Survey Text

2015
2010
2005
2000
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2015

No questionnaire text is available for this sample.


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2010
Survey form view entire document:  text  image

Question ID: NAH.050_00.001

Instrument Variable Name: FHMTYP_1
QuestionText:
What kind of cancer did your mother have?
* 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
UniverseText: Sample adults 18+ whose mother ever had cancer
SkipInstructions:
(1-19,21-25,27-30,RF,DK) goto FHMAGE1
(20,26) goto ERR_FHMTYP_1
Question ID: NAH.050_00.002

Instrument Variable Name: FHMTYP_2
QuestionText:
* 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
UniverseText: Sample adults 18+ who either provided an age range for a first kind of cancer or didn't know how old mother was
when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to answer
a first kind of cancer
SkipInstructions:
(1-19,21-25,27-30,RF,DK) if FHMTYP_2 = FHMTYP_1 goto ERR2_FHMTYP_2
else goto FHMAGE2
(96) goto FHBNUM
(20,26) goto ERR1_FHMTYP_2
Question ID: NAH.050_00.003

Instrument Variable Name: FHMTYP_3
QuestionText:
* 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
UniverseText: Sample adults 18+ who either provided an age range for a second kind of cancer or didn't know how old mother
was when first diagnosed with that kind of cancer or else refused to provide an age range and had not refused to
answer a second kind of cancer
SkipInstructions:
(1-19,21-25,27-30,RF,DK) if FHMTYP_3 = FHMTYP_1 or FHMTYP_2 goto ERR2_FHMTYP_3
else goto FHMAGE3
(96) goto FHBNUM
(20,26) goto ERR1_FHMTYP_3

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2005
Survey form view entire document:  text  image

NAH.050_00.001

Instrument Variable Name: FHMTYP_1
Question Text:
What kind of cancer did your mother have?
*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

NAH.050_00.002

Instrument Variable Name: FHMTYP_2
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

NAH.050_00.003

Instrument Variable Name: FHMTYP_3
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

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2000
Survey form view entire document:  text  image

NAH.050

What kind of cancer did your mother have?

FR: ENTER UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3 KINDS, ENTER "96" IN THE FOURTH ANSWER SPACE. ENTER (N) FOR NO MORE.
FHMTYP
(1) Bladder
(2) Blood
(3) Bone
(4) Brain
(5) Breast
(6) Cervix
(7) Colon
(8) Esophagus
(9) Gallbladder
(10) Kidney
(11) Larynx-windpipe
(12) Leukemia
(13) Liver
(14) Lung
(15) Lymphoma
(16) Melanoma
(17) Mouth/tongue/lip
(18) Ovary
(19) Pancreas
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't Know what kind)
(24) Soft Tissue (muscle/fat)
(25) Stomach
(27) Throat -pharynx
(28) Thyroid
(29) Uterus
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know

____ (Mother Cancer Type 1)
____ (Mother Cancer Type 2)
____ (Mother Cancer Type 3)
____ (N or 96)