Survey Text

1996 1990 1984 1978
1995 1989 1983 1977
1994 1988 1982 1976
1993 1987 1981 1975
1992 1986 1980
1991 1985 1979
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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
______

top
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 ____

top
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
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).

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)

top
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.