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2018

Survey form view entire document: text image

Question ID: NAF.150_01.000

Instrument Variable Name: RPAP1_M1
Question Text:

1 of 2
[Fill1: Earlier you said you had a Pap test.]
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.

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

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-12,D) [goto RPAP1_Y1]
(R) store 'R' in RPAP1_Y1 [goto RPAP21]
(96) store '9996' in RPAP1_Y1 [goto RPAP1N1]

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2015

Survey form view entire document: text image

Question ID: NAF.150_01.000

Instrument Variable Name: RPAP1_M1
Question Text:

1 of 2
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.

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

Universe Text: Female sample adults 18+ who have ever had a Pap test
Skip Instructions:

(1-12,D) [go to RPAP1_Y1]
(R) store "R' in RPAP1_Y1 [go to RPAP21]
(96) store "9996" in RPAP1_Y1 [go to RPAP1N1]

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2013

Survey form view entire document: text image

Question ID: NAF.150_01.000

Instrument Variable Name: RPAP1_M1
Question Text:

1 of 2
[Fill1: Earlier you said you had a Pap test.]
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.

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

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-12,D) [goto RPAP1_Y1]
(R) store 'R' in RPAP1_Y1 [goto RPAP21]
(96) store '9996' in RPAP1_Y1 [goto RPAP1N1]

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2010

Survey form view entire document: text image

Question ID: NAF.150_01.000

Instrument Variable Name: RPAP1_M1
QuestionText:

1 of 2
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.

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

UniverseText: Female sample adults 18+ who have ever had a Pap smear
SkipInstructions:

(1-12,D) [goto RPAP1_Y1] (R) store "R' in RPAP1_Y1 [goto RPAP21] (96) store "9996" in RPAP1_Y1 [goto
RPAP1N1]

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2008

Survey form view entire document: text image

Question ID:NAF.150_01.000

Instrument Variable Name:RPAP1_MT
QuestionText:

1 of 2
When did you have your MOST RECENT Pap smear or Pap test?
* Enter month of last Pap smear or Pap test.
* Enter '96' to go to number and time period format.

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

UniverseText:Female sample adults 18+ who have ever had a Pap smear or Pap test
SkipInstructions:

(1-12,D) goto RPAP1_YR
(R) store "R" in RPAP1_YR and goto RPAP2
(96) store "96" in RPAP1_YR and goto RPAP1N
(13-95) goto ERR_RPAP1_MT

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2005

Survey form view entire document: text image

NAF.150_01.000

Instrument Variable Name: RPAP1_MT
Question Text:

1 of 2
*Enter month of last Pap smear test.
*Enter '96' to go to number and time period format.

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

Universe Text: Female sample adults 18+ who have ever had a Pap smear
Skip Instructions:

(1-12,D) [goto RPAP1_YR] (R) store "R' in RPAP1_YR [goto RPAP2] (96) store "96" in RPAP1_YR [goto RPAP1N]

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2003

Survey form view entire document: text image

NAF.150

When did you have your MOST RECENT Pap smear test?

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

Month:

RPAP1_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(NAF.155/RPAP1_NO)
(97) Don't know (NAF.160)
(99) Refused (NAF.160)
(T) Time Period

Year:

RPAP1_YR

(1950-2004) 1950-2004 (NAF.170)
(9997) Refused (NAF.160)
(9999) Don't know (NAF.160)

NAF.155

When did you have your MOST RECENT Pap smear test?

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

[ ] Number

RPAP1_NO

(01-94) 1-94
(95) 95+
(97) Don't know (NAF.160)
(99) Refused (NAF.160)

[ ] Time Period

RPAP1_TP

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

[Go to NAF.170]

NAF.160

FR: SHOW FLASHCARD A17.

Was it: (READ CATEGORIES BELOW)

Card A17

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

RPAP2CA

(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

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2000

Survey form view entire document: text image

Check item NAFCCI03: Refer to Household Composition, Basic Module.
SEX/HHC.110 and AGE/HHC.120.
(1) Male 18-39 (under 30) (END_NAF)
(2) Male 40+ (Check Item NAFCCI09)
(3) Female (NAF.080)

NAF.150

When did you have your MOST RECENT Pap smear test?

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

Month:

RPAP1_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 (RPAP1_NO)

Year:

RPAP1_YR

(1950-2000) 1950-2000 (NAF.170)
(9997) Don't know (NAF.160)
(9999) Refused (NAF.160)

When did you have your MOST RECENT Pap smear test?

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

[ ] Number

RPAP1_NO

(01-94) 1-94 (RPAP1_TP/NAF.150)
(95) 95+ (RPAP1_TP/NAF.150)
(97) Don't know (NAF.160)
(99) Refused (NAF.160)

[ ] Time Period

RPAP1_TP

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

[Go to NAF.170]

NAF.160

FR: SHOW CARD CAN19

Was it: (READ CATEGORIES BELOW)

Card CAN19

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

RPAPCA

(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

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1992

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14a. When did you have your most recent Pap smear test?

Month ____ [if 3 years ago or less (15); if more than 3 years ago (16)]
Year 19____ [if 3 years ago or less (15); if more than 3 years ago (16)]
OR

Number ____

1[] Days ago [if 3 years ago or less (15); if more than 3 years ago (16)]
2[] Weeks ago [if 3 years ago or less (15); if more than 3 years ago (16)]
3[] Months ago [if 3 years ago or less (15); if more than 3 years ago (16)]
4[] Years ago [if 3 years ago or less (15); if more than 3 years ago (16)]

999[] DK (14b)

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1987

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c. When did you have your last Pap smear?

If 3 years ago or less (2)
if More than 3 years ago (4)

Mo. ____
Year 19_ _

OR
_____

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

999[] DK (1d)

Survey Text