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2016 NHIS Questionnaire -Sample Adult
Adult Identification
Document Version Date: 12-Jun-17

Question ID: AID.005_00.000

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

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

Universe Text: This is the Sample Adult and (the Sample Adult section has not been started or completed).
Skip Instructions:
(1) if Sample Adult = demographics.hhc.RELRESP_A
goto beginning of adult.asd
elseif Sample Adult = demographics.hhc.HHRESP
goto beginning of adult.asd
else
goto AIDVERF_S
endif
(2)
goto callbk.ACALLBK1
(3)
goto PROX1
(R)
store '4' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif

Question ID: AID.010_00.000

Instrument Variable Name: PROX1
Questionnaire File Name: Sample Adult
Question Text:
* Proxy interviews can be done for sample adults that have a mental or physical condition that prevents them from responding for themselves.
Is a family member or caregiver that is knowledgeable about [fill: ALIAS of Sample Adult]'s health available?
1 Yes
2 No
Universe Text: The Sample Adult's physical or mental condition prohibits responding.
Skip Instructions:
(1) goto PROX2
(2) goto PROX3

Question ID: AID.015_00.000

Instrument Variable Name: PROX2
Questionnaire File Name: Sample Adult
Question Text:
* Ask if necessary.
What is this person's relationship to [fill: ALIAS of Sample Adult]?
1 Relative who lives in household
2 Relative who doesn't live in household
3 Other caregiver
4 Other
7 Refused
9 Don't know
Universe Text: Knowledgeable proxy is available.
Skip Instructions:
(1-4) goto AIDVERF_S

Question ID: AID.020_00.000

Instrument Variable Name: PROX3
Questionnaire File Name: Sample Adult
Question Text:
*Ask if necessary.
Can a callback with someone knowledgeable about [fill: ALIAS of Sample Adult]'s health be arranged?
1 Yes
2 No
Universe Text: Knowledgeable proxy is not available.
Skip Instructions:
(1) goto callbk.ACALLBK1
(2)
store '3' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif

Question ID: AID.030_00.000

Instrument Variable Name: AIDVERF_S
Questionnaire File Name: Sample Adult
Question Text:
* Please verify the following information about the sample adult before proceeding:
I have recorded your sex as [fill: Sex of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
Universe Text: Sample Adult is not the person entered in HHRESP or RELRESP_A. Or PROX1 = 'Yes'.
Skip Instructions:
(1) goto AIDVERF_A
(2) goto AIDSEX

Question ID: AID.040_00.000

Instrument Variable Name: AIDSEX
Questionnaire File Name: Sample Adult
Question Text:
Are you Male or Female?
* If don?t know or refused enter your best guess of the person's sex.
1 Male
2 Female
Universe Text: Respondent said his/her sex is not correct.
Skip Instructions:
(1,2) store AIDSEX in SEX
goto ERR_AIDSEX
reset AIDVERF_S
goto AIDVERF_S
ERR_AIDSEX
Hard Edit:
*The gender will now be changed to [fill: AIDSEX].
goto AIDVERF_S (as the default goto)

Question ID: AID.045_00.000

Instrument Variable Name: AIDVERF_A
Questionnaire File Name: Sample Adult
Question Text:
* Please verify the following information about the sample adult before proceeding:
I have recorded your age as [fill: Age of Sample Adult] old. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
Universe Text: Sample Adult said his/her sex is correct.
Skip Instructions:
(1) goto AIDVERF_D
(2) goto AIDAGE

Question ID: AID.050_00.000

Instrument Variable Name: AIDAGE
Questionnaire File Name: Sample Adult
Question Text:
How old are you?
000-120 Age in years
997 Refused
999 Don't know
Universe Text: Respondent said his/her age is not correct
Skip Instructions:
(0-120, Refused, Don't know)
if AIDAGE = 'Refused' or AIDAGE = 'Don't know' or AIDAGE = AGE
reset AIDVERF_A
goto ERR_AIDAGE
else
store AIDAGE in AGE
goto AIDDOB_M
Soft Edit: ERR_AIDAGE
*Age of [fill1: ALIAS of Sample Adult] remains [fill2: Age of Sample Adult] years old.
goto AIDVERF_A (whether suppressed or not)

Question ID: AID.055_00.000

Instrument Variable Name: AIDVERF_D
Questionnaire File Name: Sample Adult
Question Text:
* Please verify the following information about the sample adult before proceeding:
I have recorded your birthday as [fill: Birthday of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
1 Yes
2 No
Universe Text: Sample Adult said his/her age is correct.
Skip Instructions:
(1) if AGE of Sample Adult le '17'
goto NO_MORE
else
goto beginning of adult.asd
endif
(2) goto AIDDOB_M

Question ID: AID.060_01.000

Instrument Variable Name: AIDDOB_M
Questionnaire File Name: Sample Adult
Question Text:
1 of 3
What is your birthday?
*Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99Don't know
Universe Text: Respondent said his/her date of birth is not correct or his/her age is not correct
Skip Instructions:
(01-12, Refused, Don't know) goto AIDDOB_D

Question ID: AID.060_02.000

Instrument Variable Name: AIDDOB_D
Questionnaire File Name: Sample Adult
Question Text:
2 of 3
*Enter day of birth.
01-31 Day of the month
97 Refused
99 Don't know
Universe Text: Respondent said his/her date of birth is not correct or his/her age is not correct
Skip Instructions:
(01-31,Refused,Don't know) goto AIDDOB_Y
If days not valid, goto ERR_AIDDOB_D
Hard Edit: ERR_AIDDOB_D
*[fill1: AIDDOB_D] is not a valid day for [fill2: AIDDOB_M].
*Please correct.

Question ID: AID.060_03.000

Instrument Variable Name: AIDDOB_Y
Questionnaire File Name: Sample Adult
Question Text:
3 of 3
*Enter year of birth.
1880-2020 Year of birth
Universe Text: Respondent said his/her date of birth is not correct or his/her age is not correct
Skip Instructions:
(1880-2020, Refused, Don't know) if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
goto AIDVERF_D
endif
(if year GT current year) or (if year = current year and month GT current month) or (if year = current year and month = current month and day GT current day)
goto ERR1_AIDDOB_Y
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
goto ERR2_AIDDOB_Y
endif
(if AIDDOB_M = 'Ref' or 'DK') or (if AIDDOB_D = 'Re'f or 'DK') or (if AIDDOB_Y = 'Ref' or 'DK')
goto ERR3_AIDDOB_Y
else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
goto AIDVERF_D
endif
endif
Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.
if age from AIDDOB items is ne AGE and age from AIDDOB items is valid reset AIDVERF_A or AIDVERF_D.
goto ERR4_AIDDOB_Y
endif
Hard Edit: ERR1_AIDDOB_Y
*Future date invalid: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR2_AIDDOB_Y
*Not a valid day: [fill1: (AIDDOB_M) (AIDDOB_D), (AIDDOB_Y)]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR3_AIDDOB_Y
*DOB of [fill2: ALIAS of Sample Adult] remains [fill3: (DOBM) (DOBD), (DOBY)]
goto AIDVERF_A (whether suppressed or not)
ERR4_AIDDOB_Y
* Data mismatched. Please fix Age or Birthday.

Question ID: ASD.050_00.000

Instrument Variable Name: WRKVER
Questionnaire File Name: Sample Adult
Question Text:
Earlier I recorded that in the last week you were
(Fill1: working for pay at a job or business.)
(Fill2: with a job or business but not at work.)
(Fill3: looking for work.)
(Fill4: working, but not for pay, at a family-owned job or business.)
(Fill5: not working at a job or business and not looking for work.)
Is that correct?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working or not working last week
Skip Instructions:
(1)if DOINGLW2 = 1,2,4 [goto WHOWRK]
else if DOINGLW2 = 3,5 [goto EVERWRK]
(2) [go to WRKCOR]
(R,D) [go to EVERWRK]

Question ID: ASD.060_00.000

Instrument Variable Name: WRKCOR
Questionnaire File Name: Sample Adult
Question Text:
(book) A1 ? [F1]
What is your correct working status?
* Read answer categories.
1 Working for pay at a job or business
2 With a job or business but not at work
3 Looking for work
4 Working, but not for pay, at a family-owned job or business
5 Not working at a job or business and not looking for work
7 Refused
9 Don't know
Universe Text: Sample adults 18+ whose working status was incorrect or who were not the Family Respondent and with an answer of D or R to DOINGLW.
Skip Instructions:
(1,4) [goto to WHOWRK]
(2,5) [goto WHYNOWK2]
(3,R,D) [goto EVERWRK]

Question ID: ASD.062_00.000

Instrument Variable Name: DOINGLW2
Questionnaire File Name: Sample Adult
Question Text:
Corrected Employment Status Last Week: (not displayed)
1 Working for pay at a job or business
2 With a job or business but not at work
3 Looking for work
4 Working, but not for pay, at a family-owned job or business
5 Not working at a job or business and not looking for work
7 Refused
9 Don't know
Universe Text: Sample Adults 18+ and also the family section respondent and said Refused or Don't know to the working last week status question in the family section
Skip Instructions:
if DOINGLW2 = Refused or Don't know then
[goto EVERWRK]
endif

Question ID: ASD.065_00.000

Instrument Variable Name: WHYNOWK2
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
(Fill1: What is the main reason you did not work last week?)
(Fill2: What is the main reason you did not have a job or business last week?)
01 Taking care of house or family
02 Going to school
03 Retired
04 On a planned vacation from work
05 On family or maternity leave
06 Temporarily unable to work for health reasons
07 Have job or contract and off-season
08 On layoff
09 Disabled
10 Other
97 Refused
99 Don't know
Universe Text: Sample Adults 18+ whose corrected working status last week was not working at a job or business and not looking for work or with a job or business but not at work
Skip Instructions:
(1-10,D,R) if WRKCOR = 2 then
[goto WHOWRK]
else [goto EVERWRK]

Question ID: ASD.066_00.000

Instrument Variable Name: EVERWRK
Questionnaire File Name: Sample Adult
Question Text:
Have you ever held a job or worked at a business?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were NOT working at a job or business and not looking for work or looking for work last week or didn't know or refused to provide their employment status last week
Skip Instructions:
(1) [goto WHOWRK]
(2,D,R) [goto SCHOOLYR]

Question ID: ASD.070_00.000

Instrument Variable Name: WHOWRK
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
(Fill1:For whom did you work at your MAIN job or business? (Name of company, business, organization or employer))
(Fill2: Thinking about the job you held the longest, for whom did you work? (Name of company, business, organization or employer))
(Fill3: Thinking about the job you held most recently, for whom did you work? (Name of company, business, organization or employer))
Verbatim
Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(90 char long,D,R) [goto KINDIND]

Question ID: ASD.080_00.000

Instrument Variable Name: KINDIND
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
What kind of business or industry was this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)
Verbatim
Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(90 char long,D,R) [goto KINDWRK]

Question ID: ASD.090_00.000

Instrument Variable Name: KINDWRK
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)
Verbatim
Verbatim response
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(90 char long,D,R) [goto IMPACT]

Question ID: ASD.100_00.000

Instrument Variable Name: IMPACT
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates printing press.)
Verbatim
Verbatim response
7Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(90 char long,D,R) [goto SUPERVIS]

Question ID: ASD.105_00.010

Instrument Variable Name: SUPERVIS
Questionnaire File Name: Sample Adult
Question Text:
Did you supervise other employees as part of your job?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(1,2,R,D) [goto WRKCAT]

Question ID: ASD.110_00.000

Instrument Variable Name: WRKCAT
Questionnaire File Name: Sample Adult
Question Text:
(book) A2 ? [F1]
[If DOINGLW2 eq (1,2,4)] Looking at the card, which of these best describes your current job or work situation? [Else if EVERWRK eq (1) and [WHYNOWK2 eq 03 or AGE ge 65] Looking at the card, which of these best describes the job you held for the longest time?[Else if EVERWRK eq (1) and WHYNOWK2 ne 03 and AGE lt 65] Looking at the card, which of these best describes the job you held most recently?
* Read answer choices if necessary.
1 Employee of a PRIVATE company for wages
2 A FEDERAL government employee
3 A STATE government employee
4 A LOCAL government employee
5 Self-employed in OWN business, professional practice or farm
6 Working WITHOUT PAY in a family-owned business or farm
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(1-4,6,D,R)[goto LOCALLNO]
(5) [goto BUSINC]

Question ID: ASD.112_00.000

Instrument Variable Name: BUSINC
Questionnaire File Name: Sample Adult
Question Text:
Is this business incorporated?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are self-employed
Skip Instructions:
(1,2,D,R) [goto LOCALLNO]

Question ID: ASD.120_00.000

Instrument Variable Name: LOCALLNO
Questionnaire File Name: Sample Adult
Question Text:
(book) A3
Thinking about
(Fill1: this MAIN job or business)
(Fill2: your last week at the job you held the longest)
(Fill3: your last week at the job you held most recently)
how many people (Fill4:work/Fill5: worked) at this location? Please include yourself.
* "People" includes both FULL- and PART-time employees.
* "Location" refers to the street address of the workplace.
01 1 employee
02 2-9 employees
03 10-24 employees
04 25-49 employees
05 50-99 employees
06 100-249 employees
07 250-499 employees
08 500-999 employees
09 1000 employees or more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(1-9, R,D) [goto WRKLONGN]

Question ID: ASD.140_01.000

Instrument Variable Name: WRKLONGN
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
1 of 2
About how long [If DOINGLW2 eq (1,2,4)] have you worked at this MAIN job or business? [Else if EVERWRK eq (1) and [WHYNOWK2 eq 03 or AGE ge 65] did you work at the job you held the longest? [Else if EVERWRK eq (1) and WHYNOWK2 ne 03 and AGE lt 65] did you work at the job you held most recently?
001-365 1-365
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(1-365) [goto WRKLONGT]
(D,R) if EVERWRK eq 1 and (WHYNOWK2 eq 03 or AGE GE 65)
[goto HOURPD] ;
Else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or (DOINGLW2 = 1,2,4)
[goto WRKLONGH]

Question ID: ASD.140_02.000

Instrument Variable Name: WRKLONGT
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
Universe Text: Sample adults 18+ (who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked) and who gave a number entry in WRKLONGN
Skip Instructions:
(4) if WRKLONGN gt AGE then [goto ERR_WRKLONGT]
(1-4) if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65) then [goto HOURPD]
else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or (DOINGLW2 = 1,2,4)
[goto WRKLONGH]
Hard Edit: ERR_WRKLONGT
* Number of years is greater than age.
*Please correct.

Question ID: ASD.146_00.000

Instrument Variable Name: WRKLONGH
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
[If DOINGLW2 eq 1,2,4] Is this MAIN job or business the job you have held for the longest? [Else if EVERWRK eq 1 and WHYNOWK2 ne 03 and AGE lt 65] Was your most recently held job also the job you held the longest?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ (who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business,) or (who have ever worked and are not retired and are less than 65 years of age.)
Skip Instructions:
(1,2,R,D) [goto HOURPD]

Question ID: ASD.150_00.000

Instrument Variable Name: HOURPD
Questionnaire File Name: Sample Adult
Question Text:
[If DOINGLW2 eq (1,2,4)] Are you paid by the hour at this MAIN job or business? [Else if EVERWRK eq (1) and [WHYNOWK2 eq 03 or AGE ge 65] Were you paid by the hour on the job you held the longest? [Else if EVERWRK eq (1) and WHYNOWK2 ne 03 and AGE lt 65] Were you paid by the hour on the job you held most recently?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(1,2,D,R) [goto PDSICK]

Question ID: ASD.160_00.000

Instrument Variable Name: PDSICK
Questionnaire File Name: Sample Adult
Question Text:
[If DOINGLW2 eq (1,2,4)] Do you have paid sick leave on this MAIN job or business? [Else if EVERWRK eq (1) and [WHYNOWK2 eq 03 or AGE ge 65] Did you ever have paid sick leave on the job you held the longest?[Else if EVERWRK eq (1) and WHYNOWK2 ne 03 and AGE lt 65] Did you ever have paid sick leave on the job you held most recently?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business, or who have ever worked
Skip Instructions:
(1,2,D,R)
if DOINGLW2 = 1,2,4 then [goto ONEJOB];
else if DOINGLW2=3,5 then [goto WRKLYR2];
else if DOINGLW2=D, R then [goto next section]

Question ID: ASD.170_00.000

Instrument Variable Name: ONEJOB
Questionnaire File Name: Sample Adult
Question Text:
Do you have more than one job or business?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were working last week, or who were with a job or business but not at work, or who were working but not for pay at a family-owned job or business
Skip Instructions:
(1,2,R,D) [goto next section]

Question ID: ASD.210_00.000

Instrument Variable Name: WRKLYR2
Questionnaire File Name: Sample Adult
Question Text:
Although you did not work last week, did you have a job or business at any time in the PAST 12 MONTHS?
0 Had job last week
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were looking for work or who were not working at a job or business AND who were not looking for work in the last week
Skip Instructions:
(1,2,D,R) [goto next section]

Question ID: ACN.010_00.000

Instrument Variable Name: HYPEV
Questionnaire File Name: Sample Adult
Question Text:
Now I am going to ask you about certain medical conditions.
Have you EVER been told by a doctor or other health professional that you had
... Hypertension, also called high blood pressure?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto HYPDIFV]
(2,R,D) [goto CHLEV]

Question ID: ACN.020_00.000

Instrument Variable Name: HYPDIFV
Questionnaire File Name: Sample Adult
Question Text:
Were you told on two or more DIFFERENT visits that you had hypertension, also called high blood pressure?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were told they had hypertension
Skip Instructions:
(1) [goto HYPYR]
(2,R,D) [goto HYPMDEV2]

Question ID: ACN.020_00.010

Instrument Variable Name: HYPYR
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you had hypertension, also called high blood pressure?
*Enter '1' if respondent is taking medication to control his/her high blood pressure.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were ever told they had hypertension (2+ visits)
Skip Instructions:
(1,2,R,D) [goto HYPMDEV2]

Question ID: ACN.031_01.000

Instrument Variable Name: CHDEV
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER been told by a doctor or other health professional that you had
... Coronary heart disease?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto ANGEV]

Question ID: ACN.031_02.000

Instrument Variable Name: ANGEV
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
... Angina, also called angina pectoris?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto MIEV]

Question ID: ACN.031_03.000

Instrument Variable Name: MIEV
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A heart attack (also called myocardial infarction)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto HRTEV]

Question ID: ACN.031_04.000

Instrument Variable Name: HRTEV
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...Any kind of heart condition or heart disease (other than the ones I just asked about)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto STREV]

Question ID: ACN.031_05.000

Instrument Variable Name: STREV
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A stroke?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto EPHEV]

Question ID: ACN.031_06.000

Instrument Variable Name: EPHEV
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...Emphysema?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto COPDEV]

Question ID: ACN.035_00.000

Instrument Variable Name: COPDEV
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER been told by a doctor or other health professional that you had chronic obstructive pulmonary disease, also called COPD?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [if AGE GE 40, goto ASPMEDEV
else goto AASMEV]

Question ID: ACN.040_00.010

Instrument Variable Name: ASPMEDEV
Questionnaire File Name: Sample Adult
Question Text:
Has a doctor or other health professional EVER told you to take a low-dose aspirin each day to prevent or control heart disease?
* If the respondent volunteers they have been told to take an aspirin every other day or ?regularly? for these reasons, enter 1 for ?yes.?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+
Skip Instructions:
(1) [goto ASPMEDAD]
(2,R,D) [goto ASPONOWN]

Question ID: ACN.040_00.020

Instrument Variable Name: ASPMEDAD
Questionnaire File Name: Sample Adult
Question Text:
Are you NOW following this advice?
* If the respondent provides an answer such as ?sometimes,? ?occasionally,? or ?from time to time,? enter 1 for ?yes."
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have ever been advised to take a low-dose aspirin every day to prevent or control heart disease
Skip Instructions:
(1,R,D) [goto AASMEV]
(2) [goto ASPMDMED]

