can
1

2010 NHIS Questionnaire, Sample Adult
Diet and Nutrition

Document Version Date: April 18, 2011

Question ID: NAC.005_00.000
Instrument Variable Name: SPSPEAK
QuestionText:

(book) CAN1
First, I would like to ask about the language you use most often. In general, what language do you speak?

1 Only Spanish
2 Mostly Spanish
3 Spanish and English about the same
4 Mostly English
5 Only English
6 Other
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1 to 5,R,D) [goto CEREALNO];
(6) [goto OTHLANG]

Question ID: NAC.006_00.000

Instrument Variable Name: OTHLANG
QuestionText:

*Specify the language used most often.

Verbatim Verbatim response
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who gave other language used most often
SkipInstructions:

(allow 20,R,D) [goto CEREALNO]

Question ID: NAC.010_01.000

Instrument Variable Name: CEREALNO
QuestionText:

1 of 2
These questions are about the different kinds of foods you ate or drank during the past month, that is, the past 30 days.
When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else.
During the past month, how often did you eat HOT OR COLD CEREALS? You can tell me per day, per week, or per
month.
*Read if necessary: Include cereals eaten at any time of the day.
* Enter number.
* Enter '0' for Never.

000 Never
001-995 1 to 995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto MILKNO];
(1 to 995)[ [goto CEREALTP]

Question ID: NAC.010_02.000
Instrument Variable Name: CEREALTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate cereal in the past month
SkipInstructions:

[if (CEREALNO gt (10) and CEREALTP eq (1)) or
( CEREALNO gt (70) and CEREALTP eq (2)) or
( CEREALNO gt (310) and CEREALTP eq (3)) [goto ERR1_CEREALTP] )
Else (1 to 3,R,D) [goto CERTYP]

Question ID: NAC.015_00.000

Instrument Variable Name: CERTYP
QuestionText:

During the past month, what kinds of cereal did you USUALLY eat? You may choose up to two.
* Enter the name of the cereal to locate in the lookup table.
* If second cereal is mentioned, enter 'Yes' at next screen and enter cereal name at the following screen.
* If cereal is not found, type ZZ

97 Refused
99 Don't know
Verbatim Verbatim response
ZZ Other specify

UniverseText: Sample adults 18+ who ate cereal in the past month
SkipInstructions:

(ZZ) [goto CERTPSP];
else goto CERTYP2
All goto CERTYP2

Question ID: NAC.015_00.010
Instrument Variable Name: CERTPSP
QuestionText:

* Enter the other cereal as reported by the respondent.

Verbatim Verbatim response

UniverseText: Selection in data base not found, go here to input actual response
SkipInstructions:

(allow 30) [goto CERTYP2]

Question ID: NAC.015_01.000
Instrument Variable Name: CERTYP2
QuestionText:

During the past month, was there another cereal that you usually ate?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate cereal in the past month
SkipInstructions:

(1) [goto CERTYP3]
(2, D, R) [goto MILKNO]

Question ID: NAC.015_02.000

Instrument Variable Name: CERTYP3
QuestionText:

* Enter the name of the cereal to locate in the lookup table.
* If cereal is not found, type ZZ

97 Refused
99 Don't know
Verbatim Verbatim response
ZZ Other specify

UniverseText: Sample adults 18+ who ate another cereal in the past month
SkipInstructions:

(ZZ) [goto CERTP3SP];
else goto MILKNO

Question ID: NAC.015_02.010

Instrument Variable Name: CERTP3SP
QuestionText:

* Enter the other cereal as reported by the respondent.

Verbatim Verbatim response

UniverseText: Selection in data base not found, go here to input actual response
SkipInstructions:

(allow 30) [goto MILKNO]

Question ID: NAC.020_01.000

Instrument Variable Name: MILKNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you have MILK, either to drink or on cereal? Do NOT include soy milk or small amounts of milk in coffee
or tea.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001 to 995 1 to 995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto SODANO];
(1 to 995) [goto MILKTP]

Question ID: NAC.020_02.000

Instrument Variable Name: MILKTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank milk in past month
SkipInstructions:

[if (MILKNO gt (10) and MILKTP eq (1)) or
(MILKNO gt (70) and MILKTP eq (2)) or
( MILKNO gt (310) and MILKTP eq (3)) [goto ERR1_MILKTP] )
Else (1 to 3,R,D) [goto MILKTYP]

Question ID: NAC.025_00.000

Instrument Variable Name: MILKTYP
QuestionText:

What type of milk was it? Was it usually...
* Read categories below.
* If respondent drinks soy milk only, go back and change MILKNO to '0'.

1 Whole or regular milk
2 2% fat or reduced-fat milk
3 1% fat or low-fat milk (includes 0.5% fat milk or "low-fat" milk no further specified)
4 Fat-free, skim or nonfat milk
5 Other
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank milk in past month
SkipInstructions:

(1-6,R,D) [goto SODANO]

Question ID: NAC.030_01.000

Instrument Variable Name: SODANO
QuestionText:

1 of 2
During the past month, how often did you drink REGULAR SODA or pop that contains sugar? Do NOT include diet
soda. You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1 to 995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto FRJUICNO];
(1-995)[goto SODATP]

Question ID: NAC.030_02.000

Instrument Variable Name: SODATP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank soda in past month
SkipInstructions:

[if (SODANO gt (10) and SODATP eq (1)) or
(SODANO gt (70) and SODATP eq (2)) or
( SODANO gt (310) and SODATP eq (3)) [goto ERR1_SODATP] )
Else (1-3,R,D) [goto FRTJUICNO]

Question ID: NAC.040_01.000

Instrument Variable Name: FRJUICNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you drink 100% PURE fruit juice such as orange, mango, apple, grape and pineapple juices? Do NOT
include fruit flavored drinks with added sugar or fruit juice you made at home and added sugar to.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto COFFEENO];
(1-995)[goto FRJUICTP]

Question ID: NAC.040_02.000

Instrument Variable Name: FRJUICTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank fruit juice in past month
SkipInstructions:

[if (FRJUICNO gt (10) and FRJUICTP eq (1)) or
(FRJUICNO gt (70) and FRJUICTP eq (2)) or
( FRJUICNO gt (310) and FRJUICTP eq (3)) [goto ERR1_FRJUICTP] )
Else (1-3,R,D)[goto COFFEENO]

Question ID: NAC.042_01.000

Instrument Variable Name: COFFEENO
QuestionText:

1 of 2
*Read if necessary: During the past month
How often did you drink COFFEE, including lattes, and TEA, including bottled tea, that was sweetened with sugar or
honey? Do not include drinks with things like Splenda or Equal.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto SPORDRNO];
(1-995) [goto COFFEETP]

Question ID: NAC.042_02.000

Instrument Variable Name: COFFEETP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank coffee in past month
SkipInstructions:

[if (COFFEENO gt (10) and COFFEETP eq (1)) or
(COFFEENO gt (70) and COFFEETP eq (2)) or
( COFFEENO gt (310) and COFFEETP eq (3)) [goto ERR1_COFFEETP] )
Else (1-3,R,D) [goto SPORDRNO]

Question ID: NAC.045_01.000

Instrument Variable Name: SPORDRNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you drink SPORTS and ENERGY drinks such as Gatorade, Red Bull, and Vitamin water?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto FRTDRNO];
(1-995) [goto SPORDRTP]

Question ID: NAC.045_02.000

Instrument Variable Name: SPORDRTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank sports drink in past month
SkipInstructions:

[if (SPORDRNO gt (10) and SPORDRTP eq (1)) or
(SPORDRNO gt (70) and SPORDRTP eq (2)) or
( SPORDRNO gt (310) and SPORDRTP eq (3)) [goto ERR1_SPORDRTP] )
Else (1-3,R,D) [goto FRTDRNO]

Question ID: NAC.060_01.000

Instrument Variable Name: FRTDRNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you drink sweetened fruit drinks, such as Kool-aid, cranberry and lemonade? Include fruit drinks you
made at home and added sugar to.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto FRUITNO];
(1-995) [goto FRTDRTP]

Question ID: NAC.060_02.000

Instrument Variable Name: FRTDRTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank fruit drinks in past month
SkipInstructions:

[if ( FRTDRNO gt (10) and FRTDRTP eq (1)) or
(FRTDRNO gt (70) and FRTDRTP eq (2)) or
( FRTDRNO gt (310) and FRTDRTP eq (3)) [goto ERR1_FRTDRTP] )
Else (1-3,R,D) [goto FRUITNO]

Question ID: NAC.070_01.000

Instrument Variable Name: FRUITNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat FRUIT? Include fresh, frozen, or canned fruit. Do NOT include juices.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto SALADNO];
(1-995) [goto FRUITTP]

Question ID: NAC.070_02.000

Instrument Variable Name: FRUITTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate fruit in past month
SkipInstructions:

[if (FRUITNO gt (10) and FRUITTP eq (1)) or
(FRUITNO gt (70) and FRUITTP eq (2)) or
(FRUITNO gt (310) and FRUITTP eq (3)) [goto ERR1_FRUITTP] )
Else (1-3,R,D) [goto SALADNO]

Question ID: NAC.090_01.000

Instrument Variable Name: SALADNO
QuestionText:

1 of 2
*Read if necessary: During the past month . .
How often did you eat a green leafy or lettuce SALAD, with or without other vegetables?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto FRIESNO];
(1-995) [goto SALADTP]

Question ID: NAC.090_02.000

Instrument Variable Name: SALADTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate salad in past month
SkipInstructions:

[if (SALADNO gt (10) and SALADTP eq (1)) or
(SALADNO gt (70) and SALADTP eq (2)) or
(SALADNO gt (310) and SALADTP eq (3)) [goto ERR1_SALADTP] )
Else (1-3,R,D) [goto FRIESNO]

Question ID: NAC.100_01.000

Instrument Variable Name: FRIESNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat any kind of FRIED POTATOES, including French fries, home fries, or hash brown potatoes?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto POTATONO];
(1-995) [goto FRIESTP]

Question ID: NAC.100_02.000

Instrument Variable Name: FRIESTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate fried potatoes in past month
SkipInstructions:

[if (FRIESNO gt (10) and FRIESTP eq (1)) or
(FRIESNO gt (70) and FRIESTP eq (2)) or
(FRIESNO gt (310) and FRIESTP eq (3)) [goto ERR1_FRIESTP] )
Else (1-3,R,D) [goto POTATONO]

Question ID: NAC.110_01.000

Instrument Variable Name: POTATONO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat any OTHER KIND OF POTATOES, such as baked, boiled, mashed potatoes, sweet potatoes, or
potato salad?
*Read if necessary: You can tell me per day, per week, or per month.
*Read if necessary: INCLUDE red-skinned and Yukon Gold potatoes.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto BEANSNO];
(1-995) [goto POTATOTP]

Question ID: NAC.110_02.000

Instrument Variable Name: POTATOTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate other potatoes in the past month
SkipInstructions:

[if (POTATONO gt (10) and POTATOTP eq (1)) or
(POTATONO gt (70) and POTATOTP eq (2)) or
(POTATONO gt (310) and POTATOTP eq (3)) [goto ERR1_POTATOTP] )
Else (1-3,R,D) [goto BEANSNO]

Question ID: NAC.120_01.000

Instrument Variable Name: BEANSNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat refried beans, baked beans, beans in soup, pork and beans or any other type of cooked dried
beans? Do NOT include green beans.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto BRRICENO];
(1-995) [goto BEANSTP]

Question ID: NAC.120_02.000

Instrument Variable Name: BEANSTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate beans in past month
SkipInstructions:

[if (BEANSNO gt (10) and BEANSTP eq (1)) or
(BEANSNO gt (70) and BEANSTP eq (2)) or
(BEANSNO gt (310) and BEANSTP eq (3)) [goto ERR1_BEANSTP] )
Else (1-3,R,D) [goto BRRICENO]

Question ID: NAC.125_01.000

Instrument Variable Name: BRRICENO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat BROWN RICE or other cooked whole grains, such as bulgur, cracked wheat, or millet? Do NOT
include white rice.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto OVEGNO];
(1-995) [goto BRRICETP]

Question ID: NAC.125_02.000

Instrument Variable Name: BRRICETP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate brown rice in past month
SkipInstructions:

[if (BRRICENO gt (10) and BRRICETP eq (1)) or
(BRRICENO gt (70) and BRRICETP eq (2)) or
(BRRICENO gt (310) and BRRICETP eq (3)) [goto ERR1_BRRICETP] )
Else (1-3,R,D) [goto OVEGNO]

Question ID: NAC.130_01.000

Instrument Variable Name: OVEGNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
Not including what you just told me about (lettuce salads, potatoes, cooked dried beans), how often did you eat OTHER
VEGETABLES?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto SALSANO];
(1-995) [goto OVEGTP]

Question ID: NAC.130_02.000

Instrument Variable Name: OVEGTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate other vegetables in past month
SkipInstructions:

[if (OVEGNO gt (10) and OVEGTP eq (1)) or
(OVEGNO gt (70) and OVEGTP eq (2)) or
(OVEGNO gt (310) and OVEGTP eq (3)) [goto ERR1_OVEGTP] )
Else (1-3,R,D) [goto SALSANO]

Question ID: NAC.131_01.000

Instrument Variable Name: SALSANO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you have Mexican-type SALSA made with tomato?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto PIZZANO];
(1-995) [goto SALSATP]

Question ID: NAC.131_02.000

Instrument Variable Name: SALSATP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate salsa in past month
SkipInstructions:

[if (SALSANO gt (10) and SALSATP eq (1)) or
(SALSANO gt (70) and SALSATP eq (2)) or
(SALSANO gt (310) and SALSATP eq (3)) [goto ERR1_SALSATP] )
Else (1-3,R,D) [goto PIZZANO]

Question ID: NAC.132_01.000

Instrument Variable Name: PIZZANO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat PIZZA? Include frozen pizza, fast food pizza, and homemade pizza. You can tell me per day, per
week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto TOMSAUNO];
(1-995) [goto PIZZATP]

Question ID: NAC.132_02.000

Instrument Variable Name: PIZZATP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate pizza in past month
SkipInstructions:

[if (PIZZANO gt (10) and PIZZATP eq (1)) or
(PIZZANO gt (70) and PIZZATP eq (2)) or
(PIZZANO gt (310) and PIZZATP eq (3)) [goto ERR1_PIZZATP] )
Else (1-3,R,D) [goto TOMSAUNO]

Question ID: NAC.133_01.000

Instrument Variable Name: TOMSAUNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you have TOMATO SAUCES such as with spaghetti or noodles or mixed into foods such as lasagna? Do
not include tomato sauce on pizza.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto CHEESENO];
(1-995) [goto TOMSAUTP]

Question ID: NAC.133_02.000

Instrument Variable Name: TOMSAUTP

QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate tomato sauces in past month
SkipInstructions:

[if (TOMSAUNO gt (10) and TOMSAUTP eq (1)) or
(TOMSAUNO gt (70) and TOMSAUTP eq (2)) or
(TOMSAUNO gt (310) and TOMSAUTP eq (3)) [goto ERR1_TOMSAUTP] )
Else (1-3,R,D) [goto CHEESENO]

Question ID: NAC.134_01.000

Instrument Variable Name: CHEESENO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat any kind of CHEESE? Include cheese as a snack, cheese on burgers, sandwiches, and cheese in
foods such as lasagna, quesadillas, or casseroles. Do not include cheese on pizza.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto REDMETNO];
(1-995) [goto CHEESETP]

Question ID: NAC.134_02.000

Instrument Variable Name: CHEESETP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate cheese in past month
SkipInstructions:

[if (CHEESENO gt (10) and CHEESETP eq (1)) or
(CHEESENO gt (70) and CHEESETP eq (2)) or
(CHEESENO gt (310) and CHEESETP eq (3)) [goto ERR1_CHEESETP] )
Else (1-3,R,D) [goto CHEESTYP]

Question ID: NAC.135_00.000
Instrument Variable Name: CHEESTYP
QuestionText:

How often was the cheese you ate light or low-fat cheese, including cottage cheese?
*Read categories below...

1 Almost never or never
2 About 1/4 of the time
3 About 1/2 of the time
4 About 3/4 of the time
5 Almost always or always
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate cheese in past month
SkipInstructions:

(1-5,R,D) [goto REDMETNO]

Question ID: NAC.136_01.000

Instrument Variable Name: REDMETNO
QuestionText:

(book) CAN2
1 of 2
*Read if necessary: During the past month . . .
Looking at this card, how often did you eat RED MEAT, such as beef, pork, ham, or sausage? Do NOT include chicken,
turkey, or seafood.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto PROMETNO];
(1-995) [goto REDMETTP]

Question ID: NAC.136_02.000
Instrument Variable Name: REDMETTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate red meat in past month
SkipInstructions:

[if (REDMETNO gt (10) and REDMETTP eq (1)) or
(REDMETNO gt (70) and REDMETTP eq (2)) or
(REDMETNO gt (310) and REDMETTP eq (3)) [goto ERR1_REDMETTP] )
Else (1-3,R,D) [goto PROMETNO]

Question ID: NAC.137_01.000

Instrument Variable Name: PROMETNO
QuestionText:

1 of 2
(book) CAN3
*Read if necessary: During the past month . . .
Looking at this card, how often did you eat PROCESSED MEAT, such as bacon, lunch meats, or hot dogs?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto BREADNO];
(1-995) [goto PROMETTP]

Question ID: NAC.137_02.000

Instrument Variable Name: PROMETTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate processed meat in past month
SkipInstructions:

[if (PROMETNO gt (10) and PROMETTP eq (1)) or
(PROMETNO gt (70) and PROMETTP eq (2)) or
(PROMETNO gt (310) and PROMETTP eq (3)) [goto ERR1_PROMETTP] )
Else (1-3,R,D) [goto BREADNO]

Question ID: NAC.138_01.000

Instrument Variable Name: BREADNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat WHOLE GRAIN BREAD including toast, rolls and in sandwiches? Whole grain breads include
whole wheat, rye, oatmeal and pumpernickel. Do NOT include white bread.
*Read if necessary: You can tell me per day, per week, or per month.
*Read if necessary: INCLUDE cracked wheat, multi-grain and bran breads.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto CANDYNO];
(1-995) [goto BREADTP]

Question ID: NAC.138_02.000

Instrument Variable Name: BREADTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate whole grain bread in past month
SkipInstructions:

[if (BREADNO gt (10) and BREADTP eq (1)) or
(BREADNO gt (70) and BREADTP eq (2)) or
(BREADNO gt (310) and BREADTP eq (3)) [goto ERR1_BREADTP] )
Else (1-3,R,D) [goto CANDYNO]

Question ID: NAC.139_01.000

Instrument Variable Name: CANDYNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat CHOCOLATE, or any other types of CANDY? Do NOT include SUGAR-FREE CANDY. You
can tell me per day, per week or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto DONUTNO];
(1-995) [goto CANDYTP]

Question ID: NAC.139_02.000

Instrument Variable Name: CANDYTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText:
Sample adults 18+ who ate candy in past month
SkipInstructions:

[if (CANDYNO gt (10) and CANDYTP eq (1)) or
(CANDYNO gt (70) and CANDYTP eq (2)) or
(CANDYNO gt (310) and CANDYTP eq (3)) [goto ERR1_CANDYTP] )
Else (1-3,R,D) [goto DONUTNO]

Question ID: NAC.140_01.000

Instrument Variable Name: DONUTNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat DOUGHNUTS, sweet rolls, Danish, muffins, (pan dulce) or pop-tarts? Do NOT include sugar-
free items.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto COOKIENO];
(1-995) [goto DONUTTP]

Question ID: NAC.140_02.000

Instrument Variable Name: DONUTTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate donuts in past month
SkipInstructions:

[if (DONUTNO gt (10) and DONUTTP eq (1)) or
(DONUTNO gt (70) and DONUTTP eq (2)) or
(DONUTNO gt (310) and DONUTTP eq (3)) [goto ERR1_DONUTTP] )
Else (1-3,R,D) [goto COOKIENO]

Question ID: NAC.141_01.000

Instrument Variable Name: COOKIENO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat COOKIES, CAKE, PIE, or BROWNIES? Do NOT include sugar-free kinds.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto ICECRNO];
(1-995) [goto COOKIETP]

Question ID: NAC.141_02.000

Instrument Variable Name: COOKIETP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate cookies in past month
SkipInstructions:

[if (COOKIENO gt (10) and COOKIETP eq (1)) or
(COOKIENO gt (70) and COOKIETP eq (2)) or
(COOKIENO gt (310) and COOKIETP eq (3)) [goto ERR1_COOKIETP] )
Else (1-3,R,D) [goto ICECRNO]

Question ID: NAC.145_01.000

Instrument Variable Name: ICECRNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat ICE CREAM OR OTHER FROZEN DESSERTS? Do NOT include sugar-free kinds.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto POPCNNO];
(1-995) [goto ICECRTP]

Question ID: NAC.145_02.000

Instrument Variable Name: ICECRTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate ice cream in past month
SkipInstructions:

[if (ICECRNO gt (10) and ICECRTP eq (1)) or
(ICECRNO gt (70) and ICECRTP eq (2)) or
(ICECRNO gt (310) and ICECRTP eq (3)) [goto ERR1_ICECRTP] )
Else (1-3,R,D) [goto POPCNNO]

Question ID: NAC.150_01.000

Instrument Variable Name: POPCNNO
QuestionText:

1 of 2
*Read if necessary: During the past month . . .
How often did you eat POPCORN?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.

000 Never
001-995 1-995 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [goto VITMIN];
(1-995) [goto POPCNTP]

Question ID: NAC.150_02.000

Instrument Variable Name: POPCNTP
QuestionText:

2 of 2
*Enter time period.

