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


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
else goto 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?
1 Male
2 Female
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
ERR_AIDSEX
Hard Edit:
*The gender will now be changed to [fill: AIDSEX]. goto AIDVERF_S (as the default goto)

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".
1 Yes
2 No
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:
QuestionText:
How old are you?
000-120 Age in years
997 Refused
999 Don't know
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
ERR_AIDAGE
Soft Edit:
*Age of [fill1: ALIAS of Sample Adult] remains [fill2: Age of Sample Adult] years old.
goto AIDVERF_A (whether suppressed or not)

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
UniverseText: Sample Adult said his/her age is correct.
SkipInstructions:
(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
QuestionText:
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
QuestionText:
*Enter day of birth.
01-31 Day of the month
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:
(01-31,Refused,Don't know) goto AIDDOB_Y
If days not valid, goto ERR_AIDDOB_D
ERR_AIDDOB_D
Hard Edit:
*[fill1: AIDDOB_D] is not a valid day for [fill2: AIDDOB_M].
*Please correct.

Question ID: AID.060_03.000

Instrument Variable Name: AIDDOB_Y
QuestionText:
1880-2020
*Enter year of birth.
Year of birth
UniverseText: Respondent said his/her date of birth is not correct or his/her age is not correct
SkipInstructions:
(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
ERR1_AIDDOB_Y
Hard Edit:
*Future date invalid: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR2_AIDDOB_Y
*Not a valid day: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR3_AIDDOB_Y
*DOB of [fill2: ALIAS of Sample Adult] remains [fill3: (DOBM) (DOBD), (DOBY)]
goto AIDVERF_A (whether suppressed or not)
ERR4_AIDDOB_Y
* Data mismatched. Please fix Age or Birthday.
* If still cannot reconcile, enter 'Don't know' for year of birth.
* Please correct.


2011 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date: 30-May-12


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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were working or not working last week
SkipInstructions:
(1)if DOINGLW2 = 1,2,4 [goto WHOWRK]
else if DOINGLW2 = 3,5 [goto EVERWRK]
(2)go to WRKCOR
(R,D)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.
1 Working for pay at a job or business
2 With a job or business but not at work
3 Looking for work , at a family-owned job or business
4 Not working at a job or business
5 Working, but not for payand not looking for work
7 Refused
9 Don't know
UniverseText: 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.
SkipInstructions:
(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)
1 Working for pay at a job or business
2 With a job or business but not at work
3 Looking for work
4 Working, but not for pay, at a family-owned job or business
5 Not working at a job or business and not looking for work
7 Refused
9 Don't know
UniverseText: 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
SkipInstructions:
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?)
01 Taking care of house or family
02 Going to school
03 Retired
04 On a planned vacation from work
05 On family or maternity leave
06 Temporarily unable to work for health reasons
07 Have job/contract and off-season
08 On layoff
09 Disabled
10 Other
97 Refused
99 Don'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?
1 Yes
2 No
7 Refused
9 Don'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))
Verbatim Verbatim response
7 Refused
9 Don'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)
Verbatim Verbatim response
7 Refused
9 Don'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 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.)
Verbatim Verbatim response
7 Refused
9 Don'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:
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.)
Verbatim Verbatim response
7 Refused
9 Don'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.
1 Employee of a PRIVATE company for wages
2 A FEDERAL government employee
3 A STATE government employee
4 A LOCAL government employee
5 Self-employed in OWN business, professional practice or farm
6 Working WITHOUT PAY in a family-owned business or farm
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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) A3
Thinking 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.
01 1-9 employees
02 10-24 employees
03 25-49 employees
04 50-99 employees
05 100-249 employees
06 250-499 employees
07 500-999 employees
08 1000 employees or more
97 Refused
99 Don'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:
(1-8, R,D)[goto WRKLONGN]


Question ID: ASD.140_01.000

Instrument Variable Name: WRKLONGN
QuestionText:
? [F1]
1 of 2
About 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
997 Refused
999 Don'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.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(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]
ERR_WRKLONGT
Hard Edit:
* Number of years is greater than age.
* Please correct.


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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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 next section]


Question ID: ASD.170_00.000

Instrument Variable Name: ONEJOB
QuestionText:
Do you have more than one job or business?
1 Yes
2 No
7 Refused
9 Don'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) [goto next section]


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?
0 Had job last week
1 Yes
2 No
7 Refused
9 Don'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:
(0-2,D,R) [goto next section]


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


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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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)?
1 Yes
2 No
7 Refused
9 Don'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)?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were ever told they had asthma
SkipInstructions:
(1,2,R,D) [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 ulcer
This could be a stomach, duodenal or peptic ulcer.
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who were ever told they had cancer
SkipInstructions:
Hard Edit:
(1-30,R,D)[goto CANAGE_1]
IF SEX=1 (MALE) and No. (6,18,29) selected goto ERR1_CANKIND_1
IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_1
ERR1_CANKIND_1
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_1
* Code 20 or 26 is unavailable for females.
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.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who either provided an age 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_2
Hard Edit:
IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_2
ERR1_CANKIND_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_2
* Code 20 or 26 is unavailable for females.
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.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who either provided an age 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_3
Hard Edit:
IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_3
ERR1_CANKIND_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_3
* Code 20 or 26 is unavailable for females.
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.
95 More than three kinds
96 No 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
997 Refused
999 Don'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
Hard Edit: ERR_ CANAGE_1
* [Fill2: CANAGE_1] years old is older than age[fill3: AGE].
* Please correct.
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
997 Refused
999 Don'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
Hard Edit: ERR_ CANAGE_2
* [Fill2: CANAGE_2] years old is older than your age[fill3: AGE].
* Please correct.
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
997 Refused
999 Don'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
ERR_ CANAGE_3
Hard Edit:
* [Fill2: CANAGE_3] years old is older than your age[fill3: AGE].
* Please correct.


