Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of
difficulty, or you cannot do this at all?

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction:
If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses";
else fill "seeing"

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Sample Adults 18+

1-4,RF,DK [goto next section]

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction:
If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses";
else fill "seeing"

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Sample Adults 18+

1-4,RF,DK [goto next section]

^GLASSCONTACT ^SCNAME have difficulty seeing? Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?

Description: When wearing glasses ^CONTACTS does/Does
Instruction:
If WEARGLSS_C=1 fill "When wearing glasses ^CONTACTS does" else if WEARGLSS_C ne 1 "Does"

Description: or contact lenses
Instruction:
If AGE=5-17 fill "or contact lenses"

Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1

Description: He/She/They
Instruction:
If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C =blank: fill "They"

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Sample Children 2-17

1-4,RF,DK [goto next section]

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of
difficulty, or you cannot do this at all?

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction:
If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses";
else fill "seeing"

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Sample Adults 18+

1-4,RF,DK [goto next section]

^GLASSCONTACT ^SCNAME have difficulty seeing? Would you say ^SCNAME has: no difficulty, some
difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?

Description: When wearing glasses ^CONTACTS does/Does
Instruction:
If WEARGLSS_C=1 fill "When wearing glasses ^CONTACTS does" else if WEARGLSS_C ne 1 "Does"

Description: or contact lenses
Instruction:
If AGE=5-17 fill "or contact lenses"

Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1

Description: He/She/They
Instruction:
If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C =blank: fill "They"

1 - No difficulty
2 - Some difficulty
3 - A lot of difficulty
4 - Cannot do at all
7 - Refused
9 - Don't Know

Sample Children 2-17

1-4,RF,DK [goto next section]

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

^AGLASSCNTS

Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction: If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses"; else fill "seeing"

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know

Sample Adults 18+

1-4,RF,DK = [goto next section]

^GLASSCONTACT ^SCNAME have difficulty seeing? Would you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?

Description When wearing glasses ^CONTACTS does/Does
Instruction If WEARGLSS_C=1 fill "When wearing glasses ^CONTACTS does" else if WEARGLSS_C ne 1 "Does"

Description or contact lenses
Instruction If AGE=5-17 fill "or contact lenses"

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

Description He/She/They
Instruction If SEX_FINAL_C=1 fill "He" else if SEX_FINAL_C=2 fill "She" elseif SEX_FINAL_C =blank: fill "They"

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know

Sample Children 2-17

1-4,RF,DK = [goto next section]

Instrument Variable Name: VIS_SS
Questionnaire File Name: Sample Adult
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+
Skip Instructions:

(1,2,R,D) [goto HEAR_1]

Instrument Variable Name: VIS_SS
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB)
Skip Instructions: (1-4,R,D)[go to HEAR_1]

Instrument Variable Name: VIS_SS
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB)
Skip Instructions: (1-4,R,D)[go to HEAR_1]

Instrument Variable Name: VIS_SS
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB)
Skip Instructions: (1-4,R,D)[go to HEAR_1]

Instrument Variable Name: VIS_SS
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB)
Skip Instructions: (1-4,R,D)[go to HEAR_1]

Instrument Variable Name: VIS_SS
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB)
Skip Instructions: (1-4,R,D)[go to HEAR_1]

Instrument Variable Name: VIS_SS
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB)
Skip Instructions: (1-4,R,D)[go to HEAR_1]

Instrument Variable Name: VIS_SS
Question Text:

Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/unable to do
7 Refused
9 Don't know

Universe Text: Sample adults 18+ who were asked the family disability questions (FDB)
Skip Instructions: (1-4,R,D)[go to HEAR_1]

Instrument Variable Name: VIS_SS
QuestionText:

These next questions are new and we are testing them. Some may sound similar to questions you already answered.
Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section
SkipInstructions:

(1-3,R,D)[goto VIS_1]
(4) [goto HEAR_SS]