1
Page 1 of 35
2010 NHIS Questionnaire - Sample Adult
Quality of Life
Instrument Variable Name: VIS_SS
QuestionText:
QuestionText:
These next questions are new and we are testing them. Some may sound similar to questions you already answered.
Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto VIS_1]
(4) [goto HEAR_SS]
(4) [goto HEAR_SS]
Instrument Variable Name: VIS_1
QuestionText:
QuestionText:
Do you wear glasses to see far away?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto VIS_2]
Instrument Variable Name: VIS_2
QuestionText:
QuestionText:
Do you have difficulty clearly seeing someone's face across a room {fill: even when wearing these glasses}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto VIS_3]
Instrument Variable Name: VIS_3
QuestionText:
QuestionText:
Do you wear glasses for reading or to see up close?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto VIS_4]
Instrument Variable Name: VIS_4
QuestionText:
QuestionText:
Do you have difficulty clearly seeing the picture on a coin {fill: even when wearing these glasses}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto HEAR_SS]
Instrument Variable Name: HEAR_SS
QuestionText:
QuestionText:
Do you have difficulty hearing, even when using a hearing aid? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto HEAR_1]
(4)[goto MOB_SS]
(4)[goto MOB_SS]
Instrument Variable Name: HEAR_1
QuestionText:
QuestionText:
Do you use a hearing aid?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty hearing, even when using a hearing aid
SkipInstructions:
SkipInstructions:
(1)[goto HEAR_2]
(2,R,D)[goto HEAR_3]
(2,R,D)[goto HEAR_3]
Instrument Variable Name: HEAR_2
QuestionText:
QuestionText:
How often do you use your hearing aid(s)? Would you say all of the time, some of the time, rarely, or never?
1 All of the time
2 Some of the time
3 Rarely
4 Never
7 Refused
9 Don't know
2 Some of the time
3 Rarely
4 Never
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use a hearing aid
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto HEAR_3]
Instrument Variable Name: HEAR_3
QuestionText:
QuestionText:
Do you have difficulty hearing what is said in a conversation with one other person in a quiet room {fill: even when wearing your hearing aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty hearing, even when using a hearing aid
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto HEAR_4]
(4)[goto MOB_SS]
(4)[goto MOB_SS]
Instrument Variable Name: HEAR_4
QuestionText:
QuestionText:
Do you have difficulty hearing what is said in a conversation with one other person in a noisier room {fill: even when wearing your hearing aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refuse or don't know if they have difficulty hearing what is said in a conversation with one other person in a quiet room (even when wearing their hearing aid(s))
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto MOB_SS]
Instrument Variable Name: MOB_SS
QuestionText:
QuestionText:
Do you have any difficulty walking or climbing steps? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto MOB_1]
Instrument Variable Name: MOB_1
QuestionText:
QuestionText:
Do you have difficulty moving around inside your home? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto MOB_2]
Instrument Variable Name: MOB_2
QuestionText:
QuestionText:
Do you use any equipment or receive help with walking, climbing steps, or moving around?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1)[goto MOB_3A]
(2,R,D)[goto MOB_4]
(2,R,D)[goto MOB_4]
Instrument Variable Name: MOB_3A
QuestionText:
QuestionText:
Do you use any of the following...
Cane or walking stick?
Cane or walking stick?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto MOB_3B]
Instrument Variable Name: MOB_3B
QuestionText:
QuestionText:
*Read if necessary.
Do you use any of the following...
Walker?
Do you use any of the following...
Walker?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto MOB_3C]
Instrument Variable Name: MOB_3C
QuestionText:
QuestionText:
*Read if necessary.
Do you use any of the following...
Crutches?
Do you use any of the following...
Crutches?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto MOB_3D]
Instrument Variable Name: MOB_3D
QuestionText:
QuestionText:
*Read if necessary.
Do you use any of the following...
Wheelchair?
Do you use any of the following...
Wheelchair?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto MOB_3E]
Instrument Variable Name: MOB_3E
QuestionText:
QuestionText:
*Read if necessary.
Do you use any of the following...
Prosthesis?
Do you use any of the following...
Prosthesis?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto MOB_3F]
Instrument Variable Name: MOB_3F
QuestionText:
QuestionText:
*Read if necessary.
Do you use any of the following...
Someone's assistance?
Do you use any of the following...
Someone's assistance?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto MOB_3G]
Instrument Variable Name: MOB_3G
QuestionText:
QuestionText:
*Read if necessary.
