2012 NHIS Questionnaire: Sample Child
Child Identification

Document Version Date: 23-May-13

Question ID:: CID.001_00.000

Instrument Variable Name:: CURRES
QuestionText:

* Enter the line number of the person to whom you are speaking.

01-25 Person number of the respondent for Sample Child

UniverseText: Sample child section not started or not completed
SkipInstructions:

if CSTAT ne empty and CSTAT ne '2' THEN
if ASTAT = empty or ASTAT = '2' THEN
goto adult.aid.SADULT
elseif recontact.RCIFLAG ne '1' THEN
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif
goto back.OUTCOMEB1 procedure
endif
(01-25) if this is NOT an allowable line number
goto ERR_CURRES
elseif CURRES = a line number entered in KNOWSC2
store CURRES in CSPAVAIL and CSRESP
goto CSRELTIV
elseif KNOWSC2 = 'Don't know' or 'Refused' or empty (no line numbers in KNOWSC2)
goto KNOAVAIL
else
goto CSPAVAIL
endif
Hard Edit: ERR_CURRES
* You have selected a non-selectable person.
* Please correct.

Question ID:: CID.010_00.000

Instrument Variable Name:: CSPAVAIL
QuestionText:

The next questions are about [fill1: ALIAS of Sample Child]. Is [fill2:KNOWSC2 names] available to answer some questions about [fill3: HISHER] health?
* Enter line number of available respondent from list or enter '96' if no one is available.
* If refused enter CTRL_R.

01-25 Person # of person available to answer questions about Sample Child
96 No person available

UniverseText: Someone identified as knowledgeable about child's health and knowledgeable person(s) not entered in CURRES
SkipInstructions:

(01-25) if line number not equal one of the line numbers in KNOWSC2 goto child.cid.ERR_CSPAVAIL
else store child.cid.CSPAVAIL in child.cid.CSRESP
goto child.cid.CSRELTIV
endif
(96) store child.cid.CSPAVAIL in child.cid.CSRESP
goto cbk.CCALLBK1
(R) store '4' in CSTAT(FAMINT)
if ASTAT = empty or ASTAT = '2' THEN
goto adult.aid.SADULT
else if recontact.RCIFLAG ne '1' THEN
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif

Hard Edit: ERR_CSPAVAIL

* You have selected a non-selectable person.
* Please correct.

Question ID:: CID.030_00.000

Instrument Variable Name:: CSRELTIV
QuestionText:

(book) C1 [fill1: The next questions are about [fill2: ALIAS of Sample Child].] What is your relationship to [fill2: ALIAS of Sample Child]?

01 Parent (Biological, adoptive, or step)
02 Grandparent
03 Aunt/Uncle
04 Brother/Sister
05 Other relative
06 Legal guardian
07 Foster parent
08 Other non-relative
97 Refused
99 Don't know

UniverseText: Someone identified as knowledgeable about child's health
SkipInstructions:

(1-8,R,D) If CSRESP = demographics.hhc.RELRESP_A
goto child.chs.BWGT_LB
elseif CSRESP = demographics.hhc.HHRESP
goto child.chs.BWGT_LB
else]
goto CSPVERF_S
endif]

Question ID:: CID.040_00.000

Instrument Variable Name:: CSPVERF_S
QuestionText:

* Please verify the following information about the sample child before proceeding: I have recorded [fill1: ALIAS of Sample Child]'s sex as [fill2: Sex of Sample Child]. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

UniverseText: Respondent is not the person entered in HHRESP or RELRESP_A.
SkipInstructions:

(1) goto CSPVERF_A
(2) goto NEWSEX

Question ID:: CID.041_00.000

Instrument Variable Name:: NEWSEX
QuestionText:

* Ask if appropriate; otherwise, enter your best guess of the person's sex. Is [fill: ALIAS of Sample Child] Male or Female?

1 Male
2 Female

UniverseText: Respondent said child's sex is not correct.
SkipInstructions:

(1,2) store NEWSEX in SEX
goto ERR_NEWSEX
reset CSPVERF_S
goto CSPVERF_S

Hard Edit: ERR_NEWSEX

* The gender will now be changed to [fill: NEWSEX].

goto CSPVERF_S (as the default goto )

Question ID:: CID.042_00.000

Instrument Variable Name:: CSPVERF_A
QuestionText:

* Please verify the following information about the sample child before proceeding: I have recorded [fill1: ALIAS of Sample Child]'s age as [fill2: Age of Sample Child] old. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

UniverseText: Respondent verified child's sex
SkipInstructions:

(1) goto CSPVERF_D
(2) goto NEWAGE

Question ID:: CID.043_00.000

Instrument Variable Name:: NEWAGE
QuestionText:

How old is [fill1: ALIAS of Sample Child]?
* If age given in months, weeks, or days, convert age to appropriate year. If less than one year old, enter "0".

000-120 Age in years

UniverseText: Respondent said child's age is not correct
SkipInstructions:

(0-120, Refused, Don't know)

if NEWAGE = 'Refused' or NEWAGE = 'Don't know' or NEWAGE = AGE
reset CSPVERF_A
goto ERR_NEWAGE
else
store NEWAGE in AGE
goto NEWDOB_M

Hard Edit: ERR_NEWAGE

*Age of [fill1: ALIAS of Sample Child] remains [fill2: Age of Sample Child] years old.

goto CSPVERF_A (whether suppressed or not)

Question ID:: CID.044_00.000

Instrument Variable Name:: CSPVERF_D
QuestionText:

* Please verify the following information about the sample child before proceeding: I have recorded [fill1: ALIAS of Sample Child]'s birthday as [fill2: Birthday of Sample Child]. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".

1 Yes
2 No

UniverseText: Respondent verified child's sex
SkipInstructions:

(1) if AGE of Sample Child ge '18'
goto CNO_MORE
else
goto child.chs.BWGT_LB
endif
(2) goto NEWDOB_M

Question ID:: CID.046_01.000

Instrument Variable Name:: NEWDOB_M
QuestionText:

1 of 3 What is [fill: ALIAS of Sample Child]'s birthday?
*Enter month of birth.

1 January
10 October
11 November
12 December
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September

UniverseText: Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:

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

Question ID:: CID.046_02.000

Instrument Variable Name:: NEWDOB_D
QuestionText:

2 of 3 * Enter day of birth.

01-31 Day of the month

UniverseText: Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:

(01-31,Refused,Don't know) goto NEWDOB_Y

If days not valid, goto ERR_NEWDOB_D

Hard Edit: ERR_NEWDOB_D

* [fill2: NEWDOB_D] is not a valid day for [fill3: NEWDOB_M].
* Please correct.

Question ID:: CID.046_03.000

Instrument Variable Name:: NEWDOB_Y
QuestionText:

3 of 3 * Enter year of birth.

1880-2020 Year of birth

UniverseText: Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:

(1880-2020, Refused, Don't know) if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty
goto CSPVERF_A
elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty
goto CSPVERF_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_NEWDOB_Y
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
goto ERR2_NEWDOB_Y
endif
(if NEWDOB_M = 'Ref' or 'DK') or (if NEWDOB_D = 'Ref' or 'DK') or (if NEWDOB_Y = 'Ref' or 'DK')
goto ERR3_NEWDOB_Y
else
store NEWDOB_M in DOBM
store NEWDOB_D in DOBD
store NEWDOB_Y in DOBY
if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty
goto CSPVERF_A
elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty
goto CSPVERF_D
endif
endif
Calculate age from NEWDOB_M, NEWDOB_D, and NEWDOB_Y.
if age from NEWDOB items is ne AGE and age from NEWDOB items is valid
reset CSPVERF_A or CSPVERF_D
goto ERR4_NEWDOB_Y
endif

Hard Edit: ERR1_NEWDOB_Y

*Future date invalid: [fill2: (NEWDOB_M) (NEWDOB_D), (NEWDOB_Y)]
*Please correct.

goto NEWDOB_M (whether suppressed or not)

ERR2_NEWDOB_Y

*Not a valid day: [fill2: (NEWDOB_M) (NEWDOB_D), (NEWDOB_Y)]
*Please correct.

goto NEWDOB_M (whether suppressed or not)

ERR3_NEWDOB_Y

*DOB of [fill1: ALIAS of Sample Child] remains [fill3: (DOBM) (DOBD), (DOBY)]

goto CSPVERF_A

ERR4_NEWDOB_Y

*Data mismatched. Please fix Age or Birthday.
goto CSPVERF_A (whether suppressed or not)

Question ID:: CHS.010_01.000

Instrument Variable Name:: BWGT_LB
QuestionText:

?[F1] What was [fill: S.C.name]'s birth weight?
* Enter 'M' to record metric measurements.

01-15 1-15 pounds
97 Refused
99 Don't know
M Metric

UniverseText: Sample children LT 18
SkipInstructions:

(1-12) [goto BWGT_OZ]
(13-15) [goto ERR1_BWGT_LB]
(R,D) [goto CHGT_FT]
(M) [goto BWGT_GR]
[If NE (1-15, M, D, R) goto ERR2_BWGT_LB]

Hard Edit: ERR2_BWGT_LB

* Only "1-15" or "M" or "Don't know/Refused" allowed in this field.
* Please correct.

Soft Edit: ERR1_BWGT_LB

* [fill: BWGT_LB] is an unusually high number.
* Please verify.

Question ID:: CHS.010_02.000

Instrument Variable Name:: BWGT_OZ
QuestionText:

* Enter ounces.

00-15 0-15 ounces
97 Refused
99 Don't know
Blank Blank

UniverseText: Sample children LT 18 who have a value entered for weight in pounds.
SkipInstructions:

(0-15,R,D) [goto CHGT_FT]
[if BWGT_LB = (0-15, D, R) and BWGT_OZ = (empty) goto CHGT_FT]

Question ID:: CHS.011_00.000

Instrument Variable Name:: BWGT_GR
QuestionText:

* Enter weight in grams.

0500 500 grams or less
0501-6899 501-6899 grams
6900 6900+ grams
9997 Refused
9999 Don't know

UniverseText: Sample children LT 18 whose birth weight will be entered in metric.
SkipInstructions:

(500-5485, R,D) [goto CHGT_FT]
(5486-6900) [goto ERR_BWGT_GR]

Soft Edit: ERR_BWGT_GR

* [fill1: BWGT_GR] is an unusually high number (equal to [fill2] pounds, [fill3] ounces).
* Please verify.

Question ID:: CHS.020_01.000

Instrument Variable Name:: CHGT_FT
QuestionText:

?[F1] How tall is [fill: S.C. name] now (without shoes)?
* If the child's height is given in inches, press 'ENTER' at feet and enter the measure in inches (36 inches maximum).
* Enter 'M' to record metric measurements.

00-07 0-7 feet
97 Refused
99 Don't know
M Metric

UniverseText: Sample children 12+
SkipInstructions:

(empty) [goto CHGT_IN]
(0-7) [goto CHGT_IN]
(R,D) [goto CWGT_LB]
(M) [goto CHGT_M]
[If NE (0-7, M, D, R) goto ERR_CHGT_FT]

Hard Edit: ERR_CHGT_FT

* Only "0-7" or "M" or "Don't know/Refused" allowed in this field.
* Please correct.

Question ID:: CHS.020_02.000

Instrument Variable Name:: CHGT_IN
QuestionText:

* Enter inches.

00-36 0-36 inches
97 Refused
99 Don't know

UniverseText: Sample children 12+ whose height in feet is 0-7 or is left empty.
SkipInstructions:

(0-36,R,D) If (CHGT_FT = '0', 'empty') and (CHGT_IN = '0', 'empty')
goto ERR1_CHGT_IN
elseif CHGT_FT = '1-7' and CHGT_IN ge '12'
goto ERR2_CHGT_IN

elseif (SEX = '1' and
AGE = '12' and (CHTINCH lt '53' or CHTINCH gt '68')) or
AGE = '13' and (CHTINCH lt '55' or CHTINCH gt '72')) or
AGE = '14' and (CHTINCH lt '58' or CHTINCH gt '73')) or
AGE = '15' and (CHTINCH lt '60' or CHTINCH gt '74')) or
AGE = '16' and (CHTINCH lt '61' or CHTINCH gt '74')) or
AGE = '17' and (CHTINCH lt '62' or CHTINCH gt '75')) or

(SEX = '2' and
AGE = '12' and (CHTINCH lt '54' or CHTINCH gt '68')) or
AGE = '13' and (CHTINCH lt '55' or CHTINCH gt '69')) or
AGE = '14' and (CHTINCH lt '57' or CHTINCH gt '69')) or
AGE = '15' and (CHTINCH lt '57' or CHTINCH gt '69')) or
AGE = '16' and (CHTINCH lt '57' or CHTINCH gt '70')) or
AGE = '17' and (CHTINCH lt '57' or CHTINCH gt '69'))

goto ERR3_CHGT_IN
else
goto CWGT_LB

Hard Edit: ERR1_CHGT_IN

* Must enter an answer in at least the inches item.
* Please correct.
ERR2_CHGT_IN

* Number of inches exceeds maximum allowed.
* Please correct.

