top

2003

Survey form view entire document: text image

Question ID:NAF.270_01.000

Instrument Variable Name:RMAM1N
QuestionText:

1 of 2
When did you have your MOST RECENT mammogram?
* Enter number for time since last mammogram.
* Enter '95' for 95 or more.

01-94 1-94
95 95+
97 Refused
99 Don't know

UniverseText:Female sample adults 30+ who selected number and time period format for most recent mammogram from the initial month screen
SkipInstructions:

(1-95) goto RMAM1T
(R,D) store "R","D" in RMAM1T and goto RMAM2

Question ID:NAF.270_02.000

Instrument Variable Name:RMAM1T
QuestionText:

2 of 2
* Enter time period for time since most recent mammogram.

1 Days ago
2 Weeks ago
3 Months ago
4 Years ago
7 Refused
9 Don't know

UniverseText:Female sample adults 30+ who answered 1-95 for number part of this 2 part question
SkipInstructions:

(1-3) goto MAMREAS
(4) if RMAM1N=4
set RMAM2=4
goto MAMREAS
elseif RMAM1N gt 5 and RMAM1N gt AGE
goto ERR_RMAM1T (greater than persons age)
elseif RMAM1N gt 5 and RMAM1N le AGE
set RMAM2=5
goto MAMREAS
elseif RMAM1N=1,2,3,5
goto RMAM2
(R,D) goto RMAM2

top

2000

Survey form view entire document: text image

Check item NAFCCI05: Refer to Household Composition, Basic Module.
AGE/HHC.120 "What is {name/your} age...?"
(1)Female 18-29 (under 30) (Check item NAFCCI07)
(2)Female 30+ (NAF.230)

NAF.260

When did you have your MOST RECENT mammogram?

FR: ENTER "T" TO USE TIME PERIOD FORMAT.

Month:

RMAM1_MT

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Don't know
(99) Refused
(T) Time Period (RMAM1_NO)

Year:

RMAM1_YR

(1950-2000) 1950-2000 (NAF.280)
(9997) Don't know (NAF.270)
(9999) Refused (NAF.270)

When did you have your MOST RECENT mammogram?

FR: IF GREATER THAN "95", ENTER "95".

[ ] Number

RMAM1_NO

(01-94) 1-94 (RMAM1_TP/NAF.260)
(95) 95+ (RMAM1_TP/NAF.260)
(97) Refused (NAF.270)
(99) Don't know (NAF.270)

[ ] Time Period

RMAM1_TP

(1) Days ago
(2) Weeks ago
(3) Months ago
(4) Years ago
(7) Refused
(9) Don't know

[Go to NAF.280]

NAF.270

FR: SHOW CARD CAN24

Was it: (READ CATEGORIES BELOW)

Card CAN24

1. A year ago or less
2. More than 1 year but not more 2 years
3. More than 2 years but not more 3 years
4. More than 3 years but not more 5 years
5. Over 5 years ago

RMAMCA

(1) A year ago or less?
(2) More than 1 year but not more than 2 years?
(3) More than 2 years but not more than 3 years?
(4) More than 3 years but not more than 5 years?
(5) Over 5 years ago?
(7) Refused
(9) Don't know

top

1992

Survey form view entire document: text image

20a. When did you have your (most recent) mammogram?

Month ____ [if 3 years ago or less (21); if more than 3 years ago (24)]
Year 19____ [if 3 years ago or less (21); if more than 3 years ago (24)]
OR

Number ____

1[] Days ago [if 3 years ago or less (21); if more than 3 years ago (24)]
2[] Weeks [if 3 years ago or less (21); if more than 3 years ago (24)]
3[] Months ago [if 3 years ago or less (21); if more than 3 years ago (24)]
4[] Years ago [if 3 years ago or less (21); if more than 3 years ago (24)]

999[] DK (20b)

top

1990

Survey form view entire document: text image

3a. When did you have your (most recent) mammogram?

Number ____

[] Days ago
[] Weeks ago
[] Months ago
[] Years ago

9[] DK

top

1987

Survey form view entire document: text image

c. When did you have your last mammogram?

(If 3 years ago or less (16), If more than 3 years ago (18))

Mo. ____
Year 19_ _

OR
_____
1 [] Days ago
2 [] Weeks ago
3 [] Months ago
4 [] Years ago

999 [] DK

d. Was it within the past year or a year or more ago?

1 [] Within past year (15e)
2 [] 1 year or more (15f)
9 [] DK (18)

e. Was it less than three months, or 3 or more months ago?

1 [] Less than 3 months (16)
2 [] 3 or more months (16)
9 [] DK (16)

f. Was it 3 years ago or less, between three and 5 years, or 5 or more years ago?

1 [] 3 years or less (16)
2 [] Between 3 and 5 years (18)
3 [] 5 or more years (18)
9 [] DK (18)

Survey Text