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2015 NHIS Questionnaire - Sample Adult Diet and Nutrition Document Version Date: 27-May-16

Question ID: NAC.005_00.000

Instrument Variable Name: SPSPEAK
Question Text:
(book) CAN1 Next, I would like to ask about the language you use most often. In general, what language do you speak? 1 Only Spanish
2 Mostly Spanish
3 Spanish and English about the same
4 Mostly English
5 Only English
6 Only other, mostly other, or other and English about the same
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [go to CEREALNO]; (6) [go to OTHLANG]

Question ID: NAC.006_00.000

Instrument Variable Name: OTHLANG
Question Text:
*Specify the language used most often.
Verbatim Verbatim response
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who gave other language used most often
Skip Instructions:
(allow 20,R,D) [go to CEREALNO]

Question ID: NAC.010_01.000

Instrument Variable Name: CEREALNO
Question Text:
1 of 2
These questions are about the different kinds of foods you ate or drank during the past month, that is, the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else.
During the past month, how often did you eat HOT or COLD cereals? You can tell me per day, per week, or per month.
*Read if necessary: Include cereals eaten at any time of the day.
*Enter number.
*Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to MILKNO];
(1-995)[ [go to CEREALTP]

Question ID: NAC.010_02.000

Instrument Variable Name: CEREALTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate cereal in the past month
Skip Instructions:
[if (CEREALNO gt (10) and CEREALTP eq (1)) or
( CEREALNO gt (70) and CEREALTP eq (2)) or
( CEREALNO gt (310) and CEREALTP eq (3)) [go to ERR1_CEREALTP] )
Else (1-3,R,D) [go to CERTYP]
Soft Edit:
* [Fill1:CEREALNO] times per [Fill2: CEREALTP] is unusually high.
* Please verify.

Question ID: NAC.015_00.000

Instrument Variable Name: CERTYP
Question Text:
During the past month, what kinds of cereal did you USUALLY eat? You may choose up to two.
* Enter the name of the cereal to locate in the lookup table.
* If second cereal is mentioned, enter 'Yes' at next screen and enter cereal name at the following screen.
* If cereal is not found, type ZZ
Verbatim Verbatim response
97 Refused
99 Don't know
ZZ Other specify
Universe Text: Sample adults 18+ who ate cereal in the past month
Skip Instructions:
(ZZ) [go to CERTPSP]; else go to CERTYP2

Question ID: NAC.015_00.010

Instrument Variable Name: CERTPSP
Question Text:
* Enter the other cereal as reported by the respondent.
Verbatim Verbatim response
Universe Text: Selection in data base not found, go here to input actual response
Skip Instructions:
allow 30) [go to CERTYP2]

Question ID: NAC.015_01.000

Instrument Variable Name: CERTYP2
Question Text:
During the past month, was there another cereal that you usually ate?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate cereal in the past month
Skip Instructions:
(1) [go to CERTYP3]
(2, D, R) [go to MILKNO]

Question ID: NAC.015_02.000

Instrument Variable Name: CERTYP3
Question Text:
* Enter the name of the cereal to locate in the lookup table.
* If cereal is not found, type ZZ
Verbatim Verbatim response
97 Refused
99 Don't know
ZZ Other specify
Universe Text: Sample adults 18+ who ate another cereal in the past month
Skip Instructions:
(ZZ) [go to CERTP3SP];
else go to MILKNO

Question ID: NAC.015_02.010

Instrument Variable Name: CERTP3SP
Question Text:
* Enter the other cereal as reported by the respondent.
Verbatim Verbatim response
Universe Text: Selection in data base not found, go here to input actual response
Skip Instructions:
(allow 30) [go to MILKNO]

Question ID: NAC.020_01.000

Instrument Variable Name: MILKNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you have MILK, either to drink or on cereal? Do NOT include soy milk or small amounts of milk in coffee or tea.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to SODANO];
(1-995) [go to MILKTP]

Question ID: NAC.020_02.000

Instrument Variable Name: MILKTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank milk in past month
Skip Instructions:
[if (MILKNO gt (10) and MILKTP eq (1)) or
(MILKNO gt (70) and MILKTP eq (2)) or
( MILKNO gt (310) and MILKTP eq (3)) [go to ERR1_MILKTP] )
Else (1-3,R,D) [go to MILKTYP]
Soft Edit:
* [Fill1:MILKNO] times per [Fill2: MILKTP] is unusually high.
* Please verify.

Question ID: NAC.025_00.000

Instrument Variable Name: MILKTYP
Question Text:
What type of milk was it? Was it usually?
*Read categories below.
*If respondent drinks soy milk only, go back and change MILKNO to '0'.
1 Whole or regular milk
2 2% fat or reduced-fat milk
3 1% fat or low-fat milk (includes 0.5% fat milk or "low-fat" milk not further specified)
4 Fat-free, skim or nonfat milk
5 Other
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank milk in past month
Skip Instructions:
(1-6,R,D) [go to SODANO]

Question ID: NAC.030_01.000

Instrument Variable Name: SODANO
Question Text:
1 of 2
During the past month, how often did you drink REGULAR SODA or pop that contains sugar?
Do NOT include diet soda. You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FRJUICNO];
(1-995)[go to SODATP]

Question ID: NAC.030_02.000

Instrument Variable Name: SODATP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank soda in past month
Skip Instructions:
[if (SODANO gt (10) and SODATP eq (1)) or
(SODANO gt (70) and SODATP eq (2)) or
( SODANO gt (310) and SODATP eq (3)) [go to ERR1_SODATP] )
Else (1-3,R,D) [go to FRTJUICNO]
* [Fill1:SODANO] times per [Fill2: SODATP ] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.040_01.000

Instrument Variable Name: FRJUICNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you drink 100% PURE fruit juice such as orange, mango, apple, grape and pineapple juices?
Do NOT include fruit flavored drinks with added sugar or fruit juice you made at home and added sugar to.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to COFFEEN1]; (1-995)[go to FRJUICTP]

Question ID: NAC.040_02.000

Instrument Variable Name: FRJUICTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank fruit juice in past month
Skip Instructions:
[if (FRJUICNO gt (10) and FRJUICTP eq (1)) or
(FRJUICNO gt (70) and FRJUICTP eq (2)) or
( FRJUICNO gt (310) and FRJUICTP eq (3)) [go to ERR1_FRJUICTP] )
Else (1-3,R,D)[go to COFFEEN1]
* [Fill1:FRJUICNO] times per [Fill2: FRJUICTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.042_01.000

Instrument Variable Name: COFFEEN1
Question Text:
1 of 2
*Read if necessary: During the past month...
How often did you drink COFFEE or tea that had sugar or honey added to it? Include coffee and tea you sweetened yourself and presweetened tea and coffee drinks such as Arizona Iced Tea and Frappuccino. Do not include artificially sweetened coffee or diet tea.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to SPORDRNO]; (1-995) [go to COFFEET1]

Question ID: NAC.042_02.000

Instrument Variable Name: COFFEET1
Question Text:
2 of 2
*Enter time period. 0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank coffee in past month
Skip Instructions:
[if (COFFEEN1 gt (10) and COFFEET1 eq (1)) or (COFFEEN1 gt (70) and COFFEET1 eq (2)) or ( COFFEEN1 gt (310) and COFFEET1 eq (3)) [go to ERR1_COFFEET1] )
Else (1-3,R,D) [go to SPORDRNO]
Soft Edit:
* [Fill1:COFFEEN1] times per [Fill2: COFFEET1] is unusually high.
* Please verify.

Question ID: NAC.045_01.000

Instrument Variable Name: SPORDRNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you drink SPORTS and ENERGY drinks such as Gatorade, Red Bull, and Vitamin water?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FRTDRNO]; (1-995) [go to SPORDRTP]

Question ID: NAC.045_02.000

Instrument Variable Name: SPORDRTP
Question Text:
2 of 2
*Enter time period. 0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank sports drink in past month
Skip Instructions:
[if (SPORDRNO gt (10) and SPORDRTP eq (1)) or (SPORDRNO gt (70) and SPORDRTP eq (2)) or ( SPORDRNO gt (310) and SPORDRTP eq (3)) [go to ERR1_SPORDRTP] )
Else (1-3,R,D) [go to FRTDRNO]
Soft Edit:
* [Fill1:SPORDRNO] times per [Fill2: SPORDRTP] is unusually high.
* Please verify.

Question ID: NAC.060_01.000

Instrument Variable Name: FRTDRNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you drink sweetened fruit drinks, such as Kool-aid, cranberry and lemonade?
Include fruit drinks you made at home and added sugar to.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FRUITNO];
(1-995) [go to FRTDRTP]

Question ID: NAC.060_02.000

Instrument Variable Name: FRTDRTP
Question Text:
2 of 2
*Enter time period. 0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank fruit drinks in past month
Skip Instructions:
[if ( FRTDRNO gt (10) and FRTDRTP eq (1)) or (FRTDRNO gt (70) and FRTDRTP eq (2)) or ( FRTDRNO gt (310) and FRTDRTP eq (3)) [go to ERR1_FRTDRTP] )
Else (1-3,R,D) [go to FRUITNO]
Soft Edit:
* [Fill1:FRTDRNO] times per [Fill2: FRTDRTP] is unusually high.
* Please verify.

Question ID: NAC.070_01.000

Instrument Variable Name: FRUITNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat FRUIT? Include fresh, frozen, or canned fruit. Do NOT include juices.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to SALADNO];
(1-995) [go to FRUITTP]

Question ID: NAC.070_02.000

Instrument Variable Name: FRUITTP
Question Text:
2 of 2
*Enter time period. 0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate fruit in past month
Skip Instructions:
[if (FRUITNO gt (10) and FRUITTP eq (1)) or (FRUITNO gt (70) and FRUITTP eq (2)) or (FRUITNO gt (310) and FRUITTP eq (3)) [go to ERR1_FRUITTP] )
Else (1-3,R,D) [go to SALADNO]
Soft Edit:
* [Fill1:FRUITNO] times per [Fill2: FRUITTP] is unusually high.
* Please verify.

Question ID: NAC.090_01.000

Instrument Variable Name: SALADNO
Question Text:
1 of 2
*Read if necessary: During the past month . .
How often did you eat a green leafy or lettuce SALAD, with or without other vegetables?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FRIESNO];
(1-995) [go to SALADTP]

Question ID: NAC.090_02.000

Instrument Variable Name: SALADTP
Question Text:
2 of 2
*Enter time period. 0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate salad in past month
Skip Instructions:
[if (SALADNO gt (10) and SALADTP eq (1)) or (SALADNO gt (70) and SALADTP eq (2)) or (SALADNO gt (310) and SALADTP eq (3)) [go to ERR1_SALADTP] )
Else (1-3,R,D) [go to FRIESNO]
Soft Edit:
* [Fill1:SALADNO] times per [Fill2: SALADTP] is unusually high.
* Please verify.

Question ID: NAC.100_01.000

Instrument Variable Name: FRIESNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat any kind of FRIED POTATOES, including French fries, home fries, or hash brown potatoes?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to POTATONO]; (1-995) [go to FRIESTP]

Question ID: NAC.100_02.000

Instrument Variable Name: FRIESTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate fried potatoes in past month
Skip Instructions:
[if (FRIESNO gt (10) and FRIESTP eq (1)) or
(FRIESNO gt (70) and FRIESTP eq (2)) or
(FRIESNO gt (310) and FRIESTP eq (3)) [go to ERR1_FRIESTP] )
Else (1-3,R,D) [go to POTATONO]
* [Fill1:FRIESNO] times per [Fill2: FRIESTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.110_01.000

Instrument Variable Name: POTATONO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat any OTHER KIND OF POTATOES, such as baked, boiled, mashed potatoes, sweet potatoes, or potato salad?
*Read if necessary: You can tell me per day, per week, or per month.
*Read if necessary: INCLUDE red-skinned and Yukon Gold potatoes.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to BEANSNO]; (1-995) [go to POTATOTP]

Question ID: NAC.110_02.000

Instrument Variable Name: POTATOTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate other potatoes in the past month
Skip Instructions:
[if (POTATONO gt (10) and POTATOTP eq (1)) or
(POTATONO gt (70) and POTATOTP eq (2)) or
(POTATONO gt (310) and POTATOTP eq (3)) [go to ERR1_POTATOTP] )
Else (1-3,R,D) [go to BEANSNO]
* [Fill1:POTATONO] times per [Fill2: POTATOTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.120_01.000

Instrument Variable Name: BEANSNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat refried beans, baked beans, beans in soup, pork and beans or any other type of cooked dried beans? Do NOT include green beans.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to BRRICENO]; (1-995) [go to BEANSTP]

Question ID: NAC.120_02.000

Instrument Variable Name: BEANSTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate beans in past month
Skip Instructions:
[if (BEANSNO gt (10) and BEANSTP eq (1)) or
(BEANSNO gt (70) and BEANSTP eq (2)) or
(BEANSNO gt (310) and BEANSTP eq (3)) [go to ERR1_BEANSTP] )
Else (1-3,R,D) [go to BRRICENO]
* [Fill1:BEANSNO] times per [Fill2: BEANSNO] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.125_01.000

Instrument Variable Name: BRRICENO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat BROWN RICE or other cooked whole grains, such as bulgur, cracked wheat, or millet? Do NOT include white rice.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to OVEGNO]; (1-995) [go to BRRICETP]

Question ID: NAC.125_02.000

Instrument Variable Name: BRRICETP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate brown rice in past month
Skip Instructions:
[if (BRRICENO gt (10) and BRRICETP eq (1)) or
(BRRICENO gt (70) and BRRICETP eq (2)) or
(BRRICENO gt (310) and BRRICETP eq (3)) [go to ERR1_BRRICETP] )
Else (1-3,R,D) [go to OVEGNO]
* [Fill1:BRRICENO] times per [Fill2: BRRICETP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.130_01.000

Instrument Variable Name: OVEGNO
Question Text:
? [F1] 1 of 2
*Read if necessary: During the past month . . .
Not including what you just told me about (lettuce salads, potatoes, cooked dried beans), how often did you eat OTHER VEGETABLES?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to SALSANO]; (1-995) [go to OVEGTP]

Question ID: NAC.130_02.000

Question Text:
2 of 2
*Enter time period.
Instrument Variable Name: OVEGTP
Never0
Day1
Week 2
Month 3
Refused 7
Don't know 9
Universe Text: Sample adults 18+ who ate other vegetables in past month
Skip Instructions:
[if (OVEGNO gt (10) and OVEGTP eq (1)) or (OVEGNO gt (70) and OVEGTP eq (2)) or (OVEGNO gt (310) and OVEGTP eq (3)) [go to ERR1_OVEGTP] )
Else (1-3,R,D) [go to SALSANO]
Soft Edit:
* [Fill1:OVEGNO] times per [Fill2: OVEGTP] is unusually high.
* Please verify.

Question ID: NAC.131_01.000

Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you have Mexican-type SALSA made with tomato?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Instrument Variable Name: SALSANO
Never 000
1-995 times 001-995
Refused 997
Don't know 999
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to PIZZANO]; (1-995) [go to SALSATP]
Question ID: NAC.131_02.000

Instrument Variable Name: SALSATP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate salsa in past month
Skip Instructions:
[if (SALSANO gt (10) and SALSATP eq (1)) or
(SALSANO gt (70) and SALSATP eq (2)) or
(SALSANO gt (310) and SALSATP eq (3)) [go to ERR1_SALSATP] )
Else (1-3,R,D) [go to PIZZANO]
* [Fill1:SALSANO] times per [Fill2: SALSATP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.132_01.000

Instrument Variable Name: PIZZANO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat PIZZA? Include frozen pizza, fast food pizza, and homemade pizza.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to TOMSAUNO];
(1-995) [go to PIZZATP]

Question ID: NAC.132_02.000

Instrument Variable Name: PIZZATP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate pizza in past month
Skip Instructions:
[if (PIZZANO gt (10) and PIZZATP eq (1)) or
(PIZZANO gt (70) and PIZZATP eq (2)) or
(PIZZANO gt (310) and PIZZATP eq (3)) [go to ERR1_PIZZATP] )
Else (1-3,R,D) [go to TOMSAUNO]
* [Fill1:PIZZANO] times per [Fill2: PIZZATP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.133_01.000

Instrument Variable Name: TOMSAUNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you have TOMATO SAUCES such as with spaghetti or noodles or mixed into foods such as lasagna? Do not include tomato sauce on pizza.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to CHEESENO]; (1-995) [go to TOMSAUTP]

Question ID: NAC.133_02.000

Instrument Variable Name: TOMSAUTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate tomato sauces in past month
Skip Instructions:
[if (TOMSAUNO gt (10) and TOMSAUTP eq (1)) or
(TOMSAUNO gt (70) and TOMSAUTP eq (2)) or
(TOMSAUNO gt (310) and TOMSAUTP eq (3)) [go to ERR1_TOMSAUTP] )
Else (1-3,R,D) [go to CHEESENO]
* [Fill1:TOMSAUNO] times per [Fill2: TOMSAUTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.134_01.000

Instrument Variable Name: CHEESENO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat any kind of CHEESE? Include cheese as a snack, cheese on burgers, sandwiches, and cheese in foods such as lasagna, quesadillas, or casseroles. Do not include cheese on pizza.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to REDMETNO]; (1-995) [go to CHEESETP]

Question ID: NAC.134_02.000

Instrument Variable Name: CHEESETP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate cheese in past month
Skip Instructions:
[if (CHEESENO gt (10) and CHEESETP eq (1)) or
(CHEESENO gt (70) and CHEESETP eq (2)) or
(CHEESENO gt (310) and CHEESETP eq (3)) [go to ERR1_CHEESETP] )
Else (1-3,R,D) [go to REDMETNO]
* [Fill1:CHEESENO] times per [Fill2: CHEESETP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.136_01.000

Instrument Variable Name: REDMETNO
Question Text:
(book) CAN2
1 of 2
*Read if necessary: During the past month . . .
Looking at this card, how often did you eat RED MEAT, such as beef, pork, ham, or sausage? Do NOT include chicken, turkey, or seafood.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to PROMETNO]; (1-995) [go to REDMETTP]

Question ID: NAC.136_02.000

Instrument Variable Name: REDMETTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate red meat in past month
Skip Instructions:
[if (REDMETNO gt (10) and REDMETTP eq (1)) or
(REDMETNO gt (70) and REDMETTP eq (2)) or
(REDMETNO gt (310) and REDMETTP eq (3)) [go to ERR1_REDMETTP] )
Else (1-3,R,D) [go to PROMETNO]
* [Fill1:REDMETNO] times per [Fill2: REDMETTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.137_01.000

Instrument Variable Name: PROMETNO
Question Text:
1 of 2
(book) CAN3
*Read if necessary: During the past month . . .
Looking at this card, how often did you eat PROCESSED MEAT, such as bacon, lunch meats, or hot dogs?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to BREADNO]; (1-995) [go to PROMETTP]

Question ID: NAC.137_02.000

Instrument Variable Name: PROMETTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate processed meat in past month
Skip Instructions:
[if (PROMETNO gt (10) and PROMETTP eq (1)) or
(PROMETNO gt (70) and PROMETTP eq (2)) or
(PROMETNO gt (310) and PROMETTP eq (3)) [go to ERR1_PROMETTP] )
Else (1-3,R,D) [go to BREADNO]
* [Fill1:PROMETNO] times per [Fill2: PROMETTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.138_01.000

Instrument Variable Name: BREADNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat WHOLE GRAIN BREAD including toast, rolls and in sandwiches? Whole grain breads include whole wheat, rye, oatmeal and pumpernickel. Do NOT include white bread.
*Read if necessary: You can tell me per day, per week, or per month.
*Read if necessary: INCLUDE cracked wheat, multi-grain and bran breads.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to CANDYNO]; (1-995) [go to BREADTP]

Question ID: NAC.138_02.000

Instrument Variable Name: BREADTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate whole grain bread in past month
Skip Instructions:
[if (BREADNO gt (10) and BREADTP eq (1)) or
(BREADNO gt (70) and BREADTP eq (2)) or
(BREADNO gt (310) and BREADTP eq (3)) [go to ERR1_BREADTP] )
Else (1-3,R,D) [go to CANDYNO]
* [Fill1:BREADNO] times per [Fill2: BREADTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.139_01.000

Instrument Variable Name: CANDYNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat CHOCOLATE, or any other types of CANDY? Do NOT include SUGAR-FREE CANDY.
*Read if necessary: You can tell me per day, per week or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to DONUTNO]; (1-995) [go to CANDYTP]

Question ID: NAC.139_02.000

Instrument Variable Name: CANDYTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate candy in past month
Skip Instructions:
[if (CANDYNO gt (10) and CANDYTP eq (1)) or
(CANDYNO gt (70) and CANDYTP eq (2)) or
(CANDYNO gt (310) and CANDYTP eq (3)) [go to ERR1_CANDYTP] )
Else (1-3,R,D) [go to DONUTNO]
* [Fill1:CANDYNO] times per [Fill2: CANDYTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.140_01.000

Instrument Variable Name: DONUTNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat DOUGHNUTS, sweet rolls, Danish, muffins, (pan dulce) or pop-tarts? Do NOT include sugar-free items.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to COOKIENO]; (1-995) [go to DONUTTP]

Question ID: NAC.140_02.000

Instrument Variable Name: DONUTTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate donuts in past month
Skip Instructions:
[if (DONUTNO gt (10) and DONUTTP eq (1)) or
(DONUTNO gt (70) and DONUTTP eq (2)) or
(DONUTNO gt (310) and DONUTTP eq (3)) [go to ERR1_DONUTTP] )
Else (1-3,R,D) [go to COOKIENO]
* [Fill1:DONUTNO] times per [Fill2: DONUTTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.141_01.000

Instrument Variable Name: COOKIENO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat COOKIES, CAKE, PIE, or BROWNIES? Do NOT include sugar-free kinds.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to ICECRNO];
(1-995) [go to COOKIETP]

Question ID: NAC.141_02.000

Instrument Variable Name: COOKIETP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate cookies in past month
Skip Instructions:
[if (COOKIENO gt (10) and COOKIETP eq (1)) or
(COOKIENO gt (70) and COOKIETP eq (2)) or
(COOKIENO gt (310) and COOKIETP eq (3)) [go to ERR1_COOKIETP] )
Else (1-3,R,D) [go to ICECRNO]
* [Fill1:COOKIENO] times per [Fill2: COOKIETP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.145_01.000

Instrument Variable Name: ICECRNO
Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat ICE CREAM OR OTHER FROZEN DESSERTS? Do NOT include sugar-free kinds.
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
000 Never
001-995 1-995 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to POPCNNO]; (1-995) [go to ICECRTP]

Question ID: NAC.145_02.000

Question Text:
2 of 2
*Enter time period.
Instrument Variable Name: ICECRTP
Never0
Day1
Week 2
Month3
Refused7
Don't know 9
Universe Text: Sample adults 18+ who ate ice cream in past month
Skip Instructions:
[if (ICECRNO gt (10) and ICECRTP eq (1)) or (ICECRNO gt (70) and ICECRTP eq (2)) or (ICECRNO gt (310) and ICECRTP eq (3)) [go to ERR1_ICECRTP] )
Else (1-3,R,D) [go to POPCNNO]
Soft Edit:
* [Fill1:ICECRNO] times per [Fill2: ICECRTP] is unusually high.
* Please verify.

