Survey Text

1996 1987 1978 1969
1995 1986 1977 1968
1994 1985 1976 1967
1993 1984 1975 1966
1992 1983 1974 1965
1991 1982 1973 1964
1990 1981 1972 1963
1989 1980 1971
1988 1979 1970
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1996
Survey form view entire document:  text  image

Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

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1995
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

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1994
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2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

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1993
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

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1992
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

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1991
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

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1990
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

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1989
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

top
1988
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[]No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
no. of work-loss days
_____

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
no. of school-loss days
_____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None
no. of bed days
_____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)
[- missed from work
- missed from school
- (and) in bed],
was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00[] No (D3)

b. (Again, not counting the day(s)
[- missed from work
- missed from school
- (and) in bed,]
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
No. of cut-down days
______

top
1987
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00 [] None (4)

No. of work--loss days ____ (4)

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00 [] None

No. of school--loss days ____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00 [] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00 [] None (6)

No. of bed days ____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)

[missed from work
missed from school,
(and) in bed]

was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00 [] No (D3)

b. (Again, not counting the day(s)

[missed from work
missed from school,
(and) in bed]

During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00 [] None

No. of cut-down days ____

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1986
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00 [] None (4)

No. of work--loss days ____ (4)

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00 [] None

No. of school--loss days ____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00 [] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00 [] None (6)

No. of bed days ____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)

[missed from work
missed from school,
(and) in bed]

was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00 [] No (D3)

b. (Again, not counting the day(s)

[missed from work
missed from school,
(and) in bed]

During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00 [] None

No. of cut-down days ____

top
1985
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00 [] None (4)

No. of work--loss days ____ (4)

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00 [] None

No. of school--loss days ____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00 [] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00 [] None (6)

No. of bed days ____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)

[missed from work
missed from school,
(and) in bed]

was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00 [] No (D3)

b. (Again, not counting the day(s)

[missed from work
missed from school,
(and) in bed]

During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00 [] None

No. of cut-down days ____

top
1984
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00 [] None (4)

No. of work--loss days ____ (4)

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00 [] None

No. of school--loss days ____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00 [] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00 [] None (6)

No. of bed days ____ (D2)

top
1983
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00 [] None (4)

No. of work--loss days ____ (4)

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00 [] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00 [] None

No. of school--loss days ____

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00 [] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00 [] None (6)

No. of bed days ____ (D2)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s)

[missed from work
missed from school,
(and) in bed]

was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes
00 [] No (D3)

b. (Again, not counting the day(s)

[missed from work
missed from school,
(and) in bed]

During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00 [] None

No. of cut-down days ____

top
1982
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Refer to age.

[] Under 5 (4)
[] 5-17 (3)
[] 18 and over (1)

2a. During those 2 weeks, did -- miss any time from a job or business because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from -- job or business because of illness or injury?

00[] None (4)
____ No. of work-loss days (4)

3a. During those 2 weeks, did -- miss any time from school because of illness or injury?

[] Yes
00[] No (4)

b. During that 2-week period, how many days did -- miss more than half of the day from school because of illness or injury?

00[] None
____ No. of school-loss days

4a. During those 2 weeks, did -- stay in bed because of illness or injury?

[] Yes
00[] No (6)

b. During that 2-week period, how many days did -- stay in bed more than half of the day because of illness or injury?

00[] None (6)
____ No. of bed days

Refer to 2b and 3b

[] No days in 2b or 3b (6)
[] 1 or more days in 2b or 3b (5)

Refer to 2b, 3b and 4b.
6a. (Not counting the day(s) missed from work missed from school, (and) in bed ). Was there any (OTHER) time during those 2 weeks that -- cut down on the things -- usually does because of illness or injury?

[] Yes 00
[] No (D3)

b. (Again, not counting the day(s) missed from work, missed from school, (and) in bed)
During that period, how many (OTHER) days did -- cut down for more than half of the day because of illness or injury?

00[] None
____ No. of cut down days

top
1981
Survey form view entire document:  text  image

This survey is being conducted to collect information on the Nation's health. I will ask about visits to doctors and dentists, illness in the family, and other health related items. (Hand calendar)

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday (date) and ending this past Sunday (date).
5a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (5b)
00 [] N If age: 17+ (6) 6-17 (7) Under 6 (9)

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

____ Days If age: 17+ (6) 6-17 (7) Under 6 (9)

6. During those 2 weeks, how many days did illness or injury keep -- from work?
(For females): not counting work around the house?