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?]
1 Yes
2 No
3 Borderline
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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
97 Refused
99 Don'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
ERR_ DIBAGE
Hard Edit:
* [Fill1: DIBAGE] years old is older than your age[fill2: AGE].
* Please correct.


Question ID: ACN.180_00.000

Instrument Variable Name: INSLN
QuestionText:
Are you NOW taking insulin?
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 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 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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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.
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [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?
1 Yes
2 No
7 Refused
9 Don'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) A4
Which joints are affected?
* Enter all that apply, separate with commas.
01 Shoulder-right
02 Shoulder-left
03 Elbow-right
04 Elbow-left
05 Hip-right
06 Hip-left
07 Wrist-right
08 Wrist-left
09 Knee-right
10 Knee-left
11 Ankle-right
12 Ankle-left
13 Toes-right
14 Toes-left
15 Fingers/thumb-right
16 Fingers/thumb-left
17 Other joint not listed
97 Refused
99 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
((1) or JNTSYMP eq (1)) [goto ARTHLMT];
else ((2,R,D) and JNTSYMP ne 1) [goto PAINECK]


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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with joint pain or arthritis
SkipInstructions:
(1,2,R,D) [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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto PAINLB]


Question ID: ACN.310_00.000

Instrument Variable Name: PAINLB
QuestionText:
*Read if necessary
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ACOLD2W]


Question ID: ACN.350_00.000

Instrument Variable Name: ACOLD2W
QuestionText:
These next questions are about your recent health DURING THE LAST 2 WEEKS. Did you have a head cold or chest cold that started DURING THE LAST 2 WEEKS?
1 Yes
2 No
7 Refused
9 Don'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 THE LAST TWO WEEKS?
1 Yes
2 No
7 Refused
9 Don'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 AGEGTE50)) [goto HRAIDNOW]


Question ID: ACN.370_00.000

Instrument Variable Name: PREGNOW
QuestionText:
Are you currently pregnant?
1 Yes
2 No
7 Refused
9 Don'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)?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Excellent
2 Good
3 A little trouble hearing
4 Moderate trouble
5 A lot of trouble
6 Deaf
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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.
1 Enter 1 to continue
UniverseText: Sample adults 18+
SkipInstructions:
(1) [goto SAD]


Question ID: ACN.471_01.000

Instrument Variable Name: SAD
QuestionText:
(book) A5
DURING 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?
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 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?
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 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?
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 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?
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 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?
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:
If (SAD eq (1-3) or NERVOUS eq (1-3) or RESTLESS eq (1-3) or HOPELESS eq (1-3) or EFFORT eq LT1
3GT 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?
1 A lot
2 Some
3 A little
4 Not at all
7 Refused
9 Don'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]


2011 NHIS Questionnaire - Sample Adult
Adult Health Status and Limitations
Document Version Date: 30-May-12


Question ID: AHS.040_00.000

Instrument Variable Name: WKDAYR
QuestionText:
During the PAST 12 MONTHS, 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]
ERR_WKDAYR
Soft Edit:
* [Fill: WKDAYR] is an unusually large number.
* Please verify.


Question ID: AHS.050_00.000

Instrument Variable Name: BEDDAYR
QuestionText:
During the PAST 12 MONTHS, 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]
ERR_BEDDAYR
Soft Edit:
* [Fill: BEDDAYR] is an unusually large number.
* Please verify.


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(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example, 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]
GTENTERLT 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
Hard Edit: $ You should enter something specific.
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]
GTENTERLT only with no description [goto ERR1_AFLHCA_S1]
Hard Edit: $ You should enter something specific.


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
ERR1_AHCL01T
Hard Edit:
*Time with condition cannot be greater than age.
* Please correct.
* "6" not selectable.
ERR2_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
ERR1_AHCL02T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.
* "6" not selectable.
ERR2_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
ERR_AHCL03T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 01-94
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
ERR_AHCL04T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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
ERR_AHCL05T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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
ERR_AHCL06T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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
ERR_AHCL07T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL08T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL09T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL10T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL11T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL12T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


Question ID: AHS.313_01.000

Instrument Variable Name: AHCL14N
QuestionText:
1 of 2
How long have you had intellectual disability, also known as mental retardation?
* Enter number for time with intellectual disability/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 intellectual disability/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
ERR_AHCL14T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL15T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL16T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 01-94
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
ERR_AHCL17T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 01-94
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 Months(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
ERR_AHCL18T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 1-94
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
ERR_AHCL19T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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 1-94
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
ERR_AHCL20T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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 01-94
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
ERR_AHCL21T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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
ERR_AHCL22T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR_AHCL23T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR_AHCL24T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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 01-94
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
ERR_AHCL25T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR_AHCL26T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR_AHCL27T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR_AHCL28T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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 1-94
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
ERR_AHCL29T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR_AHCL30T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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 1-94
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
ERR_AHCL31T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR_AHCL32T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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 1-94
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
ERR_AHCL33T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR1_AHCL34T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

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
ERR1_AHCL35T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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
ERR_AHCL90T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


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
ERR_AHCL91T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.


2011 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 30-May-12


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
ERR_SMKREG
Hard Edit:
* Starting age exceeded current age.
* Please correct.


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
ERR2_SMKQTTP
Hard Edit:
* Age started ([Fill1: SMKREG]) + years since quit ([Fill2: SMKQTNO]) exceeds current age ([Fill3: AGE]).
* Please correct.
ERR1_SMKQTTP
Soft Edit:
* Respondent quit smoking before age 15?
* Please verify.


