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2010 NHIS Questionnaire - Sample Adult Adult Identification

Document Version Date: 16-Apr-11

Question ID: AID.005_00.000

Instrument Variable Name: SADULT
QuestionText:

* The sample adult person is [fill: ALIAS of Sample Adult]. The next questions must be answered by this person. Probe
as necessary to determine the availability of [fill: ALIAS of Sample Adult].
* If refused enter CTRL-R

1 Available
2 Not available
3 Physical or mental condition prohibits responding
7 Refused

UniverseText: This is the Sample Adult and (the Sample Adult section has not been started or completed).
SkipInstructions:

(1) if Sample Adult = demographics.hhc.RELRESP_A
goto beginning of adult.asd
elseif Sample Adult = demographics.hhc.HHRESP
goto beginning of adult.asd
else
goto AIDVERF_S
endif
(2) goto callbk.ACALLBK1
(3) goto PROX1
(R) store '4' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif

Question ID: AID.010_00.000

Instrument Variable Name: PROX1
QuestionText:

* Proxy interviews can be done for sample adults that have a mental or physical condition that
prevents them from responding for themselves.
Is a family member or caregiver that is knowledgeable about [fill: ALIAS of Sample Adult]'s health available?

1 Yes
2 No

UniverseText: The Sample Adult's physical or mental condition prohibits responding.
SkipInstructions:

(1) goto PROX2
(2) goto PROX3

Question ID: AID.015_00.000

Instrument Variable Name: PROX2
QuestionText:

* Ask if necessary.
What is this person's relationship to [fill: ALIAS of Sample Adult]?

1 Relative who lives in household
2 Relative who doesn't live in household
3 Other caregiver
4 Other
7 Refused
9 Don't know

UniverseText: Knowledgeable proxy is available.
SkipInstructions:

(1-4) goto AIDVERF_S

Question ID: AID.020_00.000

Instrument Variable Name: PROX3
QuestionText:

*Ask if necessary.
Can a callback with someone knowledgeable about [fill: ALIAS of Sample Adult]'s health be arranged?

1 Yes
2 No

UniverseText: Knowledgeable proxy is not available.
SkipInstructions:

(1) goto callbk.ACALLBK1
(2) store '3' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
elsegoto back.OUTCOMEB1 procedure
endif

Question ID: AID.030_00.000

Instrument Variable Name: AIDVERF_S
QuestionText:

* Please verify the following information about the sample adult before proceeding:
I have recorded your sex as [fill: Sex of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

UniverseText: Sample Adult is not the person entered in HHRESP or RELRESP_A. Or PROX1 = 'Yes'.
SkipInstructions:

(1) goto AIDVERF_A
(2) goto AIDSEX

Question ID: AID.040_00.000

Instrument Variable Name: AIDSEX
QuestionText:

* Ask if appropriate; otherwise, enter your best guess of the person's sex.
Are you Male or Female?

Male1
Female 2

UniverseText: Respondent said his/her sex is not correct.
SkipInstructions:

(1,2) store AIDSEX in SEX
goto ERR_AIDSEX
reset AIDVERF_S
goto AIDVERF_S

Question ID: AID.045_00.000

Instrument Variable Name: AIDVERF_A
QuestionText:

* Please verify the following information about the sample adult before proceeding:
I have recorded your age as [fill: Age of Sample Adult] old. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".

Yes1
No2

UniverseText: Sample Adult said his/her sex is correct.
SkipInstructions:

(1) goto AIDVERF_D
(2) goto AIDAGE

Question ID: AID.050_00.000

Instrument Variable Name: AIDAGE
QuestionText:

How old are you?

Age in years 000-120
Refused 997
Don't know 999

UniverseText: Respondent said his/her age is not correct
SkipInstructions:

(0-120, Refused, Don't know)
if AIDAGE = 'Refused' or AIDAGE = 'Don't know' or AIDAGE = AGE
reset AIDVERF_A
goto ERR_AIDAGE
else
store AIDAGE in AGE
goto AIDDOB_M

Question ID: AID.055_00.000

Instrument Variable Name: AIDVERF_D
QuestionText:

* Please verify the following information about the sample adult before proceeding:

I have recorded your birthday as [fill: Birthday of Sample Adult]. Is this correct?

*If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

Universe Text: Sample Adult said his/her age is correct.

Skip Instructions:

(1) if AGE of Sample Adult le '17'
goto NO_MORE
else
goto beginning of adult.asd
endif
(2) goto AIDDOB_M

Question ID: AID.060_01.000

Instrument Variable Name: AIDDOB_M
Question Text:

1 of 3

What is your birthday?

*Enter month of birth.

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Respondent said his/her date of birth is not correct or his/her age is not correct

SkipInstructions:

(01-12, Refused, Don't know) goto AIDDOB_D

Question ID: AID.060_02.000

Instrument Variable Name: AIDDOB_D
Question Text:

2 of 3
*Enter day of birth.

01-31 Day of the month
97 Refused
99 Don't know

Universe Text: Respondent said his/her date of birth is not correct or his/her age is not correct
Skip Instructions:

(01-31,Refused,Don't know)goto AIDDOB_Y
If days not valid, goto ERR_AIDDOB_D

Question ID: AID.060_03.000

Instrument Variable Name: AIDDOB_Y
Question Text:

3 of 3
*Enter year of birth.

1880-2020 Year of birth

Universe Text: Respondent said his/her date of birth is not correct or his/her age is not correct

Skip Instructions:

(1880-2020, Refused, Don't know) if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
goto AIDVERF_D
endif

(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and
month = current month and day GT current day)
goto ERR1_AIDDOB_Y
endif

(if birth month = '02' and birth day = '29' and this is not a leap year)
goto ERR2_AIDDOB_Y
endif

(if AIDDOB_M = 'Ref' or 'DK') or (if AIDDOB_D = 'Re'f or 'DK') or (if AIDDOB_Y = 'Ref' or 'DK')
goto ERR3_AIDDOB_Y

else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty

goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
goto AIDVERF_D
endif
endif

Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.

if age from AIDDOB items is ne AGE and age from AIDDOB items is valid
reset AIDVERF_A or AIDVERF_D.
goto ERR4_AIDDOB_Y

endif

Question ID:ASD.050_00.000

Instrument Variable Name:WRKVER
QuestionText:

Earlier I recorded that in the last week you were(Fill1: working for pay at a job or business.)
(Fill2: with a job or business but not at work.)
(Fill3: looking for work.)
(Fill4: working, but not for pay, at a family-owned job or business.)
(Fill5: not working at a job or business and not looking for work.)
Is that correct?

1Yes
2No
7Refused
9Don't know

Universe Text: Sample adults 18+ who were working or not working last week
Skip Instructions:

(1)if DOINGLW2 = 1,2,4 [goto WHOWRK]
else if DOINGLW2 = 3,5 [goto EVERWRK]
(2)go to WRKCOR LT R,D GT go to EVERWRK

Question ID:ASD.060_00.000

Instrument Variable Name:WRKCOR
QuestionText:

(book) A1 ? [F1]
What is your correct working status?
* Read answer categories.

1Working for pay at a job or business
2With a job or business but not at work
3Looking for work
4Working, but not for pay, at a family-owned job or business
5Not working at a job or business and not looking for work
7Refused
9Don't know

Universe Text: Sample adults 18+ whose working status was incorrect or who were not the Family Respondent and with an
answer of D or R to DOINGLW.
Skip Instructions:

(1,4)[goto to WHOWRK]
(2,5)[goto WHYNOWK2]
(3,R,D)[goto EVERWRK]

Question ID:ASD.062_00.000

Instrument Variable Name:DOINGLW2
QuestionText:

Corrected Employment Status Last Week: (not displayed)

Universe Text:Sample Adults 18+ and also the family section respondent and said Refused or Don't know to the working last
week status question in the family section
Skip Instructions:

if DOINGLW2 = Refused or Don't know then
[goto EVERWRK]
endif

Question ID:ASD.065_00.000

Instrument Variable Name:WHYNOWK2
QuestionText:

? [F1]
(Fill1: What is the main reason you did not work last week?)
(Fill2: What is the main reason you did not have a job or business last week?)

01Taking care of house or family
02Going to school
03Retired
04On a planned vacation from work
05On family or maternity leave
06Temporarily unable to work for health reasons
07Have job/contract and off-season
08On layoff
09Disabled
10Other
97Refused
99Don't know

UniverseText: Sample Adults 18+ whose corrected working status last week was not working at a job or business and not looking
for work or with a job or business but not at work
SkipInstructions:

(1-10,D,R) if WRKCOR = 2 then
[goto WHOWRK]
else [goto EVERWRK]

Question ID:ASD.066_00.000

Instrument Variable Name:EVERWRK
QuestionText:

Have you ever held a job or worked at a business?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who were NOT working at a job or business and not looking for work or looking for work last
week or didn't know or refused to provide their employment status last week
SkipInstructions:

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

Question ID:ASD.070_00.000

Instrument Variable Name:WHOWRK
QuestionText:

? [F1]
(Fill1:For whom did you work at your MAIN job or business? (Name of company, business, organization or
employer))
(Fill2: Thinking about the job you held the longest, for whom did you work? (Name of company, business, organization
or employer))
(Fill3: Thinking about the job you held most recently, for whom did you work? (Name of company, business,
organization or employer))

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:

(90 char long,D,R) [goto KINDIND]

Question ID:ASD.080_00.000

Instrument Variable Name:KINDIND
QuestionText:

? [F1]
What kind of business or industry was this? (For example: TV and radio mgt., retail shoe store, State Department of
Labor)

VerbatimVerbatim response
7Refused
9Don't know

(90 char long, D,R) [goto KINDWRK]

Question ID:ASD.090_00.000

Instrument Variable Name:KINDWRK
QuestionText:

? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:

(90 char long, D,R) [goto IMPACT]

Question ID:ASD.100_00.000

Instrument Variable Name:IMPACT
QuestionText:

? [F1]
What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press.)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:

(90 char long, D,R) [goto WRKCAT]

Question ID:ASD.110_00.000

Instrument Variable Name:WRKCAT
QuestionText:

(book) A2 ? [F1]
[If DOINGLW2 eq (1,2,4)]Looking at the card, which of these best describes your current job or work situation? [Else if
EVERWRK eq (1) and [WHYNOWK2 eq 03 or AGE ge 65] Looking at the card, which of these best describes the job
you held for the longest time?[Else if EVERWRK eq (1) and WHYNOWK2 ne 03 and AGE lt 65] Looking at the card,
which of these best describes the job you held most recently?
* Read answer choices if necessary.

1Employee of a PRIVATE company for wages
2A FEDERAL government employee
3A STATE government employee
4A LOCAL government employee
5Self-employed in OWN business, professional practice or farm6Working WITHOUT PAY in a family-owned business or farm
7Refused
9Don't know

UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:

(1-4,6,D,R)[goto LOCALLNO]
(5)[goto BUSINC]

Question ID:ASD.112_00.000

Instrument Variable Name:BUSINC
QuestionText:

Is this business incorporated?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who are self-employed
SkipInstructions:

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

Question ID:ASD.120_00.000

Instrument Variable Name: LOCALLNO
QuestionText:

(book) A3Thinking about [If DOINGLW2 eq (1,2,4)]this MAIN job or business [Else if EVERWRK eq (1) and [WHYNOWK2
eq 03 or AGE ge 65] your last week at the job you held the longest [Else if EVERWRK eq (1) and WHYNOWK2 ne 03
and AGE lt 65] your last week at the job you held most recently how many people work(ed) at this location?
how many people (Fill4:work/Fill5: worked) at this location?
* "People" includes both FULL- and PART-time employees; "location" refers to the street address of the workplace.

011-9 employees
0210-24 employees
0325-49 employees
0450-99 employees
05100-249 employees
06250-499 employees
07500-999 employees
081000 employees or more
97Refused
99Don't know

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

Question ID: ASD.140_01.000

Instrument Variable Name:WRKLONGN
QuestionText:

? [F1]
1 of 2About how long [If DOINGLW2 eq (1,2,4)]have you worked at this MAIN job or business? [Else if EVERWRK eq (1)
and [WHYNOWK2 eq 03 or AGE ge 65] did you work at the job you held the longest? [Else if EVERWRK eq (1) and
WHYNOWK2 ne 03 and AGE lt 65] did you work at the job you held most recently?

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

UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:

(1-365) [goto WRKLONGT]
(D,R) if EVERWRK eq 1 and (WHYNOWK2 eq 03 or AGE GE 65)
[goto HOURPD] ;
Else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or (DOINGLW2 = 1,2,4)
[goto WRKLONGH]

Question ID:ASD.140_02.000

Instrument Variable Name:WRKLONGT
QuestionText:

2 of 2* Enter time period.

1Day(s)
2Week(s)
3Month(s)
4Year(s)

UniverseText: Sample adults 18+ (who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked) and who gave a number
entry in WRKLONGN
SkipInstructions:

(4) if WRKLONGN gt AGE then [goto ERR_WRKLONGT]
(1-4) if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65) then [goto HOURPD]
else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or (DOINGLW2 = 1,2,4)
[goto WRKLONGH]

Question ID:ASD.146_00.000

Instrument Variable Name:WRKLONGH
QuestionText:

? [F1]
[If DOINGLW2 eq 1,2,4] Is this MAIN job or business the job you have held for the longest? [Else if EVERWRK eq 1
and WHYNOWK2 ne 03 and AGE lt 65] Was your most recently held job also the job you held the longest?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ (who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business,) or (who have ever worked and are not retired and are
less than 65 years of age.)
SkipInstructions:

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

Question ID:ASD.150_00.000

Instrument Variable Name:HOURPD
QuestionText:

[If DOINGLW2 eq (1,2,4)]Are you paid by the hour at this MAIN job or business? [Else if EVERWRK eq (1) and
[WHYNOWK2 eq 03 or AGE ge 65] Were you paid by the hour on the job you held the longest? [Else if EVERWRK eq
(1) and WHYNOWK2 ne 03 and AGE lt 65] Were you paid by the hour on the job you held most recently?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:

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

Question ID:ASD.160_00.000

Instrument Variable Name:PDSICK
QuestionText:

[If DOINGLW2 eq (1,2,4)]Do you have paid sick leave on this MAIN job or business? [Else if EVERWRK eq (1) and
[WHYNOWK2 eq 03 or AGE ge 65] Did you ever have paid sick leave on the job you held the longest?[Else if
EVERWRK eq (1) and WHYNOWK2 ne 03 and AGE lt 65] Did you ever have paid sick leave on the job you held most
recently?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business, or who have ever worked
SkipInstructions:

(1,2,D,R)
if DOINGLW2 = 1,2,4 then [goto ONEJOB];
else if DOINGLW2=3,5 then [goto WRKLYR2];
else if DOINGLW2=D, R then [goto ADULT.ACN.HYPEV]

Question ID:ASD.170_00.000

Instrument Variable Name:ONEJOB
QuestionText:

Do you have more than one job or business?

1Yes
2No
7Refused
9Don't know

UniverseText:
Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were
working but not for pay at a family-owned job or business
SkipInstructions:

(1,2,D,R)
if WRKLONGH=1,D,R, [goto WRKARRNG];
else if WRKLONGH=2 [goto WHOWRKLH]

Question ID:ASD.210_00.000

Instrument Variable Name:WRKLYR2
QuestionText:

Although you did not work last week, did you have a job or business at any time in the PAST 12 MONTHS?

0Had job last week
1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who were looking for work or who were not working at a job or business AND who were not
looking for work in the last week
SkipInstructions:

(1) if (WHYNOWK2=3) or (AGE GTE 65), [goto MRECLONG];
else if (WRKLONGH=2 and WHYNOWK2 ne 3 and AGE LT 65) [goto WHOWRKLH]
else if (WRKLONGH = 1,D,R and WHYNOWK2 ne 3 and AGE LT 65) [goto WRKARRNG]
(2,D,R)[goto ADULT.ACN.HYPEV]

Question ID:ASD.210_00.010

Instrument Variable Name:MRECLONG
QuestionText:

Was the most recent job or business you held in the PAST 12 MONTHS the longest-held job you reported earlier?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who are not currently employed, are retired or 65 or older, and worked in the past 12 months
SkipInstructions:

(1, D, R)[goto WRKARRNG]
(2) [goto WHOWRKPY]

Question ID:ASD.210_00.020
Instrument Variable Name:WHOWRKPY
QuestionText:

? [F1]
For whom did you work at your most recent job or business? (Name of company, business, organization or employer)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText: Sample adults 18+ who are not currently employed, are retired or 65 or older, worked in the past 12 months, and
whose job in the past 12 months was not their longest-held job
SkipInstructions:

(90 char long, D,R) [goto KINDINPY]

Question ID:ASD.210_00.030

Instrument Variable Name:KINDINPY
QuestionText:

? [F1]
What kind of business or industry was this? (For example: TV and radio management, retail shoe store, State Department
of Labor)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are not currently employed, are retired or 65 or older, worked in the past 12 months, and
whose job in the past 12 months was not their longest-held job
SkipInstructions:

(90 char long, D,R) [goto KINDWKPY]

Question ID:ASD.210_00.040

Instrument Variable Name:KINDWKPY
QuestionText:

? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are not currently employed, are retired or 65 or older, worked in the past 12 months, and
whose job in the past 12 months was not their longest-held job
SkipInstructions:

(90 char long, D,R) [goto IMPACTPY]

Question ID:ASD.210_00.050

Instrument Variable Name:IMPACTPY
QuestionText:

? [F1]
What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are not currently employed, are retired or 65 or older, worked in the past 12 months, and
whose job in the past 12 months was not their longest-held job
SkipInstructions:

(90 char long, D,R) [goto WRKCATPY]

Question ID:ASD.210_00.060

Instrument Variable Name:WRKCATPY
QuestionText:

(book) A2 ? [F1]
Looking at the card, which of these best describes the job or business you held most recently?
* Read answer choices if necessary.