0 Never
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ate popcorn in past month
SkipInstructions:

[if (POPCNNO gt (10) and POPCNTP eq (1)) or
(POPCNNO gt (70) and POPCNTP eq (2)) or
(POPCNNOO gt (310) and POPCNTP eq (3)) [goto ERR1_POPCNTP] )
Else (1-3,R,D) [goto VITMIN]

Question ID: NAC.170_00.000

Instrument Variable Name: VITMIN
QuestionText:

These next questions are about vitamins and minerals you may have taken during the past month, that is, the past 30 days.
DURING THE PAST MONTH, did you take any vitamin or mineral pills or supplements of ANY kind?
*Read if necessary: INCLUDE vitamin or mineral pills or liquids. Do NOT include vitamin-fortified foods.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto VITMULT]
(2,R,D) [goto next section]

Question ID: NAC.180_00.000

Instrument Variable Name: VITMULT
QuestionText:

DURING THE PAST MONTH, did you take any MULTI-vitamins such as One-A-Day, Theragran, or Centrum?
*Read if necessary: Include combinations of three or more vitamins and minerals, such as those labeled "stress" or "antioxidant".
Do not include combinations of herbal or plant substances, or combinations of just two, like calcium and
vitamin D.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have taken vitamins or mineral supplements in the past month
SkipInstructions:

(1) [goto VITMULD]
(2,R,D) [goto CALCA]

Question ID: NAC.200_01.000

Instrument Variable Name: VITMULD
QuestionText:

On how many DAYS during the past month did you take a MULTI-vitamin?
*Enter number of days taking multi-vitamins.
*Enter '30' for all days in the month.

01-30 1-30 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have taken a multi-vitamin in the past month
SkipInstructions:

(1-30, R, D) [goto CALCA]

Question ID: NAC.210_00.000

Instrument Variable Name: CALCA
QuestionText:

DURING THE PAST MONTH, did you take any CALCIUM SUPPLEMENTS, including Tums or calcium chews?
[Fill1: Do NOT include any calcium in the MULTI-vitamins you told me about.]
*Read if necessary: Do NOT include milk or calcium-fortified orange juice.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have taken vitamins or mineral supplements in the past month
SkipInstructions:

(1) [goto CALCD]
(2,R,D) [goto VITD]

Question ID: NAC.215_01.000

Instrument Variable Name: CALCD
QuestionText:

1 of 2
On how many DAYS during the past month did you take calcium supplements?
*Enter number of days taking calcium.
*Enter '30' for all days in the month.

01-30 1-30 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have taken calcium in the past month
SkipInstructions:

(1-30, R, D) [goto VITD]

Question ID: NAC.270_00.000

Instrument Variable Name: VITD
QuestionText:

DURING THE PAST MONTH, did you take any VITAMIN D PILLS OR SUPPLEMENTS?
Fill1: [Do NOT include any vitamin D in the MULTI-vitamins you told me about.]
Fill2: [Do NOT include calcium supplements that contain vitamin D.]
Fill3: [Do not include calcium supplements that contain vitamin D or MULTI-vitamins you told me about.]
*Read if necessary: Do NOT include vitamin D fortified milk or other foods such as cereals and bread.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have taken vitamin or mineral supplements in the past month
SkipInstructions:

(1) [goto VITDM]
(2,R,D) [goto next section]

Question ID: NAC.280_00.000

Instrument Variable Name: VITDM
QuestionText:

On how many DAYS during the past month did you take vitamin D?
*Enter '30' for all days in the month.

01-30 1-30 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have taken vitamin D in the past month
SkipInstructions:

(1-30, R, D) [goto VITDWHY]

Question ID: NAC.290_01.000

Instrument Variable Name: VITDWHY
QuestionText:

Which of these is the MAIN reason you took vitamin D...?
*Read categories below.

1 For OVERALL health
2 For BONE health
3 To prevent CANCER
4 For some other reason
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have taken vitamin D in the past month
SkipInstructions:

(1-3, R,D)[goto next section]
(4) [goto VITDSPEC]

Question ID: NAC.300_00.000

Instrument Variable Name: VITDSPEC
QuestionText:

*Specify the reason took vitamin D.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Sample adults 18+ who gave other reason for taking vitamin D
SkipInstructions:

(allow 20,R,D) [goto next section]

Physical Activity

Question ID: NAD.010_00.000

Instrument Variable Name: AD11A
QuestionText:

The next questions are about walking for transportation. I will ask you separately about walking for other reasons like
relaxation or exercise.
During the past 7 days, did you walk to get some place that took you at least 10 minutes?

1 Yes
2 No
3 Unable to walk
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto AD12A]
(2,R,D) [goto AD14A]
(3) [goto SITWDAY]

Question ID: NAD.011_00.000

Instrument Variable Name: AD12A
QuestionText:

In the past 7 days, how many times did you do that?
*Read if necessary: Walk for at least 10 minutes to get some place.

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

UniverseText: Sample adults 18+ who have walked for transportation in the past 7 days
SkipInstructions:

(1-94) [goto AD13ANO]
(R,D) [goto AD14A]

Question ID: NAD.012_01.000

Instrument Variable Name: AD13ANO
QuestionText:

1 of 2
[Fill1: How long did that walk take?/ Fill2: On average, how long did those walks take?]
* Enter number for length of walk for transportation.

001-995 1-995
997 Refused
999 Don't know

UniverseText:
Sample adults 18+ who have walked for transportation at least once in the past week
SkipInstructions:

(1-995)[goto AD13ATP]
[If AD13ANO= 'R', 'D' store 'R', 'D' in AD13ATP]
(R,D)[goto AD14A]

Question ID: NAD.012_02.000

Instrument Variable Name: AD13ATP
QuestionText:

2 of 2
* Enter time period for length of walking for transportation.

1 Minutes
2 Hours
7 Refused
9 Don't know

UniverseText:
Sample adults 18+ who have walked for transportation at least once in the past week and gave a number for the
first part of this two-part question
SkipInstructions:

If AD13ANO gt (24) and AD13ATP eq (2) [goto ERR1_ AD13ATP]
(IF AD13ANO gt (90) and AD13ATP eq (1) ) or ( if AD13ANO gt (2) and AD13ATP eq (2) ) [goto ERR2_
AD13ATP]
(1,2,R,D) [goto AD14A] and
If AD13ANO= 'R', 'D' store 'R', 'D' in AD13ATP

Question ID: NAD.013_00.000

Instrument Variable Name: AD14A
QuestionText:

Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. During the past 7 days, did you walk for at least
10 minutes for any of these reasons? Please do not include walking for transportation.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are able to walk
SkipInstructions:

(1) [goto AD15A]
(2,R,D) [goto SITWDAY]

Question ID: NAD.014_00.000

Instrument Variable Name: AD15A
QuestionText:

In the past 7 days, how many times did you do that?

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

UniverseText: Sample adults 18+ who have walked for leisure in the past 7 days
SkipInstructions:

(1-94) [goto AD16ANO]
(R,D) [goto SITWDAY]

Question ID: NAD.015_01.000

Instrument Variable Name: AD16ANO
QuestionText:

1 of 2
[Fill1: How long did that walk take?/ Fill2: On average, how long did those walks take?]
* Enter number for length of walk for fun, relaxation, or exercise.

001-995 1-995
997 Refused
999 Don't know

UniverseText: Sample Adults 18+ who have walked for leisure at least once in the past week.
SkipInstructions:

(1-995)[goto AD16ATP]
(R,D)[goto SITWDAY] and [If AD16ANO= 'R', 'D' store 'R', 'D' in AD16ATP]

Question ID: NAD.015_02.000

Instrument Variable Name: AD16ATP
QuestionText:

2 of 2
* Enter time period for length of walking for fun, relaxation, or exercise.

1 Minutes
2 Hours
7 Refused
9 Don' know

UniverseText: Sample adults 18+ who have walked for leisure at least once in the past week and gave a number for the first part
of this two-part question
SkipInstructions:

If AD16ANO gt (24) and AD16ATP eq (2) [goto ERR1_ AD16ATP]
(IF AD16ANO gt (90) and AD16ATP eq (1) ) or ( if AD16ANO gt (2) and AD16ATP eq (2) ) [goto ERR2_
AD16ATP]
(1,2,R,D)[goto SITWDAY]; [If AD16ANO= 'R', 'D' store 'R', 'D' in AD16ATP]

Question ID: NAD.040_00.000

Instrument Variable Name: SITWDAY
QuestionText:

[Fill1:Outside of work, how/ Fill2: How ] many hours do you spend per day during the WEEKDAYS sitting?
*Read if necessary: Include watching television or videos, working on the computer, playing video games, using the
Internet, knitting, sewing, reading, fishing, taking long drives, watching ball games or doing other sitting activities.
*If person is bedridden, include only waking hours lying down

00 None
01-24 1-24 hours
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-24,R,D) [goto SITWEND]

Question ID: NAD.050_00.000

Instrument Variable Name: SITWEND
QuestionText:

[Fill1: Outside of work, how / Fill2: How] many hours do you spend per day during the WEEKEND sitting?
*Read if necessary: Include watching television or videos, working on the computer, playing video games, using the
Internet, knitting, sewing, reading, fishing, taking long drives, watching ball games or doing other sitting activities.
Weekend means any days off, not necessarily Saturday and Sunday.
*If person is bedridden, include only waking hours lying down.

00 None
01-24 1-24 hours
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-24,R,D) if AMDLONG eq (1,2,R,D) [goto MDEXER];
else if AMDLONG eq (0,3,4,5) [goto next section]

Question ID: NAD.060_00.000

Instrument Variable Name: MDEXER
QuestionText:

DURING THE PAST 12 MONTHS, did a doctor or other health professional RECOMMEND that you BEGIN or
CONTINUE to do any type of exercise or physical activity?

1 Yes
2 No
3 Did not see a doctor in the PAST 12 MONTHS
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have seen a doctor or other health professional in the PAST 12 MONTHS
SkipInstructions:

(1-3,R,D) [goto next section]

Question ID: NAE.010_00.000

Instrument Variable Name: MENTHOLF
QuestionText:

Earlier you said you used to smoke cigarettes. Think back to the 12 months BEFORE you quit smoking. During that
time, was your usual cigarette brand menthol or non-menthol?

1 Menthol
2 Non menthol
3 No usual type
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers
SkipInstructions:

(1-3,R,D) if SMKREG ne '96' [goto NUMCIGA];
else if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [goto FQUITA_1];
else [goto CIGEV1]

Question ID: NAE.015_00.000

Instrument Variable Name: NUMCIGA
QuestionText:

When you last smoked FAIRLY REGULARLY, how many cigarettes did you usually smoke per day?
*Enter '95' if varied.
*Enter '96' if never smoked cigarettes regularly.

01-94 1-94 cigarettes
95 Varied
96 Never smoked regularly
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who are former smokers and had smoked regularly in the past
SkipInstructions:

(1-94,96,R,D) if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [goto FQUITA_1];
else [goto CIGEV1]
(95) [goto NUMCVAR]

Tobacco

Question ID: NAE.017_00.000

Instrument Variable Name: NUMCVAR
QuestionText:

What is the average number of cigarettes that you smoked daily during the longest period that you smoked?
*Read if necessary: 1 pack equals 20 cigarettes.
*Enter '95' if 95 or more.

01-94 1-94 cigarettes
95 95 or more cigarettes
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who said number of cigarettes smoked daily varied
SkipInstructions:

(1-95,R,D) if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [goto FQUITA_1];
else [goto CIGEV1]

Question ID: NAE.020_01.000

Instrument Variable Name: FQUITA_1
QuestionText:

Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine patch?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto FQUITA_2]

Question ID: NAE.020_02.000

Instrument Variable Name: FQUITA_2
QuestionText:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine gum or lozenge?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto FQUITA_3]

Question ID: NAE.020_03.000

Instrument Variable Name: FQUITA_3
QuestionText:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine containing nasal spray or inhaler?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto FQUITA_4]

Question ID: NAE.020_04.000

Instrument Variable Name: FQUITA_4
QuestionText:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A prescription pill called Chantix (CHAN-tix) or Varenicline (vuh-REN-ih-klin)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto FQUITA_5]

Question ID: NAE.020_05.000

Instrument Variable Name: FQUITA_5
QuestionText:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A prescription pill called Zyban (ZI-ban), Bupropion (byoo-PRO-pee-ON), or Wellbutrin (well-BYOO-trin)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto FQUITB_1]

Question ID: NAE.025_01.000

Instrument Variable Name: FQUITB_1
QuestionText:

Thinking back to when you stopped smoking completely, did you use ANY of the following:
A telephone help line or quit line?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto FQUITB_2]

Question ID: NAE.025_02.000

Instrument Variable Name: FQUITB_2
QuestionText:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
One-on-one counseling?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto FQUITB_3]

Question ID: NAE.025_03.000

Instrument Variable Name: FQUITB_3
QuestionText:

*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
A stop smoking clinic, class or support group?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are former smokers and quit in the last 2 years
SkipInstructions:

(1,2,R,D) [goto CIGEV1]

Question ID: NAE.060_00.000

Instrument Variable Name: MENTHOL
QuestionText:

Earlier you said you smoke cigarettes.
Is your usual cigarette brand menthol or non-menthol?

1 Menthol
2 Non menthol
3 No usual type
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers
SkipInstructions:

(1-3,R,D) if CIGQTYR=1 [store '1' in CSQEV] and [goto CQUITA_1];
else [goto CSQEV]

Question ID: NAE.075_00.000

Instrument Variable Name: CSQEV
QuestionText:

Have you EVER stopped smoking for one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers
SkipInstructions:

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

Question ID: NAE.080_01.000

Instrument Variable Name: CQUITA_1
QuestionText:

Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following
PRODUCTS:
A nicotine patch?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

(1,2,R,D) [goto CQUITA_2]

Question ID: NAE.080_02.000

Instrument Variable Name: CQUITA_2
QuestionText:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following
PRODUCTS:
A nicotine gum or lozenge?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

(1,2,R,D) [goto CQUITA_3]

Question ID: NAE.080_03.000

Instrument Variable Name: CQUITA_3
QuestionText:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following
PRODUCTS:
A nicotine containing nasal spray or inhaler?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

(1,2,R,D) [goto CQUITA_4]

Question ID: NAE.080_04.000

Instrument Variable Name: CQUITA_4
QuestionText:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following
PRODUCTS:
A prescription pill called Chantix or Varenicline?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

(1,2,R,D) [goto CQUITA_5]

Question ID: NAE.080_05.000

Instrument Variable Name: CQUITA_5
QuestionText:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following
PRODUCTS:
A prescription pill, such as Zyban, Bupropion, or Wellbutrin?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

(1,2,R,D) [goto CQUITB_1]

Question ID: NAE.085_01.000

Instrument Variable Name: CQUITB_1
QuestionText:

Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
A telephone help line or quit line?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

(1,2,R,D) [goto CQUITB_2]

Question ID: NAE.085_02.000

Instrument Variable Name: CQUITB_2
QuestionText:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
One-on-one counseling?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

(1,2,R,D) [goto CQUITB_3]

Question ID: NAE.085_03.000

Instrument Variable Name: CQUITB_3
QuestionText:

*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
A stop smoking clinic, class or support group?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers and tried to quit in the last year
SkipInstructions:

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

Question ID: NAE.100_00.000

Instrument Variable Name: QWANT
QuestionText:

Would you like to completely quit smoking cigarettes?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are current smokers
SkipInstructions:

(1,2,R,D) [goto CIGEV1]

Question ID: NAE.146_00.000

Instrument Variable Name: CIGEV1
QuestionText:

? [F1]
[fill1: These questions are about tobacco use.]
Have you ever smoked a cigar EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto CIGEV50] (2,R,D) [goto SNUFFEV]

Question ID: NAE.148_00.000

Instrument Variable Name: CIGEV50
QuestionText:

Have you smoked at least 50 cigars in your entire life?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever smoked a cigar
SkipInstructions:

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

Question ID: NAE.150_00.000

Instrument Variable Name: CIGCUR
QuestionText:

Do you now smoke a cigar 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 have ever smoked a cigar
SkipInstructions:

(1,3) [goto SNUFFEV] (2,R,D) [goto CIG30D]

Question ID: NAE.152_00.000

Instrument Variable Name: CIG30D
QuestionText:

On how many of the PAST 30 DAYS have you smoked a cigar?
*Enter '0' for none.
*Enter '30' for all days in the month.

00 None
01-30 1-30 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who smoke a cigar some days or refused or don't know current cigar smoking status
SkipInstructions:

(0-30,R,D) [goto SNUFFEV]

Question ID: NAE.154_00.000

Instrument Variable Name: SNUFFEV
QuestionText:

? [F1]
Have you EVER used snuff, such as Skoal, Skoal Bandits, or Copenhagen, EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [(goto SNUFEV20)] (2,R,D) [(goto CHEWEV)]

Question ID: NAE.156_00.000

Instrument Variable Name: SNUFEV20
QuestionText:

Have you used snuff, (such as Skoal, Skoal Bandits, or Copenhagen) at least 20 times in your entire life?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever used snuff
SkipInstructions:

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

Question ID: NAE.158_00.000

Instrument Variable Name: SNUFFCUR
QuestionText:

Do you now use snuff 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 have ever used snuff
SkipInstructions:

(1,3) [goto CHEWEV] (2,R,D) [goto SNUFF30D]

Question ID: NAE.159_00.000

Instrument Variable Name: SNUFF30D
QuestionText:

On how many of the PAST 30 DAYS have you used snuff?
*Enter '0' for none.
*Enter '30' for all days in the month.

00 None
01-30 1-30 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who use snuff some days or refused or don't know current snuff using status
SkipInstructions:

(0-30,R,D) [goto CHEWEV]

Question ID: NAE.160_00.000
Instrument Variable Name: CHEWEV
QuestionText:

Have you EVER used chewing tobacco, such as Redman, Levi Garrett, or Beech-Nut EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto CHEWEV20]
(2,R,D) if (01LTE SNUFF30D LTE30) or SNUFFCUR=1 [goto CHEWTYP]
elseif (AMDLONG IN ('1','2','7','9') or ADENLONG IN ('1','2','7','9')) and
((CIGCUR IN ('1','2') or SNUFFCUR IN ('1','2') or CHEWCUR IN ('1','2')) or
(SMKEV='1' and
(SMKNOW IN ('1','2') or (SMKNOW='3' and
((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '52' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '12' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '01' and SMKQTTP(e)='4')))))) [goto MDTOB2]
else [goto LIVINTRO]

Question ID: NAE.162_00.000

Instrument Variable Name: CHEWEV20
QuestionText:

Have you used chewing tobacco (such as Redman, Levi Garrett, or Beech-Nut) at least 20 times in your entire life?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever used chewing tobacco
SkipInstructions:

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

Question ID: NAE.164_00.000

Instrument Variable Name: CHEWCUR
QuestionText:

Do you now use chewing tobacco 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 have ever used chewing tobacco
SkipInstructions:

(1) [goto CHEWTYP]
(2,R,D) [goto CHEW30D]
(3) if (01LTE SNUFF30D LTE30) or SNUFFCUR=1 [goto CHEWTYP]
elseif (AMDLONG IN ('1','2','7','9') or ADENLONG IN ('1','2','7','9')) and
((CIGCUR IN ('1','2') or SNUFFCUR IN ('1','2') or CHEWCUR IN ('1','2')) or
(SMKEV='1' and
(SMKNOW IN ('1','2') or (SMKNOW='3' and
((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '52' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '12' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '01' and SMKQTTP(e)='4')))))) [goto MDTOB2]
else [goto LIVINTRO]

Question ID: NAE.166_00.000

Instrument Variable Name: CHEW30D
QuestionText:

On how many of the PAST 30 DAYS have you used chewing tobacco?
*Enter '0' for none.
*Enter '30' for all days in the month.

00 None
01-30 1-30 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who use chewing tobacco some days or refused or don't know current chewing tobacco status
SkipInstructions:

(0,R,D) if (01 LTE SNUFF30D LTE 30) or SNUFFCUR=1 [goto CHEWTYP]
elseif (AMDLONG IN ('1','2','7','9') or ADENLONG IN ('1','2','7','9')) and
((CIGCUR IN ('1','2') or SNUFFCUR IN ('1','2') or CHEWCUR IN ('1','2')) or
(SMKEV='1' and
(SMKNOW IN ('1','2') or (SMKNOW='3' and
((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '52' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '12' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '01' and SMKQTTP(e)='4')))))) [goto MDTOB2]
else [goto LIVINTRO];
(1-30) [goto CHEWTYP]

Question ID: NAE.167_00.000

Instrument Variable Name: CHEWTYP
QuestionText:

During the past 30 days, what brand of [fill: snuff/chewing tobacco/snuff or chewing tobacco] did you use MOST
OFTEN?
*Do not read categories.

01 Beech-Nut
02 Camel Snus
03 Cope
04 Copenhagen
05 Cougar
06 Grizzly
07 Hawken
08 Husky
09 Kayak
10 Kodiak
11 Levi Garrett
12 Longhorn
13 Marlboro Snus
14 Red Man
15 Red Seal
16 Rooster
17 Silver Creek
18 Skoal
19 Taylor's Pride
20 Timber Wolfe
21 Brand not on list (specify)
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who use snuff or chewing tobacco at least once in the past 30 days
SkipInstructions:

(1-20,R,D) if (AMDLONG IN ('1','2','7','9') or ADENLONG IN ('1','2','7','9')) and
((CIGCUR IN ('1','2') or SNUFFCUR IN ('1','2') or CHEWCUR IN ('1','2')) or
(SMKEV='1' and
(SMKNOW IN ('1','2') or (SMKNOW='3' and
((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '52' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '12' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '01' and SMKQTTP(e)='4')))))) [goto MDTOB2]
else [goto LIVINTRO]
(21) [goto CHTYPOTH]

Question ID: NAE.168_00.000

Instrument Variable Name: CHTYPOTH
QuestionText:

*Enter other brand of snuff/chewing tobacco.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Sample adults 18+ who use other brand of snuff/chewing tobacco
SkipInstructions:

(allow 50,R,D) if (AMDLONG IN ('1','2','7','9') or ADENLONG IN ('1','2','7','9')) and
((CIGCUR IN ('1','2') or SNUFFCUR IN ('1','2') or CHEWCUR IN ('1','2')) or
(SMKEV='1' and
(SMKNOW IN ('1','2') or (SMKNOW='3' and
((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '52' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '12' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '01' and SMKQTTP(e)='4')))))) [goto MDTOB2]
else [goto LIVINTRO]

Question ID: NAE.170_00.000

Instrument Variable Name: MDTOB2
QuestionText:

In the PAST 12 MONTHS, has a medical doctor, dentist, or other health professional ADVISED you to quit smoking, or
quit using other kinds of tobacco?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have seen a doctor or other health professional in the past year and are current smokers or
former smokers who have quit in the past 12 months or who currently smoke cigars, use snuff, or chew tobacco
every day or some days
SkipInstructions:

(1) [goto HPTOB2] (2,R,D) [goto LIVINTRO]

Question ID: NAE.171_00.000

Instrument Variable Name: HPTOB2
QuestionText:

? [F1]
In the PAST 12 MONTHS, which health professional(s) advised you to quit smoking or quit using other kinds of tobacco?
*Read answer categories below.
*Enter all that apply, separate with commas.