Do you use any of the following...
Other type of equipment or help?
Do you use any of the following...
Other type of equipment or help?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(1)[goto MOBSPEC]
(2,R,D)
if MOB_3D='1' [goto COM_SS]
elseif MOB_3D IN (2,R,D) [goto MOB_4]
(2,R,D)
if MOB_3D='1' [goto COM_SS]
elseif MOB_3D IN (2,R,D) [goto MOB_4]
Instrument Variable Name: MOBSPEC
QuestionText:
QuestionText:
*Specify other type of equipment or help received for getting around.
Verbatim Verbatim response
97 Refused
99 Don't know
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who use an other type of equipment or help for walking, climbing steps, or moving around
SkipInstructions:
SkipInstructions:
(allow 50,R,D)
if MOB_3D='1' [goto COM_SS]
elseif MOB_3D IN (2,R,D) [goto MOB_4]
if MOB_3D='1' [goto COM_SS]
elseif MOB_3D IN (2,R,D) [goto MOB_4]
Instrument Variable Name: MOB_4
QuestionText:
QuestionText:
Do you have difficulty walking 100 yards on level ground, that would be about the length of one football field or one city block {fill: without the use of your aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not use a wheelchair
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto MOB_5]
(4)[goto MOB_6]
(4)[goto MOB_6]
Instrument Variable Name: MOB_5
QuestionText:
QuestionText:
Do you have difficulty walking a third of a mile on level ground, that would be the length of five football fields or five city blocks {fill: without the use of your aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not use a wheelchair and have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty walking 100 yards on level ground (without the use of their aid)
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto MOB_6]
Instrument Variable Name: MOB_6
QuestionText:
QuestionText:
Do you have difficulty walking up or down 12 steps {fill: without the use of your aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not use a wheelchair
SkipInstructions:
SkipInstructions:
(1-4,R,D)
if MOB_2 IN '2,R,D' [goto COM_SS]
elseif MOB_2 = '1' [goto MOB_7]
if MOB_2 IN '2,R,D' [goto COM_SS]
elseif MOB_2 = '1' [goto MOB_7]
Instrument Variable Name: MOB_7
QuestionText:
QuestionText:
Do you have difficulty walking 100 yards on level ground, that would be about the length of one (1) football field or one city block, when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for getting around but do not use a wheelchair
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto MOB_8]
(4)[goto MOB_9]
(4)[goto MOB_9]
Instrument Variable Name: MOB_8
QuestionText:
QuestionText:
Do you have difficulty walking a third of a mile on level ground, that would be the length of five football fields or five city blocks, when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for getting around but do not use a wheelchair and who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty walking 100 yards on level ground, when using their aid
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto MOB_9]
Instrument Variable Name: MOB_9
QuestionText:
QuestionText:
Do you have difficulty walking up or down 12 steps, even when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who use equipment or receive help for getting around but do not use a wheelchair
Instrument Variable Name: COM_SS
QuestionText:
QuestionText:
Using your usual language, do you have difficulty communicating, for example understanding or being understood?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto COM_1]
Instrument Variable Name: COM_1
QuestionText:
QuestionText:
Do people have difficulty understanding you when you speak? Would you say no difficulty, some difficulty, a lot of difficulty, or are they unable to understand you?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(if COM_SS IN (1,R,D) and COM_1 IN (1,R,D)) [goto COM_2];
elseif (COM_SS IN (2,3,4) or COM_1 IN (2,3,4)) [goto P_COM_1A]
elseif (COM_SS IN (2,3,4) or COM_1 IN (2,3,4)) [goto P_COM_1A]
Instrument Variable Name: P_COM_1A
QuestionText:
QuestionText:
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no to each.
...Because you sometimes talk too fast, feel shy or have trouble expressing yourself?
...Because you sometimes talk too fast, feel shy or have trouble expressing yourself?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or cannot communicate, or have some difficulty, a lot of difficulty or cannot be understood when speaking
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COM_1B]
Instrument Variable Name: P_COM_1B
QuestionText:
QuestionText:
*Read if necessary.
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no to each.
...Because of a physical problem with your mouth or tongue?
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no to each.
...Because of a physical problem with your mouth or tongue?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or cannot communicate, or have some difficulty, a lot of difficulty or cannot be understood when speaking
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COM_1C]
Instrument Variable Name: P_COM_1C
QuestionText:
QuestionText:
*Read if necessary.
