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2013 NHIS Questionnaire - Sample Adult
Adult Identification
Document Version Date: 29-May-14

Question ID: AID.005_00.000

Instrument Variable Name: SADULT
Question Text:

The sample adult person is [fill: ALIAS of Sample Adult]. The next questions must be answered by this person. Probe as necessary to determine the availability of [fill: ALIAS of Sample Adult].
* If refused enter CTRL-R
1 Physical or mental condition prohibits responding
2 Sample adult is able to respond
3 Unknown

Universe Text: This is the Sample Adult and (the Sample Adult section has not been started or completed).
Skip Instructions:

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

Question ID: AID.010_00.000

Instrument Variable Name: PROX1
Question Text:

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

1 Yes
2 No

Universe Text: The Sample Adult's physical or mental condition prohibits responding.
Skip Instructions:

(1) goto PROX2
(2) goto PROX3

Question ID: AID.015_00.000

Instrument Variable Name: PROX2
Question Text:

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

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

Universe Text: Knowledgeable proxy is available.
Skip Instructions:

(1-4) goto AIDVERF_S

Question ID: AID.020_00.000

Instrument Variable Name: PROX3
Question Text:

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

1 Yes
2 No

Universe Text: Knowledgeable proxy is not available.
Skip Instructions:

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

Question ID: AID.030_00.000

Instrument Variable Name: AIDVERF_S
Question Text:

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

1 Yes
2 No

Universe Text: Sample Adult is not the person entered in HHRESP or RELRESP_A. Or PROX1 = 'Yes'.
Skip Instructions:

(1) goto AIDVERF_A
(2) goto AIDSEX

Question ID: AID.040_00.000

Instrument Variable Name: AIDSEX
Question Text: Are you Male or Female?

* If don't know or refused enter your best guess of the person's sex.

1 Male
2 Female

Universe Text: Respondent said his/her sex is not correct.
Skip Instructions:

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

Hard Edit:

*The gender will now be changed to [fill: AIDSEX].
goto AIDVERF_S (as the default goto)

Question ID: AID.045_00.000

Instrument Variable Name: AIDVERF_A
Question Text:

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

1 Yes
2 No

Universe Text: Sample Adult said his/her sex is correct.
Skip Instructions:

(1) goto AIDVERF_D
(2) goto AIDAGE

Question ID: AID.050_00.000

Instrument Variable Name: AIDAGE
Question Text:

How old are you?

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

Universe Text: Respondent said his/her age is not correct
Skip Instructions:

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

Soft Edit:

*Age of [fill1: ALIAS of Sample Adult] remains [fill2: Age of Sample Adult] years old.
goto AIDVERF_A (whether suppressed or not)

Question ID: AID.055_00.000

Instrument Variable Name: AIDVERF_D
Question Text:

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

1 Yes
2 No

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

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

Question ID: AID.060_01.000

Instrument Variable Name: AIDDOB_M
Question Text:

1 of 3
What is your birthday?
*Enter month of birth.

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

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

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

Question ID: AID.060_02.000

Instrument Variable Name: AIDDOB_D
Question Text:

2 of 3
*Enter day of birth.

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

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

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

Hard Edit:

*[fill1: AIDDOB_D] is not a valid day for [fill2: AIDDOB_M]. *Please correct.

Question ID: AID.060_03.000

Instrument Variable Name: AIDDOB_Y
Question Text:

3 of 3
*Enter year of birth. Year of birth

1880-2020

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

(1880-2020, Refused, Don't know) if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty goto AIDVERF_A elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty goto AIDVERF_D endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and month = current month and day GT current day) goto ERR1_AIDDOB_Y endif
(if birth month = '02' and birth day = '29' and this is not a leap year) goto ERR2_AIDDOB_Y endif
(if AIDDOB_M = 'Ref' or 'DK') or (if AIDDOB_D = 'Re'f or 'DK') or (if AIDDOB_Y = 'Ref' or 'DK') goto ERR3_AIDDOB_Y
else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty goto AIDVERF_D endif endif
Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.
if age from AIDDOB items is ne AGE and age from AIDDOB items is valid reset AIDVERF_A or AIDVERF_D. goto ERR4_AIDDOB_Y
endif
ERR1_AIDDOB_Y

Hard Edit:

*Future date invalid: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)] *Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR2_AIDDOB_Y
*Not a valid day: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)] *Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR3_AIDDOB_Y
*DOB of [fill2: ALIAS of Sample Adult] remains [fill3: (DOBM) (DOBD), (DOBY)]
goto AIDVERF_A (whether suppressed or not)
ERR4_AIDDOB_Y
* Data mismatched. Please fix Age or Birthday.
*If still cannot reconcile, enter 'Don't know' for year of birth.
*Please correct.

Question ID: ASD.050_00.000

Instrument Variable Name: WRKVER
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ASD.060_00.000

Instrument Variable Name: WRKCOR
Question Text:

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

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

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

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

Question ID: ASD.062_00.000

Instrument Variable Name: DOINGLW2
Question Text:

Corrected Employment Status Last Week: (not displayed)

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

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

Question ID: ASD.065_00.000

Instrument Variable Name: WHYNOWK2
Question Text:

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

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

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

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

Question ID: ASD.066_00.000

Instrument Variable Name: EVERWRK
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ASD.070_00.000

Instrument Variable Name: WHOWRK
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Question ID: ASD.080_00.000

Instrument Variable Name: KINDIND
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

Question ID: ASD.090_00.000

Instrument Variable Name: KINDWRK
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

Question ID: ASD.100_00.000

Instrument Variable Name: IMPACT
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

Question ID: ASD.110_00.000

Instrument Variable Name: WRKCAT
Question Text:

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

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

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

Question ID: ASD.112_00.000

Instrument Variable Name: BUSINC
Question Text:

Is this business incorporated?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are self-employed
Skip Instructions: (1,2,D,R) [goto LOCALLNO]

Question ID: ASD.120_00.000

Instrument Variable Name: LOCALLNO
Question Text:

(book) A3
Thinking about [If DOINGLW2 eq (1,2,4)] this MAIN job or business [Else if EVERWRK eq (1) and [WHYNOWK2 eq 03 or AGE ge 65] your last week at the job you held the longest [Else if EVERWRK eq (1) and WHYNOWK2 ne 03 and AGE lt 65] your last week at the job you held most recently how many people work(ed) at this location?
how many people (Fill4:work/Fill5: worked) at this location?
* "People" includes both FULL- and PART-time employees; "location" refers to the street address of the workplace.

01 1-9 employees
02 10-24 employees
03 25-49 employees
04 50-99 employees
05 100-249 employees
06 250-499 employees
07 500-999 employees
08 1000 employees or more
97 Refused
99 Don't know

Question ID: ASD.140_01.000

Instrument Variable Name: WRKLONGN
Question Text:

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

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

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

Question ID: ASD.140_02.000

Instrument Variable Name: WRKLONGT
Question Text:

2 of 2
* Enter time period.

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

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

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

Hard Edit:

ERR_WRKLONGT
*Number of years is greater than age.
*Please correct.

Question ID: ASD.146_00.000

Instrument Variable Name: WRKLONGH
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ (who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business,) or (who have ever worked and are not retired and are less than 65 years of age.)
Skip Instructions: (1,2,R,D) [goto HOURPD]

Question ID: ASD.150_00.000

Instrument Variable Name: HOURPD
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Question ID: ASD.160_00.000

Instrument Variable Name: PDSICK
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

(1,2,D,R)
if DOINGLW2 = 1,2,4 then [goto ONEJOB];
else if DOINGLW2=3,5 then [goto WRKLYR2];
else if DOINGLW2=D, R then [goto next section]

Question ID: ASD.170_00.000

Instrument Variable Name: ONEJOB
Question Text:

Do you have more than one job or business?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business
Skip Instructions: (1,2,D,R) [goto next section]

Question ID: ASD.210_00.000

Instrument Variable Name: WRKLYR2
Question Text:

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

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

Universe Text: Sample adults 18+ who were looking for work or who were not working at a job or business AND who were not looking for work in the last week
Skip Instructions: (0-2,D,R) [goto next section]

Question ID: ACN.010_00.000

Instrument Variable Name: HYPEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.020_00.000

Instrument Variable Name: HYPDIFV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [goto HYPYR]
(2,R,D) [goto CHLYR]

Question ID: ACN.025_00.010

Instrument Variable Name: CHLYR
Question Text:

DURING THE PAST 12 MONTHS, have you had high cholesterol?
*Enter '1' if respondent is taking medication to control his/her high cholesterol.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.031_01.000

Instrument Variable Name: CHDEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.031_02.000

Instrument Variable Name: ANGEV
Question Text:

* Read if necessary:

Have you EVER been told by a doctor or other health professional that you had
... Angina, also called angina pectoris?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)

[goto MIEV]

Question ID: ACN.031_03.000

Instrument Variable Name: MIEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.031_04.000

Instrument Variable Name: HRTEV
Question Text:

? [F1]

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.031_05.000

Instrument Variable Name: STREV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.031_06.000

Instrument Variable Name: EPHEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.035_00.000

Instrument Variable Name: COPDEV
Question Text:

Have you EVER been told by a doctor or other health professional that you had chronic obstructive pulmonary disease, also called COPD?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) [if AGE GE 40, goto ASPMDMED; else goto AASMEV]

Question ID: ACN.040_00.010

Instrument Variable Name: ASPMEDEV
Question Text:

Has a doctor or other health professional EVER told you to take a low-dose aspirin each day to prevent or control heart disease?
* If the respondent volunteers they have been told to take an aspirin every other day or "regularly" for these reasons, enter 1 for "yes."

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto ASPMEDAD]
(2,R,D) [goto ASPONOWN]

Question ID: ACN.040_00.020

Instrument Variable Name: ASPMEDAD
Question Text:

Are you NOW following this advice?
* If the respondent provides an answer such as "sometimes," "occasionally," or "from time to time," enter 1 for "yes."

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have ever been advised to take a low-dose aspirin every day to prevent or control heart disease
SkipInstructions:

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

Question ID: ACN.040_00.030

Instrument Variable Name: ASPMDMED
Question Text:

Did a doctor or other health professional advise you to stop taking a low-dose aspirin every day?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have ever been advised to take aspirin every day, but are not currently following that advice
SkipInstructions:

(1,2,R,D) goto AASMEV

Question ID: ACN.040_00.040

Instrument Variable Name: ASPONOWN
Question Text:

On your own, are you now taking a low-dose aspirin each day to prevent or control heart disease?
* If the respondent volunteers they are taking an aspirin every other day or "regularly" for these reasons, enter 1 for "yes."

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have not been advised to take aspirin every day or Ref/DK if they have been advised to take aspirin every day
SkipInstructions:

(1,2,R,D) goto AASMEV

Question ID: ACN.080_00.000

Instrument Variable Name: AASMEV
Question Text:

? [F1]

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.085_00.000

Instrument Variable Name: AASSTILL
Question Text:

? [F1]

Do you still have asthma?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.090_00.000

Instrument Variable Name: AASMYR
Question Text:

? [F1]

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.100_00.000

Instrument Variable Name: AASMERYR
Question Text:

? [F1]

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) if AASSTILL=1 or AASMYR=1 [go to AASMHSP];
else if AASSTILL=2,R,D and AASMYR=2,R,D [go to ULCEV]

Question ID: ACN.100_00.010

Instrument Variable Name: AASMHSP
Question Text:

DURING THE PAST 12 MONTHS, have you stayed overnight in a hospital because of asthma?
*If in hospital for asthma AND other reasons, enter '1'.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.100_00.030

Instrument Variable Name: AWZMSWK
Question Text:

DURING THE PAST 12 MONTHS, HOW MANY DAYS were you UNABLE to [fill1: work/get work done around the house] because of your asthma?
*Enter '0' for none.
*Enter '996' if respondent is unable to do this activity.

000 None
001-365 1-365 days
996 Unable to do this activity
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

(0-100,996,R,D) [go to AASMPMED]
(101-365) [go to ERR1_AWZMSWK]
(366-994) [go to ERR2_AWZMSWK]
Hard Edit: if AWZMSWK = 366-994 then display ERR2_AWZMSWK:
"366-994 days not allowed in this field.
*Please correct."
Soft Edit: if AWZMSWK >100 and ne 996 then display ERR1_AWZMSWK:
"AWZMSWK is an unusually large number;
*Please verify.

Question ID: ACN.100_00.060

Instrument Variable Name: AASMPMED
Question Text:

Now I'm going to ask you about two different kinds of ASTHMA medicine. One prevents symptoms over the long term. The other is for quick relief of symptoms during an attack or episode. This quick relief medicine is breathed in through your mouth using a canister inhaler or a disk inhaler.
DURING THE PAST 3 MONTHS, have you used the kind of PRESCRIPTION asthma inhaler that gives QUICK relief from asthma symptoms during an attack? Include only medications prescribed by a health care professional.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

(1) [goto AASMTYP]
(2,R,D) [go to AASMDTP2]

Question ID: ACN.100_00.065

Instrument Variable Name: AASMTYP
Question Text:

When you take your rescue prescription asthma medication, would you say that you most often use an inhaler and/or disk, or do you most often use a nebulizer?
*Read if necessary: Both an inhaler or a disk inhaler are very portable canisters or devices used to inhale medication in one or two breaths. A nebulizer is a machine that turns liquid medication into a mist that you inhale into the lungs over a few minutes

1 Inhaler or disk
2 Nebulizer
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have used a quick relief prescription asthma inhaler in the past three months
SkipInstructions:

(1) [go to AASMCAN]
(2,R,D) [go to AASMDTP2]

Question ID: ACN.100_00.070

Instrument Variable Name: AASMCAN
Question Text:

DURING THE PAST 3 MONTHS, did you use more than three canisters or disks of this type of quick relief inhaler?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have used a prescription asthma inhaler/disk most often in the past three months
SkipInstructions:

(1,2,R,D) [go to AASMDTP2]

Question ID: ACN.100_00.090

Instrument Variable Name: AASMDTP2
Question Text:

The second kind of asthma medication is different from inhalers used for quick relief. It is the preventive kind that is used to protect your lungs and keep you from having attacks. It can be either a pill or an inhaler.
Are you NOW taking a preventive asthma medication every day or almost every day, less often, or never?

1 Every day or almost every day
2 Less often
3 Never
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

(1-3,R,D) [go to AASWMP]

Question ID: ACN.100_00.100

Instrument Variable Name: AASWMP
Question Text:

An asthma action plan is a printed form with specific instructions based on your asthma that tells when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room. Has a doctor or other health professional EVER given you an asthma action plan?
*Read if necessary: Include nurses and asthma educators.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.100_00.110

Instrument Variable Name: AASCLASS
Question Text:

Have you ever taken a course or class on how to manage asthma yourself?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.105_01.010

Instrument Variable Name: AAS_REC
Question Text:

Has a doctor or other health professional EVER taught you...how to recognize early signs or symptoms of an asthma episode?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.105_02.020

Instrument Variable Name: AAS_RES
Question Text:

*Read if necessary: Has a doctor or other health professional EVER taught you...how to respond to episodes of asthma?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.105_03.030

Instrument Variable Name: AAS_MON
Question Text:

*Read if necessary: Has a doctor or other health professional EVER taught you...how to monitor peak flow for daily therapy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.107_00.010

Instrument Variable Name: AAPENVLN
Question Text:

Has a doctor or other health professional EVER advised you to change things in your home, school, or work environment to improve your asthma?

1 Yes
2 No
3 Was told no changes needed
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

(1-3,R,D) [go to AAROUTIN]

Question ID: ACN.107_00.020

Instrument Variable Name: AAROUTIN
Question Text:

DURING THE PAST 12 MONTHS, how many times did you see a doctor or other health professional for a routine checkup for your asthma? Please do not include emergency room visits, visits to urgent care centers, or other visits for acute care for an asthma episode or attack.
*Enter '0' for none.

000 None
001-365 1-365 times
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

(0-50,R,D) [go to AASYMPT]
(51-365) [goto ERR_AAROUTIN]

Soft Edit:

ERR_AAROUTIN
[fill4: AAROUTIN] is an unusually large number. * Please verify.

