Survey Text

2018 2012 2006 2000
2017 2011 2005 1999
2016 2010 2004 1998
2015 2009 2003 1997
2014 2008 2002
2013 2007 2001
top
2018
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2017
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2016
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2015
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2014
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2013
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2012
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2011
Survey form view entire document:  text  image

Question ID:FHS.270_00.000

Instrument Variable Name: LAHCC
Question Text:

(book) F1 ? [F1] What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Intellectual disability, also known as mental retardation
08 Other developmental problem (for example, cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons less than 18 years of age who have at least one reported limitation
Skip Instructions:

(1-4,6-13) [go to appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5) [fill "96" in LHCL05N and fill "6" in LHCL05T]
(90) [go to LAHCC_S1]
(91) [go to LAHCC_S2]
(R,D) [repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, go to LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.
Question ID:FHS.271_90.000

Instrument Variable Name: LAHCC_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL90N
Question ID:FHS.271_91.000

Instrument Variable Name: LAHCC_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHCL91N

Survey form view entire document:  text  image

Question ID:FHS.350_00.000 QuestionnaireFileName:

Instrument Variable Name: LAHCA Family
Question Text:
(book) F2 What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(for example, asthma and emphysema)
12 Cancer
13 Birth defect
14 Intellectual disability, also known as mental retardation
15 Other developmental problem (for example cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
Universe Text All persons 18 years of age or older who have at least one reported limitation
Skip Instructions:
(1-12,14-35) [go to appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T]
(90) [go to LAHCA_S1]
(91) [go to LAHCA_S2]
(R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.
Question ID:FHS.351_90.000

Instrument Variable Name: LAHCA_S1
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL90N
Question ID:FHS.351_91.000

Instrument Variable Name: LAHCA_S2
Question Text:

* Read if necessary. What is the other impairment or problem?
Verbatim Verbatim response
7 Refused
9 Don't know
Universe Text All persons less than 18 years of age who have a limitation due to at least one condition not listed at LAHCC
Skip Instructions:

go to LHAL91N

top
2010
Survey form view entire document:  text  image

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
QuestionText:
(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions:
(1-4,6-13)[goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5)[fill "96" in LHCL05N and fill "6" in LHCL05T]
(90)[goto LAHCC_S1]
(91)[goto LAHCC_S2]
(R,D)[repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Survey form view entire document:  text  image

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
QuestionText:
(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions:
(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T] (90) [goto LAHCA_S1] (91) [goto LAHCA_S2] (R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.

top
2009
Survey form view entire document:  text  image

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
QuestionText:
(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions:
(1-4,6-13)[goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5)[fill "96" in LHCL05N and fill "6" in LHCL05T]
(90)[goto LAHCC_S1]
(91)[goto LAHCC_S2]
(R,D)[repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Survey form view entire document:  text  image

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
QuestionText:
(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions:
(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T] (90) [goto LAHCA_S1] (91) [goto LAHCA_S2] (R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.

top
2008
Survey form view entire document:  text  image

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
QuestionText:
(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions:
(1-4,6-13)[goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5)[fill "96" in LHCL05N and fill "6" in LHCL05T]
(90)[goto LAHCC_S1]
(91)[goto LAHCC_S2]
(R,D)[repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Survey form view entire document:  text  image

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
QuestionText:
(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions:
(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T] (90) [goto LAHCA_S1] (91) [goto LAHCA_S2] (R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.

top
2007
Survey form view entire document:  text  image

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
QuestionText:
(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions:
(1-4,6-13)[goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5)[fill "96" in LHCL05N and fill "6" in LHCL05T]
(90)[goto LAHCC_S1]
(91)[goto LAHCC_S2]
(R,D)[repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Survey form view entire document:  text  image

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
QuestionText:
(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions:
(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T] (90) [goto LAHCA_S1] (91) [goto LAHCA_S2] (R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.

top
2006
Survey form view entire document:  text  image

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
QuestionText:
(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions:
(1-4,6-13)[goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5)[fill "96" in LHCL05N and fill "6" in LHCL05T]
(90)[goto LAHCC_S1]
(91)[goto LAHCC_S2]
(R,D)[repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Survey form view entire document:  text  image

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
QuestionText:
(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions:
(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T] (90) [goto LAHCA_S1] (91) [goto LAHCA_S2] (R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.

