2015 NHIS Questionnaire - Sample Adult
Adult Identification
Document Version Date: 10-May-16

Sample Adult: Adult Identification

Question ID: AID.005_00.000

Instrument Variable Name: SADULT
Questionnaire File Name: Sample Adult
Question Text:

* The sample adult person is [fill: ALIAS of Sample Adult]. The next questions must be answered by this person. Probe as necessary to determine the availability of [fill: ALIAS of Sample Adult].
* If refused enter CTRL-R

1 Physical or mental condition prohibits responding
2 Sample adult is able to respond
3 Unknown

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

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

Question ID: AID.010_00.000

Instrument Variable Name: PROX1
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No

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

(1) go to PROX2
(2) go to PROX3

Question ID: AID.015_00.000

Instrument Variable Name: PROX2
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Knowledgeable proxy is available.
Skip Instructions:

(1-4) go to AIDVERF_S

Question ID: AID.020_00.000

Instrument Variable Name: PROX3
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No

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

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

Question ID: AID.030_00.000

Instrument Variable Name: AIDVERF_S
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No

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

(1) go to AIDVERF_A
(2) go to AIDSEX

Question ID: AID.040_00.000

Instrument Variable Name: AIDSEX
Questionnaire File Name: Sample Adult
Question Text:

Are you Male or Female?
* If don?t know or refused enter your best guess of the person's sex.

1 Male
2 Female

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

(1,2) store AIDSEX in SEX
go to ERR_AIDSEX
reset AIDVERF_S
go to AIDVERF_S
Hard Edit: ERR_AIDSEX
*The gender will now be changed to [fill: AIDSEX].
go to AIDVERF_S (as the default go to)

Question ID: AID.045_00.000

Instrument Variable Name: AIDVERF_A
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No

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

(1) go to AIDVERF_D
(2) go to AIDAGE

Question ID: AID.050_00.000

Instrument Variable Name: AIDAGE
Questionnaire File Name: Sample Adult
Question Text:

How old are you?

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

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

(0-120, Refused, Don't know)
if AIDAGE = 'Refused' or AIDAGE = 'Don't know' or AIDAGE = AGE
reset AIDVERF_A
go to ERR_AIDAGE
else
store AIDAGE in AGE
go to AIDDOB_M
Soft Edit: ERR_AIDAGE
*Age of [fill1: ALIAS of Sample Adult] remains [fill2: Age of Sample Adult] years old.
go to AIDVERF_A (whether suppressed or not)

Question ID: AID.055_00.000

Instrument Variable Name: AIDVERF_D
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No

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

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

Question ID: AID.060_01.000

Instrument Variable Name: AIDDOB_M
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

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

Question ID: AID.060_02.000

Instrument Variable Name: AIDDOB_D
Questionnaire File Name: Sample Adult
Question Text:

2 of 3
*Enter day of birth.

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

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

(01-31,Refused,Don't know) go to AIDDOB_Y
If days not valid, go to ERR_AIDDOB_D
Hard Edit: ERR_AIDDOB_D
*[fill1: AIDDOB_D] is not a valid day for [fill2: AIDDOB_M].
*Please correct.

NHIS Questionnaire - Sample Adult
Question ID: AID.060_03.000

Instrument Variable Name: AIDDOB_Y
Questionnaire File Name: Sample Adult
Question Text:

3 of 3
1880-2020
*Enter year of birth.
Year of birth

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

(1880-2020, Refused, Don't know) if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
go to AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
go to AIDVERF_D
endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and
month = current month and day GT current day)
go to ERR1_AIDDOB_Y
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
go to ERR2_AIDDOB_Y
endif
(if AIDDOB_M = 'Ref' or 'DK') or (if AIDDOB_D = 'Re'f or 'DK') or (if AIDDOB_Y = 'Ref' or 'DK')
go to ERR3_AIDDOB_Y
else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
go to AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
go to AIDVERF_D
endif
endif
Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.
if age from AIDDOB items is ne AGE and age from AIDDOB items is valid
reset AIDVERF_A or AIDVERF_D.
go to ERR4_AIDDOB_Y
endif
Hard Edit: ERR1_AIDDOB_Y
*Future date invalid: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)]
*Please correct.
go to AIDDOB_M (whether suppressed or not)
ERR2_AIDDOB_Y
*Not a valid day: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)]
*Please correct.
go to AIDDOB_M (whether suppressed or not)
ERR3_AIDDOB_Y
*DOB of [fill2: ALIAS of Sample Adult] remains [fill3: (DOBM) (DOBD), (DOBY)]
go to AIDVERF_A (whether suppressed or not)
ERR4_AIDDOB_Y
* Data mismatched. Please fix Age or Birthday.
* If still cannot reconcile, enter 'Don't know' for year of birth.
* Please correct.

Question ID: ASD.050_00.000

Instrument Variable Name: WRKVER
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ASD.060_00.000

Instrument Variable Name: WRKCOR
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

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

Name: DOINGLW2

Questionnaire File Name: Sample Adult
Question Text:

Corrected Employment Status Last Week: (not displayed)

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

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

Question ID: ASD.065_00.000

Instrument Variable Name: WHYNOWK2
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

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

Question ID: ASD.066_00.000

Instrument Variable Name: EVERWRK
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1) [go to WHOWRK]
(2,D,R) [go to SCHOOLYR]

Question ID: ASD.070_00.000

Instrument Variable Name: WHOWRK
Questionnaire File Name: Sample Adult
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

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

(90 char long,D,R) [go to KINDIND]

Question ID: ASD.080_00.000

Instrument Variable Name: KINDIND
Questionnaire File Name: Sample Adult
Question Text:

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

Verbatim Verbatim response
7 Refused
9 Don't know

(90 char long,D,R) [go to KINDWRK]

Question ID: ASD.090_00.000

Instrument Variable Name: KINDWRK
Questionnaire File Name: Sample Adult
Question Text:

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

7 Refused
9 Don't know

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

(90 char long,D,R) [go to IMPACT]

Question ID: ASD.100_00.000

Instrument Variable Name: IMPACT
Questionnaire File Name: Sample Adult
Question Text:

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

7 Refused
9 Don't know

(90 char long,D,R) [go to SUPERVIS]

Question ID: ASD.105_00.010

Instrument Variable Name: SUPERVIS
Questionnaire File Name: Sample Adult
Question Text:

Did you supervise other employees as part of your job?

1 Yes
2 No
7 Refused
9 Don't know

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

Question ID: ASD.110_00.000

Instrument Variable Name: WRKCAT
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

Question ID: ASD.112_00.000

Instrument Variable Name: BUSINC
Questionnaire File Name: Sample Adult
Question Text:

Is this business incorporated?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are self-employed
Skip Instructions:

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

Question ID: ASD.120_00.000

Instrument Variable Name: LOCALLNO
Questionnaire File Name: Sample Adult
Question Text:

(book) A3
Thinking about
(Fill1: this MAIN job or business)
(Fill2: your last week at the job you held the longest)
(Fill3: your last week at the job you held most recently)
how many people (Fill4:work/Fill5: worked) at this location? Please include yourself.
* "People" includes both FULL- and PART-time employees.
* "Location" refers to the street address of the workplace.

01 1 employee
02 2-9 employees
03 10-24 employees
04 25-49 employees
05 50-99 employees
06 100-249 employees
07 250-499 employees
08 500-999 employees
09 1000 employees or more
97 Refused
99 Don't know

(1-9, R,D) [go to WRKLONGN]

Question ID: ASD.140_01.000

Instrument Variable Name: WRKLONGN
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

Question ID: ASD.140_02.000

Instrument Variable Name: WRKLONGT
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period.

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

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

(4) if WRKLONGN gt AGE then [go to ERR_WRKLONGT]
(1-4) if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65) then [go to HOURPD]
else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or (DOINGLW2 = 1,2,4)
[go to WRKLONGH]
Hard Edit: ERR_WRKLONGT
* Number of years is greater than age.
* Please correct.

Question ID: ASD.146_00.000

Instrument Variable Name: WRKLONGH
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ASD.150_00.000

Instrument Variable Name: HOURPD
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

Question ID: ASD.160_00.000

Instrument Variable Name: PDSICK
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

Question ID: ASD.170_00.000

Instrument Variable Name: ONEJOB
Questionnaire File Name: Sample Adult
Question Text:

Do you have more than one job or business?

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) if WRKLONGH=2, then [go to WHOWRKLH];
else [go to WRKARRNG / ASD.220_00.080]

Question ID: ASD.210_00.000

Instrument Variable Name: WRKLYR2
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who were looking for work or who were not working at a job or business AND who were not looking for work in the last week
Skip Instructions:

(1,2,D,R) [go to next section]

Question ID: ASD.220_00.010

Instrument Variable Name: WHOWRKLH
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Thinking of ALL the jobs or businesses you have ever had, including work done in the Armed Forces, for whom did you work the longest? (Name of company, business, organization or employer)
Verbatim Verbatim response

7 Refused
9 Don't know

Universe Text: Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Skip Instructions:

(allow 90,R,D) [go to KINDINLH]

Question ID: ASD.220_00.020

Instrument Variable Name: KINDINLH
Questionnaire File Name: Sample Adult
Question Text:

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

7 Refused
9 Don't know

Universe Text: Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Skip Instructions:

(allow 90,R,D) [go to KINDWKLH]

Question ID: ASD.220_00.030

Instrument Variable Name: KINDWKLH
Questionnaire File Name: Sample Adult
Question Text:

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

7 Refused
9 Don't know

Universe Text: Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Skip Instructions:

(allow 90,R,D) [go to IMPACTLH]

Question ID: ASD.220_00.040

Instrument Variable Name: IMPACTLH
Questionnaire File Name: Sample Adult
Question Text:

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

7 Refused
9 Don't know

Universe Text: Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Skip Instructions:

(allow 90,R,D) [go to WRKCATLH]

Question ID: ASD.220_00.050

Instrument Variable Name: WRKCATLH
Questionnaire File Name: Sample Adult
Question Text:

(book) A2 ? [F1]
Looking at the card, which of these best describes the job or business you held for the longest time?

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

Universe Text: Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Skip Instructions:

(1-6,R,D) [go to WRKLGLHN]

Question ID: ASD.220_00.060

Instrument Variable Name: WRKLGLHN
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
About how long did you work at the job or business you held the longest?
* Enter number.

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

Universe Text: Sample adults 18+ whose current, MAIN job is NOT the job they held the longest
Skip Instructions:

(1-365) [go to WRKLGLHT]
(R,D) [go to WRKARRNG]

Question ID: ASD.220_00.070

Instrument Variable Name: WRKLGLHT
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period.

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

Universe Text: Sample adults 18+ whose current, MAIN job is NOT the job they held the longest and who gave a number at WRKLGLHN
Skip Instructions:

(1-4,R,D) [go to WRKARRNG]

Question ID: ASD.220_00.080

Instrument Variable Name: WRKARRNG
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
The next set of questions refers to your [fill: job as a (KINDWRK) with (WHOWRK)/current, MAIN job]. Which of the following best describes your work arrangement?
* Read categories below.

1 You work as an independent contractor, independent consultant, or freelance worker
2 You are paid by a temporary agency
3 You work for a contractor who provides workers and services to others under contract
4 You are a regular, permanent employee (standard work arrangement)
5 Some other work arrangement
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1-5,R,D) [go to WRKSCHED]

Question ID: ASD.220_00.090

Instrument Variable Name: WRKSCHED
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Which of the following best describes the hours you usually work?
* Read categories below.

1 A regular daytime schedule
2 A regular evening shift
3 A regular night shift
4 A rotating shift
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1-4,R,D) [go to NIGHTWK]

Question ID: ASD.220_00.100

Instrument Variable Name: NIGHTWK
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
DURING THE PAST 30 DAYS, did you work ANY amount of time between 1:00 AM and 5:00 AM?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1) [go to NIGHTFRQ]
(2,R,D) [go to WORKWFAM]

Question ID: ASD.220_00.105

Instrument Variable Name: NIGHTFRQ
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
DURING THE PAST 30 DAYS, on how many days did you work ANY amount of time between 1:00 AM and 5:00 AM?

01-30 1-30
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who are currently employed and worked between the hours of 1:00 AM and 5:00 AM during the past 30 days
Skip Instructions:

(1-30,R,D) [go to WORKWFAM]

Question ID: ASD.220_00.110

Instrument Variable Name: WORKWFAM
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
These next four questions ask about your [fill: job as a (KINDWRK) with (WHOWRK)/current, MAIN job]. Please tell me whether you strongly agree, agree, disagree, or strongly disagree with each of these statements.
"The demands of my job interfere with my personal or family life."

1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1-4,R,D) [go to JOBDMAND]

Question ID: ASD.220_00.120

Instrument Variable Name: JOBDMAND
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
* Read if necessary: Please tell me whether you strongly agree, agree, disagree, or strongly disagree with this statement.
"I have enough time to get the job done."

1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1-4,R,D) [go to JOBCNTRL]

Question ID: ASD.220_00.130

Instrument Variable Name: JOBCNTRL
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
* Read if necessary: Please tell me whether you strongly agree, agree, disagree, or strongly disagree with this statement.
"My job allows me to make a lot of decisions on my own."

1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1-4,R,D) [if WRKCAT=5, then go to WORUNEMP;
else go to JOBSPPRT]

Question ID: ASD.220_00.140

Instrument Variable Name: JOBSPPRT
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
* Read if necessary: Please tell me whether you strongly agree, agree, disagree, or strongly disagree with this statement.
"I can count on my supervisor or manager for support when I need it."

1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed but not self-employed
Skip Instructions:

(1-4,R,D) [go to WORUNEMP]

Question ID: ASD.220_00.150

Instrument Variable Name: WORUNEMP
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Are you worried about losing your [fill: job as a (KINDWRK) with (WHOWRK)/current, MAIN job]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

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

Question ID: ASD.220_00.160

Instrument Variable Name: SAFETY
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
The next [fill 1: question is/two questions are] about workplace safety and health. Please answer for your [fill 2: job as a (KINDWRK) with (WHOWRK)/current, MAIN job].
Overall, how safe do you think your workplace is? Would you say?
* Read categories below.