Question ID: NAC.150_01.000

Question Text:
1 of 2
*Read if necessary: During the past month . . .
How often did you eat POPCORN?
*Read if necessary: You can tell me per day, per week, or per month.
* Enter '0' for Never.
Instrument Variable Name: POPCNNO
Never 000
1-995 times 001-995
Refused997
Don't know 999
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to VITMIN]; (1-995) [go to POPCNTP]

Question ID: NAC.150_02.000

Instrument Variable Name: POPCNTP
Question Text:
2 of 2
*Enter time period.
0 Never
1 Day
2 Week
3 Month
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who ate popcorn in past month
Skip Instructions:
[if (POPCNNO gt (10) and POPCNTP eq (1)) or
(POPCNNO gt (70) and POPCNTP eq (2)) or
(POPCNNOO gt (310) and POPCNTP eq (3)) [go to ERR1_POPCNTP] )
Else (1-3,R,D) [go to VITMIN]
* [Fill1:POPCNNO] times per [Fill2: POPCNTP] is unusually high.
Soft Edit:
* Please verify.

Question ID: NAC.170_00.000

Instrument Variable Name: VITMIN
Question Text:
These next questions are about vitamins and minerals you may have taken during the past month, that is, the past 30 days.
DURING THE PAST MONTH, did you take any vitamin or mineral pills or supplements of ANY kind?
*Read if necessary: INCLUDE vitamin or mineral pills or liquids. Do NOT include vitamin-fortified foods.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to VITMULT]
(2,R,D) [go to next section]

Question ID: NAC.180_00.000

Instrument Variable Name: VITMULT
Question Text:
DURING THE PAST MONTH, did you take any MULTI-vitamins such as One-A-Day, Theragran, or Centrum?
*Read if necessary: Include combinations of three or more vitamins and minerals, such as those labeled "stress" or "antioxidant." Do not include combinations of herbal or plant substances, or combinations of just two, like calcium and vitamin D.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have taken vitamins or mineral supplements in the past month
Skip Instructions:
(1) [go to VITMULD]
(2,R,D) [go to CALCA]

Question ID: NAC.200_01.000

Instrument Variable Name: VITMULD
Question Text:
On how many DAYS during the past month did you take a MULTI-vitamin?
*Enter number of days taking multi-vitamins.
*Enter '30' for all days in the month.
01-30 1-30 days
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have taken a multi-vitamin in the past month
Skip Instructions:
(1-30, R, D) [go to CALCA]

Question ID: NAC.210_00.000

Instrument Variable Name: CALCA
Question Text:
DURING THE PAST MONTH, did you take any CALCIUM SUPPLEMENTS, including Tums or calcium chews? [Fill1: Do NOT include any calcium in the MULTI-vitamins you told me about.]
*Read if necessary: Do NOT include milk or calcium-fortified orange juice.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have taken vitamins or mineral supplements in the past month
Skip Instructions:
(1) [go to CALCD]
(2,R,D) [go to VITD]

Question ID: NAC.215_01.000

Instrument Variable Name: CALCD
Question Text:
On how many DAYS during the past month did you take calcium supplements?
*Enter number of days taking calcium.
*Enter '30' for all days in the month.
01-30 1-30 days
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have taken calcium in the past month
Skip Instructions:
(1-30, R, D) [go to VITD]

Question ID: NAC.270_00.000

Instrument Variable Name: VITD
Question Text:
DURING THE PAST MONTH, did you take any VITAMIN D PILLS OR SUPPLEMENTS?
Fill1: [Do NOT include any vitamin D in the MULTI-vitamins you told me about.]
Fill2: [Do NOT include calcium supplements that contain vitamin D.]
Fill3: [Do not include calcium supplements that contain vitamin D or MULTI-vitamins you told me about.]
*Read if necessary: Do NOT include vitamin D fortified milk or other foods such as cereals and bread.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have taken vitamin or mineral supplements in the past month
Skip Instructions:
(1) [go to VITDM] (2,R,D) [go to next section]

Question ID: NAC.280_00.000

Instrument Variable Name: VITDM
Question Text:
On how many DAYS during the past month did you take vitamin D?
*Enter '30' for all days in the month.
01-30 1-30 days
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have taken vitamin D in the past month
Skip Instructions:
(1-30, R, D) [go to VITDWHY]

Question ID: NAC.290_01.000

Instrument Variable Name: VITDWHY
Question Text:
Which of these is the MAIN reason you took vitamin D??
*Read categories below.
1 For OVERALL health
2 For BONE health
3 To prevent CANCER
4 For some other reason
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have taken vitamin D in the past month
Skip Instructions:
(1-3, R,D)[go to NAC module]
(4) [go to VITDSPEC]

Question ID: NAC.300_00.000

Instrument Variable Name: VITDSPEC
Question Text:
*Specify the reason took vitamin D.
Verbatim Verbatim response
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who gave other reason for taking vitamin D
Skip Instructions:
(allow 20,R,D) [go to NAC module]

Question ID: NAD.010_00.000

Instrument Variable Name: AD11A
Question Text:
The next questions are about walking for transportation. I will ask you separately about walking for other reasons like relaxation or exercise.
During the past 7 days, did you walk to get some place that took you at least 10 minutes?
1 Yes
2 No
3 Unable to walk
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to AD12A]
(2,R,D) [go to AD14A]
(3) [go to PAHOME]

Question ID: NAD.011_00.000

Instrument Variable Name: AD12A
Question Text:
In the past 7 days, how many times did you do that?
*Read if necessary: Walk for at least 10 minutes to get some place.
01-94 1-94
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have walked for transportation in the past 7 days
Skip Instructions:
(1-94) [go to AD13ANO]
(R,D) [go to AD14A]

Question ID: NAD.012_01.000

Instrument Variable Name: AD13ANO
Question Text:
1 of 2
[Fill1: How long did that walk take?/ Fill2: On average, how long did those walks take?]
* Enter number for length of walk for transportation.
001-995 1-995
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who have walked for transportation at least once in the past week
Skip Instructions:
(1-995)[go to AD13ATP]
[If AD13ANO= 'R', 'D' store 'R', 'D' in AD13ATP]
(R,D)[go to AD14A]

Question ID: NAD.012_02.000

Instrument Variable Name: AD13ATP
Question Text:
2 of 2
* Enter time period for length of walking for transportation.
1 Minute(s)
2 Hour(s)
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have walked for transportation at least once in the past week and gave a number for the first part of this two-part question
Skip Instructions:
If AD13ANO gt (24) and AD13ATP eq (2) [go to ERR1_ AD13ATP]
(IF AD13ANO gt (90) and AD13ATP eq (1) ) or ( if AD13ANO gt (2) and AD13ATP eq (2) ) [go to ERR2_ AD13ATP]
(1,2,R,D) [go to AD14A] and If AD13ANO= 'R', 'D' store 'R', 'D' in AD13ATP
ERR1_ AD13ATP
Hard Edit:
*Number of hours given for walking for transportation in a day are out of bounds.
*Please correct.
ERR2_ AD13ATP
Soft Edit:
*
[Fill1: AD13ANO] [Fill2: AD13ATP] per day is unusually high.
*
Please verify.

Question ID: NAD.013_00.000

Instrument Variable Name: AD14A
Question Text:
Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. During the past 7 days, did you walk for at least 10 minutes for any of these reasons? Please do not include walking for transportation.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are able to walk
Skip Instructions:
(1) [go to AD15A]
(2,R,D) [go to PAHOME]

Question ID: NAD.014_00.000

Instrument Variable Name: AD15A
Question Text:
In the past 7 days, how many times did you do that?
01-94 1-94 times
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have walked for leisure in the past 7 days
Skip Instructions:
(1-94) [go to AD16ANO]
(R,D) [go to PAHOME]

Question ID: NAD.015_01.000

Instrument Variable Name: AD16ANO
Question Text:
1 of 2
[Fill1: How long did that walk take?/ Fill2: On average, how long did those walks take?]
* Enter number for length of walk for fun, relaxation, or exercise.
001-995 1-995
997 Refused
999 Don't know
Universe Text: Sample Adults 18+ who have walked for leisure at least once in the past week.
Skip Instructions:
(1-995)[go to AD16ATP]
(R,D)[go to PAHOME] and [If AD16ANO= 'R', 'D' store 'R', 'D' in AD16ATP]
ERR1_AD16ATP
Hard Edit:
*Number of hours given for walking for fun, relaxation, or exercise in a day are out of bounds.
*Please correct.
ERR2_AD16ATP
Soft Edit:
* [Fill1: AD16ANO] [Fill2: AD16ATP] is unusually high. *Please verify.

Question ID: NAD.015_02.000

Instrument Variable Name: AD16ATP
Question Text:
2 of 2
* Enter time period for length of walking for fun, relaxation, or exercise.
1 Minute(s)
2 Hour(s)
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have walked for leisure at least once in the past week and gave a number for the first part of this two-part question
Skip Instructions:
If AD16ANO gt (24) and AD16ATP eq (2) [go to ERR1_ AD16ATP] (IF AD16ANO gt (90) and AD16ATP eq (1) ) or ( if AD16ANO gt (2) and AD16ATP eq (2) ) [go to ERR2_ AD16ATP] (1,2,R,D)[go to PAHOME]; [If AD16ANO= 'R', 'D' store 'R', 'D' in AD16ATP]

Question ID: NAD.020_00.000

Instrument Variable Name: PAHOME
Question Text:
How often are there people walking within sight of your home? Would you say?
*Read categories below.
1 Every day
2 Every 2-3 days
3 About once a week
4 Less than once a week
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [go to PAWTHR]

Question ID: NAD.025_00.000

Instrument Variable Name: PAWTHR
Question Text:
How often does the weather make you less likely to walk? Would you say?
*Read if necessary: We mean any kind of bad weather that makes you less likely to walk, such as hot, cold, rainy, snowy, and windy.
*Read answer categories.
1 Almost always
2 Most of the time
3 Some of the time
4 A little of the time
5 Never
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [go to PAROAD]

Question ID: NAD.030_00.000

Instrument Variable Name: PAROAD
Question Text:
The next questions are about where you live.
*Read if necessary: These questions are about your walking or places you can walk, not walking by other people.
Where you live, are there roads, sidewalks, paths or trails where you can walk?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PASHOPS]

Question ID: NAD.035_00.000

Instrument Variable Name: PASHOPS
Question Text:
*Read if necessary: Where you live?
Are there shops, stores, or markets that you can walk to?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PATRANS]

Question ID: NAD.040_00.000

Instrument Variable Name: PATRANS
Question Text:
*Read if necessary: Where you live?
Are there bus or transit stops that you can walk to?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PAMOVIE]

Question ID: NAD.045_00.000

Instrument Variable Name: PAMOVIE
Question Text:
*Read if necessary: Where you live?
Are there places like movies, libraries, or churches that you can walk to?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PARELAX]

Question ID: NAD.050_00.000

Instrument Variable Name: PARELAX
Question Text:
*Read if necessary: Where you live?
Are there places that you can walk to that help you relax, clear your mind, and reduce stress?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PASIDEW]

Question ID: NAD.055_00.000

Instrument Variable Name: PASIDEW
Question Text:
*Read if necessary: Where you live?
Do most streets have sidewalks?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PATRAFF]

Question ID: NAD.060_00.000

Instrument Variable Name: PATRAFF
Question Text:
*Read if necessary: Where you live?
Does traffic make it unsafe for you to walk?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PACRIME]

Question ID: NAD.065_00.000

Instrument Variable Name: PACRIME
Question Text:
*Read if necessary: Where you live?
Does crime make it unsafe for you to walk?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to PAANIMAL]

Question ID: NAD.070_00.000

Instrument Variable Name: PAANIMAL
Question Text:
*Read if necessary: Where you live?
Do dogs or other animals make it unsafe for you to walk?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to next section]

Question ID: NAE.010_00.000

Instrument Variable Name: MENTHOLF
Question Text:
Earlier you said you used to smoke cigarettes. Think back to the 12 months BEFORE you quit smoking. During that time, was your usual cigarette brand menthol or non-menthol?
1 Menthol
2 Non-menthol
3 No usual type
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers
Skip Instructions:
(1-3,R,D) if SMKREG ne '96' [go to NUMCIGA];
else if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [go to FQUITA_1];
else [go to ECIGEV1]

Question ID: NAE.015_00.000

Instrument Variable Name: NUMCIGA
Question Text:
When you last smoked FAIRLY REGULARLY, how many cigarettes did you usually smoke per day?
*Enter '95' if varied.
*Enter '96' if never smoked cigarettes regularly.
01-94 1-94 cigarettes
95 Varied
96 Never smoked regularly
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who are former smokers and had smoked regularly in the past
Skip Instructions:
(1-94,96,R,D) if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [go to FQUITA_1];
else [go to ECIGEV1]
(95) [go to NUMCVAR]

Question ID: NAE.017_00.000

Instrument Variable Name: NUMCVAR
Question Text:
What is the average number of cigarettes that you smoked daily during the longest period that you smoked?
*Read if necessary: 1 pack equals 20 cigarettes.
*Enter '95' if 95 or more.
01-94 1-94 cigarettes
95 95 or more cigarettes
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who said number of cigarettes smoked daily varied
Skip Instructions:
(1-95,R,D) if ((SMKQTNO(e) LE '95' and SMKQTTP(e)='1') or
(SMKQTNO(e) LE '95' and SMKQTTP(e)='2') or
(SMKQTNO(e) LE '24' and SMKQTTP(e)='3') or
(SMKQTNO(e) LE '02' and SMKQTTP(e)='4')) [go to FQUITA_1];
else [go to ECIGEV1]

Question ID: NAE.020_01.000

Instrument Variable Name: FQUITA_1
Question Text:
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine patch?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to FQUITA_2]

Question ID: NAE.020_02.000

Instrument Variable Name: FQUITA_2
Question Text:
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine gum or lozenge (LA-zenj)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to FQUITA_3]

Question ID: NAE.020_03.000

Instrument Variable Name: FQUITA_3
Question Text:
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A nicotine containing nasal spray or inhaler?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to FQUITA_4]

Question ID: NAE.020_04.000

Instrument Variable Name: FQUITA_4
Question Text:
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A prescription pill called Chantix (CHAN-tix) or Varenicline (vuh-REN-ih-klin)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to FQUITA_5]

Question ID: NAE.020_05.000

Instrument Variable Name: FQUITA_5
Question Text:
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following PRODUCTS:
A prescription pill called Zyban (ZI-ban), Bupropion (byoo-PRO-pee-on), or Wellbutrin (well-BYOO-trin)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to FQUITB_1]

Question ID: NAE.025_01.000

Instrument Variable Name: FQUITB_1
Question Text:
Thinking back to when you stopped smoking completely, did you use ANY of the following:
A telephone help line or quit line?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to FQUITB_2]

Question ID: NAE.025_02.000

Instrument Variable Name: FQUITB_2
Question Text:
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
One-on-one counseling?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to FQUITB_3]

Question ID: NAE.025_03.000

Instrument Variable Name: FQUITB_3
Question Text:
*Read if necessary.
Thinking back to when you stopped smoking completely, did you use ANY of the following:
A stop smoking clinic, class or support group?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are former smokers and quit in the last 2 years
Skip Instructions:
(1,2,R,D) [go to ECIGEV1]

Question ID: NAE.060_00.000

Instrument Variable Name: MENTHOL
Question Text:
Earlier you said you smoke cigarettes. Is your usual cigarette brand menthol or non-menthol?
1 Menthol
2 Non-menthol
3 No usual type
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers
Skip Instructions:
(1-3,R,D) if CIGQTYR=1 [store '1' in CSQEV] and [go to CQUITA_1];
else [go to CSQEV]

Question ID: NAE.075_00.000

Instrument Variable Name: CSQEV
Question Text:
Have you EVER stopped smoking for one day or longer BECAUSE YOU WERE TRYING TO QUIT SMOKING?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers that have not already said they tried to quit smoking
Skip Instructions:
(1,2,R,D) [go to QWANT]

Question ID: NAE.080_01.000

Instrument Variable Name: CQUITA_1
Question Text:
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A nicotine patch?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to CQUITA_2]

Question ID: NAE.080_02.000

Instrument Variable Name: CQUITA_2
Question Text:
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A nicotine gum or lozenge (LA-zenj)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to CQUITA_3]

Question ID: NAE.080_03.000

Instrument Variable Name: CQUITA_3
Question Text:
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A nicotine containing nasal spray or inhaler?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to CQUITA_4]

Question ID: NAE.080_04.000

Instrument Variable Name: CQUITA_4
Question Text:
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A prescription pill called Chantix (CHAN-tix) or Varenicline (vuh-REN-ih-klin)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to CQUITA_5]

Question ID: NAE.080_05.000

Instrument Variable Name: CQUITA_5
Question Text:
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following PRODUCTS:
A prescription pill called Zyban (ZI-ban), Bupropion (byoo-PRO-pee-on), or Wellbutrin (well-BYOO-trin)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to CQUITB_1]

Question ID: NAE.085_01.000

Instrument Variable Name: CQUITB_1
Question Text:
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
A telephone help line or quit line?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to CQUITB_2]

Question ID: NAE.085_02.000

Instrument Variable Name: CQUITB_2
Question Text:
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
One-on-one counseling?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to CQUITB_3]

Question ID: NAE.085_03.000

Instrument Variable Name: CQUITB_3
Question Text:
*Read if necessary.
Thinking back to when you tried to QUIT smoking in the PAST 12 MONTHS, did you use ANY of the following:
A stop smoking clinic, class or support group?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers and tried to quit in the last year
Skip Instructions:
(1,2,R,D) [go to QWANT]

Question ID: NAE.100_00.000

Instrument Variable Name: QWANT
Question Text:
Would you like to completely quit smoking cigarettes?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are current smokers
Skip Instructions:
(1,2,R,D) [go to ECIGEV1]

Question ID: NAE.105_00.000

Instrument Variable Name: ECIGEV1
Question Text:
The next question is about electronic cigarettes or e-cigarettes. You may also know them as vape-pens, hookah-pens, e-hookahs, or e-vaporizers. Some look like cigarettes, and others look like pens or small pipes. These are battery-powered, usually contain liquid nicotine, and produce vapor instead of smoke.
Have you EVER used an e-cigarette EVEN ONE TIME?
*Read if necessary: E-cigarettes and similar products can be bought as one-time, disposable products, as re-usable kits with a cartridge, or with refillable chambers. These usually contain a liquid, often called an ?e-liquid? or ?e-juice.? Popular brands include NJOY, BLU, LOGIC, and VUSE.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to ECIGCUR1]
(2,R,D) [go to CIGAREV]

Question ID: NAE.110_00.000

Instrument Variable Name: ECIGCUR1
Question Text:
Do you now use e-cigarettes every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever used e-cigarettes
Skip Instructions:
(1) [go to CIGAREV]
(2,3,R,D) [go to ECIG30D]

Question ID: NAE.115_00.000

Instrument Variable Name: ECIG30D
Question Text:
On how many of the PAST 30 DAYS have you used e-cigarettes?
00-30 0-30
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who now use e-cigarettes some days, not at all, or refused, or don't know current e-cigarette status
Skip Instructions:
(0-30,R,D) [go to CIGAREV]

Question ID: NAE.145_00.000

Instrument Variable Name: CIGAREV
Question Text:
Have you ever smoked a regular cigar, cigarillo, or a little filtered cigar EVEN ONE TIME?
*Read if necessary: ?Cigarillos? are medium cigars that sometimes are sold with plastic or wooden tips. Some common brands are Black and Mild, Swisher Sweets, Dutch Masters and Phillies Blunts. Cigarillos are usually sold individually or in packs of 5 or fewer. Little filtered cigars look like cigarettes and are usually brown in color. Like cigarettes, little filtered cigars have a spongy filter and are sold in packs of 20. Some common brands are Prime Time and Winchester.
*Read if necessary: Do not include electronic cigars or e-cigars.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to CIGEV501]
(2,R,D) [go to PIPEV1]

Question ID: NAE.148_00.000

Instrument Variable Name: CIGEV501
Question Text:
Have you smoked at least 50 cigars, cigarillos, or little filtered cigars in your entire life?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever smoked a regular cigar, cigarillo, or filtered cigar
Skip Instructions:
(1,2,R,D) [go to CIGCUR1]

Question ID: NAE.150_00.000

Instrument Variable Name: CIGCUR1
Question Text:
Do you now smoke regular cigars, cigarillos, or little filtered cigars every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever smoked a regular cigar, cigarillo, or filtered cigar
Skip Instructions:
(1) [go to PIPEV1]
(2,3,R,D) [go to CIG30D1]

Question ID: NAE.151_00.000

Instrument Variable Name: CIG30D1
Question Text:
On how many of the PAST 30 DAYS have you smoked a regular cigar, cigarillo, or little filtered cigar?
00-30 0-30
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who now smoke a regular cigar, cigarillo, or little filtered cigar some days, not at all, or refused, or don?t know current cigar smoking status
Skip Instructions:
(0-30,R,D) [go to PIPEV1]

Question ID: NAE.152_00.000

Instrument Variable Name: PIPEV1
Question Text:
Have you EVER smoked a pipe filled with tobacco-either a regular pipe, water pipe, or hookah EVEN ONE TIME?
*Read if necessary: A hookah is a type of water pipe. It is sometimes called a ?narghile? (NAR-ge-lee) pipe. Do not include electronic hookah or e-hookahs.
*Read if necessary: Do not include electronic pipes or e-pipes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to PIPECUR1]
(2,R,D) [go to SMKLSTOB]

Question ID: NAE.153_00.000

Instrument Variable Name: PIPECUR1
Question Text:
Do you now smoke pipes filled with tobacco ? either regular pipes, water pipes, or hookahs, every day, some days, or not at all?
*Read if necessary: Do not include pipes filled with substances other than tobacco.
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever smoked a regular pipe, water pipe or hookah filled with tobacco
Skip Instructions:
(1-3,R,D) [go to SMKLSTOB]

Question ID: NAE.155_00.000

Instrument Variable Name: SMKLSTOB
Question Text:
Smokeless tobacco products are placed in the mouth or nose and can include chewing tobacco, snuff, dip, snus (SNOOSE), or dissolvable tobacco.
Have you ever used smokeless tobacco products EVEN ONE TIME?
*Read if necessary: Do not include nicotine replacement therapy products (such as patch, gum, lozenge, or spray, which are considered smoking cessation treatments.)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to SMKLS20]
(2,R,D) if (AAU.AMDLONG=1,2,R,D or AAU.ADENLONG=1,2,R,D) and ((CIGCUR1=1,2 or
PIPECUR1=1,2 or ECIGCUR1=1,2) or
(SMKEV=1 and (SMKNOW=1,2 or
(SMKNOW=3 and ((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [go to MDTOB3];
else if SEX=2 and AGE=18-49 [go to LIVEBTH];
else [go to next section]

Question ID: NAE.157_00.000

Instrument Variable Name: SMKLS20
Question Text:
Have you used smokeless tobacco products at least 20 times in your entire life?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever used smokeless tobacco products
Skip Instructions:
(1,2,R,D) [go to SMKLSCUR]

Question ID: NAE.159_00.000

Instrument Variable Name: SMKLSCUR
Question Text:
Do you NOW use smokeless tobacco products every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever used smokeless tobacco products
Skip Instructions:
(1) [go to SMKLBRND]
(2,3,R,D) [go to SMKLS30D]

