Not Assigned Family Identification

Page 1 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.100_00.000 Instrument Variable Name: HHCHANGE QuestionnaireFileName: Family

QuestionText: I have recorded that [your name is {fill fullname}, you are /fill ALIAS is] [fill sex], [fill age] years old, born on [fill

birthdate]. [His/Her] national origin is [fill Hispanic origin], and [his/her] race is [fill race]:

Is this information correct?

1 Yes, this information is correct

2 No, correction(s) needed/more corrections needed

UniverseText: All nondeleted family members

SkipInstructions: <1> if no additional PX remain

if SCREENIN = 0 and I_SCRN_STATUS = S [goto EXIT(HHC)]

else [goto FIDCC13]

<2> [goto CWHAT2]

Question ID: FID.110_00.000 Instrument Variable Name: CWHAT2 QuestionnaireFileName: Family

QuestionText: * Change(s) needed for [ALIAS].

* Enter each number that applies. If a wrong choice, type that choice again.

1 Name

2 Age or DOB

3 Sex

4 National origin

5 Race

UniverseText: HHCHANGE = 2 (No, not correct)

SkipInstructions: <1> [goto CHG_NAME_FNAME]

<2> [goto CHG_AGEDOB_1]

<3> [goto CHG_SEX]

<4> [goto CHG_NATOR]

<5> [goto CHG_RACE]

Question ID: FID.245_00.000 Instrument Variable Name: HHCHANGE_1 QuestionnaireFileName: Family

QuestionText: I have recorded that {your name is/ALIAS is} {fill full name}, age is {fill age}, date of birth is {fill birthdate}, {his/her}

national origin is {fill Hispanic origin}, and {his/her} {fill race} is:

Is this information correct?

UniverseText: All nondeleted family members with a change made to their demographic information

SkipInstructions: <1> if no additional PX remain

if SCREENIN = 0 and I_SCRN_STATUS = S, GOTO EXIT(HHC)

else GOTO FIDCC13

<2> GOTO ERR_HHCHANGE_1

Page 2 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.250_00.000 Instrument Variable Name: MARITAL QuestionnaireFileName: Family

QuestionText: * ASK OR VERIFY

[fill: Are you/Is ALIAS] now married, widowed, divorced, separated, never married, or living with a partner?

1 Married

2 Widowed

3 Divorced

4 Separated

5 Never Married

6 Living with partner

7 Refused

9 Don't know

UniverseText: All persons, 14 and older, who don't have a marital status yet

SkipInstructions: <1> [goto SPFLAG]

<2-5, R, D> [goto FIDCCI3]

<6> if LINTAL[FAMINT] = 1 [goto FIDCCI4]

else [goto COHAB1]

Question ID: FID.250_03.000 Instrument Variable Name: MARVER_FLG QuestionnaireFileName: Family

QuestionText:

1 Yes

2 No

7 Refused

9 Don't know

UniverseText:

SkipInstructions:

Question ID: FID.260_00.000 Instrument Variable Name: SPOUS QuestionnaireFileName: Family

QuestionText: * ASK OR VERIFY

Is [fill: your/ALIAS's] spouse living in the household?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: A potential spouse lives in the unit.

SkipInstructions: <1> If SPOUS2[PX] = null [goto SPOUS2]

else [goto FIDCCI3]

<2,R,D> [goto FIDCCI3]

Page 3 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.270_00.000 Instrument Variable Name: SPOUS2 QuestionnaireFileName: Family

QuestionText: * Probe as necessary and enter the line number of the spouse.

[Display all possible spouse candidates]

01-25 Person # of spouse

UniverseText: Person has an unidentified spouse in the household.

SkipInstructions: Do not allow line number of the subject to be entered. If so [goto ERR_SPOUS2]

<1-25,R,D> [goto FIDCCI3]

Question ID: FID.280_00.000 Instrument Variable Name: COHAB1 QuestionnaireFileName: Family

QuestionText: [fill: Have you/Has ALIAS] ever been married?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Marital status is "living with a partner."

SkipInstructions: <1> [goto COHAB2]

<2,R,D> if COHAB3[PX] = null [goto COHAB3]

else [goto FIDCCI3]

Question ID: FID.290_00.000 Instrument Variable Name: COHAB2 QuestionnaireFileName: Family

QuestionText: What is [fill: your/ALIAS's] current legal marital status?

1 Married

2 Widowed

3 Divorced

4 Separated

7 Refused

9 Don't know

UniverseText: Person has been married.