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:
(1-95,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:
(1-95,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:
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]
ERR1_VIGTP
Soft Edit:
* [Fill1: VIGNO] times per [Fill2: VIGTP] is unusually high.
* Please verify.


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
ERR1_VIGLNGTP
Hard Edit:
* Question asked for activities lasting at least 10 minutes.
* Please correct.
ERR2_VIGLNGTP
Soft Edit:
* [Fill1: VIGLNGNO] [fill2: VIGLNGTP] is unusually high.
* Please verify.


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
ERR_MODNO
Soft Edit:
* [Fill1: MODNO] times per [fill2: MODTP] is unusually high.
* Please verify.


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
ERR1_MODLNGTP
Hard Edit:
* Question asked for activities lasting at least 10 minutes.
* Please correct.
ERR2_MODLNGTP
Soft Edit:
* [Fill1: MODLNGNO] [Fill2: MODLNGTP] is unusually high.
* Please verify.


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 DISHFAC]


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 DISHFAC
[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]
ERR_STRNGTP
Soft Edit:
* [Fill1: STRNGNO] times per [Fill2: STRNGTP] is unusually high.
* Please verify.


Question ID: AHB.135_00.010

Instrument Variable Name: DISHFAC
QuestionText:
The next questions are about health clubs, wellness programs or fitness facilities, such as the YMCA, community recreation programs, and employer fitness programs. If you wanted to use one, is there a health club, wellness program or fitness facility in your area that meets your needs?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,R,D) [goto ALC1YR]
(2) [goto DISHFL02]


Question ID: AHB.136_01.010

Instrument Variable Name: DISHFL02
QuestionText:
Do any of these barriers limit or prevent you from using a health club, wellness program, or fitness facility that meets your needs? I am going to read a list. Please say yes or no to each one.
...Cost is too high.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not have a health club, wellness program or fitness facility in their area that meets their needs, if they wanted to use one
SkipInstructions:
(1,2,R,D) [goto DISHFL03]


Question ID: AHB.136_02.020

Instrument Variable Name: DISHFL03
QuestionText:
* Read if necessary.
Do any of these barriers limit or prevent you from using a health club, wellness program, or fitness facility that meets your needs?
...Lack of staff or instructors who understand your needs.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not have a health club, wellness program or fitness facility in their area that meets their needs, if they wanted to use one
SkipInstructions:
(1,2,R,D) [goto DISHFL04]


Question ID: AHB.136_03.030

Instrument Variable Name: DISHFL04
QuestionText:
* Read if necessary.
Do any of these barriers limit or prevent you from using a health club, wellness program, or fitness facility that meets your needs?
...Lack of exercise equipment that meets your needs.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not have a health club, wellness program or fitness facility in their area that meets their needs, if they wanted to use one
SkipInstructions:
(1,2,R,D) [goto DISHFL05]


Question ID: AHB.136_04.040

Instrument Variable Name: DISHFL05
QuestionText:
* Read if necessary.
Do any of these barriers limit or prevent you from using a health club, wellness program, or fitness facility that meets your needs?
...Difficulty getting into or moving around the building.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not have a health club, wellness program or fitness facility in their area that meets their needs, if they wanted to use one
SkipInstructions:
(1,2,R,D) [goto DISHFL06]


Question ID: AHB.136_05.050

Instrument Variable Name: DISHFL06
QuestionText:
* Read if necessary.
Do any of these barriers limit or prevent you from using a health club, wellness program, or fitness facility that meets your needs?
...Inadequate transportation.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not have a health club, wellness program or fitness facility in their area that meets their needs, if they wanted to use one
SkipInstructions:
(1,2,D,R) [goto DISHFL07]


Question ID: AHB.136_06.060

Instrument Variable Name: DISHFL07
QuestionText:
* Read if necessary.
Do any of these barriers limit or prevent you from using a health club, wellness program, or fitness facility that meets your needs?
...Some other barrier.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do not have a health club, wellness program or fitness facility in their area that meets their needs, if they wanted to use one
SkipInstructions:
(1,2,R,D) [goto ALC1YR]


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]
ERR_ALC12MTP
Hard Edit:
* [Fill1: ALC12MNO] days per [Fill2: ALC12MTP] exceeds number possible in this time period.
* Please correct.


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:
(1-95,R,D) [goto ALC5UPNO]
(10-95)[goto ERR_ALCAMT]
ERR_ALCAMT
Soft Edit:
* [Fill: ALCAMT] drinks is an unusually high number.
* Please verify.
* Do not probe


Question ID: AHB.180_01.000

Instrument Variable Name:
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]
ERR1_ALC5UPTP
Hard Edit:
* [Fill1: ALC12MNO] days per [Fill2: ALC12MTP] exceeds number possible in this time period.
* Please correct.
ERR2_ALC5UPTP
* Number of days had 5 or more drinks exceeds number of days drank.
* Please correct.
* Do not probe.


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]
ERR1_AHGT_FT
Hard Edit:
* Only 2-7, Don't Know/Refused or M allowed in this field.
* Please correct.
ERR2_AHGT_FT
Soft Edit:
* Respondent's height in feet is [fill: AHGT_FT]?
* Please verify.
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]
ERR1_AHGT_IN
Hard Edit:
* If [fill: AHGT_FT] feet exactly, enter "0"; otherwise enter number of inches.
ERR2_AHGT_IN
Soft Edit:
* Please verify that the height was entered correctly. Probe only if necessary.
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]
ERR_AHGT_M
Hard Edit:
* If height is being given in centimeters only, enter "0"; otherwise enter number of meters.
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]
ERR1_AHGT_CM
Hard Edit:
* Total height exceeds maximum allowed.
* Please correct.
ERR2_AHGT_CM
* If [fill: AHGT_M] meters exactly, enter "0"; otherwise enter number of centimeters.
ERR3_AHGT_CM
Soft Edit:
* Please verify that the height was entered correctly. Probe only if necessary.