1An employee of a PRIVATE company, business, or individual for wages, salary, or commission
2A FEDERAL government employee
3A STATE government employee
4A LOCAL government employee
5Self-employed in OWN business, professional practice or farm
6Working WITHOUT PAY in family-owned business or farm
7Refused
9Don't know

UniverseText:Sample adults 18+ who are not currently employed, are retired or 65 or older, worked in the past 12 months, and
whose job in the past 12 months was not their longest-held job
SkipInstructions: (1-6,D,R) [goto WRKLGPYN]

Question ID:ASD.210_00.070

Instrument Variable Name:WRKLGPYN
QuestionText:

1 of 2About how long did you work at this job or business?
* Enter number.

001-3651-365
997Refused
999Don't know

UniverseText:Sample adults 18+ who are not currently employed, are retired or 65 or older, worked in the past 12 months, and
whose job in the past 12 months was not their longest-held job
SkipInstructions:

(1-365)[goto WRKLGPYT]
(D,R)[goto WRKARRNG]

Question ID:ASD.210_00.075

Instrument Variable Name:WRKLGPYT
QuestionText:

2 of 2*Read if necessary: About how long did you work at this job or business?
* Enter time period.

1Day(s)
2Week(s)
3Month(s)
4Year(s)
7Refused
9Don't know

UniverseText:Sample adults 18+ who are not currently employed, are retired or 65 or older, worked in the past 12 months,
whose job in the past 12 months was not their longest-held job, and who gave a number entry at WRKLGPYN
SkipInstructions:

(4) if WRKLGPYN gt AGE then [goto ERR_WRKLGPYT]
(1-4,D,R)[goto WRKARRNG]

Question ID:ASD.210_00.080

Instrument Variable Name:WHOWRKLH
QuestionText:

? [F1]
Thinking of all the jobs or businesses you have ever had, including work done in the Armed Forces, for whom did you
work the longest? (Name of company, business, organization or employer)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ whose current or most recent job was not the job they held the longest
SkipInstructions:

(90 char long, D,R) [goto KINDINLH]

Question ID:ASD.210_00.090

Instrument Variable Name:KINDINLH
QuestionText:

? [F1]
What kind of business or industry was this? (For example: TV and radio management, retail shoe store, State Department
of Labor)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText: Sample adults 18+ whose current or most recent job was not the job they held the longest
SkipInstructions:

(90 char long, D,R) [goto KINDWKLH]

Question ID: ASD.210_00.100

Instrument Variable Name:KINDWKLH
QuestionText:

? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText: Sample adults 18+ whose current or most recent job was not the job they held the longest
SkipInstructions:

(90 char long, D,R) [goto IMPACTLH]

Question ID:ASD.210_00.110
Instrument Variable Name:IMPACTLH
QuestionText:

? [F1]
What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ whose current or most recent job was not the job they held the longest
SkipInstructions:

(90 char long, D,R) [goto WRKCATLH]

Question ID:ASD.210_00.120

Instrument Variable Name:WRKCATLH
QuestionText:

(book) A2 ? [F1]
Looking at the card, which of these best describes the job or business you held for the longest time?
* Read answer choices if necessary.

UniverseText:Sample adults 18+ whose current or most recent job was not the job they held the longest
SkipInstructions:

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

Question ID:ASD.210_00.130

Instrument Variable Name:WRKLGLHN
QuestionText:

1 of 2About how long did you work at the job or business you held the longest?
* Enter number.

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

UniverseText: Sample adults 18+ whose current or most recent job was not the job they held the longest
SkipInstructions:

(1-365)[goto WRKLGLHT]
(D,R)[goto WRKARRNG]

Question ID:ASD.210_00.135

Instrument Variable Name:WRKLGLHT
QuestionText:

2 of 2*Read if necessary: About how long did you work at the job or business you held the longest?
* Enter time period.

1Day(s)
2Week(s)
3Month(s)
4Year(s)
7Refused
9Don't know

UniverseText:Sample adults 18+ whose current or most recent job was not the job they held the longest and who gave a number
entry at WRKLGLHN
SkipInstructions:

(4) if WRKLGLHN gt AGE then [goto ERR_WRKLGLHT]
(1-4,D,R)[goto WRKARRNG]

Question ID:ASD.210_00.140

Instrument Variable Name:WRKARRNG
QuestionText:

? [F1]
The next few questions refer to [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the MAIN job
you held last week/the job you held most recently]. Which of the following best [fill 2: describes/described] your work
arrangement?
* Read answer categories.

1You [work/worked] as an independent contractor, independent consultant, or freelance worker
2You [are/were] on-call, and [work/worked] only when called to work
3You [are/were] paid by a temporary agency
4You [work/worked] for a contractor who provides workers and services to others under contract
5You [are/were] a regular, permanent employee (standard work arrangement)
6Other
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.150

Instrument Variable Name:WRKTEMP
QuestionText:

? [F1]
Some people are in temporary jobs that last only for a limited time or until the completion of a project. [fill1: Is your/Was
your] job temporary?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.160

Instrument Variable Name:WRKSCHED
QuestionText:

? [F1]
Which of the following best describes the hours you usually [fill1: work/worked]?
* Read answer categories.

1A regular daytime schedule
2A regular evening shift
3A regular night shift
4A rotating shift
5Some other schedule
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.170

Instrument Variable Name:WORUNEMP
QuestionText:

? [F1]
Now I'm going to read two statements that may or may not [fill 1: apply/have applied ] to [fill 2: your job as a (JOB
DESCRIPTION) with (EMPLOYER NAME)/the MAIN job you held last week/the job you held most recently]. Please
tell me whether you strongly agree, agree, disagree, or strongly disagree with each of these statements.
...I [fill 3:am/was] worried about becoming unemployed

1Strongly agree
2Agree
3Disagree
4Strongly disagree
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.180

Instrument Variable Name:WORKWFAM
QuestionText:

? [F1]
*Read if necessary: Please tell me whether you strongly agree, agree, disagree, or strongly disagree with each of these
statements.
...It [fill1: is/was] easy for me to combine work with family responsibilities.

1Strongly agree
2Agree
3Disagree
4Strongly disagree
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.190

Instrument Variable Name:HARASSED
QuestionText:

? [F1]
Again, think about [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the MAIN job you held last
week/the job you held most recently]. DURING THE PAST 12 MONTHS, were you threatened, bullied or harassed by
anyone while you were on the job?
*Read if necessary: Like all information you provide, your answer will be kept strictly confidential.

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.200

Instrument Variable Name:CHEMEXP
QuestionText:

? [F1]
The next few questions ask about possible exposures to hazards at [fill 1: your job as a (JOB DESCRIPTION) with
(EMPLOYER NAME)/the MAIN job you held last week/the job you held most recently].
DURING THE PAST 12 MONTHS, did you regularly handle or were you in skin contact with chemical products or
substances at work twice a week or more?
*Read if necessary: Chemical products may include cleaning agents, bleach, solvents, formaldehyde, oils or cutting
fluids, paints or coatings, sealants, glues or adhesives, etc.

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.210

Instrument Variable Name:SMOKEXP
QuestionText:

? [F1]
DURING THE PAST 12 MONTHS, were you regularly exposed to tobacco smoke from other people at work twice a
week or more?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.220

Instrument Variable Name:WRKOUTDR
QuestionText:

? [F1]
DURING THE PAST 12 MONTHS, did you regularly work outdoors twice a week or more?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

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

Question ID:ASD.210_00.230

Instrument Variable Name:VAPOREXP
QuestionText:

? [F1]
This next question refers to [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the MAIN job you
held last week/the job you held most recently/the job you held the longest].
Please tell me if you [fill 2: are/were] regularly exposed to vapors, gas, dust, or fumes at work twice a week or more?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months
SkipInstructions:

(1,2,D,R)
if FIJ.IPWHAT=2 [goto INJWCCLM];
else if FIJ.IPWHAT= blank, 1, 3-11, D,R [goto ACN.HYPEV]

Question ID:ASD.210_00.240

Instrument Variable Name:INJWCCLM
QuestionText:

? [F1]
Now I'm going to ask about on-the-job injuries and poisonings. Earlier I recorded that you were [fill 1:
injured/poisoned/injured and poisoned] in the past three months while working at a paid job. Did you file a workers'
compensation claim for [fill 2: your injury/any of your injuries/ your poisoning/any of your poisonings/your injury or
poisoning/any of your injuries or poisonings]?

1Yes
2No
3No injuries/poisonings on the job
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months and suffered an
injury or poisoning in the past three months while working at a paid job
SkipInstructions:

(1) [goto INJWCBEN]
(2,3,D,R) [goto ACN.HYPEV]

Question ID:ASD.210_00.250

Instrument Variable Name:INJWCBEN
QuestionText:

? [F1]
Did you receive workers' compensation benefits for [fill: your injury/any of your injuries/your poisoning/any of your
poisonings/your injury or poisoning/any of your injuries or poisonings]?

1Yes
2No
3Claim(s) in process
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, suffered an injury
or poisoning in the past three months while working at a paid job, and filed a workers' compensation claim
SkipInstructions:

(1,2,3,D,R) [goto ACN.HYPEV]

Question ID:ACN.010_00.000

Instrument Variable Name:HYPEV
QuestionText:

Now I am going to ask you about certain medical conditions.
Have you EVER been told by a doctor or other health professional that you had: Hypertension, also called high blood pressure?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto HYPDIFV]
(2,R,D)[goto CHDEV]

Question ID:ACN.020_00.000

Instrument Variable Name:HYPDIFV
QuestionText:

Were you told on two or more DIFFERENT visits that you had hypertension, also called high blood pressure?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who were told they had hypertension
SkipInstructions:

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

Question ID:ACN.031_01.000

Instrument Variable Name:CHDEV
QuestionText:

Have you EVER been told by a doctor or other health professional that you had: Coronary heart disease?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID:ACN.031_02.000

Instrument Variable Name:ANGEV
QuestionText:

* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had: Angina, also called angina pectoris?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID:ACN.031_03.000

Instrument Variable Name:MIEV
QuestionText:

* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had:A heart attack (also called myocardial infarction)?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.031_04.000

Instrument Variable Name:HRTEV
QuestionText:

* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
:Any kind of heart condition or heart disease (other than the ones I just asked about)?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.031_05.000

Instrument Variable Name:STREV
QuestionText:

* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
:A stroke?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.031_06.000

Instrument Variable Name:EPHEV
QuestionText:

* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had:Emphysema?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.080_00.000

Instrument Variable Name:AASMEV
QuestionText:

Have you EVER been told by a doctor or other health professional that you had asthma?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto AASSTILL]
(2,R,D)[goto ULCEV]

Question ID:ACN.085_00.000

Instrument Variable Name:AASSTILL
QuestionText:

Do you still have asthma?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who were ever told they have asthma
SkipInstructions:

(1,2,R,D)[go to AASMYR]

Question ID:ACN.090_00.000

Instrument Variable Name:AASMYR
QuestionText:

DURING THE PAST 12 MONTHS, have you had an episode of asthma or an asthma attack?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who were ever told they had asthma
SkipInstructions:

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

Question ID:ACN.100_00.000
Instrument Variable Name:AASMERYR
QuestionText:

DURING THE PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who were ever told they had asthma
SkipInstructions:

(1,2,R,D)
if (DOINGLW2= 1,2,4 or WRKLYR2= 1) and AASSTILL =1 [goto AASAGE]
else [goto ULCEV

Question ID:ACN.105_00.010

Instrument Variable Name:AASAGE
QuestionText:

How old were you when you were first told you had asthma?

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

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months and still have
asthma
SkipInstructions:

If AASAGE ge AGE, then [goto ERR_AASAGE]
(001-015) [goto AASSTAT]
(016-120) [goto AASEMP]
(D, R) [goto AASAGE16]

Question ID:ACN.105_00.015

Instrument Variable Name:AASAGE16
QuestionText:

Were you less than 16 or 16 or older when you were first told you had asthma?

1Less than 16
2 16 or older
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
and refused or said don't know to question on age they were first told they had asthma
SkipInstructions:

(1) [goto AASSTAT]
(2,D,R)[goto AASEMP]

Question ID:ACN.105_00.020

Instrument Variable Name:AASSTAT
QuestionText:

Compared to when you were first told you had asthma, would you say your asthma has been better, worse, or about the
same as an adult?

1Better
2Worse
3About the same
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
and were less than 16 years of age when they were told they had asthma
SkipInstructions:

(1,3,D,R) [gotoAASWKREL]
(2) [goto AASEMP]

Question ID:ACN.105_00.030

Instrument Variable Name:AASEMP
QuestionText:

Were you employed when [fill 1: you first developed symptoms of asthma/your asthma got worse]?

1Yes
2No
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
and were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR
age at time of diagnosis is unknown
SkipInstructions:

(1) [goto AASCJOB]
(2,D,R)[goto AASWKREL]

Question ID:ACN.105_00.040

Instrument Variable Name:AASCJOB
QuestionText:

Was this [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the MAIN job you held last week/the
job you held most recently]?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR age at
time of diagnosis is unknown, and were employed when they first developed symptoms/asthma got worse
SkipInstructions:

(1,D,R) [goto AASWKREL]
(2)
if (WRKLONGH=2 or MRECLONG=2,D,R) [goto AASLHJOB]
else if (WRKLONGH=1,D,R) or (MRECLONG=1) [goto AASWHOWK]

Question ID:ACN.105_00.045
Instrument Variable Name:AASLHJOB
QuestionText:

Was this [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the job you held the longest]?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR age at
time of diagnosis is unknown, were employed when they first developed symptoms/asthma got worse, and their
symptoms first developed/asthma got worse at a job other than their current/most recent job
SkipInstructions:

(1,D,R) [goto AASWKREL]
(2) [goto AASWHOWK]

Question ID:ACN.105_00.050

Instrument Variable Name:AASWHOWK
QuestionText:

For whom did you work when [fill 1: you first developed symptoms of asthma/your asthma got worse]? (Name of
company, business, organization, or employer)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText: Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR age at
time of diagnosis is unknown, were employed when they first developed symptoms/asthma got worse, and their
symptoms first developed/asthma got worse at a job other than their current/most recent and longest-held jobs
SkipInstructions:

(90 char long, D,R) [goto AASKIND]

Question ID:ACN.105_00.060

Instrument Variable Name:AASKIND
QuestionText:

What kind of business or industry was this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR age at
time of diagnosis is unknown, were employed when they first developed symptoms/asthma got worse, and their
symptoms first developed/asthma got worse at a job other than their current/most recent and longest-held jobs
SkipInstructions:

(90 char long, D,R) [goto AASKWORK]

Question ID:ACN.105_00.070

Instrument Variable Name:AASKWORK
QuestionText:

What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR age at
time of diagnosis is unknown, were employed when they first developed symptoms/asthma got worse, and their
symptoms first developed/asthma got worse at a job other than their current/most recent and longest-held jobs
SkipInstructions:

(90 char long, D,R) [goto AASIMPAC]

Question ID:ACN.105_00.080

Instrument Variable Name:AASIMPAC
QuestionText:

What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR age at
time of diagnosis is unknown, were employed when they first developed symptoms/asthma got worse, and their
symptoms first developed/asthma got worse at a job other than their current/most recent and longest-held jobs
SkipInstructions:

(90 char long, D,R) [goto AASWKREL]

Question ID:ACN.105_00.100

Instrument Variable Name:AASWKREL
QuestionText:

Have you been told by a doctor or other health professional that your asthma [fill: was probably caused by your work/was
probably made worse by your work/was ever made worse by any job you have ever had]?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
and were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR
age at time of diagnosis is unknown
SkipInstructions:

(1) [goto AASWCCLM]
(2,D,R)[goto AASDWKRL]

Question ID:ACN.105_00.110

Instrument Variable Name:AASDWKRL
QuestionText:

Did YOU ever discuss with a doctor or other health professional whether your asthma [fill: was probably caused by your
work/was probably made worse by your work/was ever made worse by any job you have ever had]?