Question ID: ACN.107_00.030

Instrument Variable Name: AASYMPT
Question Text:

The next three questions are about the last time you saw a doctor or other health care professional for routine care or for any reason.
At your last visit, did your doctor or other health professional ask HOW OFTEN?.you had asthma symptoms?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

(1,2,R,D) [go to AARESCUE];

Question ID: ACN.107_00.040

Instrument Variable Name: AARESCUE
Question Text:

At your last visit, did your doctor or other health professional ask HOW OFTEN?.you used a quick relief inhaler?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.107_00.050

Instrument Variable Name: AAACTLIM
Question Text:

At your last visit, did your doctor or other health professional ask HOW OFTEN?asthma symptoms limited your daily activities?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:

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

Question ID: ACN.110_00.000

Instrument Variable Name: ULCEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.120_00.000

Instrument Variable Name: ULCYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.130_00.000

Instrument Variable Name: CANEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.140_00.001

Instrument Variable Name: CANKIND_1
Question Text:

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

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

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

(1-30,R,D)[goto CANAGE_1]
IF SEX=1 (MALE) and No. (6,18,29) selected goto ERR1_CANKIND_1
IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_1

Hard Edit:

ERR1_CANKIND_1
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_1
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.002

Instrument Variable Name: CANKIND_2
Question Text:

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

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

(1-30,R,D)[goto CANAGE_2] (96) goto DIBEV
IF SEX=1 (MALE) and No. (6,18,29) selected goto ERR1_CANKIND_2
IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_2

Hard Edit:

ERR1_CANKIND_2
*Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_2
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.003

Instrument Variable Name: CANKIND_3
Question Text:

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

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

(1-30,R,D)[goto CANAGE_3] (96) [goto DIBEV]
IF SEX=1 (MALE) and No. (6,18,29) selected goto ERR1_CANKIND_3
IF SEX=2 (FEMALE) and No. (20,26) selected goto ERR2_CANKIND_3

Hard Edit:

ERR1_CANKIND_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_3
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.004

Instrument Variable Name: CANKIND_4
Question Text:

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

95 More than three kinds
96 No more

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

(95,96) [goto DIBEV]

Question ID: ACN.150_00.001

Instrument Variable Name: CANAGE_1
Question Text:

?[F1] How old were you when [Fill1: CANKIND_1 / Fill2: this cancer] was first diagnosed?

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

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

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

Hard Edit:

ERR_ CANAGE_1
* [Fill2: CANAGE_1] years old is older than age[fill3: AGE].
* Please correct.

Question ID: ACN.150_00.002

Instrument Variable Name: CANAGE_2
Question Text:

?[F1] How old were you when [Fill1: CANKIND_2 / Fill2: this cancer] was first diagnosed?

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

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

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

Hard Edit:

ERR_ CANAGE_2
* [Fill2: CANAGE_2] years old is older than age[fill3: AGE].
* Please correct.

Question ID: ACN.150_00.003

Instrument Variable Name: CANAGE_3
Question Text:

?[F1] How old were you when [Fill1: CANKIND_3 / Fill2: this cancer] was first diagnosed?

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

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

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

Hard Edit:

ERR_ CANAGE_3
* [Fill2: CANAGE_3] years old is older than age[fill3: AGE].
* Please correct.

Question ID: ACN.160_00.000

Instrument Variable Name: DIBEV
Question Text:

? [F1]
[Fill1:Other than during pregnancy, have you EVER been told by a doctor or other health professional that you have diabetes or sugar diabetes?]/[Fill2:Have you EVER been told by a doctor or other health professional that you have diabetes or sugar diabetes?]

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.165_00.000

Instrument Variable Name: DIBPRE1
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.170_00.000

Instrument Variable Name: DIBAGE
Question Text:

? [F1]

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

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

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

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

Hard Edit:

ERR_ DIBAGE
*[Fill1: DIBAGE] years old is older than your age[fill2: AGE].
*Please correct.

Question ID: ACN.180_00.000

Instrument Variable Name: INSLN
Question Text:

Are you NOW taking insulin?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.190_00.000

Instrument Variable Name: DIBPILL
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.192_00.010

Instrument Variable Name: EPILEP1
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.192_00.020

Instrument Variable Name: EPILEP2
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.192_00.030

Instrument Variable Name: EPILEP3
Question Text:

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

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

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

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

Question ID: ACN.192_00.040

Instrument Variable Name: EPILEP4
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.192_00.050

Instrument Variable Name: EPILEP5
Question Text:

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

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

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

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

Question ID: ACN.201_01.000

Instrument Variable Name: AHAYFYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.201_02.000

Instrument Variable Name: SINYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.201_03.000

Instrument Variable Name: CBRCHYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.201_04.000

Instrument Variable Name: KIDWKYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.201_05.000

Instrument Variable Name: LIVYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.250_00.000

Instrument Variable Name: JNTSYMP
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.260_00.000

Instrument Variable Name: JMTHP
Question Text:

book) A4
Which joints are affected?
* Enter all that apply, separate with commas.

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

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

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

Question ID: ACN.270_00.000

Instrument Variable Name: JNTCHR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.280_00.000

Instrument Variable Name: JNTHP
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.290_00.000

Instrument Variable Name: ARTH
Question Text:

? [F1]
Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia (fy-bro-my-AL-jee-uh)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.295_00.000

Instrument Variable Name: ARTHLMT
Question Text:

? [F1] Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.300_00.000

Instrument Variable Name: PAINECK
Question Text:

? [F1]
The following questions are about pain you may have experienced in the PAST THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor.
DURING THE PAST THREE MONTHS, did you have... Neck pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.310_00.000

Instrument Variable Name: PAINLB
Question Text:

? [F1] * Read if necessary.
DURING THE PAST THREE MONTHS, did you have... Low back pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.320_00.000

Instrument Variable Name: PAINLEG
Question Text:

? [F1] Did this pain spread down either leg to areas below the knees?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.331_01.000

Instrument Variable Name: PAINFACE
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.331_02.000

Instrument Variable Name: AMIGR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.350_00.000

Instrument Variable Name: ACOLD2W
Question Text:

These next questions are about your recent health DURING THE LAST 2 WEEKS.
Did you have a head cold or chest cold that started DURING THE LAST 2 WEEKS?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.360_00.000

Instrument Variable Name: AINTIL2W
Question Text:

Did you have a stomach or intestinal illness with vomiting or diarrhea that started DURING THE LAST TWO WEEKS?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.370_00.000

Instrument Variable Name: PREGNOW
Question Text:

Are you currently pregnant?

1 Yes
2 No
7 Refused
9 Don't know

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

(1) if INTERVIEW_MONTH=4,5,6,7 (April-July) [goto PREGFLYR];
else [goto HRAIDNOW]
(R) [goto HRAIDNOW]
(2,D) [goto PREGFLYR]

Question ID: ACN.370_00.010

Instrument Variable Name: PREGFLYR
Question Text:

[fill1: Were you pregnant any time since August 1st, [fill: LAST YEAR]?/Were you pregnant any time from August [fill: LAST YEAR] through March [fill: CURYEAR]?/Were you pregnant any time since August 1st, [fill: CURYEAR]?]

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18-49 years of age who are not currently pregnant or who don't know if they are currently pregnant and interviewed April - July
SkipInstructions:

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

Question ID: ACN.400_00.000

Instrument Variable Name: HRAIDNOW
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

\

Question ID: ACN.410_00.000

Instrument Variable Name: HRAIDEV
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.420_00.000

Instrument Variable Name: AHEARST1
Question Text:

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

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.430_00.000

Instrument Variable Name: AVISION
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ACN.440_00.000

Instrument Variable Name: ABLIND
Question Text:

Are you blind or unable to see at all?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.451_00.000

Instrument Variable Name: LUPPRT
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AIS.010_00.010

Instrument Variable Name: AIMSUPEV
Question Text:

Have you EVER been told by a doctor or other health professional that your immune system is weakened?
*Read if necessary: A weakened immune system is also called immune compromised or immune suppressed. It means that you are not able to fight infections and is usually caused by an underlying illness or by various medical treatments or prescription medications.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AIS.010_00.020

Instrument Variable Name: AIMSPSTL
Question Text:

Based on what a doctor or other health professional told you, do you still have a weakened immune system?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever been told by a doctor/other health professional that they had a weakened immune system
SkipInstructions:

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

Question ID: AIS.010_00.030

Instrument Variable Name: AIMSPMED
Question Text:

The next questions are about reasons a doctor or other health professional may have told you that your immune system was weakened. Please say yes or no to each.
DURING THE PAST 6 MONTHS, have you taken prescription medication or had any medical treatments that a doctor or other health professional told you would weaken your immune system? Examples include steroid or corticosteroid pills, such as prednisone, or other oral or injected medications for treating many types of autoimmune conditions or certain cancers.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever been told by a doctor/other health professional that they had a weakened immune system
SkipInstructions:

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

Question ID: AIS.010_00.040

Instrument Variable Name: AIMSPCHC
Question Text:

Do you currently have a health condition that a doctor or other health professional told you weakens the immune system, even without related medications or treatments? Examples include certain kinds of leukemia, lymphoma, or HIV infection.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever been told by a doctor/other health professional that they had a weakened immune system
SkipInstructions:

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

Question ID: AIS.010_00.050

Instrument Variable Name: AIMSPSHC
Question Text:

Has a doctor or other health professional EVER told you that your immune system is weakened because you have kidney disease, lung disease, liver disease, diabetes, poor nutrition, or general frailty?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever been told by a doctor/other health professional that they had a weakened immune system
SkipInstructions:

(1,2,R,D) If CANKIND_1=1-30 or CANKIND_2=1-30 or CANKIND_3=1-30 or CANKIND_4=96 [goto AIMSPCAN]; else [goto AIMSPCLD]

Question ID: AIS.010_00.060

Instrument Variable Name: AIMSPCAN
Question Text:

Earlier you said you had {fill1: type of cancer from CANKIND_1, CANKIND_2, CANKIND_3, CANKIND_4 cancer}. Did a doctor or other health professional EVER tell you that your immune system is weakened because of {fill2: this cancer/these cancers}?
*Read if necessary: Please only respond yes if a doctor or health care professional told you the cancer weakens the immune system, even if you are not now having treatments or taking prescription medicines that weaken the immune system.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever been told by a doctor/other health professional that they had a weakened immune system and have one or more kinds of cancer
SkipInstructions:

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

Question ID: AIS.010_00.070

Instrument Variable Name: AIMSPCLD
Question Text:

Has a doctor or other health professional EVER told you that your immune system is weakened because you seem to get many infections and colds or that you can't seem to get over them?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever been told by a doctor/other health professional that they had a weakened immune system
SkipInstructions:

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

Question ID: AHS.040_00.000

Instrument Variable Name: WKDAYR
Question Text:

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

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

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

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

Soft Edit:

ERR_WKDAYR
* [Fill: WKDAYR] is an unusually large number.
* Please verify.

Question ID: AHS.050_00.000

Instrument Variable Name:BEDDAYR
Question Text:

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

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Soft Edit:

ERR_BEDDAYR
* [Fill: BEDDAYR] is an unusually large number.
* Please verify.

Question ID: AHS.060_00.000

Instrument Variable Name: AHSTATYR
Question Text:

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

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.070_00.000

Instrument Variable Name: SPECEQ
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.091_01.000

Instrument Variable Name: FLWALK
Question Text:

(book) A5

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

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.091_02.000

Instrument Variable Name: FLCLIMB
Question Text:

(book) A5

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

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.091_03.000

Instrument Variable Name: FLSTAND
Question Text:

(book) A5

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

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.091_04.000

Instrument Variable Name: FLSIT
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Sit for about 2 hours?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.091_05.000

Instrument Variable Name: FLSTOOP
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Stoop, bend, or kneel?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.091_06.000

Instrument Variable Name: FLREACH
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Reach up over your head?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.141_01.000

Instrument Variable Name: FLGRASP
Question Text:

(book) A5 * Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Use your fingers to grasp or handle small objects?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.141_02.000

Instrument Variable Name: FLCARRY
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Lift or carry something as heavy as 10 pounds such as a full bag of groceries?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.141_03.000

Instrument Variable Name: FLPUSH
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Push or pull large objects like a living room chair?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.171_01.000

Instrument Variable Name: FLSHOP
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Go out to things like shopping, movies, or sporting events?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.171_02.000

Instrument Variable Name: FLSOCL
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.171_03.000

Instrument Variable Name: FLRELAX
Question Text:

(book) A5
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AHS.200_00.000

Instrument Variable Name: AFLHCA
Question Text:

(book) A6
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
*Enter condition number for all that apply, separate with commas.
*Do not probe, except to clarify answer.

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

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

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

Question ID: AHS.201_90.000

Instrument Variable Name: AFLHCA_S1
Question Text:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

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

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

Hard Edit:

$ You should enter something specific.

Question ID: AHS.201_91.000

Instrument Variable Name: AFLHCA_S2
Question Text: :

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

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

(50 chars)[goto AHCL91N]
>ENTER only with no description [goto ERR1_AFLHCA_S1]

Hard Edit:

$ You should enter something specific.

Question ID: AHS.300_01.000

Instrument Variable Name: AHCL01N
Question Text:

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

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

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

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

Question ID: AHS.300_02.000

Instrument Variable Name: AHCL01T
Question Text:

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

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

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

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

Hard Edit:

ERR1_AHCL01T
*Time with condition cannot be greater than age.
*Please correct.
ERR2_AHCL01T
*"6" not selectable.

Question ID: AHS.301_01.000

Instrument Variable Name: AHCL02N
Question Text:

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

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

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

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

Question ID: AHS.301_02.000

Instrument Variable Name: AHCL02T
Question Text:

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

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

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

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

Hard Edit:

ERR1_AHCL02T
* Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL02T
* "6" not selectable.

Question ID: AHS.302_01.000

Instrument Variable Name: AHCL03N
Question Text:

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

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

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

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

Question ID: AHS.302_02.000

Instrument Variable Name: AHCL03T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL03T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.303_01.000

Instrument Variable Name: AHCL04N
Question Text:

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

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

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

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

Question ID: AHS.303_02.000

Instrument Variable Name: AHCL04T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL04T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.304_01.000

Instrument Variable Name: AHCL05N
Question Text:

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

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

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

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

Question ID: AHS.304_02.000

Instrument Variable Name: AHCL05T
Question Text:

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

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

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

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

Hard Edit:

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

Question ID: AHS.305_01.000

Instrument Variable Name: AHCL06N
Question Text:

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

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

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

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

Question ID: AHS.305_02.000

Instrument Variable Name: AHCL06T
Question Text:

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

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

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

(1- 4, R,D) [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL06T [if [AHCL06N = Number greater than person years old and AHCL06T= 4]] goto ERR1_AHCL06T
Hard Edit:
ERR_AHCL06T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.306_01.000

Instrument Variable Name: AHCL07N
Question Text:

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

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

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

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

Question ID: AHS.306_02.000

Instrument Variable Name: AHCL07T
Question Text:

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

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

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

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

Hard Edit:

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

Question ID: AHS.307_01.000

Instrument Variable Name: AHCL08N
Question Text:

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

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

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

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

Question ID: AHS.307_02.000

Instrument Variable Name: AHCL08T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL08T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.308_01.000

Instrument Variable Name: AHCL09N
Question Text:

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

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

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

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

Question ID: AHS.308_02.000

Instrument Variable Name: AHCL09T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL09T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.309_01.000

Instrument Variable Name: AHCL10N
Question Text:

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

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

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

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

Question ID: AHS.309_02.000

Instrument Variable Name: AHCL10T
Question Text:

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

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

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

(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL10T [if [AHCL10N = Number greater than person years old and AHCL10T= 4]] goto ERR1_AHCL10T
Hard Edit:
ERR_AHCL10T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.310_01.000

Instrument Variable Name: AHCL11N
Question Text:

1 of 2

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

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

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

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

Question ID: AHS.310_02.000

Instrument Variable Name: AHCL11T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL11T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.311_01.000

Instrument Variable Name: AHCL12N
Question Text:

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

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

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

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

Question ID: AHS.311_02.000

Instrument Variable Name: AHCL12T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL12T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.313_01.000

Instrument Variable Name: AHCL14N
Question Text:

1 of 2
How long have you had intellectual disability, also known as mental retardation?
*Enter number for time with intellectual disability/mental retardation.
*Enter '95'' for 95 or more.
*Enter "96" if since birth.