Question ID: ACN.040_00.030

Instrument Variable Name: ASPMDMED
Questionnaire File Name: Sample Adult
Question Text:
Did a doctor or other health professional advise you to stop taking a low-dose aspirin every day?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have ever been advised to take aspirin every day, but are not currently following that advice
Skip Instructions:
(1,2,R,D) [goto AASMEV]

Question ID: ACN.040_00.040

Instrument Variable Name: ASPONOWN
Questionnaire File Name: Sample Adult
Question Text:
On your own, are you now taking a low-dose aspirin each day to prevent or control heart disease?
* If the respondent volunteers they are taking an aspirin every other day or ?regularly? for these reasons, enter 1 for ?yes.?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 40+ who have not been advised to take aspirin every day or Ref/DK if they have been advised to take aspirin every day
Skip Instructions:
(1,2,R,D) [goto AASMEV]

Question ID: ACN.080_00.000

Instrument Variable Name: AASMEV
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
Have you EVER been told by a doctor or other health professional that you had asthma?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto AASSTILL]
(2,R,D) [goto ULCEV]

Question ID: ACN.085_00.000

Instrument Variable Name: AASSTILL
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
Do you still have asthma?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were ever told they have asthma
Skip Instructions:
(1,2,R,D) [go to AASMYR]

Question ID: ACN.090_00.000

Instrument Variable Name: AASMYR
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
DURING THE PAST 12 MONTHS, have you had an episode of asthma or an asthma attack?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were ever told they had asthma
Skip Instructions:
(1,2,R,D) [goto AASMERYR]

Question ID: ACN.100_00.000

Instrument Variable Name: AASMERYR
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
DURING THE PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were ever told they had asthma
Skip Instructions:
(1,2,R,D) [go to ULCEV]

Question ID: ACN.110_00.000

Instrument Variable Name: ULCEV
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER been told by a doctor or other health professional that you had
...An ulcer
This could be a stomach, duodenal or peptic ulcer.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ULCYR]
(2,R,D) [goto ULCCOLEV]

Question ID: ACN.120_00.000

Instrument Variable Name: ULCYR
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS have you had
... An ulcer?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were ever told they had an ulcer
Skip Instructions:
(1,2,R,D) [goto ULCCOLEV]

Question ID: ACN.120_00.010

Instrument Variable Name: ULCCOLEV
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER been told by a doctor or other health professional that you had Crohn?s disease or ulcerative colitis?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto CANEV]

Question ID: ACN.130_00.000

Instrument Variable Name: CANEV
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER been told by a doctor or other health professional that you had
...Cancer or a malignancy of any kind?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto CANKIND_1]
(2,R,D) if SEX=2 [goto PREGEVER];
else if SEX=1 [goto DBHVPAY]

Question ID: ACN.140_00.001

Instrument Variable Name: CANKIND_1
Question Text:
What kind of cancer was it?
* Enter code for the first kind of cancer.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:
(1-30,R,D) [goto CANAGE_1]
IF SEX=1 (MALE) and No. (6,18,29) selected [goto ERR1_CANKIND_1]
IF SEX=2 (FEMALE) and No. (20,26) selected [goto ERR2_CANKIND_1]
Hard Edit: ERR1_CANKIND_1
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_1
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.002

Instrument Variable Name: CANKIND_2
Questionnaire File Name: Sample Adult
NHIS Questionnaire -Sample Adult
Question Text:
* Enter code for the second kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age for one kind of cancer or didn't know how old they were when first diagnosed with that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_1.
Skip Instructions:
(1-30,R,D)[goto CANAGE_2]
(96) if SEX=2 [goto PREGEVER];
else IF SEX=1 [goto DBHVPAY]
IF SEX=1 (MALE) and No. (6,18,29) selected [goto ERR1_CANKIND_2]
Hard Edit:
IF SEX=2 (FEMALE) and No. (20,26) selected [goto ERR2_CANKIND_2]
ERR1_CANKIND_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_2
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.003

Instrument Variable Name: CANKIND_3
Questionnaire File Name: Sample Adult
NHIS Questionnaire -Sample Adult
Question Text:
* Enter code for the third kind of cancer.
* Enter '96' for no more.
01 Bladder
02 Blood
03 Bone
04 Brain
05 Breast
06 Cervix
07 Colon
08 Esophagus
09 Gallbladder
10 Kidney
11 Larynx-windpipe
12 Leukemia
13 Liver
14 Lung
15 Lymphoma
16 Melanoma
17 Mouth/tongue/lip
18 Ovary
19 Pancreas
20 Prostate
21 Rectum
22 Skin (non-melanoma)
23 Skin (DK what kind)
24 Soft tissue (muscle or fat)
25 Stomach
26 Testis
27 Throat - pharynx
28 Thyroid
29 Uterus
30 Other
96 No more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who either provided an age for a second kind of cancer or didn't know how old they were when first diagnosed that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_2.
Skip Instructions:
(1-30,R,D)[goto CANAGE_3]
(96) if SEX=2 [goto PREGEVER];
else IF SEX=1 [goto DBHVPAY]
IF SEX=1 (MALE) and No. (6,18,29) selected [goto ERR1_CANKIND_3]
Hard Edit:
IF SEX=2 (FEMALE) and No. (20,26) selected [goto ERR2_CANKIND_3]
ERR1_CANKIND_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_3
* Code 20 or 26 is unavailable for females.

Question ID: ACN.140_00.004

Instrument Variable Name: CANKIND_4
Questionnaire File Name: Sample Adult
Question Text:
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
95 More than three kinds
96 No more
Universe Text: Sample adults 18+ who either provided an age for a third kind of cancer or didn't know how old they were when first diagnosed that kind of cancer or else refused to provide an age but had not refused to answer CANKIND_3
Skip Instructions:
(95,96) if SEX=2 [goto PREGEVER];
else IF SEX=1 [goto DBHVPAY]

Question ID: ACN.150_00.001

Instrument Variable Name: CANAGE_1
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
How old were you when [Fill1: CANKIND_1 / Fill2: this cancer] was first diagnosed?
001-100 1-100 years
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:
(1-100, D) goto CANKIND_2
(R)
and (R) at CANKIND_1 if SEX=2 [goto PREGEVER];
else IF SEX=1 [goto DBHVPAY]
(R)
and CANKIND_1 NE (R) [goto CANKIND_2]
If number in CANAGE_1 greater than person years old (AGE) [goto ERR_ CANAGE_1]
ERR_ CANAGE_1
Hard Edit:
* [Fill2: CANAGE_1] years old is older than age[fill3: AGE].
* Please correct.

Question ID: ACN.150_00.002

Instrument Variable Name: CANAGE_2
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
How old were you when [Fill1: CANKIND_2/Fill2: this cancer] was first diagnosed?
001-100 1-100 years
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:
(1-100, D) [goto CANKIND_3]
(R)
and (R) at CANKIND_2 if SEX=2 [goto PREGEVER];
else IF SEX=1 [goto DBHVPAY]
(R)
and CANKIND_2 NE (R) [goto CANKIND_3]
If number in CANAGE_2 greater than person years old (AGE) [goto ERR_ CANAGE_2]
ERR_ CANAGE_2
Hard Edit:
* [Fill2: CANAGE_2] years old is older than your age[fill3: AGE].
* Please correct.

Question ID: ACN.150_00.003

Instrument Variable Name: CANAGE_3
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
How old were you when [Fill1: CANKIND_3/Fill2: this cancer ] was first diagnosed?
001-100 1-100 years
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who were ever told they had cancer
Skip Instructions:
(1-100, D) [goto CANKIND_4]
(R)
and (R) at CANKIND_3 if SEX=2 [goto PREGEVER];
else IF SEX=1 [goto DBHVPAY]
(R)
and CANKIND_3 NE (R) [goto CANKIND_4]
If number in CANAGE_3 greater than person years old (AGE) [goto ERR_ CANAGE_3]
ERR_ CANAGE_3
Hard Edit:
* [Fill2: CANAGE_3] years old is older than your age[fill3: AGE].
* Please correct.

Question ID: ACN.154_00.010

Instrument Variable Name: PREGEVER
Questionnaire File Name: Sample Adult
Question Text:
Have you ever been pregnant?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto DBHVPAY]

Question ID: ACN.155_00.010

Instrument Variable Name: DBHVPAY
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you been told by a doctor or health professional to do any of the following ...
Increase your physical activity or exercise?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto DBHVCLY]

Question ID: ACN.155_00.020

Instrument Variable Name: DBHVCLY
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
DURING THE PAST 12 MONTHS, have you been told by a doctor or health professional to do any of the following...
Reduce the amount of fat or calories in your diet?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto DBHVWLY]

Question ID: ACN.155_00.030

Instrument Variable Name: DBHVWLY
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
DURING THE PAST 12 MONTHS, have you been told by a doctor or health professional to do any of the following...
Participate in a weight loss program?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto DBHVPAN]

Question ID: ACN.155_00.040

Instrument Variable Name: DBHVPAN
Questionnaire File Name: Sample Adult
Question Text:
Are you NOW doing any of the following...
Increasing your physical activity or exercise?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto DBHVCLN]

Question ID: ACN.155_00.070

Instrument Variable Name: DIBREL
Questionnaire File Name: Sample Adult
Question Text:
Has your mother, father, brother, or sister EVER been told by a doctor or other health professional that they have diabetes or sugar diabetes?
*Include only blood relatives. Do not include step-relatives or those unrelated by blood.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto DIBEV1]

Question ID: ACN.160_00.000

Instrument Variable Name: DIBEV1
Questionnaire File Name: Sample Adult
Question Text:
?[F1]
[Fill1:Other than during pregnancy, have you EVER been told by a doctor or other health professional that you have diabetes or sugar diabetes?]/
[Fill2: Have you EVER been told by a doctor or other health professional that you have diabetes or sugar diabetes?]
1 Yes
2 No
3 Borderline or prediabetes
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto DIBAGE]
(2,R,D) [goto DIBPRE1]
(3) [goto DIBTEST]

Question ID: ACN.165_00.000

Instrument Variable Name: DIBPRE1
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER been told by a doctor or other health professional that you have any of the following: prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were never told they had diabetes, or who refused or said don?t know to having been told they had diabetes
Skip Instructions:
(1,2,R,D) [goto DIBTEST]

Question ID: ACN.167_00.010

Instrument Variable Name: DIBTEST
Questionnaire File Name: Sample Adult
Question Text:
About how long has it been since you last had a blood test for high blood sugar or diabetes?
1 1 year ago or less
2 More than 1 year, but not more than 2 years ago
3 More than 2 years, but not more than 3 years ago
4 More than 3 years ago
5 Never
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who do not have diabetes
Skip Instructions:
(1-5,R,D) if DIBPRE1='1' [goto DIBPILL];
else if SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto DIBPRGM];
else (SEX=2 and PREGEVER=1) [goto DIBGDM]

Question ID: ACN.170_00.000

Instrument Variable Name: DIBAGE
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
How old were you when a doctor or other health professional FIRST told you that you had diabetes or sugar diabetes?
000 thru 100 Age at which diagnosed
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy)
Skip Instructions:
(1-100 R,D) [goto DIBTYPE]
If number in DIBAGE greater than person years old (AGE) goto ERR_ DIBAGE
Hard Edit: ERR_ DIBAGE
* [Fill1: DIBAGE] years old is older than your age[fill2: AGE].
* Please correct.

Question ID: ACN.175_00.010

Instrument Variable Name: DIBTYPE
Questionnaire File Name: Sample Adult
Question Text:
What type of diabetes do you have?
*Read answer categories below.
1 Type 1
2 Type 2
3 Other
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy)
Skip Instructions:
(1-3,R,D) [goto DIBPILL]

Question ID: ACN.180_00.000

Instrument Variable Name: DIBPILL
Questionnaire File Name: Sample Adult
Question Text:
Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy) or who were told they had pre-diabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar
Skip Instructions:
(1,2,R,D) [goto INSLN1]

Question ID: ACN.190_00.000

Instrument Variable Name: INSLN1
Questionnaire File Name: Sample Adult
Question Text:
Insulin can be taken by shot or pump. Are you NOW taking insulin?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were told they had diabetes or sugar diabetes (other than during pregnancy) or who were told they had prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar
Skip Instructions:
(1) if DIBEV1=1 and INSLN1=1 [goto DIBINS2]
else if DIBEV1 ne 1 and (SEX=2 and PREGEVER=1) [goto DIBGDM]
else DIBEV1 ne 1 and SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto DIBPRGM]
(2,R,D) SEX=2 and PREGEVER=1 [goto DIBGDM]
else if DIBEV1=1 and SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto AHAYFYR]
else if DIBEV1 ne 1 and SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto DIBPRGM]

Question ID: ACN.190_00.010

Instrument Variable Name: DIBINS2
Questionnaire File Name: Sample Adult
Question Text:
Thinking back to when you were first diagnosed with diabetes, how long was it before you started taking insulin?
1 Less than 1 month
2 1 month to less than 6 months
3 6 months to less than 1 year
4 1 year or more
7 Refused
9 Don't know
Universe Text: Sample adults 18+ with diabetes who have ever taken insulin by shot or pump
Skip Instructions:
(1-4,R,D) [goto DIBINS3]

Question ID: ACN.190_00.020

Instrument Variable Name: DIBINS3
Questionnaire File Name: Sample Adult
Question Text:
Since you started taking insulin, have you ever stopped taking it for more than 6 months?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ with diabetes who have ever taken insulin by shot or pump
Skip Instructions:
(1) if DIBINS2=1,2,3 [goto DIBINS4]
else if SEX=1 or SEX=2 and PREGEVER=2,R,D [goto AHAYFYR];
else (SEX=2 and PREGEVER=1) [goto DIBGDM]
(2,R,D) if (SEX=2 and PREGEVER=1) [goto DIBGDM]
else [goto AHAYFYR]

Question ID: ACN.190_00.030

Instrument Variable Name: DIBINS4
Questionnaire File Name: Sample Adult
Question Text:
Was this only during the first year after you were diagnosed with diabetes?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who started taking insulin within a year of being diagnosed with diabetes and stopped taking it for more than six months
Skip Instructions:
(1,2,R,D) if SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto DIBPRGM];
else (SEX=2 and PREGEVER=1) [goto DIBGDM]

Question ID: ACN.195_00.010

Instrument Variable Name: DIBGDM
Questionnaire File Name: Sample Adult
Question Text:
[Fill1: Were you FIRST told by a doctor or other health professional that you had diabetes, sugar diabetes, or gestational diabetes during pregnancy?/
Were you EVER told by a doctor or other health professional that you had diabetes, sugar diabetes, or gestational diabetes during pregnancy?]
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female Sample adults 18+ who have ever been pregnant
Skip Instructions:
(1,2,R,D) [goto DIBBABY]

Question ID: ACN.197_00.010

Instrument Variable Name: DIBBABY
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER had a baby that weighed 9 pounds (4 kg) or more at birth?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female Sample adults 18+ who have ever been pregnant
Skip Instructions:
(1,2,R,D) if DIBEV1=1 [goto AHAYFYR];
else if DIBEV=2,R,D [goto DIBPRGM]

Question ID: ACN.198_00.010

Instrument Variable Name: DIBPRGM
Questionnaire File Name: Sample Adult
Question Text:
These next questions are about a year-long program that can help people prevent Type 2 diabetes. This program has weekly sessions during the first 6 months and monthly sessions over the last 6 months. People in the program receive support from a lifestyle coach on achieving and maintaining a healthy lifestyle.
Have you EVER participated in this type of year-long program to prevent Type 2 diabetes?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have not been diagnosed with diabetes
Skip Instructions:
(1,2,R,D) [goto DIBREFER]

Question ID: ACN.198_00.020

Instrument Variable Name: DIBREFER
Questionnaire File Name: Sample Adult
Question Text:
Has a doctor or other health care professional ever referred you to such a program to prevent Type 2 diabetes?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have not been diagnosed with diabetes
Skip Instructions:
(1) if DIBPRGM=1 [goto AHAYFYR];
else if DIBPRGM=2,R,D [goto DIBBEGIN]
(2,R,D) [goto DIBBEGIN]

Question ID: ACN.198_00.030

Instrument Variable Name: DIBBEGIN
Questionnaire File Name: Sample Adult
Question Text:
How interested are you in beginning such a year-long program to prevent Type 2 diabetes? Would you say...
*Read categories below.
1 Very interested
2 Somewhat interested
3 Not interested
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have not participated in a diabetes prevention program and were not referred to one
Skip Instructions:
(1-3,R,D) [goto AHAYFYR]

Question ID: ACN.201_01.000

Instrument Variable Name: AHAYFYR
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had
...Hay fever?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto SINYR]

Question ID: ACN.201_02.000

Instrument Variable Name: SINYR
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had
...Sinusitis?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto CBRCHYR]

Question ID: ACN.201_03.000

Instrument Variable Name: CBRCHYR
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health professional that you had
...Chronic bronchitis?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto KIDWKYR]

Question ID: ACN.250_00.000

Instrument Variable Name: JNTSYMP
Questionnaire File Name: Sample Adult
Question Text:
The next questions refer to your joints. Please do NOT include the back or neck. DURING THE PAST 30 DAYS, have you had any symptoms of pain, aching, or stiffness in or around a joint?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto JMTHP]
(2,R,D) [goto ARTH]

Question ID: ACN.260_00.000

Instrument Variable Name: JMTHP
Questionnaire File Name: Sample Adult
Question Text:
(book) A5
Which joints are affected?
* Enter all that apply, separate with commas.
01 Shoulder-right
02 Shoulder-left
03 Elbow-right
04 Elbow-left
05 Hip-right
06 Hip-left
07 Wrist-right
08 Wrist-left
09 Knee-right
10 Knee-left
11 Ankle-right
12 Ankle-left
13 Toes-right
14 Toes-left
15 Fingers/thumb-right
16 Fingers/thumb-left
17 Other joint not listed
97 Refused
99Don't know
Universe Text: Sample adults 18+ who had joint pain in the past 30 days
Skip Instructions:
(1-17,R,D) [goto JNTCHR]

Question ID: ACN.270_00.000

Instrument Variable Name: JNTCHR
Questionnaire File Name: Sample Adult
Question Text:
Did your joint symptoms FIRST begin more than 3 months ago?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had joint pain in the past 30 days
Skip Instructions:
(1,2,R,D) [goto JNTHP]

Question ID: ACN.280_00.000

Instrument Variable Name: JNTHP
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER seen a doctor or other health professional for these joint symptoms?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had joint pain in the past 30 days
Skip Instructions:
(1,2,R,D) [goto ARTH]

Question ID: ACN.290_00.000

Instrument Variable Name: ARTH
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia (fy-bro-my-AL-jee-uh)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ARTHLMT]
(2,R,D) if JNTSYMP = 1 [goto ARTHLMT];
elseif JNTSYMP ne 1 [goto PAINECK]

Question ID: ACN.295_00.000

Instrument Variable Name: ARTHLMT
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ with joint pain or arthritis
Skip Instructions:
(1,2,R,D) [goto PAINECK]

Question ID: ACN.300_00.000

Instrument Variable Name: PAINECK
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
The following questions are about pain you may have experienced in the PAST THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor.
DURING THE PAST THREE MONTHS, did you have
... Neck pain?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto PAINLB]

Question ID: ACN.310_00.000

Instrument Variable Name: PAINLB
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
* Read if necessary.
DURING THE PAST THREE MONTHS, did you have
... Low back pain?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto PAINLEG]
(2,R,D) [goto PAINFACE]

Question ID: ACN.320_00.000

Instrument Variable Name: PAINLEG
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
Did this pain spread down either leg to areas below the knees?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ with low back pain in the past 3 months
Skip Instructions:
(1,2,R,D) [goto PAINFACE]