1 Medical doctor
2 Dentist
3 Nurse
4 Dental Hygienist
5 Other health professional (specify)
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose doctor or other health professional advised them to quit smoking or using other kinds of
tobacco in the past 12 months
SkipInstructions:

(1-4,R,D) [goto LIVINTRO] (5) [goto HPTOTH]

Question ID: NAE.172_00.000

Instrument Variable Name: HPTOTH
QuestionText:

*Enter other health professional.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Sample adults 18+ who were advised to quit using tobacco by other health professional
SkipInstructions:

(allow 20,R,D) [goto LIVINTRO]

Question ID: NAE.173_00.000

Instrument Variable Name: LIVINTRO
QuestionText:

In a usual week, does ANYONE who lives here, including yourself, smoke cigarettes, cigars, or pipes anywhere inside this
home?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto LIVSMOKE]
(2,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section

Question ID: NAE.174_00.000

Instrument Variable Name: LIVSMOKE
QuestionText:

In a usual week, how many people WHO LIVE here, including yourself, smoke cigarettes, cigars, or pipes anywhere
INSIDE this home?
*Enter '0' for none.
*Enter '96' for 96 or more smokers.

00 None
01-95 1-95 persons
96 96+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have people living in the home that smoke in a usual week
SkipInstructions:

(1-96) [goto LVDYSMOK]
(0,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section

Question ID: NAE.176_00.000

Instrument Variable Name: LVDYSMOK
QuestionText:

Usually, about how many days per week do people WHO LIVE here smoke anywhere INSIDE this home?
*Enter '0' for less than 1 day per week/rarely/none
*Enter '7' for all days per week

00 Less than one day per week/rarely/none
01-07 1-7 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have at least one resident smoking inside the home
SkipInstructions:

(0-7,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section

Question ID: NAE.190_00.000

Instrument Variable Name: LIVEBTH
QuestionText:

Have you given birth to a live born infant within the past 5 years?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age 18-49
SkipInstructions:

(1) if SMKEV=1 [goto SMKPREG]; else [goto next section] (2,R,D) [goto next section]

Question ID: NAE.200_00.000
Instrument Variable Name: SMKPREG
QuestionText:

Were you smoking cigarettes when you became pregnant with your last child?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and have had a live
birth in the past 5 years
SkipInstructions:

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

Question ID: NAE.210_00.000

Instrument Variable Name: SMKLST
QuestionText:

Did you smoke cigarettes at any time during your pregnancy with your last child?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and have had a live
birth in the past 5 years
SkipInstructions:

(1) [goto QUTWK] (2,R,D) [goto next section]

Question ID: NAE.220_00.000

Instrument Variable Name: QUTWK
QuestionText:

Did you quit smoking for 7 days or longer during your pregnancy with your last child?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last
pregnancy
SkipInstructions:

(1) [goto MTHQUIT] (2,R,D) [goto next section]

Question ID: NAE.230_00.000

Instrument Variable Name: MTHQUIT
QuestionText:

In what month of your pregnancy did you quit for 7 days or longer?

01 First
02 Second
03 Third
04 Fourth
05 Fifth
06 Sixth
07 Seventh
08 Eighth
09 Ninth
97 Refused
99 Don't know

UniverseText: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last
pregnancy, but quit for 7 days or longer
SkipInstructions:

(1-9,R,D) [goto STSMOK]

Question ID: NAE.240_00.000

Instrument Variable Name: STSMOK
QuestionText:

Did you start smoking again during the pregnancy or did you stay off cigarettes for the rest of the pregnancy?

1 Stayed off rest of pregnancy
2 Started again
3 Never started again
7 Refused
9 Don't know

UniverseText: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last
pregnancy, but quit for 7 days or longer
SkipInstructions:

(1-3,R,D) [goto next section]

Cancer Screening

Question ID: NAF.010_00.000

Instrument Variable Name: SUN1HR
QuestionText:

? [F1]
Now, we are going to ask you about your skin's reaction to the sun. After several months of not being in the sun very
much, if you went out in the sun for an hour without sunscreen, a hat, or protective clothing, which one of these best
describes what would happen to your skin? (*Read choices 1-5 only)
*Read if necessary: Even if you did not go out in the sun, what would happen if you did? Use the most recent
experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more.

01 Get a severe sunburn with blisters
02 Have a moderate sunburn with peeling
03 Burn mildly with some or no darkening/tanning
04 Turn darker without sunburn
05 Nothing would happen to my skin
06 Do not go out in the sun
07 Other
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-7,R,D) [goto SUNTAN]

Question ID: NAF.015_00.000

Instrument Variable Name: SUNTAN
QuestionText:

? [F1]
Next, consider that you were out in the sun repeatedly, such as every day for two weeks, without sunscreen, a hat, or
protective clothing . Which one of these best describes what your skin would LOOK like? (*Read choices 1-5 only)
*Read if necessary: Even if you did not go out in the sun, what would happen if you did? Use the most recent
experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more.

01 Very dark or deeply tanned
02 Dark/Moderately tanned
03 A little dark/mildly tanned
04 Freckled but still light skinned
05 Burned repeatedly with little or no darkening or tanning---still light skinned
06 Don't go out in the sun
07 Other
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-7,R,D) [goto SUN1_SHA]

Question ID: NAF.020_00.000

Instrument Variable Name: SUN1_SHA
QuestionText:

When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Stay in the shade? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-6,R,D) [goto SUN1_CAP]

Question ID: NAF.022_00.000

Instrument Variable Name: SUN1_CAP
QuestionText:

*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a baseball cap or sun visor? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-6,R,D) [goto SUN_HAT1]

Question ID: NAF.023_00.000

Instrument Variable Name: SUN_HAT1
QuestionText:

(book) CAN4
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a hat that shades your face, ears AND neck such as a hat with a wide brim all around? Would you say (Read
categories 1-5). . .
*Read if necessary: Do not include visors, baseball caps, or hats that do not shade the face, ears and neck. Include
legionnaire hats.

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-6,R,D) [goto SUN2_LGS]

Question ID: NAF.024_00.000

Instrument Variable Name: SUN2_LGS
QuestionText:

*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a long sleeved shirt? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-6,R,D) [goto SUN2_LGP]

Question ID: NAF.025_00.000

Instrument Variable Name: SUN2_LGP
QuestionText:

*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear long pants or other clothing that reaches your ankles? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-6,R,D) [goto SUN2_SCR]

Question ID: NAF.026_00.000

Instrument Variable Name: SUN2_SCR
QuestionText:

*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Use sunscreen? Would you say (Read categories 1-5). . .

1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-4) [goto SPF] (5,6,R,D) [goto NBURN]

Question ID: NAF.027_00.000

Instrument Variable Name: SPF
QuestionText:

? [F1]
What is the SPF number of the sunscreen you use MOST often?
*Read if necessary: If you use more than one or different ones, pick the one used most often.
*Enter '96' if unable to pick the one used most often.
*Enter '50' if 50 or higher SPF.

01-49 1-49
50 50+
96 More than one, different ones, other
97 Refused

UniverseText: Sample adults 18+ who use sunscreen at least rarely
SkipInstructions:

(1-50) [goto NBURN]
(96,R,D) [goto SPFSCALE]
5(1-95) [goto ERR_SPF]

Question ID: NAF.028_00.000

Instrument Variable Name: SPFSCALE
QuestionText:

Is the SPF usually 1-14 or 15-50?
*Enter '2' if 50 or higher SPF.

1 1-14
2 15+
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who answered more than one, different ones, or other to SPF number, or did not know or
refused to say the SPF
SkipInstructions:

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

Question ID: NAF.030_00.000

Instrument Variable Name: NBURN
QuestionText:

DURING THE PAST 12 MONTHS, how many times have you had a sunburn?
*Read if necessary: By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more. Also
include burns from sunlamps and other indoor tanning devices.
*Enter '0' for none.

000 None
001-365 1-365 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-365,R,D) [goto SNONCE]

Question ID: NAF.032_00.000

Instrument Variable Name: SNONCE
QuestionText:

DURING THE PAST 12 MONTHS, have you used an indoor tanning device such as a sunlamp, sunbed, or tanning booth
EVEN ONE TIME? Do NOT include times you have gotten a spray-on tan.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto SNNUM1](2,R,D) [goto SKNX]

Question ID: NAF.033_00.000

Instrument Variable Name: SNNUM1
QuestionText:

DURING THE PAST 12 MONTHS, how many times have you used an indoor tanning device such as a sunlamp, sunbed
or tanning booth? Do NOT include times you have gotten a spray-on tan.

001-365 1-365 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who have used indoor tanning device in past year
SkipInstructions:

(1-365,R,D) [goto SKNX]

Question ID: NAF.040_00.000

Instrument Variable Name: SKNX
QuestionText:

Now we are going to ask you about medical tests and exams that check for cancer. Have you EVER had all of your skin
from head to toe checked for cancer either by a dermatologist or some other kind of doctor?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto RSKX1_MT]
(2,R,D) [if SEX=2 goto MENSTAGE;
else if SEX=1 and AGE le 64 [goto HPVHRD]
else if SEX=1 and AGE ge 65 [goto CHESTX]

Question ID: NAF.050_01.000

Instrument Variable Name: RSKX1_MT
QuestionText:

1 of 2
When did you have your MOST RECENT skin exam to check for cancer?
*Enter month of last skin exam.
* Enter '96' to go to the number and 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 had a skin exam
SkipInstructions:

(1-12,D) [goto RSKX1_YR]
(R) store "R' in RSKX1_YR [goto RSKX2]
(96) store "9996" in RSKX1_YR [goto RSKX1N]

Question ID: NAF.050_02.000

Instrument Variable Name: RSKX1_YR
QuestionText:

2 of 2
*Enter year of last skin exam.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 18+ who answered month of last skin exam or didn't know month of last skin exam
SkipInstructions:

(valid year) if RSKX1_YR gt current year or (RSKX1_YR=current year and RSKX1_MT gt current month)
goto ERR1_ RSKX1_YR (future date)
elseif RSKX1_YR lt DOBY or (RSKX1_YR=DOBY and RSKX1_MT lt DOBM)
goto ERR2_ RSKX1_YR (prior to birth date)
elseif RSKX1_MT=D and RSKX1_YR current year-5
set RSKX2=5
goto SKINREAS
elseif RSKX1_MT=D and RSKX1_YR = current year-4
set RSKX2=4
goto SKINREAS
elseif RSKX1_MT=D and RSKX1_YR = current year
set RSKX2=1
goto SKINREAS
elseif RSKX1_MT=D and (RSKX1_YR = current year-1 or RSKX1_YR = current year-2 or RSKX1_YR =
current year-3 or RSKX1_YR = current year-5)
goto RSKX2
elseif RSKX1_MT=1-12
goto SKINREAS
(R,D) goto RSKX2

Question ID: NAF.055_01.000

Instrument Variable Name: RSKX1N
QuestionText:

1 of 2
When did you have your MOST RECENT skin exam?
*Enter number for time since last skin exam.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 18+ who selected number and time period format for most recent skin exam
SkipInstructions:

(1-95) [goto RSKX1T] (R,D) store "R,D" in RSKX1T [goto RSKX2]

Question ID: NAF.055_02.000

Instrument Variable Name: RSKX1T
QuestionText:

2 of 2
*Enter time period for time since most recent skin exam.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto SKINREAS
(4) if RSKX1N=4
set RSKX2=4
goto SKINREAS
elseif RSKX1N gt 5 and RSKX1N gt AGE
goto ERR_RSKX1T (greater than persons age)
elseif RSKX1N gt 5 and RSKX1N le AGE
set RSKX2=5
goto SKINREAS
elseif RSKX1N=1,2,3,5
goto RSKX2
(R,D) goto RSKX2

Question ID: NAF.060_00.000

Instrument Variable Name: RSKX2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last skin exam was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RSKX2] else [goto SKINREAS]

Question ID: NAF.070_00.000

Instrument Variable Name: SKINREAS
QuestionText:

What was the MAIN reason you had this skin exam -- was it part of a routine exam, because of a problem, or some other
reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have had a skin exam
SkipInstructions:

(1-3,R,D) if SEX=2 [goto MENSTAGE]
else if SEX=1 and AGE le 64 [goto HPVHRD]
else if SEX=1 and AGE ge 65 [goto CHESTX]

Question ID: NAF.080_00.000

Instrument Variable Name: MENSTAGE
QuestionText:

The following questions are about women's health. How old were you when your periods or menstrual cycles started?
*Enter '0' for haven't started.

00 Haven't started
06-60 6-60 years
97 Refused
99 Don't know

UniverseText: Female sample adults 18+
SkipInstructions:

(6-60,R,D) if MENSTAGE gt AGE [goto ERR1_MENSTAGE]
elseif AGE ge 39 [goto MENSTILL]
else if AGE le 38 and nae.LIVEBTH ne '1' [goto BIRTHEV]
elseif AGE le 38 and nae.LIVEBTH = '1' [goto BIRTHNUM]
(0) if nae.LIVEBTH ne '1' goto BIRTHEV
else goto BIRTHNUM
(1-5) [goto ERR2_MENSTAGE]

Question ID: NAF.090_00.000

Instrument Variable Name: MENSTILL
QuestionText:

Do you still have periods or menstrual cycles?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:
Female sample adults 39+ who have started menstrual cycles
SkipInstructions:

(1,R,D) if nae.LIVEBTH ne '1' [goto BIRTHEV]
elseif nae.LIVEBTH = '1' [goto BIRTHNUM]
(2) [goto MENLAST]

Question ID: NAF.100_00.000

Instrument Variable Name: MENLAST
QuestionText:

When did you have your last period or menstrual cycle? Was it...
* Read categories below.

1 1 year ago or less
2 More than 1 year ago but less than 2 years ago
3 2 years ago or more
7 Refused
9 Don't know

UniverseText: Female sample adults 39+ who do not have periods any more
SkipInstructions:

(1-3,R,D) if nae.LIVEBTH ne '1' [goto BIRTHEV]
elseif nae.LIVEBTH = '1' [goto BIRTHNUM]

Question ID: NAF.110_00.000

Instrument Variable Name: BIRTHEV
QuestionText:

*If you remember that the respondent mentioned having a biological child in the core, verify the information and enter '1'
for yes (and don't ask question).
Have you EVER given birth to a live born infant?
*Read if necessary.
A live born infant is an infant born alive.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who did not already answer they had a live birth
SkipInstructions:

(1) [goto BIRTHNUM] (2,R,D) [goto PAPHAD]

Question ID: NAF.111_00.000

Instrument Variable Name: BIRTHNUM
QuestionText:

What is the total number of live births (live born children) you have had?
*Enter '25' for 25 or more.

01-24 1-24
25 25+
97 Refused

UniverseText: Female sample adults 18+ who have ever had a live born infant
SkipInstructions:

(1-25,R,D) [goto BIRTHAGE]

Question ID: NAF.120_00.000

Instrument Variable Name: BIRTHAGE
QuestionText:

How old were you when your [fill1: child/first child] was born?

06-60 6-60 years
97 Refused
99 Don't know

UniverseText: Female sample adults 18+ who have ever had a live born infant
SkipInstructions:

(6-60,R) if BIRTHAGE GT AGE [goto ERR_BIRTHAGE] else [goto PAPHAD1]
(D) [goto BIRTHAG2]

Question ID: NAF.121_00.000

Instrument Variable Name: BIRTHAG2
QuestionText:

What year was your [fill1: child/first child] born?

1890-2011 1890-2011
9997 Refused
9999 Don't know

UniverseText: Female sample adults 18+ who didn't know their age at first's child's birth
SkipInstructions:

1880-2011,R,D) if BIRTHAG2 gt current year [goto ERR1_BIRTHAG2]
elseif BIRTHAG2 gt year of birth (DOBY) [goto ERR2_BIRTHAG2]
else [goto PAPHAD1]

Question ID: NAF.130_00.000

Instrument Variable Name: PAPHAD1
QuestionText:

Have you EVER HAD a Pap smear or Pap test?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the
cervix with a small stick or brush, and sends it to the lab.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+
SkipInstructions:

(1) if AGE 18-30 [goto PAPFRST1] else [goto PAP6YR1] (2) [goto PAPNOT1] (R,D) if AGE le 65 [goto
PREMIND] else [goto HYST]

Question ID: NAF.135_00.000

Instrument Variable Name: PAPFRST1
QuestionText:

At what age did you have your first Pap test?

06-30 6-30 years
97 Refused
99 Don't know

UniverseText: Female sample adults 18-30 who have ever had a Pap smear
SkipInstructions:

(6-30,R,D) if PAPFRST1 gt AGE(HHSTAT4='S') [goto ERR_PAPFRST1]
else [goto PAP6YR1]

Question ID: NAF.140_00.000

Instrument Variable Name: PAP6YR1
QuestionText:

How many Pap tests have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more exams.

00 None
01-94 1-94
+95 95
97 Refused
99 Don't know

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(0-95,R,D) [goto RPAP1_M1]

Question ID: NAF.150_01.000

Instrument Variable Name: RPAP1_M1
QuestionText:

1 of 2
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and 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: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-12,D) [goto RPAP1_Y1] (R) store "R' in RPAP1_Y1 [goto RPAP21] (96) store "9996" in RPAP1_Y1 [goto
RPAP1N1]

Question ID: NAF.150_02.000

Instrument Variable Name: RPAP1_Y1
QuestionText:

2 of 2
*Enter year of last Pap test.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age 18+ who answered month of last Pap smear test or didn't know month of last Pap smear
test
SkipInstructions:

(valid year) if RPAP1_Y1 gt current year or (RPAP1_Y1=current year and RPAP1_M1 gt current month)
goto ERR1_ RPAP1_Y1 (future date)
elseif RPAP1_Y1 lt DOBY or (RPAP1_Y1=DOBY and RPAP1_M1 lt DOBM)
goto ERR2_ RPAP1_Y1 (prior to birth date)
elseif RPAP1_M1=D
goto RPAP21
elseif RPAP1_M1=1-12
goto PAPREA1
(R,D) goto RPAP21

Question ID: NAF.160_01.000

Instrument Variable Name: RPAP1N1
QuestionText:

1 of 2
When did you have your MOST RECENT Pap test?
*Enter number for time since last Pap test.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults 18+ who selected number and time period format for most recent Pap smear test from the
initial month screen
SkipInstructions:

(1-95) [goto RPAP1T1] (R,D) store "R,D" in RPAP1T1 [goto RPAP21]

Question ID: NAF.160_02.000

Instrument Variable Name: RPAP1T1
QuestionText:

2 of 2
*Enter time period for time since most recent Pap test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto PAPREA1
(4) if RPAP1N1=4
set RPAP21=4
goto PAPREA1
elseif RPAP1N1 gt 5 and RPAP1N1 gt AGE
goto ERR_RPAP1T1 (greater than persons age)
elseif RPAP1N1 gt 5 and RPAP1N1 le AGE
set RPAP21=5
goto PAPREA1
elseif RPAP1N1=1,2,3,5
goto RPAP21
(R,D) goto RPAP21

Question ID: NAF.165_00.000

Instrument Variable Name: RPAP21
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last Pap smear test was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RPAP21] else [goto PAPREA1]

Question ID: NAF.170_00.000

Instrument Variable Name: PAPREA1
QuestionText:

What was the MAIN reason you had this Pap test - was it part of a routine exam, because of a problem, or some other
reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-3,R,D) [goto PRESULT]

Question ID: NAF.175_00.000

Instrument Variable Name: PRESULT
QuestionText:

Did you get the results of your MOST RECENT Pap test?

1 Yes
2 No
3 Only notified if there was a problem
7 Refused
9 Don't know

UniverseText:
Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-3,R,D) if (RPAP21 = 1,2,3) or (RPAP1T1 = 1,2) or (RPAP1_Y1 = (current year -- 3) and RPAP1_M1 ge
current month) or (RPAP1_Y1 gt (current year -- 3)) or (RPAP1T1 = 3 and RPAP1N1 le 36) [goto PAPABN3]
elseif (RPAP21 = 4,5) or (RPAP1_Y1 = (current year -- 3) and RPAP1_M1 lt current month) or (RPAP1_Y1 lt
(current year -- 3)) or (RPAP1T1 = 3 and RPAP1N1 gt 36) [goto PAPNOT1]
elseif RPAP21 = R,D [goto MDRECP1]

Question ID: NAF.180_00.000

Instrument Variable Name: PAPABN3
QuestionText:

Have you had a Pap test in the LAST 3 YEARS where the results were NOT normal?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have had a Pap smear in the past 3 years
SkipInstructions:

(1) [goto PAPADDE] (2,R,D) [goto MDRECP1]

Question ID: NAF.190_00.000

Instrument Variable Name: PAPADDE
QuestionText:

Because of these results, was it recommended that you have more follow-up exams or tests?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have had an abnormal Pap smear in past 3 years
SkipInstructions:

(1) [goto PAPTRT]
(2,R,D) [goto MDRECP1]

Question ID: NAF.200_00.000

Instrument Variable Name: PAPTRT
QuestionText:

Did you follow the recommendation to have more follow-up exams or tests?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have had an abnormal Pap smear in past 3 years and told to have more tests
SkipInstructions:

(1,R,D) [goto MDRECP1] (2) [goto PNOTFOL]

Question ID: NAF.209_00.000

Instrument Variable Name: PNOTFOL
QuestionText:

What is the most important reason that you DID NOT follow the recommendation to have more follow-up exams or tests?
*Put response into correct category below.