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

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

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

Question ID: AHS.313_02.000

Instrument Variable Name: AHCL14T
Question Text:

2 of 2
* Enter time period for time with intellectual disability/mental retardation.

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

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

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

Hard Edit:

ERR_AHCL14T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.314_01.000

Instrument Variable Name: AHCL15N
Question Text:

1 of 2

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

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

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

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

Question ID: AHS.314_02.000

Instrument Variable Name: AHCL15T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL15T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.315_01.000

Instrument Variable Name: AHCL16N
Question Text:

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

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

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

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

Question ID: AHS.315_02.000

Instrument Variable Name: AHCL16T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL16T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.316_01.000

Instrument Variable Name: AHCL17N
Question Text:

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

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

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

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

Question ID: AHS.316_02.000 Instrument Variable Name: AHCL17T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL17T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.317_01.000

Instrument Variable Name: AHCL18N
Question Text:

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

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

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

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

Question ID: AHS.317_02.000

Instrument Variable Name: AHCL18T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL18T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.318_01.000

Instrument Variable Name: AHCL19N
Question Text:

1 of 2

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

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

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

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

Question ID: AHS.318_02.000

Instrument Variable Name: AHCL19T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL19T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.319_01.000

Instrument Variable Name: AHCL20N
Question Text:

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

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

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

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

Question ID: AHS.319_02.000

Instrument Variable Name: AHCL20T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL20T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.320_01.000

Instrument Variable Name: AHCL21N
Question Text:

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

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

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

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

Question ID: AHS.320_02.000

Instrument Variable Name: AHCL21T
Question Text:

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

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

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

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

Hard Edit:

ERR_AHCL21T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.321_01.000

Instrument Variable Name: AHCL22N
Question Text:

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

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

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

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

Question ID: AHS.321_02.000

Instrument Variable Name: AHCL22T
Question Text:

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

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

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

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

Hard Edit:

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

Question ID: AHS.322_01.000

Instrument Variable Name: AHCL23N
Question Text:

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

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

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

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

Question ID: AHS.322_02.000

Instrument Variable Name: AHCL23T
Question Text:

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

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

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

(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL23T [if [AHCL23N = Number greater than person years old and AHCL23T= 4]] goto ERR1_AHCL23T
Hard Edit:
ERR_AHCL23T
*Time with condition cannot be greater than age.
*Please correct.

Question ID: AHS.323_01.000

Instrument Variable Name: AHCL24N
Question Text:

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

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

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

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

Question ID: AHS.323_02.000

Instrument Variable Name: AHCL24T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL24T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.324_01.000

Instrument Variable Name: AHCL25N
Question Text:

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

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

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

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

Question ID: AHS.324_02.000

Instrument Variable Name: AHCL25T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL25T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.325_01.000

Instrument Variable Name: AHCL26N
Question Text:

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

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

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

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

Question ID: AHS.325_02.000

Instrument Variable Name: AHCL26T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL26T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.326_01.000

Instrument Variable Name: AHCL27N
Question Text:

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

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

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

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

Question ID: AHS.326_02.000

Instrument Variable Name: AHCL27T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL27T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.327_01.000

Instrument Variable Name: AHCL28N
Question Text:

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

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

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

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

Question ID: AHS.327_02.000

Instrument Variable Name: AHCL28T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL28T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.328_01.000

Instrument Variable Name: AHCL29N
Question Text:

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

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

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

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

Question ID: AHS.328_02.000

Instrument Variable Name: AHCL29T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL29T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.329_01.000

Instrument Variable Name: AHCL30N
Question Text:

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

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

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

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

Question ID: AHS.329_02.000

Instrument Variable Name: AHCL30T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL30T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.330_01.000

Instrument Variable Name: AHCL31N
Question Text:

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

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

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

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

Question ID: AHS.330_02.000

Instrument Variable Name: AHCL31T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL31T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.331_01.000

Instrument Variable Name: AHCL32N
Question Text:

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

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

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

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

Question ID: AHS.331_02.000

Instrument Variable Name: AHCL32T
Question Text:

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

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

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

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

Hard Edit: ERR_AHCL32T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.332_01.000

Instrument Variable Name: AHCL33N
Question Text:

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

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

UniverseText: Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
SkipInstructions:

(1-95,D)[goto AHCL33T]
(R)[store "R" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.332_02.000

Instrument Variable Name: AHCL33T
Question Text:

2 of 2 * Enter time period for time with thyroid problem, Grave's disease or gout.

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

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

(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL33T [if [AHCL33N = Number greater than person years old and AHCL33T= 4]] goto ERR1_AHCL33T

Hard Edit: ERR_AHCL33T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.333_01.000

Instrument Variable Name: AHCL34N
Question Text:

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

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

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

(1-95,D)[goto AHCL34T]
(R)[store "R" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.333_02.000

Instrument Variable Name: AHCL34T
Question Text:

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

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

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

(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL34T [if [AHCL34N = Number greater than person years old and AHCL34T= 4]] goto ERR1_AHCL34T

Hard Edit: ERR1_AHCL34T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.334_01.000

Instrument Variable Name: AHCL35N
Question Text:

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

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

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

(1-95,D)[goto AHCL35T]
(R)[store "R" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.334_02.000

Instrument Variable Name: AHCL35T
Question Text:

2 of 2 * Enter time period for time with migraine headaches.

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

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

SkipInstructions:

(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL35T [if [AHCL35N = Number greater than person years old and AHCL35T= 4]] goto ERR1_AHCL35T

Hard Edit: ERR1_AHCL35T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.335_01.000

Instrument Variable Name: AHCL90N
Question Text:

1 of 2 How long have you had {problem in AFLHCA90}?
* Enter number for time with {problem in AFLHCA90}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA90}
SkipInstructions:

(1-95,D)[goto AHCL90T]
(R)[store "R" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.335_02.000

Instrument Variable Name: AHCL90T
Question Text:

2 of 2 * Enter time period for time with {problem in AFLHCA90}.

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

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

(1- 4, R,D)[[if 91 selected in AFLHCA goto AFLHCA_S2]
Else goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL90T [if [AHCL90N = Number greater than person years old and AHCL90T= 4]] goto ERR1_AHCL90T

Hard Edit: ERR_AHCL90T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.336_01.000

Instrument Variable Name: AHCL91N
Question Text:

1 of 2 How long have you had {problem in AFLHCA91}?
* Enter number for time with {problem in AFLHCA91}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA91}
SkipInstructions:

(1-95,D)[goto AHCL91T]
(R)[store "R" in AHCL91T] [goto SMKEV (next section)]
(96)[store "6" in AHCL91T] [goto SMKEV (next section)]

Question ID: AHS.336_02.000

Instrument Variable Name: AHCL91T
Question Text:

2 of 2 * Enter time period for time with {problem in AFLHCA91}.

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

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

(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL91T [if [AHCL91N = Number greater than person years old and AHCL91T= 4]] goto ERR1_AHCL91T

Hard Edit: ERR_AHCL91T

* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHB.010_00.000

Instrument Variable Name: SMKEV
Question Text:

These next questions are about cigarette smoking. Have you smoked at least 100 cigarettes in your ENTIRE LIFE?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1)[goto SMKREG]
(2,R,D)[goto OTHCIGEV]

Question ID: AHB.020_00.000

Instrument Variable Name: SMKREG
Question Text:

How old were you when you FIRST started to smoke fairly regularly?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years old or older.
* Enter '96' if never smoked regularly.

06-84 6 - 84 years
85 85 years or older
96 Never smoked regularly
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions:

(6-95,96,R,D) [goto SMKNOW] [If SMKREG gt AGE and SMKREG ne (96), goto ERR_SMKREG

Hard Edit: ERR_SMKREG

* Starting age exceeded current age.
* Please correct.

Question ID: AHB.030_00.000

Instrument Variable Name: SMKNOW
Question Text:

Do you NOW smoke cigarettes every day, some days or not at all?

1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions:

(1)[goto CIGSDA1]
(2)[goto CIGDAMO]
(3)[goto SMKQTNO]
(D,R)[goto OTHCIGEV]

Question ID: AHB.040_01.000

Instrument Variable Name: SMKQTNO
Question Text:

1 of 2 How long has it been since you quit smoking cigarettes?
* Enter number for time since quit smoking.
* Enter '95' for 95 years old or older.

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

UniverseText: Sample adults 18+ who quit smoking
SkipInstructions:

(1-95) [goto SMKQTTP]
(D,R) [goto OTHCIGEV]

Question ID: AHB.040_02.000

Instrument Variable Name: SMKQTTP
Question Text:

2 of 2 * Enter time period for time since quit smoking.

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

UniverseText: Sample adults 18+ who quit smoking
SkipInstructions:

(1-4) [goto OTHCIGEV]
(4) [if SMKQTNO gt (AGE - (15)), goto ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), goto ERR2_SMKQTTP.

Hard Edit: ERR2_SMKQTTP

* Age started ([Fill1: SMKREG]) + years since quit ([Fill2: SMKQTNO]) exceeds current age ([Fill3: AGE]).
* Please correct.

Soft Edit: ERR1_SMKQTTP

* Respondent quit smoking before age 15?
* Please verify.

Question ID: AHB.050_00.000

Instrument Variable Name: CIGSDA1
Question Text:

On the average, how many cigarettes do you now smoke a day?
* Enter '1' if less than 1 cigarette.
* Enter '95' if 95 or more cigarettes.

01-94 1 - 94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who are current every day smokers
SkipInstructions:

(1-95,R,D) [goto CIGQTYR]

Question ID: AHB.060_00.000

Instrument Variable Name: CIGDAMO
Question Text:

On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.

00 None
01-30 1-30 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who are current some day smokers
SkipInstructions:

(0)[goto CIGQTYR]
(1-30,R,D) [goto CIGSDA2]

Question ID: AHB.070_00.000

Instrument Variable Name: CIGSDA2
Question Text:

On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?
* Enter '1' if less than 1.
* Enter '95' if 95 or more cigarettes.

01-94 1-94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who are current some day smokers
SkipInstructions:

(1-95,R,D) [goto CIGQTYR]

Question ID: AHB.080_00.000

Instrument Variable Name: CIGQTYR
Question Text:

During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSEYOU WERE TRYING TO QUIT SMOKING?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who are every day or someday smokers
SkipInstructions:

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

Question ID: AHB.085_00.010

Instrument Variable Name: OTHCIGEV
Question Text:

? [F1] These next questions are about your use of tobacco products OTHER THAN CIGARETTES. Tobacco products OTHER THAN CIGARETTES that are smoked include cigars, pipes, water pipes or hookahs, very small cigars that look like cigarettes, bidis (bee-dees) or cigarillos (cig-a-ril-los). Have you ever smoked tobacco products other than cigarettes EVEN ONE TIME?
* Do not include electronic cigarettes or e-cigarettes.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto OTHCIGED]
(2,R,D) [goto SMKLESEV]

Question ID: AHB.085_00.020

Instrument Variable Name: OTHCIGED
Question Text:

Do you NOW smoke tobacco products other than cigarettes every day, some days, rarely, or not at all?

1 Every day
2 Some days
3 Rarely
4 Not at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever smoked tobacco products other than cigarettes
SkipInstructions:

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

Question ID: AHB.085_00.030

Instrument Variable Name: SMKLESEV
Question Text:

? [F1] Smokeless tobacco products are placed in the mouth or nose and can include chewing tobacco, snuff, dip, snus (snoose), or dissolvable tobacco. Have you ever used smokeless tobacco products EVEN ONE TIME?
* Do not include nicotine replacement therapy products (patch, gum, lozenge, spray), which are considered smoking cessation treatments.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto SMKLESED]
(2,R,D) [if SMKEV=1 or OTHCIGEV=1, [goto TOBLASYR]; else goto VIGNO]

Question ID: AHB.085_00.040

Instrument Variable Name: SMKLESED
Question Text:

Do you NOW use smokeless tobacco products every day, some days, rarely, or not at all?

1 Every day
2 Some days
3 Rarely
4 Not at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever used smokeless tobacco products
SkipInstructions:

(1-4,R,D) goto TOBLASYR

Question ID: AHB.085_00.050

Instrument Variable Name: TOBLASYR
Question Text:

Around this time last year, were you using ANY KIND of tobacco product?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who smoked at least 100 cigarettes in their entire life, ever smoked tobacco products other than cigarettes, or ever used smokeless tobacco products
SkipInstructions:

(1,2,R,D) If (TOBLASYR='1' or SMKNOW in('1','2') or OTHCIGED in('1','2','3') or SMKLESED in('1','2','3')) and CIGQTYR ne '2' [goto TOBQTYR];
Else If (TOBLASYR ne'1' and SMKNOW not in('1','2')and OTHCIGED not in('1','2','3') andSMKLESED not in('1','2','3')) or CIGQTYR = '2' [goto VIGNO]

Question ID: AHB.085_00.060

Instrument Variable Name: TOBQTYR
Question Text:

During the past 12 months, have you stopped using ALL KINDS of tobacco products for more than one day because you were trying to quit using tobacco?
* "All kinds" means trying to quit using tobacco completely, including smoking cigarettes, smoking products other than cigarettes, and using smokeless tobacco products.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were using tobacco products around this time last year or were current users of any tobacco products (cigarettes, non-cigarette tobacco, or smokeless)
SkipInstructions:

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

Question ID: AHB.090_01.000

Instrument Variable Name: VIGNO
Question Text:

1 of 2 The next questions are about physical activities (exercise, sports, physically active hobbies...) that you may do in your LEISURE time. How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for vigorous leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.

000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,996,R,D)[goto MODNO]
(1-995)[goto VIGTP]

Question ID: AHB.090_02.000

Instrument Variable Name: VIGTP
Question Text:

2 of 2 * Enter time period for vigorous leisure-time physical activities.

0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:

(1-4) goto VIGLNGNO [if (VIGNO gt (4) and VIGTP eq (1)) or (VIGNO gt (28) and VIGTP eq (2)) or (VIGNO gt (31) and VIGTP eq (3)) or (VIGNO gt (365) and VIGTP eq (4)) goto ERR1_VIGTP]

Soft Edit: ERR1_VIGTP

* [Fill1: VIGNO] times per [Fill2: VIGTP] is unusually high.
* Please verify.

Question ID: AHB.100_01.000

Instrument Variable Name: VIGLNGNO
Question Text:

1 of 2 About how long do you do these vigorous leisure-time physical activities each time?
* Enter number for length of vigorous leisure-time physical activities.

001-995 1-995
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:

(1-995)[goto VIGLNGTP]
(R,D)[goto MODNO]

Question ID: AHB.100_02.000

Instrument Variable Name: VIGLNGTP
Question Text:

2 of 2 * Enter time period for length of vigorous leisure-time physical activities.

1 Minutes
2 Hours
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions:

(1,2)goto MODNO if VIGLNGNO lt (10) and VIGLNGTP eq (1) goto ERR1_VIGLNGTP;

if (VIGLNGNO gt (90) and VIGLNGTP eq (1)) or if VIGLNGNO gt (2) and VIGLNGTP eq (2) goto ERR2_VIGLNGTP

Hard Edit: ERR1_VIGLNGTP

* Question asked for activities lasting at least 10 minutes.
* Please correct.

Soft Edit: ERR2_VIGLNGTP

* [Fill1: VIGLNGNO] [fill2: VIGLNGTP] is unusually high.
* Please verify.

Question ID: AHB.110_01.000

Instrument Variable Name: MODNO
Question Text:

How often do you do LIGHT OR MODERATE LEISURE-TIME physical activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?
* If necessary, prompt with: How many times per day, per week, per month, or per year do you do these activities?
* Enter number of light or moderate leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.

000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-995)[goto MODTP]
(0, 996, R,D)[goto STRNGNO]

Question ID: AHB.110_02.000

Instrument Variable Name: MODTP
Question Text:

2 of 2 * Enter time period for light or moderate leisure-time physical activities

0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:

(1-4) goto MODLNGNO [if (MODNO gt (4) and MODTP eq (1)) or (MODNO gt (28) and MODTP eq (2)) or (MODNO gt (31) and MODTP eq (3)) or (MODNO gt (365) and MODTP eq (4))] goto ERR_MODNO

Soft Edit: ERR_MODNO

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

Question ID: AHB.120_01.000

Instrument Variable Name: MODLNGNO
Question Text:

1 of 2 About how long do you do these light or moderate leisure-time physical activities each time?
* Enter number for length of light or moderate leisure-time physical activities.