Soft Edit: ERR3_CHGT_IN

* Please verify that the height was entered correctly. Probe only if necessary.

Question ID:: CHS.021_01.000

Instrument Variable Name:: CHGT_M
QuestionText:

* Enter height in metric.
* If the child's height is given in centimeters, press 'ENTER' at meters and enter the measure in centimeters (241 centimeters maximum).

0-2 0-2 meters
7 Refused
9 Don't know
Blank Blank

UniverseText: Sample children 12+ whose current height will be entered in metric.
SkipInstructions:

(0-2,empty) [goto CHGT_CM]
(R,D) [goto CWGT_LB]

Question ID:: CHS.021_02.000

Instrument Variable Name:: CHGT_CM
QuestionText:

* Enter centimeters.

000-241 0-241 centimeters
Blank Blank

UniverseText: Sample children 12+ whose weight will be entered in metric, and who entered "0-2" for height in meters or left it empty.
SkipInstructions:

(0-241,R,D) If (CHGT_M = '0', 'empty') and (CHGT_CM = '0', 'empty')
goto ERR1_CHGT_CM
elseif (CHGT_M eq '2' and CHGT_CM gt '41') or (CHGT_M eq '1' and CHGT_CM gt '141')
goto ERR2_CHGT_CM

elseif (SEX = '1' and
AGE = '12' and (CHTCM lt '137' or CHTCM gt '174')) or
AGE = '13' and (CHTCM lt '140' or CHTCM gt '184')) or
AGE = '14' and (CHTCM lt '148' or CHTCM gt '186')) or
AGE = '15' and (CHTCM lt '152' or CHTCM gt '189')) or
AGE = '16' and (CHTCM lt '156' or CHTCM gt '189')) or
AGE = '17' and (CHTCM lt '157' or CHTCM gt '192')) or

(SEX = '2' and
AGE = '12' and (CHTCM lt '138' or CHTCM gt '173')) or
AGE = '13' and (CHTCM lt '141' or CHTCM gt '176')) or
AGE = '14' and (CHTCM lt '145' or CHTCM gt '176')) or
AGE = '15' and (CHTCM lt '145' or CHTCM gt '177')) or
AGE = '16' and (CHTCM lt '145' or CHTCM gt '177')) or
AGE = '17' and (CHTCM lt '145' or CHTCM gt '176'))

goto ERR3_CHGT_CM
else
goto CWGT_LB

Hard Edit: ERR1_CHGT_CM

* Must enter an answer at least in the centimeters item.
* Please correct.
ERR2_CHGT_CM

* Total height exceeds maximum allowed.
* Please correct.

Soft Edit: ERR3_CHGT_CM

* Please verify that the height was entered correctly. Probe only if necessary.

Question ID:: CHS.022_00.000

Instrument Variable Name:: CWGT_LB
QuestionText:

How much does [fill: S.C. name] weigh now (without shoes)?
* Enter 'M' to record metric measurements.
* Enter '500' if 500 pounds or more.

001-500 1-500 pounds
997 Refused
999 Don't know
M Metric

UniverseText: Sample children 12+
SkipInstructions:

(1-500) if CWGT_LB lt '1' or CWGT_LB gt '500'
goto ERR1_CWGT_LB
elseif (SEX = '1' and
AGE = '12' and (CWGT_LB lt '62' or CWGT_LB gt '209')) or
AGE = '13' and (CWGT_LB lt '70' or CWGT_LB gt '247')) or
AGE = '14' and (CWGT_LB lt '83' or CWGT_LB gt '266')) or
AGE = '15' and (CWGT_LB lt '94' or CWGT_LB gt '267')) or
AGE = '16' and (CWGT_LB lt '98' or CWGT_LB gt '306')) or
AGE = '17' and (CWGT_LB lt '106' or CWGT_LB gt '317')) or
(SEX = '2' and
AGE = '12' and (CWGT_LB lt '62' or CWGT_LB gt '212')) or
AGE = '13' and (CWGT_LB lt '73' or CWGT_LB gt '238')) or
AGE = '14' and (CWGT_LB lt '84' or CWGT_LB gt '252')) or
AGE = '15' and (CWGT_LB lt '84' or CWGT_LB gt '238')) or
AGE = '16' and (CWGT_LB lt '87' or CWGT_LB gt '257')) or
AGE = '17' and (CWGT_LB lt '90' or CWGT_LB gt '292'))
goto ERR2_CWGT_LB
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE ge '2'
goto ADD_1
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE lt '2'
goto ADD1_2
else
calculate the BMI (Body Mass Index)
(R,D) if AGE ge '2'
goto ADD_1
else
goto ADD1_2
(M) goto CWGT_KG

Hard Edit: ERR1_CWGT_LB

* Weight is out of range (1-500).
* Please correct.

Soft Edit: ERR2_CWGT_LB

* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID:: CHS.023_00.000

Instrument Variable Name:: CWGT_KG
QuestionText:

* Enter weight in kilograms.

002-226 2-226 kilograms

UniverseText: Sample children 12+ whose weight will be entered in metric.
SkipInstructions:

(2-226) if CWGT_KG lt '2' or CWGT_KG gt '226'
goto ERR1_CWGT_KG
elseif (SEX = '1' and
AGE = '12' and (CWGT_KG = '28' or CWGT_KG = '95')) or
AGE = '13' and (CWGT_KG = '32' or CWGT_KG = '112')) or
AGE = '14' and (CWGT_KG = '38' or CWGT_KG = '121')) or
AGE = '15' and (CWGT_KG = '42' or CWGT_KG = '121')) or
AGE = '16' and (CWGT_KG = '44' or CWGT_KG = '139')) or
AGE = '17' and (CWGT_KG = '48' or CWGT_KG = '144')) or
(SEX = '2' and
AGE = '12' and (CWGT_KG = '28' or CWGT_KG = '96')) or
AGE = '13' and (CWGT_KG = '33' or CWGT_KG = '108')) or
AGE = '14' and (CWGT_KG = '38' or CWGT_KG = '114')) or
AGE = '15' and (CWGT_KG = '38' or CWGT_KG = '108')) or
AGE = '16' and (CWGT_KG = '39' or CWGT_KG = '117')) or
AGE = '17' and (CWGT_KG = '41' or CWGT_KG = '133'))
goto ERR2_CWGT_KG
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE ge '2'
goto ADD_1
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE lt '2'
goto ADD1_2
else
calculate the BMI (Body Mass Index)
(R,D) if AGE ge '2'
goto ADD_1
else
goto ADD1_2

Hard Edit: ERR1_CWGT_KG

* Weight is out of range (2-226).
* Please correct.

Soft Edit: ERR2_CWGT_KG

* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID:: CHS.031_02.000

Instrument Variable Name:: ADD1_2
QuestionText:

Has a doctor or health professional ever told you that [fill: S.C. name] had_ an intellectual disability, also known as mental retardation?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto ADD1_3]

Question ID:: CHS.031_03.000

Instrument Variable Name:: ADD1_3
QuestionText:

?[F1] * Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had... Any other developmental delay?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 2
SkipInstructions:

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

Question ID:: CHS.032_01.000

Instrument Variable Name:: ADD_1
QuestionText:

?[F1] Has a doctor or health professional ever told you that [fill: S.C. name] had... Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 2-17
SkipInstructions:

(1,2,R,D) [goto ADD_2]

Question ID:: CHS.032_02.000

Instrument Variable Name:: ADD_2
QuestionText:

* Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had_. an intellectual disability, also known as mental retardation?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 2-17
SkipInstructions:

(1,2,R,D) [goto ADD_3]

Question ID:: CHS.032_03.000

Instrument Variable Name:: ADD_3
QuestionText:

?[F1] * Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had... Any other developmental delay?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 2-17
SkipInstructions:

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

Question ID:: CHS.060_00.000

Instrument Variable Name:: CONDL
QuestionText:

(book) C2 ?[F1] Looking at this list, has a doctor or health professional ever told you that [fill: SC name] had any of these conditions?
*Read if necessary.
Down syndrome
Cerebral palsy
Muscular dystrophy
Cystic fibrosis
Sickle cell anemia
Autism/Autism spectrum disorder
Diabetes
Arthritis
Congenital heart disease
Other heart condition

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto CONDL1]
(2,R,D) [goto CPOX]

Question ID:: CHS.061_00.000

Instrument Variable Name:: CONDL1
QuestionText:

(book) C2 ?[F1] Which ones?
* Enter all that apply, separate with commas.

01 Down syndrome
02 Cerebral palsy
03 Muscular dystrophy
04 Cystic fibrosis
05 Sickle cell anemia
06 Autism/Autism spectrum disorder
07 Diabetes
08 Arthritis
09 Congenital heart disease
10 Other heart condition

UniverseText: Sample children LT 18 and CONDL=1
SkipInstructions:

(1-10, R,D) [goto CPOX]

Question ID:: CHS.070_00.000

Instrument Variable Name:: CPOX
QuestionText:

Has [fill: SC Name] EVER had chickenpox?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto CPOX12MO]
(2, D, R) [goto CASHMEV]

Question ID:: CHS.072_00.000

Instrument Variable Name:: CPOX12MO
QuestionText:

Has [fill: SC name] had chickenpox DURING THE PAST 12 MONTHS?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 who have had chickenpox
SkipInstructions:

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

Question ID:: CHS.080_00.000

Instrument Variable Name:: CASHMEV
QuestionText:

? [F1] Has a doctor or other health professional EVER told you that [fill: SC name] had asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto CASSTILL]
(2,R,D) if AGE GE 6 [goto CHPYR];
else if AGE = 4-5 [goto CFLUPNYR];
else if AGE LE 2 [goto CCONDT1_1];
else [goto CCONDT_1]

Question ID:: CHS.085_00.000

Instrument Variable Name:: CASSTILL
QuestionText:

Does [fill: SC name] still have asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:

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

Question ID:: CHS.090_00.000

Instrument Variable Name:: CASHYR
QuestionText:

The following questions are about [fill: SC name]'s asthma DURING THE PAST 12 MONTHS. DURING THE PAST 12 MONTHS, has [fill: SC name] had an episode of asthma or an asthma attack?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:

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

Question ID:: CHS.100_00.000

Instrument Variable Name:: CASMERYR
QuestionText:

DURING THE PAST 12 MONTHS, did [fill1: SC name] have to visit an emergency room or urgent care center because of [fill2: his/her] asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:

(1,2,R,D) if AGE GE 6 [goto CHPYR]; else if AGE = 4-5 [goto CFLUPNYR]; else if AGE LE 2 [goto CCONDT1_1]; else [goto CCONDT_1]

Question ID:: CHS.105_00.010

Instrument Variable Name:: CHPYR
QuestionText:

DURING THE PAST 12 MONTHS, has a doctor or other health professional told you that [fill1: S.C. name] had _Hypertension, also called high blood pressure?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

(1) [goto CHYPMED]
(2,R,D) [goto CCHLYR]

Question ID:: CHS.105_00.020

Instrument Variable Name:: CHYPMED
QuestionText:

Does [fill: S.C. name] take prescription medication to control [fill2: his/her] blood pressure?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+ who were ever told they had hypertension
SkipInstructions:

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

Question ID:: CHS.105_00.030

Instrument Variable Name:: CCHLYR
QuestionText:

DURING THE PAST 12 MONTHS, has a doctor or other health professional told you that [fill1: S.C. name] had _High cholesterol?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.106_00.010

Instrument Variable Name:: CFLUPNYR
QuestionText:

DURING THE PAST 12 MONTHS, has a doctor or other health professional told you that [fill1: S.C. name] had _Influenza or pneumonia?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.106_00.020

Instrument Variable Name:: CCONMED
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has a doctor or other health professional told you that [fill1: S.C. name] had _Constipation severe enough to require medication?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.106_00.030

Instrument Variable Name:: CSINYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has a doctor or other health professional told you that [fill1: S.C. name] had _Sinusitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.106_00.040

Instrument Variable Name:: CSTREPYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has a doctor or other health professional told you that [fill1: S.C. name] had _Strep throat or tonsillitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

(1,2,R,D) [goto CCONDT_1]

Question ID:: CHS.111_01.000

Instrument Variable Name:: CCONDT1_1
QuestionText:

DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Hay fever?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

(1,2,R,D) [goto CCONDT1_2]

Question ID:: CHS.111_02.000

Instrument Variable Name:: CCONDT1_2
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Any kind of respiratory allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

(1,2,R,D) [goto CCONDT1_3]

Question ID:: CHS.111_03.000

Instrument Variable Name:: CCONDT1_3
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Any kind of food or digestive allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

(1,2,R,D) [goto CCONDT1_4]

Question ID:: CHS.111_04.000

Instrument Variable Name:: CCONDT1_4
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Eczema or any kind of skin allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

(1,2,R,D) [goto CCONDT1_5]

Question ID:: CHS.111_05.000

Instrument Variable Name:: CCONDT1_5
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Frequent or repeated diarrhea or colitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

(1,2,R,D) [goto CCONDT1_6]