01 No reason/never thought about it
02 Put if off/didn't get around to it
03 Too expensive/no insurance/cost
04 Too painful, unpleasant, or embarrassing
05 Had hysterectomy
06 Don't have doctor
07 Fear
08 Other
97 Refused
99 Don't know

UniverseText: Female sample adults 18+ who did not follow advice to have more tests
SkipInstructions:

(1-8,R,D) [goto MDRECP1]

Question ID: NAF.210_00.000

Instrument Variable Name: PAPNOT1
QuestionText:

What is the most important reason you have [Fill1: NEVER had a Pap test/NOT had a Pap test in the LAST 3 YEARS]?
*Put response into correct category below.

01 No reason/never thought about it
02 Didn't need it/didn't know I needed this type of test
03 Doctor didn't order it/didn't say I needed it
04 Haven't had any problems
05 Put it off/didn't get around to it
06 Too expensive/no insurance/cost
07 Too painful, unpleasant, or embarrassing
08 Had hysterectomy
09 Don't have doctor
10 Had an HPV DNA test
11 Had HPV vaccine
12 Other
97 Refused
99 Don't know

UniverseText: Female sample adults 18+ who have never had a Pap smear, or who have not had a Pap smear in the last 3 years
SkipInstructions:

(1,2,4-7,10-12,R,D) [goto MDRECP1]
(3) if age le 65 [goto PREMIND]
elseif age ge 66 [goto HYST]
(8) [goto RHYS1_MT]
(9) [goto HYST]

Question ID: NAF.215_00.000

Instrument Variable Name: MDRECP1
QuestionText:

Fill1 (IF PAPHAD1=1 and most recent screening exam LE 3 years from system date)
"Was your most recent Pap test recommended by a doctor or other health professional?"
Else (IF PAPHAD1=2, or PAPHAD1=1 and GT 3 years from system date or RPAP21=R,D)
"In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a PAP test?"

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who had a doctor, who didn't answer that her doctor didn't recommend a Pap Smear,
who haven't had a hysterectomy, and gave a reason for not having Pap test ever/in the last 3 years
SkipInstructions:

(1,2,3,R,D) if AGE le 65 and ((PAPHAD1 = '2') or (RPAP21 = 4,5) or (RPAP1_Y1 = (current year -- 3) and
RPAP1_M1 lt current month) or (RPAP1_Y1 lt (current year -- 3)) or (RPAP1T1 = 3 and RPAP1N1 gt 36)) [goto
PREMIND];
elseif AGE le 65 and ((RPAP21 = 1,2,3) or (RPAP1T1 = 1,2) or (RPAP1_Y1 = (current year -- 3) and RPAP1_M1
ge current month) or (RPAP1_Y1 gt (current year -- 3)) or (RPAP1T1 = 3 and RPAP1N1 le 36)) [goto HYST];
else if AGE ge 66 [goto HYST]

Question ID: NAF.217_00.000

Instrument Variable Name: PREMIND
QuestionText:

Would a reminder to have a pap test from your doctor or other health professional be helpful to you?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18-65 who had a doctor, who haven't had a hysterectomy and have never had a Pap test or
have not had a Pap test in the last 3 years
SkipInstructions:

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

Question ID: NAF.220_00.000

Instrument Variable Name: HYST
QuestionText:

Have you had a hysterectomy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have not already indicated they have had a hysterectomy
SkipInstructions:

(1) [goto RHYS1_MT] (2,R,D) [goto OVARIES]

Question ID: NAF.221_01.000

Instrument Variable Name: RHYS1_MT
QuestionText:

1 of 2
When was your hysterectomy?
*Enter month of hysterectomy.
*Enter '96' to go to number and 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: Female sample adults 18+ who have ever had a hysterectomy
SkipInstructions:

(1-12,D) [goto RHYS1_YR] (R) store "R' in RHYS1_YR [goto RHYS2] (96) store "9996" in RHYS1_YR
[goto RHYS1N]

Question ID: NAF.221_02.000

Instrument Variable Name: RHYS1_YR
QuestionText:

2 of 2
*Enter year of hysterectomy.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age 18+ who answered month of hysterectomy or didn't know month of hysterectomy
SkipInstructions:

(valid year) if RHYS1_YR gt current year or (RHYS1_YR=current year and RHYS1_MT gt current month)
goto ERR1_ RHYS1_YR (future date)
elseif RHYS1_YR lt DOBY or (RHYS1_YR=DOBY and RHYS1_MT lt DOBM)
goto ERR2_ RHYS1_YR (prior to birth date)
elseif RHYS1_MT=D
goto RHYS2
elseif RHYS1_MT=1-12
goto OVARIES
(R,D) goto RHYS2

Question ID: NAF.222_01.000

Instrument Variable Name: RHYS1N
QuestionText:

1 of 2
When was your hysterectomy?
*Enter number for time since hysterectomy.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults 18+ who selected number and time period format for hysterectomy from the initial month
screen
SkipInstructions:

(1-95) [goto RHYS1T] (R,D) store "R,D" in RHYS1T [goto RHYS2]

Question ID: NAF.222_02.000

Instrument Variable Name: RHYS1T
QuestionText:

2 of 2
*Enter time period for time since hysterectomy.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto OVARIES
(4) if RHYS1N=4
set RHYS2=4
goto OVARIES
elseif RHYS1N gt 5 and RHYS1N gt AGE
goto ERR_RHYS1T (greater than persons age)
elseif RHYS1N gt 5 and RHYS1N le AGE
set RHYS2=5
goto OVARIES
elseif RHYS1N=1,2,3,5
goto RHYS2
(R,D) goto RHYS

Question ID: NAF.225_00.000

Instrument Variable Name: RHYS2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose hysterectomy was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RHYS2] else [goto OVARIES]

Question ID: NAF.226_00.000

Instrument Variable Name: OVARIES
QuestionText:

Have you EVER had BOTH ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age 18+
SkipInstructions:

(1) [goto OVARAGE] (2,R,D) if age LE 64 [goto HPVHRD] else [goto MAMHAD]

Question ID: NAF.227_00.000

Instrument Variable Name: OVARAGE
QuestionText:

How old were you when you had BOTH of your ovaries removed?

001-120 1-120 years
997 Refused
999 Don't know

UniverseText:
Female sample adults age 18+ who have had BOTH ovaries removed
SkipInstructions:

(1-120,R,D) if OVARAGE GT AGE [goto ERR_OVARAGE]
elseif age LE 64 [goto HPVHRD] else [goto MAMHAD]

Question ID: NAF.228_01.000

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) [goto HPVHAD]
(2,R,D) goto SHHPVHRD

Question ID: NAF.228_02.000

Instrument Variable Name: HPVHAD
QuestionText:

Have you ever been told by a doctor or other health professional that you had HPV?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults LE 64 who have ever heard of HPV
SkipInstructions:

(1,2,R,D) goto SHHPVHRD

Question ID: NAF.228_03.000

Instrument Variable Name: SHHPVHRD
QuestionText:

Two vaccines, or shots, to prevent HPV infection are available in the United States. Both vaccines prevent cervical cancer
and one also prevents genital warts. The two HPV vaccines are sometimes called CERVARIX? or GARDASIL?.
Before this survey, have you ever heard of HPV vaccines or shots?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults age LE 64
SkipInstructions:

(1,2,R,D) goto SHTHPV

Question ID: NAF.228_04.000

Instrument Variable Name: SHTHPV
QuestionText:

Have you ever received an HPV shot or vaccine?

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

UniverseText: Sample adults age LE 64
SkipInstructions:

(1) goto SHHPVDOS
(2,3,R,D) if SEX=2
goto HPVINT
elseif SEX=1 and AGE ge 40
goto CHESTX
elseif SEX=1 and AGE = 18-39
goto ASPIRIN

Question ID: NAF.228_05.000

Instrument Variable Name: SHHPVDOS
QuestionText:

How many HPV shots did you receive?
*Enter '50' if 50 or more shots
*Enter '96' for all shots

01-49 1-49
50 50+
96All shots
97 Refused
99 Don't know

UniverseText: Sample adults age LE 64 who have had a HPV shot
SkipInstructions:

1-50,(96,R,D) if SEX=2
goto HPV_MT
elseif SEX=1 and AGE ge 40
goto CHESTX
elseif SEX=1 and AGE = 18-39
goto ASPIRIN
5(1-95) goto ERR_SHHPVDOS

Question ID: NAF.228_06.000

Instrument Variable Name: HPV_MT
QuestionText:

1 of 2
When was your last HPV shot?
*Enter month of last HPV shot.
*Enter '96' to go to number and 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: Female sample adults age LE 64 who have ever had a HPV shot
SkipInstructions:

(1-12,D) [goto HPV_YR] (R) store "R' in HPV_YR [goto HPV2] (96) store "9996" in HPV_YR [goto HPVN]

Question ID: NAF.228_07.000

Instrument Variable Name: HPV_YR
QuestionText:

2 of 2
*Enter year of last HPV shot.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age LE 64 who answered month of last HPV shot or didn't know month of last HPV shot
SkipInstructions:

(2006-2011) if HPV_YR gt current year or (HPV_YR=current year and HPV_MT gt current month)
goto ERR_ HPV_YR (future date)
elseif HPV_MT=D
goto HPV2
elseif HPV_MT=1-12
if AGE ge 30
goto MAMHAD
elseif AGE = 18-29
goto ASPIRIN
(R,D) goto HPV2

Question ID: NAF.228_08.000

Instrument Variable Name: HPVN
QuestionText:

1 of 2
When was your last HPV shot?
*Enter number for time since last HPV shot.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults age LE 64 who selected number and time period format for HPV from the initial month
screen
SkipInstructions:

(1-95) [goto HPVT] (R,D) store "R,D" in HPVT [goto HPV2]

Question ID: NAF.228_09.000

Instrument Variable Name: HPVT
QuestionText:

2 of 2
*Enter time period for time since last HPV shot.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults age LE 64 who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-2) if AGE ge 30 [goto MAMHAD]
elseif AGE = 18-29 [goto ASPIRIN]
(3) if HPVN gt 48
goto ERR_HPVT (before vaccine available)
(4) if HPVN=4
set HPV2=4
if AGE ge 30 [goto MAMHAD]
elseif AGE = 18-29 [goto ASPIRIN]
elseif HPVN ge 5
goto ERR_HPVT (before vaccine available)
elseif HPVN=1,2,3
goto HPV2
(R,D) goto HPV2

Question ID: NAF.228_10.000

Instrument Variable Name: HPV2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Female sample adults age LE 64 who failed to give a complete date in either the month or year format or failed to
give a complete date in the number and time period format, or entered years ago in the time period format
SkipInstructions:

(1-4,R,D) if answer code is grayed out [goto ERR_HPV2]
elseif AGE GE 30 [goto MAMHAD]; elseif AGE = 18-29 [goto ASPIRIN]

Question ID: NAF.229_01.000

Instrument Variable Name: HPVINT
QuestionText:

Would you be interested in getting the HPV vaccine?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age LE 64 who have never had a HPV shot or doctor refused when asked to give shot or
Ref/DK this information
SkipInstructions:

(1) goto HPVCOST
(2,D) goto HPVNOT
(R) if AGE ge 30 [goto MAMHAD] elseif AGE = 18-29 [goto ASPIRIN]

Question ID: NAF.229_02.000

Instrument Variable Name: HPVNOT
QuestionText:

What is the MAIN reason you would NOT want to get the vaccine?

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

UniverseText: All female sample adults LE 64 year old who are not interested in getting the HPV shot or said don't know for
interested in getting the shot
SkipInstructions:

1,2,4-1(1,R,D) if AGE ge 30 [goto MAMHAD] else if AGE=18-29 [goto ASPIRIN]
(3) goto HPVLOCST

Question ID: NAF.229_03.000

Instrument Variable Name: HPVCOST
QuestionText:

The cost of the vaccine may be about $360-$500. Would you get the HPV vaccine if you had to pay this amount?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age LE 64 who are interested in getting the HPV vaccine
SkipInstructions:

(1,R,D) if AGE ge 30
goto MAMHAD
elseif AGE=18-29
goto ASPRIN
(2) goto HPVLOCST

Question ID: NAF.229_04.000

Instrument Variable Name: HPVLOCST
QuestionText:

If you could get the HPV vaccine free or at a much lower cost, would you get it?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age LE 64 who would not pay $360-500 for the HPV vaccine or for whom the main reason
not to get the vaccine was because it was too expensive
SkipInstructions:

(1,2,R,D) if AGE ge 30
[goto MAMHAD]
elseif AGE=18-29
[goto ASPIRIN]

Question ID: NAF.230_00.000

Instrument Variable Name: MAMHAD
QuestionText:

Have you EVER HAD a mammogram?
*Read if necessary.
A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults age 30+
SkipInstructions:

(1) [goto MAMAGE] (2) [goto MAMNOT] (R,D) [goto CBEHAD]

Question ID: NAF.240_00.000

Instrument Variable Name: MAMAGE
QuestionText:

About how old were you when you had your first mammogram? Were you:
*Read answer categories.

1 Under 30 years
2 30-39
3 40-49
4 50-59
5 60 years or older
7 Refused
9 Don't know

UniverseText: Female sample adults age 30+ who have ever had a mammogram
SkipInstructions:

(1,2) if answer code is grayed out [goto ERR_MAMAGE] else [goto MAMREA]
(3-5,R,D) if answer code is grayed out [goto ERR_MAMAGE] else [goto MAM6YR]

Question ID: NAF.245_00.000

Instrument Variable Name: MAMREA
QuestionText:

What was the MAIN reason you had your first mammogram?
*Put response into correct category below.

1 Because of a breast problem
2 My healthcare provider told me I was high-risk
3 Family history of breast cancer
4 Part of a routine exam
5 I requested it
6 Other reason
7 Refused
9 Don't know

UniverseText: Female sample adults age 30+ who have ever had a mammogram and who had first mammogram at age 39 or less
SkipInstructions:

(1-6,R,D) [goto MAM6YR]

Question ID: NAF.250_00.000

Instrument Variable Name: MAM6YR
QuestionText:

How many mammograms have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more mammograms.

00 None
01-94 1-94
95 95+
97 Refused
99 Don't know

UniverseText: Female sample adults 30+ who have ever had a mammogram
SkipInstructions:

(0-95,R,D) [goto RMAM1_MT]

Question ID: NAF.260_01.000

Instrument Variable Name: RMAM1_MT
QuestionText:

1 of 2
When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and 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: Female sample adults 30+ who have ever had a mammogram
SkipInstructions:

(1-12,D) [goto RMAM1_YR] (R) store "R' in RMAM1_YR [goto RMAM2] (96) store "9996" in
RMAM1_YR [goto RMAM1N]

Question ID: NAF.260_02.000

Instrument Variable Name: RMAM1_YR
QuestionText:

2 of 2
*Enter year of last mammogram.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age 30+ who answered month of last mammogram or didn't know month of last mammogram
SkipInstructions:

(valid year) if RMAM1_YR gt current year or (RMAM1_YR=current year and RMAM1_MT gt current month)
goto ERR1_ RMAM1_YR (future date)
elseif RMAM1_YR lt DOBY or (RMAM1_YR=DOBY and RMAM1_MT lt DOBM)
goto ERR2_ RMAM1_YR (prior to birth date)
elseif RMAM1_MT=D
goto RMAM2
elseif RMAM1_MT=1-12
goto MAMREAS
(R,D) goto RMAM2

Question ID: NAF.270_01.000

Instrument Variable Name: RMAM1N
QuestionText:

1 of 2
When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults 30+ who selected number and time period format for most recent mammogram from the
initial month screen
SkipInstructions:

(1-95) [goto RMAM1T] (R,D) store "R,D" in RMAM1T [goto RMAM2]

Question ID: NAF.270_02.000

Instrument Variable Name: RMAM1T
QuestionText:

2 of 2
*Enter time period for time since most recent mammogram.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto MAMREAS
(4) if RMAM1N=4
set RMAM2=4
goto MAMREAS
elseif RMAM1N gt 5 and RMAM1N gt AGE
goto ERR_RMAM1T (greater than persons age)
elseif RMAM1N gt 5 and RMAM1N le AGE
set RMAM2=5
goto MAMREAS
elseif RMAM1N=1,2,3,5
goto RMAM2
(R,D) goto RMAM2

Question ID: NAF.275_00.000

Instrument Variable Name: RMAM2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last mammogram was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RMAM2]
else [goto MAMREAS]

Question ID: NAF.310_00.000

Instrument Variable Name: MAMREAS
QuestionText:

What was the MAIN reason you had this mammogram -- was it part of a routine exam, because of a problem, or some
other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have ever had a mammogram
SkipInstructions:

(1-3,R,D) [goto MAMABN]

Question ID: NAF.320_00.000

Instrument Variable Name: MAMABN
QuestionText:

After your MOST RECENT mammogram, was it recommended that you have more tests?
*Read if necessary: More tests may include another mammogram, a sonogram, an MRI, a biopsy, or something else to
check for problems in your breast.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have ever had a mammogram
SkipInstructions:

(1) [goto MFOLLOW] (2,R,D) [goto LUMPEV2]

Question ID: NAF.325_00.000

Instrument Variable Name: MFOLLOW
QuestionText:

Did you follow the recommendation to have more tests?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have ever had a mammogram and was recommended to have more tests
SkipInstructions:

(1) [goto MAMCAN]
(2) [goto MNOTFOL]
(R,D) [goto LUMPEV2]

Question ID: NAF.330_00.000

Instrument Variable Name: MNOTFOL
QuestionText:

What is the most important reason why you DID NOT follow the recommendation to have more tests?
*Put response into correct category below.

01 No reason/never thought about it
02 Put if off/didn't get around to it
03 Too expensive/no insurance/cost
04 Too painful, unpleasant, or embarrassing
05 I'm too young
06 Don't have doctor
07 Fear
08 Other
97 Refused
99 Don't know

UniverseText: Female sample adults 30+ who have ever had a mammogram and did not follow recommendation to have more
tests
SkipInstructions:

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

Question ID: NAF.335_00.000

Instrument Variable Name: MAMMODE
QuestionText:

*Record mode of previous question.

1 In person
2 Over the telephone

UniverseText: Female sample adults 30+ who have ever had a mammogram and did not follow recommendation to have more
tests
SkipInstructions:

(1,2) [goto LUMPEV2]

Question ID: NAF.340_00.000

Instrument Variable Name: MAMCAN
QuestionText:

As a result of these additional tests after your mammogram(s), were you diagnosed with cancer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who followed recommendation for follow-up after a mammogram
SkipInstructions:

(1) [goto MFOUND]
(2,R,D) [goto LUMPEV2]

Question ID: NAF.345_00.000

Instrument Variable Name: MFOUND
QuestionText:

How was your breast cancer found?
*Put response into correct category below.

01 Found by myself by accident
02 Found by myself during a self-breast examination
03 Found by my spouse or partner
04 Found by my physician during routine breast exam
05 Found by mammogram
06 Found by Magnetic Resonance Imaging (MRI)
07 Other: specify
97 Refused
99 Don't know

UniverseText: Female sample adults 30+ who followed recommendation for follow-up after a mammogram and were diagnosed
with cancer
SkipInstructions:

(1-6,R,D) [goto LUMPEV2]
(7) [goto MFOUND2]

Question ID: NAF.346_00.000

Instrument Variable Name: MFOUND2
QuestionText:

How was your breast cancer found?
*Record verbatim response.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Female sample adults 30+ who followed recommendation for follow-up after a mammogram and were diagnosed
with cancer
SkipInstructions:

(allow 75,R,D) [goto LUMPEV2]

Question ID: NAF.350_00.000

Instrument Variable Name: LUMPEV2
QuestionText:

Have you EVER HAD a biopsy to test or remove a lump from your breast that was found NOT to be cancer?
*Read if necessary: A biopsy is the removal of a sample of tissue to see whether cancer cells are present.

1 Yes
2 No
3 Lump removed was cancerous
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have ever had a mammogram
SkipInstructions:

(1) [goto LUMPNUM2]
(2,3,R,D) if (RMAM2 = 3,4,5) or (RMAM1_YR = (current year -- 2) and RMAM1_MT lt current month) or
(RMAM1_YR lt (current year -- 2)) or (RMAM1T = 3 and RMAM1N gt 24)
[goto MAMNOT1]
elseif (RMAM2 = 1,2,R,D) or (RMAM1T = 1,2) or (RMAM1_YR = (current year -- 2) and RMAM1_MT ge
current month) or (RMAM1_YR gt (current year -- 2)) or (RMAM1T = 3 and RMAM1N le 24)
[goto MDRECMAM]

Question ID: NAF.351_00.000

Instrument Variable Name: LUMPNUM2
QuestionText:

How many of these biopsies have you had?
*Enter '95' if 95 or more biopsies
*Read if necessary: A biopsy is the removal of a sample of tissue to see whether cancer cells are present

01-94 1-94
95 95+
97 Refused

UniverseText: Female sample adults 30+ who have had a lump removed that was not cancerous
SkipInstructions:

(1-95,R,D) if (RMAM2 = 3,4,5) or (RMAM1_YR = (current year -- 2) and RMAM1_MT lt current month) or
(RMAM1_YR lt (current year -- 2)) or (RMAM1T = 3 and RMAM1N gt 24)
[goto MAMNOT1]
elseif (RMAM2 = 1,2,R,D) or (RMAM1T = 1,2) or (RMAM1_YR = (current year -- 2) and RMAM1_MT ge
current month) or (RMAM1_YR gt (current year -- 2)) or (RMAM1T = 3 and RMAM1N le 24)
[goto MDRECMAM]

Question ID: NAF.360_00.000

Instrument Variable Name: MAMNOT
QuestionText:

What is the most important reason why you have [fill1: NEVER had a mammogram/NOT had a mammogram in the PAST
2 YEARS]?
*Put response into correct category below.