top
2005
Survey form view entire document:  text  image

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
QuestionText:
(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions:
(1-4,6-13)[goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5)[fill "96" in LHCL05N and fill "6" in LHCL05T]
(90)[goto LAHCC_S1]
(91)[goto LAHCC_S2]
(R,D)[repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Survey form view entire document:  text  image

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
QuestionText:
(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions:
(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T] (90) [goto LAHCA_S1] (91) [goto LAHCA_S2] (R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.

top
2004
Survey form view entire document:  text  image

Question ID: FHS.270_00.000

Instrument Variable Name: LAHCC
QuestionText:
(book) F1 ? [F1]
What conditions or health problems cause [fill: ALIAS]'s limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Speech problem
04 Asthma/breathing problem
05 Birth defect
06 Injury
07 Mental retardation
08 Other developmental problem (e.g., cerebral palsy)
09 Other mental, emotional or behavioral problem
10 Bone, joint, or muscle problem
11 Epilepsy or seizures
12 Learning disability
13 Attention Deficit/Hyperactivity Disorder (ADD/ADHD)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons less than 18 years of age who have at least one reported limitation
SkipInstructions:
(1-4,6-13)[goto appropriate follow-up questions: LHCL01N - LHCL04N, LHCL06N - LHCL13N]
(5)[fill "96" in LHCL05N and fill "6" in LHCL05T]
(90)[goto LAHCC_S1]
(91)[goto LAHCC_S2]
(R,D)[repeat this question for the next person less than 18 years of age with a reported limitation; if no more persons less than 18 years of age with a reported limitation, goto LAHCA]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person less than 18 years of age with a reported limitation. The instrument then proceeds to LAHCA.

Survey form view entire document:  text  image

Question ID: FHS.350_00.000

Instrument Variable Name: LAHCA
QuestionText:
(book) F2
What conditions or health problems cause [fill: your/ALIAS's] limitations?
* Enter all that apply, separate with commas.
* Do not probe except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g. cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign tumors, cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/not sure
UniverseText: All persons 18 years of age or older who have at least one reported limitation
SkipInstructions:
(1-12,14-35) [goto appropriate follow-up questions: LHAL01N - LHAL12N, LHAL14N - LHAL35N]
(13) [fill "96" in LHAL13N and fill "6" in LHAL13T] (90) [goto LAHCA_S1] (91) [goto LAHCA_S2] (R,D) [repeat this question for the next person 18 years of age or older with a reported limitation; if no more persons 18 years of age or older with a reported limitation, goto PHSTAT]
NOTE: This question and all appropriate follow-up questions are asked, in sequence, for each person 18 years of age or older with a reported limitation. The instrument then proceeds to PHSTAT.

top
2003
Survey form view entire document:  text  image
Check item FHSCCI3:For family members with an entry in FHS.010 through FHS.260: If AGE is less than 18 go to FHS.270; else go to FHS.350. If none with entry in FHS.010 through FHS.260, or the family roster is exhausted go to FHS.500.

FHS.270

What conditions or health problems cause {subject's name}'s limitations?

FR: SHOW FLASHCARD F1. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F1
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g., cerebral palsy)
9. Other mental, emotional, or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy or seizures
12. Learning disability
13. Attention deficit/Hyperactivity disorder (ADD/ADHD)
Other impairment/problem
LAHCC1 (1) Vision / problem seeing
LAHCC2 (2) Hearing problem
LAHCC3 (3) Speech problem
LAHCC4 (4) Asthma / breathing problem
LAHCC5 (5) Birth defect
LAHCC6 (6) Injury
LAHCC7 (7) Mental retardation
LAHCC8 (8) Other developmental problem (e.g. cerebral palsy)
LAHCC9 (9) Other mental, emotional, or behavioral problem
LAHCC10 (10) Bone, joint, or muscle problem
LAHCC11 (11) Epilepsy or seizures
LAHCC12 (12) Learning disability
LAHCC13 (13) Attention deficit/Hyperactivity disorder (ADD/ADHD)
LAHCC14 (14) Other impairment (specify one) (LAHCC@S1)
LAHCC15 (15) Other impairment (specify one) (LAHCC@S2)
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S2 Condition: __________________________________________

Survey form view entire document:  text  image

FHS.290

What condition or health problem causes {subject's name} limitations?

