Not Assigned Family Injury and Poisoning

National Health Interview Survey 2007-2009

3-FIJ

NHIS 2007 Family Core Questionnaire

OMB: 0920-0214

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Page 1 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.010_00.000 Instrument Variable Name: FINJ3M QuestionnaireFileName: Family

QuestionText: ? [F1]

The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly,

accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.

DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or

anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4: (random

set of injury examples)]?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]

<2,R,D> [goto FPOI3M]

Question ID: FIJ.012_00.000 Instrument Variable Name: WFINJ3M QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who was this?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one person was injured during the past 3 months

SkipInstructions: <R,D> [goto FPOI3M]

else, goto TFINJ3M

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.014_00.000 Instrument Variable Name: TFINJ3M QuestionnaireFileName: Family

QuestionText: ? [F1]

DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?

01-91 1-91 times

97 Refused

99 Don't know

UniverseText: All persons injured during the past 3 months

SkipInstructions: <1-10,D> [goto MFINJ3M]

<R> [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,

goto FPOI3M]

<11-91> [goto ERR_TFINJ3M]

Page 2 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.016_00.000 Instrument Variable Name: MFINJ3M QuestionnaireFileName: Family

QuestionText: ? [F1]

Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these

injuries/this injury/your injury or injuries/his injury or injuries/her injury or injuries]?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All persons with at least one or an unknown number of injury episodes during the past 3 months

SkipInstructions: <1> [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]

<2,R,D> [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury

episode, goto FPOI3M]

Question ID: FIJ.018_00.000 Instrument Variable Name: MTFINJ3M QuestionnaireFileName: Family

QuestionText: ? [F1]

Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of

those times was the injury serious enough that a medical professional was consulted?

01-91 1-91 times

97 Refused

99 Don't know

UniverseText: All persons who consulted a medical professional for their injury episode(s)

SkipInstructions: <1-91> [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto

ERR2_MTFINJ3M; else, goto IPDATEM]

<R,D> [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury

episode, goto FPOI3M]

Question ID: FIJ.020_00.000 Instrument Variable Name: FPOI3M QuestionnaireFileName: Family

QuestionText: ? [F1]

DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you

or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or

too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in WFPOI3M and goto TFPOI3M; else, goto WFPOI3M]

Page 3 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.022_00.000 Instrument Variable Name: WFPOI3M QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who was this?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one person was poisoned during the past 3 months

SkipInstructions: <R,D> [goto FDMED12M]

else, goto TFPOI3M

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIJ.024_00.000 Instrument Variable Name: TFPOI3M QuestionnaireFileName: Family

QuestionText: ? [F1]

DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include

food poisoning, sun poisoning, or poison ivy rashes.

01-91 1-91 times

97 Refused

99 Don't know

UniverseText: All persons poisoned during the past 3 months

SkipInstructions: <1-10,D> [goto MFPOI3M]

<R> [goto TFPOI3M for next person with a reported poisoning episode; if no more persons with a poisoning

episode, goto FDMED12M]

<11-91> [goto ERR_TFPOI3M]

Question ID: FIJ.026_00.000 Instrument Variable Name: MFPOI3M QuestionnaireFileName: Family

QuestionText: ? [F1]

Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these

poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All persons with at least one or an unknown number of poisoning episodes during the past 3 months

SkipInstructions: <1> [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else, goto MTFPOI3M]

<2,R,D> [goto TFPOI3M for the next person with a reported poisoning episode; if no more persons with a

poisoning episode, goto FDMED12M]

Page 4 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.028_00.000 Instrument Variable Name: MTFPOI3M QuestionnaireFileName: Family

QuestionText: ? [F1]

Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of

those times was the poisoning serious enough that a medical professional was consulted?

01-91 1-91 times

97 Refused

99 Don't know

UniverseText: All persons who consulted a medical professional for their poisoning episode(s)

SkipInstructions: <1-91> [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, if MTFPOI3M gt 3 and TFPOI3M eq D,

goto ERR2_MTFPOI3M; else, goto IPDATEM]

<R,D> [goto TFPOI3M for the next person with a reported poisoning episode; if no more persons with a poisoning

episode, goto FDMED12M]

Page 5 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.050_01.000 Instrument Variable Name: IPDATEM QuestionnaireFileName: Family

QuestionText: 1 of 3

* Please hand the calendar card to the respondent.

{if only 1 injury/poisoning episode for the person}

When did [fill1: your/ALIAS’s] [fill2: injury/poisoning] happen for which a medical professional was consulted?