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]
Hard Edit: ERR1_AWGT_LB
* Weight is out of range (50-500).
* Please correct.
Soft Edit: ERR2_AWGT_LB
* Please verify that the weight was entered correctly. Probe only if necessary.
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]
Hard Edit: ERR1_AWGT_KG
*Weight is out of range (23-226).
* Please correct.
Soft Edit: ERR2_AWGT_KG
* Please verify that the weight was entered correctly. Probe only if necessary.


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]
ERR_SLEEP
Soft Edit:
* Average number of hours of sleep is [SLEEP].
* Please verify.


2011 NHIS Questionnaire - Sample Adult
Adult Access to Health Care and Utilization
Document Version Date: 30-May-12


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?
1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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]


Question ID: 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 [goto ANOUSLPL]; else if AUSUALPL=R,D goto APRVTRYR
ELSE 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 APRVTRYR]


Question ID: AAU.050_00.000

Instrument Variable Name: AHCCHGHI
QuestionText:
Was this change for a reason related to health insurance?
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 who CHANGED their USUAL place for health care in past 12 months
SkipInstructions:
(1,2,R,D)[goto APRVTRYR]


Question ID: AAU.050_00.010

Instrument Variable Name: ANOUSLPL
QuestionText:
Why don't you have a usual source of medical care?
*Enter all that apply, separate with commas.
01 Doesn't need a doctor/Haven't had any problems
02 Doesn't like/trust/believe in doctors
03 Doesn't know where to go
04 Previous doctor is not available/moved
05 Too expensive/no insurance/cost
06 Speak a different language
07 No care available/Care too far away, not convenient
08 Put it off/Didn't get around to it
09 Other
97 Refused
99 Don't know
UniverseText: Sample adults 18+ without a usual place of care
SkipInstructions:
(1-9,R,D)[goto APRVTRYR ]


Question ID: AAU.051_00.010

Instrument Variable Name: APRVTRYR
QuestionText:
DURING THE PAST 12 MONTHS, did you have any trouble finding a general doctor or provider who would see you?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1)[goto APRVTRFD ]
(2,R,D)[goto ADRNANP]


Question ID: AAU.053_00.010

Instrument Variable Name: APRVTRFD
QuestionText:
Were you able to find a general doctor or provider who could see you?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had trouble finding a provider
SkipInstructions:
(1,2,R,D)[goto ADRNANP]


Question ID: AAU.057_00.010

Instrument Variable Name: ADRNANP
QuestionText:
DURING THE PAST 12 MONTHS, were you told by a doctor's office or clinic that they would not accept you as a new patient?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ADRNAI]


Question ID: AAU.059_00.010

Instrument Variable Name: ADRNAI
QuestionText:
DURING THE PAST 12 MONTHS, were you told by a doctor's office or clinic that they did not accept your health care coverage?
1 Yes
2 No
7 Refused
9 Don't' know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto AHCDLY_1]


Question ID: 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.
1 Yes
2 No
7 Refused
9 Don'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 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?
...You couldn't get an appointment soon enough.
1 Yes
2 No
7 Refused
9 Don'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]


Question ID: AAU.061_04.000

Instrument Variable Name: AHCDLY_4
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?
...The (clinic/doctor's) office wasn't open when you could get there.
1 Yes
2 No
7 Refused
9 Don'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 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?
...You didn't have transportation.
1 Yes
2 No
7 Refused
9 Don'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.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto AHCAFY_2]


Question ID: 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.
1 Yes
2 No
7 Refused
9 Don'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).
1 Yes
2 No
7 Refused
9 Don'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.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto AHCAFY_5]


Question ID: AAU.111_05.010

Instrument Variable Name: AHCAFY_5
QuestionText:
*Read 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?
...To see a specialist.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto AHCAFY_6]


Question ID: AAU.111_06.010

Instrument Variable Name: AHCAFY_6
QuestionText:
*Read 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?
...Follow-up care.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto AWORPAY]


Question ID: AAU.113_00.010

Instrument Variable Name: AWORPAY
QuestionText:
If you get sick or have an accident, how worried are you that you will be able to pay your medical bills? Are you very worried, somewhat worried, or not at all worried?
1 Very worried
2 Somewhat worried
3 Not at all worried
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1-3,R,D)[goto AHICOMP]


Question ID: AAU.113_00.020

Instrument Variable Name: AHICOMP
QuestionText:
In regard to your health insurance or health care coverage, how does it compare to a year ago? Is it 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:
(1,2,3,R,D)[goto ARXPR_1]


Question ID: AAU.127_01.010

Instrument Variable Name: ARXPR_1
QuestionText:
The following questions concern the use of prescription medication DURING THE PAST 12 MONTHS, are any of the following true for you?
...You skipped medication doses to save money
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ARXPR_2]


Question ID: AAU.127_02.010

Instrument Variable Name: ARXPR_2
QuestionText:
*Read if necessary..
The following questions concern the use of prescription medication DURING THE PAST 12 MONTHS, are any of the following true for you?
...you took less medicine to save money
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ARXPR_3]