SkipInstructions: <1-4,R,D> If COHAB3[PX] = null [goto COHAB3]

else [goto FIDCCI3]

Question ID: FID.300_00.000 Instrument Variable Name: COHAB3 QuestionnaireFileName: Family

QuestionText: * Probe as necessary and enter the line number of the cohabiting partner.

[Display all possible cohabitation candidates]

01-25 Person number

UniverseText: Co-habitating partner has yet to be identified.

SkipInstructions: If line number of the subject is entered [goto ERR_COHAB3]

<1-25,R,D> [goto FIDCCI3]

Page 4 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.322_00.000 Instrument Variable Name: DEGREE4 QuestionnaireFileName: Family

QuestionText: I noted that [father's fullname] is the father of [child's fullname]. Is [child's fullname] his biological, adoptive, step, foster, or

[fill: son/daughter] in law?

1 Biological

2 Adoptive

3 Step

4 Foster

5 -in-law

7 Refused

9 Don't know

UniverseText: When the reference person is the person in question's parent.

SkipInstructions: <1> if AGEDIFF <12 [goto ERR_DEGREE4]

if ERR_DEGREE4 = 1 [goto FIDCCI4B]

else reset DEGREE4 [goto DEGREE4] endif

else [goto FIDCCI4B]

<2-5,R,D> [goto FIDCCI4B]

Question ID: FID.324_00.000 Instrument Variable Name: DEGREE5 QuestionnaireFileName: Family

QuestionText: I noted that [mother's fullname] is the mother of [child's fullname]. Is [child's fullname] her biological, adoptive, step, foster,

or [fill: son/daughter] in law?

1 Biological

2 Adoptive

3 Step

4 Foster

5 -in-law

7 Refused

9 Don't know

UniverseText: When the reference person is the person in question's parent.

SkipInstructions: <1> if AGEDIFF <12 [goto ERR_DEGREE5]

if yes, continue the interview [goto FIDCCI4B]

else, reset DEGREE5 [goto DEGREE5] endif

else [goto FIDCCI4B]

<2-5,R,D> [goto FIDCCI4B]

Page 5 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.326_00.000 Instrument Variable Name: MOTHER QuestionnaireFileName: Family

QuestionText: * Ask or verify

Is [fill: your/ALIAS's] mother a household member? (Include biological (natural), adoptive, step, or foster mother or

mother-in-law)

* Enter the line number of the mother or mother-in-law.

If the mother or mother-in-law is not a household member, enter "0".

If the person has no parents present but has a legal guardian, enter "96".

* Choose mother over mother-in-law if both are present.

00 Mother not a household member

01-25 Person number of mother

96 Has legal guardian

97 Refused

99 Don't know

UniverseText: Potential mother in the Family, mother not already identified

SkipInstructions: <01-25> [goto MOTHERCK_A]

<0,R,D> [goto FIDCCI5]

<96> [goto GUARD]

Question ID: FID.330_01.000 Instrument Variable Name: MOTHERCK_A QuestionnaireFileName: Family

QuestionText: [fill1: Are you/Is ALIAS] [fill2: ALIAS's/your] biological (natural), adoptive, step, or foster mother or mother-in-law?

1 Biological mother

2 Adoptive mother

3 Step mother

4 Foster mother

5 Mother-in-law

7 Refused

9 Don't know

UniverseText: Mother is in the immediate family.

SkipInstructions: <1> If AGEDIFF <12 [goto ERR_MOTHERCK_A]

if <1> [goto FIDCCI5]

elseif <2> [goto MOTHER]

elseif <3>, reset MOTHERCK_A [goto MOTHERCK_A]

else [goto FIDCCI5]

<2-5,R,D> [goto FIDCCI5]

Page 6 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.330_02.000 Instrument Variable Name: MOTHERCK_A QuestionnaireFileName: Family

QuestionText: [fill1: Are you/Is ALIAS] [fill2: ALIAS's/your] biological (natural), adoptive, step, or foster mother or mother-in-law?

UniverseText: Mother is in the immediate family.

SkipInstructions: <1> If AGEDIFF <12 [goto ERR_MOTHERCK_A]

if <1> [goto FIDCCI5]

elseif <2> [goto MOTHER]

elseif <3>, reset MOTHERCK_A [goto MOTHERCK_A]

else [goto FIDCCI5]

<2-5,R,D> [goto FIDCCI5]

Question ID: FID.340_00.000 Instrument Variable Name: FATHER QuestionnaireFileName: Family

QuestionText: * Ask or verify

Is [fill: your/ALIAS's] father a household member? (Include biological (natural), adoptive, step, or foster father or father-in-

law).