01 No reason/never thought about it
02 Didn't need it/didn't know I needed this type of test
03 Doctor didn't order it/didn't say I needed it
04 Haven't had any problems
05 Put it off/Didn't get around to it
06 Too expensive/no insurance/cost
07 Too painful, unpleasant or embarrassing
08 I'm too young
09 Don't have doctor
10 Other
97 Refused
99 Don't know

UniverseText: Female sample adults 30+ who have never had a mammogram or had a last mammogram more than 2 years ago
SkipInstructions:

(1-2,4-8,10,R,D) [goto MDRECMAM] (3,9) [goto CBEHAD]

Question ID: NAF.370_00.000

Instrument Variable Name: MDRECMAM
QuestionText:

Fill1 (IF MAMHAD=1 and most recent screening exam LE 2 years from system date)
[Was your most recent mammogram recommended by a doctor or other health professional?]
Else (IF MAMHAD=2, or MAMHAD GT 2 years from system date or RMAM2=R,D)
[In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a mammogram?]

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have a doctor and had a mammogram in the past 2 years
SkipInstructions:

(1,2,3,R,D) [goto CBEHAD]

Question ID: NAF.390_00.000

Instrument Variable Name: CBEHAD
QuestionText:

Have you EVER HAD a breast exam done by a doctor or other health professional to check for lumps or other signs of
breast cancer?
*Read if necessary.
A breast exam is when the breasts are felt by a doctor or other health professional to check for lumps or other signs of
breast cancer.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+
SkipInstructions:

(1) [goto RCBE1_MT] (2,R,D) [goto MRIHAD]

Question ID: NAF.400_01.000

Instrument Variable Name: RCBE1_MT
QuestionText:

1 of 2
When did you have your MOST RECENT breast exam?
*Enter month of last breast exam.
*Enter '96' to go to number and 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: Female sample adults 30+ who have ever had a breast exam
SkipInstructions:

(1-12,D) [goto RCBE1_YR] (R) store "R' in RCBE1_YR [goto RCBE2] (96) store "9996" in RCBE1_YR
[goto RCBE1N]

Question ID: NAF.400_02.000

Instrument Variable Name: RCBE1_YR
QuestionText:

2 of 2
*Enter year of last breast exam.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age 30+ who answered month of last breast exam or didn't know month of last breast exam
SkipInstructions:

(valid year) if RCBE1_YR gt current year or (RCBE1_YR=current year and RCBE1_MT gt current month)
goto ERR1_ RCBE1_YR (future date)
elseif RCBE1_YR lt DOBY or (RCBE1_YR=DOBY and RCBE1_MT lt DOBM)
goto ERR2_ RCBE1_YR (prior to birth date)
elseif RCBE1_MT=D
goto RCBE2
elseif RCBE1_MT=1-12
goto MRIHAD
(R,D) goto RCBE2

Question ID: NAF.410_01.000

Instrument Variable Name: RCBE1N
QuestionText:

1 of 2
When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults 30+ who selected number and time period format for most recent breast exam from the
initial month screen
SkipInstructions:

(1-95) [goto RCBE1T] (R,D) store "R,D" in RCBE1T [goto RCBE2]

Question ID: NAF.410_02.000

Instrument Variable Name: RCBE1T
QuestionText:

2 of 2
*Enter time period for time since most recent breast exam.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto MRIHAD
(4) if RCBE1N=4
set RCBE2=4
goto MRIHAD
elseif RCBE1N gt 5 and RCBE1N gt AGE
goto ERR_RCBE1T (greater than persons age)
elseif RCBE1N gt 5 and RCBE1N le AGE
set RCBE2=5
goto MRIHAD
elseif RCBE1N=1,2,3,5
goto RCBE2
(R,D) goto RCBE2

Question ID: NAF.415_00.000

Instrument Variable Name: RCBE2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

(1-5,R,D) if answer code is grayed out [goto ERR_RCBE2] else [goto MRIHAD]

Question ID: NAF.416_00.000

Instrument Variable Name: MRIHAD
QuestionText:

A breast MRI, or magnetic resonance image, shows what is inside the breast, like a mammogram, but does not require
squeezing the breast. Before getting a breast MRI, you are given a dye through a needle in the arm. During the test, you
lie on your stomach and the bed moves into a tunnel-shaped machine.
Have you EVER HAD a breast MRI?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+
SkipInstructions:

(1) [goto MRI_MT] (2,R,D) if AGE GE 40 [goto CHESTX]; elseif AGE = 30-39 [goto ASPIRIN]

Question ID: NAF.417_01.000

Instrument Variable Name: MRI_MT
QuestionText:

1 of 2
When did you have your MOST RECENT breast MRI?
*Enter month of last breast MRI.
*Enter '96' to go to number and 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: Female sample adults 30+ who have ever had a breast MRI
SkipInstructions:

(1-12,D) [goto MRI_YR] (R) store "R' in MRI_YR [goto MRI2] (96) store "9996" in MRI_YR [goto MRIN]

Question ID: NAF.417_02.000

Instrument Variable Name: MRI_YR
QuestionText:

2 of 2
*Enter year of last breast MRI.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age 30+ who answered month of last breast MRI or didn't know month of last breast MRI
SkipInstructions:

(valid year) if MRI_YR gt current year or (MRI_YR=current year and MRI_MT gt current month)
goto ERR1_ MRI_YR (future date)
elseif MRI_YR lt DOBY or (MRI_YR=DOBY and MRI_MT lt DOBM)
goto ERR2_ MRI_YR (prior to birth date)
elseif MRI_MT=D
goto MRI2
elseif MRI_MT=1-12
goto MRIREA
(R,D) goto MRI2

Question ID: NAF.420_01.000

Instrument Variable Name: MRIN
QuestionText:

1 of 2
When did you have your MOST RECENT breast MRI?
*Enter number for time since last breast MRI.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults 30+ who selected number and time period format for most recent breast MRI from the initial
month screen
SkipInstructions:

(1-95) [goto MRIT] (R,D) store "R,D" in MRIT [goto MRI2]

Question ID: NAF.420_02.000

Instrument Variable Name: MRIT
QuestionText:

2 of 2
*Enter time period for time since most recent breast MRI.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) if AGE ge 40 [goto CHESTX]; elseif AGE = 30-39 [goto ASPIRIN]
(4) if MRIN=4
set MRI2=4
goto MRIREA
elseif MRIN gt 5 and MRIN gt AGE
goto ERR_MRIT (greater than persons age)
elseif MRIN gt 5 and MRIN le AGE
set MRI2=5
goto MRIREA
elseif MRIN=1,2,3,5
goto MRI2
(R,D) goto MRI2

Question ID: NAF.421_00.000

Instrument Variable Name: MRI2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

(1-5,R,D) if answer code is grayed out [goto ERR_MRI2] else [goto MRIREA]

Question ID: NAF.422_00.000

Instrument Variable Name: MRIREA
QuestionText:

What is the MAIN reason you had this breast MRI?
*Put response into correct category below.

01 A follow up of an abnormal mammogram
02 Because of a breast problem
03 Because my healthcare provider told me I was high risk
04 I have a family history of breast cancer
05 Part of a routine exam
06 I requested it
07 Other
97 Refused
99 Don't know

UniverseText: Female sample adults 30+ who have ever had a breast MRI
SkipInstructions:

(1-5,R,D) if AGE GE 40 [goto CHESTX] ; elseif AGE = 30-39 [goto ASPIRIN]

Question ID: NAF.423_01.000

Instrument Variable Name: CHESTX
QuestionText:

The next set of questions is about tests of your chest area. These questions ask about chest x-rays and CT scans, but not
mammograms.
In the last 12 months, did you have a chest x-ray?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto CHESTREA]
(2,D,R) [goto CAT12]

Question ID: NAF.423_02.000

Instrument Variable Name: CHESTREA
QuestionText:

Were any of the chest x-rays you had in the last 12 months done to check for lung cancer, rather than for some other
reason?

1 Yes, to check for lung cancer
2 No, for some other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a chest xray in the past 12 months
SkipInstructions:

(1,2,D,R) [goto CAT12]

Question ID: NAF.423_03.000

Instrument Variable Name: CAT12
QuestionText:

In the last 12 months, did you have a CAT scan or CT scan? During this test, you are lying down and moved through a
donut shaped x-ray machine while holding your breath.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto CATCHEST]
(2,D,R) [goto ASPIRIN]

Question ID: NAF.423_04.000

Instrument Variable Name: CATCHEST
QuestionText:

Were any of the CAT scans you had in the last 12 months done of your chest area?

1 Yes
2 No
3 Several areas of upper body region
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a CAT scan or CT scan in the past 12 months
SkipInstructions:

(1,3) [goto CATLUNG]
(2,D,R) [goto ASPIRIN]

Question ID: NAF.423_05.000

Instrument Variable Name: CATLUNG
QuestionText:

Were any of the CAT scans of your chest area done to check for lung cancer, rather than for some other reason?

1 Yes, to check for lung cancer
2 No, for some other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a CAT scan or CT scan of the chest area in the past 12 months
SkipInstructions:

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

Question ID: NAF.424_02.000

Instrument Variable Name: ASPIRIN
QuestionText:

? [F1]
Do you now take any of the following medications regularly, that is, at least 3 times a week?
Aspirin, Bayer, Bufferin, or Excedrin?
*Read if necessary: Do NOT include Tylenol.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ASPIR3M] (2,D,R) [goto ADVIL]

Question ID: NAF.424_03.000

Instrument Variable Name: ASPIR3M
QuestionText:

Have you taken any of these kinds of medications regularly for the last 3 months?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who now take Aspirin etc.
SkipInstructions:

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

Question ID: NAF.424_04.000

Instrument Variable Name: ADVIL
QuestionText:

Do you now take any of the following medications regularly, that is, at least 3 times a week?
Advil, Ibuprofen, Motrin, Nuprin, Aleve, Naprosyn, Naproxen, or Celebrex?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ADVIL3M]
(2,R,D) if SEX=1 [goto PROPECIA]
elseif AGE GE 30 [goto MEDHRT]
elseif AGE = 18-29 [goto MEDBC]

Question ID: NAF.424_05.000

Instrument Variable Name: ADVIL3M
QuestionText:

Have you taken any of these kinds of medications regularly for the last 3 months?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who now take Advil etc.
SkipInstructions:

(1,2,R,D) if SEX=1 [goto PROPECIA]
elseif AGE GE 30 [goto MEDHRT]
elseif AGE = 18-29 [goto MEDBC]

Question ID: NAF.424_06.000

Instrument Variable Name: PROPECIA
QuestionText:

Some men take medications such as Propecia (pro-PEE-she-ah), Proscar (PRAHS-car) or Finasteride (fin-AS-tur-eyed)
for hair loss or for problems with their prostate gland. Do you now take any of these medications regularly, that is, at least
3 times a week?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 18+
SkipInstructions:

(1) [goto PROPMTHS]
(2,R,D) if AGE ge 40 [goto PSAREC]
elseif AGE = 18-39 [goto genetic testing]

Question ID: NAF.424_07.000

Instrument Variable Name: PROPMTHS
QuestionText:

Have you taken Propecia, Proscar or Finasteride regularly for the last 3 months?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 18+ who take Propecia, Proscar, or Finasteride regularly
SkipInstructions:

(1) [goto PROPREAS]
(2,R,D) if AGE ge 40 [goto PSAREC]
elseif AGE = 18-39 [goto genetic testing]

Question ID: NAF.424_08.000

Instrument Variable Name: PROPREAS
QuestionText:

What is the main reason you are taking Propecia, Proscar or Finasteride?
*Read categories below.

1 For problems related to my prostate
2 For male pattern baldness
3 To reduce the chance that I may develop prostate cancer
4 Other
7 Refused
9 Don't know

UniverseText: Male sample adults 18+ who have taken Propecia, Proscar or Finasteride regularly for last 3 months
SkipInstructions:

(1-4,R,D) if AGE ge 40 [goto PSAREC]
elseif AGE = 18-39 [goto genetic testing]

Question ID: NAF.425_01.000

Instrument Variable Name: MEDHRT
QuestionText:

Are you currently taking Hormone Replacement Therapy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+
SkipInstructions:

(1) [goto MEDTAMX]
(2,R,D) [goto HRTEVER]

Question ID: NAF.425_02.000

Instrument Variable Name: HRTEVER
QuestionText:

Have you ever taken Hormone Replacement Therapy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who are not currently taking HRT
SkipInstructions:

(1) [goto HRTSTOP]
(2,R,D) [goto MEDTAMX]

Question ID: NAF.425_03.000

Instrument Variable Name: HRTSTOP
QuestionText:

About how long ago did you stop using Hormone Replacement Therapy -- was it 2 years ago or less, more than 2 years
ago but not more than 5 years, or more than 5 years ago?

1 2 years ago or less
2 More than 2 years ago but not more than 5 years ago
3 More than 5 years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have ever taken HRT but not currently
SkipInstructions:

(1-3,R,D) goto MEDTAMX

Question ID: NAF.425_04.000

Instrument Variable Name: MEDTAMX
QuestionText:

Are you currently taking Tamoxifen, also known as Nolvadex?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+
SkipInstructions:

(1) [goto TAMMAIN]
(2,R,D) [goto MEDRALX]

Question ID: NAF.425_05.000

Instrument Variable Name: TAMMAIN
QuestionText:

What is the main reason you are taking tamoxifen?
*Put response into correct category below.

1 As part of my treatment for breast cancer
2 To reduce the chance I may develop breast cancer
3 Both
4 Other reason
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who are currently taking tamoxifen
SkipInstructions:

(1-4,R,D) [goto MEDRALX]

Question ID: NAF.425_06.000

Instrument Variable Name: MEDRALX
QuestionText:

Are you currently taking Raloxifene (rah-LOX-ih-fen), also known as Evista?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+
SkipInstructions:

(1) [goto RALXREAS]
(2,R,D) [goto MEDBC]

Question ID: NAF.425_07.000

Instrument Variable Name: RALXREAS
QuestionText:

What is the main reason you are taking raloxifene?
*Put response into correct category below.

1 As part of my treatment for osteoporosis
2 To reduce the chance that I may develop breast cancer
3 Both
4 Other reason
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who are currently taking raloxifene
SkipInstructions:

(1-4,R,D) [goto MEDBC]

Question ID: NAF.425_08.000

Instrument Variable Name: MEDBC
QuestionText:

Are you currently taking birth control pills, birth control implants, or birth control shots?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+
SkipInstructions:

(1,2,R,D) if AGE ge 40 [goto COLHAD]; elseif AGE=18-39 [goto genetic testing]

Question ID: NAF.427_00.000

Instrument Variable Name: PSAREC
QuestionText:

Has a doctor EVER recommended that you have a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 40+
SkipInstructions:

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

Question ID: NAF.430_00.000

Instrument Variable Name: PSAHAD
QuestionText:

Have you EVER HAD a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 40+
SkipInstructions:

(1) [goto RPSA1_MT] (2,R,D) [goto PSAADV]

Question ID: NAF.440_00.000

Instrument Variable Name: RPSA1_MT
QuestionText:

1 of 2
When did you have your MOST RECENT PSA test?
* Enter month of last PSA test.
* Enter '96' to go to number and 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: Male sample adults 40+ who have had a PSA test
SkipInstructions:

(1-12,D) [goto RPSA1_YR] (R) store "R' in RPSA1_YR [goto RPSA2] (96) store "9996" in RPSA1_YR [goto
RPSA1N]

Question ID: NAF.440_01.000

Instrument Variable Name: RPSA1_YR
QuestionText:

2 of 2
* Enter year of last PSA test.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Male sample adults 40+ who have had a PSA test
SkipInstructions:

(valid year) if RPSA1_YR gt current year or (RPSA1_YR=current year and RPSA1_MT gt current month)
goto ERR1_ RPSA1_YR (future date)
elseif RPSA1_YR lt DOBY or (RPSA1_YR=DOBY and RPSA1_MT lt DOBM)
goto ERR2_ RPSA1_YR (prior to birth date)
elseif RPSA1_MT=D
goto RPSA2
elseif RPSA1_MT=1-12
goto PSAREAS
(R,D) goto RPSA2

Question ID: NAF.440_02.000

Instrument Variable Name: RPSA1N
QuestionText:

1 of 2
When did you have your MOST RECENT PSA test?
* Enter number for time since last PSA test.
* Enter '95' for 95 or more.

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

UniverseText: Male sample adults 40+ who have selected number and time period format for most recent PSA test from the
initial month screen
SkipInstructions:

(1-95) [goto RPSA1T] (R,D) store "R,D" in RPSA1T [goto RPSA2]

Question ID: NAF.440_03.000

Instrument Variable Name: RPSA1T
QuestionText:

2 of 2
* Enter time period for time since most recent PSA test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Male sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto PSAREAS
(4) if RPSA1N=4
set RPSA2=4
goto PSAREAS
elseif RPSA1N gt 5 and RPSA1N gt AGE
goto ERR_RPSA1T (greater than persons age)
elseif RPSA1N gt 5 and RPSA1N le AGE
set RPSA2=5
goto PSAREAS
elseif RPSA1N=1,2,3,5
goto RPSA2
(R,D) goto RPSA2

Question ID: NAF.440_04.000

Instrument Variable Name: RPSA2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Male sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last PSA test was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RPSA2] else [goto PSAREAS]

Question ID: NAF.441_00.000

Instrument Variable Name: PSAREAS
QuestionText:

What was the MAIN reason you had this PSA test - was it part of a routine exam, because of a problem, or some other
reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Male sample adults 40+ who have had a PSA test
SkipInstructions:

(1-3,R,D) [goto PSAAGE1]

Question ID: NAF.442_00.000

Instrument Variable Name: PSAAGE1
QuestionText:

How old were you when you had your first PSA test? Were you:
*Read answer categories.

01 Under 40 years
02 40-44
03 45-49
04 50-54
05 55-59
06 60-64
07 65-69
08 70 years and older
97 Refused
99 Don't know

UniverseText: Male sample adults 40+ who have had a PSA test
SkipInstructions:

(1-8,R,D) if answer code is grayed out [goto ERR_MAMAGE] else [goto PSA5YR]

Question ID: NAF.450_00.000

Instrument Variable Name: PSA5YR
QuestionText:

How many PSA tests have you had in the LAST 5 years?
*Enter '0' for none.
*Enter '95" for 95 or more PSA tests.

00 None
01-94 1-94
95 95+
97 Refused
99 Don't know

UniverseText: Male sample adults 40+ who have had a PSA test
SkipInstructions:

(0-95,R,D) [goto PSAADV]

Question ID: NAF.455_00.000

Instrument Variable Name: PSAADV
QuestionText:

[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the advantages of [fill 2: it/the PSA test]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 40+
SkipInstructions:

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

Question ID: NAF.460_00.000

Instrument Variable Name: PSADISAV
QuestionText:

[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the disadvantages of [fill 2: it/the PSA
test]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 40+
SkipInstructions:

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

Question ID: NAF.470_00.000

Instrument Variable Name: PSAEXP
QuestionText:

[fill 1: Before you had the PSA test did/Did] a doctor EVER tell you that some experts disagree about whether men
should have PSA tests?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 40+
SkipInstructions:

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

Question ID: NAF.540_00.000

Instrument Variable Name: COLHAD
QuestionText:

Colonoscopy (colon-OS-copy) and Sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a tube into the
rectum to look for polyps or cancer. For a colonoscopy, the doctor checks the entire colon, and you are given medication
through a needle in your arm to make you sleepy, and told to have someone drive you home. For a Sigmoidoscopy, the
doctor checks only part of the colon and you are fully awake.
Have you EVER HAD a colonoscopy?
*Read if necessary:
A polyp is a small growth that develops on the inside of the colon or rectum.
Before these tests, you are asked to take a medication that causes diarrhea.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto COL_MT] (2,R,D) [goto SIGHAD]

Question ID: NAF.560_01.000

Instrument Variable Name: COL_MT
QuestionText:

1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter month of last exam.
*Enter '96' to go to number and 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 40+ who have ever had a colonoscopy
SkipInstructions:

(1-12,D) [goto COL_YR] (R) store "R' in COL_YR [goto COL2] (96) store "9996" in COL_YR [goto COLN]

Question ID: NAF.560_02.000

Instrument Variable Name: COL_YR
QuestionText:

2 of 2
*Enter year of last colonoscopy.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 40+ who answered month of last colonoscopy or didn't know month of last colonoscopy
SkipInstructions:

(valid year) if COL_YR gt current year or (COL_YR=current year and COL_MT gt current month)
goto ERR1_ COL_YR (future date)
elseif COL_YR lt DOBY or (COL_YR=DOBY and COL_MT lt DOBM)
goto ERR2_ COL_YR (prior to birth date)
elseif COL_MT=D
goto COL2
elseif COL_MT=1-12
goto COLREAS
(R,D) goto COL2

Question ID: NAF.570_01.000

Instrument Variable Name: COLN
QuestionText:

1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter number for time since last colonoscopy.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent colonoscopy from the initial
month screen
SkipInstructions:

(1-95) [goto COLT] (R,D) store "R,D" in COLT [goto COL2]

Question ID: NAF.570_02.000

Instrument Variable Name: COLT
QuestionText:

2 of 2
*Enter time period for time since most recent colonoscopy.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto COLREAS
(4) if COLN=4
set COL2=4
goto COLREAS
elseif COLN=6,7,8,9
set COL2=5
goto COLREAS
elseif COLN gt 10 and COLN gt AGE
goto ERR_COLT (greater than persons age)
elseif COLN gt 10 and COLN le AGE
set COL2=6
goto COLREAS
elseif COLN=1,2,3,5,10
goto COL2
(R,D) goto COL2

Question ID: NAF.575_00.000

Instrument Variable Name: COL2
QuestionText:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 years
6 Over 10 years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last colonoscopy was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out [goto ERR_COL2] else [goto COLREAS]

Question ID: NAF.590_00.000

Instrument Variable Name: COLREAS
QuestionText:

What was the MAIN reason you had this colonoscopy - was it part of a routine exam, because of a problem, as a follow-
up test of an earlier test or screening exam, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Follow-up test of an earlier test or sceening exam
4 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a colonoscopy
SkipInstructions:

(1-4,R,D) [goto SIGHAD]

Question ID: NAF.591_00.000

Instrument Variable Name: SIGHAD
QuestionText:

Recall that a Sigmoidoscopy is similar to a colonoscopy but the doctor checks only part of the colon and you are fully
awake. Have you EVER HAD a Sigmoidoscopy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto SIG_MT] (2,R,D) [goto CTHEARD]

Question ID: NAF.592_01.000

Instrument Variable Name: SIG_MT
QuestionText:

1 of 2
When did you have your MOST RECENT Sigmoidoscopy?
*Enter month of last exam.
*Enter '96' to go to number and 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 40+ who have ever had a Sigmoidoscopy
SkipInstructions:

(1-12,D) [goto SIG_YR] (R) store "R' in SIG_YR [goto SIG2] (96) store "9996" in SIG_YR [goto SIGN]

Question ID: NAF.593_02.000

Instrument Variable Name: SIG_YR
QuestionText:

2 of 2
*Enter year of last Sigmoidoscopy.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 40+ who answered month of last Sigmoidoscopy or didn't know month of last Sigmoidoscopy
SkipInstructions:

(valid year) if SIG_YR gt current year or (SIG_YR=current year and SIG_MT gt current month)
goto ERR1_ SIG_YR (future date)
elseif SIG_YR lt DOBY or (SIG_YR=DOBY and SIG_MT lt DOBM)
goto ERR2_ SIG_YR (prior to birth date)
elseif SIG_MT=D
goto SIG2
elseif SIG_MT=1-12
goto SIGREAS
(R,D) goto SIG2

Question ID: NAF.594_01.000

Instrument Variable Name: SIGN
QuestionText:

1 of 2
When did you have your MOST RECENT Sigmoidoscopy?
*Enter number for time since last Sigmoidoscopy.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent Sigmoidoscopy from the initial
month screen
SkipInstructions:

(1-95) [goto SIGT] (R,D) store "R,D" in SIGT [goto SIG2]

Question ID: NAF.595_02.000

Instrument Variable Name: SIGT
QuestionText:

2 of 2
*Enter time period for time since most recent Sigmoidoscopy.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto SIGREAS
(4) if SIGN=4
set SIG2=4
goto SIGREAS
elseif SIGN=6,7,8,9
set SIG2=5
goto SIGREAS
elseif SIGN gt 10 and SIGN gt AGE
goto ERR_SIGT (greater than persons age)
elseif SIGN gt 10 and SIGN le AGE
set SIG2=6
goto SIGREAS
elseif SIGN=1,2,3,5,10
goto SIG2
(R,D) goto SIG2

Question ID: NAF.596_00.000

Instrument Variable Name: SIG2
QuestionText:

Was it:
*Read answer categories.