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no
to each.
...Because you need to understand other languages or different ways of speaking?
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no
to each.
...Because you need to understand other languages or different ways of speaking?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or cannot communicate, or have some difficulty, a lot of difficulty or cannot be understood when speaking
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COM_1D]
Instrument Variable Name: P_COM_1D
QuestionText:
QuestionText:
*Read if necessary.
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no to each.
...Because you have trouble hearing?
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no to each.
...Because you have trouble hearing?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or cannot communicate, or have some difficulty, a lot of difficulty or cannot be understood when speaking
Instrument Variable Name: COM_2
QuestionText:
QuestionText:
Do you use sign language?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto COG_SS]
Instrument Variable Name: COG_SS
QuestionText:
QuestionText:
Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1)[goto UB_SS]
(2-4,R,D)[goto COG_1]
(2-4,R,D)[goto COG_1]
Instrument Variable Name: COG_1
QuestionText:
QuestionText:
Do you have difficulty remembering, concentrating, or both?
1 Difficulty remembering only
2 Difficulty concentrating only
3 Difficulty with both remembering and concentrating
7 Refused
9 Don't know
2 Difficulty concentrating only
3 Difficulty with both remembering and concentrating
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or are unable to remember or concentrate, or don't know or refused if they are able to remember or concentrate
SkipInstructions:
SkipInstructions:
(1,3,R,D)[goto COG_2]
(2)[goto COG_4]
(2)[goto COG_4]
Instrument Variable Name: COG_2
QuestionText:
QuestionText:
How often do you have difficulty remembering? Would you say sometimes, often or all of the time?
1 Sometimes
2 Often
3 All of the time
7 Refused
9 Don't know
2 Often
3 All of the time
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,3,R,D)[goto COG_3]
Instrument Variable Name: COG_3
QuestionText:
QuestionText:
Do you have difficulty remembering a few things, a lot of things, or almost everything?
1 A few things
2 A lot of things
3 Almost everything
7 Refused
9 Don't know
2 A lot of things
3 Almost everything
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,3,R,D)[goto P_COG_3A]
Instrument Variable Name: P_COG_3A
QuestionText:
QuestionText:
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I forget things because I am busy and have too much to remember.
...I forget things because I am busy and have too much to remember.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText:
Sample adults 18+ who have difficulty remembering
SkipInstructions:
Sample adults 18+ who have difficulty remembering
SkipInstructions:
(1,2,R,D)[goto P_COG_3B]
Instrument Variable Name: P_COG_3B
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty is getting worse.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty is getting worse.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COG_3C]
Instrument Variable Name: P_COG_3C
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty has put me or my family in danger.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty has put me or my family in danger.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COG_3D]
Instrument Variable Name: P_COG_3D
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I only forget little or inconsequential things.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I only forget little or inconsequential things.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COG_3E]
Instrument Variable Name: P_COG_3E
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I must write down important things, such as my address or when to take medicine, so that I do not forget.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I must write down important things, such as my address or when to take medicine, so that I do not forget.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COG_3F]
Instrument Variable Name: P_COG_3F
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My family members or friends are worried about my difficulty remembering.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My family members or friends are worried about my difficulty remembering.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_COG_3G]
Instrument Variable Name: P_COG_3G
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty is normal for someone my age.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty is normal for someone my age.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty remembering
SkipInstructions:
SkipInstructions:
(1,2,R,D)
if COG_1=1 [goto UB_SS]
elseif COG_1 IN (3,R,D) [goto COG_4]
if COG_1=1 [goto UB_SS]
elseif COG_1 IN (3,R,D) [goto COG_4]
Instrument Variable Name: COG_4
QuestionText:
QuestionText:
How much difficulty do you have concentrating for ten minutes? Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have difficulty concentrating
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto UB_SS]
(3)[goto COG_5]
(3)[goto COG_5]
Instrument Variable Name: COG_5
QuestionText:
QuestionText:
Would you say this is closer to a little, closer to a lot, or exactly in the middle?
