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2000

Survey form view entire document: text image

Check item NAFCCI08: Refer to Household Composition, Basic Module.
AGE, HHC.120 "What is {name/your} age...?"
(1)Female 18-29 (under 30) (END_NAF)
(2)Female 30+ (NAF.390)

NAF.400

When did you have your MOST RECENT breast exam?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RCBE1_MT

(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) Don't know
(99) Refused
(T) Time Period (RCBE1_NO)

Year:

RCBE1_YR

(1950-2000) 1950-2000 (Check item NAFCCI09)
(9997) Don't know (NAF.410)
(9999) Refused (NAF.410)

When did you have your MOST RECENT breast exam?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RCBE1_NO

(01-94) 1-94 (RCBE1_TP/NAF.400)
(95) 95+(RCBE1_TP/NAF.400)
(97) Refused (NAF.410)
(99) Don't know (NAF.410)

[ ] Time Period

RCBE1_TP

(1) Days ago
(2) Weeks ago
(3) Months ago
(4) Years ago
(7) Refused
(9) Don't know

[Go to Check item NAFCCI09]

NAF.410

FR: SHOW CARD CAN27

Was it: (READ CATEGORIES BELOW)

Card CAN27

1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago

RCBE2

(1) A year ago or less?
(2) More than 1 year but not more than 2 years?
(3) More than 2 years but not more than 3 years?
(4) More than 3 years but not more than 5 years?
(5) Over 5 years ago?
(7) Refused
(9) Don't know

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1992

Survey form view entire document: text image

27a. When did you have your most recent breast physical exam?

Month ____ [if 3 years ago or less (28); if more than 3 years ago (29)]
Year 19____ [if 3 years ago or less (28); if more than 3 years ago (29)]
OR

Number ____

1[] Days ago [if 3 years ago or less (28); if more than 3 years ago (29)]
2[] Weeks [if 3 years ago or less (28); if more than 3 years ago (29)]
3[] Months ago [if 3 years ago or less (28); if more than 3 years ago (29)]
4[] Years ago [if 3 years ago or less (28); if more than 3 years ago (29)]

999[] DK (27b)

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1987

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c. When did you have your last breast physical exam?

If 3 years ago or less (10).
If more than 3 years ago (12)

Mo. ____
Year 19_ _

OR
_____
1 [] Days ago
2 [] Weeks ago
3 [] Months ago
4 [] Years ago

999 [] DK (9d)

d. Was it within the past year or a year or more ago?

1 [] Within past year (9e)
2 [] 1 year or more (9f)
9 [] DK (12)

e. Was it less than three months, or 3 or more months ago?

1 [] Less than 3 months (10)
2 [] 3 or more months (10)
9 [] DK (10)

f. Was it 3 years ago or less, between three and 5 years, or 5 or more years ago?

1 [] 3 years or less (10)
2 [] Between 3 and 5 years (12)
3 [] 5 or more years (12)
9 [] DK (12)

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