001-995 1-995
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:

(1-995)[goto MODLNGTP]
(R,D)[goto STRNGNO]

Question ID: AHB.120_02.000

Instrument Variable Name: MODLNGTP
Question Text:

2 of 2 * Enter time period for length of light or moderate leisure-time physical activities.

1 Minutes
2 Hours
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions:

(1,2) goto STRNGNO if MODLNGNO lt (10) and MODLNGTP eq (1) goto ERR1_MODLNGTP if MODLNGNO gt (90) and MODLNGTP eq (1) or if MODLNGNO gt (2) and MODLNGTP eq (2) goto ERR2_MODLNGTP

Hard Edit: ERR1_MODLNGTP

* Question asked for activities lasting at least 10 minutes.
* Please correct.

Soft Edit: ERR2_MODLNGTP

* [Fill1: MODLNGNO] [Fill2: MODLNGTP] is unusually high.
* Please verify.

Question ID: AHB.130_01.000

Instrument Variable Name: STRNGNO
Question Text:

How often do you do LEISURE-TIME physical activities specifically designed to STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for strengthening activities.
* Enter '0' for Never.
* Enter '996' for Unable to do this type activity

000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-995)[goto STRNGTP]
(0, 996,R,D)[goto ALC1YR]

Question ID: AHB.130_02.000

Instrument Variable Name: STRNGTP
Question Text:

2 of 2 * Enter time period for strengthening activities

0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do strengthening activities
SkipInstructions:

(1-4) goto ALC1YR [If (STRNGNO gt (4) and STRNGTP = (1)) or (STRNGNO gt (28) and STRNGTP = (2)) or (STRNGNO gt (31) and STRNGTP = (3)) or (STRNGNO gt (365) and STRNGTP = (4)) goto ERR_STRNGTP]

Soft Edit: ERR_STRNGTP

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

Question ID: AHB.140_00.000

Instrument Variable Name: ALC1YR
Question Text:

These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.
In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ALC12MNO]
(2,R,D) [goto ALCLIFE]

Question ID: AHB.150_00.000

Instrument Variable Name: ALCLIFE
Question Text:

In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did or refused to answer
SkipInstructions:

(1) [goto ALC12MNO]
(2,R,D) [goto AHGT_FT]

Question ID: AHB.160_01.000

Instrument Variable Name: ALC12MNO
Question Text:

1 of 2 In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcoholic beverages were consumed in the past year.
*Enter '0' for Never.

000 Never
001-365 1-365 days
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks in their entire life
SkipInstructions:

(1-365)[goto ALC12MTP]
(0,R,D)[goto AHGT_FT]

Question ID: AHB.160_02.000

Instrument Variable Name: ALC12MTP
Question Text:

2 of 2 * Enter time period for how often alcoholic beverages were consumed in the past year.

0 Never/None
1 Week
2 Month
3 Year
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who drank at least once in the past year
SkipInstructions:

(1-3) [goto ALCAMT] [If (ALC12MNO gt (7) and ALC12MTP = (1)) or (ALC12MNO gt (31) and ALC12MTP = (2)) or (ALC12MNO gt (365) and ALC12MTP = (3)) goto ERR_ALC12MTP]

Hard Edit: ERR_ALC12MTP

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

Question ID: AHB.170_00.000

Instrument Variable Name: ALCAMT
Question Text:

In the PAST YEAR, on those days that you drank alcoholic beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.

01-94 1-94 drinks
95 95+ drinks
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions:

(1-95,R,D) [goto ALC5UPNO]
(10-95)[goto ERR_ALCAMT]

Soft Edit: ERR_ALCAMT

* [Fill: ALCAMT] drinks is an unusually high number.
* Please verify.
* Do not probe

Question ID: AHB.180_01.000

Instrument Variable Name: ALC5UPNO
Question Text:

1 of 2 In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have 5 or more drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.

000 Never/None
001-365 1-365 days
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions:

(1-365)[goto ALC5UPTP]
(0,R,D)[goto AHGT_FT]

Question ID: AHB.180_02.000

Instrument Variable Name: ALC5UPTP
Question Text:

2 of 2 * Enter time period for days per week, per month or per year.

0 Never/None
1 Per week
2 Per month
3 Per year
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have had 5+ drinks in one day at least once in the past year
SkipInstructions:

(1-3) goto AHGT_FT [If (ALC5UPNO gt (7) and ALC5UPTP = (1)) or (ALC5UPNO gt (31) and ALC5UPTP = (2)) or (ALC5UPNO gt (365) and ALC5UPTP = (3)) goto ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP) lt number of days per year with 5 or more drinks (calculated from ALC5UPNO and ALC5UPTP)] goto ERR2_ALC5UPTP]

Hard Edit: ERR1_ALC5UPTP

* [Fill1: ALC5UPNO] days per [Fill2: ALC5UPTP] exceeds number possible in this time period.
* Please correct.

ERR2_ALC5UPTP

* Number of days had 5 or more drinks exceeds number of days drank.
* Please correct.
* Do not probe.

Question ID: AHB.190_01.000

Instrument Variable Name: AHGT_FT
Question Text:

How tall are you without shoes?
* Enter "M" to record metric measurements

02-07 2-7 feet
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(2-7) [goto AHGT_IN]
(R,D) [goto AWGT_LB]
(M) [goto AHGT_M] [if AHGT_FT NE(2-7,D,R,M) goto ERR1_AHGT_FT]
[if AHGT_FT = (2,3) goto ERR2_AHGT_FT]

Hard Edit: ERR1_AHGT_FT

* Only 2-7, Don't Know/Refused or M allowed in this field.
* Please correct.

Soft Edit: ERR2_AHGT_FT

* Respondent's height in feet is [fill: AHGT_FT]?
* Please verify.

Question ID: AHB.190_02.000

Instrument Variable Name: AHGT_IN
Question Text:

How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.

00-11 0-11 inches
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who answered their height in feet
SkipInstructions:

(0-11,R,D) [goto AWGT_LB]
(empty) [goto ERR_AHGT_IN]

Hard Edit: ERR1_AHGT_IN

* If [fill: AHGT_FT] feet exactly, enter "0"; otherwise enter number of inches.

Soft Edit: ERR2_AHGT_IN

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

Question ID: AHB.190_03.000

Instrument Variable Name: AHGT_M
Question Text:

How tall are you without shoes?
* Enter height in metric.

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

UniverseText: Sample adults 18+ who choose to give their height in metric measurements
SkipInstructions:

(0-2) [goto AHGT_CM]
(R,D) [goto AWGT_LB]
(empty) [goto ERR_AHGT_M]

Hard Edit: ERR_AHGT_M

* If height is being given in centimeters only, enter "0"; otherwise enter number of meters.

Question ID: AHB.190_04.000

Instrument Variable Name: AHGT_CM
Question Text:

*Enter centimeters.

000-241 0-241 centimeters
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who answered their height in meters
SkipInstructions:

(0-241,R,D) goto AWGT_LB [If AHGT_M eq (2) and AHGT_CM gt (41) or AHGT_M eq (1) and AHGT_CM gt (141)] goto ERR1_AHGT_CM]
( ) goto ERR2_AHGT_CM [If AHGT_M eq (1) and AHGT_CM lt (20) or AHGT_M eq (0) and AHGT_CM lt (120)] goto ERR3_AHGT_CM]

Hard Edit: ERR1_AHGT_CM

* Total height exceeds maximum allowed.
* Please correct.

ERR2_AHGT_CM
* If [fill: AHGT_M] meters exactly, enter "0"; otherwise enter number of centimeters.

Soft Edit: ERR3_AHGT_CM

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

Question ID: AHB.200_01.000

Instrument Variable Name: AWGT_LB
Question Text:

How much do you weigh without shoes?
* Enter "M" to record metric measurements
* Enter '500' for 500 pounds or more

050-500 50-500 pounds
997 Refused
999 Don't know
M Metric

UniverseText: Sample adults 18+
SkipInstructions:

(50-500) [goto SLEEP]
[if AWGT_LB lt (50) or gt (500) goto ERR_AWGT_LB
(R,D)[goto SLEEP]
(M) [goto AWGT_KG]

Hard Edit: ERR1_AWGT_LB
* Weight is out of range (50-500).
* Please correct.

Soft Edit: ERR2_AWGT_LB
* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID: AHB.200_02.000

Instrument Variable Name: AWGT_KG
Question Text:

How much do you weigh without shoes?
* Enter weight in kilograms

023-226 23-226 kilograms
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who choose to give their weight in metric measurements
SkipInstructions:

(23-226,R,D) [goto SLEEP]
[If AWGT_KG lt (23) or K gt (226)goto ERR_AWGT_KG]

Hard Edit: ERR1_AWGT_KG
*Weight is out of range (23-226).
* Please correct.

Soft Edit: ERR2_AWGT_KG
* Please verify that the weight was entered correctly. Probe only if necessary.
Sample Adult

Question ID: AAU.020_00.000

Instrument Variable Name: AUSUALPL
Question Text:

Is there a place that you USUALLY go to when you are sick or need advice about your health?

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-3) [goto APLKIND]
(2,R,D) [goto AHCPLKND]

Question ID: AAU.035_00.000

Instrument Variable Name: AHCPLROU
Question Text:

Is that {fill: place from (APLKIND)} the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults aged 18+ years having a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some other place that they usually go to when they are sick or need advice about their health
SkipInstructions:

(1) [goto AHCCHGYR]
(2,R,D) [go to AHCPLKND]

Question ID: AAU.037_00.000

Instrument Variable Name: AHCPLKND
Question Text:

What kind of place do you USUALLY go to when you need routine or preventive care, such as a physical examination or check-up?

0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know

UniverseText: Sample Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a usual source of sick care; who have a usual source of sick care but do not go to one place most often or Ref/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source of sick care but Ref/DK if it is same place as usual source of routine/preventive care.
SkipInstructions:

(0-6,R,D) if AUSUALPL = 2 [goto ANOUSLPL]; else if AUSUALPL=R,D goto APRVTRYR
ELSE goto AHCCHGYR

Question ID: AAU.040_00.000

Instrument Variable Name: AHCCHGYR
Question Text:

At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who reported same place as usual source of routine/preventive care]
SkipInstructions:

(1)[goto AHCCHGHI]
(2,R,D)[goto APRVTRYR]

Question ID: AAU.050_00.000

Instrument Variable Name: AHCCHGHI
Question Text:

Was this change for a reason related to health insurance?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who CHANGED their USUAL place for health care in past 12 months
SkipInstructions:

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

Question ID: AAU.050_00.010

Instrument Variable Name: ANOUSLPL
Question Text:

Why don't you have a usual source of medical care?
*Enter all that apply, separate with commas.

01 Doesn't need a doctor/Haven't had any problems
02 Doesn't like/trust/believe in doctors
03 Doesn't know where to go
04 Previous doctor is not available/moved
05 Too expensive/no insurance/cost
06 Speak a different language
07 No care available/Care too far away, not convenient
08 Put it off/Didn't get around to it
09 Other
97 Refused
99 Don't know

UniverseText: Sample adults 18+ without a usual place of care
SkipInstructions:

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

Question ID: AAU.051_00.010

Instrument Variable Name: APRVTRYR
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,)[goto APRVTRFD ]
(2,R,D)[goto ADRNANP]

Question ID: AAU.053_00.010

Instrument Variable Name: APRVTRFD
Question Text:

Were you able to find a general doctor or provider who could see you?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who had trouble finding a provider
SkipInstructions:

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

Question ID: AAU.057_00.010

Instrument Variable Name: ADRNANP
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.059_00.010

Instrument Variable Name: ADRNAI
Question Text:

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

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

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_1]

Question ID: AAU.061_01.000

Instrument Variable Name: AHCDLY_1
Question Text:

There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS? ...You couldn't get through on the telephone.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_2]

Question ID: AAU.061_02.000

Instrument Variable Name: AHCDLY_2
Question Text:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS? ...You couldn't get an appointment soon enough.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_3]

Question ID: AAU.061_03.000

Instrument Variable Name: AHCDLY_3
Question Text:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS? ...Once you get there, you have to wait too long to see the doctor.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_4]

Question ID: AAU.061_04.000

Instrument Variable Name: AHCDLY_4
Question Text:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS? ...The (clinic/doctor's) office wasn't open when you could get there.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCDLY_5]

Question ID: AAU.061_05.000

Instrument Variable Name: AHCDLY_5
Question Text:

* Read Lead-in if Necessary There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS? ...You didn't have transportation.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_1]

Question ID: AAU.111_01.000

Instrument Variable Name: AHCAFY_1
Question Text:

DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it? ...Prescription medicines.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_2]

Question ID: AAU.111_02.000

Instrument Variable Name: AHCAFY_2
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it? ...Mental health care or counseling.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_3]

Question ID: AAU.111_03.000

Instrument Variable Name: AHCAFY_3
Question Text:

* Read Lead-in if Necessary.DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it? ...Dental care (including check ups).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_4]

Question ID: AAU.111_04.000

Instrument Variable Name: AHCAFY_4
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it? ...Eyeglasses.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_5]

Question ID: AAU.111_05.010

Instrument Variable Name: AHCAFY_5
Question Text:

*Read if necessary.. DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it? ...To see a specialist.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto AHCAFY_6]

Question ID: AAU.111_06.010

Instrument Variable Name: AHCAFY_6
Question Text:

*Read if necessary.. DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it? ...Follow-up care.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.113_00.010

Instrument Variable Name: AWORPAY
Question Text:

If you get sick or have an accident, how worried are you that you will be able to pay your medical bills? Are you very worried, somewhat worried, or not at all worried?

1 Very worried
2 Somewhat worried
3 Not at all worried
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.113_00.020

Instrument Variable Name: AHICOMP
Question Text:

In regard to your health insurance or health care coverage, how does it compare to a year ago? Is it better, worse, or about the same?

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

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,3,R,D)[goto ARXPR_1]

Question ID: AAU.126_01.010

Instrument Variable Name: ARX12MO
Question Text:

DURING THE PAST 12 MONTHS, were you prescribed medication by a doctor or other health professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ARX12_1]
(2,R,D) [goto ARX12_5]

Question ID: AAU.127_01.010

Instrument Variable Name: ARX12_1
Question Text:

DURING THE PAST 12 MONTHS, were any of the following true for you?
?You skipped medication doses to save money

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who had been prescribed medication in the past 12 months
SkipInstructions:

(1,2,R,D)[goto ARX12_2]

Question ID: AAU.127_02.010

Instrument Variable Name: ARX12_2
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You took less medicine to save money

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who had been prescribed medication in the past 12 months
SkipInstructions:

(1,2,R,D) [goto ARX12_3]

Question ID: AAU.127_03.010

Instrument Variable Name: ARX12_3
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You delayed filling a prescription to save money

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who had been prescribed medication in the past 12 months
SkipInstructions:

(1,2,R,D)[goto ARX12_4]

Question ID: AAU.127_04.010

Instrument Variable Name: ARX12_4
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You asked your doctor for a lower cost medication to save money.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who had been prescribed medication in the past 12 months
SkipInstructions:

(1,2,R,D)[goto ARX12_5]

Question ID: AAU.127_05.010

Instrument Variable Name: ARX12_5
Question Text:

DURING THE PAST 12 MONTHS, were any of the following true for you?
?You bought prescription drugs from another country to save money.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[goto ARX12_6]

Question ID: AAU.127_06.010

Instrument Variable Name: ARX12_6
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You used alternative therapies to save money.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.135_00.000

Instrument Variable Name: ADENLONG
Question Text:

(book) A7 About how long has it been since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

0 Never
1 6 months or less
2 More than 6 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-5,R,D)[ goto AHCSY1_1]

Question ID: AAU.141_01.000

Instrument Variable Name: AHCSY1_1
Question Text:

DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_2]

Question ID: AAU.141_02.000

Instrument Variable Name: AHCSY1_2
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...An optometrist, ophthalmologist (AHF-thal-MOL-oh-jist), or eye doctor (someone who prescribes eyeglasses).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_3]

Question ID: AAU.141_03.000

Instrument Variable Name: AHCSY1_3
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A foot doctor.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_4]

Question ID: AAU.141_04.000

Instrument Variable Name: AHCSY1_4
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A chiropractor.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_5]

Question ID: AAU.141_05.000

Instrument Variable Name: AHCSY1_5
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[ goto AHCSY1_6]

Question ID: AAU.141_06.000

Instrument Variable Name: AHCSY1_6
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A nurse practitioner, physician assistant, or midwife.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D)[if SEX=1goto AHCSY8_8; else if SEX=2 goto AHCSYR7]

Question ID: AAU.200_00.000

Instrument Variable Name: AHCSYR7
Question Text:

* Read lead-in if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A doctor who specializes in women's health (an obstetrician/gynecologist).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample female adults aged 18+ years
SkipInstructions:

(1,2,R,D) [go to AHCSY8_ 8]

Question ID: AAU.211_01.000

Instrument Variable Name: AHCSY8_ 8
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist,
psychiatrist, or ophthalmologist).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) [go to AHCSY8_ 9]

Question ID: AAU.211_02.000

Instrument Variable Name: AHCSY8_ 9
Question Text:

* Read Lead-in if Necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? ...A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto AHCSYR10]
(2,R,D) [goto AHERNOYR]

Question ID: AAU.230_00.000

Instrument Variable Name: AHCSYR10
Question Text:

Does that doctor treat children and adults (a doctor in general practice or family medicine)?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have seen or talked to a general doctor during the past 12 months
SkipInstructions:

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

Question ID: AAU.240_00.000

Instrument Variable Name: AHERNOYR
Question Text:

(book) A8 DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own health (This includes emergency room visits that resulted in a hospital admission.)?

