Survey Text

2020
2019
top
2020

No questionnaire text is available for this sample.


top
2019
Survey form view entire document:  text  image
Question ID: VIS.0030.00.1
Variable: VISIONDF_C
Interview Module: Child
Content Type: Annual Core


Question Text:

^GLASSCONTACT ^SCNAME have difficulty seeing? Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^GLASSCONTACT

Description When wearing glasses ^CONTACTS does/Does
Instruction If WEARGLSS_C=1 fill "When wearing glasses ^CONTACTS does" else if WEARGLSS_C ne 1 "Does"

^CONTACTS

Description or contact lenses
Instruction If AGE=5-17 fill "or contact lenses"

^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 2-17
Skip Instructions:
1-4,RF,DK = [goto next section]
Question ID: HEA.0020.00.1
Variable: HEARINGDF_C
Interview Module: Child
Content Type: Annual Core


Question Text:

^USEHRAID_C ^SCNAME have difficulty hearing sounds like people's voices or music? Would you say
^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^USEHRAID_C

Description When using ^hisher_C hearing aid(s) does/Does
Instruction If HEARAID_C=1 fill "When using ^hisher_C hearing aid(s) does " else fill "Does "

^hisher_C

Description his/her/their
Instruction if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill "their"

^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 2-17
Skip Instructions:
1-4,DK,RF = [goto next section]
Question ID: MOB.0050.00.1
Variable: NOEQWLK100_C
Interview Module: Child
Content Type: Annual Core


Question Text:

WITHOUT USING ^hisher_C equipment or assistance, does ^SCNAME have difficulty walking 100 yards on level ground? That would be about the length of 1 football field or 1 city block. Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^hisher_C

Description his/her/their
Instruction if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill "their"

^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17 who use equipment or assistance for walking
Skip Instructions:
1-3,RF,DK = [goto NOEQWLK13M_C]
4 = [goto EQWLK100_C]
Question ID: MOB.0060.00.1
Variable: NOEQWLK13M_C
Interview Module: Child
Content Type: Annual Core


Question Text:

WITHOUT USING ^hisher_C equipment or assistance, does ^SCNAME have difficulty walking a third of a mile on level ground? That would be about the length of 5 football fields or 5 city blocks.

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^hisher_C

Description his/her/their
Instruction if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill "their"

^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17 who use equipment or assistance for walking and have no, some or a lot difficulty walking 100 yards when not using their equipment/assistance or Refused or Do not Know
Skip Instructions:
1-4,RF,DK = [goto EQWLK100_C]
Question ID: MOB.0090.00.1
Variable: WLK100_C
Interview Module: Child
Content Type: Annual Core


Question Text:

Compared with children of the same age, does ^SCNAME have difficulty walking 100 yards on level ground? That would be about the length of 1 football field or 1 city block. Would you say
^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME
Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"

Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17 who do not use equipment or assistance for walking or Refused or Do not Know
Skip Instructions:
1-3,RF,DK = [goto WLK13M_C]
4 = [goto next section]
Question ID: MOB.0100.00.1
Variable: WLK13M_C
Interview Module: Child
Content Type: Annual Core


Question Text:

Compared with children of the same age, does ^SCNAME have difficulty walking a third of a mile on level ground? That would be about the length of 5 football fields or 5 city blocks.

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17 who do not use equipment or assistance for walking and have no difficulty, some difficulty, or a lot of difficulty walking 100 yards or Refused or Do not Know
Skip Instructions:
1-4,RF,DK = [goto next section]
Question ID: UPP.0020.00.1
Variable: SELFCAREDF_C
Interview Module: Child
Content Type: AnnualCore


Question Text:

Does ^SCNAME have difficulty with self care, such as eating or dressing?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17
Skip Instructions:
1-4,DK,RF = [goto next section]
Question ID: COM.0030.00.1
Variable: UNDRSTIHH_C
Interview Module: Child
Content Type: Annual Core


Question Text:

When ^SCNAME speaks, ^doesheshedothey_C have difficulty being understood by people inside of this household?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^doesheshedothey_C

Description does he/does she/do they
Instruction If SEX=1 fill: "does he" If SEX=2 fill: "does she"
If SEX IN ('RF','DK') fill: "do they"

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17
Skip Instructions:
1-4,RF,DK = [goto UNDRSTOHH_C]
Question ID: COM.0040.00.0
Variable: UNDRSTOHH_C
Interview Module: Child
Content Type: Annual Core