1 Very safe
2 Safe
3 Unsafe
4 Very unsafe
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1-4,R,D) [if WRKCAT=5 go to HARASSED;
else go to SAFCLIMT]

Question ID: ASD.220_00.170

Instrument Variable Name: SAFCLIMT
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Please tell me whether you strongly agree, agree, disagree, or strongly disagree with this statement. "The health and safety of workers is a high priority with management where I work."

1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed but not self-employed
Skip Instructions:

(1-4,R,D) [go to HARASSED]

Question ID: ASD.220_00.180

Instrument Variable Name: HARASSED
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Again, think about your [fill: job as a (KINDWRK) with (WHOWRK)/current, MAIN job].
DURING THE PAST 12 MONTHS, were you threatened, bullied, or harassed by anyone while you were on the job?

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

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(1) [go to HARASFRQ]
(2,R,D) [go to EXERTION]

Question ID: ASD.220_00.185

Instrument Variable Name: HARASFRQ
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
DURING THE PAST 12 MONTHS, how often were you threatened, bullied, or harassed by anyone while you were on the
job? Would you say...
* Read categories below.

1 Once
2 A few times
3 Monthly
4 Weekly
5 Daily
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed and were threatened, bullied, or harassed while on the job in the past 12 months
Skip Instructions:

(1-4,R,D) [go to EXERTION]

Question ID: ASD.220_00.190

Instrument Variable Name: EXERTION
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Again, continue thinking about your [fill: job as a (KINDWRK) with (WHOWRK)/current, MAIN job]. How often does your job involve repeated lifting, pushing, pulling, or bending? Would you say...
* Read categories below.

0 Never
1 Seldom
2 Sometimes
3 Often
4 Always
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(0-4,R,D) [go to STAND]

Question ID: ASD.220_00.200

Instrument Variable Name: STAND
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
How often does your job involve standing or walking around? Would you say...
* Read categories below.

0 Never
1 Seldom
2 Sometimes
3 Often
4 Always
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(0-4,R,D) [go to SMOKEXP]

Question ID: ASD.220_00.210

Instrument Variable Name: SMOKEXP
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
DURING THE PAST 12 MONTHS, while at work, how often were you exposed to tobacco smoke from other people?
Would you say...
* Read categories below.

0 Never
1 Less than twice a week
2 Twice a week or more, but not every day
3 Every day
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed
Skip Instructions:

(0-3,R,D) [if WRKCAT=5, then go to ACN.HYPEV;
else go to HLTHPROM]

Question ID: ASD.220_00.230

Instrument Variable Name: HLTHPROM
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
In the past year, were health promotion programs made available to you by your employer? Examples of health promotion programs include education about weight management, smoking cessation, screening for high blood pressure, high cholesterol, or other health risks, and onsite fitness facilities or discounted gym memberships.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed but not self-employed
Skip Instructions:

(1) [go to HPROMPAR]
(2,R,D) [go to ACN.HYPEV]

Question ID: ASD.220_00.240

Instrument Variable Name: HPROMPAR
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
How often did you participate in any of these activities in the past year? Would you say...
* Read categories below.

0 Never
1 Once
2 A few times
3 Monthly
4 Weekly
5 Daily
7 Refused
9Don't know

Universe Text: Sample adults 18+ who are currently employed but not self-employed and their employers offer health promotion programs
Skip Instructions:

(0-5,R,D) [go to ACN.HYPEV]

Question ID: ACN.010_00.000

Instrument Variable Name: HYPEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to HYPDIFV]
(2,R,D) [go to CHLEV]

Question ID: ACN.020_00.000

Instrument Variable Name: HYPDIFV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were told they had hypertension
Skip Instructions:

(1) [go to HYPYR]
(2,R,D) [go to HYPMDEV2]

Question ID: ACN.020_00.010

Instrument Variable Name: HYPYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever told they had hypertension (2+ visits)
Skip Instructions:

(1,2,R,D) [go to HYPMDEV2]

Question ID: ACN.022_02.020

Instrument Variable Name: HYPMDEV2
Questionnaire File Name: Sample Adult
Question Text:

Was any medicine EVER prescribed by a doctor for your high blood pressure?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever been told they had high blood pressure
Skip Instructions:

(1) [go to HYPMED2]
(2,R,D) [go to CHLEV]

Question ID: ACN.022_03.030

Instrument Variable Name: HYPMED2
Questionnaire File Name: Sample Adult
Question Text:

Are you NOW taking any medicine prescribed by a doctor for your high blood pressure?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever prescribed medicine for high blood pressure
Skip Instructions:

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

Question ID: ACN.023_00.010

Instrument Variable Name: CHLEV
Questionnaire File Name: Sample Adult
Question Text:

Have you EVER been told by a doctor or other health professional that you had high cholesterol?
*Enter '1' if respondent is taking medication to control his/her high cholesterol.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to CHLYR]
(2,R,D) [go to CHDEV]

Question ID: ACN.023_00.020

Instrument Variable Name: CHLYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever told they had high cholesterol
Skip Instructions:

(1,2,R,D) [go to CHLMDEV2]

Question ID: ACN.023_03.030

Instrument Variable Name: CHLMDEV2
Questionnaire File Name: Sample Adult
Question Text:

Was any medication EVER prescribed by a doctor to help lower your cholesterol?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever been told they had high cholesterol
Skip Instructions:

(1) [go to CHLMDNW2]
(2,R,D) [go to CHDEV]

Question ID: ACN.023_04.040

Instrument Variable Name: CHLMDNW2
Questionnaire File Name: Sample Adult
Question Text:

Are you NOW taking any medicine prescribed by a doctor to help lower your cholesterol?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever prescribed medicine for high cholesterol
Skip Instructions:

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

Question ID: ACN.031_01.000

Instrument Variable Name: CHDEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.031_02.000

Instrument Variable Name: ANGEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.031_03.000

Instrument Variable Name: MIEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.031_04.000

Instrument Variable Name: HRTEV
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...Any kind of heart condition or heart disease (other than the ones I just asked about)?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.031_05.000

Instrument Variable Name: STREV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.031_06.000

Instrument Variable Name: EPHEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.035_00.000

Instrument Variable Name: COPDEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [if AGE GE 40, go to ASPMEDEV
else go to AASMEV]

Question ID: ACN.040_00.010

Instrument Variable Name: ASPMEDEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 40+
Skip Instructions:

(1) [go to ASPMEDAD]
(2,R,D) [go to ASPONOWN]

Question ID: ACN.040_00.020

Instrument Variable Name: ASPMEDAD
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1,R,D) [go to AASMEV]
(2) [go to ASPMDMED]

Question ID: ACN.040_00.030

Instrument Variable Name: ASPMDMED
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who have ever been advised to take aspirin every day, but are not currently following that advice
Skip Instructions:

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

Question ID: ACN.040_00.040

Instrument Variable Name: ASPONOWN
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 40+ who have not been advised to take aspirin every day or Ref/DK if they have been advised to take aspirin every day
Skip Instructions:

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

Question ID: ACN.080_00.000

Instrument Variable Name: AASMEV
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Have you EVER been told by a doctor or other health professional that you had asthma?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AASSTILL]
(2,R,D) [go to ULCEV]

Question ID: ACN.085_00.000

Instrument Variable Name: AASSTILL
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Do you still have asthma?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever told they have asthma
Skip Instructions:

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

Question ID: ACN.090_00.000

Instrument Variable Name: AASMYR
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
DURING THE PAST 12 MONTHS, have you had an episode of asthma or an asthma attack?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever told they had asthma
Skip Instructions:

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

Question ID: ACN.100_00.000

Instrument Variable Name: AASMERYR
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
DURING THE PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever told they had asthma
Skip Instructions:

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

Question ID: ACN.110_00.000

Instrument Variable Name: ULCEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ULCYR]
(2,R,D) [go to ULCCOLEV]

Question ID: ACN.120_00.000

Instrument Variable Name: ULCYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were ever told they had an ulcer
Skip Instructions:

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

Question ID: ACN.120_00.010

Instrument Variable Name: ULCCOLEV
Questionnaire File Name: Sample Adult
Question Text:

Have you EVER been told by a doctor or other health professional that you had Crohn?s disease or ulcerative colitis?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.130_00.000

Instrument Variable Name: CANEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to CANKIND]
(2,R,D) [go to DIBEV]

Question ID: ACN.140_00.001

Instrument Variable Name: CANKIND_1
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:

(1-30,R,D) [go to CANAGE_1]
IF SEX=1 (MALE) and No. (6,18,29) selected [go to ERR1_CANKIND_1]
IF SEX=2 (FEMALE) and No. (20,26) selected [go to ERR2_CANKIND_1]
Hard Edit: ERR1_CANKIND_1
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_1
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.002

Instrument Variable Name: CANKIND_2
Questionnaire File Name: Sample Adult
Question Text:

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

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

(1-30,R,D)[go to CANAGE_2]
(96) [go to DIBEV]
IF SEX=1 (MALE) and No. (6,18,29) selected [go to ERR1_CANKIND_2]
Hard Edit:
IF SEX=2 (FEMALE) and No. (20,26) selected [go to ERR2_CANKIND_2]
ERR1_CANKIND_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_2
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.003

Instrument Variable Name: CANKIND_3
Questionnaire File Name: Sample Adult
Question Text:

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

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

(1-30,R,D)[go to CANAGE_3]
(96) [go to DIBEV]
IF SEX=1 (MALE) and No. (6,18,29) selected [go to ERR1_CANKIND_3]
Hard Edit:
IF SEX=2 (FEMALE) and No. (20,26) selected [go to ERR2_CANKIND_3]
ERR1_CANKIND_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_3
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.004

Instrument Variable Name: CANKIND_4
Questionnaire File Name: Sample Adult
Question Text:

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

95 More than three kinds
96 No more

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

(95,96) [go to DIBEV]

Question ID: ACN.150_00.001

Questionnaire File Name:
Instrument Variable Name: CANAGE_1
Question Text:

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

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

Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:

(1-100, D) go to CANKIND_2
(R) and (R) at CANKIND_1 [go to DIBEV]
(R) and CANKIND_1 NE (R) [go to CANKIND_2]
If number in CANAGE_1 greater than person years old (AGE) [go to ERR_ CANAGE_1]
Hard Edit: ERR_ CANAGE_1
* [Fill2: CANAGE_1] years old is older than age[fill3: AGE].
* Please correct.
Sample Adult

Question ID: ACN.150_00.002

Questionnaire File Name:
Instrument Variable Name: CANAGE_2
Question Text:

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

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

Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:

(1-100, D) [go to CANKIND_3]
(R) and (R) at CANKIND_2 [go to DIBEV]
(R) and CANKIND_2 NE (R) [go to CANKIND_3]
If number in CANAGE_2 greater than person years old (AGE) [go to ERR_ CANAGE_2]
Hard Edit: ERR_ CANAGE_2
* [Fill2: CANAGE_2] years old is older than your age[fill3: AGE].
* Please correct.
Sample Adult

Question ID: ACN.150_00.003

Instrument Variable Name: CANAGE_3
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:

(1-100, D) [go to CANKIND_4]
(R) and (R) at CANKIND_3 [go to DIBEV]
(R) and CANKIND_3 NE (R) [go to CANKIND_4]
If number in CANAGE_3 greater than person years old (AGE) [go to ERR_ CANAGE_3]
Hard Edit: ERR_ CANAGE_3
* [Fill2: CANAGE_3] years old is older than your age[fill3: AGE].
* Please correct.

Question ID: ACN.160_00.000

Instrument Variable Name: DIBEV
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.165_00.000

Instrument Variable Name: DIBPRE1
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were never told they had diabetes, or who refused or said don?t know to having been told they had diabetes
Skip Instructions:

(1) [go to INSLN]
(2,R,D) [go to EPILEP1]

Question ID: ACN.170_00.000

Instrument Variable Name: DIBAGE
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
How old were you when a doctor or other health professional FIRST told you that you had diabetes or sugar diabetes?

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

Universe Text: Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy)
Skip Instructions:

(1-100 R,D) [go to INSLN]
If number in DIBAGE greater than person years old (AGE) [go to ERR_ DIBAGE]
Hard Edit: ERR_ DIBAGE
* [Fill1: DIBAGE] years old is older than your age[fill2: AGE].
* Please correct.

Question ID: ACN.180_00.000

Instrument Variable Name: INSLN
Questionnaire File Name: Sample Adult
Question Text:

Are you NOW taking insulin?

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.190_00.000

Instrument Variable Name: DIBPILL
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

(1,2,R,D) [go to EPILEP1]

Question ID: ACN.192_00.010

Instrument Variable Name: EPILEP1
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to EPILEP2]
(2,R,D) [go to AHAYFYR]

Question ID: ACN.192_00.020

Instrument Variable Name: EPILEP2
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Skip Instructions:

(1,2,R,D) [go to EPILEP3]

Question ID: ACN.192_00.030

Instrument Variable Name: EPILEP3
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Skip Instructions:

(0-4,R,D) [go to EPILEP4]

Question ID: ACN.192_00.040

Instrument Variable Name: EPILEP4
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Skip Instructions:

(1,2,R,D) [go to EPILEP5]

Question ID: ACN.192_00.050

Instrument Variable Name: EPILEP5
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who have ever been told they have epilepsy or a seizure disorder
Skip Instructions:

(1-5,R,D) [go to AHAYFYR]

Question ID: ACN.201_01.000

Instrument Variable Name: AHAYFYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.201_02.000

Instrument Variable Name: SINYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.201_03.000

Instrument Variable Name: CBRCHYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.201_04.000

Instrument Variable Name: KIDWKYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.201_05.000

Instrument Variable Name: LIVYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.250_00.000

Instrument Variable Name: JNTSYMP
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to JMTHP]
(2,R,D) [go to ARTH]

Question ID: ACN.260_00.000

Instrument Variable Name: JMTHP
Questionnaire File Name: Sample Adult
Question Text:

(book) A5
Which joints are affected?
* Enter all that apply, separate with commas.

