Survey Text

Survey form view entire document:  text  image
2a. Have any adults in the family ever received a pneumonia vaccination?
Read if necessary: This shot first became available in 1979, and is given only once in a person's lifetime.

[] Yes
[] No (3)
[] DK (3)

b. Who was this?
Mark "Pneumonia vaccination" box in person's column.

1[] Pneumonia vaccination

c. Anyone else?

[] Yes (Reask 2b and c)
[] No

Ask for each person with "Pneumonia vaccination" in 2b.
d. Did -- receive the pneumonia shot within the past 12 months?

1[] Yes
2[] No
9[] DK