1Yes
2No
7Refused
9Don't know

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

Question ID:ACN.105_00.120

Instrument Variable Name:AASWCCLM
QuestionText:

Have you ever filed a workers' compensation claim for your asthma?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
and were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR
age at time of diagnosis is unknown
SkipInstructions:

(1) [goto AASWCBEN]
(2,D,R)[goto AASWKDAY]

Question ID:ACN.105_00.130

Instrument Variable Name:AASWCBEN
QuestionText:

Have you ever received workers' compensation benefits for your asthma?

1Yes
2No
3Claim(s) in process
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR age at
time of diagnosis is unknown, and filed a workers' compensation claim for their asthma
SkipInstructions:

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

Question ID:ACN.105_00.140

Instrument Variable Name:AASWKDAY
QuestionText:

DURING THE PAST 12 MONTHS, how many full days did you miss from work because of your asthma?
* Enter '0' for None.

000None
001-3661-366 days
997Refused
999Don't know

(000-366,D,R) [goto AASCHJOB]

Question ID:ACN.105_00.150

Instrument Variable Name:AASCHJOB
QuestionText:

DURING THE PAST 12 MONTHS, did you stop working, change jobs, or make a major change in your work activities,
such as taking on lighter duties, because of your asthma?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, still have asthma,
and were 16 years of age or older OR less than 16 years of age and their asthma has gotten worse as an adult OR
age at time of diagnosis is unknown
SkipInstructions:

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

Question ID:ACN.110_00.000

Instrument Variable Name:ULCEV
QuestionText:

Have you EVER been told by a doctor or other health professional that you had:An ulcerThis could be a stomach, duodenal or peptic ulcer.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto ULCYR]
(2,R,D)[goto CANEV]

Question ID:ACN.120_00.000
Instrument Variable Name:ULCYR
QuestionText:

DURING THE PAST 12 MONTHS have you had: An ulcer?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who were ever told they had an ulcer
SkipInstructions:

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

Question ID:ACN.130_00.000

Instrument Variable Name:CANEV
QuestionText:

Have you EVER been told by a doctor or other health professional that you had:Cancer or a malignancy of any kind?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto CANKIND]
(2,R,D)[goto DIBEV]

Question ID:ACN.140_00.001

Instrument Variable Name:CANKIND_1
QuestionText:

What kind of cancer was it?
* Enter code for the first kind of cancer.

01Bladder
02Blood
03Bone
04Brain
05Breast
06Cervix
07Colon
08Esophagus
09Gallbladder
10Kidney
11Larynx-windpipe
12Leukemia
13Liver
14Lung
15Lymphoma
16Melanoma
17Mouth/tongue/lip
18Ovary
19Pancreas
20Prostate
21Rectum
22Skin (non-melanoma)
23Skin (DK what kind)
24Soft tissue (muscle or fat)
25Stomach
26Testis
27Throat - pharynx
28Thyroid
29Uterus
30Other
97Refused
99Don't know

UniverseText:Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-30,R,D)[goto CANAGE_1]
IF SEX=1 (MALE) and No. (6,18,29) selected goto ERR1_CANKIND_1IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_1

Question ID:ACN.140_00.002

Instrument Variable Name:CANKIND_2
QuestionText:

* Enter code for the second kind of cancer.
* Enter '96' for no more.

UniverseText:Sample adults 18+ who either provided an age for one kind of cancer or didn't know how old they were when first
diagnosed with that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_1.
SkipInstructions:

(1-30,R,D)[goto CANAGE_2]
(96)goto DIBEV
IF SEX=1 (MALE) and No. (6,18,29) selected goto ERR1_CANKIND_2IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_2

Question ID:ACN.140_00.003

Instrument Variable Name:CANKIND_3
QuestionText:

* Enter code for the third kind of cancer.
* Enter '96' for no more.

UniverseText:Sample adults 18+ who either provided an age for a second kind of cancer or didn't know how old they were when
first diagnosed that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_2.
SkipInstructions:

(1-30,R,D)[goto CANAGE_3]
(96) [goto DIBEV]
IF SEX=1 (MALE) and No. (6,18,29) selected goto ERR1_CANKIND_3IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_3

Question ID:ACN.140_00.004

Instrument Variable Name:CANKIND_4
QuestionText:

* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.

95More than three kinds
96No more

UniverseText:Sample adults 18+ who either provided an age for a third kind of cancer or didn't know how old they were when
first diagnosed that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_3
SkipInstructions:

(95,96) [goto DIBEV]

Question ID:ACN.150_00.001

Instrument Variable Name:CANAGE_1
QuestionText:

How old were you when [Fill1: CANKIND_1 / Fill2: this cancer] was first diagnosed?

001-100 1-100 years
997Refused
999Don't know

UniverseText:Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-100, D) goto CANKIND_2(R) and (R) at CANKIND_1[goto DIBEV]
(R) and CANKIND_1 NE (R) [goto CANKIND_2]
If number in CANAGE_1 greater than person years old (AGE) goto ERR_ CANAGE_1

Question ID:ACN.150_00.002

Instrument Variable Name:CANAGE_2
QuestionText:

How old were you when [Fill1: CANKIND_2/Fill2: this cancer] was first diagnosed?

001-100 1-100 years
997Refused
999Don't know

UniverseText:Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-100, D) goto CANKIND_3(R) and (R) at CANKIND_2goto DIBEV]
(R) and CANKIND_2 NE (R) [goto CANKIND_3]
If number in CANAGE_2 greater than person years old (AGE) goto ERR_ CANAGE_2

Question ID:ACN.150_00.003

Instrument Variable Name:CANAGE_3
QuestionText:

How old were you when [Fill1: CANKIND_3/Fill2: this cancer ] was first diagnosed?

001-100 1-100 years
997Refused
999Don't know

UniverseText:Sample adults 18+ who were ever told they had cancer
SkipInstructions:

(1-100, D) goto CANKIND_4(R) and (R) at CANKIND_3[goto DIBEV]
(R) and CANKIND_3 NE (R) [goto CANKIND_4]
If number in CANAGE_3 greater than person years old (AGE) goto ERR_ CANAGE_3

Question ID:ACN.160_00.000

Instrument Variable Name:DIBEV
QuestionText:

[Fill1:Other than during pregnancy, have you EVER been told by a doctor or other health professional that you have
diabetes or sugar diabetes?]/[Fill2:Have you EVER been told by a doctor or other health professional that you have
diabetes or sugar diabetes?]

1Yes
2No
3Borderline
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto DIBAGE]
(2,R,D)[goto DIBPRE1]
(3) [goto INSLN]

Question ID:ACN.165_00.000

Instrument Variable Name:DIBPRE1
QuestionText:

Have you EVER been told by a doctor or other health professional that you have any of the following: prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who were never told they had diabetes, or who refused or said don't know to having been told
they had diabetes
SkipInstructions:

(1) [goto INSLN]
(2,R,D)[goto EPILEP1]

Question ID:ACN.170_00.000

Instrument Variable Name:DIBAGE
QuestionText:

How old were you when a doctor or other health professional FIRST told you that you had diabetes or sugar diabetes?

01-84 1-84 years
85 85+ years
97Refused
99Don't know

UniverseText:Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy)
SkipInstructions:

(1-100 R,D) [goto INSLN]
If number in DIBAGE greater than person years old (AGE) goto ERR_ DIBAGE

Question ID:ACN.180_00.000

Instrument Variable Name:INSLN
QuestionText:

Are you NOW taking insulin?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy) or who were told they had prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar
SkipInstructions:

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

Question ID:ACN.190_00.000

Instrument Variable Name:DIBPILL
QuestionText:

Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy) or who were told they had pre-diabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar
SkipInstructions:

(1,2,R,D)[goto EPILEP1]

Question ID:ACN.192_00.010

Instrument Variable Name:EPILEP1
QuestionText:

Have you ever been told by a doctor or other health professional that you have a seizure disorder or epilepsy?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto EPILEP2]
(2,R,D)[goto AHAYFYR]

Question ID:ACN.192_00.020

Instrument Variable Name:EPILEP2
QuestionText:

Are you currently taking any medicine to control your seizure disorder or epilepsy?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
SkipInstructions:

(1,2,R,D)[goto EPILEP3]

Question ID:ACN.192_00.030

Instrument Variable Name:EPILEP3
QuestionText:

Today is [fill: Current Date]. Think back to last year about the same time. About how many seizures of any type have you
had in the past year?
*Read if necessary: Some people may call it "convulsion," "fit," "falling out spell," "episode," "attack," "drop attack,"
"staring spell," or "out-of-touch.".
*If the respondent mentions and counts "auras" as seizures accept the response. If a respondent indicates that he/she has
had nothing more than an aura and is unsure about counting the aura(s), do NOT count auras as seizures.

0None
1One
2Two or three
3Between four and ten
4More than 10
7Refused
9Don't know

UniverseText:Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
SkipInstructions:

(0-4,R,D) [goto EPILEP4]

Question ID:ACN.192_00.040

Instrument Variable Name:EPILEP4
QuestionText:

In the past year have you seen a neurologist or epilepsy specialist for your epilepsy or seizure disorder?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
SkipInstructions:

(1,2,R,D)[goto EPILEP5]

Question ID:ACN.192_00.050

Instrument Variable Name:EPILEP5
QuestionText:

DURING THE PAST 30 DAYS, to what extent has epilepsy or its treatment interfered with your normal activities like
working, school, or socializing with family or friends? Would you say...
*Read categories below.

1Not at all
2Slightly
3Moderately
4Quite a bit
5Extremely
7Refused
9Don't know

UniverseText:Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
SkipInstructions:

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

Question ID:ACN.201_01.000

Instrument Variable Name:AHAYFYR
QuestionText:

DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had:Hay fever?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.201_02.000

Instrument Variable Name:SINYR
QuestionText:

* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had:Sinusitis?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.201_03.000

Instrument Variable Name:CBRCHYR
QuestionText:

* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had:Chronic bronchitis?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.201_04.000

Instrument Variable Name:KIDWKYR
QuestionText:

* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had::Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.201_05.000

Instrument Variable Name:LIVYR
QuestionText:

* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had:Any kind of liver condition?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.210_00.010

Instrument Variable Name:DRMYR
QuestionText:

? [F1]
DURING THE PAST 12 MONTHS, have you had dermatitis, eczema, or any other red, inflamed skin rash?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto DRMBODY]
(2,D,R)[goto JNTSYMP]

Question ID:ACN.215_00.010

Instrument Variable Name:DRMBODY
QuestionText:

What parts of your body were affected by this skin condition?
* Enter all that apply, separate with commas.

1Hands
2Arms
3Head, face, or neck
4Other
7Refused
9Don't know

UniverseText:Sample adults 18+ who reported having dermatitis, eczema, or any other red, inflamed skin rash in the past 12
months
SkipInstructions:

(1-4,D,R)
if DOINGLW2 = 1,2,4 or WRKLYR2=1 [goto DRMTRET]
else [goto JNTSYMP]

Question ID:ACN.217_00.010

Instrument Variable Name:DRMTRET
QuestionText:

Have you ever seen a doctor or other health professional for your skin condition?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, and reported
having dermatitis, eczema, or any other red, inflamed skin rash in the past 12 months.
SkipInstructions:

(1) [goto DRMWKREL]
(2,D,R)[goto DRMWKDAY]

Question ID:ACN.217_00.020

Instrument Variable Name:DRMWKREL
QuestionText:

Have you been told by a doctor or other health professional that your skin condition was probably work-related?

1Yes
2No
7Refused
9Don't know

(1) [goto DRMCJOB]
(2,D,R)[goto DRMWCCLM]

Question ID:ACN.220_00.020

Instrument Variable Name:DRMCJOB
QuestionText:

Was this [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the MAIN job you held last week/the
job you held most recently]?

1Yes
2No
7Refused
9Don't know

(1,D,R) [goto DRMWCCLM]
(2)
if WRKLONGH=2 or MRECLONG=2, D, R [goto DRMLHJOB]
else if WRKLONGH=1,D,R or MRECLONG=1 [goto DRMWHOWK]

Question ID:ACN.220_00.030

Instrument Variable Name:DRMLHJOB
QuestionText:

Was this [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the job you held the longest]?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
dermatitis, eczema, or any other red, inflamed skin rash in the past 12 months, have been told by a doctor or other
health professional that their skin condition was probably work related, and whose current job or job in the past 12
months was not their longest-held job and was not associated with their skin condition
SkipInstructions:

(1,D,R) [goto DRMWCCLM]
(2) [goto DRMWHOWK]

Question ID:ACN.220_00.040

Instrument Variable Name:DRMWHOWK
QuestionText:

For whom did you work when you developed your skin condition? (Name of company, business, organization, or
employer)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
dermatitis, eczema, or any other red, inflamed skin rash in the past 12 months, have been told by a doctor or other
health professional that their skin condition was probably work related, and whose current job or job in the past 12
months and their longest-held job, if different from their current job or job in the past 12 months, were not
associated with their skin condition
SkipInstructions:

(90 char long, D,R) [goto DRMKIND]

Question ID:ACN.220_00.050

Instrument Variable Name:DRMKIND
QuestionText:

What kind of business or industry was this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
dermatitis, eczema, or any other red, inflamed skin rash in the past 12 months, have been told by a doctor or other
health professional that their skin condition was probably work related, and whose current job or job in the past 12
months and their longest-held job, if different from their current job or job in the past 12 months, were not
associated with their skin condition
SkipInstructions:

(90 char long, D,R) [goto DRMKWRK]

Question ID:ACN.220_00.060

Instrument Variable Name:DRMKWRK
QuestionText:

What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
dermatitis, eczema, or any other red, inflamed skin rash in the past 12 months, have been told by a doctor or other
health professional that their skin condition was probably work related, and whose current job or job in the past 12
months and their longest-held job, if different from their current job or job in the past 12 months, were not
associated with their skin condition
SkipInstructions:

(90 char long, D,R) [goto DRMIMPAC]

Question ID:ACN.220_00.070

Instrument Variable Name:DRMIMPAC
QuestionText:

What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
dermatitis, eczema, or any other red, inflamed skin rash in the past 12 months, have been told by a doctor or other
health professional that their skin condition was probably work related, and whose current job or job in the past 12
months and their longest-held job, if different from their current job or job in the past 12 months, were not
associated with their skin condition
SkipInstructions:

(90 char long, D,R) [goto DRMWCCLM]

Question ID:ACN.220_00.100

Instrument Variable Name:DRMWCCLM
QuestionText:

Have you ever filed a workers' compensation claim for your skin condition?

1Yes
2No
7Refused
9Don't know

(1) [goto DRMWCBEN]
(2,D,R)[DRMWKDAY]

Question ID:ACN.220_00.110

Instrument Variable Name:DRMWCBEN
QuestionText:

Have you ever received workers' compensation benefits for your skin condition?

1Yes
2No
3Claim(s) in process
7Refused
9Don't know

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

Question ID:ACN.220_00.120
Instrument Variable Name:DRMWKDAY
QuestionText:

DURING THE PAST 12 MONTHS, how many full days did you miss from work because of your skin condition?
* Enter '0' for None.

000None
001-366 1-366 days
997Refused
999Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months and reported
having dermatitis, eczema, or any other red, inflamed skin rash in the past 12 months
SkipInstructions:

(000-366,D,R) [goto DRMCHJOB]

Question ID:ACN.220_00.130

Instrument Variable Name:DRMCHJOB
QuestionText:

DURING THE PAST 12 MONTHS, did you stop working, change jobs, or make a major change in your work activities,
such as taking on lighter duties, because of your skin condition?

1Yes
2No
7Refused
9Don't know

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

Question ID:ACN.250_00.000

Instrument Variable Name:JNTSYMP
QuestionText:

The next questions refer to your joints. Please do NOT include the back or neck. DURING THE PAST 30 DAYS, have you had any symptoms of pain, aching, or stiffness in or around a joint?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto JMTHP]
(2,R,D)[goto ARTH]

Question ID:ACN.260_00.000

Instrument Variable Name:JMTHP
QuestionText:

(book) A4Which joints are affected?
* Enter all that apply, separate with commas.