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

Universe Text: Sample adults 18+ who had joint pain in the past 30 days
Skip Instructions:

(1-17,R,D) [go to JNTCHR]

Question ID: ACN.270_00.000

Instrument Variable Name: JNTCHR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had joint pain in the past 30 days
Skip Instructions:

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

Question ID: ACN.280_00.000

Instrument Variable Name: JNTHP
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had joint pain in the past 30 days
Skip Instructions:

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

Question ID: ACN.290_00.000

Instrument Variable Name: ARTH
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ARTHLMT]
(2,R,D) if JNTSYMP = 1 [go to ARTHLMT];
elseif JNTSYMP ne 1 [go to CTSEVER]

Question ID: ACN.295_00.000

Instrument Variable Name: ARTHLMT
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ with joint pain or arthritis
Skip Instructions:

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

Question ID: ACN.296_00.010

Instrument Variable Name: CTSEVER
Questionnaire File Name: Sample Adult
Question Text:

Have you EVER been told by a doctor or other health professional that you have a condition affecting the wrist and hand called carpal tunnel syndrome?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to CTSYR]
(2,R,D) [go to PAINECK]

Question ID: ACN.296_00.020

Instrument Variable Name: CTSYR
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you had carpal tunnel syndrome?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever been told by a doctor or other health professional that they have carpal tunnel syndrome
Skip Instructions:

(1) [if DOINGLW2 IN(1,2,4), then go to CTSWKREL;
else go to PAINECK]
(2,R,D) [go to PAINECK]

Question ID: ACN.297_00.010

Instrument Variable Name: CTSWKREL
Questionnaire File Name: Sample Adult
Question Text:

Have you ever been told by a doctor or other health professional that your carpal tunnel syndrome was probably work related?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed and had carpal tunnel syndrome in the past 12 months
Skip Instructions:

(1,R,D) [go to PAINECK]
(2) [go to CTSWKRL2]

Question ID: ACN.297_00.020

Instrument Variable Name: CTSWKRL2
Questionnaire File Name: Sample Adult
Question Text:

Did YOU ever discuss with a doctor or other health professional whether your carpal tunnel syndrome was probably caused by your work?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed, had carpal tunnel syndrome in the past 12 months, and were not told by a doctor or other health professional that their carpal tunnel syndrome was probably work-related
Skip Instructions:

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

Question ID: ACN.300_00.000

Instrument Variable Name: PAINECK
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.310_00.000

Instrument Variable Name: PAINLB
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to PAINLEG]
(2,R,D) [go to PAINFACE]

Question ID: ACN.320_00.000

Instrument Variable Name: PAINLEG
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ with low back pain in the past 3 months
Skip Instructions:

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

Question ID: ACN.325_00.010

Instrument Variable Name: LBPFREQ
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST THREE MONTHS, how often did you have low back pain? Would you say...
* Read categories below.

1 Some days
2 Most days
3 Every day
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had low back pain in the past 3 months
Skip Instructions:

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

Question ID: ACN.325_00.020

Instrument Variable Name: LBPSEV
Questionnaire File Name: Sample Adult
Question Text:

Thinking about the last time you had pain, how much pain did you have? Would you say?
* Read categories below.

1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had low back pain in the past 3 months
Skip Instructions:

(1-3,R,D) if DOINGLW IN(1,2,4), [go to LBPWKREL];
else go to PAINFACE

Question ID: ACN.325_00.030

Instrument Variable Name: LBPWKREL
Questionnaire File Name: Sample Adult
Question Text:

Have you ever been told by a doctor or other health professional that your low back pain was probably work-related?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed and had low back pain in the past 3 months
Skip Instructions:

(1,R,D) [go to LBPWCCLM]
(2) [go to LBPWKRL2]

Question ID: ACN.325_00.040

Instrument Variable Name: LBPWKRL2
Questionnaire File Name: Sample Adult
Question Text:

Did YOU ever discuss with a doctor or other health professional whether your low back pain was probably caused by your work?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed and had low back pain in the past 3 months and a doctor or other health did not say that the low back pain was probably work-related
Skip Instructions:

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

Question ID: ACN.325_00.050

Instrument Variable Name: LBPWCCLM
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Have you ever filed a workers' compensation claim for your low back pain?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed and had low back pain in the past 3 months
Skip Instructions:

(1) [go to LBPWCBEN]
(2,R,D) [go to LBPWKDAY]

Question ID: ACN.325_00.060

Instrument Variable Name: LBPWCBEN
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Have you ever received workers' compensation benefits for your low back pain?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed and had low back pain in the past 3 months and a workers' compensation claim was filed for the low back pain
Skip Instructions:

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

Question ID: ACN.325_00.070

Instrument Variable Name: LBPWKDAY
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST THREE MONTHS, how many full days did you miss from work because of your low back pain?
* Enter '0' for None.

00-92 0-92
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who are currently employed and had low back pain in the past 3 months
Skip Instructions:

(0-92,R,D) [go to LBPCHJOB]

Question ID: ACN.325_00.080

Instrument Variable Name: LBPCHJOB
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST THREE MONTHS, did you stop working, change jobs, or make a major change in your work activities, such as taking on lighter duties, because of your low back pain?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are currently employed and had low back pain in the past 3 months
Skip Instructions:

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

Question ID: ACN.331_01.000

Instrument Variable Name: PAINFACE
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.331_02.000

Instrument Variable Name: AMIGR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to ACOLD2W]

Question ID: ACN.350_00.000

Instrument Variable Name: ACOLD2W
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [go to AINTIL2W]

Question ID: ACN.360_00.000

Instrument Variable Name: AINTIL2W
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: ACN.370_00.000

Instrument Variable Name: PREGNOW
Questionnaire File Name: Sample Adult
Question Text:

Are you currently pregnant?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18-49 years of age
Skip Instructions:

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

Question ID: ACN.370_00.010

Instrument Variable Name: PREGFLYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

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

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

Question ID: ACN.400_00.000

Instrument Variable Name: HRAIDNOW
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AHEARST1]
(2,R,D) [go to HRAIDEV]

Question ID: ACN.410_00.000

Instrument Variable Name: HRAIDEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
3 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who do not now use a hearing aid or REF/DK whether they now use a hearing aid
Skip Instructions:

(1,2,R,D) [go to AHEARST1]

Question ID: ACN.420_00.000

Instrument Variable Name: AHEARST1
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-6,R,D) [go to AVISION]

Question ID: ACN.430_00.000

Instrument Variable Name: AVISION
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ABLIND]
(2,R,D) [go to LUPPRT]

Question ID: ACN.440_00.000

Instrument Variable Name: ABLIND
Questionnaire File Name: Sample Adult
Question Text:

Are you blind or unable to see at all?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have trouble seeing even when wearing glasses/contact lenses
Skip Instructions:

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

Question ID: ACN.451_00.000

Instrument Variable Name: LUPPRT
Questionnaire File Name: Sample Adult
Question Text:

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

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: AHS.040_00.000

Instrument Variable Name: WKDAYR
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who worked or had a job or business with or without pay in the last week or who had a job or business in the past 12 months
Skip Instructions:

(0-366,R,D) [go to BEDDAYR]
(120-366) [go to ERR_WKDAYR]
Soft Edit: ERR_WKDAYR
* [Fill: WKDAYR] is an unusually large number.
* Please verify.

Question ID: AHS.050_00.000

Instrument Variable Name: BEDDAYR
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+
Skip Instructions:

(0-366,R,D) [go to AHSTATYR]
(120-366) [go to ERR_BEDDAYR]
Soft Edit: ERR_BEDDAYR
* [Fill: BEDDAYR] is an unusually large number.
* Please verify.

Question ID: AHS.060_00.000

Instrument Variable Name: AHSTATYR
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.070_00.000

Instrument Variable Name: SPECEQ
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.091_01.000

Instrument Variable Name: FLWALK
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or emotional problem or illness (not including pregnancy).
By yourself, and without using any special equipment, how difficult is it for you to...
...Walk a quarter of a mile - about 3 city blocks?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.091_02.000

Instrument Variable Name: FLCLIMB
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Walk up 10 steps without resting?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.091_03.000

Instrument Variable Name: FLSTAND
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Stand or be on your feet for about 2 hours?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.091_04.000

Instrument Variable Name: FLSIT
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Sit for about 2 hours?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.091_05.000

Instrument Variable Name: FLSTOOP
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Stoop, bend, or kneel?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.091_06.000

Instrument Variable Name: FLREACH
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Reach up over your head?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.141_01.000

Instrument Variable Name: FLGRASP
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Use your fingers to grasp or handle small objects?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.141_02.000

Instrument Variable Name: FLCARRY
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Lift or carry something as heavy as 10 pounds such as a full bag of groceries?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.141_03.000

Instrument Variable Name: FLPUSH
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Push or pull large objects like a living room chair?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.171_01.000

Instrument Variable Name: FLSHOP
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Go out to things like shopping, movies, or sporting events?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.171_02.000

Instrument Variable Name: FLSOCL
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.171_03.000

Instrument Variable Name: FLRELAX
Questionnaire File Name: Sample Adult
Question Text:

(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHS.200_00.000

Instrument Variable Name: AFLHCA
Questionnaire File Name: Sample Adult
Question Text:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for all that apply, separate with commas.
* Do not probe, except to clarify answer.

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

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

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

Question ID: AHS.201_90.000

Instrument Variable Name: AFLHCA_S1
Questionnaire File Name: Sample Adult
Question Text:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9Don't know

Universe Text: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least one condition not listed in AFLHCA
Skip Instructions:

(50 chars)[go to AHCL90N]
)ENTER( only with no description [go to ERR1_AFLHCA_S1]
Else go to the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order, as specified in AFLHCA
Hard Edit: $ You should enter something specific.

Question ID: AHS.201_91.000

Instrument Variable Name: AFLHCA_S2
Questionnaire File Name: Sample Adult
Question Text:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

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

(50 chars)[go to AHCL91N]
)ENTER( only with no description [go to ERR1_AFLHCA_S1]
Hard Edit: $ You should enter something specific.

Question ID: AHS.300_01.000

Instrument Variable Name: AHCL01N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to a vision problem or problem seeing
Skip Instructions:

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

Question ID: AHS.300_02.000

Instrument Variable Name: AHCL01T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL01T
[if [AHCL01N = Number greater than person years old and AHCL01T= 4]] go to
ERR1_AHCL01T
Hard Edit: ERR1_AHCL01T
*Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL01T
* "6" not selectable.

Question ID: AHS.301_01.000

Instrument Variable Name: AHCL02N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to a hearing problem
Skip Instructions:

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

Question ID: AHS.301_02.000

Instrument Variable Name: AHCL02T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL02T
[if [AHCL02N = Number greater than person years old and AHCL02T= 4]] go to
ERR1_AHCL02T
Hard Edit: ERR1_AHCL02T
* Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL02T
* "6" not selectable.

Question ID: AHS.302_01.000

Instrument Variable Name: AHCL03N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to arthritis or rheumatism
Skip Instructions:

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

Question ID: AHS.302_02.000

Instrument Variable Name: AHCL03T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL03T
[if [AHCL03N = Number greater than person years old and AHCL03T= 4]] go to
ERR1_AHCL03T
Hard Edit: ERR_AHCL03T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.303_01.000

Instrument Variable Name: AHCL04N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to a back or neck problem
Skip Instructions:

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

Question ID: AHS.303_02.000

Instrument Variable Name: AHCL04T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL04T
[if [AHCL04N = Number greater than person years old and AHCL04T= 4]] go to
ERR1_AHCL04T
Hard Edit: ERR_AHCL04T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.304_01.000

Instrument Variable Name: AHCL05N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to a fracture, bone, or joint injury
Skip Instructions:

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

Question ID: AHS.304_02.000

Instrument Variable Name: AHCL05T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL05T
[if [AHCL05N = Number greater than person years old and AHCL05T= 4]] go to
ERR1_AHCL05T
Hard Edit: ERR_AHCL05T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.305_01.000

Instrument Variable Name: AHCL06N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
9595+
96 Since birth
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who had difficulty due to an injury other than a fracture, bone, or joint injury
Skip Instructions:

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

Question ID: AHS.305_02.000

Instrument Variable Name: AHCL06T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

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

Question ID: AHS.306_01.000

Instrument Variable Name: AHCL07N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to a heart problem
Skip Instructions:

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

Question ID: AHS.306_02.000

Instrument Variable Name: AHCL07T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL07T
[if [AHCL07N = Number greater than person years old and AHCL07T= 4]] go to
ERR1_AHCL07T
Hard Edit: ERR_AHCL07T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.307_01.000

Instrument Variable Name: AHCL08N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to a stroke problem
Skip Instructions:

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

Question ID: AHS.307_02.000

Instrument Variable Name: AHCL08T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL08T
[if [AHCL08N = Number greater than person years old and AHCL08T= 4]] go to
ERR1_AHCL08T
Hard Edit: ERR_AHCL08T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.308_01.000

Instrument Variable Name: AHCL09N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to hypertension or high blood pressure
Skip Instructions:

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

Question ID: AHS.308_02.000

Instrument Variable Name: AHCL09T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL09T
[if [AHCL09N = Number greater than person years old and AHCL09T= 4]] go to
ERR1_AHCL09T
Hard Edit: ERR_AHCL09T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.309_01.000

Instrument Variable Name: AHCL10N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to diabetes
Skip Instructions:

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

Question ID: AHS.309_02.000

Instrument Variable Name: AHCL10T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

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

Question ID: AHS.310_01.000

Instrument Variable Name: AHCL11N
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
How long have you had a lung or breathing problem (e.g. asthma and emphysema)?
* Enter number for time with a lung or breathing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

Universe Text: Sample adults 18+ who had difficulty due to a lung or breathing problem
Skip Instructions:

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

Question ID: AHS.310_02.000

Instrument Variable Name: AHCL11T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL11T
[if [AHCL11N = Number greater than person years old and AHCL11T= 4]] go to
ERR1_AHCL11T
Hard Edit: ERR_AHCL11T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.311_01.000

Instrument Variable Name: AHCL12N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to cancer
Skip Instructions:

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

Question ID: AHS.311_02.000

Instrument Variable Name: AHCL12T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL12T
[if [AHCL12N = Number greater than person years old and AHCL12T= 4]] go to
ERR1_AHCL12T
Hard Edit: ERR_AHCL12T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.313_01.000

Instrument Variable Name: AHCL14N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to intellectual disability/mental retardation
Skip Instructions:

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

Question ID: AHS.313_02.000

Instrument Variable Name: AHCL14T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL14T
[if [AHCL14N = Number greater than person years old and AHCL14T= 4]] go to
ERR1_AHCL14T
Hard Edit: ERR_AHCL14T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.314_01.000

Instrument Variable Name: AHCL15N
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
How long have you had a developmental problem (e.g., cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

Universe Text: Sample adults 18+ who had difficulty due to a developmental problem
Skip Instructions:

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

Question ID: AHS.314_02.000

Instrument Variable Name: AHCL15T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL15T
[if [AHCL15N = Number greater than person years old and AHCL15T= 4]] go to
ERR1_AHCL15T
Hard Edit: ERR_AHCL15T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.315_01.000

Instrument Variable Name: AHCL16N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to senility
Skip Instructions:

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

Question ID: AHS.315_02.000

Instrument Variable Name: AHCL16T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL16T
[if [AHCL16N = Number greater than person years old and AHCL16T= 4]] go to
ERR1_AHCL16T
Hard Edit: ERR_AHCL16T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.316_01.000

Instrument Variable Name: AHCL17N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to depression, anxiety, or an emotional problem
Skip Instructions:

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

Question ID: AHS.316_02.000

Instrument Variable Name: AHCL17T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL17T
[if [AHCL17N = Number greater than person years old and AHCL17T= 4]] go to
ERR1_AHCL17T
Hard Edit: ERR_AHCL17T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.317_01.000

Instrument Variable Name: AHCL18N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to a weight problem
Skip Instructions:

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

Question ID: AHS.317_02.000

Instrument Variable Name: AHCL18T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL18T
[if [AHCL18N = Number greater than person years old and AHCL18T= 4]] go to
ERR1_AHCL18T
Hard Edit: ERR_AHCL18T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.318_01.000

Instrument Variable Name: AHCL19N
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
How long have you had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.

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

Universe Text: Sample adults 18+ who had difficulty due to a missing limb
Skip Instructions:

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

Question ID: AHS.318_02.000

Instrument Variable Name: AHCL19T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL19T
[if [AHCL19N = Number greater than person years old and AHCL19T= 4]] go to
ERR1_AHCL19T
Hard Edit: ERR_AHCL19T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.319_01.000

Instrument Variable Name: AHCL20N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to a kidney, bladder or renal problem
Skip Instructions:

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

Question ID: AHS.319_02.000

Instrument Variable Name: AHCL20T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL20T
[if [AHCL20N = Number greater than person years old and AHCL20T= 4]] go to
ERR1_AHCL20T
Hard Edit: ERR_AHCL20T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.320_01.000

Instrument Variable Name: AHCL21N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to a circulation problem
Skip Instructions:

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

Question ID: AHS.320_02.000

Instrument Variable Name: AHCL21T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL21T
[if [AHCL21N = Number greater than person years old and AHCL21T= 4]] go to
ERR1_AHCL21T
Hard Edit: ERR_AHCL21T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.321_01.000

Instrument Variable Name: AHCL22N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to benign tumors or cysts
Skip Instructions:

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

Question ID: AHS.321_02.000

Instrument Variable Name: AHCL22T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL22T
[if [AHCL22N = Number greater than person years old and AHCL22T= 4]] go to
ERR1_AHCL22T
Hard Edit: ERR_AHCL22T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.322_01.000

Instrument Variable Name: AHCL23N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to fibromyalgia or lupus
Skip Instructions:

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

Question ID: AHS.322_02.000

Instrument Variable Name: AHCL23T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

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

Question ID: AHS.323_01.000

Instrument Variable Name: AHCL24N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to osteoporosis or tendinitis
Skip Instructions:

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

Question ID: AHS.323_02.000

Instrument Variable Name: AHCL24T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL24T
[if [AHCL24N = Number greater than person years old and AHCL24T= 4]] go to
ERR1_AHCL24T
Hard Edit: ERR_AHCL24T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.324_01.000

Instrument Variable Name: AHCL25N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to epilepsy or seizures
Skip Instructions:

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

Question ID: AHS.324_02.000

Instrument Variable Name: AHCL25T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL25T
[if [AHCL25N = Number greater than person years old and AHCL25T= 4]] go to
ERR1_AHCL25T
Hard Edit: ERR_AHCL25T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.325_01.000

Instrument Variable Name: AHCL26N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to multiple sclerosis or muscular dystrophy
Skip Instructions:

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

Question ID: AHS.325_02.000

Instrument Variable Name: AHCL26T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL26T
[if [AHCL26N = Number greater than person years old and AHCL26T= 4]] go to
ERR1_AHCL26T
Hard Edit: ERR_AHCL26T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.326_01.000

Instrument Variable Name: AHCL27N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to polio(myelitis), paralysis or para/quadriplegia
Skip Instructions:

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

Question ID: AHS.326_02.000

Instrument Variable Name: AHCL27T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL27T
[if [AHCL27N = Number greater than person years old and AHCL27T= 4]] go to
ERR1_AHCL27T
Hard Edit: ERR_AHCL27T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.327_01.000

Instrument Variable Name: AHCL28N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to Parkinson's disease or tremors
Skip Instructions:

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

Question ID: AHS.327_02.000

Instrument Variable Name: AHCL28T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL28T
[if [AHCL28N = Number greater than person years old and AHCL28T= 4]] go to
ERR1_AHCL28T
Hard Edit: ERR_AHCL28T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.328_01.000

Instrument Variable Name: AHCL29N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to nerve damage
Skip Instructions:

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

Question ID: AHS.328_02.000

Instrument Variable Name: AHCL29T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL29T
[if [AHCL29N = Number greater than person years old and AHCL29T= 4]] go to
ERR1_AHCL29T
Hard Edit: ERR_AHCL29T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.329_01.000

Instrument Variable Name: AHCL30N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to a hernia
Skip Instructions:

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

Question ID: AHS.329_02.000

Instrument Variable Name: AHCL30T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL30T
[if [AHCL30N = Number greater than person years old and AHCL30T= 4]] go to
ERR1_AHCL30T
Hard Edit: E
RR_AHCL30T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.330_01.000

Instrument Variable Name: AHCL31N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to an ulcer
Skip Instructions:

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

Question ID: AHS.330_02.000

Instrument Variable Name: AHCL31T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL31T
[if [AHCL31N = Number greater than person years old and AHCL31T= 4]] go to
ERR1_AHCL31T
Hard Edit: ERR_AHCL31T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.331_01.000

Instrument Variable Name: AHCL32N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to varicose veins or hemorrhoids
Skip Instructions:

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

Question ID: AHS.331_02.000

Instrument Variable Name: AHCL32T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL32T
[if [AHCL32N = Number greater than person years old and AHCL32T= 4]] go to
ERR1_AHCL32T
Hard Edit: ERR_AHCL32T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.332_01.000

Instrument Variable Name: AHCL33N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
Skip Instructions:

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

Question ID: AHS.332_02.000

Instrument Variable Name: AHCL33T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL33T
[if [AHCL33N = Number greater than person years old and AHCL33T= 4]] go to
ERR1_AHCL33T
Hard Edit: ERR_AHCL33T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.333_01.000

Instrument Variable Name: AHCL34N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to a knee problem
Skip Instructions:

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

Question ID: AHS.333_02.000

Instrument Variable Name: AHCL34T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL34T
[if [AHCL34N = Number greater than person years old and AHCL34T= 4]] go to
ERR1_AHCL34T
Hard Edit: ERR1_AHCL34T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.334_01.000

Instrument Variable Name: AHCL35N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to migraine headaches
Skip Instructions:

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

Question ID: AHS.334_02.000

Instrument Variable Name: AHCL35T
Questionnaire File Name: Sample Adult
Question Text:

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

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL35T
[if [AHCL35N = Number greater than person years old and AHCL35T= 4]] go to
ERR1_AHCL35T
Hard Edit: ERR1_AHCL35T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.335_01.000

Instrument Variable Name: AHCL90N
Questionnaire File Name: Sample Adult
Question Text:

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

01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who had difficulty due to [problem in AFLHCA90]
Skip Instructions:

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

Question ID: AHS.335_02.000

Instrument Variable Name: AHCL90T
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period for time with [problem in AFLHCA90].

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

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

(1- 4, R,D)[[if 91 selected in AFLHCA go to AFLHCA_S2]
Else go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL90T
[if [AHCL90N = Number greater than person years old and AHCL90T= 4]] go to
ERR1_AHCL90T
Hard Edit: ERR_AHCL90T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.336_01.000

Instrument Variable Name: AHCL91N
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who had difficulty due to [problem in AFLHCA91]
Skip Instructions:

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

Question ID: AHS.336_02.000

Instrument Variable Name: AHCL91T
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period for time with [problem in AFLHCA91].

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

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

(1- 4, R,D)[go to the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, go to SMKEV (next section)]
(6) go to ERR2_AHCL91T
[if [AHCL91N = Number greater than person years old and AHCL91T= 4]] go to
ERR1_AHCL91T
Hard Edit: ERR_AHCL91T
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHB.010_00.000

Instrument Variable Name: SMKEV
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to SMKREG]
(2 [go to SMKANY]
(R) [go to VIGNO]
(D[go to SMKANY]

Question ID: AHB.020_00.000

Instrument Variable Name: SMKREG
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who ever smoked 100 cigarettes
Skip Instructions:

(6-95,96,R,D) [go to SMKNOW]
If SMKREG gt AGE and SMKREG ne (96), go to ERR_SMKREG
Hard Edit: ERR_SMKREG
* Starting age exceeded current age.
* Please correct.

Question ID: AHB.030_00.000

Instrument Variable Name: SMKNOW
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who ever smoked 100 cigarettes
Skip Instructions:

(1)[go to CIGSDA1]
(2)[go to CIGDAMO]
(3)[go to SMKQTNO]
(R,D)[go to VIGNO]

Question ID: AHB.040_01.000

Instrument Variable Name: SMKQTNO
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who quit smoking
Skip Instructions:

(1-95) [go to SMKQTTP]
(R,D) [go to VIGNO]

Question ID: AHB.040_02.000

Instrument Variable Name: SMKQTTP
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who quit smoking
Skip Instructions:

(1-4,R,D) [go to VIGNO]
(4) [if SMKQTNO gt (AGE - (15)), go to ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), go to ERR2_SMKQTTP.
Hard Edit: ERR2_SMKQTTP
* Age started ([Fill1: SMKREG]) + years since quit ([Fill2: SMKQTNO]) exceeds current age ([Fill3: AGE]).
* Please correct.
Soft Edit: ERR1_SMKQTTP
* Respondent quit smoking before age 15?
* Please verify.

Question ID: AHB.050_00.000

Instrument Variable Name: CIGSDA1
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who are current every day smokers
Skip Instructions:

(1-95,R,D) [go to CIGQTYR]

Question ID: AHB.060_00.000

Instrument Variable Name: CIGDAMO
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who are current some day smokers
Skip Instructions:

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

Question ID: AHB.070_00.000

Instrument Variable Name: CIGSDA2
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who are current some day smokers
Skip Instructions:

(1-95,D,R) [go to CIGQTYR]

Question ID: AHB.080_00.000

Instrument Variable Name: CIGQTYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who are every day or someday smokers
Skip Instructions:

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

Question ID: AHB.081_00.000

Instrument Variable Name: SMKANY
Questionnaire File Name: Sample Adult
Question Text:

Have you ever smoked a cigarette EVEN ONE TIME?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have not smoked or don?t know if smoked 100+ cigarettes in lifetime
Skip Instructions:

(1) [go to SMKAGEX]
(2,R,D)[go to VIGNO]

Question ID: AHB.082_00.000

Instrument Variable Name: SMKAGEX
Questionnaire File Name: Sample Adult
Question Text:

How old were you the FIRST TIME you smoked a cigarette?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years or older

06-95 6-95
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who have not smoked or don?t know if smoked 100+ cigarettes in lifetime but have smoked at least one cigarette
Skip Instructions:

(6-95) if SMKAGEX GT AGE [go to ERR_SMKAGEX]; else [go to SMKNOWX]
(R,D) [go to VIGNO]
Hard Edit: ERR_SMKAGEX
* [Fill1: SMKAGEX] years old is older than age[fill2: AGE].
* Please correct.

Question ID: AHB.083_00.000

Instrument Variable Name: SMKNOWX
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who have not smoked or don?t know if smoked 100+ cigarettes in lifetime but have smoked at least one cigarette and gave an age in SMKAGEX question
Skip Instructions:

(R,D) [go to VIGNO]
(1,2) [go to CIGDAMOX]
(3) [go to SMKNONOX]

Question ID: AHB.084_01.000

Instrument Variable Name: SMKNONOX
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
How long has it been since you smoked a cigarette?
* Enter number for time since smoked.
* Enter '95' for 95 or more.

01-95 1-95
96 Since birth
97 Refused
99 Don?t know

Universe Text: Sample adults 18+ who have not smoked 100 cigarettes in lifetime but have smoked a cigarette at least once in lifetime and are currently not smoking at all
Skip Instructions:

(1-95) [go to SMKNOTPX]
(R,D) [go to VIGNO

Question ID: AHB.084_02.000

Instrument Variable Name: SMKNOTPX
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period for time since smoked a cigarette

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

Universe Text: Sample adults 18+ who have not smoked 100 cigarettes in lifetime but have smoked a cigarette at least once in lifetime and are currently not smoking at all and answered 1-95 to the number part of this question
Skip Instructions:

(1-4,R,D) [go to VIGNO]
(4) [if SMKNONOX gt (AGE - (15)), go to ERR1_SMKNOTPX
if (SMKAGEX + SMKNONOX gt AGE), go to ERR2_SMKNOTPX
Hard Edit: ERR2_SMKNOTPX
* Age started ([Fill1: SMKAGEX]) + years since last cigarette ([Fill2: SMKNONOX]) exceeds current age ([Fill3: AGE]).
Soft Edit: ERR1_SMKNOTPX
* Respondent LAST SMOKED before age 15?
* Please verify.

Question ID: AHB.085_00.000

Instrument Variable Name: CIGDAMOX
Questionnaire File Name: Sample Adult
Question Text:

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

00-30 0-30
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have not smoked or don?t know if smoked 100+ cigarettes in lifetime and are current every day or some day smokers
Skip Instructions:

(0-30,R,D) [go to VIGNO]

Question ID: AHB.090_01.000

Instrument Variable Name: VIGNO
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHB.090_02.000

Instrument Variable Name: VIGTP
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who do vigorous activities
Skip Instructions:

(1-4) go to VIGLNGNO
[if (VIGNO gt (4) and VIGTP eq (1)) or
(VIGNO gt (28) and VIGTP eq (2)) or
(VIGNO gt (31) and VIGTP eq (3)) or
(VIGNO gt (365) and VIGTP eq (4)) go to ERR1_VIGTP]
Soft Edit: ERR1_VIGTP
* [Fill1: VIGNO] times per [Fill2: VIGTP] is unusually high.
* Please verify.

Question ID: AHB.100_01.000

Instrument Variable Name: VIGLNGNO
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who do vigorous activities
Skip Instructions:

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

Question ID: AHB.100_02.000

Instrument Variable Name: VIGLNGTP
Questionnaire File Name: Sample Adult
Question Text:

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

1 Minutes
2 Hours
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who do vigorous activities
Skip Instructions:

(1,2)go to MODNO
if VIGLNGNO lt (10) and VIGLNGTP eq (1) go to ERR1_VIGLNGTP;
if (VIGLNGNO gt (90) and VIGLNGTP eq (1)) or if VIGLNGNO gt (2) and VIGLNGTP eq (2) go to
ERR2_VIGLNGTP
Hard Edit: ERR1_VIGLNGTP
* Question asked for activities lasting at least 10 minutes.
* Please correct.
Soft Edit: ERR2_VIGLNGTP
* [Fill1: VIGLNGNO] [fill2: VIGLNGTP] is unusually high.
* Please verify.

Question ID: AHB.110_01.000

Instrument Variable Name: MODNO
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHB.110_02.000

Instrument Variable Name: MODTP
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who do light or moderate activities
Skip Instructions:

(1-4) go to MODLNGNO
[if (MODNO gt (4) and MODTP eq (1)) or
(MODNO gt (28) and MODTP eq (2)) or
(MODNO gt (31) and MODTP eq (3)) or
(MODNO gt (365) and MODTP eq (4))] go to ERR_MODNO
Soft Edit: ERR_MODNO
* [Fill1: MODNO] times per [fill2: MODTP] is unusually high.
* Please verify.

Question ID: AHB.120_01.000

Instrument Variable Name: MODLNGNO
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+ who do light or moderate activities
Skip Instructions:

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

Question ID: AHB.120_02.000

Instrument Variable Name: MODLNGTP
Questionnaire File Name: Sample Adult
Question Text:

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

1 Minutes
2 Hours
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who do light or moderate activities
Skip Instructions:

(1,2) go to STRNGNO
if MODLNGNO lt (10) and MODLNGTP eq (1) go to ERR1_MODLNGTP
if MODLNGNO gt (90) and MODLNGTP eq (1) or if MODLNGNO gt (2) and MODLNGTP eq (2)go to
ERR2_MODLNGTP
Hard Edit: ERR1_MODLNGTP
* Question asked for activities lasting at least 10 minutes.
* Please correct.
Soft Edit: ERR2_MODLNGTP
* [Fill1: MODLNGNO] [Fill2: MODLNGTP] is unusually high.
* Please verify.

Question ID: AHB.130_01.000

Instrument Variable Name: STRNGNO
Questionnaire File Name: Sample Adult
Question Text:

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

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

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AHB.130_02.000

Instrument Variable Name: STRNGTP
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period for strengthening activities

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

Universe Text: Sample adults 18+ who do strengthening activities
Skip Instructions:

(1-4) [go to ALC1YR]
[If (STRNGNO gt (4) AND STRNGTP = (1)) or (STRNGNO gt (28) AND STRNGTP = (2)) or
(STRNGNO gt (31) AND STRNGTP = (3)) or (STRNGNO gt (365) AND STRNGTP = (4)) go to
ERR_STRNGTP]
Soft Edit: ERR_STRNGTP
* [Fill1: STRNGNO] times per [Fill2: STRNGTP] is unusually high.
* Please verify.

Question ID: AHB.140_00.000

Instrument Variable Name: ALC1YR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ALC12MNO]
(2,R,D) [go to ALCLIFE]

Question ID: AHB.150_00.000

Instrument Variable Name: ALCLIFE
Questionnaire File Name: Sample Adult
Question Text:

In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did or refused to answer
Skip Instructions:

(1) [go to ALC12MNO]
(2,R,D) [go to AHGT_FT]

Question ID: AHB.160_01.000

Instrument Variable Name: ALC12MNO
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcoholic beverages were consumed in the past year.
*Enter '0' for Never.

000 Never
001-365 1-365 days
997 Refused
999 Don't know

Universe Text: Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks in their entire life
Skip Instructions:

(1-365)[go to ALC12MTP]
(0,D,R)[go to AHGT_FT]

Question ID: AHB.160_02.000

Instrument Variable Name: ALC12MTP
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period for how often alcoholic beverages were consumed in the past year.

0 Never/None
1 Week
2 Month
3 Year
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who drank at least once in the past year
Skip Instructions:

(1-3) [go to ALCAMT]
[If (ALC12MNO gt (7) AND ALC12MTP = (1)) or (ALC12MNO gt (31) AND ALC12MTP = (2)) or
(ALC12MNO gt (365) AND ALC12MTP = (3)) go to ERR_ALC12MTP]
Hard Edit: ERR_ALC12MTP
* [Fill1: ALC12MNO] days per [Fill2: ALC12MTP] exceeds number possible in this time period.
* Please correct.

Question ID: AHB.170_00.000

Instrument Variable Name: ALCAMT
Questionnaire File Name: Sample Adult
Question Text:

In the PAST YEAR, on those days that you drank alcoholic beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.

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

Universe Text: Sample adults 18+ who have had at least 1 drink in the past year
Skip Instructions:

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

Question ID: AHB.180_01.000

Instrument Variable Name: ALC5UPNO
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
1 of 2
In the PAST YEAR, on how many DAYS did you have [fill: 5 or more/4 or more] drinks of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have [fill: 5 or more/4 or more] drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.

000 Never/None
001-365 1-365 days
997 Refused
999 Don't know

Universe Text: Sample adults 18+ who have had at least 1 drink in the past year
Skip Instructions:

(1-365)[go to ALC5UPTP]
(0,R,D)[go to AHGT_FT]

Question ID: AHB.180_02.000

Instrument Variable Name: ALC5UPTP
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
* Enter time period for days per week, per month or per year.

0 Never/None
1 Per week
3 Per month
4 Per year
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least once in the past year
Skip Instructions:

(1-3) [go to BINGE1]
[If (ALC5UPNO gt (7) AND ALC5UPTP = (1)) or
(ALC5UPNO gt (31) AND ALC5UPTP = (2)) or
(ALC5UPNO gt (365) AND ALC5UPTP = (3)) go to ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP) lt number of days per year with 5 or more (for males)/4+ (females) drinks (calculated from ALC5UPNO and ALC5UPTP)] go to
ERR2_ALC5UPTP]
Hard Edit: ERR1_ALC5UPTP
* [Fill1: ALC5UPNO] days per [Fill2: ALC5UPTP] exceeds number possible in this time period.
* Please correct
ERR2_ALC5UPTP
* Number of days had [fill: 5 or more/4 or more] drinks exceeds number of days drank.
* Please correct.
* Do not probe.

Question ID: AHB.181_00.000

Instrument Variable Name: BINGE1
Questionnaire File Name: Sample Adult
Question Text:

? [F1]
Considering all types of alcoholic beverages, DURING THE PAST 30 DAYS, how many times did you have [fill: 5 or more/4 or more] drinks on an occasion?
* Enter '0' if none.
* Enter '60' if 60 or more times.

00-60 0-60
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least once in the past year
Skip Instructions:

(0-60,R,D) [go to AHGT_FT]

Question ID: AHB.190_01.000

Instrument Variable Name: AHGT_FT
Questionnaire File Name: Sample Adult
Question Text:

How tall are you without shoes?
* Enter "M" to record metric measurements

02-07 2-7 feet
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(2-7) [go to AHGT_IN]
(R.D) [go to AWGT_LB]
(M) [go to AHGT_M]
[if AHGT_FT NE(2-7,R,D,M) go to ERR1_AHGT_FT]
[if AHGT_FT = (2,3) go to ERR2_AHGT_FT]
Hard Edit: ERR1_AHGT_FT
* Only 2-7, Don't Know/Refused or M allowed in this field.
* Please correct.
Soft Edit: ERR2_AHGT_FT
* Respondent's height in feet is [fill: AHGT_FT]?
* Please verify.

Question ID: AHB.190_02.000

Instrument Variable Name: AHGT_IN
Questionnaire File Name: Sample Adult
Question Text:

How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.

00-11 0-11 inches
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who answered their height in feet
Skip Instructions:

(empty) go to ERR_AHGT_IN
(0-11,R,D) if (SEX = ?1? and (AHTINCH lt ?61? or AHTINCH gt ?75?)) or
(SEX = ?2? and (AHTINCH lt ?56? or AHTINCH gt ?69?))
go to ERR2_AHGT_IN
else
go to AWGT_LB
Hard Edit: ERR1_AHGT_IN
* If [fill: AHGT_FT] feet exactly, enter "0"; otherwise enter number of inches.
Soft Edit: ERR2_AHGT_IN
* Please verify that the height was entered correctly. Probe only if necessary.

Question ID: AHB.190_03.000

Instrument Variable Name: AHGT_M
Questionnaire File Name: Sample Adult
Question Text:

How tall are you without shoes?
* Enter height in metric.

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

Universe Text: Sample adults 18+ who choose to give their height in metric measurements
Skip Instructions:

(empty) go to ERR_AHGT_M
(0-2) go to AHGT_CM
(R,D) go to AWGT_LB
Hard Edit: ERR_AHGT_M
* If height is being given in centimeters only, enter "0"; otherwise enter number of meters.

Question ID: AHB.190_04.000

Instrument Variable Name: AHGT_CM
Questionnaire File Name: Sample Adult
Question Text:

*Enter centimeters.

000-241 0-241 centimeters
997 Refused
999 Don?t know

Universe Text: Sample adults 18+ who answered their height in meters
Skip Instructions:

(empty) go to ERR2_AHGT_CM
(0-241,R,D) if (AHGT_M eq ?2? and AHGT_CM gt ?41?) or (AHGT_M eq ?1? and AHGT_CM gt ?141?)
go to ERR1_AHGT_CM
elseif (SEX = ?1? and (AHTCM lt ?156? or AHTCM gt ?192?)) or
(SEX = ?2? and (AHTCM lt ?143? or AHTCM gt ?176?))
go to ERR3_AHGT_CM
else
go to AWGT_LB
Hard Edit: ERR1_AHGT_CM
* Total height exceeds maximum allowed.
* Please correct.
ERR2_AHGT_CM
* If [fill: AHGT_M] meters exactly, enter "0"; otherwise enter number of centimeters.
Soft Edit: ERR3_AHGT_CM
* Please verify that the height was entered correctly. Probe only if necessary.

Question ID: AHB.200_01.000

Instrument Variable Name: AWGT_LB
Questionnaire File Name: Sample Adult
Question Text:

How much do you weigh without shoes?
* Enter "M" to record metric measurements
* Enter '500' for 500 pounds or more

050-500 50-500 pounds
997 Refused
999 Don't know
M Metric

Universe Text: Sample adults 18+
Skip Instructions:

(50-500) if AWGT_LB lt ?50? or AWGT_LB gt ?500?
go to ERR1_AWGT_LB
elseif ((SEX = ?1? and (AWGT_LB lt ?113? or AWGT_LB gt ?316?)) or
((SEX = ?2? and (AWGT_LB lt ?96? or AWGT_LB gt ?293?))
go to ERR2_AWGT_LB
elseif AHGT_FLG = ?1? and AWGT_FLG = ?1?
[go to next section]
else
calculate the BMI (Body Mass Index) - See BMI spec page
(R,D) [go to next section]
Hard Edit: ERR1_AWGT_LB
* Weight is out of range (50-500).
* Please correct.
Soft Edit: ERR2_AWGT_LB
* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID: AHB.200_02.000

Instrument Variable Name: AWGT_KG
Questionnaire File Name: Sample Adult
Question Text:

How much do you weigh without shoes?
* Enter weight in kilograms

023-226 23-226 kilograms
997 Refused
999 Don't know

Universe Text: Sample adults 18+ who choose to give their weight in metric measurements
Skip Instructions:

(23-226) if AWGT_KG lt ?23? or AWGT_KG gt ?226?
go to ERR1_AWGT_KG
elseif ((SEX = ?1? and (AWGT_KG lt ?51? or AWGT_KG gt ?143?)) or
((SEX = ?2? and (AWGT_KG lt ?43? or AWGT_KG gt ?133?))
go to ERR2_AWGT_KG
elseif AHGT_FLG = ?1? and AWGT_FLG = ?1?
go to next section
else
calculate the BMI (Body Mass Index) - See BMI spec page
(R,D) go to next section
Hard Edit: ERR1_AWGT_KG
*Weight is out of range (23-226).
* Please correct.
Soft Edit: ERR2_AWGT_KG
* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID: AAU.020_00.000

Instrument Variable Name: AUSUALPL
Questionnaire File Name: Sample Adult
Question Text:

Is there a place that you USUALLY go to when you are sick or need advice about your health?

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

Universe Text: Sample adults 18+
Skip Instructions:

(1-3) [go to APLKIND]
(2,R,D) [go to AHCPLKND]

Question ID: AAU.030_00.000

Instrument Variable Name: APLKIND
Questionnaire File Name: Sample Adult
Question Text:

[Fill1: What kind of place is it - a clinic, doctor's office, emergency room, or some other place?
[Fill2: What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?]

1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know

Universe Text: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice
Skip Instructions:

(1-5) [go to AHCPLROU]
(6,R,D) [go to AHCPLKND]

Question ID: AAU.035_00.000

Instrument Variable Name: AHCPLROU
Questionnaire File Name: Sample Adult
Question Text:

Is that [fill: place from (APLKIND)] the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults aged 18+ years having a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some other place that they usually go to when they are sick or need advice about their health
Skip Instructions:

(1) [go to AHCCHGYR]
(2,R,D) [go to AHCPLKND]

Question ID: AAU.037_00.000

Instrument Variable Name: AHCPLKND
Questionnaire File Name: Sample Adult
Question Text:

What kind of place do you USUALLY go to when you need routine or preventive care, such as a physical examination or check-up?

0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know

Universe Text: Sample Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a usual source of sick care; who have a usual source of sick care but do not go to one place most often or Ref/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source of sick care but Ref/DK if it is same place as usual source of routine/preventive care.
Skip Instructions:

(0-6,R,D) if AUSUALPL=2,R,D [go to APRVTRYR]; ELSE [go to AHCCHGYR]

Question ID: AAU.040_00.000

Instrument Variable Name: AHCCHGYR
Questionnaire File Name: Sample Adult
Question Text:

At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who reported same place as usual source of routine/preventive care]
Skip Instructions:

(1)[go to AHCCHGHI]
(2,R,D)[go to APRVTRYR]

Question ID: AAU.050_00.000

Instrument Variable Name: AHCCHGHI
Questionnaire File Name: Sample Adult
Question Text:

Was this change for a reason related to health insurance?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who CHANGED their USUAL place for health care in past 12 months
Skip Instructions:

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

Question ID: AAU.051_00.010

Instrument Variable Name: APRVTRYR
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,)[go to APRVTRFD ]
(2,R,D)[go to ADRNANP]

Question ID: AAU.053_00.010

Instrument Variable Name: APRVTRFD
Questionnaire File Name: Sample Adult
Question Text:

Were you able to find a general doctor or provider who could see you?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who had trouble finding a provider
Skip Instructions:

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

Question ID: AAU.057_00.010

Instrument Variable Name: ADRNANP
Questionnaire File Name: Sample Adult
Question Text:

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

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.059_00.010

Instrument Variable Name: ADRNAI
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, were you told by a doctor?s office or clinic that they did not accept your health care coverage?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCDLY_1]

Question ID: AAU.061_01.000

Instrument Variable Name: AHCDLY_1
Questionnaire File Name: Sample Adult
Question Text:

There are many reasons people delay getting medical care.
Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...You couldn't get through on the telephone.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCDLY_2]

Question ID: AAU.061_02.000

Instrument Variable Name: AHCDLY_2
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...You couldn't get an appointment soon enough.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCDLY_3]

Question ID: AAU.061_03.000

Instrument Variable Name: AHCDLY_3
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...Once you get there, you have to wait too long to see the doctor.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCDLY_4]

Question ID: AAU.061_04.000

Instrument Variable Name: AHCDLY_4
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...The (clinic/doctor's) office wasn't open when you could get there.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

1,2,R,D)[go to AHCDLY_5]

Question ID: AAU.061_05.000

Instrument Variable Name: AHCDLY_5
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...You didn't have transportation.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCAFY_1]

Question ID: AAU.111_01.000

Instrument Variable Name: AHCAFY_1
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...Prescription medicines.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCAFY_2]

Question ID: AAU.111_02.000

Instrument Variable Name: AHCAFY_2
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...Mental health care or counseling.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCAFY_3]

Question ID: AAU.111_03.000

Instrument Variable Name: AHCAFY_3
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...Dental care (including check ups).

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCAFY_4]

Question ID: AAU.111_04.000

Instrument Variable Name: AHCAFY_4
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...Eyeglasses.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCAFY_5]

Question ID: AAU.111_05.010

Instrument Variable Name: AHCAFY_5
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...To see a specialist.

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to AHCAFY_6]

Question ID: AAU.111_06.010

Instrument Variable Name: AHCAFY_6
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...Follow-up care.

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.113_00.010

Instrument Variable Name: AWORPAY
Questionnaire File Name: Sample Adult
Question Text:

If you get sick or have an accident, how worried are you that you will be able to pay your medical bills? Are you very worried, somewhat worried, or not at all worried?

1 Very worried
2 Somewhat worried
3 Not at all worried
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.113_00.020

Instrument Variable Name: AHICOMP
Questionnaire File Name: Sample Adult
Question Text:

In regard to your health insurance or health care coverage, how does it compare to a year ago? Is it better, worse, or about the same?

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

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,3,R,D)[go to ARX12MO]

Question ID: AAU.126_01.010

Instrument Variable Name: ARX12MO
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, were you prescribed medication by a doctor or other health professional?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ARX12_1]
(2,R,D) [go to ARX12_5]

Question ID: AAU.127_01.010

Instrument Variable Name: ARX12_1
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, were any of the following true for you?
?You skipped medication doses to save money.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:

(1,2,R,D)[go to ARX12_2]

Question ID: AAU.127_02.010

Instrument Variable Name: ARX12_2
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You took less medicine to save money.

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:

(1,2,R,D)[go to ARX12_3]

Question ID: AAU.127_03.010

Instrument Variable Name: ARX12_3
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You delayed filling a prescription to save money.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:

(1,2,R,D)[go to ARX12_4]

Question ID: AAU.127_04.010

Instrument Variable Name: ARX12_4
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You asked your doctor for a lower cost medication to save money.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:

(1,2,R,D)[go to ARX12_5]

Question ID: AAU.127_05.010

Instrument Variable Name: ARX12_5
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, were any of the following true for you?
?You bought prescription drugs from another country to save money.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[go to ARX12_6]

Question ID: AAU.127_06.010

Instrument Variable Name: ARX12_6
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
?You used alternative therapies to save money.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.135_00.000

Instrument Variable Name: ADENLONG
Questionnaire File Name: Sample Adult
Question Text:

(book) A8
About how long has it been since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.

0 Never
1 6 months or less
2 More than 6 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0-5,R,D)[ go to AHCSY1_1]

Question ID: AAU.141_01.000

Instrument Variable Name: AHCSY1_1
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[ go to AHCSY1_2]

Question ID: AAU.141_02.000

Instrument Variable Name: AHCSY1_2
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...An optometrist, ophthalmologist (AHF-thal-MOL-oh-jist), or eye doctor (someone who prescribes eyeglasses).

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[ go to AHCSY1_3]

Question ID: AAU.141_03.000

Instrument Variable Name: AHCSY1_3
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A foot doctor.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[ go to AHCSY1_4]

Question ID: AAU.141_04.000

Instrument Variable Name: AHCSY1_4
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A chiropractor.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[ go to AHCSY1_5]

Question ID: AAU.141_05.000

Instrument Variable Name: AHCSY1_5
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[ go to AHCSY1_6]

Question ID: AAU.141_06.000

Instrument Variable Name: AHCSY1_6
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A nurse practitioner, physician assistant, or midwife.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D)[if SEX=1go to AHCSY8_8; else if SEX=2 go to AHCSYR7]

Question ID: AAU.200_00.000

Instrument Variable Name: AHCSYR7
Questionnaire File Name: Sample Adult
Question Text:

* Read lead-in if necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A doctor who specializes in women's health (an obstetrician/gynecologist).

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample female adults aged 18+ years
Skip Instructions:

(1,2,R,D) [go to AHCSY8_ 8]

Question ID: AAU.211_01.000

Instrument Variable Name: AHCSY8_8
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist, or ophthalmologist).

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [go to AHCSY8_ 9]

Question ID: AAU.211_02.000

Instrument Variable Name: AHCSY8_9
Questionnaire File Name: Sample Adult
Question Text:

* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AHCSYR10]
(2,R,D) [go to AHERNOYR]

Question ID: AAU.230_00.000

Instrument Variable Name: AHCSYR10
Questionnaire File Name: Sample Adult
Question Text:

Does that doctor treat children and adults (a doctor in general practice or family medicine)?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have seen or talked to a general doctor during the past 12 months
Skip Instructions:

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

Question ID: AAU.240_00.000

Instrument Variable Name: AHERNOYR
Questionnaire File Name: Sample Adult
Question Text:

(book) A9
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own health (This includes emergency room visits that resulted in a hospital admission.)?

00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0,R,D) [go to AHCHYR] (1-8) [go to AERVISND]

Question ID: AAU.243_00.010

Instrument Variable Name: AERVISND
Questionnaire File Name: Sample Adult
Question Text:

Thinking about your most recent emergency room visit, did you go to the emergency room either at night or on the weekend?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

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

Question ID: AAU.245_00.010

Instrument Variable Name: AERHOS
Questionnaire File Name: Sample Adult
Question Text:

Did this emergency room visit result in a hospital admission?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS1]

Question ID: AAU.248_01.010

Instrument Variable Name: AERREAS1
Questionnaire File Name: Sample Adult
Question Text:

Tell me which of these apply to your last emergency room visit?
? You didn't have another place to go

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS2]

Question ID: AAU.248_02.020

Instrument Variable Name: AERREAS2
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? Your doctor?s office or clinic was not open

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS3]

Question ID: AAU.248_03.030

Instrument Variable Name: AERREAS3
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? Your health provider advised you to go

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS4]

Question ID: AAU.248_04.040

Instrument Variable Name: AERREAS4
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? The problem was too serious for the doctor?s office or clinic

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS5]

Question ID: AAU.248_05.050

Instrument Variable Name: AERREAS5
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? Only a hospital could help you

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS6]

Question ID: AAU.248_06.060

Instrument Variable Name: AERREAS6
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
? the emergency room is your closest provider

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS7]

Question ID: AAU.248_07.070

Instrument Variable Name: AERREAS7
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
?you get most of your care at the emergency room

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

(1,2,R,D) [go to AERREAS8]

Question ID: AAU.248_08.080

Instrument Variable Name: AERREAS8
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
Tell me which of these apply to your last emergency room visit?
?you arrived by ambulance or other emergency vehicle

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:

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

Question ID: AAU.250_00.000

Instrument Variable Name: AHCHYR
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1)[go to AHCHMOYR]
(2,R,D)[go to AHCNOYR]

Question ID: AAU.260_00.000

Instrument Variable Name: AHCHMOYR
Questionnaire File Name: Sample Adult
Question Text:

During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?

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

Universe Text: Sample adults 18+ who received home care from a health professional during the past 12 months
Skip Instructions:

(1-12,R,D)[go to AHCHNOYR]

Question ID: AAU.270_00.000

Instrument Variable Name: AHCHNOYR
Questionnaire File Name: Sample Adult
Question Text:

(book) A10
What was the total number of home visits received during [Fill1: that month/Fill2: those months]?

01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who received home care from a health professional during the past 12 months
Skip Instructions:

(1-8,R,D)[go to AHCNOYR]

Question ID: AAU.280_00.000

Instrument Variable Name: AHCNOYR
Questionnaire File Name: Sample Adult
Question Text:

(book) A9
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR?S OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times you were hospitalized overnight, visits to hospital emergency rooms, home visits, dental visits, or telephone calls.

00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0-8,R,D)[go to ASRGYR]

Question ID: AAU.290_00.000

Instrument Variable Name: ASRGYR
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or outpatient?
* Read if necessary: This includes both major surgery and minor procedures such as setting bones or removing growths.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1)[go to ASRGNOYR]
(2,R,D) [go to AMDLONG]

Question ID: AAU.300_00.000

Instrument Variable Name: ASRGNOYR
Questionnaire File Name: Sample Adult
Question Text:

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during the PAST 12 MONTHS?
* Enter "95" for 95 or more times.

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

Universe Text: Sample adults 18+ who had surgery or surgical procedures during past 12 months
Skip Instructions:

(1-95,R,D) [go to AMDLONG]
(11-95) [go to ERR_ASGYR]
Soft Edit: * [ASRGYR] is an unusually large number.
* Please verify.

Question ID: AAU.305_00.000

Instrument Variable Name: AMDLONG
Questionnaire File Name: Sample Adult
Question Text:

(book) A8 ? [F1]
About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.

Universe Text: Sample adults 18+
Skip Instructions:

(0-5,R,D) [go to HIT1A]

Question ID: AAU.309_00.010

Instrument Variable Name: HIT1A
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
?Look up health information on the Internet.

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [go to HIT2A]

Question ID: AAU.309_00.020

Instrument Variable Name: HIT2A
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
?Fill a prescription.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [go to HIT3A]

Question ID: AAU.309_00.030

Instrument Variable Name: HIT3A
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
?Schedule an appointment with a health care provider.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [go to HIT4A]

Question ID: AAU.309_00.040

Instrument Variable Name: HIT4A
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
?Communicate with a health care provider by email.

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [go to HIT5A]

Question ID: AAU.309_00.050

Instrument Variable Name: HIT5A
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
?Use online chat groups to learn about health topics.

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.310_00.000

Instrument Variable Name: SHTFLUYR
Questionnaire File Name: Sample Adult
Question Text:

?[F1]
DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: A flu shot is injected in the arm. Do not include an influenza vaccine sprayed in the nose.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ASHFLU_M]
(2,R,D) [ go to SPRFLUYR ]

Question ID: AAU.312_01.000

Instrument Variable Name: ASHFLU_M
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
During what month and year did you receive your most recent flu shot?

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

Universe Text: Sample adults 18+ who have had a flu shot
Skip Instructions:

(1-12,D) [ go to ASHFLU_Y] (R) [go to SPRFLUYR]

Question ID: AAU.312_02.000

Instrument Variable Name: ASHFLU_Y
Questionnaire File Name: Sample Adult
Question Text:

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

Year Year
9997 Refused
9999 Don?t know

Universe Text: Sample adults 18+ who gave a month for their last flu shot or who didn?t know the month
Skip Instructions:

(valid year,R,D) [go to SPRFLUYR]
[If ASHFLU_M and ASHFLU_Y = a future date [go to ERR1_ASHFLU_Y]
[If ASHFLU_M and ASHFLU_Y = a date prior to birth [go to ERR2_ASHFLU_Y ]
[If ASHFLU_M and ASHFLU_Y = a date before 12 months ago [go to ERR3_ASHFLU_Y ]
Hard Edit: ERR1_ASHFLU_Y
*Future date invalid
ERR2_ASHFLU_Y
*Date before birth
ERR3_ASHFLU_Y
*Date more than 12 months ago

Question ID: AAU.313_00.000

Instrument Variable Name: FLUSHPG1
Questionnaire File Name: Sample Adult
Question Text:

Did you get a flu shot before or during your current pregnancy?

1 Before this pregnancy
2 During this pregnancy
7 Refused
9 Don't know

Universe Text: Female sample adults 18-49 who are currently pregnant and are interviewed January-March or August-December
Skip Instructions:

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

Question ID: AAU.314_00.000

Instrument Variable Name: FLUSHPG2
Questionnaire File Name: Sample Adult
Question Text:

[Fill1: Earlier you said you were pregnant sometime since August 1st, [last year]. Did you get a flu shot before, during or after this pregnancy?/Earlier you said you were pregnant sometime between August [last year] and March [current year].
Did you get a flu shot before, during or after this pregnancy?/Earlier you said you were pregnant sometime between August [last year] and March [current year].
Did you get a flu shot before, during or after this pregnancy?/

1 Before this pregnancy
2 During this pregnancy
3 After this pregnancy
7 Refused
9 Don't know

Universe Text: Female sample adults 18-49 who are currently pregnant and were interviewed April-July or who have been determined to be pregnant at a specific point in the past year
Skip Instructions:

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

Question ID: AAU.315_00.000

Instrument Variable Name: SPRFLUYR
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects against influenza for the flu season.
* Read if necessary: This influenza vaccine is called FluMist (trademark).

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ASPFLU_M]
[if SHTFLUYR =1 and SPRFLUYR=1] go to ERR1_SPRFLUYR
[if AGE GE 50] go to ERR2_SPRFLUYR
(2,D,R) [go to SHTPNUYR]
Soft Edit: ERR1_SPRFLUYR
*Respondent says they have received both a flu shot and flu nasal vaccine.
*Please verify.
ERR2_SPRFLUYR
*Respondent says they have received a nasal vaccine to PREVENT the flu, not to TREAT symptoms of the flu.
*Please verify.

Question ID: AAU.318_01.000

Instrument Variable Name: ASPFLU_M
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
During what month and year did you receive your most recent flu nasal spray?

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

Universe Text: Sample adults 18+ who have had a flu nasal vaccine
Skip Instructions:

(1-12,D) [ go to ASPFLU_Y]
(R) [go to SHTPNUYR]

Question ID: AAU.318_02.000

Instrument Variable Name: ASPFLU_Y
Questionnaire File Name: Sample Adult
Question Text:

2 of 2

Year Year
9997 Refused
9999 Don't know

*Enter year of most recent flu nasal spray.

Universe Text: Sample adults 18+ who gave a month for their flu nasal vaccine or who didn?t know the month
Skip Instructions:

(valid year, R, D) [go to SHTPNUYR]
[If ASPFLU_M and ASPFLU_Y = a future date] go to ERR1_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date prior to birth] go to ERR2_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date before 12 months ago] go to ERR3_ASPFLU_Y
Hard Edit: ERR1_ASPFLU_Y
*Future date invalid
ERR2_ASPFLU_Y
*Date before birth
ERR3_ASPFLU_Y
*Date more than 12 months ago

Question ID: AAU.320_00.000

Instrument Variable Name: SHTPNUYR
Questionnaire File Name: Sample Adult
Question Text:

Have you EVER had a pneumonia shot?
This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.330_00.000

Instrument Variable Name: APOX
Questionnaire File Name: Sample Adult
Question Text:

Have you EVER had chickenpox?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to APOX12MO]
(2,R,D) [go to AHEP]

Question ID: AAU.340_00.000

Instrument Variable Name: APOX12MO
Questionnaire File Name: Sample Adult
Question Text:

Have you had chickenpox in the PAST 12 MONTHS?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever had chickenpox
Skip Instructions:

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

Question ID: AAU.350_00.000

Instrument Variable Name: AHEP
Questionnaire File Name: Sample Adult
Question Text:

Have you EVER had hepatitis?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AHEPBTST]
(2,R,D) [go to AHEPLIV]

Question ID: AAU.360_00.000

Instrument Variable Name: AHEPLIV
Questionnaire File Name: Sample Adult
Question Text:

Have you ever lived with someone who had hepatitis?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
Skip Instructions:

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

Question ID: AAU.365_00.010

Instrument Variable Name: AHEPBTST
Questionnaire File Name: Sample Adult
Question Text:

Have you ever had a blood test for hepatitis B?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.370_00.000

Instrument Variable Name: SHTHEPB
Questionnaire File Name: Sample Adult
Question Text:

Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to SHEPDOS]
(2,R,D) [go to SHTHEPA]

Question ID: AAU.380_00.000

Instrument Variable Name: SHEPDOS
Questionnaire File Name: Sample Adult
Question Text:

Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?

1 Received at least 3 doses
2 Received less than 3 doses
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have ever received the Hepatitis B vaccine
Skip Instructions:

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

Question ID: AAU.390_00.010

Instrument Variable Name: SHTHEPA
Questionnaire File Name: Sample Adult
Question Text:

The hepatitis A vaccine is given as a two dose series routinely to some children starting at 1 year of age, and to some adults and people who travel outside the United States. Although it can be given as a combination vaccine with hepatitis B, it is different from the hepatitis B shot, and has only been available since 1995. Have you ever received the hepatitis A vaccine?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) go to SHEPANUM
(2,R,D) [go to AHEPCTST]

Question ID: AAU.400_00.010

Instrument Variable Name: SHEPANUM
Questionnaire File Name: Sample Adult
Question Text:

How many hepatitis A shots did you receive?
*Enter '96' if all shots were received

01-95 01-95 shots
96 Received all shots
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have had a hepatitis A vaccine
Skip Instructions:

(1-95,96,R,D) [go to AHEPCTST]

Question ID: AAU.405_00.010

Instrument Variable Name: AHEPCTST
Questionnaire File Name: Sample Adult
Question Text:

Have you ever had a blood test for hepatitis C?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AHEPCRES]
(2,R,D) if AGE GE 50 go to SHINGLES
elseif AGE LT 50 go to SHTTD

Question ID: AAU.405_00.020

Instrument Variable Name: AHEPCRES
Questionnaire File Name: Sample Adult
Question Text:

What is the MAIN reason you were tested for hepatitis C? Was it because...
*Read answer categories below.
1 You or your doctor thought you were at risk of having hepatitis C because a blood test or symptoms like fatigue, nausea, stomach pain, yellowing of the eyes or skin indicated you might have liver disease
2 You were born from 1945 through 1965
3 You were at risk of hepatitis C infection due to exposure to blood on your job, injection drug use or receipt of transfusion before 1992

4 Some other reason
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who have had a blood test for hepatitis C
Skip Instructions:

(1-4,R,D) if AGE GE 50 [go to SHINGLES];
elseif AGE LT 50 go to SHTTD

Question ID: AAU.410_00.010

Instrument Variable Name: SHINGLES
Questionnaire File Name: Sample Adult
Question Text:

Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is generally on one side of the body or face. Shingles is caused by the chicken pox virus. A vaccine for shingles has been available since May 2006. Have you ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 50+
Skip Instructions:

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

Question ID: AAU.420_00.010

Instrument Variable Name: SHTTD
Questionnaire File Name: Sample Adult
Question Text:

Have you received a tetanus shot in the past 10 years?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) go to SHTTD05
(2,R,D) and AGE )64 [go to LIVEV]
Else if (2,R,D) and AGE(65 [go to SHTHPV2]

Question ID: AAU.430_00.010

Instrument Variable Name: SHTTD05
Questionnaire File Name: Sample Adult
Question Text:

Was your most recent tetanus shot given in 2005 or later?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have had a tetanus shot in the past 10 years
Skip Instructions:

(1,R) [go to SHTTDAP]
(2,D) if AGE le 64 [go to SHTHPV2]
elseif AGE gt 64 go to LIVEV

Question ID: AAU.440_00.010

Instrument Variable Name: SHTTDAP
Questionnaire File Name: Sample Adult
Question Text:

There are currently two types of tetanus shots available today. One is the Td or tetanus-diphtheria vaccine and the other is called Tdap or Adacel (trademark) or Boostrix (trademark). They are similar except the Tdap shot also includes a pertussis (per-TUH-sis) or whooping cough vaccine. Thinking back to your most recent tetanus shot, did your health care provider tell you or did the vaccine information sheet say the vaccine included the pertussis or whooping cough vaccine? The shot is often called Tdap or ADACEL (trademark) or BOOSTRIX (trademark).

1 Yes-included pertussis
2 No-did not include pertussis
3 Doctor did not say
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who have had a tetanus shot in 2005 or beyond or refused to say if they had a tetanus shot in 2005 or beyond
Skip Instructions:

(1-3,R,D) if age le 64 [go to SHTHPV2];
else [go to LIVEV]

Question ID: AAU.446_00.010

Instrument Variable Name: SHTHPV2
Questionnaire File Name: Sample Adult
Question Text:

Have you ever received an HPV shot or vaccine?
*HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
*The vaccines are sometimes called CERVARIX (trademark) or GARDASIL (trademark).

1 Yes
2 No
3 Doctor refused when asked
7 Refused
9 Don't know

Universe Text: Sample adults LE 64
Skip Instructions:

(1) [go to SHHPVDOS]
(2,3,R,D) [go to LIVEV]

Question ID: AAU.448_00.010

Question Text:

How many HPV shots did you receive?
* Enter '50' if 50 or more shots
* Enter '96' for all shots
Instrument Variable Name: SHHPVDOS

01-49 1-49 shots
50+ 50+
96 All shots
97 Refused
99 Don't know

Universe Text: Sample adults LE 64 who received an HPV shot
Skip Instructions:

(1-50,96,R,D) [go to AHPVAGE]
(51-95) [go to ERR_SHHPVDOS]
Hard Edit: ERR_SHHPVDOS
* Shots should be in the range 1-50 or 96 for all shots.
* Please correct.

Question ID: AAU.449_00.010

Instrument Variable Name: AHPVAGE
Questionnaire File Name: Sample Adult
Question Text:

How old were you when you received your first HPV shot?

008-064 8-64 years
997 Refused
999 Don't know

Universe Text: Sample adults LE 64 who received an HPV shot
Skip Instructions:

(8-120,R,D) [go to LIVEV]

Question ID: AAU.450_00.010

Instrument Variable Name: LIVEV
Questionnaire File Name: Sample Adult
Questionnaire File Name: Sample Adult
Question Text:

Has a doctor or other health professional ever told you that you had any kind of chronic, or long-term liver condition?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.460_00.010

Instrument Variable Name: TRAVEL
Questionnaire File Name: Sample Adult
Question Text:

Have you ever traveled outside of the United States to countries other than Europe, Japan, Australia, New Zealand or Canada, since 1995?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.465_00.010

Instrument Variable Name: WRKHLTH
Questionnaire File Name: Sample Adult
Question Text:

Do you currently volunteer or work in a hospital, medical clinic, doctor?s office, dentist?s office, nursing home or some other health-care facility? This includes emergency responders and public safety personnel, part-time and unpaid work in a health care facility as well as professional nursing care provided in the home.
*Read if necessary: This includes non-health care professionals, such as administrative staff, who work in a health-care facility.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to WRKDIR] (2,R,D) [go to APSBPCHK]

Question ID: AAU.470_00.010

Instrument Variable Name: WRKDIR
Questionnaire File Name: Sample Adult
Question Text:

Do you provide direct patient care as part of your routine work? By direct patient care we MEAN PHYSICAL OR HANDS ON CONTACT WITH PATIENTS.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who work or volunteer in a health-care setting
Skip Instructions:

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

Question ID: AAU.500_00.010

Instrument Variable Name: APSBPCHK
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you had your blood pressure checked by a doctor, nurse, or other health professional?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.510_00.010

Instrument Variable Name: APSCHCHK
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you had your blood cholesterol checked by a doctor, nurse, or other health professional?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

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

Question ID: AAU.520_00.010

Instrument Variable Name: APSBSCHK
Questionnaire File Name: Sample Adult
Question Text:

Have you had a fasting test for high blood sugar or diabetes DURING THE PAST 12 MONTHS?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) and SEX=1 and AGE GE 40 [go to APSCOL]
If (1,2,R,D) and SEX=1 and AGE ( 40 [go to APSDIET]
Else (1,2,R,D) and SEX=2 [go to APSPAP]

Question ID: AAU.530_00.010

Instrument Variable Name: APSPAP
Questionnaire File Name: Sample Adult
Question Text:

Have you had a Pap smear or Pap test DURING THE PAST 12 MONTHS?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 18+
Skip Instructions:

(1,2,R,D) if AGE GE 30 [go to APSMAM];
else (1,2,R,D and AGE(30 [go to APSDIET]

Question ID: AAU.540_00.010

Instrument Variable Name: APSMAM
Questionnaire File Name: Sample Adult
Question Text:

Have you had a Mammogram DURING THE PAST 12 MONTHS?
*Read if necessary.
A mammogram is an x-ray of each breast to look for breast cancer.

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Female sample adults 30+
Skip Instructions:

(1,2,R,D) if AGE GE 40 [go toAPSCOL];
else (1,2,R,D and AGE(40) [go to APSDIET]

Question ID: AAU.550_00.010

Instrument Variable Name: APSCOL
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, have you had any test done for colon cancer?
*Read if necessary.
Colon cancer tests include blood stool tests, colonoscopy and sigmoidoscopy.
A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood.
A sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems.

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 40+
Skip Instructions:

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

Question ID: AAU.560_00.010

Instrument Variable Name: APSDIET
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your diet?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) if SMKNOW in ('1','2') [go to APSSMKC];
else [go to AINDINS]

Question ID: AAU.570_00.010

Instrument Variable Name: APSSMKC
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your smoking?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ currently who smoke every day or some days
Skip Instructions:

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

Question ID: AAU.600_00.010

Instrument Variable Name: AINDINS
Questionnaire File Name: Sample Adult
Question Text:

DURING THE PAST 3 YEARS, did you try to purchase health insurance directly, that is, not through any employer, union, or government program?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AINDPRCH]
(2,R,D) if age LT 65 [go to AEXCHNG];
else age GE 65 [go to next section]

Question ID: AAU.600_00.020

Instrument Variable Name: AINDPRCH
Questionnaire File Name: Sample Adult
Question Text:

Was a plan purchased?

