1
2016 NHIS Questionnaire - Functioning And Disability
Adult Functioning and Disability
Document Version Date: 12-Jun-17
Question ID: AFD.090_00.000
Instrument Variable Name: VIS_0
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Now I am going to ask you some questions about your ability to do different activities, and how you have been feeling.
Although some of these questions may seem similar to ones you have already answered, it is important that we ask them all.
Do you wear glasses?
Although some of these questions may seem similar to ones you have already answered, it is important that we ask them all.
Do you wear glasses?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto VIS_SS
Instrument Variable Name: VIS_SS
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-4,R,D)[goto HEAR_1]
Instrument Variable Name: HEAR_1
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you use a hearing aid?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1) [goto HEAR_2]
(2,R,D) [goto HEAR_SS]
(2,R,D) [goto HEAR_SS]
Instrument Variable Name: HEAR_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
How often do you use your hearing aid(s)? Would you say all of the time, some of the time, rarely, or never?
1 All of the time
2 Some of the time
3 Rarely
4 Never
7 Refused
9 Don't know
2 Some of the time
3 Rarely
4 Never
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the
Functioning and Disability (AFD) section, and use a hearing aid
Skip Instructions:
Functioning and Disability (AFD) section, and use a hearing aid
Skip Instructions:
(1,2,R,D) goto HEAR_SS
Instrument Variable Name: HEAR_SS
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty hearing [fill: , even when using your hearing aid(s)]? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-3,R,D)[goto HEAR_3]
(4) [goto MOB_SS]
(4) [goto MOB_SS]
Instrument Variable Name: HEAR_3
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty hearing what is said in a conversation with one other person in a quiet room [fill: even when using your hearing aid(s)]? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty hearing, even when using a hearing aid
Skip Instructions:
Skip Instructions:
(1-3,R,D)[goto HEAR_4]
(4)[goto MOB_SS]
(4)[goto MOB_SS]
Instrument Variable Name: HEAR_4
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty hearing what is said in a conversation with one other person in a noisier room [fill: even when using your hearing aid(s)]? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and have no difficulty, some difficulty, a lot of difficulty, or refuse or don't know if they have difficulty hearing what is said in a conversation with one other person in a quiet room (even when wearing their hearing aid(s))
Skip Instructions:
Skip Instructions:
(1-4,R,D)[goto MOB_SS]
Instrument Variable Name: MOB_SS
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty walking or climbing steps? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-4,R,D) goto MOB_2
Instrument Variable Name: MOB_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you use any equipment or receive help for getting around?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1)[goto MOB_3A]
(2,R,D)[goto MOB_4]
(2,R,D)[goto MOB_4]
Instrument Variable Name: MOB_3A
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you use any of the following...
Cane or walking stick?
Cane or walking stick?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto MOB_3B
Instrument Variable Name: MOB_3B
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
*Read if necessary.
Do you use any of the following...
Walker or Zimmer frame?
Do you use any of the following...
Walker or Zimmer frame?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto MOB_3C
Instrument Variable Name: MOB_3C
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
*Read if necessary.
Do you use any of the following...
Crutches?
Do you use any of the following...
Crutches?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto MOB_3D
Instrument Variable Name: MOB_3D
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
*Read if necessary.
Do you use any of the following...
Wheelchair or scooter?
Do you use any of the following...
Wheelchair or scooter?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto MOB_3E
Instrument Variable Name: MOB_3E
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
*Read if necessary.
Do you use any of the following...
Artificial limb (leg/foot)?
Do you use any of the following...
Artificial limb (leg/foot)?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto MOB_3F
Instrument Variable Name: MOB_3F
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
*Read if necessary.
Do you use any of the following...
Someone's assistance?
Do you use any of the following...
Someone's assistance?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto MOB_3G
Instrument Variable Name: MOB_3G
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
*Read if necessary.
Do you use any of the following...
Other type of equipment or help?
Do you use any of the following...