FR: SHOW FLASHCARD F2. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F2
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (e.g., asthma and emphysema)
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g., cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
LAHCA1 (1) Vision/ problem seeing
LAHCA2 (2) Hearing problem
LAHCA3 (3) Arthritis / rheumatism
LAHCA4 (4) Back or neck problem
LAHCA5 (5) Fracture, bone / joint injury
LAHCA6 (6) Other injury
LAHCA7 (7) Heart problem
LAHCA8 (8) Stroke problem
LAHCA9 (9) Hypertension / high blood pressure
LAHCA10 (10) Diabetes
LAHCA11 (11) Lung / breathing problem (e.g. asthma and emphysema)
LAHCA12 (12) Cancer
LAHCA13 (13) Birth defect
LAHCA14 (14) Mental retardation
LAHCA15 (15) Other developmental problem (e.g. cerebral palsy)
LAHCA16 (16) Senility
LAHCA17 (17) Depression / anxiety / emotional problem
LAHCA18 (18) Weight problem
(M) More conditions
(97) Refused
(99) Don't know/not sure

FHS.290

(What condition or health problem causes your limitations?)

FR: MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE

(19) Missing limbs (fingers, toes or digits), amputee
(20) Kidney, bladder or renal problems
(21) Circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendonitis
(25) Epilepsy, seizures
(26) Multiple sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (myelitis), paralysis, para/quadriplegia
(28) Parkinson's disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves disease, gout
(34) Knee problems (not arthritis (03), not joint injury (05)
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (Specify one) (LAHCA@S1)
(37) Other impairment/problem (Specify one) (LAHCA@S2)
(B) Back-up to previous screen

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S2 Condition: __________________________________________

top
2002
Survey form view entire document:  text  image
Check item FHSCCI3:For family members with an entry in FHS.010 through FHS.260: If AGE is less than 18 go to FHS.270; else go to FHS.350. If none with entry in FHS.010 through FHS.260, or the family roster is exhausted go to FHS.500.

FHS.270

What conditions or health problems cause {subject's name}'s limitations?

FR: SHOW FLASHCARD F1. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F1
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g., cerebral palsy)
9. Other mental, emotional, or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy or seizures
12. Learning disability
13. Attention deficit/Hyperactivity disorder (ADD/ADHD)
Other impairment/problem
LAHCC1 (1) Vision / problem seeing
LAHCC2 (2) Hearing problem
LAHCC3 (3) Speech problem
LAHCC4 (4) Asthma / breathing problem
LAHCC5 (5) Birth defect
LAHCC6 (6) Injury
LAHCC7 (7) Mental retardation
LAHCC8 (8) Other developmental problem (e.g. cerebral palsy)
LAHCC9 (9) Other mental, emotional, or behavioral problem
LAHCC10 (10) Bone, joint, or muscle problem
LAHCC11 (11) Epilepsy or seizures
LAHCC12 (12) Learning disability
LAHCC13 (13) Attention deficit/Hyperactivity disorder (ADD/ADHD)
LAHCC14 (14) Other impairment (specify one) (LAHCC@S1)
LAHCC15 (15) Other impairment (specify one) (LAHCC@S2)
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S2 Condition: __________________________________________

Survey form view entire document:  text  image

FHS.290

What condition or health problem causes {subject's name} limitations?

FR: SHOW FLASHCARD F2. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F2
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (e.g., asthma and emphysema)
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g., cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
LAHCA1 (1) Vision/ problem seeing
LAHCA2 (2) Hearing problem
LAHCA3 (3) Arthritis / rheumatism
LAHCA4 (4) Back or neck problem
LAHCA5 (5) Fracture, bone / joint injury
LAHCA6 (6) Other injury
LAHCA7 (7) Heart problem
LAHCA8 (8) Stroke problem
LAHCA9 (9) Hypertension / high blood pressure
LAHCA10 (10) Diabetes
LAHCA11 (11) Lung / breathing problem (e.g. asthma and emphysema)
LAHCA12 (12) Cancer
LAHCA13 (13) Birth defect
LAHCA14 (14) Mental retardation
LAHCA15 (15) Other developmental problem (e.g. cerebral palsy)
LAHCA16 (16) Senility
LAHCA17 (17) Depression / anxiety / emotional problem
LAHCA18 (18) Weight problem
(M) More conditions
(97) Refused
(99) Don't know/not sure

FHS.290

(What condition or health problem causes your limitations?)