1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have somewhere in between a little and a lot of difficulty concentrating for ten minutes
SkipInstructions:
SkipInstructions:
(1,2,3,R,D)[goto UB_SS]
Instrument Variable Name: UB_SS
QuestionText:
QuestionText:
Do you have difficulty with self care, such as washing all over or dressing? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto UB_1]
Instrument Variable Name: UB_1
QuestionText:
QuestionText:
Do you have difficulty raising a 2 liter bottle of water or soda from waist to eye level? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto UB_2]
Instrument Variable Name: UB_2
QuestionText:
QuestionText:
Do you have difficulty using your hands and fingers, such as picking up small objects, for example, a button or pencil, or opening or closing containers or bottles? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto LEARN_1]
Instrument Variable Name: LEARN_1
QuestionText:
QuestionText:
Do you have difficulty learning the rules for a new game? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto LEARN_2]
Instrument Variable Name: LEARN_2
QuestionText:
QuestionText:
Do you have difficulty understanding and following instructions for example, to use a cell phone or to get to a new place?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto ANX_1]
Instrument Variable Name: ANX_1
QuestionText:
QuestionText:
How often do you feel worried, nervous or anxious? Would you say daily, weekly, monthly, a few times a year, or never?
1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-5,R,D)[goto ANX_2]
Instrument Variable Name: ANX_2
QuestionText:
QuestionText:
Do you take medication for these feelings?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1,2,R,D)
if (ANX_1 IN (4,5) and ANX_2=2) [goto DEP_1];
elseif (ANX_1 IN (1,2,3,R,D) or ANX_2 IN (1,R,D)) ([goto ANX_3]
if (ANX_1 IN (4,5) and ANX_2=2) [goto DEP_1];
elseif (ANX_1 IN (1,2,3,R,D) or ANX_2 IN (1,R,D)) ([goto ANX_3]
Instrument Variable Name: ANX_3
QuestionText:
QuestionText:
Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings?
Would you say a little, a lot, or somewhere in between?
Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_ANX_4A]
(3)[goto ANX_4]
(3)[goto ANX_4]
Instrument Variable Name: ANX_4
QuestionText:
QuestionText:
Would you say this was closer to a little, closer to a lot, or exactly in the middle?
1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings and the last time they felt worried, anxious, or nervous described the level of these feelings as somewhere in between a little and a lot
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto P_ANX_4A]
Instrument Variable Name: P_ANX_4A
QuestionText:
QuestionText:
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...My feelings are caused by the type and amount of work I do.
...My feelings are caused by the type and amount of work I do.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_ANX_4B]
Instrument Variable Name: P_ANX_4B
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...Sometimes the feelings can be so intense that my chest hurts and I have trouble breathing.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...Sometimes the feelings can be so intense that my chest hurts and I have trouble breathing.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_ANX_4C]
Instrument Variable Name: P_ANX_4C
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...These are positive feelings that help me to accomplish goals and be productive.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...These are positive feelings that help me to accomplish goals and be productive.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_ANX_4D]
Instrument Variable Name: P_ANX_4D
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...The feelings sometimes interfere with my life, and I wish that I did not have them.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...The feelings sometimes interfere with my life, and I wish that I did not have them.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_ANX_4E]
Instrument Variable Name: P_ANX_4E
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...If I had more money or a better job, I would not have these feelings.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...If I had more money or a better job, I would not have these feelings.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_ANX_4F]
Instrument Variable Name: P_ANX_4F
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...Everybody has these feelings. They are part of life and are normal.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...Everybody has these feelings. They are part of life and are normal.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_ANX_4G]
Instrument Variable Name: P_ANX_4G
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...I have been told by a medical professional that I have anxiety.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...I have been told by a medical professional that I have anxiety.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto DEP_1]
Instrument Variable Name: DEP_1
QuestionText:
QuestionText:
How often do you feel depressed? Would you say daily, weekly, monthly, a few times a year, or never?
1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-5,R,D)[goto DEP_2]
Instrument Variable Name: DEP_2
QuestionText:
QuestionText:
Do you take medication for depression?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1, 2, R, D) (if DEP_1 IN (4,5) and DEP_2=2) [goto PAIN_1]
elseif (DEP_1 IN (1,2,3,R,D) or (DEP_1 IN (4,5) and DEP_2 IN (1,R,D))) [goto DEP_3]
elseif (DEP_1 IN (1,2,3,R,D) or (DEP_1 IN (4,5) and DEP_2 IN (1,R,D))) [goto DEP_3]
Instrument Variable Name: DEP_3
QuestionText:
QuestionText:
Thinking about the last time you felt depressed, how depressed did you feel? Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_DEP_4A]
(3)[goto DEP_4]
(3)[goto DEP_4]
Instrument Variable Name: DEP_4
QuestionText:
QuestionText:
Would you say this was closer to a little, closer to a lot, or exactly in the middle?