Question ID: AAU.127_03.010

Instrument Variable Name: ARXPR_3
QuestionText:
*Read if necessary.
The following questions concern the use of prescription medication DURING THE PAST 12 MONTHS, are any of the following true for you?
...You delayed filling a prescription to save money
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ARXPR_4]


Question ID: AAU.127_04.010

Instrument Variable Name: ARXPR_4
QuestionText:
*Read if necessary..
The following questions concern the use of prescription medication DURING THE PAST 12 MONTHS, are any of the following true for you?
...You asked your doctor for a lower cost medication to save money.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ARXPR_5]


Question ID: AAU.127_05.010

Instrument Variable Name: ARXPR_5
QuestionText:
*Read if necessary..
The following questions concern the use of prescription medication DURING THE PAST 12 MONTHS, are any of the following true for you?
...You bought prescription drugs from another country to save money.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ARXPR_6]


Question ID: AAU.127_06.010

Instrument Variable Name: ARXPR_6
QuestionText:
*Read if necessary..
The following questions concern the use of prescription medication DURING THE PAST 12 MONTHS, are any of the following true for you?
...You used alternative therapies to save money.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[goto ADENLONG]


Question ID: AAU.135_00.000

Instrument Variable Name: ADENLONG
QuestionText:
(book) A8
About 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, 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.
1 Yes
2 No
7 Refused
9 Don'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, have you seen or talked to any of the following health care providers about your own health?
...An optometrist, ophthalmologist (AHF-thal-MOL-oh-jist), or eye doctor (someone who prescribes eyeglasses).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[ goto AHCSY1_3]


Question ID: AAU.141_03.000

Instrument Variable Name: AHCSY1_3
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A foot doctor.
1 Yes
2 No
7 Refused
9 Don'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:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you
seen or talked to any of the following health care providers about your own health
...A chiropractor.
1 Yes
2 No
7 Refused
9 Don'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, have yohealth?
u seen or talked to any of the following health care providers about your own
...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D)[ goto AHCSY1_6]


Question ID: AAU.141_06.000

Instrument Variable Name: AHCSY1_6
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have yohealth?
u seen or talked to any of the following health care providers about your own
...A nurse practitioner, physician assistant, or midwife.
1 Yes
2 No
7 Refused
9 Don'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, 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).
1 Yes
2 No
7 Refused
9 Don'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, 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).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [go to AHCSY8_ 9]


Question ID: AAU.211_02.000

Instrument Variable Name: AHCSY8_ 9
QuestionText:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, 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)?
1 Yes
2 No
7 Refused
9 Don'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)?
1 Yes
2 No
7 Refused
9 Don'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) A9
DURING 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
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(0,R,D) [go to AHCHYR] (1-8) [goto AERVISND]


Question ID: AAU.243_00.010

Instrument Variable Name: AERVISND
QuestionText:
Thinking about your most recent emergency room visit, did you go to the emergency room either at night or on the weekend?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to AERHOS]


Question ID: AAU.245_00.010

Instrument Variable Name: AERHOS
QuestionText:
Did this emergency room visit result in a hospital admission?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year
SkipInstructions:
(1,R,D) [goto AHCHYR]
(2) [go to AERREAS1]


Question ID: AAU.248_01.010

Instrument Variable Name: AERREAS1
QuestionText:
Tell me which of these apply to your last emergency room visit?
... You didn't have another place to go
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AERREAS2]


Question ID: AAU.248_02.020

Instrument Variable Name: AERREAS2
QuestionText:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... Your doctor's office or clinic was not open
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AERREAS3]


Question ID: AAU.248_03.030

Instrument Variable Name: AERREAS3
QuestionText:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... Your health provider advised you to go
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AERREAS4]


Question ID: AAU.248_04.040

Instrument Variable Name: AERREAS4
QuestionText:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... The problem was too serious for the doctor's office or clinic
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AERREAS5]


Question ID: AAU.248_05.050

Instrument Variable Name: AERREAS5
QuestionText:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... Only a hospital could help you
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AERREAS6]


Question ID: AAU.248_06.060

Instrument Variable Name: AERREAS6
QuestionText:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
...the emergency room is your closest provider
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AERREAS7]


Question ID: AAU.248_07.070

Instrument Variable Name: AERREAS7
QuestionText:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
...you get most of your care at the emergency room
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AERREAS8]


Question ID: AAU.248_08.080

Instrument Variable Name: AERREAS8
QuestionText:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
...you arrived by ambulance or other emergency vehicle
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had at least one ER visit in the past year and the last visit did not result in a hospital admission
SkipInstructions:
(1,2,R,D) [goto AHCHYR]


Question ID: 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?
1 Yes
2 No
7 Refused
9 Don'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) A10
What 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
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions:
(1-8,R,D)[goto AHCNOYR]


Question ID: AAU.280_00.000

Instrument Variable Name: AHCNOYR
QuestionText:
(book) A9
DURING 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.
00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don'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.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1)[goto ASRGNOYR]
(2,R,D) [goto AMDLONG]


Question ID: 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:
(1-95,R,D) [goto AMDLONG]
(11-95) [goto ERR_ASGYR]
Soft Edit: * {ASRGYR} is an unusually large number.
* Please verify.