FR: MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE

(19) Missing limbs (fingers, toes or digits), amputee
(20) Kidney, bladder or renal problems
(21) Circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendonitis
(25) Epilepsy, seizures
(26) Multiple sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (myelitis), paralysis, para/quadriplegia
(28) Parkinson's disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves disease, gout
(34) Knee problems (not arthritis (03), not joint injury (05)
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (Specify one) (LAHCA@S1)
(37) Other impairment/problem (Specify one) (LAHCA@S2)
(B) Back-up to previous screen

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S2 Condition: __________________________________________

top
2001
Survey form view entire document:  text  image
Check item FHSCCI3:For family members with an entry in FHS.010 through FHS.260: If AGE is less than 18 go to FHS.270; else go to FHS.350. If none with entry in FHS.010 through FHS.260, or the family roster is exhausted go to FHS.500.

FHS.270

What conditions or health problems cause {subject's name}'s limitations?

FR: SHOW FLASHCARD F1. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F1
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g., cerebral palsy)
9. Other mental, emotional, or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy or seizures
12. Learning disability
13. Attention deficit/Hyperactivity disorder (ADD/ADHD)
Other impairment/problem
LAHCC1 (1) Vision / problem seeing
LAHCC2 (2) Hearing problem
LAHCC3 (3) Speech problem
LAHCC4 (4) Asthma / breathing problem
LAHCC5 (5) Birth defect
LAHCC6 (6) Injury
LAHCC7 (7) Mental retardation
LAHCC8 (8) Other developmental problem (e.g. cerebral palsy)
LAHCC9 (9) Other mental, emotional, or behavioral problem
LAHCC10 (10) Bone, joint, or muscle problem
LAHCC11 (11) Epilepsy or seizures
LAHCC12 (12) Learning disability
LAHCC13 (13) Attention deficit/Hyperactivity disorder (ADD/ADHD)
LAHCC14 (14) Other impairment (specify one) (LAHCC@S1)
LAHCC15 (15) Other impairment (specify one) (LAHCC@S2)
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S2 Condition: __________________________________________

Survey form view entire document:  text  image

FHS.290

What condition or health problem causes {subject's name} limitations?

FR: SHOW FLASHCARD F2. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F2
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (e.g., asthma and emphysema)
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g., cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
LAHCA1 (1) Vision/ problem seeing
LAHCA2 (2) Hearing problem
LAHCA3 (3) Arthritis / rheumatism
LAHCA4 (4) Back or neck problem
LAHCA5 (5) Fracture, bone / joint injury
LAHCA6 (6) Other injury
LAHCA7 (7) Heart problem
LAHCA8 (8) Stroke problem
LAHCA9 (9) Hypertension / high blood pressure
LAHCA10 (10) Diabetes
LAHCA11 (11) Lung / breathing problem (e.g. asthma and emphysema)
LAHCA12 (12) Cancer
LAHCA13 (13) Birth defect
LAHCA14 (14) Mental retardation
LAHCA15 (15) Other developmental problem (e.g. cerebral palsy)
LAHCA16 (16) Senility
LAHCA17 (17) Depression / anxiety / emotional problem
LAHCA18 (18) Weight problem
(M) More conditions
(97) Refused
(99) Don't know/not sure

FHS.290

(What condition or health problem causes your limitations?)

FR: MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE

(19) Missing limbs (fingers, toes or digits), amputee
(20) Kidney, bladder or renal problems
(21) Circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendonitis
(25) Epilepsy, seizures
(26) Multiple sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (myelitis), paralysis, para/quadriplegia
(28) Parkinson's disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves disease, gout
(34) Knee problems (not arthritis (03), not joint injury (05)
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (Specify one) (LAHCA@S1)
(37) Other impairment/problem (Specify one) (LAHCA@S2)
(B) Back-up to previous screen

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S2 Condition: __________________________________________

top
2000
Survey form view entire document:  text  image
Check item FHSCCI3:For family members with an entry in FHS.010 through FHS.260: If AGE is less than 18 go to FHS.270; else go to FHS.350. If none with entry in FHS.010 through FHS.260, or the family roster is exhausted go to FHS.500.

FHS.270

What conditions or health problems cause {subject's name}'s limitations?

FR: SHOW FLASHCARD F1. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F1
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g., cerebral palsy)
9. Other mental, emotional, or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy or seizures
12. Learning disability
13. Attention deficit/Hyperactivity disorder (ADD/ADHD)
Other impairment/problem
LAHCC1 (1) Vision / problem seeing
LAHCC2 (2) Hearing problem
LAHCC3 (3) Speech problem
LAHCC4 (4) Asthma / breathing problem
LAHCC5 (5) Birth defect
LAHCC6 (6) Injury
LAHCC7 (7) Mental retardation
LAHCC8 (8) Other developmental problem (e.g. cerebral palsy)
LAHCC9 (9) Other mental, emotional, or behavioral problem
LAHCC10 (10) Bone, joint, or muscle problem
LAHCC11 (11) Epilepsy or seizures
LAHCC12 (12) Learning disability
LAHCC13 (13) Attention deficit/Hyperactivity disorder (ADD/ADHD)
LAHCC14 (14) Other impairment (specify one) (LAHCC@S1)
LAHCC15 (15) Other impairment (specify one) (LAHCC@S2)
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCC@S2 Condition: __________________________________________

Survey form view entire document:  text  image

FHS.290

What condition or health problem causes {subject's name} limitations?