____ WL days (8)
00[] None (9)

7. During those 2 weeks, how many days did illness or injury keep -- from school?

____ SL days
00[] None (9)

top
1980
Survey form view entire document:  text  image

This survey is being conducted to collect information on the Nation's health. I will ask about visits to doctors and dentists, illness in the family, and other health related items. (Hand calendar)

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday (date) and ending this past Sunday (date).
5a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (5b)
00 [] N If age: 17+ (6) 6-17 (7) Under 6 (9)

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

____ Days If age: 17+ (6) 6-17 (7) Under 6 (9)

6. During those 2 weeks, how many days did illness or injury keep -- from work?
(For females): not counting work around the house?

____ WL days (8)
00[] None (9)

7. During those 2 weeks, how many days did illness or injury keep -- from school?

____ SL days
00[] None (9)

top
1979
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The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday, ____ (date), and ending this past Sunday, ____(date).

5 a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (5b)
00 [] N (If age: 17+ (6), 6-16 (7), Under 6 (9))

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

____ Days

If age:

[] 17+ (6)
[] 6-16 (7)
[] Under 6 (9)

6. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL ____days (8)
00 [] None (9)

7. During those 2 weeks, how many days did illness or injury keep -- from school?

SL ____days
00 [] None (9)

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1978
Survey form view entire document:  text  image

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar,
beginning Monday, (date), and ending this past Sunday, (date).

5a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (5b)
00 [] N (If age: 17+ (6), 6-16 (7), Under 6 (9))

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

Days ____ (If age: 17+ (6), 6-16 (7), Under 6 (9))

6. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL ____ days (8)
00 [] None (9)

7. During those 2 weeks, how many days did illness or injury keep -- from school?

SL days ____
00 [] None (9)

If one or more days in 5b, ask 8; otherwise go to 9.

8. On how many of these -- days lost from

[work
school]

did -- stay in bed all or most of the day?

Days ____
00 [] None

9a. NOT COUNTING the day(s)

[in bed
lost from work
lost from school]

Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?

1 [] Y
2 [] N (10)

b. Again, not counting the day(s)

[in bed
lost from work
lost from school]

During that period, how many (other) days did he cut down for as much as a day?

Days ____
00 [] None

top
1977
Survey form view entire document:  text  image

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar,
beginning Monday, (date), and ending this past Sunday, (date).

5a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (5b)
00 [] N (If age: 17+ (6), 6-16 (7), Under 6 (9))

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

Days ____ (If age: 17+ (6), 6-16 (7), Under 6 (9))

6. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL ____ days (8)
00 [] None (9)

7. During those 2 weeks, how many days did illness or injury keep -- from school?

SL days ____
00 [] None (9)

If one or more days in 5b, ask 8; otherwise go to 9.

8. On how many of these -- days lost from

[work
school]

did -- stay in bed all or most of the day?

Days ____
00 [] None

9a. NOT COUNTING the day(s)

[in bed
lost from work
lost from school]

Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?

1 [] Y
2 [] N (10)

b. Again, not counting the day(s)

[in bed
lost from work
lost from school]

During that period, how many (other) days did he cut down for as much as a day?

Days ____
00 [] None

top
1976
Survey form view entire document:  text  image

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar,
beginning Monday, (date), and ending this past Sunday, (date).

5a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (5b)
00 [] N (If age: 17+ (6), 6-16 (7), Under 6 (9))

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

Days ____ (If age: 17+ (6), 6-16 (7), Under 6 (9))

6. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL ____ days (8)
00 [] None (9)

7. During those 2 weeks, how many days did illness or injury keep -- from school?

SL days ____
00 [] None (9)

If one or more days in 5b, ask 8; otherwise go to 9.

8. On how many of these -- days lost from

[work
school]

did -- stay in bed all or most of the day?

Days ____
00 [] None

9a. NOT COUNTING the day(s)

[in bed
lost from work
lost from school]

Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?

1 [] Y
2 [] N (10)

b. Again, not counting the day(s)

[in bed
lost from work
lost from school]

During that period, how many (other) days did he cut down for as much as a day?