Question ID: NAE.161_00.000

Instrument Variable Name: SMKLS30D
Question Text:
On how many of the PAST 30 DAYS have you used chewing tobacco, snuff, dip, snus, or dissolvable tobacco?
00-30 0-30
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who use smokeless tobacco products some days, not at all, or refused or don't know current smokeless using status
Skip Instructions:
(0,R,D)
if AAU.AMDLONG=1,2,R,D or AAU.ADENLONG=1,2,R,D and
((CIGCUR1=1,2 or PIPECUR1=1,2 or ECIGCUR1=1,2 or SMKLSCUR=1,2)
or
(SMKEV=1 and
(SMKNOW=1,2 or (SMKNOW=3 and
((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [go to MDTOB3];
else if SEX=2 and AGE=18-49 [go to LIVEBTH];
else [go to next section]
(1-30) [go to SMKLBRND]

Question ID: NAE.163_00.000

Instrument Variable Name: SMKLBRND
Question Text:
During the past 30 days, what brand of smokeless tobacco product did you use MOST OFTEN?
*Do not read categories
01 Beech-Nut
02 Camel Snus
03 Cope
04 Copenhagen
05 General Snus
06 Grizzly
07 Husky
08 Kayak
09 Kodiak
10 Levi Garrett
11 Longhorn
12 Marlboro Snus
13 Red Man
14 Red Man Golden Blend
15 Red Seal
16 Skoal
17 Skoal Snus
18 Skoal X-tra
19 Stoker's
20 Timber Wolf
21 Other (Specify)
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who use smokeless tobacco products at least once in the past 30 days.
Skip Instructions:

(1-20,R,D)

if AAU.AMDLONG=1,2,R,D or AAU.ADENLONG=1,2,R,D and
((CIGCUR1=1,2 or PIPECUR1=1,2 or ECIGCUR1=1,2 or SMKLSCUR=1,2)
or
(SMKEV=1 and
(SMKNOW=1,2 or (SMKNOW=3 and
((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [go to MDTOB3];
else if SEX=2 and AGE=18-49 [go to LIVEBTH];
else [go to next section]
(21) [go to SMKLBRSP]

Question ID: NAE.165_00.000

Instrument Variable Name: SMKLBRSP
Question Text:
*Specify the other brand of smokeless tobacco product used most often.
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who use other brand of smokeless tobacco most often
Skip Instructions:
(Allow 30,R,D)
if AAU.AMDLONG=1,2,R,D or AAU.ADENLONG=1,2,R,D and
((CIGCUR1=1,2 or PIPECUR1=1,2 or ECIGCUR1=1,2 or SMKLSCUR=1,2)
or
(SMKEV=1 and
(SMKNOW=1,2 or (SMKNOW=3 and
((SMKQTNO LE 95 and SMKQTTP=1) or
(SMKQTNO LE 52 and SMKQTTP=2) or
(SMKQTNO LE 12 and SMKQTTP=3) or
(SMKQTNO LE 1 and SMKQTTP=4)))))) [go to MDTOB3];
else if SEX=2 and AGE=18-49 [go to LIVEBTH];
else [go to next section]

Question ID: NAE.170_00.000

Instrument Variable Name: MDTOB3
Question Text:
In the PAST 12 MONTHS, has a medical doctor, dentist, or other health professional ADVISED you to quit smoking, or to quit using other kinds of tobacco?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have seen a doctor or other health professional in the past year and are current cigarette smokers or former cigarette smokers who have quit in the past 12 months, or who currently smoke cigars, or pipes, or use smokeless tobacco every day or some days
Skip Instructions:
(1) [go to HPTOB3]
(2,R,D) if SEX=2 and AGE=18-49 [go to LIVEBTH];
else [go to next section]

Question ID: NAE.171_00.000

Instrument Variable Name: HPTOB3
Question Text:
? [F1]
In the PAST 12 MONTHS, which of the following health professionals advised you to quit smoking or quit using other kinds of tobacco?
*Read answer categories below.
*Enter all that apply, separate with commas.
1 Medical doctor
2 Dentist
3 Nurse
4 Dental Hygienist
5 Other health professional
7 Refused
9 Don't know
Universe Text: Sample adults 18+ whose doctor or other health professional advised them to quit smoking or using other kinds of tobacco in the past 12 months
Skip Instructions:
(1-4,R,D)
if SEX=2 and AGE=18-49 [go to LIVEBTH];
else [go to next section]
(5) [go to HPTOTH1]

Question ID: NAE.172_00.000

Instrument Variable Name: HPTOTH1
Question Text:
*Enter other health professional.
Verbatim Verbatim response
Universe Text: Sample adults 18+ who were advised to quit using tobacco by other health professional
Skip Instructions:
(Allow 30,R,D) if SEX=2 and AGE=18-49[go to LIVEBTH];
else [go to next section]

Question ID: NAE.190_00.000

Instrument Variable Name: LIVEBTH
Question Text:
Have you given birth to a live born infant within the past 5 years?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults age 18-49
Skip Instructions:
(1) if SMKEV=1 [go to SMKPREG];
else [go to next section]
(2,R,D) [go to next section]

Question ID: NAE.200_00.000

Instrument Variable Name: SMKPREG
Question Text:
Were you smoking cigarettes when you became pregnant with your last child?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and have had a live birth in the past 5 years
Skip Instructions:
(1,2,R,D) [go to SMKLST]

Question ID: NAE.210_00.000

Instrument Variable Name: SMKLST
Question Text:
Did you smoke cigarettes at any time during your pregnancy with your last child?
1 Yes
2 No
7 Refused
9Don't know
Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and have had a live birth in the past 5 years
Skip Instructions
(1) [go to QUTWK] (2,R,D) [go to next section]

Question ID: NAE.220_00.000

Instrument Variable Name: QUTWK
Question Text:
Did you quit smoking for 7 days or longer during your pregnancy with your last child?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last pregnancy
Skip Instructions:
(1) [go to MTHQUIT] (2,R,D) [go to next section]

Question ID: NAE.230_00.000

Instrument Variable Name: MTHQUIT
Question Text:
In what month of your pregnancy did you quit for 7 days or longer?
01 First
02 Second
03 Third
04 Fourth
05 Fifth
06 Sixth
07 Seventh
08 Eighth
09 Ninth
97 Refused
99 Don't know
Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last pregnancy, but quit for 7 days or longer
Skip Instructions:
(1-9,R,D) [go to STSMOK]

Question ID: NAE.240_00.000

Instrument Variable Name: STSMOK
Question Text:
Did you start smoking again during the pregnancy or did you stay off cigarettes for the rest of the pregnancy?
1 Stayed off rest of pregnancy
2 Started again
3 Never started again
7 Refused
9 Don't know
Universe Text: Female sample adults age 18-49 who have smoked at least 100 cigarettes in their entire life and smoked during last pregnancy, but quit for 7 days or longer
Skip Instructions:
(1-3,R,D) [go to NAF module]

Question ID: NAF.010_00.000

Instrument Variable Name: SUN1HR
Question Text:
? [F1]
Now, we are going to ask you about your skin's reaction to the sun. After several months of not being in the sun very much, if you went out in the sun for an hour without sunscreen, a hat, or protective clothing, which one of these best describes what would happen to your skin? (*Read choices 1-5 only)
*Read if necessary: Even if you did not go out in the sun, what would happen if you did? Use the most recent experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more.
01 Get a severe sunburn with blisters
02 Have a moderate sunburn with peeling
03 Burn mildly with some or no darkening/tanning
04 Turn darker without sunburn
05 Nothing would happen to my skin
06 Do not go out in the sun
07 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-7,R,D) [go to SUNTAN]

Question ID: NAG.001_00.000

Instrument Variable Name: GCEVER
Question Text:
These next questions refer to genetic COUNSELING for cancer risk. We will ask about genetic TESTING for cancer risk in a few minutes. Genetic counseling involves a discussion with a specially trained health care provider about your family history of cancer and how likely you are to develop cancer. It may also include a discussion about whether genetic testing is right for you.
Have you ever received genetic counseling for cancer risk?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to GCMREAS]
(2,R,D) [go to GTPOSS1]

Question ID: NAG.002_00.000

Instrument Variable Name: GCMREAS
Question Text:
What was the MAIN reason you had genetic counseling?
*Read answer categories.
1 Your doctor recommended it
2 You requested it
3 Family member suggested it
4 You heard or read about it in the news
5 Other
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1-5,R,D) [go to GCBREAST]

Question ID: NAG.003_00.000

Instrument Variable Name: GCBREAST
Question Text:
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for breast cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1,2,R,D) if SEX=2 [go to GCOVRN];
else [go to GCCOLON]

Question ID: NAG.004_00.000

Instrument Variable Name: GCOVRN
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for ovarian cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1,2,R,D) [go to GCCOLON]

Question ID: NAG.005_00.000

Instrument Variable Name: GCCOLON
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for colon or rectal cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1,2,R,D) [go to GCANOTH]

Question ID: NAG.006_00.000

Instrument Variable Name: GCANOTH
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for another type of cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1) [go to GCSPEC]
(2,R,D) [go to GTPOSS1]

Question ID: NAG.007_00.000

Instrument Variable Name: GCSPEC
Question Text:
*Specify other cancer for which genetic counseling was received.
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling for another type of cancer
Skip Instructions:
(allow 30,R,D) [go to GTPOSS1]

Question ID: NAG.015_00.000

Instrument Variable Name: GTPOSS1
Question Text:
The following questions refer to genetic TESTING for cancer risk. That is, testing your blood to see if you carry genes which may predict a greater chance of developing cancer at some point in your life. This does NOT include tests to determine if you have cancer now. Do NOT include self-testing kits administered at home.
Have you EVER DISCUSSED the possibility of getting a genetic test for cancer risk with a doctor or other health professional?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to GTADVIS1]
(2,R,D) [go to GTGRISK]

Question ID: NAG.025_00.000

Instrument Variable Name: GTADVIS1
Question Text:
Did a doctor or other health professional ADVISE you to have such a test?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have discussed the possibility of getting a genetic test with a doctor or other health professional
Skip Instructions:
(1,2,R,D) [go to GTGRISK]

Question ID: NAG.030_00.000

Instrument Variable Name: GTGRISK
Question Text:
Have you EVER HAD a genetic test to determine if you are at greater risk of developing cancer in the FUTURE?
*Read if necessary: This does not include any test to see whether you had cancer in the PAST or have cancer NOW.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to GTBRE];
(2,R,D) [go to GTCCLOM]

Question ID: NAG.040_01.000

Instrument Variable Name: GTBRE
Question Text:
Please think about your MOST RECENT genetic test for cancer risk. Was it for breast cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1,2,R,D) if SEX=2 [go to GTOVA];
else SEX=1 [go to GTCOL]

Question ID: NAG.040_02.000

Instrument Variable Name: GTOVA
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for ovarian cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1,2,R,D) [go to GTCOL]

Question ID: NAG.040_03.000

Instrument Variable Name: GTCOL
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for colon or rectal cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1,2,R,D) [go to GTOTH]

Question ID: NAG.040_04.000

Instrument Variable Name: GTOTH
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for another type of cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1) go to [GTRSKOTH]
(2,R,D) go to [GTRSK_MT]

Question ID: NAG.044_00.000

Instrument Variable Name: GTRSKOTH
Question Text:
*Specify other test for genetic risk of cancer.
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had a genetic test for another type of cancer
Skip Instructions:
(allow 30,R,D) go to [GTRSK_MT]

Question ID: NAG.050_01.000

Instrument Variable Name: GTRSK_MT
Question Text:
1 of 2
When did you have this genetic test done?
*Enter month of genetic test.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have had a genetic test for cancer
Skip Instructions:
(1-12,D) go to GTRSK_YR
(R) store "R' in GTRSK_YR then [go to GTRSK2]
(96) store "9996" in GTRSK_YR then [go to GTRSKN]

Question ID: NAG.050_02.000

Instrument Variable Name: GTRSK_YR
Question Text:
2 of 2
*Enter year of genetic test.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don't know
Universe Text: Sample adults 18+ who gave a month for their genetic test date or who didn't know the month
Skip Instructions:
(valid year) if GTRSK_YR gt current year or
(GTRSK_YR =current year and GTRSK_MT gt current month) go to ERR1_ GTRSK_YR (future date)
elseif GTRSK_YR lt DOBY or
(GTRSK_YR =DOBY and GTRSK_MT lt DOBM) go to ERR2_ GTRSK_YR _YR (prior to birth date)
elseif GTRSK_MT =D and GTRSK_YR ( current year-5 set GTRSK2=5 go to GTCCLOM
elseif GTRSK_MT =D and GTRSK_YR = current year-4 set GTRSK2=4 go to GTCCLOM
elseif GTRSK_MT =D and GTRSK_YR = current year set GTRSK2=1 go to GTCCLOM
elseif GTRSK_MT =D and (GTRSK_YR = current year-1 or GTRSK_YR = current year-2 or GTRSK_YR = current year-3 or GTRSK_YR = current year-5) go to GTRSK2
elseif GTRSK_MT =1-12 go to GTCCLOM (R,D) go to GTRSK2

Question ID: NAG.055_01.000

Instrument Variable Name: GTRSKN
Question Text:
1 of 2
*Read if necessary: When did you have this genetic test done?
*Enter number for time since genetic test.
*Enter '95' for 95 or more.
01-94 1-94
95 95+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who requested the time period format at GTRSK_MT
Skip Instructions:
(1-95) [go to GTRSKT]
(R,D) store ?R,D? in GTRSKT then [go to GTRSK2]

Question ID: NAG.055_02.000

Instrument Variable Name: GTRSKT
Question Text:
2 of 2
*Enter time period for time since genetic test.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95 for the number part of this 2-part question
Skip Instructions:
(1-3) go to GTCCLOM
(4) if GTRSKN=4, set GTRSK2=4, [go to GTCCLOM]
elseif GTRSKN gt 5 and GTRSKN gt AGE, [go to ERR_GTRSKT (greater than persons age)]
elseif GTRSKN gt 5 and GTRSKN le AGE, set GTRSK2=5, [go to GTCCLOM]
elseif GTRSKN=1,2,3,5, go to GTRSK2
(R,D) go to GTRSK2

Question ID: NAG.060_00.000

Instrument Variable Name: GTRSK2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last genetic test was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_GTRSK2] else [go to GTCCLOM]
ERR_GTRSK2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAG.080_00.000

Instrument Variable Name: GTCCLOM
Question Text:
Compared to the average [fill1: man/woman] your age, would you say that you are more likely to get colon or rectal cancer, less likely, or about as likely?
*Read if necessary.
For a colon or rectal cancer survivor, this means getting colon or rectal cancer again in the future.
1 More likely
2 Less likely
3 About as likely
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had a genetic test for another type of cancer
Skip Instructions:
(1-3,R,D) [if SEX = 1, go to next section;
else if SEX = 2, go to GTCBOM]

Question ID: NAG.090_00.000

Instrument Variable Name: GTCBOM
Question Text:
Compared to the average woman your age, would you say that you are more likely to get breast cancer, less likely, or about as likely?
*Read if necessary.
For a breast cancer survivor, this means getting breast cancer again in the future.
1 More likely
2 Less likely
3 About as likely
7 Refused
9 Don't know
Universe Text: Female sample adults age 18+
Skip Instructions:
(1-3,R,D) [go to next section]

Question ID: NAF.015_00.000

Instrument Variable Name: SUNTAN
Question Text:
? [F1]
Next, consider that you were out in the sun repeatedly, such as every day for two weeks, without sunscreen, a hat, or protective clothing . Which one of these best describes what your skin would LOOK like? (*Read choices 1-5 only)
*Read if necessary: Even if you did not go out in the sun, what would happen if you did? Use the most recent experience. If none, then think about the past.
*By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more.
01 Very dark or deeply tanned
02 Dark/Moderately tanned
03 A little dark/Mildly tanned
04 Freckled but still light skinned
05 Burned repeatedly with little or no darkening or tanning---still light skinned
06 Don't go out in the sun
07 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-7,R,D) [go to SUN1_SHA]

Question ID: NAF.020_00.000

Instrument Variable Name: SUN1_SHA
Question Text:
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Stay in the shade? Would you say (*Read categories 1-5). . .
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-6,R,D) [go to SUN1_CAP]

Question ID: NAF.022_00.000

Instrument Variable Name: SUN1_CAP
Question Text:
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a baseball cap or sun visor? Would you say (*Read categories 1-5). . .
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-6,R,D) [go to SUN_HAT1]

Question ID: NAF.023_00.000

Instrument Variable Name: SUN_HAT1
Question Text:
(book) CAN4
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a hat that shades your face, ears AND neck such as a hat with a wide brim all around? Would you say (*Read categories 1-5). . .
*Read if necessary: Do not include visors, baseball caps, or hats that do not shade the face, ears and neck. Include legionnaire hats.
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-6,R,D) [go to SUN2_LGS]

Question ID: NAF.024_00.000

Instrument Variable Name: SUN2_LGS
Question Text:
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear a long sleeved shirt? Would you say (*Read categories 1-5). . .
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-6,R,D) [go to SUN2_LGP]

Question ID: NAF.025_00.000

Instrument Variable Name: SUN2_LGP
Question Text:
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Wear long pants or other clothing that reaches your ankles? Would you say (*Read categories 1-5). . .
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-6,R,D) [go to SUN2_SCR]

Question ID: NAF.026_00.000

Instrument Variable Name: SUN2_SCR
Question Text:
*Read if necessary.
When you go outside on a warm sunny day for MORE than one hour, how often do you. . .
Use sunscreen? Would you say (*Read categories 1-5). . .
1 Always
2 Most of the time
3 Sometimes
4 Rarely
5 Never
6 Don't go out in the sun
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4) [go to SPF]
(5,6,R,D) [go to NBURN]

Question ID: NAF.027_00.000

Instrument Variable Name: SPF
Question Text:
? [F1]
What is the SPF number of the sunscreen you use MOST often?
*Read if necessary: If you use more than one or different ones, pick the one used most often.
*Enter '96' if unable to pick the one used most often.
*Enter '50' if 50 or higher SPF.
01-49 1-49
50 50+
96 More than one, different ones, other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who use sunscreen at least rarely
Skip Instructions:
(1-50) [go to NBURN]
(96,R,D) [go to SPFSCALE]
(51-95) [go to ERR_SPF]
ERR_SPF
Hard Edit:
*51-95 not allowed in this field.
*Please correct.

Question ID: NAF.028_00.000

Instrument Variable Name: SPFSCALE
Question Text:
Is the SPF usually 1-14 or 15-50?
*Enter '2' if 50 or higher SPF.
1 1-14
2 15+
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered more than one, different ones, or other to SPF number, or did not know or refused to say the SPF
Skip Instructions:
(1,2,R,D) [go to NBURN]

Question ID: NAF.030_00.000

Instrument Variable Name: NBURN
Question Text:
DURING THE PAST 12 MONTHS, how many times have you had a sunburn?
*Read if necessary: By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more. Also include burns from sunlamps and other indoor tanning devices.
*Enter '0' for none.
000 None
001-365 1-365 times
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-365,R,D) [go to SNEVER]

Question ID: NAF.031_00.000

Instrument Variable Name: SNEVER
Question Text:
Have you EVER used an indoor tanning device such as a sunlamp, sunbed, or tanning booth? Do NOT include times you have gotten a spray-on tan.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to SNONCE]
(2,R,D) [go to STP12M ]

Question ID: NAF.032_00.000

Instrument Variable Name: SNONCE
Question Text:
DURING THE PAST 12 MONTHS, have you used an indoor tanning device such as a sunlamp, sunbed, or tanning booth EVEN ONE TIME? Do NOT include times you have gotten a spray-on tan.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever used an indoor tanning device
Skip Instructions:
(1) [go to SNNUM1]
(2,R,D) [go to STP12M]

Question ID: NAF.033_00.000

Instrument Variable Name: SNNUM1
Question Text:
DURING THE PAST 12 MONTHS, how many times have you used an indoor tanning device such as a sunlamp, sunbed or tanning booth? Do NOT include times you have gotten a spray-on tan.
001-365 1-365
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who have used indoor tanning device in the past year
Skip Instructions:
(1-365,R,D) [go to SNPROB]

Question ID: NAF.035_00.000

Instrument Variable Name: SNPROB
Question Text:
DURING THE PAST 12 MONTHS, have you had a problem such as a burn, rash, or skin infection caused by using an indoor tanning device such as a sunlamp, sunbed, or tanning booth?
*Read if necessary: Do NOT include problems you have experienced from getting a spray-on tan.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have used indoor tanning device in the past year
Skip Instructions:
(1) [go to SNPRTYP]
(2,R,D) [go to STP12M]

Question ID: NAF.037_00.000

Instrument Variable Name: SNPRTYP
Question Text:
Which of the following problem or problems did you have?
*Read categories below.
*Read if necessary: By ?sunburn? we mean even a small part of your skin turns red or hurts for 12 hours or more.
* Enter all that apply, separate with commas.
1 Got a sunburn
2 Got a rash
3 Got a skin infection
4 Experienced another problem
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had a problem using an indoor tanning device in past year
Skip Instructions:
(1-4,R,D) [go to STP12M]

Question ID: NAF.038_00.000

Instrument Variable Name: STP12M
Question Text:
DURING THE PAST 12 MONTHS, have you used self-applied sunless tanning products, also known as self-tanning or fake tanning?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to SPR12M]

Question ID: NAF.039_00.000

Instrument Variable Name: SPR12M
Question Text:
DURING THE PAST 12 MONTHS, have you gotten a spray-on or mist tan AT A TANNING SALON or other business?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [go to SKNX]

Question ID: NAF.040_00.000

Instrument Variable Name: SKNX
Question Text:
Now we are going to ask you about medical tests and exams that check for cancer. Have you EVER had all of your skin from head to toe checked for cancer either by a dermatologist or some other kind of doctor?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to RSKX1_MT]

(2,R,D) if SEX=2 [go to MENSTAGE];
else if SEX=1 and AGE le 64 [go to HPVHRD]
else if SEX=1 and AGE ge 65 [go to CHESTX]

Question ID: NAF.050_01.000

Instrument Variable Name: RSKX1_MT
Question Text:
1 of 2
When did you have your MOST RECENT skin exam to check for cancer?
*Enter month of last skin exam.
* Enter '96' to go to the number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have had a skin exam
Skip Instructions:
(1-12,D) [go to RSKX1_YR]
(R) store "R' in RSKX1_YR [go to RSKX2]
(96) store "9996" in RSKX1_YR [go to RSKX1N]

Question ID: NAF.050_02.000

Instrument Variable Name: RSKX1_YR
Question Text:
2 of 2
*Enter year of last skin exam.
1880-2016
9996 Time period format
9997 Refused
9999 Don't know
Universe Text: Sample adults age 18+ who answered month of last skin exam or didn't know month of last skin exam
Skip Instructions:
(valid year) if RSKX1_YR gt current year or
(RSKX1_YR=current year and RSKX1_MT gt current month) go to ERR1_ RSKX1_YR (future date) elseif RSKX1_YR lt DOBY or
(RSKX1_YR=DOBY and RSKX1_MT lt DOBM) go to ERR2_ RSKX1_YR (prior to birth date)
elseif RSKX1_MT=D and RSKX1_YR ( current year-5 set RSKX2=5 go to SKINREAS
elseif RSKX1_MT=D and RSKX1_YR = current year-4 set RSKX2=4 go to SKINREAS
elseif RSKX1_MT=D and RSKX1_YR = current year set RSKX2=1 go to SKINREAS
elseif RSKX1_MT=D and (RSKX1_YR = current year-1 or RSKX1_YR = current year-2 or RSKX1_YR = current year-3 or RSKX1_YR = current year-5) go to RSKX2 elseif RSKX1_MT=1-12 go to SKINREAS (R,D) go to RSKX2
ERR1_ RSKX1_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ RSKX1_YR
*
Date before birth. Please correct.