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last Sigmoidoscopy was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out {goto ERR_SIG2] else [goto SIGREAS]

Question ID: NAF.597_00.000

Instrument Variable Name: SIGREAS
QuestionText:

What was the MAIN reason you had this Sigmoidoscopy - was it part of a routine exam, because of a problem, as a follow-
up test of an earlier test or screening exam, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Follow-up test of an earlier test or screening exam
4 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a Sigmoidoscopy
SkipInstructions:

(1-4,R,D) [goto CTHEARD]

Question ID: NAF.611_00.000

Instrument Variable Name: CTHEARD
QuestionText:

CT colonography, sometimes called virtual colonoscopy, is a new type of test that looks for cancer in the colon. Unlike
regular colonoscopies, you do not need medication to make you sleepy during the test. In this new test, your colon is filled
with air and you are moved through a donut-shaped X-ray machine as you lie on your back and then your stomach.
Before today, HAD YOU EVER HEARD of CT colonography or virtual colonoscopy?
*Read if necessary:
This is not the same as a colonoscopy or a Sigmoidoscopy.
Unlike CT tests for other purposes, you DO take laxatives to clean out your colon for this test.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto CTHADEV]
(2,R,D) [goto POLYP]

Question ID: NAF.612_00.000

Instrument Variable Name: CTHADEV
QuestionText:

Have you EVER HAD a CT colonography or virtual colonoscopy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have ever heard of a CT colonography or a virtual colonoscopy
SkipInstructions:

(1) [goto CT_MT] (2,R,D) [goto POLYP]

Question ID: NAF.613_01.000

Instrument Variable Name: CT_MT
QuestionText:

1 of 2
When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter month of last CT colonography or virtual colonoscopy.
*Enter '96' to go to number and 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 40+ who have ever had a CT colonography or virtual colonoscopy
SkipInstructions:

(1-12,D) [goto CT_YR] (R) store "R' in CT_YR [goto CT2] (96) store "9996" in CT_YR [goto CTN]

Question ID: NAF.614_02.000

Instrument Variable Name: CT_YR
QuestionText:

2 of 2
*Enter year of last CT colonography or virtual colonoscopy.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 40+ who answered month of last CT colonography or virtual colonoscopy or didn't know month
of last CT colonography or virtual colonoscopy
SkipInstructions:

(valid year) if CT_YR gt current year or (CT_YR=current year and CT_MT gt current month)
goto ERR1_ CT_YR (future date)
elseif CT_YR lt DOBY or (CT_YR=DOBY and CT_MT lt DOBM)
goto ERR2_ CT_YR (prior to birth date)
elseif CT_MT=D
goto CT2
elseif CT_MT=1-12
goto CTREAS
(R,D) goto CT2

Question ID: NAF.615_01.000

Instrument Variable Name: CTN
QuestionText:

1 of 2
When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter number for time since last CT colonography or virtual colonoscopy.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent CT colonography or virtual
colonoscopy from the initial month screen
SkipInstructions:

(1-95) [goto CTT] (R,D) store "R,D" in CTT [goto CT2]

Question ID: NAF.616_02.000

Instrument Variable Name: CTT
QuestionText:

2 of 2
*Enter time period for time since most recent CT colonography or virtual colonoscopy.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto CTREAS (4) if CTN=4
set CT2=4
goto CTREAS
elseif CTN=6,7,8,9
set CT2=5
goto CTREAS
elseif CTN gt 10 and CTN gt AGE
goto ERR_CTT (greater than persons age)
elseif CTN gt 10 and CTN le AGE
set CT2=6
goto CTREAS
elseif CTN=1,2,3,5,10
goto CT2
(R,D) goto CT2

Question ID: NAF.617_00.000

Instrument Variable Name: CT2
QuestionText:

Was it:
*Read answer categories.

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last CT colonography or virtual colonoscopy was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out [goto ERR_CT2] else [goto CTREAS]

Question ID: NAF.618_00.000

Instrument Variable Name: CTREAS
QuestionText:

What was the MAIN reason you had this CT colonography or virtual colonoscopy - was it part of a routine exam, because
of a problem, as a follow-up test of an earlier test or screening exam, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Follow-up test or an earlier test or screening exam
4 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a CT colonography or virtual colonoscopy
SkipInstructions:

(1-4,R,D) [goto POLYP]

Question ID: NAF.619_00.000

Instrument Variable Name: POLYP
QuestionText:

A polyp is a small growth that develops on the inside of the colon or rectum. During the past 10 years did a doctor tell
you that you had a polyp in your colon or rectum?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

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

Question ID: NAF.620_00.000

Instrument Variable Name: HFOBHAD
QuestionText:

The following questions are about the blood stool or occult blood test, a test to determine whether you have blood in your
stool or bowel movement. The blood stool test can be done at home using a kit. You use a stick or brush to obtain a
small amount of stool at home and send it back to the doctor or lab.
Have you EVER HAD a blood stool test, using a HOME test kit?
*Read if necessary:
Do not include tests done at the doctor's office.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) goto RHFO1_MT
(2,R,D) goto HFONOTDO

Question ID: NAF.640_01.000

Instrument Variable Name: RHFO1_MT
QuestionText:

1 of 2
When did you have your MOST RECENT blood stool test using a kit at home?
*Enter month of last home blood stool test.
*Enter '96' to go to number and 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 40+ who have ever had a home blood stool test
SkipInstructions:

(1-12,D) goto RHFO1_YR
(R) store "R" in RHFO1_YR and goto RHFO2
(96) store "9996" in RHFO1_YR and goto RHFO1N

Question ID: NAF.640_02.000

Instrument Variable Name: RHFO1_YR
QuestionText:

2 of 2
*Enter year of last home blood stool test.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 40+ who answered month of last home blood stool test or didn't know month of last test
SkipInstructions:

(valid year) if RHFO1_YR gt current year or (RHFO1_YR=current year and RHRO1_MT gt current month)
goto ERR1_RHFO1_YR (future date)
elseif RHFO1_YR lt DOBY or (RHFO1_YR=DOBY and RHFO1_MT lt DOBM)
goto ERR2_RHFO1_YR (prior to birth date)
elseif RHFO1_MT=D
goto RHFO2
elseif RHFO1_MT=1-12
goto HFOBREA1
(R,D) goto RHFO2

Question ID: NAF.650_01.000

Instrument Variable Name: RHFO1N
QuestionText:

1 of 2
When did you have your MOST RECENT blood stool test using a kit at home?
*Enter number for time since last home blood stool test.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent home blood stool test from the
initial month screen
SkipInstructions:

(1-95) [goto RHFO1T] (R,D) store "R,D" in RHFO1T [goto RHFO2]

Question ID: NAF.650_02.000

Instrument Variable Name: RHFO1T
QuestionText:

2 of 2
*Enter time period for time since most recent home blood stool test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto HFOBREA1
(4) if RHFO1N=4
set RHFO2=4
goto HFOBREA1
elseif RHFO1N=6,7,8,9
set RHFO2=5
goto HFOBREA1
elseif RHFO1N gt 10 and RHFO1N gt AGE
goto ERR_RHFO1T (greater than persons age)
elseif RHFO1N gt 10 and RHFO1N le AGE
set RHFO2=6
goto HFOBREA1
elseif RHFO1N=1,2,3,5,10
goto RHFO2
(R,D) goto RHFO2

Question ID: NAF.655_00.000

Instrument Variable Name: RHFO2
QuestionText:

Was it:
*Read answer categories.

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last home blood stool test was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out [goto ERR_RHFO2] else [goto HFOBREA1]

Question ID: NAF.660_00.000

Instrument Variable Name: HFOBREA1
QuestionText:

What was the MAIN reason you had this home blood stool test - was it part of a routine exam, because of a problem, or
some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a home blood stool test
SkipInstructions:

(1-3,R,D) [goto HFOBABN1]

Question ID: NAF.670_00.000

Instrument Variable Name: HFOBABN1
QuestionText:

Have you had a HOME blood stool test in the LAST 3 YEARS where the results were NOT normal?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have ever had a home blood stool test
SkipInstructions:

(1) [goto HFOBTST] (2,R,D) [goto HFONOTDO]

Question ID: NAF.680_00.000

Instrument Variable Name: HFOBTST
QuestionText:

Because of these results, what additional tests or surgery did you have?
*Enter all that apply, separate with commas.

0 None
1 Another Fecal Occult Blood Test
2 Sigmoidoscopy
3 Colonoscopy
4 Barium enema
5 Surgery
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who had an abnormal home blood stool test in the past 3 years
SkipInstructions:

(0-5,R,D) [goto HFONOTDO]

Question ID: NAF.690_06.000

Instrument Variable Name: HFONOTDO
QuestionText:

Have you EVER been given a HOME blood stool test kit that you did not complete and return to the doctor or laboratory?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

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

Question ID: NAF.710_00.000

Instrument Variable Name: FOBHAD
QuestionText:

Have you EVER HAD a blood stool test in which your doctor or other health care professional collected a stool sample
during an office visit?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto RFOB1_MT]
(2, R, D) if ((COLHAD = 2,R,D) or (COL2 = 6) or (COL_YR = (current year -- 10) and COL_MT lt current
month) or (COL_YR lt (current year -- 10))) and ((SIGHAD = 2,R,D) or (SIG2 = 5,6) or (SIG_YR = (current year
-- 5) and SIG_MT lt current month) or (SIG_YR lt (current year -- 5))) and ((CTHEARD = 2,R,D) or (CTHADEV
= 2,R,D) or (CT2 = 5,6) or (CT_YR = (current year -- 5) and CT_MT lt current month) or (CT_YR lt (current year -- 5))) and ((HFOBHAD = 2,R,D) or (RHFO2 = 2-6) or (RHFO1_YR = (current year -- 1) and RHFO1_MT lt
current month) or (RHFO1_YR lt (current year -- 1)) or (RHFO1T = 2 and RHFO1N gt 52) or
(RHFO1T = 3 and RHFO1N gt 12)) [goto COLPROB]
else [goto genetic testing]

Question ID: NAF.720_01.000

Instrument Variable Name: RFOB1_MT
QuestionText:

1 of 2
When did you have your MOST recent OFFICE blood stool test?
*Enter month of last office blood stool test.
*Enter '96' to go to number and 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 40+ who have ever had a office blood stool test
SkipInstructions:

(1-12,D) [goto RFOB1_YR] (R) store "R' in RFOB1_YR [goto RFOB2] (96) store "9996" in RFOB1_YR
[goto RFOB1N]

Question ID: NAF.720_02.000

Instrument Variable Name: RFOB1_YR
QuestionText:

2 of 2
*Enter year of last office blood stool test.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults 40+ who answered month of last office blood stool test or didn't know month of last office blood
stool test
SkipInstructions:

(valid year) if RFOB1_YR gt current year or (RFOB1_YR=current year and RFOB1_MT gt current month)
goto ERR1_ RFOB1_YR (future date)
elseif RFOB1_YR lt DOBY or (RFOB1_YR=DOBY and RFOB1_MT lt DOBM)
goto ERR2_ RFOB1_YR (prior to birth date)
elseif RFOB1_MT=D
goto RFOB2
elseif RFOB1_MT=1-12
goto RFOBREAS
(R,D) goto RFOB2

Question ID: NAF.730_01.000

Instrument Variable Name: RFOB1N
QuestionText:

1 of 2
When did you have your MOST recent OFFICE blood stool test?
*Enter number for time since last office blood stool test.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent office blood stool test from the
initial month screen
SkipInstructions:

(1-95) [goto RFOB1T] (R,D) store "R,D" in RFOB1T [goto RFOB2]

Question ID: NAF.730_02.000

Instrument Variable Name: RFOB1T
QuestionText:

2 of 2
*Enter time period for time since most recent office blood stool test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto RFOBREAS
(4) if RFOB1N=4
set RFOB2=4
goto RFOBREAS
elseif RFOB1N=6,7,8,9
set RFOB2=5
goto RFOBREAS
elseif RFOB1N gt 10 and RFOB1N gt AGE
goto ERR_RFOB1T (greater than persons age)
elseif RFOB1N gt 10 and RFOB1N le AGE
set RFOB2=6
goto RFOBREAS
elseif RFOB1N=1,2,3,5,10
goto RFOB2
(R,D) goto RFOB2

Question ID: NAF.735_00.000

Instrument Variable Name: RFOB2
QuestionText:

Was it:
*Read answer categories.

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last office blood stool test was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out [goto ERR_RFOB2] else [goto RFOBREAS]

Question ID: NAF.740_00.000

Instrument Variable Name: RFOBREAS
QuestionText:

What was the MAIN reason you had this office blood stool test - was it part of a routine exam, because of a problem, or
some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had an office blood stool test
SkipInstructions:

(1-3,R,D) if ((COLHAD = 2) or (COL2 = 6) or (COL_YR = (current year -- 10) and COL_MT lt current month)
or (COL_YR lt (current year -- 10))) and ((SIGHAD = 2) or (SIG2 = 5,6) or (SIG_YR = (current year -- 5) and SIG_MT lt current month) or (SIG_YR lt (current year -- 5))) and ((CTHEARD = 2) or (CTHADEV = 2) or (CT2
= 5,6) or (CT_YR = (current year -- 5) and CT_MT lt current
month) or (CT_YR lt (currentyear -- 5))) and ((HFOBHAD = 2) or (RHFO2 = 2-6) or (RHFO1_YR = (current year
-- 1) and RHFO1_MT lt current month) or (RHFO1_YR lt (current year -- 1)) or (RHFO1T = 2 and RHFO1N gt
52) or (RHFO1T = 3 and
RHFO1N gt 12)) [goto COLPROB]
else [goto genetic testing]

Question ID: NAF.750_00.000

Instrument Variable Name: COLPROB
QuestionText:

In the PAST 12 MONTHS, did a doctor or other health professional RECOMMEND that you be tested to look for
problems in your colon or rectum?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have NOT had a colonoscopy in the past 10 years, Sigmoidoscopy in the past 5 years, CT
colonography in the past 5 years, or home blood stool test in the last year
SkipInstructions:

(1) [goto COLTEST]
(2,R,D) [goto COLNOT]

Question ID: NAF.760_00.000

Instrument Variable Name: COLTEST
QuestionText:

Did the doctor or other health professional recommend to you any particular tests?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had tests recommended to look for problems in the colon and who have NOT had a
colonoscopy in the past 10 years, Sigmoidoscopy in the past 5 years, CT colonography in the past 5 years, or home
blood stool test in the last year
SkipInstructions:

(1) [goto COLKIND]; (2,R,D) [goto COLNOT]

Question ID: NAF.770_00.000

Instrument Variable Name: COLKIND
QuestionText:

Which tests to check for colon cancer did the doctor or other health professional recommend to you? Possible tests
include stool blood or fecal occult blood test; Sigmoidoscopy; colonoscopy; CT colonography or virtual colonoscopy; or
other.
*Enter all that apply, separate with commas.

1 Stool blood test/fecal occult blood test
2 Sigmoidoscopy
3 Colonoscopy
4 CT colonography/virtual colonoscopy
5 Other
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had particular tests recommended to look for problems in the colon and who have
NOT had a colonoscopy in the past 10 years, Sigmoidoscopy in the past 5 years, CT colonography in the past 5
years, or home blood stool test in the last year and who had another type of test recommended
SkipInstructions:

(1-5,R,D) [goto COLNOT]

Question ID: NAF.780_01.000

Instrument Variable Name: COLNOT
QuestionText:

What is the most important reason why you have [fill1: NEVER had any kind of test to look for problems in your colon or
rectum/NOT had any kind of test to look for problems in your colon or rectum RECENTLY]?
*Put response into correct category below.

01 No reason/never thought about it
02 Didn't need it/didn't know I needed this type of test
03 Doctor didn't order it/didn't say I needed it
04 Haven't had any problems
05 Put it off/Didn't get around to it
06 Too expensive/no insurance/cost
07 Too painful, unpleasant, or embarrassing
08 Had another type of colorectal exam
09 Don't have doctor
10 Other
97 Refused
99 Don't know

(01-10,R,D) [goto genetic testing]

Question ID: NAG.010_00.000

Instrument Variable Name: GTHEARD
QuestionText:

The following questions refer to "genetic testing for cancer risk." That is, testing your blood to see if you carry genes which may predict a greater chance of developing cancer at some point in your life. This does NOT include tests to
determine if you have cancer now.
Have you EVER HEARD of genetic testing to determine if a person is at greater risk of developing cancer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) goto GTPOSS
(2,R,D) goto GTCCOM

Question ID: NAG.020_00.000

Instrument Variable Name: GTPOSS
QuestionText:

Have you EVER DISCUSSED the possibility of getting a genetic test for cancer risk with a doctor or other health
professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:
Sample adults 18+ who have ever heard of genetic testing
SkipInstructions:

(1) goto GTADVISE
(2,R,D) goto GTGRISK

Question ID: NAG.025_00.000

Instrument Variable Name: GTADVISE
QuestionText:

Did the doctor or other health professional ADVISE you to have such a test?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who discussed getting genetic test with doctor or other health professional
SkipInstructions:

(1,2,R,D) goto GTGRISK

Genetic Testing

Question ID: NAG.030_00.000

Instrument Variable Name: GTGRISK
QuestionText:

Have you EVER HAD a genetic test to determine if you are at greater risk of developing cancer in the FUTURE?
*Read if necessary.
This does not include any test to see whether you had cancer in the PAST or have cancer NOW.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever heard of a genetic test
SkipInstructions:

(1) if SEX=1 goto GTCOL
else if SEX=2 goto GTBRE
(2,R,D) goto GTCCOM

Question ID: NAG.040_01.000

Instrument Variable Name: GTBRE
QuestionText:

Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Breast?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have ever had a genetic test
SkipInstructions:

(1,2,R,D) goto GTOVA

Question ID: NAG.040_02.000

Instrument Variable Name: GTOVA
QuestionText:

*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Ovarian?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have ever had a genetic test
SkipInstructions:

(1,2,R,D) goto GTCOL

Question ID: NAG.040_03.000

Instrument Variable Name: GTCOL
QuestionText:

Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Colon or rectal?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever had a genetic test
SkipInstructions:

(1,2,R,D) goto GTOTH

Question ID: NAG.040_04.000

Instrument Variable Name: GTOTH
QuestionText:

*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Another type of cancer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever had a genetic test
SkipInstructions:

(1) goto GTRSKOTH
(2,R,D) goto GTRSK_MT

Question ID: NAG.044_00.000

Instrument Variable Name: GTRSKOTH
QuestionText:

*Specify other test for genetic risk of cancer.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Sample adults 18+ who have had a genetic test for another type of cancer
SkipInstructions:

(allow 20,R,D) goto GTRSK_MT

Question ID: NAG.050_01.000

Instrument Variable Name: GTRSK_MT
QuestionText:

1 of 2
When did you have this genetic test done?
*Enter month of genetic test.
*Enter '96' to go to number and 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 had a genetic test for cancer
SkipInstructions:

(1-12,D) goto GTRSK_YR
(R) store "R' in GTRSK_YR then goto GTINSURE
(96) store "9996" in GTRSK_YR then goto GTRSKN

Question ID: NAG.050_02.000

Instrument Variable Name: GTRSK_YR
QuestionText:

2 of 2
*Enter year of genetic test.

