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

Question ID: CID.001_00.000

Instrument Variable Name: CURRES
QuestionText:

* Enter the line number of the person to whom you are speaking.
01-25 Person number of the respondent for Sample Child
UniverseText: Sample child section not started or not completed
SkipInstructions:
if CSTAT ne empty and CSTAT ne '2' THEN
if ASTAT = empty or ASTAT = '2' THEN
goto adult.aid.SADULT
elseif recontact.RCIFLAG ne '1' THEN
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif
goto back.OUTCOMEB1 procedure
endif
(01-25) if this is NOT an allowable line number
goto ERR_CURRES
elseif CURRES = a line number entered in KNOWSC2
store CURRES in CSPAVAIL and CSRESP
goto CSRELTIV
elseif KNOWSC2 = 'Don't know' or 'Refused' or empty (no line numbers in KNOWSC2)
goto KNOAVAIL
else
goto CSPAVAIL
endif
Hard Edit: ERR_CURRES
* You have selected a non-selectable person.
* Please correct.

Question ID: CID.010_00.000

Instrument Variable Name: CSPAVAIL
QuestionText:
The next questions are about [fill1: ALIAS of Sample Child]. Is [fill2:KNOWSC2 names] available to answer some questions about [fill3: HISHER] health?
* Enter line number of available respondent from list or enter '96' if no one is available.
* If refused enter CTRL_R.
01-25 Person # of person available to answer questions about Sample Child
96 No person available
UniverseText: Someone identified as knowledgeable about child's health and knowledgeable person(s) not entered in CURRES
SkipInstructions:
(01-25) if line number not equal one of the line numbers in KNOWSC2 go to child.cid.ERR_CSPAVAIL
else store child.cid.CSPAVAIL in child.cid.CSRESP
go to child.cid.CSRELTIV
endif
(96) store child.cid.CSPAVAIL in child.cid.CSRESP
go to cbk.CCALLBK1
(R) store '4' in CSTAT(FAMINT)
if ASTAT = empty or ASTAT = '2' THEN
go to adult.aid.SADULT
elseif recontact.RCIFLAG ne '1' THEN
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif

Hard Edit: ERR_CSPAVAIL

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

Question ID: CID.030_00.000

Instrument Variable Name: CSRELTIV
QuestionText:
(book) C1 [fill1: The next questions are about [fill2: ALIAS of Sample Child].] What is your relationship to [fill2: ALIAS of Sample Child]?
01 Parent (Biological, adoptive, or step)
02 Grandparent
03 Aunt/Uncle
04 Brother/Sister
05 Other relative
06 Legal guardian
07 Foster parent
08 Other non-relative
97 Refused
99 Don't know
UniverseText: Someone identified as knowledgeable about child's health
SkipInstructions:
(1-8,R,D) If CSRESP = demographics.hhc.RELRESP_A
goto child.chs.BWGT_LB
elseif CSRESP = demographics.hhc.HHRESP
go to child.chs.BWGT_LB
else]
go to CSPVERF_S
endif]

Question ID: CID.040_00.000

Instrument Variable Name: CSPVERF_S
QuestionText:
* Please verify the following information about the sample child before proceeding: I have recorded [fill1: ALIAS of Sample Child]'s sex as [fill2: Sex of Sample Child]. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
UniverseText: Respondent is not the person entered in HHRESP or RELRESP_A.
SkipInstructions:
(1) go to CSPVERF_A
(2) go to NEWSEX

Question ID: CID.041_00.000

Instrument Variable Name: NEWSEX
QuestionText:
Is [fill: ALIAS of Sample Child] Male or Female?
* If don't know or refused enter your best guess of the child's sex.
1 Male
2 Female
UniverseText: Respondent said child's sex is not correct.
SkipInstructions:
(1,2) store NEWSEX in SEX
go to ERR_NEWSEX
reset CSPVERF_S
go to CSPVERF_S

Hard Edit: ERR_NEWSEX

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

go to CSPVERF_S (as the default go to)

Question ID: CID.042_00.000

Instrument Variable Name: CSPVERF_A
QuestionText:
* Please verify the following information about the sample child before proceeding: I have recorded [fill1: ALIAS of Sample Child]'s age as [fill2: Age of Sample Child] old. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
UniverseText: Respondent verified child's sex
SkipInstructions:
(1) go to CSPVERF_D
(2) go to NEWAGE

Question ID: CID.043_00.000

Instrument Variable Name: NEWAGE
QuestionText:
How old is [fill1: ALIAS of Sample Child]?
* If age given in months, weeks, or days, convert age to appropriate year. If less than one year old, enter "0".
000-120 Age in years
UniverseText: Respondent said child's age is not correct
SkipInstructions:

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

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

Hard Edit: ERR_NEWAGE

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

go to CSPVERF_A (whether suppressed or not)

Question ID: CID.044_00.000

Instrument Variable Name: CSPVERF_D
QuestionText:
* Please verify the following information about the sample child before proceeding: I have recorded [fill1: ALIAS of Sample Child]'s birthday as [fill2: Birthday of Sample Child]. Is this correct?
* If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
UniverseText: Respondent verified child's sex
SkipInstructions:
(1) if AGE of Sample Child ge '18'
go to CNO_MORE
else
go to child.chs.BWGT_LB
endif
(2) go to NEWDOB_M

Question ID: CID.046_01.000

Instrument Variable Name: NEWDOB_M
QuestionText:
1 of 3 What is [fill: ALIAS of Sample Child]'s birthday?
*Enter month of birth.
1 January
10 October
11 November
12 December
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
UniverseText: Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:
(01-12, Refused, Don't know) go to NEWDOB_D

Question ID: CID.046_02.000

Instrument Variable Name: NEWDOB_D
QuestionText:
2 of 3 * Enter day of birth.
01-31 Day of the month
UniverseText: Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:
(01-31,Refused,Don't know) go to NEWDOB_Y

If days not valid, go to ERR_NEWDOB_D

Hard Edit: ERR_NEWDOB_D

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

Question ID: CID.046_03.000

Instrument Variable Name: NEWDOB_Y
QuestionText:
3 of 3 * Enter year of birth.
1880-2020 Year of birth
UniverseText: Respondent said child's date of birth is not correct or child's age is not correct
SkipInstructions:
(1880-2020, Refused, Don't know) if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty
go to CSPVERF_A
elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty
goto CSPVERF_D
endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and
month = current month and day GT current day)
go to ERR1_NEWDOB_Y
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
go to ERR2_NEWDOB_Y
endif
(if NEWDOB_M = 'Ref' or 'DK') or (if NEWDOB_D = 'Ref' or 'DK') or (if NEWDOB_Y = 'Ref' or 'DK')
go to ERR3_NEWDOB_Y
else
store NEWDOB_M in DOBM
store NEWDOB_D in DOBD
store NEWDOB_Y in DOBY
if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty
go to CSPVERF_A
elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty
goto CSPVERF_D
endif
endif
Calculate age from NEWDOB_M, NEWDOB_D, and NEWDOB_Y.
if age from NEWDOB items is ne AGE and age from NEWDOB items is valid
reset CSPVERF_A or CSPVERF_D
go to ERR4_NEWDOB_Y
endif

Hard Edit: ERR1_NEWDOB_Y

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

goto NEWDOB_M (whether suppressed or not)

ERR2_NEWDOB_Y

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

goto NEWDOB_M (whether suppressed or not)

ERR3_NEWDOB_Y

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

goto CSPVERF_A

ERR4_NEWDOB_Y

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

Question ID: CHS.010_01.000

Instrument Variable Name: BWGT_LB
QuestionText:
?[F1] What was [fill: S.C.name]'s birth weight?
* Enter 'M' to record metric measurements.
01-15 1-15 pounds
97 Refused
99 Don't know
M Metric
UniverseText: Sample children LT 18
SkipInstructions:
(1-12) [go to BWGT_OZ]
(13-15) [go to ERR1_BWGT_LB]
(R,D) [go to CHGT_FT]
(M) [go to BWGT_GR]
[If NE (1-15, M, D, R) go to ERR2_BWGT_LB]

Hard Edit: ERR2_BWGT_LB

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

Soft Edit: ERR1_BWGT_LB

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

Question ID: CHS.010_02.000

Instrument Variable Name: BWGT_OZ
QuestionText:
* Enter ounces.
00-15 0-15 ounces
97 Refused
99 Don't know
Blank Blank
UniverseText: Sample children LT 18 who have a value entered for weight in pounds.
SkipInstructions:
(0-15,R,D) [go to CHGT_FT]
[if BWGT_LB = (0-15, D, R) and BWGT_OZ = (empty) go to CHGT_FT]

Question ID: CHS.011_00.000

Instrument Variable Name: BWGT_GR
QuestionText:
* Enter weight in grams.
0500 500 grams or less
0501-6899 501-6899 grams
6900 6900+ grams
9997 Refused
9999 Don't know
UniverseText: Sample children LT 18 whose birth weight will be entered in metric.
SkipInstructions:
(500-5485, R,D) [go to CHGT_FT]
(5486-6900) [go to ERR_BWGT_GR]

Soft Edit: ERR_BWGT_GR

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

Question ID: CHS.020_01.000

Instrument Variable Name: CHGT_FT
QuestionText:
?[F1] How tall is [fill: S.C. name] now (without shoes)?
* If the child's height is given in inches, press 'ENTER' at feet and enter the measure in inches (36 inches maximum).
* Enter 'M' to record metric measurements.
00-07 0-7 feet
97 Refused
99 Don't know
M Metric
UniverseText: Sample children 12+
SkipInstructions:
(empty) [go to CHGT_IN]
(0-7) [go to CHGT_IN]
(R,D) [go to CWGT_LB]
(M) [go to CHGT_M]
[If NE (0-7, M, D, R) go to ERR_CHGT_FT]

Hard Edit: ERR_CHGT_FT

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

Question ID: CHS.020_02.000

Instrument Variable Name: CHGT_IN
QuestionText:
* Enter inches.
00-36 0-36 inches
97 Refused
99 Don't know
UniverseText: Sample children 12+ whose height in feet is 0-7 or is left empty.
SkipInstructions:
(0-36,R,D) If (CHGT_FT = '0', 'empty') and (CHGT_IN = '0', 'empty')
go to ERR1_CHGT_IN
elseif CHGT_FT = '1-7' and CHGT_IN ge '12'
go to ERR2_CHGT_IN