Question ID:: CHS.111_06.000

Instrument Variable Name:: CCONDT1_6
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Anemia?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

(1,2,R,D) [goto CCONDT1_8]

Question ID:: CHS.111_08.000

Instrument Variable Name:: CCONDT1_8
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Three or more ear infections?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

(1,2,R,D) [goto CCONDT1_9]

Question ID:: CHS.111_09.000

Instrument Variable Name:: CCONDT1_9
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Seizures?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LE 2
SkipInstructions:

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

Question ID:: CHS.115_01.000

Instrument Variable Name:: CCONDT_1
QuestionText:

DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Hay fever?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_2]

Question ID:: CHS.115_02.000

Instrument Variable Name:: CCONDT_2
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Any kind of respiratory allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_3]

Question ID:: CHS.115_03.000

Instrument Variable Name:: CCONDT_3
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Any kind of food or digestive allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_4]

Question ID:: CHS.115_04.000

Instrument Variable Name:: CCONDT_4
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Eczema or any kind of skin allergy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_5]

Question ID:: CHS.115_05.000

Instrument Variable Name:: CCONDT_5
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Frequent or repeated diarrhea or colitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_6]

Question ID:: CHS.115_06.000

Instrument Variable Name:: CCONDT_6
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Anemia?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_7]

Question ID:: CHS.115_07.000

Instrument Variable Name:: CCONDT_7
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Frequent or severe headaches, including migraines?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_8]

Question ID:: CHS.115_08.000

Instrument Variable Name:: CCONDT_8
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Three or more ear infections?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_9]

Question ID:: CHS.115_09.000

Instrument Variable Name:: CCONDT_9
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Seizures?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) [goto CCONDT_10]

Question ID:: CHS.115_10.000

Instrument Variable Name:: CCONDT_10
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions... Stuttering or stammering?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children = 3-17
SkipInstructions:

(1,2,R,D) if AGE GE 6 [goto CHEADYR];
else if AGE = 4-5 [goto CTHOTHYR];
else [goto CHSTATYR]

Question ID:: CHS.120_00.010

Instrument Variable Name:: CHEADYR
QuestionText:

DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Recurring headache, other than migraine?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.020

Instrument Variable Name:: CABDOMYR
QuestionText:

*Read if necessary.
DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Abdominal pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.030

Instrument Variable Name:: CJNTSYMP
QuestionText:

DURING THE PAST 30 DAYS, has [fill1: S.C. name] 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 children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.040

Instrument Variable Name:: CPAINECK
QuestionText:

DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Neck pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.050

Instrument Variable Name:: CPAINLB
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Low back pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.060

Instrument Variable Name:: CMUSCLYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Other muscle or bone pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.070

Instrument Variable Name:: CSPNYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Any severe sprains or strains?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.080

Instrument Variable Name:: CDENYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Dental pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.090

Instrument Variable Name:: CPNOTHYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Other chronic pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.120_00.100

Instrument Variable Name:: COVRWTYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Problems with being overweight?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.125_00.010

Instrument Variable Name:: CTHOTHYR
QuestionText:

DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Sore throat other than strep or tonsillitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.125_00.020

Instrument Variable Name:: CFEVRYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Fever more than one day?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.125_00.030

Instrument Variable Name:: CCOLDYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _A head or chest cold?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.125_00.040

Instrument Variable Name:: CNAUSYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Nausea and/or vomiting?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.125_00.050

Instrument Variable Name:: CFATIGYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Fatigue or lack of energy more than three days?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.125_00.060

Instrument Variable Name:: CFATYR
QuestionText:

DURING THE PAST 12 MONTHS, has [fill1: S.C name] _Regularly had excessive sleepiness during the day?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.125_00.070

Instrument Variable Name:: CINSYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] _Regularly had insomnia or trouble sleeping?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4+
SkipInstructions:

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

Question ID:: CHS.210_00.000

Instrument Variable Name:: CHSTATYR
QuestionText:

Compared with 12 months ago, would you say [fill: SC name]'s health is now better, worse, or about the same?

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

UniverseText: Sample children LT 18
SkipInstructions:

(1-3,R,D) [if AGE le (4) goto CCOLD2W; else goto SCHDAYR]

Question ID:: CHS.220_00.000

Instrument Variable Name:: SCHDAYR
QuestionText:

DURING THE PAST 12 MONTHS about how many days did [fill2: SC name] miss school because of illness or injury?
* Enter '996' if child did not goto school in the past 12 months.

000 None
001-240 1-240 days
996 Did not goto school
997 Refused
999 Don't know

UniverseText: Sample children 5-17
SkipInstructions:

(0-99,996,R,D) [goto CCOLD2W]
(100-240) [goto ERR1_SCHDAYR]
(241-995) [goto ERR2_SCHDAYR]

Hard Edit: ERR2_SCHDAYR

* "241-995" days not allowed in this field.
* Please correct.

Soft Edit: ERR1_SCHDAYR

[fill4: SCHDAYR] is an unusually large number. Did [fill2: SC name] miss [fill: SCHDAYR] days of school because of illness or injury?

* Please verify.

Question ID:: CHS.230_00.000

Instrument Variable Name:: CCOLD2W
QuestionText:

These next questions are about [fill: SC name]'s recent health DURING THE LAST 2 WEEKS. Did [fill: SC name] 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 children LT 18
SkipInstructions:

(1,2,R,D) [goto CINTIL2W]

Question ID:: CHS.240_00.000

Instrument Variable Name:: CINTIL2W
QuestionText:

Did [fill: SC name] have a stomach or intestinal illness with vomiting or diarrhea that started DURING THE LAST 2 WEEKS?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHEARST1]

Question ID:: CHS.250_00.000

Instrument Variable Name:: CHEARST1
QuestionText:

Which statement best describes [fill: SC name]'s hearing without a hearing aid: Excellent, good, a little trouble hearing, moderate trouble, a lot of trouble, or is [fill: SC's name] 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 children LT 18
SkipInstructions:

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

Question ID:: CHS.260_00.000

Instrument Variable Name:: CVISION
QuestionText:

Does [fill1: SC name] have any trouble seeing [fill2: , even when wearing glasses or contact lenses]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto CBLIND]
(2,R,D) [goto IHSPEQ]

Question ID:: CHS.270_00.000

Instrument Variable Name:: CBLIND
QuestionText:

Is [fill: SC name] blind or unable to see at all?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 having trouble seeing
SkipInstructions:

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

Question ID:: CHS.290_00.000

Instrument Variable Name:: IHSPEQ
QuestionText:

Does [fill1: SC name] have any impairment or health problem that requires [fill2: him/her] to use special equipment, such as a brace, a wheelchair, or a hearing aid (excluding ordinary eyeglasses or corrective shoes)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

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

Question ID:: CHS.300_00.000

Instrument Variable Name:: IHMOB
QuestionText:

Does [fill1: SC name] have an impairment or health problem that limits [fill2: his/her] ability to (crawl), walk, run, or play?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto IHMOBYR]
(2,R,D) [goto PROBRX]

Question ID:: CHS.310_00.000

Instrument Variable Name:: IHMOBYR
QuestionText:

Is this an impairment or health problem that has lasted, or is expected to last, 12 months or longer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 that have limited ability to crawl, walk, run, or play
SkipInstructions:

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

Question ID:: CHS.311_00.000

Instrument Variable Name:: PROBRX
QuestionText:

?[F1] Does [fill1: SC name] NOW have a problem for which [fill2: he/she] has regularly taken prescription medication for at least three months?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1,2,R,D) [if AGE LE (1) goto CAU.CUSUALPL;
else if AGE GE 3 goto LEARND;
else if AGE = 2 and SEX = 1 goto CMHAGM11_1;
if AGE = 2 and SEX = 2 goto CMHAGF11_1]

Question ID:: CHS.312_00.000

Instrument Variable Name:: LEARND
QuestionText:

?[F1] Has a representative from a school or a health professional ever told you that [fill: SC name] had a learning disability?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3-17
SkipInstructions:

(1,2,R,D) if AGE GE 6 goto CDEPRSYR;
if AGE =3 and SEX = 1 goto CMHAGM11_1;
if AGE = 3 and SEX = 2 goto CMHAGF11_1];
else goto CAU.CUSUALPL

Question ID:: CHS.321_01.000

Instrument Variable Name:: CMHAGM11_1
QuestionText:

(book) C3 ?[F1] I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: SC name] DURING THE PAST TWO MONTHS.
He: Has been uncooperative?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Male sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CMHAGM11_2]

Question ID:: CHS.321_02.000

Instrument Variable Name:: CMHAGM11_2
QuestionText:

(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: SC name] DURING THE PAST TWO MONTHS.
He: Has trouble getting to sleep?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Male sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CMHAGM11_3]

Question ID:: CHS.321_03.000

Instrument Variable Name:: CMHAGM11_3
QuestionText:

(book) C3?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: SC name] DURING THE PAST TWO MONTHS.
He: Has speech problems?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Male sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CMHAGM11_4]

Question ID:: CHS.321_04.000

Instrument Variable Name:: CMHAGM11_4
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Male sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CAU.CUSUALPL]

Question ID:: CHS.361_01.000

Instrument Variable Name:: CMHAGF11_1
QuestionText:

(book) C3 ?[F1]
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
She: Has temper tantrums or a hot temper?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Female sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CMHAGF11_2]

Question ID:: CHS.361_02.000

Instrument Variable Name:: CMHAGF11_2
QuestionText:

(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
She: Has speech problems?

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Female sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CMHAGF11_3]

Question ID:: CHS.361_03.000

Instrument Variable Name:: CMHAGF11_3
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Female sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CMHAGF11_4]

Question ID:: CHS.361_04.000

Instrument Variable Name:: CMHAGF11_4
QuestionText:

0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know

UniverseText: Female sample children 2-3
SkipInstructions:

(0-2,R,D) [goto CAU.CUSUALPL]

Question ID:: CHS.370_00.010

Instrument Variable Name:: CDEPRSYR
QuestionText:

DURING THE PAST 12 MONTHS, has a doctor or other health professional told you that [fill1: S.C. name] had _Depression?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.370_00.020

Instrument Variable Name:: CANXNWYR
QuestionText:

DURING THE PAST 12 MONTHS, has [fill1: S.C name] _Frequently felt anxious, nervous, or worried?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

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

Question ID:: CHS.370_00.030

Instrument Variable Name:: CSTRESYR
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] _Frequently felt stressed?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 6+
SkipInstructions:

(1,2,R,D) if SEX=2 and AGE GE 10 [goto MENSTYR]; else [goto CAU.CUSUALPL]

Question ID:: CHS.375_00.010

Instrument Variable Name:: MENSTYR
QuestionText:

*Read if necessary.
DURING THE PAST 12 MONTHS, has [fill1: S.C name] had _Menstrual problems such as heavy bleeding, bothersome cramping, or premenstrual syndrome (also called PMS)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample children 10+
SkipInstructions:

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

Question ID:: CHS.375_00.020

Instrument Variable Name:: CGYNYR
QuestionText:

*Read if necessary. DURING THE PAST 12 MONTHS, has [fill1: S.C name] had_Gynecologic problems such as vaginal infection?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample children 10+
SkipInstructions:

(1,2,R,D) [goto CAU.CUSUALPL]

Question ID:: CAU.020_00.000

Instrument Variable Name:: CUSUALPL
QuestionText:

The next questions are about health care. Is there a place that [fill1: alias] USUALLY goes when [fill2: he/she] is sick or you need advice about [fill3: his/her] health?

