In the 2000 survey instrument, interviewers were instructed to show respondents a flashcard listing the acceptable responses, which included, "Part of a routine physical exam/screening test," "Because of a specific skin problem," "Followup to a previous skin problem," and "Family history." The response choices in 1992 were very similar, but presented in a different order on the card shown to respondents. In the 2005 and forward survey forms, interviewers were instructed to read the acceptable responses to respondents; acceptable responses included "Part of a routine exam," "Because of a problem," "Other reason." In 2005 and forward, no flashcard was used

According to the 2000 and 2005 Field Representative's Manuals, a "skin exam" is a "thorough examination of the skin done by a doctor to detect precancerous or cancerous lesions of the skin."

The 2000 Manual provided the following definitions, which are pertinent to the response categories available for that year:

• Specific problem: A problem that the respondent was reporting to a physician for the first time, and was the reason for undergoing the screening exam.

• Previous problem: A problem that had already been reported to a doctor, for which this was a follow-up visit.

• Routine physical exam: A regular physical examination (such as an annual exam) that was not scheduled because of a specific problem.

• Family history: When family member of the respondent have a history of having had that specific cancer, including parents, siblings, children and other relatives related by blood.

The 2005 and forward Manual provided a similarly worded definition for routine physical exam.

The Manual instructed interviewers that if the respondent "had a problem but is not sure which reason to pick" to record the first reason respondents give, as their "initial thought is probably the best option." The Manual continued with, "The main purpose of this question is to distinguish between a regularly scheduled exam . . . and an exam . . . scheduled specifically because of a problem, whether new or already known."

For more information, please see SKNCANX.