FR: SHOW FLASHCARD F2. DO NOT READ. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F2
You may choose more than one.

1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (e.g., asthma and emphysema)
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g., cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
LAHCA1 (1) Vision/ problem seeing
LAHCA2 (2) Hearing problem
LAHCA3 (3) Arthritis / rheumatism
LAHCA4 (4) Back or neck problem
LAHCA5 (5) Fracture, bone / joint injury
LAHCA6 (6) Other injury
LAHCA7 (7) Heart problem
LAHCA8 (8) Stroke problem
LAHCA9 (9) Hypertension / high blood pressure
LAHCA10 (10) Diabetes
LAHCA11 (11) Lung / breathing problem (e.g. asthma and emphysema)
LAHCA12 (12) Cancer
LAHCA13 (13) Birth defect
LAHCA14 (14) Mental retardation
LAHCA15 (15) Other developmental problem (e.g. cerebral palsy)
LAHCA16 (16) Senility
LAHCA17 (17) Depression / anxiety / emotional problem
LAHCA18 (18) Weight problem
(M) More conditions
(97) Refused
(99) Don't know/not sure

FHS.290

(What condition or health problem causes your limitations?)

FR: MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (N) FOR NO MORE

(19) Missing limbs (fingers, toes or digits), amputee
(20) Kidney, bladder or renal problems
(21) Circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendonitis
(25) Epilepsy, seizures
(26) Multiple sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (myelitis), paralysis, para/quadriplegia
(28) Parkinson's disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves disease, gout
(34) Knee problems (not arthritis (03), not joint injury (05)
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (Specify one) (LAHCA@S1)
(37) Other impairment/problem (Specify one) (LAHCA@S2)
(B) Back-up to previous screen

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LAHCA@S2 Condition: __________________________________________

top
1999
Survey form view entire document:  text  image
Check item FHSCCI3:
For family members with an entry in FHS.010 through FHS.260:
If AGE is less than 18 go to FHS.270; Else go to FHS.290. If none with entry in
FHS.010 through FHS.260, or the family roster is exhausted go to FHS.310.

FHS.270

What conditions or health problems cause {subject's name} limitations?

FR: SHOW CARD F1. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F1
1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g. cerebral palsy)
9. Other mental, emotional or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy
12. Other impairment/problem
LAHCC
(1) Vision/ problem seeing
(2) Hearing problem
(3) Speech problem
(4) Asthma/breathing problem
(5) Birth defect
(6) Injury
(7) Mental retardation
(8) Other developmental problem (e.g. cerebral palsy)
(9) Other mental, emotional, or behavioral problem
(10) Bone, joint, or muscle problem
(11) Epilepsy
(12) Other impairment/problem (specify one)(FHS.271)
(13) Other impairment/problem (specify one)(FHS.272)
(97) Refused
(99) Don't know/not sure

[ ]
[ ]
[ ]
[ ]
[ ]

(Go to FHS.280)

FHS.271

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACCSPEC CONDITION: _______________

FHS.272

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACCSPEC_1 CONDITION: _______________

Survey form view entire document:  text  image

FHS.290

What conditions or health problems cause {subject's name} limitations?

FR: SHOW CARD F2. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F2
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g. cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
19. Other impairment/problem
LAHCA
(1) Vision/ problem seeing
(2) Hearing problem
(3) Arthritis/rheumatism
(4) Back or neck problem
(5) Fractures, bone/joint injury
(6) Other injury
(7) Heart problem
(8) Stroke problem
(9) Hypertension/high blood pressure
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (e.g. cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem
(19) Other impairment/problem (specify one)(FHS.291)
(20) Other impairment/problem (specify one)(FHS.292)
(97) Refused
(99) Don't know/not sure

[ ]
[ ]
[ ]
[ ]
[ ]

(Go to FHS.300)

FHS.291

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACASPEC CONDITION: _______________

FHS.292

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACASPEC_1 CONDITION: _______________

top
1998
Survey form view entire document:  text  image
Check item FHSCCI3:
For family members with an entry in FHS.010 through FHS.260:
If AGE is less than 18 go to FHS.270; Else go to FHS.290. If none with entry in
FHS.010 through FHS.260, or the family roster is exhausted go to FHS.310.

