2010 NHIS Questionnaire, Sample Adult
Diet and Nutrition
Question ID: NAC.005_00.000
Instrument Variable Name: SPSPEAK
QuestionText:
First, I would like to ask about the language you use most often. In general, what language do you speak?
2 Mostly Spanish
3 Spanish and English about the same
4 Mostly English
5 Only English
6 Other
7 Refused
9 Don't know
SkipInstructions:
(6) [goto OTHLANG]
QuestionText:
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
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.
001-995 1 to 995 times
997 Refused
999 Don't know
SkipInstructions:
(1 to 995)[ [goto CEREALTP]
Instrument Variable Name: CEREALTP
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
( 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]
QuestionText:
* 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
99 Don't know
Verbatim Verbatim response
ZZ Other specify
SkipInstructions:
else goto CERTYP2
All goto CERTYP2
Instrument Variable Name: CERTPSP
QuestionText:
SkipInstructions:
Question ID: NAC.015_01.000
Instrument Variable Name: CERTYP2
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2, D, R) [goto MILKNO]
QuestionText:
* If cereal is not found, type ZZ
99 Don't know
Verbatim Verbatim response
ZZ Other specify
SkipInstructions:
else goto MILKNO
QuestionText:
SkipInstructions:
QuestionText:
*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.
001 to 995 1 to 995 times
997 Refused
999 Don't know
SkipInstructions:
(1 to 995) [goto MILKTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
* Read categories below.
* If respondent drinks soy milk only, go back and change MILKNO to '0'.
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
SkipInstructions:
QuestionText:
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.
001-995 1 to 995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995)[goto SODATP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995)[goto FRJUICTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto COFFEETP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto SPORDRTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto FRTDRTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto FRUITTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto SALADTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto FRIESTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto POTATOTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto BEANSTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto BRRICETP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto OVEGTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto SALSATP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto PIZZATP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto TOMSAUTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto CHEESETP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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:
*Read categories below...
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
SkipInstructions:
QuestionText:
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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto REDMETTP]
Instrument Variable Name: REDMETTP
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
(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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto PROMETTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto BREADTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto CANDYTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
Sample adults 18+ who ate candy in past month
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto DONUTTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto COOKIETP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto ICECRTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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.
001-995 1-995 times
997 Refused
999 Don't know
SkipInstructions:
(1-995) [goto POPCNTP]
QuestionText:
*Enter time period.
1 Per day
2 Per week
3 Per month
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto next section]
QuestionText:
*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.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto CALCA]
QuestionText:
*Enter number of days taking multi-vitamins.
*Enter '30' for all days in the month.
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
[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.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto VITD]
QuestionText:
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.
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto next section]
QuestionText:
*Enter '30' for all days in the month.
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
*Read categories below.
2 For BONE health
3 To prevent CANCER
4 For some other reason
7 Refused
9 Don't know
SkipInstructions:
(4) [goto VITDSPEC]
QuestionText:
99 Don't know
Verbatim Verbatim response
SkipInstructions:
Physical Activity
QuestionText:
relaxation or exercise.
During the past 7 days, did you walk to get some place that took you at least 10 minutes?
2 No
3 Unable to walk
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto AD14A]
(3) [goto SITWDAY]
QuestionText:
*Read if necessary: Walk for at least 10 minutes to get some place.
97 Refused
99 Don't know
SkipInstructions:
(R,D) [goto AD14A]
QuestionText:
[Fill1: How long did that walk take?/ Fill2: On average, how long did those walks take?]
* Enter number for length of walk for transportation.
997 Refused
999 Don't know
Sample adults 18+ who have walked for transportation at least once in the past week
SkipInstructions:
[If AD13ANO= 'R', 'D' store 'R', 'D' in AD13ATP]
(R,D)[goto AD14A]
QuestionText:
* Enter time period for length of walking for transportation.
2 Hours
7 Refused
9 Don't know
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 (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
QuestionText:
10 minutes for any of these reasons? Please do not include walking for transportation.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto SITWDAY]
QuestionText:
97 Refused
99 Don't know
SkipInstructions:
(R,D) [goto SITWDAY]
QuestionText:
[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.
997 Refused
999 Don't know
SkipInstructions:
(R,D)[goto SITWDAY] and [If AD16ANO= 'R', 'D' store 'R', 'D' in AD16ATP]
QuestionText:
* Enter time period for length of walking for fun, relaxation, or exercise.
2 Hours
7 Refused
9 Don' know
of this two-part question
SkipInstructions:
(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]
QuestionText:
*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
01-24 1-24 hours
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
*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.
01-24 1-24 hours
97 Refused
99 Don't know
SkipInstructions:
else if AMDLONG eq (0,3,4,5) [goto next section]
QuestionText:
CONTINUE to do any type of exercise or physical activity?