00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0,R,D) [go to AHCHYR]
(1-8) [goto AERVISND]

Question ID: AAU.243_00.010

Instrument Variable Name: AERVISND
Question Text:

Thinking about your most recent emergency room visit, did you go to the emergency room either at night or on the weekend?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: AAU.245_00.010

Instrument Variable Name: AERHOS
Question Text:

Did this emergency room visit result in a hospital admission?

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [go to AERREAS1]

Question ID: AAU.248_01.010

Instrument Variable Name: AERREAS1
Question Text:

Tell me which of these apply to your last emergency room visit?
? You didn't have another place to go

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [goto AERREAS2]

Question ID: AAU.248_02.020

Instrument Variable Name: AERREAS2
Question Text:

*Read if necessary
Tell me which of these apply to your last emergency room visit?
? Your doctor's office or clinic was not open

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [goto AERREAS3]

Question ID: AAU.248_03.030

Instrument Variable Name: AERREAS3
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit? ? Your health provider advised you to go

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [goto AERREAS4]

Question ID: AAU.248_04.040

Instrument Variable Name: AERREAS4
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? The problem was too serious for the doctor's office or clinic

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [goto AERREAS5]

Question ID: AAU.248_05.050

Instrument Variable Name: AERREAS5
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? Only a hospital could help you

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [goto AERREAS6]

Question ID: AAU.248_06.060

Instrument Variable Name: AERREAS6
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? the emergency room is your closest provider

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [goto AERREAS7]

Question ID: AAU.248_07.070

Instrument Variable Name: AERREAS7
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
?you get most of your care at the emergency room

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [goto AERREAS8]

Question ID: AAU.248_08.080

Instrument Variable Name: AERREAS8
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
?you arrived by ambulance or other emergency vehicle

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: AAU.250_00.000

Instrument Variable Name: AHCHYR
Question Text:

DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1)[goto AHCHMOYR]
(2,R,D)[goto AHCNOYR]

Question ID: AAU.260_00.000

Instrument Variable Name: AHCHMOYR
Question Text:

During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?

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

UniverseText: Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions:

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

Question ID: AAU.270_00.000

Instrument Variable Name: AHCHNOYR
Question Text:

(book) A9 What was the total number of home visits received during {Fill1: that month/Fill2: those months}?

01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions:

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

Question ID: AAU.280_00.000

Instrument Variable Name: AHCNOYR
Question Text:

(book) A8 DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times you were hospitalized overnight, visits to hospital emergency rooms, home visits, dental visits, or telephone calls.

00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.290_00.000

Instrument Variable Name: ASRGYR
Question Text:

DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or outpatient?
* Read if necessary: This includes both major surgery and minor procedures such as setting bones or removing growths.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1)[goto ASRGNOYR]
(2,R,D) [goto AMDLONG]

Question ID: AAU.300_00.000

Instrument Variable Name: ASRGNOYR
Question Text:

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during the PAST 12 MONTHS?
* Enter "95" for 95 or more times.

01-94 1-94 times
95 95+ times
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who had surgery or surgical procedures during past 12 months
SkipInstructions:

(1-95,R,D) [goto AMDLONG]
(11-95) [goto ERR_ASGYR]

Soft Edit: * {ASRGYR} is an unusually large number.

* Please verify.

Question ID: AAU.305_00.000

Instrument Variable Name: AMDLONG
Question Text:

(book) A7 ? [F1] About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.306_00.010

Instrument Variable Name: AVISLAST
Question Text:

Thinking about your last visit for any type of medical care, where did you go?
*Read categories if necessary.

1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Urgent care center
6 Some other place
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever seen/talked to a doctor
SkipInstructions:

(1,2,4,6) [goto ALASTTYP]
(3,5) [goto AWAITRMN]
(R,D) [goto HIT1A]

Question ID: AAU.306_00.020

Instrument Variable Name: ALASTTYP
Question Text:

Did you see a general doctor, a specialist, a nurse practitioner or physician assistant, or someone else?

1 General doctor
2 Specialist
3 Nurse practitioner/Physician assistant
4 Someone else
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who visited a clinic, doctor's office/HMO, hospital outpatient department or someplace else (not ER or urgent care center) on their last visit
SkipInstructions:

(1-3,R,D) [goto AVISAPTN]
(4) [goto ALASTSPC]

Question ID: AAU.306_00.025

Instrument Variable Name: ALASTSPC
Question Text:

What kind of health professional did you see at your last visit?

Verbatim Verbatim response

UniverseText: Sample adults 18+ who saw some other kind of provider on their last health care visit
SkipInstructions:

(Allow 75,R,D) [goto AVISAPTN]

Question ID: AAU.307_01.010

Instrument Variable Name: AVISAPTN
Question Text:

1 of 2 For this visit, how long did you have to wait between the time you made the appointment and the day you actually saw the doctor or other health professional?
*Enter '0' for same day , walk-in appointment , or no appointment made.
*Enter number for appointment wait time.
*Enter '96' for routine appointment, appointment arranged during a previous visit, or received a reminder card from provider.

00 Same day/walk-in appt/no appt made
01-95 1-95
96 Routine appt/appt arranged on previous visit/rec'd appt reminder card
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who visited a clinic, doctor's office/HMO, hospital outpatient department or someplace else (not ER or urgent care center) on their last visit
SkipInstructions:

(0,96,R) [goto AWAITRMN]
(1-95,D) [goto AVISAPTT]

Question ID: AAU.307_02.020

Instrument Variable Name: AVISAPTT
Question Text:

2 of 2 *Enter time period for appointment wait time.

1 Days
2 Weeks
3 Months
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who visited a clinic, doctor's office/HMO, hospital outpatient department or someplace else and gave a number or answered DK for length of time to make an appointment
SkipInstructions:

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

Question ID: AAU.308_01.010

Instrument Variable Name: AWAITRMN
Question Text:

1 of 2 How long did you have to wait in the waiting room before you saw a doctor or other health professional for this visit?
*Enter '0' for no wait time.
*Enter number for time in waiting room.

00 No time
01-96 1-96
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who had a place of last medical visit
SkipInstructions:

(0,R) [goto HIT1A]
(1-96,D) [goto AWAITRMT]

Question ID: AAU.308_02.020

Instrument Variable Name: AWAITRMT
Question Text:

2 of 2 *Enter time period for time in waiting room.

1 Minutes
2 Hours
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who had a place of last medical visit and did not refuse number portion of waiting room time
SkipInstructions:

(1,2,R,D) [goto HIT1A]

Question ID: AAU.309_00.010

Instrument Variable Name: HIT1A
Question Text:

DURING THE PAST 12 MONTHS, have you ever used computers for any of the following ?Look up health information on the Internet.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) [goto HIT2A]

Question ID: AAU.309_00.020

Instrument Variable Name: HIT2A
Question Text:

*Read if necessary.. DURING THE PAST 12 MONTHS, have you ever used computers for any of the following ?Fill a prescription.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) [goto HIT3A]

Question ID: AAU.309_00.030

Instrument Variable Name: HIT3A
Question Text:

*Read if necessary.. DURING THE PAST 12 MONTHS, have you ever used computers for any of the following ?Schedule an appointment with a health care provider.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) [goto HIT4A]

Question ID: AAU.309_00.040

Instrument Variable Name: HIT4A
Question Text:

*Read if necessary.. DURING THE PAST 12 MONTHS, have you ever used computers for any of the following ?Communicate with a health care provider by email.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) [goto HIT5A]

Question ID: AAU.309_00.050

Instrument Variable Name: HIT5A
Question Text:

*Read if necessary.. DURING THE PAST 12 MONTHS, have you ever used computers for any of the following ?Use online chat groups to learn about health topics.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.310_00.000

Instrument Variable Name: SHTFLUYR
Question Text:

?[F1] DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: A flu shot is injected in the arm. Do not include an influenza vaccine sprayed in the nose.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ASHFLU_M]
(2,R,D) [ goto SPRFLUYR ]

Question ID: AAU.312_01.000

Instrument Variable Name: ASHFLU_M
Question Text:

1 of 2 During what month and year did you receive your most recent flu shot?

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

UniverseText: Sample adults 18+ who have had a flu shot
SkipInstructions:

(1-12,D) [ goto ASHFLU_Y]
(R) [goto SPRFLUYR]

Question ID: AAU.312_02.000

Instrument Variable Name: ASHFLU_Y
Question Text:

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

Year Year
9997 Refused
9999 Don't know

UniverseText: Sample adults 18+ who gave a month for their last flu shot or who didn't know the month
SkipInstructions:

(valid year,R,D) [goto SPRFLUYR]
[If ASHFLU_M and ASHFLU_Y = a future date [goto ERR1_ASHFLU_Y]
[If ASHFLU_M and ASHFLU_Y = a date prior to birth [goto ERR2_ASHFLU_Y ]
[If ASHFLU_M and ASHFLU_Y = a date before 12 months ago [goto ERR3_ASHFLU_Y ]

Hard Edit: ERR1_ASHFLU_Y

*Future date invalid
ERR2_ASHFLU_Y
*Date before birth
ERR3_ASHFLU_Y
*Date more than 12 months ago

Question ID: AAU.313_00.000

Instrument Variable Name: FLUSHPG1
Question Text:

Did you get a flu shot before or during your current pregnancy?

1 Before this pregnancy
2 During this pregnancy
7 Refused
9 Don't know

UniverseText: Female sample adults 18-49 who are currently pregnant and are interviewed January-March or August-December
SkipInstructions:

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

Question ID: AAU.314_00.000

Instrument Variable Name: FLUSHPG2
Question Text:

[Fill1: Earlier you said you were pregnant sometime since August 1st, 2011. Did you
get a flu shot before, during or after this pregnancy?/ Earlier you said you were pregnant sometime between August 2011 and March 2012. Did you get a flu shot before, during or after this pregnancy?/]

1 Before this pregnancy
2 During this pregnancy
3 After this pregnancy
7 Refused
9 Don't know

UniverseText: Female sample adults 18-49 who are currently pregnant and were interviewed April-July or who have been determined to be pregnant at a specific point in the past year
SkipInstructions:

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

Question ID: AAU.315_00.000

Instrument Variable Name: SPRFLUYR
Question Text:

DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: This influenza vaccine is called FluMist (trademark).

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ASPFLU_M]
[if SHTFLUYR =1 and SPRFLUYR=1] goto ERR1_SPRFLUYR
[if AGE GE 50] goto ERR2_SPRFLUYR
(2,D,R) [goto SHTPNUYR]

Soft Edit: ERR1_SPRFLUYR

*Respondent says they have received both a flu shot and flu nasal vaccine.
*Please verify.

ERR2_SPRFLUYR

*Respondent says they have received a nasal vaccine to PREVENT the flu, not to TREAT symptoms of the flu.

*Please verify.

Question ID: AAU.318_01.000

Instrument Variable Name: ASPFLU_M
Question Text:

1 of 2 During what month and year did you receive your most recent flu nasal spray?

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

UniverseText: Sample adults 18+ who have had a flu nasal vaccine
SkipInstructions:

(1-12,D) [ goto ASPFLU_Y]
(R) [goto SHTPNUYR]

Question ID: AAU.318_02.000

Instrument Variable Name: ASPFLU_Y
Question Text:

2 of 2 *Enter year of most recent flu nasal spray.

Year Year
9997 Refused
9999 Don't know

UniverseText: Sample adults 18+ who gave a month for their flu nasal vaccine or who didn't know the month
SkipInstructions:

(valid year, R, D) [goto SHTPNUYR]
[If ASPFLU_M and ASPFLU_Y = a future date] goto ERR1_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date prior to birth] goto ERR2_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date before 12 months ago] goto ERR3_ASPFLU_Y

Hard Edit: ERR1_ASPFLU_Y

*Future date invalid
ERR2_ASPFLU_Y
*Date before birth
ERR3_ASPFLU_Y
*Date more than 12 months ago

Question ID: AAU.320_00.000

Instrument Variable Name: SHTPNUYR
Question Text:

Have you EVER had a pneumonia shot? This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.330_00.000

Instrument Variable Name: APOX
Question Text:

Have you EVER had chickenpox?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto APOX12MO]
(2,R,D) [goto AHEP]

Question ID: AAU.340_00.000

Instrument Variable Name: APOX12MO
Question Text:

Have you had chickenpox in the PAST 12 MONTHS?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever had chickenpox
SkipInstructions:

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

Question ID: AAU.350_00.000

Instrument Variable Name: AHEP
Question Text:

Have you EVER had hepatitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto AHEPBTST]
(2,R,D) [goto AHEPLIV]

Question ID: AAU.360_00.000

Instrument Variable Name: AHEPLIV
Question Text:

Have you ever lived with someone who had hepatitis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
SkipInstructions:

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

Question ID: AAU.365_00.010

Instrument Variable Name: AHEPBTST
Question Text:

Have you ever had a blood test for hepatitis B?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.370_00.000

Instrument Variable Name: SHTHEPB
Question Text:

Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto SHEPDOS]
(2,R,D) [goto SHTHEPA]

Question ID: AAU.380_00.000

Instrument Variable Name: SHEPDOS
Question Text:

Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?

1 Received at least 3 doses
2 Received less than 3 doses
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have ever received the Hepatitis B vaccine
SkipInstructions:

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

Question ID: AAU.390_00.010

Instrument Variable Name: SHTHEPA
Question Text:

The hepatitis A vaccine is given as a two dose series routinely to some children starting at 1 year of age, and to some adults and people who travel outside the United States. Although it can be given as a combination vaccine with hepatitis B, it is different from the hepatitis B shot, and has only been available since 1995. Have you ever received the hepatitis A vaccine?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto SHEPANUM]
(2,R,D) [goto AHEPCTST]

Question ID: AAU.400_00.010

Instrument Variable Name: SHEPANUM
Question Text:

How many hepatitis A shots did you receive?
*Enter '96' if all shots were received

01-95 01-95 shots
96 Received all shots
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have had a hepatitis A vaccine
SkipInstructions:

(1-95,96,R,D) [goto AHEPCTST]

Question ID: AAU.405_00.010

Instrument Variable Name: AHEPCTST
Question Text:

Have you ever had a blood test for hepatitis C?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto AHEPCRES]
(2,R,D) if AGE GE 50 goto SHINGLES
elseif AGE LT 50 goto SHTTD

Question ID: AAU.405_00.020

Instrument Variable Name: AHEPCRES
Question Text:

What is the MAIN reason you were tested for hepatitis C? Was it because...
*Read answer categories below.