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

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

go to ERR3_CHGT_IN
else
go to CWGT_LB

Hard Edit: ERR1_CHGT_IN

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

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

Soft Edit: ERR3_CHGT_IN

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

Question ID: CHS.021_01.000

Instrument Variable Name: CHGT_M
QuestionText:
* Enter height in metric.
* If the child's height is given in centimeters, press 'ENTER' at meters and enter the measure in centimeters (241 centimeters maximum).
0-2 0-2 meters
7 Refused
9 Don't know
Blank Blank
UniverseText: Sample children 12+ whose current height will be entered in metric.
SkipInstructions:
(0-2,empty) [go to CHGT_CM]
(R,D) [go to CWGT_LB]

Question ID: CHS.021_02.000

Instrument Variable Name: CHGT_CM
QuestionText:
* Enter centimeters.
000-241 0-241 centimeters
Blank Blank
UniverseText: Sample children 12+ whose weight will be entered in metric, and who entered "0-2" for height in meters or left it empty.
SkipInstructions:
(0-241,R,D) If (CHGT_M = '0', 'empty') and (CHGT_CM = '0', 'empty')
go to ERR1_CHGT_CM
elseif (CHGT_M eq '2' and CHGT_CM gt '41') or (CHGT_M eq '1' and CHGT_CM gt '141')
go to ERR2_CHGT_CM

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

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

go to ERR3_CHGT_CM
else
go to CWGT_LB

Hard Edit: ERR1_CHGT_CM

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

* Total height exceeds maximum allowed.
* Please correct.

Soft Edit: ERR3_CHGT_CM

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

Question ID: CHS.022_00.000

Instrument Variable Name: CWGT_LB
QuestionText:
How much does [fill: S.C. name] weigh now (without shoes)?
* Enter 'M' to record metric measurements.
* Enter '500' if 500 pounds or more.
001-500 1-500 pounds
997 Refused
999 Don't know
M Metric
UniverseText: Sample children 12+
SkipInstructions:
(1-500) if CWGT_LB lt '1' or CWGT_LB gt '500'
go to ERR1_CWGT_LB
elseif (SEX = '1' and
AGE = '12' and (CWGT_LB lt '62' or CWGT_LB gt '209')) or
AGE = '13' and (CWGT_LB lt '70' or CWGT_LB gt '247')) or
AGE = '14' and (CWGT_LB lt '83' or CWGT_LB gt '266')) or
AGE = '15' and (CWGT_LB lt '94' or CWGT_LB gt '267')) or
AGE = '16' and (CWGT_LB lt '98' or CWGT_LB gt '306')) or
AGE = '17' and (CWGT_LB lt '106' or CWGT_LB gt '317')) or
(SEX = '2' and
AGE = '12' and (CWGT_LB lt '62' or CWGT_LB gt '212')) or
AGE = '13' and (CWGT_LB lt '73' or CWGT_LB gt '238')) or
AGE = '14' and (CWGT_LB lt '84' or CWGT_LB gt '252')) or
AGE = '15' and (CWGT_LB lt '84' or CWGT_LB gt '238')) or
AGE = '16' and (CWGT_LB lt '87' or CWGT_LB gt '257')) or
AGE = '17' and (CWGT_LB lt '90' or CWGT_LB gt '292'))
go to ERR2_CWGT_LB
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE ge '2'
go to ADD_1
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE lt '2'
go to ADD1_2
else
calculate the BMI (Body Mass Index)
(R,D) if AGE ge '2'
go to ADD_1
else
go to ADD1_2
(M) go to CWGT_KG

Hard Edit: ERR1_CWGT_LB

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

Soft Edit: ERR2_CWGT_LB

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

Question ID: CHS.023_00.000

Instrument Variable Name: CWGT_KG
QuestionText:
* Enter weight in kilograms.

002-226 2-226 kilograms
UniverseText: Sample children 12+ whose weight will be entered in metric.
SkipInstructions:
(2-226) if CWGT_KG lt '2' or CWGT_KG gt '226'
go to ERR1_CWGT_KG
elseif (SEX = '1' and
AGE = '12' and (CWGT_KG = '28' or CWGT_KG = '95')) or
AGE = '13' and (CWGT_KG = '32' or CWGT_KG = '112')) or
AGE = '14' and (CWGT_KG = '38' or CWGT_KG = '121')) or
AGE = '15' and (CWGT_KG = '42' or CWGT_KG = '121')) or
AGE = '16' and (CWGT_KG = '44' or CWGT_KG = '139')) or
AGE = '17' and (CWGT_KG = '48' or CWGT_KG = '144')) or
(SEX = '2' and
AGE = '12' and (CWGT_KG = '28' or CWGT_KG = '96')) or
AGE = '13' and (CWGT_KG = '33' or CWGT_KG = '108')) or
AGE = '14' and (CWGT_KG = '38' or CWGT_KG = '114')) or
AGE = '15' and (CWGT_KG = '38' or CWGT_KG = '108')) or
AGE = '16' and (CWGT_KG = '39' or CWGT_KG = '117')) or
AGE = '17' and (CWGT_KG = '41' or CWGT_KG = '133'))
go to ERR2_CWGT_KG
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE ge '2'
go to ADD_1
elseif CHGT_FLG = '1' and CWGT_FLG = '1' and AGE lt '2'
go to ADD1_2
else
calculate the BMI (Body Mass Index)
(R,D) if AGE ge '2'
go to ADD_1
else
go to ADD1_2

Hard Edit: ERR1_CWGT_KG

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

Soft Edit: ERR2_CWGT_KG

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

Question ID: CHS.031_02.000

Instrument Variable Name: ADD1_2
QuestionText:
Has a doctor or health professional ever told you that [fill: S.C. name] had_ an intellectual disability, also known as mental retardation?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to ADD1_3]

Question ID: CHS.031_03.000

Instrument Variable Name: ADD1_3
QuestionText:
?[F1] * Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had_ Any other developmental delay?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to CONDL]

Question ID: CHS.032_01.000

Instrument Variable Name: ADD_1
QuestionText:
?[F1] Has a doctor or health professional ever told you that [fill: S.C. name] had_ Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 2-17
SkipInstructions:
(1,2,R,D) [go to ADD_2]

Question ID: CHS.032_02.000

Instrument Variable Name: ADD_2
QuestionText:
* Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had_. an intellectual disability, also known as mental retardation?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 2-17
SkipInstructions:
(1,2,R,D) [go to ADD_3]

Question ID: CHS.032_03.000

Instrument Variable Name: ADD_3
QuestionText:
?[F1] * Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had_ Any other developmental delay?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 2-17
SkipInstructions:
(1,2,R,D) [go to CONDL]

Question ID: CHS.060_00.000

Instrument Variable Name: CONDL
QuestionText:
(book) C2 ?[F1] Looking at this list, has a doctor or health professional ever told you that [fill: SC name] had any of these conditions?
*Read if necessary.
Down syndrome
Cerebral palsy
Muscular dystrophy
Cystic fibrosis
Sickle cell anemia
Autism/Autism spectrum disorder
Diabetes
Arthritis
Congenital heart disease
Other heart condition
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CONDL1]
(2,R,D) [go to CPOX]

Question ID: CHS.061_00.000

Instrument Variable Name: CONDL1
QuestionText:
(book) C2 ?[F1] Which ones?
* Enter all that apply, separate with commas.
01 Down syndrome
02 Cerebral palsy
03 Muscular dystrophy
04 Cystic fibrosis
05 Sickle cell anemia
06 Autism/Autism spectrum disorder
07 Diabetes
08 Arthritis
09 Congenital heart disease
10 Other heart condition
UniverseText: Sample children LT 18 and CONDL=1
SkipInstructions:
(1-10, R,D) [go to CPOX]

Question ID: CHS.070_00.000

Instrument Variable Name: CPOX
QuestionText:
Has [fill: SC Name] EVER had chickenpox?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CPOX12MO]
(2, D, R) [go to CASHMEV]

Question ID: CHS.072_00.000

Instrument Variable Name: CPOX12MO
QuestionText:
Has [fill: SC name] had chickenpox DURING THE PAST 12 MONTHS?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who have had chickenpox
SkipInstructions:
(1,2,R,D) [go to CASHMEV]

Question ID: CHS.080_00.000

Instrument Variable Name: CASHMEV
QuestionText:
? [F1] Has a doctor or other health professional EVER told you that [fill: SC name] had asthma?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CASSTILL]
(2,R,D) if AGE LE 2 [go to CCONDT1_1];
else [go to CCONDT_1]

Question ID: CHS.085_00.000

Instrument Variable Name: CASSTILL
QuestionText:
Does [fill: SC name] still have asthma?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:
(1,2,R,D) [go to CASHYR]

Question ID: CHS.090_00.000

Instrument Variable Name: CASHYR
QuestionText:
The following questions are about [fill: SC name]'s asthma DURING THE PAST 12 MONTHS. DURING THE PAST 12 MONTHS, has [fill: SC name] had an episode of asthma or an asthma attack?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:
(1,2,R,D) [go to CASMERYR]

Question ID: CHS.100_00.000

Instrument Variable Name: CASMERYR
QuestionText:
DURING THE PAST 12 MONTHS, did [fill1: SC name] have to visit an emergency room or urgent care center because of [fill2: his/her] asthma?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 and doctor has informed that child had asthma
SkipInstructions:
(1,2,R,D) if CASSTILL=1 or CASHYR=1 [go to CASMHSP]; else if CASSTILL=2,R,D and CASHYR=2,R,D and AGE LE 2 [go to CCONDT1_1]; else [go to CCONDT_1]

Question ID: CHS.100_00.010

Instrument Variable Name: CASMHSP
QuestionText:
DURING THE PAST 12 MONTHS, has [fill: S.C. name] 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 child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1,2,R,D) [go to CWZMSWK]