2 No
3 Did not see a doctor in the PAST 12 MONTHS
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
time, was your usual cigarette brand menthol or non-menthol?
2 Non menthol
3 No usual type
7 Refused
9 Don't know
SkipInstructions:
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]
QuestionText:
*Enter '95' if varied.
*Enter '96' if never smoked cigarettes regularly.
95 Varied
96 Never smoked regularly
97 Refused
99 Don't know
SkipInstructions:
(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
QuestionText:
*Read if necessary: 1 pack equals 20 cigarettes.
*Enter '95' if 95 or more.
95 95 or more cigarettes
97 Refused
99 Don't know
SkipInstructions:
(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]
QuestionText:
A nicotine patch?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine gum or lozenge?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine containing nasal spray or inhaler?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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)?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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)?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
A telephone help line or quit line?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Thinking back to when you stopped smoking completely, did you use ANY of the following:
One-on-one counseling?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Thinking back to when you stopped smoking completely, did you use ANY of the following:
A stop smoking clinic, class or support group?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Is your usual cigarette brand menthol or non-menthol?
2 Non menthol
3 No usual type
7 Refused
9 Don't know
SkipInstructions:
else [goto CSQEV]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
PRODUCTS:
A nicotine patch?
2 No
7 Refused
9 Don't know
SkipInstructions:
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 gum or lozenge?
2 No
7 Refused
9 Don't know
SkipInstructions:
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 containing nasal spray or inhaler?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
A telephone help line or quit line?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
[fill1: These questions are about tobacco use.]
Have you ever smoked a cigar EVEN ONE TIME?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 Some days
3 Not at all
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Enter '0' for none.
*Enter '30' for all days in the month.
01-30 1-30 days
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
Have you EVER used snuff, such as Skoal, Skoal Bandits, or Copenhagen, EVEN ONE TIME?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 Some days
3 Not at all
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Enter '0' for none.
*Enter '30' for all days in the month.
01-30 1-30 days
97 Refused
99 Don't know
SkipInstructions:
Question ID: NAE.160_00.000
Instrument Variable Name: CHEWEV
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 Some days
3 Not at all
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*Enter '0' for none.
*Enter '30' for all days in the month.
01-30 1-30 days
97 Refused
99 Don't know
SkipInstructions:
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]
QuestionText:
OFTEN?
*Do not read categories.
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
SkipInstructions:
((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]
QuestionText:
99 Don't know
Verbatim Verbatim response
SkipInstructions:
((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]
QuestionText:
quit using other kinds of tobacco?
2 No
7 Refused
9 Don't know
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:
QuestionText:
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.
2 Dentist
3 Nurse
4 Dental Hygienist
5 Other health professional (specify)
7 Refused
9 Don't know
tobacco in the past 12 months
SkipInstructions:
QuestionText:
99 Don't know
Verbatim Verbatim response
SkipInstructions:
QuestionText:
home?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section
QuestionText:
INSIDE this home?
*Enter '0' for none.
*Enter '96' for 96 or more smokers.
01-95 1-95 persons
96 96+
97 Refused
99 Don't know
SkipInstructions:
(0,R,D) [if SEX = 2 and AGE = 18-49 [goto LIVEBTH]]; else goto next section
QuestionText:
*Enter '0' for less than 1 day per week/rarely/none
*Enter '7' for all days per week
01-07 1-7 days
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
Question ID: NAE.200_00.000
Instrument Variable Name: SMKPREG
QuestionText:
2 No
7 Refused
9 Don't know
birth in the past 5 years
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
birth in the past 5 years
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
pregnancy
SkipInstructions:
QuestionText:
02 Second
03 Third
04 Fourth
05 Fifth
06 Sixth
07 Seventh
08 Eighth
09 Ninth
97 Refused
99 Don't know
pregnancy, but quit for 7 days or longer
SkipInstructions:
QuestionText:
2 Started again
3 Never started again
7 Refused
9 Don't know
pregnancy, but quit for 7 days or longer
SkipInstructions:
Cancer Screening
QuestionText:
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.
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
SkipInstructions:
QuestionText:
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.
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
SkipInstructions:
QuestionText:
Stay in the shade? Would you say (Read categories 1-5). . .
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
SkipInstructions:
QuestionText:
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). . .
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
SkipInstructions:
QuestionText:
*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.
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
SkipInstructions:
QuestionText:
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). . .
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
SkipInstructions:
QuestionText:
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). . .
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
SkipInstructions:
QuestionText:
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). . .
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
SkipInstructions:
QuestionText:
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.
50 50+
96 More than one, different ones, other
97 Refused
SkipInstructions:
(96,R,D) [goto SPFSCALE]
5(1-95) [goto ERR_SPF]
QuestionText:
*Enter '2' if 50 or higher SPF.
2 15+
7 Refused
9 Don't know
refused to say the SPF
SkipInstructions:
QuestionText:
*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.