1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1,3) [goto CPLKIND]
(2,R,D) [goto CHCPLKND]

Question ID:: CAU.030_00.000

Instrument Variable Name:: CPLKIND
QuestionText:

[fill1: What kind of place is it / What kind of place does [fill2: alias] goto 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 goto one place most often
7 Refused
9 Don't know

UniverseText: Sample children LT 18 with one or more usual places to go when sick or need health advice
SkipInstructions:

(1-5) [goto CHCPLROU]
(6,R,D) [goto CHCPLKND]

Question ID:: CAU.035_00.000

Instrument Variable Name:: CHCPLROU
QuestionText:

Is that [fill1: CPLKIND/CAU.030] the same place [fill2: alias] USUALLY goes when [fill3: he/she] needs routine or preventive care, such as a physical examination or (well baby/child) check-up?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 with one or more usual places to go when sick or need health advice who reported that place as a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some other place
SkipInstructions:

(1) [goto CHCCHGYR]
(2,R,D) [goto CHCPLKND]

Question ID:: CAU.037_00.000

Instrument Variable Name:: CHCPLKND
QuestionText:

What kind of place does [fill1: alias] USUALLY goto when [fill2: he/she] needs routine or preventive care, such as a physical examination or (well baby/child) 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 goto one place most often
7 Refused
9 Don't know

UniverseText: Sample children LT18 who do not have a usual source of sick care; who Ref/NA/DK if have a usual source of sick care; who have a usual source of sick care but does not goto one place most often; who have a usual source of sick care but Ref/NA/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/NA/DK if it is same place as usual source of routine/preventive care.
SkipInstructions:

(0-6,R,D) if CUSUALPL=2 [goto CNOUSLPL]; else if CUSUALPL=,R,D [goto CPRVTRYR]; else [goto CHCCHGYR]

Question ID:: CAU.040_00.000

Instrument Variable Name:: CHCCHGYR
QuestionText:

At any time IN THE PAST 12 MONTHS did you CHANGE the place(s) to which [fill: alias] USUALLY goes for health care?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 with one or more place to go when sick/need advice [or who reported same place as usual source of routine/preventive care]
SkipInstructions:

(1) [goto CHCCHGHI]
(2,R,D) [goto to CPRVTRYR]

Question ID:: CAU.050_00.000

Instrument Variable Name:: CHCCHGHI
QuestionText:

Was this change for a reason related to health insurance?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT18 that have changed their usual place of health care in the past 12 months

SkipInstructions:

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

Question ID:: CAU.050_00.010

Instrument Variable Name:: CNOUSLPL
QuestionText:

Why doesn't [fill: alias] 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 children LT 18 who don't have a usual place of care
SkipInstructions:

(1-9,R,D) [goto CPRVTRYR]

Question ID:: CAU.052_00.010

Instrument Variable Name:: CPRVTRYR
QuestionText:

DURING THE PAST 12 MONTHS, did you have any trouble finding a general doctor or provider who would see [fill: alias]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto CPRVTRFD ]
(2,R,D) [goto CDRNANP]

Question ID:: CAU.053_00.010

Instrument Variable Name:: CPRVTRFD
QuestionText:

Were you able to find a general doctor or provider who could see [fill: alias]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 who had trouble finding a provider in the last year
SkipInstructions:

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

Question ID:: CAU.055_00.010

Instrument Variable Name:: CDRNANP
QuestionText:

DURING THE PAST 12 MONTHS, were you told by a doctor's office or clinic that they would not accept [fill: alias] as a new patient?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

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

Question ID:: CAU.056_00.010

Instrument Variable Name:: CDRNAI
QuestionText:

DURING THE PAST 12 MONTHS, were you told by a doctor's office or clinic that they did not accept [fill: alias]'s health care coverage?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCDLYR_1]

Question ID:: CAU.080_01.000

Instrument Variable Name:: CHCDLYR1_1
QuestionText:

There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] 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 children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCDLYR1_2]

Question ID:: CAU.080_02.000

Instrument Variable Name:: CHCDLYR1_2
QuestionText:

* Read if necessary. There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS... You couldn't get an appointment for [fill: alias] soon enough.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCDLYR1_3]

Question ID:: CAU.080_03.000

Instrument Variable Name:: CHCDLYR1_3
QuestionText:

* Read if necessary. There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS... Once you get there, [fill: alias] has to wait too long to see the doctor.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions

(1,2,R,D) [goto CHCDLYR1_4]

Question ID:: CAU.080_04.000

Instrument Variable Name:: CHCDLYR1_4
QuestionText:

* Read if necessary. There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] 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 children LT 18
SkipInstructions

(1,2,R,D) [goto CHCDLYR1_5]

Question ID:: CAU.080_05.000

Instrument Variable Name:: CHCDLYR1_5
QuestionText:

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1,2,R,D) [if AGE GE (2) goto CHCAFYR1_1; else goto CHCAFYR]

Question ID:: CAU.130_00.000

Instrument Variable Name:: CHCAFYR
QuestionText:

DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children LT 2
SkipInstructions:

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

Question ID:: CAU.133_00.010

Instrument Variable Name:: CHCAFYRN
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children LT 2
SkipInstructions:

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

Question ID:: CAU.133_00.020

Instrument Variable Name:: CHCAFYRF
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children LT 2
SkipInstructions:

(1,2,R,D) [if AGE LT 1 goto CHCSYR1_2; else goto CDENLONG]

Question ID:: CAU.135_01.000

Instrument Variable Name:: CHCAFYR1_1
QuestionText:

DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children GE 2
SkipInstructions

(1,2,R,D) [goto CHCAFYR1_2]

Question ID:: CAU.135_02.000

Instrument Variable Name:: CHCAFYR1_2
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCAFYR1_3]

Question ID:: CAU.135_03.000

Instrument Variable Name:: CHCAFYR1_3
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCAFYR1_4]

Question ID:: CAU.135_04.000

Instrument Variable Name:: CHCAFYR1_4
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children GE 2
SkipInstructions

(1,2,R,D) [goto CHCAFYR1_5]

Question ID:: CAU.135_05.010

Instrument Variable Name:: CHCAFYR1_5
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCAFYR1_6]

Question ID:: CAU.135_06.010

Instrument Variable Name:: CHCAFYR1_6
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] 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 children GE 2
SkipInstructions:

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

Question ID:: CAU.160_00.000

Instrument Variable Name:: CDENLONG
QuestionText:

(book) C4 About how long has it been since [fill: alias] 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 months, but not more than 1 year ago
3 More than 1 year, but not more than 2 years ago
4 More than 2 years, but not more than 5 years ago
5 More than 5 years ago
7 Refused
9 Don't know

UniverseText: Sample children GE 1
SkipInstructions:

(0-5,R,D) [if AGE GE (2) goto CHCSYR_1; else goto CHCSYR1_2]

Question ID:: CAU.170_01.000

Instrument Variable Name:: CHCSYR1_2
QuestionText:

DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR1_3]

Question ID:: CAU.170_02.000

Instrument Variable Name:: CHCSYR1_3
QuestionText:

?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? A foot doctor?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR1_5]

Question ID:: CAU.170_03.000

Instrument Variable Name:: CHCSYR1_5
QuestionText:

?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR1_6]

Question ID:: CAU.170_04.000

Instrument Variable Name:: CHCSYR1_6
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? A nurse practitioner, physician assistant or midwife?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR8_1]

Question ID:: CAU.175_01.000

Instrument Variable Name:: CHCSYR_1
QuestionText:

DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s 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 children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_2]

Question ID:: CAU.175_02.000

Instrument Variable Name:: CHCSYR_2
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_3]

Question ID:: CAU.175_03.000

Instrument Variable Name:: CHCSYR_3
QuestionText:

?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A foot doctor?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_4]

Question ID:: CAU.175_04.000

Instrument Variable Name:: CHCSYR_4
QuestionText:

?[F1] Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A chiropractor?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_5]

Question ID:: CAU.175_05.000

Instrument Variable Name:: CHCSYR_5
QuestionText:

?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children GE 2
SkipInstructions:

(1,2,R,D) [goto CHCSYR_6]

Question ID:: CAU.175_06.000

Instrument Variable Name:: CHCSYR_6
QuestionText:

?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A nurse practitioner, physician assistant or midwife?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children GE 2
SkipInstructions:

(1,2,R,D) [if SEX eq (2) and AGE GE 15 goto CHCSYR7; else goto CHCSYR8_1]

Question ID:: CAU.230_00.000

Instrument Variable Name:: CHCSYR7
QuestionText:

?[F1] DURING THE PAST 12 MONTHS, have you seen or talked to a doctor who specializes in women's health (an obstetrician/gynecologist) about [fill2: alias]'s health?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children GE 15 who are female
SkipInstructions:

(1,2,R,D) [goto CHCSYR8_1]

Question ID:: CAU.240_01.000

Instrument Variable Name:: CHCSYR8_1
QuestionText:

DURING THE PAST 12 MONTHS, have you seen or talked to the following about [fill2: alias]'s health? A medical doctor who specializes in a particular medical disease or problem (fill3:other than obstetrician/ gynecologist, psychiatrist or ophthalmologist? /fill4: other than psychiatrist or ophthalmologist)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1,2,R,D) [goto CHCSYR8_2]

Question ID:: CAU.240_02.000

Instrument Variable Name:: CHCSYR8_2
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to the following about [fill2: alias]'s health? A general doctor who treats a variety of illnesses (a doctor in general practice, pediatrics, family medicine, or internal medicine)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto CHCSYR10]
(2,R,D) [goto CHPEXYR]

Question ID:: CAU.260_00.000

Instrument Variable Name:: CHCSYR10
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 children LT 18 who have seen or talked to a general doctor during the past 12 months
SkipInstructions:

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

Question ID:: CAU.265_00.000

Instrument Variable Name:: CHCSYREM
QuestionText:

Did you see or talk to this general doctor because of an emotional or behavioral problem that [fill1: alias] may have?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 who have seen a general doctor in the past 12 months
SkipInstructions:

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

Question ID:: CAU.270_00.000

Instrument Variable Name:: CHPEXYR
QuestionText:

DURING THE PAST 12 MONTHS, did [fill1: alias] receive a well-child check-up, that is a general check-up, when [fill2: he/she] was not sick or injured?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

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

Question ID:: CAU.280_00.000

Instrument Variable Name:: CHERNOYR
QuestionText:

(book) C5 DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] gone to a HOSPITAL EMERGENCY ROOM about [fill2: his/her] 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 children LT 18
SkipInstructions:

(0,R,D) [goto CHCHYR]
(1-8) [goto CERVISND]

Question ID:: CAU.281_00.010

Instrument Variable Name:: CERVISND
QuestionText:

Thinking about [fill: S.C. name]'s most recent emergency room visit, did [fill: he/she ] goto the emergency room either at night or on the weekend?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:

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

Question ID:: CAU.282_00.010

Instrument Variable Name:: CERHOS
QuestionText:

Did this emergency room visit result in a hospital admission?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:

Q1: (1,R,D) [goto CHCHYR] (2) [goto CERREAS1]
Q2-Q4: (1,2,R,D) [goto CERREAS1]

Question ID:: CAU.283_01.010

Instrument Variable Name:: CERREAS1
QuestionText:

Tell me which of these apply to [fill: alias]'s last emergency room visit? _ [fill: He/She] didn't have another place to go

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Q1: Sample children LT 18 who had at least one ER visit in the past year which did not result in a hospital admission
Q2-Q4: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:

(1,2,R,D) [goto CERREAS2]

Question ID:: CAU.283_02.020

Instrument Variable Name:: CERREAS2
QuestionText:

*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit? _ [fill: alias]'s doctor's office or clinic was not open

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D) [goto CERREAS3]

Question ID:: CAU.283_03.030

Instrument Variable Name:: CERREAS3
QuestionText:

*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_ [fill: alias]'s health provider advised that [fill: he/she] go

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Q1: Sample children LT 18 who had at least one ER visit in the past year which did not result in a hospital admission
Q2-Q4: Sample children LT18 who had at least one ER visit in the past year
SkipInstructions:

(1,2,R,D) [goto CERREAS4]

Question ID:: CAU.283_04.040

Instrument Variable Name:: CERREAS4
QuestionText:

*Read if necessary. Tell me which of these apply to [fill: alias]'s 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

(1,2,R,D) [goto CERREAS5]

Question ID:: CAU.283_05.050

Instrument Variable Name:: CERREAS5
QuestionText:

*Read if necessary.
Tell me which of these apply to [fill: alias]'s last emergency room visit?
_ Only a hospital could help [fill: alias]

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D) [goto CERREAS6]

Question ID:: CAU.283_06.060

Instrument Variable Name:: CERREAS6
QuestionText:

*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_ The emergency room is [fill: alias]'s closest provider

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D) [goto CERREAS7]

Question ID:: CAU.283_07.070

Instrument Variable Name:: CERREAS7
QuestionText:

*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_[fill: alias] gets most of [fill: his/her] care at the emergency room

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D) [goto CERREAS8]

Question ID:: CAU.283_08.080

Instrument Variable Name:: CERREAS8
QuestionText:

*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_[fill: alias] arrived by ambulance or other emergency vehicle

1 Yes
2 No
7 Refused
9 Don't know

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

Question ID:: CAU.290_00.000

Instrument Variable Name:: CHCHYR
QuestionText:

DURING THE PAST 12 MONTHS, did [fill1: alias] receive care AT HOME from a nurse or other health care professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children LT 18
SkipInstructions:

(1) [goto CHCHMOYR]
(2,R,D) [goto CHCNOYR]

Question ID:: CAU.300_00.000

Instrument Variable Name:: CHCHMOYR
QuestionText:

DURING THE PAST 12 MONTHS, how many months did [fill: alias] receive care AT HOME from a health care professional?