Question ID: : CHS.100_00.030

Instrument Variable Name: CWZMSWK
QuestionText:
DURING THE PAST 12 MONTHS, HOW MANY DAYS of [fill1: daycare or preschool/fill2: school/fill3: school or work] did [fill: S.C. name] miss because of [fill: his/her] asthma?
*Enter '0' for none.
*Enter 995 if child home schooled.
*Enter 996 if child did not go to [fill1: daycare or preschool/fill2: school/fill3: school or work].
000 None
001-365 1-365 days
995 Child is home schooled
996 Child does not go to school
997 Refused
999 Don't know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(0-100,995,996,R,D) [go to CASMPMED]
(101-365) [go to ERR1_CWZMSWK]
(366-994) [go to ERR2_CWZMSWK]
Hard Edit: if CWZMSWK = 366-994 then display ERR2_CWZMSWK:
"366-994 days not allowed in this field.
* Please correct."
Soft Edit: if CWZMSWK GT 100 and ne 996 then display ERR1_CWZMSWK: "CWZMSWK is an unusually large number; Did [fill: S.C. name] miss CWZMSWK days of [fill1/fill2/fill3] due to asthma?" 1 correct proceed to CASMPMED; 2 incorrect, change answer

Question ID: CHS.100_00.060

Instrument Variable Name: CASMPMED
QuestionText:
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, has [fill: S.C. name] 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 child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1) [goto CASMTYP]
(2,R,D) [go to CASMDTP2]

Question ID: CHS.100_00.065

Instrument Variable Name: CASMTYP
QuestionText:
When [fill: S.C. name] takes [his/her]rescue prescription asthma medication, would you say that [he/she] most often uses an inhaler and/or disk, or does [he/she] 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 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample child LT 18 who have used a quick relief prescription asthma inhaler in the past three months
SkipInstructions:
(1) [go to CASMCAN]
(2,R,D) [go to CASMDTP2]

Question ID: : CHS.100_00.070

Instrument Variable Name: CASMCAN
QuestionText:
DURING THE PAST 3 MONTHS, did [fill: S.C. name] 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 child LT 18 who have used a prescription asthma inhaler/disk most often in the past three months
SkipInstructions:
(1,2,R,D) [go to CASMDTP2]

Question ID: CHS.100_00.090

Instrument Variable Name: CASMDTP2
QuestionText:
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.
Is [fill: S.C. name] 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 child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1-3,R,D) [go to CASWMP]

Question ID: CHS.100_00.100

Instrument Variable Name: CASWMP
QuestionText:
An asthma action plan is a printed form with specific instructions based on [fill: S.C. name]'s 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 [fill: S.C. name] an asthma action plan?
*Read if necessary: Include nurses and asthma educators.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1,2,R,D) [go to CASCLASS]

Question ID: CHS.100_00.110

Instrument Variable Name: CASCLASS
QuestionText:
Has [fill: S.C. name] ever taken a course or class on how to manage [fill: his/her] asthma?
*Include adult(s) who took a course for the child's asthma.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1,2,R,D) [go to CAS_REC]

Question ID: CHS.100_00.116

Instrument Variable Name: CAS_REC
QuestionText:
Has a doctor or other health professional EVER taught [fill: S.C. name] or [fill: his/her] parent or guardian how to recognize early signs or symptoms of an asthma episode?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1,2,R,D) [go to CAS_RES]

Question ID: CHS.100_00.117

Instrument Variable Name: CAS_RES
QuestionText:
*Read if necessary: Has a doctor or other health professional EVER taught [fill: S.C. name] or [fill: his/her] parent or guardian how to respond to episodes of asthma?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1,2,R,D) [go to CAS_MON]

Question ID: : CHS.100_00.118

Instrument Variable Name: CAS_MON
QuestionText:
*Read if necessary: Has a doctor or other health professional EVER taught [fill: S.C. name] or [fill: his/her] parent or guardian how to monitor peak flow for daily therapy?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1,2,R,D) [go to CAPENVLN]

Question ID: CHS.100_00.130

Instrument Variable Name: CAPENVLN
QuestionText:
Has a doctor or other health professional EVER advised you to change things in [fill: S.C. name]'s home, school, or work environment to improve [fill: his/her] asthma?
1 Yes
2 No
3 Was told no changes needed
7 Refused
9 Don't know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1-3,R,D) [go to CAROUTIN]

Question ID: CHS.100_00.135

Instrument Variable Name: CAROUTIN
QuestionText:
DURING THE PAST 12 MONTHS, how many times did [fill: S.C. name] see a doctor or other health professional for a routine checkup for [fill: his/her] 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 child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(0-50,R,D) [go to CASYMPT]
(51-365) [goto ERR_CAROUTIN]
ERR_CAROUTIN
Soft Edit:
[fill4: CAROUTIN] is an unusually large number.
* Please verify.

Question ID: CHS.100_00.140

Instrument Variable Name: CASYMPT
QuestionText:
The next three questions are about the last time [S.C. name] saw a doctor or other health care professional for routine care or for any reason.
At his/her last visit, did [fill: S.C. name]'s doctor or other health professional ask HOW OFTEN
_.[fill: he/she] had asthma symptoms?
1 Yes
2 No
7 Refused
9 Don’t know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
TO: (1,2,R,D) [go to CARESCUE]

Question ID: CHS.100_00.145

Instrument Variable Name: CARESCUE
QuestionText:
At his/her last visit, did [fill: S.C. name]’s doctor or other health professional ask HOW OFTEN
_[fill: he/she] used a quick relief inhaler
1 Yes
2 No
7 Refused
9 Don’t know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions::
(1,2,R,D) [go to CAACTLIM]

Question ID: CHS.100_00.150

Instrument Variable Name: CAACTLIM
QuestionText:
At his/her last visit, did [fill: S.C. name]’s doctor or other health professional ask HOW OFTEN
_asthma symptoms limited [fill: his/her] daily activities?
1 Yes
2 No
7 Refused
9 Don’t know
UniverseText: Sample child LT 18 who still have asthma or who had asthma episode/attack in past 12 months
SkipInstructions:
(1,2,R,D) [if AGE LE 2 go to CCONDT1_1; else go to CCONDT_1]

Question ID: CHS.111_01.000

Instrument Variable Name: CCONDT1_1
QuestionText:
DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Hay fever?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CCONDT1_2]

Question ID: CHS.111_02.000

Instrument Variable Name: CCONDT1_2
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Any kind of respiratory allergy?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CCONDT1_3]

Question ID: CHS.111_03.000

Instrument Variable Name: CCONDT1_3
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Any kind of food or digestive allergy?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CCONDT1_4]

Question ID: CHS.111_04.000

Instrument Variable Name: CCONDT1_4
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Eczema or any kind of skin allergy?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CCONDT1_5]

Question ID: CHS.111_05.000

Instrument Variable Name: CCONDT1_5
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Frequent or repeated diarrhea or colitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CCONDT1_6]

Question ID: CHS.111_06.000

Instrument Variable Name: CCONDT1_6
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Anemia?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CCONDT1_8]

Question ID: CHS.111_08.000

Instrument Variable Name: CCONDT1_8
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Three or more ear infections?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CCONDT1_9]

Question ID: CHS.111_09.000

Instrument Variable Name: CCONDT1_9
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Seizures?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LE 2
SkipInstructions:
(1,2,R,D) [go to CHSTATYR]

Question ID: CHS.115_01.000

Instrument Variable Name: CCONDT_1
QuestionText:
DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Hay fever?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_2]

Question ID: CHS.115_02.000

Instrument Variable Name: CCONDT_2
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Any kind of respiratory allergy?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_3]

Question ID: CHS.115_03.000

Instrument Variable Name: CCONDT_3
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Any kind of food or digestive allergy?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_4]

Question ID: CHS.115_04.000

Instrument Variable Name: CCONDT_4
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Eczema or any kind of skin allergy?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_5]

Question ID: CHS.115_05.000

Instrument Variable Name: CCONDT_5
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Frequent or repeated diarrhea or colitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_6]

Question ID: CHS.115_06.000

Instrument Variable Name: CCONDT_6
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Anemia?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_7]

Question ID: CHS.115_07.000

Instrument Variable Name: CCONDT_7
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Frequent or severe headaches, including migraines?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_8]

Question ID: CHS.115_08.000

Instrument Variable Name: CCONDT_8
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Three or more ear infections?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_9]

Question ID: CHS.115_09.000

Instrument Variable Name: CCONDT_9
QuestionText:

* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Seizures?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CCONDT_10]

Question ID: CHS.115_10.000

Instrument Variable Name: CCONDT_10
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions_ Stuttering or stammering?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children = 3-17
SkipInstructions:
(1,2,R,D) [go to CHSTATYR]

Question ID: CHS.210_00.000

Instrument Variable Name: CHSTATYR
QuestionText:
Compared with 12 months ago, would you say [fill: SC name]'s health is now better, worse, or about the same?
1 Better
2 Worse
3 About the same
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1-3,R,D) [if AGE le (4) go to CCOLD2W; else go to SCHDAYR]

Question ID: CHS.220_00.000

Instrument Variable Name: SCHDAYR
QuestionText:
DURING THE PAST 12 MONTHS about how many days did [fill2: SC name] miss school because of illness or injury?
* Enter '996' if child did not go to school in the past 12 months.
000 None
001-240 1-240 days
996 Did not go to school
997 Refused
999 Don't know
UniverseText: Sample children 5-17
SkipInstructions:
(0-99,996,R,D) [go to CCOLD2W]
(100-240) [go to ERR1_SCHDAYR]
(241-995) [go to ERR2_SCHDAYR]

Hard Edit: ERR2_SCHDAYR

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

Soft Edit: ERR1_SCHDAYR

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

* Please verify.