1880-2011 1880-2011
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults 18+ who gave a month for their genetic test date or who didn't know the month
SkipInstructions:

(valid year,R,D) goto GTINSURE
elseif GTRSK_MT and GTRSK_YR = a future date [goto ERR1_GTRSK_YR
elseif GTRSK_MT and GTRSK_YR = a date prior to birth date goto ERR2_GTRSK_YR

Question ID: NAG.055_01.000

Instrument Variable Name: GTRSKN
QuestionText:

1 of 2
When did you have this genetic test done?
*Enter number for time since genetic test.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 18+ who requested the time period format at GTRSK_MT
SkipInstructions:

(1-95) goto GTRSKT
(R,D) store 'R,D" in GTRSKT then goto GTINSURE

Question ID: NAG.055_02.000

Instrument Variable Name: GTRSKT
QuestionText:

2 of 2
*Enter time period for time since genetic test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who answered 1-95 for the number part of this 2-part question
SkipInstructions:

(1-4,R,D) goto GTINSURE
if (GTRSKN = number greater than person years old and GTRSKT=4) then goto ERR1_GTRSKT

Question ID: NAG.060_00.000

Instrument Variable Name: GTINSURE
QuestionText:

Do you believe that getting a genetic test for cancer risk has or will affect your health insurance coverage?
*Read if necessary.
Effects include losing your health insurance coverage or not being eligible for health insurance if you change jobs or move.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have had a genetic test for cancer.
SkipInstructions:

(1,2,D,R) goto GTCCOM

Question ID: NAG.070_00.000

Instrument Variable Name: GTCCOM
QuestionText:

Compared to the average {man/woman} your age, would you say that you are more likely to get cancer, less likely, or
about as likely?
*Read if necessary.
For a cancer survivor, this means getting another cancer in the future.

1 More likely to get cancer
2 Less likely
3 About as likely
7 Refused
9 Don't know

UniverseText: Sample adults age 18+
SkipInstructions:

(1,2,3,R,D) goto GTCCLOM

Question ID: NAG.080_00.000

Instrument Variable Name: GTCCLOM
QuestionText:

Compared to the average {man/woman} your age, would you say that you are more likely to get colon or rectal cancer,
less likely, or about as likely?
*Read if necessary.
For a colon or rectal cancer survivor, this means getting colon or rectal cancer again in the future.

1 More likely to get colon or rectal cancer
2 Less likely
3 About as likely
7 Refused
9 Don't know

UniverseText: Sample adults age 18+
SkipInstructions:

(1,2,3,R,D) [if SEX = 1, goto next section; else if SEX = 2, go to GTCBOM]

Question ID: NAG.090_00.000

Instrument Variable Name: GTCBOM
QuestionText:

Compared to the average woman your age, would you say that you are more likely to get breast cancer, less likely, or
about as likely?
*Read if necessary.
For a breast cancer survivor, this means getting breast cancer again in the future.

1 More likely to get breast cancer
2 Less likely
3 About as likely
7 Refuse
9 Don't know

UniverseText: Female sample adults age 18+
SkipInstructions:

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

Family History

Question ID: NAH.010_00.000

Instrument Variable Name: FHFCAN
QuestionText:

We would like to ask you a few questions about your family history of cancer. Did your BIOLOGICAL FATHER EVER
have cancer of any kind?

1 Yes
2 No
3 Adopted or don't know biological father
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto FHFTYP_1]
(2,3,RF,DK) [goto FHMCAN]

Question ID: NAH.020_00.001

Instrument Variable Name: FHFTYP_1
QuestionText:

What kind of cancer did your father have?
* 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+ whose father ever had cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) goto FHFAGE1
(6,18,29) goto ERR_FHFTYP_1

Question ID: NAH.020_00.002

Instrument Variable Name: FHFTYP_2
QuestionText:

* Enter code for the second kind of cancer.
* Enter '96' for no more.

UniverseText: Sample adults 18+ who either provided an age range for a first kind of cancer or didn't know how old father was
when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to give
first kind of cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) if FHFTYP_2 = FHFTYP_1 goto ERR2_FHFTYP_2
else goto FHFAGE2
(96) goto FHMCAN
(6,18,29) goto ERR1_FHFTYP_2

Question ID: NAH.020_00.003

Instrument Variable Name: FHFTYP_3
QuestionText:

* Enter code for the third kind of cancer.
* Enter '96' for no more.

UniverseText: Sample adults 18+ who either provided an age range for a second kind of cancer or didn't know how old father was
when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to give a
second type of cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) if FHFTYP_3 = FHFTYP_1 or FHFTYP_2
goto ERR2_FHFTYP_3
else goto FHFAGE3
(96) goto FHMCAN
(6,18,29) goto ERR1_FHFTYP_3

Question ID: NAH.020_00.004

Instrument Variable Name: FHFTYP_4
QuestionText:

* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.

95 More than 3 kinds
96 No more

UniverseText: Sample adults 18+ who either provided an age range for a third kind of cancer or didn't know how old father was
when first diagnosed that kind of cancer or else refused to provide an age range but had not refused to give a third
kind of cancer
SkipInstructions:

(95,96) goto FHMCAN
(1-30) goto ERR_FHFTYP_4

Question ID: NAH.030_00.001

Instrument Variable Name: FHFAGE1
QuestionText:

Was your biological father under 50 years of age when [Fill: FHFTYP_1] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who selected a first kind of cancer for father or refused to answer or didn't know kind of cancer
SkipInstructions:

(1,2,DK) goto FHFTYP_2
(RF) IF FHFTYP_1=RF [goto FHMCAN]
else if FHFTYP_1 NE RF [goto FHFTYP_2]

Question ID: NAH.030_00.002

Instrument Variable Name: FHFAGE2
QuestionText:

Was your biological father under 50 years of age when [Fill: FHFTYP_2] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who selected a second kind of cancer for father or refused to answer or didn't know kind of
cancer
SkipInstructions:

(1,2,DK) goto FHFTYP_3
(RF) IF FHFTYP_2=RF [goto FHMCAN]
else if FHFTYP NE RF [goto FHFTYP_3]

Question ID: NAH.030_00.003

Instrument Variable Name: FHFAGE3
QuestionText:

Was your biological father under 50 years of age when [Fill: FHFTYP_3] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who selected a third kind of cancer for father or refused to answer or didn't know kind of cancer
SkipInstructions:

(1,2,DK) goto FHFTYP_4
(RF) IF FHFTYP_3=RF [goto FHMCAN]
else if FHFTYP_3 NE RF [goto FHFTYP_4]

Question ID: NAH.040_00.000

Instrument Variable Name: FHMCAN
QuestionText:

Did your BIOLOGICAL MOTHER EVER have cancer of any kind?

1 Yes
2 No
3 Adopted or don't know biological mother
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto FHMTYP_1]
(2,3,RF,DK) [goto FHBNUM]

Question ID: NAH.050_00.001

Instrument Variable Name: FHMTYP_1
QuestionText:

What kind of cancer did your mother have?
* 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+ whose mother ever had cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) goto FHMAGE1
(20,26) goto ERR_FHMTYP_1

Question ID: NAH.050_00.002

Instrument Variable Name: FHMTYP_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 range for a first kind of cancer or didn't know how old mother was
when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer
a first kind of cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) if FHMTYP_2 = FHMTYP_1 goto ERR2_FHMTYP_2
else goto FHMAGE2
(96) goto FHBNUM
(20,26) goto ERR1_FHMTYP_2

Question ID: NAH.050_00.003

Instrument Variable Name: FHMTYP_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 range for a second kind of cancer or didn't know how old mother
was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to
answer a second kind of cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) if FHMTYP_3 = FHMTYP_1 or FHMTYP_2 goto ERR2_FHMTYP_3
else goto FHMAGE3
(96) goto FHBNUM
(20,26) goto ERR1_FHMTYP_3

Question ID: NAH.050_00.004

Instrument Variable Name: FHMTYP_4
QuestionText:

* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.

95 More than 3 kinds
96 No more

UniverseText: Sample adults 18+ who either provided an age range for a third kind of cancer or didn't know how old mother was
when first diagnosed with that kind of cancer or else refused to provide an age range but had not refused to answer
a third kind of cancer
SkipInstructions:

(95,96) goto FHBNUM
(1-30) ERR_FHMTYP_4

Question ID: NAH.060_00.001

Instrument Variable Name: FHMAGE1
QuestionText:

Was your biological mother under 50 years of age when [Fill: FHMTYP_1] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who selected a first kind of cancer for mother or refused to answer or didn't know kind of cancer
SkipInstructions:

(1,2,DK) goto FHMTYP_2
(RF) IF FHMTYP_1=RF goto FHBNUM
else if FHMTYP_1 NE RF goto FHMTYP_2

Question ID: NAH.060_00.002

Instrument Variable Name: FHMAGE2
QuestionText:

Was your biological mother under 50 years of age when [Fill: FHMTYP_2] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who selected a second kind of cancer for mother or refused to answer or didn't know kind of
cancer
SkipInstructions:

(1,2,DK) goto FHMTYP_3
(RF) IF FHMTYP_2=RF goto FHBCAN
else if FHMTYP_2 NE RF goto FHMTYP_3

Question ID: NAH.060_00.003

Instrument Variable Name: FHMAGE3
QuestionText:

Was your biological mother under 50 years of age when [Fill: FHMTYP_3] was first diagnosed?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who selected a third kind of cancer for mother or refused to answer or didn't know kind of
cancer
SkipInstructions:

(1,2,DK) goto FHMTYP_4
(RF) IF FHMTYP_3=RF goto FHBNUM
else if FHMTYP_3 NE RF goto FHMTYP_4

Question ID: NAH.070_00.000

Instrument Variable Name: FHBNUM
QuestionText:

FULL BROTHERS have the same biological mother and father as you. How many FULL BROTHERS do you have?
Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more brothers.

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,RF,DK) [goto FHSNUM]
(1-21)[goto FHBCAN]

Question ID: NAH.080_00.000

Instrument Variable Name: FHBCAN
QuestionText:

[Fill1: Did your BROTHER EVER have cancer of any kind?
*Enter '0' if brother has not had any kind of cancer.
*Enter '1' if brother has had cancer.]
[Fill2: How many of your BROTHERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have at least one full brother
SkipInstructions:

(0,RF,DK) goto FHSNUM
(1-21) if FHBCAN GT FHBNUM
goto ERR_FHBCAN
else
goto FHBTYP_1

Question ID: NAH.090_00.001

Instrument Variable Name: FHBTYP_1
QuestionText:

What kinds of cancer did your [Fill1: brother/Fill2: brothers] have?
* 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+ whose brother(s) ever had cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) if FHBCAN = '1' goto FHBAGE1
else goto FHBMAN1
(6,18,29) goto ERR_FHBTYP_1

Question ID: NAH.090_00.002

Instrument Variable Name: FHBTYP_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 provided age range for brother(s) diagnosed with the first kind of cancer or didn't know
how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range
and had not refused to answer the first kind of cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) if FHBTYP_2 = FHBTYP_1 goto ERR2_FHBTYP_2
elseif FHBCAN = '1' goto FHBAGE2
else goto FHBMAN2
(96) goto FHSNUM
(6,18,29) goto ERR1_FHBTYP_2

Question ID: NAH.090_00.003

Instrument Variable Name: FHBTYP_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 provided age range for brother(s) diagnosed with the second kind of cancer or didn't know
how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range
and had not refused to answer the second kind of cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) if FHBTYP_3 = FHBTYP_1 or FHBTYP_2 goto ERR2_FHBTYP_3
elseif FHBCAN = '1' goto FHBAGE3
else goto FHBMAN3
(96) goto FHSNUM
(6,18,29) goto ERR1_FHBTYP_3

Question ID: NAH.090_00.004

Instrument Variable Name: FHBTYP_4
QuestionText:

* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.

95 More than 3 kinds
96 No more

UniverseText: Sample adults 18+ who provided age range for brother(s) diagnosed with the third kind of cancer or didn't know
how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range
and had not refused to answer the third kind of cancer
SkipInstructions:

(95,96) goto FHSNUM
(1-30) goto ERR_FHBTYP_4

Question ID: NAH.091_00.000

Instrument Variable Name: FHBMAN1
QuestionText:

How many brothers have had [Fill: FHBTYP_1]?
*Enter '21' for 21 or more brothers.

01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have brothers with a first kind of cancer
SkipInstructions:

(1-21) if FHBMAN1 GT FHBCAN goto ERR_FHBMAN1
else goto FHBAGE1
(RF,DK) goto FHBAGE1

Question ID: NAH.092_00.000

Instrument Variable Name: FHBAGE1
QuestionText:

[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_1] was first diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText:
Sample adults 18+ whose brother(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
SkipInstructions:

(0-21) if FHBMAN1 NE 'Refused' and FHBMAN1 NE 'Don't know' and FHBAGE1 GT FHBMAN1
goto ERR1_FHBAGE1
elseif (FHBMAN1 = 'Refused' or FHBMAN1 = 'Don't know') and FHBAGE1 GT FHBCAN
goto ERR2_FHBAGE1
else
goto FHBTYP_2
(DK) goto FHBTYP_2
(RF) IF FHBTYP_1=RF goto FHSNUM
else if FHBTYP_1 NE RF goto FHBTYP_2

Question ID: NAH.093_00.000

Instrument Variable Name: FHBMAN2
QuestionText:

How many brothers have had [Fill: FHBTYP_2]?
*Enter '21' for 21 or more brothers.

01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have brothers with a second kind of cancer
SkipInstructions:

(1-21) if FHBMAN2 GT FHBCAN
goto ERR_FHBMAN2
else
goto FHBAGE2
(RF,DK) goto FHBAGE2

Question ID: NAH.094_00.000

Instrument Variable Name: FHBAGE2
QuestionText:

[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_2] was first diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose brother(s) had a second kind of cancer or refused or didn't know name of second kind of
cancer
SkipInstructions:

(0-21) if FHBMAN2 NE 'Refused' and FHBMAN2 ne 'Don't know' and FHBAGE2 GT FHBMAN2
goto ERR1_FHBAGE2
elseif (FHBMAN2 = 'Refused' or FHBMAN2 = 'Don't know') and FHBAGE2 GT FHBCAN
goto ERR2_FHBAGE2
else
goto FHBTYP_3
(DK) goto FHBTYP_3
(RF) and (RF) at FHBTYP_2 goto FHSNUM
(RF) and FHBTYP_2 NE (RF) goto FHBTYP_3

Question ID: NAH.095_00.000

Instrument Variable Name: FHBMAN3
QuestionText:

How many brothers have had [Fill: FHBTYP_3]?
*Enter '21' for 21 or more brothers.

01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have brothers with a third kind of cancer
SkipInstructions:

(1-21) if FHBMAN3 GT FHBCAN
goto ERR_FHBMAN3
else
goto FHBAGE3
(RF,DK) goto FHBAGE3

Question ID: NAH.096_00.000

Instrument Variable Name: FHBAGE3
QuestionText:

[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]

00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose brother(s) had a third kind of cancer or refused or didn't know name of third kind of
cancer
SkipInstructions:

(0-21) if FHBMAN3 NE 'Refused' and FHBMAN3 NE 'Don't know' and FHBAGE3 GT FHBMAN3
goto ERR1_FHBAGE3
elseif (FHBMAN3 = 'Refused' or FHBMAN3 = 'Don't know') and FHBAGE3 GT FHBCAN
goto ERR2_FHBAGE3
else
goto FHBTYP_4
(DK) goto FHBTYP_4
(RF) and (RF) at FHBTYP_3 goto FHSNUM
(RF) and FHBTYP_3 NE (RF) goto FHBTYP_4

Question ID: NAH.100_00.000

Instrument Variable Name: FHSNUM
QuestionText:

FULL SISTERS have the same biological mother and father as you. How many FULL SISTERS do you have? Please
include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more sisters.

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,RF,DK) goto FHNNUM
(1-21) goto FHSCAN

Question ID: NAH.110_00.000

Instrument Variable Name: FHSCAN
QuestionText:

[Fill1: Did your SISTER EVER have cancer of any kind?
*Enter '0' if sister has not had any kind of cancer.
*Enter '1' if sister has had cancer.]
[Fill2: How many of your SISTERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have at least one full sister
SkipInstructions:

(0,RF,DK) goto FHNNUM
(1-21) if FHSCAN gt FHSNUM
goto ERR_FHSCAN
else
goto FHSTYP_1

Question ID: NAH.120_00.001

Instrument Variable Name: FHSTYP_1
QuestionText:

What kind of cancer did your [Fill1: sister/Fill2: sisters] have?
* 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+ whose sister(s) ever had cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) if FHSCAN = '1'
goto FHSAGE1
else
goto FHSMAN1
(20,26) goto ERR_FHSTYP_1

Question ID: NAH.120_00.002

Instrument Variable Name: FHSTYP_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 provided age range for sister(s) diagnosed with the first kind of cancer or didn't know how
old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and
had not refused to answer the first kind of cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) if FHSTYP_2 = FHSTYP_1
goto ERR2_FHSTYP_2
elseif FHSCAN = '1'
goto FHSAGE2
else
goto FHSMAN2
(96) goto FHNNUM
LT (20,26) goto ERR1_FHSTYP_2

Question ID: NAH.120_00.003

Instrument Variable Name: FHSTYP_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 provided age range for sister(s) diagnosed with the second kind of cancer or didn't know
how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) if FHSTYP_2 = FHSTYP_1 or FHSTYP_2
goto ERR2_FHSTYP_3
elseif FHSCAN = '1'
goto FHSAGE3
else
goto FHSMAN3
(96) goto FHNNUM
(20,26) goto ERR1_FHSTYP_3

Question ID: NAH.120_00.004

Instrument Variable Name: FHSTYP_4
QuestionText:

* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
95 More than 3 kinds
96 No more

UniverseText: Sample adults 18+ who provided age range for sister(s) diagnosed with the third kind of cancer or didn't know
how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range
and had not refused to answer the third kind of cancer
SkipInstructions:

(95,96) goto FHNNUM
(1-30) goto ERR_FHSTYP_4

Question ID: NAH.121_00.000

Instrument Variable Name: FHSMAN1
QuestionText:

How many sisters have had [Fill: FHSTYP_1]?
* Enter '21' for 21 or more sisters.

01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have sisters with a first kind of cancer
SkipInstructions:

(1-21) if FHSMAN1 GT FHSCAN
goto ERR_FHSMAN1
else
goto FHSAGE1
(RF,DK) goto FHSAGE1

Question ID: NAH.122_00.000

Instrument Variable Name: FHSAGE1
QuestionText:

[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_1] was first diagnosed?
* Enter '0' if sister was 50 or over.
* Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose sister(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
SkipInstructions:

(0-21) if FHSMAN1 NE 'Refused' and FHSMAN1 NE 'Don't know' and FHSAGE1 GT FHSMAN1
goto ERR1_FHSAGE1
elseif (FHSMAN1 = 'Refused' or FHSMAN1 = 'Don't know') and FHSAGE1 GT FHSCAN
goto ERR2_FHSAGE1
else
goto FHSTYP_2
(DK) goto FHSTYP_2
(RF) and (RF) at FHSTYP_1 goto FHNNUM
(RF) and FHSTYP_1 NE (RF) goto FHSTYP_2

Question ID: NAH.123_00.000

Instrument Variable Name: FHSMAN2
QuestionText:

How many sisters have had [Fill: FHSTYP_2]?
* Enter '21' for 21 or more sisters.

01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have sisters with a second kind of cancer
SkipInstructions:

(1-21) if FHSMAN2 GT FHSCAN
goto ERR_FHSMAN2
else
goto FHSAGE2
(RF,DK) goto FHSAGE2

Question ID: NAH.124_00.000

Instrument Variable Name: FHSAGE2
QuestionText:

[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_2] was first diagnosed?
* Enter '0' if sister was 50 or over.
* Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose sister(s) had a second kind of cancer or refused or didn't know name of second kind of
cancer
SkipInstructions:

(0-21) if FHSMAN2 NE 'Refused' and FHSMAN2 NE 'Don't know' and FHSAGE2 GT FHSMAN2
goto ERR1_FHSAGE2
elseif (FHSMAN2 = 'Refused' or FHSMAN2 = 'Don't know') and FHSAGE2 GT FHSCAN
goto ERR2_FHSAGE2
else goto FHSTYP_3
(DK) goto FHSTYP_3
(RF) and (RF) at FHSTYP_2 goto FHNNUM
(RF) and FHSTYP_2 NE (RF) goto FHSTYP_3

Question ID: NAH.125_00.000

Instrument Variable Name: FHSMAN3
QuestionText:

How many sisters have had [Fill1: FHSTYP_3]?
* Enter '21' for 21 or more sisters.

01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have sisters with a third kind of cancer
SkipInstructions:

(1-21) if FHSMAN3 GT FHSCAN
goto ERR_FHSMAN3
else
goto FHSAGE3
(RF,DK) goto FHSAGE3

Question ID: NAH.126_00.000

Instrument Variable Name: FHSAGE3
QuestionText:

[Fill1: Was your sister under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' if sister was 50 or over.
*Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
* Enter '0' for none. * Enter '21' for 21 or more sisters.]

00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose sister(s) had a third kind of cancer or refused or didn't know name of third kind of cancer
SkipInstructions:

(0-21) if FHSAGE3 GT FHSMAN3
goto ERR_FHSAGE3
elseif (FHSMAN3 = 'Refused' or FHSMAN3 = 'Don't know') and FHSAGE3 GT FHSCAN
goto ERR2_FHSAGE3
else
goto FHSTYP_4
(DK) goto FHSTYP_4
(RF) and (RF) at FHSTYP_3 goto FHNNUM
(RF) and FHSTYP_3 NE (RF) goto FHSTYP_4

Question ID: NAH.130_00.000

Instrument Variable Name: FHNNUM

QuestionText:

How many BIOLOGICAL SONS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more biological sons.
*Enter '96' for no biological children.