1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression and the last time they felt depressed described the level of this feeling as somewhere in between a little and a lot
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto P_DEP_4A]
Instrument Variable Name: P_DEP_4A
QuestionText:
QuestionText:
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...My feelings are caused by the death of a loved one.
...My feelings are caused by the death of a loved one.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_DEP_4B]
Instrument Variable Name: P_DEP_4B
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...Sometimes the feelings can be so intense that I cannot get out of bed.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...Sometimes the feelings can be so intense that I cannot get out of bed.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_DEP_4C]
Instrument Variable Name: P_DEP_4C
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...The feelings sometimes interfere with my life, and I wish I did not have them.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...The feelings sometimes interfere with my life, and I wish I did not have them.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_DEP_4D]
Instrument Variable Name: P_DEP_4D
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...If I had more money or a better job, I would not have these feelings.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...If I had more money or a better job, I would not have these feelings.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_DEP_4E]
Instrument Variable Name: P_DEP_4E
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...Everybody has these feelings. They are part of life and are normal.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...Everybody has these feelings. They are part of life and are normal.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_DEP_4F]
Instrument Variable Name: P_DEP_4F
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...I have been told by a medical professional that I have depression.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...I have been told by a medical professional that I have depression.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto PAIN_1]
Instrument Variable Name: PAIN_1
QuestionText:
QuestionText:
Do you have frequent pain?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto PAIN_2]
Instrument Variable Name: PAIN_2
QuestionText:
QuestionText:
In the past 3 months, how often did you have pain? Would you say never, some days, most days, or every day?
1 Never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)
(if PAIN_1=2 and PAIN_2=1) [goto TIRED_1];
elseif (PAIN_1 IN (1,R,D) or PAIN_2 IN (2,3,4,R,D)) [goto PAIN_3]
(if PAIN_1=2 and PAIN_2=1) [goto TIRED_1];
elseif (PAIN_1 IN (1,R,D) or PAIN_2 IN (2,3,4,R,D)) [goto PAIN_3]
Instrument Variable Name: PAIN_3
QuestionText:
QuestionText:
Thinking about the last time you had pain, how long did the pain last? Would you say some of the day, most of the day, or all of the day?
1 Some of the day
2 Most of the day
3 All of the day
7 Refused
9 Don't know
2 Most of the day
3 All of the day
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto PAIN_4]
Instrument Variable Name: PAIN_4
QuestionText:
QuestionText:
Thinking about the last time you had pain, how much pain did you have? Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_PAIN5A]
(3)[goto PAIN_5]
(3)[goto PAIN_5]
Instrument Variable Name: PAIN_5
QuestionText:
QuestionText:
Would you say the amount of pain was closer to a little, closer to a lot, or exactly in the middle?
1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who the last time they had pain it was somewhere between a little and a lot
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto P_PAIN5A]
Instrument Variable Name: P_PAIN5A
QuestionText:
QuestionText:
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...It is constantly present.
...It is constantly present.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_PAIN5B]
Instrument Variable Name: P_PAIN5B
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Sometimes I'm in a lot of pain and sometimes it's not so bad.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Sometimes I'm in a lot of pain and sometimes it's not so bad.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_PAIN5C]
Instrument Variable Name: P_PAIN5C
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Sometimes it is unbearable and excruciating.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Sometimes it is unbearable and excruciating.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_PAIN5D]
Instrument Variable Name: P_PAIN5D
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...When I get my mind on other things, I am not aware of the pain.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...When I get my mind on other things, I am not aware of the pain.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_PAIN5E]
Instrument Variable Name: P_PAIN5E
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Medication can take my pain away completely.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Medication can take my pain away completely.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_PAIN5F]
Instrument Variable Name: P_PAIN5F
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...My pain is because of work.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...My pain is because of work.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto P_PAIN5G]
Instrument Variable Name: P_PAIN5G
QuestionText:
QuestionText:
*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...My pain is because of exercise.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...My pain is because of exercise.
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto TIRED_1]
Instrument Variable Name: TIRED_1
QuestionText:
QuestionText:
In the past 3 months, how often did you feel very tired or exhausted? Would you say never, some days, most days, or every day?