Question ID: CHS.230_00.000

Instrument Variable Name: CCOLD2W
QuestionText:
These next questions are about [fill: SC name]'s recent health DURING THE LAST 2 WEEKS. Did [fill: SC name] have a head cold or chest cold that started DURING THE LAST 2 WEEKS?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CINTIL2W]

Question ID: CHS.240_00.000

Instrument Variable Name: CINTIL2W
QuestionText:
Did [fill: SC name] have a stomach or intestinal illness with vomiting or diarrhea that started DURING THE LAST 2 WEEKS?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CHEARST1]

Question ID: CHS.250_00.000

Instrument Variable Name: CHEARST1
QuestionText:
Which statement best describes [fill: SC name]'s hearing without a hearing aid: Excellent, good, a little trouble hearing, moderate trouble, a lot of trouble, or is [fill: SC's name] deaf?
1 Excellent
2 Good
3 A little trouble hearing
4 Moderate trouble
5 A lot of trouble
6 Deaf
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1-6,R,D) [go to CVISION]

Question ID: CHS.260_00.000

Instrument Variable Name: CVISION
QuestionText:
Does [fill1: SC name] have any trouble seeing [fill2: , even when wearing glasses or contact lenses]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CBLIND]
(2,R,D) [go to IHSPEQ]

Question ID: CHS.270_00.000

Instrument Variable Name: CBLIND
QuestionText:
Is [fill: SC name] blind or unable to see at all?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 having trouble seeing
SkipInstructions:
(1,2,R,D) [go to IHSPEQ]

Question ID: CHS.290_00.000

Instrument Variable Name: IHSPEQ
QuestionText:
Does [fill1: SC name] have any impairment or health problem that requires [fill2: him/her] to use special equipment, such as a brace, a wheelchair, or a hearing aid (excluding ordinary eyeglasses or corrective shoes)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to IHMOB]

Question ID: CHS.300_00.000

Instrument Variable Name: IHMOB
QuestionText:
Does [fill1: SC name] have an impairment or health problem that limits [fill2: his/her] ability to (crawl), walk, run, or play?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to IHMOBYR]
(2,R,D) [go to PROBRX]

Question ID: CHS.310_00.000

Instrument Variable Name: IHMOBYR
QuestionText:
Is this an impairment or health problem that has lasted, or is expected to last, 12 months or longer?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 that have limited ability to crawl, walk, run, or play
SkipInstructions:
(1,2,R,D) [go to PROBRX]

Question ID: CHS.311_00.000

Instrument Variable Name: PROBRX
QuestionText:
?[F1] Does [fill1: SC name] NOW have a problem for which [fill2: he/she] has regularly taken prescription medication for at least three months?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [if AGE LE (1) go to CAU.CUSUALPL;
else if AGE GE 3 go to LEARND;
else if AGE = 2 and SEX = 1 go to CMHAGM11_1;
if AGE = 2 and SEX = 2 go to CMHAGF11_1]

Question ID: CHS.312_00.000

Instrument Variable Name: LEARND
QuestionText:
?[F1] Has a representative from a school or a health professional ever told you that [fill: SC name] had a learning disability?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 3-17
SkipInstructions:
(1,2,R,D) [if AGE LT 3 go to CUSUALPL;
if AGE =3 and SEX = 1 go to CMHAGM11_1;
if AGE = 3 and SEX = 2 go to CMHAGF11_1];

Question ID: CHS.321_01.000

Instrument Variable Name: CMHAGM11_1
QuestionText:
(book) C3 ?[F1] I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: SC name] DURING THE PAST TWO MONTHS.
He: Has been uncooperative?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Male sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CMHAGM11_2]

Question ID: CHS.321_02.000

Instrument Variable Name: CMHAGM11_2
QuestionText:
(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: SC name] DURING THE PAST TWO MONTHS.
He: Has trouble getting to sleep?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Male sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CMHAGM11_3]

Question ID: CHS.321_03.000

Instrument Variable Name: CMHAGM11_3
QuestionText:
(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: SC name] DURING THE PAST TWO MONTHS.
He: Has speech problems?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Male sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CMHAGM11_4]

Question ID: CHS.321_04.000

Instrument Variable Name: CMHAGM11_4
QuestionText:
(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: SC name] DURING THE PAST TWO MONTHS.
He: Has been unhappy, sad, or depressed?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Male sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CAU.CUSUALPL]

Question ID: CHS.361_01.000

Instrument Variable Name: CMHAGF11_1
QuestionText:
(book) C3 ?[F1]
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
She: Has temper tantrums or a hot temper?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Female sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CMHAGF11_2]

Question ID: CHS.361_02.000

Instrument Variable Name: CMHAGF11_2
QuestionText:
(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
She: Has speech problems?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Female sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CMHAGF11_3]

Question ID: CHS.361_03.000

Instrument Variable Name: CMHAGF11_3
QuestionText:
(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
She: Has been nervous or high-strung?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Female sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CMHAGF11_4]

Question ID: CHS.361_04.000

Instrument Variable Name: CMHAGF11_4
QuestionText:
(book) C3 ?[F1] * Read if necessary.
I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [fill: S.C. name] DURING THE PAST TWO MONTHS.
She: Has been unhappy, sad, or depressed?
0 Not true
1 Sometimes true
2 Often true
7 Refused
9 Don't know
UniverseText: Female sample children 2-3
SkipInstructions:
(0-2,R,D) [go to CAU.CUSUALPL]

Question ID: CAU.020_00.000

Instrument Variable Name: CUSUALPL
QuestionText:
The next questions are about health care. Is there a place that [fill1: alias] USUALLY goes when [fill2: he/she] is sick or you need advice about [fill3: his/her] health?
1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don't know
UniverseText: Sample children LT 18

SkipInstructions:
(1,3) [go to CPLKIND]
(2,R,D) [go to CHCPLKND]

Question ID: CAU.030_00.000

Instrument Variable Name: CPLKIND
QuestionText:
[fill1: What kind of place is it / What kind of place does [fill2: alias] go to most often] - a clinic, doctor's office, emergency room, or some other place?
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know
UniverseText: Sample children LT 18 with one or more usual places to go when sick or need health advice
SkipInstructions:
(1-5) [go to CHCPLROU]
(6,R,D) [go to CHCPLKND]

Question ID: CAU.035_00.000

Instrument Variable Name: CHCPLROU
QuestionText:
Is that [fill1: CPLKIND/CAU.030] the same place [fill2: alias] USUALLY goes when [fill3: he/she] needs routine or preventive care, such as a physical examination or (well baby/child) check-up?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 with one or more usual places to go when sick or need health advice who reported that place as a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some other place
SkipInstructions:
(1) [go to CHCCHGYR]
(2,R,D) [go to CHCPLKND]

Question ID: CAU.037_00.000

Instrument Variable Name: CHCPLKND
QuestionText:
What kind of place does [fill1: alias] USUALLY go to when [fill2: he/she] needs routine or preventive care, such as a physical examination or (well baby/child) check-up?
0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know
UniverseText: Sample children LT18 who do not have a usual source of sick care; who Ref/NA/DK if have a usual source of sick care; who have a usual source of sick care but does not go to one place most often; who have a usual source of sick care but Ref/NA/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source of sick care but Ref/NA/DK if it is same place as usual source of routine/preventive care.
SkipInstructions:
(0-6,R,D) if CUSUALPL=2 [go to CNOUSLPL]; else if CUSUALPL=,R,D [go to CPRVTRYR]; else [go to CHCCHGYR]

Question ID: CAU.040_00.000

Instrument Variable Name: CHCCHGYR
QuestionText:
At any time IN THE PAST 12 MONTHS did you CHANGE the place(s) to which [fill: alias] USUALLY goes for health care?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 with one or more place to go when sick/need advice [or who reported same place as usual source of routine/preventive care]
SkipInstructions:
(1) [go to CHCCHGHI]
(2,R,D) [go to to CPRVTRYR]

Question ID: CAU.050_00.000

Instrument Variable Name: CHCCHGHI
QuestionText:
Was this change for a reason related to health insurance?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT18 that have changed their usual place of health care in the past 12 months

SkipInstructions:
(1,2,R,D) [go to CPRVTRYR]

Question ID: CAU.050_00.010

Instrument Variable Name: CNOUSLPL
QuestionText:
Why doesn't [fill: alias] have a usual source of medical care?
*Enter all that apply, separate with commas.
01 Doesn't need a doctor/Haven't had any problems
02 Doesn't like/trust/believe in doctors
03 Doesn't know where to go
04 Previous doctor is not available/moved
05 Too expensive/no insurance/cost
06 Speak a different language
07 No care available/Care too far away, not convenient
08 Put it off/Didn't get around to it
09 Other
97 Refused
99 Don't know
UniverseText: Sample children LT 18 who don't have a usual place of care
SkipInstructions:
(1-9,R,D) [go to CPRVTRYR]

Question ID: CAU.052_00.010

Instrument Variable Name: CPRVTRYR
QuestionText:
DURING THE PAST 12 MONTHS, did you have any trouble finding a general doctor or provider who would see [fill: alias]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CPRVTRFD ]
(2,R,D) [go to CDRNANP]

Question ID: CAU.053_00.010

Instrument Variable Name: CPRVTRFD
QuestionText:
Were you able to find a general doctor or provider who could see [fill: alias]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had trouble finding a provider in the last year
SkipInstructions:
(1,2,R,D) [go to CDRNANP]

Question ID: CAU.055_00.010

Instrument Variable Name: CDRNANP
QuestionText:
DURING THE PAST 12 MONTHS, were you told by a doctor's office or clinic that they would not accept [fill: alias] as a new patient?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CDRNAI]

Question ID: CAU.056_00.010

Instrument Variable Name: CDRNAI
QuestionText:
DURING THE PAST 12 MONTHS, were you told by a doctor's office or clinic that they did not accept [fill: alias]'s health care coverage?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CHCDLYR_1]

Question ID: CAU.080_01.000

Instrument Variable Name: CHCDLYR1_1
QuestionText:
There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS_ You couldn't get through on the telephone.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CHCDLYR1_2]

Question ID: CAU.080_02.000

Instrument Variable Name: CHCDLYR1_2
QuestionText:
* Read if necessary. There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS_ You couldn't get an appointment for [fill: alias] soon enough.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CHCDLYR1_3]

Question ID: CAU.080_03.000

Instrument Variable Name: CHCDLYR1_3
QuestionText:
* Read if necessary. There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS_ Once you get there, [fill: alias] has to wait too long to see the doctor.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions
(1,2,R,D) [go to CHCDLYR1_4]

Question ID: CAU.080_04.000

Instrument Variable Name: CHCDLYR1_4
QuestionText:
* Read if necessary. There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS_ The (clinic/doctor's office) wasn't open when you could get there.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions
(1,2,R,D) [go to CHCDLYR1_5]