01-12 1-12 months
97 Refused
99 Don't know

UniverseText: Sample children LT 18 that have received home care from health professional during the past 12 months
SkipInstructions:

(01-12,R,D) [goto CHCHNOYR]

Question ID:: CAU.310_00.000

Instrument Variable Name:: CHCHNOYR
QuestionText:

(book) C6 ?[F1] What was the total number of home visits received for [fill1: alias] during [fill2: that month/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 children LT 18 that have received home care from health professional during the past 12 months
SkipInstructions:

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

Question ID:: CAU.320_00.000

Instrument Variable Name:: CHCNOYR
QuestionText:

(book) C5 ?[F1] DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] seen a doctor or other health care professional about [fill2: his/her] health at A DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times [fill1: alias] was 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 children LT 18
SkipInstructions:

(0-8,R,D) [goto CSRGYR]

Question ID:: CAU.330_00.000

Instrument Variable Name:: CSRGYR
QuestionText:

DURING THE PAST 12 MONTHS has [fill1: alias] 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 children LT 18
SkipInstructions:

(1) [goto CSRGNOYR]
(2,R,D) [goto CMDLONG]

Question ID:: CAU.340_00.000

Instrument Variable Name:: CSRGNOYR
QuestionText:

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES has [fill1: alias] 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 children LT 18 that have undergone surgery during the past 12 months
SkipInstructions:

(1-10,R,D) [goto CMDLONG]
(11-95) [goto ERR_CMDLONG]

Soft Edit: ERR_CMDLONG

[fill2: CSRGNOYR] is an unusually large number. Did [fill1: alias] have [fill2: CSRGNOYR] surgical procedures?

*Please verify.

Question ID:: CAU.345_00.000

Instrument Variable Name:: CMDLONG
QuestionText:

(book) C4 About how long has it been since anyone in the family last saw or talked to a doctor or other health care professional about [fill1: alias]'s health? Include doctors seen while [fill2: he/she] was a patient in a hospital.

UniverseText: Sample children LT 18
SkipInstructions:

(0-5, D, R) [goto next section]

Question ID:: CCD.010_00.000

Instrument Variable Name:: CVSLWRD
QuestionText:

How old was {fill1: S.C. name} when {fill2: he/she} spoke {fill3: his/her} first words other than "ma-ma" or "da-da"?

01 6 to 8 months
02 9 to 11 months
03 12 to 14 months
04 15 to 17 months
05 18 to 23 months
06 24 months (2 years) or later
07 Cannot talk
97 Refused
99 Don't know

UniverseText: Sample children 3+
SkipInstructions:

(1-7,R,D) [goto CVSLVYR]

Question ID:: CCD.015_00.000

Instrument Variable Name:: CVSLVYR
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: S.C. name} had any problems or difficulties with {fill2: his/her} VOICE, such as too weak, hoarse, or strained that lasted for a week or longer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CCD.020_00.000

Instrument Variable Name:: CVSLSWYR
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: S.C. name} had a problem swallowing food or beverages that lasted for a week or longer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CCD.025_00.000

Instrument Variable Name:: CVSLSPYR
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: S.C. name} had a problem speaking, such as making speech sounds correctly or stuttering that lasted for a week or longer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CCD.030_00.000

Instrument Variable Name:: CVSLLGYR
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: S.C. name} had a problem learning, using, or understanding words or sentences that lasted for a week or longer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

(1,2,R,D) if CVSLVYR=2,R,D and CVSLSWYR=2,R,D and CVSLSPYR=2,R,D and CVSLLGYR=2,R,D [goto CVSLEVER]; else if CVSLVYR=1 or CVSLSWYR=1 or CVSLSPYR=1 or CVSLLGYR=1 [goto CVSLDG]

Question ID:: CCD.035_00.000

Instrument Variable Name:: CVSLEVER
QuestionText:

Has {fill1: S.C. name} EVER had a voice, swallowing, speech, or language problem that lasted a week or longer?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have not had a voice, swallowing, speech, or language problem in the past 12 months
SkipInstructions:

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

Question ID:: CCD.040_00.000

Instrument Variable Name:: CVSLDG
QuestionText:

Did a health or education professional EVER tell you a diagnosis or reason for {fill1: S.C. name}'s voice, swallowing, speech, or language problem?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have ever had a voice, swallowing, speech, or language problem
SkipInstructions:

(1) [goto CVSLDGTP]
(2,R,D) (if CVSLVYR=1 or CVSLSWYR=1 or CVSLSPYR=1 or CVSLLGYR=1) [goto applicable CVSLVAG, CVSLSWAG, CVSLSPAG, CVSLLGAG series]; else [goto next section]

Question ID:: CCD.045_00.000

Instrument Variable Name:: CVSLDGTP
QuestionText:

For which problem(s)?
*Read if necessary: Was this for problems with {fill1: S.C. name}'s voice, swallowing, speech, or language?
*Enter all that apply, separate with commas.

1 Voice problem
2 Swallowing problem
3 Speech problem
4 Language problem
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have been given a diagnosis for their voice, swallowing, speech, or language problem
SkipInstructions:

(1) [goto CVSLVDG]
(2) [goto CVSLSWDG]
(3) [goto CVSLSPDG]
(4) [goto CVSLLGDG]
(R,D) [if CVSLVYR=1 or CVSLSWYR=1 or CVSLSPYR=1 or CVSLLGYR=1 goto CVSLVAG, CVSLSWAG, CVSLSPAG, CVSLLGAG series; else goto next section]

Question ID:: CCD.050_00.000

Instrument Variable Name:: CVSLVDG
QuestionText:

What diagnoses or reasons were you told caused {fill1: S.C. name}'s voice problems?
*Enter all that apply, separate with commas.

01 Laryngitis caused by colds/strep or by voice misuse/abuse/overuse
02 Head/neck injury
03 Allergies or airborne irritants
04 Tissue damage in throat (accident, intubation, ingestion of caustic material)
05 Laryngeal growths (polyps, papillomas, laryngeal web, nodules)
06 Cancer anywhere in the head, neck or throat
07 Neurological cause (cerebral palsy, muscular dystrophy, etc.)
08 Congenital malformation/Birth defect
09 Gastroesophageal reflux
10 Prescription medication or drugs
11 Other
97 Refused
99 Don't Know

UniverseText: Sample children 3+ who have been given a diagnosis for their voice problem
SkipInstructions:

(1-11,R,D) [cycle through CVSLSWDG, CVSLSPDG, CVSLLGDG if applicable]; then if CVSLVYR=1 or CVSLSWYR=1 or CVSLSPYR=1 or CVSLLGYR=1 [goto CVSLVAG, CVSLSWAG, CVSLSPAG, CVSLLGAG series]; else [goto next section]

Question ID:: CCD.055_00.000

Instrument Variable Name:: CVSLSWDG
QuestionText:

What diagnoses or reasons were you told caused {fill1: S.C. name}'s problems swallowing?
*Enter all that apply, separate with commas.

01 Neurological cause (cerebral palsy, muscular dystrophy, stroke, etc.)
02 Head/neck injury
03 Tissue damage in mouth or throat (accident, intubation, ingestion of caustic material)
04 Congenital malformation/Birth defect
05 Genetic syndrome
06 Cancer anywhere in the head, neck or throat
07 Asthma
08 Prescription medication or drugs
09 Other
97 Refused
99 Don't Know

UniverseText: Sample children 3+ who have been given a diagnosis for their swallowing problem
SkipInstructions:

(1-9,R,D) [cycle through CVSLSPDG, CVSLLGDG if applicable]; then if CVSLVYR=1 or CVSLSWYR=1 or CVSLSPYR=1 or CVSLLGYR=1 [goto CVSLVAG, CVSLSWAG, CVSLSPAG, CVSLLGAG series]; else [goto next section]

Question ID:: CCD.060_00.000

Instrument Variable Name:: CVSLSPDG
QuestionText:

What diagnoses or reasons were you told caused {fill1: S.C. name}'s speech problems?
*Enter all that apply, separate with commas.

01 Hearing loss or deafness
02 Developmental speech sound disorder (phonology, articulation, apraxia, dyspraxia, etc.)
03 Stuttering
04 Congenital malformation/Birth defect (cleft lip/palate, craniofacial anomaly)
05 Genetic syndrome
06 Neurological cause or disease (cerebral palsy, muscular dystrophy, stroke, etc.)
07 Head/neck injury
08 Cancer anywhere in the head, neck or throat
09 Prescription medication or drugs
10 Other
97 Refused
99 Don't Know

UniverseText: Sample children 3+ who have been given a diagnosis for their speech problem
SkipInstructions:

(1-10,R,D) [cycle through CVSLLGDG if applicable]; then if CVSLVYR=1 or CVSLSWYR=1 or CVSLSPYR=1 or CVSLLGYR=1 [goto CVSLVAG, CVSLSWAG, CVSLSPAG, CVSLLGAG series]; else [goto next section]

Question ID:: CCD.065_00.000

Instrument Variable Name:: CVSLLGDG
QuestionText:

What diagnoses or reasons were you told caused {fill1: S.C. name}'s problems learning, using, or understanding words or sentences?
*Enter all that apply, separate with commas.

01 Hearing loss or deafness
02 Genetic syndrome
03 Intellectual disability, also known as mental retardation
04 Autism spectrum disorder
05 Developmental language-learning disorder (specific language impairment, learning disability, dyslexia)
06 Head injury, traumatic brain injury (TBI)
07 Other neurological cause (stroke, seizure disorder, etc.)
08 Prescription medication or drugs
09 Other
97 Refused
99 Don't Know

UniverseText: Sample children 3+ who have been given a diagnosis for their language problem
SkipInstructions:

(1-9,R,D) if CVSLVYR=1 or CVSLSWYR=1 or CVSLSPYR=1 or CVSLLGYR=1 [goto CVSLVAG, CVSLSWAG, CVSLSPAG, CVSLLGAG series]; else [goto next section]

Question ID:: CCD.070_00.000

Instrument Variable Name:: CVSLVAG
QuestionText:

At what age did {fill1: S.C. name} FIRST begin to have any voice problems?
* Enter '0' if since birth.

00-17 0-17
97 Refused
99 Don't know

UniverseText: Sample children 3+ who have had a voice problem in the past 12 months for a week or longer
SkipInstructions:

(0-Current Age,R,D) [cycle through CVSLSWAG, CVSLSPAG, CVSLLGAG if applicable, then goto CVSLVPB, CVSLSWPB, CVSLSPPB, CVSLLGPB series]

Question ID:: CCD.075_00.000

Instrument Variable Name:: CVSLSWAG
QuestionText:

At what age did {fill1: S.C. name} FIRST begin to have any problems swallowing?
* Enter '0' if since birth.

00-17 0-17
97 Refused
99 Don't know

UniverseText: Sample children 3+ who have had a swallowing problem in the past 12 months for a week or longer
SkipInstructions:

(0-Current Age,R,D) [cycle through CVSLSPAG, CVSLLGAG if applicable, then goto CVSLVPB, CVSLSWPB, CVSLSPPB, CVSLLGPB series]

Question ID:: CCD.080_00.000

Instrument Variable Name:: CVSLSPAG
QuestionText:

At what age did {fill1: S.C. name} FIRST begin to have any speech problems?
* Enter '0' if since birth.

00-17 0-17
97 Refused
99 Don't know

UniverseText: Sample children 3+ who have had a speech problem in the past 12 months for a week or longer
SkipInstructions:

(0-Current Age,R,D) [cycle through CVSLLGAG if applicable, then goto CVSLVPB, CVSLSWPB, CVSLSPPB, CVSLLGPB series]

Question ID:: CCD.085_00.000

Instrument Variable Name:: CVSLLGAG
QuestionText:

At what age did {fill1: S.C. name} FIRST begin to have any problems learning, using, or understanding words or sentences?
* Enter '0' if since birth.

