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Survey Text

1996
1995
1994
1993
1992
1991
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1996
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM I4
Refer to shot record.

1[] Available (2)
2[] Not available (1)

1. Ask only on initial interview. On callback, skip to 9.
We will need the shot record to complete this section of the interview.
If I called you within the next few days, would you be able to have --'s shot record available?

1[] Yes (Arrange callback, then I5 on page 4)
2[] No (9)
9[] DK (9)

2. Transcribe from shot record - If telephone ask: Looking at the shot record, please tell me how many times -- has received (name of vaccines)?
Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third, etc. shots.

3. Are all the immunizations that -- ever received included on this shot record?

1[] Yes (11)
2[] No (4)
9[] DK (4)

10a. Has -- ever received:


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1995
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM I4
Refer to shot record.

1[] Available (2)
2[] Not available (1)

1. Ask only on initial interview. On callback, skip to 9.
We will need the shot record to complete this section of the interview.
If I called you within the next few days, would you be able to have --'s shot record available?

1[] Yes (Arrange callback, then I5 on page 6)
2[] No (9)
9[] DK (9)

2. Transcribe from shot record - If telephone ask: Looking at the shot record, please tell me how many times -- has received (name of vaccines)?
Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third, etc. shots.

3. Are all the immunizations that -- ever received included on this shot record?

1[] Yes (11)
2[] No (4)
9[] DK (4)

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1994
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to [his/her] shot record.

ITEM I4
Refer to shot record.

[] 1 Available (2)
[] 2 Not available (1)

1. Ask only on initial interview. On callback, skip to 9.
We will need the shot record to complete this section of the interview. If I called you within the next few days, would you be able to have --'s shot record available?

[] 1 Yes (Arrange callback, then I5 on page 6)
[] 2 No (9)
[] 9 DK (9)

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1993
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM IZ2
Refer to shot record.

1 [] Available (1)
2 [] Not available (8)

8. Has -- ever received an immunization (that is a shot or drops)?

1 [] Yes (9)
2 [] No (Item IZ3)
9 [] DK (Item IZ3)

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1992
Survey form view entire document:  text  image
These questions refer to (read name), and are about immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

ITEM IZ2
Refer to shot record.

1 [] Available (1)
2 [] Not available (8)

About how often did the respondent appear to answer the questions in Immunization accurately?

1 [] All the time
2 [] Most of the time
3 [] Some of the time
4 [] Rarely or never
9 [] DK
ITEM IZ4
About how often did the respondent appear to answer the questions in Immunization honestly?

1 [] All the time
2 [] Most of the time
3 [] Some of the time
4 [] Rarely or never
9 [] DK

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1991
Survey form view entire document:  text  image
These questions refer to (read name), and are about various health topics, including immunizations that -- may have received. It would be helpful if we could refer to -- shot record.

Item D4
Refer to shot record

1[] Available (1)
2[] Not available (7)