001-365 1-365 times
997 Refused
999 Don't know
SkipInstructions:
QuestionText:
EVEN ONE TIME? Do NOT include times you have gotten a spray-on tan.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
or tanning booth? Do NOT include times you have gotten a spray-on tan.
997 Refused
999 Don't know
SkipInstructions:
QuestionText:
from head to toe checked for cancer either by a dermatologist or some other kind of doctor?
2 No
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
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.
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
SkipInstructions:
(R) store "R' in RSKX1_YR [goto RSKX2]
(96) store "9996" in RSKX1_YR [goto RSKX1N]
QuestionText:
*Enter year of last skin exam.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT skin exam?
*Enter number for time since last skin exam.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
*Enter time period for time since most recent skin exam.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
reason?
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
SkipInstructions:
else if SEX=1 and AGE le 64 [goto HPVHRD]
else if SEX=1 and AGE ge 65 [goto CHESTX]
QuestionText:
*Enter '0' for haven't started.
06-60 6-60 years
97 Refused
99 Don't know
SkipInstructions:
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]
QuestionText:
2 No
7 Refused
9 Don't know
Female sample adults 39+ who have started menstrual cycles
SkipInstructions:
elseif nae.LIVEBTH = '1' [goto BIRTHNUM]
(2) [goto MENLAST]
QuestionText:
* Read categories below.
2 More than 1 year ago but less than 2 years ago
3 2 years ago or more
7 Refused
9 Don't know
SkipInstructions:
elseif nae.LIVEBTH = '1' [goto BIRTHNUM]
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Enter '25' for 25 or more.
25 25+
97 Refused
SkipInstructions:
QuestionText:
97 Refused
99 Don't know
SkipInstructions:
(D) [goto BIRTHAG2]
QuestionText:
9997 Refused
9999 Don't know
SkipInstructions:
elseif BIRTHAG2 gt year of birth (DOBY) [goto ERR2_BIRTHAG2]
else [goto PAPHAD1]
QuestionText:
*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.
2 No
7 Refused
9 Don't know
SkipInstructions:
PREMIND] else [goto HYST]
QuestionText:
97 Refused
99 Don't know
SkipInstructions:
else [goto PAP6YR1]
QuestionText:
*Enter '0' for none.
*Enter '95' for 95 or more exams.
01-94 1-94
+95 95
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
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.
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
SkipInstructions:
RPAP1N1]
QuestionText:
*Enter year of last Pap test.
9996 Time period format
9997 Refused
9999 Don't know
test
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT Pap test?
*Enter number for time since last Pap test.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
initial month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent Pap test.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
reason?
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
3 Only notified if there was a problem
7 Refused
9 Don't know
Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:
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]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto MDRECP1]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Put response into correct category below.
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
SkipInstructions:
QuestionText:
*Put response into correct category below.
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
SkipInstructions:
(3) if age le 65 [goto PREMIND]
elseif age ge 66 [goto HYST]
(8) [goto RHYS1_MT]
(9) [goto HYST]
QuestionText:
"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?"
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know
who haven't had a hysterectomy, and gave a reason for not having Pap test ever/in the last 3 years
SkipInstructions:
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]
QuestionText:
2 No
7 Refused
9 Don't know
have not had a Pap test in the last 3 years
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
When was your hysterectomy?
*Enter month of hysterectomy.
*Enter '96' to go to number and time period format.
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
SkipInstructions:
[goto RHYS1N]
QuestionText:
*Enter year of hysterectomy.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When was your hysterectomy?
*Enter number for time since hysterectomy.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
screen
SkipInstructions:
QuestionText:
*Enter time period for time since hysterectomy.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
997 Refused
999 Don't know
Female sample adults age 18+ who have had BOTH ovaries removed
SkipInstructions:
elseif age LE 64 [goto HPVHRD] else [goto MAMHAD]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) goto SHHPVHRD
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
3 Doctor refused when asked
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Enter '50' if 50 or more shots
*Enter '96' for all shots
50 50+
96All shots
97 Refused
99 Don't know
SkipInstructions:
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
QuestionText:
When was your last HPV shot?
*Enter month of last HPV shot.
*Enter '96' to go to number and time period format.
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
SkipInstructions:
QuestionText:
*Enter year of last HPV shot.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When was your last HPV shot?
*Enter number for time since last HPV shot.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
screen
SkipInstructions:
QuestionText:
*Enter time period for time since last HPV shot.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
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
QuestionText:
*Read answer categories.