1 You or your doctor thought you were at risk of having hepatitis C because a blood test or symptoms like fatigue, nausea,
stomach pain, yellowing of the eyes or skin indicated you might have liver disease
2 You were born from 1945 through 1965
3 You were at risk of hepatitis C infection due to exposure to blood on your job, injection drug use or receipt of transfusion before 1992
4 Some other reason
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have had a blood test for hepatitis C
SkipInstructions:

(1-4,R,D) if AGE GE 50 [goto SHINGLES]; elseif AGE LT 50 goto SHTTD

Question ID: AAU.410_00.010

Instrument Variable Name: SHINGLES
Question Text:

Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is generally on one side of the body or face. Shingles is caused by the chicken pox virus. A vaccine for shingles has been available since May 2006. Have you ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 50+
SkipInstructions:

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

Question ID: AAU.420_00.010

Instrument Variable Name: SHTTD
Question Text:

Have you received a tetanus shot in the past 10 years?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) goto SHTTD05
(2,R,D) and AGE GT 64 [goto LIVEV]
Else if (2,R,D) and AGE LT 65 [goto SHTHPV2]

Question ID: AAU.430_00.010

Instrument Variable Name: SHTTD05
Question Text:

Was your most recent tetanus shot given in 2005 or later?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have had a tetanus shot in the past 10 years
SkipInstructions:

(1,R) [goto SHTTDAP]
(2,D) if AGE le 64 [goto SHTHPV2]
elseif AGE gt 64 goto LIVEV

Question ID: AAU.440_00.010

Instrument Variable Name: SHTTDAP
Question Text:

There are currently two types of tetanus shots available today. One is the Td or tetanus-diphtheria vaccine and the other is called Tdap or Adacel (trademark) or Boostrix (trademark). They are similar except the Tdap shot also includes a pertussis (per-TUH-sis) or whooping cough vaccine. Thinking back to your most recent tetanus shot, did your health care provider
tell you or did the vaccine information sheet say the vaccine included the pertussis or whooping cough vaccine? The shot is often called Tdap or ADACEL (trademark) or BOOSTRIX (trademark).

1 Yes-included pertussis
2 No-did not include pertussis
3 Doctor did not say
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have had a tetanus shot in 2005 or beyond or refused to say if they had a tetanus shot in 2005 or beyond
SkipInstructions:

(1-3,R,D) if age le 64 [goto SHTHPV2];
else [goto LIVEV]

Question ID: AAU.446_00.010

Instrument Variable Name: SHTHPV2
Question Text:

Have you ever received an HPV shot or vaccine?
*HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
*The vaccines are sometimes called CERVARIX (trademark) or GARDASIL (trademark).

1 Yes
2 No
3 Doctor refused when asked
7 Refused
9 Don't know

UniverseText: Sample adults LE 64
SkipInstructions:

(1) SHHPVDOS
(2,3,R,D) [goto LIVEV]

Question ID: AAU.448_00.010

Instrument Variable Name: SHHPVDOS
Question Text:

How many HPV shots did you receive?
* Enter '50' if 50 or more shots
* Enter '96' for all shots

01-49 1-49 shots
50+ 50+
96 All shots
97 Refused
99 Don't know

UniverseText: Sample adults LE 64 who received an HPV shot
SkipInstructions:

(1-50,96,R,D) [goto AHPVAGE]
(51-95) [goto ERR_SHHPVDOS]
Hard Edit:
ERR_SHHPVDOS
* Shots should be in the range 1-50 or 96 for all shots.
* Please correct.

Question ID: AAU.449_00.010

Instrument Variable Name: AHPVAGE
Question Text:

How old were you when you received your first HPV shot?

008-064 8-64 years
997 Refused
999 Don't know

UniverseText: Sample adults LE 64 who received an HPV shot
SkipInstructions:

(8-120,R,D) [goto LIVEV]

Question ID: AAU.450_00.010

Instrument Variable Name: LIVEV
Question Text:

Has a doctor or other health professional ever told you that you had any kind of chronic, or long-term liver condition?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.460_00.010

Instrument Variable Name: TRAVEL
Question Text:

Have you ever traveled outside of the United States to countries other than Europe, Japan, Australia, New Zealand or Canada, since 1995?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.465_00.010

Instrument Variable Name: WRKHLTH
Question Text:

Do you currently volunteer or work in a hospital, medical clinic, doctor's office, dentist's office, nursing home or some other health-care facility? This includes emergency responders and public safety personnel, part-time and unpaid work in a health care facility as well as professional nursing care provided in the home.
*Read if necessary: This includes non-health care professionals, such as administrative staff, who work in a health-care facility.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto WRKDIR]
(2,R,D) [goto APSBPCHK]

Question ID: AAU.470_00.010

Instrument Variable Name: WRKDIR
Question Text:

Do you provide direct patient care as part of your routine work? By direct patient care we MEAN PHYSICAL OR HANDS ON CONTACT WITH PATIENTS.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who work or volunteer in a health-care setting
SkipInstructions:

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

Question ID: AAU.500_00.010

Instrument Variable Name: APSBPCHK
Question Text:

DURING THE PAST 12 MONTHS, have you had your blood pressure checked by a doctor, nurse, or other health professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.510_00.010

Instrument Variable Name: APSCHCHK
Question Text:

DURING THE PAST 12 MONTHS, have you had your blood cholesterol checked by a doctor, nurse, or other health professional?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.520_00.010

Instrument Variable Name: APSBSCHK
Question Text:

Have you had a fasting test for high blood sugar or diabetes DURING THE PAST 12 MONTHS?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) and SEX=1 and AGE GE 40 [goto APSCOL]
If (1,2,R,D) and SEX=1 and AGE LT 40 [goto APSDIET]
Else (1,2,R,D) and SEX=2 [goto APSPAP]

Question ID: AAU.530_00.010

Instrument Variable Name: APSPAP
Question Text:

Have you had a Pap smear or Pap test DURING THE PAST 12 MONTHS?
*Read if necessary. A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+
SkipInstructions:

(1,2,R,D) if AGE GE 30 [goto APSMAM];
else (1,2,R,D and AGE LT 30 [goto APSDIET]

Question ID: AAU.540_00.010

Instrument Variable Name: APSMAM
Question Text:

Have you had a Mammogram DURING THE PAST 12 MONTHS?
*Read if necessary. A mammogram is an x-ray of each breast to look for breast cancer.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+
SkipInstructions:

(1,2,R,D) if AGE GE 40 [gotoAPSCOL];
else (1,2,R,D and AGE(40) [goto APSDIET]

Question ID: AAU.550_00.010

Instrument Variable Name: APSCOL
Question Text:

DURING THE PAST 12 MONTHS, have you had any test done for colon cancer?
*Read if necessary.
Colon cancer tests include blood stool tests, colonoscopy and sigmoidoscopy.
A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. A sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

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

Question ID: AAU.560_00.010

Instrument Variable Name: APSDIET
Question Text:

DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your diet?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1,2,R,D) if SMKNOW in ('1','2') [goto APSSMKC];
else if (40 LTE AGE LTE 65) [goto LTCFAM];
else [goto AINDINS]

Question ID: AAU.570_00.010

Instrument Variable Name: APSSMKC
Question Text:

DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your smoking?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ currently who smoke every day or some days
SkipInstructions:

(1,2,R,D) if (40 LTE AGE LTE65) [goto LTCFAM];
else [goto AINDINS]

Question ID: AAU.580_00.010

Instrument Variable Name: LTCFAM
Question Text:

Do you have a parent, spouse, sibling, or adult child who has needed help for at least a year with everyday needs like bathing, dressing or eating due to a long term condition?
*Read if necessary. Due to a chronic illness or disability.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40-65
SkipInstructions:

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

Question ID: AAU.582_00.010

Instrument Variable Name: LTCHELP
Question Text:

How likely is it that you may someday need help with daily activities like bathing, dressing, eating, or using the toilet due to a long term condition? Would you say?
*Read categories below.

1 Very likely
2 Somewhat likely
3 Somewhat unlikely
4 Very unlikely
7 Refused
9 Don't know

UniverseText: Sample adults 40-65
SkipInstructions:

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

Question ID: AAU.584_00.010

Instrument Variable Name: LTCWHO
Question Text:

If you needed such help, who would provide this help?
*Enter all that apply, separate with commas.

1 My family
2 Someone I hire
3 Home health care organization
4 Nursing home/assisted living
5 Other
7 Refused
9 Don't know

UniverseText: Sample adults 40-65
SkipInstructions:

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

Question ID: AAU.600_00.010

Instrument Variable Name: AINDINS
Question Text:

DURING THE PAST 3 YEARS, did you try to purchase health insurance directly, that is, not through any employer, union, or government program?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AAU.600_00.020

Instrument Variable Name: AINDPRCH
Question Text:

Was a plan purchased?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who tried to purchase health insurance directly in the past 3 years
SkipInstructions:

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

Question ID: AAU.600_00.030

Instrument Variable Name: AINDWHO
Question Text:

Was this plan for yourself, someone else in your family, or both?

1 Self
2 Someone else in family
3 Both
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:

(1-3,R,D) [goto AINDDIF1]

Question ID: AAU.600_00.040

Instrument Variable Name: AINDDIF1
Question Text:

How difficult was it to find a plan with the type of coverage you needed? Would you say?
*Read categories below.

1 Very difficult
2 Somewhat difficult
3 Not at all difficult
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:

(1-3,R,D) [goto AINDDIF2]

Question ID: AAU.600_00.050

Instrument Variable Name: AINDDIF2
Question Text:

How difficult was it to find a plan you could afford? Would you say?
*Read categories below.

1 Very difficult
2 Somewhat difficult
3 Not at all difficult
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:

(1-3,R,D) [goto AINDENY1]

Question ID: AAU.600_01.060

Instrument Variable Name: AINDENY1
Question Text:

Did any company turn you down when you tried to buy coverage on your own ?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:

(1,2,R,D) [goto AINDENY2]

Question ID: AAU.600_02.060

Instrument Variable Name: AINDENY2
Question Text:

Did any company charge a higher price because of {fill 1: your/your family's/you or your family's} health?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:

(1,2,R,D) [goto AINDENY3]

Question ID: AAU.600_03.060

Instrument Variable Name: AINDENY3
Question Text:

Did any company exclude a specific health problem from the coverage?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who purchased health insurance directly in the past 3 years
SkipInstructions:

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

Question ID: AAU.601_00.070

Instrument Variable Name: AINDNOT
Question Text:

Why did you not buy the plan?
*Enter all that apply, separate with commas.

1 Turned down
2 Cost
3 Pre-existing condition
4 Got health insurance from other source
5 Other
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who tried but did not purchase health insurance directly in the past 3 years
SkipInstructions:

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

Question ID: AAU.601_00.080

Instrument Variable Name: AINDNTSP
Question Text:

*Specify other reason plan was not obtained.

Verbatim Verbatim response

UniverseText: Sample adults 18+ who had other reason plan was not purchased
SkipInstructions:

(allow 75,R,D) [goto next section]

Question ID: AAU.605_00.010

Instrument Variable Name: AEXCHNG
Question Text:

Have you looked into purchasing health insurance coverage through the [Fill: ]?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults LT 65 years
SkipInstructions:

(1,2,R,D) [goto next section]
NOTE: This is a new question beginning in Q4 2013.

Question ID: NAF.032_00.000

Instrument Variable Name: SNONCE
Question Text:

DURING THE PAST 12 MONTHS, have you used an indoor tanning device such as a sunlamp, sunbed, or tanning booth EVEN ONE TIME? Do NOT include times you have gotten a spray-on tan.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto SNNUM1]
(2,R,D) if SEX=2 and if APSPAP=1 [goto RPAP1_M1];
else if SEX=2 and APSPAP ne 1 [goto PAPHAD1];
else if SEX=1 and AGE GE 40 [goto PSAREC];
else if SEX =1 and AGE LT40 [goto next section]

Question ID: NAF.033_00.000

Instrument Variable Name: SNNUM1
Question Text:

DURING THE PAST 12 MONTHS, how many times have you used an indoor tanning device such as a sunlamp, sunbed or tanning booth? Do NOT include times you have gotten a spray-on tan.

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

UniverseText: Sample adults 18+ who have used indoor tanning device in past year
SkipInstructions:

(1-365,R,D) if SEX=2 and if APSPAP=1 [goto RPAP1_M1];
else if SEX=2 and APSPAP ne 1 [goto PAPHAD1];
else if SEX=1 and AGE GE 40 [goto PSAREC];
else if SEX =1 and AGE LT 40 [goto next section]

Question ID: NAF.130_00.000

Instrument Variable Name: PAPHAD1
Question Text:

Have you EVER HAD a Pap smear or Pap test?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have not had a Pap test in the past 12 months
SkipInstructions:

(1) [goto RPAP1_M1]
(2) [goto MDRECP1]
(R,D) [goto HYST]

Question ID: NAF.150_01.000

Instrument Variable Name: RPAP1_M1
Question Text:

1 of 2
[Fill1: Earlier you said you had a Pap test.]
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.

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

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-12,D) [goto RPAP1_Y1]
(R) store 'R' in RPAP1_Y1 [goto RPAP21]
(96) store '9996' in RPAP1_Y1 [goto RPAP1N1]

Question ID: NAF.150_02.000

Instrument Variable Name: RPAP1_Y1
Question Text:

2 of 2
*Enter year of last Pap test.

1880-current year 1880-current year
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age 18+ who answered month of last Pap smear test or didn't know month of last Pap smear test
SkipInstructions:

(valid year) if RPAP1_Y1 gt current year or (RPAP1_Y1=current year and RPAP1_M1 gt current month)
goto ERR1_ RPAP1_Y1 (future date)
elseif RPAP1_Y1 lt DOBY or (RPAP1_Y1=DOBY and RPAP1_M1 lt DOBM)
goto ERR2_ RPAP1_Y1 (prior to birth date)
elseif RPAP1_M1=D
goto RPAP21
elseif RPAP1_M1=1-12
goto PAPREA1
(R,D) goto RPAP21
Hard Edit:
ERR1_ RPAP1_Y1
*Future date invalid. Please correct.
ERR2_ RPAP1_Y1
*Date before birth. Please correct.

Question ID: NAF.160_01.000

Instrument Variable Name: RPAP1N1
Question Text:

1 of 2
When did you have your MOST RECENT Pap test?
*Enter number for time since last Pap test.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults 18+ who selected number and time period format for most recent Pap smear test from the initial month screen
SkipInstructions:

(1-95) [goto RPAP1T1]
(R,D) store 'R,D' in RPAP1T1 [goto RPAP21]

Question ID: NAF.160_02.000

Instrument Variable Name: RPAP1T1
Question Text:

2 of 2
*Enter time period for time since most recent Pap test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto PAPREA1
(4) if RPAP1N1=4
set RPAP21=4
goto PAPREA1
elseif RPAP1N1 gt 5 and RPAP1N1 gt AGE goto ERR_RPAP1T1 (greater than persons age)
elseif RPAP1N1 gt 5 and RPAP1N1 le AGE set RPAP21=5 goto PAPREA1
elseif RPAP1N1=1,2,3,5
goto RPAP21
(R,D) goto RPAP21
ERR_RPAP1T1
Hard Edit:
*Time since last exam cannot be greater than age.
*Please correct.

Question ID: NAF.165_00.000

Instrument Variable Name: RPAP21
Question Text:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last Pap smear test was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RPAP21]; else [goto PAPREA1]
Hard Edit:
ERR_RPAP21
*That is not a valid response.
*Please correct.

Question ID: NAF.170_00.000

Instrument Variable Name: PAPREA1
Question Text:

What was the MAIN reason you had this Pap test - was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-3,R,D) [goto MDRECP1]

Question ID: NAF.215_00.000

Instrument Variable Name: MDRECP1
Question Text:

Fill1: (IF PAPHAD1=1 and most recent screening exam LE 3 years from system date)
"Was your most recent Pap test recommended by a doctor or other health professional?"
Else (IF PAPHAD1=2, or PAPHAD1=1 and GT 3 years from system date or RPAP21=R,D)
"In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a PAP test?"