Question ID: NAF.055_01.000

Instrument Variable Name: RSKX1N
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT skin exam?
*Enter number for time since last skin exam.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who selected number and time period format for most recent skin exam
Skip Instructions:
(1-95) [go to RSKX1T]
(R,D) store "R,D" in RSKX1T [go to RSKX2]

Question ID: NAF.055_02.000

Instrument Variable Name: RSKX1T
Question Text:
2 of 2
*Enter time period for time since most recent skin exam.
1 Day(s) ago
2 Week(s) ago
3 Month(s) ago
4 Year(s) ago
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to SKINREAS
(4) if RSKX1N=4, set RSKX2=4, [go to SKINREAS]
elseif RSKX1N gt 5 and RSKX1N gt AGE, [go to ERR_RSKX1T (greater than persons age)]
elseif RSKX1N gt 5 and RSKX1N le AGE, set RSKX2=5, [go to SKINREAS]
elseif RSKX1N=1,2,3,5, go to RSKX2
(R,D) go to RSKX2

Question ID: NAF.060_00.000

Instrument Variable Name: RSKX2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last skin exam was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_RSKX2] else [go to SKINREAS]
ERR_RSKX2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.070_00.000

Instrument Variable Name: SKINREAS
Question Text:
What was the MAIN reason you had this skin exam -- was it part of a routine exam, because of a problem, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had a skin exam
Skip Instructions:
(1-3,R,D)
if SEX=2 [go to MENSTAGE]
else if SEX=1 and AGE le 64 [go to HPVHRD]
else if SEX=1 and AGE ge 65 [go to CHESTX]

Question ID: NAF.080_00.000

Instrument Variable Name: MENSTAGE
Question Text:
The following questions are about women's health. How old were you when your periods or menstrual cycles started?
*Enter '0' for haven't started.
00 Haven't started
06-60 6-60 years
97 Refused
99 Don't know
Universe Text: Female sample adults 18+
Skip Instructions:
(6-60,R,D)
if MENSTAGE gt AGE [go to ERR1_MENSTAGE]
elseif AGE ge 39 [go to MENSTILL]
else if AGE le 38 and nae.LIVEBTH ne '1' [go to BIRTHEV]
elseif AGE le 38 and nae.LIVEBTH = '1' [go to BIRTHNUM]
(0) if nae.LIVEBTH ne '1' go to BIRTHEV
else go to BIRTHNUM
(1-5) [go to ERR2_MENSTAGE]
ERR1_MENSTAGE
Hard Edit:
*
Entry cannot be greater than age.
*
Please correct.
ERR2_MENSTAGE
*
Not a valid code.
*
Please correct.

Question ID: NAF.090_00.000

Instrument Variable Name: MENSTILL
Question Text:
Do you still have periods or menstrual cycles?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 39+ who have started menstrual cycles
Skip Instructions:
(1,R,D) if nae.LIVEBTH ne '1' [go to BIRTHEV]
elseif nae.LIVEBTH = '1' [go to BIRTHNUM]
(2) [go to MENLAST]

Question ID: NAF.100_00.000

Instrument Variable Name: MENLAST
Question Text:
When did you have your last period or menstrual cycle? Was it?
* Read categories below.
1 1 year ago or less
2 More than 1 year ago but less than 2 years ago
3 2 years ago or more
7 Refused
9 Don't know
Universe Text: Female sample adults 39+ who do not have periods any more
Skip Instructions:
(1-3,R,D)
if nae.LIVEBTH ne '1' [go to BIRTHEV]
elseif nae.LIVEBTH = '1' [go to BIRTHNUM]

Question ID: NAF.110_00.000

Instrument Variable Name: BIRTHEV
Question Text:
*If you remember that the respondent mentioned having a biological child in the core, verify the information and enter '1' for yes (and don't ask question).
Have you EVER given birth to a live born infant?
*Read if necessary.
A live born infant is an infant born alive.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who did not already answer they had a live birth
Skip Instructions:
(1) [go to BIRTHNUM]
(2,R,D) [go to PAPHAD1]

Question ID: NAF.111_00.000

Instrument Variable Name: BIRTHNUM
Question Text:
What is the total number of live births (live born children) you have had?
*Enter '25' for 25 or more.
01-24 1-24
25 25+
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who have ever had a live born infant
Skip Instructions:
(1-25,R,D) [go to BIRTHAGE]

Question ID: NAF.120_00.000

Instrument Variable Name: BIRTHAGE
Question Text:
How old were you when your [fill1: child/first child] was born?
06-60 6-60
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who have ever had a live born infant
Skip Instructions:
(6-60,R)
if BIRTHAGE GT AGE [go to ERR_BIRTHAGE]
else [go to PAPHAD1]
(D) [go to BIRTHAG2]
ERR_BIRTHAGE
Hard Edit:
*
Entry cannot be greater than age.
*
Please correct.

Question ID: NAF.121_00.000

Instrument Variable Name: BIRTHAG2
Question Text:
What year was your [fill1: child/first child] born?
1880-2016 1880-2016
9997 Refused
9999 Don't know
Universe Text: Female sample adults 18+ who didn't know their age at first's child's birth
Skip Instructions:
(1880-2016,R,D)
if BIRTHAG2 gt current year [go to ERR1_BIRTHAG2]
elseif BIRTHAG2 gt year of birth (DOBY) [go to ERR2_BIRTHAG2]
else [go to PAPHAD1]
ERR1_BIRTHAG2
Hard Edit:
*
Entry must be current year or earlier.
*
Please correct.
ERR2_BIRTHAG2
*
Entry cannot be earlier than sample adult's year of birth.
*
Please correct.

Question ID: NAF.130_00.000

Instrument Variable Name: PAPHAD1
Question Text:
Have you EVER HAD a Pap smear or Pap test?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+
Skip Instructions:
(1) if AGE 18-30 [go to PAPFRST1] else [go to PAP6YR1]
(2) if AGE LE 64 [go to HPVHRD]; else [go to PAPNOT2]
(R,D) if AGE le 64 [go to HPVHRD]; else [go to HYST]

Question ID: NAF.135_00.000

Instrument Variable Name: PAPFRST1
Question Text:
At what age did you have your first Pap test?
06-30 6-30
97 Refused
99 Don't know
Universe Text: Female sample adults 18-30 who have ever had a Pap test
Skip Instructions:
(6-30,R,D) if PAPFRST1 gt AGE(HHSTAT4='S') [go to ERR_PAPFRST1]
else [go to PAP6YR1]
ERR_PAPFRST1
Hard Edit:
*
Age at first Pap test cannot be greater than age.
*
Please correct.

Question ID: NAF.140_00.000

Instrument Variable Name: PAP6YR1
Question Text:
How many Pap tests have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more exams.
00-95 0-95
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who have ever had a Pap test
Skip Instructions:
(0-95,R,D) [go to RPAP1_M1]

Question ID: NAF.150_01.000

Instrument Variable Name: RPAP1_M1
Question Text:
1 of 2
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who have ever had a Pap test
Skip Instructions:
(1-12,D) [go to RPAP1_Y1]
(R) store "R' in RPAP1_Y1 [go to RPAP21]
(96) store "9996" in RPAP1_Y1 [go to RPAP1N1]

Question ID: NAF.150_02.000

Instrument Variable Name: RPAP1_Y1
Question Text:
2 of 2
*Enter year of last Pap test.
1880-2016
9996 Time period format
9997 Refused
9999 Don't know
Universe Text: Female sample adults age 18+ who answered month of last Pap test test or didn't know month of last Pap test test
Skip Instructions:
(valid year) if RPAP1_Y1 gt current year or
(RPAP1_Y1=current year and RPAP1_M1 gt current month) [go to ERR1_ RPAP1_Y1 (future date)]
elseif RPAP1_Y1 lt DOBY or (RPAP1_Y1=DOBY and RPAP1_M1 lt DOBM) [go to ERR2_ RPAP1_Y1 (prior to birth date)]
elseif RPAP1_M1=D
[go to RPAP21]
elseif RPAP1_M1=1-12 and AGE LT 65 [go to HPVHRD]; else [go to PAPREA2]
(R,D) [go to RPAP21]
ERR1_ RPAP1_Y1
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ RPAP1_Y1
*
Date before birth. Please correct.

Question ID: NAF.160_01.000

Instrument Variable Name: RPAP1N1
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT Pap test?
*Enter number for time since last Pap test.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who selected number and time period format for most recent Pap test test from the initial month screen
Skip Instructions:
(1-95) [go to RPAP1T1] (R,D) store "R,D" in RPAP1T1 [go to RPAP21]

Question ID: NAF.160_02.000

Instrument Variable Name: RPAP1T1
Question Text:
2 of 2
*Enter time period for time since most recent Pap test.
1 Day(s) ago
2 Week(s) ago
3 Month(s) ago
4 Year(s) ago
7 Refused
9 Don?t know
Universe Text: Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) if AGE LT 65 [go to HPVHRD]; else [go to PAPREA2]
(4) (if RPAP1N1=4, set RPAP21=4; and if AGE LT 65 [go to HPVHRD];
else [go to PAPREA2])
elseif RPAP1N1 gt 5 and RPAP1N1 gt AGE, [go to ERR_RPAP1T1 (greater than persons age)]
elseif RPAP1N1 gt 5 and RPAP1N1 le AGE, set RPAP21=5
if AGE LT 65 [go to HPVHRD]; else [go to PAPREA2] elseif RPAP1N1=1,2,3,5, [go to RPAP21] (R,D) [go to RPAP21]
ERR_RPAP1T1
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.165_00.000

Instrument Variable Name: RPAP21
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last Pap test test was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_RPAP21]
else if AGE LT 65 [go to HPVHRD]; else [go to PAPREA2]
ERR_RPAP21
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.167_00.000

Instrument Variable Name: HPVHRD
Question Text:
Have you ever heard of HPV? HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults LE 64
Skip Instructions:
(1,2,R,D) If SEX=1 and AGE GE 40 [go to CHESTX];
else if SEX=1 and AGE LT 40 [go to ASPIRIN];
else if SEX=2 and PAPHAD1=2 [go to PAPNOT2];
else SEX=2 and PAPHAD1 ne 2 [go to HPVPAP]

Question ID: NAF.168_00.000

Instrument Variable Name: HPVPAP
Question Text:
An HPV test is sometimes given with the Pap test for cervical cancer screening. Did you have an HPV test with your most recent Pap?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adult who have ever had a Pap test
Skip Instructions:
(1,2,R,D) [go to PAPREA2]

Question ID: NAF.170_00.000

Instrument Variable Name: PAPREA2
Question Text:
What was the MAIN reason you had this [fill1: Pap/Pap or HPV] test - was it part of a routine exam, because of a problem, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who have ever had a Pap or HPV test
Skip Instructions:
(1-3,R,D) if (RPAP21 = 1,2,3) or
(RPAP1T1 = 1,2) or
(RPAP1_Y1 = (current year ? 3) and RPAP1_M1 ge current month) or
(RPAP1_Y1 gt (current year ? 3)) or
(RPAP1T1 = 3 and RPAP1N1 le 36) [go to PAPABN3]
elseif (RPAP21 = 5) or (RPAP1_Y1 = (current year ? 5) and RPAP1_M1 lt current month) or (RPAP1_Y1 lt
(current year ? 5)) or (RPAP1T1 = 3 and RPAP1N1 gt 60) [go to PAPNOT2]
elseif RPAP21 = R,D [go to MDRECP1]

Question ID: NAF.180_00.000

Instrument Variable Name: PAPABN3
Question Text:
Have you had a [fill1: Pap/Pap or HPV] test in the LAST 3 YEARS where the results were NOT normal?
1 Yes, Pap test not normal
2 Yes, HPV test not normal
3 Yes, both were not normal
4 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who have had a Pap test in the past 3 years
Skip Instructions:
(1-4,R,D) [go to MDRECP1]

Question ID: NAF.210_00.000

Instrument Variable Name: PAPNOT2
Question Text:
What is the most important reason you have [Fill1: NEVER had a Pap test/NEVER had a Pap or HPV test/ NOT had a Pap test in the LAST 5 YEARS/ NOT had a Pap or HPV test in the LAST 5 YEARS]?
*Put response into correct category below.
01 No reason/never thought about it
02 Didn't need it/didn?t know I needed this type of test
03 Doctor didn?t order it/didn?t say I needed it
04 Haven't had any problems
05 Put it off/didn?t get around to it
06 Too expensive/no insurance/cost
07 Too painful, unpleasant, or embarrassing
08 Had hysterectomy
09 Don't have doctor
10 Had HPV vaccine
11 Other
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who have never had a Pap test, or who have not had a Pap test in the last 5 years
Skip Instructions:
(1,2,4-7,10-11,R,D) [go to MDRECP1] (3,8,9) [go to PAPHPVPY]

Question ID: NAF.215_00.000

Instrument Variable Name: MDRECP1
Question Text:
[fill1: Was your most recent Pap test recommended by a doctor or other health professional?/Was your most recent Pap or HPV test recommended by a doctor or other health professional?"
[fill2: In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a PAP test?/In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a PAP or HPV test?]
1 Yes
2 No
3 Did not see a doctor in the last 12 months
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who had a doctor, who didn't answer that her doctor didn't recommend a Pap test, who haven't had a hysterectomy, and gave a reason for not having Pap test ever/in the last 5 years
Skip Instructions:
(1,2,3,R,D) [go to PAPHPVPY]

Question ID: NAF.217_00.000

Instrument Variable Name: PAPHPVPY
Question Text:
How much did you pay out of pocket for this [fill1: Pap/Pap or HPV] test-Was it NONE, PART, or ALL of the cost?
1 None of the cost
2 Part of the cost
3 All of the cost
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who have ever had a Pap or HPV test
Skip Instructions:
(1-3,R,D) if PAPNOT2=8 [go to RHYS1_MT];
else [go to HYST]

Question ID: NAF.220_00.000

Instrument Variable Name: HYST
Question Text:
Have you had a hysterectomy?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who have not already indicated they have had a hysterectomy
Skip Instructions:
(1) [go to RHYS1_MT]
(2,R,D) [go to OVARIES]

Question ID: NAF.221_01.000

Instrument Variable Name: RHYS1_MT
Question Text:
1 of 2
When was your hysterectomy?
*Enter month of hysterectomy.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who have ever had a hysterectomy
Skip Instructions:
(1-12,D) [go to RHYS1_YR]
(R) store "R' in RHYS1_YR [go to RHYS2]
(96) store "9996" in RHYS1_YR [go to RHYS1N]

Question ID: NAF.221_02.000

Instrument Variable Name: RHYS1_YR
Question Text:
2 of 2
*Enter year of hysterectomy.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Female sample adults age 18+ who answered month of hysterectomy or didn't know month of hysterectomy
Skip Instructions:
(valid year) if RHYS1_YR gt current year or
(RHYS1_YR=current year and RHYS1_MT gt current month) go to ERR1_ RHYS1_YR (future date)
elseif RHYS1_YR lt DOBY or
(RHYS1_YR=DOBY and RHYS1_MT lt DOBM) go to ERR2_ RHYS1_YR (prior to birth date)
elseif RHYS1_MT=D go to RHYS2
elseif RHYS1_MT=1-12 go to OVARIES (R,D) go to RHYS2
ERR1_ RHYS1_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ RHYS1_YR
*
Date before birth. Please correct

Question ID: NAF.222_01.000

Instrument Variable Name: RHYS1N
Question Text:
1 of 2
*Read if necessary: When was your hysterectomy?
*Enter number for time since hysterectomy.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don't know
Universe Text: Female sample adults 18+ who selected number and time period format for hysterectomy from the initial month screen
Skip Instructions:
(1-95) [go to RHYS1T] (R,D) store "R,D" in RHYS1T [go to RHYS2]

Question ID: NAF.222_02.000

Instrument Variable Name: RHYS1T
Question Text:
2 of 2
*Enter time period for time since hysterectomy.
1 Day(s) ago
2 Week(s) ago
3 Month(s) ago
4 Year(s) ago
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) [go to OVARIES]
(4) if RHYS1N=4
set RHYS2=4
[go to OVARIES]
elseif RHYS1N gt 5 and RHYS1N gt AGE [go to ERR_RHYS1T (greater than persons age)]
elseif RHYS1N gt 5 and RHYS1N le AGE set RHYS2=5 [go to OVARIES]
elseif RHYS1N=1,2,3,5
[go to RHYS2]
(R,D) [go to RHYS2]
ERR_RHYS1T
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct

Question ID: NAF.225_00.000

Instrument Variable Name: RHYS2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don?t know
Universe Text: Female sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose hysterectomy was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_RHYS2] else [go to OVARIES]
ERR_RHYS2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.226_00.000

Instrument Variable Name: OVARIES
Question Text:
Have you EVER had BOTH ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults age 18+
Skip Instructions:
(1) [go to OVARAGE]
(2,R,D) if age GE 30 [go to CBEHAD];
else [go to ASPIRIN]

Question ID: NAF.227_00.000

Instrument Variable Name: OVARAGE
Question Text:
How old were you when you had BOTH of your ovaries removed?
001-120 1-120 years
997 Refused
999 Don't know
Universe Text: Female sample adults age 18+ who have had BOTH ovaries removed
Skip Instructions:
(1-120,R,D) if OVARAGE GT AGE [go to ERR_OVARAGE]
elseif age GE 30 [go to CBEHAD];
elseIF age lt 30 [go to ASPIRIN]
ERR_OVARAGE
Hard Edit:
*
Entry is greater than sample adult's age.
*
Please correct.

Question ID: NAF.228_00.000

Instrument Variable Name: CBEHAD
Question Text:
Have you EVER HAD a breast exam done by a doctor or other health professional to check for lumps or other signs of breast cancer?
*Read if necessary. A breast exam is when the breasts are felt by a doctor or other health professional to check for lumps or other signs of breast cancer.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+
Skip Instructions:
(1) [go to RCBE1_MT]
(2,R,D) [go to MAMHAD]

Question ID: NAF.229_01.000

Instrument Variable Name: RCBE1_MT
Question Text:
1 of 2
When did you have your MOST RECENT breast exam?
*Enter month of last breast exam.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Female sample adults 30+ who have ever had a breast exam
Skip Instructions:
(1-12,D) [go to RCBE1_YR]
(R) store "R' in RCBE1_YR [go to RCBE2]
(96) store "9996" in RCBE1_YR [go to RCBE1N]

Question ID: NAF.229_02.000

Instrument Variable Name: RCBE1_YR
Question Text:
2 of 2
*Enter year of most recent breast exam.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Female sample adults age 30+ who answered month of breast exam didn't know month of breast exam
Skip Instructions:
(valid year) if RCBE1_YR gt current year or
(RCBE1_YR=current year and RCBE1_MT gt current month) go to ERR1_ RCBE1_YR (future date)
elseif RCBE1_YR lt DOBY or (RCBE1_YR=DOBY and RCBE1_MT lt DOBM) go to ERR2_ RCBE1_YR (prior to birth date)
elseif RCBE1_MT=D go to RCBE2
elseif RCBE1_MT=1-12 [go to MAMHAD] (R,D) [go to RCBE2]

Question ID: NAF.229_03.000

Instrument Variable Name: RCBE1N
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.
01-95 1-95
97 Refuse
99 Don?t know
Universe Text: Female sample adults 30+ who selected number and time period format for breast exam from the initial month screen
Skip Instructions:
(1-95) [go to RCBE1T] (R,D) store "R,D" in RCBE1T [go to RCBE2]

Question ID: NAF.229_04.000

Instrument Variable Name: RCBE1T
Question Text:
2 of 2
*Enter time period for time since most recent breast exam.
1 Day(s) ago
2 Week(s) ago
3 Month(s) ago
4 Year(s) ago
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) [go to MAMHAD]
(4) if RCBE1N=4
set RCBE2=4
[go to MAMHAD]
elseif RCBE1N gt 5 and RCBE1N gt AGE [go to ERR_RCBE1T (greater than persons age)]
elseif RCBE1N gt 5 and RCBE1N le AGE
set RCBE2=5
[go to MAMHAD]
elseif RCBE1N=1,2,3,5
[go to RCBE2]
(R,D) go to RCBE2
ERR_RCBE1T
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.229_05.000

Instrument Variable Name: RCBE2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don?t know
Universe Text: Female sample adults 30+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose breast exam was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_RCBE2] else [go to MAMHAD]

Question ID: NAF.230_00.000

Instrument Variable Name: MAMHAD
Question Text:
Have you EVER HAD a mammogram?
*Read if necessary.
A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults age 30+
Skip Instructions:
(1) [go to MAM6YR]
(2) [go to MDRECMAM]
(R,D) if AGE GE 40 [go to CHESTX];
else [go to ASPIRIN]

Question ID: NAF.250_00.000

Instrument Variable Name: MAM6YR
Question Text:
How many mammograms have you had in the LAST 6 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more mammograms.
00-95 0-95
97 Refused
99 Don't know
Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:
(0-95,R,D) [go to RMAM1_MT]

Question ID: NAF.260_01.000

Instrument Variable Name: RMAM1_MT
Question Text:
1 of 2
When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:
(1-12,D) [go to RMAM1_YR]
(R) store "R' in RMAM1_YR [go to RMAM2]
(96) store "9996" in RMAM1_YR [go to RMAM1N]

Question ID: NAF.260_02.000

Instrument Variable Name: RMAM1_YR
Question Text:
2 of 2
*Enter year of last mammogram.
1880-2016 1880-2016
9996 Time period format
9997 refused
9999 Don?t know
Universe Text: Female sample adults age 30+ who answered month of last mammogram or didn't know month of last mammogram
Skip Instructions:
(valid year) if RMAM1_YR gt current year or
(RMAM1_YR=current year and RMAM1_MT gt current month) go to ERR1_ RMAM1_YR (future date)
elseif RMAM1_YR lt DOBY or
(RMAM1_YR=DOBY and RMAM1_MT lt DOBM) go to ERR2_ RMAM1_YR (prior to birth date)
elseif RMAM1_MT=D go to RMAM2
elseif RMAM1_MT=1-12 go to MAMPAY (R,D) go to RMAM2
ERR1_ RMAM1_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ RMAM1_YR
*
Date before birth. Please correct.