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
give a complete date in the number and time period format, or entered years ago in the time period format
SkipInstructions:
elseif AGE GE 30 [goto MAMHAD]; elseif AGE = 18-29 [goto ASPIRIN]
QuestionText:
2 No
7 Refused
9 Don't know
Ref/DK this information
SkipInstructions:
(2,D) goto HPVNOT
(R) if AGE ge 30 [goto MAMHAD] elseif AGE = 18-29 [goto ASPIRIN]
QuestionText:
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
interested in getting the shot
SkipInstructions:
(3) goto HPVLOCST
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
goto MAMHAD
elseif AGE=18-29
goto ASPRIN
(2) goto HPVLOCST
QuestionText:
2 No
7 Refused
9 Don't know
not to get the vaccine was because it was too expensive
SkipInstructions:
[goto MAMHAD]
elseif AGE=18-29
[goto ASPIRIN]
QuestionText:
*Read if necessary.
A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read answer categories.
2 30-39
3 40-49
4 50-59
5 60 years or older
7 Refused
9 Don't know
SkipInstructions:
(3-5,R,D) if answer code is grayed out [goto ERR_MAMAGE] else [goto MAM6YR]
QuestionText:
*Put response into correct category below.
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
SkipInstructions:
QuestionText:
*Enter '0' for none.
*Enter '95' for 95 or more mammograms.
01-94 1-94
95 95+
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and time period format.
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
SkipInstructions:
RMAM1_YR [goto RMAM1N]
QuestionText:
*Enter year of last mammogram.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
initial month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent mammogram.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
else [goto MAMREAS]
QuestionText:
other reason?
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*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.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2) [goto MNOTFOL]
(R,D) [goto LUMPEV2]
QuestionText:
*Put response into correct category below.
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
tests
SkipInstructions:
QuestionText:
2 Over the telephone
tests
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto LUMPEV2]
QuestionText:
*Put response into correct category below.
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
with cancer
SkipInstructions:
(7) [goto MFOUND2]
QuestionText:
*Record verbatim response.
99 Don't know
Verbatim Verbatim response
with cancer
SkipInstructions:
QuestionText:
*Read if necessary: A biopsy is the removal of a sample of tissue to see whether cancer cells are present.
2 No
3 Lump removed was cancerous
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
*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
95 95+
97 Refused
SkipInstructions:
(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]
QuestionText:
2 YEARS]?
*Put response into correct category below.
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
SkipInstructions:
QuestionText:
[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?]
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
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
SkipInstructions:
[goto RCBE1N]
QuestionText:
*Enter year of last breast exam.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
initial month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent breast exam.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last breast exam was over 5 years ago)
SkipInstructions:
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
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
SkipInstructions:
QuestionText:
*Enter year of last breast MRI.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT breast MRI?
*Enter number for time since last breast MRI.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent breast MRI.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
complete date in the number and time period format, or entered years ago in the time period format (excluding
those whose last breast MRI was over 5 years ago)
SkipInstructions:
QuestionText:
*Put response into correct category below.
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
SkipInstructions:
QuestionText:
mammograms.
In the last 12 months, did you have a chest x-ray?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,D,R) [goto CAT12]
QuestionText:
reason?
2 No, for some other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
donut shaped x-ray machine while holding your breath.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,D,R) [goto ASPIRIN]
QuestionText:
2 No
3 Several areas of upper body region
7 Refused
9 Don't know
SkipInstructions:
(2,D,R) [goto ASPIRIN]
QuestionText:
2 No, for some other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Advil, Ibuprofen, Motrin, Nuprin, Aleve, Naprosyn, Naproxen, or Celebrex?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) if SEX=1 [goto PROPECIA]
elseif AGE GE 30 [goto MEDHRT]
elseif AGE = 18-29 [goto MEDBC]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
elseif AGE GE 30 [goto MEDHRT]
elseif AGE = 18-29 [goto MEDBC]
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) if AGE ge 40 [goto PSAREC]
elseif AGE = 18-39 [goto genetic testing]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) if AGE ge 40 [goto PSAREC]
elseif AGE = 18-39 [goto genetic testing]
QuestionText:
*Read categories below.
2 For male pattern baldness
3 To reduce the chance that I may develop prostate cancer
4 Other
7 Refused
9 Don't know
SkipInstructions:
elseif AGE = 18-39 [goto genetic testing]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto HRTEVER]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto MEDTAMX]
QuestionText:
ago but not more than 5 years, or more than 5 years ago?
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
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto MEDRALX]
QuestionText:
*Put response into correct category below.
2 To reduce the chance I may develop breast cancer
3 Both
4 Other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto MEDBC]
QuestionText:
*Put response into correct category below.
2 To reduce the chance that I may develop breast cancer
3 Both
4 Other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
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
SkipInstructions:
RPSA1N]
QuestionText:
* Enter year of last PSA test.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT PSA test?
* Enter number for time since last PSA test.
* Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
initial month screen
SkipInstructions:
QuestionText:
* Enter time period for time since most recent PSA test.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
reason?
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read answer categories.
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
SkipInstructions:
QuestionText:
*Enter '0' for none.
*Enter '95" for 95 or more PSA tests.
