Instrument Variable Name: AFLHCA
Questionnaire File Name: Sample Adult
Question Text:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile; walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10 pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or relaxing at home (reading/sewing).
Skip Instructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order
(13) store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90) [goto AFLHCA_S1]
(91) [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
( R,D) [goto SMKEV (next section)]

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7 What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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

UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile; walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order
(13) store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90) [goto AFLHCA_S1]
(91) [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
( R,D) [goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least one condition not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL90N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order, as specified in AFLHCA

Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL91N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7 What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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

UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile; walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order
(13) store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90) [goto AFLHCA_S1]
(91) [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
( R,D) [goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least one condition not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL90N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order, as specified in AFLHCA

Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL91N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7 What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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

UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile; walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order
(13) store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90) [goto AFLHCA_S1]
(91) [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
( R,D) [goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least one condition not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL90N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order, as specified in AFLHCA

Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL91N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7 What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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

UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile; walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order
(13) store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90) [goto AFLHCA_S1]
(91) [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
( R,D) [goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least one condition not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL90N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order, as specified in AFLHCA

Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL91N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7 What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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

UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile; walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order
(13) store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90) [goto AFLHCA_S1]
(91) [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
( R,D) [goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least one condition not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL90N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order, as specified in AFLHCA

Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars) [goto AHCL91N]
)ENTER( only with no description [goto ERR1_AFLHCA_S1]
Hard Edit: $ You should enter something specific.

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Instrument Variable Name: AFLHCA
QuestionText:

(book) A7
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for 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: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects; going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions:

[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
(13)store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
(90)[goto AFLHCA_S1]
(91)[goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
(R,D)[goto SMKEV (next section)]

Instrument Variable Name: AFLHCA_S1
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL90N]
only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical
order, as specified in AFLHCA

Instrument Variable Name: AFLHCA_S2
QuestionText:

* Enter other impairment/problem.

Verbatim Verbatim response
7 Refused
9 Don't know

UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more
than one condition that is not listed in AFLHCA
SkipInstructions:

(50 chars)[goto AHCL91N]

Check item AHSCCI3: If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; else go to the next section -HEALTH BEHAVIORS.

[IF 3 OR LESS CONDITIONS MENTIONED]
What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

[Else]
What condition or health problem causes you to have difficulty with these activities?

FR: SHOW FLASHCARD A7. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (M) FOR CONDITIONS NOT ON THE FLASHCARD. ENTER (N) FOR NO MORE.

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
Other impairment/problem

AFLHCA1 (1) Vision/problem seeing
AFLHCA2 (2) Hearing problem
AFLHCA3 (3) Arthritis/rheumatism
AFLHCA4 (4) Back or neck problem
AFLHCA5 (5) Fractures, bone/joint injury
AFLHCA6 (6) Other injury
AFLHCA7 (7) Heart problem
AFLHCA8 (8) Stroke problem
AFLHCA9 (9) Hypertension/high blood pressure
AFLHCA10 (10) Diabetes
AFLHCA11 (11) Lung/breathing problem (e.g. asthma and emphysema)
AFLHCA12 (12) Cancer
AFLHCA13 (13) Birth defect
AFLHCA14 (14) Mental retardation
AFLHCA15 (15) Other developmental problem (e.g. cerebral palsy)
AFLHCA16 (16) Senility
AFLHCA17 (17) Depression/anxiety/emotional problem
AFLHCA18 (18) Weight problem

(97) Refused
(99) Don't know
(M) More conditions (AHS.205)

(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)
(37) Other impairment/problem (specify one)
(97) Refused
(99) Don't know

If answers = 1-37 then go to AHS.300; Else go to end of section.

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

AFLSPEC1 Condition: __________________________________________

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

AFLSPEC2 Condition: ___________________________________________

Check item AHSCCI3: If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; else go to the next section -HEALTH BEHAVIORS.

[IF 3 OR LESS CONDITIONS MENTIONED]
What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

[Else]
What condition or health problem causes you to have difficulty with these activities?

FR: SHOW FLASHCARD A7. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (M) FOR CONDITIONS NOT ON THE FLASHCARD. ENTER (N) FOR NO MORE.

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
Other impairment/problem

AFLHCA1 (1) Vision/problem seeing
AFLHCA2 (2) Hearing problem
AFLHCA3 (3) Arthritis/rheumatism
AFLHCA4 (4) Back or neck problem
AFLHCA5 (5) Fractures, bone/joint injury
AFLHCA6 (6) Other injury
AFLHCA7 (7) Heart problem
AFLHCA8 (8) Stroke problem
AFLHCA9 (9) Hypertension/high blood pressure
AFLHCA10 (10) Diabetes
AFLHCA11 (11) Lung/breathing problem (e.g. asthma and emphysema)
AFLHCA12 (12) Cancer
AFLHCA13 (13) Birth defect
AFLHCA14 (14) Mental retardation
AFLHCA15 (15) Other developmental problem (e.g. cerebral palsy)
AFLHCA16 (16) Senility
AFLHCA17 (17) Depression/anxiety/emotional problem
AFLHCA18 (18) Weight problem

(97) Refused
(99) Don't know
(M) More conditions (AHS.205)

(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)
(37) Other impairment/problem (specify one)
(97) Refused
(99) Don't know

If answers = 1-37 then go to AHS.300; Else go to end of section.

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

AFLSPEC1 Condition: __________________________________________

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

AFLSPEC2 Condition: ___________________________________________

Check item AHSCCI3: If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; else go to the next section -HEALTH BEHAVIORS.

[IF 3 OR LESS CONDITIONS MENTIONED]
What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

[Else]
What condition or health problem causes you to have difficulty with these activities?