Question ID: CAU.080_05.000

Instrument Variable Name: CHCDLYR1_5
QuestionText:
* Read if necessary. There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the following reasons IN THE PAST 12 MONTHS_ You didn't have transportation.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [if AGE GE (2) go to CHCAFYR1_1; else go to CHCAFYR]

Question ID: CAU.130_00.000

Instrument Variable Name: CHCAFYR
QuestionText:
DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ Prescription medicines?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to CHCAFYRN]

Question ID: CAU.133_00.010

Instrument Variable Name: CHCAFYRN
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ To see a specialist?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to CHCAFYRF]

Question ID: CAU.133_00.020

Instrument Variable Name: CHCAFYRF
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ Follow-up care?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [if AGE LT 1 go to CHCSYR1_2; else go to CDENLONG]

Question ID: CAU.135_01.000

Instrument Variable Name: CHCAFYR1_1
QuestionText:
DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ Prescription medicines?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions
(1,2,R,D) [go to CHCAFYR1_2]

Question ID: CAU.135_02.000

Instrument Variable Name: CHCAFYR1_2
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ Mental health care or counseling?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCAFYR1_3]

Question ID: CAU.135_03.000

Instrument Variable Name: CHCAFYR1_3
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ Dental care (including check-ups)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCAFYR1_4]

Question ID: CAU.135_04.000

Instrument Variable Name: CHCAFYR1_4
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ Eyeglasses?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions
(1,2,R,D) [go to CHCAFYR1_5]

Question ID: CAU.135_05.010

Instrument Variable Name: CHCAFYR1_5
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ To see a specialist?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCAFYR1_6]

Question ID: CAU.135_06.010

Instrument Variable Name: CHCAFYR1_6
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it because you couldn't afford it_ Follow-up care?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CDENLONG]

Question ID: CAU.160_00.000

Instrument Variable Name: CDENLONG
QuestionText:
(book) C4 About how long has it been since [fill: alias] last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
0 Never
1 6 months or less
2 More than 6 months, but not more than 1 year ago
3 More than 1 year, but not more than 2 years ago
4 More than 2 years, but not more than 5 years ago
5 More than 5 years ago
7 Refused
9 Don't know
UniverseText: Sample children GE 1
SkipInstructions:
(0-5,R,D) [if AGE GE (2) go to CHCSYR_1; else go to CHCSYR1_2]

Question ID: CAU.170_01.000

Instrument Variable Name: CHCSYR1_2
QuestionText:
DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR1_3]

Question ID: CAU.170_02.000

Instrument Variable Name: CHCSYR1_3
QuestionText:
?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? A foot doctor?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR1_5]

Question ID: CAU.170_03.000

Instrument Variable Name: CHCSYR1_5
QuestionText:
?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR1_6]

Question ID: CAU.170_04.000

Instrument Variable Name: CHCSYR1_6
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]'s health? A nurse practitioner, physician assistant or midwife?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR8_1]

Question ID: CAU.175_01.000

Instrument Variable Name: CHCSYR_1
QuestionText:
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR_2]

Question ID: CAU.175_02.000

Instrument Variable Name: CHCSYR_2
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR_3]

Question ID: CAU.175_03.000

Instrument Variable Name: CHCSYR_3
QuestionText:
?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A foot doctor?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR_4]

Question ID: CAU.175_04.000

Instrument Variable Name: CHCSYR_4
QuestionText:
?[F1] Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A chiropractor?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR_5]

Question ID: CAU.175_05.000

Instrument Variable Name: CHCSYR_5
QuestionText:
?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [go to CHCSYR_6]

Question ID: CAU.175_06.000

Instrument Variable Name: CHCSYR_6
QuestionText:
?[F1] * Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about [fill2: alias]'s health? A nurse practitioner, physician assistant or midwife?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 2
SkipInstructions:
(1,2,R,D) [if SEX eq (2) and AGE GE 15 go to CHCSYR7; else go to CHCSYR8_1]

Question ID: CAU.230_00.000

Instrument Variable Name: CHCSYR7
QuestionText:
?[F1] DURING THE PAST 12 MONTHS, have you seen or talked to a doctor who specializes in women's health (an obstetrician/gynecologist) about [fill2: alias]'s health?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children GE 15 who are female
SkipInstructions:
(1,2,R,D) [go to CHCSYR8_1]

Question ID: CAU.240_01.000

Instrument Variable Name: CHCSYR8_1
QuestionText:
DURING THE PAST 12 MONTHS, have you seen or talked to the following about [fill2: alias]'s health? A medical doctor who specializes in a particular medical disease or problem (fill3:other than obstetrician/ gynecologist, psychiatrist or ophthalmologist? /fill4: other than psychiatrist or ophthalmologist)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CHCSYR8_2]

Question ID: CAU.240_02.000

Instrument Variable Name: CHCSYR8_2
QuestionText:
* Read if necessary. DURING THE PAST 12 MONTHS, have you seen or talked to the following about [fill2: alias]'s health? A general doctor who treats a variety of illnesses (a doctor in general practice, pediatrics, family medicine, or internal medicine)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CHCSYR10]
(2,R,D) [go to CHPEXYR]

Question ID: CAU.260_00.000

Instrument Variable Name: CHCSYR10
QuestionText:
Does that doctor treat children and adults (a doctor in general practice or family medicine)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who have seen or talked to a general doctor during the past 12 months
SkipInstructions:
(1,2,R,D) [go to CHCSYREM]

Question ID: CAU.265_00.000

Instrument Variable Name: CHCSYREM
QuestionText:
Did you see or talk to this general doctor because of an emotional or behavioral problem that [fill1: alias] may have?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who have seen a general doctor in the past 12 months
SkipInstructions:
(1,2,R,D) [go to CHPEXYR]

Question ID: CAU.270_00.000

Instrument Variable Name: CHPEXYR
QuestionText:
DURING THE PAST 12 MONTHS, did [fill1: alias] receive a well-child check-up, that is a general check-up, when [fill2: he/she] was not sick or injured?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1,2,R,D) [go to CHERNOYR]

Question ID: CAU.280_00.000

Instrument Variable Name: CHERNOYR
QuestionText:
(book) C5 DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] gone to a HOSPITAL EMERGENCY ROOM about [fill2: his/her] health? (This includes emergency room visits that resulted in a hospital admission.)
00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(0,R,D) [go to CHCHYR]
(1-8) [go to CERVISND]

Question ID: CAU.281_00.010

Instrument Variable Name: CERVISND
QuestionText:
Thinking about [fill: S.C. name]'s most recent emergency room visit, did [fill: he/she ] go to the emergency room either at night or on the weekend?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERHOS]

Question ID: CAU.282_00.010

Instrument Variable Name: CERHOS
QuestionText:
Did this emergency room visit result in a hospital admission?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS1]

Question ID: CAU.283_01.010

Instrument Variable Name: CERREAS1
QuestionText:
Tell me which of these apply to [fill: alias]'s last emergency room visit? _ [fill: He/She] didn't have another place to go
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS2]

Question ID: CAU.283_02.020

Instrument Variable Name: CERREAS2
QuestionText:
*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit? _ [fill: alias]'s doctor's office or clinic was not open
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS3]

Question ID: CAU.283_03.030

Instrument Variable Name: CERREAS3
QuestionText:
*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_ [fill: alias]'s health provider advised that [fill: he/she] go
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS4]

Question ID: CAU.283_04.040

Instrument Variable Name: CERREAS4
QuestionText:
*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_ The problem was too serious for the doctor's office or clinic
1 Yes
2 No
7 Refused
9 Don't' know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS5]

Question ID: CAU.283_05.050

Instrument Variable Name: CERREAS5
QuestionText:
*Read if necessary.
Tell me which of these apply to [fill: alias]'s last emergency room visit?
_ Only a hospital could help [fill: alias]
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS6]

Question ID: CAU.283_06.060

Instrument Variable Name: CERREAS6
QuestionText:

*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_ The emergency room is [fill: alias]'s closest provider
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS7]

Question ID: CAU.283_07.070

Instrument Variable Name: CERREAS7
QuestionText:
*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_[fill: alias] gets most of [fill: his/her] care at the emergency room
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CERREAS8]

Question ID: CAU.283_08.080

Instrument Variable Name: CERREAS8
QuestionText:
*Read if necessary. Tell me which of these apply to [fill: alias]'s last emergency room visit?
_[fill: alias] arrived by ambulance or other emergency vehicle
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18 who had at least one ER visit in the past year
SkipInstructions:
(1,2,R,D) [go to CHCHYR]

Question ID: CAU.290_00.000

Instrument Variable Name: CHCHYR
QuestionText:
DURING THE PAST 12 MONTHS, did [fill1: alias] receive care AT HOME from a nurse or other health care professional?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CHCHMOYR]
(2,R,D) [go to CHCNOYR]

Question ID: CAU.300_00.000

Instrument Variable Name: CHCHMOYR
QuestionText:
DURING THE PAST 12 MONTHS, how many months did [fill: alias] receive care AT HOME from a health care professional?
01-12 1-12 months
97 Refused
99 Don't know
UniverseText: Sample children LT 18 that have received home care from health professional during the past 12 months
SkipInstructions:
(01-12,R,D) [go to CHCHNOYR]

Question ID: CAU.310_00.000

Instrument Variable Name: CHCHNOYR
QuestionText:
(book) C6 ?[F1] What was the total number of home visits received for [fill1: alias] during [fill2: that month/those months]?
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
UniverseText: Sample children LT 18 that have received home care from health professional during the past 12 months
SkipInstructions:
(1-8,R,D) [go to CHCNOYR]

Question ID: CAU.320_00.000

Instrument Variable Name: CHCNOYR
QuestionText:
(book) C5 ?[F1] DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] seen a doctor or other health care professional about [fill2: his/her] health at A DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times [fill1: alias] was hospitalized overnight, visits to hospital emergency rooms, home visits, dental visits or telephone calls.
00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(0-8,R,D) [go to CSRGYR]

Question ID: CAU.330_00.000

Instrument Variable Name: CSRGYR
QuestionText:
DURING THE PAST 12 MONTHS has [fill1: alias] had SURGERY or other surgical procedures either as an inpatient or outpatient?
* Read if necessary. This includes both major surgery and minor procedures such as setting bones or removing growths.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(1) [go to CSRGNOYR]
(2,R,D) [go to CMDLONG]

Question ID: CAU.340_00.000

Instrument Variable Name: CSRGNOYR
QuestionText:
Including any times you may have already told me about, HOW MANY DIFFERENT TIMES has [fill1: alias] had surgery DURING THE PAST 12 MONTHS?
* Enter '95' for 95 or more times.
01-94 1-94 times
95 95+ times
97 Refused
99 Don't know
UniverseText: Sample children LT 18 that have undergone surgery during the past 12 months
SkipInstructions:
(1-10,R,D) [go to CMDLONG]
(11-95) [go to ERR_CMDLONG]

Soft Edit: ERR_CMDLONG

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

*Please verify.