01-94 1-94
95 95+
97 Refused
99 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
test]?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
should have PSA tests?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
When did you have your MOST RECENT colonoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
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
SkipInstructions:
QuestionText:
*Enter year of last colonoscopy.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT colonoscopy?
*Enter number for time since last colonoscopy.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent colonoscopy.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
up test of an earlier test or screening exam, or some other reason?
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
SkipInstructions:
QuestionText:
awake. Have you EVER HAD a Sigmoidoscopy?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
When did you have your MOST RECENT Sigmoidoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
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
SkipInstructions:
QuestionText:
*Enter year of last Sigmoidoscopy.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have your MOST RECENT Sigmoidoscopy?
*Enter number for time since last Sigmoidoscopy.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent Sigmoidoscopy.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
up test of an earlier test or screening exam, or some other reason?
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
SkipInstructions:
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) [goto POLYP]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
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
SkipInstructions:
QuestionText:
*Enter year of last CT colonography or virtual colonoscopy.
9996 Time period format
9997 Refused
9999 Don't know
of last CT colonography or virtual colonoscopy
SkipInstructions:
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
QuestionText:
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.
95 95+
97 Refused
99 Don't know
colonoscopy from the initial month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent CT colonography or virtual colonoscopy.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
of a problem, as a follow-up test of an earlier test or screening exam, or some other reason?
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
SkipInstructions:
QuestionText:
you that you had a polyp in your colon or rectum?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) goto HFONOTDO
QuestionText:
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.
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
SkipInstructions:
(R) store "R" in RHFO1_YR and goto RHFO2
(96) store "9996" in RHFO1_YR and goto RHFO1N
QuestionText:
*Enter year of last home blood stool test.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
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.
95 95+
97 Refused
99 Don't know
initial month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent home blood stool test.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
some other reason?
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Enter all that apply, separate with commas.
1 Another Fecal Occult Blood Test
2 Sigmoidoscopy
3 Colonoscopy
4 Barium enema
5 Surgery
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
during an office visit?
2 No
7 Refused
9 Don't know
SkipInstructions:
(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]
QuestionText:
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.
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
SkipInstructions:
[goto RFOB1N]
QuestionText:
*Enter year of last office blood stool test.
9996 Time period format
9997 Refused
9999 Don't know
stool test
SkipInstructions:
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
QuestionText:
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.
95 95+
97 Refused
99 Don't know
initial month screen
SkipInstructions:
QuestionText:
*Enter time period for time since most recent office blood stool test.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
(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
QuestionText:
*Read answer categories.
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
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:
QuestionText:
some other reason?
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
SkipInstructions:
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]
QuestionText:
problems in your colon or rectum?
2 No
7 Refused
9 Don't know
colonography in the past 5 years, or home blood stool test in the last year
SkipInstructions:
(2,R,D) [goto COLNOT]
QuestionText:
2 No
7 Refused
9 Don't know
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:
QuestionText:
include stool blood or fecal occult blood test; Sigmoidoscopy; colonoscopy; CT colonography or virtual colonoscopy; or
other.
*Enter all that apply, separate with commas.
2 Sigmoidoscopy
3 Colonoscopy
4 CT colonography/virtual colonoscopy
5 Other
7 Refused
9 Don't know
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:
QuestionText:
rectum/NOT had any kind of test to look for problems in your colon or rectum RECENTLY]?
*Put response into correct category below.
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
colonography in the past 5 years, or home blood stool test in the last year
SkipInstructions:
QuestionText:
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?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) goto GTCCOM
QuestionText:
professional?
2 No
7 Refused
9 Don't know
Sample adults 18+ who have ever heard of genetic testing
SkipInstructions:
(2,R,D) goto GTGRISK
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
Genetic Testing
QuestionText:
*Read if necessary.
This does not include any test to see whether you had cancer in the PAST or have cancer NOW.
2 No
7 Refused
9 Don't know
SkipInstructions:
else if SEX=2 goto GTBRE
(2,R,D) goto GTCCOM
QuestionText:
Breast?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Ovarian?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Colon or rectal?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
Please think about your MOST RECENT genetic test for cancer risk. Which kinds of cancer was it for?
Another type of cancer?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D) goto GTRSK_MT
QuestionText:
99 Don't know
Verbatim Verbatim response
SkipInstructions:
QuestionText:
When did you have this genetic test done?
*Enter month of genetic test.
*Enter '96' to go to number and time period format.
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
SkipInstructions:
(R) store "R' in GTRSK_YR then goto GTINSURE
(96) store "9996" in GTRSK_YR then goto GTRSKN
QuestionText:
*Enter year of genetic test.
9996 Time period format
9997 Refused
9999 Don't know
SkipInstructions:
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
QuestionText:
When did you have this genetic test done?
*Enter number for time since genetic test.
*Enter '95' for 95 or more.