{first of multiple injury/poisoning episodes for the person}

Now I’m going to ask a few questions about the [fill3: ^MTFINJ3M/^MTFPOI3M] times [fill4: you were/ALIAS was]

[fill5: injured/poisoned] for which a medical professional was consulted. Starting with the most recent time, when did this

[fill2: injury/poisoning] happen?

{second plus of multiple injury/poisoning episodes for the person}

You just told me about [fill1: your/ALIAS’s] [fill6: (month, day of previous event)] [fill7:most recent/second most

recent/third most recent/fourth most recent][fill2: injury/poisoning]. What was the date of the [fill2: injury/poisoning] before

that for which a medical professional was consulted?

* Enter month.

01 January

02 February

03 March

04 April

05 May

06 June

07 July

08 August

09 September

10 October

11 November

12 December

97 Refused

99 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1-12> [goto IPDATED]

<R> [goto IPHOW]

<D> [goto IPDATENO]

Question ID: FIJ.050_02.000 Instrument Variable Name: IPDATED QuestionnaireFileName: Family

QuestionText: 2 of 3

* Enter day.

01-31 1-31

97 Refused

99 Don't know

UniverseText: All injury/poisoning episodes where a valid month of episode was entered

SkipInstructions: <1-31> [goto IPDATEY]

<R> [goto IPHOW]

<D> [goto IPDATEMT]

Page 6 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.050_03.000 Instrument Variable Name: IPDATEY QuestionnaireFileName: Family

QuestionText: 3 of 3

* Enter year.

2003 2003

2004 2004

9997 Refused

9999 Don't know

UniverseText: All injury/poisoning episodes where a valid day of episode was enetered

SkipInstructions: if IPDATEM, IPDATED and IPDATEY result in a future date; goto ERR_IPDATEY; else, if IPDATEM,

IPDATED and IPDATEY result in a date prior to the start date of the 91 day reference period, goto

ERR1_IPDATEY; else, goto IPHOW

Question ID: FIJ.051_01.000 Instrument Variable Name: IPDATENO QuestionnaireFileName: Family

QuestionText: 1 of 2

Can you tell me approximately how long ago [fill1: your/ALIAS’s] [fill2: injury/poisoning] happened?

*Enter number for time since event.

01-91 1-91

97 Refused

99 Don't know

UniverseText: All injury/poisoning episodes where don't know was entered for month of episode

SkipInstructions: <1-91> [goto IPDATETP]

<R,D> [goto IPHOW]

Question ID: FIJ.051_02.000 Instrument Variable Name: IPDATETP QuestionnaireFileName: Family

QuestionText: 2 of 2

*Enter number for time period since event.

^IPDATENO…

1 Days

2 Weeks

3 Months

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes where don't know was entered for month of episode and 1-91 was entered for the

"number" part of this two-part question

SkipInstructions: goto IPHOW

Page 7 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.052_00.000 Instrument Variable Name: IPDATEMT QuestionnaireFileName: Family

QuestionText: (book) F3 ? [F1]

Was this in the beginning of [fill: ^IPDATEM (text)], the middle of [fill: ^IPDATEM (text)], or the end of [fill:

^IPDATEM (text)]?

1 Beginning

2 Middle

3 End

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes where don't know was entered for day of episode

SkipInstructions: gotoIPHOW

Question ID: FIJ.060_00.000 Instrument Variable Name: IPHOW QuestionnaireFileName: Family

QuestionText: ? [F1]

[fill1: How did [fill2: your/ALIAS’s] [fill3: injury/poisoning] on [fill4: ^IPDATEM ^IPDATED (starting with most recent

if multiple)] happen?/How did this [fill3: injury/poisoning] happen?] Please describe fully the circumstances or events

leading to the [fill3: injury/poisoning], and any objects, substances, or other people involved.

* Enter the verbatim response, probing for as much detail as possible, including specifically what the person was doing at

the time and all circumstances surrounding the event. Record all volunteered information.

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <verbatim> [if an injury episode, goto ICAUS; else, if a poisoning episode, goto PPCC]

<R> [if an injury episode, fill "R" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]

<D> [if an injury episode, fill "D" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]

Page 8 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.065_00.000 Instrument Variable Name: ICAUS QuestionnaireFileName: Family

QuestionText: ? [F1]

* Do not read.

* Enter the number which best describes the cause of the person’s injury from the list below.