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who did not answer refused or don't know to initial Pap test question
SkipInstructions:

(1-3,R,D) if PAPHAD1=1 [goto PAPWHEN]; else PAPHAD ne 1 [goto HYST]

Question ID: NAF.216_00.000

Instrument Variable Name: PAPWHEN
Question Text:

When do you expect to have your next Pap smear or Pap test?

01 A year or less from now
02 More than 1 year to 3 years from now
03 More than 3 years to 5 years from now
04 More than 5 years from now
05 When doctor recommends it
06 Never, had HPV DNA test
07 Never, had HPV vaccine
08 Never, other reason
97 Refused
99 Don't know

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

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

Question ID: NAF.220_00.000

Instrument Variable Name: HYST
Question Text:

Have you had a hysterectomy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 18+
SkipInstructions:

(1,2,R,D)
if AGE GE 30 [goto MAMHAD];
else if AGE LT 30 [goto next section]

Question ID: NAF.230_00.000

Instrument Variable Name: MAMHAD
Question Text:

Have you EVER HAD a mammogram?
*Read if necessary.
A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have not had a mammogram in the past 12 months
SkipInstructions:

(1) [goto RMAM1_MT]
(2) [goto MDRECMAM]
(R,D) if AGE GE 40 [goto COLHAD];
else [goto next section]

Question ID:NAF.260_01.000

Instrument Variable Name: RMAM1_MT
Question Text:

1 of 2
[Fill1: Earlier you said you had a mammogram.]
When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and time period format.

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

UniverseText: Female sample adults 30+ who have ever had a mammogram
SkipInstructions:

(1-12,D) [goto RMAM1_YR]
(R) store 'R' in RMAM1_YR [goto RMAM2]
(96) store '9996' in RMAM1_YR [goto RMAM1N]

Question ID: NAF.260_02.000

Instrument Variable Name: RMAM1_YR
Question Text:

2 of 2
*Enter year of last mammogram.

1880-current year 1880-current year
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Female sample adults age 30+ who answered month of last mammogram or didn't know month of last mammogram
SkipInstructions:

(valid year) if RMAM1_YR gt current year or (RMAM1_YR=current year and RMAM1_MT gt current month) goto ERR1_ RMAM1_YR (future date) elseif RMAM1_YR lt DOBY or (RMAM1_YR=DOBY and RMAM1_MT lt DOBM) goto ERR2_ RMAM1_YR (prior to birth date) elseif RMAM1_MT=D goto RMAM2 elseif RMAM1_MT=1-12 goto MAMREAS
(R,D) goto RMAM2
Hard Edit:
ERR1_ RMAM1_YR
*Future date invalid. Please correct.
ERR2_ RMAM1_YR
*Date before birth. Please correct.

Question ID: NAF.270_01.000

Instrument Variable Name: RMAM1N
Question Text:

1 of 2
When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.

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

UniverseText: Female sample adults 30+ who selected number and time period format for most recent mammogram from the initial month screen
SkipInstructions:

(1-95) [goto RMAM1T]
(R,D) store 'R,D' in RMAM1T [goto RMAM2]

Question ID: NAF.270_02.000

Instrument Variable Name: RMAM1T
Question Text:

2 of 2
*Enter time period for time since most recent mammogram.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto MAMREAS
(4) if RMAM1N=4
set RMAM2=4
goto MAMREAS
elseif RMAM1N gt 5 and RMAM1N gt AGE goto ERR_RMAM1T (greater than persons age)
elseif RMAM1N gt 5 and RMAM1N le AGE set RMAM2=5 goto MAMREAS
elseif RMAM1N=1,2,3,5
goto RMAM2
(R,D) goto RMAM2
ERR_RMAM1T
Hard Edit:
*Time since last exam cannot be greater than age.
*Please correct.

Question ID: NAF.275_00.000

Instrument Variable Name: RMAM2
Question Text:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last mammogram was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RMAM2] else [goto MAMREAS]
Hard Edit:
ERR_RMAM2
*That is not a valid response.
*Please correct.

Question ID: NAF.310_00.000

Instrument Variable Name: MAMREAS
Question Text:

What was the MAIN reason you had this mammogram -- was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who have ever had a mammogram
SkipInstructions:

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

Question ID: NAF.370_00.000

Instrument Variable Name: MDRECMAM
Question Text:

Fill1: (IF MAMHAD=1 and most recent screening exam LE 2 years from system date)
[Was your most recent mammogram recommended by a doctor or other health professional?]
Else (IF MAMHAD=2, or MAMHAD GT 2 years from system date or RMAM2=R,D)
[In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a mammogram?]

1 Yes
2 No
3 Did not see a doctor in the past 12 months
7 Refused
9 Don't know

UniverseText: Female sample adults 30+ who did not answer refused or don't know to initial mammogram question
SkipInstructions:

(1-3,R,D) if AGE GE 40 [goto COLHAD]; else [goto next section]

Question ID: NAF.427_00.000

Instrument Variable Name: PSAREC
Question Text:

Has a doctor EVER recommended that you have a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 40+
SkipInstructions:

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

Question ID: NAF.430_00.000

Instrument Variable Name: PSAHAD
Question Text:

Have you EVER HAD a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Male sample adults 40+
SkipInstructions:

(1) [goto RPSA1_MT]
(2,R,D) [goto COLHAD]

Question ID: NAF.440_00.000

Instrument Variable Name: RPSA1_MT
Question Text:

1 of 2
When did you have your MOST RECENT PSA test?
*Enter month of last PSA test.
*Enter '96' to go to number and time period format.

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

UniverseText: Male sample adults 40+ who have had a PSA test
SkipInstructions:

(1-12,D) [goto RPSA1_YR]
(R) store 'R' in RPSA1_YR [goto RPSA2]
(96) store '9996' in RPSA1_YR [goto RPSA1N]

Question ID: NAF.440_01.000

Instrument Variable Name: RPSA1_YR
Question Text:

2 of 2
* Enter year of last PSA test.

1880-current year 1880-current year
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Male sample adults 40+ who answered month of last PSA test or didn't know month of last PSA test
SkipInstructions:

(valid year) if RPSA1_YR gt current year or (RPSA1_YR=current year and RPSA1_MT gt current month) goto ERR1_ RPSA1_YR (future date)
elseif RPSA1_YR lt DOBY or (RPSA1_YR=DOBY and RPSA1_MT lt DOBM) goto ERR2_ RPSA1_YR (prior to birth date)
elseif RPSA1_MT=D goto RPSA2 elseif RPSA1_MT=1-12 goto PSAREAS
(R,D) goto RPSA2
Hard Edit:
ERR1_ RPSA1_YR
*Future date invalid. Please correct.
ERR2_ RPSA1_YR
*Date before birth. Please correct.

Question ID: NAF.440_02.000

Instrument Variable Name: RPSA1N
Question Text:

1 of 2
When did you have your MOST RECENT PSA test?
* Enter number for time since last PSA test.
* Enter '95' for 95 or more.

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

UniverseText: Male sample adults 40+ who have selected number and time period format for most recent PSA test from the initial month screen
SkipInstructions:

(1- 95) [goto RPSA1T]
(R,D) store 'R,D' in RPSA1T [goto RPSA2]

Question ID: NAF.440_03.000

Instrument Variable Name: RPSA1T
Question Text:

2 of 2
* Enter time period for time since most recent PSA test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Male sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto PSAREAS
(4) if RPSA1N=4
set RPSA2=4
goto PSAREAS
elseif RPSA1N gt 5 and RPSA1N gt AGE goto ERR_RPSA1T (greater than persons age)
elseif RPSA1N gt 5 and RPSA1N le AGE
set RPSA2=5
goto PSAREAS
elseif RPSA1N=1,2,3,5
goto RPSA2
(R,D) goto RPSA2
ERR_RPSA1T
Hard Edit:
*Time since last exam cannot be greater than age.
*Please correct.

Question ID: NAF.440_04.000

Instrument Variable Name: RPSA2
Question Text:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know

UniverseText: Male sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last PSA test was over 5 years ago)
SkipInstructions:

(1-5,R,D) if answer code is grayed out [goto ERR_RPSA2]; else [goto PSAREAS]
Hard Edit:
ERR_RPSA2
*That is not a valid response.
*Please correct.

Question ID: NAF.441_00.000

Instrument Variable Name: PSAREAS
Question Text:

What was the MAIN reason you had this PSA test - was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Male sample adults 40+ who have had a PSA test
SkipInstructions:

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

Question ID: NAF.540_00.000

Instrument Variable Name: COLHAD
Question Text:

Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a tube into the rectum to look for polyps or cancer. For a colonoscopy, the doctor checks the entire colon, and you are given medication through a needle in your arm to make you sleepy, and told to have someone drive you home. For a sigmoidoscopy, the doctor checks only part of the colon and you are fully awake.
Have you EVER HAD a colonoscopy?
*Read if necessary:
A polyp is a small growth that develops on the inside of the colon or rectum.
Before these tests, you are asked to take a medication that causes diarrhea.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto COL_MT]
(2,R,D) [goto SIGHAD]

Question ID: NAF.560_01.000

Instrument Variable Name: COL_MT
Question Text:

1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.

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

UniverseText: Sample adults 40+ who have ever had a colonoscopy
SkipInstructions:

(1-12,D) [goto COL_YR]
(R) store 'R' in COL_YR [goto COL2]
(96) store '9996' in COL_YR [goto COLN]

Question ID: NAF.560_02.000

Instrument Variable Name: COL_YR
Question Text:

2 of 2
*Enter year of last colonoscopy.

1880-current year 1880-current year
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 40+ who answered month of last colonoscopy or didn't know month of last colonoscopy
SkipInstructions:

(valid year) if COL_YR gt current year or (COL_YR=current year and COL_MT gt current month)
goto ERR1_ COL_YR (future date)
elseif COL_YR lt DOBY or (COL_YR=DOBY and COL_MT lt DOBM)
goto ERR2_ COL_YR (prior to birth date)
elseif COL_MT=D
goto COL2
elseif COL_MT=1-12
goto COLREAS
(R,D) goto COL2
Hard Edit:
ERR1_ COL_YR
*Future date invalid. Please correct.
ERR2_ COL_YR
*Date before birth. Please correct.

Question ID: NAF.570_01.000

Instrument Variable Name: COLN
Question Text:

1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter number for time since last colonoscopy.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent colonoscopy from the initial month screen
SkipInstructions:

(1-95) [goto COLT]
(R,D) store 'R,D' in COLT [goto COL2]

Question ID: NAF.570_02.000

Instrument Variable Name: COLT
Question Text:

2 of 2
*Enter time period for time since most recent colonoscopy.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto COLREAS
(4) if COLN=4
set COL2=4
goto COLREAS
elseif COLN=6,7,8,9
set COL2=5
goto COLREAS
elseif COLN gt 10 and COLN gt AGE goto ERR_COLT (greater than persons age)
elseif COLN gt 10 and COLN le AGE
set COL2=6
goto COLREAS
elseif COLN=1,2,3,5,10
goto COL2
(R,D) goto COL2
Hard Edit:
ERR_COLT
*Time since last exam cannot be greater than age.
*Please correct.

Question ID: NAF.575_00.000

Instrument Variable Name: COL2
Question Text:

Was it:
*Read answer categories.

1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 years
6 Over 10 years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last colonoscopy was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out [goto ERR_COL2]; else [goto COLREAS]
Hard Edit:
ERR_COL2
*That is not a valid response.
*Please correct.

Question ID: NAF.590_00.000

Instrument Variable Name: COLREAS
Question Text:

What was the MAIN reason you had this colonoscopy - was it part of a routine exam, because of a problem, as a follow-up test of an earlier test or screening exam, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Follow-up test of an earlier test or screening exam
4 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a colonoscopy
SkipInstructions:

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

Question ID: NAF.591_00.000

Instrument Variable Name: SIGHAD
Question Text:

Recall that a sigmoidoscopy is similar to a colonoscopy but the doctor checks only part of the colon and you are fully awake. Have you EVER HAD a sigmoidoscopy?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto SIG_MT]
(2,R,D) [goto HFOBHAD]

Question ID: NAF.592_01.000

Instrument Variable Name: SIG_MT
Question Text:

1 of 2
When did you have your MOST RECENT sigmoidoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.

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

UniverseText: Sample adults 40+ who have ever had a sigmoidoscopy
SkipInstructions:

(1-12,D) [goto SIG_YR]
(R) store 'R' in SIG_YR [goto SIG2]
(96) store '9996' in SIG_YR [goto SIGN]

Question ID: NAF.593_02.000

Instrument Variable Name: SIG_YR
Question Text:

2 of 2
*Enter year of last sigmoidoscopy.

1880-current year 1880-current year
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 40+ who answered month of last sigmoidoscopy or didn't know month of last sigmoidoscopy
SkipInstructions:

(valid year) if SIG_YR gt current year or (SIG_YR=current year and SIG_MT gt current month)
goto ERR1_ SIG_YR (future date)
elseif SIG_YR lt DOBY or (SIG_YR=DOBY and SIG_MT lt DOBM)
goto ERR2_ SIG_YR (prior to birth date)
elseif SIG_MT=D
goto SIG2
elseif SIG_MT=1-12
goto SIGREAS
(R,D) goto SIG2
Hard Edit:
ERR1_ SIG_YR
*Future date invalid. Please correct.
ERR2_ SIG_YR
*Date before birth. Please correct.

Question ID: NAF.594_01.000

Instrument Variable Name: SIGN
Question Text:

1 of 2
When did you have your MOST RECENT sigmoidoscopy?
*Enter number for time since last sigmoidoscopy.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent sigmoidoscopy from the initial month screen
SkipInstructions:
(1-95) [goto SIGT]
(R,D) store 'R,D' in SIGT [goto SIG2]

Question ID: NAF.595_02.000

Instrument Variable Name: SIGT
Question Text:

2 of 2
*Enter time period for time since most recent sigmoidoscopy.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto SIGREAS
(4) if SIGN=4
set SIG2=4
goto SIGREAS
elseif SIGN=6,7,8,9
set SIG2=5
goto SIGREAS
elseif SIGN gt 10 and SIGN gt AGE goto ERR_SIGT (greater than persons age)
elseif SIGN gt 10 and SIGN le AGE
set SIG2=6
goto SIGREAS
elseif SIGN=1,2,3,5,10
goto SIG2
(R,D) goto SIG2
Hard Edit:
ERR_SIGT
*Time since last exam cannot be greater than age.
*Please correct.

Question ID: NAF.596_00.000

Instrument Variable Name: SIG2
Question Text:

Was it:
*Read answer categories.

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last sigmoidoscopy was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out {goto ERR_SIG2] else [goto SIGREAS]
Hard Edit:
ERR_SIG2
*That is not a valid response. *Please correct.

Question ID: NAF.597_00.000

Instrument Variable Name: SIGREAS
Question Text:

What was the MAIN reason you had this sigmoidoscopy - was it part of a routine exam, because of a problem, as a follow-up test of an earlier test or screening exam, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Follow-up test of an earlier test or screening exam
4 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a sigmoidoscopy
SkipInstructions:

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

Question ID: NAF.620_00.000

Instrument Variable Name: HFOBHAD
Question Text:

The following questions are about the blood stool or occult blood test, a test to determine whether you have blood in your stool or bowel movement. The blood stool test can be done at home using a kit. You use a stick or brush to obtain a small amount of stool at home and send it back to the doctor or lab.
Have you EVER HAD a blood stool test, using a HOME test kit?
*Read if necessary:
Do not include tests done at the doctor's office.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

(1) [goto RHFO1_MT]
(2,R,D) [goto COLPROB]

Question ID: NAF.640_01.000

Instrument Variable Name: RHFO1_MT
Question Text:

1 of 2
When did you have your MOST RECENT blood stool test using a kit at home?
*Enter month of last home blood stool test.
*Enter '96' to go to number and time period format.

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

UniverseText: Sample adults 40+ who have ever had a home blood stool test
SkipInstructions:

(1-12,D) goto RHFO1_YR
(R) store "R" in RHFO1_YR and goto RHFO2
(96) store "9996" in RHFO1_YR and goto RHFO1N

Question ID: NAF.640_02.000

Instrument Variable Name: RHFO1_YR
Question Text:

2 of 2
*Enter year of last home blood stool test.