01Shoulder-right
02Shoulder-left
03Elbow-right
04Elbow-left
05Hip-right
06Hip-left
07Wrist-right
08Wrist-left
09Knee-right
10Knee-left
11Ankle-right
12Ankle-left
13Toes-right
14Toes-left
15Fingers/thumb-right
16Fingers/thumb-left
17Other joint not listed
97Refused
99Don't know

UniverseText:Sample adults 18+ who had joint pain in the past 30 days
SkipInstructions:

(1-17,R,D) [goto JNTCHR]

Question ID:ACN.270_00.000

Instrument Variable Name:JNTCHR
QuestionText:

Did your joint symptoms FIRST begin more than 3 months ago?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who had joint pain in the past 30 days
SkipInstructions:

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

Question ID:ACN.280_00.000

Instrument Variable Name:JNTHP
QuestionText:

Have you EVER seen a doctor or other health professional for these joint symptoms?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who had joint pain in the past 30 days
SkipInstructions:

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

Question ID:ACN.290_00.000

Instrument Variable Name:ARTH
QuestionText:

Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid
arthritis, gout, lupus, or fibromyalgia (fy-bro-my-AL-jee-uh)?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

((1) or JNTSYMP eq (1)) [goto ARTHLMT];
else ((2,R,D)and JNTSYMP ne 1) [goto CTSEVER]

Question ID:ACN.295_00.000

Instrument Variable Name:ARTHLMT
QuestionText:

Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ with joint pain or arthritis
SkipInstructions:

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

Question ID:ACN.296_00.010

Instrument Variable Name:CTSEVER
QuestionText:

Have you EVER been told by a doctor or other health professional that you have a condition affecting the wrist and hand called carpal tunnel syndrome?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto CTSYR]
(2,D,R)[goto PAINECK]

Question ID:ACN.296_00.020

Instrument Variable Name:CTSYR
QuestionText:

DURING THE PAST 12 MONTHS have you had carpal tunnel syndrome?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have ever been diagnosed with carpal tunnel syndrome
SkipInstructions:

(1)
if DOINGLW2=1,2,4 or WRKLYR2=1 [goto CTSAGE]
else [goto PAINECK]
(2,D,R)[goto PAINECK]

Question ID:ACN.297_00.010

Instrument Variable Name:CTSAGE
QuestionText:

How old were you when you were first told you had carpal tunnel syndrome?

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

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months and reported
having carpal tunnel syndrome in the past 12 months
SkipInstructions:

(001-014) [goto PAINECK]
(015-120,D,R) [goto CTSWKREL]

Question ID:ACN.297_00.015

Instrument Variable Name:CTSWKREL
QuestionText:

Have you been told by a doctor or other health professional that your carpal tunnel syndrome was probably work-related?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
carpal tunnel syndrome in the past 12 months, and were first diagnosed with carpal tunnel syndrome at age 15 or
older or age of diagnosis was refused or don't know
SkipInstructions:

(1) [goto CTSCJOB]
(2,D,R)[goto CTSWCCLM]

Question ID:ACN.297_00.030

Instrument Variable Name:CTSCJOB
QuestionText:

Was this [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the MAIN job you held last week/the
job you held most recently]?

1Yes
2No
7Refused
9Don't know

(1,D,R) [goto CTSWCCLM]
(2)
if WRKLONGH=2 or MRECLONG=2,D,R [goto CTSLHJOB]
else if WRKLONGH=1,D,R or MRECLONG=1 [goto CTSWHOWK]

Question ID:ACN.297_00.040

Instrument Variable Name:CTSLHJOB
QuestionText:

Was this [fill 1: your job as a (JOB DESCRIPTION) with (EMPLOYER NAME)/the job you held the longest]?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
carpal tunnel syndrome in the past 12 months, were first diagnosed with carpal tunnel syndrome at age 15 or older
or age of diagnosis was refused or don't know, have been told by a doctor or other health professional that their
carpal tunnel syndrome was probably work related, and whose current job or job in the past 12 months was not
their longest-held job and was not associated with their carpal tunnel syndrome
SkipInstructions:

(1,D,R) [goto CTSWCCLM]
(2) [goto CTSWHOWK]

Question ID:ACN.297_00.050

Instrument Variable Name:CTSWHOWK
QuestionText:

For whom did you work when you developed carpal tunnel syndrome? (Name of company, business, organization or
employer)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
carpal tunnel syndrome in the past 12 months, were first diagnosed with carpal tunnel syndrome at age 15 or older
or age of diagnosis was refused or don't know, have been told by a doctor or other health professional that their
carpal tunnel syndrome was probably work related, and whose current job or job in the past 12 months and their
longest-held job, if different from their current job or job in the past 12 months, were not associated with their
carpal tunnel syndrome
SkipInstructions:

(90 char long, D,R) [goto CTSKIND]

Question ID:ACN.297_00.060

Instrument Variable Name:CTSKIND
QuestionText:

What kind of business or industry was this? (For example: TV and radio mgmt., retail shoe store, State Department of
Labor)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
carpal tunnel syndrome in the past 12 months, were first diagnosed with carpal tunnel syndrome at age 15 or older
or age of diagnosis was refused or don't know, have been told by a doctor or other health professional that their
carpal tunnel syndrome was probably work related, and whose current job or job in the past 12 months and their
longest-held job, if different from their current job or job in the past 12 months, were not associated with their
carpal tunnel syndrome
SkipInstructions:

(90 char long, D,R) [goto CTSKWRK]

Question ID:ACN.297_00.070

Instrument Variable Name:CTSKWRK
QuestionText:

What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
carpal tunnel syndrome in the past 12 months, were first diagnosed with carpal tunnel syndrome at age 15 or older
or age of diagnosis was refused or don't know, have been told by a doctor or other health professional that their
carpal tunnel syndrome was probably work related, and whose current job or job in the past 12 months and their
longest-held job, if different from their current job or job in the past 12 months, were not associated with their
carpal tunnel syndrome
SkipInstructions:

(90 char long, D,R) [goto CTSIMPAC]

Question ID:ACN.297_00.080

Instrument Variable Name:CTSIMPAC
QuestionText:

What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press)

VerbatimVerbatim response
7Refused
9Don't know

UniverseText:Sample adults 18+ who are currently employed or employed at some time in the past 12 months, reported having
carpal tunnel syndrome in the past 12 months, were first diagnosed with carpal tunnel syndrome at age 15 or older
or age of diagnosis was refused or don't know, have been told by a doctor or other health professional that their
carpal tunnel syndrome was probably work related, and whose current job or job in the past 12 months and their
longest-held job, if different from their current job or job in the past 12 months, were not associated with their
carpal tunnel syndrome
SkipInstructions:

(90 char long, D,R) [goto CTSWCCLM]

Question ID:ACN.297_00.100

Instrument Variable Name:CTSWCCLM
QuestionText:

Have you ever filed a workers' compensation claim for your carpal tunnel syndrome?

1Yes
2No
7Refused
9Don't know

(1) [goto CTSWCBEN]
(2,D,R)[goto CTSWKDAY]

Question ID:ACN.297_00.110

Instrument Variable Name:CTSWCBEN
QuestionText:

Have you ever received workers' compensation benefits for your carpal tunnel syndrome?

1Yes
2No
7Refused
9Don't know

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

Question ID:ACN.297_00.120

Instrument Variable Name:CTSWKDAY
QuestionText:

DURING THE PAST 12 MONTHS, how many full days did you miss from work because of carpal tunnel syndrome?
* Enter '0' for None.

000None
001-366 1-366 days
997Refused
999Don't know

(000-366,D,R) [goto CTSCHJOB]

Question ID:ACN.297_00.130

Instrument Variable Name:CTSCHJOB
QuestionText:

DURING THE PAST 12 MONTHS, did you stop working, change jobs, or make a major change in your work activities,
such as taking on lighter duties, because of your carpal tunnel syndrome?

1Yes
2No
7Refused
9Don't know

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

Question ID:ACN.300_00.000

Instrument Variable Name:PAINECK
QuestionText:

The following questions are about pain you may have experienced in the PAST THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor. DURING THE PAST THREE MONTHS, did you have: Neck pain?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.310_00.000

Instrument Variable Name:PAINLB
QuestionText:

DURING THE PAST THREE MONTHS, did you have : low back pain?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto PAINLEG]
(2,R,D)[goto PAINFACE]

Question ID:ACN.320_00.000

Instrument Variable Name:PAINLEG
QuestionText:

Did this pain spread down either leg to areas below the knees?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ with low back pain in the past 3 months
SkipInstructions:

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

Question ID:ACN.331_01.000

Instrument Variable Name:PAINFACE
QuestionText:

DURING THE PAST THREE MONTHS, did you have: Facial ache or pain in the jaw muscles or the joint in front of the ear?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.331_02.000

Instrument Variable Name:AMIGR
QuestionText:

* Read if necessary:
DURING THE PAST THREE MONTHS, did you have:Severe headache or migraine?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto ACOLD2W]

Question ID:ACN.350_00.000

Instrument Variable Name:ACOLD2W
QuestionText:

* Hand calendar cardThese next questions are about your recent health during the TWO WEEKS outlined on that calendar.
Did you have a head cold or chest cold that started during those TWO WEEKS?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AINTIL2W]

Question ID:ACN.360_00.000

Instrument Variable Name:AINTIL2W
QuestionText:

Did you have a stomach or intestinal illness with vomiting or diarrhea that started during those TWO WEEKS?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)if SEX=2 and age 18-49 [goto PREGNOW];
else (1,2,R,D)and ((SEX=1) or (SEX=2 and AGE GTE50)) [goto HRAIDNOW]

Question ID:ACN.370_00.000

Instrument Variable Name:PREGNOW
QuestionText:

Are you currently pregnant?

1Yes
2No
7Refused
9Don't know

UniverseText:Female sample adults 18-49 years of age
SkipInstructions:

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

Question ID:ACN.400_00.000

Instrument Variable Name:HRAIDNOW
QuestionText:

These next questions are about your hearing, vision, and teeth.
Do you now use a hearing aid(s)?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto AHEARST1]
(2,R,D)[goto HRAIDEV]

Question ID:ACN.410_00.000

Instrument Variable Name:HRAIDEV
QuestionText:

Have you ever used a hearing aid(s) in the past?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who do not now use a hearing aid or REF/DK whether they now use a hearing aid
SkipInstructions:

(1,2,R,D)[goto AHEARST1]

Question ID:ACN.420_00.000

Instrument Variable Name:AHEARST1
QuestionText:

WITHOUT the use of hearing aids or other listening devices, is your hearing excellent, good, a little trouble hearing,
moderate trouble, a lot of trouble, or are you deaf?

1Excellent
2Good
3A little trouble hearing
4Moderate trouble
5A lot of trouble
6Deaf
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.430_00.000

Instrument Variable Name:AVISION
QuestionText:

Do you have any trouble seeing, even when wearing glasses or contact lenses?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto ABLIND]
(2,R,D)[goto LUPPRT]

Question ID:ACN.440_00.000

Instrument Variable Name:ABLIND
QuestionText:

Are you blind or unable to see at all?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have trouble seeing even when wearing glasses/contact lenses
SkipInstructions:

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

Question ID:ACN.451_00.000

Instrument Variable Name:LUPPRT
QuestionText:

Have you lost all of your upper and lower natural (permanent) teeth?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.470_00.000

Instrument Variable Name:MHSAD_CK
QuestionText:

Now I am going to ask you some questions about feelings you may have experienced over the PAST 30 DAYS.

1Enter 1 to continue

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto SAD]

Question ID:ACN.471_01.000

Instrument Variable Name:SAD
QuestionText:

(book) A5DURING THE PAST 30 DAYS, how often did you feel: So sad that nothing could cheer you up?

1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.471_02.000

Instrument Variable Name:NERVOUS
QuestionText:

(book) A5* Read if necessary:
During the PAST 30 DAYS, how often did you feel: Nervous?

1ALL of the time
2MOST of the time
3SOME of the time
4A LITTLE of the time
5NONE of the time
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.471_03.000

Instrument Variable Name:RESTLESS
QuestionText:

(book) A5* Read lead-in if necessary:
During the PAST 30 DAYS, how often did you feel: Restless or fidgety?

1ALL of the time
2MOST of the time
3SOME of the time
4A LITTLE of the time
5NONE of the time
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.471_04.000

Instrument Variable Name:HOPELESS
QuestionText:

(book) A5* Read if necessary:
During the PAST 30 DAYS, how often did you feel: Hopeless?

1ALL of the time
2MOST of the time
3SOME of the time
4A LITTLE of the time
5NONE of the time
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.471_05.000

Instrument Variable Name:EFFORT
QuestionText:

(book) A5* Read if necessary:
During the PAST 30 DAYS, how often did you feel:That everything was an effort?

1ALL of the time
2MOST of the time
3SOME of the time
4A LITTLE of the time
5NONE of the time
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:ACN.471_06.000

Instrument Variable Name:WORTHLS
QuestionText:

(book) A5* Read if necessary:
During the PAST 30 DAYS, how often did you feel:Worthless?

1ALL of the time
2MOST of the time
3SOME of the time
4A LITTLE of the time
5NONE of the time
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

If (SAD eq (1-3)or NERVOUS eq (1-3)or RESTLESS eq (1-3)or HOPELESS eq (1-3)or EFFORTeq(1-3)
or WORTHLS eq (1-3)) [goto MHAMTMO];
else [goto Next Section]

Question ID:ACN.530_00.000

Instrument Variable Name:MHAMTMO
QuestionText:

We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings
interfere with your life or activities: a lot, some, a little, or not at all?

1A lot
2Some
3A little
4Not at all
7Refused
9Don't know

UniverseText:Sample adults 18+ who at least some of the time have felt sad, nervous, restless or fidgety, hopeless, that
everything was an effort, or worthless, in the past 30 days
SkipInstructions:

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

Adult Health Status and Limitations

Question ID: AHS.040_00.000

Instrument Variable Name: WKDAYR
QuestionText:

During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did you miss work at a job
or business because of illness or injury (do not include maternity leave)?
* Enter '0' for None.

000 None
001-366 1-366 days
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who worked or had a job or business with or without pay in the last week or who had a job or
business in the past 12 months
SkipInstructions:

(0-366,R,D) [goto BEDDAYR]
(120-366) [goto ERR_WKDAYR]

Question ID: AHS.050_00.000

Instrument Variable Name: BEDDAYR
QuestionText:

During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did illness or injury keep
you in bed more than half of the day (include days while an overnight patient in a hospital)?
* Enter '0' for None.

000 None
001-366 1-366 days
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-366,R,D)[goto AHSTATYR]
(120-366)[goto ERR_BEDDAYR]

Question ID: AHS.060_00.000

Instrument Variable Name: AHSTATYR
QuestionText:

Compared with 12 MONTHS AGO, would you say your health is better, worse, or about the same?

1 Better
2 Worse
3 About the same
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.070_00.000

Instrument Variable Name: SPECEQ
QuestionText:

Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special
bed, or a special telephone?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.091_01.000

Instrument Variable Name: FLWALK
QuestionText:

(book) A6
The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM. By
"health problem" we mean any physical, mental, or emotional problem or illness (not including pregnancy).
By yourself, and without using any special equipment, how difficult is it for you to:
:Walk a quarter of a mile - about 3 city blocks?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLCLIMB]

Question ID: AHS.091_02.000

Instrument Variable Name: FLCLIMB
QuestionText:

(book) A6 * Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Walk up 10 steps without resting?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLSTAND]

Question ID: AHS.091_03.000

Instrument Variable Name: FLSTAND
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Stand or be on your feet for about 2 hours?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLSIT]

Question ID: AHS.091_04.000

Instrument Variable Name: FLSIT
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Sit for about 2 hours?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLSTOOP]

Question ID: AHS.091_05.000

Instrument Variable Name: FLSTOOP
QuestionText: (book) A6

* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Stoop, bend, or kneel?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLREACH]

Question ID: AHS.091_06.000

Instrument Variable Name: FLREACH
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Reach up over your head?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLGRASP]

Question ID: AHS.141_01.000

Instrument Variable Name: FLGRASP
QuestionText: (book) A6

* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Use your fingers to grasp or handle small objects?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLCARRY]

Question ID: AHS.141_02.000
Instrument Variable Name: FLCARRY
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Lift or carry something as heavy as 10 pounds such as a full bag of groceries?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLPUSH]

Question ID: AHS.141_03.000

Instrument Variable Name: FLPUSH
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Push or pull large objects like a living room chair?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLSHOP]

Question ID: AHS.171_01.000

Instrument Variable Name: FLSHOP
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Go out to things like shopping, movies, or sporting events?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLSOCL]

Question ID: AHS.171_02.000

Instrument Variable Name: FLSOCL
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-4,6,R,D)[goto FLRELAX]

Question ID: AHS.171_03.000

Instrument Variable Name: FLRELAX
QuestionText:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to:
:Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?

0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-4 or FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND= 1-4 or FLSIT= 1-4 or FLSTOOP= 1-4 or FLREACH=
1-4 or FLGRASP= 1-4 or FLCARRY= 1-4 or FLPUSH= 1-4 or FLSHOP= 1-4 or FLSOCL= 1-4)[goto AFLHCA]
Else goto SMKEV (next section)

Question ID: AHS.200_00.000

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for all that apply, separate with commas.
* Do not probe, except to clarify answer.