Question ID: ACN.331_01.000

Instrument Variable Name: PAINFACE
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST THREE MONTHS, did you have
... Facial ache or pain in the jaw muscles or the joint in front of the ear?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto AMIGR]

Question ID: ACN.331_02.000

Instrument Variable Name: AMIGR
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary:
DURING THE PAST THREE MONTHS, did you have
...Severe headache or migraine?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto ACOLD2W]

Question ID: ACN.350_00.000

Instrument Variable Name: ACOLD2W
Questionnaire File Name: Sample Adult
Question Text:
These next questions are about your recent health DURING THE LAST 2 WEEKS.
Did you have a head cold or chest cold that started DURING THE LAST 2 WEEKS?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto AINTIL2W]

Question ID: ACN.360_00.000

Instrument Variable Name: AINTIL2W
Questionnaire File Name: Sample Adult
Question Text:
Did you have a stomach or intestinal illness with vomiting or diarrhea that started DURING THE LAST TWO WEEKS?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) if SEX=2 and AGE 18-49 [goto PREGNOW];
else if SEX=1 or AGE )49 [goto HRAIDNOW]

Question ID: ACN.370_00.000

Instrument Variable Name: PREGNOW
Questionnaire File Name: Sample Adult
Question Text:
Are you currently pregnant?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18-49 years of age
Skip Instructions:
(1) if INTERVIEW_MONTH=4,5,6,7 (April-July) [goto PREGFLYR];
else [goto HRAIDNOW]
(R)
[goto HRAIDNOW]
(2,D) [goto PREGFLYR]

Question ID: ACN.370_00.010

Instrument Variable Name: PREGFLYR
Questionnaire File Name: Sample Adult
Question Text:
[fill1: Were you pregnant any time since August 1st, [fill: LAST YEAR]?/Were you pregnant any time from August [fill: LAST YEAR] through March [fill: CURYEAR]?/Were you pregnant any time since August 1st, [fill: CURYEAR]?]
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18-49 years of age who are not currently pregnant or who don't know if they are currently pregnant and interviewed April - July
Skip Instructions:
(1,2,R,D) [goto HRAIDNOW]

Question ID: ACN.400_00.000

Instrument Variable Name: HRAIDNOW
Questionnaire File Name: Sample Adult
Question Text:
These next questions are about your hearing, vision, and teeth.
Do you now use a hearing aid(s)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto AHEARST1]
(2,R,D) [goto HRAIDEV]

Question ID: ACN.410_00.000

Instrument Variable Name: HRAIDEV
Questionnaire File Name: Sample Adult
Question Text:
Have you ever used a hearing aid(s) in the past?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who do not now use a hearing aid or REF/DK whether they now use a hearing aid
Skip Instructions:
(1,2,R,D) [goto AHEARST1]

Question ID: ACN.420_00.000

Instrument Variable Name: AHEARST1
Questionnaire File Name: Sample Adult
Question Text:
WITHOUT the use of hearing aids or other listening devices, is your hearing excellent, good, a little trouble hearing, moderate trouble, a lot of trouble, or are you deaf?
1 Excellent
2 Good
3 A little trouble hearing
4 Moderate trouble
5 A lot of trouble
6 Deaf
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-6,R,D) [goto AVISION]

Question ID: ACN.430_00.000

Instrument Variable Name: AVISION
Questionnaire File Name: Sample Adult
Question Text:
Do you have any trouble seeing, even when wearing glasses or contact lenses?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ABLIND]
(2,R,D) [goto VIM_DREV]

Question ID: ACN.440_00.030

Instrument Variable Name: VIM_CAEV
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary.
Have you EVER been told by a doctor or other health professional that you had
...Cataracts?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to VIMLS_CA]
[2,R,D) [goto VIM_GLEV]

Question ID: ACN.440_00.040

Instrument Variable Name: VIMLS_CA
Questionnaire File Name: Sample Adult
Question Text:
Have you lost any vision because of cataracts?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ told they have cataracts
Skip Instructions:
[1,2,R,D) [goto VIMCSURG]

Question ID: ACN.440_00.045

Instrument Variable Name: VIMCSURG
Questionnaire File Name: Sample Adult
Question Text:
Have you ever had cataract surgery?
1 Yes
2 No
7Refused
9 Don't know
Universe Text: Sample adults 18+ ever had cataracts
Skip Instructions:
(1, 2,R,D) [go to VIM_GLEV]

Question ID: ACN.440_00.060

Instrument Variable Name: VIMLS_GL
Questionnaire File Name: Sample Adult
Question Text:
Have you lost any vision because of glaucoma?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ told they have glaucoma
Skip Instructions:
(1,2,R,D) [goto VIM_MDEV]

Question ID: ACN.440_00.070

Instrument Variable Name: VIM_MDEV
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary.
Have you EVER been told by a doctor or other health professional that you had
...Macular Degeneration
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [go to VIMLS_MD];
(2,R,D) and ABLIND=2,R,D,? ? [goto VIMGLASS]
else if (2,R,D) and ABLIND=1 [goto AVISREH]

Question ID: ACN.440_00.080

Instrument Variable Name: VIMLS_MD
Questionnaire File Name: Sample Adult
Question Text:
Have you lost any vision because of macular degeneration?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ told they have macular degeneration
Skip Instructions:
(1,2,R,D)and ABLIND=2,R,D,? ? [goto VIMGLASS];
else (1,2,R,D) and ABLIND=1 [goto AVISREH]

Question ID: ACN.440_00.100

Instrument Variable Name: VIMGLASS
Questionnaire File Name: Sample Adult
Question Text:
Do you currently wear eyeglasses or contact lenses?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are not blind
Skip Instructions:
(1,) [go to VIMREAD];
(2,R,D) and AVISION=1 [go to AVISREH];
else (2,R,D) and AVISION=2,R,D [goto AVDF_NWS]

Question ID: ACN.440_00.110

Instrument Variable Name: VIMREAD
Questionnaire File Name: Sample Adult
Question Text:
Do you wear eyeglasses or contact lenses to read books or newspapers, write, or do other things that require you to see well up close, such as cooking, sewing or fixing things?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ wear glasses or contacts
Skip Instructions:
(1,2,R,D) [go to VIMDRIVE]

Question ID: ACN.440_00.120

Instrument Variable Name: VIMDRIVE
Questionnaire File Name: Sample Adult
Question Text:
Do you wear eyeglasses or contact lenses to drive, read road and street signs, watch TV, or see things in the distance?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ wear glasses or contacts
Skip Instructions:
(1,2,R,D) and
If AVISION=1 [go to AVISREH];
Else if AVISION=2,R,D [goto AVDF_NWS]

Question ID: ACN.440_00.130

Instrument Variable Name: AVISREH
Questionnaire File Name: Sample Adult
Question Text:
Do you use any vision rehabilitation services, such as job training, counseling, or training in daily living skills and mobility?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have trouble seeing
Skip Instructions:
(1 2,R,D) [goto AVISDEV]

Question ID: ACN.440_00.140

Instrument Variable Name: AVISDEV
Questionnaire File Name: Sample Adult
Question Text:
Do you use any adaptive devices such as telescopic or other prescriptive lenses, magnifiers, large print or talking materials, CCTV, white cane, or guide dog?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have trouble seeing
Skip Instructions:
(1 2,R,D) and if ABLIND = 2,R,D then [goto AVDF_NWS];
else (1,2,R,D) and ABLIND=1 [goto AVISEXAM]

Question ID: ACN.441_00.010

Instrument Variable Name: AVDF_NWS
Questionnaire File Name: Sample Adult
Question Text:
[Fill1: Even when wearing glasses or contacts lenses, because of your eyesight, / Fill 2: Because of your eyesight,] how difficult is it for you
...To read ordinary print in newspapers
*Read categories below.
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all because of eyesight
6 Do not do this activity for other reasons
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are not blind
Skip Instructions:
(0-4,6,R,D) [goto AVDF_CLS]

Question ID: ACN.441_00.020

Instrument Variable Name: AVDF_CLS
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because of your eyesight, / Fill 2: Because of your eyesight,] how difficult is it for you
...To do work or hobbies that require you to see well up close such as cooking, sewing, fixing things around the house or using hand tools
*Read categories below.
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all because of eyesight
6 Do not do this activity for other reasons
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are not blind
Skip Instructions:
(0-4,6,R,D) [goto AVDF_NIT]

Question ID: ACN.441_00.030

Instrument Variable Name: AVDF_NIT
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because of your eyesight, / Fill 2: Because of your eyesight,] how difficult is it for you
...To go down steps, stairs, or curbs in dim light or at night
*Read categories below.
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all because of eyesight
6 Do not do this activity for other reasons
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are not blind
Skip Instructions:
(0-4,6,R,D) [goto AVDF_DRV]

Question ID: ACN.441_00.040

Instrument Variable Name: AVDF_DRV
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because of your eyesight, / Fill 2: Because of your eyesight,] how difficult is it for you
...To drive during daytime in familiar places
*Read categories below.
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all because of eyesight
6 Do not do this activity for other reasons
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are not blind
Skip Instructions:
(0-4,6,R,D) [goto AVDF_PER]

Question ID: ACN.441_00.050

Instrument Variable Name: AVDF_PER
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because of your eyesight, / Fill 2: Because of your eyesight,] how difficult is it for you
...To notice objects off to the side while you are walking along
*Read categories below.
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all because of eyesight
6 Do not do this activity for other reasons
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are not blind
Skip Instructions:
(0-4,6,R,D) [goto AVDF_CRD]

Question ID: ACN.441_00.060

Instrument Variable Name: AVDF_CRD
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because of your eyesight, / Fill 2: Because of your eyesight, ] how difficult is it for you
...To find something on a crowded shelf
*Read categories below.
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all because of eyesight
6 Do not do this activity for other reasons
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are not blind
Skip Instructions:
(0-4,6,R,D) [goto AVISEXAM]

Question ID: ACN.442_00.010

Instrument Variable Name: AVISEXAM
Questionnaire File Name: Sample Adult
Question Text:
When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light.
1 Less than one month
2 1-12 months
3 13-24 months
4 More than 2 years
5 Never
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto AVISACT]

Question ID: ACN.442_00.020

Instrument Variable Name: AVISACT
Questionnaire File Name: Sample Adult
Question Text:
Outside of work, do you participate in sports, hobbies, or other activities that can cause eye injury?
This includes activities such as baseball, basketball, mowing the lawn, wood working, or working with chemicals.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto AVISPROT]
(2,R,D) [goto LUPPRT]

Question ID: AHS.040_00.000

Instrument Variable Name: WKDAYR
Questionnaire File Name: Sample Adult
Question Text:
During the PAST 12 MONTHS, that is, since [12-month ref. date], ABOUT how many days did you miss work at a job or business because of illness or injury (do not include maternity leave)?
* Enter '0' for None.
000 None
001-366 1-366 days
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who worked or had a job or business with or without pay in the last week or who had a job or business in the past 12 months
Skip Instructions:
(0-366,R,D) [goto BEDDAYR]
(120-366) [goto ERR_WKDAYR]
Soft Edit: ERR_WKDAYR
* [Fill: WKDAYR] is an unusually large number.
* Please verify.

Question ID: AHS.050_00.000

Instrument Variable Name: BEDDAYR
Questionnaire File Name: Sample Adult
Question Text:
During the PAST 12 MONTHS, that is, since [12-month ref. date], ABOUT how many days did illness or injury keep you in bed more than half of the day (include days while an overnight patient in a hospital)?
* Enter '0' for None.
000 None
001-366 1-366 days
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-366,R,D) [goto AHSTATYR]
(120-366) [goto ERR_BEDDAYR]
Soft Edit: ERR_BEDDAYR
* [Fill: BEDDAYR] is an unusually large number.
* Please verify.

Question ID: AHS.060_00.000

Instrument Variable Name: AHSTATYR
Questionnaire File Name: Sample Adult
Question Text:
Compared with 12 MONTHS AGO, would you say your health is better, worse, or about the same?
1 Better
2 Worse
3 About the same
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-3,R,D) [goto SPECEQ]

Question ID: AHS.070_00.000

Instrument Variable Name: SPECEQ
Questionnaire File Name: Sample Adult
Question Text:
Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto FLWALK]

Question ID: AHS.091_01.000

Instrument Variable Name: FLWALK
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or emotional problem or illness (not including pregnancy).
By yourself, and without using any special equipment, how difficult is it for you to...
...Walk a quarter of a mile - about 3 city blocks?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLCLIMB]

Question ID: AHS.091_02.000

Instrument Variable Name: FLCLIMB
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Walk up 10 steps without resting?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLSTAND]

Question ID: AHS.091_03.000

Instrument Variable Name: FLSTAND
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Stand or be on your feet for about 2 hours?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLSIT]

Question ID: AHS.091_04.000

Instrument Variable Name: FLSIT
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Sit for about 2 hours?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLSTOOP]

Question ID: AHS.091_05.000

Instrument Variable Name: FLSTOOP
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Stoop, bend, or kneel?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLREACH]

Question ID: AHS.091_06.000

Instrument Variable Name: FLREACH
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Reach up over your head?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLGRASP]

Question ID: AHS.141_01.000

Instrument Variable Name: FLGRASP
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Use your fingers to grasp or handle small objects?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLCARRY]

Question ID: AHS.141_02.000

Instrument Variable Name: FLCARRY
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLPUSH]

Question ID: AHS.141_03.000

Instrument Variable Name: FLPUSH
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Push or pull large objects like a living room chair?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLSHOP]

Question ID: AHS.171_01.000

Instrument Variable Name: FLSHOP
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Go out to things like shopping, movies, or sporting events?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLSOCL]

Question ID: AHS.171_02.000

Instrument Variable Name: FLSOCL
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-4,6,R,D) [goto FLRELAX]

Question ID: AHS.171_03.000

Instrument Variable Name: FLRELAX
Questionnaire File Name: Sample Adult
Question Text:
(book) A6
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4 or FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND= 1-4 or FLSIT= 1-4 or FLSTOOP= 1-4 or FLREACH=
1-4 or FLGRASP= 1-4 or FLCARRY= 1-4 or FLPUSH= 1-4 or FLSHOP= 1-4 or FLSOCL= 1-4)[goto AFLHCA]
Else goto SMKEV (next section)

Question ID: AHS.300_01.000

Instrument Variable Name: AHCL01N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a vision problem or problem seeing?
* Enter number for time with your vision problem or problem seeing..
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a vision problem or problem seeing
Skip Instructions:
(1-95,D)[goto AHCL01T]
(R)[store "R" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.300_02.000

Instrument Variable Name: AHCL01T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with vision problem or problem seeing.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL01T
[if [AHCL01N = Number greater than person years old and AHCL01T= 4]] goto
ERR1_AHCL01T
ERR1_AHCL01T
Hard Edit:
*Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL01T
* "6" not selectable.

Question ID: AHS.301_01.000

Instrument Variable Name: AHCL02N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a hearing problem
Skip Instructions:
(1-95,D)[goto AHCL02T]
(R)[store "R" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.301_02.000

Instrument Variable Name: AHCL02T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with hearing problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL02T
[if [AHCL02N = Number greater than person years old and AHCL02T= 4]] goto
ERR1_AHCL02T
ERR1_AHCL02T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL02T
* "6" not selectable.

Question ID: AHS.302_01.000

Instrument Variable Name: AHCL03N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to arthritis or rheumatism
Skip Instructions:
(1-95,D)[goto AHCL03T]
(R)[store "R" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.302_02.000

Instrument Variable Name: AHCL03T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with arthritis or rheumatism.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL03T
[if [AHCL03N = Number greater than person years old and AHCL03T= 4]] goto
ERR1_AHCL03T
ERR_AHCL03T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.303_01.000

Instrument Variable Name: AHCL04N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a back or neck problem?
* Enter number for time with back or neck problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a back or neck problem
Skip Instructions:
(1-95,D)[goto AHCL04T]
(R)[store "R" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.303_02.000

Instrument Variable Name: AHCL04T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with back or neck problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL04T
[if [AHCL04N = Number greater than person years old and AHCL04T= 4]] goto
ERR1_AHCL04T
ERR_AHCL04T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.304_01.000

Instrument Variable Name: AHCL05N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone, or joint injury.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a fracture, bone, or joint injury
Skip Instructions:
(1-95,D)[goto AHCL05T]
(R)[store "R" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.304_02.000

Instrument Variable Name: AHCL05T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with fracture, bone, or joint injury.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL05T
[if [AHCL05N = Number greater than person years old and AHCL05T= 4]] goto
ERR1_AHCL05T
ERR_AHCL05T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.305_01.000

Instrument Variable Name: AHCL06N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had the (fill: other) injury that caused your limitation?
* Enter number for time with injury that caused your limitation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to an injury other than a fracture, bone, or joint injury
Skip Instructions:
(1-95,D)[goto AHCL06T]
(R)[store "R" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.305_02.000

Instrument Variable Name: AHCL06T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with (fill: other) injury.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL06T
[if [AHCL06N = Number greater than person years old and AHCL06T= 4]] goto
ERR1_AHCL06T
ERR_AHCL06T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.308_01.000

Instrument Variable Name: AHCL09N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to hypertension or high blood pressure
Skip Instructions:
(1-95,D)[goto AHCL09T]
(R)[store "R" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.308_02.000

Instrument Variable Name: AHCL09T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with hypertension or high blood pressure.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL09T
[if [AHCL09N = Number greater than person years old and AHCL09T= 4]] goto
ERR1_AHCL09T
ERR_AHCL09T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.309_01.000

Instrument Variable Name: AHCL10N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had diabetes?
* Enter number for time with diabetes.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to diabetes
Skip Instructions:
(1-95,D)[goto AHCL10T]
(R)[store "R" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.309_02.000

Instrument Variable Name: AHCL10T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with diabetes.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL10T
[if [AHCL10N = Number greater than person years old and AHCL10T= 4]] goto
ERR1_AHCL10T
ERR_AHCL10T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.310_01.000

Instrument Variable Name: AHCL11N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a lung or breathing problem (e.g. asthma and emphysema)?
* Enter number for time with a lung or breathing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a lung or breathing problem
Skip Instructions:
(1-95,D)[goto AHCL11T]
(R)[store "R" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.310_02.000

Instrument Variable Name: AHCL11T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with lung or breathing problem (e.g. asthma and emphysema).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL11T
[if [AHCL11N = Number greater than person years old and AHCL11T= 4]] goto
ERR1_AHCL11T
ERR_AHCL11T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.311_01.000

Instrument Variable Name: AHCL12N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had cancer?
* Enter number for time with cancer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to cancer
Skip Instructions:
(1-95,D)[goto AHCL12T]
(R)[store "R" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.311_02.000

Instrument Variable Name: AHCL12T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with cancer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL12T
[if [AHCL12N = Number greater than person years old and AHCL12T= 4]] goto
ERR1_AHCL12T
ERR_AHCL12T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.313_01.000

Instrument Variable Name: AHCL14N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had intellectual disability, also known as mental retardation?
* Enter number for time with intellectual disability/mental retardation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to intellectual disability/mental retardation
Skip Instructions:
(1-95,D)[goto AHCL14T]
(R)[store "R" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.313_02.000

Instrument Variable Name: AHCL14T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with intellectual disability/mental retardation.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL14T
[if [AHCL14N = Number greater than person years old and AHCL14T= 4]] goto
ERR1_AHCL14T
ERR_AHCL14T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.314_01.000

Instrument Variable Name: AHCL15N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a developmental problem (e.g., cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a developmental problem
Skip Instructions:
(1-95,D)[goto AHCL15T]
(R)[store "R" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.314_02.000

Instrument Variable Name: AHCL15T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with developmental problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL15T
[if [AHCL15N = Number greater than person years old and AHCL15T= 4]] goto
ERR1_AHCL15T
ERR_AHCL15T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.315_01.000