Question ID: CAU.345_00.000

Instrument Variable Name: CMDLONG
QuestionText:
(book) C4 About how long has it been since anyone in the family last saw or talked to a doctor or other health care professional about [fill1: alias]'s health? Include doctors seen while [fill2: he/she] was a patient in a hospital.
0 Never
1 6 months or less
2 More than 6 months, but not more than 1 year ago
3 More than 1 year, but not more than 2 years ago
4 More than 2 years, but not more than 5 years ago
5 More than 5 years ago
7 Refused
9 Don't know
UniverseText: Sample children LT 18
SkipInstructions:
(0-5, D, R) [if AGE=4-17 goto CMHCOPY; else goto CH1N1_1]

Question ID: CMB.010_00.000

Instrument Variable Name: CMHCOPY
QuestionText:
* The following statements are not to be read to the respondent. They are displayed and included here for legal reasons.
* The next 6 items contained in CMHMF_1 through CMHDIFF are included in this survey with permission as indicated below.
* The SDQ questions are copyrighted by Robert Goodman, Ph.D., FRCPSYCH, MRCP. State and local agencies may use these questions without charge and without seeking separate permission provided the wording is not modified, all the questions are retained, and Dr. Goodman's copyright is acknowledged.
* Enter 1 to Continue.
1 Enter 1 to continue
UniverseText: Sample children GE 4
SkipInstructions:
(1) [go to CMHMF_1]

Question ID: CMB.020_01.000

Instrument Variable Name: CMHMF_1
QuestionText:
(book) C7 I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS_ [fill2: He/She] _is generally well behaved, usually does what adults request.
0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know
UniverseText: Sample children GE 4
SkipInstructions:
(1-3,D,R) [go to CMHMF_2]

Question ID: CMB.020_02.000

Instrument Variable Name: CMHMF_2
QuestionText:
(book) C7 * Read if necessary.
I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS_ [fill2: He/She] _has many worries, or often seems worried.
0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know
UniverseText: Sample children GE 4
SkipInstructions:
(1-3,D,R) [go to CMHMF_3]

Question ID: CMB.020_03.000

Instrument Variable Name: CMHMF_3
QuestionText:
(book) C7 * Read if necessary.
I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS_ [fill2: He/She] _is often unhappy, depressed or tearful.
0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know
UniverseText: Sample children GE 4
SkipInstructions:
(1-3,D,R) [go to CMHMF_4]

Question ID: CMB.020_04.000

Instrument Variable Name: CMHMF_4
QuestionText:
(book) C7 * Read if necessary. I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS_ [fill2: He/She] _gets along better with adults than with other [fill3: children/youth].
0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know
UniverseText: Sample children GE 4
SkipInstructions
(1-3,D,R) [go to CMHMF_5]

Question ID: CMB.020_05.000

Instrument Variable Name: CMHMF_5
QuestionText:
(book) C7 * Read if necessary. I am going to read a list of items that describe children. For each item, please tell me if it has been NOT TRUE, SOMEWHAT TRUE, or CERTAINLY TRUE for [fill1: SC name] DURING THE PAST SIX MONTHS_ [fill2: He/She] _has good attention span, sees chores or homework through to the end.
0 Not true
1 Somewhat true
2 Certainly true
7 Refused
9 Don't know
UniverseText: Sample children GE 4
SkipInstructions:
(1-3,D,R) [go to CMHDIFF]

Question ID: CMB.030_00.000

Instrument Variable Name: CMHDIFF
QuestionText:
(book) C8 Overall, do you think that [fill1: SC name] has difficulties in any of the following areas: emotions, concentration, behavior, or being able to get along with other people?
1 No
2 Yes, minor difficulties
3 Yes, definite difficulties
4 Yes, severe difficulties
7 Refused
9 Don't know
UniverseText: Sample children GE 4
SkipInstructions:
(1-4,R,D) [go to next section]

Question ID: CMS.001_00.000

Instrument Variable Name: DIFF6M
QuestionText:
Has [fill: SC name] had any difficulties with emotions, concentration, behavior, or getting along with others DURING THE PAST 6 MONTHS, that is since [fill month and year of 6 month reference period]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17
SkipInstructions:
(1) [go to DIFFINTF]
(2,R,D) [if CMHDIFF (variable name in layouts is RSCL6) IN ('2',3','4') [go to
DIFFINTF]; else [go to PRESCP6M]

Question ID: CMS.005_00.000

Instrument Variable Name: DIFFINTF
QuestionText:
DURING THE PAST 6 MONTHS, did the difficulties interfere with or limit [fill1: SC name] being able to get along in your family, in school, or in daily activities?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who have at least minor difficulties with emotions, concentration, behavior, or being able to get along with others
SkipInstructions
(1) [go to DIFFDEG]
(2,R,D) [go to DIFFLNG]

Question ID: CMS.007_00.000

Instrument Variable Name: DIFFDEG
QuestionText:
How much did these difficulties interfere with [fill: S.C. name] being able to get along in your family, in school, or in daily activities? Would you say_
*Read categories below.
1 A lot
2 Some
3 A little
7 Refused
9 Don't know
UniverseText: Sample children 4-17 whose difficulties interfere with child being able to get along in the family, school, or daily
activities
SkipInstructions:
(1-3,R,D) [go to DIFFLNG]

Question ID: CMS.008_00.000

Instrument Variable Name: DIFFLNG
QuestionText:
How long have these difficulties been present?
1 Less than a month
2 1-5 months
3 6 to 12 months
4 Over a year
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who have at least minor difficulties with emotions, concentration, behavior, or being able to get along with others
SkipInstructions:
(1-4,R,D) [go to PRESCP6M]

Question ID: CMS.010_00.000

Instrument Variable Name: PRESCP6M
QuestionText:
DURING THE PAST 6 MONTHS, was [fill1: S.C. name] prescribed medication or taking prescription medication for difficulties with emotions, concentration, behavior, or being able to get along with others?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17
SkipInstructions:
(1) [go to PRESHELP]
(2,R,D) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [end]; else [go to NSDUH21]

Question ID: CMS.011_00.000

Instrument Variable Name: PRESHELP
QuestionText:
During the past 6 months, how much has this prescription medication helped [fill: S.C. name]? Would you say_
*Read categories below.
1 Not at all
2 A little
3 Some
4 A lot
7 Refused
9 Don't know
UniverseText: Sample children 4-17 have taken prescription medicine in the past 6 mos
SkipInstructions:
(1-4,R,D) [go to PMEDPED]

Question ID: CMS.012_01.000

Instrument Variable Name: PMEDPED
QuestionText:
Who FIRST prescribed the medication? Was it _A pediatrician or other family doctor?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who have been prescribed or have taken prescription medication in the past 6 months
SkipInstructions:
(1) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [go to TRETHELP]; else [go to NSDUH21]; (2,R,D) [go to PMEDPSY]

Question ID: CMS.012_02.000

Instrument Variable Name: PMEDPSY
QuestionText:
*Read if necessary. Who FIRST prescribed the medication? Was it _A psychiatrist, psychologist or other mental health professional?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who were prescribed medication in the past 6 months by someone other than a pediatrician or other family doctor
SkipInstructions:
(1) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [go to TRETHELP]; else [go to NSDUH21]; (2,R,D) [go to PMEDNEU]

Question ID: CMS.012_03.000

Instrument Variable Name: PMEDNEU
QuestionText:
*Read if necessary.
Who FIRST prescribed the medication? Was it _A neurologist?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who were prescribed medication in the past 6 months by someone other than a pediatrician, psychiatrist/ or other family doctor
SkipInstructions:
(1) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [go to TRETHELP]; else [go to NSDUH21]; (2,R,D) [go to PMEDOTH]

Question ID: CMS.012_04.000

Instrument Variable Name: PMEDOTH
QuestionText:
*Read if necessary. Who FIRST prescribed the medication? Was it _Someone else?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who were prescribed medication in the past 6 months by someone other than a pediatrician, family doctor, psychiatrist or neurologist
SkipInstructions:
(1,2,R,D) if CMHDIFF=1,R,D and DIFF6M=2,R,D then [go to TRETHELP]; else [go to NSDUH21]

Question ID: CMS.014_00.000

Instrument Variable Name: NSDUH21
QuestionText:
Sometimes students get treatment or counseling through the school system for DIFFICULTIES WITH emotions, concentration, behavior, or being able to get along with others. DURING THE PAST 6 MONTHS, did [fill: S.C. name] receive any treatment or counseling FROM A SCHOOL SOCIAL WORKER, SCHOOL PSYCHOLOGIST, SCHOOL NURSE, SCHOOL
COUNSELOR, SPECIAL ED TEACHER, OR SCHOOL SPEECH, OCCUPATIONAL OR PHYSICAL THERAPIST?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NSDUH3]

Question ID: CMS.015_00.000

Instrument Variable Name: NSDUH3
QuestionText:
At any time DURING THE PAST 6 MONTHS did [fill1: S.C. name] attend a school for students with difficulties with emotions, concentration, behavior, or being able to get along with others?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:
(1) [go to NSDUH31
(2,R,D) [go to NSDUH4]

Question ID: CMS.015_00.010

Instrument Variable Name: NSDUH31
QuestionText:
Was it a day school or school where {S.C. name} stayed overnight or longer?
1 Day School
2 Overnight School
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months, and attend a special needs school
SkipInstructions:
(1) [go to NSDUH32]
(2,R,D) [go to NSDUH4]