01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g., cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign Tumors, Cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/Not sure

UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Question ID: AHS.201_90.000

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Question ID: AHS.201_91.000

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Question ID: AHS.300_01.000

Instrument Variable Name: AHCL01N
QuestionText:

1 of 2
How long have you had a vision problem or problem seeing?
* Enter number for time with your vision problem or problem seeing..
* Enter '95' for 95 or more.
* Enter '96' if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a vision problem or problem seeing
SkipInstructions:

(1-95,D)[goto AHCL01T]
(R)[store "R" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.300_02.000

Instrument Variable Name: AHCL01T
QuestionText:

2 of 2
* Enter time period for time with vision problem or problem seeing.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL01T
[if [AHCL01N = Number greater than person years old and AHCL01T= 4]] goto
ERR1_AHCL01T

Question ID: AHS.301_01.000

Instrument Variable Name: AHCL02N
QuestionText:

1 of 2
How long have you had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a hearing problem
SkipInstructions:

(1-95,D)[goto AHCL02T]
(R)[store "R" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.301_02.000

Instrument Variable Name: AHCL02T
QuestionText:

2 of 2
* Enter time period for time with hearing problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL02T
[if [AHCL02N = Number greater than person years old and AHCL02T= 4]] goto
ERR1_AHCL02T

Question ID: AHS.302_01.000

Instrument Variable Name: AHCL03N
QuestionText:

1 of 2
How long have you had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to arthritis or rheumatism
SkipInstructions:

(1-95,D)[goto AHCL03T]
(R)[store "R" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.302_02.000

Instrument Variable Name: AHCL03T
QuestionText:

2 of 2
* Enter time period for time with arthritis or rheumatism.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL03T
[if [AHCL03N = Number greater than person years old and AHCL03T= 4]] goto
ERR1_AHCL03T

Question ID: AHS.303_01.000

Instrument Variable Name: AHCL04N
QuestionText:

1 of 2
How long have you had a back or neck problem?
* Enter number for time with back or neck problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a back or neck problem
SkipInstructions:

(1-95,D)[goto AHCL04T]
(R)[store "R" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.303_02.000

Instrument Variable Name: AHCL04T
QuestionText:

2 of 2
* Enter time period for time with back or neck problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL04T
[if [AHCL04N = Number greater than person years old and AHCL04T= 4]] goto
ERR1_AHCL04T

Question ID: AHS.304_01.000

Instrument Variable Name: AHCL05N
QuestionText:

1 of 2
How long have you had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone, or joint injury.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a fracture, bone, or joint injury
SkipInstructions:

(1-95,D)[goto AHCL05T]
(R)[store "R" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.304_02.000

Instrument Variable Name: AHCL05T
QuestionText:

2 of 2
* Enter time period for time with fracture, bone, or joint injury.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL05T
[if [AHCL05N = Number greater than person years old and AHCL05T= 4]] goto
ERR1_AHCL05T

Question ID: AHS.305_01.000

Instrument Variable Name: AHCL06N
QuestionText:

1 of 2
How long have you had the (fill: other) injury that caused your limitation?
* Enter number for time with injury that caused your limitation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to an injury other than a fracture, bone, or joint injury
SkipInstructions:

(1-95,D)[goto AHCL06T]
(R)[store "R" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.305_02.000

Instrument Variable Name: AHCL06T
QuestionText:

2 of 2
* Enter time period for time with (fill: other) injury.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL06T
[if [AHCL06N = Number greater than person years old and AHCL06T= 4]] goto
ERR1_AHCL06T

Question ID: AHS.306_01.000

Instrument Variable Name: AHCL07N
QuestionText:

1 of 2
How long have you had a heart problem?
* Enter number for time with a heart problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a heart problem
SkipInstructions:

(1-95,D)[goto AHCL07T]
(R)[store "R" in AHCL07T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL07T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.306_02.000

Instrument Variable Name: AHCL07T
QuestionText:

2 of 2
* Enter time period for time with heart problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL07T
[if [AHCL07N = Number greater than person years old and AHCL07T= 4]] goto
ERR1_AHCL07T

Question ID: AHS.307_01.000

Instrument Variable Name: AHCL08N
QuestionText:

1 of 2
How long have you had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a stroke problem
SkipInstructions:

(1-95,D)[goto AHCL08T]
(R)[store "R" in AHCL08T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL08T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.307_02.000

Instrument Variable Name: AHCL08T
QuestionText:

2 of 2
* Enter time period for time with stroke problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL08T
[if [AHCL08N = Number greater than person years old and AHCL08T= 4]] goto
ERR1_AHCL08T

Question ID: AHS.308_01.000

Instrument Variable Name: AHCL09N
QuestionText:

1 of 2
How long have you had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to hypertension or high blood pressure
SkipInstructions:

(1-95,D)[goto AHCL09T]
(R)[store "R" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.308_02.000

Instrument Variable Name: AHCL09T
QuestionText:

2 of 2
* Enter time period for time with hypertension or high blood pressure.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL09T
[if [AHCL09N = Number greater than person years old and AHCL09T= 4]] goto
ERR1_AHCL09T

Question ID: AHS.309_01.000

Instrument Variable Name: AHCL10N
QuestionText:

1 of 2
How long have you had diabetes?
* Enter number for time with diabetes.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to diabetes
SkipInstructions:

(1-95,D)[goto AHCL10T]
(R)[store "R" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.309_02.000

Instrument Variable Name: AHCL10T
QuestionText:

2 of 2
* Enter time period for time with diabetes.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL10T
[if [AHCL10N = Number greater than person years old and AHCL10T= 4]] goto
ERR1_AHCL10T

Question ID: AHS.310_01.000

Instrument Variable Name: AHCL11N
QuestionText:

1 of 2
How long have you had a lung or breathing problem (e.g. asthma and emphysema)?
* Enter number for time with a lung or breathing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a lung or breathing problem
SkipInstructions:

(1-95,D)[goto AHCL11T]
(R)[store "R" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.310_02.000

Instrument Variable Name: AHCL11T
QuestionText:

2 of 2
* Enter time period for time with lung or breathing problem (e.g. asthma and emphysema).

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL11T
[if [AHCL11N = Number greater than person years old and AHCL11T= 4]] goto
ERR1_AHCL11T

Question ID: AHS.311_01.000

Instrument Variable Name: AHCL12N
QuestionText:

1 of 2
How long have you had cancer?
* Enter number for time with cancer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to cancer
SkipInstructions:

(1-95,D)[goto AHCL12T]
(R)[store "R" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.311_02.000

Instrument Variable Name: AHCL12T
QuestionText:

2 of 2
* Enter time period for time with cancer.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL12T
[if [AHCL12N = Number greater than person years old and AHCL12T= 4]] goto
ERR1_AHCL12T

Question ID: AHS.313_01.000

Instrument Variable Name: AHCL14N
QuestionText:

1 of 2
How long have you had mental retardation?
* Enter number for time with mental retardation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to mental retardation
SkipInstructions:

(1-95,D)[goto AHCL14T]
(R)[store "R" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.313_02.000
Instrument Variable Name: AHCL14T
QuestionText:

2 of 2
* Enter time period for time with mental retardation.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL14T
[if [AHCL14N = Number greater than person years old and AHCL14T= 4]] goto
ERR1_AHCL14T

Question ID: AHS.314_01.000

Instrument Variable Name: AHCL15N
QuestionText:

1 of 2
How long have you had a developmental problem (e.g., cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a developmental problem
SkipInstructions:

(1-95,D)[goto AHCL15T]
(R)[store "R" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.314_02.000

Instrument Variable Name: AHCL15T
QuestionText:

2 of 2
* Enter time period for time with developmental problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL15T
[if [AHCL15N = Number greater than person years old and AHCL15T= 4]] goto
ERR1_AHCL15T

Question ID: AHS.315_01.000

Instrument Variable Name: AHCL16N
QuestionText:

1 of 2
How long have you had senility?
* Enter number for time with senility.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to senility
SkipInstructions:

(1-95,D)[goto AHCL16T]
(R)[store "R" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.315_02.000
Instrument Variable Name: AHCL16T
QuestionText:

2 of 2
* Enter time period for time with senility.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL16T
[if [AHCL16N = Number greater than person years old and AHCL16T= 4]] goto
ERR1_AHCL16T

Question ID: AHS.316_01.000

Instrument Variable Name: AHCL17N
QuestionText:

1 of 2
How long have you had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety, or an emotional problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to depression, anxiety, or an emotional problem
SkipInstructions:

(1-95,D)[goto AHCL17T]
(R)[store "R" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.316_02.000

Instrument Variable Name: AHCL17T
QuestionText:

2 of 2
* Enter time period for time with depression, anxiety, or emotional problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL17T
[if [AHCL17N = Number greater than person years old and AHCL17T= 4]] goto
ERR1_AHCL17T

Question ID: AHS.317_01.000

Instrument Variable Name: AHCL18N
QuestionText:

1 of 2
How long have you had a weight problem?
* Enter number for time with a weight problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a weight problem
SkipInstructions:

(1-95,D)[goto AHCL18T]
(R)[store "R" in AHCL18T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL18T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.317_02.000

Instrument Variable Name: AHCL18T
QuestionText:

2 of 2
* Enter time period for time with weight problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL18T
[if [AHCL18N = Number greater than person years old and AHCL18T= 4]] goto
ERR1_AHCL18T

Question ID: AHS.318_01.000

Instrument Variable Name: AHCL19N
QuestionText:

1 of 2
How long have you had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a missing limb
SkipInstructions:

(1-95,D)[goto AHCL19T]
(R)[store "R" in AHCL19T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL19T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.318_02.000

Instrument Variable Name: AHCL19T
QuestionText:

2 of 2
* Enter time period for time with missing limb.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL19T
[if [AHCL19N = Number greater than person years old and AHCL19T= 4]] goto
ERR1_AHCL19T

Question ID: AHS.319_01.000

Instrument Variable Name: AHCL20N
QuestionText:

1 of 2
How long have you had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a kidney, bladder or renal problem
SkipInstructions:

(1-95,D)[goto AHCL20T]
(R)[store "R" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.319_02.000

Instrument Variable Name: AHCL20T
QuestionText:

2 of 2
* Enter time period for time with kidney, bladder or renal problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL20T
[if [AHCL20N = Number greater than person years old and AHCL20T= 4]] goto
ERR1_AHCL20T

Question ID: AHS.320_01.000

Instrument Variable Name: AHCL21N
QuestionText:

1 of 2
How long have you had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a circulation problem
SkipInstructions:

(1-95,D)[goto AHCL21T]
(R)[store "R" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.320_02.000

Instrument Variable Name: AHCL21T
QuestionText:

2 of 2
* Enter time period for time with circulation problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL21T
[if [AHCL21N = Number greater than person years old and AHCL21T= 4]] goto
ERR1_AHCL21T

Question ID: AHS.321_01.000

Instrument Variable Name: AHCL22N
QuestionText:

1 of 2
How long have you had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to benign tumors or cysts
SkipInstructions:

(1-95,D)[goto AHCL22T]
(R)[store "R" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.321_02.000

Instrument Variable Name: AHCL22T
QuestionText:

2 of 2
* Enter time period for time with benign tumors or cysts.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL22T
[if [AHCL22N = Number greater than person years old and AHCL22T= 4]] goto
ERR1_AHCL22T

Question ID: AHS.322_01.000

Instrument Variable Name: AHCL23N
QuestionText:

1 of 2
How long have you had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to fibromyalgia or lupus
SkipInstructions:

(1-95,D)[goto AHCL23T]
(R)[store "R" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.322_02.000

Instrument Variable Name: AHCL23T
QuestionText:

2 of 2
* Enter time period for time with fibromyalgia or lupus.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL23T
[if [AHCL23N = Number greater than person years old and AHCL23T= 4]] goto
ERR1_AHCL23T

Question ID: AHS.323_01.000

Instrument Variable Name: AHCL24N
QuestionText:

1 of 2
How long have you had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to osteoporosis or tendinitis
SkipInstructions:

(1-95,D)[goto AHCL24T]
(R)[store "R" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.323_02.000

Instrument Variable Name: AHCL24T
QuestionText:

2 of 2
* Enter time period for time with osteoporosis or tendinitis.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL24T
[if [AHCL24N = Number greater than person years old and AHCL24T= 4]] goto
ERR1_AHCL24T

Question ID: AHS.324_01.000

Instrument Variable Name: AHCL25N
QuestionText:

1 of 2
How long have you had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to epilepsy or seizures
SkipInstructions:

(1-95,D)[goto AHCL25T]
(R)[store "R" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.324_02.000

Instrument Variable Name: AHCL25T
QuestionText:

2 of 2
* Enter time period for time with epilepsy or seizures.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL25T
[if [AHCL25N = Number greater than person years old and AHCL25T= 4]] goto
ERR1_AHCL25T

Question ID: AHS.325_01.000

Instrument Variable Name: AHCL26N
QuestionText:

1 of 2
How long have you had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclerosis (MS) or muscular dystrophy (MD).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to multiple sclerosis or muscular dystrophy
SkipInstructions:

(1-95,D)[goto AHCL26T]
(R)[store "R" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.325_02.000

Instrument Variable Name: AHCL26T
QuestionText:

2 of 2
* Enter time period for time with multiple sclerosis or muscular dystrophy.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL26T
[if [AHCL26N = Number greater than person years old and AHCL26T= 4]] goto
ERR1_AHCL26T

Question ID: AHS.326_01.000

Instrument Variable Name: AHCL27N
QuestionText:

1 of 2
How long have you had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis), paralysis or para/quadriplegia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to polio(myelitis), paralysis or para/quadriplegia
SkipInstructions:

(1-95,D)[goto AHCL27T]
(R)[store "R" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.326_02.000

Instrument Variable Name: AHCL27T
QuestionText:

2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL27T
[if [AHCL27N = Number greater than person years old and AHCL27T= 4]] goto
ERR1_AHCL27T

Question ID: AHS.327_01.000

Instrument Variable Name: AHCL28N
QuestionText:

1 of 2
How long have you had Parkinson's disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to Parkinson's disease or tremors
SkipInstructions:

(1-95,D)[goto AHCL28T]
(R)[store "R" in AHCL28T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL28T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.327_02.000

Instrument Variable Name: AHCL28T
QuestionText:

2 of 2
* Enter time period for time with Parkinson's disease or tremors.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL28T
[if [AHCL28N = Number greater than person years old and AHCL28T= 4]] goto
ERR1_AHCL28T

Question ID: AHS.328_01.000

Instrument Variable Name: AHCL29N
QuestionText:

1 of 2
How long have you had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerve damage (including carpal tunnel syndrome).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to nerve damage
SkipInstructions:

(1-95,D)[goto AHCL29T]
(R)[store "R" in AHCL29T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL29T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.328_02.000

Instrument Variable Name: AHCL29T
QuestionText:

2 of 2
* Enter time period for time with nerve damage.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL29T
[if [AHCL29N = Number greater than person years old and AHCL29T= 4]] goto
ERR1_AHCL29T

Question ID: AHS.329_01.000

Instrument Variable Name: AHCL30N
QuestionText:

1 of 2
How long have you had a hernia?
* Enter number for time with a hernia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a hernia
SkipInstructions:

(1-95,D)[goto AHCL30T]
(R)[store "R" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.329_02.000

Instrument Variable Name: AHCL30T
QuestionText:

2 of 2
* Enter time period for time with hernia.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL30T
[if [AHCL30N = Number greater than person years old and AHCL30T= 4]] goto
ERR1_AHCL30T

Question ID: AHS.330_01.000

Instrument Variable Name: AHCL31N
QuestionText:

1 of 2
How long have you had an ulcer?
* Enter number for time with an ulcer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to an ulcer
SkipInstructions:

(1-95,D)[goto AHCL31T]
(R)[store "R" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.330_02.000

Instrument Variable Name: AHCL31T
QuestionText:

2 of 2
* Enter time period for time with ulcer.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL31T
[if [AHCL31N = Number greater than person years old and AHCL31T= 4]] goto
ERR1_AHCL31T

Question ID: AHS.331_01.000

Instrument Variable Name: AHCL32N
QuestionText:

1 of 2
How long have you had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to varicose veins or hemorrhoids
SkipInstructions:

(1-95,D)[goto AHCL32T]
(R)[store "R" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.331_02.000

Instrument Variable Name: AHCL32T
QuestionText:

2 of 2
* Enter time period for time with varicose veins or hemorrhoids.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL32T
[if [AHCL32N = Number greater than person years old and AHCL32T= 4]] goto
ERR1_AHCL32T

Question ID: AHS.332_01.000

Instrument Variable Name: AHCL33N
QuestionText:

1 of 2
How long have you had a thyroid problem, Grave's disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
SkipInstructions:

(1-95,D)[goto AHCL33T]
(R)[store "R" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.332_02.000

Instrument Variable Name: AHCL33T
QuestionText:

2 of 2
* Enter time period for time with thyroid problem, Grave's disease or gout.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL33T
[if [AHCL33N = Number greater than person years old and AHCL33T= 4]] goto
ERR1_AHCL33T

Question ID: AHS.333_01.000

Instrument Variable Name: AHCL34N
QuestionText:

1 of 2
How long have you had a knee problem?
* Enter number for time with a knee problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to a knee problem
SkipInstructions:

(1-95,D)[goto AHCL34T]
(R)[store "R" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.333_02.000

Instrument Variable Name: AHCL34T
QuestionText:

2 of 2
* Enter time period for time with knee problem.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL34T
[if [AHCL34N = Number greater than person years old and AHCL34T= 4]] goto
ERR1_AHCL34T

Question ID: AHS.334_01.000

Instrument Variable Name: AHCL35N
QuestionText:

1 of 2
How long have you had migraine headaches?
* Enter number for time with migraine headaches.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to migraine headaches
SkipInstructions:

(1-95,D)[goto AHCL35T]
(R)[store "R" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.334_02.000

Instrument Variable Name: AHCL35T
QuestionText:

2 of 2
* Enter time period for time with migraine headaches.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL35T
[if [AHCL35N = Number greater than person years old and AHCL35T= 4]] goto
ERR1_AHCL35T

Question ID: AHS.335_01.000

Instrument Variable Name: AHCL90N
QuestionText:

1 of 2
How long have you had {problem in AFLHCA90}?
* Enter number for time with {problem in AFLHCA90}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA90}
SkipInstructions:

(1-95,D)[goto AHCL90T]
(R)[store "R" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If
this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.335_02.000

Instrument Variable Name: AHCL90T
QuestionText:

2 of 2
* Enter time period for time with {problem in AFLHCA90}.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[[if 91 selected in AFLHCA goto AFLHCA_S2]
Else goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition
selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL90T
[if [AHCL90N = Number greater than person years old and AHCL90T= 4]] goto
ERR1_AHCL90T

Question ID: AHS.336_01.000

Instrument Variable Name: AHCL91N
QuestionText:

1 of 2
How long have you had {problem in AFLHCA91}?
* Enter number for time with {problem in AFLHCA91}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA91}
SkipInstructions:

(1-95,D)[goto AHCL91T]
(R)[store "R" in AHCL91T] [goto SMKEV (next section)]
(96)[store "6" in AHCL91T] [goto SMKEV (next section)]

Question ID: AHS.336_02.000

Instrument Variable Name: AHCL91T
QuestionText:

2 of 2
* Enter time period for time with {problem in AFLHCA91}.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know

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

(1-4,R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
(6)goto ERR2_AHCL91T
[if [AHCL91N = Number greater than person years old and AHCL91T= 4]] goto
ERR1_AHCL91T

Adult Health Behaviors
2010

Question ID: AHB.010_00.000

Instrument Variable Name: SMKEV
QuestionText:

These next questions are about cigarette smoking.
Have you smoked at least 100 cigarettes in your ENTIRE LIFE?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1)[goto SMKREG]
(2,R,D)[goto VIGNO]

Question ID: AHB.020_00.000

Instrument Variable Name: SMKREG
QuestionText:

How old were you when you FIRST started to smoke fairly regularly?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years old or older.
* Enter '96' if never smoked regularly.

06-84 6 - 84 years
85 85 years or older
96 Never smoked regularly
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions:

(6-95,96,R,D) [goto SMKNOW]
[If SMKREG gt AGE and SMKREG ne (96),goto ERR_SMKREG

Question ID: AHB.030_00.000

Instrument Variable Name: SMKNOW
QuestionText:

Do you NOW smoke cigarettes every day, some days or not at all?

1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions:

(1)[goto CIGSDA1]
(2) [goto CIGDAMO]
(3) [goto SMKQTNO]
(R,D)[goto VIGNO]

Question ID: AHB.040_01.000

Instrument Variable Name: SMKQTNO
QuestionText:

1 of 2
How long has it been since you quit smoking cigarettes?
* Enter number for time since quit smoking.
* Enter '95' for 95 years old or older.

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

UniverseText: Sample adults 18+ who quit smoking
SkipInstructions:

(1-95)[goto SMKQTTP]
(R,D)[goto VIGNO]

Question ID: AHB.040_02.000

Instrument Variable Name: SMKQTTP
QuestionText:

2 of 2
* Enter time period for time since quit smoking.

1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who quit smoking
SkipInstructions:

(1-4) [goto VIGNO]
(4) [if SMKQTNO gt (AGE - (15)), goto ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), goto ERR2_SMKQTTP

Question ID: AHB.050_00.000

Instrument Variable Name: CIGSDA1
QuestionText:

On the average, how many cigarettes do you now smoke a day?
* Enter '1' if less than 1 cigarette.
* Enter '95' if 95 or more cigarettes.

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

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

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

Question ID: AHB.060_00.000

Instrument Variable Name: CIGDAMO
QuestionText:

On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.

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

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

(0)[goto CIGQTYR]
(1-30,R,D)[goto CIGSDA2]

Question ID: AHB.070_00.000

Instrument Variable Name: CIGSDA2
QuestionText:

On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?
* Enter '1' if less than 1.
* Enter '95' if 95 or more cigarettes.

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

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

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

Question ID: AHB.080_00.000

Instrument Variable Name: CIGQTYR
QuestionText:

During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO
QUIT SMOKING?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are every day or someday smokers
SkipInstructions:

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

Question ID: AHB.090_01.000

Instrument Variable Name: VIGNO
QuestionText:

1 of 2
The next questions are about physical activities (exercise, sports, physically active hobbies:) that you may do in your LEISURE time.

How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for vigorous leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.

000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,996,R,D)[goto MODNO]
(1-995)[goto VIGTP]

Question ID: AHB.090_02.000

Instrument Variable Name: VIGTP
QuestionText:

2 of 2
* Enter time period for vigorous leisure-time physical activities.

0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know

UniverseText:
Sample adults 18+ who do vigorous activities
SkipInstructions:

(1-4) goto VIGLNGNO
[if (VIGNO gt (4) and VIGTP eq (1)) or
(VIGNO gt (28)and VIGTP eq (2)) or
(VIGNO gt (31) and VIGTP eq (3)) or
(VIGNO gt (365)and VIGTP eq (4)) goto ERR1_VIGTP]

Question ID: AHB.100_01.000

Instrument Variable Name: VIGLNGNO
QuestionText:

1 of 2
About how long do you do these vigorous leisure-time physical activities each time?
* Enter number for length of vigorous leisure-time physical activities.

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

UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:

(1-995)[goto VIGLNGTP]
(R,D)[goto MODNO]

Question ID: AHB.100_02.000

Instrument Variable Name: VIGLNGTP
QuestionText:

2 of 2
* Enter time period for length of vigorous leisure-time physical activities.

1 Minutes
2 Hours
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:

(1,2)goto MODNO
if VIGLNGNO lt (10)and VIGLNGTP eq (1) goto ERR1_VIGLNGTP;
if (VIGLNGNO gt (90)and VIGLNGTP eq (1)) or if VIGLNGNO gt (2) and VIGLNGTP eq (2) goto
ERR2_VIGLNGTP

Question ID: AHB.110_01.000

Instrument Variable Name: MODNO
QuestionText:

How often do you do LIGHT OR MODERATE LEISURE-TIME physical activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?
* If necessary, prompt with: How many times per day, per week, per month, or per year do you do these activities?
* Enter number of light or moderate leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.

000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-995)[goto MODTP]
(0, 996, R,D)[goto STRNGNO]

Question ID: AHB.110_02.000

Instrument Variable Name: MODTP
QuestionText:

2 of 2
* Enter time period for light or moderate leisure-time physical activities

0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:

(1-4) goto MODLNGNO
[if (MODNO gt (4) and MODTP eq (1)) or
(MODNO gt (28)and MODTP eq (2)) or
(MODNO gt (31) and MODTP eq (3)) or
(MODNO gt (365)and MODTP eq (4))] goto ERR_MODNO

Question ID: AHB.120_01.000

Instrument Variable Name: MODLNGNO
QuestionText:

1 of 2
About how long do you do these light or moderate leisure-time physical activities each time?
* Enter number for length of light or moderate leisure-time physical activities.

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

UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:

(1-995)[goto MODLNGTP]
(R,D)[goto STRNGNO]

Question ID: AHB.120_02.000
Instrument Variable Name: MODLNGTP
QuestionText:

2 of 2
* Enter time period for length of light or moderate leisure-time physical activities.

1 Minutes
2 Hours
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:

(1,2) goto STRNGNO
if MODLNGNO lt (10)and MODLNGTP eq (1) goto ERR1_MODLNGTP
if MODLNGNO gt (90)and MODLNGTP eq (1) or if MODLNGNO gt (2) and MODLNGTP eq (2)goto
ERR2_MODLNGTP

Question ID: AHB.130_01.000

Instrument Variable Name: STRNGNO
QuestionText:

How often do you do LEISURE-TIME physical activities specifically designed to STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)

* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for strengthening activities.
* Enter '0' for Never.
* Enter '996' for Unable to do this type activity

000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-995)[goto STRNGTP]
(0, 996,R,D)[goto ALC1YR]

Question ID: AHB.130_02.000

Instrument Variable Name: STRNGTP
QuestionText:

2 of 2
* Enter time period for strengthening activities

0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do strengthening activities
SkipInstructions:

(1-4) goto ALC1YR
[If (STRNGNO gt (4) and STRNGTP = (1)) or (STRNGNO gt (28) and STRNGTP = (2)) or
(STRNGNO gt (31) and STRNGTP = (3)) or (STRNGNO gt (365) and STRNGTP = (4)) goto
ERR_STRNGTP]

Question ID: AHB.140_00.000

Instrument Variable Name: ALC1YR
QuestionText:

These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.

In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ALC12MNO]
(2,R,D)[goto ALCLIFE]

Question ID: AHB.150_00.000
Instrument Variable Name: ALCLIFE
QuestionText:

In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did or refused to answer
SkipInstructions:

(1) [goto ALC12MNO]
(2,R,D)[goto AHGT_FT]

Question ID: AHB.160_01.000

Instrument Variable Name: ALC12MNO
QuestionText:

1 of 2
In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcoholic beverages were consumed in the past year.
*Enter '0' for Never.

000 Never
001-365 1-365 days
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks in their entire life
SkipInstructions:

(1-365)[goto ALC12MTP]
(0,R,D)[goto AHGT_FT]

Question ID: AHB.160_02.000

Instrument Variable Name: ALC12MTP
QuestionText:

2 of 2
* Enter time period for how often alcoholic beverages were consumed in the past year.

0 Never/None
1 Week
2 Month
3 Year
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank at least once in the past year
SkipInstructions:

(1-3)[goto ALCAMT]
[If (ALC12MNO gt (7) and ALC12MTP = (1)) or (ALC12MNO gt (31) and ALC12MTP = (2)) or
(ALC12MNO gt (365) and ALC12MTP = (3)) goto ERR_ALC12MTP]

Question ID: AHB.170_00.000

Instrument Variable Name: ALCAMT
QuestionText:

In the PAST YEAR, on those days that you drank alcoholic beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.

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

UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions:

(1-9,R,D)[goto ALC5UPNO]
(10-95)[goto ERR_ALCAMT]

Question ID: AHB.180_01.000

Instrument Variable Name: ALC5UPNO
QuestionText:

1 of 2
In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have 5 or more drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.

000 Never/None
001-365 1-365 days
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions:

(1-365)[goto ALC5UPTP]
(0,R,D)[goto AHGT_FT]

Question ID: AHB.180_02.000

Instrument Variable Name: ALC5UPTP
QuestionText:

2 of 2
* Enter time period for days per week, per month or per year.

0 Never/None
1 Per week
2 Per month
3 Per year
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have had 5+ drinks in one day at least once in the past year
SkipInstructions:

(1-3)goto AHGT_FT
[If (ALC5UPNO gt (7) and ALC5UPTP = (1)) or
(ALC5UPNO gt (31) and ALC5UPTP = (2)) or
(ALC5UPNO gt (365) and ALC5UPTP = (3)) goto ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP) lt number of days per
year with 5 or more drinks (calculated from ALC5UPNO and ALC5UPTP)] goto ERR2_ALC5UPTP]

Question ID: AHB.190_01.000

Instrument Variable Name: AHGT_FT
QuestionText:

How tall are you without shoes?
* Enter "M" to record metric measurements

02-07 2-7 feet
97 Refused
99 Don't know
M Metric

UniverseText: Sample adults 18+
SkipInstructions:

(2-7)[goto AHGT_IN]
(R,D)[goto AWGT_LB]
(M)[goto AHGT_M]
[if AHGT_FT NE(2-7,D,R,M) goto ERR1_AHGT_FT]
[if AHGT_FT = (2,3)goto ERR2_AHGT_FT]

Question ID: AHB.190_02.000

Instrument Variable Name: AHGT_IN
QuestionText:

How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.

00-11 0-11 inches
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who answered their height in feet
SkipInstructions:

(0-11,R,D) [goto AWGT_LB]
(empty)[goto ERR_AHGT_IN]

Question ID: AHB.190_03.000

Instrument Variable Name: AHGT_M
QuestionText:

How tall are you without shoes?
* Enter height in metric.

0-2 0-2 meters
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who choose to give their height in metric measurements
SkipInstructions:

(0-2)[goto AHGT_CM]
(R,D)[goto AWGT_LB]
(empty)[goto ERR_AHGT_M]

Question ID: AHB.190_04.000

Instrument Variable Name: AHGT_CM
QuestionText:

*Enter centimeters.

000-241 0-241 centimeters
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who answered their height in meters
SkipInstructions:

(0-241,R,D)goto AWGT_LB
[If AHGT_M eq (2) and AHGT_CM gt (41)or AHGT_M eq (1) and AHGT_CM gt (141)] goto
ERR1_AHGT_CM]
( )goto ERR2_AHGT_CM
[If AHGT_M eq (1) and AHGT_CM lt (20)or AHGT_M eq (0) and AHGT_CM lt
(120)]goto ERR3_AHGT_CM]

Question ID: AHB.200_01.000

Instrument Variable Name: AWGT_LB
QuestionText:

How much do you weigh without shoes?
* Enter "M" to record metric measurements
* Enter '500' for 500 pounds or more

050-500 50-500 pounds
997 Refused
999 Don't know
M Metric

UniverseText: Sample adults 18+
SkipInstructions:

(50-500)[goto SLEEP]
[if AWGT_LB lt (50)or gt (500)goto ERR_AWGT_LB
(R,D)[goto SLEEP]
(M)[goto AWGT_KG]

Question ID: AHB.200_02.000

Instrument Variable Name: AWGT_KG
QuestionText:

How much do you weigh without shoes?
* Enter weight in kilograms

023-226 23-226 kilograms
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who choose to give their weight in metric measurements
SkipInstructions:

(23-226,R,D)[goto SLEEP]
[If AWGT_KG lt (23)or K gt (226)goto ERR_AWGT_KG]

Question ID: AHB.210_00.000

Instrument Variable Name: SLEEP
QuestionText:

On average, how many hours of sleep do you get in a 24-hour period?
* Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more UP to the next whole hour and dropping 29 or fewer minutes.

01-24 1-24 hours
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-24,R,D)[goto next section]
[If SLEEP eq (1-5)goto ERR_SLEEP]

2010 NHIS Questionnaire -

Sample Adult Adult Access to Health Care and Utilization Document Version Date:25-May-11

Question ID:AAU.020_00.000

Instrument Variable Name:AUSUALPL
QuestionText:

Is there a place that you USUALLY go to when you are sick or need advice about your health?

1Yes
2There is NO place
3There is MORE THAN ONE place
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1-3)[goto APLKIND]
(2,R,D)[goto AHCPLKND]

Question ID:AAU.030_00.000

Instrument Variable Name:APLKIND
QuestionText:

[Fill1: What kind of place is it - a clinic, doctor's office, emergency room, or some other place?
[Fill2: What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?]

1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know

UniverseText:Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice
SkipInstructions:

(1-5)[go to AHCPLROU]
(6,R,D)[go to AHCPLKND]

Question ID:AAU.035_00.000

Instrument Variable Name:AHCPLROU
QuestionText:

Is that {fill: place from (APLKIND)} the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults aged 18+ years having a clinic or health center, doctor's office or HMO, hospital emergency room,
hospital outpatient department, or some other place that they usually go to when they are sick or need advice
about their health
SkipInstructions:

(1) [goto AHCCHGYR]
(2,R,D)[go to AHCPLKND]

QuestionID:AAU.037_00.000

Instrument Variable Name:AHCPLKND
QuestionText:

What kind of place do you USUALLY go to when you need routine or preventive care, such as a physical examination or
check-up?