95 95+
97 Refused
99 Don't know
SkipInstructions:
(R,D) store 'R,D" in GTRSKT then goto GTINSURE
QuestionText:
*Enter time period for time since genetic test.
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
SkipInstructions:
if (GTRSKN = number greater than person years old and GTRSKT=4) then goto ERR1_GTRSKT
QuestionText:
*Read if necessary.
Effects include losing your health insurance coverage or not being eligible for health insurance if you change jobs or move.
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
about as likely?
*Read if necessary.
For a cancer survivor, this means getting another cancer in the future.
2 Less likely
3 About as likely
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
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.
2 Less likely
3 About as likely
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
about as likely?
*Read if necessary.
For a breast cancer survivor, this means getting breast cancer again in the future.
2 Less likely
3 About as likely
7 Refuse
9 Don't know
SkipInstructions:
Family History
QuestionText:
have cancer of any kind?
2 No
3 Adopted or don't know biological father
7 Refused
9 Don't know
SkipInstructions:
(2,3,RF,DK) [goto FHMCAN]
QuestionText:
* Enter code for the first kind of cancer.
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
SkipInstructions:
(6,18,29) goto ERR_FHFTYP_1
QuestionText:
* Enter '96' for no more.
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
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:
else goto FHFAGE2
(96) goto FHMCAN
(6,18,29) goto ERR1_FHFTYP_2
QuestionText:
* Enter '96' for no more.
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
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:
goto ERR2_FHFTYP_3
else goto FHFAGE3
(96) goto FHMCAN
(6,18,29) goto ERR1_FHFTYP_3
QuestionText:
* Enter '96' for no more.
96 No more
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:
(1-30) goto ERR_FHFTYP_4
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(RF) IF FHFTYP_1=RF [goto FHMCAN]
else if FHFTYP_1 NE RF [goto FHFTYP_2]
QuestionText:
2 No
7 Refused
9 Don't know
cancer
SkipInstructions:
(RF) IF FHFTYP_2=RF [goto FHMCAN]
else if FHFTYP NE RF [goto FHFTYP_3]
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(RF) IF FHFTYP_3=RF [goto FHMCAN]
else if FHFTYP_3 NE RF [goto FHFTYP_4]
QuestionText:
2 No
3 Adopted or don't know biological mother
7 Refused
9 Don't know
SkipInstructions:
(2,3,RF,DK) [goto FHBNUM]
QuestionText:
* Enter code for the first kind of cancer.
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
SkipInstructions:
(20,26) goto ERR_FHMTYP_1
QuestionText:
* Enter '96' for no more.
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
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:
else goto FHMAGE2
(96) goto FHBNUM
(20,26) goto ERR1_FHMTYP_2
QuestionText:
* Enter '96' for no more.
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
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:
else goto FHMAGE3
(96) goto FHBNUM
(20,26) goto ERR1_FHMTYP_3
QuestionText:
* Enter '96' for no more.
96 No more
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:
(1-30) ERR_FHMTYP_4
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(RF) IF FHMTYP_1=RF goto FHBNUM
else if FHMTYP_1 NE RF goto FHMTYP_2
QuestionText:
2 No
7 Refused
9 Don't know
cancer
SkipInstructions:
(RF) IF FHMTYP_2=RF goto FHBCAN
else if FHMTYP_2 NE RF goto FHMTYP_3
QuestionText:
2 No
7 Refused
9 Don't know
cancer
SkipInstructions:
(RF) IF FHMTYP_3=RF goto FHBNUM
else if FHMTYP_3 NE RF goto FHMTYP_4
QuestionText:
Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more brothers.
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
SkipInstructions:
(1-21)[goto FHBCAN]
QuestionText:
*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.]
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
SkipInstructions:
(1-21) if FHBCAN GT FHBNUM
goto ERR_FHBCAN
else
goto FHBTYP_1
QuestionText:
* Enter code for the first kind of cancer.
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
SkipInstructions:
else goto FHBMAN1
(6,18,29) goto ERR_FHBTYP_1
QuestionText:
* Enter '96' for no more.
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
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:
elseif FHBCAN = '1' goto FHBAGE2
else goto FHBMAN2
(96) goto FHSNUM
(6,18,29) goto ERR1_FHBTYP_2
QuestionText:
* Enter '96' for no more.
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
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:
elseif FHBCAN = '1' goto FHBAGE3
else goto FHBMAN3
(96) goto FHSNUM
(6,18,29) goto ERR1_FHBTYP_3
QuestionText:
* Enter '96' for no more.
96 No more
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:
(1-30) goto ERR_FHBTYP_4
QuestionText:
*Enter '21' for 21 or more brothers.
21 21+
97 Refused
99 Don't know
SkipInstructions:
else goto FHBAGE1
(RF,DK) goto FHBAGE1
QuestionText:
*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.]