Other type of equipment or help?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around
Skip Instructions:
Skip Instructions:
(1,2,R,D) if MOB_3D=1, [goto COM_SS];
else if MOB_3D=2,R,D [goto MOB_4]
else if MOB_3D=2,R,D [goto MOB_4]
Instrument Variable Name: MOB_4
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty walking 100 yards on level ground, that would be about the length of one football field or one city block [fill: without the use of your aid(s)]? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and do not use a wheelchair or scooter
Skip Instructions:
Skip Instructions:
(1-3,R,D)[goto MOB_5]
(4)[goto MOB_6]
(4)[goto MOB_6]
Instrument Variable Name: MOB_5
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty walking a third of a mile on level ground, that would be the length of five football fields or five city blocks [fill: without the use of your aid(s)]? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, do not use a wheelchair or scooter, and have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty walking 100 yards on level ground (without the use of their aid)
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto MOB_6
Instrument Variable Name: MOB_6
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty walking up or down 12 steps? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and did not use any equipment or receive help with getting around or did not use a wheelchair or scooter
Skip Instructions:
Skip Instructions:
(1-4,R,D) if MOB_2 IN (2,R,D) [goto COM_SS];
else if MOB_2=1 [goto MOB_7]
else if MOB_2=1 [goto MOB_7]
Instrument Variable Name: MOB_7
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty walking 100 yards on level ground, that would be about the length of one football field or one city block, when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and use equipment or receive help for getting around but do not use a wheelchair or scooter
Skip Instructions:
Skip Instructions:
(1-3,R,D)[goto MOB_8]
(4)[goto COM_SS]
(4)[goto COM_SS]
Instrument Variable Name: MOB_8
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty walking a third of a mile on level ground, that would be the length of five football fields or five city blocks, when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, use equipment or receive help for getting around but do not use a wheelchair or scooter, and who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty walking 100 yards on level ground, when using their aid
Skip Instructions:
Skip Instructions:
(1-4,R,D) goto COM_SS
Instrument Variable Name: COM_SS
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Using your usual language, do you have difficulty communicating, for example, understanding or being understood?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-4,R,D) goto COM_2
Instrument Variable Name: COM_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you use sign language?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1,2,R,D) goto COG_SS
Instrument Variable Name: COG_SS
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1)[goto UB_SS]
(2-4,R,D)[goto COG_1]
(2-4,R,D)[goto COG_1]
Instrument Variable Name: COG_1
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty remembering, concentrating, or both?
1 Difficulty remembering only
2 Difficulty concentrating only
3 Difficulty with both remembering and concentrating
7 Refused
9 Don't know
2 Difficulty concentrating only
3 Difficulty with both remembering and concentrating
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and have some difficulty, a lot of difficulty, or are unable to remember or concentrate, or don't know or refused if they are able to remember or concentrate
Skip Instructions:
Skip Instructions:
(1,3,R,D)[goto COG_2]
(2)[goto UB_SS]
(2)[goto UB_SS]
Instrument Variable Name: COG_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
How often do you have difficulty remembering? Would you say sometimes, often or all of the time?
1 Sometimes
2 Often
3 All of the time
7 Refused
9 Don't know
2 Often
3 All of the time
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and had some difficulty, a lot of difficulty, or were unable to remember or concentrate, or refused to answer or didn't know if they had difficulty remembering or concentrating AND they had difficulty remembering only, difficulty both remembering and concentrating, or refused to answer or didn't know if they had difficulty remembering, concentrating, or both
Skip Instructions:
Skip Instructions:
(1-3,R,D) goto COG_3
Instrument Variable Name: COG_3
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty remembering a few things, a lot of things, or almost everything?
1 A few things
2 A lot of things
3 Almost everything
7 Refused
9 Don't know
2 A lot of things
3 Almost everything
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and had some difficulty, a lot of difficulty, or were unable to remember or concentrate, or refused to answer or didn't know if they had difficulty remembering or concentrating AND they had difficulty remembering only, difficulty both remembering and concentrating, or refused to answer or didn't know if they had difficulty remembering, concentrating, or both
Skip Instructions:
Skip Instructions:
(1-3,R,D) goto UB_SS
Instrument Variable Name: UB_SS
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty with self care, such as washing all over or dressing? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-4,R,D) goto UB_1
Instrument Variable Name: UB_1
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty raising a 2 liter bottle of water or soda from waist to eye level? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-4,R,D) goto UB_2
Instrument Variable Name: UB_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you have difficulty using your hands and fingers, such as picking up small objects, for example, a button or pencil, or opening or closing containers or bottles? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-4,R,D) goto ANX_1
Instrument Variable Name: ANX_1
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
How often do you feel worried, nervous or anxious? Would you say daily, weekly, monthly, a few times a year, or never?