0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know

UniverseText:Sample Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a usual source of sick care; who have a usual source of sick care but do not go to one place most often or Ref/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source of sick care but Ref/DK if it is same place as usual source of routine/preventive care.
SkipInstructions:

(0-6,R,D)if AUSUALPL = 2,R,D goto AHCDLY_1ELSE goto AHCCHGYR

Question ID:AAU.040_00.000

Instrument Variable Name:AHCCHGYR
QuestionText:

At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who reported same place as
usual source of routine/preventive care]
SkipInstructions:

(1)[goto AHCCHGHI]
(2,R,D)[goto AHCDLY_1]

Question ID:AAU.050_00.000
Instrument Variable Name:AHCCHGHI
QuestionText:

Was this change for a reason related to health insurance?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who CHANGED their USUAL place
for health care in past 12 months
SkipInstructions:

(1,2,R,D)[goto AHCDLY_1]

QuestionID:AAU.061_01.000

Instrument Variable Name:AHCDLY_1
QuestionText:

There are many reasons people delay getting medical care.
Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?: You couldn't get through on the telephone.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_2]

Question ID:AAU.061_02.000

Instrument Variable Name:AHCDLY_2
QuestionText:

* Read Lead-in if NecessaryThere are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?: You couldn't get an appointment soon enough.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_3]

Question ID:AAU.061_03.000

Instrument Variable Name:AHCDLY_3
QuestionText:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?: Once you get there, you have to wait too long to see the doctor.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_4]

QuestionID:AAU.061_04.000

Instrument Variable Name:AHCDLY_4
QuestionText:

* Read Lead-in if NecessaryThere are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?: The (clinic/doctor's) office wasn't open when you could get there.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_5]

Question ID:AAU.061_05.000

Instrument Variable Name:AHCDLY_5
QuestionText:

* Read Lead-in if NecessaryThere are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?: You didn't have transportation.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_1]

Question ID:AAU.111_01.000

Instrument Variable Name:AHCAFY_1
QuestionText:

DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?: Prescription medicines.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_2]

QuestionID:AAU.111_02.000

Instrument Variable Name:AHCAFY_2
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because
you couldn't afford it?
:Mental health care or counseling.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_3]

Question ID:AAU.111_03.000

Instrument Variable Name:AHCAFY_3
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because
you couldn't afford it?
:Dental care (including check ups).

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_4]

Question ID:AAU.111_04.000

Instrument Variable Name:AHCAFY_4
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because
you couldn't afford it?
:Eyeglasses.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

QuestionID:AAU.135_00.000

Instrument Variable Name:ADENLONG
QuestionText:

(book) A8About how long has it been since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons,
and all other dental specialists, as well as dental hygienists.

0 Never
1 6 months or less
2 More than 6 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(0-5,R,D)[ goto AHCSY1_1]

Question ID:AAU.141_01.000

Instrument Variable Name:AHCSY1_1
QuestionText:

DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_2]

Question ID:AAU.141_02.000

Instrument Variable Name:AHCSY1_2
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses).

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_3]

QuestionID:AAU.141_03.000

Instrument Variable Name:AHCSY1_3
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:A foot doctor.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_4]

Question ID:AAU.141_04.000

Instrument Variable Name:AHCSY1_4
QuestionText:

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_5]

Question ID:AAU.141_05.000

Instrument Variable Name:AHCSY1_5
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_6]

QuestionID:AAU.141_06.000

Instrument Variable Name:AHCSY1_6
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:A nurse practitioner, physician assistant, or midwife.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[if SEX=1goto AHCSY8_8; else if SEX=2 goto AHCSYR7]

Question ID:AAU.200_00.000

Instrument Variable Name:AHCSYR7
QuestionText:

* Read lead-in if necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:A doctor who specializes in women's health (an obstetrician/gynecologist).

1Yes
2No
7Refused
9Don't know

UniverseText:Sample female adults aged 18+ years
SkipInstructions:

(1,2,R,D)[go to AHCSY8_ 8]

Question ID:AAU.211_01.000

Instrument Variable Name:AHCSY8_ 8
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist,
psychiatrist, or ophthalmologist).

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1,2,R,D)[go to AHCSY8_ 9]

QuestionID:AAU.211_02.000

Instrument Variable Name:AHCSY8_ 9
QuestionText:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
:A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto AHCSYR10]
(2,R,D)[goto AHERNOYR]

Question ID:AAU.230_00.000

Instrument Variable Name:AHCSYR10
QuestionText:

Does that doctor treat children and adults (a doctor in general practice or family medicine)?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have seen or talked to a general doctor during the past 12 months
SkipInstructions:

(1,2,R,D)[go to AHERNOYR]

Question ID:AAU.240_00.000

Instrument Variable Name:AHERNOYR
QuestionText:

(book) A9DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about
your own health (This includes emergency room visits that resulted in a hospital admission.)?

00 None
011
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97Refused
99Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(0 - 8,R,D) [go to AHCHYR]

QuestionID:AAU.250_00.000

Instrument Variable Name:AHCHYR
QuestionText:

DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1)[goto AHCHMOYR]
(2,R,D)[goto AHCNOYR]

Question ID:AAU.260_00.000

Instrument Variable Name:AHCHMOYR
QuestionText:

During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?

01-12 01-12 months
97 Refused
99 Don't know

UniverseText:Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions:

(1-12,R,D)[goto AHCHNOYR]

Question ID:AAU.270_00.000

Instrument Variable Name:AHCHNOYR
QuestionText:

(book) A10What was the total number of home visits received during {Fill1: that month/Fill2: those months}?

01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97Refused
99Don't know

UniverseText:Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions:

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

QuestionID:AAU.280_00.000

Instrument Variable Name:AHCNOYR
QuestionText:

(book) A9DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about
your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? DO NOT INCLUDE TIMES YOU
WERE HOSPITALIZED OVERNIGHT, VISITS TO HOSPITAL EMERGENCY ROOMS, HOME VISITS, DENTAL
VISITS, OR TELEPHONE CALLS.

00None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97Refused
99Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(0-8,R,D)[goto ASRGYR]

Question ID:AAU.290_00.000

Instrument Variable Name:ASRGYR
QuestionText:

DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or
outpatient?
* Read if necessary: This includes both major surgery and minor procedures such as setting bones or removing growths.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1)[goto ASRGNOYR]
(2,R,D)[goto AMDLONG]

QuestionID:AAU.300_00.000

Instrument Variable Name:ASRGNOYR
QuestionText:

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery
during the PAST 12 MONTHS?
* Enter "95" for 95 or more times.

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

UniverseText:Sample adults 18+ who had surgery or surgical procedures during past 12 months
SkipInstructions:

(1-9,R,D)[goto AMDLONG]
(11-95)[goto ERR_ASGYR]

Question ID:AAU.305_00.000

Instrument Variable Name:AMDLONG
QuestionText:

(book) A8 ? [F1]
About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.

UniverseText:Sample adults 18+
SkipInstructions:

(0-5,R,D) [goto AH1N1_1/SHTFLUYR]

Question ID:AAU.306_00.010

Instrument Variable Name:AH1N1_1
QuestionText:

This question was removed from the instrument in August 2010.
There are currently two kinds of flu vaccines available, the seasonal flu vaccine, and the 2009 H1N1 flu vaccine. I will
first ask you questions about the vaccine for H1N1 flu, which is sometimes called swine flu or pandemic flu, and then ask
you questions about the seasonal flu.
Since October 2009, have you had a H1N1 flu vaccination? There are two types of H1N1 flu vaccinations. One is a shot
and the other is a spray, mist, or drop in the nose.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults GE 18 years
SkipInstructions:

(1) [goto AH1N1_3M]
(2,R,D)[goto SHTFLUYR]

QuestionID:AAU.306_00.030

Instrument Variable Name:AH1N1_3M
QuestionText:

This question was removed from the instrument in August 2010.1 of 2During what month and year did you receive your H1N1 flu vaccine?

01January
02February
03March
04April
05May
06June
07July
08August
09September
10October
11November
12December
97Refused
99Don't know

UniverseText:Sample adults aged 18+ years who have had an H1N1 vaccine dose
SkipInstructions:

(1-12,D) [ goto AH1N1_4Y]
(R) [goto AH1N1_5]

Question ID:AAU.306_00.040

Instrument Variable Name:AH1N1_4Y
QuestionText:

This question was removed from the instrument in August 2010.2 of 2*Enter year of H1N1 flu vaccine.

YearYear
9997Refused
9999Don't know

UniverseText:Sample adults GE 18 years who have had a H1N1 vaccine dose and gave month/don't know month of vaccine dose
SkipInstructions:

If AH1N1_3M and AH1N1_4Y = a future date [goto ERR1_AH1N1_4Y]
If AH1N1_3M and AH1N1_4Y = a date before October 2009 [goto ERR2_AH1N1_4Y]
(valid year,R,D) [goto AH1N1_5]

QuestionID:AAU.306_00.050

Instrument Variable Name:AH1N1_5
QuestionText:

This question was removed from the instrument in August 2010.
Was this a shot, or was it a vaccine sprayed in the nose?

1Flu shot
2Flu nasal spray (spray, mist or drop in nose)
7Refused
9Don't know

UniverseText:Sample adults aged 18+ years who have had an H1N1 vaccine dose
SkipInstructions:

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

Question ID:AAU.310_00.000

Instrument Variable Name:SHTFLUYR
QuestionText:

This question was removed from the instrument in August 2010.
Now I'm going to ask you about the seasonal flu vaccine.

DURING THE PAST 12 MONTHS, have you had a seasonal flu shot? A seasonal flu shot is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: A flu shot is injected in the arm. Do not include an influenza vaccine sprayed in the nose.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto ASHFLU_M] (2,R,D)[ goto SPRFLUYR ]

QuestionID:AAU.310_00.000.

Instrument Variable Name:SHTFLUYR
QuestionText:

This question was added to the instrument in August 2010.
During the past 12 months, several kinds of flu vaccines have been available. I will ask you about your most recent flu
vaccination.
DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against
influenza for the flu season.
* Read if necessary: A flu shot is injected in the arm. Do not include an influenza vaccine sprayed in the nose.
*Read if necessary: Your most recent flu vaccination could have been the new 2010-2011 flu vaccine available starting
this fall, or either of the two types available last season, one called "seasonal" and the other called "H1N1" or "swine" flu
vaccine.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto ASHFLU_M]
(2,R,D)[ goto SPRFLUYR ]

Question ID:AAU.312_01.000

Instrument Variable Name:ASHFLU_M
QuestionText:

This question was removed from the instrument in August 2010.1 of 2During what month and year did you receive your most recent seasonal flu shot?

01January
02February
03March
04April
05May
06June
07July
08August
09September
10October
11November
12December
97Refused
99Don't know

UniverseText:Sample adults 18+ who have had a seasonal flu shot
SkipInstructions:

(1-12,D) [ goto ASHFLU_Y] (R) [goto SPRFLUYR]

QuestionID:AAU.312_01.000.

Instrument Variable Name:ASHFLU_M
QuestionText:

This question was added to the instrument in August 2010.1 of 2During what month and year did you receive your most recent flu shot?

01January
02February
03March
04April
05May
06June
07July
08August
09September
10October
11November
12December
97Refused
99Don't know

UniverseText:Sample adults 18+ who have had a flu shot
SkipInstructions:

(1-12,D) [ goto ASHFLU_Y] (R) [goto SPRFLUYR]

Question ID:AAU.312_02.000
Instrument Variable Name:ASHFLU_Y
QuestionText:

This question was removed from the instrument in August 2010.2 of 2*Enter year of most recent seasonal flu shot.

YearYear
9997Refused
9999Don't know

UniverseText:Sample adults 18+ who gave a month for their last seasonal flu shot or who didn't know the month
SkipInstructions:

(valid year,R,D) [goto SPRFLUYR]
[If ASHFLU_M and ASHFLU_Y = a future date] goto ERR1_ASHFLU_Y[If ASHFLU_M and ASHFLU_Y = a date prior to birth] goto ERR2_ASHFLU_Y
[If ASHFLU_M and ASHFLU_Y = a date before 12 months ago] goto ERR3_ASHFLU_Y

QuestionID:AAU.312_02.000.

Instrument Variable Name:ASHFLU_Y
QuestionText:

This question was added to the instrument in August 2010.2 of 2*Enter year of most recent flu shot.

YearYear
9997Refused
9999Don't know

UniverseText:Sample adults 18+ who gave a month for their most recent flu shot or who didn't know the month
SkipInstructions:

(valid year,R,D) [goto SPRFLUYR]
[If ASHFLU_M and ASHFLU_Y = a future date [goto ERR1_ASHFLU_Y]
[If ASHFLU_M and ASHFLU_Y = a date prior to birth [goto ERR2_ASHFLU_Y ]
[If ASHFLU_M and ASHFLU_Y = a date before 12 months ago [goto ERR3_ASHFLU_Y ]

Question ID:AAU.315_00.000

Instrument Variable Name:SPRFLUYR
QuestionText:

This question was removed from the instrument in August 2010.
DURING THE PAST 12 MONTHS, have you had a seasonal flu vaccine sprayed in your nose by a doctor or other health
professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects
against influenza for the flu season.
* Read if necessary: This influenza vaccine is called FluMist (trademark).

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto ASPFLU_M]
[if SHTFLUYR =1 and SPRFLUYR=1] goto ERR1_SPRFLUYR
[if AGE GE 50] goto ERR2_SPRFLUYR(2,D,R)[goto SHTPNUYR]

QuestionID:AAU.315_00.000.

Instrument Variable Name:SPRFLUYR
QuestionText:

This question was added to the instrument in August 2010.
DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health
professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects
against influenza for the flu season.
* Read if necessary: This influenza vaccine is called FluMist (trademark).
*Read if necessary: Your most recent flu vaccination could have been the new 2010-2011 flu vaccine available starting
this fall, or either of the two types available last season, one called "seasonal" and the other called "H1N1" or "swine" flu
vaccine.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto ASPFLU_M]
[if SHTFLUYR =1 and SPRFLUYR=1] goto ERR1_SPRFLUYR
[if AGE GE 50] goto ERR2_SPRFLUYR(2,D,R)[goto SHTPNUYR]

Question ID:AAU.318_01.000

Instrument Variable Name:ASPFLU_M
QuestionText:

This question was removed from the instrument in August 2010.1 of 2During what month and year did you receive your most recent seasonal flu nasal spray?

01January
02February
03March
04April
05May
06June
07July
08August
09September
10October
11November
12December
97Refused
99Don't know

UniverseText:Sample adults 18+ who have had a seasonal flu nasal vaccine
SkipInstructions:

(1-12,D) [ goto ASPFLU_Y] (R) [goto SHTPNUYR]

QuestionID:AAU.318_01.000.

Instrument Variable Name:ASPFLU_M
QuestionText:

This question was added to the instrument in August 2010.1 of 2During what month and year did you receive your most recent flu nasal spray?

01January
02February
03March
04April
05May
06June
07July
08August
09September
10October
11November
12December
97Refused
99Don't know

UniverseText:Sample adults 18+ who have had a flu nasal vaccine
SkipInstructions:

(1-12,D) [ goto ASPFLU_Y]
(R) [goto SHTPNUYR]

Question ID:AAU.318_02.000

Instrument Variable Name:ASPFLU_Y
QuestionText:

This question was removed from the instrument in August 2010.2 of 2*Enter year of most recent seasonal flu nasal spray.

YearYear
9997Refused
9999Don't know

UniverseText:Sample adults 18+ who gave a month for their seasonal flu nasal vaccine or who didn't know the month
SkipInstructions:

(valid year, R, D) [goto SHTPNUYR]
[If ASPFLU_M and ASPFLU_Y = a future date] goto ERR1_ASPFLU_Y[If ASPFLU_M and ASPFLU_Y = a date prior to birth] goto ERR2_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date before 12 months ago] goto ERR3_ASPFLU_Y

QuestionID:AAU.318_02.000.

Instrument Variable Name:ASPFLU_Y
QuestionText:

This question was added to the instrument in August 2010.2 of 2*Enter year of most recent flu nasal spray.

YearYear
9997Refused
9999Don't know

UniverseText:Sample adults 18+ who gave a month for their most recent flu nasal vaccine or who didn't know the month
SkipInstructions:

Question ID:AAU.320_00.000

Instrument Variable Name:SHTPNUYR
QuestionText:

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

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:AAU.330_00.000

Instrument Variable Name:APOX
QuestionText:

Have you EVER had chickenpox?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto APOX12MO]
(2,R,D)[goto AHEP]

QuestionID:AAU.340_00.000

Instrument Variable Name:APOX12MO
QuestionText:

Have you had chickenpox in the PAST 12 MONTHS?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have ever had chickenpox
SkipInstructions:

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

Question ID:AAU.350_00.000

Instrument Variable Name:AHEP
QuestionText:

Have you EVER had hepatitis?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto SHTHEPB]
(2,R,D)[goto AHEPLIV]

Question ID:AAU.360_00.000

Instrument Variable Name:AHEPLIV
QuestionText:

Have you ever lived with someone who had hepatitis?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
SkipInstructions:

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

QuestionID:AAU.370_00.000

Instrument Variable Name:SHTHEPB
QuestionText:

Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available since 1991. It is recommended for
newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto SHEPDOS]
(2,R,D)[goto SHTHEPA]

Question ID:AAU.380_00.000

Instrument Variable Name:SHEPDOS
QuestionText:

Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?

