top

2023

No questionnaire text is available for this sample.

top

2022

Survey form view entire document: text image

Question ID: VIS.0030.00.1
Variable: VISIONDF_A
Interview Module: Adult
Content Type: Annual Core

Question text:

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of
difficulty, or you cannot do this at all?

Fills:

^AGLASSCNTS

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction:
If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses";
else fill "seeing"

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto next section]

top

2021

Survey form view entire document: text image

Question ID: VIS.0030.00.1
Variable: VISIONDF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Fills:

^AGLASSCNTS

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction:
If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses";
else fill "seeing"

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto next section]

Question ID: HEA.0030.00.1
Variable: HEARINGDF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty hearing^HEARAID? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Fills:

^HEARAID

Description: , even when using your hearing aid(s)
Instruction:
If HEARAID_A=1, fill: ", even when using your hearing aid (s)"
else NO FILL

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-3,RF,DK [goto HEARQTRM_A]
4 [goto next section]

Question ID: MOB.0010.00.1
Variable: DIFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty walking or climbing steps? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto EQUIP_A]

Question ID: COM.0010.00.1
Variable: COMDIFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Using your usual language, do you have difficulty communicating, for example, understanding or being understood?
Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto COMUSESL_A]

Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty remembering or concentrating?
Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1,RF,DK [goto next section]
2-4 [goto COGTYPEDFF_A]

Question ID: UPP.0010.00.1
Variable: UPPSLFCR_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty with self care, such as washing all over or dressing? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto UPPRAISE_A]

top

2020

Survey form view entire document: text image

Question ID: VIS.0030.00.1
Variable: VISIONDF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of
difficulty, or you cannot do this at all?

Fills:

^AGLASSCNTS

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction:
If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses";
else fill "seeing"

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto next section]

Question ID: HEA.0030.00.1
Variable: HEARINGDF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty hearing^HEARAID? Would you say no difficulty, some difficulty, a lot of
difficulty, or you cannot do this at all?

Fills:

^HEARAID

Description: , even when using your hearing aid(s)
Instruction:
If HEARAID_A=1, fill: ", even when using your hearing aid (s)"
else NO FILL

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto next section]

Question ID: MOB.0010.00.1
Variable: DIFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty walking or climbing steps? Would you say no difficulty, some difficulty,
a lot of difficulty, or you cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto EQUIP_A]

Question ID: COM.0010.00.1
Variable: COMDIFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Using your usual language, do you have difficulty communicating, for example, understanding or
being understood?
* Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you
cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto next section]

Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty remembering or concentrating?
*Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you
cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1,RF,DK [goto next section]
2-4 [goto COGTYPEDFF_A]

Question ID: UPP.0010.00.1
Variable: UPPSLFCR_A
Interview Module: Adult
Content Type: Annual Core
Question text:

Do you have difficulty with self care, such as washing all over or dressing? Would you say no
difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Universe:

Sample Adults 18+

Skip Instructions:

1-4,RF,DK [goto UPPRAISE_A]

top

2019

Survey form view entire document: text image

Question ID: VIS.0030.00.1
Variable: VISIONDF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Fills:

^AGLASSCNTS

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction: If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses"; else fill "seeing"

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 Adults 18+

Skip Instructions:

1-4,RF,DK = [goto next section]

Question ID: HEA.0030.00.1
Variable: HEARINGDF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty hearing^HEARAID? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Fills:

^HEARAID

Description: even when using your hearing aid(s)
Instruction: If HEARAID_A=1, fill: ", even when using your hearing aid (s)"
else NO FILL

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 Adults 18+

Skip Instructions:

1-4,RF,DK = [goto next section]

Question ID: MOB.0010.00.1
Variable: DIFF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty walking or climbing steps? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

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 Adults 18+

Skip Instructions:

1-4,RF,DK = [goto EQUIP_A]

Question ID: COM.0010.00.1
Variable: COMDIFF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Using your usual language, do you have difficulty communicating, for example, understanding or being understood?

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

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 Adults 18+

Skip Instructions:

1-4,RF,DK = [goto next section]

Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty remembering or concentrating?

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

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 Adults 18+

Skip Instructions:

1,RF,DK = [goto next section]
2-4 = [goto COGTYPEDFF_A]

Question ID: UPP.0010.00.1
Variable: UPPSLFCR_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty with self care, such as washing all over or dressing? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

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 Adults 18+

Skip Instructions:

1-4,RF,DK = [goto UPPRAISE_A]

Survey Text