Instrument Variable Name: AHCL16N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had senility?
* Enter number for time with senility.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to senility
Skip Instructions:
(1-95,D)[goto AHCL16T]
(R)[store "R" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.315_02.000

Instrument Variable Name: AHCL16T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with senility.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL16T
[if [AHCL16N = Number greater than person years old and AHCL16T= 4]] goto
ERR1_AHCL16T
ERR_AHCL16T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.316_01.000

Instrument Variable Name: AHCL17N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety, or an emotional problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to depression, anxiety, or an emotional problem
Skip Instructions:
(1-95,D)[goto AHCL17T]
(R)[store "R" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.316_02.000

Instrument Variable Name: AHCL17T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with depression, anxiety, or emotional problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL17T
[if [AHCL17N = Number greater than person years old and AHCL17T= 4]] goto
ERR1_AHCL17T
ERR_AHCL17T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.319_01.000

Instrument Variable Name: AHCL20N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a kidney, bladder or renal problem
Skip Instructions:
(1-95,D)[goto AHCL20T]
(R)[store "R" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.319_02.000

Instrument Variable Name: AHCL20T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with kidney, bladder or renal problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL20T
[if [AHCL20N = Number greater than person years old and AHCL20T= 4]] goto
ERR1_AHCL20T
ERR_AHCL20T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.320_01.000

Instrument Variable Name: AHCL21N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a circulation problem
Skip Instructions:
(1-95,D)[goto AHCL21T]
(R)[store "R" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.320_02.000

Instrument Variable Name: AHCL21T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with circulation problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL21T
[if [AHCL21N = Number greater than person years old and AHCL21T= 4]] goto
ERR1_AHCL21T
ERR_AHCL21T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.321_01.000

Instrument Variable Name: AHCL22N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to benign tumors or cysts
Skip Instructions:
(1-95,D)[goto AHCL22T]
(R)[store "R" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.321_02.000

Instrument Variable Name: AHCL22T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with benign tumors or cysts.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL22T
[if [AHCL22N = Number greater than person years old and AHCL22T= 4]] goto
ERR1_AHCL22T
ERR_AHCL22T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.322_01.000

Instrument Variable Name: AHCL23N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to fibromyalgia or lupus
Skip Instructions:
(1-95,D)[goto AHCL23T]
(R)[store "R" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.322_02.000

Instrument Variable Name: AHCL23T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with fibromyalgia or lupus.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6)
goto ERR2_AHCL23T
[if [AHCL23N = Number greater than person years old and AHCL23T= 4]] goto
ERR1_AHCL23T
ERR_AHCL23T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.323_01.000

Instrument Variable Name: AHCL24N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to osteoporosis or tendinitis
Skip Instructions:
(1-95,D)[goto AHCL24T]
(R)[store "R" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.323_02.000

Instrument Variable Name: AHCL24T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with osteoporosis or tendinitis.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL24T
[if [AHCL24N = Number greater than person years old and AHCL24T= 4]] goto
ERR1_AHCL24T
ERR_AHCL24T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.324_01.000

Instrument Variable Name: AHCL25N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to epilepsy or seizures
Skip Instructions:
(1-95,D)[goto AHCL25T]
(R)[store "R" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.324_02.000

Instrument Variable Name: AHCL25T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with epilepsy or seizures.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6)
goto ERR2_AHCL25T
[if [AHCL25N = Number greater than person years old and AHCL25T= 4]] goto
ERR1_AHCL25T
ERR_AHCL25T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.325_01.000

Instrument Variable Name: AHCL26N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclerosis (MS) or muscular dystrophy (MD).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to multiple sclerosis or muscular dystrophy
Skip Instructions:
(1-95,D)[goto AHCL26T]
(R)[store "R" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.325_02.000

Instrument Variable Name: AHCL26T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with multiple sclerosis or muscular dystrophy.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL26T
[if [AHCL26N = Number greater than person years old and AHCL26T= 4]] goto
ERR1_AHCL26T
ERR_AHCL26T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.326_01.000

Instrument Variable Name: AHCL27N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis), paralysis or para/quadriplegia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to polio(myelitis), paralysis or para/quadriplegia
Skip Instructions:
(1-95,D)[goto AHCL27T]
(R)[store "R" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.326_02.000

Instrument Variable Name: AHCL27T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL27T
[if [AHCL27N = Number greater than person years old and AHCL27T= 4]] goto
ERR1_AHCL27T
ERR_AHCL27T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.329_01.000

Instrument Variable Name: AHCL30N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a hernia?
* Enter number for time with a hernia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a hernia
Skip Instructions:
(1-95,D)[goto AHCL30T]
(R)[store "R" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.329_02.000

Instrument Variable Name: AHCL30T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with hernia.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL30T
[if [AHCL30N = Number greater than person years old and AHCL30T= 4]] goto
ERR1_AHCL30T
ERR_AHCL30T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.330_01.000

Instrument Variable Name: AHCL31N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had an ulcer?
* Enter number for time with an ulcer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to an ulcer
Skip Instructions:
(1-95,D)[goto AHCL31T]
(R)[store "R" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.330_02.000

Instrument Variable Name: AHCL31T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with ulcer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL31T
[if [AHCL31N = Number greater than person years old and AHCL31T= 4]] goto
ERR1_AHCL31T
ERR_AHCL31T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.331_01.000

Instrument Variable Name: AHCL32N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to varicose veins or hemorrhoids
Skip Instructions:
(1-95,D)[goto AHCL32T]
(R)[store "R" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.331_02.000

Instrument Variable Name: AHCL32T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with varicose veins or hemorrhoids.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL32T
[if [AHCL32N = Number greater than person years old and AHCL32T= 4]] goto
ERR1_AHCL32T
ERR_AHCL32T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.332_01.000

Instrument Variable Name: AHCL33N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a thyroid problem, Grave's disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
Skip Instructions:
(1-95,D)[goto AHCL33T]
(R)[store "R" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.332_02.000

Instrument Variable Name: AHCL33T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with thyroid problem, Grave's disease or gout.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL33T
[if [AHCL33N = Number greater than person years old and AHCL33T= 4]] goto
ERR1_AHCL33T
ERR_AHCL33T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.333_01.000

Instrument Variable Name: AHCL34N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had a knee problem?
* Enter number for time with a knee problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to a knee problem
Skip Instructions:
(1-95,D)[goto AHCL34T]
(R)[store "R" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.333_02.000

Instrument Variable Name: AHCL34T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with knee problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL34T
[if [AHCL34N = Number greater than person years old and AHCL34T= 4]] goto
ERR1_AHCL34T
ERR1_AHCL34T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.334_01.000

Instrument Variable Name: AHCL35N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had migraine headaches?
* Enter number for time with migraine headaches.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to migraine headaches
Skip Instructions:
(1-95,D)[goto AHCL35T]
(R)[store "R" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.334_02.000

Instrument Variable Name: AHCL35T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with migraine headaches.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL35T
[if [AHCL35N = Number greater than person years old and AHCL35T= 4]] goto
ERR1_AHCL35T
ERR1_AHCL35T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.335_01.000

Instrument Variable Name: AHCL90N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had [problem in AFLHCA90]?
* Enter number for time with [problem in AFLHCA90].
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to [problem in AFLHCA90]
Skip Instructions:
(1-95,D)[goto AHCL90T]
(R)[store "R" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(96)[store "6" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]

Question ID: AHS.335_02.000

Instrument Variable Name: AHCL90T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with [problem in AFLHCA90].
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[[if 91 selected in AFLHCA goto AFLHCA_S2]
Else goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL90T
[if [AHCL90N = Number greater than person years old and AHCL90T= 4]] goto
ERR1_AHCL90T
ERR_AHCL90T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHS.336_01.000

Instrument Variable Name: AHCL91N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How long have you had [problem in AFLHCA91]?
* Enter number for time with [problem in AFLHCA91].
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had difficulty due to [problem in AFLHCA91]
Skip Instructions:
(1-95,D)[goto AHCL91T]
(R)[store "R" in AHCL91T] [goto SMKEV (next section)]
(96)[store "6" in AHCL91T] [goto SMKEV (next section)]

Question ID: AHS.336_02.000

Instrument Variable Name: AHCL91T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time with [problem in AFLHCA91].
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since birth
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Skip Instructions:
(1- 4, R,D)[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
(6) goto ERR2_AHCL91T
[if [AHCL91N = Number greater than person years old and AHCL91T= 4]] goto
ERR1_AHCL91T
ERR_AHCL91T
Hard Edit:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: AHB.040_02.000

Instrument Variable Name: SMKQTTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time since quit smoking.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who quit smoking
Skip Instructions:
(1-4) [goto ECIGEV2]
(4) [if SMKQTNO gt (AGE - (15)), goto ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), goto ERR2_SMKQTTP.
ERR2_SMKQTTP
Hard Edit:
* Age started ([Fill1: SMKREG]) + years since quit ([Fill2: SMKQTNO]) exceeds current age ([Fill3: AGE]).
* Please correct.
ERR1_SMKQTTP
Soft Edit:
* Respondent quit smoking before age 15?
* Please verify.

Question ID: AHB.050_00.000

Instrument Variable Name: CIGSDA1
Questionnaire File Name: Sample Adult
Question Text:
On the average, how many cigarettes do you now smoke a day?
* Enter '1' if less than 1 cigarette.
* Enter '95' if 95 or more cigarettes.
01-94 1 - 94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who are current every day smokers
Skip Instructions:
(1-95,R,D) [goto CIGQTYR]

Question ID: AHB.060_00.000

Instrument Variable Name: CIGDAMO
Questionnaire File Name: Sample Adult
Question Text:
On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.
00 None
01-30 1-30 days
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who are current some day smokers
Skip Instructions:
(0)[goto CIGQTYR]
(1-30,R,D) [goto CIGSDA2]

Question ID: AHB.070_00.000

Instrument Variable Name: CIGSDA2
Questionnaire File Name: Sample Adult
Question Text:
On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?
* Enter '1' if less than 1.
* Enter '95' if 95 or more cigarettes.
01-94 1-94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who are current some day smokers
Skip Instructions:
(1-95,D,R) [goto CIGQTYR]

Question ID: AHB.080_00.000

Instrument Variable Name: CIGQTYR
Questionnaire File Name: Sample Adult
Question Text:
During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO QUIT SMOKING?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who are every day or someday smokers
Skip Instructions:
(1,2,R,D) [goto ECIGEV2]

Question ID: AHB.085_00.010

Instrument Variable Name: ECIGEV2
Questionnaire File Name: Sample Adult
Question Text:
The next question is about electronic cigarettes or e-cigarettes. You may also know them as vape-pens, hookah-pens, e-hookahs, or e-vaporizers. Some look like cigarettes, and others look like pens or small pipes. These are battery-powered, usually contain liquid nicotine, and produce vapor instead of smoke.
Have you EVER used an e-cigarette EVEN ONE TIME?
*Read if necessary: E-cigarettes and similar products can be bought as one-time, disposable products, as re-usable kits with a cartridge, or with refillable chambers. These usually contain a liquid, often called an ?e-liquid? or ?e-juice.? Popular brands include NJOY, BLU, LOGIC, and VUSE.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ECIGCUR2]
(2,R,D) [goto CIGAREV2]

Question ID: AHB.085_00.020

Instrument Variable Name: ECIGCUR2
Questionnaire File Name: Sample Adult
Question Text:
Do you now use e-cigarettes every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever used e-cigarettes
Skip Instructions:
(1,R,D) [go to CIGAREV2]
(2,3) [go to ECIG30D2]

Question ID: AHB.085_00.030

Instrument Variable Name: ECIG30D2
Questionnaire File Name: Sample Adult
Question Text:
On how many of the PAST 30 DAYS have you used e-cigarettes?
00-30 0-30
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who now use e-cigarettes some days or not at all
Skip Instructions:
(0-30,R,D) [goto CIGAREV2]

Question ID: AHB.085_00.040

Instrument Variable Name: CIGAREV2
Questionnaire File Name: Sample Adult
Question Text:
Have you ever smoked a regular cigar, cigarillo, or a little filtered cigar EVEN ONE TIME?
*Read if necessary: ?Cigarillos? are medium cigars that sometimes are sold with plastic or wooden tips. Some common brands are Black and Mild, Swisher Sweets, Dutch Masters and Phillies Blunts. Cigarillos are usually sold individually or in packs of 5 or fewer. Little filtered cigars look like cigarettes and are usually brown in color. Like cigarettes, little filtered cigars have a spongy filter and are sold in packs of 20. Some common brands are Prime Time and Winchester.
*Read if necessary: Do not include electronic cigars or e-cigars.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto CIGCUR2]
(2, R, D) [goto PIPEV2]

Question ID: AHB.085_00.050

Instrument Variable Name: CIGCUR2
Questionnaire File Name: Sample Adult
Question Text:
Do you now smoke regular cigars, cigarillos, or little filtered cigars every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever smoked a regular cigar, cigarillo, or filtered cigar
Skip Instructions:
(1 R,D) [goto PIPEV2]
(2,3) [go to CIG30D2]

Question ID: AHB.085_00.060

Instrument Variable Name: CIG30D2
Questionnaire File Name: Sample Adult
Question Text:
On how many of the PAST 30 DAYS have you smoked a regular cigar, cigarillo, or little filtered cigar?
00-30 0-30
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who now smoke a regular cigar, cigarillo, or little filtered cigar some days or not at all
Skip Instructions:
(0-30,R,D) [goto PIPEV2]

Question ID: AHB.085_00.070

Instrument Variable Name: PIPEV2
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER smoked a pipe filled with tobacco-either a regular pipe, water pipe, or hookah EVEN ONE TIME?
*Read if necessary: A hookah is a type of water pipe. It is sometimes called a ?narghile? (NAR-ge-lee) pipe. Do not include electronic hookah or e-hookahs.
*Read if necessary: Do not include electronic pipes or e-pipes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto PIPECUR2]
(2,R,D) [goto SMKLSTB1]

Question ID: AHB.085_00.080

Instrument Variable Name: PIPECUR2
Questionnaire File Name: Sample Adult
Question Text:
Do you now smoke pipes filled with tobacco ? either regular pipes, water pipes, or hookahs, every day, some days, or not at all?
*Read if necessary: Do not include pipes filled with substances other than tobacco.
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever smoked a regular pipe, water pipe or hookah filled with tobacco
Skip Instructions:
(1-3,R,D) [goto SMKLSTB1]

Question ID: AHB.085_00.090

Instrument Variable Name: SMKLSTB1
Questionnaire File Name: Sample Adult
Question Text:
Smokeless tobacco products are placed in the mouth or nose and can include chewing tobacco, snuff, dip, snus (SNOOSE), or dissolvable tobacco.
Have you ever used smokeless tobacco products EVEN ONE TIME?
*Read if necessary: Do not include nicotine replacement therapy products (such as patch, gum, lozenge, or spray, which are considered smoking cessation treatments.)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto SMKLSCR2]
(2,R,D) [goto VIGNO]

Question ID: AHB.085_00.100

Instrument Variable Name: SMKLSCR2
Questionnaire File Name: Sample Adult
Question Text:
Do you NOW use smokeless tobacco products every day, some days, or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever used smokeless tobacco products
Skip Instructions:
(1-3,R,D) [goto VIGNO]

Question ID: AHB.090_01.000

Instrument Variable Name: VIGNO
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
The next questions are about physical activities (exercise, sports, physically active hobbies...) that you may do in your LEISURE time.
How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for vigorous leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,996,R,D)[goto MODNO]
(1-995)[goto VIGTP

Question ID: AHB.110_02.000

Instrument Variable Name: MODTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for light or moderate leisure-time physical activities
0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who do light or moderate activities
Skip Instructions:
(1-4) goto MODLNGNO
[if (MODNO gt (4) and MODTP eq (1)) or
(MODNO gt (28) and MODTP eq (2)) or
(MODNO gt (31) and MODTP eq (3)) or
(MODNO gt (365) and MODTP eq (4))] goto ERR_MODNO
Soft Edit:
ERR_MODNO
* [Fill1: MODNO] times per [fill2: MODTP] is unusually high.
* Please verify.

Question ID: AHB.120_01.000

Instrument Variable Name: MODLNGNO
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
About how long do you do these light or moderate leisure-time physical activities each time?
* Enter number for length of light or moderate leisure-time physical activities.
001-995 1-995
997 Refused
999 Don't konw
Universe Text: Sample adults 18+ who do light or moderate activities
Skip Instructions:
(1-995)[goto MODLNGTP]
(R,D)[goto STRNGNO]

Question ID: AHB.120_02.000

Instrument Variable Name: MODLNGTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for length of light or moderate leisure-time physical activities.
1 Minutes
2 Hours
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who do light or moderate activities
Skip Instructions:
(1,2) goto STRNGNO
if MODLNGNO lt (10) and MODLNGTP eq (1) goto ERR1_MODLNGTP
if MODLNGNO gt (90) and MODLNGTP eq (1) or if MODLNGNO gt (2) and MODLNGTP eq (2)goto
ERR2_MODLNGTP
ERR1_MODLNGTP
Hard Edit:
* Question asked for activities lasting at least 10 minutes.
* Please correct.
ERR2_MODLNGTP
Soft Edit:
* [Fill1: MODLNGNO] [Fill2: MODLNGTP] is unusually high.
* Please verify.

Question ID: AHB.130_01.000

Instrument Variable Name: STRNGNO
Questionnaire File Name: Sample Adult
Question Text:
How often do you do LEISURE-TIME physical activities specifically designed to STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for strengthening activities.
* Enter '0' for Never.
* Enter '996' for Unable to do this type activity
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-995)[goto STRNGTP]
(0, 996,R,D)[goto ALC1YR]

Question ID: AHB.130_02.000

Instrument Variable Name: STRNGTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for strengthening activities
0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who do strengthening activities
Skip Instructions:
(1-4) [goto ALC1YR]
[If (STRNGNO gt (4) AND STRNGTP = (1)) or (STRNGNO gt (28) AND STRNGTP = (2)) or
(STRNGNO gt (31) AND STRNGTP = (3)) or (STRNGNO gt (365) AND STRNGTP = (4)) goto
ERR_STRNGTP]
ERR_STRNGTP
Soft Edit:
* [Fill1: STRNGNO] times per [Fill2: STRNGTP] is unusually high.
* Please verify.

Question ID: AHB.140_00.000

Instrument Variable Name: ALC1YR
Questionnaire File Name: Sample Adult
Question Text:
These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.
In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ALC12MNO]
(2,R,D) [goto ALCLIFE]

Question ID: AHB.150_00.000

Instrument Variable Name: ALCLIFE
Questionnaire File Name: Sample Adult
Question Text:
In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did or refused to answer
Skip Instructions:
(1) [goto ALC12MNO]
(2,R,D) [goto AHGT_FT]

Question ID: AHB.160_01.000

Instrument Variable Name: ALC12MNO
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcoholic beverages were consumed in the past year.
*Enter '0' for Never.
000 Never
001-365 1-365 days
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks in their entire life
Skip Instructions:
(1-365)[goto ALC12MTP]
(0,D,R)[goto AHGT_FT]

Question ID: AHB.160_02.000

Instrument Variable Name: ALC12MTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for how often alcoholic beverages were consumed in the past year.
0 Never/None
1 Week
2 Month
3 Year
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who drank at least once in the past year
Skip Instructions:
(1-3) [goto ALCAMT]
[If (ALC12MNO gt (7) AND ALC12MTP = (1)) or (ALC12MNO gt (31) AND ALC12MTP = (2)) or
(ALC12MNO gt (365) AND ALC12MTP = (3)) goto ERR_ALC12MTP]
ERR_ALC12MTP
Hard Edit:
* [Fill1: ALC12MNO] days per [Fill2: ALC12MTP] exceeds number possible in this time period.
* Please correct.

Question ID: AHB.170_00.000

Instrument Variable Name: ALCAMT
Questionnaire File Name: Sample Adult
Question Text:
In the PAST YEAR, on those days that you drank alcoholic beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.
01-94 1-94 drinks
95 95+ drinks
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have had at least 1 drink in the past year
Skip Instructions:
(1-95,D,R)[goto ALC5UPNO]
(10-95)[goto ERR_ALCAMT]
ERR_ALCAMT
Soft Edit:
* [Fill: ALCAMT] drinks is an unusually high number.
* Please verify.
* Do not probe

Question ID: AHB.180_01.000

Instrument Variable Name: ALC5UPNO
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
1 of 2
In the PAST YEAR, on how many DAYS did you have [fill: 5 or more/4 or more] drinks of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have [fill: 5 or more/4 or more] drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.
000 Never/None
001-365 1-365 days
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who have had at least 1 drink in the past year
Skip Instructions:
(1-365)[goto ALC5UPTP]
(0,R,D)[goto AHGT_FT]

Question ID: AHB.180_02.000

Instrument Variable Name: ALC5UPTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for days per week, per month or per year.
0 Never/None
1 Per week
2 Per month
3 Per year
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least once in the past year
Skip Instructions:
(1-3) [goto BINGE1]
[If (ALC5UPNO gt (7) AND ALC5UPTP = (1)) or
(ALC5UPNO gt (31) AND ALC5UPTP = (2)) or
(ALC5UPNO gt (365) AND ALC5UPTP = (3)) goto ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP) lt number of days per year with 5 or more (for males)/4+ (females) drinks (calculated from ALC5UPNO and ALC5UPTP)] goto
ERR2_ALC5UPTP]
ERR1_ALC5UPTP
Hard Edit:
* [Fill1: ALC5UPNO] days per [Fill2: ALC5UPTP] exceeds number possible in this time period.
* Please correct
ERR2_ALC5UPTP
* Number of days had [fill: 5 or more/4 or more] drinks exceeds number of days drank.
* Please correct.
* Do not probe.

Question ID: AHB.181_00.000

Instrument Variable Name: BINGE1
Questionnaire File Name: Sample Adult
Question Text:
? [F1]
Considering all types of alcoholic beverages, DURING THE PAST 30 DAYS, how many times did you have [fill: 5 or more/4 or more] drinks on an occasion?
* Enter '0' if none.
* Enter '60' if 60 or more times.
00-60 0-60
97 Refused
99Don't know
Universe Text: Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least once in the past year
Skip Instructions:
(0-60,R,D) [goto AHGT_FT]

Question ID: AHB.190_01.000

Instrument Variable Name: AHGT_FT
Questionnaire File Name: Sample Adult
Question Text:
How tall are you without shoes?
* Enter "M" to record metric measurements
02-07 2-7 feet
97 Refused
99 Don't kow
Universe Text: Sample adults 18+
Skip Instructions:
(2-7) [goto AHGT_IN]
(R.D) [goto AWGT_LB]
(M) [goto AHGT_M]
[if AHGT_FT NE(2-7,R,D,M) goto ERR1_AHGT_FT]
[if AHGT_FT = (2,3) goto ERR2_AHGT_FT]
Hard Edit:
ERR1_AHGT_FT
* Only 2-7, Don't Know/Refused or M allowed in this field.
* Please correct.
Soft Edit:
ERR2_AHGT_FT
* Respondent's height in feet is [fill: AHGT_FT]?
* Please verify.

Question ID: AHB.190_02.000

Instrument Variable Name: AHGT_IN
Questionnaire File Name: Sample Adult
Question Text:
How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.
00-11 0-11 inches
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who answered their height in feet
Skip Instructions:
(empty) goto ERR_AHGT_IN
(0-11,R,D) if (SEX = ?1? and (AHTINCH lt ?61? or AHTINCH gt ?75?)) or
(SEX = ?2? and (AHTINCH lt ?56? or AHTINCH gt ?69?))
goto ERR2_AHGT_IN
else
goto AWGT_LB
Hard Edit:
ERR1_AHGT_IN
* If [fill: AHGT_FT] feet exactly, enter "0"; otherwise enter number of inches.
Soft Edit:
ERR2_AHGT_IN
* Please verify that the height was entered correctly. Probe only if necessary.

Question ID: AHB.200_02.000

Instrument Variable Name: AWGT_KG
Questionnaire File Name: Sample Adult
Question Text:
How much do you weigh without shoes?
* Enter weight in kilograms
023-226 23-226 kilograms
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who choose to give their weight in metric measurements
Skip Instructions:
(23-226) if AWGT_KG lt ?23? or AWGT_KG gt ?226?
goto ERR1_AWGT_KG
elseif ((SEX = ?1? and (AWGT_KG lt ?51? or AWGT_KG gt ?143?)) or
((SEX = ?2? and (AWGT_KG lt ?43? or AWGT_KG gt ?133?))
goto ERR2_AWGT_KG
elseif AHGT_FLG = ?1? and AWGT_FLG = ?1?
goto next section
else
calculate the BMI (Body Mass Index) - See BMI spec page
(R,D) goto next section
ERR1_AWGT_KG
Hard Edit:
*Weight is out of range (23-226).
* Please correct.
ERR2_AWGT_KG
Soft Edit:
* Please verify that the weight was entered correctly. Probe only if necessary.

Question ID: AAU.020_00.000

Instrument Variable Name: AUSUALPL
Questionnaire File Name: Sample Adult
Question Text:
Is there a place that you USUALLY go to when you are sick or need advice about your health?
1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,3) [goto APLKIND]
(2,R,D) [goto AHCPLKND]

Question ID: AAU.030_00.000

Instrument Variable Name: APLKIND
Questionnaire File Name: Sample Adult
Question Text:
[Fill1: What kind of place is it - a clinic, doctor's office, emergency room, or some other place?
[Fill2: What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?]
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know
Universe Text: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice
Skip Instructions:
(1-5) [go to AHCPLROU]
(6,R,D) [go to AHCPLKND]

Question ID: AAU.035_00.000

Instrument Variable Name: AHCPLROU
Questionnaire File Name: Sample Adult
Question Text:
Is that [fill: place from (APLKIND)] the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults aged 18+ years having a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some other place that they usually go to when they are sick or need advice about their health
Skip Instructions:
(1) [goto AHCCHGYR]
(2,R,D) [go to AHCPLKND]

Question ID: AAU.037_00.000

Instrument Variable Name: AHCPLKND
Questionnaire File Name: Sample Adult
Question Text:
What kind of place do you USUALLY go to when you need routine or preventive care, such as a physical examination or check-up?
0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know
Universe Text: Sample Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a usual source of sick care; who have a usual source of sick care but do not go to one place most often or Ref/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source of sick care but Ref/DK if it is same place as usual source of routine/preventive care.
Skip Instructions:
(0-6,R,D) if AUSUALPL=2,R,D [goto APRVTRYR]; ELSE [goto AHCCHGYR]

Question ID: AAU.040_00.000

Instrument Variable Name: AHCCHGYR
Questionnaire File Name: Sample Adult
Question Text:
At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who reported same place as usual source of routine/preventive care]
Skip Instructions:
(1)[goto AHCCHGHI]
(2,R,D)[goto APRVTRYR]

Question ID: AAU.050_00.000

Instrument Variable Name: AHCCHGHI
Questionnaire File Name: Sample Adult
Question Text:
Was this change for a reason related to health insurance?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who CHANGED their USUAL place for health care in past 12 months
Skip Instructions:
(1,2,R,D) [goto APRVTRYR]

Question ID: AAU.051_00.010

Instrument Variable Name: APRVTRYR
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, did you have any trouble finding a general doctor or provider who would see you?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,)[goto APRVTRFD ]
(2,R,D)[goto ADRNANP]

Question ID: AAU.053_00.010

Instrument Variable Name: APRVTRFD
Questionnaire File Name: Sample Adult
Question Text:
Were you able to find a general doctor or provider who could see you?
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who had trouble finding a provider
Skip Instructions:
(1,2,R,D)[goto ADRNANP]

Question ID: AAU.057_00.010

Instrument Variable Name: ADRNANP
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, were you told by a doctor?s office or clinic that they would not accept you as a new patient?
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto ADRNAI]

Question ID: AAU.059_00.010

Instrument Variable Name: ADRNAI
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, were you told by a doctor?s office or clinic that they did not accept your health care coverage?
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AHCDLY_1]

Question ID: AAU.061_01.000

Instrument Variable Name: AHCDLY_1
Questionnaire File Name: Sample Adult
Question Text:
There are many reasons people delay getting medical care.
Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...You couldn't get through on the telephone.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AHCDLY_2]

Question ID: AAU.061_02.000

Instrument Variable Name: AHCDLY_2
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...You couldn't get an appointment soon enough.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AHCDLY_3]

Question ID: AAU.061_03.000

Instrument Variable Name: AHCDLY_3
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...Once you get there, you have to wait too long to see the doctor.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AHCDLY_4]

Question ID: AAU.061_04.000

Instrument Variable Name: AHCDLY_4
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...The (clinic/doctor's) office wasn't open when you could get there.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AHCDLY_5]

Question ID: AAU.061_05.000

Instrument Variable Name: AHCDLY_5
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?
...You didn't have transportation.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AHCAFY_1]

Question ID: AAU.111_01.000

Instrument Variable Name: AHCAFY_1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...Prescription medicines.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AHCAFY_2]

Question ID: AAU.111_06.010

Instrument Variable Name: AHCAFY_6
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because you couldn't afford it?
...Follow-up care.
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto AWORPAY]

Question ID: AAU.113_00.010

Instrument Variable Name: AWORPAY
Questionnaire File Name: Sample Adult
Question Text:
If you get sick or have an accident, how worried are you that you will be able to pay your medical bills? Are you very worried, somewhat worried, or not at all worried?
1 Very worried
2 Somewhat worried
3 Not at all worried
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-3,R,D)[goto AHICOMP]

Question ID: AAU.113_00.020

Instrument Variable Name: AHICOMP
Questionnaire File Name: Sample Adult
Question Text:
In regard to your health insurance or health care coverage, how does it compare to a year ago? Is it better, worse, or about the same?
1 Better
2 Worse
3 About the same
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,3,R,D)[goto ARX12MO]

Question ID: AAU.126_01.010

Instrument Variable Name: ARX12MO
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, were you prescribed medication by a doctor or other health professional?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ARX12_1]
(2,R,D) [goto ARX12_5]

Question ID: AAU.127_01.010

Instrument Variable Name: ARX12_1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, were any of the following true for you?
...You skipped medication doses to save money.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:
(1,2,R,D)[goto ARX12_2]

Question ID: AAU.127_02.010

Instrument Variable Name: ARX12_2
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
...You took less medicine to save money.
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:
(1,2,R,D)[goto ARX12_3]

Question ID: AAU.127_03.010

Instrument Variable Name: ARX12_3
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
...You delayed filling a prescription to save money.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:
(1,2,R,D)[goto ARX12_4]

Question ID: AAU.127_04.010

Instrument Variable Name: ARX12_4
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
...You asked your doctor for a lower cost medication to save money.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had been prescribed medication in the past 12 months
Skip Instructions:
(1,2,R,D)[goto ARX12_5]

Question ID: AAU.127_05.010

Instrument Variable Name: ARX12_5
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, were any of the following true for you?
...You bought prescription drugs from another country to save money.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto ARX12_6]

Question ID: AAU.127_06.010

Instrument Variable Name: ARX12_6
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
...You used alternative therapies to save money.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[goto ADENLONG]

Question ID: AAU.135_00.000

Instrument Variable Name: ADENLONG
Questionnaire File Name: Sample Adult
Question Text:
(book) A8
About how long has it been since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
0 Never
1 6 months or less
2 More than 6 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-5,R,D)[ goto AHCSY1_1]

Question ID: AAU.141_01.000

Instrument Variable Name: AHCSY1_1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[ goto AHCSY1_2]

Question ID: AAU.141_02.000

Instrument Variable Name: AHCSY1_2
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...An optometrist, ophthalmologist (AHF-thal-MOL-oh-jist), or eye doctor (someone who prescribes eyeglasses).
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[ goto AHCSY1_3]

Question ID: AAU.141_03.000

Instrument Variable Name: AHCSY1_3
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A foot doctor.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[ goto AHCSY1_4]

Question ID: AAU.141_04.000

Instrument Variable Name: AHCSY1_4
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A chiropractor.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[ goto AHCSY1_5]

Question ID: AAU.141_05.000

Instrument Variable Name: AHCSY1_5
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[ goto AHCSY1_6]

Question ID: AAU.141_06.000

Instrument Variable Name: AHCSY1_6
Questionnaire File Name: Sample Adult
Question Text:
* Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
...A nurse practitioner, physician assistant, or midwife.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)[if SEX=1goto AHCSY8_8; else if SEX=2 goto AHCSYR7]

Question ID: AAU.240_00.000

Instrument Variable Name: AHERNOYR
Questionnaire File Name: Sample Adult
Question Text:
(book) A9
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own health (This includes emergency room visits that resulted in a hospital admission.)?
00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0,R,D) [go to AHCHYR] (1-8) [goto AERVISND]

Question ID: AAU.243_00.010

Instrument Variable Name: AERVISND
Questionnaire File Name: Sample Adult
Question Text:
Thinking about your most recent emergency room visit, did you go to the emergency room either at night or on the weekend?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [go to AERHOS]

Question ID: AAU.245_00.010

Instrument Variable Name: AERHOS
Questionnaire File Name: Sample Adult
Question Text:
Did this emergency room visit result in a hospital admission?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [go to AERREAS1]

Question ID: AAU.248_01.010

Instrument Variable Name: AERREAS1
Questionnaire File Name: Sample Adult
Question Text:
Tell me which of these apply to your last emergency room visit?
... You didn't have another place to go
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AERREAS2]

Question ID: AAU.248_02.020

Instrument Variable Name: AERREAS2
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... Your doctor?s office or clinic was not open
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AERREAS3]

Question ID: AAU.248_03.030

Instrument Variable Name: AERREAS3
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... Your health provider advised you to go
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AERREAS4]

Question ID: AAU.248_04.040

Instrument Variable Name: AERREAS4
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... The problem was too serious for the doctor?s office or clinic
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AERREAS5]

Question ID: AAU.248_05.050

Instrument Variable Name: AERREAS5
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... Only a hospital could help you
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AERREAS6]

Question ID: AAU.248_06.060

Instrument Variable Name: AERREAS6
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
... the emergency room is your closest provider
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AERREAS7]

Question ID: AAU.248_07.070

Instrument Variable Name: AERREAS7
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
...you get most of your care at the emergency room
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AERREAS8]

Question ID: AAU.248_08.080

Instrument Variable Name: AERREAS8
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
Tell me which of these apply to your last emergency room visit?
...you arrived by ambulance or other emergency vehicle
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who had at least one ER visit in the past year
Skip Instructions:
(1,2,R,D) [goto AHCHYR]

Question ID: AAU.250_00.000

Instrument Variable Name: AHCHYR
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text:Sample adults 18+
Skip Instructions:
(1)[goto AHCHMOYR]
(2,R,D)[goto AHCNOYR]

Question ID: AAU.260_00.000

Instrument Variable Name: AHCHMOYR
Questionnaire File Name: Sample Adult
Question Text:
During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?
01-12 01-12 months
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who received home care from a health professional during the past 12 months
Skip Instructions:
(1-12,R,D)[goto AHCHNOYR]

Question ID: AAU.270_00.000

Instrument Variable Name: AHCHNOYR
Questionnaire File Name: Sample Adult
Question Text:
(book) A10
What was the total number of home visits received during [Fill1: that month/Fill2: those months]?
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who received home care from a health professional during the past 12 months
Skip Instructions:
(1-8,R,D)[goto AHCNOYR]

Question ID: AAU.280_00.000

Instrument Variable Name: AHCNOYR
Questionnaire File Name: Sample Adult
Question Text:
(book) A9
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR?S OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times you were hospitalized overnight, visits to hospital emergency rooms, home visits, dental visits, or telephone calls.
00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-8,R,D)[goto ASRGYR]

Question ID: AAU.290_00.000

Instrument Variable Name: ASRGYR
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or outpatient?
* Read if necessary: This includes both major surgery and minor procedures such as setting bones or removing growths.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ASRGNOYR]
(2,R,D) [goto AMDLONG]

Question ID: AAU.300_00.000

Instrument Variable Name: ASRGNOYR
Questionnaire File Name: Sample Adult
Question Text:
Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during the PAST 12 MONTHS?
* Enter "95" for 95 or more times.
01-94 1-94 times
95 95+ times
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who had surgery or surgical procedures during past 12 months
Skip Instructions:
(1-95,R,D) [goto AMDLONG]
(11-95) [goto ERR_ASRGNOYR]
ERR_ASRGNOYR
Soft Edit:
* [ASRGNOYR] is an unusually large number.
* Please verify.

Question ID: AAU.309_00.040

Instrument Variable Name: HIT4A
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
...Communicate with a health care provider by email.
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto HIT5A]

Question ID: AAU.309_00.050

Instrument Variable Name: HIT5A
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the following
...Use online chat groups to learn about health topics.
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto FLUVACYR]

Question ID: AAU.310_00.000

Instrument Variable Name: FLUVACYR
Questionnaire File Name: Sample Adult
Question Text:
?[F1]
DURING THE PAST 12 MONTHS, have you 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 adults 18+
Skip Instructions:
(1) [goto FLUVACTP]
(2,R,D) [ goto SHTPNUYR]

Question ID: AAU.311_00.000

Instrument Variable Name: FLUVACTP
Questionnaire File Name: Sample Adult
Question Text:
Was this a shot, or was it a vaccine sprayed in the nose?
* Read if necessary: A flu shot is injected in the arm.
*Read if necessary: The flu nasal spray is called FluMist?
1 Flu shot
2 Flu nasal spray (spray, mist or drop in nose)
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have received a flu vaccination in the past 12 months
Skip Instructions:
(1,2,R,D) [goto FLUVAC_M]

Question ID: AAU.312_01.000

Instrument Variable Name: FLUVAC_M
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
During what month and year did you receive your most recent flu vaccination?
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have received a flu vaccination in the past 12 months
Skip Instructions:
(1-12,D) [ goto FLUVAC_Y]
:
(R)
if FLUVACTP=1 and PREGNOW=1 and INTERVIEW_MONTH=1-3,8-12 [goto FLUSHPG1];
:
else if FLUVACTP=1 and PREGNOW=1 and INTERVIEW_MONTH=4-7 or PREGFLYR=1 [goto FLUSHPG2];

Question ID: AAU.312_02.000

Instrument Variable Name: FLUVAC_Y
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
*Enter year of most recent flu vaccination.
Year Year
9997 Refused
9999 Don't know
Universe Text: Sample adults 18+ who gave a month for their last flu vaccination or who didn?t know the month
Skip Instructions:
(valid year,R,D) if FLUVACTP=1 and PREGNOW=1 and INTERVIEW_MONTH=1-3,8-12 [goto FLUSHPG1];
else if FLUVACTP=1 and PREGNOW=1 and INTERVIEW_MONTH=4-7 or PREGFLYR=1 [goto FLUSHPG2];
else [goto SHTPNUYR]
[If FLUVAC_M and FLUVAC_Y = a future date [goto ERR1_FLUVAC_Y]
[If FLUVAC_M and FLUVAC_Y = a date prior to birth [goto ERR2_FLUVAC_Y ]
[If FLUVAC_M and FLUVAC_Y = a date before 12 months ago [goto ERR3_FLUVAC_Y ]
ERR1_FLUVAC_Y
Hard Edit:
*Future date invalid
ERR2_FLUVAC_Y
*Date before birth
ERR3_FLUVAC_Y
*Date more than 12 months ago

Question ID: AAU.313_00.000

Instrument Variable Name: FLUSHPG1
Questionnaire File Name: Sample Adult
Question Text:
Did you get a flu shot before or during your current pregnancy?
1 Before this pregnancy
2 During this pregnancy
7 Refused
9 Don't know
Universe Text: Female sample adults 18-49 who are currently pregnant and are interviewed January-March or August-December and received a flu shot in the past 12 months
Skip Instructions:
(1-3,R,D) [goto SHTPNUYR]

Question ID: AAU.314_00.000

Instrument Variable Name: FLUSHPG2
Questionnaire File Name: Sample Adult
Question Text:
[Fill1: Earlier you said you were pregnant sometime since August 1st, [last year]. Did you get a flu shot before, during or after this pregnancy?/
Earlier you said you were pregnant sometime between August [last year] and March [current year].
Did you get a flu shot before, during or after this pregnancy?/
Earlier you said you were pregnant sometime between August [last year] and March [current year].
Did you get a flu shot before, during or after this pregnancy?
1 Before this pregnancy
2 During this pregnancy
3 After this pregnancy
7 Refused
9 Don't know
Universe Text: Female sample adults 18-49 who are currently pregnant and were interviewed April-July or who have been determined to be pregnant at a specific point in the past year and received a flu shot in the past 12 months
Skip Instructions:
(1-3,R,D) [goto SHTPNUYR]

Question ID: AAU.320_00.000

Instrument Variable Name: SHTPNUYR
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER had a pneumonia shot?
This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto APOX]

Question ID: AAU.330_00.000

Instrument Variable Name: APOX
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER had chickenpox?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto APOX12MO]
(2,R,D) [goto AHEP]

Question ID: AAU.340_00.000

Instrument Variable Name: APOX12MO
Questionnaire File Name: Sample Adult
Question Text:
Have you had chickenpox in the PAST 12 MONTHS?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had chickenpox
Skip Instructions:
(1,2,R,D) [goto AHEP]

Question ID: AAU.350_00.000

Instrument Variable Name: AHEP
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER had hepatitis?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto AHEPBTST]
(2,R,D) [goto AHEPLIV]

Question ID: AAU.360_00.000

Instrument Variable Name: AHEPLIV
Questionnaire File Name: Sample Adult
Question Text:
Have you ever lived with someone who had hepatitis?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
Skip Instructions:
(1,2,R,D) [goto AHEPBTST]

Question ID: AAU.365_00.010

Instrument Variable Name: AHEPBTST
Questionnaire File Name: Sample Adult
Question Text:
Have you ever had a blood test for hepatitis B?
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto SHTHEPB]

Question ID: AAU.370_00.000

Instrument Variable Name: SHTHEPB
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto SHEPDOS]
(2,R,D) [goto SHTHEPA]

Question ID: AAU.380_00.000

Instrument Variable Name: SHEPDOS
Questionnaire File Name: Sample Adult
Question Text:
Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?
1 Received at least 3 doses
2 Received less than 3 doses
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever received the Hepatitis B vaccine
Skip Instructions:
(1,2,R,D) [goto SHTHEPA]

Question ID: AAU.390_00.010

Instrument Variable Name: SHTHEPA
Questionnaire File Name: Sample Adult
Question Text:
The hepatitis A vaccine is given as a two dose series routinely to some children starting at 1 year of age, and to some adults and people who travel outside the United States. Although it can be given as a combination vaccine with hepatitis B, it is different from the hepatitis B shot, and has only been available since 1995. Have you ever received the hepatitis A vaccine?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) goto SHEPANUM
(2,R,D) [goto AHEPCTST]

Question ID: AAU.400_00.010

Instrument Variable Name: SHEPANUM
Questionnaire File Name: Sample Adult
Question Text:
How many hepatitis A shots did you receive?
*Enter '96' if all shots were received
01-95 01-95 shots
96 Received all shots
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have had a hepatitis A vaccine
Skip Instructions:
(1-95,96,R,D) [goto AHEPCTST]

Question ID: AAU.440_00.010

Instrument Variable Name: SHTTDAP
Questionnaire File Name: Sample Adult
Question Text:
There are currently two types of tetanus shots available today. One is the Td or tetanus-diphtheria vaccine and the other is called Tdap or Adacel (trademark) or Boostrix (trademark). They are similar except the Tdap shot also includes a pertussis (per-TUH-sis) or whooping cough vaccine. Thinking back to your most recent tetanus shot, did your health care provider tell you or did the vaccine information sheet say the vaccine included the pertussis or whooping cough vaccine? The shot is often called Tdap or ADACEL (trademark) or BOOSTRIX (trademark).
1 Yes-included pertussis
2 No-did not include pertussis
3 Doctor did not say
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have had a tetanus shot in 2005 or beyond or refused to say if they had a tetanus shot in 2005 or beyond
Skip Instructions:
(1-3,R,D) if age le 64 [goto SHTHPV2];
else [goto LIVEV]

Question ID: AAU.446_00.010

Instrument Variable Name: SHTHPV2
Questionnaire File Name: Sample Adult
Question Text:
Have you ever received an HPV shot or vaccine?
*HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
*The vaccines are sometimes called CERVARIX (trademark) or GARDASIL (trademark).
1 Yes
2 No
3 Doctor refused when asked
7 Refused
9 Don't know
Universe Text: Sample adults LE 64
Skip Instructions:
(1) [goto SHHPVDOS]
(2,3,R,D) [goto LIVEV]

Question ID: AAU.448_00.010

Instrument Variable Name: SHHPVDOS
Questionnaire File Name: Sample Adult
Question Text:
How many HPV shots did you receive?
* Enter '50' if 50 or more shots
* Enter '96' for all shots
01-49 1-49 shots
50 50+ shots
96 All shots
97 Refused
99 Don't know
Universe Text: Sample adults LE 64 who received an HPV shot
Skip Instructions:
(1-50,96,R,D) [goto AHPVAGE]
(51-95) [goto ERR_SHHPVDOS]
ERR_SHHPVDOS
Hard Edit:
* Shots should be in the range 1-50 or 96 for all shots.
* Please correct.

Question ID: AAU.449_00.010

Instrument Variable Name: AHPVAGE
Questionnaire File Name: Sample Adult
Question Text:
How old were you when you received your first HPV shot?
008-064 8-64 years
997 Refused
999 Don't know
Universe Text: Sample adults LE 64 who received an HPV shot
Skip Instructions:
(8-64,R,D) [goto LIVEV]

Question ID: AAU.450_00.010

Instrument Variable Name: LIVEV
Questionnaire File Name: Sample Adult
Question Text:
Has a doctor or other health professional ever told you that you had any kind of chronic, or long-term liver condition?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto TRAVEL]

Question ID: AAU.460_00.010

Instrument Variable Name: TRAVEL
Questionnaire File Name: Sample Adult
Question Text:
Have you ever traveled outside of the United States to countries other than Europe, Japan, Australia, New Zealand or Canada, since 1995?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto WRKHLTH]

Question ID: AAU.465_00.010

Instrument Variable Name: WRKHLTH
Questionnaire File Name: Sample Adult
Question Text:
Do you currently volunteer or work in a hospital, medical clinic, doctor?s office, dentist?s office, nursing home or some other health-care facility? This includes emergency responders and public safety personnel, part-time and unpaid work in a health care facility as well as professional nursing care provided in the home.
*Read if necessary: This includes non-health care professionals, such as administrative staff, who work in a health-care facility.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto WRKDIR] (2,R,D) [goto APSBPCHK]

Question ID: AAU.470_00.010

Instrument Variable Name: WRKDIR
Questionnaire File Name: Sample Adult
Question Text:
Do you provide direct patient care as part of your routine work? By direct patient care we MEAN PHYSICAL OR HANDS ON CONTACT WITH PATIENTS.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who work or volunteer in a health-care setting
Skip Instructions:
(1,2,R,D) [goto APSBPCHK]

Question ID: AAU.500_00.010

Instrument Variable Name: APSBPCHK
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you had your blood pressure checked by a doctor, nurse, or other health professional?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto APSCHCHK]

Question ID: AAU.510_00.010

Instrument Variable Name: APSCHCHK
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you had your blood cholesterol checked by a doctor, nurse, or other health professional?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto APSBSCHK]

Question ID: AAU.520_00.010

Instrument Variable Name: APSBSCHK
Questionnaire File Name: Sample Adult
Question Text:
Have you had a fasting test for high blood sugar or diabetes DURING THE PAST 12 MONTHS?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) if SEX=1 and AGE GE 40 [goto APSCOL]
:
Else if SEX=1 and AGE ( 40 [goto APSDIET]
: Else if SEX=2 [goto APSPAP]

Question ID: AAU.530_00.010

Instrument Variable Name: APSPAP
Questionnaire File Name: Sample Adult
Question Text:
Have you had a Pap smear or Pap test DURING THE PAST 12 MONTHS?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+
Skip Instructions:
(1,2,R,D) if AGE GE 30 [goto APSMAM];
:
Else if AGE(30 [goto APSDIET]

Question ID: AAU.540_00.010

Instrument Variable Name: APSMAM
Questionnaire File Name: Sample Adult
Question Text:
Have you had a Mammogram DURING THE PAST 12 MONTHS?
*Read if necessary.
A mammogram is an x-ray of each breast to look for breast cancer.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 30+
Skip Instructions:
(1,2,R,D) if AGE GE 40 [gotoAPSCOL];
:
Else if AGE LT 40 [goto APSDIET]

Question ID: AAU.550_00.010

Instrument Variable Name: APSCOL
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you had any test done for colon cancer?
*Read if necessary.
Colon cancer tests include blood stool tests, colonoscopy and sigmoidoscopy.
A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood.
A sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems.
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 40+
Skip Instructions:
(1,2,R,D) [goto APSDIET]

Question ID: AAU.560_00.010

Instrument Variable Name: APSDIET
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your diet?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) if SMKNOW in ('1','2') [goto APSSMKC];
else [goto AINDINS]

Question ID: AAU.570_00.010

Instrument Variable Name: APSSMKC
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, has a doctor or other health professional talked to you about your smoking?
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ currently who smoke every day or some days
Skip Instructions:
(1,2,R,D) [goto AINDINS]

Question ID: AAU.600_00.010

Instrument Variable Name: AINDINS
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 3 YEARS, did you try to purchase health insurance directly, that is, not through any employer, union, or government program?
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto AINDPRCH]
(2,R,D) if age LT 65 [goto AEXCHNG];
else age GE 65 [goto next section]

Question ID: AAU.600_00.020

Instrument Variable Name: AINDPRCH
Questionnaire File Name: Sample Adult
Question Text:
Was a plan purchased?
1 Yes
2 No
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who tried to purchase health insurance directly in the past 3 years
Skip Instructions:
(1) [goto AINDWHO]
(2,R,D) if age LT 65 [goto AEXCHNG];
else [goto next section]

Question ID: AAU.600_00.030

Instrument Variable Name: AINDWHO
Questionnaire File Name: Sample Adult
Question Text:
Was this plan for yourself, someone else in your family, or both?
1 Self
2 Someone else in family
3 Both
7 Refused
9 Don?t know
Universe Text: Sample adults 18+ who purchased health insurance directly in the past 3 years
Skip Instructions:
(1-3,R,D) [goto AINDDIF1]

Question ID: ASI.005_00.000

Instrument Variable Name: ASIINTRO
Questionnaire File Name: Sample Adult
Question Text:
*You are about to enter the Sexual Identity and Lifestyle questions section. This section includes questions on computer use, the respondent?s neighborhood, sexual identity, financial worries, mental health, and HIV testing.
*Enter 1 to Continue.
1 Continue
Universe Text: Sample adults 18+
Skip Instructions:
(1) goto ACICPUSE

Question ID: ASI.130_00.000

Instrument Variable Name: ACICPUSE
Questionnaire File Name: Sample Adult
Question Text:
These questions are about you and your neighborhood.
How often do you use a computer?
*Read answer categories.
1 Never or almost never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACISATHC]

Question ID: ASI.140_00.000

Instrument Variable Name: ACISATHC
Questionnaire File Name: Sample Adult
Question Text:
In general, how satisfied are you with the health care you received in the past 12 months?
*Read answer categories.
1 Very satisfied
2 Somewhat satisfied
3 Somewhat dissatisfied
4 Very dissatisfied
5 You haven't had health care in the past 12 months
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACITENUR]

Question ID: ASI.150_00.000

Instrument Variable Name: ACITENUR
Questionnaire File Name: Sample Adult
Question Text:
About how long have you lived in your present neighborhood?
1 Less than 1 year
2 1-3 years
3 4-10 years
4 11-20 years
5 More than 20 years
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACINHELP]

Question ID: ASI.160_00.000

Instrument Variable Name: ACINHELP
Questionnaire File Name: Sample Adult
Question Text:
How much do you agree or disagree with the following statements about your neighborhood?
People in this neighborhood help each other out.
Would you say...
*Read answer categories.
1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACINCNTO]

Question ID: ASI.170_00.000

Instrument Variable Name: ACINCNTO
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
There are people I can count on in this neighborhood.
Would you say...
*Read answer categories if necessary.
1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACINTRU]

Question ID: ASI.180_00.000

Instrument Variable Name: ACINTRU
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
People in this neighborhood can be trusted.
Would you say...
*Read answer categories if necessary.
1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACINKNT]

Question ID: ASI.190_00.000

Instrument Variable Name: ACINKNT
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary.
How much do you agree or disagree with the following statements about your neighborhood?
This is a close-knit neighborhood.
Would you say...
*Read answer categories if necessary.
1 Definitely agree
2 Somewhat agree
3 Somewhat disagree
4 Definitely disagree
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D)
[if SEX=1, goto ACISIM; elseif SEX=2, goto ACISIF]

Question ID: ASI.220_00.000

Instrument Variable Name: ACISIM
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI1
Which of the following best represents how you think of yourself?
1 Gay
2 Straight, that is, not gay
3 Bisexual
4 Something else
5 I don't know the answer
7 Refused
Universe Text: Male sample adults 18+
Skip Instructions:
(1-5,R) [goto ACIRETR]

Question ID: ASI.240_00.000

Instrument Variable Name: ACISIF
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI2
Which of the following best represents how you think of yourself?
1 Lesbian or gay
2 Straight, that is, not lesbian or gay
3 Bisexual
4 Something else
5 I don't know the answer
7 Refused
Universe Text: Female sample adults 18+
Skip Instructions:
(1-5,R) [goto ACIRETR]

Question ID: ASI.260_00.000

Instrument Variable Name: ACIRETR
Questionnaire File Name: Sample Adult
Question Text:
The next questions ask how worried you are right now about financial matters.
How worried are you right now about not having enough money for retirement? Are you...
*Read answer categories.
1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACIMEDC]

Question ID: ASI.270_00.000

Instrument Variable Name: ACIMEDC
Questionnaire File Name: Sample Adult
Question Text:
How worried are you right now about not being able to pay medical costs of a serious illness or accident? Are you...
*Read answer categories if necessary.
1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACISTLV]

Question ID: ASI.280_00.000

Instrument Variable Name: ACISTLV
Questionnaire File Name: Sample Adult
Question Text:
How worried are you right now about not being able to maintain the standard of living you enjoy? Are you...
*Read answer categories if necessary.
1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACICNHC]

Question ID: ASI.290_00.000

Instrument Variable Name: ACICNHC
Questionnaire File Name: Sample Adult
Question Text:
How worried are you right now about not being able to pay medical costs for normal healthcare? Are you...
*Read answer categories if necessary.
1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACICCOLL]

Question ID: ASI.300_00.000

Instrument Variable Name: ACICCOLL
Questionnaire File Name: Sample Adult
Question Text:
How worried are you right now about not having enough money to pay for your children's college? Are you...
*Read answer categories if necessary.
1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
5 This does not apply to me
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACINBILL]

Question ID: ASI.310_00.000

Instrument Variable Name: ACINBILL
Questionnaire File Name: Sample Adult
Question Text:
How worried are you right now about not having enough to pay your normal monthly bills? Are you...
*Read answer categories if necessary.
1 Very worried
2 Moderately worried
3 Not too worried
4 Not worried at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-4,R,D) [goto ACIHCST]

Question ID: ASI.360_00.000

Instrument Variable Name: ACISLPST
Questionnaire File Name: Sample Adult
Question Text:
In the past week, how many times did you have trouble staying asleep?
*Enter '0' if respondent did not have trouble staying asleep in the past week.
*Enter '7' for 7 or more times.
00 Did not have trouble staying asleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-7,R,D) [goto ACISLPMD]

Question ID: ASI.370_00.000

Instrument Variable Name: ACISLPMD
Questionnaire File Name: Sample Adult
Question Text:
In the past week, how many times did you take medication to help you fall asleep or stay asleep?
*Enter '0' if respondent did not take medication to help sleep in the past week.
*Enter '7' for 7 or more times.
00 Did not take medication to help sleep in the past week
01-06 1-6 times
07 7 or more times
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-7,R,D) [goto ACIREST]

Question ID: ASI.380_00.000

Instrument Variable Name: ACIREST
Questionnaire File Name: Sample Adult
Question Text:
In the past week, on how many days did you wake up feeling well rested?
*Enter '0' if respondent never felt well rested in the past week.
00 Never felt rested in the past week
01-07 1-7 days
97 Refused
99 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(0-7,R,D) [goto MHSAD_CK]

Question ID: ASI.390_00.000

Instrument Variable Name: MHSAD_CK
Questionnaire File Name: Sample Adult
Question Text:
Now I am going to ask you some questions about feelings you may have experienced over the PAST 30 DAYS.
1 Enter 1 to continue
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto ACISAD]

Question ID: ASI.390_01.000

Instrument Variable Name: ACISAD
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI5
DURING THE PAST 30 DAYS, how often did you feel
...So sad that nothing could cheer you up?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACINERV]

Question ID: ASI.390_02.000

Instrument Variable Name: ACINERV
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Nervous?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACIRSTLS]

Question ID: ASI.390_03.000

Instrument Variable Name: ACIRSTLS
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Restless or fidgety?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACIHOPLS]

Question ID: ASI.390_04.000

Instrument Variable Name: ACIHOPLS
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Hopeless?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACIEFFRT]

Question ID: ASI.390_05.000

Instrument Variable Name: ACIEFFRT
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...That everything was an effort?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D) [goto ACIWTHLS]

Question ID: ASI.390_06.000

Instrument Variable Name: ACIWTHLS
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI5
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Worthless?
1 ALL of the time
2 MOST of the time
3 SOME of the time
4 A LITTLE of the time
5 NONE of the time
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1-5,R,D)
if ACISAD or ACINERV or ACIRSTLS or ACIHOPLS or ACIEFFRT or ACIWTHLS=1-3 [goto ACIMUCH];
else [goto ACIBLD12]

Question ID: ASI.400_00.000

Instrument Variable Name: ACIMUCH
Questionnaire File Name: Sample Adult
Question Text:
We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?
1 A lot
2 Some
3 A little
4 Not at all
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who at least some of the time have felt sad, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless, in the past 30 days
Skip Instructions:
(1-4,R,D) [goto ACIBLD12]

Question ID: ASI.405_00.000

Instrument Variable Name: ACIBLD12
Questionnaire File Name: Sample Adult
Question Text:
Now, I am going to ask about giving blood donations to a blood bank such as the American Red Cross.
During the PAST 12 MONTHS, have you donated blood?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto ACIHIVT]

Question ID: ASI.410_00.000

Instrument Variable Name: ACIHIVT
Questionnaire File Name: Sample Adult
Question Text:
The next question is about the test for HIV, the virus that causes AIDS. Except for tests you may have had as part of blood donations, have you ever been tested for HIV?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,R,D) [goto next section]
(2) [goto ACIHIVWN]

Question ID: ASI.420_00.000

Instrument Variable Name: ACIHIVWN
Questionnaire File Name: Sample Adult
Question Text:
(book) ASI6
I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes AIDS).
Which one of these would you say is the MAIN reason why you have not been tested?
01 It's unlikely you've been exposed to HIV
02 You were afraid to find out if you were HIV positive (that you had HIV)
03 You didn't want to think about HIV or about being HIV positive
04 You were worried your name would be reported to the government if you tested positive
05 You didn't know where to get tested
06 You don't like needles
07 You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
08 Some other reason
09 No particular reason
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who have never been tested for HIV
Skip Instructions:
(1-9,R,D) [goto next section]

Question ID: BAL.010_00.000

Instrument Variable Name: BALEV
Questionnaire File Name: Sample Adult
Question Text:
These next questions are about dizziness or balance problems. Have you EVER had a problem with dizziness, lightheadedness, feeling as if you are going to pass out or faint, or with unsteadiness or feeling off-balance? Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto BALAGE]
(2,R,D) [goto BRPROB1]

Question ID: BAL.020_00.000

Instrument Variable Name: BALAGE
Questionnaire File Name: Sample Adult
Question Text:
At what age were you FIRST BOTHERED by dizziness, lightheadedness, feeling as if you are going to pass out or faint, or with unsteadiness or feeling off-balance?
*Do not include times when drinking alcohol.
*Enter '996' if since birth.
001-995 001-995
01-84 1-84 years
85 85+ years
96 Since birth
97 Refused
99 Don't know
996 Since birth
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who have ever had a balance or dizziness problem
Skip Instructions:
(1-120, 996,R,D) [goto BDIZZ1]

Question ID: BAL.050_04.000

Instrument Variable Name: BRPROB4
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the following problems? Do not include times when drinking alcohol. Please say yes or no to each.
...Difficulty walking in the dark without using support
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto BRPROB5]

Question ID: BAL.050_05.000

Instrument Variable Name: BRPROB5
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the following problems? Do not include times when drinking alcohol. Please say yes or no to each.
...Difficulty walking on uneven ground or surfaces
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto BRPROB6]

Question ID: BAL.050_06.000

Instrument Variable Name: BRPROB6
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the following problems? Do not include times when drinking alcohol. Please say yes or no to each.
...Had fear of heights
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D) [goto BRPROB7]

Question ID: BAL.050_07.000

Instrument Variable Name: BRPROB7
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the following problems? Do not include times when drinking alcohol. Please say yes or no to each.
...Difficulty riding an escalator or moving walkway
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1,2,R,D)
if BALEV=2,R,D and BRPROB1 through BRPROB7 all=2 then [goto BBIO1];
else if BALEV=1 and BDIZZ1=2 and BRPROB1 through BRPROB7 all=2 then [goto BHOSP2];
else where (BDIZZ1(e) =1) or (any BRPROB1 -BRPROB6 = 1 or BRPROB7=1,R,D) [goto BTYPE_1 ]

Question ID: BAL.060_01.000

Instrument Variable Name: BTYPE_1
Questionnaire File Name: Sample Adult
Question Text:
This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
A spinning or vertigo sensation or other illusion of motion such as tipping, tilting, or rocking
*Read if necessary: Vertigo is an illusion of rotation or other motion, as if riding a carousel.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTYPE_2]

Question ID: BAL.060_02.000

Instrument Variable Name: BTYPE_2
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
...A floating, spacey, or disconnected sensation
*Read if necessary: Your head doesn't feel quite right or normal.
* Read if necessary: Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTYPE_3]

Question ID: BAL.060_03.000

Instrument Variable Name: BTYPE_3
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
...Feeling lightheaded, without a sense of motion
* Read if necessary: Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTYPE_4]

Question ID: BAL.060_04.000

Instrument Variable Name: BTYPE_4
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
...Feeling as if you are going to pass out or faint
* Read if necessary: Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTYPE_5]

Question ID: BAL.060_05.000

Instrument Variable Name: BTYPE_5
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
...Blurring of your vision when you move your head
* Read if necessary: Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTYPE_6]

Question ID: BAL.060_06.000

Instrument Variable Name: BTYPE_6
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
...Feeling off-balance or unsteady
* Read if necessary: Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTYPE_7]

Question ID: BAL.060_07.000

Instrument Variable Name: BTYPE_7
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. This next question is about symptoms of dizziness or balance problems. Please tell me if you have had any of these problems in the past 12 months. Please say yes or no to each.
...Other dizziness or balance problem.
* Read if necessary: Do not include times when drinking alcohol.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least one balance related problem in the past 12 months
Skip Instructions:
(1,2,R,D) if BALEV=2,R,D and (all BTYPE_1 -BTYPE_7 = 2,R,D) [goto BBIO1];
else if BALEV=1 and (all BRPROB1-BRPROB7= 2,R,D) and (all BTYPE_1 -BTYPE_7 = 2,R,D) [goto BHOSP2]
else if BDIZZ1=1 and (all BTYPE_1 -BTYPE_7 = 2,R,D) fill '7' in BBOTH1 and [goto BAGE1]
else if two or more BTYPE_1 - BTYPE_7 = 1,7,9 [goto BBOTH1];
else [goto BAGE1]

Question ID: BAL.070_00.000

Instrument Variable Name: BBOTH1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, which ONE of these feelings of dizziness or balance problems bothered you the most?
*Read answer categories below.
01 the spinning, vertigo, or motion sensation
02 the floating, spacey, or disconnected feeling
03 the feeling of lightheadedness
04 the feeling like you are about to pass out
05 Blurred vision
06 Unsteadiness
07 Other dizziness or balance problem
97 Refused
99 Don't know
Universe Text: Sample adults 18+ and more than one balance symptom
Skip Instructions:
(1-7,R,D) [goto BAGE1]

Question ID: BAL.080_00.000

Instrument Variable Name: BAGE1
Questionnaire File Name: Sample Adult
Question Text:
About how old were you when (Fill: most bothersome or only feeling) first happened?
*Read if necessary. If unsure, estimate as best you can.
*Enter '996' If since birth.
001-995 1-995
01-84 1-84 years
85 85+ years
96 Since birth
97 Refused
99 Don't know
996 Since birth
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1-120) if BAGE1 gt AGE
[goto ERR2_BAGE1];
Else
[goto BOFTN]
(121-995) [goto ERR1_BAGE1]
('996', R, D) [goto BOFTN]
If BAGE1= 121-995 then display ERR1_BAGE1:
Hard Edit:
* 121-995 years not allowed in this field.
*Please correct.
If BAGE gt AGE, then display ERR2_BAGE:
* Time with condition cannot be greater than age.
* Please correct.

Question ID: BAL.100_01.000

Instrument Variable Name: BOFTN
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
DURING THE PAST 12 MONTHS, about how often have you had (Fill: most bothersome or only feeling)?
*Please tell me the number of times per day, per week, per month.
*Enter '996' for 'Constantly' or 'Almost Always'.
001-995 1-995
996 Constantly or almost always
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1-365) [goto BOFTT]
(996,R,D) [goto BLAST1]

Question ID: BAL.100_02.000

Instrument Variable Name: BOFTT
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
*Enter time period.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year
6 Constantly or almost always
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who gave a number to how often they had the dizziness or balance problem
Skip Instructions:
(1-4,R,D) [goto BLAST1]

Question ID: BAL.120_04.000

Instrument Variable Name: BTRG_04
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following usually cause or trigger your dizziness or balance problem(s)? Please say yes or no to each.
...Headache, including migraine
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ have a dizziness or at least one balance symptom and does not almost always have unsteadiness
Skip Instructions:
(1,2,R,D) [goto BTRG_05]

Question ID: BAL.120_05.000

Instrument Variable Name: BTRG_05
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following usually cause or trigger your dizziness or balance problem(s)? Please say yes or no to each.
...A visual problem such as double vision, or your eyes "jerk", "bounce", move rapidly or oscillate
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ have a dizziness or at least one balance symptom and does not almost always have unsteadiness
Skip Instructions:
(1,2,R,D) [goto BTRG_06]

Question ID: BAL.120_06.000

Instrument Variable Name: BTRG_06
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following usually cause or trigger your dizziness or balance problem(s)? Please say yes or no to each.
...Riding in a car, bus, airplane, boat, or train
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTRG_07]

Question ID: BAL.120_07.000

Instrument Variable Name: BTRG_07
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following usually cause or trigger your dizziness or balance problem(s)? Please say yes or no to each.
...Walking down a grocery store aisle
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTRG_08]

Question ID: BAL.120_08.000

Instrument Variable Name: BTRG_08
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following usually cause or trigger your dizziness or balance problem(s)? Please say yes or no to each.
...Hearing loud sounds
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTRG_09]

Question ID: BAL.120_09.000

Instrument Variable Name: BTRG_09
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following usually cause or trigger your dizziness or balance problem(s)? Please say yes or no to each.
...Blowing your nose
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BTRG_10]

Question ID: BAL.120_10.000

Instrument Variable Name: BTRG_10
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following usually cause or trigger your dizziness or balance problem(s)? Please say yes or no to each.
...Taking prescription medicines or drugs, or over-the-counter medications, e.g., for allergy or sleep aids
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BSAME]

Question ID: BAL.130_01.000

Instrument Variable Name: BSAME_1
Questionnaire File Name: Sample Adult
Question Text:
Do any of the following problems happen around the same time as your dizziness or balance problem(s)? Please say yes or no to each.
...Nausea or vomiting
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BONLY_1]
(2,R,D) [goto BSAME_2]

Question ID: BAL.130_02.000

Instrument Variable Name: BSAME_2
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following problems happen around the same time as your dizziness or balance problem(s)? Please say yes or no to each.
...Hearing loss in only one ear
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BONLY_2]
(2,R,D) [goto BSAME_3]

Question ID: BAL.130_03.000

Instrument Variable Name: BSAME_3
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following problems happen around the same time as your dizziness or balance problem(s)? Please say yes or no to each.
...Ringing, buzzing, or roaring in one ear-medical term is Tinnitus (TIN-uh-tus)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BONLY_3]
(2,R,D) [goto BSAME_4]

Question ID: BAL.130_04.000

Instrument Variable Name: BSAME_4
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following problems happen around the same time as your dizziness or balance problem(s)? Please say yes or no to each.
...Fullness, pressure, or stuffed-up feeling in one ear without pain
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BONLY_4]
(2,R,D) [goto BSAME_5]

Question ID: BAL.130_05.000

Instrument Variable Name: BSAME_5
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following problems happen around the same time as your dizziness or balance problem(s)? Please say yes or no to each.
...Sinus congestion
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BONLY_5]
(2,R,D) [goto BSAME_6]

Question ID: BAL.130_06.000

Instrument Variable Name: BSAME_6
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following problems happen around the same time as your dizziness or balance problem(s)? Please say yes or no to each.
...Anxiety
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BONLY_6];
(2,R,D) [goto BSAME_7]

Question ID: BAL.130_07.000

Instrument Variable Name: BSAME_7
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Do any of the following problems happen around the same time as your dizziness or balance problem(s)? Please say yes or no to each.
...Depression
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a dizziness or balance problem in the past 12 months or who identified at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BONLY_7];
(2,R,D) [goto BHOSP2]

Question ID: BAL.140_01.000

Instrument Variable Name: BONLY_1
Questionnaire File Name: Sample Adult
Question Text:
Do you have nausea or vomiting only when you have dizziness or balance problem(s) or do you have it regardless?
*Read if necessary. We mean around the same time, or just before, during or following the dizziness or balance problem(s).
1 Only
2 Regardless
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had nausea or vomiting around the same time as their dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BSAME_2]

Question ID: BAL.140_02.000

Instrument Variable Name: BONLY_2
Questionnaire File Name: Sample Adult
Question Text:
Do you have hearing loss only when you have dizziness or balance problem(s) or do you have it regardless?
*Read if necessary. We mean around the same time, or just before, during or following the dizziness or balance problem(s).
1 Only
2 Regardless
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had hearing loss around the same time as their dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BSAME_3]

Question ID: BAL.140_07.000

Instrument Variable Name: BONLY_7
Questionnaire File Name: Sample Adult
Question Text:
Do you have depression only when you have the dizziness or balance problem(s) or do you have it regardless?
*Read if necessary. We mean around the same time, or just before, during or following the dizziness or balance problem(s).
1 Only
2 Regardless
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had depression around the same time as their dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BHOSP2]

Question ID: BAL.150_00.000

Instrument Variable Name: BHOSP2
Questionnaire File Name: Sample Adult
Question Text:
Have you ever gone to a hospital or emergency room about a dizziness or balance problem?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a balance or dizziness problem or who had at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BHOSPNO1]
(2, R, D) [goto BHP1]

Question ID: BAL.160_00.000

Instrument Variable Name: BHOSPNO1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, about how many times have you gone to a hospital emergency room about a dizziness or balance problem?
0 None
1 1 time
2 2 times
3 3-4 times
4 5-9 times
5 10-14 times
6 15 or more times
7 Refused
9 Don't know
Universe Text: Sample adults 18+ and ever been to ER about dizziness
Skip Instructions:
(0-6, R,D) [goto BHP1]

Question ID: BAL.170_00.000

Instrument Variable Name: BHP1
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER seen a doctor or other health professional, except for in the emergency room, about a dizziness or balance problem?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have ever had a balance or dizziness problem or who had at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) if BALEV=1 and BDIZZ1=2,R,D and all from
BTYPE_1-BTYPE_7=2,R,D [goto BBIO1];
else if BDIZZ1=1 or any from BTYPE_1-BTYPE_7=1 and BHP1=2,R,D and
BHOSP2=2,R,D [goto BTRET1];
else if BDIZZ1=1 or any from BTYPE_1-BTYPE_7=1 and BHP1=2,R,D and
BHOSP2=1 [goto BFIRST1];
else if BDIZZ1=1 or any from BTYPE_1-BTYPE_7=1 and BHP1=1 [goto BHP1_01]

Question ID: BAL.180_01.000

Instrument Variable Name: BHP1_01
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)? Please say yes or no to each.
... Family doctor, internal medicine doctor or general practitioner
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
( 1, 2, R,D) [goto BHP1_02

Question ID: BAL.180_02.000

Instrument Variable Name: BHP1_02
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Cardiologist or heart specialist
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_03]

Question ID: BAL.180_03.000

Instrument Variable Name: BHP1_03
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Ear, nose, and throat doctor
* Ear, nose, and throat doctors are also known as: ?otolaryngologists?, ?otologists? or ?neurotologists
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_04]

Question ID: BAL.180_04.000

Instrument Variable Name: BHP1_04
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Neurologist
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_05]

Question ID: BAL.180_05.000

Instrument Variable Name: BHP1_05
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
... Eye doctor, optometrist, or ophthalmologist (AHF-thal-MOL-oh-jist)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_06]

Question ID: BAL.180_06.000

Instrument Variable Name: BHP1_06
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Dentist, orthodontist or oral surgeon
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) and SEX =2 [goto BHP1_07];
Else if SEX=1 [goto BHP1_08]

Question ID: BAL.180_07.000

Instrument Variable Name: BHP1_07
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Gynecologist or OB/GYN
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Female sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_08]

Question ID: BAL.180_08.000

Instrument Variable Name: BHP1_08
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Psychiatrist, psychologist or social worker
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_09]

Question ID: BAL.180_09.000

Instrument Variable Name: BHP1_09
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Osteopath (OS-te-o-path) or doctor of osteopathy (os-tee-OP-uh-thee)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_10]

Question ID: BAL.180_10.000

Instrument Variable Name: BHP1_10
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Occupational therapist, physical therapist or rehabilitation ("rehab") specialist/doctor
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_11]

Question ID: BAL.180_11.000

Instrument Variable Name: BHP1_11
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Physician assistant or nurse practitioner
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_12]

Question ID: BAL.180_12.000

Instrument Variable Name: BHP1_12
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or health professionals about your dizziness or balance problem(s)?
Please say yes or no to each.
...Nutritionist or dietician
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional about a dizziness or balance problem
Skip Instructions:
(1,2,R,D) [goto BHP1_13]

Question ID: BAL.200_00.000

Instrument Variable Name: BFIRST1
Questionnaire File Name: Sample Adult
Question Text:
How long ago did you FIRST see a doctor or other health professional, including emergency room physicians about your dizziness or balance problem(s)?
1 Less than 12 months
2 12 months to less than 3 years
3 3 years to less than 5 years
4 5 years to less than 10 years
5 10 years to less than 15 years
6 15 years or more
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional (including ER) about a dizziness or balance problem
Skip Instructions:
( 1-6,R,D) [goto BHELP1]

Question ID: BAL.220_00.000

Instrument Variable Name: BHELP1
Questionnaire File Name: Sample Adult
Question Text:
How much do you feel these doctors or other health professionals helped your dizziness or balance problem(s)? Would you say...
*Read answer categories below.
1 No help at all
2 A little help
3 Moderate help
4 A lot of help
5 Problem was cured or no longer exists
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional (including ER) about a dizziness or balance problem
Skip Instructions:
(1,R,D) [goto BDIAG1]
(2,3,4,5) [goto BTHLP_N]

Question ID: BAL.230_01.000

Instrument Variable Name: BTHLP_N
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
About how long was it between the first time you saw a doctor or other health professional about your dizziness or balance problem(s) until you began to feel helped by treatments or advice you received?
Please tell me the number of days, weeks, months or years.
001-365 1-365
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who feel doctor or other health professional helped dizziness at least a little
Skip Instructions:
(1-365, D) [goto BTHLP_T];
(R)
[goto BDIAG1]

Question ID: BAL.230_02.000

Instrument Variable Name: BTHLP_T
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
*Enter time period for time since last saw a doctor or other health professional.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who gave a number to the time between when first saw doctor and began to feel help, or said DK to the number part of this question
Skip Instructions:
(1-3,R,D) [goto BDIAG1]
(4)
if (BTHLP_T gt AGE and BTHLP_T=4) [goto ERR_BTHLP_T]
else [goto BDIAG1]
* Time with condition cannot be greater than age.
Hard Edit:
* Please correct

Question ID: BAL.240_00.000

Instrument Variable Name: BDIAG1
Questionnaire File Name: Sample Adult
Question Text:
Did any of the doctors or health care professionals tell you the cause or give you a diagnosis for your dizziness or balance problem(s)?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and who ever saw a doctor or other health professional (including ER) about a dizziness or balance problem
Skip Instructions:
(1) [goto BCAUS1]
(2,R,D) [goto BTRET1]

Question ID: BAL.250_00.000

Instrument Variable Name: BCAUS1
Questionnaire File Name: Sample Adult
Question Text:
What did the doctor(s) or health care professional(s) tell you was the cause or causes of your dizziness or balance problem(s)?
* Enter all that apply, separate with commas.
*Read the list if necessary.
01 Allergies
02 Anxiety or depression
03 Benign positional vertigo (BPV or BPPV)
04 Crystals-loose or dislodged in ear
05 Diabetes
06 Headache or migraines
07 Head or neck trauma or concussion
08 Heart disease
09 Inner ear infection, viral labrynthitis
10 M?ni?re?s (Men-e-AIRZ) disease
11 Neurological-multiple sclerosis (MS), seizures, etc.
12 Side effects from medications (antibiotics, cancer treatments, etc.)
13 Stroke
14 Other health problem(s)
97 Refused
99 Don't know
Universe Text: Sample adults 18+ who were told cause of dizziness or balance problem
Skip Instructions:
(1-14,R,D) [goto BTRET1]

Question ID: BAL.260_00.000

Instrument Variable Name: BTRET1
Questionnaire File Name: Sample Adult
Question Text:
Have you EVER taken or tried anything to treat your dizziness or balance problem(s) such as physical therapy, certain exercises, avoiding certain foods, taking medicines, surgery, or wearing magnets or wristbands?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BTRT1_01]
(2,R,D) [goto BSTAT1]

Question ID: BAL.270_01.000

Instrument Variable Name: BTRT1_01
Questionnaire File Name: Sample Adult
Question Text:
Have you ever tried any of the following treatments? Please say yes or no to each.
...Exercises or physical therapy
* Do not include Tai Chi, Yoga, or Qi Gong.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_02]

Question ID: BAL.270_02.000

Instrument Variable Name: BTRT1_02
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Bed rest for several hours or days
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_03]

Question ID: BAL.270_03.000

Instrument Variable Name: BTRT1_03
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
... Head rolling maneuver by a doctor or therapist (Epley maneuver)
* Do not include treatment by a chiropractor.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_04]

Question ID: BAL.270_04.000

Instrument Variable Name: BTRT1_04
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
... Steroid injections into the ear
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_05]

Question ID: BAL.270_05.000

Instrument Variable Name: BTRT1_05
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Gentamicin (jen-tah-MI-sin) injection into the ear
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_06]

Question ID: BAL.270_06.000

Instrument Variable Name: BTRT1_06
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Surgery
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_07]

Question ID: BAL.270_07.000

Instrument Variable Name: BTRT1_07
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Low salt diet
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_08]

Question ID: BAL.270_08.000

Instrument Variable Name: BTRT1_08
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Avoiding or cutting back on certain foods or drinks such as chocolate, coffee, or alcohol
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D)
if SMKEV=1 [goto BTRT1_09];
else [goto BTRT1_10]

Question ID: BAL.270_09.000

Instrument Variable Name: BTRT1_09
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Quitting or reducing use of tobacco or cigarettes
* Enter '2' for non-smokers.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem who have ever smoked
Skip Instructions:
( 1,2,R,D) [goto BTRT1_10]

Question ID: BAL.270_10.000

Instrument Variable Name: BTRT1_10
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Prescription medicine or drugs
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_11]

Question ID: BAL.270_14.000

Instrument Variable Name: BTRT1_14
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Acupuncture
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_15]

Question ID: BAL.270_15.000

Instrument Variable Name: BTRT1_15
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Herbal remedy such as feverfew leaf, ginger or ginkgo biloba (GIN-ko bye-LO-bah)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BTRT1_16]

Question ID: BAL.270_16.000

Instrument Variable Name: BTRT1_16
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever tried any of the following treatments? Please say yes or no to each.
...Wearing magnets or acupressure wristband
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ treated for dizziness or balance problem
Skip Instructions:
( 1,2,R,D) [goto BSTAT1]

Question ID: BAL.280_00.000

Instrument Variable Name: BSTAT1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have your dizziness or balance problem(s) gotten worse, stayed the same, improved somewhat, or improved greatly?
1 Gotten worse
2 Stayed the same
3 Improved somewhat
4 Improved greatly
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(1-4, R, D) [goto BMEDIC1]

Question ID: BAL.300_00.000

Instrument Variable Name: BMEDIC1
Questionnaire File Name: Sample Adult
Question Text:
Do you regularly take any medicine that makes your dizziness or balance problem(s) worse?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
( 1,2, R, D) [goto BCHNG1]

Question ID: BAL.310_00.000

Instrument Variable Name: BCHNG1
Questionnaire File Name: Sample Adult
Question Text:
Do your dizziness or balance problems prevent you in any way from doing things you otherwise could do?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(1) [goto BCHG1_01]
(2, R,D) [goto BM12WS]

Question ID: BAL.320_01.000

Instrument Variable Name: BCHG1_01
Questionnaire File Name: Sample Adult
Question Text:
Have your dizziness or balance problems caused you to change or cut back on any of the following activities? Please say yes or no to each.
...Driving a motor vehicle
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and whose problem prevents them from doing things
Skip Instructions:
(1,2,R,D) [goto BCHNG_02]

Question ID: BAL.320_02.000

Instrument Variable Name: BCHG1_02
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have your dizziness or balance problems caused you to change or cut back on any of the following activities? Please say yes or no to each.
...Riding in a car, bus, airplane, boat or train
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and whose problem prevents them from doing things
Skip Instructions:
(1,2,R,D) [goto BCHNG_03]

Question ID: BAL.320_03.000

Instrument Variable Name: BCHG1_03
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have your dizziness or balance problems caused you to change or cut back on any of the following activities? Please say yes or no to each.
....Exercising or taking walks
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and whose problem prevents them from doing things
Skip Instructions:
(1,2,R,D) [goto BCHNG_04]

Question ID: BAL.320_04.000

Instrument Variable Name: BCHG1_04
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have your dizziness or balance problems caused you to change or cut back on any of the following activities? Please say yes or no to each.
...Walking down a flight of stairs
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and whose problem prevents them from doing things
Skip Instructions:
(1,2,R,D) [goto BCHNG_05]

Question ID: BAL.320_05.000

Instrument Variable Name: BCHG1_05
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have your dizziness or balance problems caused you to change or cut back on any of the following activities? Please say yes or no to each.
...Participating in social activities outside your home
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and whose problem prevents them from doing things
Skip Instructions:
(1,2,R,D) [goto BCHNG_06]

Question ID: BAL.320_06.000

Instrument Variable Name: BCHG1_06
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have your dizziness or balance problems caused you to change or cut back on any of the following activities? Please say yes or no to each.
... Performing household chores, such as cleaning or laundry
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and whose problem prevents them from doing things
Skip Instructions:
(1,2,R,D) [goto BCHNG_07]

Question ID: BAL.320_07.000

Instrument Variable Name: BCHG1_07
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have your dizziness or balance problems caused you to change or cut back on any of the following activities? Please say yes or no to each.
... Going to the toilet
* If respondent is unable to do this activity for reasons OTHER than dizziness or balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don?t have a driver?s license, etc.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months and whose problem prevents them from doing things
Skip Instructions:
(1,2,R,D) [goto BM12WS_N]

Question ID: BAL.350_00.000

Instrument Variable Name: BM12WS
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, how many days of work or school have you missed because of your dizziness or balance problems?
Enter '0' for none.
000-365 000-365 days
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(0-365,R,D) [goto BM12RA]

Question ID: BAL.355_00.000

Instrument Variable Name: BM12RA
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, how many days of other regularly scheduled activities - excluding work and school days - have you missed because of your dizziness or balance problems?
Enter '0' for none.
000-365 000-365 days
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(0-365,R,D) [goto BPROB1]

Question ID: BAL.360_00.000

Instrument Variable Name: BPROB1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, how much of a problem was your dizziness or balance condition? Would you say it was no problem, a small problem, a moderate problem, a big problem, or a very big problem?
1 No problem
2 A small problem
3 A moderate problem
4 A big problem
5 A very big problem
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
( 1-5,R,D) [goto BMED_1]

Question ID: BAL.370_01.000

Instrument Variable Name: BMED_1
Questionnaire File Name: Sample Adult
Question Text:
Have you ever taken or had any of the following medications or treatments for ANY health conditions or problems.
Please say yes or no to each.
...Meclizine or Antivert? for dizziness, nausea or vomiting
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
( 1,2,R,D) [goto BMED_2]

Question ID: BAL.370_02.000

Instrument Variable Name: BMED_2
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever taken or had any of the following medications or treatments for ANY health conditions or problems. Please say yes or no to each.
...Other medicine or patches for motion sickness, nausea or vomiting
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
( 1,2,R,D) [goto BMED_3]

Question ID: BAL.370_03.000

Instrument Variable Name: BMED_3
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you ever taken or had any of the following medications or treatments for ANY health conditions or problems. Please say yes or no to each.
...Medicines for anxiety or depression
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
( 1,2,R,D) [goto BMED_4]

Question ID: BAL.400_01.000

Instrument Variable Name: BFL1_01
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the time you were feeling a sense of spinning or other movement sensation?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have a balance symptom of feeling a sense of spinning or other movement sensation and have fallen past 5 years
Skip Instructions:
(1,2,R,D) if BTYPE_2=1 [goto BFL1_02];
else if BTYPE_3=1 [goto BFL1_03];
else if BTYPE_4=1 [goto BFL1_04];
else if BTYPE_5=1 [goto BFL1_05];
else if BTYPE_6=1 [goto BFL1_06];
else if BTYPE_7=1 [goto BFL1_07];
else [goto BFALL12A]

Question ID: BAL.400_02.000

Instrument Variable Name: BFL1_02
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the time you were having a floating, spacey, or disconnected feeling?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have a balance symptom of a floating, spacey, or disconnected feeling and have fallen past 5 years
Skip Instructions:
(1,2,R,D) if BTYPE_3=1 [goto BFL1_03];
else if BTYPE_4=1 [goto BFL1_04];
else if BTYPE_5=1 [goto BFL1_05];
else if BTYPE_6=1 [goto BFL1_06];
else if BTYPE_7=1 [goto BFL1_07];
else [goto BFALL12A]

Question ID: BAL.400_03.000

Instrument Variable Name: BFL1_03
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the time you were feeling lightheaded?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have a balance symptom of feeling lightheaded and have fallen past 5 years
Skip Instructions:
(1,2,R,D) if BTYPE_4=1 [goto BFL1_04];
else if BTYPE_5=1 [goto BFL1_05];
else if BTYPE_6=1 [goto BFL1_06];
else if BTYPE_7=1 [goto BFL1_07];
else [goto BFALL12A]

Question ID: BAL.400_04.000

Instrument Variable Name: BFL1_04
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the time you were feeling like you are about to pass out?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have a balance symptom of feeling like they are about to pass out and have fallen past 5 years
Skip Instructions:
(1,2,R,D) if BTYPE_5=1 [goto BFL1_05];
else if BTYPE_6=1 [goto BFL1_06];
else if BTYPE_7 =1[goto BFL1_07];
else [goto BFALL12A]

Question ID: BAL.400_05.000

Instrument Variable Name: BFL1_05
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the time you were having blurred vision?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have a balance symptom of blurred vision and have fallen past 5 years
Skip Instructions:
(1,2,R,D) if BTYPE_6=1 [goto BFL1_06];
else if BTYPE_7=1 [goto BFL1_07];
else [goto BFALL12A]

Question ID: BAL.400_06.000

Instrument Variable Name: BFL1_06
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the time you were having a general feeling of being unsteady or off-balance?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have a balance symptom of unsteadiness and have fallen past 5 years
Skip Instructions:
(1,2,R,D)
if BTYPE_7=1 [goto BFL1_07];
else [goto BFALL12A]

Question ID: BAL.400_07.000

Instrument Variable Name: BFL1_07
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the time you were having and other or general problem with dizziness or imbalance?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have an other or general balance symptom and have fallen past 5 years
Skip Instructions:
(1,2,R,D) [goto BFALL12A]

Question ID: BAL.410_00.000

Instrument Variable Name: BFALL12A
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you fallen at least once a month on average?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a fall in past 5 years
Skip Instructions:
(1) go to BF12M_NO]
(2,R,D) [goto BFTIME1]

Question ID: BAL.420_01.000

Instrument Variable Name: BF12M_NO
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
DURING THE PAST 12 MONTHS, about how many times per day, week, or month have you fallen?
001-365 001-365
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in last 12 months
Skip Instructions:
(1-365,D) [goto BF12M_TP]
(R)
[goto BINJ1]

Question ID: BAL.420_02.000

Instrument Variable Name: BF12M_TP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
* Enter time period for time fallen.
1 Day(s)
2 Week(s)
3 Month(s)
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the last 12 months and gave a number for time fallen or said DK to number part of this question
Skip Instructions:
If (BF12M_NO ge 10 and BF12M_TP='1'), then [goto ERR_BF12M_TP];
If (BF12M_NO ge 50 and BF12M_TP='2'), then [goto ERR_BF12M_TP];
If (BF12M_NO ge 200 and BF12M_TP='3'), then [goto ERR_BF12M_TP];
(1-3,R,D) [goto BINJ1]
If (BF12M_NO ge 10 and BF12M_TP='1') or (BF12M_NO ge 50 and BF12M_TP='2') or (BF12M_NO ge 200
Soft Edit:
and BF12M_TP='3'),
then ERR_BF12M_TP:
* [Fill1: BF12M_NO] times per [Fill2: BF12M_TP] is unusually high.
* Please verify.

Question ID: BAL.430_00.000

Instrument Variable Name: BFTIME1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, how many times have you fallen?
*Read if necessary. If unsure, estimate as best you can.
0 None
1 1 time
2 2 times
3 3-4 times
4 5-7 times
5 8 or more times
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who haven't fallen at least once a month in the past 12 months
Skip Instructions:
(0) [goto BNRFALL]
(1-5, R,D) [goto BINJ1]

Question ID: BAL.440_00.000

Instrument Variable Name: BINJ1
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, did you have an injury as a result of a fall? For example, with a bruise, cut or wound, sprain, dislocation, fracture, broken bones, back pain, head or neck injury.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1) [goto BINJWS]
(2,R,D) [goto BFWH_01]

Question ID: BAL.450_00.000

Instrument Variable Name: BINJWS
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, how many days of work or school did you miss because of injury from falls?
* Enter '996 if doesn't work or go to school.
000-995 000-995 days
996 Doesn't work or go to school
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who were injured by fall(s) in the past 12 months
Skip Instructions:
(0-365,996,R,D) [goto BINJHP]

Question ID: BAL.455_00.000

Instrument Variable Name: BINJHP
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, did you talk to or see a doctor or other health professional about any injuries that you had as a result of a fall or falling?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who were injured by fall(s) in the past 12 months
Skip Instructions:
(1) [goto BINJHPN]
(2,R,D) [goto BFWH_01]

Question ID: BAL.457_00.000

Instrument Variable Name: BINJHPN
Questionnaire File Name: Sample Adult
Question Text:
Thinking about your worst injury that resulted from a fall or falling DURING THE PAST 12 MONTHS, how many times did you talk to or see a medical professional about that injury?
0 None
1 1 time
2 2 times
3 3-4 times
4 5-9 times
5 10-14 times
6 15 or more times
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who talked to a doctor or other health professional about falls or falling in the past 12 months
Skip Instructions:
(0-6,R,D) [goto BFWH_01]

Question ID: BAL.460_01.000

Instrument Variable Name: BFWH_01
Questionnaire File Name: Sample Adult
Question Text:
Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You tripped, stumbled, or slipped
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_02]

Question ID: BAL.460_02.000

Instrument Variable Name: BFWH_02
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You blacked out or fainted
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_03]

Question ID: BAL.460_03.000

Instrument Variable Name: BFWH_03
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You were playing sports or exercising
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2 R,D) [goto BFWH_04]

Question ID: BAL.460_04.000

Instrument Variable Name: BFWH_04
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You had a problem with vision
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_05]

Question ID: BAL.460_05.000

Instrument Variable Name: BFWH_05
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You had weakness or numbness in one or both legs
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_06]

Question ID: BAL.460_06.000

Instrument Variable Name: BFWH_06
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You had not eaten recently or you had low blood sugar
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_07]

Question ID: BAL.460_07.000

Instrument Variable Name: BFWH_07
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You drank too much alcohol
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_08]

Question ID: BAL.460_08.000

Instrument Variable Name: BFWH_08
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You had a problem using a walker, cane, or other aid that helps you get around
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_09]

Question ID: BAL.460_09.000

Instrument Variable Name: BFWH_09
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...You had a problem with shoes, sandals or socks
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BFWH_10]

Question ID: BAL.460_10.000

Instrument Variable Name: BFWH_10
Questionnaire File Name: Sample Adult
Question Text:
* Read if necessary. Have you fallen during the past 12 months due to any of the following reasons? Please say yes or no to each.
...Some other reason
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who have fallen at least once a month in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BNRFALL]

Question ID: BAL.470_00.000

Instrument Variable Name: BNRFALL
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, how many times have you slipped or lost your balance and caught yourself WITHOUT falling?
0 None
1 1 time
2 2 times
3 3 to 4 times
4 5 to 7 times
5 8 or more times
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(0-5,R,D) [goto BINTHI]

Question ID: BAL.475_01.000

Instrument Variable Name: BINTHI
Questionnaire File Name: Sample Adult
Question Text:
DURING THE PAST 12 MONTHS, have you used the Internet for any of the following reasons? Please say yes or no to each.
...To look up health information on your dizziness or balance problems
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BINTTR]

Question ID: BAL.475_02.000

Instrument Variable Name: BINTTR
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary. DURING THE PAST 12 MONTHS, have you used the Internet for any of the following reasons?
Please say yes or no to each.
...To learn about medical or other recommended treatments for your dizziness or balance problems
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D) [goto BINTRS]

Question ID: BAL.475_03.000

Instrument Variable Name: BINTRS
Questionnaire File Name: Sample Adult
Question Text:
*Read if necessary. DURING THE PAST 12 MONTHS, have you used the Internet for any of the following reasons?
Please say yes or no to each.
...To learn about rehabilitation services or intervention programs for your dizziness or balance problems
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who had a balance or dizziness problem in the past 12 months or who had at least one symptom in the past 12 months
Skip Instructions:
(1,2,R,D)
If FDRN_FLG= '1' [goto VIS_0 / AFD.090_00.000]
Else if FDRN_FLG= '2' [goto AWEBUSE / AWB.010_00.000]

Question ID: AWB.010_00.000

Instrument Variable Name: AWEBUSE
Questionnaire File Name: Sample Adult
Question Text:
The next questions are about your Internet and email use.
Do you use the Internet?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto AWEBOFNO] (2,R,D) [goto AWEBEML]

Question ID: AWB.020_01.000

Instrument Variable Name: AWEBOFNO
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How often do you use the Internet?
*Read if necessary: How many times per day, per week, per month, or per year do you use the Internet?
*Enter number.
001-995 1-995
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who use the Internet
Skip Instructions:
(1-995) [goto AWEBOFTP]
(R,D) [goto AWEBEML](1-995) [goto AWEBOFTP]
(R,D) [goto AWEBEML]

Question ID: AWB.020_02.000

Instrument Variable Name: AWEBOFTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
*Enter time period for how often Internet is used.
1 Per day
2 Per week
3 Per month
4 Per year
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who use the Internet and gave a valid value for the number portion of this question
Skip Instructions:
(1-4,R,D) [goto AWEBEML]

Question ID: AWB.030_00.000

Instrument Variable Name: AWEBEML
Questionnaire File Name: Sample Adult
Question Text:
Do you send or receive emails?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: Sample adults 18+
Skip Instructions:
(1) [goto AWEBEMAD] (2,R,D) [goto next section]

Question ID: AWB.040_00.000

Instrument Variable Name: AWEBEMAD
Questionnaire File Name: Sample Adult
Question Text:
We may want to contact you to obtain additional health-related information.
May I have your email address?
*Enter email address.
*Enter 'N' for none.
allow 75
97 Refused
99 Don't Know
Universe Text: Sample adults 18+ who send or receive email
Skip Instructions:
(address) [goto AWBEMNO] (N,R,D) [goto next section]

Question ID: AWB.050_01.000

Instrument Variable Name: AWEBMNO
Questionnaire File Name: Sample Adult
Question Text:
1 of 2
How often do you check this email account?
*Read if necessary: How many times per day, per week, per month, or per year do you check this email account?
*Enter number.
001-995 1-995
997 Refused
999 Don't know
Universe Text: Sample adults 18+ who gave an email address
Skip Instructions:
(1-995) [goto AWBEMTP] (R,D) [goto next section]

Question ID: AWB.050_02.000

Instrument Variable Name: AWEBMTP
Questionnaire File Name: Sample Adult
Question Text:
2 of 2
*Enter time period for how often email is checked.
1 Per day
2 Per week
3 Per month
4 Per year
7 Refused
9 Don't know
Universe Text: Sample adults 18+ who gave an email address and gave a valid value for the number portion of this question
Skip Instructions:
(1-4,R,D) [goto next section]