than HIV or AIDS who were tested at some other place
SkipInstructions:
[20 char long][goto TBHRD]


Question ID: ADS.200_00.000

Instrument Variable Name: TBHRD
QuestionText:
The next questions are about tuberculosis, or TB.
Have you ever heard of tuberculosis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
[1][goto TBKNOW]
[2,R,D] [goto HOMELESS]


Question ID:ADS.210_00.000

Instrument Variable Name: TBKNOW
QuestionText:
Have you ever personally known anyone who had TB?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have heard of tuberculosis
SkipInstructions:
[1,2,R,D] [goto TB]

[p.11]


Question ID: ADS.220_00.000

Instrument Variable Name: TB
QuestionText:
How much do you know about TB - a lot, some, a little, or nothing?
1 A lot
2 Some
3 A little
4 Nothing
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have heard of tuberculosis
SkipInstructions:
[1-3] [goto TBSPRD]
[4][goto TBCHANC]
[R,D] [goto HOMELESS]


Question ID:ADS.230_00.000

Instrument Variable Name: TBSPRD
QuestionText:
(book) A16
How is TB spread?
* Probe: Can TB be spread in any other way?
* Mark all that apply, separate with commas.
1 Breathing the air around a person who is sick with TB 1
2 Sharing eating/drinking utensils 2
3 Through semen or vaginal secretions shared during sexual intercourse
4 From smoking
5 From mosquito or other insect bites
6 Other
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have knowledge of tuberculosis
SkipInstructions:
[1-6,R,D] goto TBCURED


Question ID:ADS.240_00.000

Instrument Variable Name:TBCURED
QuestionText:
As far as you know, can TB be cured?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have knowledge of tuberculosis
SkipInstructions:
[1,2,R,D] [goto TBCHANC]

[p.12]


Question ID: ADS.250_00.000

Instrument Variable Name: TBCHANC
QuestionText:
What are your chances of getting TB? Would you say high, medium, low, or none?
1 High
2 Medium
3 Low
4 None
5 Already have TB
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have knowledge or heard of tuberculosis or know nothing about tuberculosis
SkipInstructions:
[1-5,R,D] [goto TBSHAME]


Question ID:ADS.260_00.000

Instrument Variable Name:TBSHAME
QuestionText:
(Fill1: If a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?)
(Fill2: If you or a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+ who have knowledge or heard of tuberculosis or know nothing about tuberculosis
SkipInstructions:
[1,2,R,D] [goto HOMELESS]


Question ID: ADS.270_00.000

Instrument Variable Name: HOMELESS
QuestionText:
Have you ever spent more than 24 hours living on the streets, in a shelter, or in a jail or prison?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText:Sample adults 18+
SkipInstructions:
[1,2,R,D] [goto next section]