FHS.270

What conditions or health problems cause {subject's name} limitations?

FR: SHOW CARD F1. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F1
1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g. cerebral palsy)
9. Other mental, emotional or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy
12. Other impairment/problem
LAHCC
(1) Vision/ problem seeing
(2) Hearing problem
(3) Speech problem
(4) Asthma/breathing problem
(5) Birth defect
(6) Injury
(7) Mental retardation
(8) Other developmental problem (e.g. cerebral palsy)
(9) Other mental, emotional, or behavioral problem
(10) Bone, joint, or muscle problem
(11) Epilepsy
(12) Other impairment/problem (specify one)(FHS.271)
(13) Other impairment/problem (specify one)(FHS.272)
(97) Refused
(99) Don't know/not sure

[ ]
[ ]
[ ]
[ ]
[ ]

(Go to FHS.280)

FHS.271

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACCSPEC CONDITION: _______________

FHS.272

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACCSPEC_1 CONDITION: _______________

Survey form view entire document:  text  image

FHS.290

What conditions or health problems cause {subject's name} limitations?

FR: SHOW CARD F2. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F2
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g. cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
19. Other impairment/problem
LAHCA
(1) Vision/ problem seeing
(2) Hearing problem
(3) Arthritis/rheumatism
(4) Back or neck problem
(5) Fractures, bone/joint injury
(6) Other injury
(7) Heart problem
(8) Stroke problem
(9) Hypertension/high blood pressure
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (e.g. cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem
(19) Other impairment/problem (specify one)(FHS.291)
(20) Other impairment/problem (specify one)(FHS.292)
(97) Refused
(99) Don't know/not sure

[ ]
[ ]
[ ]
[ ]
[ ]

(Go to FHS.300)

FHS.291

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACASPEC CONDITION: _______________

FHS.292

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACASPEC_1 CONDITION: _______________

top
1997
Survey form view entire document:  text  image
Check item FHSCCI3:
For family members with an entry in FHS.010 through FHS.260:
If AGE is less than 18 go to FHS.270; Else go to FHS.290. If none with entry in
FHS.010 through FHS.260, or the family roster is exhausted go to FHS.310.

FHS.270

What conditions or health problems cause {subject's name} limitations?

FR: SHOW CARD F1. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F1
1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Mental retardation
8. Other developmental problem (e.g. cerebral palsy)
9. Other mental, emotional or behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy
12. Other impairment/problem
LAHCC
(1) Vision/ problem seeing
(2) Hearing problem
(3) Speech problem
(4) Asthma/breathing problem
(5) Birth defect
(6) Injury
(7) Mental retardation
(8) Other developmental problem (e.g. cerebral palsy)
(9) Other mental, emotional, or behavioral problem
(10) Bone, joint, or muscle problem
(11) Epilepsy
(12) Other impairment/problem (specify one)(FHS.271)
(13) Other impairment/problem (specify one)(FHS.272)
(97) Refused
(99) Don't know/not sure

[ ]
[ ]
[ ]
[ ]
[ ]

(Go to FHS.280)

FHS.271

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACCSPEC CONDITION: _______________

FHS.272

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACCSPEC_1 CONDITION: _______________

Survey form view entire document:  text  image

FHS.290

What conditions or health problems cause {subject's name} limitations?

FR: SHOW CARD F2. DO NOT READ. CODE ALL THAT APPLY, UP TO 5, BUT DO NOT PROBE. ENTER (N) FOR NO MORE.
Card F2
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g. cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
19. Other impairment/problem
LAHCA
(1) Vision/ problem seeing
(2) Hearing problem
(3) Arthritis/rheumatism
(4) Back or neck problem
(5) Fractures, bone/joint injury
(6) Other injury
(7) Heart problem
(8) Stroke problem
(9) Hypertension/high blood pressure
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (e.g. cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem
(19) Other impairment/problem (specify one)(FHS.291)
(20) Other impairment/problem (specify one)(FHS.292)
(97) Refused
(99) Don't know/not sure

[ ]
[ ]
[ ]
[ ]
[ ]

(Go to FHS.300)

FHS.291

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACASPEC CONDITION: _______________

FHS.292

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
LACASPEC_1 CONDITION: _______________