Survey Text

2017 2011 2005 1999
2016 2010 2004 1998
2015 2009 2003 1997
2014 2008 2002
2013 2007 2001
2012 2006 2000
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2017

No questionnaire text is available for this sample.


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2016

No questionnaire text is available for this sample.


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2015

No questionnaire text is available for this sample.


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2014

No questionnaire text is available for this sample.


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2013

No questionnaire text is available for this sample.


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2012

No questionnaire text is available for this sample.


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2011

No questionnaire text is available for this sample.


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2010
Survey form view entire document:  text  image

Question ID:FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text:

? [F1] The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4: (random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text All families
Skip Instructions:

(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, go to WFINJ3M]
(2,R,D) [go to FPOI3M]

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2009
Survey form view entire document:  text  image

Question ID: FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text: ? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4:
(random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
(2,R,D) [goto FPOI3M]
Question ID: FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least one person was injured during the past 3 months
Skip Instructions:
(R,D) [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons injured during the past 3 months
Skip Instructions:
(1-10,D) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
(11-91) [goto ERR_TFINJ3M]
ERR_TFINJ3M
Soft Edit:
* ^TFINJ3M is unusually high. Please verify.
(Suppress) [goto MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Goto) [reset TFINJ3M for new entry]
Question ID: FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about injuries/this injury/your injury or injuries?
1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:

(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]
(2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text: ? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their injury episode(s)
SkipInstructions:
(1-91) [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto
ERR2_MTFINJ3M; else, goto IPDATEM]
(R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
ERR1_MTFINJ3M
Hard Edit:
[If (MTIFNJ3M gt TFINJ3M), display ERR1_MTFINJ3M]:
[^MTFINJ3M] is greater than the total number of times you said [you were/ALIAS was] injured, which is
[^TFINJ3M]. For this question, we are asking about the number of times [you were/ALIAS was] injured and a
medical professional was consulted. For example, if you were injured three different times but only sought
medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained
medical professional more than once about that injury event.
Goto
Close
ERR2_MTFINJ3M
Soft Edit:
[If (TFINJ3M = 99 and MTFINJ3M gt 3), display ERR2_MTFINJ3M]:
^MTFINJ3M is an unusually high number of injuries for which a medical professional was consulted. Please
verify.
*Read if necessary.
For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical
professional was consulted. For example, if you were injured three different times, but only sought medical advice
or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical
professional more than once about that injury event.
Suppress
Goto
Close
Question ID: FIJ.020_00.000

Instrument Variable Name: FPOI3M
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if single-person family, store person number in WFPOI3M and goto TFPOI3M; else,
goto WFPOI3M]
(2,DK,R) [goto next section]
Question ID: FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text:All families with two or more persons and at least one person was poisoned during the past 3 months
Skip Instructions:
(1-25) [All family members. Avoid duplicate; goto TFPOI3M]
(DK,R) [goto next section]
Question ID: FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons poisoned during the past 3 months
Skip Instructions:
(01-10, DK) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with reported poisoning; if
no more persons with a poisoning, goto next section]
(11-91) [goto ERR_TFPOI3M]
ERR_TFPOI3M
Soft Edit:
[If TFPOI3M gt 10, display ERR_TFPOI3M]
* ^TFPOI3M is unusually high. Please verify.
(Suppress) [goto MFPOI3M]
(Close) [goto TFPOI3M for new entry]
(Goto) [goto TFPOI3M for new entry]
Question ID: FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Unknown
Universe Text: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:
(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else goto MTFPOI3M]
(2,DK,R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto
next section]
Question ID: FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Question Text: ? [F1]
Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of those times was the poisoning serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their poisoning episode(s)
SkipInstructions:
(01-91) [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, goto IPDATEM]
(DK, R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto next section]
If ((MTFPOI3M gt TFPOI3M) or (TFPOI3M eq DK and MTFPOI3M gt 3)), display ERR_MTFPOI3M]:
ERR1_MTFPOI3M
Hard Edit:
[If (MTFPOI3M gt TFPOI3M), display ERR1_MTFPOI3M]:
[^MTFPOI3M] is greater than the total number of times you said [you were/ALIAS was] poisoned, which is [^TFPOI3M]. For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
(Close) [goto MTFPOI3M for new entry]
(Goto) [goto TFPOI3M or MTFPOI3M for new entry]
ERR2_MTFPOI3M
Soft Edit:
[If TFPOI3M = 99 and MTFPOI3M gt 3), display ERR2_MTFINJ3M]:
* ^MTFINJ3M is an unusually high number.
For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
Suppress
Goto
Close