00-17 0-17
97 Refused
99 Don't know

UniverseText: Sample children 3+ who have had a language problem in the past 12 months for a week or longer
SkipInstructions:

(0-Current Age,R,D) [goto CVSLVPB, CVSLSWPB, CVSLSPPB, CVSLLGPB series]

Question ID:: CCD.090_00.000

Instrument Variable Name:: CVSLVPB
QuestionText:

DURING THE PAST 12 MONTHS, how much of a problem did {fill1: S.C. name} have with {fill2: his/her} voice? Would you say it was...
*Read categories below

1 No problem
2 A small problem
3 A moderate problem
4 A big problem
5 A very big problem
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a voice problem in the past 12 months for a week or longer
SkipInstructions:

(1-5,R,D) [cycle through CVSLSWPB, CVSLSPPB, CVSLLGPB if applicable, then goto CVSLVSP, CVSLSWSP, CVSLSPSP, CVSLLGSP series]

Question ID:: CCD.095_00.000

Instrument Variable Name:: CVSLSWPB
QuestionText:

DURING THE PAST 12 MONTHS, how much of a swallowing problem did {fill1: S.C. name} have? Would you say it was...
*Read categories below

1 No problem
2 A small problem
3 A moderate problem
4 A big problem
5 A very big problem
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a swallowing problem in the past 12 months for a week or longer
SkipInstructions:

(1-5,R,D) [cycle through CVSLSPPB, CVSLLGPB if applicable, then goto CVSLVSP, CVSLSWSP, CVSLSPSP, CVSLLGSP series]

Question ID:: CCD.100_00.000

Instrument Variable Name:: CVSLSPPB
QuestionText:

DURING THE PAST 12 MONTHS, how much of a problem did {fill1: S.C. name} have with {fill2: his/her} speech? Would you say it was...
*Read categories below

1 No problem
2 A small problem
3 A moderate problem
4 A big problem
5 A very big problem
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a speech problem in the past 12 months for a week or longer
SkipInstructions:

(1-5,R,D) [cycle through CVSLLGPB if applicable, then goto CVSLVSP, CVSLSWSP, CVSLSPSP, CVSLLGSP series]

Question ID:: CCD.110_00.000

Instrument Variable Name:: CVSLLGPB
QuestionText:

DURING THE PAST 12 MONTHS, how much of a problem did {fill1: S.C. name} have learning, using or understanding words or sentences? Would you say it was...
*Read categories below

1 No problem
2 A small problem
3 A moderate problem
4 A big problem
5 A very big problem
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a language problem in the past 12 months for a week or longer
SkipInstructions:

(1-5,R,D) [goto CVSLVSP, CVSLSWSP, CVSLSPSP, CVSLLGSP series]

Question ID:: CCD.115_00.000

Instrument Variable Name:: CVSLVSP
QuestionText:

DURING THE PAST 12 MONTHS, did {fill1: S.C. name} receive speech language therapy or other intervention services for {fill2: his/her} voice problems?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a voice problem in the past 12 months for a week or longer
SkipInstructions:

(1) [cycle through CVSLSWSP, CVSLSPSP, CVSLLGSP if applicable; else goto HP series]
(2) [goto CVSLVPE]
(R,D) [cycle through the SP series if applicable; else goto next section CBL.010]

Question ID:: CCD.120_00.000

Instrument Variable Name:: CVSLVPE
QuestionText:

Did {fill1: S.C. name} EVER receive speech language therapy or other intervention services for {fill2: his/her} voice problems?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have not had speech language therapy for a voice problem in the past 12 months
SkipInstructions:

(1) [cycle through CVSLSWSP, CVSLSPSP, CVSLLGSP if applicable; else goto HP series] (2,R,D) [cycle through SP series if applicable; else goto next section CBL.010]

Question ID:: CCD.125_00.000

Instrument Variable Name:: CVSLSWSP
QuestionText:

DURING THE PAST 12 MONTHS, did {fill1: S.C. name} receive speech language therapy or other intervention services for {fill2: his/her} problems swallowing?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a swallowing problem in the past 12 months for a week or longer
SkipInstructions:

(1) [cycle through CVSLSPSP, CVSLLGSP if applicable; else goto HP series]
(2) [goto CVSLSWPE]
(R,D) [cycle through SP series if applicable; else if CVSLVSP='1' or CVSLVPE='1' goto HP series; else goto next section CBL.010]

Question ID:: CCD.130_00.000

Instrument Variable Name:: CVSLSWPE
QuestionText:

Did {fill1: S.C. name} EVER receive speech language therapy or other intervention services for {fill2: his/her} problems swallowing?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have not had speech language therapy for a swallowing problem in the past 12 months
SkipInstructions:

(1) [cycle through CVSLSPSP, CVSLLGSP if applicable; else goto HP series]
(2,R,D) [cycle through SP series if applicable; else if CVSLVSP='1' or CVSLVPE='1' goto HP series; else goto next section CBL.010]

Question ID:: CCD.135_00.000

Instrument Variable Name:: CVSLSPSP
QuestionText:

DURING THE PAST 12 MONTHS, did {fill1: S.C. name} receive speech language therapy or other intervention services for {fill2: his/her} speech problems?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a speech problem in the past 12 months for a week or longer
SkipInstructions:

(1) [cycle through CVSLLGSP if applicable; else goto HP series]
(2) [goto CVSLSPPE]
(R,D) [cycle through CVSLLGSP if applicable; else if CVSLVSP='1' or CVSLVPE='1' or CVSLSWSP='1' or CVSLSWPE='1' goto HP series; else goto next section CBL.010]

Question ID:: CCD.140_00.000

Instrument Variable Name:: CVSLSPPE
QuestionText:

Did {fill1: S.C. name} EVER receive speech language therapy or other intervention services for {fill2: his/her} speech problems?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have not had speech language therapy for a speech problem in the past 12 months
SkipInstructions:

(1) [cycle through CVSLLGSP if applicable; else goto HP series]
(2,R,D) [cycle through CVSLLGSP if applicable; else if CVSLVSP='1' or CVSLVPE='1' or CVSLSWSP='1' or CVSLSWPE='1' goto HP series; else goto next section CBL.010]

Question ID:: CCD.145_00.000

Instrument Variable Name:: CVSLLGSP
QuestionText:

DURING THE PAST 12 MONTHS, did {fill1: S.C. name} receive speech language therapy or other intervention services for {fill2: his/her} problems using, learning or understanding words or sentences?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had a language problem in the past 12 months for a week or longer
SkipInstructions:

(1,R,D) [if CVSLVSP=1 or CVSLVPE=1 or CVSLSWSP=1 or CVSLSWPE=1 or CVSLSPSP=1 or CVSLSPPE=1 or CVSLLGSP=1 or CVSLLGPE=1 cycle through CVSLVHP, CVSLSWHP, CVSLSPHP, CVSLLGHP if applicable; else goto next section CBL.010]
(2) [goto CVSLLGPE]

Question ID:: CCD.150_00.000

Instrument Variable Name:: CVSLLGPE
QuestionText:

Did {fill1: S.C. name} EVER receive speech language therapy or other intervention services for {fill2: his/her} problems learning, using, or understanding words or sentences?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have not had speech language therapy for a language problem in the past 12 months
SkipInstructions:

(1,2,R,D) if CVSLVSP=1 or CVSLVPE=1 or CVSLSWSP=1 or CVSLSWPE=1 or CVSLSPSP=1 or CVSLSPPE=1 or CVSLLGSP=1 or CVSLLGPE=1 [cycle through CVSLVHP, CVSLSWHP, CVSLSPHP, CVSLLGHP if applicable]; else [goto CBL.010]

Question ID:: CCD.155_00.000

Instrument Variable Name:: CVSLVHP
QuestionText:

Who provided this (for {fill1: S.C. name}'s voice problems)?
*Enter all that apply, separate with commas.

01 Speech-Language Pathologist
02 Early Intervention Specialist/Program
03 Occupational/Physical Therapist
04 Ear, Nose and Throat Doctor (ENT, or otolaryngologist)
05 Audiologist or Hearing Aid Specialist
06 Pediatrician or Family Practice Doctor
07 Neurologist or Other Specialist
08 Nutritionist or Dietician
09 Psychiatrist or Psychologist
10 Other
97 Refused
99 Don't know

UniverseText: Sample children 3+ who have ever had speech language therapy or other intervention services for a voice problem
SkipInstructions:

(1-10,R,D) [cycle through CVSLSWHP, CVSLSPHP, CVSLLGHP if applicable]; else [goto CBL.010]

Question ID:: CCD.160_00.000

Instrument Variable Name:: CVSLSWHP
QuestionText:

Who provided this (for {fill1: S.C. name}'s problems swallowing)?
*Enter all that apply, separate with commas.

UniverseText: Sample children 3+ who have ever had speech language therapy or other intervention services for a swallowing
problem
SkipInstructions:

(1-10,R,D) [cycle through CVSLSPHP, CVSLLGHP if applicable]; else [goto CBL.010]

Question ID:: CCD.165_00.000

Instrument Variable Name:: CVSLSPHP
QuestionText:

Who provided this (for {fill1: S.C. name}'s speech problems)?
*Enter all that apply, separate with commas.

UniverseText: Sample children 3+ who have ever had speech language therapy or other intervention services for a speech problem
SkipInstructions:

(1-10,R,D) [cycle through CVSLLGHP if applicable]; else [goto CBL.010]

Question ID:: CCD.170_00.000

Instrument Variable Name:: CVSLLGHP
QuestionText:

Who provided this (for {fill1: S.C. name}'s problems learning, using, or understanding words or sentences)?
*Enter all that apply, separate with commas.

UniverseText: Sample children 3+ who have ever had speech language therapy or other intervention services for a language problem
SkipInstructions

(1-10,R,D) [goto CBL.010]

Question ID:: CBL.010_00.000

Instrument Variable Name:: CBALWLK
QuestionText:

At what age did {fill1: S.C. name} take {fill2: his/her} first steps without support?

01 6 to 8 months
02 9 to 11 months
03 12 to 14 months
04 15 to 17 months
05 18 to 23 months
06 24 months (2 years) or later
07 Cannot walk
97 Refused
99 Don't know

UniverseText: Sample children 3+
SkipInstructions

(1-7,R,D) [goto CBALLIMB]

Question ID:: CBL.015_00.000

Instrument Variable Name:: CBALLIMB
QuestionText:

Does {fill1: S.C. name} have any problem standing, walking, or using {fill2: his/her} arms or legs?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CBL.020_00.000

Instrument Variable Name:: CBALVRTG
QuestionText:

These next questions are about balance problems or disorders that children may experience such as feeling unsteady, dizzy, light headed, or woozy or having body or motor coordination problems. DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of any of the following dizziness or balance problems? Vertigo, a spinning sensation like a Merry-Go-Round?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CBL.025_00.000

Instrument Variable Name:: CBALSTED
QuestionText:

*Read if necessary. DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of any of the following dizziness or balance problems? Poor balance, an unsteady or woozy feeling that makes it difficult to stand up or walk?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CBL.027_00.000

Instrument Variable Name:: CBALMOTR
QuestionText:

*Read if necessary. DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of any of the following dizziness or balance problems? Problems with body or motor coordination or clumsiness?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CBL.030_00.000

Instrument Variable Name:: CBALFALL
QuestionText:

*Read if necessary. DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of any of the following dizziness or balance problems? Frequent falls?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CBL.035_00.000

Instrument Variable Name:: CBALPASS
QuestionText:

*Read if necessary. DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of any of the following dizziness or balance problems? Light-headedness, fainting, or feeling {fill2: he/she} is about to pass out?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

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

Question ID:: CBL.040_00.000

Instrument Variable Name:: CBALOTH
QuestionText:

*Read if necessary. DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of any of the following dizziness or balance problems? Any other type of balance or dizziness problems?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+
SkipInstructions:

(1,2,R,D) if CBALVRTG=1 or CBALSTED=1 or CBALMOTR=1 or CBALFALL=1 or CBALPASS=1 or CBALOTH=1 [goto CBALDGHP]; else [goto CAU.CUSUALPL]

Question ID:: CBL.045_00.000

Instrument Variable Name:: CBALDGHP
QuestionText:

Did a doctor or other health professional EVER tell you a diagnosis or reason for {fill1: S.C. name}'s dizziness or balance problems?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had episodes of balance problems or dizziness in the past 12 months
SkipInstructions:

(1) [goto CBALDIGN]
(2,R,D) [goto CBALPART]

Question ID:: CBL.050_00.000

Instrument Variable Name:: CBALDIGN
QuestionText:

What diagnoses or reasons were you told caused {fill1: S.C. name}'s balance or dizziness problems?
*Enter all that apply, separate with commas.

01 Ear infections (inner ear infection, otitis media, fluid in ears)
02 Vision problems/Blurred vision
03 Positional dizziness or vertigo (BPPV)
04 Severe headaches or migraine
05 Head or neck injury or concussion
06 Neurologic disorders including seizures, stroke, or brain tumors
07 Developmental motor coordination disorder ("clumsy" child)
08 Malformation of the ear
09 Other genetic cause (Asperger Syndrome, Usher's Syndrome, etc.)
10 Metabolic problem, such as "low blood sugar" (hypoglycemia)
11 Prescription medication or drugs
12 Other
97 Refused
99 Don't Know

UniverseText: Sample children 3+ who have ever been told a diagnosis for their balance problem or dizziness
SkipInstructions:

(1-12,R,D) [goto CBALPART]

Question ID:: CBL.055_00.000

Instrument Variable Name:: CBALPART
QuestionText:

Did any of these episodes of dizziness or balance problems keep {fill1: S.C. name} from participating in home, school, {fill2: work,} or recreational activities?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had episodes of balance problems or dizziness in the past 12 months
SkipInstructions:

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

Question ID:: CBL.060_00.000

Instrument Variable Name:: CBALPROB
QuestionText:

DURING THE PAST 12 MONTHS, how much of a problem were these episodes of dizziness or imbalance for {fill1: S.C. name}? Would you say it was...
*Read categories below.

1 No problem
2 A small problem
3 A moderate problem
4 A big problem
5 A very big problem
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had episodes of balance problems or dizziness in the past 12 months
SkipInstructions:

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

Question ID:: CBL.065_00.000

Instrument Variable Name:: CBALHPYR
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: S.C name} seen a doctor, physical or occupational therapist, or other health care professional about these episodes of dizziness or balance problems? Include visits to the Emergency Room, hospital, or health clinics.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had episodes of balance problems or dizziness in the past 12 months
SkipInstructions:

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

Question ID:: CBL.070_00.000

Instrument Variable Name:: CBALTRET
QuestionText:

DURING THE PAST 12 MONTHS, has {fill1: S.C. name} tried methods recommended by a doctor, physical or occupational therapist, or other health care professional for treating {fill2: his/her} episodes of dizziness or balance problems?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 3+ who have had episodes of balance problems or dizziness in the past 12 months
SkipInstructions:

(1,2,R,D) [IF AGE=4-17 goto CMHCOPY; else goto CH1N1_1]

Question ID:: CMB.010_00.000

Instrument Variable Name:: CMHCOPY
QuestionText:

* The following statements are not to be read to the respondent. They are displayed and included here for legal reasons.
* The next 6 items contained in CMHMF_1 through CMHDIFF are included in this survey with permission as indicated below.
* The SDQ questions are copyrighted by Robert Goodman, Ph.D., FRCPSYCH, MRCP. State and local agencies may use these questions without charge and without seeking separate permission provided the wording is not modified, all the questions are retained, and Dr. Goodman's copyright is acknowledged.
* Enter 1 to Continue.