Question ID: NAF.270_01.000

Instrument Variable Name: RMAM1N
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don?t know
Universe Text: Female sample adults 30+ who selected number and time period format for most recent mammogram from the initial month screen
Skip Instructions:
(1-95) [go to RMAM1T] (R,D) store "R,D" in RMAM1T [go to RMAM2]

Question ID: NAF.270_02.000

Instrument Variable Name: RMAM1T
Question Text:
2 of 2
*Enter time period for time since most recent mammogram.
1 Day(s) ago
2 Week(s) ago
3 Month(s) ago
4 Year(s) ago
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to MAMPAY
(4) if RMAM1N=4
set RMAM2=4
go to MAMPAY
elseif RMAM1N gt 5 and RMAM1N gt AGE go to ERR_RMAM1T (greater than persons age)
elseif RMAM1N gt 5 and RMAM1N le AGE set RMAM2=5 go to MAMPAY
elseif RMAM1N=1,2,3,5
go to RMAM2
(R,D) go to RMAM2
ERR_RMAM1T
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.275_00.000

Instrument Variable Name: RMAM2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don?t know
Universe Text: Female sample adults 30+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last mammogram was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_RMAM2] else [go to MAMPAY]
ERR_RMAM2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.280_00.000

Instrument Variable Name: MAMPAY
Question Text:
How much did you pay out of pocket for this mammogram -- was it NONE, PART, or ALL of the cost?
1 None of the cost
2 Part of the cost
3 All of the cost
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who who have ever had a mammogram
Skip Instructions:
(1-3,R,D) [go to MAMREAS]

Question ID: NAF.310_00.000

Instrument Variable Name: MAMREAS
Question Text:
What was the MAIN reason you had this mammogram -- was it part of a routine exam, because of a problem, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:
(1-3,R,D) [go to MDRECMAM]

Question ID: NAF.315_00.000

Instrument Variable Name: MDRECMAM
Question Text:
Fill1 (IF MAMHAD=1 and most recent screening exam LE 2 years from system date)
[Was your most recent mammogram recommended by a doctor or other health professional?]
Else (IF MAMHAD=2, or MAMHAD GT 2 years from system date or RMAM2=R,D)
[In the PAST 12 MONTHS, has a doctor or other health professional RECOMMENDED that you have a mammogram?]
1 Yes
2 No
3 Did not see a doctor in the last 12 months
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who have not answered Refused or Don't know to ever having a mammogram
Skip Instructions:
(1-3,R,D) if MAMHAD=1 [go to MAMDNBR];
else if AGE GE 40 [go to CHESTX];
else IF AGE LT 40 [go to ASPIRIN]

Question ID: NAF.317_00.000

Instrument Variable Name: MAMDNBR
Question Text:
Were you informed that your mammogram showed that you have dense breast tissue?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who who have ever had a mammogram
Skip Instructions:
(1,2,R,D) [go to MAMABN1]

Question ID: NAF.320_00.000

Instrument Variable Name: MAMABN1
Question Text:
After your MOST RECENT mammogram, were you advised to have more tests?
*Read if necessary: More tests may include another mammogram, a sonogram, an MRI, a biopsy, or something else to check for problems in your breast.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:
(1) [go to MFOLLOW1]
(2,R,D) [go to LUMPEV2]

Question ID: NAF.325_00.000

Instrument Variable Name: MFOLLOW1
Question Text:
Which tests did you actually have?
*Enter all that apply, separate with commas.
0 None
1 Ultrasound
2 Breast MRI
3 Additions mammogram(s)
4 Biopsy
5 Other
7 Refused
9 Don?t know
Universe Text: Female sample adults 30+ who have ever had a mammogram and was recommended to have more tests
Skip Instructions:
(0) [go to MNOTFOL1] (1-5,R,D) [go to MAMCAN]

Question ID: NAF.330_00.000

Instrument Variable Name: MNOTFOL1
Question Text:
What is the most important reason why you DID NOT follow the recommendation to have more tests?
*Put response into correct category below.
01 No reason/never thought about it
02 Put it off/didn't get around to it
03 Too expensive/no insurance/cost
04 Too painful, unpleasant, or embarrassing
05 I'm too young
06 Don't have doctor
07 Fear
08 Other reason
97 Refused
99 Don't know
Universe Text: Female sample adults 30+ who have ever had a mammogram and did not follow recommendation to have more tests
Skip Instructions:
(1-8,R,D) [go to MAMMODE]

Question ID: NAF.335_00.000

Instrument Variable Name: MAMMODE
Question Text:
*Record mode of previous question.
1 In person
2 Over the telephone
Universe Text: Female sample adults 30+ who have ever had a mammogram and did not follow recommendation to have more tests
Skip Instructions:
(1,2) [go to LUMPEV2]

Question ID: NAF.340_00.000

Instrument Variable Name: MAMCAN
Question Text:
As a result of these additional tests after your mammogram(s), were you diagnosed with cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who followed recommendation for follow-up after a mammogram
Skip Instructions:
(1,2,R,D) [go to LUMPEV2]

Question ID: NAF.350_00.000

Instrument Variable Name: LUMPEV2
Question Text:
Have you EVER HAD a biopsy to test or remove a lump from your breast that was found NOT to be cancer?
*Read if necessary: A biopsy is the removal of a sample of tissue to see whether cancer cells are present.
1 Yes
2 No
3 Lump removed was cancerous
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who have ever had a mammogram
Skip Instructions:
(1) [go to LUMPNUM2]
(2,3,R,D) if age ge 40 [go to CHESTX];
else if age lt 40 [go to ASPIRIN]

Question ID: NAF.351_00.000

Instrument Variable Name: LUMPNUM2
Question Text:
How many of these biopsies have you had?
*Enter '95' if 95 or more biopsies
*Read if necessary: A biopsy is the removal of a sample of tissue to see whether cancer cells are present.
01-95 1-95
97 Refused
99 Don't know
Universe Text: Female sample adults 30+ who have had a lump removed that was not cancerous
Skip Instructions:
(1-95,R,D) if age ge 40 [go to CHESTX];
else if age lt 40 [go to ASPIRIN]

Question ID: NAF.423_01.000

Instrument Variable Name: CHESTX
Question Text:
The next set of questions is about tests of your chest area. These questions ask about chest x-rays and CT scans, but not mammograms.
In the last 12 months, did you have a chest x-ray?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [go to CHESTREA]
(2,D,R) [go to CATEVER]

Question ID: NAF.423_02.000

Instrument Variable Name: CHESTREA
Question Text:
Were any of the chest x-rays you had in the last 12 months done to check for lung cancer, rather than for some other reason?
1 Yes, to check for lung cancer
2 No, for some other reason
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a chest xray in the past 12 months
Skip Instructions:
(1,2,D,R) [go to CATEVER]

Question ID: NAF.423_03.000

Instrument Variable Name: CATEVER
Question Text:
The following questions are about CT scans, also called CAT scans. During this test, you are lying down and moved through a donut shaped x-ray machine while holding your breath.
Have you EVER HAD a CT or CAT scan?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [go to CATCHST1]
(2,D,R) [go to ASPIRIN]

Question ID: NAF.423_04.000

Instrument Variable Name: CATCHST1
Question Text:
Were any of the CT or CAT scans you had done of your chest area?
1 Yes
2 No
3 Several areas of upper body region
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have ever had a CAT scan or CT scan
Skip Instructions:
(1,3) [go to CATLUNG1]
(2,R,D) [go to ASPIRIN]

Question ID: NAF.423_05.000

Instrument Variable Name: CATLUNG1
Question Text:
The next questions are only about CT or CAT scans to check or screen for lung cancer. Do not include any CT or CAT scans of your chest area that were done for other reasons.
Were any of the CAT scans of your chest area done to check for lung cancer, rather than for some other reason?
1 Yes, to check for lung cancer
2 No, for some other reason
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a CAT scan or CT scan of the chest area in the past 12 months
Skip Instructions:
(1) [go to CATWHEN]
(2,R,D) [go to ASPIRIN]

Question ID: NAF.423_06.000

Instrument Variable Name: CATWHEN
Question Text:
When did you have your MOST RECENT CT or CAT scan of your chest area to check or screen for lung cancer?
1 A year ago or less
2 More than 1 year but not more than 2 years ago
3 More than 2 years but not more than 3 years ago
4 More than 3 years but not more than 5 years ago
5 Over 5 years ago
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a CAT scan or CT scan of the chest area to screen for lung cancer
Skip Instructions:
(1-5,R,D) [go to CATNUM]

Question ID: NAF.423_07.000

Instrument Variable Name: CATNUM
Question Text:
How many CT or CAT scans to check or screen for lung cancer have you had in the LAST 3 YEARS?
*Enter '0' for none.
*Enter '95' for 95 or more CT scans.
00-95 0-95
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who have had a CAT scan or CT scan of the chest area to screen for lung cancer
Skip Instructions:
(0-95,R,D) [go to CATNEXT]

Question ID: NAF.423_08.000

Instrument Variable Name: CATNEXT
Question Text:
When do you expect to have your next CT scan of your chest area to check or screen for lung cancer?
1 Less than a year from now
2 One year from now
3 More than one year from now
4 When doctor recommends it
5 Never
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a CAT scan or CT scan of the chest area to screen for lung cancer
Skip Instructions:
(1-5,R,D) [go to ASPIRIN]

Question ID: NAF.424_02.000

Instrument Variable Name: ASPIRIN
Question Text:
? [F1]
Do you now take any of the following medications regularly, that is, at least 3 times a week?
Aspirin, Bayer, Bufferin, or Excedrin?
*Read if necessary: Do NOT include Tylenol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to ASPIR3M]
(2,R,D) [go to ADVIL]

Question ID: NAF.424_03.000

Instrument Variable Name: ASPIR3M
Question Text:
Have you taken any of these kinds of medications regularly for the last 3 months?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who now take Aspirin etc.
Skip Instructions:
(1,2,R,D) [go to ADVIL]

Question ID: NAF.424_04.000

Instrument Variable Name: ADVIL
Question Text:
Do you now take any of the following medications regularly, that is, at least 3 times a week?
Advil, Ibuprofen, Motrin, Nuprin, Aleve, Naprosyn, Naproxen, or Celebrex?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to ADVIL3M]
(2,R,D) [go to ACETOCT]

Question ID: NAF.424_05.000

Instrument Variable Name: ADVIL3M
Question Text:
Have you taken any of these kinds of medications regularly for the last 3 months?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who now take Advil etc.
Skip Instructions:
(1,2,R,D) [go to ACETOCT]

Question ID: NAF.424_05.010

Instrument Variable Name: ACETOCT
Question Text:
Do you now take any OVER-THE-COUNTER MEDICATIONS that contain acetaminophen regularly, that is, at least 3 times a week? Acetaminophen is contained in many products such as Tylenol, Tylenol PM, Nyquil, Theraflu, Excedrin, Alka Seltzer Plus, and Midol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to ACETOC3M]
(2,R,D) [go to ACETPR]

Question ID: NAF.424_05.020

Instrument Variable Name: ACETOC3M
Question Text:
Have you taken any of these kinds of medications regularly for the last 3 months?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who take over the counter acetaminophen
Skip Instructions:
(1,2,R,D) [go to ACETPR]

Question ID: NAF.424_05.030

Instrument Variable Name: ACETPR
Question Text:
Do you now take any of the following PRESCRIPTION PAIN MEDICATIONS that contain acetaminophen regularly, that is, at least 3 times a week? Acetaminophen is contained in many prescription pain products such as Vicodin, Percocet, Endocet, Tylenol with Codeine, and Fioricet.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to ACETPR3M]
(2,R,D) if SEX=1 [go to PROPECIA]
elseif SEX =2 AND AGE GE 30 [go to MEDHRT]
elseif SEX=2 AND AGE = 18-29 [go to MEDBC]

Question ID: NAF.424_05.040

Instrument Variable Name: ACETPR3M
Question Text:
Have you taken any of these kinds of medications regularly for the last 3 months?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who take prescription acetaminophen
Skip Instructions:
(1,2,R,D) if SEX=1 [go to PROPECIA]
elseif SEX=2 AND AGE GE 30 [go to MEDHRT]
elseif SEX=2 AND AGE = 18-29 [go to MEDBC]

Question ID: NAF.424_06.000

Instrument Variable Name: PROPECIA
Question Text:
Some men take medications such as Propecia (pro-PEE-she-ah), Proscar (PRAHS-car) or Finasteride (fin-AS-tur-eyed) for hair loss or for problems with their prostate gland. Do you now take any of these medications regularly, that is, at least 3 times a week?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Male sample adults 18+
Skip Instructions:
(1) [go to PROPMTHS]
(2,R,D) if AGE ge 40 [go to PSAHAD]
elseif AGE = 18-39 [go to genetic testing (NAG)]

Question ID: NAF.424_07.000

Instrument Variable Name: PROPMTHS
Question Text:
Have you taken Propecia, Proscar or Finasteride regularly for the last 3 months?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Male sample adults 18+ who take Propecia regularly
Skip Instructions:
(1) [go to PROPREAS]
(2,R,D) if AGE ge 40 [go to PSAHAD]
elseif AGE = 18-39 [go to genetic testing (NAG)]

Question ID: NAF.424_08.000

Instrument Variable Name: PROPREAS
Question Text:
What is the main reason you are taking Propecia, Proscar or Finasteride?
*Read categories below.
1 For problems related to your prostate
2 For male pattern baldness
3 To reduce the chance that you may develop prostate cancer
4 Other reason
7 Refused
9 Don't know
Universe Text: Male sample adults 18+ who have taken Propecia regularly for last 3 months
Skip Instructions:
(1-4,R,D) if AGE ge 40 [go to PSAHAD]
elseif AGE = 18-39 [go to genetic testing (NAG)]

Question ID: NAF.425_01.000

Instrument Variable Name: MEDHRT
Question Text:
Are you currently taking Hormone Replacement Therapy?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+
Skip Instructions:
(1) [go to MEDTAMX]
(2,R,D) [go to HRTEVER]

Question ID: NAF.425_02.000

Instrument Variable Name: HRTEVER
Question Text:
Have you ever taken Hormone Replacement Therapy?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who are not currently taking HRT
Skip Instructions:
(1) [go to HRTSTOP]
(2,R,D) [go to MEDTAMX]

Question ID: NAF.425_03.000

Instrument Variable Name: HRTSTOP
Question Text:
About how long ago did you stop using Hormone Replacement Therapy -- was it 2 years ago or less, more than 2 years ago but not more than 5 years ago, or more than 5 years ago?
1 2 years ago or less
2 more than 2 years ago but not more than 5 years ago
3 more than 5 years ago
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who have ever taken HRT but not currently
Skip Instructions:
(1-3,R,D) go to MEDTAMX

Question ID: NAF.425_04.000

Instrument Variable Name: MEDTAMX
Question Text:
Are you currently taking Tamoxifen, also known as Nolvadex?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+
Skip Instructions:
(1) [go to TAMMAIN]
(2,R,D) [go to MEDRALX]

Question ID: NAF.425_05.000

Instrument Variable Name: TAMMAIN
Question Text:
What is the main reason you are taking tamoxifen?
*Put response into correct category below.
1 As part of your treatment for breast cancer
2 To reduce the chance that you may develop breast cancer
3 Both
4 Other reason
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who are currently taking tamoxifen
Skip Instructions:
(1-3,R,D) [go to MEDRALX]
(4) [go to TAMOXSP]

Question ID: NAF.425_05.010

Instrument Variable Name: TAMOXSP
Question Text:
*Enter other reason for taking tamoxifen.
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who are currently taking tamoxifen for other reason
Skip Instructions:
(Allow 30,R,D) [go to MEDRALX]

Question ID: NAF.425_06.000

Instrument Variable Name: MEDRALX
Question Text:
Are you currently taking Raloxifene (rah-LOX-ih-fen), also known as Evista?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+
Skip Instructions:
(1) [go to RALXREAS]
(2,R,D) [go to MEDBC]

Question ID: NAF.425_07.000

Instrument Variable Name: RALXREAS
Question Text:
What is the main reason you are taking raloxifene?
*Put response into correct category below.
1 As part of your treatment for osteoporosis
2 To reduce the chance that you may develop breast cancer
3 Both
4 Other reason
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who are currently taking raloxifene
Skip Instructions:
(1-3,R,D) [go to MEDBC]
(4) [go to RALOXSP]

Question ID: NAF.425_07.010

Instrument Variable Name: RALOXSP
Question Text:
*Enter other reason for taking raloxifen.
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text: Female sample adults 30+ who are currently taking raloxifen for other reason
Skip Instructions:
(Allow 30,R,D) [go to MEDBC]

Question ID: NAF.425_08.000

Instrument Variable Name: MEDBC
Question Text:
Are you currently taking birth control pills, birth control implants, birth control shots or have a birth control patch?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+
Skip Instructions:
(1,2,R,D) if AGE ge 40 [go to COLDIS];
elseif AGE=18-39 [go to genetic testing, #31 NAG]

Question ID: NAF.430_00.000

Instrument Variable Name: PSAHAD
Question Text:
Have you EVER HAD a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also called a prostate-specific antigen test.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Male sample adults 40+
Skip Instructions:
(1) [go to RPSA1_MT]
(2,R,D) [go to PSAADV]

Question ID: NAF.440_00.000

Instrument Variable Name: RPSA1_MT
Question Text:
1 of 2
When did you have your MOST RECENT PSA test?
*Enter month of last PSA test.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:
(1-12,D) [go to RPSA1_YR]
(R) store "R' in RPSA1_YR [go to RPSA2]
(96) store "9996" in RPSA1_YR [go to RPSA1N]

Question ID: NAF.440_01.000

Instrument Variable Name: RPSA1_YR
Question Text:
2 of 2
* Enter year of last PSA test.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:
(valid year) if RPSA1_YR gt current year or
(RPSA1_YR=current year and RPSA1_MT gt current month) go to ERR1_ RPSA1_YR (future date)
elseif RPSA1_YR lt DOBY or (RPSA1_YR=DOBY and RPSA1_MT lt DOBM) go to ERR2_ RPSA1_YR (prior to birth date)
elseif RPSA1_MT=D go to RPSA2
elseif RPSA1_MT=1-12 go to PSAREAS (R,D) go to RPSA2
ERR1_ RPSA1_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ RPSA1_YR
*
Date before birth. Please correct.

Question ID: NAF.440_02.000

Instrument Variable Name: RPSA1N
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT PSA test?
* Enter number for time since last PSA test.
* Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don?t know
Universe Text: Male sample adults 40+ who have selected number and time period format for most recent PSA test from the initial month screen
Skip Instructions:
(1-95) [go to RPSA1T] (R,D) store "R,D" in RPSA1T [go to RPSA2]

Question ID: NAF.440_03.000

Instrument Variable Name: RPSA1T
Question Text:
2 of 2
* Enter time period for time since most recent PSA test.
1 Day(s) ago
2 Week(s) ago
3 Month(s) ago
4 Year(s) ago
7 Refused
9 Don't know
Universe Text: Male sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to PSAREAS
(4) if RPSA1N=4
set RPSA2=4
go to PSAREAS
elseif RPSA1N gt 5 and RPSA1N gt AGE go to ERR_RPSA1T (greater than persons age)
elseif RPSA1N gt 5 and RPSA1N le AGE
set RPSA2=5
go to PSAREAS
elseif RPSA1N=1,2,3,5
go to RPSA2
(R,D) go to RPSA2
ERR_RPSA1T
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.440_04.000

Instrument Variable Name: RPSA2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don't know
Universe Text: Male sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last PSA test was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_RPSA2] else [go to PSAREAS]
ERR_RPSA2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.441_00.000

Instrument Variable Name: PSAREAS
Question Text:
What was the MAIN reason you had this PSA test - was it part of a routine exam, because of a problem, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:
(1-3,R,D) [go to PSASUGG]

Question ID: NAF.445_00.000

Instrument Variable Name: PSASUGG
Question Text:
Who first suggested the PSA test: you, your doctor, or someone else?
1 Self
2 Doctor
3 Someone else
7 Refused
9 Don't know
Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:
(1-3,R,D) [go to PSA5YR]

Question ID: NAF.450_00.000

Instrument Variable Name: PSA5YR
Question Text:
How many PSA tests have you had in the LAST 5 years?
*Enter '0' for none.
*Enter '95" for 95 or more PSA tests.
00-95 0-95
97 Refused
99 Don't know
Universe Text: Male sample adults 40+ who have had a PSA test
Skip Instructions:
(0-95,R,D) [go to PSAADV]

Question ID: NAF.455_00.000

Instrument Variable Name: PSAADV
Question Text:
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the advantages of [fill 2: it/the PSA test]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Male sample adults 40+
Skip Instructions:
(1,2,R,D) [go to PSADISAV]

Question ID: NAF.460_00.000

Instrument Variable Name: PSADISAV
Question Text:
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the disadvantages of [fill 2: it/the PSA test]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Male sample adults 40+
Skip Instructions:
(1,2,R,D) [go to PSAEXP]

Question ID: NAF.470_00.000

Instrument Variable Name: PSAEXP
Question Text:
[fill 1: Before you had the PSA test did/Did] a doctor EVER tell you that some experts disagree about whether men should have PSA tests?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Male sample adults 40+
Skip Instructions:
(1,2,R,D) [go to COLDIS]

Question ID: NAF.500_00.000

Instrument Variable Name: COLDIS
Question Text:
Have you and your doctor or other health professional ever DISCUSSED getting a test to check for colon cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1,2,R,D) [go to COLHAD]

Question ID: NAF.540_00.000

Instrument Variable Name: COLHAD
Question Text:
There are several different kinds of tests to check for colon cancer. Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a tube into the rectum to look for polyps or cancer. For a colonoscopy, the doctor checks the entire colon, and you are given medication through a needle in your arm to make you sleepy, and told to have someone drive you home. For a Sigmoidoscopy, the doctor checks only part of the colon and you are fully awake.
Have you EVER HAD a colonoscopy?
*Read if necessary:
A polyp is a small growth that develops on the inside of the colon or rectum.
Before these tests, you are asked to take a medication that causes diarrhea.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [go to COL_MT]
(2,R,D) [go to SIGHAD]

Question ID: NAF.560_01.000

Instrument Variable Name: COL_MT
Question Text:
1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who have ever had a colonoscopy
Skip Instructions:
(1-12,D) [go to COL_YR]
(R) store "R" in COL_YR [go to COL2]
(96) store "9996" in COL_YR [go to COLN]

Question ID: NAF.560_02.000

Instrument Variable Name: COL_YR
Question Text:
2 of 2
*Enter year of last colonoscopy.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don't know
Universe Text: Sample adults age 40+ who answered month of last colonoscopy or didn't know month of last colonoscopy
Skip Instructions:
(valid year) if COL_YR gt current year or
(COL_YR=current year and COL_MT gt current month) go to ERR1_ COL_YR (future date)
elseif COL_YR lt DOBY or
(COL_YR=DOBY and COL_MT lt DOBM) go to ERR2_ COL_YR (prior to birth date)
elseif COL_MT=D go to COL2
elseif COL_MT=1-12 go to COLREAS (R,D) go to COL2
ERR1_ COL_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ COL_YR
*
Date before birth. Please correct.