1Received at least 3 doses
2Received less than 3 doses
7Refused
9Don't know

UniverseText:Sample adults 18+ who have ever received the Hepatitis B vaccine
SkipInstructions:

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

Question ID:AAU.390_00.010

Instrument Variable Name:SHTHEPA
QuestionText:

The hepatitis A vaccine is given as a two dose series routinely to some children starting at 1 year of age, and to some
adults and people who travel outside the United States. Although it can be given as a combination vaccine with hepatitis
B, it is different from the hepatitis B shot, and has only been available since 1995. Have you ever received the hepatitis A
vaccine?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto SHEPANUM]
(2,R,D)if AGE GE 50 goto SHINGLES
else goto SHTTD

QuestionID:AAU.400_00.010

Instrument Variable Name:SHEPANUM
QuestionText:

How many hepatitis A shots did you receive?
*Enter '96' if all shots were received

01-95 01-95 shots
96 Received all shots
97 Refused
99 Don't know

UniverseText:Sample adults 18+ who have had a hepatitis A vaccine
SkipInstructions:

(1-95,96,R,D) if AGE GE 50 [goto SHINGLES]
elseif AGE LT 50 [goto SHTTD]

Question ID:AAU.410_00.010

Instrument Variable Name:SHINGLES
QuestionText:

Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is generally on
one side of the body or face. Shingles is caused by the chicken pox virus. A vaccine for shingles has been available since
May 2006. Have you ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 50+
SkipInstructions:

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

Question ID:AAU.420_00.010

Instrument Variable Name:SHTTD
QuestionText:

Have you received a tetanus shot in the past 10 years?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

(1) [goto SHTTD05]
(2,R,D)[goto LIVEV]

QuestionID:AAU.430_00.010

Instrument Variable Name:SHTTD05
QuestionText:

Was your most recent tetanus shot given in 2005 or later?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who have had a tetanus shot in the past 10 years
SkipInstructions:

(1,R)if AGE le 64 [goto SHTTDAP]
(1,R)if AGE gt 64 [goto LIVEV]
(2,D) [goto LIVEV]

Question ID:AAU.440_00.010

Instrument Variable Name:SHTTDAP
QuestionText:

There are currently two types of tetanus shots available today. One is the Td or tetanus-diphtheria vaccine and the other is
called Tdap or Adacel (trademark). They are similar except the Tdap shot also includes a pertussis (per-TUH-sis) or
whooping cough vaccine. Thinking back to your most recent tetanus shot, did the doctor tell you the vaccine included the
pertussis or whooping cough vaccine? The shot is often called Tdap or ADACEL (trademark).

1Yes-included pertussis
2No-did not include pertussis
3Doctor did not say
7Refused
9Don't know

UniverseText:Sample adults LT65 who have had a tetanus shot in 2005 or beyond or refused to say if they had a tetanus shot in
2005 or beyond
SkipInstructions:

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

Question ID:AAU.450_00.010

Instrument Variable Name:LIVEV
QuestionText:

Has a doctor or other health professional ever told you that you had any kind of chronic, or long-term liver condition?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

QuestionID:AAU.460_00.010

Instrument Variable Name:TRAVEL
QuestionText:

Have you ever traveled outside of the United States to countries other than Europe, Japan, Australia, New Zealand or
Canada, since 1995?

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:AAU.465_00.010

Instrument Variable Name:WRKHLTH
QuestionText:

Do you currently volunteer or work in a hospital, medical clinic, doctor's office, dentist's office, nursing home or some
other health-care facility? This includes part-time and unpaid work in a health care facility as well as professional nursing
care provided in the home.
*Read if necessary: This includes non-health care professionals, such as administrative staff, who work in a health-care
facility.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+
SkipInstructions:

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

Question ID:AAU.470_00.010

Instrument Variable Name:WRKDIR
QuestionText:

Do you provide direct patient care as part of your routine work? By direct patient care we mean physical or hands on
contact with patients.

1Yes
2No
7Refused
9Don't know

UniverseText:Sample adults 18+ who work or volunteer in a health-care setting
SkipInstructions:

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

AIDS Knowledge and Attitudes

Question ID: ADS.010_00.000

Instrument Variable Name: BLDGV
QuestionText:

Now, I am going to ask about giving blood donations to a blood bank such as the American Red Cross.
Have you donated blood since March 1985?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto BLDG12M]
(2,R,D)[goto HIVTST]

Question ID: ADS.020_00.000

Instrument Variable Name: BLDG12M
QuestionText:

During the PAST 12 MONTHS, that is, since [fill: 12-month ref. Date], have you donated blood?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have given blood since March 1985
SkipInstructions:

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

Question ID: ADS.040_00.000

Instrument Variable Name: HIVTST
QuestionText:

The next questions are about the test for HIV (the virus that causes AIDS).
[fill: Except for tests you may have had as part of blood donations, have you ever been tested for HIV?/Have you ever
been tested for HIV?]

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto TST12M_M]
(2) [goto WHYTST]
(R,D)[goto EXTST12M]

Question ID: ADS.050_00.000

Instrument Variable Name: WHYTST
QuestionText: (book) A11

I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes AIDS).
Which one of these would you say is the MAIN reason why you have not been tested?

01 It's unlikely you've been exposed to HIV
02 You were afraid to find out if you were HIV positive (that you had HIV)
03 You didn't want to think about HIV or about being HIV positive
04 You were worried your name would be reported to the government if you tested positive
05 You didn't know where to get tested
06 You don't like needles
07 You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
08 Some other reason
09 No particular reason
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have not been tested for HIV
SkipInstructions:

(1-7,9,R,D)[goto EXTST12M]
(8)[goto WHYSPEC]

Question ID: ADS.055_00.000

Instrument Variable Name: WHYSPEC
QuestionText:

What was the main reason why you have not been tested?

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ with some other reason for no HIV test
SkipInstructions:

(20 char long)[goto EXTST12M]

Question ID: ADS.060_01.000

Instrument Variable Name: TST12M_M
QuestionText:

1 of 2
[fill: Not including blood donations, in what month and year was your last test for HIV (the virus that causes AIDS)?/In
what month and year was your last test for HIV, (the virus that causes AIDS)?]
* Enter month of last HIV test.
* Enter "96" to go to the time period format.

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV/AIDS
SkipInstructions:

(R,96) [goto TIMETST]
(1-12,D) [goto TST12M_Y]

Question ID: ADS.060_02.000

Instrument Variable Name: TST12M_Y
QuestionText:

2 of 2
* Enter year of last HIV test.

1985-2009 1985-2009
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults 18+ who gave a month for their last HIV test or who didn't know the month
SkipInstructions:

(1880-2030) [goto REATST]
(R,D)[goto TIMETST]
[if TST12M_M and TST12M_Y = a future date] goto ERR1_TST12M_Y
[if TST12M_M and TST12M_Y = a date prior to birth date] goto ERR2_TST12M_Y

Question ID: ADS.061_00.000

Instrument Variable Name: TIMETST
QuestionText:

Was it:
* Read answer categories.
1 6 months or less
2 More than 6 months but not more than 1 year ago
3 More than 1 year, but not more than 2 years ago
4 More than 2 years, but not more than 5 years ago
5 More than 5 years ago
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV, who refused or requested the time period format at
TEST12M_M, or refused or don't know the year of their last HIV test.
SkipInstructions:

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

Question ID: ADS.065_00.000
Instrument Variable Name: REATST
QuestionText:

(book) A12
I am going to show you a list of reasons why some people have been tested for HIV (the virus that causes AIDS).
[fill: Not including your blood donations, which of these would you say was the MAIN reason for your last HIV
test?/Which of these would you say was the MAIN reason for your last HIV test?]

01 Someone suggested you should be tested
02 You might have been exposed through sex or drug use
03 You might have been exposed through your work or at work
04 You just wanted to find out if you were infected or not
05 For part of a routine medical check-up, or for hospitalization or surgical procedure
06 You were sick or had a medical problem
07 You were pregnant or delivered a baby
08 For health or life insurance coverage
09 For military induction, separation, or military service
10 For immigration
11 For marriage license or to get married
12 You were concerned you could give HIV to someone
13 You wanted medical care or new treatments if you tested positive
14 Some other reason
15 No particular reason
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV
SkipInstructions:

(1)[goto REASWHO]
(2-13,15,R,D) [goto LASTST]
(14) [goto REASPEC]

Question ID: ADS.066_00.000

Instrument Variable Name: REASWHO
QuestionText:

Who suggested you should be tested - a doctor, nurse or other health care professional, a sex partner, someone at the
health department, or someone else?

1 Doctor, nurse or other health care professional
2 Sex partner
3 Someone at health department
4 Family member or friend
5 Other
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV because someone suggested it
SkipInstructions:

(1-4,R,D) [goto LASTST]
(5)[goto WHOSPEC]

Question ID: ADS.067_00.000

Instrument Variable Name: WHOSPEC
QuestionText:

Who suggested you should be tested?

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV because someone not listed in REASWHO suggested it
SkipInstructions:

(20 char long)[goto LASTST]

Question ID: ADS.069_00.000

Instrument Variable Name: REASPEC
QuestionText:

What was the main reason for your last HIV test?

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV for some reason not listed in REATST
SkipInstructions:

(20 char long)[goto LASTST]

Question ID: ADS.070_00.000

Instrument Variable Name: LASTST
QuestionText:

(book) A13
[fill: Not including your blood donations, where did you have your last HIV test?/Where did you have your last HIV test?]

01 Private doctor/HMO
02 AIDS clinic/counseling/testing site
03 Hospital, emergency room, outpatient clinic
04 Other type of clinic
05 Public health department
06 At home
07 Drug treatment facility
08 Military induction or military service site
09 Immigration site
10 In a correctional facility (jail or prison)
11 Other location
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV
SkipInstructions:

(1-3,5,7-10,R,D) [goto GIVNAM]
(4) [goto CLINTYP]
(6)[goto WHOADM]
(11)[goto LASTSPEC]

Question ID: ADS.072_00.000

Instrument Variable Name: CLINTYP
QuestionText:

What type of clinic did you go to for your last HIV test?

01 Family planning clinic
02 Prenatal clinic
03 Tuberculosis clinic
04 STD clinic
05 Community health clinic
06 Clinic run by employer or insurance company
07 Other
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV at another type of clinic
SkipInstructions:

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

Question ID: ADS.074_00.000

Instrument Variable Name: WHOADM
QuestionText:

Was this test administered by a nurse or other health worker, or did you use a self-sampling kit?

1 Nurse or health worker
2 Self-sampling kit
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV at home
SkipInstructions:

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

Question ID: ADS.076_00.000

Instrument Variable Name: LASTSPEC
QuestionText:

Where did you have your last HIV test?
* This should be a specific location that is not on the list.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were tested at another location
SkipInstructions:

(20 char long)[goto GIVNAM]

Question ID: ADS.080_00.000

Instrument Variable Name: GIVNAM
QuestionText:

The last time you were tested, did you have to give your first and last names?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have been tested for HIV
SkipInstructions:

(1,2,R,D)[goto EXTST12M]

Question ID: ADS.110_00.000

Instrument Variable Name: EXTST12M
QuestionText:

[fill: Do you expect to have another test for HIV in the next 12 months, not including blood donations?/Do you expect to
have a test for HIV in the next 12 months, not including blood donations?]

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ADS.140_00.000

Instrument Variable Name: CHNSADS
QuestionText:

What are your chances of GETTING HIV (the virus that causes AIDS)?
Would you say high, medium, low, or none?

1 High
2 Medium
3 Low
4 None
5 Already have HIV or AIDS
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ADS.150_00.000

Instrument Variable Name: STMTRU
QuestionText:

(book) A14
Tell me if ANY of these statements is true for YOU. Do NOT tell me WHICH Statement or statements are true for you.
Just IF ANY of them are.
* Read if necessary.
(a) You have hemophilia and have received clotting factor concentrations.
(b) You are a man who has had sex with other men, even just one time.
(c ) You have taken street drugs by needle, even just one time.
(d) You have traded sex for money or drugs, even just one time.
(e) You have tested positive for HIV (the virus that causes AIDS).
(f) You have had sex (even just one time) with someone who would answer "yes" to any of these statements.

1 Yes, at least one statement is true
2 No, none of these statements are true
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[If AGE GE (50)[go to TBHRD] else [go to STD]]

Question ID: ADS.160_00.000

Instrument Variable Name: STD
QuestionText:

The next questions are about other sexually transmitted diseases or STDs. STDs are also known as venereal diseases or
VD. Examples of STDs are gonorrhea, Chlamydia (CLUH-MIH-DEE-UH), syphilis, herpes, and genital warts.
In the past five years, have you had an STD other than HIV or AIDS?
* If asked, tell respondent to include newly contracted STDs and recurring flare-ups of previously contracted STDs.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18-49
SkipInstructions:

(1) [goto STDDOC]
(2,R,D)[goto TBHRD]

Question ID: ADS.170_00.000

Instrument Variable Name: STDDOC
QuestionText:

The last time you had an STD other than HIV or AIDS, did you see a doctor or other health professional to get it checked?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18 - 49 who have had an STD other than HIV or AIDS in the past 5 years
SkipInstructions:

(1) [goto STDWHER]
(2,R,D)[goto TBHRD]

Question ID: ADS.180_00.000

Instrument Variable Name: STDWHER
QuestionText:

Where did you go to be checked?
* Read answer choices only if necessary.

1 Private doctor
2 Family planning clinic
3 STD clinic
4 Emergency room
5 Health department
6 Some other place
7 Refused
9 Don't know

UniverseText: Sample adults 18-49 who have had an STD other than HIV or AIDS who saw a doctor or other health professional
SkipInstructions:

(1-5,R,D) [goto TBHRD]
(6)[goto STDWOTH]

Question ID: ADS.190_00.000

Instrument Variable Name: STDWOTH
QuestionText:

Where did you go to be checked?

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18-49 who have had an STD other than HIV or AIDS who were tested at some other place
SkipInstructions:

(20 char long)[goto TBHRD]

Question ID: ADS.200_00.000

Instrument Variable Name: TBHRD
QuestionText:

The next questions are about tuberculosis, or TB.
Have you ever heard of tuberculosis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto TBKNOW]
(2,R,D)[goto HOMELESS]

Question ID: ADS.210_00.000

Instrument Variable Name: TBKNOW
QuestionText:

Have you ever personally known anyone who had TB?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have heard of tuberculosis
SkipInstructions:

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

Question ID: ADS.220_00.000

Instrument Variable Name: TB
QuestionText:

How much do you know about TB - a lot, some, a little, or nothing?

1 A lot
2 Some
3 A little
4 Nothing
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have heard of tuberculosis
SkipInstructions:

(1-3)[goto TBSPRD]
(4) [goto TBCHANC]
(R,D)[goto HOMELESS]

Question ID: ADS.230_00.000

Instrument Variable Name: TBSPRD
QuestionText:

(book) A15
How is TB spread?
* Probe: Can TB be spread in any other way?
* Mark all that apply, separate with commas.

1 Breathing the air around a person who is sick with TB
2 Sharing eating/drinking utensils
3 Through semen or vaginal secretions shared during sexual intercourse
4 From smoking
5 From mosquito or other insect bites
6 Other
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have knowledge of tuberculosis
SkipInstructions:

(1-6,R,D) goto TBCURED

Question ID: ADS.240_00.000

Instrument Variable Name: TBCURED
QuestionText:

As far as you know, can TB be cured?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have knowledge of tuberculosis
SkipInstructions:

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

Question ID: ADS.250_00.000

Instrument Variable Name: TBCHANC
QuestionText:

What are your chances of getting TB? Would you say high, medium, low, or none?

1 High
2 Medium
3 Low
4 None
5 Already have TB
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have knowledge or heard of tuberculosis or know nothing about tuberculosis
SkipInstructions:

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

Question ID: ADS.260_00.000

Instrument Variable Name: TBSHAME
QuestionText:

(Fill1: If a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?)
(Fill2: If you or a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?)

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have knowledge or heard of tuberculosis or know nothing about tuberculosis
SkipInstructions:

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

Question ID: ADS.270_00.000

Instrument Variable Name: HOMELESS
QuestionText:

Have you ever spent more than 24 hours living on the streets, in a shelter, or in a jail or prison?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

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