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.
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,R,D) [goto HIT1A] (1-5) [goto AVISLAST]


Question ID: AAU.306_00.010

Instrument Variable Name: AVISLAST
QuestionText:
Thinking about your last visit for any type of medical care, where did you go?
*Read categories if necessary.
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Urgent care center
6 Some other place
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have ever seen/talked to a doctor
SkipInstructions:
(1,2,4,6) [goto ALASTTYP]
(3,5) [goto AWAITRMN]
(R,D) [goto HIT1A]


Question ID: AAU.306_00.020

Instrument Variable Name: ALASTTYP
QuestionText:
Did you see a general doctor, a specialist, or someone else?
1 General doctor
2 Specialist
3 Someone else
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who visited a clinic, doctor's office/HMO, hospital outpatient department or someplace else (not ER or urgent care center) on their last visit
SkipInstructions:
(1-3,R,D) [goto AVISAPTN]


Question ID: AAU.307_01.010

Instrument Variable Name: AVISAPTN
QuestionText:
1 of 2
For this visit, how long did you have to wait between the time you made the appointment and the day you actually saw the doctor or other health professional?
*Enter '0' for same day , walk-in appointment , or no appointment made.
*Enter number for appointment wait time.
00 Same day
01-96 1-96
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who visited a clinic, doctor's office/HMO, hospital outpatient department or someplace else (not ER or urgent care center) on their last visit
SkipInstructions:
(0,R) [goto AWAITRMN]
(1-96,D) [goto AVISAPTT]


Question ID: AAU.307_02.020

Instrument Variable Name: AVISAPTT
QuestionText:
2 of 2
*Enter time period for appointment wait time.
1 Days
2 Weeks
3 Months
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who visited a clinic, doctor's office/HMO, hospital outpatient department or someplace else and gave a number or answered DK for length of time to make an appointment
SkipInstructions:
(1-3,R,D) [goto AWAITRMN]


Question ID: AAU.308_01.010

Instrument Variable Name: AWAITRMN
QuestionText:
1 of 2
How long did you have to wait in the waiting room before you saw a doctor or other health professional for this visit?
*Enter '0' for no wait time.
*Enter number for time in waiting room.
00 No time
01-96 1-96
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had a place of last medical visit
SkipInstructions:
(0,R) [goto HIT1A]
(1-96,D) [goto AWAITRMT]


Question ID: AAU.308_02.020

Instrument Variable Name: AWAITRMT
QuestionText:
2 of 2
*Enter time period for time in waiting room.
1 Minutes
2 Hours
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who had a place of last medical visit and did not refuse number portion of waiting room time
SkipInstructions:
(1,2,R,D) [goto HIT1A]


Question ID: AAU.309_00.010

Instrument Variable Name: HIT1A
QuestionText:
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following ...Look up health information on the Internet.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto HIT2A]


Question ID: AAU.309_00.020

Instrument Variable Name: HIT2A
QuestionText:
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
...Fill a prescription.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto HIT3A]


Question ID: AAU.309_00.030

Instrument Variable Name: HIT3A
QuestionText:
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
...Schedule an appointment with a health care provider.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto HIT4A]


Question ID: AAU.309_00.040

Instrument Variable Name: HIT4A
QuestionText:
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
...Communicate with a health care provider by email.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto HIT5A]


Question ID: AAU.309_00.050

Instrument Variable Name: HIT5A
QuestionText:
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
...Use online chat groups to learn about health topics.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto SHTFLUYR]


Question ID: AAU.310_00.000

Instrument Variable Name: SHTFLUYR
QuestionText:
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 last fall, or either of the two types available last season, one called "seasonal" and the other called "H1N1" or "swine" flu vaccine.
1 Yes
2 No
7 Refused
9 Don'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:
1 of 2
During what month and year did you receive your most recent flu shot?
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: 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:
2 of 2
*Enter year of most recent flu shot.
Year Year
9997 Refused
9999 Don't know
UniverseText: Sample adults 18+ who gave a month for their last 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 ]
*/ OLD INSTRUCTIONS BEFORE 10/25/04
(1880-2030,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
ERR1_ASHFLU_Y
Hard Edit:
*Future date invalid
ERR2_ASHFLU_Y
*Date before birth
ERR3_ASHFLU_Y
*Date more than 12 months ago


Question ID: AAU.315_00.000

Instrument Variable Name: SPRFLUYR
QuestionText:
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 last fall, or either of the two types available last season, one called "seasonal" and the other called "H1N1" or "swine" flu vaccine.
1 Yes
2 No
7 Refused
9 Don'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]
ERR1_SPRFLUYR
Soft Edit:
*Respondent says they have received both a flu shot and flu nasal vaccine.
*Please verify.
ERR2_SPRFLUYR
*Respondent says they have received a nasal vaccine to PREVENT the flu, not to TREAT symptoms of the flu.
*Please verify.


Question ID: AAU.318_01.000

Instrument Variable Name: ASPFLU_M
QuestionText:
1 of 2
During what month and year did you receive your most recent flu nasal spray?
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: 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:
2 of 2
*Enter year of most recent flu nasal spray.
Year Year
9997 Refused
9999 Don't know
UniverseText: Sample adults 18+ who gave a month for their 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
*/ OLD INSTRUCTIONS BEFORE 10/25/04
(1880-2030,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
/*
ERR1_ASPFLU_Y
Hard Edit:
*Future date invalid
ERR2_ASPFLU_Y
*Date before birth
ERR3_ASPFLU_Y
*Date more than 12 months ago


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.
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1) [goto APOX12MO]
(2,R,D) [goto AHEP]


Question ID: AAU.340_00.000

Instrument Variable Name: APOX12MO
QuestionText:
Have you had chickenpox in the PAST 12 MONTHS?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
SkipInstructions:
(1,2,R,D) [goto SHTHEPB]


Question ID: 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.
1 Yes
2 No
7 Refused
9 Don'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?
1 Received at least 3 doses
2 Received less than 3 doses
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1) [goto SHEPANUM]
(2,R,D) if AGE GE 50 goto SHINGLES
else goto SHTTD