top
2008
Survey form view entire document:  text  image

Question ID: FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text: ? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4:
(random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
(2,R,D) [goto FPOI3M]
Question ID: FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least one person was injured during the past 3 months
Skip Instructions:
(R,D) [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons injured during the past 3 months
Skip Instructions:
(1-10,D) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
(11-91) [goto ERR_TFINJ3M]
ERR_TFINJ3M
Soft Edit:
* ^TFINJ3M is unusually high. Please verify.
(Suppress) [goto MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Goto) [reset TFINJ3M for new entry]
Question ID: FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about injuries/this injury/your injury or injuries?
1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:

(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]
(2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text: ? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their injury episode(s)
SkipInstructions:
(1-91) [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto
ERR2_MTFINJ3M; else, goto IPDATEM]
(R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
ERR1_MTFINJ3M
Hard Edit:
[If (MTIFNJ3M gt TFINJ3M), display ERR1_MTFINJ3M]:
[^MTFINJ3M] is greater than the total number of times you said [you were/ALIAS was] injured, which is
[^TFINJ3M]. For this question, we are asking about the number of times [you were/ALIAS was] injured and a
medical professional was consulted. For example, if you were injured three different times but only sought
medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained
medical professional more than once about that injury event.
Goto
Close
ERR2_MTFINJ3M
Soft Edit:
[If (TFINJ3M = 99 and MTFINJ3M gt 3), display ERR2_MTFINJ3M]:
^MTFINJ3M is an unusually high number of injuries for which a medical professional was consulted. Please
verify.
*Read if necessary.
For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical
professional was consulted. For example, if you were injured three different times, but only sought medical advice
or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical
professional more than once about that injury event.
Suppress
Goto
Close
Question ID: FIJ.020_00.000

Instrument Variable Name: FPOI3M
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if single-person family, store person number in WFPOI3M and goto TFPOI3M; else,
goto WFPOI3M]
(2,DK,R) [goto next section]
Question ID: FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text:All families with two or more persons and at least one person was poisoned during the past 3 months
Skip Instructions:
(1-25) [All family members. Avoid duplicate; goto TFPOI3M]
(DK,R) [goto next section]
Question ID: FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons poisoned during the past 3 months
Skip Instructions:
(01-10, DK) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with reported poisoning; if
no more persons with a poisoning, goto next section]
(11-91) [goto ERR_TFPOI3M]
ERR_TFPOI3M
Soft Edit:
[If TFPOI3M gt 10, display ERR_TFPOI3M]
* ^TFPOI3M is unusually high. Please verify.
(Suppress) [goto MFPOI3M]
(Close) [goto TFPOI3M for new entry]
(Goto) [goto TFPOI3M for new entry]
Question ID: FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Unknown
Universe Text: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:
(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else goto MTFPOI3M]
(2,DK,R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto
next section]
Question ID: FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Question Text: ? [F1]
Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of those times was the poisoning serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their poisoning episode(s)
SkipInstructions:
(01-91) [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, goto IPDATEM]
(DK, R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto next section]
If ((MTFPOI3M gt TFPOI3M) or (TFPOI3M eq DK and MTFPOI3M gt 3)), display ERR_MTFPOI3M]:
ERR1_MTFPOI3M
Hard Edit:
[If (MTFPOI3M gt TFPOI3M), display ERR1_MTFPOI3M]:
[^MTFPOI3M] is greater than the total number of times you said [you were/ALIAS was] poisoned, which is [^TFPOI3M]. For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
(Close) [goto MTFPOI3M for new entry]
(Goto) [goto TFPOI3M or MTFPOI3M for new entry]
ERR2_MTFPOI3M
Soft Edit:
[If TFPOI3M = 99 and MTFPOI3M gt 3), display ERR2_MTFINJ3M]:
* ^MTFINJ3M is an unusually high number.
For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
Suppress
Goto
Close

top
2007
Survey form view entire document:  text  image

Question ID: FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text: ? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4:
(random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
(2,R,D) [goto FPOI3M]
Question ID: FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least one person was injured during the past 3 months
Skip Instructions:
(R,D) [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons injured during the past 3 months
Skip Instructions:
(1-10,D) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
(11-91) [goto ERR_TFINJ3M]
ERR_TFINJ3M
Soft Edit:
* ^TFINJ3M is unusually high. Please verify.
(Suppress) [goto MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Goto) [reset TFINJ3M for new entry]
Question ID: FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about injuries/this injury/your injury or injuries?
1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:

(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]
(2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text: ? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their injury episode(s)
SkipInstructions:
(1-91) [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto
ERR2_MTFINJ3M; else, goto IPDATEM]
(R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
ERR1_MTFINJ3M
Hard Edit:
[If (MTIFNJ3M gt TFINJ3M), display ERR1_MTFINJ3M]:
[^MTFINJ3M] is greater than the total number of times you said [you were/ALIAS was] injured, which is
[^TFINJ3M]. For this question, we are asking about the number of times [you were/ALIAS was] injured and a
medical professional was consulted. For example, if you were injured three different times but only sought
medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained
medical professional more than once about that injury event.
Goto
Close
ERR2_MTFINJ3M
Soft Edit:
[If (TFINJ3M = 99 and MTFINJ3M gt 3), display ERR2_MTFINJ3M]:
^MTFINJ3M is an unusually high number of injuries for which a medical professional was consulted. Please
verify.
*Read if necessary.
For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical
professional was consulted. For example, if you were injured three different times, but only sought medical advice
or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical
professional more than once about that injury event.
Suppress
Goto
Close
Question ID: FIJ.020_00.000

Instrument Variable Name: FPOI3M
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if single-person family, store person number in WFPOI3M and goto TFPOI3M; else,
goto WFPOI3M]
(2,DK,R) [goto next section]
Question ID: FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text:All families with two or more persons and at least one person was poisoned during the past 3 months
Skip Instructions:
(1-25) [All family members. Avoid duplicate; goto TFPOI3M]
(DK,R) [goto next section]
Question ID: FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons poisoned during the past 3 months
Skip Instructions:
(01-10, DK) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with reported poisoning; if
no more persons with a poisoning, goto next section]
(11-91) [goto ERR_TFPOI3M]
ERR_TFPOI3M
Soft Edit:
[If TFPOI3M gt 10, display ERR_TFPOI3M]
* ^TFPOI3M is unusually high. Please verify.
(Suppress) [goto MFPOI3M]
(Close) [goto TFPOI3M for new entry]
(Goto) [goto TFPOI3M for new entry]
Question ID: FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Unknown
Universe Text: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:
(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else goto MTFPOI3M]
(2,DK,R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto
next section]
Question ID: FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Question Text: ? [F1]
Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of those times was the poisoning serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their poisoning episode(s)
SkipInstructions:
(01-91) [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, goto IPDATEM]
(DK, R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto next section]
If ((MTFPOI3M gt TFPOI3M) or (TFPOI3M eq DK and MTFPOI3M gt 3)), display ERR_MTFPOI3M]:
ERR1_MTFPOI3M
Hard Edit:
[If (MTFPOI3M gt TFPOI3M), display ERR1_MTFPOI3M]:
[^MTFPOI3M] is greater than the total number of times you said [you were/ALIAS was] poisoned, which is [^TFPOI3M]. For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
(Close) [goto MTFPOI3M for new entry]
(Goto) [goto TFPOI3M or MTFPOI3M for new entry]
ERR2_MTFPOI3M
Soft Edit:
[If TFPOI3M = 99 and MTFPOI3M gt 3), display ERR2_MTFINJ3M]:
* ^MTFINJ3M is an unusually high number.
For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
Suppress
Goto
Close

top
2006
Survey form view entire document:  text  image

Question ID: FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text: ? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4:
(random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
(2,R,D) [goto FPOI3M]
Question ID: FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least one person was injured during the past 3 months
Skip Instructions:
(R,D) [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons injured during the past 3 months
Skip Instructions:
(1-10,D) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
(11-91) [goto ERR_TFINJ3M]
ERR_TFINJ3M
Soft Edit:
* ^TFINJ3M is unusually high. Please verify.
(Suppress) [goto MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Goto) [reset TFINJ3M for new entry]
Question ID: FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about injuries/this injury/your injury or injuries?
1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:

(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]
(2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text: ? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their injury episode(s)
SkipInstructions:
(1-91) [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto
ERR2_MTFINJ3M; else, goto IPDATEM]
(R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
ERR1_MTFINJ3M
Hard Edit:
[If (MTIFNJ3M gt TFINJ3M), display ERR1_MTFINJ3M]:
[^MTFINJ3M] is greater than the total number of times you said [you were/ALIAS was] injured, which is
[^TFINJ3M]. For this question, we are asking about the number of times [you were/ALIAS was] injured and a
medical professional was consulted. For example, if you were injured three different times but only sought
medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained
medical professional more than once about that injury event.
Goto
Close
ERR2_MTFINJ3M
Soft Edit:
[If (TFINJ3M = 99 and MTFINJ3M gt 3), display ERR2_MTFINJ3M]:
^MTFINJ3M is an unusually high number of injuries for which a medical professional was consulted. Please
verify.
*Read if necessary.
For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical
professional was consulted. For example, if you were injured three different times, but only sought medical advice
or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical
professional more than once about that injury event.
Suppress
Goto
Close
Question ID: FIJ.020_00.000

Instrument Variable Name: FPOI3M
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if single-person family, store person number in WFPOI3M and goto TFPOI3M; else,
goto WFPOI3M]
(2,DK,R) [goto next section]
Question ID: FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text:All families with two or more persons and at least one person was poisoned during the past 3 months
Skip Instructions:
(1-25) [All family members. Avoid duplicate; goto TFPOI3M]
(DK,R) [goto next section]
Question ID: FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons poisoned during the past 3 months
Skip Instructions:
(01-10, DK) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with reported poisoning; if
no more persons with a poisoning, goto next section]
(11-91) [goto ERR_TFPOI3M]
ERR_TFPOI3M
Soft Edit:
[If TFPOI3M gt 10, display ERR_TFPOI3M]
* ^TFPOI3M is unusually high. Please verify.
(Suppress) [goto MFPOI3M]
(Close) [goto TFPOI3M for new entry]
(Goto) [goto TFPOI3M for new entry]
Question ID: FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Unknown
Universe Text: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:
(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else goto MTFPOI3M]
(2,DK,R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto
next section]
Question ID: FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Question Text: ? [F1]
Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of those times was the poisoning serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their poisoning episode(s)
SkipInstructions:
(01-91) [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, goto IPDATEM]
(DK, R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto next section]
If ((MTFPOI3M gt TFPOI3M) or (TFPOI3M eq DK and MTFPOI3M gt 3)), display ERR_MTFPOI3M]:
ERR1_MTFPOI3M
Hard Edit:
[If (MTFPOI3M gt TFPOI3M), display ERR1_MTFPOI3M]:
[^MTFPOI3M] is greater than the total number of times you said [you were/ALIAS was] poisoned, which is [^TFPOI3M]. For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
(Close) [goto MTFPOI3M for new entry]
(Goto) [goto TFPOI3M or MTFPOI3M for new entry]
ERR2_MTFPOI3M
Soft Edit:
[If TFPOI3M = 99 and MTFPOI3M gt 3), display ERR2_MTFINJ3M]:
* ^MTFINJ3M is an unusually high number.
For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
Suppress
Goto
Close

top
2005
Survey form view entire document:  text  image

Question ID: FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text: ? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4:
(random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
(2,R,D) [goto FPOI3M]
Question ID: FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least one person was injured during the past 3 months
Skip Instructions:
(R,D) [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons injured during the past 3 months
Skip Instructions:
(1-10,D) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
(11-91) [goto ERR_TFINJ3M]
ERR_TFINJ3M
Soft Edit:
* ^TFINJ3M is unusually high. Please verify.
(Suppress) [goto MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Goto) [reset TFINJ3M for new entry]
Question ID: FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about injuries/this injury/your injury or injuries?
1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:

(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]
(2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text: ? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their injury episode(s)
SkipInstructions:
(1-91) [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto
ERR2_MTFINJ3M; else, goto IPDATEM]
(R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
ERR1_MTFINJ3M
Hard Edit:
[If (MTIFNJ3M gt TFINJ3M), display ERR1_MTFINJ3M]:
[^MTFINJ3M] is greater than the total number of times you said [you were/ALIAS was] injured, which is
[^TFINJ3M]. For this question, we are asking about the number of times [you were/ALIAS was] injured and a
medical professional was consulted. For example, if you were injured three different times but only sought
medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained
medical professional more than once about that injury event.
Goto
Close
ERR2_MTFINJ3M
Soft Edit:
[If (TFINJ3M = 99 and MTFINJ3M gt 3), display ERR2_MTFINJ3M]:
^MTFINJ3M is an unusually high number of injuries for which a medical professional was consulted. Please
verify.
*Read if necessary.
For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical
professional was consulted. For example, if you were injured three different times, but only sought medical advice
or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical
professional more than once about that injury event.
Suppress
Goto
Close
Question ID: FIJ.020_00.000

Instrument Variable Name: FPOI3M
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if single-person family, store person number in WFPOI3M and goto TFPOI3M; else,
goto WFPOI3M]
(2,DK,R) [goto next section]
Question ID: FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text:All families with two or more persons and at least one person was poisoned during the past 3 months
Skip Instructions:
(1-25) [All family members. Avoid duplicate; goto TFPOI3M]
(DK,R) [goto next section]
Question ID: FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons poisoned during the past 3 months
Skip Instructions:
(01-10, DK) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with reported poisoning; if
no more persons with a poisoning, goto next section]
(11-91) [goto ERR_TFPOI3M]
ERR_TFPOI3M
Soft Edit:
[If TFPOI3M gt 10, display ERR_TFPOI3M]
* ^TFPOI3M is unusually high. Please verify.
(Suppress) [goto MFPOI3M]
(Close) [goto TFPOI3M for new entry]
(Goto) [goto TFPOI3M for new entry]
Question ID: FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Unknown
Universe Text: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:
(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else goto MTFPOI3M]
(2,DK,R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto
next section]
Question ID: FIJ.028_00.000

Instrument Variable Name: MTFPOI3M
Question Text: ? [F1]
Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of those times was the poisoning serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their poisoning episode(s)
SkipInstructions:
(01-91) [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, goto IPDATEM]
(DK, R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto next section]
If ((MTFPOI3M gt TFPOI3M) or (TFPOI3M eq DK and MTFPOI3M gt 3)), display ERR_MTFPOI3M]:
ERR1_MTFPOI3M
Hard Edit:
[If (MTFPOI3M gt TFPOI3M), display ERR1_MTFPOI3M]:
[^MTFPOI3M] is greater than the total number of times you said [you were/ALIAS was] poisoned, which is [^TFPOI3M]. For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
(Close) [goto MTFPOI3M for new entry]
(Goto) [goto TFPOI3M or MTFPOI3M for new entry]
ERR2_MTFPOI3M
Soft Edit:
[If TFPOI3M = 99 and MTFPOI3M gt 3), display ERR2_MTFINJ3M]:
* ^MTFINJ3M is an unusually high number.
For this question, we are asking about the number of times [you were/ALIAS was] poisoned and a medical professional was consulted. For example, if you were poisoned three different times but only sought medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical professional more than once about that poisoning event.
Suppress
Goto
Close

top
2004
Survey form view entire document:  text  image

Question ID: FIJ.010_00.000

Instrument Variable Name: FINJ3M
Question Text: ? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly, accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4:
(random set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
(2,R,D) [goto FPOI3M]
Question ID: FIJ.012_00.000

Instrument Variable Name: WFINJ3M
Question Text:

* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families with two or more persons and at least one person was injured during the past 3 months
Skip Instructions:
(R,D) [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent. As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.014_00.000

Instrument Variable Name: TFINJ3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons injured during the past 3 months
Skip Instructions:
(1-10,D) [goto MFINJ3M]
(R) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
(11-91) [goto ERR_TFINJ3M]
ERR_TFINJ3M
Soft Edit:
* ^TFINJ3M is unusually high. Please verify.
(Suppress) [goto MFINJ3M]
(Close) [reset TFINJ3M for new entry]
(Goto) [reset TFINJ3M for new entry]
Question ID: FIJ.016_00.000

Instrument Variable Name: MFINJ3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about injuries/this injury/your injury or injuries?
1 Yes
2 No
7 Refused
9 Don't know

Universe Text: All persons with at least one or an unknown number of injury episodes during the past 3 months
Skip Instructions:

(1) [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]
(2,R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.018_00.000

Instrument Variable Name: MTFINJ3M
Question Text: ? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons who consulted a medical professional for their injury episode(s)
SkipInstructions:
(1-91) [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto
ERR2_MTFINJ3M; else, goto IPDATEM]
(R,D) [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
ERR1_MTFINJ3M
Hard Edit:
[If (MTIFNJ3M gt TFINJ3M), display ERR1_MTFINJ3M]:
[^MTFINJ3M] is greater than the total number of times you said [you were/ALIAS was] injured, which is
[^TFINJ3M]. For this question, we are asking about the number of times [you were/ALIAS was] injured and a
medical professional was consulted. For example, if you were injured three different times but only sought
medical advice or treatment for one of those times, the answer would be one, even if you saw or talked to a trained
medical professional more than once about that injury event.
Goto
Close
ERR2_MTFINJ3M
Soft Edit:
[If (TFINJ3M = 99 and MTFINJ3M gt 3), display ERR2_MTFINJ3M]:
^MTFINJ3M is an unusually high number of injuries for which a medical professional was consulted. Please
verify.
*Read if necessary.
For this question, we are asking about the number of times [you were/ALIAS was] injured and a medical
professional was consulted. For example, if you were injured three different times, but only sought medical advice
or treatment for one of those times, the answer would be one, even if you saw or talked to a trained medical
professional more than once about that injury event.
Suppress
Goto
Close
Question ID: FIJ.020_00.000

Instrument Variable Name: FPOI3M
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
Universe Text: All families
Skip Instructions:
(1) [if single-person family, store person number in WFPOI3M and goto TFPOI3M; else,
goto WFPOI3M]
(2,DK,R) [goto next section]
Question ID: FIJ.022_00.000

Instrument Variable Name: WFPOI3M
Question Text:
* Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
Universe Text:All families with two or more persons and at least one person was poisoned during the past 3 months
Skip Instructions:
(1-25) [All family members. Avoid duplicate; goto TFPOI3M]
(DK,R) [goto next section]
Question ID: FIJ.024_00.000

Instrument Variable Name: TFPOI3M
Question Text: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
Universe Text: All persons poisoned during the past 3 months
Skip Instructions:
(01-10, DK) [goto MFPOI3M]
(R) [goto TFPOI3M for next person with reported poisoning; if
no more persons with a poisoning, goto next section]
(11-91) [goto ERR_TFPOI3M]
ERR_TFPOI3M
Soft Edit:
[If TFPOI3M gt 10, display ERR_TFPOI3M]
* ^TFPOI3M is unusually high. Please verify.
(Suppress) [goto MFPOI3M]
(Close) [goto TFPOI3M for new entry]
(Goto) [goto TFPOI3M for new entry]
Question ID: FIJ.026_00.000

Instrument Variable Name: MFPOI3M
Question Text: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Unknown
Universe Text: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
Skip Instructions:
(1) [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else goto MTFPOI3M]
(2,DK,R) [goto TFPOI3M for next person with reported poisoning; if no more persons with a poisoning, goto
next section]

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2003
Survey form view entire document:  text  image

FIJ.010

DURING THE PAST THREE MONTHS, that is since {91 days before today date}, {were/was} {you/anyone in the family} injured or poisoned seriously enough that {you/they} got medical advice or treatment?
FINJ3M
(1) Yes (FIJ.020)
(2) No (FAU.010)
(7) Refused (FAU.010)
(9) Don't know (FAU.010)

FIJ.020

FR: ASK OR VERIFY. ENTER APPLICABLE LINE NUMBER(S). ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.