Question Text:

When ^SCNAME speaks, ^doesheshedothey_C have difficulty being understood by people outside of this household?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^doesheshedothey_C

Description does he/does she/do they
Instruction If SEX=1 fill: "does he" If SEX=2 fill: "does she"
If SEX IN ('RF','DK') fill: "do they"

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17
Skip Instructions:
1-4,RF,DK = [goto next section]
Question ID: COG.0010.00.1
Variable: LEARNDF_C
Interview Module: Child
Content Type: Annual Core

Question Text:

Compared with children of the same age, does ^SCNAME have difficulty learning things?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They

"

Response:

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 2-17
Skip Instructions:
1-4,RF,DK = [goto REMEMBERDF_C]
Question ID: COG.0020.00.1
Variable: REMEMBERDF_C
Interview Module: Child
Content Type: Annual Core


Question Text:

Compared with children of the same age, does ^SCNAME have difficulty remembering things?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

^heshe_C

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Children 5-17
Skip Instructions:
1-4,RF,DK = [goto next section]
Question ID: ANX.0010.00.1
Variable: ANXFREQ_C
Interview Module: Child
Content Type: Annual Core

Question Text:

How often does ^SCNAME seem very anxious, nervous, or worried? Would you say: daily, weekly, monthly, a few times a year, or never?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1
Response:
1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Do not Know
Universe:
Sample Children 5-17
Skip Instructions:
1-5,RF,DK = [goto next section]
Question ID: DEP.0010.00.1
Variable: DEPFREQ_C
Interview Module: Child
Content Type: Annual Core

Question Text:

How often does ^SCNAME seem very sad or depressed? Would you say: daily, weekly, monthly, a few times a year, or never?
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1
Response:
1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Do not Know
Universe:
Sample Children 5-17
Skip Instructions:
1-5,RF,DK = [goto next section]
Question ID: BEH.0030.00.1
Variable: BEHDFCNTR_C
Interview Module: Child
Content Type: Annual Core
Question Text:
Compared with children of the same age, does ^SCNAME have difficulty controlling ^hisher_C behavior?

Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description: Sample child's name
Instruction: Fill ALIAS of HHSTAT_C=1

^hisher_C

Description: his/her/their
Instruction: if GEN.SEX_FINAL[PX_C]=1 fill "his"; else if GEN.SEX_FINAL[PX_C]=2 fill "her"; else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill "their"

^heshe_C

Description: He/She/They
Instruction: If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe: Sample Children 5-17
Skip Instructions: 1-4,RF,DK = [goto BEHDFFCS_C]

Question ID: BEH.0040.00.1
Variable: BEHDFFCS_C
Interview Module: Child
Content Type: Annual Core
Question Text:

Does ^SCNAME have difficulty concentrating on an activity that ^heshe_C enjoy^s doing?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description: Sample child's name
Instruction: Fill ALIAS of HHSTAT_C=1

^heshe_C

Description: He/She/They
Instruction: If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"

^s

Description: s
Instruction: if SEX_FINAL[PX_C]=1,2 fill "s" else fill blank
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe: Sample Children 5-17
Skip Instructions: 1-4,RF,DK = [goto BEHDFCHG_C]

Question ID: BEH.0050.00.1
Variable: BEHDFCHG_C
Interview Module: Child
Content Type: Annual Core
Question Text:

Does ^SCNAME have difficulty accepting changes in ^hisher_C routine?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description: Sample child's name
Instruction: Fill ALIAS of HHSTAT_C=1

^hisher_C

Description: his/her/their
Instruction: if GEN.SEX_FINAL[PX_C]=1 fill "his"; else if GEN.SEX_FINAL[PX_C]=2 fill "her"; else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill "their"

^heshe_C

Description: He/She/They
Instruction: If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe: Sample Children 5-17
Skip Instructions: 1-4,RF,DK = [goto BEHDFMKFR_C]

Question ID: BEH.0060.00.1
Variable: BEHDFMKFR_C
Interview Module: Child
Content Type: Annual Core
Question Text:

Does ^SCNAME have difficulty making friends?

*Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Fills:
^SCNAME

Description: Sample child's name
Instruction: Fill ALIAS of HHSTAT_C=1

^heshe_C

Description: He/She/They
Instruction: If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe: Sample Children 5-17
Skip Instructions: 1-4,RF,DK = [goto next section]