Question ID: 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®?
1 Yes
2 No
7 Refused
9 Don'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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1) goto SHTTD05 (2,R,D) and AGE GT64 [goto LIVEV] Else if (2,R,D) and AGELT65 [goto HPVHRD]


Question ID: AAU.430_00.010

Instrument Variable Name: SHTTD05
QuestionText:
Was your most recent tetanus shot given in 2005 or later?
1 Yes
2 No
7 Refused
9 Don'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 elseif AGE gt 64 goto LIVEV(2,D) if AGE le 64 goto HPVHRD elseif AGE
gt 64 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).
1 Yes-included pertussis
2 No-did not include pertussis
3 Doctor did not say
7 Refused
9 Don'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 HPVHRD]


Question ID: AAU.442_00.010

Instrument Variable Name: HPVHRD
QuestionText:
Have you ever heard of HPV? HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults LE 64
SkipInstructions:
(1,2,R,D) [goto SHHPVHD1]


Question ID: AAU.444_00.010

Instrument Variable Name: SHHPVHD1
QuestionText:
Two vaccines, or shots, to prevent HPV infection are available in the United States. Both vaccines prevent cervical cancer and one also prevents genital warts. The two HPV vaccines are sometimes called CERVARIX® or GARDASIL®. Before this survey, have you ever heard of HPV vaccines or shots?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults LE 64
SkipInstructions:
(1,2,R,D) [goto SHTHPV1]


Question ID: AAU.446_00.010

Instrument Variable Name: SHTHPV1
QuestionText:
Have you ever received an HPV shot or vaccine?
1 Yes
2 No
3 Doctor refused when asked
7 Refused
9 Don't know
UniverseText: Sample adults LE 64
SkipInstructions:
(1) SHHPVDOS (2,3,R,D) [goto LIVEV]


Question ID: AAU.448_00.010

Instrument Variable Name: SHHPVDOS
QuestionText:
How many HPV shots did you receive?
* Enter '50' if 50 or more shots
* Enter '96' for all shots
01-49 1-49 shots
50 50+ shots
96 All shots
97 Refused
99 Don't know
UniverseText: Sample adults LE 64 who received an HPV shot
SkipInstructions:
(01-50,96,R,D) [goto LIVEV]
ERR_SHHPVDOS
* Shots should be in the range 1-50 or 96 for all shots.
* Please correct.


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?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto TRAVEL]


Question ID: 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?
1 Yes
2 No
7 Refused
9 Don'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.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1) [goto WRKDIR] (2,R,D) [goto APSBPCHK]


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.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who work or volunteer in a health-care setting
SkipInstructions:
(1,2,R,D) [goto APSBPCHK]


Question ID: AAU.500_00.010

Instrument Variable Name: APSBPCHK
QuestionText:
DURING THE PAST 12 MONTHS, have you had your blood pressure checked by a doctor, nurse, or other health professional?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto APSCHCHK]


Question ID: AAU.510_00.010

Instrument Variable Name: APSCHCHK
QuestionText:
DURING THE PAST 12 MONTHS, have you had your blood cholesterol checked by a doctor, nurse, or other health professional?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto APSBSCHK]


Question ID: AAU.520_00.010

Instrument Variable Name: APSBSCHK
QuestionText:
Have you had a fasting test for high blood sugar or diabetes DURING THE PAST 12 MONTHS?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) and SEX=1 and AGE GE 40 [goto APSCOL]
If (1,2,R,D) and SEX=1 and AGE LT 40 [goto APSDIET]
Else (1,2,R,D) and SEX=2 [goto APSPAP]


Question ID: AAU.530_00.010

Instrument Variable Name: APSPAP
QuestionText:
Have you had a Pap smear or Pap test DURING THE PAST 12 MONTHS?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Female sample adults 18+
SkipInstructions:
(1,2,R,D) if AGE GE 30 [goto APSMAM];
else (1,2,R,D) and AGELT30 [goto APSDIET]


Question ID: AAU.540_00.010

Instrument Variable Name: APSMAM Q
QuestionText:
Have you had a Mammogram DURING THE PAST 12 MONTHS?
*Read if necessary.
A mammogram is an x-ray of each breast to look for breast cancer.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Female sample adults 30+
SkipInstructions:
(1,2,R,D) if AGE GE 40 [gotoAPSCOL];
else (1,2,R,D) and AGELT40GT [goto APSDIET]


Question ID: AAU.550_00.010

Instrument Variable Name: APSCOL
QuestionText:
DURING THE PAST 12 MONTHS, have you had any test done for colon cancer?
*Read if necessary.
Colon cancer tests include blood stool tests, colonoscopy and sigmoidoscopy.
A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood.
A sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 40+
SkipInstructions:
(1,2,R,D) [goto APSDIET]


Question ID: AAU.560_00.010

Instrument Variable Name: APSDIET
QuestionText:
DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your diet?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) if SMKNOW in ('1','2') [goto APSSMKC];
else if (40LTEAGELTE65) [goto LTCFAM];
else [goto AINDINS]


Question ID: AAU.570_00.010

Instrument Variable Name: APSSMKC
QuestionText:
DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your smoking?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ currently who smoke every day or some days
SkipInstructions:
(1,2,R,D) if (40LTEAGELTE65) [goto LTCFAM];
else [goto AINDINS]


Question ID: AAU.580_00.010

Instrument Variable Name: LTCFAM
QuestionText:
Do you have a parent, spouse, sibling, or adult child who has needed help for at least a year with everyday needs like bathing, dressing or eating due to a long term condition?
*Read if necessary.
Due to a chronic illness or disability.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 40-65
SkipInstructions:
(1,2,R,D) [goto LTCHELP]


