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1


2011 NHIS Questionnaire - Sample Child
Document Version Date: 30-May-12


Question ID: CDB.020_00.000

Instrument Variable Name: P2DCHEAR
QuestionText:
With this next set of questions, we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities. Though different, these questions may sound similar to ones I asked earlier.
Is {S.C. name} deaf or does {S.C. name} have serious difficulty hearing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 1-17 years and random number generator=1
SkipInstructions:
(1,2,D,R) go to P2DCSEE


Question ID: CDB.040_00.000

Instrument Variable Name: P2DCSEE
QuestionText:

Is {S.C. name} blind or does {S.C. name} have serious difficulty seeing even when wearing glasses?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 1-17 years and random number generator=1
SkipInstructions:

(1,2,D,R) if AGE GE 5 goto P2DCCON;
else if AGE LE 4 goto SCSSN4


Question ID: CDB.060_00.000

Instrument Variable Name: P2DCCON
QuestionText:

Because of a physical, mental, or emotional condition, does {S.C. name} have serious difficulty concentrating, remembering, or making decisions?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 5-17 years and random number generator=1
SkipInstructions:
(1,2,D,R) goto P2DCWALK


Question ID: CDB.080_00.000

Instrument Variable Name: P2DCWALK
QuestionText:
Does {S.C. name} have serious difficulty walking or climbing stairs?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 5-17 years and random number generator=1
SkipInstructions:

(1,2,D,R) goto P2DCDRES


Question ID: CDB.100_00.000

Instrument Variable Name: P2DCDRES
QuestionText:
Does {S.C. name} have difficulty dressing or bathing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 5-17 years and random number generator=1
SkipInstructions:
(1,2,D,R) if AGE GE 15 goto P2DCERR,
else goto SCSSN4


Question ID: CDB.120_00.000

Instrument Variable Name: P2DCERR
QuestionText:

Because of a physical, mental, or emotional condition, does {S.C. name} have difficulty doing errands alone such as visiting a doctor's office or shopping?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 15-17 years and random number generator=1
SkipInstructions:
(1,2,D,R) goto end of section