Question ID: CMS.015_00.020

Instrument Variable Name: NSDUH32
QuestionText:
Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Special Ed teacher
2 Other school teacher
3 School counselor, psychologist, nurse or social worker
4 School speech, occupational or physical therapist
5 Other school official
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who participated in a special needs day school with program for these difficulties
SkipInstructions:
(1-5,R,D) [go to NSDUH4];

Question ID: CMS.016_00.000

Instrument Variable Name: NSDUH4
QuestionText:
Regular schools sometimes provide programs for students with difficulties with emotions, concentration, behavior, or being able to get along with others. DURING THE PAST 6 MONTHS, did [fill1: S.C. name] participate in a school program that was just for students with
these kinds of difficulties?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:
(1) [go to NSDUH5]
(2,R,D) if age 4-6 [go to TRETWHR1]; else [go to TRETWHR2]

Question ID: CMS.017_00.000

Instrument Variable Name: NSDUH5
QuestionText:
Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Special Ed teacher
2 Other school teacher
3 School counselor, psychologist, nurse or social worker
4 School speech, occupational or physical therapist
5 Other school official
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who participated in a school program for difficulties with emotions, concentration, behavior
SkipInstructions:
(1-5,R,D) age 4-6 [go to TRETWHR1]; else [go to TRETWHR2]

Question ID: CMS.020_01.000

Instrument Variable Name: TRETWHR1
QuestionText:
Now I'd like to ask about places other than {S.C.name}'s school where children and adolescents receive treatment or counseling for difficulties with emotions, concentration, behavior, or being able to get along with others. DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties_ At daycare, child care, or play group?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-6 who had at least minor difficulties
SkipInstructions:
(1) [go to TRETWHO1]
(2,R,D) [go to TRETWHR2]

Question ID: CMS.020_02.000

Instrument Variable Name: TRETWHO1
QuestionText:
(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation of juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know
UniverseText: Sample children 4-6 who received counseling at daycare, child care, or play group
SkipInstructions:
(1,3-6,R,D) [go to TRETWHR2]
(2) [go to TRTMHP1]

Question ID: CMS.020_03.000

Instrument Variable Name: TRTMHP1
QuestionText:
You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas
1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know
UniverseText: Sample children 4-6 who received counseling or treatment at daycare, child care, or play group from mental health provider
SkipInstructions:
(1-4,R,D) [go to TRETWHR2]

Question ID: CMS.021_01.000

Instrument Variable Name: TRETWHR2
QuestionText:
[fill2: Now I'd like to ask about places other than {S.C. name}'s school where children and adolescents receive treatment or counseling for difficulties with emotions, concentration, behavior, or being able to get along with others.] DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties_ In an office, clinic or center in your community?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:
(1) [go to TRETWHO2]
(2,R,D) [go to TRETWHR3]

Question ID: CMS.021_02.000

Instrument Variable Name: TRETWHO2
QuestionText:
(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling at an office, clinic or community center
SkipInstructions:
(1,3-6,R,D) [go to TRETWHR3]
(2) [go to TRTMHP2]

Question ID: CMS.021_03.000

Instrument Variable Name: TRTMHP2
QuestionText:
You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas
1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling or treatment at an office, clinic or community center from mental health provider
SkipInstructions:
(1-4,R,D) [go to TRETWHR3]

Question ID: CMS.022_01.000

Instrument Variable Name: TRETWHR3
QuestionText:
DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties_ In your home, for example, from a visiting teacher or counselor?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:
(1) [go to TRETWHO3]
(2,R,D) [go to TRETWHR4]

Question ID: CMS.022_02.000

Instrument Variable Name: TRETWHO3
QuestionText:
(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling at home from visiting teacher or counselor
SkipInstructions:
(1,3-6,R,D) [go to TRETWHR4]
(2) [go to TRTMHP3]

Question ID: CMS.022_03.000

Instrument Variable Name: TRTMHP3
QuestionText:
You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas
1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling or treatment at home from mental health provider
SkipInstructions:
(1-4,R,D) [go to TRETWHR4]

Question ID: CMS.023_01.000

Instrument Variable Name: TRETWHR4
QuestionText:
DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties_ In a hospital emergency room, crisis center, or emergency shelter?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:
(1) [go to TRETWHO4]
(2,R,D) [go to TRETWHR5]

Question ID: CMS.023_02.000

Instrument Variable Name: TRETWHO4
QuestionText:
(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling at hospital/ER/crisis center/shelter
SkipInstructions:
(1,3-6,R,D) [go to TRETWHR5]
(2) [go to TRTMHP4]

Question ID: CMS.023_03.000

Instrument Variable Name: TRTMHP4
QuestionText:
You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric
nurse. Who was this?
*Enter all that apply, separate with commas
1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling or treatment at hospital/ER/crisis center/shelter from mental health provider
SkipInstructions:
(1-4,R,D) [go to TRETWHR5]

Question ID: CMS.024_01.000

Instrument Variable Name: TRETWHR5
QuestionText:
DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties_ At a day treatment program in a hospital or in your community?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:
(1) [go to TRETWHO5]
(2,R,D) [go to TRETWHR6]

Question ID: CMS.024_02.000

Instrument Variable Name: TRETWHO5
QuestionText:
(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections officer or court counselor
6 Other
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling at day treatment program in a hospital or community
SkipInstructions:
(1,3-6,R,D) [go to TRETWHR6]
(2) [go to TRTMHP5]

Question ID: CMS.024_03.000

Instrument Variable Name: TRTMHP5
QuestionText:
You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas
1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling or treatment at day treatment program in a hospital or community from mental health provider
SkipInstructions:
(1-4,R,D) [go to TRETWHR6]

Question ID: CMS.025_01.000

Instrument Variable Name: TRETWHR6
QuestionText:
DURING THE PAST 6 MONTHS, did [fill1: SC name] receive treatment or counseling for these difficulties_ Any other place?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who had at least minor difficulties
SkipInstructions:
(1) [go to TRETWHO6]
(2,R,D) [go to OVERNT6M]

Question ID: CMS.025_02.000

Instrument Variable Name: TRETWHO6
QuestionText:
(book) C9 Who provided the treatment or counseling?
*Enter all that apply, separate with commas.
1 Pediatrician or family doctor
2 Psychiatrist, psychologist, clinical social worker or psychiatric nurse
3 Speech, occupational or physical therapist
4 Religious or spiritual counselor or advisor
5 Probation or juvenile corrections or court counselor
6 Other
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling at another place
SkipInstructions
(1,3-6,R,D) [go to OVERNT6M]
(2) [go to TRTMHP6]

Question ID: CMS.025_03.000

Instrument Variable Name: TRTMHP6
QuestionText:
You just told me [S.C. name] received treatment from a psychiatrist, psychologist, clinical social worker or psychiatric nurse. Who was this?
*Enter all that apply, separate with commas
1 Psychiatrist
2 Psychologist
3 Clinical social worker
4 Psychiatric nurse
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received counseling or treatment at another place from mental health provider
SkipInstructions
(1-4,R,D) [go to OVERNT6M]

Question ID: CMS.050_00.000

Instrument Variable Name: OVERNT6M
QuestionText:
DURING THE PAST 6 MONTHS, in addition to a school you may have told me about, did [fill: S.C. name] stay overnight or longer in a hospital, any type of group home, any type of juvenile detention center, sometimes called juvie, or juvenile hall, youth prison, training school or jail, foster care home, or another special type of center or shelter to receive counseling or treatment for these difficulties?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions
(1) [go to OVERWHCH]
(2,R,D) [go to SH1]

Question ID: CMS.060_00.000

Instrument Variable Name: OVERWHCH
QuestionText:
Which ones?
*Read list if necessary.
*Enter all that apply, separate with commas.
01 Hospital
02 Residential treatment center
03 Foster care or therapeutic foster care home
04 In any type of juvenile detention center, sometimes called "juvie", prison, or jail
05 Group home
06 Homeless shelter
07 In another place
97 Refused
99 Don't know
UniverseText: Sample children 4-17 who stayed overnight in a hospital or other overnight location for difficulties
SkipInstructions:
(1-7,R,D) [go to SH1]

Question ID: CMS.070_00.000

Instrument Variable Name: SH1
QuestionText:
DURING THE PAST 6 MONTHS, did [fill1: S.C. name] take part in a self-help group for children and youth with these difficulties?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:
(1,2,R,D) [go to SH2]

Question ID: CMS.080_00.000

Instrument Variable Name: SH2
QuestionText:
DURING THE PAST 6 MONTHS, did [fill1: S.C. name] use the Internet to seek treatment or counseling for these difficulties?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions
(1,2,R,D) [go to CASEM6M]

Question ID: CMS.100_00.000

Instrument Variable Name: CASEM6M
QuestionText:
Parents and caregivers sometimes get help from people sometimes called case managers or care coordinators who help to find or organize treatment for children's difficulties with emotions, concentration, behavior, or being able to get along with others.
*Read if necessary: This type of help is sometimes called care coordination or case management. People or agencies that do this work might also help you develop a service plan, contact providers for you, and provide support to you in getting the help your child or adolescent needs. DURING THE PAST 6 MONTHS, did you or [fill1: S.C. name] receive this type of help from any individual or agency?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:
(1) [go to CASEMWHO];
(2,R,D) IF PRESCP6M=1 or NSDUH21=1 or NSDUH3=1 or NSDUH4=1 or TRETWHR1=1 or TRETWHR2=1 or TRETWHR3=1 or TRETWHR4=1 or TRETWHR5=1 or TRETWHR6=1 or OVERNT6M=1 or SH1=1 or SH2=1 or CASEM6M=1 [go to TRETHELP]; else [go to TRTNEED1]

Question ID: CMS.110_00.000

Instrument Variable Name: CASEMWHO
QuestionText:
Who provides help arranging or coordinating [fill1: S.C. name]'s care?
*Enter the MAIN answer.
01 Child welfare/social services/family and child services agency
02 School or educational system
03 Mental health agency
04 Private mental health professional
05 Juvenile justice agency or court system
06 Private insurance service
07 Family or friend
08 Pediatrician or other family doctor
09 Family or youth advocacy groups
10 Other
97 Refused
99 Don't know
UniverseText: Sample children 4-17 who received help from case managers/care coordinators in the past 6 months
SkipInstructions:
(1-10,R,D) [go to TRETHELP]

