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2015

Survey form view entire document: text image

Question ID: NAF.229_03.000

Instrument Variable Name: RCBE1N
Question Text:

1 of 2
*Read if necessary: When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.

01-95 1-95
97 Refuse
99 Don?t know

Universe Text: Female sample adults 30+ who selected number and time period format for breast exam from the initial month screen
Skip Instructions:

(1-95) [go to RCBE1T] (R,D) store "R,D" in RCBE1T [go to RCBE2]

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2010

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Question ID: NAF.410_01.000

Instrument Variable Name: RCBE1N
QuestionText:

1 of 2
When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.

01-94 1-94
95 95+
97 Refused
99 Don't know

UniverseText: Female sample adults 30+ who selected number and time period format for most recent breast exam from the initial month screen
SkipInstructions:

(1-95) [goto RCBE1T] (R,D) store "R,D" in RCBE1T [goto RCBE2]

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2005

Survey form view entire document: text image

NAF.410_01.000

Instrument Variable Name: RCBE1N
Question Text:

1 of 2
When did you have your MOST RECENT breast exam?
*Enter number for time since last breast exam.
*Enter '95' for 95 or more.

01-94 1-94
95 95+
97 Refused
99 Don't know

Universe Text: Female sample adults 30+ who selected number and time period format for most recent breast exam from the initial month screen
Skip Instructions:

(1-95) [goto RCBE1T] (R,D) store "R,D" in RCBE1T [goto RCBE2]

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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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1999

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AAU.111.031

When did you have your most recent breast physical exam?

RBEX1NO

[ ] NUMBER

(01-94) 01-94 (Check Item AAUCCI3)
(95) 95+ (Check Item AAUCCI3)
(97) Refused (AAU.111.040)
(99) Don't know (AAU.111.040)

RBEX1TP

[ ] TIME PERIOD

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

AAU.111.040

FR: SHOW CARD A9

Was it a year ago or less, more than 1 year but not more than 2 years, more than 2 years but not more than 3 years, more than 3 years but not more than 5 years, or over 5 years ago?

Card A9

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

RBEX2

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

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1992

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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)

Survey Text