1 Yes
2 No
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who tried to purchase health insurance directly in the past 3 years
Skip Instructions:

(1) [go to AINDWHO]
(2,R,D) if age LT 65 [go to AEXCHNG];
else [go to next section]

Question ID: AAU.600_00.030

Instrument Variable Name: AINDWHO
Questionnaire File Name: Sample Adult
Question Text:

Was this plan for yourself, someone else in your family, or both?

1 Self
2 Someone else in family
3 Both
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who purchased health insurance directly in the past 3 years
Skip Instructions:

(1-3,R,D) [go to AINDDIF1]

Question ID: AAU.600_00.040

Instrument Variable Name: AINDDIF1
Questionnaire File Name: Sample Adult
Question Text:

How difficult was it to find a plan with the type of coverage you needed? Would you say?
*Read categories below.

1 Very difficult
2 Somewhat difficult
3 Not at all difficult
7 Refused
9 Don?t know

Universe Text: Sample adults 18+ who purchased health insurance directly in the past 3 years
Skip Instructions:

(1-3,R,D) [go to AINDDIF2]

Question ID: AAU.600_00.050

Instrument Variable Name: AINDDIF2
Questionnaire File Name: Sample Adult
Question Text:

How difficult was it to find a plan you could afford? Would you say?
*Read categories below.

1 Very difficult
2 Somewhat difficult
3 Not at all difficult
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who purchased health insurance directly in the past 3 years
Skip Instructions:

(1-3,R,D) if age LT 65 [go to AEXCHNG];
else [go to next section]

Question ID: AAU.605_00.010

Instrument Variable Name: AEXCHNG
Questionnaire File Name: Sample Adult
Question Text:

Have you looked into purchasing health insurance coverage through Healthcare.gov or the [fill: Health Insurance Marketplace/Health Insurance Marketplace, such as (fill: state name)]?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults LT 65 years
Skip Instructions:

(1,2,R,D) [go to next section]

Question ID: ASI.005_00.000

Instrument Variable Name: ASIINTRO
Questionnaire File Name: Sample Adult
Question Text:

*You are about to enter the Sexual Identity and Lifestyle questions section. This section includes questions on computer use, the respondent?s neighborhood, sexual identity, financial worries, mental health, and HIV testing.
*Enter 1 to Continue.

1 Continue

Universe Text: Sample adults 18+
Skip Instructions:

(1) go to ACICPUSE

Question ID: ASI.130_00.000

Instrument Variable Name: ACICPUSE
Questionnaire File Name: Sample Adult
Question Text:

These questions are about you and your neighborhood.
How often do you use a computer?
*Read answer categories.

1 Never or almost never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACISATHC]

Question ID: ASI.140_00.000

Instrument Variable Name: ACISATHC
Questionnaire File Name: Sample Adult
Question Text:

In general, how satisfied are you with the health care you received in the past 12 months?
*Read answer categories.

1 Very satisfied
2 Somewhat satisfied
3 Somewhat dissatisfied
4 Very dissatisfied
5 You haven't had health care in the past 12 months
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACITENUR]

Question ID: ASI.150_00.000

Instrument Variable Name: ACITENUR
Questionnaire File Name: Sample Adult
Question Text:

About how long have you lived in your present neighborhood?

1 Less than 1 year
2 1-3 years
3 4-10 years
4 11-20 years
5 More than 20 years
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACINHELP]

Question ID: ASI.160_00.000

Instrument Variable Name: ACINHELP
Questionnaire File Name: Sample Adult
Question Text:

How much do you agree or disagree with the following statements about your neighborhood?
People in this neighborhood help each other out.
Would you say?
*Read answer categories.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACINCNTO]

Question ID: ASI.170_00.000

Instrument Variable Name: ACINCNTO
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
There are people I can count on in this neighborhood.
Would you say?
*Read answer categories if necessary.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACINTRU]

Question ID: ASI.180_00.000

Instrument Variable Name: ACINTRU
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
People in this neighborhood can be trusted.
Would you say?
*Read answer categories if necessary.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACINKNT]

Question ID: ASI.190_00.000

Instrument Variable Name: ACINKNT
Questionnaire File Name: Sample Adult
Question Text:

*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
This is a close-knit neighborhood.
Would you say?
*Read answer categories if necessary.

1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D)
[if SEX=1, go to ACISIM; elseif SEX=2, go to ACISIF]

Question ID: ASI.220_00.000

Instrument Variable Name: ACISIM
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI1
Which of the following best represents how you think of yourself?

1 Gay
2 Straight, that is, not gay
3 Bisexual
4 Something else
5 I don't know the answer
7 Refused

Universe Text: Male sample adults 18+
Skip Instructions:

(1-5,R) [go to ACIRETR]

Question ID: ASI.240_00.000

Instrument Variable Name: ACISIF
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI2
Which of the following best represents how you think of yourself?

1 Lesbian or gay
2 Straight, that is, not lesbian or gay
3 Bisexual
4 Something else
5 I don't know the answer
7 Refused

Universe Text: Female sample adults 18+
Skip Instructions:

(1-5,R) [go to ACIRETR]

Question ID: ASI.260_00.000

Instrument Variable Name: ACIRETR
Questionnaire File Name: Sample Adult
Question Text:

The next questions ask how worried you are right now about financial matters.
How worried are you right now about not having enough money for retirement? Are you?
*Read answer categories.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACIMEDC]

Question ID: ASI.270_00.000

Instrument Variable Name: ACIMEDC
Questionnaire File Name: Sample Adult
Question Text:

How worried are you right now about not being able to pay medical costs of a serious illness or accident? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACISTLV]

Question ID: ASI.280_00.000

Instrument Variable Name: ACISTLV
Questionnaire File Name: Sample Adult
Question Text:

How worried are you right now about not being able to maintain the standard of living you enjoy? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACICNHC]

Question ID: ASI.290_00.000

Instrument Variable Name: ACICNHC
Questionnaire File Name: Sample Adult
Question Text:

How worried are you right now about not being able to pay medical costs for normal healthcare? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACICCOLL]

Question ID: ASI.300_00.000

Instrument Variable Name: ACICCOLL
Questionnaire File Name: Sample Adult
Question Text:

How worried are you right now about not having enough money to pay for your children's college? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
5 This does not apply to me
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACINBILL]

Question ID: ASI.310_00.000

Instrument Variable Name: ACINBILL
Questionnaire File Name: Sample Adult
Question Text:

How worried are you right now about not having enough to pay your normal monthly bills? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACIHCST]

Question ID: ASI.320_00.000

Instrument Variable Name: ACIHCST
Questionnaire File Name: Sample Adult
Question Text:

How worried are you right now about not being able to pay your rent, mortgage, or other housing costs? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-4,R,D) [go to ACICCMP]

Question ID: ASI.330_00.000

Instrument Variable Name: ACICCMP
Questionnaire File Name: Sample Adult
Question Text:

How worried are you right now about not being able to make the minimum payments on your credit cards? Are you?
*Read answer categories if necessary.

1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
5 I don't have credit cards
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACISLEEP]

Question ID: ASI.340_00.000

Instrument Variable Name: ACISLEEP
Questionnaire File Name: Sample Adult
Question Text:

On average, how many hours of sleep do you get in a 24-hour period?
*Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more UP to the next whole hour and dropping 29 or fewer minutes.

01-24 1-24 hours
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5)[go to ERR_SLEEP];
(1-24, R,D)[go to ACISLPFL]
Soft Edit: ERR_SLEEP
*Average number of hours of sleep is [ACISLEEP].
* Please verify.

Question ID: ASI.350_00.000

Instrument Variable Name: ACISLPFL
Questionnaire File Name: Sample Adult
Question Text:

In the past week, how many times did you have trouble falling asleep?
*Enter '0' if respondent did not have trouble falling asleep in the past week.
*Enter '7' for 7 or more times.

00 Did not have trouble falling asleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0-7,R,D) [go to ACISLPST]

Question ID: ASI.360_00.000

Instrument Variable Name: ACISLPST
Questionnaire File Name: Sample Adult
Question Text:

In the past week, how many times did you have trouble staying asleep?
*Enter '0' if respondent did not have trouble staying asleep in the past week.
*Enter '7' for 7 or more times.

00 Did not have trouble staying asleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0-7,R,D) [go to ACISLPMD]

Question ID: ASI.370_00.000

Instrument Variable Name: ACISLPMD
Questionnaire File Name: Sample Adult
Question Text:

In the past week, how many times did you take medication to help you fall asleep or stay asleep?
*Enter '0' if respondent did not take medication to help sleep in the past week.
*Enter '7' for 7 or more times.

00 Did not take medication to help sleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0-7,R,D) [go to ACIREST]

Question ID: ASI.380_00.000

Instrument Variable Name: ACIREST
Questionnaire File Name: Sample Adult
Question Text:

In the past week, on how many days did you wake up feeling well rested?
*Enter '0' if respondent never felt well rested in the past week.

00 Never felt rested in the past week
01-07 1-7 days
97 Refused
99 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(0-7,R,D) [go to MHSAD_CK]

Question ID: ASI.390_00.000

Instrument Variable Name: MHSAD_CK
Questionnaire File Name: Sample Adult
Question Text:

Now I am going to ask you some questions about feelings you may have experienced over the PAST 30 DAYS.

1 Enter 1 to continue

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to ACISAD]

Question ID: ASI.390_01.000

Instrument Variable Name: ACISAD
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI5
DURING THE PAST 30 DAYS, how often did you feel
...So sad that nothing could cheer you up?

1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACINERV]

Question ID: ASI.390_02.000

Instrument Variable Name: ACINERV
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Nervous?

1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACIRSTLS]

Question ID: ASI.390_03.000

Instrument Variable Name: ACIRSTLS
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Restless or fidgety?

1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACIHOPLS]

Question ID: ASI.390_04.000

Instrument Variable Name: ACIHOPLS
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Hopeless?

1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACIEFFRT]

Question ID: ASI.390_05.000

Instrument Variable Name: ACIEFFRT
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...That everything was an effort?

1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) [go to ACIWTHLS]

Question ID: ASI.390_06.000

Instrument Variable Name: ACIWTHLS
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Worthless?

1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1-5,R,D) if ACISAD or ACINERV or ACIRSTLS or ACIHOPLS or ACIEFFRT or ACIWTHLS=1-3 [go to
ACIMUCH];
else [go to ACIHIVT]

Question ID: ASI.400_00.000

Instrument Variable Name: ACIMUCH
Questionnaire File Name: Sample Adult
Question Text:

We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?

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

Universe Text: Sample adults 18+ who at least some of the time have felt sad, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless, in the past 30 days
Skip Instructions:

(1-4,R,D) [go to ACIHIVT]

Question ID: ASI.410_00.000

Instrument Variable Name: ACIHIVT
Questionnaire File Name: Sample Adult
Question Text:

The next question is about the test for HIV, the virus that causes AIDS. Except for tests you may have had as part of blood donations, have you ever been tested for HIV?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,R,D) [go to next section]
(2) [go to ACIHIVWN]

Question ID: ASI.420_00.000

Instrument Variable Name: ACIHIVWN
Questionnaire File Name: Sample Adult
Question Text:

(book) ASI6
I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes AIDS).
Which one of these would you say is the MAIN reason why you have not been tested?

01 It's unlikely you've been exposed to HIV
02 You were afraid to find out if you were HIV positive (that you had HIV)
03 You didn't want to think about HIV or about being HIV positive
04 You were worried your name would be reported to the government if you tested positive
05 You didn't know where to get tested
06 You don't like needles
07 You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
08 Some other reason
09 No particular reason
97 Refused
99 Don't know

Universe Text: Sample adults 18+ who have never been tested for HIV
Skip Instructions:

(1-9,R,D) [go to next section]

Question ID: AWB.010_00.000

Instrument Variable Name: AWEBUSE
Questionnaire File Name: Sample Adult
Question Text:

The next questions are about your Internet and email use.
Do you use the Internet?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AWEBOFNO] (2,R,D) [go to AWEBEML]

Question ID: AWB.020_01.000

Instrument Variable Name: AWEBOFNO
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
How often do you use the Internet?
*Read if necessary: How many times per day, per week, per month, or per year do you use the Internet?
*Enter number.

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

Universe Text: Sample adults 18+ who use the Internet
Skip Instructions:

(1-995) [go to AWEBOFTP]
(R,D) [go to AWEBORP]

Question ID: AWB.020_02.000

Instrument Variable Name: AWEBOFTP
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
*Enter time period for how often Internet is used.

1 Per day
2 Per week
3 Per month
4 Per year
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who use the Internet and gave a valid value for the number portion of this question
Skip Instructions:

(1-4,R,D) [go to AWEBORP]

Question ID: AWB.025_00.000

Instrument Variable Name: AWEBORP
Questionnaire File Name: Sample Adult
Question Text:

Research companies invite people to become members of online research panels where they regularly respond to surveys online. Are you currently a member of an online research panel?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who use the Internet
Skip Instructions:

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

Question ID: AWB.030_00.000

Instrument Variable Name: AWEBEML
Questionnaire File Name: Sample Adult
Question Text:

Do you send or receive emails?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1) [go to AWEBEMAD] (2,R,D) [go to next section]

Question ID: AWB.040_00.000

Instrument Variable Name: AWEBEMAD
Questionnaire File Name: Sample Adult
Question Text:

We may want to contact you to obtain additional health-related information.
May I have your email address?
*Enter email address.
*Enter 'N' for none.

allow 75
97 Refused
99 Don't Know

Universe Text: Sample adults 18+ who send or receive email
Skip Instructions:

(address) [go to AWBEMNO] (N,R,D) [go to next section]

Question ID: AWB.050_01.000

Instrument Variable Name: AWEBMNO
Questionnaire File Name: Sample Adult
Question Text:

1 of 2
How often do you check this email account?
*Read if necessary: How many times per day, per week, per month, or per year do you check this email account?
*Enter number.

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

Universe Text: Sample adults 18+ who gave an email address
Skip Instructions:

(1-995) [go to AWBEMTP] (R,D) [go to next section]

Question ID: AWB.050_02.000

Instrument Variable Name: AWEBMTP
Questionnaire File Name: Sample Adult
Question Text:

2 of 2
*Enter time period for how often email is checked.

1 Per day
2 Per week
3 Per month
4 Per year
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who gave an email address and gave a valid value for the number portion of this question
Skip Instructions:

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

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