Question ID: AAU.582_00.010

Instrument Variable Name: LTCHELP
QuestionText:
How likely is it that you may someday need help with daily activities like bathing, dressing, eating, or using the toilet due to a long term condition? Would you say...
*Read categories below.
1 Very likely
2 Somewhat likely
3 Somewhat unlikely
4 Very unlikely
7 Refused
9 Don't know
UniverseText: Sample adults 40-65
SkipInstructions:
(1-4,R,D) [goto LTCWHO]


Question ID: AAU.584_00.010

Instrument Variable Name: LTCWHO
QuestionText:
If you needed such help, who would provide this help?
*Enter all that apply, separate with commas.
1 My family
2 Someone I hire
3 Home health care organization
4 Nursing home/assisted living
5 Other
7 Refused
9 Don't know
UniverseText: Sample adults 40-65
SkipInstructions:
(1-5,R,D) [goto LTCPRCH]


Question ID: AAU.586_00.010

Instrument Variable Name: LTCPRCH
QuestionText:
Health Care Reform establishes a voluntary, government-run insurance program to pay for help with everyday needs like bathing, dressing or eating. People will be able to enroll, and pay a monthly premium. Once they need care they would receive an average of $50 each day. Would you be interested in purchasing this insurance?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 40-65
SkipInstructions:
(1,D) [goto LTCPAY]
(2,R) [goto AINDINS]


Question ID: AAU.588_00.010

Instrument Variable Name: LTCPAY
QuestionText:
How much would you be willing to pay per month NOW to receive this benefit later in life?
01 $1-$24 per month
02 $25-$49 per month
03 $50-$74 per month
04 $75-$99 per month
05 $100-$124 per month
06 $125 per month or more
07 Nothing/Not interested in the program
97 Refused
99 Don't know
UniverseText: Sample adults 40-65 who would be interested in purchasing long-term care insurance or don't know if they are
interested
SkipInstructions:
(1-7,R) [goto AINDINS]
(D) [goto LTC100M]


Question ID: AAU.590_00.010

Instrument Variable Name: LTC100M
QuestionText:
How likely would it be for you to pay $100 per month for this insurance? Would you say...
*Read categories below.
1 Very likely
2 Somewhat likely
3 Somewhat unlikely
4 Very unlikely
7 Refused
9 Don't know
UniverseText: Sample adults 40-65 who don't know how much they would be willing to pay per month for long-term care insurance
SkipInstructions:
(1-4,R,D) [goto AINDINS]


Question ID: AAU.600_00.010

Instrument Variable Name: AINDINS
QuestionText:
DURING THE PAST 3 YEARS, did you try to purchase health insurance directly, that is, not through any employer, union, or government program?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1) [goto AINDPRCHGT
(2,R,D) [goto HIVTST1]


Question ID: AAU.600_00.020

Instrument Variable Name: AINDPRCH
QuestionText:
Was a plan purchased?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who tried to purchase health insurance directly in the past 3 years
SkipInstructions:
(1) [goto AINDWHO]
(2) [goto AINDNOT]
(R,D) [goto HIVTST1]


Question ID: AAU.600_00.030

Instrument Variable Name: AINDWHO
QuestionText:
Was this plan for yourself, someone else in your family, or both?
1 Self
2 Someone else in family
3 Both
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:
(1-3,R,D) [goto AINDDIF1]


Question ID: AAU.600_00.040

Instrument Variable Name: AINDDIF1
QuestionText:
How difficult was it to find a plan with the type of coverage you needed? Would you say...
*Read categories below.
1 Very difficult
2 Somewhat difficult
3 Not at all difficult
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:
(1-3,R,D) [goto AINDDIF2]


Question ID: AAU.600_00.050

Instrument Variable Name: AINDDIF2
QuestionText:
How difficult was it to find a plan you could afford? Would you say...
*Read categories below.
1 Very difficult
2 Somewhat difficult
3 Not at all difficult
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:
(1-3,R,D) [goto AINDENY1]


Question ID: AAU.600_01.060

Instrument Variable Name: AINDENY1
QuestionText:
Did any company turn you down when you tried to buy coverage on your own ?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:
(1,2,R,D) [goto AINDENY2]


Question ID: AAU.600_02.060

Instrument Variable Name: AINDENY2
QuestionText:
Did any company charge a higher price because of {fill 1: your/your family's/you or your family's} health?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:
(1,2,R,D) [goto AINDENY3]


Question ID: AAU.600_03.060

Instrument Variable Name: AINDENY3
QuestionText:
Did any company exclude a specific health problem from the coverage?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:
(1,2,R,D) [goto HIVTST1]


Question ID: AAU.601_00.070

Instrument Variable Name: AINDNOT
QuestionText:
Why did you not buy the plan?
*Enter all that apply, separate with commas.
1 Turned down
2 Cost
3 Pre-existing condition
4 Got health insurance from other source
5 Other
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who tried but did not purchase health insurance directly in the past 3 years
SkipInstructions:
(1-4,R,D) [goto HIVTST1]
(5) [goto AINDNTSP]
Question ID: AAU.601_00.080

Instrument Variable Name: AINDNTSP
QuestionText:
*Specify other reason plan was not obtained.
Verbatim Verbatim response
UniverseText: Sample adults 18+ who had other reason plan was not purchased
SkipInstructions:
(allow 75,R,D) [goto HIVTST1]


Question ID: AAU.700_00.000

Instrument Variable Name: HIVTST1
QuestionText:
The next question is about the test for HIV (the virus that causes AIDS).
Except for tests you may have had as part of blood donations, have you ever been tested for HIV?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions:
(1,2,R,D) [goto next section]