1 Enter 1 to continue

UniverseText: Sample children GE 4
SkipInstructions:

(1) [goto CMHMF_1]

Question ID:: CMB.020_01.000

Instrument Variable Name:: CMHMF_1
QuestionText:

(book) C7 I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS... [fill2: He/She] ...is generally well behaved, usually does what adults request.

0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know

UniverseText: Sample children GE 4
SkipInstructions:

(1-3,D,R) [goto CMHMF_2]

Question ID:: CMB.020_02.000

Instrument Variable Name:: CMHMF_2
QuestionText:

(book) C7 * Read if necessary.
I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS... [fill2: He/She] ...has many worries, or often seems worried.

0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know

UniverseText: Sample children GE 4
SkipInstructions:

(1-3,D,R) [goto CMHMF_3]

Question ID:: CMB.020_03.000

Instrument Variable Name:: CMHMF_3
QuestionText:

0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know

UniverseText: Sample children GE 4
SkipInstructions:

(1-3,D,R) [goto CMHMF_4]

Question ID:: CMB.020_04.000

Instrument Variable Name:: CMHMF_4
QuestionText:

(book) C7 * Read if necessary. I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS... [fill2: He/She] ...gets along better with adults than with other [fill3: children/youth].

0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know

UniverseText: Sample children GE 4
SkipInstructions

(1-3,D,R) [goto CMHMF_5]

Question ID:: CMB.020_05.000

Instrument Variable Name:: CMHMF_5
QuestionText:

(book) C7 * Read if necessary. I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS... [fill2: He/She] ...has good attention span, sees chores or homework through to the end.

0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know

UniverseText: Sample children GE 4
SkipInstructions:

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

Question ID:: CMB.030_00.000

Instrument Variable Name:: CMHDIFF
QuestionText:

(book) C8 Overall, do you think that [fill1: SC name] has difficulties in any of the following areas: emotions, concentration, behavior, or being able to get along with other people?

1 No
2 Yes, minor difficulties
3 Yes, definite difficulties
4 Yes, severe difficulties
7 Refused
9 Don't know

UniverseText: Sample children GE 4
SkipInstructions:

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

Question ID:: CMS.001_00.000

Instrument Variable Name:: DIFF6M
QuestionText:

Has [fill: SC name] had any difficulties with emotions, concentration, behavior, or getting along with others DURING THE PAST 6 MONTHS, that is since [fill month and year of 6 month reference period]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17
SkipInstructions:

(1) [goto DIFFINTF]
(2,R,D) [if CMHDIFF (variable name in layouts is RSCL6) IN ('2',3','4') [goto
DIFFINTF]; else [goto PRESCP6M]

Question ID:: CMS.005_00.000

Instrument Variable Name:: DIFFINTF
QuestionText:

DURING THE PAST 6 MONTHS, did the difficulties interfere with or limit [fill1: SC name] being able to get along in your family, in school, or in daily activities?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who have at least minor difficulties with emotions, concentration, behavior, or being able to get along with others
SkipInstructions

(1) [goto DIFFDEG]
(2,R,D) [goto DIFFLNG]

Question ID:: CMS.007_00.000

Instrument Variable Name:: DIFFDEG
QuestionText:

How much did these difficulties interfere with [fill: S.C. name] being able to get along in your family, in school, or in daily activities? Would you say...
*Read categories below.

1 A lot
2 Some
3 A little
7 Refused
9 Don't know

UniverseText: Sample children 4-17 whose difficulties interfere with child being able to get along in the family, school, or daily
activities
SkipInstructions:

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

Question ID:: CMS.008_00.000

Instrument Variable Name:: DIFFLNG
QuestionText:

How long have these difficulties been present?

1 Less than a month
2 1-5 months
3 6 to 12 months
4 Over a year
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who have at least minor difficulties with emotions, concentration, behavior, or being able to get along with others
SkipInstructions:

(1-4,R,D) [goto PRESCP6M]

Question ID:: CMS.010_00.000

Instrument Variable Name:: PRESCP6M
QuestionText:

DURING THE PAST 6 MONTHS, was [fill1: S.C. name] prescribed medication or taking prescription medication for difficulties with emotions, concentration, behavior, or being able to get along with others?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17
SkipInstructions:

(1) [goto PRESHELP]
(2,R,D) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [end]; else [goto NSDUH21]

Question ID:: CMS.011_00.000

Instrument Variable Name:: PRESHELP
QuestionText:

During the past 6 months, how much has this prescription medication helped [fill: S.C. name]? Would you say_
*Read categories below.

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

UniverseText: Sample children 4-17 have taken prescription medicine in the past 6 mos
SkipInstructions:

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

Question ID:: CMS.012_01.000

Instrument Variable Name:: PMEDPED
QuestionText:

Who FIRST prescribed the medication? Was it ...A pediatrician or other family doctor?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who have been prescribed or have taken prescription medication in the past 6 months
SkipInstructions:

(1) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [goto TRETHELP]; else [goto NSDUH21]; (2,R,D) [goto PMEDPSY]

Question ID:: CMS.012_02.000

Instrument Variable Name:: PMEDPSY
QuestionText:

*Read if necessary. Who FIRST prescribed the medication? Was it ...A psychiatrist, psychologist or other mental health professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who were prescribed medication in the past 6 months by someone other than a pediatrician or other family doctor
SkipInstructions:

(1) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [goto TRETHELP]; else [goto NSDUH21]; (2,R,D) [goto PMEDNEU]

Question ID:: CMS.012_03.000

Instrument Variable Name:: PMEDNEU
QuestionText:

*Read if necessary.
Who FIRST prescribed the medication? Was it ...A neurologist?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who were prescribed medication in the past 6 months by someone other than a pediatrician, psychiatrist/ or other family doctor
SkipInstructions:

(1) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [goto TRETHELP]; else [goto NSDUH21]; (2,R,D) [goto PMEDOTH]

Question ID:: CMS.012_04.000

Instrument Variable Name:: PMEDOTH
QuestionText:

*Read if necessary. Who FIRST prescribed the medication? Was it ...Someone else?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who were prescribed medication in the past 6 months by someone other than a pediatrician, family doctor, psychiatrist or neurologist
SkipInstructions:

(1,2,R,D) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [goto TRETHELP]; else [goto NSDUH21]

Question ID:: CMS.014_00.000

Instrument Variable Name:: NSDUH21
QuestionText:

Sometimes students get treatment or counseling through the school system for DIFFICULTIES WITH emotions, concentration, behavior, or being able to get along with others. DURING THE PAST 6 MONTHS, did [fill: S.C. name] receive any treatment or counseling FROM A SCHOOL SOCIAL WORKER, SCHOOL PSYCHOLOGIST, SCHOOL NURSE, SCHOOL
COUNSELOR, SPECIAL ED TEACHER, OR SCHOOL SPEECH, OCCUPATIONAL OR PHYSICAL THERAPIST?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:

(1,2,R,D) [goto NSDUH3]

Question ID:: CMS.015_00.000

Instrument Variable Name:: NSDUH3
QuestionText:

At any time DURING THE PAST 6 MONTHS did [fill1: S.C. name] attend a school for students with difficulties with emotions, concentration, behavior, or being able to get along with others?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:

(1) [goto NSDUH31
(2,R,D) [goto NSDUH4]

Question ID:: CMS.015_00.010

Instrument Variable Name:: NSDUH31
QuestionText:

Was it a day school or school where {S.C. name} stayed overnight or longer?

1 Day School
2 Overnight School
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months, and attend a special needs school
SkipInstructions:

(1) [goto NSDUH32]
(2,R,D) [goto NSDUH4]

Question ID:: CMS.015_00.020

Instrument Variable Name:: NSDUH32
QuestionText:

Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Special Ed teacher
2 Other school teacher
3 School counselor, psychologist, nurse or social worker
4 School speech, occupational or physical therapist
5 Other school official
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who participated in a special needs day school with program for these difficulties
SkipInstructions:

(1-5,R,D) [goto NSDUH4];

Question ID:: CMS.016_00.000

Instrument Variable Name:: NSDUH4
QuestionText:

Regular schools sometimes provide programs for students with difficulties with emotions, concentration, behavior, or being able to get along with others. DURING THE PAST 6 MONTHS, did [fill1: S.C. name] participate in a school program that was just for students with
these kinds of difficulties?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:

(1) [goto NSDUH5]
(2,R,D) if age 4-6 [goto TRETWHR1]; else [goto TRETWHR2]

Question ID:: CMS.017_00.000

Instrument Variable Name:: NSDUH5
QuestionText:

Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Special Ed teacher
2 Other school teacher
3 School counselor, psychologist, nurse or social worker
4 School speech, occupational or physical therapist
5 Other school official
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who participated in a school program for difficulties with emotions, concentration, behavior
SkipInstructions:

(1-5,R,D) age 4-6 [goto TRETWHR1]; else [goto TRETWHR2]

Question ID:: CMS.020_01.000

Instrument Variable Name:: TRETWHR1
QuestionText:

Now I'd like to ask about places other than {S.C.name}'s school where children and adolescents receive treatment or counseling for difficulties with emotions, concentration, behavior, or being able to get along with others. DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties... At daycare, child care, or play group?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-6 who had at least minor difficulties
SkipInstructions:

(1) [goto TRETWHO1]
(2,R,D) [goto TRETWHR2]

Question ID:: CMS.020_02.000

Instrument Variable Name:: TRETWHO1
QuestionText:

(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation of juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know

UniverseText: Sample children 4-6 who received counseling at daycare, child care, or play group
SkipInstructions:

(1,3-6,R,D) [goto TRETWHR2]
(2) [goto TRTMHP1]

Question ID:: CMS.020_03.000

Instrument Variable Name:: TRTMHP1
QuestionText:

You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas

1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know

UniverseText: Sample children 4-6 who received counseling or treatment at daycare, child care, or play group from mental health provider
SkipInstructions:

(1-4,R,D) [goto TRETWHR2]

Question ID:: CMS.021_01.000

Instrument Variable Name:: TRETWHR2
QuestionText:

[fill2: Now I'd like to ask about places other than {S.C. name}'s school where children and adolescents receive treatment or counseling for difficulties with emotions, concentration, behavior, or being able to get along with others.] DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties... In an office, clinic or center in your community?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:

(1) [goto TRETWHO2]
(2,R,D) [goto TRETWHR3]

Question ID:: CMS.021_02.000

Instrument Variable Name:: TRETWHO2
QuestionText:

(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling at an office, clinic or community center
SkipInstructions:

(1,3-6,R,D) [goto TRETWHR3]
(2) [goto TRTMHP2]

Question ID:: CMS.021_03.000

Instrument Variable Name:: TRTMHP2
QuestionText:

You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas

1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling or treatment at an office, clinic or community center from mental health provider
SkipInstructions:

(1-4,R,D) [goto TRETWHR3]

Question ID:: CMS.022_01.000

Instrument Variable Name:: TRETWHR3
QuestionText:

DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties... In your home, for example, from a visiting teacher or counselor?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:

(1) [goto TRETWHO3]
(2,R,D) [goto TRETWHR4]

Question ID:: CMS.022_02.000

Instrument Variable Name:: TRETWHO3
QuestionText:

(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling at home from visiting teacher or counselor
SkipInstructions:

(1,3-6,R,D) [goto TRETWHR4]
(2) [goto TRTMHP3]

Question ID:: CMS.022_03.000

Instrument Variable Name:: TRTMHP3
QuestionText:

You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas

1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling or treatment at home from mental health provider
SkipInstructions:

(1-4,R,D) [goto TRETWHR4]

Question ID:: CMS.023_01.000

Instrument Variable Name:: TRETWHR4
QuestionText:

DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties... In a hospital emergency room, crisis center, or emergency shelter?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:

(1) [goto TRETWHO4]
(2,R,D) [goto TRETWHR5]

Question ID:: CMS.023_02.000

Instrument Variable Name:: TRETWHO4
QuestionText:

(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling at hospital/ER/crisis center/shelter
SkipInstructions:

(1,3-6,R,D) [goto TRETWHR5]
(2) [goto TRTMHP4]

Question ID:: CMS.023_03.000

Instrument Variable Name:: TRTMHP4
QuestionText:

You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric
nurse. Who was this?
*Enter all that apply, separate with commas

1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling or treatment at hospital/ER/crisis center/shelter from mental health provider
SkipInstructions:

(1-4,R,D) [goto TRETWHR5]

Question ID:: CMS.024_01.000

Instrument Variable Name:: TRETWHR5
QuestionText:

DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties... At a day treatment program in a hospital or in your community?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:

(1) [goto TRETWHO5]
(2,R,D) [goto TRETWHR6]

Question ID:: CMS.024_02.000

Instrument Variable Name:: TRETWHO5
QuestionText:

(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling at day treatment program in a hospital or community
SkipInstructions:

(1,3-6,R,D) [goto TRETWHR6]
(2) [goto TRTMHP5]

Question ID:: CMS.024_03.000

Instrument Variable Name:: TRTMHP5
QuestionText:

You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas

1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling or treatment at day treatment program in a hospital or community from mental health provider
SkipInstructions:

(1-4,R,D) [goto TRETWHR6]

Question ID:: CMS.025_01.000

Instrument Variable Name:: TRETWHR6
QuestionText:

DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties... Any other place?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:

(1) [goto TRETWHO6]
(2,R,D) [goto OVERNT6M]

Question ID:: CMS.025_02.000

Instrument Variable Name:: TRETWHO6
QuestionText:

(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.

