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2015 NHIS Questionnaire - Sample Child
Child Identification
Document Version Date: 31-May-16

Question ID: CID.001_00.000

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

Question ID: CID.010_00.000

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

Question ID: CID.030_00.000

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

Question ID: CID.040_00.000

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

Question ID: CID.041_00.000

Instrument Variable Name: NEWSEX
Question Text:
Is [fill: ALIAS of Sample Child] Male or Female?
* If don’t know or refused enter your best guess of the child's sex.
1 Male
2 Female
Universe Text: Respondent said child's sex is not correct.
Skip Instructions:
(1,2) store NEWSEX in SEX
go to ERR_NEWSEX
reset CSPVERF_S
go to CSPVERF_S
ERR_NEWSEX
Hard Edit:
* The gender will now be changed to [fill: NEWSEX].
go to CSPVERF_S (as the default go to)

Question ID: CID.042_00.000

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

Question ID: CID.043_00.000

Instrument Variable Name: NEWAGE
Question Text:
How old is [fill1: ALIAS of Sample Child]?
* If age given in months, weeks, or days, convert age to appropriate year. If less than one year old, enter "0".
000-120 Age in years
Universe Text: Respondent said child's age is not correct
Skip Instructions:
(0-120, Refused, Don't know)
if NEWAGE = 'Refused' or NEWAGE = 'Don't know' or NEWAGE = AGE reset CSPVERF_A go to ERR_NEWAGE
else
store NEWAGE in AGE
go to NEWDOB_MERR_NEWAGE
Hard Edit:
*Age of [fill1: ALIAS of Sample Child] remains [fill2: Age of Sample Child] years old.
go to CSPVERF_A (whether suppressed or not)

Question ID: CID.044_00.000

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

Question ID: CID.046_01.000

Instrument Variable Name: NEWDOB_M
Question Text:
1 of 3
What is [fill: ALIAS of Sample Child]'s 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
Universe Text: Respondent said child's date of birth is not correct or child's age is not correct
Skip Instructions:
(01-12, Refused, Don't know) go to NEWDOB_D

Question ID: CID.046_02.000

Instrument Variable Name: NEWDOB_D
Question Text:
2 of 3
* Enter day of birth.
01-31 Day of the month
Universe Text: Respondent said child's date of birth is not correct or child's age is not correct
Skip Instructions:
(01-31,Refused,Don't know) go to NEWDOB_Y
If days not valid, go to ERR_NEWDOB_D
ERR_NEWDOB_D
Hard Edit:
*[fill2: NEWDOB_D] is not a valid day for [fill3: NEWDOB_M].
*Please correct.

Question ID: Question Text: CID.046_03.000 3 of 3

Instrument Variable Name: NEWDOB_Y
1880-2020
* Enter year of birth. Year of birth
Universe Text: Respondent said child's date of birth is not correct or child's age is not correct
Skip Instructions:
(1880-2020, Refused, Don't know) if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty go to CSPVERF_A elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty go to CSPVERF_D endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and month = current month and day GT current day) go to ERR1_NEWDOB_Y endif
(if birth month = '02' and birth day = '29' and this is not a leap year) go to ERR2_NEWDOB_Y endif
(if NEWDOB_M = 'Ref' or 'DK') or (if NEWDOB_D = 'Ref' or 'DK') or (if NEWDOB_Y = 'Ref' or 'DK') go to ERR3_NEWDOB_Y
else store NEWDOB_M in DOBM store NEWDOB_D in DOBD store NEWDOB_Y in DOBY if CSPVERF_A = '2' (No) then reset CSPVERF_A to empty
go to CSPVERF_A elseif CSPVERF_D = '2' (No) then reset CSPVERF_D to empty go to CSPVERF_D endif endif
Calculate age from NEWDOB_M, NEWDOB_D, and NEWDOB_Y.
if age from NEWDOB items is ne AGE and age from NEWDOB items is valid reset CSPVERF_A or CSPVERF_D go to ERR4_NEWDOB_Y
endif
ERR1_NEWDOB_Y
Hard Edit:
*Future date invalid: [fill2: (NEWDOB_M) (NEWDOB_D), (NEWDOB_Y)] *Please correct.
go to NEWDOB_M (whether suppressed or not)
ERR2_NEWDOB_Y
*Not a valid day: [fill2: (NEWDOB_M) (NEWDOB_D), (NEWDOB_Y)] *Please correct.
go to NEWDOB_M (whether suppressed or not)
ERR3_NEWDOB_Y
*DOB of [fill1: ALIAS of Sample Child] remains [fill3: (DOBM) (DOBD), (DOBY)]
go to CSPVERF_A
ERR4_NEWDOB_Y
*Data mismatched. Please fix Age or Birthday.
go to CSPVERF_A (whether suppressed or not)

Question ID: CHS.010_01.000

Instrument Variable Name: BWGT_LB
Question Text:
?[F1]
What was [fill: S.C.name]'s birth weight?
* Enter 'M' to record metric measurements.
01-15 1-15 pounds
97 Refused
99 Don't know
M Metric
Universe Text: Sample children (18
Skip Instructions:
(1-12) [go to BWGT_OZ]
(13-15) [go to ERR1_BWGT_LB]
(R,D) [go to CHGT_FT]
(M) [go to BWGT_GR]
[If NE (1-15, M, D, R) go to ERR2_BWGT_LB]
ERR2_BWGT_LB
Hard Edit:
*Only "1-15" or "M" or "Don't know/Refused" allowed in this field.
*Please correct.
ERR1_BWGT_LB
Soft Edit:
*[fill: BWGT_LB] is an unusually high number.
*Please verify.

Question ID: CHS.010_02.000

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

Question ID: CHS.011_00.000

Instrument Variable Name: BWGT_GR
Question Text:
* Enter weight in grams.
0500 500 grams or less
0501-6899 501-6899 grams
6900 6900+ grams
9997 Refused
9999 Don't know
Universe Text: Sample children (18 whose birth weight will be entered in metric.
Skip Instructions:
(500-5485, R,D) [go to CHGT_FT]
(5486-6900) [go to ERR_BWGT_GR]
ERR_BWGT_GR
Soft Edit:
*[fill1: BWGT_GR] is an unusually high number (equal to [fill2] pounds, [fill3] ounces).
*Please verify.

Question ID: CHS.020_01.000

Instrument Variable Name: CHGT_FT
Question Text:
?[F1]
How tall is [fill: S.C. name] now (without shoes)?
*If the child's height is given in inches, press 'ENTER' at feet and enter the measure in inches (36 inches maximum).
*Enter 'M' to record metric measurements.
00-07 0-7 feet
97 Refused
99 Don't know
M Metric
Universe Text: Sample children 12+
Skip Instructions:
(empty) [go to CHGT_IN] (0-7) [go to CHGT_IN] (R,D) [go to CWGT_LB]
(M) [go to CHGT_M]
[If NE (0-7, M, D, R) go to ERR_CHGT_FT]
ERR_CHGT_FT
Hard Edit:
*Only "0-7" or "M" or "Don't know/Refused" allowed in this field.
*Please correct.

Question ID: CHS.020_02.000

Instrument Variable Name: CHGT_IN
Question Text:
* Enter inches.
00-36 0-36 inches
97 Refused
99 Don't know
Universe Text: Sample children 12+ whose height in feet is 0-7 or is left empty.
Skip Instructions:
(0-36,R,D) If (CHGT_FT = ‘0’, ’empty’) and (CHGT_IN = ‘0’, ‘empty’)
go to ERR1_CHGT_IN
elseif CHGT_FT = ‘1-7’ and CHGT_IN ge ‘12’
go to ERR2_CHGT_IN
elseif (SEX = ‘1’ and AGE = ‘12’ and (CHTINCH lt ‘53’ or CHTINCH gt ‘68’)) or AGE = ‘13’ and (CHTINCH lt ‘55’ or CHTINCH gt ‘72’)) or AGE = ‘14’ and (CHTINCH lt ‘58’ or CHTINCH gt ‘73’)) or AGE = ‘15’ and (CHTINCH lt ‘60’ or CHTINCH gt ‘74’)) or AGE = ‘16’ and (CHTINCH lt ‘61’ or CHTINCH gt ‘74’)) or AGE = ‘17’ and (CHTINCH lt ‘62’ or CHTINCH gt ‘75’)) or
(SEX = ‘2’ and AGE = ‘12’ and (CHTINCH lt ‘54’ or CHTINCH gt ‘68’)) or AGE = ‘13’ and (CHTINCH lt ‘55’ or CHTINCH gt ‘69’)) or AGE = ‘14’ and (CHTINCH lt ‘57’ or CHTINCH gt ‘69’)) or AGE = ‘15’ and (CHTINCH lt ‘57’ or CHTINCH gt ‘69’)) or AGE = ‘16’ and (CHTINCH lt ‘57’ or CHTINCH gt ‘70’)) or AGE = ‘17’ and (CHTINCH lt ‘57’ or CHTINCH gt ‘69’))
go to ERR3_CHGT_IN else go to CWGT_LB
ERR1_CHGT_IN
Hard Edit:
*Must enter an answer in at least the inches item.
*Please correct.
ERR2_CHGT_IN
*Number of inches exceeds maximum allowed.
*Please correct.
ERR3_CHGT_IN
Soft Edit:
* Please verify that the height was entered correctly. Probe only if necessary.

Question ID: CHS.021_01.000

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

Question ID: CHS.021_02.000

Instrument Variable Name: CHGT_CM
Question Text:
* Enter centimeters.
000-241 Blank
0-241 centimeters Blank
Universe Text: Sample children 12+ whose weight will be entered in metric, and who entered "0-2" for height in meters or left it empty.
Skip Instructions:

(0-241,R,D) If (CHGT_M = ‘0’, ’empty’) and (CHGT_CM = ‘0’, ‘empty’) go to ERR1_CHGT_CM elseif

(CHGT_M eq ‘2’ and CHGT_CM gt ‘41’) or (CHGT_M eq ‘1’ and CHGT_CM gt ‘141’) go to ERR2_CHGT_CM
elseif (SEX = ‘1’ and AGE = ‘12’ and (CHTCM lt ‘137’ or CHTCM gt ‘174’)) or AGE = ‘13’ and (CHTCM lt ‘140’ or CHTCM gt ‘184’)) or AGE = ‘14’ and (CHTCM lt ‘148’ or CHTCM gt ‘186’)) or AGE = ‘15’ and (CHTCM lt ‘152’ or CHTCM gt ‘189’)) or AGE = ‘16’ and (CHTCM lt ‘156’ or CHTCM gt ‘189’)) or AGE = ‘17’ and (CHTCM lt ‘157’ or CHTCM gt ‘192’)) or
(SEX = ‘2’ and AGE = ‘12’ and (CHTCM lt ‘138’ or CHTCM gt ‘173’)) or AGE = ‘13’ and (CHTCM lt ‘141’ or CHTCM gt ‘176’)) or AGE = ‘14’ and (CHTCM lt ‘145’ or CHTCM gt ‘176’)) or AGE = ‘15’ and (CHTCM lt ‘145’ or CHTCM gt ‘177’)) or AGE = ‘16’ and (CHTCM lt ‘145’ or CHTCM gt ‘177’)) or AGE = ‘17’ and (CHTCM lt ‘145’ or CHTCM gt ‘176’))
go to ERR3_CHGT_CM else go to CWGT_LB
ERR1_CHGT_CM
Hard Edit:
*Must enter an answer at least in the centimeters item.
*Please correct.
ERR2_CHGT_CM
*Total height exceeds maximum allowed.
*Please correct.
ERR3_CHGT_CM
Soft Edit:
* Please verify that the height was entered correctly. Probe only if necessary.

Question ID: CHS.022_00.000

Instrument Variable Name: CWGT_LB
Question Text:
How much does [fill: S.C. name] weigh now (without shoes)?
*Enter 'M' to record metric measurements.
*Enter '500' if 500 pounds or more.
001-500 1-500 pounds
997 Refused
999 Don't know
M Metric
Universe Text: Sample children 12+
Skip Instructions:
(1-500) if CWGT_LB lt ‘1’ or CWGT_LB gt ‘500’
go to ERR1_CWGT_LB
elseif (SEX = ‘1’ and AGE = ‘12’ and (CWGT_LB lt ‘62’ or CWGT_LB gt ‘209’)) or AGE = ‘13’ and (CWGT_LB lt ‘70’ or CWGT_LB gt ‘247’)) or AGE = ‘14’ and (CWGT_LB lt ‘83’ or CWGT_LB gt ‘266’)) or AGE = ‘15’ and (CWGT_LB lt ‘94’ or CWGT_LB gt ‘267’)) or AGE = ‘16’ and (CWGT_LB lt ‘98’ or CWGT_LB gt ‘306’)) or AGE = ‘17’ and (CWGT_LB lt ‘106’ or CWGT_LB gt ‘317’)) or
(SEX = ‘2’ and AGE = ‘12’ and (CWGT_LB lt ‘62’ or CWGT_LB gt ‘212’)) or AGE = ‘13’ and (CWGT_LB lt ‘73’ or CWGT_LB gt ‘238’)) or AGE = ‘14’ and (CWGT_LB lt ‘84’ or CWGT_LB gt ‘252’)) or AGE = ‘15’ and (CWGT_LB lt ‘84’ or CWGT_LB gt ‘238’)) or AGE = ‘16’ and (CWGT_LB lt ‘87’ or CWGT_LB gt ‘257’)) or AGE = ‘17’ and (CWGT_LB lt ‘90’ or CWGT_LB gt ‘292’))
go to ERR2_CWGT_LB elseif CHGT_FLG = ‘1’ and CWGT_FLG = ‘1’ and AGE ge ‘2’ go to ADD_1 elseif CHGT_FLG = ‘1’ and CWGT_FLG = ‘1’ and AGE lt ‘2’ go to ADD1_2 else calculate the BMI (Body Mass Index) – See CBMI spec page (R,D) if AGE ge ‘2’ go to ADD_1 else go to ADD1_2
(M) go to CWGT_KG
ERR1_CWGT_LB
Hard Edit:
*Weight is out of range (1-500).
*Please correct.
ERR2_CWGT_LB
Soft Edit:
* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID: CHS.023_00.000

Instrument Variable Name: CWGT_KG
Question Text:
* Enter weight in kilograms.
002-226 2-226 kilograms
Universe Text: Sample children 12+ whose weight will be entered in metric.
Skip Instructions:
(2-226) if CWGT_KG lt ‘2’ or CWGT_KG gt ‘226’
go to ERR1_CWGT_KG
elseif (SEX = ‘1’ and AGE = ‘12’ and (CWGT_KG = ‘28’ or CWGT_KG = ‘95’)) or AGE = ‘13’ and (CWGT_KG = ‘32’ or CWGT_KG = ‘112’)) or AGE = ‘14’ and (CWGT_KG = ‘38’ or CWGT_KG = ‘121’)) or AGE = ‘15’ and (CWGT_KG = ‘42’ or CWGT_KG = ‘121’)) or AGE = ‘16’ and (CWGT_KG = ‘44’ or CWGT_KG = ‘139’)) or AGE = ‘17’ and (CWGT_KG = ‘48’ or CWGT_KG = ‘144’)) or
(SEX = ‘2’ and AGE = ‘12’ and (CWGT_KG = ‘28’ or CWGT_KG = ‘96’)) or AGE = ‘13’ and (CWGT_KG = ‘33’ or CWGT_KG = ‘108’)) or AGE = ‘14’ and (CWGT_KG = ‘38’ or CWGT_KG = ‘114’)) or AGE = ‘15’ and (CWGT_KG = ‘38’ or CWGT_KG = ‘108’)) or AGE = ‘16’ and (CWGT_KG = ‘39’ or CWGT_KG = ‘117’)) or AGE = ‘17’ and (CWGT_KG = ‘41’ or CWGT_KG = ‘133’))
go to ERR2_CWGT_KG elseif CHGT_FLG = ‘1’ and CWGT_FLG = ‘1’ and AGE ge ‘2’ go to ADD_1 elseif CHGT_FLG = ‘1’ and CWGT_FLG = ‘1’ and AGE lt ‘2’ go to ADD1_2 else calculate the BMI (Body Mass Index) – See CBMI spec page (R,D) if AGE ge ‘2’ go to ADD_1 else go to ADD1_2
ERR1_CWGT_KG
Hard Edit:
*Weight is out of range (2-226).
*Please correct.
ERR2_CWGT_KG
Soft Edit:
* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID: CHS.031_02.000

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

Question ID: CHS.031_03.000

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

Question ID: CHS.032_01.000

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

Question ID: CHS.032_02.000

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

Question ID: CHS.032_02.010

Instrument Variable Name: AUTISM
Question Text: ?[F1]
* Read if necessary.
Has a doctor or health professional ever told you that [fill: S.C. name] had...
Autism, Asperger’s disorder, pervasive developmental disorder, or autism spectrum disorder?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample children 2-17
Skip Instructions:
(1,2,R,D) [go to ADD_3]

Question ID: CHS.032_03.000

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

Question ID: CHS.060_00.000

Instrument Variable Name: CONDL
Question Text:
(book) C2 ?[F1]
Looking at this list, has a doctor or health professional ever told you that [fill: SC name] had any of these conditions?
*Read if necessary.
Down syndrome
Cerebral palsy
Muscular dystrophy
Cystic fibrosis
Sickle cell anemia
Diabetes
Arthritis
Congenital heart disease
Other heart condition
Universe Text: Sample children (18
Skip Instructions:
(1) [go to CONDL1] (2,R,D) [go to CPOX]

Question ID: CHS.061_00.000

Instrument Variable Name: CONDL1
Question Text:
(book) C2 ? [F1]
Which ones?
* Enter all that apply, separate with commas.
Universe Text: Sample children (18 and CONDL=1
Skip Instructions:
(1-9, R,D) [go to CPOX]

Question ID: CHS.070_00.000

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

Question ID: CHS.072_00.000

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

Question ID: CHS.080_00.000

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

Question ID: CHS.085_00.000

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

Question ID: CHS.090_00.000

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

Question ID: CHS.100_00.000

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

Question ID: CHS.111_01.000

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

Question ID: CHS.111_02.000

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

Question ID: CHS.111_03.000

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

Question ID: CHS.111_04.000

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

Question ID: CHS.111_05.000

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

Question ID: CHS.111_06.000

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

Question ID: CHS.111_08.000

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

Question ID: CHS.111_09.000

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

Question ID: CHS.115_01.000

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

Question ID: CHS.115_02.000

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

Question ID: CHS.115_03.000

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

Question ID: CHS.115_04.000

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

Question ID: CHS.115_05.000

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

Question ID: CHS.115_06.000

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

Question ID: CHS.115_07.000

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

Question ID: CHS.115_08.000

Instrument Variable Name: CCONDT_8
Question Text:
* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions...
Three or more ear infections?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample children = 3-17
Skip Instructions:
(1,2,R,D) [go to CCONDT_9]

Question ID: CHS.115_09.000

Instrument Variable Name: CCONDT_9
Question Text:
* Read if necessary.
DURING THE PAST 12 MONTHS, has [fill: SC name] had any of the following conditions...
Seizures?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample children = 3-17
Skip Instructions:
(1,2,R,D) [go to CCONDT_10]

Question ID: CHS.115_10.000

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

Question ID: CHS.210_00.000

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

Question ID: CHS.220_00.000

Instrument Variable Name: SCHDAYR
Question Text:
DURING THE PAST 12 MONTHS about how many days did [fill2: SC name] miss school because of illness or injury?
* Enter '996' if child did not go to school in the past 12 months.
000 None
001-240 1-240 days
996 Did not go to school
997 Refused
999 Don't know
Universe Text: Sample children 5-17
Skip Instructions:
(0-99,996,R,D) [go to CCOLD2W]
(100-240) [go to ERR1_SCHDAYR]
(241-995) [go to ERR2_SCHDAYR]
ERR2_SCHDAYR
Hard Edit:
*"241-995" days not allowed in this field.
*Please correct.
ERR1_SCHDAYR
Soft Edit:
[fill4: SCHDAYR] is an unusually large number. Did [fill2: SC name] miss [fill: SCHDAYR] days of school because of illness or injury?
* Please verify.

Question ID: CHS.230_00.000

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

Question ID: CHS.240_00.000

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

Question ID: CHS.250_00.000

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

Question ID: CHS.260_00.000

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

Question ID: CHS.270_00.000

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

Question ID: CHS.290_00.000

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

Question ID: CHS.300_00.000

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

Question ID: CHS.310_00.000

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

Question ID: CHS.311_00.000

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

Question ID: CHS.312_00.000

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

Question ID: CHS.321_01.000

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

Question ID: CHS.321_02.000

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

Question ID: CHS.321_03.000

Instrument Variable Name: CMHAGM11_3
Question Text:

(book) C3 ?[F1]

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

Question ID: CHS.321_04.000

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

Question ID: CHS.361_01.000

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

Question ID: CHS.361_02.000

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

Question ID: CHS.361_03.000

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

Question ID: CHS.361_04.000

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

Question ID: CAU.020_00.000

Instrument Variable Name: CUSUALPL
Question Text:
The next questions are about health care.
Is there a place that [fill1: alias] USUALLY goes when [fill2: he/she] is sick or you need advice about [fill3: his/her] health?
1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don't know
Universe Text: Sample children (18
Skip Instructions:
(1,3) [go to CPLKIND]
(2,R,D) [go to CHCPLKND]

Question ID: CAU.030_00.000

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

Question ID: CAU.035_00.000

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

Question ID: CAU.037_00.000

Instrument Variable Name: CHCPLKND
Question Text:
What kind of place does [fill1: alias] USUALLY go to when [fill2: he/she] needs routine or preventive care, such as a physical examination or (well baby/child) check-up?
0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know
Universe Text: Sample children (18 who do not have a usual source of sick care; who Ref/NA/DK if have a usual source of sick care; who have a usual source of sick care but does not go to one place most often; who have a usual source of sick care but Ref/NA/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source of sick care but Ref/NA/DK if it is same place as usual source of routine/preventive care.
Skip Instructions:
(0-6,R,D) if CUSUALPL=2,R,D [go to CPRVTRYR]; ELSE [go to CHCCHGYR]

Question ID: CAU.040_00.000

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

Question ID: CAU.050_00.000

Instrument Variable Name: CHCCHGHI
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 children (18 that have changed their usual place of health care in the past 12 months
Skip Instructions:
(1,2,R,D) [go to CPRVTRYR]

Question ID: CAU.052_00.010

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

Question ID: CAU.053_00.010

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

Question ID: CAU.055_00.010

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

Question ID: CAU.056_00.010

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

Question ID: CAU.080_01.000

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

Question ID: CAU.080_02.000

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

Question ID: CAU.080_03.000

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

Question ID: CAU.080_04.000

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

Question ID: CAU.080_05.000

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

Question ID: CAU.130_00.000

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

Question ID: CAU.133_00.010

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

Question ID: CAU.133_00.020

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

Question ID: CAU.135_01.000

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

Question ID: CAU.135_02.000

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

Question ID: CAU.135_03.000

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

Question ID: CAU.135_04.000

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

Question ID: CAU.135_05.010

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

Question ID: CAU.135_06.010

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

Question ID: CAU.160_00.000

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

Question ID: CAU.170_01.000

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

Question ID: CAU.170_02.000

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

Question ID: CAU.170_03.000

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

Question ID: CAU.170_04.000

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

Question ID: CAU.175_01.000

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

Question ID: CAU.175_02.000

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

Question ID: CAU.175_03.000

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

Question ID: CAU.175_04.000

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

Question ID: CAU.175_05.000

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

Question ID: CAU.175_06.000

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

Question ID: CAU.230_00.000

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

Question ID: CAU.240_01.000

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

Question ID: CAU.240_02.000

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

Question ID: CAU.260_00.000

Instrument Variable Name: CHCSYR10
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 children (18 who have seen or talked to a general doctor during the past 12 months
Skip Instructions:
(1,2,R,D) [go to CHCSYREM

]

Question ID: CAU.265_00.000

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

Question ID: CAU.270_00.000

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

Question ID: CAU.280_00.000

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

Question ID: CAU.281_00.010

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

Question ID: CAU.282_00.010

Instrument Variable Name: CERHOS
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 children (18 who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [go to CERREAS1]

Question ID: CAU.283_01.010

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

Question ID: CAU.283_02.020

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

Question ID: CAU.283_03.030

Instrument Variable Name: CERREAS3
Question Text:
*Read if necessary.
Tell me which of these apply to [fill: alias]'s last emergency room visit?
… [fill: alias]'s health provider advised that [fill: he/she] go
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample children (18 who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [go to CERREAS4]

Question ID: CAU.283_04.040

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

Question ID: CAU.283_05.050

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

Question ID: CAU.283_06.060

Instrument Variable Name: CERREAS6
Question Text:
*Read if necessary.
Tell me which of these apply to [fill: alias]'s last emergency room visit?
… The emergency room is [fill: alias]'s closest provider
1 Yes
2 No
7 Refused
9 Don’t know
Universe Text: Sample children (18 who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [go to CERREAS7]

Question ID: CAU.283_07.070

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

Question ID: CAU.283_08.080

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

Question ID: CAU.290_00.000

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

Question ID: CAU.300_00.000

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

Question ID: CAU.310_00.000

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

Question ID: CAU.320_00.000

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

Question ID: CAU.330_00.000

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

Question ID: CAU.340_00.000

Instrument Variable Name: CSRGNOYR
Question Text:
Including any times you may have already told me about, HOW MANY DIFFERENT TIMES has [fill1: alias] had surgery DURING THE PAST 12 MONTHS?
* Enter '95' for 95 or more times.
01-94 1-94 times
95 95+ times
97 Refused
99 Don't know
Universe Text: Sample children (18 that have undergone surgery during the past 12 months
Skip Instructions:
(1-10,R,D) [go to CMDLONG]
(11-95) [go to ERR_CMDLONG]
ERR_CMDLONG
Soft Edit:
[fill2: CSRGNOYR] is an unusually large number. Did [fill1: alias] have [fill2: CSRGNOYR] surgical procedures?
*Please verify.

Question ID: CAU.345_00.000

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

Question ID: CMB.010_00.000

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

Question ID: CMB.020_01.000

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

Question ID: CMB.020_02.000

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

Question ID: CMB.020_03.000

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

Question ID: CMB.020_04.000

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

Question ID: CMB.020_05.000

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

Question ID: CMB.030_00.000

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

Question ID: CFI.005_00.010

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

Question ID: CFI.005_00.020

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

Question ID: CFI.005_00.030

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

Question ID: CFI.005_00.040

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

Question ID: CFI.005_00.050

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

Question ID: CFI.005_00.060

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

Question ID: CFI.005_00.070

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

Question ID: CFI.005_00.080

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