1 Never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1)[goto QOL_1]
(2-4,R,D)[goto TIRED_2]
(2-4,R,D)[goto TIRED_2]
Instrument Variable Name: TIRED_2
QuestionText:
QuestionText:
Thinking about the last time you felt very tired or exhausted, how long did it last? Would you say some of the day, most of the day, or all of the day?
1 Some of the day
2 Most of the day
3 All of the day
7 Refused
9 Don't know
2 Most of the day
3 All of the day
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto TIRED_3]
Instrument Variable Name: TIRED_3
QuestionText:
QuestionText:
Thinking about the last time you felt this way, how would you describe the level of tiredness? Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto PTIRED4A]
(3)[goto TIRED_4]
(3)[goto TIRED_4]
Instrument Variable Name: TIRED_4
QuestionText:
QuestionText:
Would you say it was closer to a little, closer to a lot, or exactly in the middle?
1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months and the last time they felt this way the level of tiredness was somewhere between a little and a lot
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto PTIRED4A]
Instrument Variable Name: PTIRED4A
QuestionText:
QuestionText:
Is your tiredness the result of any of the following? Please say yes or no to each.
...Too much work or exercise?
...Too much work or exercise?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto PTIRED4B]
Instrument Variable Name: PTIRED4B
QuestionText:
QuestionText:
*Read if necessary.
Is your tiredness the result of any of the following? Please say yes or no to each.
...Not getting enough sleep?
Is your tiredness the result of any of the following? Please say yes or no to each.
...Not getting enough sleep?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto PTIRED4C]
Instrument Variable Name: PTIRED4C
QuestionText:
QuestionText:
*Read if necessary.
Is your tiredness the result of any of the following? Please say yes or no to each.
...A physical or health-related problem?
Is your tiredness the result of any of the following? Please say yes or no to each.
...A physical or health-related problem?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
SkipInstructions:
SkipInstructions:
(1,2,R,D)[goto PTIRED4D]
Instrument Variable Name: PTIRED4D
QuestionText:
QuestionText:
*Read if necessary.
Is your tiredness the result of any of the following? Please say yes or no to each.
...Something else?
Is your tiredness the result of any of the following? Please say yes or no to each.
...Something else?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
SkipInstructions:
SkipInstructions:
(1) [goto PTIRED4E]
(2,R,D) [goto QOL_1]
(2,R,D) [goto QOL_1]
Instrument Variable Name: PTIRED4E
QuestionText:
QuestionText:
*Specify other reason for tiredness.
97 Refused
99 Don't know
Verbatim Verbatim response
99 Don't know
Verbatim Verbatim response
UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months and whose tiredness is the result of something else
SkipInstructions:
SkipInstructions:
(allow 50,R,D) [goto QOL_1]
Instrument Variable Name: QOL_1
QuestionText:
QuestionText:
Are you limited in your ability to carry out daily activities? Would you say not at all, a little, a lot, or completely limited?
1 Not at all
2 A little
3 A lot
4 Completely
7 Refused
9 Don't know
2 A little
3 A lot
4 Completely
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-4,R,D)[goto QOL_2B]
Instrument Variable Name: QOL_2B
QuestionText:
QuestionText:
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Working outside the home to earn an income?
Working outside the home to earn an income?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto QOL_2C]
Instrument Variable Name: QOL_2C
QuestionText:
QuestionText:
*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Going to school or achieving your education goals?
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Going to school or achieving your education goals?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto QOL_2D]
Instrument Variable Name: QOL_2D
QuestionText:
QuestionText:
*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in leisure or social activities?
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in leisure or social activities?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto QOL_2E]
Instrument Variable Name: QOL_2E
QuestionText:
QuestionText:
*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Getting out with friends or family?
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Getting out with friends or family?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto QOL_2F]
Instrument Variable Name: QOL_2F
QuestionText:
QuestionText:
*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Doing household chores such as cooking and cleaning?
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Doing household chores such as cooking and cleaning?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto QOL_2G]
Instrument Variable Name: QOL_2G
QuestionText:
QuestionText:
*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Using transportation to get to places you want to go?
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Using transportation to get to places you want to go?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto QOL_2H]
Instrument Variable Name: QOL_2H
QuestionText:
QuestionText:
*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in religious activities?
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in religious activities?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto QOL_2I]
Instrument Variable Name: QOL_2I
QuestionText:
QuestionText:
*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in community gatherings?
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in community gatherings?
1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:
SkipInstructions:
(1-3,R,D)[goto next section]