00 None
01-20 1-20 sons
21 21+
96 No biological children
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,RF,DK) [goto FHDNUM]
(1-21)[goto FHNCAN]
(22-95) goto ERR_FHNNUM
(96) goto SASSN

Question ID: NAH.140_00.000

Instrument Variable Name: FHNCAN
QuestionText:

[Fill1: Did your SON EVER have cancer of any kind?
*Enter '0' if son has not had any kind of cancer.
*Enter '1' if son has had cancer.]
[Fill2: How many of your SONS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]

00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have at least one biological son
SkipInstructions:

(0,RF,DK) goto FHDNUM
(1-21) if FHNCAN gt FHNNUM
goto ERR_FHNCAN
else
goto FHNTYP_1

Question ID: NAH.150_00.001

Instrument Variable Name: FHNTYP_1
QuestionText:

What kinds of cancer did your [Fill1: son/Fill2: sons] have?
* 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+ whose sons(s) ever had cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) if FHNCAN = '1'
goto FHNAGE1
else
goto FHNMAN1
(6,18,29) goto ERR_FHNTYP_1

Question ID: NAH.150_00.002

Instrument Variable Name: FHNTYP_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 provided age range for son(s) diagnosed with the first kind of cancer or didn't know how
old sons(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had
not refused to answer the first kind of cancer
SkipInstructions:

(1-5,7-17,19-28,30,RF,DK) if FHNTYP_2 = FHNTYP_1
goto ERR2_FHNTYP_2
elseif FHNCAN = '1'
goto FHNAGE2
else
goto FHNMAN2
(96) goto FHDNUM
(6,18,29) goto ERR1_FHNTYP_2

Question ID: NAH.150_00.003

Instrument Variable Name: FHNTYP_3
QuestionText:

* Enter '95' if respondent offers more than 2 kinds of cancer.
* Enter '96' for no more.

95 More than 2 kinds
96 No more

UniverseText: Sample adults 18+ who provided age range for son(s) diagnosed with the second kind of cancer or didn't know how old son(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and
had not refused to answer the second kind of cancer
SkipInstructions:

(95,96) goto FHDNUM
(1-30) goto ERR_FHNTYP_3

Question ID: NAH.151_00.000

Instrument Variable Name: FHNMAN1
QuestionText:

How many sons have had [Fill1: FHNTYP_1]?
*Enter '21' for 21 or more sons.

01-20 1-20 sons
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have sons with a first kind of cancer
SkipInstructions:

(1-21) if FHNMAN1 GT FHNCAN
goto ERR_FHNMAN1
else
goto FHNAGE1
(RF,DK) goto FHNAGE1

Question ID: NAH.152_00.000

Instrument Variable Name: FHNAGE1
QuestionText:

[Fill1: Was your son under 50 years of age when [Fill3: FHNTYP_1] was first diagnosed?
*Enter '0' if son was 50 or over.
*Enter '1' if son was under 50.]
[Fill2: How many of these sons were under 50 years of age when [Fill3: FHNTYP_1] was first diagnosed?
*Enter '0' for none. *Enter '21' for 21 or more sons.]

00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose son(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
SkipInstructions:

(0-21) if FHNMAN1 NE 'Refused' and FHNMAN1 NE 'Don't know' and FHNAGE1 GT FHNMAN1
goto ERR2_FHNAGE1
elseif (FHNMAN1 = 'Refused' or FHNMAN1 = 'Don't know') and FHNAGE1 GT FHNCAN
goto ERR3_FHNAGE1
elseif AGE LE '55' and FHNMAN1 NE 'Refused' and FHNMAN1 NE 'Don't know' and FHNAGE1 LT
FHNMAN1
goto ERR1_FHNAGE1
elseif AGE LE '55' and (FHNMAN1 = 'Refused' or FHNMAN1 = 'Don't know') and FHNAGE1 = '0'
goto ERR1_FHNAGE1
else
goto FHNTYP_2
(DK) goto FHNTYP_2
(RF) IF FHNTYP_1=RF goto FHDNUM
else if FHNTYP_1 NE (RF) goto FHNTYP_2

Question ID: NAH.153_00.000

Instrument Variable Name: FHNMAN2
QuestionText:

How many sons have had [Fill: FHNTYP_2]?
*Enter '21' for 21 or more sons.

01-20 1-20 sons
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have sons with a second kind of cancer
SkipInstructions:

(1-21) if FHNMAN2 GT FHNCAN
goto ERR_FHNMAN2
else
goto FHNAGE2
(RF,DK) goto FHNAGE2

Question ID: NAH.154_00.000

Instrument Variable Name: FHNAGE2
QuestionText:

[Fill1: Was your son under 50 years of age when [Fill3: FHNTYP_2] was first diagnosed?
*Enter '0' if son was 50 or over.
*Enter '1' if son was under 50.]
[Fill2: How many of these sons were under 50 years of age when [Fill3: FHNTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]

00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose sons(s) had a second kind of cancer or refused or didn't know name of second kind of
cancer
SkipInstructions:

(0-21) if FHNMAN2 NE 'Refused' and FHNMAN2 NE 'Don't know' and FHNAGE2 GT FHNMAN2
goto ERR2_FHNAGE2
elseif (FHNMAN2 = 'Refused' or FHNMAN2 = 'Don't know') and FHNAGE2 GT FHNCAN
goto ERR3_FHNAGE2
elseif AGE LE '55' and FHNMAN2 NE 'Refused' and FHNMAN2 NE 'Don't know' and FHNAGE2 LT
FHNMAN1
goto ERR1_FHNAGE2
elseif AGE LE '55' and (FHNMAN2 = 'Refused' or FHNMAN2 = 'Don't know') and FHNAGE2 = '0'
goto ERR1_FHNAGE2
else
goto FHNTYP_3
(DK) goto FHNTYP_3
(RF) and (RF) at FHNTYP_2 goto FHDNUM
(RF) and FHNTYP_2 NE (RF) goto FHNTYP_3

Question ID: NAH.160_00.000

Instrument Variable Name: FHDNUM
QuestionText:

How many BIOLOGICAL DAUGHTERS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more biological daughters.

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who did not say they did not have any biological children at the 'number of biological sons'
question
SkipInstructions:

(0,RF,DK) goto next section
(1-21) goto FHDCAN

Question ID: NAH.170_00.000

Instrument Variable Name: FHDCAN
QuestionText:

[Fill1: Did your DAUGHTER EVER have cancer of any kind?
*Enter '0' if daughter has not had any kind of cancer.
*Enter '1' if daughter has had cancer.]
[Fill2: How many of your DAUGHTERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have at least one biological daughter
SkipInstructions:

(0,RF,DK) goto next section
(1-21) if FHDCAN gt FHDNUM
goto ERR_FHDCAN
else
goto FHDTYP_1

Question ID: NAH.180_00.001

Instrument Variable Name: FHDTYP_1
QuestionText:

What kinds of cancer did your [Fill1: daughter/Fill2: daughters] have?
* 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+ whose daughter(s) ever had cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) if FHDCAN = '1'
goto FHDAGE1
else
goto FHDMAN1
(20,26) goto ERR_FHDTYP_1

Question ID: NAH.180_00.002

Instrument Variable Name: FHDTYP_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 provided age range for daughter(s) diagnosed with the first kind of cancer or didn't know
how old daughter(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range
and had not refused to answer the first kind of cancer
SkipInstructions:

(1-19,21-25,27-30,RF,DK) if FHDTYP_2 = FHDTYP_1
goto ERR2_FHDTYP_2
elseif FHDCAN = '1'
goto FHDAGE2
else
goto FHDMAN2
(96) goto next section
(20,26) goto ERR_FHDTYP_2

Question ID: NAH.180_00.003

Instrument Variable Name: FHDTYP_3
QuestionText:

* Enter '95' if respondent offers more than 2 kinds of cancer.
* Enter '96' for no more.

95 More than 2 kinds
96 No more

UniverseText: Sample adults 18+ who provided age range for daughter(s) diagnosed with the second kind of cancer or didn't
know how old daughter(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age
range and had not refused to answer the second kind of cancer
SkipInstructions:

(95,96) goto next section
(1-30) goto ERR_FHDTYP_3

Question ID: NAH.190_00.000

Instrument Variable Name: FHDMAN1
QuestionText:

How many daughters have had [Fill: FHDTYP_1]?
*Enter '21' for 21 or more daughters.

01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have daughters with a first kind of cancer
SkipInstructions:

(1-21) if FHDMAN1 GT FHDCAN
goto ERR_FHDMAN1
else
goto FHDAGE1
(RF,DK) goto FHDAGE1

Question ID: NAH.191_00.000

Instrument Variable Name: FHDAGE1
QuestionText:

[Fill1: Was your daughter under 50 years of age when [Fill3: FHDTYP_1] was first diagnosed?
*Enter '0' if daughter was 50 or over.
*Enter '1' if daughter was under 50.]
[Fill2: How many of these daughters were under 50 years of age when [Fill3: FHDTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose daughter(s) had a first kind of cancer or refused or didn't know name of first kind of
cancer
SkipInstructions:

(0-21) if FHDMAN1 NE 'Refused' and FHDMAN1 NE 'Don't know' and FHDAGE1 GT FHDMAN1
goto ERR2_FHDAGE1
elseif (FHDMAN1 = 'Refused' or FHDMAN1 = 'Don't know') and FHDAGE1 GT FHDCAN
goto ERR3_FHDAGE1
elseif AGE LE '55' and FHDMAN1 NE 'Refused' and FHDMAN1 NE 'Don't know' and FHDAGE1 LT
FHDMAN1
goto ERR1_FHDAGE1
elseif AGE LE '55' and (FHDMAN1 = 'Refused' or FHDMAN1 = 'Don't know') and FHDAGE1 = '0'
goto ERR1_FHDAGE1
else
goto FHDTYP_2
(DK) goto FHDTYP_2
(RF) IF FHDTYP_1=RF goto next section
else if FHDTYP_1 NE RF goto FHDTYP_2

Question ID: NAH.192_00.000

Instrument Variable Name: FHDMAN2
QuestionText:

How many daughters have had [Fill: FHDTYP_2]?
*Enter '21' for 21 or more daughters.

01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have daughters with a second kind of cancer
SkipInstructions:

(1-21) if FHDMAN2 GT FHDCAN
goto ERR_FHDMAN2
else
goto FHDAGE2
(RF,DK) goto FHDAGE2

Question ID: NAH.193_00.000

Instrument Variable Name: FHDAGE2
QuestionText:

[Fill1: Was your daughter under 50 years of age when [Fill3: FHDTYP_2] was first diagnosed?
*Enter '0' if daughter was 50 or over.
*Enter '1' if daughter was under 50.]
[Fill2: How many of these daughters were under 50 years of age when [Fill3: FHDTYP_2] was first diagnosed?
*Enter '0' for none. *Enter '21' for 21 or more daughters.]

00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know

UniverseText: Sample adults 18+ whose daughter(s) had a second kind of cancer or refused or didn't know name of second kind
of cancer
SkipInstructions:

(0-21)if FHDMAN2 NE 'Refused' and FHDMAN2 NE 'Don't know' and FHDAGE2 GT FHDMAN2
goto ERR2_FHDAGE2
elseif (FHDMAN2 = 'Refused' or FHDMAN2 = 'Don't know') and FHDAGE2 GT FHDCAN
goto ERR3_FHDAGE2
elseif AGE LE '55' and FHDMAN2 NE 'Refused' and FHDMAN2 NE 'Don't know' and FHDAGE2 LT
FHDMAN2
goto ERR1_FHDAGE2
elseif AGE LE '55' and (FHDMAN2 = 'Refused' or FHDMAN2 = 'Don't know') and FHDAGE2 = '0'
goto ERR1_FHDAGE2
else
goto FHDTYP_3
(DK) goto FHDTYP_3
(RF) IF FHDTYP_2=RF goto next section
else if FHDTYP_2 NE RF goto FHDTYP_3

Survivorship

Question ID: NAI.100_00.000

Instrument Variable Name: QOL
QuestionText:

In general, would you say your quality of life is
*Read categories below.

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto QOLPH]

Question ID: NAI.110_00.000

Instrument Variable Name: QOLPH
QuestionText:

In general, how would you rate your physical health?
*Read categories below.

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto QOLMH]

Question ID: NAI.120_00.000

Instrument Variable Name: QOLMH
QuestionText:

In general, how would you rate your mental health, including your mood and your ability to think?
*Read categories below.

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto QOLSAR]

Question ID: NAI.130_00.000

Instrument Variable Name: QOLSAR
QuestionText:

In general, how would you rate your satisfaction with your social activities and relationships?
*Read categories below.

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto COUSAR]

Question ID: NAI.140_00.000

Instrument Variable Name: COUSAR
QuestionText:

In general, please rate how well you carry out your usual social activities and roles. This includes activities at home, at
work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.
*Read categories below.

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto COEPA]

Question ID: NAI.150_00.000

Instrument Variable Name: COEPA
QuestionText:

To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying
groceries, or moving a chair?
*Read categories below.

1 Completely
2 Mostly
3 Moderately
4 A little
5 Not at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto BEP7D]

Question ID: NAI.160_00.000

Instrument Variable Name: BEP7D
QuestionText:

IN THE PAST 7 DAYS, how often have you been bothered by emotional problems such as feeling anxious, depressed, or
irritable?
*Read categories below.

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto RF7D]

Question ID: NAI.170_00.000

Instrument Variable Name: RF7D
QuestionText:

IN THE PAST 7 DAYS, how would you rate your fatigue on average?
*Read categories below.

1 None
2 Mild
3 Moderate
4 Severe
5 Very severe
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D)[goto RP7D]

Question ID: NAI.180_00.000

Instrument Variable Name: RP7D
QuestionText:

IN THE PAST 7 DAYS, how would you rate your pain on average? Use a scale of 0-10 with 0 being no pain and 10 being
the worst imaginable pain.

00-10 0-10 rate of pain
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-10,R,D)
if CANEV=1 [goto CCBG10Y]
else [goto next section]

Question ID: NAI.190_00.000

Instrument Variable Name: CCBG10Y
QuestionText:

Now, I will ask you some questions about your experiences with cancer.
What do you think are the chances that your cancer will come back or get worse within the next 10 years? Would you
say...
*Read categories below.

1 Very low
2 Fairly low
3 Moderate
4 Fairly high
5 Very high
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-5,R,D)[goto WCCBGW]

Question ID: NAI.200_00.000

Instrument Variable Name: WCCBGW
QuestionText:

How often do you worry that your cancer may come back or get worse? Would you say...
*Read categories below.

1 Never
2 Rarely
3 Sometimes
4 Often
5 All the time
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-5,R,D)[goto RECUR]

Question ID: NAI.210_00.000

Instrument Variable Name: RECUR
QuestionText:

At any time since you were first diagnosed with cancer, did a doctor or other health professional tell you that your cancer
had come back (that is, you had a recurrence)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1)[goto MRRYR]
(2,R,D)[goto TRETMRC]

Question ID: NAI.210_00.001

Instrument Variable Name: MRRYR
QuestionText:

What was the year of your most recent recurrence?

1880-2011 1880-2011
9997 Refused
9999 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer and who were told their cancer had come back
SkipInstructions:

(1880-2011,R,D)[goto TRETMRC]

Question ID: NAI.220_00.000

Instrument Variable Name: TRETMRC
QuestionText:

If you've had more than one cancer diagnosis, please think about your most recent cancer diagnosis for the next few
questions.
What types of treatment did you receive for this cancer? Please select all that apply.
*Read categories below.

01 Surgery to remove the tumor
02 Radiation
03 Chemotherapy
04 Hormonal treatments such as tamoxifen or aromatase inhibitors (Arimidex, Femara)
05 Bone marrow or stem cell transplant
06 Did not receive treatment
07 Other (specify)
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(7)[goto TMRCSPEC]
(6)[goto NFOC]
(1-5,R,D) [goto TRETBC]

Question ID: NAI.225_00.000

Instrument Variable Name: TMRCSPEC
QuestionText:

*Specify other type of treatment received for cancer.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Sample adults 18+ who were ever told they had cancer and used an other specified type of treatment for their
cancer
SkipInstructions:

(allow 20,R,D)[goto TRETBC]

Question ID: NAI.230_00.000

Instrument Variable Name: TRETBC
QuestionText:

IN THE LAST 12 MONTHS have you received either surgery, radiation therapy, chemotherapy, bone marrow transplant
or stem cell transplant to treat cancer? {Fill: Do not include long-term hormonal treatments such as tamoxifen or
aromatase (uh-ROH-muh-tayz) inhibitors for breast cancer.}

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who received some kind of treatment to treat their only or most recent cancer
SkipInstructions:

(1)[goto CIAT]
(2,R,D)[goto NFOC]

Question ID: NAI.230_00.001

Instrument Variable Name: CIAT
QuestionText:

Are you currently in active treatment now?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer and received either surgery, radiation, chemotherapy,
hormonal treatments, bone marrow transplant or stem cell transplant, or some other type of treatment to treat
cancer in the last 12 months.
SkipInstructions:

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

Question ID: NAI.240_00.000

Instrument Variable Name: NFOC
QuestionText:

To the best of your knowledge, are you now free of cancer (that is, at this time, you don't have cancer in any part of your
body)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1,2,R,D)
if TRETMRC='6' [goto HPCAEROP]
else if CIAT='1' [goto FUADVEV]
else[goto TRETDOC]

Question ID: NAI.250_00.000

Instrument Variable Name: TRETDOC
QuestionText:

At the completion of your cancer treatment(s), did your doctor give you a single written document describing ALL the
treatments you actually received? This would NOT include general pamphlets about cancer treatments or individual lab
results.

1 Yes
2 No
7 Refused
9 Don't know

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

Question ID: NAI.260_00.000

Instrument Variable Name: FUADVEV
QuestionText:

Have you EVER received advice from a doctor, nurse, or other health care professional about where you should return or
who you should see for routine cancer check-ups after completing treatment for cancer?

1 Yes
2 No
7 Refused
9 Don't know

(1)[goto FUADVFMT]
(2,R,D)[goto HICT]

Question ID: NAI.260_00.001

Instrument Variable Name: FUADVFMT
QuestionText:

Not including appointment cards or reminders, was this information written down, printed on paper, or provided in an
electronic format for you?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer and who ever received advice from a health care
professional about routine cancer check-ups after completing cancer treatment
SkipInstructions:

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

Question ID: NAI.270_00.000

Instrument Variable Name: HICT
QuestionText:

Did you have any public or private health insurance that paid for all or part of your cancer treatment?
*Read if necessary: Examples of insurance include Medicare, Medicaid, insurance offered through an employer, the
military, or a policy you bought on your own.

1 Yes
2 No
7 Refused
9 Don't know

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

Question ID: NAI.280_00.000

Instrument Variable Name: HPCAEROP
QuestionText:

After you were diagnosed with cancer, did your doctor, nurse or other health professional talk with you about how cancer
may affect your emotions or your relationships with other people?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1,R,D)[goto HPMETESN]
(2)[goto HPIDATT]

Question ID: NAI.280_00.001

Instrument Variable Name: HPIDATT
QuestionText:

Would you have liked it if your doctor had initiated a discussion about these topics with you?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer and who did not have a health care professional talk with
them about how cancer may affect their emotions or relationships with other people
SkipInstructions:

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

Question ID: NAI.290_00.000

Instrument Variable Name: HPMETESN
QuestionText:

How satisfied were you, overall, with how well your doctor, nurse, or other health professional met your emotional and
social needs related to your cancer diagnosis and treatment?
*Read categories below.

1 Very satisfied
2 Somewhat satisfied
3 Not satisfied
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-3,R,D)[goto ACDPCSG]

Question ID: NAI.300_00.000

Instrument Variable Name: ACDPCSG
QuestionText:

After your cancer was diagnosed, did you receive professional counseling or join a support group to help you cope?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1,R,D)[goto CTRSCT]
(2)[goto MRNPCSG]

Question ID: NAI.300_00.001

Instrument Variable Name: MRNPCSG
QuestionText:

What was the MAIN reason you did not get professional counseling or join a support group?
*Read categories below.

1 I didn't know these services were available
2 I didn't want it
3 I didn't think I needed it
4 I couldn't afford it
5 Some other reason (please specify)
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer and did not receive professional counseling or join a
support group to help cope with cancer diagnosis
SkipInstructions:

(1)[goto DKPCSG]
(2,3,4,R,D)[goto CTRSCT]
(5) [goto RCSGSPEC]

Question ID: NAI.300_00.002

Instrument Variable Name: RCSGSPEC
QuestionText:

*Specify other reason for not getting professional counseling or joining a support group.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Sample adults 18+ who were ever told they had cancer and did not receive professional counseling or join a
support group to help cope with cancer diagnosis because of some other reason
SkipInstructions:

(allow 20,R,D)[goto CTRSCT]

Question ID: NAI.300_00.003

Instrument Variable Name: DKPCSG
QuestionText:

Would you have been interested in receiving professional counseling or joining a support group if you had known about it?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer and did not receive professional counseling or join a
support group to help cope with cancer diagnosis because they didn't know these services were available
SkipInstructions:

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

Question ID: NAI.310_00.000

Instrument Variable Name: CTRSCT
QuestionText:

For the next few questions, please answer based on all of your experiences since the first time you were diagnosed with
cancer.
Did you participate in a research study or clinical trial as a part of your cancer treatment?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

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

Question ID: NAI.320_00.000

Instrument Variable Name: DHIBC
QuestionText:

Were you EVER denied health insurance or life insurance coverage because of your cancer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

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

Question ID: NAI.330_00.000

Instrument Variable Name: CCFP
QuestionText:

To what degree has cancer caused financial problems for you and your family?
*Read categories below.

1 A lot
2 Some
3 A little
4 Not at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-4,R,D)[goto LINKINTRO]

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