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
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a. Mark first appropriate box

1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent

_______
Person number(s) of respondent(s)

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1995
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a. Mark first appropriate box

1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent

_______
Person number(s) of respondent(s)

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1994
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a. Mark first appropriate box

1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent

_______
Person number(s) of respondent(s)

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1993
Survey form view entire document:  text  image
a. Mark first appropriate box

1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent

_______
Person number(s) of respondent(s)

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1992
Survey form view entire document:  text  image
a. Mark first appropriate box

1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent

_______
Person number(s) of respondent(s)

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1991
Survey form view entire document:  text  image
a. Mark first appropriate box

1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent

_______
Person number(s) of respondent(s)

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1990
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1989
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1988
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1987
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1986
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1985
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1984
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1983
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1982
Survey form view entire document:  text  image
a. Mark first appropriate box.

0[] Under 17
1[] Present for all questions
2[] Present for some questions
3[] Not present

b. Enter person number of respondent.

Person number(s) of respondent(s) ____

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1981
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R
For persons 17 years or over, show who responded for (or was present during the asking of) Questions 4-34.
If persons responded for self, show whether entirely or partly. For persons under 17, show who responded for them.

1[] Responded for self-entirely
2[] Responded for self-partly
Person___was respondent

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1980
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R
For persons 17 years or over, show who responded for (or was present during the asking of) Questions 4-34.
If persons responded for self, show whether entirely or partly. For persons under 17, show who responded for them.

1[] Responded for self-entirely
2[] Responded for self-partly
Person___was respondent

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1979
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R
For persons 17 years or over, show who responded for (or was present during the asking of) Questions 4-34.
If persons responded for self, show whether entirely or partly. For persons under 17, show who responded for them.

1[] Responded for self-entirely
2[] Responded for self-partly
Person___was respondent

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1978
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R
For persons 17 years or over, show who responded for (or was present during the asking of) Questions 4-34.
If persons responded for self, show whether entirely or partly. For persons under 17, show who responded for them.

1[] Responded for self-entirely
2[] Responded for self-partly
Person___was respondent

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1977
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R
For persons 17 years or over, show who responded for (or was present during the asking of) Questions 4-34.
If persons responded for self, show whether entirely or partly. For persons under 17, show who responded for them.

1[] Responded for self-entirely
2[] Responded for self-partly
Person___was respondent

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1976
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Q.'s 4-33

For persons 17+, show who responded for (or was present during the asking of) Q.'s 4-33.

If persons responded for self, show whether entirely or partly. For persons under 17 show who responded for them.

1 [] Responded for self--entirely
2 [] Responded for self--partly
Person ____ was respondent

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1975
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For persons 17 years old or over, show who responded for (or was present during the asking of) Q.'s 4-32.

If persons responded for self, show whether entirely or partly. For persons under 17 show who responded for them.

1 [] Responded for self-entirely
2 [] Responded for self-partly
Person ____ was respondent

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1974
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For persons 17 years old or over, show who responded for (or was present during the asking of) Q.'s 4-33.

If persons responded for self, show whether entirely or partly. For persons under 17 show who responded for them.

1 [] Responded for self-entirely
2 [] Responded for self-partly
Person ____ was respondent

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1973
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For persons 17 years old or over, show who responded for (or was present during the asking of) Q.'s 4-32.

If persons responded for self, show whether entirely or partly. For persons under 17 show who responded for them.

1 [] Responded for self-entirely
2 [] Responded for self-partly
Person ____ was respondent

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1972
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For persons 17 years old or over, show who responded for (or was present during the asking of) Q.'s 5-40.

If persons responded for self, show whether entirely or partly. For persons under 17 show who responded for them.
1 [] Responded for self-entirely
2 [] Responded for self-partly
Person ____ was respondent


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1971

No questionnaire text is available for this sample.


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1970
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Q.'s 5-30

For persons 19 years old or over, show who responded for (or was present during the asking of) Q.'s 5-30. If persons responded for self, show whether entirely or partly. For persons under 19 show who responded for them.
1 [] Responded for self-entirely
2 [] Responded for self-partly
Person ____ was respondent


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1969
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For persons 19 years old or over, show who responded for (or was present during the asking of) Q.'s 5-37. If persons responded for self, show whether entirely or partly. For persons under 19 show who responded for them. If eligible respondent is "at home" but did not respond for self, enter the reason in a footnote.

1 [] Responded for self-entirely
2 [] Responded for self-partly
Person _ _ was resp.

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1968
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11. During the past 2 weeks (the 2 weeks outlined in red on that calendar) how many times did -- see a medical doctor? (Do not count the doctors he saw while in the hospital.)
[] None (NP)
Number of visits ____ (NP)


(Beside those visits)
12a. During that 2-week period did anyone in the family go to a doctor's office or clinic for shots, X-rays, tests, or examinations?
[] Yes (12b and c)
[] No (13)


b. Who was this? -Mark "Doctor visit" box in person's column.
[] Doctor visit


c. Anyone else?
[] Yes (12b and c)
[] No (12d)


If "Doctor visit," ask:
d. How many times did -- visit the doctor during that period?
Number of visits ____ (NP)


13a. During that period, did anyone in the family get any medical advice from a doctor over the telephone?
[] Yes (13b and c)
[] No (14)


b. Who was the phone call about? -Mark "Phone call" box in person's column.
[] Phone call


c. Any calls about anyone else?
[] Yes (13b and c)
[] No (13d)


If "Phone call," ask
d. How many telephone calls were made to get medical advice about --?
Number of calls ____ (NP)


Make entry from Q.'s 11-13 in DV box for all persons.
Ask Q. 14a for each person with visits in DV box.

14a. For what condition did -- see or talk to a doctor during the past 2 weeks?
[] Condition (item C THEN 14d)
[] Pregnancy (14e)
[] No condition (14b)


b. Did -- see or talk to a doctor about any specific condition?
[] Yes (14c)
[] No (NP)


c. What condition?
Enter condition in item C and ask 14d


d. During that period, did -- see or talk to a doctor about any other condition?
[] Yes (14c)
[] No (NP)


e. During the past 2 weeks was -- sick because of her pregnancy?
[] Yes (14f)
[] No (NP)


f. What was the matter? -Anything else?
Enter condition in item C (NP)


INTERVIEWER CHECK ITEM
Check one box OR ask Q.15
Doctor visits in Q.'s 11-13
1[] Doctor visits in Q.'s 11-13 (NP

Hospitalized in past 2 weeks (Q.9) and no visits in Q.'s 11-13
2[] 2-week hospital stay and no doctor visits (Np)

(If neither, ask Q.15)


[p. 50]

15. ABOUT how long has it been since -- saw or talked to a medical doctor?
(Estimate is acceptable. If less than 1 year, check appropriate "Months" box; if more than 1 year, enter number of whole years).
3 [] Past 2 weeks not reported (Q.'s 11 and 14)
4 [] 2 weeks - 6 months
5 [] Over 6 - 12 months
Years ____
0 [] Never


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1967

No questionnaire text is available for this sample.


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1966

No questionnaire text is available for this sample.


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1965

No questionnaire text is available for this sample.


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1964

No questionnaire text is available for this sample.


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1963

No questionnaire text is available for this sample.