Survey Text

1999
1989
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1999
Survey form view entire document:  text  image

AAU.135.020

FR: SHOW CARD A12

[If AAU.135 = 0 read :]
What are the reasons that you have never gone to the dentist?

[Else read:]
What are the reasons that you have not visited a dentist in over 12 months?
Reason no dental visit...
Card A12
1. Afraid
2. Nervous
3. Needles
4. Cost
5. Don't know dentist
6. Dentist too far
7. Can't get there
8. No problems
9. No teeth
10. Not important
11. Didn't think of it
12. Other
ADENNOVS
(01) Afraid (Check Item AAUCCI5)
(02) Nervous (Check Item AAUCCI5)
(03) Needles (Check Item AAUCCI5)
(04) Cost/no insurance (Check Item AAUCCI5)
(05) Don't know dentist (Check Item AAUCCI5)
(06) Dentist too far (Check Item AAUCCI5)
(07) Can't get there (Check Item AAUCCI5)
(08) No problems (Check Item AAUCCI5)
(09) No teeth (Check Item AAUCCI5)
(10) Not important (Check Item AAUCCI5)
(11) Didn't think of it (Check Item AAUCCI5)
(12) Other (AAU.135.021)
(97) Refused (Check Item AAUCCI5)
(99) Don't know (Check Item AAUCCI5)

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AAU.135.021

FR: SPECIFY OTHER REASON FOR NO DENTAL VISITS. THIS SHOULD BE A REASON THAT IS NOT ON THE NO DENTAL REASON LIST.
ANOVSPEC
No dental reason _______________

Survey form view entire document:  text  image

CAU.160.020

What are the reasons {S.C. name} has never gone to the dentist? -OR- What are the reasons that {S.C. name} has not visited a dentist in over 12 months?
CDENNO
(01) Age/too young
(02) Afraid
(03) Nervous
(04) Needles
(05) Cost/no insurance
(06) Don't know dentist
(07) Dentist too far
(08) Can't get there
(09) No problems
(10) No teeth
(11) Not important
(12) Didn't think of it
(13) Other
(97) Refused
(99) DK
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(Go to CAUCCI2b)

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1989
Survey form view entire document:  text  image

3. What are the reasons -- has (not visited the dentist in over 12 months/never gone to the dentist)?
Do not read categories. Circle all that apply.

01[] Afraid
02[] Nervous
03[] Needles
04[] Cost
05[] Don't know dentist
06[] Dentist too far
07[] Can't get there
08[] No problems
09[] No teeth
10[] Not important
11[] Didn't think of it
88[] Other (Specify) ____
99[] Don't know