Question ID: NAF.570_01.000

Instrument Variable Name: COLN
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT colonoscopy?
*Enter number for time since last colonoscopy.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don?t know
Universe Text: Sample adults 40+ who selected number and time period format for most recent colonoscopy from the initial month screen
Skip Instructions:
(1-95) [go to COLT] (R,D) store "R,D" in COLT [go to COL2]

Question ID: NAF.570_02.000

Instrument Variable Name: COLT
Question Text:
2 of 2
*Enter time period for time since most recent colonoscopy.
1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to COLREAS
(4) if COLN=4
set COL2=4
go to COLREAS
elseif COLN=6,7,8,9
set COL2=5
go to COLREAS
elseif COLN gt 10 and COLN gt AGE go to ERR_COLT (greater than persons age)
elseif COLN gt 10 and COLN le AGE
set COL2=6
go to COLREAS
elseif COLN=1,2,3,5,10
go to COL2
(R,D) go to COL2
ERR_COLT
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.575_00.000

Instrument Variable Name: COL2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 years
6 Over 10 years ago
7 Refused
9 Don?t know
Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last colonoscopy was 6-9 or over 10 years ago)
Skip Instructions:
(1-6,R,D) if answer code is grayed out [go to ERR_COL2] else [go to COLREAS]
ERR_COL2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.590_00.000

Instrument Variable Name: COLREAS
Question Text:
What was the MAIN reason you had this colonoscopy - was it part of a routine exam, because of a problem, as a follow-up test of an earlier test or screening exam, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Follow-up test of an earlier test or screening exam
4 Other reason
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a colonoscopy
Skip Instructions:
(1-4,R,D) [go to COLPAY]

Question ID: NAF.590_00.010

Instrument Variable Name: COLPAY
Question Text:
How much did you pay out of pocket for your most recent colonoscopy -- was it NONE, PART, or ALL of the cost?
1 None of the cost
2 Part of the cost
3 All of the cost
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who who have ever had a colonoscopy
Skip Instructions:
(1-3,R,D) [go to SIGHAD]

Question ID: NAF.591_00.000

Instrument Variable Name: SIGHAD
Question Text:
Recall that a sigmoidoscopy is similar to a colonoscopy but the doctor checks only part of the colon and you are fully awake. Have you EVER HAD a sigmoidoscopy?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [go to SIG_MT]
(2,R,D) [go to CTHEARD]

Question ID: NAF.592_01.000

Instrument Variable Name: SIG_MT
Question Text:
1 of 2
When did you have your MOST RECENT sigmoidoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who have ever had a sigmoidoscopy
Skip Instructions:
(1-12,D) [go to SIG_YR]
(R) store "R' in SIG_YR [go to SIG2]
(96) store "9996" in SIG_YR [go to SIGN]

Question ID: NAF.593_02.000

Instrument Variable Name: SIG_YR
Question Text:
2 of 2
*Enter year of last sigmoidoscopy.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Sample adults age 40+ who answered month of last sigmoidoscopy or didn't know month of last sigmoidoscopy
Skip Instructions:
(valid year) if SIG_YR gt current year or
(SIG_YR=current year and SIG_MT gt current month) go to ERR1_ SIG_YR (future date)
elseif SIG_YR lt DOBY or (SIG_YR=DOBY and SIG_MT lt DOBM) go to ERR2_ SIG_YR (prior to birth date)
elseif SIG_MT=D go to SIG2
elseif SIG_MT=1-12 go to SIGREAS (R,D) go to SIG2
ERR1_ SIG_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ SIG_YR
*
Date before birth. Please correct.

Question ID: NAF.594_01.000

Instrument Variable Name: SIGN
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT sigmoidoscopy?
*Enter number for time since last sigmoidoscopy.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don?t know
Universe Text: Sample adults 40+ who selected number and time period format for most recent sigmoidoscopy from the initial month screen
Skip Instructions:
(1-95) [go to SIGT] (R,D) store "R,D" in SIGT [go to SIG2]

Question ID: NAF.595_02.000

Instrument Variable Name: SIGT
Question Text:
2 of 2
*Enter time period for time since most recent sigmoidoscopy.
1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to SIGREAS
(4) if SIGN=4
set SIG2=4
go to SIGREAS
elseif SIGN=6,7,8,9
set SIG2=5
go to SIGREAS
elseif SIGN gt 10 and SIGN gt AGE go to ERR_SIGT (greater than persons age)
elseif SIGN gt 10 and SIGN le AGE
set SIG2=6
go to SIGREAS
elseif SIGN=1,2,3,5,10
go to SIG2
(R,D) go to SIG2
ERR_SIGT
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.596_00.000

Instrument Variable Name: SIG2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 years
6 Over 10 years ago
7 Refused
9 Don?t know
Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last sigmoidoscopy was 6-9 or over 10 years ago)
Skip Instructions:
(1-6,R,D) if answer code is grayed out [go to ERR_SIG2] else [go to SIGREAS]
ERR_SIG2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.597_00.000

Instrument Variable Name: SIGREAS
Question Text:
What was the MAIN reason you had this sigmoidoscopy - was it part of a routine exam, because of a problem, as a follow-up test of an earlier test or screening exam, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Follow-up test of an earlier test or screening exam
4 Other reason
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a sigmoidoscopy
Skip Instructions:
(1-4,R,D) [go to CTHEARD]

Question ID: NAF.611_00.000

Instrument Variable Name: CTHEARD
Question Text:
CT colonography, sometimes called virtual colonoscopy, is a new type of test that looks for cancer in the colon. Unlike regular colonoscopies, you do not need medication to make you sleepy during the test. In this new test, your colon is filled with air and you are moved through a donut-shaped X-ray machine as you lie on your back and then your stomach.
Before today, HAD YOU EVER HEARD of CT colonography or virtual colonoscopy?
*Read if necessary:
This is not the same as a colonoscopy or a sigmoidoscopy.
Unlike CT tests for other purposes, you DO take laxatives to clean out your colon for this test.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [go to CTHADEV]
(2,R,D) [go to POLYP]

Question ID: NAF.612_00.000

Instrument Variable Name: CTHADEV
Question Text:
Have you EVER HAD a CT colonography or virtual colonoscopy?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have ever heard of a CT colonography or a virtual colonoscopy
Skip Instructions:
(1) [go to CT_MT]
(2,R,D) [go to POLYP]

Question ID: NAF.613_01.000

Instrument Variable Name: CT_MT
Question Text:
1 of 2
When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter month of last CT colonography or virtual colonoscopy.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who have ever had a CT colonography or virtual colonoscopy
Skip Instructions:
(1-12,D) [go to CT_YR]
(R) store "R' in CT_YR [go to CT2]
(96) store "9996" in CT_YR [go to CTN]

Question ID: NAF.614_02.000

Instrument Variable Name: CT_YR
Question Text:
2 of 2
*Enter year of last CT colonography or virtual colonoscopy.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Sample adults age 40+ who answered month of last CT colonography or virtual colonoscopy or didn't know month of last CT colonography or virtual colonoscopy
Skip Instructions:
(valid year) if CT_YR gt current year or (CT_YR=current year and CT_MT gt current month) go to ERR1_ CT_YR (future date)
elseif CT_YR lt DOBY or
(CT_YR=DOBY and CT_MT lt DOBM) go to ERR2_ CT_YR (prior to birth date)
elseif CT_MT=D go to CT2
elseif CT_MT=1-12 go to CTREAS (R,D) go to CT2
ERR1_ CT_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ CT_YR
*
Date before birth. Please correct.

Question ID: NAF.615_01.000

Instrument Variable Name: CTN
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter number for time since last CT colonography or virtual colonoscopy.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who selected number and time period format for most recent CT colonography or virtual colonoscopy from the initial month screen
Skip Instructions:
(1-95) [go to CTT] (R,D) store "R,D" in CTT [go to CT2]

Question ID: NAF.616_02.000

Instrument Variable Name: CTT
Question Text:
2 of 2
*Enter time period for time since most recent CT colonography or virtual colonoscopy.
1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to CTREAS
(4) if CTN=4
set CT2=4
go to CTREAS
elseif CTN=6,7,8,9
set CT2=5
go to CTREAS
elseif CTN gt 10 and CTN gt AGE go to ERR_CTT (greater than persons age)
elseif CTN gt 10 and CTN le AGE
set CT2=6
go to CTREAS
elseif CTN=1,2,3,5,10
go to CT2
(R,D) go to CT2
ERR_CTT
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.617_00.000

Instrument Variable Name: CT2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 years
6 Over 10 years ago
7 Refused
9 Don?t know
Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last CT colonography or virtual colonoscopy was 6-9 or over 10 years ago)
Skip Instructions:
(1-6,R,D) if answer code is grayed out [go to ERR_CT2] else [go to CTREAS]
ERR_CT2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.618_00.000

Instrument Variable Name: CTREAS
Question Text:
What was the MAIN reason you had this CT colonography or virtual colonoscopy - was it part of a routine exam, because of a problem, as a follow-up test of an earlier test or screening exam, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Follow-up test of an earlier test or screening exam
4 Other reason
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a CT colonography or virtual colonoscopy
Skip Instructions:
(1-4,R,D) [go to POLYP]

Question ID: NAF.619_00.000

Instrument Variable Name: POLYP
Question Text:
A polyp is a small growth that develops on the inside of the colon or rectum. During the past 10 years did a doctor tell you that you had a polyp in your colon or rectum?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1,2,R,D) [go to COLTOLD]

Question ID: NAF.619_00.010

Instrument Variable Name: COLTOLD
Question Text:
The following questions are about another type of test to check for colon cancer - the blood stool or occult blood test, or fecal immunochemical or FIT test, tests to determine whether you have blood in your stool or bowel movement. These tests can be done at home using a kit. You use a stick or brush to obtain a small amount of stool at home and send it back to the doctor or lab.
Has your doctor or other health professional EVER told you about these tests for blood in the stool to check for colon cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [go to COLGOOD]
(2,R,D] [go to HFOBHAD1]

Question ID: NAF.619_00.020

Instrument Variable Name: COLGOOD
Question Text:
Did your doctor or other health professional say that these tests for blood in the stool are a GOOD way to check for colon cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have been told by a doctor about blood stool, occult blood, and FIT tests
Skip Instructions:
(1,2,R,D) [go to HFOBHAD1]

Question ID: NAF.620_00.000

Instrument Variable Name: HFOBHAD1
Question Text:
Have you EVER HAD a blood stool or FIT test, using a HOME test kit?
*Read if necessary: Do not include tests done at the doctor's office.
1 Yes
2 No
7 Refused

9 Don't know

Universe Text: Sample adults 40+
Skip Instructions:
(1) go to RHFO2_MT
(2,R,D) go to FOBHAD1

Question ID: NAF.640_01.000

Instrument Variable Name: RHFO2_MT
Question Text:
1 of 2
When did you have your MOST RECENT blood stool or FIT test using a kit at home?
*Enter month of last home blood stool or FIT test.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who have ever had a home blood stool or FIT test
Skip Instructions:
(1-12,D) go to RHFO2_YR
(R) store "R" in RHFO2_YR and go to RHFO2
(96) store "9996" in RHFO2_YR and go to RHFO2N

Question ID: NAF.640_02.000

Instrument Variable Name: RHFO2_YR
Question Text:
2 of 2
*Enter year of last home blood stool or FIT test.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Sample adults age 40+ who answered month of last home blood stool or FIT test or didn't know month of last test
Skip Instructions:
(valid year) if RHFO2_YR gt current year or
(RHFO2_YR=current year and RHRO1_MT gt current month) go to ERR1_RHFO2_YR (future date)
elseif RHFO2_YR lt DOBY or
(RHFO2_YR=DOBY and RHFO2_MT lt DOBM) go to ERR2_RHFO2_YR (prior to birth date)
elseif RHFO2_MT=D go to RHFO2
elseif RHFO2_MT=1-12 go to HFOBREA2 (R,D) go to RHFO2
ERR1_ RHFO2_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ RHFO2_YR
*
Date before birth. Please correct.

Question ID: NAF.650_01.000

Instrument Variable Name: RHFO2N
Question Text:
1 of 2
*Read if necessary: When did you have your MOST RECENT blood stool or FIT test using a kit at home?
*Enter number for time since last home blood stool or FIT test.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who selected number and time period format for most recent home blood stool or FIT test from the initial month screen
Skip Instructions:
(1-95) [go to RHFO2T] (R,D) store "R,D" in RHFO2T [go to RHFO2]

Question ID: NAF.650_02.000

Instrument Variable Name: RHFO2T
Question Text:
2 of 2
*Enter time period for time since most recent home blood stool or FIT test.
1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to HFOBREA2
(4) if RHFO2N=4
set RHFO2=4
go to HFOBREA2
elseif RHFO2N=6,7,8,9
set RHFO2=5
go to HFOBREA2
elseif RHFO2N gt 10 and RHFO2N gt AGE go to ERR_RHFO2T (greater than persons age)
elseif RHFO2N gt 10 and RHFO2N le AGE set RHFO2=6 go to HFOBREA2
elseif RHFO2N=1,2,3,5,10
go to RHFO2
(R,D) go to RHFO2
ERR_RHFO2T
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.655_00.000

Instrument Variable Name: RHFO2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 yeas
6 Over 10 years ago
7 Refused
9 Don?t know
Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last home blood stool or FIT test was 6-9 or over 10 years ago)
Skip Instructions:
(1-6,R,D) if answer code is grayed out [go to ERR_RHFO2] else [go to HFOBREA2]
ERR_RHFO2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.660_00.000

Instrument Variable Name: HFOBREA2
Question Text:
What was the MAIN reason you had this home blood stool or FIT test - was it part of a routine exam, because of a problem, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had a home blood stool or FIT test
Skip Instructions:
(1-3,R,D) [go to FOBHAD1]

Question ID: NAF.710_00.000

Instrument Variable Name: FOBHAD1
Question Text:
Have you EVER HAD a blood stool or FIT test in which your doctor or other health care professional collected a stool sample during an office visit?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [go to RFOB2_MT] (2, R, D) if ((COLHAD = 2,R,D) or
(COL2 = 6) or
(COL_YR = (current year ? 10) and COL_MT lt current month) or
(COL_YR lt (current year ? 10))) and ((SIGHAD = 2,R,D) or
(SIG2 = 5,6) or
(SIG_YR = (current year?5) and SIG_MT lt current month) or
(SIG_YR lt (current year ? 5))) and ((CTHEARD = 2,R,D) or
(CTHADEV= 2,R,D) or
(CT2 = 5,6) or
(CT_YR = (current year ? 5) and CT_MT lt current month) or
(CT_YR lt (current year?5))) and ((HFOBHAD = 2,R,D) or (RHFO2 = 2-6) or
(RHFO2_YR = (current year ? 1) and RHFO2_MT ltcurrent month) or (RHFO2_YR lt (current year ? 1)) or
(RHFO2T = 2 and RHFO2N gt 52) or
(RHFO2T = 3 and RHFO2N gt 12)) [go to COLPROB1]
else [go to genetic testing]

Question ID: NAF.720_01.000

Instrument Variable Name: RFOB2_MT
Question Text:
1 of 2
When did you have your MOST recent OFFICE blood stool or FIT test?
*Enter month of last office blood stool/FIT test.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 40+ who have ever had a office blood stool/FIT test
Skip Instructions:
(1-12,D) [go to RFOB2_YR]
(R) store "R' in RFOB2_YR [go to RFOB2]
(96) store "9996" in RFOB2_YR [go to RFOB2N]

Question ID: NAF.720_02.000

Instrument Variable Name: RFOB2_YR
Question Text:
2 of 2
*Enter year of last office blood stool/FIT test.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Sample adults 40+ who answered month of last office blood stool/FIT test or didn't know month of last office blood stool test
Skip Instructions:
(valid year) if RFOB2_YR gt current year or
(RFOB2_YR=current year and RFOB2_MT gt current month) go to ERR1_ RFOB2_YR (future date)
elseif RFOB2_YR lt DOBY or
(RFOB2_YR=DOBY and RFOB2_MT lt DOBM) go to ERR2_ RFOB2_YR (prior to birth date)
elseif RFOB2_MT=D go to RFOB2
elseif RFOB2_MT=1-12 go to RFOBRES1 (R,D) go to RFOB2
ERR1_ RFOB2_YR
Hard Edit:
*
Future date invalid. Please correct.
ERR2_ RFOB2_YR
*
Date before birth. Please correct.

Question ID: NAF.730_01.000

Question Text:
1 of 2
*Read if necessary: When did you have your MOST recent OFFICE blood stool or FIT test?
*Enter number for time since last office blood stool/FIT test.
*Enter '95' for 95 or more.
01-95 1-95
97 Refused
99 Don?t know
Universe Text: Sample adults 40+ who selected number and time period format for most recent office blood stool/FIT test from the initial month screen
Skip Instructions:
(1-95) [go to RFOB2T] (R,D) store "R,D" in RFOB2T [go to RFOB2]

Question ID: NAF.730_02.000

Instrument Variable Name: RFOB2T
Question Text:
2 of 2
*Enter time period for time since most recent office blood stool/FIT test.
1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who answered 1-95 for number part of this 2 part question
Skip Instructions:
(1-3) go to RFOBRES1
(4) if RFOB2N=4
set RFOB2=4
go to RFOBRES1
elseif RFOB2N=6,7,8,9
set RFOB2=5
go to RFOBRES1
elseif RFOB2N gt 10 and RFOB2N gt AGE go to ERR_RFOB2T (greater than persons age)
elseif RFOB2N gt 10 and RFOB2N le AGE set RFOB2=6 go to RFOBRES1
elseif RFOB2N=1,2,3,5,10
go to RFOB2
(R,D) go to RFOB2
ERR_RFOB2T
Hard Edit:
*
Time since last exam cannot be greater than age.
*
Please correct.

Question ID: NAF.735_00.000

Instrument Variable Name: RFOB2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 More than 5 years but not more than 10 years
6 Over 10 years ago
7 Refused
9 Don?t know
Universe Text: Sample adults 40+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last office blood stool test/FIT was 6-9 or over 10 years ago)
Skip Instructions:
(1-6,R,D) if answer code is grayed out [go to ERR_RFOB2] else [go to RFOBRES1]
ERR_RFOB2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAF.740_00.000

Instrument Variable Name: RFOBRES1
Question Text:
What was the MAIN reason you had this office blood stool or FIT test - was it part of a routine exam, because of a problem, or some other reason?
1 Part of a routine exam
2 Because of a problem
3 Other reason
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had an office blood stool/FIT test
Skip Instructions:
(1-3,R,D) if ((COLHAD = 2) or (COL2 = 6) or
(COL_YR = (current year ? 10) and COL_MT lt current month) or
(COL_YR lt (current year ? 10))) and ((SIGHAD = 2) or (SIG2 = 5,6) or
(SIG_YR = (current year ? 5) and SIG_MT lt current month) or
(SIG_YR lt (current year ? 5))) and ((CTHEARD = 2) or
(CTHADEV = 2) or
(CT2 = 5,6) or (CT_YR = (current year ? 5) and CT_MT lt current month) or
(CT_YR lt (currentyear ? 5))) and ((HFOBHAD = 2) or
(RHFO2 = 2-6) or
(RHFO2_YR = (current year? 1) and RHFO2_MT lt current month) or
(RHFO2_YR lt (current year ? 1)) or (RHFO2T = 2 and RHFO2N gt52) or
(RHFO2T = 3 andRHFO2N gt 12)) [go to COLPROB1]
else [go to genetic testing]

Question ID: NAF.750_00.000

Instrument Variable Name: COLPROB1
Question Text:
In the PAST 12 MONTHS, did a doctor or other health professional RECOMMEND that you be tested to look for problems in your colon or rectum?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have NOT had a colonoscopy in the past 10 years, sigmoidoscopy in the past 5 years, CT colonography in the past 5 years, or home blood stool/FIT test in the last year
Skip Instructions:
(1) [go to COLKIND1]
(2,R,D) [go to genetic testing]

Question ID: NAF.770_00.000

Instrument Variable Name: COLKIND1
Question Text:
Which tests to check for colon cancer did the doctor or other health professional recommend to you? Possible tests include stool blood or fecal occult blood or FIT test; sigmoidoscopy; colonoscopy; CT colonography or virtual colonoscopy; or other.
*Enter all that apply, separate with commas.
1 Stool blood test/fecal occult blood/FIT test
2 Sigmoidoscopy
3 Colonoscopy
4 CT colonography/virtual colonoscopy
5 Other
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have had particular tests recommended to look for problems in the colon and who have NOT had a colonoscopy in the past 10 years, sigmoidoscopy in the past 5 years, CT colonography in the past 5 years, or home blood stool/FIT test in the last year and who had another type of test recommended
Skip Instructions:
(1-5,R,D) [go to genetic testing]

Question ID: NAG.001_00.000

Instrument Variable Name: GCEVER
Question Text:
These next questions refer to genetic COUNSELING for cancer risk. We will ask about genetic TESTING for cancer risk in a few minutes. Genetic counseling involves a discussion with a specially trained health care provider about your family history of cancer and how likely you are to develop cancer. It may also include a discussion about whether genetic testing is right for you.
Have you ever received genetic counseling for cancer risk?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to GCMREAS]
(2,R,D) [go to GTPOSS1]

Question ID: NAG.002_00.000

Instrument Variable Name: GCMREAS
Question Text:
What was the MAIN reason you had genetic counseling?
*Read answer categories.
1 Your doctor recommended it
2 You requested it
3 Family member suggested it
4 You heard or read about it in the news
5 Other
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1-5,R,D) [go to GCBREAST]

Question ID: NAG.003_00.000

Instrument Variable Name: GCBREAST
Question Text:
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for breast cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1,2,R,D) if SEX=2 [go to GCOVRN];
else [go to GCCOLON]

Question ID: NAG.004_00.000

Instrument Variable Name: GCOVRN
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for ovarian cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1,2,R,D) [go to GCCOLON]

Question ID: NAG.005_00.000

Instrument Variable Name: GCCOLON
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for colon or rectal cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1,2,R,D) [go to GCANOTH]

Question ID: NAG.006_00.000

Instrument Variable Name: GCANOTH
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic counseling session for cancer risk.
Was it for another type of cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling
Skip Instructions:
(1) [go to GCSPEC]
(2,R,D) [go to GTPOSS1]

Question ID: NAG.007_00.000

Instrument Variable Name: GCSPEC
Question Text:
*Specify other cancer for which genetic counseling was received.
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received genetic counseling for another type of cancer
Skip Instructions:
(allow 30,R,D) [go to GTPOSS1]

Question ID: NAG.015_00.000

Instrument Variable Name: GTPOSS1
Question Text:
The following questions refer to genetic TESTING for cancer risk. That is, testing your blood to see if you carry genes which may predict a greater chance of developing cancer at some point in your life. This does NOT include tests to determine if you have cancer now. Do NOT include self-testing kits administered at home.
Have you EVER DISCUSSED the possibility of getting a genetic test for cancer risk with a doctor or other health professional?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to GTADVIS1]
(2,R,D) [go to GTGRISK]

Question ID: NAG.025_00.000

Instrument Variable Name: GTADVIS1
Question Text:
Did a doctor or other health professional ADVISE you to have such a test?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have discussed the possibility of getting a genetic test with a doctor or other health professional
Skip Instructions:
(1,2,R,D) [go to GTGRISK]

Question ID: NAG.030_00.000

Instrument Variable Name: GTGRISK
Question Text:
Have you EVER HAD a genetic test to determine if you are at greater risk of developing cancer in the FUTURE?
*Read if necessary: This does not include any test to see whether you had cancer in the PAST or have cancer NOW.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to GTBRE];
(2,R,D) [go to GTCCLOM]

Question ID: NAG.040_01.000

Instrument Variable Name: GTBRE
Question Text:
Please think about your MOST RECENT genetic test for cancer risk. Was it for breast cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1,2,R,D) if SEX=2 [go to GTOVA];
else SEX=1 [go to GTCOL]

Question ID: NAG.040_02.000

Instrument Variable Name: GTOVA
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for ovarian cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1,2,R,D) [go to GTCOL]

Question ID: NAG.040_03.000

Instrument Variable Name: GTCOL
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for colon or rectal cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1,2,R,D) [go to GTOTH]