Question ID: CMS.115_00.000

Instrument Variable Name: TRETHELP
QuestionText:
You told us that [S.C. child] has received treatment or counseling for difficulties with emotions, concentration, behavior, or being able to get along with others. During the past 6 months, how much has this treatment or counseling helped [S.C. child]? Would you say_
* Read answer categories below.
1 Not at all
2 A little
3 Some
4 A lot
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who received treatment in the past 6 months
SkipInstructions:
(1-4,R,D) if CMHDIFF=2-4 and DIFF6M=1 [go to TRPAYPHI]; else [go to next section]

Question ID: CMS.120_01.000

Instrument Variable Name: TRPAYPHI
QuestionText:
Next I'm going to read a list of ways that treatment and counseling get paid for. Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Private health insurance, such as insurance that comes with a job?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:
(1,2,R,D) [go to TRPAYSCH]

Question ID: CMS.120_02.000

Instrument Variable Name: TRPAYSCH
QuestionText:
*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. School system?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions
(1,2,R,D) [go to TRPAYSLF]

Question ID: CMS.120_03.000

Instrument Variable Name: TRPAYSLF
QuestionText:
*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. You or your family (sometimes called out of pocket or co-payment)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:
(1,2,R,D) [go to TRPAYMED]

Question ID: CMS.120_04.000

Instrument Variable Name: TRPAYMED
QuestionText:
(Book) F14 *Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Medicaid?
*Read if necessary: In this State it is also called *(Refer to flashcard F14 for state Medicaid names).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:
(1,2,R,D) [go to TRPAYCHP]

Question ID: CMS.120_05.000

Instrument Variable Name: TRPAYCHP
QuestionText:
*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. [fill2: A state CHIP/SCHIP program?/ [STNAME1]]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:
(1,2,R,D) [go to TRPAYMIL]

Question ID: CMS.120_06.000

Instrument Variable Name: TRPAYMIL
QuestionText:
*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Military health care?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:
(1,2,R,D) [go to TRPAYSHP]

Question ID: CMS.120_07.000

Instrument Variable Name: TRPAYSHP
QuestionText:
*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Some other state or county sponsored health plan, Medicare or other government program?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months SkipInstructions:
(1,2,R,D) [go to TRPAYIHS]

Question ID: CMS.120_09.000

Instrument Variable Name: TRPAYIHS
QuestionText:
*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Indian Health Service?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:
(1,2,R,D) [go to TRPAYOTH]

Question ID: CMS.120_10.000

Instrument Variable Name: TRPAYOTH
QuestionText:
*Read if necessary: Please tell me who pays or paid for [fill1: S.C. name]'s treatment or counseling during the past 6 months. Some other source?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months and received some type of treatment or counseling in the past 6 months
SkipInstructions:
(1,2,R,D) if TRPAYPHI=2,R,D and TRPAYSCH=2,R,D and TRPAYSLF=2,R,D and TRPAYMED=2,R,D and TRPAYCHP=2,R,D and TRPAYMIL=2,R,D and TRPAYSHP=2,R,D and TRPAYIHS=2,R,D and TRPAYOTH=2,R,D [go to TRETFREE];
else [go to TRTNEED1]

Question ID: CMS.120_12.000

Instrument Variable Name: TRETFREE
QuestionText:
Was ALL OF THE treatment or counseling [fill1: S.C. name] RECEIVED during the past 6 months free?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who did not pay for treatment
SkipInstructions:
(1,2,R,D) [go to TRTNEED1]

Question ID: CMS.150_00.000

Instrument Variable Name: TRTNEED1
QuestionText:
DURING THE PAST 6 MONTHS, did [fill1: S.C. name] need treatment or counseling for these difficulties but didn't get it?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties with emotions, concentration, behavior, or being able to get along in the past 6 months
SkipInstructions:
(1) [go to NTRTCOST]
(2,R,D) [go to next section]

Question ID: CMS.150_01.000

Instrument Variable Name: NTRTCOST
QuestionText:
Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Help was too expensive?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTLOC]

Question ID: CMS.150_02.000

Instrument Variable Name: NTRTLOC
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You didn't know where to go?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTNEXP]

Question ID: CMS.150_03.000

Instrument Variable Name: NTRTNEXP
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You had a negative experience with professionals?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTFEAR]

Question ID: CMS.150_04.000

Instrument Variable Name: NTRTFEAR
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You are afraid or you don't like professionals?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTLOSE]

Question ID: CMS.150_05.000

Instrument Variable Name: NTRTLOSE
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You were afraid [fill1: S.C. name] would be taken from your home or that you would lose your parental rights or custody?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTSAY]

Question ID: CMS.150_06.000

Instrument Variable Name: NTRTSAY
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You were afraid of what your family or friends would say?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTWAIT]

Question ID: CMS.150_07.000

Instrument Variable Name: NTRTWAIT
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You had to wait a long time for an appointment?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTTRAN]

Question ID: CMS.150_08.000

Instrument Variable Name: NTRTTRAN
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. You had no way to get there?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTINCV]

Question ID: CMS.150_09.000

Instrument Variable Name: NTRTINCV
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Services were too inconvenient to use?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTFAR]

Question ID: CMS.150_10.000

Instrument Variable Name: NTRTFAR
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Services were too far away?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to NTRTCHNO]

Question ID: CMS.150_11.000

Instrument Variable Name: NTRTCHNO
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. [fill1: S.C. name] did not want to go?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions
(1,2,R,D) [go to NTRTOTH]

Question ID: CMS.150_12.000

Instrument Variable Name: NTRTOTH
QuestionText:
*Read lead-in if necessary: Please tell me if any of these reasons kept [fill1: S.C. name] from getting treatment or counseling. Some other reason?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample children 4-17 who currently have or have had at least minor difficulties and who needed treatment but didn't get it in the past 6 months
SkipInstructions:
(1,2,R,D) [go to next section]

Question ID: CFI.005_00.010

Instrument Variable Name: CH1N1_1
QuestionText:
?[F1] DURING THE PAST 12 MONTHS, has {SC name} had a flu vaccination? A flu vaccination is usually given in the fall and protects against influenza for the flu season.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample Child LE 17 years
SkipInstructions:
(1) [go to CH1N1_2]
(2,R,D) [go to next section]

Question ID: CFI.005_00.020

Instrument Variable Name: CH1N1_2
QuestionText:
How many vaccinations has {S.C. name} received?
1 1 vaccination or dose
2 2 or more vaccination doses
7 Refused
9 Don't know
UniverseText: Sample Child LE 17 years who have had an vaccine dose
SkipInstructions:
(1,2) [go to CH1N1_3M]
(R,D) [go to next section]

Question ID: CFI.005_00.030

Instrument Variable Name: CH1N1_3M
QuestionText:
1 of 2 During what month and year did {S.C. name} receive {fill: his/her} most recent flu vaccine?
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: Sample Child LE 17 who have had one or more vaccine doses
SkipInstructions:
(1-12,D) [ go to CH1N1_4Y]
(R) [go to CH1N1_5]

Question ID: CFI.005_00.040

Instrument Variable Name: CH1N1_4Y
QuestionText:
2 of 2 *Enter year of most recent flu vaccine.
Year Year
9997 Refused
9999 Don't know
UniverseText: Sample Child LE 17 years who have had one or more vaccine doses and gave month/don't know month of vaccine dose
SkipInstructions
(valid year,R,D) [go to CH1N1_5]
[If CH1N1_3M and CH1N1_4Y = a future date] go to ERR1_ CH1N1_4Y]
[If CH1N1_3M and CH1N1_4Y = a date prior to birth] go to ERR2_ CH1N1_4Y]
[If CH1N1_3M and CH1N1_4Y = a date prior to 12 months ago] go to ERR3_ CH1N1_4Y]

Hard Edit: ERR1_ CH1N1_4Y

*Future date invalid.

ERR2_ CH1N1_4Y

*Date before birth.

ERR3_ CH1N1_4Y

*Date before 12 months ago.

Question ID: CFI.005_00.050

Instrument Variable Name: CH1N1_5
QuestionText:
Was this a shot, or was it a vaccine sprayed in the nose?
*Read if necessary: The flu nasal spray is called FluMist(trademark).
1 Flu shot
2 Flu nasal spray (spray, mist or drop in nose)
7 Refused
9 Don't know
UniverseText: Sample Child LE 17 years who have had one or more vaccine doses
SkipInstructions:
(1-2,R,D) IF CH1N1_2=1 [go to next section]; else if CH1N1_2=2 [go to CH1N1_6M]

Question ID: CFI.005_00.060

Instrument Variable Name: CH1N1_6M
QuestionText:
1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:
(1-12,D) [ go to CH1N1_7Y]
(R) [go to CH1N1_8]

Question ID: CFI.005_00.070

Instrument Variable Name: CH1N1_7Y
QuestionText:
2 of 2 *Enter year of next most recent flu vaccine.
Year Year
9997 Refused
9999 Don't know
UniverseText: Sample Child LE 17 years who have had more than one vaccine doses and gave month/don't know month of vaccine dose
SkipInstructions:
(valid year,R,D) [go to CH1N1_8]
[If CH1N1_6M and CH1N1_7Y = a future date] go to ERR1_ CH1N1_7Y]
[If CH1N1_6M and CH1N1_7Y = a date prior to birth] go to ERR2_ CH1N1_7Y]
[If CH1N1_6M and CH1N1_7Y = a date prior to 12 months ago] go to ERR3_ CH1N1_7Y]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Question ID: CFI.005_00.080

Instrument Variable Name: CH1N1_8
QuestionText:
Was this a shot, or was it a vaccine sprayed in the nose?
*Read if necessary: The flu nasal spray is called FluMist(trademark).
1 Flu shot
2 Flu nasal spray (spray, mist or drop in nose)
7 Refused
9 Don't know
UniverseText: Sample Child LE 17 years who have more than one vaccine dose
SkipInstructions:
(1-2,R,D) [go to next section]