FR: SHOW FLASHCARD A7. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (M) FOR CONDITIONS NOT ON THE FLASHCARD. ENTER (N) FOR NO MORE.

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
Other impairment/problem

AFLHCA1 (1) Vision/problem seeing
AFLHCA2 (2) Hearing problem
AFLHCA3 (3) Arthritis/rheumatism
AFLHCA4 (4) Back or neck problem
AFLHCA5 (5) Fractures, bone/joint injury
AFLHCA6 (6) Other injury
AFLHCA7 (7) Heart problem
AFLHCA8 (8) Stroke problem
AFLHCA9 (9) Hypertension/high blood pressure
AFLHCA10 (10) Diabetes
AFLHCA11 (11) Lung/breathing problem (e.g. asthma and emphysema)
AFLHCA12 (12) Cancer
AFLHCA13 (13) Birth defect
AFLHCA14 (14) Mental retardation
AFLHCA15 (15) Other developmental problem (e.g. cerebral palsy)
AFLHCA16 (16) Senility
AFLHCA17 (17) Depression/anxiety/emotional problem
AFLHCA18 (18) Weight problem

(97) Refused
(99) Don't know
(M) More conditions (AHS.205)

(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)
(37) Other impairment/problem (specify one)
(97) Refused
(99) Don't know

If answers = 1-37 then go to AHS.300; Else go to end of section.

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

AFLSPEC1 Condition: __________________________________________

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

AFLSPEC2 Condition: ___________________________________________

Check item AHSCCI3 : If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; Else go to the next section-HEALTH BEHAVIORS.

What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

FR: SHOW FLASHCARD A6. ENTER ALL THAT APPLY UP TO 5 (but do not probe). IF OLD AGE IS REPORTED, PROBE FOR SPECIFIC CONDITION(S) CAUSED BY OLD AGE. ENTER (N) FOR NO MORE.

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
Other impairment/problem

(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
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (as cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem pressure
(19) Other impairment/problem
(20) Other impairment/problem
(97) Refused
(99) Don't know

[ ]
[ ]
[ ]
[ ]
[ ]

If answers equal (1) - (12) and (14) - (18) then go to AHS.300; if answer equals (19) and/or (20) goto AHS.201; else go to next section.

FR: THESE SHOULD BE NAMES OF SPECIFIC CONDITIONS THAT ARE NOT ON THE CONDITION LIST.

AFLSPEC1 First condition: ___________________
AFLSPEC2 Second condition: ___________________

Check item AHSCCI3 : If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; Else go to the next section-HEALTH BEHAVIORS.

What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

FR: SHOW FLASHCARD A6. ENTER ALL THAT APPLY UP TO 5 (but do not probe). IF OLD AGE IS REPORTED, PROBE FOR SPECIFIC CONDITION(S) CAUSED BY OLD AGE. ENTER (N) FOR NO MORE.

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
Other impairment/problem

(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
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (as cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem pressure
(19) Other impairment/problem
(20) Other impairment/problem
(97) Refused
(99) Don't know

[ ]
[ ]
[ ]
[ ]
[ ]

If answers equal (1) - (12) and (14) - (18) then go to AHS.300; if answer equals (19) and/or (20) goto AHS.201; else go to next section.

FR: THESE SHOULD BE NAMES OF SPECIFIC CONDITIONS THAT ARE NOT ON THE CONDITION LIST.

AFLSPEC1 First condition: ___________________
AFLSPEC2 Second condition: ___________________

Check item AHSCCI3 : If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; Else go to the next section-HEALTH BEHAVIORS.

What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

FR: SHOW FLASHCARD A6. ENTER ALL THAT APPLY UP TO 5 (but do not probe). IF OLD AGE IS REPORTED, PROBE FOR SPECIFIC CONDITION(S) CAUSED BY OLD AGE. ENTER (N) FOR NO MORE.

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
Other impairment/problem

(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
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (as cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem pressure
(19) Other impairment/problem
(20) Other impairment/problem
(97) Refused
(99) Don't know

[ ]
[ ]
[ ]
[ ]
[ ]

If answers equal (1) - (12) and (14) - (18) then go to AHS.300; if answer equals (19) and/or (20) goto AHS.201; else go to next section.

FR: THESE SHOULD BE NAMES OF SPECIFIC CONDITIONS THAT ARE NOT ON THE CONDITION LIST.

AFLSPEC1 First condition: ___________________
AFLSPEC2 Second condition: ___________________

Check item AHSCCI3 : If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; Else go to the next section-HEALTH BEHAVIORS.

What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

FR: SHOW FLASHCARD A6. ENTER ALL THAT APPLY UP TO 5 (but do not probe). IF OLD AGE IS REPORTED, PROBE FOR SPECIFIC CONDITION(S) CAUSED BY OLD AGE. ENTER (N) FOR NO MORE.

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
Other impairment/problem

(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
(10) Diabetes
(11) Lung/breathing problem
(12) Cancer
(13) Birth defect
(14) Mental retardation
(15) Other developmental problem (as cerebral palsy)
(16) Senility
(17) Depression/anxiety/emotional problem
(18) Weight problem pressure
(19) Other impairment/problem
(20) Other impairment/problem
(97) Refused
(99) Don't know

[ ]
[ ]
[ ]
[ ]
[ ]

If answers equal (1) - (12) and (14) - (18) then go to AHS.300; if answer equals (19) and/or (20) goto AHS.201; else go to next section.

FR: THESE SHOULD BE NAMES OF SPECIFIC CONDITIONS THAT ARE NOT ON THE CONDITION LIST.

AFLSPEC1 First condition: ___________________
AFLSPEC2 Second condition: ___________________