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
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:
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
QuestionText:
*Enter '21' for 21 or more brothers.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHBMAN2
else
goto FHBAGE2
(RF,DK) goto FHBAGE2
QuestionText:
*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.]
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
cancer
SkipInstructions:
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
QuestionText:
*Enter '21' for 21 or more brothers.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHBMAN3
else
goto FHBAGE3
(RF,DK) goto FHBAGE3
QuestionText:
*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.]
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
cancer
SkipInstructions:
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
QuestionText:
include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more sisters.
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
SkipInstructions:
(1-21) goto FHSCAN
QuestionText:
*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.]
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
SkipInstructions:
(1-21) if FHSCAN gt FHSNUM
goto ERR_FHSCAN
else
goto FHSTYP_1
QuestionText:
* Enter code for the first kind of cancer.
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
SkipInstructions:
goto FHSAGE1
else
goto FHSMAN1
(20,26) goto ERR_FHSTYP_1
QuestionText:
* Enter '96' for no more.
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
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:
goto ERR2_FHSTYP_2
elseif FHSCAN = '1'
goto FHSAGE2
else
goto FHSMAN2
(96) goto FHNNUM
LT (20,26) goto ERR1_FHSTYP_2
QuestionText:
* Enter '96' for no more.
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
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:
goto ERR2_FHSTYP_3
elseif FHSCAN = '1'
goto FHSAGE3
else
goto FHSMAN3
(96) goto FHNNUM
(20,26) goto ERR1_FHSTYP_3
QuestionText:
* Enter '96' for no more.
95 More than 3 kinds
96 No more
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:
(1-30) goto ERR_FHSTYP_4
QuestionText:
* Enter '21' for 21 or more sisters.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHSMAN1
else
goto FHSAGE1
(RF,DK) goto FHSAGE1
QuestionText:
* 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.]
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
SkipInstructions:
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
QuestionText:
* Enter '21' for 21 or more sisters.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHSMAN2
else
goto FHSAGE2
(RF,DK) goto FHSAGE2
QuestionText:
* 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.]
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
cancer
SkipInstructions:
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
QuestionText:
* Enter '21' for 21 or more sisters.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHSMAN3
else
goto FHSAGE3
(RF,DK) goto FHSAGE3
QuestionText:
*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.]
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
SkipInstructions:
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
QuestionText:
*Enter '0' for none.
*Enter '21' for 21 or more biological sons.
*Enter '96' for no biological children.
01-20 1-20 sons
21 21+
96 No biological children
97 Refused
99 Don't know
SkipInstructions:
(1-21)[goto FHNCAN]
(22-95) goto ERR_FHNNUM
(96) goto SASSN
QuestionText:
*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.]
01-20 1-20 sons
21 21+
97 Refused
99 Don't know
SkipInstructions:
(1-21) if FHNCAN gt FHNNUM
goto ERR_FHNCAN
else
goto FHNTYP_1
QuestionText:
* Enter code for the first kind of cancer.
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
SkipInstructions:
goto FHNAGE1
else
goto FHNMAN1
(6,18,29) goto ERR_FHNTYP_1
QuestionText:
* Enter '96' for no more.
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
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:
goto ERR2_FHNTYP_2
elseif FHNCAN = '1'
goto FHNAGE2
else
goto FHNMAN2
(96) goto FHDNUM
(6,18,29) goto ERR1_FHNTYP_2
QuestionText:
* Enter '96' for no more.
96 No more
had not refused to answer the second kind of cancer
SkipInstructions:
(1-30) goto ERR_FHNTYP_3
QuestionText:
*Enter '21' for 21 or more sons.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHNMAN1
else
goto FHNAGE1
(RF,DK) goto FHNAGE1
QuestionText:
*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.]
01-20 1-20 sons
21 21+
97 Refused
99 Don't know
SkipInstructions:
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
QuestionText:
*Enter '21' for 21 or more sons.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHNMAN2
else
goto FHNAGE2
(RF,DK) goto FHNAGE2
QuestionText:
*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.]
01-20 1-20 sons
21 21+
97 Refused
99 Don't know
cancer
SkipInstructions:
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
QuestionText:
*Enter '0' for none.
*Enter '21' for 21 or more biological daughters.
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
question
SkipInstructions:
(1-21) goto FHDCAN
QuestionText:
*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.]
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
SkipInstructions:
(1-21) if FHDCAN gt FHDNUM
goto ERR_FHDCAN
else
goto FHDTYP_1
QuestionText:
* Enter code for the first kind of cancer.
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
SkipInstructions:
goto FHDAGE1
else
goto FHDMAN1
(20,26) goto ERR_FHDTYP_1
QuestionText:
* Enter '96' for no more.
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
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:
goto ERR2_FHDTYP_2
elseif FHDCAN = '1'
goto FHDAGE2
else
goto FHDMAN2
(96) goto next section
(20,26) goto ERR_FHDTYP_2
QuestionText:
* Enter '96' for no more.