Days ____
00 [] None

top
1975

No questionnaire text is available for this sample.


top
1974
Survey form view entire document:  text  image


This survey is being conducted to collect information on the Nation's health. I will ask about visits to doctors and dentists, illness in the family, and other health related items. (HAND CALENDAR)

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday, (date), and ending this past Sunday, (date).

5a. During those 2 weeks, did -- stay in bed because of any illness or injury?
[] Y (5b)
[] 00 N (If age: 17+ (5c,) 6-16 (5d), Under 6 (5f))


b. During that 2-week period, how many days did -- stay in bed all or most of the day?
Days ____ (If age: 17+ (5c,) 6-16 (5d), Under 6 (5f))


c. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL days ____ (5e)
00 [] None (5f)


d. During those 2 weeks, how many days did illness or injury keep -- from school?
SL days ____ (5e)
00 [] None (5f)


IF BOTH bed days AND work or school loss days, ask:
e. On how many of these -- days lost from work/school did -- stay in bed all or most of the day?
Days ____ (5f)
00 [] None (5f)


f. NOT COUNTING the day(s)

in bed
lost from work
lost from school


Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?
1 [] Y (5g)
2 [] N (6)


g. (Again, not counting the day(s)
in bed
lost from work
lost from school

During that period, how many days did he cut down for as much as a day?
Days ____ (6a)
00 [] None (6)



top
1973
Survey form view entire document:  text  image

This survey is being conducted to collect information on the Nation's health. I will ask about visits to doctors and dentists, illness in the family, and other health related items. (HAND CALENDAR)

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday, (date), and ending this past Sunday, (date).

4a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (4b)
00 [] N

If age: 17+ (5), 6-16 (6), Under 6 (8)

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

Days ____

If age: 17+ (5), 6-16 (6), Under 6 (8)

5. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL days ____ (7)
00 [] None (8)

6. During those 2 weeks, how many days did illness or injury keep -- from school?

SL days ____
00 [] None (8)

If NO days in Q. 4b, go to Q. 8

7. On how many of these -- days lost from

[work
school]

did -- stay in bed all or most of the day?
_____ Days
00 [] None

8a. NOT COUNTING the day(s)

[in bed
lost from work
lost from school]

Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?

1 [] Y
2 [] N (9)

b. Again, not counting the day(s)

[in bed
lost from work
lost from school]

During that period, how many days did he cut down for as much as a day?

Days ____
00 [] None

top
1972
Survey form view entire document:  text  image

This survey is being conducted to collect information on the Nation's health. I will ask about visits to doctors and dentists, illness in the family, and other health related items. (HAND CALENDAR)

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday, (date), and ending this past Sunday, (date).

4a. During those 2 weeks, did -- stay in bed because of any illness or injury?

[] Y (4b)
00 [] N

If age: 17+ (5), 6-16 (6), Under 6 (8)

b. During that 2-week period, how many days did -- stay in bed all or most of the day?

Days ____

If age: 17+ (5), 6-16 (6), Under 6 (8)

5. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL days ____ (7)
00 [] None (8)

6. During those 2 weeks, how many days did illness or injury keep -- from school?

SL days ____
00 [] None (8)

If NO days in Q. 4b, go to Q. 8

7. On how many of these -- days lost from

[work
school]

did -- stay in bed all or most of the day?
_____ Days
00 [] None

8a. NOT COUNTING the day(s)

[in bed
lost from work
lost from school]

Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?

1 [] Y
2 [] N (9)

b. Again, not counting the day(s)

[in bed
lost from work
lost from school]

During that period, how many days did he cut down for as much as a day?

Days ____
00 [] None

top
1971
Survey form view entire document:  text  image


This survey is being conducted to collect information on the Nation's health. I will ask about visits to doctors and dentists, illness in the family, and other health related items. (HAND CALENDAR)

The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday, (date), and ending this past Sunday, (date).