1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections or court counselor
6 Other
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling at another place
SkipInstructions

(1,3-6,R,D) [goto OVERNT6M]
(2) [goto TRTMHP6]

Question ID:: CMS.025_03.000

Instrument Variable Name:: TRTMHP6
QuestionText:

You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas

1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who received counseling or treatment at another place from mental health provider
SkipInstructions

(1-4,R,D) [goto OVERNT6M]

Question ID:: CMS.050_00.000

Instrument Variable Name:: OVERNT6M
QuestionText:

DURING THE PAST 6 MONTHS, in addition to a school you may have told me about, did [fill: S.C. name] stay overnight or longer in a hospital, any type of group home, any type of juvenile detention center, sometimes called juvie, or juvenile hall, youth prison, training school or jail, foster care home, or another special type of center or shelter to receive counseling or treatment for these difficulties?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions

(1) [goto OVERWHCH]
(2,R,D) [goto SH1]

Question ID:: CMS.060_00.000

Instrument Variable Name:: OVERWHCH
QuestionText:

Which ones?
*Read list if necessary.
*Enter all that apply, separate with commas.

01 Hospital
02 Residential treatment center
03 Foster care or therapeutic foster care home
04 In any type of juvenile detention center, sometimes called "juvie", prison, or jail
05 Group home
06 Homeless shelter
07 In another place
97 Refused
99 Don't know

UniverseText: Sample children 4-17 who stayed overnight in a hospital or other overnight location for difficulties
SkipInstructions:

(1-7,R,D) [goto SH1]

Question ID:: CMS.070_00.000

Instrument Variable Name:: SH1
QuestionText:

DURING THE PAST 6 MONTHS, did [fill1: S.C. name] take part in a self-help group for children and youth with these difficulties?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:

(1,2,R,D) [goto SH2]

Question ID:: CMS.080_00.000

Instrument Variable Name:: SH2
QuestionText:

DURING THE PAST 6 MONTHS, did [fill1: S.C. name] use the Internet to seek treatment or counseling for these difficulties?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions

(1,2,R,D) [goto CASEM6M]

Question ID:: CMS.100_00.000

Instrument Variable Name:: CASEM6M
QuestionText:

Parents and caregivers sometimes get help from people sometimes called case managers or care coordinators who help to find or organize treatment for children's difficulties with emotions, concentration, behavior, or being able to get along with others.
*Read if necessary: This type of help is sometimes called care coordination or case management. People or agencies that do this work might also help you develop a service plan, contact providers for you, and provide support to you in getting the help your child or adolescent needs. DURING THE PAST 6 MONTHS, did you or [fill1: S.C. name] receive this type of help from any individual or agency?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:

(1) [goto CASEMWHO];
(2,R,D) IF PRESCP6M=1 or NSDUH21=1 or NSDUH3=1 or NSDUH4=1 or TRETWHR1=1 or TRETWHR2=1 or TRETWHR3=1 or TRETWHR4=1 or TRETWHR5=1 or TRETWHR6=1 or OVERNT6M=1 or SH1=1 or SH2=1 or CASEM6M=1 [goto TRETHELP]; else [goto TRTNEED1]

Question ID:: CMS.110_00.000

Instrument Variable Name:: CASEMWHO
QuestionText:

Who provides help arranging or coordinating [fill1: S.C. name]'s care?
*Enter the MAIN answer.

01 Child welfare/social services/family and child services agency
02 School or educational system
03 Mental health agency
04 Private mental health professional
05 Juvenile justice agency or court system
06 Private insurance service
07 Family or friend
08 Pediatrician or other family doctor
09 Family or youth advocacy groups
10 Other
97 Refused
99 Don't know

UniverseText: Sample children 4-17 who received help from case managers/care coordinators in the past 6 months
SkipInstructions:

(1-10,R,D) [goto TRETHELP]

Question ID:: CMS.115_00.000

Instrument Variable Name:: TRETHELP
QuestionText:

You told us that [S.C. child] has received treatment or counseling for difficulties with emotions, concentration, behavior, or being able to get along with others. During the past 6 months, how much has this treatment or counseling helped [S.C. child]? Would you say_
* Read answer categories below.

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

UniverseText: Sample children 4-17 who received treatment in the past 6 months
SkipInstructions:

(1-4,R,D) if CMHDIFF=2-4 and DIFF6M=1 [goto TRPAYPHI]; else [goto next section]

Question ID:: CMS.120_01.000

Instrument Variable Name:: TRPAYPHI
QuestionText:

Next I'm going to read a list of ways that treatment and counseling get paid for. Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Private health insurance, such as insurance that comes with a job?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:

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

Question ID:: CMS.120_02.000

Instrument Variable Name:: TRPAYSCH
QuestionText:

*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. School system?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions

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

Question ID:: CMS.120_03.000

Instrument Variable Name:: TRPAYSLF
QuestionText:

*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. You or your family (sometimes called out of pocket or co-payment)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:

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

Question ID:: CMS.120_04.000

Instrument Variable Name:: TRPAYMED
QuestionText:

(Book) F14 *Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Medicaid?
*Read if necessary: In this State it is also called *(Refer to flashcard F14 for state Medicaid names).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:

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

Question ID:: CMS.120_05.000

Instrument Variable Name:: TRPAYCHP
QuestionText:

*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. [fill2: A state CHIP/SCHIP program?/ [STNAME1]]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:

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

Question ID:: CMS.120_06.000

Instrument Variable Name:: TRPAYMIL
QuestionText:

*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Military health care?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:

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

Question ID:: CMS.120_07.000

Instrument Variable Name:: TRPAYSHP
QuestionText:

*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Some other state or county sponsored health plan, Medicare or other government program?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months SkipInstructions:

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

Question ID:: CMS.120_09.000

Instrument Variable Name:: TRPAYIHS
QuestionText:

*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Indian Health Service?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:

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

Question ID:: CMS.120_10.000

Instrument Variable Name:: TRPAYOTH
QuestionText:

*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Some other source?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:

(1,2,R,D) if TRPAYPHI=2,R,D and TRPAYSCH=2,R,D and TRPAYSLF=2,R,D and TRPAYMED=2,R,D and TRPAYCHP=2,R,D and TRPAYMIL=2,R,D and TRPAYSHP=2,R,D and TRPAYIHS=2,R,D and TRPAYOTH=2,R,D [goto TRETFREE];
else [goto TRTNEED1]

Question ID:: CMS.120_12.000

Instrument Variable Name:: TRETFREE
QuestionText:

Was ALL OF THE treatment or counseling [fill1: S.C. name] RECEIVED during the past 6 months free?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who did not pay for treatment
SkipInstructions:

(1,2,R,D) [goto TRTNEED1]

Question ID:: CMS.150_00.000

Instrument Variable Name:: TRTNEED1
QuestionText:

DURING THE PAST 6 MONTHS, did [fill1: S.C. name] need treatment or counseling for these difficulties but didn't get it?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_01.000

Instrument Variable Name:: NTRTCOST
QuestionText:

Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Help was too expensive?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_02.000

Instrument Variable Name:: NTRTLOC
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You didn't know where to go?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_03.000

Instrument Variable Name:: NTRTNEXP
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You had a negative experience with professionals?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_04.000

Instrument Variable Name:: NTRTFEAR
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You are afraid or you don't like professionals?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_05.000

Instrument Variable Name:: NTRTLOSE
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You were afraid [fill1: S.C. name] would be taken from your home or that you would lose your parental rights or custody?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_06.000

Instrument Variable Name:: NTRTSAY
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You were afraid of what your family or friends would say?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_07.000

Instrument Variable Name:: NTRTWAIT
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You had to wait a long time for an appointment?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_08.000

Instrument Variable Name:: NTRTTRAN
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You had no way to get there?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_09.000

Instrument Variable Name:: NTRTINCV
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Services were too inconvenient to use?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_10.000

Instrument Variable Name:: NTRTFAR
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Services were too far away?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CMS.150_11.000

Instrument Variable Name:: NTRTCHNO
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. [fill1: S.C. name] did not want to go?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions

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

Question ID:: CMS.150_12.000

Instrument Variable Name:: NTRTOTH
QuestionText:

*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Some other reason?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:

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

Question ID:: CFI.005_00.010

Instrument Variable Name:: CH1N1_1
QuestionText:

?[F1] DURING THE PAST 12 MONTHS, has {SC name} had a flu vaccination? A flu vaccination is usually given in the fall and protects against influenza for the flu season.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample Child LE 17 years
SkipInstructions:

(1) [goto CH1N1_2]
(2,R,D) [goto next section]

Question ID:: CFI.005_00.020

Instrument Variable Name:: CH1N1_2
QuestionText:

How many vaccinations has {S.C. name} received?

1 1 vaccination or dose
2 2 or more vaccination doses
7 Refused
9 Don't know

UniverseText: Sample Child LE 17 years who have had an vaccine dose
SkipInstructions:

(1,2) [goto CH1N1_3M]
(R,D) [goto next section]

Question ID:: CFI.005_00.030

Instrument Variable Name:: CH1N1_3M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} most recent flu vaccine?

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 Child LE 17 who have had one or more vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_4Y]
(R) [goto CH1N1_5]

Question ID:: CFI.005_00.040

Instrument Variable Name:: CH1N1_4Y
QuestionText:

2 of 2 *Enter year of most recent flu vaccine.

Year Year
9997 Refused
9999 Don't know

UniverseText: Sample Child LE 17 years who have had one or more vaccine doses and gave month/don't know month of vaccine dose
SkipInstructions

(valid year,R,D) [goto CH1N1_5]
[If CH1N1_3M and CH1N1_4Y = a future date] goto ERR1_ CH1N1_4Y]
[If CH1N1_3M and CH1N1_4Y = a date prior to birth] goto ERR2_ CH1N1_4Y]
[If CH1N1_3M and CH1N1_4Y = a date prior to 12 months ago] goto ERR3_ CH1N1_4Y]

Hard Edit: ERR1_ CH1N1_4Y

*Future date invalid.

ERR2_ CH1N1_4Y

*Date before birth.

ERR3_ CH1N1_4Y

*Date before 12 months ago.

Question ID:: CFI.005_00.050

Instrument Variable Name:: CH1N1_5
QuestionText:

Was this a shot, or was it a vaccine sprayed in the nose?
*Read if necessary: The flu nasal spray is called FluMist(trademark).

1 Flu shot
2 Flu nasal spray (spray, mist or drop in nose)
7 Refused
9 Don't know

UniverseText: Sample Child LE 17 years who have had one or more vaccine doses
SkipInstructions:

(1-2,R,D) IF CH1N1_2=1 [goto next section]; else if CH1N1_2=2 [goto CH1N1_6M]

Question ID:: CFI.005_00.060

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

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 Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Question ID:: CFI.005_00.070

Instrument Variable Name:: CH1N1_7Y
QuestionText:

2 of 2 *Enter year of next most recent flu vaccine.

Year Year
9997 Refused
9999 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses and gave month/don't know month of vaccine dose
SkipInstructions:

(valid year,R,D) [goto CH1N1_8]
[If CH1N1_6M and CH1N1_7Y = a future date] goto ERR1_ CH1N1_7Y]
[If CH1N1_6M and CH1N1_7Y = a date prior to birth] goto ERR2_ CH1N1_7Y]
[If CH1N1_6M and CH1N1_7Y = a date prior to 12 months ago] goto ERR3_ CH1N1_7Y]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Question ID:: CFI.005_00.080

Instrument Variable Name:: CH1N1_8
QuestionText:

Was this a shot, or was it a vaccine sprayed in the nose?
*Read if necessary: The flu nasal spray is called FluMist(trademark).

1 Flu shot
2 Flu nasal spray (spray, mist or drop in nose)
7 Refused
9 Don't know

UniverseText: Sample Child LE 17 years who have more than one vaccine dose
SkipInstructions:

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

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