Question ID: NAG.040_04.000

Instrument Variable Name: GTOTH
Question Text:
*Read if necessary.
Please think about your MOST RECENT genetic test for cancer risk.
Was it for another type of cancer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a genetic test
Skip Instructions:
(1) go to [GTRSKOTH]
(2,R,D) go to [GTRSK_MT]

Question ID: NAG.044_00.000

Instrument Variable Name: GTRSKOTH
Question Text:
*Specify other test for genetic risk of cancer.
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had a genetic test for another type of cancer
Skip Instructions:
(allow 30,R,D) go to [GTRSK_MT]

Question ID: NAG.050_01.000

Instrument Variable Name: GTRSK_MT
Question Text:
1 of 2
When did you have this genetic test done?
*Enter month of genetic test.
*Enter '96' to go to number and time period format.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
96 Time period format
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have had a genetic test for cancer
Skip Instructions:
(1-12,D) go to GTRSK_YR
(R) store "R' in GTRSK_YR then [go to GTRSK2]
(96) store "9996" in GTRSK_YR then [go to GTRSKN]

Question ID: NAG.050_02.000

Instrument Variable Name: GTRSK_YR
Question Text:
2 of 2
*Enter year of genetic test.
1880-2016 1880-2016
9996 Time period format
9997 Refused
9999 Don?t know
Universe Text: Sample adults 18+ who gave a month for their genetic test date or who didn't know the month
Skip Instructions:
(valid year) if GTRSK_YR gt current year or
(GTRSK_YR =current year and GTRSK_MT gt current month) go to ERR1_ GTRSK_YR (future date)
elseif GTRSK_YR lt DOBY or
(GTRSK_YR =DOBY and GTRSK_MT lt DOBM) go to ERR2_ GTRSK_YR _YR (prior to birth date)
elseif GTRSK_MT =D and GTRSK_YR ( current year-5 set GTRSK2=5 go to GTCCLOM
elseif GTRSK_MT =D and GTRSK_YR = current year-4 set GTRSK2=4 go to GTCCLOM
elseif GTRSK_MT =D and GTRSK_YR = current year set GTRSK2=1 go to GTCCLOM
elseif GTRSK_MT =D and (GTRSK_YR = current year-1 or GTRSK_YR = current year-2 or GTRSK_YR = current year-3 or GTRSK_YR = current year-5) go to GTRSK2
elseif GTRSK_MT =1-12 go to GTCCLOM (R,D) go to GTRSK2

Question ID: NAG.055_01.000

Instrument Variable Name: GTRSKN
Question Text:
1 of 2
*Read if necessary: When did you have this genetic test done?
*Enter number for time since genetic test.
*Enter '95' for 95 or more.
01-94 1-94
95 95+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who requested the time period format at GTRSK_MT
Skip Instructions:
(1-95) [go to GTRSKT]
(R,D) store ?R,D? in GTRSKT then [go to GTRSK2]

Question ID: NAG.055_02.000

Instrument Variable Name: GTRSKT
Question Text:
2 of 2
*Enter time period for time since genetic test.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who answered 1-95 for the number part of this 2-part question
Skip Instructions:
(1-3) go to GTCCLOM
(4) if GTRSKN=4, set GTRSK2=4, [go to GTCCLOM]
elseif GTRSKN gt 5 and GTRSKN gt AGE, [go to ERR_GTRSKT (greater than persons age)]
elseif GTRSKN gt 5 and GTRSKN le AGE, set GTRSK2=5, [go to GTCCLOM]
elseif GTRSKN=1,2,3,5, go to GTRSK2(R,D) go to GTRSK2

Question ID: NAG.060_00.000

Instrument Variable Name: GTRSK2
Question Text:
Was it:
*Read answer categories.
1 A year ago or less
2 More than 1 year but not more than 2 years
3 More than 2 years but not more than 3 years
4 More than 3 years but not more than 5 years
5 Over 5 years ago
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who failed to give a complete date in either the month or year format or failed to give a complete date in the number and time period format, or entered years ago in the time period format (excluding those whose last genetic test was over 5 years ago)
Skip Instructions:
(1-5,R,D) if answer code is grayed out [go to ERR_GTRSK2] else [go to GTCCLOM]
ERR_GTRSK2
Hard Edit:
*That is not a valid response.
*Please correct.

Question ID: NAG.080_00.000

Instrument Variable Name: GTCCLOM
Question Text:
Compared to the average [fill1: man/woman] your age, would you say that you are more likely to get colon or rectal cancer, less likely, or about as likely?
*Read if necessary.
For a colon or rectal cancer survivor, this means getting colon or rectal cancer again in the future.
1 More likely
2 Less likely
3 About as likely
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had a genetic test for another type of cancer
Skip Instructions:
(1-3,R,D) [if SEX = 1, go to next section;
else if SEX = 2, go to GTCBOM]

Question ID: NAG.090_00.000

Instrument Variable Name: GTCBOM
Question Text:
Compared to the average woman your age, would you say that you are more likely to get breast cancer, less likely, or about as likely?
*Read if necessary.
For a breast cancer survivor, this means getting breast cancer again in the future.
1 More likely
2 Less likely
3 About as likely
7 Refused
9 Don't know
Universe Text: Female sample adults age 18+
Skip Instructions:
(1-3,R,D) [go to next section]

Question ID: NAH.010_00.000

Instrument Variable Name: FHFCAN
Question Text:
We would like to ask you a few questions about your family history of cancer. Did your BIOLOGICAL FATHER EVER have cancer of any kind?
1 Yes
2 No
3 Adopted or don't know biological father
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to FHFTYP_1]
(2,3,R,D) [go to FHMCAN]

Question ID: NAH.020_00.001

Instrument Variable Name: FHFTYP_1
Question Text:
What kind of cancer did your father have?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose father ever had cancer
Skip Instructions:
(1-5,7-17,19-28,30,R,D) [go to FHFAGE1]
(6,18,29) [go to ERR_FHFTYP_1]
ERR_FHFTYP_1
Hard Edit:
* Code 6 or 18 or 29 is unavailable for males.

Question ID: NAH.020_00.002

Instrument Variable Name: FHFTYP_2
Question Text:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age range for a first kind of cancer or didn't know how old father was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to give first kind of cancer
Skip Instructions:
Hard Edit:
(1-5,7-17,19-28,30,R,D) if FHFTYP_2 = FHFTYP_1 [go to ERR2_FHFTYP_2] else [go to FHFAGE2] (96) [go to FHMCAN] (6,18,29) go to ERR1_FHFTYP_2 ERR1_FHFTYP_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHFTYP_2
* Cannot select pre-selected answer.
Default should go to FHFTYP_2

Question ID: NAH.020_00.003

Instrument Variable Name: FHFTYP_3
Question Text:
* Enter code for the third kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age range for a second kind of cancer or didn't know how old father was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to give a second type of cancer
Skip Instructions:
Hard Edit:
(1-5,7-17,19-28,30,R,D) if FHFTYP_3 = (FHFTYP_1 or FHFTYP_2), go to ERR2_FHFTYP_3 else [go to FHFAGE3] (96) [go to FHMCAN] (6,18,29) [go to ERR1_FHFTYP_3] ERR1_FHFTYP_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHFTYP_3
* Cannot select pre-selected answer.
Default should go to FHFTYP_3

Question ID: NAH.020_00.004

Instrument Variable Name: FHFTYP_4
Question Text:
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
95 More than 3 kinds of cancer
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age range for a third kind of cancer or didn't know how old father was when first diagnosed that kind of cancer or else refused to provide an age range but had not refused to give a third kind of cancer
Skip Instructions:
(R,D,95,96) [go to FHMCAN] (1-30) [go to ERR_FHFTYP_4]
ERR_FHFTYP_4
Hard Edit:
* The only valid answers are '95' and '96' for this screen.

Question ID: NAH.030_00.001

Instrument Variable Name: FHFAGE1
Question Text:
Was your biological father under 50 years of age when [Fill: FHFTYP_1] was first diagnosed?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who selected a first kind of cancer for father or refused to answer or didn't know kind of cancer
Skip Instructions:
(1,2,D) [go to FHFTYP_2]
(R) IF FHFTYP_1=R [go to FHMCAN] else if FHFTYP_1 ne R [go to FHFTYP_2]

Question ID: NAH.030_00.002

Instrument Variable Name: FHFAGE2
Question Text:
Was your biological father under 50 years of age when [Fill: FHFTYP_2] was first diagnosed?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who selected a second kind of cancer for father or refused to answer or didn't know kind of cancer
Skip Instructions:
(1,2,D) [go to FHFTYP_3]
(R) IF FHFTYP_2=R [go to FHMCAN]
else if FHFTYP ne R [go to FHFTYP_3]

Question ID: NAH.030_00.003

Instrument Variable Name: FHFAGE3
Question Text:
Was your biological father under 50 years of age when [Fill: FHFTYP_3] was first diagnosed?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who selected a third kind of cancer for father or refused to answer or didn't know kind of cancer
Skip Instructions:
(1,2,D) go to FHFTYP_4
(R) IF FHFTYP_3=R [go to FHMCAN] else if FHFTYP_3 ne R [go to FHFTYP_4]

Question ID: NAH.040_00.000

Instrument Variable Name: FHMCAN
Question Text:
Did your BIOLOGICAL MOTHER EVER have cancer of any kind?
1 Yes
2 No
3 Adopted or don't know biological mother
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to FHMTYP_1]
(2,3,R,D) [go to FHBNUM]

Question ID: NAH.050_00.001

Instrument Variable Name: FHMTYP_1
Question Text:
What kind of cancer did your mother have?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose mother ever had cancer
Skip Instructions:
(1-19,21-25,27-30,R,D) [go to FHMAGE1]
(20,26) [go to ERR_FHMTYP_1]
ERR_FHMTYP_1
Hard Edit:
* Code 20 or 26 is unavailable for females.

Question ID: NAH.050_00.002

Instrument Variable Name: FHMTYP_2
Question Text:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age range for a first kind of cancer or didn't know how old mother was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer a first kind of cancer
Skip Instructions:
Hard Edit:
(1-19,21-25,27-30,R,D) if FHMTYP_2 = FHMTYP_1 [go to ERR2_FHMTYP_2] else [go to FHMAGE2] (96) [go to FHBNUM] (20,26) [go to ERR1_FHMTYP_2] ERR1_FHMTYP_2
* Code 20 or 26 is unavailable for females.
ERR2_FHMTYP_2
* Cannot select pre-selected answer.
Default should go to FHMTYP_2

Question ID: NAH.050_00.003

Instrument Variable Name: FHMTYP_3
Question Text:
* Enter code for the third kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age range for a second kind of cancer or didn't know how old mother was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer a second kind of cancer
Skip Instructions:
Hard Edit:
(1-19,21-25,27-30,R,D) if FHMTYP_3 = FHMTYP_1 or FHMTYP_2 [go to ERR2_FHMTYP_3] else [go to FHMAGE3] (96) [go to FHBNUM] (20,26) go to ERR1_FHMTYP_3 ERR_FHMTYP_3
* Code 20 or 26 is unavailable for females.
ERR2_FHMTYP_3
* Cannot select pre-selected answer.
Default should go to FHMTYP_3

Question ID: NAH.050_00.004

Instrument Variable Name: FHMTYP_4
Question Text:
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma )
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat )
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
95 More than 3 kinds of cancer
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age range for a third kind of cancer or didn't know how old mother was when first diagnosed with that kind of cancer or else refused to provide an age range but had not refused to answer a third kind of cancer
Skip Instructions:
(R,D,95,96) go to FHBNUM (1-30) ERR_FHMTYP_4
ERR_FHMTYP_4
Hard Edit:
* The only valid answers are '95' and '96' for this screen.

Question ID: NAH.060_00.001

Instrument Variable Name: FHMAGE1
Question Text:
Was your biological mother under 50 years of age when [Fill: FHMTYP_1] was first diagnosed?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who selected a first kind of cancer for mother or refused to answer or didn't know kind of cancer
Skip Instructions:
(1,2,D) [go to FHMTYP_2]
(R) IF FHMTYP_1=R [go to FHBNUM] else if FHMTYP_1 ne R [go to FHMTYP_2]

Question ID: NAH.060_00.002

Instrument Variable Name: FHMAGE2
Question Text:
Was your biological mother under 50 years of age when [Fill: FHMTYP_2] was first diagnosed?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who selected a second kind of cancer for mother or refused to answer or didn't know kind of cancer
Skip Instructions:
(1,2,D) [go to FHMTYP_3]
(R) IF FHMTYP_2=RF [go to FHBCAN]
else if FHMTYP_2 ne R [go to FHMTYP_3]

Question ID: NAH.060_00.003

Instrument Variable Name: FHMAGE3
Question Text:
Was your biological mother under 50 years of age when [Fill: FHMTYP_3] was first diagnosed?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who selected a third kind of cancer for mother or refused to answer or didn't know kind of cancer
Skip Instructions:
(1,2,D) [go to FHMTYP_4]
(R) IF FHMTYP_3=R [go to FHBNUM]
else if FHMTYP_3 ne R [go to FHMTYP_4]

Question ID: NAH.070_00.000

Instrument Variable Name: FHBNUM
Question Text:
FULL BROTHERS have the same biological mother and father as you. How many FULL BROTHERS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more brothers.
00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FHSNUM]
(1-21)[go to FHBCAN]

Question ID: NAH.080_00.000

Instrument Variable Name: FHBCAN
Question Text:
[Fill1: Did your BROTHER EVER have cancer of any kind?
*Enter '0' if brother has not had any kind of cancer.
*Enter '1' if brother has had cancer.]
[Fill2: How many of your BROTHERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have at least one full brother
Skip Instructions:
(0,R,D) go to FHSNUM
(1-21) if FHBCAN GT FHBNUM, [go to ERR_FHBCAN]
else [go to FHBTYP_1]
ERR_FHBCAN
Hard Edit:
*
Number is greater than number of brothers.
*
Please correct.
Default should go to FHBCAN

Question ID: NAH.090_00.001

Instrument Variable Name: FHBTYP_1
Question Text:
What kinds of cancer did your [Fill1: brother/Fill2: brothers] have?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose brother(s) ever had cancer
Skip Instructions:
(1-5,7-17,19-28,30,R,D) if FHBCAN = '1' [go to FHBAGE1]
else [go to FHBMAN1]
(6,18,29) [go to ERR_FHBTYP_1]
ERR_FHBTYP_1
Hard Edit:
* Code 6 or 18 or 29 is unavailable for males.

Question ID: NAH.090_00.002

Instrument Variable Name: FHBTYP_2
Question Text:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for brother(s) diagnosed with the first kind of cancer or didn't know how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:
(1-5,7-17,19-28,30,R,D) if FHBTYP_2 = FHBTYP_1 [go to ERR2_FHBTYP_2] elseif FHBCAN = '1' [go to FHBAGE2] else [go to FHBMAN2] (96) [go to FHSNUM] (6,18,29) [go to ERR1_FHBTYP_2]
Hard Edit:
ERR1_FHBTYP_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHBTYP_2
* Cannot select pre-selected answer.
Default should go to FHBTYP_2

Question ID: NAH.090_00.003

Instrument Variable Name: FHBTYP_3
Question Text:
* Enter code for the third kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for brother(s) diagnosed with the second kind of cancer or didn't know how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:
(1-5,7-17,19-28,30,R,D) if FHBTYP_3 = FHBTYP_1 or FHBTYP_2 [go to ERR2_FHBTYP_3] elseif FHBCAN = '1' [go to FHBAGE3] else [go to FHBMAN3] (96) [go to FHSNUM] (6,18,29) [go to ERR1_FHBTYP_3]
Hard Edit:
ERR1_FHBTYP_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHBTYP_3
* Cannot select pre-selected answer.
Default should go to FHBTYP_3

Question ID: NAH.090_00.004

Instrument Variable Name: FHBTYP_4
Question Text:
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
95 More than 3 kinds of cancer
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for brother(s) diagnosed with the third kind of cancer or didn't know how old brother(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the third kind of cancer
Skip Instructions:
(95,96) [go to FHSNUM] (1-30) [go to ERR_FHBTYP_4]
ERR_FHBTYP_4
Hard Edit:
* The only valid answers are '95' and '96' for this screen.

Question ID: NAH.091_00.000

Instrument Variable Name: FHBMAN1
Question Text:
How many brothers have had [Fill: FHBTYP_1]?
*Enter '21' for 21 or more brothers.
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have brothers with a first kind of cancer
Skip Instructions:
(1-21) if FHBMAN1 GT FHBCAN [go to ERR_FHBMAN1]
else [go to FHBAGE1]
(R,D) [go to FHBAGE1]
ERR_FHBMAN1
Hard Edit:
*
Number is greater than number of brothers with cancer.
*
Please correct.
Default should go to FHBMAN1

Question ID: NAH.092_00.000

Instrument Variable Name: FHBAGE1
Question Text:
[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_1] was first diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don?t know
Universe Text: Sample adults 18+ whose brother(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:
(0-21) if FHBMAN1 ne 'Refused' and FHBMAN1 NE 'Don't know' and FHBAGE1 GT FHBMAN1 [go to ERR1_FHBAGE1]
elseif (FHBMAN1 = 'Refused' or FHBMAN1 = 'Don't know') and FHBAGE1 GT FHBCAN [go to ERR2_FHBAGE1]
else [go to FHBTYP_2]
(D) [go to FHBTYP_2]
(R) IF FHBTYP_1=RF go to FHSNUM else if FHBTYP_1 ne RF [go to FHBTYP_2]
ERR1_FHBAGE1
Hard Edit:
*
Number is greater than number of brothers with this kind of cancer.
*
Please correct.
Default should go to FHBAGE1
ERR2_FHBAGE1
*
Number is greater than number of brothers with cancer.
*
Please correct.
Default should go to FHBAGE1

Question ID: NAH.093_00.000

Instrument Variable Name: FHBMAN2
Question Text:
How many brothers have had [Fill: FHBTYP_2]?
*Enter '21' for 21 or more brothers.
01-20 1-20 brothers
21 21+
97 Refused
99 Don?t know
Universe Text: Sample adults 18+ who have brothers with a second kind of cancer
Skip Instructions:
Hard Edit:
(1-21) if FHBMAN2 GT FHBCAN [go to ERR_FHBMAN2] else [go to FHBAGE2] (R,D) [go to FHBAGE2] ERR_FHBMAN2
*Number is greater than number of brothers with cancer.
*Please correct.
Default should go to FHBMAN2

Question ID: NAH.094_00.000

Instrument Variable Name: FHBAGE2
Question Text:
[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_2] was first diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose brother(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:
(0-21) if FHBMAN2 NE 'Refused' and FHBMAN2 ne 'Don't know' and FHBAGE2 GT FHBMAN2
[go to ERR1_FHBAGE2]
elseif (FHBMAN2 = 'Refused' or FHBMAN2 = 'Don't know') and FHBAGE2 GT FHBCAN
[go to ERR2_FHBAGE2]
else
[go to FHBTYP_3]
(D) [go to FHBTYP_3]
(R)
and (R) at FHBTYP_2 [go to FHSNUM]
(R)
and FHBTYP_2 NE (R) [go to FHBTYP_3]
ERR1_FHBAGE2
Hard Edit:
*
Number is greater than number of brothers with this kind of cancer.
*
Please correct.
Default should go to FHBAGE2
ERR2_FHBAGE2
*
Number is greater than number of brothers with cancer.
*
Please correct.
Default should go to FHBAGE2

Question ID: NAH.095_00.000

Instrument Variable Name: FHBMAN3
Question Text:
How many brothers have had [Fill: FHBTYP_3]?
*Enter '21' for 21 or more brothers.
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have brothers with a third kind of cancer
Skip Instructions:
(1-21) if FHBMAN3 GT FHBCAN
[go to ERR_FHBMAN3]
else
[go to FHBAGE3]
(R,D) [go to FHBAGE3]
ERR_FHBMAN3
Hard Edit:
*
Number is greater than number of brothers with cancer.
*
Please correct.
Default should go to FHBMAN3

Question ID: NAH.096_00.000

Instrument Variable Name: FHBAGE3
Question Text:
[Fill1: Was your brother under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' if brother was 50 or over.
*Enter '1' if brother was under 50.]
[Fill2: How many of these brothers were under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more brothers.]
00 None
01-20 1-20 brothers
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose brother(s) had a third kind of cancer or refused or didn't know name of third kind of cancer
Skip Instructions:
(0-21) if FHBMAN3 NE 'Refused' and FHBMAN3 NE 'Don't know' and FHBAGE3 GT FHBMAN3
[go to ERR1_FHBAGE3]
elseif (FHBMAN3 = 'Refused' or FHBMAN3 = 'Don't know') and FHBAGE3 GT FHBCAN
[go to ERR2_FHBAGE3]
else
[go to FHBTYP_4]
(D) [go to FHBTYP_4]
(R)
and (R) at FHBTYP_3 [go to FHSNUM]
(R)
and FHBTYP_3 NE (R) [go to FHBTYP_4]
ERR1_FHBAGE3
Hard Edit:
*
Number is greater than number of brothers with this kind of cancer.
*
Please correct.
Default should go to FHBAGE3
ERR2_FHBAGE3
*
Number is greater than number of brothers with cancer.
*
Please correct.
Default should go to FHBAGE3

Question ID: NAH.100_00.000

Instrument Variable Name: FHSNUM
Question Text:
FULL SISTERS have the same biological mother and father as you. How many FULL SISTERS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more sisters.
00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FHNNUM]
(1-21) [go to FHSCAN]

Question ID: NAH.110_00.000

Instrument Variable Name: FHSCAN
Question Text:
[Fill1: Did your SISTER EVER have cancer of any kind?
*Enter '0' if sister has not had any kind of cancer.
*Enter '1' if sister has had cancer.]
[Fill2: How many of your SISTERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]
00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have at least one full sister
Skip Instructions:
(0,R,D) [go to FHNNUM]
(1-21) if FHSCAN gt FHSNUM
[go to ERR_FHSCAN]
else
[go to FHSTYP_1]
ERR_FHSCAN
Hard Edit:
*
Number is greater than number of sisters.
*
Please correct.
Default should go to FHSCAN

Question ID: NAH.120_00.001

Instrument Variable Name: FHSTYP_1
Question Text:
What kind of cancer did your [Fill1: sister/Fill2: sisters] have?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose sister(s) ever had cancer
Skip Instructions:
(1-19,21-25,27-30,R,D) if FHSCAN = '1'
[go to FHSAGE1]
else
[go to FHSMAN1]
(20,26) [go to ERR_FHSTYP_1]
ERR_FHSTYP_1
Hard Edit:
*Code 20 or 26 is unavailable for females.