5a. During those 2 weeks, did -- stay in bed because of any illness or injury?
[] Y (5b)
[] 00 N (If age: 17+ (5c,) 6-16 (5d), Under 6 (5f))


b. During that 2-week period, how many days did -- stay in bed all or most of the day?
Days ____ (If age: 17+ (5c,) 6-16 (5d), Under 6 (5f))


c. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL days ____ (5e)
00 [] None (5f)


d. During those 2 weeks, how many days did illness or injury keep -- from school?
SL days ____ (5e)
00 [] None (5f)


IF BOTH bed days AND work or school loss days, ask:
e. On how many of these -- days lost from work/school did -- stay in bed all or most of the day?
Days ____ (5f)
00 [] None (5f)


f. NOT COUNTING the day(s)

in bed
lost from work
lost from school


Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?
1 [] Y (5g)
2 [] N (6)


g. (Again, not counting the day(s)
in bed
lost from work
lost from school

During that period, how many days did he cut down for as much as a day?
Days ____ (6a)
00 [] None (6)



top
1970
Survey form view entire document:  text  image


The next few questions refer to the past 2 weeks, the 2 weeks outlined in red on that calendar, beginning Monday, (date), and ending this past Sunday, (date).

5a. During those 2 weeks, did -- stay in bed because of illness or injury?
[] Y (5b)
[] 00 N


If age:
17+ (5c)
6-16 (5d)
Under 6 (5f)

b. During that 2-week period, how many days did -- stay in bed all or most of the day?
Days ____


If age:
17+ (5c)
6-16 (5d)
Under 6 (5f)

c. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.
WL days ____ (5e)
00 [] None (5f)


d. During those 2 weeks, how many days did illness or injury keep -- from school?
SL ____ days (5e)
00 [] None (5f)


IF BOTH bed days AND work or school loss days, ask:
e. On how many of these -- days lost from
[work
school]
did -- stay in bed all or most of the day?
Days ____ (5f)
00 [] None (5f)


f. (NOT COUNTING the day(s)
[in bed
lost from work
lost from school]
Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?
1 [] Y (5g)
2 [] N (6)


g. (Again, not counting the day(s)
[in bed
lost from work
lost from school]
During that period, how many days did he cut down for as much as a day?
Days ____ (6a)
00 [] None (6)


If 1+ days in Q. 5, ask 6; otherwise go to next person.


top
1969
Survey form view entire document:  text  image



This survey is being conducted to collect information on the Nation's health. I will ask about visits to doctors and dentists, illness in the family, and other health related items. (HAND CALENDAR)

The first few questions refer to the past 2 weeks, that is, the 2 weeks in red on that calendar, beginning Monday, ____, and ending this past Sunday, ____.

5. a. During those 2 weeks, did -- stay in bed because of an illness or injury?
[] Yes (5b)
[] No


(If age: 17+ (5c), 6-16 (5d), Under 6 (5f))

b. During that 2-week period, how many days did -- stay in bed all or most of the day?
Days ____

(If age:17+ (5c), 6-16 (5d),Under 6 (5f))


c. During those 2 weeks, how many days did illness or injury keep -- from work? (For females): not counting work around the house.

WL days ____ (5e)
[] None (5f)


d. During those two weeks, how many days did illness keep -- from school?
SL days ____ (5e)
[] None (5f)


If BOTH bed days AND work or school days, ask:

e. On how many of these -- days lost from work/ school did -- stay in bed all or most of the day?
Days ____ (5f)
[] None (5f)


f. (NOT COUNTING the day(s) in bed
lost from work
lost from school: )

Were there any (other) days during the past 2 weeks that -- cut down on the things he usually does because of illness or injury?

[] Yes (5g)
[] No (6)


g. (Again, not counting day(s)
in bed
lost from work
lost from school)

During that period, how many days did he cut down for as much as a day?
Days ____ (6a)
[] None (6)



top
1968
Survey form view entire document:  text  image



f. (NOT COUNTING the day(s)
[in bed
lost from work
lost from school] )
Were there any (other) days during the past 2 weeks that -- had to cut down on the things he usually does because of his health?
[] Yes (5g)
[] No (6)


g. (Again, NOT COUNTING the day(s)
[in bed
lost from work
lost from school])
How many days did he cut down for as much as a day?
Days ____ (6a)
[] None (6)



top
1967

No questionnaire text is available for this sample.


top
1966

No questionnaire text is available for this sample.


top
1965

No questionnaire text is available for this sample.


top
1964

No questionnaire text is available for this sample.


top
1963

No questionnaire text is available for this sample.