1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-5,R,D) goto ANX_2
Instrument Variable Name: ANX_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you take medication for these feelings?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1,R,D) [goto ANX_3]
(2) if ANX_1=5 [goto DEP_1];
else [goto ANX_3]
(2) if ANX_1=5 [goto DEP_1];
else [goto ANX_3]
Instrument Variable Name: ANX_3
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings?
Would you say a little, a lot, or somewhere in between?
Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and feel worried, anxious, or nervous daily, weekly, monthly, a few times a year or don't know or refused how often OR who do take medication for these feelings or don't know or refused if they take medication for these feelings
Skip Instructions:
Skip Instructions:
(1-3,R,D) goto DEP_1
Instrument Variable Name: DEP_1
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
How often do you feel depressed? Would you say daily, weekly, monthly, a few times a year, or never?
1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1-5,R,D) goto DEP_2
Instrument Variable Name: DEP_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Do you take medication for depression?
1 Yes
2 No
7 Refused
9 Don't know
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1,R,D) [goto DEP_3]
(2) if DEP_1=5 and CHPAIN6M=2-4,R,D [goto PAIN_2];
else [goto TIRED_1];
else [goto DEP_3]
(2) if DEP_1=5 and CHPAIN6M=2-4,R,D [goto PAIN_2];
else [goto TIRED_1];
else [goto DEP_3]
Instrument Variable Name: DEP_3
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Thinking about the last time you felt depressed, how depressed did you feel? Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and feel depressed daily, weekly, monthly, a few times a year or refused or don't know how often they feel depressed OR who do take medication or refused or don't know if they take medication for depression.
Skip Instructions:
Skip Instructions:
(1-3,R,D) if CHPAIN6M=2-4,R,D [goto PAIN_2];
else [goto TIRED_1]
else [goto TIRED_1]
Instrument Variable Name: PAIN_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
In the past 3 months, how often did you have pain? Would you say never, some days, most days, or every day?
1 Never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section and who previously indicated that they had pain in the past 6 months
Skip Instructions:
Skip Instructions:
(1) [goto TIRED_1]
(2,3,4,R,D) [goto PAIN_4]
(2,3,4,R,D) [goto PAIN_4]
Instrument Variable Name: PAIN_4
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Thinking about the last time you had pain, how much pain did you have? Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months
Skip Instructions:
Skip Instructions:
(1-3,R,D) goto TIRED_1
Instrument Variable Name: TIRED_1
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
In the past 3 months, how often did you feel very tired or exhausted? Would you say never, some days, most days, or every day?
1 Never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB) and were randomly selected to receive the Functioning and Disability (AFD) section
Skip Instructions:
Skip Instructions:
(1)[goto next section]
(2-4,R,D)[goto TIRED_2]
(2-4,R,D)[goto TIRED_2]
Instrument Variable Name: TIRED_2
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Thinking about the last time you felt very tired or exhausted, how long did it last? Would you say some of the day, most of the day, or all of the day?
1 Some of the day
2 Most of the day
3 All of the day
7 Refused
9 Don't know
2 Most of the day
3 All of the day
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
Skip Instructions:
Skip Instructions:
(1-3,R,D) goto TIRED_3
Instrument Variable Name: TIRED_3
Questionnaire File Name: Functioning And Disability
Question Text:
Questionnaire File Name: Functioning And Disability
Question Text:
Thinking about the last time you felt this way, how would you describe the level of tiredness? Would you say a little, a lot, or somewhere in between?
1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were asked the family disability questions (FDB), were randomly selected to receive the Functioning and Disability (AFD) section, and felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months
Skip Instructions:
Skip Instructions:
(1-3,R,D) goto next section