Question ID: NAH.120_00.002

Instrument Variable Name: FHSTYP_2
Question Text:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for sister(s) diagnosed with the first kind of cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:
(1-19,21-25,27-30,R,D) if FHSTYP_2 = FHSTYP_1, [go to ERR2_FHSTYP_2] elseif FHSCAN = '1', [go to FHSAGE2] else [go to FHSMAN2] (96) [go to FHNNUM] (20,26) [go to ERR1_FHSTYP_2]
Hard Edit:
ERR1_FHSTYP_2
*Code 20 or 26 is unavailable for females.
ERR2_FHSTYP_2
* Cannot select pre-selected answer.
Default should go to FHSTYP_2

Question ID: NAH.120_00.003

Instrument Variable Name: FHSTYP_3
Question Text:
* Enter code for the third kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for sister(s) diagnosed with the second kind of cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:
Hard Edit:
(1-19,21-25,27-30,R,D) if FHSTYP_2 = FHSTYP_1 or FHSTYP_2 [go to ERR2_FHSTYP_3] elseif FHSCAN = '1' [go to FHSAGE3] else [go to FHSMAN3]
(96) [go to FHNNUM] (20,26) [go to ERR1_FHSTYP_3]
ERR1_FHSTYP_3 *Code 20 or 26 is unavailable for females.
ERR2_FHSTYP_3
* Cannot select pre-selected answer.
Default should be FHSTYP_3

Question ID: NAH.120_00.004

Instrument Variable Name: FHSTYP_4
Question Text:
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
95 More than 3 kinds of cancer
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for sister(s) diagnosed with the third kind of cancer or didn't know how old sister(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the third kind of cancer
Skip Instructions:
(95,96) go to FHNNUM (1-30) go to ERR_FHSTYP_4
ERR_FHSTYP_4
Hard Edit:
* The only valid answers are '95' and '96' for this screen.

Question ID: NAH.121_00.000

Instrument Variable Name: FHSMAN1
Question Text:
How many sisters have had [Fill: FHSTYP_1]?
* Enter '21' for 21 or more sisters.
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have sisters with a first kind of cancer
Skip Instructions:
(1-21) if FHSMAN1 GT FHSCAN
[go to ERR_FHSMAN1]
else
[go to FHSAGE1]
(R,D) [go to FHSAGE1]
ERR_FHSMAN1
Hard Edit:
*
Number is greater than number of sisters with cancer.
*
Please correct.
Default should be FHSMAN1

Question ID: NAH.122_00.000

Instrument Variable Name: FHSAGE1
Question Text:
[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_1] was first diagnosed?
* Enter '0' if sister was 50 or over.
* Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]
00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don?t know
Universe Text: Sample adults 18+ whose sister(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:
(0-21) if FHSMAN1 NE 'Refused' and FHSMAN1 NE 'Don?t know' and FHSAGE1 GT FHSMAN1 [go to ERR1_FHSAGE1]
elseif (FHSMAN1 = 'Refused' or FHSMAN1 = 'Don't know') and FHSAGE1 GT FHSCAN [go to ERR2_FHSAGE1] else [go to FHSTYP_2]
(D) go to FHSTYP_2
(R)
and (R) at FHSTYP_1 [go to FHNNUM]
(R)
and FHSTYP_1 ne (RF) [go to FHSTYP_2]
ERR1_FHSAGE1
Hard Edit:
*
Number is greater than number of sisters with this kind of cancer.
*
Please correct.
Default should go to FHSAGE1
ERR2_FHSAGE1
*
Number is greater than number of sisters with cancer.
*Please correct.
Default should go to FHSAGE1

Question ID: NAH.123_00.000

Instrument Variable Name: FHSMAN2
Question Text:
How many sisters have had [Fill: FHSTYP_2]?
* Enter '21' for 21 or more sisters.
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have sisters with a second kind of cancer
Skip Instructions:
(1-21) if FHSMAN2 GT FHSCAN
[go to ERR_FHSMAN2]
else
[go to FHSAGE2]
(R,D) [go to FHSAGE2]
ERR_FHSMAN2
Hard Edit:
*Number is greater than number of sisters with cancer.
*Please correct.
Default should be FHSMAN2

Question ID: NAH.124_00.000

Instrument Variable Name: FHSAGE2
Question Text:
[Fill1: Was your sister under 50 years of age when [Fill3: FHSTYP_2] was first diagnosed?
*Enter '0' if sister was 50 or over.
*Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHSTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sisters.]
00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose sister(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:
(0-21) if FHSMAN2 NE 'Refused' and FHSMAN2 NE 'Don?t know' and FHSAGE2 GT FHSMAN2
[go to ERR1_FHSAGE2]
elseif (FHSMAN2 = 'Refused' or FHSMAN2 = 'Don't know') and FHSAGE2 GT FHSCAN
[go to ERR2_FHSAGE2]
else
[go to FHSTYP_3]
(D) [go to FHSTYP_3]
(R)
and (R) at FHSTYP_2[ go to FHNNUM]
(R)
and FHSTYP_2 ne R [go to FHSTYP_3]
ERR1_FHSAGE2
Hard Edit:
*Number is greater than number of sisters with this kind of cancer.
*Please correct.
Default should go to FHSAGE2
ERR2_FHSAGE2
*Number is greater than number of sisters with cancer.
*Please correct.
Default should go to FHSAGE2

Question ID: NAH.125_00.000

Instrument Variable Name: FHSMAN3
Question Text:
How many sisters have had [Fill1: FHSTYP_3]?
* Enter '21' for 21 or more sisters.
01-20 1-20 sisters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have sisters with a third kind of cancer
Skip Instructions:
(1-21) if FHSMAN3 GT FHSCAN
[go to ERR_FHSMAN3]
else
[go to FHSAGE3]
(R,D) [go to FHSAGE3]
ERR_FHSMAN3
Hard Edit:
*Number is greater than number of sisters with cancer.
*Please correct.
Default should be FHSMAN3

Question ID: NAH.126_00.000

Instrument Variable Name: FHSAGE3
Question Text:
[Fill1: Was your sister under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
*Enter '0' if sister was 50 or over.
*Enter '1' if sister was under 50.]
[Fill2: How many of these sisters were under 50 years of age when [Fill3: FHBTYP_3] was first diagnosed?
* Enter '0' for none.
* Enter '21' for 21 or more sisters.]
00 None
01-20 1-20 sisters
21 21+
97 Refused
99 Don?t know
Universe Text: Sample adults 18+ whose sister(s) had a third kind of cancer or refused or didn't know name of third kind of cancer
Skip Instructions:
(0-21) if FHSAGE3 GT FHSMAN3 [go to ERR_FHSAGE3] elseif (FHSMAN3 = 'Refused' or FHSMAN3 = 'Don't know') and FHSAGE3 GT FHSCAN [ go to ERR2_FHSAGE3] else [go to FHSTYP_4]
(D) [go to FHSTYP_4]
(R)
and (R) at FHSTYP_3 [go to FHNNUM]
(R)
and FHSTYP_3 NE (R) [go to FHSTYP_4]
ERR1_FHSAGE3
Hard Edit:
*Number is greater than number of sisters with this kind of cancer.
*Please correct.
Default should go to FHSAGE3ERR2_FHSAGE3
*Number is greater than number of sisters with cancer.
*Please correct.
Default should go to FHSAGE3

Question ID: NAH.130_00.000

Instrument Variable Name: FHNNUM
Question Text:
How many BIOLOGICAL SONS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more biological sons.
*Enter '96' for no biological children.
00 None
01-20 1-20 sons
21 21+
96 No biological children
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FHDNUM]
(1-21)[go to FHNCAN]
(22-95) go to ERR_FHNNUM
(96) go to SASSN4
ERR_FHNNUM
Hard Edit:
* Value not allowed as possible answer.

Question ID: NAH.140_00.000

Instrument Variable Name: FHNCAN
Question Text:
[Fill1: Did your SON EVER have cancer of any kind?
*Enter '0' if son has not had any kind of cancer.
*Enter '1' if son has had cancer.]
[Fill2: How many of your SONS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]
00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have at least one biological son
Skip Instructions:
(0,R,D) [go to FHDNUM]
(1-21) if FHNCAN gt FHNNUM
[go to ERR_FHNCAN]
else
[go to FHNTYP_1]
ERR_FHNCAN
Hard Edit:
*Number is greater than number of sons.
*Please correct.
Default should be FHNCAN

Question ID: NAH.150_00.001

Instrument Variable Name: FHNTYP_1
Question Text:
What kinds of cancer did your [Fill1: son/Fill2: sons] have?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose sons(s) ever had cancer
Skip Instructions:
(1-5,7-17,19-28,30,R,D) if FHNCAN = '1'
[go to FHNAGE1]
else
[go to FHNMAN1]
(6,18,29) [go to ERR_FHNTYP_1]
ERR_FHNTYP_1
Hard Edit:
* Code 6 or 18 or 29 is unavailable for males.

Question ID: NAH.150_00.002

Question Text:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for son(s) diagnosed with the first kind of cancer or didn't know how old sons(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:
(1-5,7-17,19-28,30,R,D) if FHNTYP_2 = FHNTYP_1 [go to ERR2_FHNTYP_2] elseif FHNCAN = '1' [go to FHNAGE2] else [go to FHNMAN2] (96) go to FHDNUM (6,18,29) go to ERR1_FHNTYP_2
Hard Edit:
ERR1_FHNTYP_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_FHNTYP_2
* Cannot select pre-selected answer.
Default should be FHNTYP_2

Question ID: NAH.150_00.003

Instrument Variable Name: FHNTYP_3
Question Text:
* Enter '95' if respondent offers more than 2 kinds of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
30 Other
95 More than 2 kinds of cancer
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for son(s) diagnosed with the second kind of cancer or didn't know how old son(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:
(95,96) [go to FHDNUM] (1-30) [go to ERR_FHNTYP_3]
ERR_FHNTYP_3
Hard Edit:
* The only valid answers are '95' and '96' for this screen.

Question ID: NAH.151_00.000

Instrument Variable Name: FHNMAN1
Question Text:
How many sons have had [Fill1: FHNTYP_1]?
*Enter '21' for 21 or more sons.
01-20 1-20 sons
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have sons with a first kind of cancer
Skip Instructions:
(1-21) if FHNMAN1 GT FHNCAN
[go to ERR_FHNMAN1]
else
[go to FHNAGE1]
(R,D) [go to FHNAGE1]
ERR_FHNMAN1
Hard Edit:
*Number is greater than number of sons with cancer.
*Please correct.
Default should be FHNMAN1

Question ID: NAH.152_00.000

Instrument Variable Name: FHNAGE1
Question Text:
[Fill1: Was your son under 50 years of age when [Fill3: FHNTYP_1] was first diagnosed?
*Enter '0' if son was 50 or over.
*Enter '1' if son was under 50.]
[Fill2: How many of these sons were under 50 years of age when [Fill3: FHNTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]
00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don?t know
Universe Text: Sample adults 18+ whose son(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:
(0-21) if FHNMAN1 NE ?Refused? and FHNMAN1 NE ?Don?t know? and FHNAGE1 GT FHNMAN1 [go to ERR2_FHNAGE1]
elseif (FHNMAN1 = ?Refused? or FHNMAN1 = ?Don?t know?) and FHNAGE1 GT FHNCAN [go to ERR3_FHNAGE1]
elseif AGE LE ?55? and FHNMAN1 NE ?Refused? and FHNMAN1 NE ?Don?t know? and FHNAGE1 LT FHNMAN1 [go to ERR1_FHNAGE1]
elseif AGE LE ?55? and (FHNMAN1 = ?Refused? or FHNMAN1 = ?Don?t know?) and FHNAGE1 = ?0? [go to ERR1_FHNAGE1] else [go to FHNTYP_2]
(D) [go to FHNTYP_2]
(R) IF FHNTYP_1=RF [go to FHDNUM] else if FHNTYP_1 ne (R) [go to FHNTYP_2]
ERR1_FHNAGE1
Hard Edit:
*At least one son is less than six years younger or is older than the respondent.
*Please correct.
Default should go to FHNAGE1
ERR2_FHNAGE1
*Number is greater than number of sons with this kind of cancer.
*Please correct.
Default should go to FHNAGE1
ERR3_FHNAGE1
*Number is greater than number of sons with cancer.
*Please correct.
Default should go to FHNAGE1

Question ID: NAH.153_00.000

Instrument Variable Name: FHNMAN2
Question Text:
How many sons have had [Fill: FHNTYP_2]?
*Enter '21' for 21 or more sons.
01-20 1-20 sons
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have sons with a second kind of cancer
Skip Instructions:
(1-21) if FHNMAN2 GT FHNCAN
[go to ERR_FHNMAN2]
else
[go to FHNAGE2]
(R,D) [go to FHNAGE2]
ERR_FHNMAN2
Hard Edit:
*Number is greater than number of sons with cancer.
*Please correct.
Default should be FHNMAN2

Question ID: NAH.154_00.000

Instrument Variable Name: FHNAGE2
Question Text:
[Fill1: Was your son under 50 years of age when [Fill3: FHNTYP_2] was first diagnosed?
*Enter '0' if son was 50 or over.
*Enter '1' if son was under 50.]
[Fill2: How many of these sons were under 50 years of age when [Fill3: FHNTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more sons.]
00 None
01-20 1-20 sons
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose sons(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:
(0-21) if FHNMAN2 NE ?Refused? and FHNMAN2 NE ?Don?t know? and FHNAGE2 GT FHNMAN2 [go to ERR2_FHNAGE2] elseif (FHNMAN2 = ?Refused? or FHNMAN2 = ?Don?t know?) and FHNAGE2 GT FHNCAN [go to ERR3_FHNAGE2] elseif AGE LE ?55? and FHNMAN2 NE ?Refused? and FHNMAN2 NE ?Don?t know? and FHNAGE2 LT FHNMAN1 [go to ERR1_FHNAGE2] elseif AGE LE ?55? and (FHNMAN2 = ?Refused? or FHNMAN2 = ?Don?t know?) and FHNAGE2 = ?0? [go to ERR1_FHNAGE2] else [go to FHNTYP_3]
(D) [go to FHNTYP_3]
(R) and FHNTYP_2=R [go to FHDNUM]
ERR1_FHNAGE2
Hard Edit:
*At least one son is less than six years younger or is older than the respondent.
*Please correct.
Default should go to FHNAGE2
ERR2_FHNAGE2
*Number is greater than number of sons with this kind of cancer.
*Please correct.
Default should go to FHNAGE2
ERR3_FHNAGE2
*Number is greater than number of sons with cancer.
*Please correct.
Default should go to FHNAGE2

Question ID: NAH.160_00.000

Instrument Variable Name: FHDNUM
Question Text:
How many BIOLOGICAL DAUGHTERS do you have? Please include any who are alive and those who may have died.
*Enter '0' for none.
*Enter '21' for 21 or more biological daughters.
00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who did not say they did not have any biological children at the 'number of biological sons' question
Skip Instructions:
(0,R,D) [go to FHSDBR]
(1-21) [go to FHDCAN]

Question ID: NAH.170_00.000

Instrument Variable Name: FHDCAN
Question Text:
[Fill1: Did your DAUGHTER EVER have cancer of any kind?
*Enter '0' if daughter has not had any kind of cancer.
*Enter '1' if daughter has had cancer.]
[Fill2: How many of your DAUGHTERS have EVER had cancer of any kind?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]
00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have at least one biological daughter
Skip Instructions:
(0,R,D) [go to FHSDBR]
(1-21) if FHDCAN gt FHDNUM
[ go to ERR_FHDCAN]
else
[go to FHDTYP_1]
ERR_FHDCAN
Hard Edit:
*Number is greater than number of daughters.
*Please correct.
Default should be FHDCAN

Question ID: NAH.180_00.001

Instrument Variable Name: FHDTYP_1
Question Text:
What kinds of cancer did your [Fill1: daughter/Fill2: daughters] have?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ whose daughter(s) ever had cancer
Skip Instructions:
(1-19,21-25,27-30,R,D)
if FHDCAN = '1' [go to FHDAGE1]
else [go to FHDMAN1]
(20,26) [go to ERR_FHDTYP_1]
ERR_FHDTYP_1
Hard Edit:
* Code 20 or 26 is unavailable for females.

Question ID: NAH.180_00.002

Instrument Variable Name: FHDTYP_2
Question Text:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for daughter(s) diagnosed with the first kind of cancer or didn't know how old daughter(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the first kind of cancer
Skip Instructions:
(1-19,21-25,27-30,R,D) if FHDTYP_2 = FHDTYP_1 [go to ERR2_FHDTYP_2] elseif FHDCAN = '1' [go to FHDAGE2] else [go to FHDMAN2] (96) [go to FHSDBR] (20,26) [go to ERR1_FHDTYP_2]
Hard Edit:
ERR1_FHDTYP_2
* Code 20 or 26 unavailable for females.
ERR2_FHDTYP_2
* Cannot select pre-selected answer.
Default should be FHDTYP_2

Question ID: NAH.180_00.003

Instrument Variable Name: FHDTYP_3
Question Text:
* Enter '95' if respondent offers more than 2 kinds of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
21 Rectum
22 Skin (non-melanoma)
23 Skin (don't know what kind)
24 Soft tissue (muscle or fat)
25 Stomach
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
95 More than 2 kinds of cancer
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who provided age range for daughter(s) diagnosed with the second kind of cancer or didn't know how old daughter(s) was/were when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer the second kind of cancer
Skip Instructions:
(R,D,95,96) [go to FHSDBR] (1-30) [go to ERR_FHDTYP_3]
ERR_FHDTYP_3
Hard Edit:
* The only valid answers are '95' and '96' for this screen.

Question ID: NAH.190_00.000

Instrument Variable Name: FHDMAN1
Question Text:
How many daughters have had [Fill: FHDTYP_1]?
*Enter '21' for 21 or more daughters.
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have daughters with a first kind of cancer
Skip Instructions:
(1-21) if FHDMAN1 gt FHDCAN
[go to ERR_FHDMAN1]
else
[go to FHDAGE1]
(R,D) go to FHDAGE1
ERR_FHDMAN1
Hard Edit:
*Number is greater than number of daughters with cancer.
*Please correct.
Default should be FHDMAN1

Question ID: NAH.191_00.000

Instrument Variable Name: FHDAGE1
Question Text:
[Fill1: Was your daughter under 50 years of age when [Fill3: FHDTYP_1] was first diagnosed?
*Enter '0' if daughter was 50 or over.
*Enter '1' if daughter was under 50.]
[Fill2: How many of these daughters were under 50 years of age when [Fill3: FHDTYP_1] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]
00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don?t know
Universe Text: Sample adults 18+ whose daughter(s) had a first kind of cancer or refused or didn't know name of first kind of cancer
Skip Instructions:
(0-21) if FHDMAN1 NE ?Refused? and FHDMAN1 NE ?Don?t know? and FHDAGE1 GT FHDMAN1 [go to ERR2_FHDAGE1] elseif (FHDMAN1 = ?Refused? or FHDMAN1 = ?Don?t know?) and FHDAGE1 GT FHDCAN [go to ERR3_FHDAGE1] elseif AGE LE ?55? and FHDMAN1 NE ?Refused? and FHDMAN1 NE ?Don?t know? and FHDAGE1 LT FHDMAN1 [go to ERR1_FHDAGE1] elseif AGE LE ?55? and (FHDMAN1 = ?Refused? or FHDMAN1 = ?Don?t know?) and FHDAGE1 = ?0? [go to ERR1_FHDAGE1] else [go to FHDTYP_2]
(D) [go to FHDTYP_2]
(R) IF FHDTYP_1=RF [go to FHSDBR]
else if FHDTYP_1 NE RF go to FHDTYP_2
ERR1_FHDAGE1
Hard Edit:
*At least one daughter is less than six years younger or is older than the respondent.
*Please correct.
Default should go to FHDAGE1
ERR2_FHDAGE1
*Number is greater than number of daughters with this kind of cancer.
*Please correct.
Default should go to FHDAGE1
ERR3_FHDAGE1
*Number is greater than number of daughters with cancer.
*Please correct.
Default should go to FHDAGE1

Question ID: NAH.192_00.000

Instrument Variable Name: FHDMAN2
Question Text:
How many daughters have had [Fill: FHDTYP_2]?
*Enter '21' for 21 or more daughters.
01-20 1-20 daughters
21 21+
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have daughters with a second kind of cancer
Skip Instructions:
(1-21) if FHDMAN2 GT FHDCAN
[go to ERR_FHDMAN2]
else
[go to FHDAGE2]
(R,D) [go to FHDAGE2]
ERR_FHDMAN2
Hard Edit:
*Number is greater than number of daughters with cancer.
*Please correct.
Default should be FHDMAN2

Question ID: NAH.193_00.000

Instrument Variable Name: FHDAGE2
Question Text:
[Fill1: Was your daughter under 50 years of age when [Fill3: FHDTYP_2] was first diagnosed?
*Enter '0' if daughter was 50 or over.
*Enter '1' if daughter was under 50.]
[Fill2: How many of these daughters were under 50 years of age when [Fill3: FHDTYP_2] was first diagnosed?
*Enter '0' for none.
*Enter '21' for 21 or more daughters.]
00 None
01-20 1-20 daughters
21 21+
97 Refused
99 Don?t know
Universe Text: Sample adults 18+ whose daughter(s) had a second kind of cancer or refused or didn't know name of second kind of cancer
Skip Instructions:

(0-21)if FHDMAN2 NE ?Refused? and FHDMAN2 NE ?Don?t know? and FHDAGE2 GT FHDMAN2

[go to ERR2_FHDAGE2] elseif (FHDMAN2 = ?Refused? or FHDMAN2 = ?Don?t know?) and FHDAGE2 GT FHDCAN [go to ERR3_FHDAGE2] elseif AGE LE ?55? and FHDMAN2 NE ?Refused? and FHDMAN2 NE ?Don?t know? and FHDAGE2 LT FHDMAN2 [go to ERR1_FHDAGE2] elseif AGE LE ?55? and (FHDMAN2 = ?Refused? or FHDMAN2 = ?Don?t know?) and FHDAGE2 = ?0? [go to ERR1_FHDAGE2] else [go to FHDTYP_3]
(D) [go to FHDTYP_3]
(R) IF FHDTYP_2=R [go to FHSDBR]
else if FHDTYP_2 ne R go to FHDTYP_3
ERR1_FHDAGE2
Hard Edit:
*At least one daughter is less than six years younger or is older than the respondent.
*Please correct.
Default should go to FHDAGE2
ERR2_FHDAGE2
*Number is greater than number of daughters with this kind of cancer.
*Please correct.
Default should go to FHDAGE2
ERR3_FHDAGE2
*Number is greater than number of daughters with cancer.
*Please correct.
Default should go to FHDAGE2

Question ID: NAH.200_00.000

Instrument Variable Name: FHSDBR
Question Text:
The next few questions are about the number of your second-degree relatives who have been diagnosed with breast or ovarian cancer.
How many of your grandparents, aunts, uncles, nieces, nephews, or grandchildren have ever been diagnosed with breast cancer?
* Read if necessary:
Do not include great grandparents, great aunts or uncles, cousins, or step-relatives.
00-96 0-96
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to FHSDOV]
(1-96) [go to FHSDBN]

Question ID: NAH.205_00.000

Instrument Variable Name: FHSDBN
Question Text:
How many of them were diagnosed with breast cancer before the age of 50?
00-96 0-96
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had at least one second-degree relative diagnosed with breast cancer
Skip Instructions:
(0-96,R,D) if FHSDBN GT FHSDBR [go to ERR1_FHSDBN];
else [go to FHSDOV]
* Number is greater than number of relatives with cancer.
Hard Edit:
* Please correct.

Question ID: NAH.210_00.000

Instrument Variable Name: FHSDOV
Question Text:
How many of your grandmothers, aunts, nieces, or granddaughters have ever been diagnosed with ovarian cancer?
* Read if necessary:
Do not include great grandmothers, great aunts, cousins, or step-relatives.
00-96 0-96
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-96,R,D) [go to next section ]