01 In a motor vehicle

02 On a bike, scooter, skateboard, skates, skis, horse, etc.

03 Pedestrian who was struck by a vehicle such as a car or bicycle

04 In a boat, train, or plane

05 Fall

06 Burned or scalded by substances such as hot objects or liquids, fire, or chemicals

07 Other

97 Refused

99 Don't know

UniverseText: All injury episodes for which a medical professional was consulted and don't know or refused was not entered at

IPHOW

SkipInstructions: goto IJBODY

Page 9 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.070_00.000 Instrument Variable Name: IJBODY QuestionnaireFileName: Family

QuestionText: (book) F4

* Enter up to 4 responses, separate with commas.

* Ask or verify.

In this injury, what parts of [fill: your/ALIAS’s] body were hurt?

01 Ankle

02 Back

03 Buttocks

04 Chest

05 Ear

06 Elbow

07 Eye

08 Face

09 Finger/thumb

10 Foot

11 Forearm

12 Groin

13 Hand

14 Head (not face)

15 Hip

16 Jaw

17 Knee

18 Lower leg

19 Mouth

20 Neck

21 Nose

22 Shoulder

23 Stomach

24 Teeth

25 Thigh

26 Toe

27 Upper arm

28 Wrist

29 Other, specify

97 Refused

99 Don't know

UniverseText: All injury episodes for which a medical professional was consulted

SkipInstructions: <1-28> [goto IJTYPE1]

<29> [goto IJBODYOS]

<R,D> [goto IPEV]

Page 10 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.071_00.000 Instrument Variable Name: IJBODYOS QuestionnaireFileName: Family

QuestionText: *Read if necessary.

What other parts of the body were hurt?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All injury episodes where some "other" part of the body was hurt

SkipInstructions: goto IJTYPE1

Question ID: FIJ.072_00.000 Instrument Variable Name: IJTYPE1 QuestionnaireFileName: Family

QuestionText: (book) F5

*Enter up to 2 responses, separate with a comma.

* Ask or verify.

In what way was [fill1: your/ALIAS’s] [fill2: first entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture

02 Sprain, strain, or twist

03 Cut

04 Scrape

05 Bruise

06 Burn

07 Insect bite

08 Animal bite

09 Other, specify

97 Refused

99 Don't know

UniverseText: All injury episodes where at least one part of the body was hurt

SkipInstructions: <1-8,D> [goto IJTYPE2 for next body part entered at IJBODY; if no more body parts, goto IPEV]

<9> [goto IJTYP1OS]

<R> [goto IPEV]

Question ID: FIJ.073_00.000 Instrument Variable Name: IJTYP1OS QuestionnaireFileName: Family

QuestionText: ? [F1]

* Read if necessary.

How was [fill1: your/ALIAS’s] [fill2: first entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All injury episodes where the first body part was hurt in some "other" way

SkipInstructions: goto IJTYPE2 for next body part; if no more body parts, goto IPEV

Page 11 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.074_00.000 Instrument Variable Name: IJTYPE2 QuestionnaireFileName: Family

QuestionText: (book) F5

*Enter up to 2 responses, separate with a comma.

* Ask or verify.

In what way was [fill1: your/ALIAS’s] [fill2: second entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture

02 Sprain, strain, or twist

03 Cut

04 Scrape

05 Bruise

06 Burn

07 Insect bite

08 Animal bite

09 Other, specify

97 Refused

99 Don't know

UniverseText: All injury episodes where at least two body parts were hurt and the type of injury or don't know was entered for the

first body part at IJTYPE1

SkipInstructions: <1-8,D> [goto IJTYPE3 for next body part entered at IJBODY; if no more body parts, goto IPEV]

<9> [goto IJTYP2OS]

<R> [goto IPEV]

Question ID: FIJ.075_00.000 Instrument Variable Name: IJTYP2OS QuestionnaireFileName: Family

QuestionText: * Read if necessary.

How else was [fill1: your/ALIAS’s] [fill2: second entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All injury episodes where the second body part was hurt in some "other" way

SkipInstructions: goto IJTYPE3 for next body part; if no more body parts, goto IPEV

Page 12 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.076_00.000 Instrument Variable Name: IJTYPE3 QuestionnaireFileName: Family

QuestionText: (book) F5

*Enter up to 2 responses, separate with a comma.

* Ask or verify.

In what way was [fill1: your/ALIAS’s] [fill2: third entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture

02 Sprain, strain, or twist

03 Cut

04 Scrape

05 Bruise

06 Burn

07 Insect bite

08 Animal bite

09 Other, specify

97 Refused

99 Don't know

UniverseText: All injury episodes where at least three body parts were hurt and type of injury or don't know was entered for the

second body part at IJTYPE2

SkipInstructions: <1-8,D> [goto IJTYPE4 for next body part entered at IJBODY; if no more body parts, goto IPEV]

<9> [goto IJTYP3OS]

<R> [goto IPEV]

Question ID: FIJ.077_00.000 Instrument Variable Name: IJTYP3OS QuestionnaireFileName: Family

QuestionText: * Read if necessary.

How else was [fill1: your/ALIAS’s] [fill2: third entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All injury episodes where the third body part was hurt in some "other" way

SkipInstructions: goto IJTYPE4 for next body part; if no more body parts, goto IPEV

Page 13 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.078_00.000 Instrument Variable Name: IJTYPE4 QuestionnaireFileName: Family

QuestionText: (book) F5

*Enter up to 2 responses, separate with a comma.

* Ask or verify.

In what way was [fill1: your/ALIAS’s] [fill2: fourth entry--^IJBODY (text) or ^IJBODYOS] hurt?

01 Broken bone or fracture

02 Sprain, strain, or twist

03 Cut

04 Scrape

05 Bruise

06 Burn

07 Insect bite

08 Animal bite

09 Other, specify

97 Refused

99 Don't know

UniverseText: All injury episodes where four body parts were hurt and type of injury or don't know was entered for the third body

part at IJTYPE3

SkipInstructions: <1-8,R,D> [goto IPEV]

<9> [goto IJTYP4OS]

Question ID: FIJ.079_00.000 Instrument Variable Name: IJTYP4OS QuestionnaireFileName: Family

QuestionText: * Read if necessary.

How else was [fill1: your/ALIAS’s] [fill2: fourth entry -- ^IJBODY (text) or ^IJBODYOS] hurt?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All injury episodes where the fourth body part was hurt in some "other" way

SkipInstructions: if a poisoning episode, goto PPCC; else, goto IPEV

Question ID: FIJ.080_01.000 Instrument Variable Name: PPCC QuestionnaireFileName: Family

QuestionText: Did [fill: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this poisoning from..

A phone call to a poison control center?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All poisoning episodes for which a medical professional was consulted

SkipInstructions: <1,2,D> [goto IPEV]

<R> [goto IPHOSP]

Page 14 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.080_02.000 Instrument Variable Name: IPEV QuestionnaireFileName: Family

QuestionText: * Read lead-in if necessary.

Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:

injury/poisoning]?

An emergency vehicle, such as an ambulance or fire truck

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1,2,D> [goto IPER]

<R> [goto IPHOSP]

Question ID: FIJ.080_03.000 Instrument Variable Name: IPER QuestionnaireFileName: Family

QuestionText: * Read lead-in if necessary.

Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:

injury/poisoning]?

A visit to an emergency room

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1,2,D> [goto IPDO]

<R> [goto IPHOSP]

Question ID: FIJ.080_04.000 Instrument Variable Name: IPDO QuestionnaireFileName: Family

QuestionText: ? [F1]

* Read lead-in if necessary.

Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:

injury/poisoning]?

A visit to a doctor’s office or other health clinic

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1,2,D> [goto IPPCHCP]

<R> [goto IPHOSP]

Page 15 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.080_05.000 Instrument Variable Name: IPPCHCP QuestionnaireFileName: Family

QuestionText: ? [F1]

* Read lead-in if necessary.

Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:

injury/poisoning]?

A phone call to a doctor, nurse, or other health care professional

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1,2,D> [goto IPOTH]

<R> [goto IPHOSP]

Question ID: FIJ.080_06.000 Instrument Variable Name: IPOTH QuestionnaireFileName: Family

QuestionText: * Read lead-in if necessary.

Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:

injury/poisoning]?

Any place else?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1> [goto IPOTHOS]

if [MTFINJ3M= 01-91 and IPEV=2] goto IPVER

<2> [if poisoning and episode and PPCC eq 2 and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2,

goto IPVER; else if an injury episode and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2, goto

IPVER; else goto IPHOSP]

<R,D> [goto IPHOSP]

Question ID: FIJ.081_00.000 Instrument Variable Name: IPOTHOS QuestionnaireFileName: Family

QuestionText: * Read lead-in if necessary.

Where else did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:

injury/poisoning]?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All injury/poisoning episodes where medical advice, treatment, or follow-up care was received from some "other" place

SkipInstructions: goto IPHOSP

Page 16 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.082_00.000 Instrument Variable Name: IPVER QuestionnaireFileName: Family

QuestionText: * Please verify.

[fill1: You/ALIAS] DID NOT receive any medical advice, treatment, or follow-up for this [fill2: injury/poisoning]. Is that

correct?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted, but no source of medical advice,

treatment, or follow-up care was selected

SkipInstructions: <1>[if the person has more injury/poisoning episodes, goto IPDATEM; else, if the person does not have more

injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an injury/poisoning; else, if no more

family members with an injury/poisoning, go to FPOI3M/FDMED12M]

<2> [if a poisoning episode, goto PPCC for new entries; else, if an injury episode, goto IPEV for new entries]

Question ID: FIJ.090_00.000 Instrument Variable Name: IPHOSP QuestionnaireFileName: Family

QuestionText: ? [F1]

[fill1: Were you/Was ALIAS] hospitalized for at least one night as a result of this [fill2: injury/poisoning]?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1> [goto IPIHNO]

<2,R,D> [if an injury episode, goto IMTRAF; if a poisoning episode, goto PPOIS]

Question ID: FIJ.091_00.000 Instrument Variable Name: IPIHNO QuestionnaireFileName: Family

QuestionText: ? [F1]

How many nights [fill: were you/was ALIAS] in the hospital?

* If still in hospital, ask how many nights up to today.

* Enter '95' for 95 or more nights.

01-94 1-94 nights

95 95+ nights

97 Refused

99 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted and resulted in hospitalization

SkipInstructions: <1-60,R,D> [if ICAUS eq 1-3, goto IMTRAF; else, if ICAUS eq 4-7,R,D, goto IPWHAT; else, if ICAUS eq 5,

goto IFALL]

<61-95> [goto ERR_IPIHNO]

Page 17 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.109_00.000 Instrument Variable Name: IMTRAF QuestionnaireFileName: Family

QuestionText: ? [F1]

* Ask or verify.

Did this accident occur on a public highway, street, or road?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All medically-consulted injury episodes that occurred while in a motor vehicle; on a bike, scooter, skateboard,

skates, skis, horse, etc.; or as a pedestrian who was struck by a vehicle such as a car or bicycle

SkipInstructions: goto IMVWHO

Question ID: FIJ.110_00.000 Instrument Variable Name: IMVWHO QuestionnaireFileName: Family

QuestionText: *Read all categories.

* Ask or verify.

[fill: Were you/Was ALIAS] injured as:

* Read answer categories.

1 The driver of a motor vehicle

2 A passenger in a motor vehicle

3 A pedestrian

4 A bicycle rider or tricycle rider

5 The rider of a scooter, skateboard, skates, or other non-motorized vehicle

7 Refused

9 Don't know

UniverseText: All medically-consulted injury episodes that occurred while in a motor vehicle; on a bike, scooter, skateboard,

skates, skis, horse, etc.; or as a pedestrian who was struck by a vehicle such as a car or bicycle

SkipInstructions: <1,2> [goto IMVTYP]

<4,5> [goto IHELMT]

<3,R,D> [goto IPWHAT]

Page 18 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.111_00.000 Instrument Variable Name: IMVTYP QuestionnaireFileName: Family

QuestionText: (book) F6 ? [F1]

* Ask or verify.

What type of vehicle [fill: were you/was ALIAS] in?

01 Passenger car

02 Passenger truck, such as a pickup truck, van, or SUV

03 Bus

04 Large commercial truck, such as a semi-truck, big rig, or 18 wheeler

05 Motorcycle (including mopeds and minibikes)

06 All terrain vehicle or ski/snow-mobile

07 Farm equipment (such as a tractor)

08 Industrial or construction vehicle

09 Other

97 Refused

99 Don't know

UniverseText: All medically-consulted injury episodes that occurred while a driver or passenger of a vehicle

SkipInstructions: <1,2,4> [goto ISBELT]

<5,6> [goto IHELMT]

<3,7,8,9,R,D> [goto IPWHAT]

Question ID: FIJ.112_00.000 Instrument Variable Name: ISBELT QuestionnaireFileName: Family

QuestionText: ? [F1]

* Ask or verify.

[fill: Were you/Was ALIAS] restrained at the time of the accident?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All medically-consulted injury episodes that occurred while a driver or passenger of a car or truck

SkipInstructions: goto IPWHAT

Page 19 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.113_00.000 Instrument Variable Name: IHELMT QuestionnaireFileName: Family

QuestionText: ? [F1]

* Ask or verify.