* Enter the line number of the father or father-in-law.

* If the father is not a household member, enter '0'.

* If the person has no parents present but has a legal guardian, enter '96'.

* Choose father over father-in-law if both are present.

00 Father not in household

01-25 Person # of father

96 Has legal guardian

97 Refused

99 Don't know

UniverseText: Potential Father in Family, not already identified

SkipInstructions: <1-25> [goto FATHERCK_A]

<0,R,D> [goto FIDCCI4]

<96> [goto GUARD]

Page 7 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.350_01.000 Instrument Variable Name: FATHERCK_A QuestionnaireFileName: Family

QuestionText: [fill1: Are you/Is ALIAS] [fill2: ALIAS's/your] biological (natural), adoptive, step, or foster father or father-in-law?

1 Biological father

2 Adoptive father

3 Step father

4 Foster father

5 Father-in-law

7 Refused

9 Don’t know

UniverseText: Father has been identified

SkipInstructions: <1> If AGEDIFF <12 [goto ERR_FATHERCK_A]

if ERRFATHERCK_A = <1> [goto FIDCCI4]

elseif <2> [goto FATHER]

elseif <3> reset FATHERCK_A

[goto FATHERCK_A] endif

else [goto FIDCCI4]

<2-5,R,D> [goto FIDCCI4]

Question ID: FID.350_02.000 Instrument Variable Name: FATHERCK_A QuestionnaireFileName: Family

QuestionText: [fill1: Are you/Is ALIAS] [fill2: ALIAS's/your] biological (natural), adoptive, step, or foster father or father-in-law?

UniverseText: Father has been identified

SkipInstructions: <1> If AGEDIFF <12 [goto ERR_FATHERCK_A]

if ERRFATHERCK_A = <1> [goto FIDCCI4]

elseif <2> [goto FATHER]

elseif <3> reset FATHERCK_A

[goto FATHERCK_A] endif

else [goto FIDCCI4]

<2-5,R,D> [goto FIDCCI4]

Question ID: FID.360_01.000 Instrument Variable Name: GUARD QuestionnaireFileName: Family

QuestionText: Who is [fill: your/ALIAS's ] legal guardian?

* Enter the line number of [fill1: your/ALIAS's] guardian.

* If the guardian is not a household member, enter '0'.

00 Guardian not a household member

01-25 Person # of guardian

97 Refused

99 Don't know

UniverseText: Child identified as a guard at mother or father or, at the FIDCCI5 procedure, it's determined that the child (AGE<14)

has no mother or father in the family.

SkipInstructions: <0-25,R,D> [goto FIDCCI4]

Page 8 of 9

2007 NHIS Questionnaire - Family

Family Identification

Document Version Date: 12-Jul-06

Question ID: FID.380_00.000 Instrument Variable Name: KNOW2 QuestionnaireFileName: Family

QuestionText: * Verify or ask

Who in the family would you say knows about the health of all the family members?

[Display all family members who not deleted and > 17 or emancipated minors.]

* Mark all that apply, separate with commas.

1 Yes, knows family members' health

2 No, does not know family member's health

7 Refused

9 Don't Know

UniverseText: More than one adult

SkipInstructions: <1-25,R,D>

if SCSEL = 0 [goto FINTRO2]

else [goto KNOWSC2]

Question ID: FID.390_03.000 Instrument Variable Name: FINTRO2 QuestionnaireFileName: Family

QuestionText: * Enter line number(s) of family members listed that are currently present. Enter up to 10 numbers, separate with commas.

[Display all family members who are not deleted and >17 or emancipated minors]

* If any persons listed are not present, say:

We would like to have all adult family members who are at home take part in the interview. Are (READ NAMES) at home

now?

* If yes, ask: Could they join us?

* If nobody is presently available, enter "96" to proceed to a callback screen.

1 Present

2 Not present

UniverseText: All nondeleted persons >17 or emancipated minors

SkipInstructions: <96> [goto FCALLBK1]

if only one PX selected [goto HLTH_BEG]

else [goto FAMRESP]

Question ID: FID.390_04.000 Instrument Variable Name: FAMRESP QuestionnaireFileName: Family

QuestionText: * Ask if necessary: With whom am I speaking?

* Enter the line number of the person you consider to be the main respondent for this family's health questions.

01-25 Person # of Family Respondent

UniverseText: More than 1 adult present.

SkipInstructions: goto HLTH_BEG