1880-current year 1880-current year
9996 Time period format
9997 Refused
9999 Don't know

UniverseText: Sample adults age 40+ who answered month of last home blood stool test or didn't know month of last test
SkipInstructions:

(valid year) if RHFO1_YR gt current year or (RHFO1_YR=current year and RHRO1_MT gt current month) goto ERR1_RHFO1_YR (future date) elseif RHFO1_YR lt DOBY or (RHFO1_YR=DOBY and RHFO1_MT lt DOBM) goto ERR2_RHFO1_YR (prior to birth date) elseif RHFO1_MT=D goto RHFO2 elseif RHFO1_MT=1-12 goto HFOBREA1
(R,D) goto RHFO2
Hard Edit:
ERR1_ RHFO1_YR
*Future date invalid. Please correct.
ERR2_ RHFO1_YR
*Date before birth. Please correct.

Question ID: NAF.650_01.000

Instrument Variable Name: RHFO1N
Question Text:

1 of 2
When did you have your MOST RECENT blood stool test using a kit at home?
*Enter number for time since last home blood stool test.
*Enter '95' for 95 or more.

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

UniverseText: Sample adults 40+ who selected number and time period format for most recent home blood stool test from the initial month screen
SkipInstructions:

(1-95) [goto RHFO1T]
(R,D) store 'R,D' in RHFO1T [goto RHFO2]

Question ID: NAF.650_02.000

Instrument Variable Name: RHFO1T
Question Text:

2 of 2
*Enter time period for time since most recent home blood stool test.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto HFOBREA1
(4) if RHFO1N=4
set RHFO2=4
goto HFOBREA1
elseif RHFO1N=6,7,8,9
set RHFO2=5
goto HFOBREA1
elseif RHFO1N gt 10 and RHFO1N gt AGE goto ERR_RHFO1T (greater than persons age)
elseif RHFO1N gt 10 and RHFO1N le AGE set RHFO2=6 goto HFOBREA1
elseif RHFO1N=1,2,3,5,10
goto RHFO2
(R,D) goto RHFO2
Hard Edit:
ERR_RHFO1T
*Time since last exam cannot be greater than age.
*Please correct.

Question ID: NAF.655_00.000

Instrument Variable Name: RHFO2
Question Text:

Was it:
*Read answer categories.

UniverseText: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last home blood stool test was 6-9 or over 10 years ago)
SkipInstructions:

(1-6,R,D) if answer code is grayed out [goto ERR_RHFO2]; else [goto HFOBREA1]
Hard Edit:
ERR_RHFO2
*That is not a valid response
*Please correct.

Question ID: NAF.660_00.000

Instrument Variable Name: HFOBREA1
Question Text:

What was the MAIN reason you had this home blood stool test - was it part of a routine exam, because of a problem, or some other reason?

1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know

UniverseText: Sample adults 40+ who have had a home blood stool test
SkipInstructions:

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

Question ID: NAF.750_00.000

Instrument Variable Name: COLPROB
Question Text:

In the PAST 12 MONTHS, did a doctor or other health professional RECOMMEND that you be tested to look for problems in your colon or rectum?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 40+
SkipInstructions:

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

Question ID: ASI.005_00.000

Instrument Variable Name: ASIINTRO
Question Text:

*You are about to enter the Sexual Identity and Lifestyle questions section. This section includes questions on computer use, the respondent's neighborhood, sexual identity, financial worries, mental health, and HIV testing.
*Enter 1 to Continue.

1 Continue

UniverseText: Sample adults 18+
SkipInstructions:

(1) goto ACICPUSE

Question ID: ASI.130_00.000

Instrument Variable Name: ACICPUSE
Question Text:

These questions are about you and your neighborhood.
How often do you use a computer?
*Read answer categories.

1Never or almost never
2Some days
3Most days
4Every day
7Refused
9Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.140_00.000

Instrument Variable Name: ACISATHC
Question Text:

In general, how satisfied are you with the health care you received in the past 12 months?
*Read answer categories.

1 Very satisfied
2 Somewhat satisfied
3 Somewhat dissatisfied
4 Very dissatisfied
5 You haven't had health care in the past 12 months
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.150_00.000

Instrument Variable Name: ACITENUR
Question Text:

About how long have you lived in your present neighborhood?

1 Less than 1 year
2 1-3 years
3 4-10 years
4 11-20 years
5 More than 20 years
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.160_00.000

Instrument Variable Name: ACINHELP
Question Text:

How much do you agree or disagree with the following statements about your neighborhood?
People in this neighborhood help each other out.
Would you say?
*Read answer categories.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.170_00.000

Instrument Variable Name: ACINCNTO
Question Text:

*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
There are people I can count on in this neighborhood.
Would you say?
*Read answer categories if necessary.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.180_00.000

Instrument Variable Name: ACINTRU
Question Text:

*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
People in this neighborhood can be trusted.
Would you say?
*Read answer categories if necessary.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.190_00.000

Instrument Variable Name: ACINKNT
Question Text:

*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
This is a close-knit neighborhood.
Would you say?
*Read answer categories if necessary.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-4,R,D) [if SEX=1, goto ACISIM; elseif SEX=2, goto ACISIF]

Question ID: ASI.220_00.000

Instrument Variable Name: ACISIM
Question Text:

(book) ASI1
Which of the following best represents how you think of yourself?

1 Gay
2 Straight, that is, not gay
3 Bisexual
4 Something else
5 I don't know the answer
7 Refused

UniverseText: Male sample adults 18+
SkipInstructions:

(1-3,R) [goto ACIRETR]
(4) [goto ACISMELS]
(5) [goto ACISIMDK]

Question ID: ASI.230_00.000

Instrument Variable Name: ACISMELS
Question Text:

(book) ASI3
What do you mean by something else?

1 You are not straight, but identify with another label such as queer, trisexual, omnisexual or pansexual
2You are transgender, transsexual or gender variant
3 You have not figured out or are in the process of figuring out your sexuality
4 You do not think of yourself as having sexuality
5 You do not use labels to identify yourself
6 You mean something else
7 Refused
9 Don't know

UniverseText: Male sample adults 18+ who think of themselves as something else
SkipInstructions:

(1-5,R,D) [goto ACIRETR]
(6) [goto ACIMSESP]

Question ID: ASI.234_00.000

Instrument Variable Name: ACISIMDK
Question Text:

(book) ASI4
What do you mean by don't know?

1 You don't understand the words
2 You understand the words, but you have not figured out or are in the process of figuring out your sexuality
3 You mean something else
7 Refused
9 Don't know

UniverseText: Male sample adults 18+ who answered don't know at ACISIM
SkipInstructions:

(1,2,R,D) [goto ACIRETR]
(3) [goto ACIMSESP]

Question ID: ASI.238_00.000

Instrument Variable Name: ACIMSESP
Question Text:

What do you mean by something else?

Verbatim Verbatim response
97 Refused
99 Don't know

UniverseText: Male sample adults 18+ who answered something else at ACISMELS or ACISIMDK
SkipInstructions:

(Allow 75,R,D) [goto ACIRETR]

Question ID: ASI.240_00.000

Instrument Variable Name: ACISIF
Question Text:

(book) ASI2
Which of the following best represents how you think of yourself?

1 Lesbian or gay
2 Straight, that is, not lesbian or gay
3 Bisexual
4 Something else
5 I don't know the answer
7 Refused

UniverseText: Female sample adults 18+
SkipInstructions:

(1-3,R) [goto ACIRETR]
(4) [goto ACISFELS]
(5) [goto ACISIFDK]

Question ID: ASI.250_00.000

Instrument Variable Name: ACISFELS
Question Text:

(book) ASI3
What do you mean by something else?

1 You are not straight, but identify with another label such as queer, trisexual, omnisexual or pansexual
2 You are transgender, transsexual or gender variant
3 You have not figured out or are in the process of figuring out your sexuality
4 You do not think of yourself as having sexuality
5 You do not use labels to identify yourself
6 You mean something else
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who think of themselves as something else
SkipInstructions:

(1-5,R,D) [goto ACIRETR]
(6) [goto ACIFSESP]

Question ID: ASI.254_00.000

Instrument Variable Name: ACISIFDK
Question Text:

(book) ASI4
What do you mean by don't know?

1 You don't understand the words
2 You understand the words, but you have not figured out or are in the process of figuring out your sexuality
3 You mean something else
7 Refused
9 Don't know

UniverseText: Female sample adults 18+ who answered don't know at ACISIF
SkipInstructions:

(1,2,R,D) [goto ACIRETR]
(3) [goto ACIFSESP]

Question ID: ASI.258_00.000

Instrument Variable Name: ACIFSESP
Question Text:

What do you mean by something else?

Verbatim Verbatim response
97 Refused
99 Don't know

UniverseText: Female sample adults 18+ who answered something else at ACISFELS or ACISIFDK
SkipInstructions:

(Allow 75,R,D) [goto ACIRETR]

Question ID: ASI.260_00.000

Instrument Variable Name: ACIRETR
Question Text:

The next questions ask how worried you are right now about financial matters.
How worried are you right now about not having enough money for retirement? Are you?
*Read answer categories.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.270_00.000

Instrument Variable Name: ACIMEDC
Question Text:

How worried are you right now about not being able to pay medical costs of a serious illness or accident? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.280_00.000

Instrument Variable Name: ACISTLV
Question Text:

How worried are you right now about not being able to maintain the standard of living you enjoy? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.290_00.000

Instrument Variable Name: ACICNHC
Question Text:

How worried are you right now about not being able to pay medical costs for normal healthcare? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.300_00.000

Instrument Variable Name: ACICCOLL
Question Text:

How worried are you right now about not having enough money to pay for your children's college? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
5 This does not apply to me
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.310_00.000

Instrument Variable Name: ACINBILL
Question Text:

How worried are you right now about not having enough to pay your normal monthly bills? Are you?
*Read answer categories if necessary.

1Very worried
2Moderately worried
3Not too worried
4Not worried at all
7Refused
9Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.320_00.000

Instrument Variable Name: ACIHCST
Question Text:

How worried are you right now about not being able to pay your rent, mortgage, or other housing costs? Are you?
*Read answer categories if necessary.

1Very worried
2Moderately worried
3Not too worried
4Not worried at all
7Refused
9Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.330_00.000

Instrument Variable Name: ACICCMP
Question Text:

How worried are you right now about not being able to make the minimum payments on your credit cards? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
5 I don't have credit cards
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.340_00.000

Instrument Variable Name: ACISLEEP
Question Text:

On average, how many hours of sleep do you get in a 24-hour period?
*Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more UP to the next whole hour and dropping 29 or fewer minutes.

01-24 1-24 hours
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1-5)[goto ERR_SLEEP];
(1-24, R,D)[goto ACISLPFL]
Soft Edit:
ERR_SLEEP
*Average number of hours of sleep is [ACISLEEP].
* Please verify.

Question ID: ASI.350_00.000

Instrument Variable Name: ACISLPFL
Question Text:

In the past week, how many times did you have trouble falling asleep?
*Enter '0' if respondent did not have trouble falling asleep in the past week.
*Enter '7' for 7 or more times.

00 Did not have trouble falling asleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-7,R,D) [goto ACISLPST]

Question ID: ASI.360_00.000

Instrument Variable Name: ACISLPST
Question Text:

In the past week, how many times did you have trouble staying asleep?
*Enter '0' if respondent did not have trouble staying asleep in the past week.
*Enter '7' for 7 or more times.

00 Did not have trouble staying asleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-7,R,D) [goto ACISLPMD]

Question ID: ASI.370_00.000

Instrument Variable Name: ACISLPMD
Question Text:

In the past week, how many times did you take medication to help you fall asleep or stay asleep?
*Enter '0' if respondent did not take medication to help sleep in the past week.
*Enter '7' for 7 or more times.

00 Did not take medication to help sleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-7,R,D) [goto ACIREST]

Question ID: ASI.380_00.000

Instrument Variable Name: ACIREST
Question Text:

In the past week, on how many days did you wake up feeling well rested?
*Enter '0' if respondent never felt well rested in the past week.

00 Never felt rested in the past week
01-07 1-7 days
97 Refused
99 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(0-7,R,D) [goto MHSAD_CK]

Question ID: ASI.390_00.000

Instrument Variable Name: MHSAD_CK
Question Text:

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

1 Enter 1 to continue

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto ACISAD]

Question ID: ASI.390_01.000

Instrument Variable Name: ACISAD
Question Text:

(book) ASI5
DURING THE PAST 30 DAYS, how often did you feel
...So sad that nothing could cheer you up?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.390_02.000

Instrument Variable Name: ACINERV
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Nervous?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.390_03.000

Instrument Variable Name: ACIRSTLS
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Restless or fidgety?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.390_04.000

Instrument Variable Name: ACIHOPLS
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Hopeless?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.390_05.000

Instrument Variable Name: ACIEFFRT
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...That everything was an effort?

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

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.390_06.000

Instrument Variable Name: ACIWTHLS
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Worthless?

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

UniverseText: Sample adults 18+
SkipInstructions:

(1-5,R,D) if ACISAD or ACINERV or ACIRSTLS or ACIHOPLS or ACIEFFRT or ACIWTHLS=1-3 [goto ACIMUCH];
else [goto ACIHIVT]

Question ID: ASI.400_00.000

Instrument Variable Name: ACIMUCH
Question Text:

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

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

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

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

Question ID: ASI.410_00.000

Instrument Variable Name: ACIHIVT
Question Text:

The next question is about the test for HIV, the virus that causes AIDS. Except for tests you may have had as part of blood donations, have you ever been tested for HIV?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: ASI.420_00.000

Instrument Variable Name: ACIHIVWN
Question Text:

(book) ASI6
I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes AIDS). Which one of these would you say is the MAIN reason why you have not been tested?

01 It's unlikely you've been exposed to HIV
02 You were afraid to find out if you were HIV positive (that you had HIV)
03 You didn't want to think about HIV or about being HIV positive
04 You were worried your name would be reported to the government if you tested positive
05 You didn't know where to get tested
06 You don't like needles
07 You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
08 Some other reason
09 No particular reason
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who have never been tested for HIV
SkipInstructions:

(1-9,R,D) [goto next section]

Question ID: AWB.010_00.000

Instrument Variable Name: AWEBUSE
Question Text:

The next questions are about your Internet and email use.
Do you use the Internet?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

(1) [goto AWEBOFNO]
(2,R,D) [goto AWEBEML]

Question ID: AWB.020_01.000

Instrument Variable Name: AWEBOFNO
Question Text:

1 of 2
How often do you use the Internet?
*Read if necessary: How many times per day, per week, per month, or per year do you use the Internet?
*Enter number.

001-995 1-995
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who use the Internet
SkipInstructions:

(1-995) [goto AWEBOFTP]
(R,D) [goto AWEBEML]

Question ID: AWB.020_02.000

Instrument Variable Name: AWEBOFTP
Question Text:

2 of 2
*Enter time period for how often Internet is used.

1 Per day
2 Per week
3 Per month
4 Per year
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use the Internet and gave a valid value for the number portion of this question
SkipInstructions:

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

Question ID: AWB.030_00.000

Instrument Variable Name: AWEBEML
Question Text:

Do you send or receive emails?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+
SkipInstructions:

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

Question ID: AWB.040_00.000

Instrument Variable Name: AWEBEMAD
Question Text:

We may want to contact you to obtain additional health-related information.
May I have your email address?
*Enter email address.
*Enter 'N' for none.
allow 75

97 Refused
99 Don't Know

UniverseText: Sample adults 18+ who send or receive email
SkipInstructions:

(address) [goto AWBEMNO]
(N,R,D) [goto next section]

Question ID: AWB.050_01.000

Instrument Variable Name: AWEBMNO
Question Text:

1 of 2
How often do you check this email account?
*Read if necessary: How many times per day, per week, per month, or per year do you check this email account?
*Enter number.

001-995 1-995
997 Refused
999 Don't know

UniverseText: Sample adults 18+ who gave an email address
SkipInstructions:

(1-995) [goto AWBEMTP]
(R,D) [goto next section]

Question ID: AWB.050_02.000

Instrument Variable Name: AWEBMTP
Question Text:

2 of 2
*Enter time period for how often email is checked.

1 Per Day
2 Per week
3 Per month
4 Per year
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who gave an email address and gave a valid value for the number portion of this question
SkipInstructions:

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

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