96 No more
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:
(1-30) goto ERR_FHDTYP_3
QuestionText:
*Enter '21' for 21 or more daughters.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHDMAN1
else
goto FHDAGE1
(RF,DK) goto FHDAGE1
QuestionText:
*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.]
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
cancer
SkipInstructions:
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
QuestionText:
*Enter '21' for 21 or more daughters.
21 21+
97 Refused
99 Don't know
SkipInstructions:
goto ERR_FHDMAN2
else
goto FHDAGE2
(RF,DK) goto FHDAGE2
QuestionText:
*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.]
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
of cancer
SkipInstructions:
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
QuestionText:
*Read categories below.
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read categories below.
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read categories below.
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read categories below.
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.
*Read categories below.
2 Very good
3 Good
4 Fair
5 Poor
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
groceries, or moving a chair?
*Read categories below.
2 Mostly
3 Moderately
4 A little
5 Not at all
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
irritable?
*Read categories below.
2 Rarely
3 Sometimes
4 Often
5 Always
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read categories below.
2 Mild
3 Moderate
4 Severe
5 Very severe
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
the worst imaginable pain.
97 Refused
99 Don't know
SkipInstructions:
if CANEV=1 [goto CCBG10Y]
else [goto next section]
QuestionText:
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.
2 Fairly low
3 Moderate
4 Fairly high
5 Very high
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read categories below.
2 Rarely
3 Sometimes
4 Often
5 All the time
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
had come back (that is, you had a recurrence)?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D)[goto TRETMRC]
QuestionText:
9997 Refused
9999 Don't know
SkipInstructions:
QuestionText:
questions.
What types of treatment did you receive for this cancer? Please select all that apply.
*Read categories below.
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
SkipInstructions:
(6)[goto NFOC]
(1-5,R,D) [goto TRETBC]
QuestionText:
99 Don't know
Verbatim Verbatim response
cancer
SkipInstructions:
QuestionText:
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.}
2 No
7 Refused
9 Don't know
SkipInstructions:
(2,R,D)[goto NFOC]
QuestionText:
2 No
7 Refused
9 Don't know
hormonal treatments, bone marrow transplant or stem cell transplant, or some other type of treatment to treat
cancer in the last 12 months.
SkipInstructions:
QuestionText:
body)?
2 No
7 Refused
9 Don't know
SkipInstructions:
if TRETMRC='6' [goto HPCAEROP]
else if CIAT='1' [goto FUADVEV]
else[goto TRETDOC]
QuestionText:
treatments you actually received? This would NOT include general pamphlets about cancer treatments or individual lab
results.
2 No
7 Refused
9 Don't know
hormonal treatments, bone marrow transplant or stem cell transplant, or some other type of treatment to treat their
most recent cancer and are not currently in active treatment
SkipInstructions:
QuestionText:
who you should see for routine cancer check-ups after completing treatment for cancer?
2 No
7 Refused
9 Don't know
hormonal treatments, bone marrow transplant or stem cell transplant, or some other type of treatment to treat their
most recent cancer
SkipInstructions:
(2,R,D)[goto HICT]
QuestionText:
electronic format for you?
2 No
7 Refused
9 Don't know
professional about routine cancer check-ups after completing cancer treatment
SkipInstructions:
QuestionText:
*Read if necessary: Examples of insurance include Medicare, Medicaid, insurance offered through an employer, the
military, or a policy you bought on your own.
2 No
7 Refused
9 Don't know
hormonal treatments, bone marrow transplant or stem cell transplant, or some other type of treatment to treat their
most recent cancer
SkipInstructions:
QuestionText:
may affect your emotions or your relationships with other people?
2 No
7 Refused
9 Don't know
SkipInstructions:
(2)[goto HPIDATT]
QuestionText:
2 No
7 Refused
9 Don't know
them about how cancer may affect their emotions or relationships with other people
SkipInstructions:
QuestionText:
social needs related to your cancer diagnosis and treatment?
*Read categories below.
2 Somewhat satisfied
3 Not satisfied
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
(2)[goto MRNPCSG]
QuestionText:
*Read categories below.
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
support group to help cope with cancer diagnosis
SkipInstructions:
(2,3,4,R,D)[goto CTRSCT]
(5) [goto RCSGSPEC]
QuestionText:
99 Don't know
Verbatim Verbatim response
support group to help cope with cancer diagnosis because of some other reason
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
support group to help cope with cancer diagnosis because they didn't know these services were available
SkipInstructions:
QuestionText:
cancer.
Did you participate in a research study or clinical trial as a part of your cancer treatment?
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
2 No
7 Refused
9 Don't know
SkipInstructions:
QuestionText:
*Read categories below.
2 Some
3 A little
4 Not at all
7 Refused
9 Don't know
SkipInstructions: