Instrument Variable Name: P2DFHEAR
Questionnaire File Name: Family
Question Text:

With this next set of questions, we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities. Though different, these questions may sound similar to ones I asked earlier.
[fill 1: Are you/Is ALIAS] deaf or [fill 2: do you/does ALIAS] have serious difficulty hearing?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 1 or older and random number generator=2
Skip Instructions:

(1,2,D,R) goto P2DFSEE

Instrument Variable Name: P2DFSEE
Questionnaire File Name: Family
Question Text:

[fill 1: Are you/Is ALIAS] blind or [fill 2: do you/does ALIAS] have serious difficulty seeing even when wearing glasses?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 1 or older
Skip Instructions:

(1,2,D,R) if no more persons age 5 or older, goto next section;
else goto P2DFCON

Instrument Variable Name: P2DFCON
Questionnaire File Name: Family
Question Text:

Because of a physical, mental, or emotional condition, [fill 1: do you/does ALIAS] have serious difficulty concentrating, remembering, or making decisions?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 5 or older and random number generator=2
Skip Instructions:

(1,2,D,R) goto P2DFWALK

Instrument Variable Name: P2DFWALK
Questionnaire File Name: Family
Question Text:

[fill 1: Do you/Does ALIAS] have serious difficulty walking or climbing stairs?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons age 5 or older and random number generator=2
Skip Instructions:

(1,2,D,R) goto P2DFDRES

Instrument Variable Name: P2DFDRES
Questionnaire File Name: Family
Question Text:

[fill 1: Do you/Does ALIAS] have difficulty dressing or bathing?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 5 or older
Skip Instructions:

(1,2,D,R) if no more persons age 15 or older, goto next section;
else goto P2DFERR

Instrument Variable Name: P2DFERR
Questionnaire File Name: Family
Question Text:

Because of a physical, mental, or emotional condition, [fill 1: do you/does ALIAS] have difficulty doing errands alone such as visiting a doctor's office or shopping?

1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons 15 or older
Skip Instructions:

(1,2,D,R) if no more persons age 1 or older, goto next section;
else return to P2DFHEAR for next person age 1 or older

Instrument Variable Name: PDFCAUSE
Questionnaire File Name: Family
Question Text:

What is the MAIN reason for [fill 1: your/ALIAS's] difficulty concentrating, remembering or making decisions?

01 Intellectual disability (formerly known as mental retardation)
02 Developmental disability (such as cerebral palsy or autism)
03 Dementia or Alzheimer?s disease
04 Learning disability or ADHD
05 Education level
06 Mental illness (such as depression, anxiety, post-traumatic stress disorder, emotional problem)
07 Traumatic brain injury or stroke
08 Age-related changes
09 Chronic health condition (such as diabetes, high blood pressure, heart disease, cancer, multiple sclerosis, Parkinson?s disease, epilepsy)
10 Drugs or medications
11 Other (specify)
97 Refused
99 Don't know

Universe Text: All persons 5 or older who have difficulty concentrating or remembering
Skip Instructions:

(1-10,R,D) if no more persons AGE )=1, [goto next section];
else return to P2DFHEAR for next person AGE )=1
(11) [goto PDFSPEC]

Instrument Variable Name: PDFSPEC
Questionnaire File Name: Family
Question Text:

*Enter the other reason for difficulty with concentrating, remembering or making decisions?

Verbatim Verbatim response, allow 60 characters
7 Refused
9 Don't know

Universe Text: All persons 5 or older who have difficulty concentrating or remembering and the cause was given as other
Skip Instructions:

(allow 60,R,D) if no more persons age 1 or older, [goto next section];
else return to P2DFHEAR for next person age 1 or older