Who was this? (Anyone else?)
PINJ3M
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

FIJ.030

How many different times in the PAST THREE MONTHS {were/was} {you/subject name} injured or poisoned seriously enough to seek medical advice or treatment?

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2002
Survey form view entire document:  text  image

FIJ.010

DURING THE PAST THREE MONTHS, that is since {91 days before today date}, {were/was} {you/anyone in the family} injured or poisoned seriously enough that {you/they} got medical advice or treatment?
FINJ3M
(1) Yes (FIJ.020)
(2) No (FAU.010)
(7) Refused (FAU.010)
(9) Don't know (FAU.010)

FIJ.020

FR: ASK OR VERIFY. ENTER APPLICABLE LINE NUMBER(S). ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.

Who was this? (Anyone else?)
PINJ3M
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

FIJ.030

How many different times in the PAST THREE MONTHS {were/was} {you/subject name} injured or poisoned seriously enough to seek medical advice or treatment?
IJNO3M_T
Times Injured (01-94):

[If IJNO3M_T gt 5]

FR: DO NOT READ.

{IJNO3M_T} is an unusually large number. Verify entry. DO NOT PROBE. Make corrections if necessary.
IJNO3M_M
(1) Make correction
(2) Proceed

FIJ.040

[If IJNO3M_T = 1]

Now I'm going to ask a few questions about {your/subject name}'s most recent injury/poisoning.
When did it happen?

FR: SHOW CALENDAR CARD - PROBE FOR SPECIFIC DATE
IJDATE_M MONTH:
IJDATE_D DAY:
IJDATE_Y YEAR:
[If IJNO3M_T gt 1 and the other injuries are asked]

We just talked about {your/subject name}'s injury/poisoning on {recent injury date}. When did {your/subject name}'s injury BEFORE THAT happen?

FR: SHOW CALENDAR CARD - PROBE FOR SPECIFIC DATE
IJDATE_M MONTH:
IJDATE_D DAY:
IJDATE_Y YEAR:

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2001
Survey form view entire document:  text  image

FIJ.010

DURING THE PAST THREE MONTHS, that is since (91 days before today date), (were/was) (you/anyone in the family) injured or poisoned seriously enough that (you/they) got medical advice or treatment?
FINJ3M
(1) Yes (FIJ.020)
(2) No (FAU.010)
(7) Refused (FAU.010)
(9) Don't know (FAU.010)

FIJ.020

FR: ASK OR VERIFY. ENTER APPLICABLE LINE NUMBER(S).
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.

Who was this? (Anyone else?)
PINJ3MR
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

FIJ.030

How many different times in the PAST THREE MONTHS (were/was) (you/subject name) injured or poisoned seriously enough to seek medical advice or treatment?
IJNO3M_T Times Injured (01-94): _________

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2000
Survey form view entire document:  text  image

FIJ.010

DURING THE PAST THREE MONTHS, that is since (91 days before today date), (were/was) (you/anyone in the family) injured or poisoned seriously enough that (you/they) got medical advice or treatment?
FINJ3M
(1) Yes (FIJ.020)
(2) No (FAU.010)
(7) Refused (FAU.010)
(9) Don't know (FAU.010)

FIJ.020

FR: ASK OR VERIFY. ENTER APPLICABLE LINE NUMBER(S).
ENTER (N) FOR NO MORE AFTER THE LAST NUMBER.

Who was this? (Anyone else?)
PINJ3MR
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]

FIJ.030

How many different times in the PAST THREE MONTHS (were/was) (you/subject name) injured or poisoned seriously enough to seek medical advice or treatment?
IJNO3M_T Times Injured (01-94): _________

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1999

No questionnaire text is available for this sample.


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1998

No questionnaire text is available for this sample.


top
1997
Survey form view entire document:  text  image

FIJ.030

How many different times in the past three months {were/was} {you/subject's name} injured seriously enough to seek medical advice or treatment?
IJNO3M Times Injured (01-94): _____________