[fill: Were you/Was ALIAS] wearing a helmet at the time of the accident?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All medically-consulted injury episodes that occurred while riding a bicycle, tricycle, scooter, skateboard, skates, or

other nonmotorized vehicle; a motorcycle; or an all terrain vehicle or ski/snow-mobile

SkipInstructions: goto IPWHAT

Question ID: FIJ.130_00.000 Instrument Variable Name: IFALL QuestionnaireFileName: Family

QuestionText: (book) F7

* Enter up to 2 responses, separate with a comma.

* Ask or verify.

How did [fill: you/ALIAS] fall? Anything else?

01 Stairs, steps, or escalator

02 Floor or level ground

03 Curb (including sidewalk)

04 Ladder or scaffolding

05 Playground equipment

06 Sports field, court, or rink

07 Building or other structure

08 Chair, bed, sofa, or other furniture

09 Bathtub, shower, toilet, or commode

10 Hole or other opening

11 Other

97 Refused

99 Don't know

UniverseText: All medically-consulted injury episodes that occurred due to a fall

SkipInstructions: goto IFALLWHY

Page 20 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.131_00.000 Instrument Variable Name: IFALLWHY QuestionnaireFileName: Family

QuestionText: (book) F8

* Ask or verify.

What caused [fill: you/ALIAS] to fall?

1 Slipping or tripping

2 Jumping or diving

3 Bumping into an object or another person

4 Being shoved or pushed by another person

5 Losing balance or having dizziness (becoming faint or having a seizure)

6 Other

7 Refused

9 Don't know

UniverseText: All medically-consulted injury episodes that occurred due to a fall

SkipInstructions: goto IPWHAT

Question ID: FIJ.140_00.000 Instrument Variable Name: PPOIS QuestionnaireFileName: Family

QuestionText: (book) F9 ? [F1]

* Ask or verify.

What did [fill: your/ALIAS’s] poisoning result from?

1 Swallowing a drug or medical substance mistakenly or in overdose

2 Swallowing or touching a harmful solid or liquid substance

3 Inhaling harmful gases or vapors

4 Eating a poisonous plant or other substance mistaken for food

5 Being bitten by a poisonous animal

6 Other, please specify

7 Refused

9 Don't know

UniverseText: All poisoning episodes for which a medical professional was consulted

SkipInstructions: <1-5,R,D> [goto IPWHAT]

<6> [goto PPOISOS]

Question ID: FIJ.141_00.000 Instrument Variable Name: PPOISOS QuestionnaireFileName: Family

QuestionText: * Read if necessary.

How did [fill: your/ALIAS’s] poisoning occur?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All medically-consulted poisoning episodes where the poisoning resulted from some "other" reason

SkipInstructions: goto IPWHAT

Page 21 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.150_00.000 Instrument Variable Name: IPWHAT QuestionnaireFileName: Family

QuestionText: (book) F10 ? [F1]

* Enter up to 2 responses, separate with a comma.

* Ask or verify.

What activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: injury/poisoning]?

01 Driving or riding in a motor vehicle

02 Working at a paid job

03 Working around the house or yard

04 Attending school

05 Unpaid work (such as volunteer work)

06 Sports and exercise

07 Leisure activity (excluding sports)

08 Sleeping, resting, eating, or drinking

09 Cooking

10 Being cared for (hands-on care from other person)

11 Other, please specify

97 Refused

99 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: <1-10,R,D> [goto IPWHER]

<11> [goto IPWHATOT]

Question ID: FIJ.151_00.000 Instrument Variable Name: IPWHATOT QuestionnaireFileName: Family

QuestionText: * Read if necessary.

What other activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: injury/poisoning]?

7 Refused

9 Don't know

Verbatim Verbatim response

UniverseText: All medically-consulted injury/poisoning episodes that occurred in some "other" place

SkipInstructions: goto IPWHER

Page 22 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.160_00.000 Instrument Variable Name: IPWHER QuestionnaireFileName: Family

QuestionText: (book) F11 ? [F1]

* Enter up to 2 responses, separate with a comma.

* Ask or verify.

Where [fill1: were you/was ALIAS] when the [fill2: injury/poisoning] happened?

01 Home (inside)

02 Home (outside)

03 School (not residential)

04 Child care center or preschool

05 Residential institution (excluding hospital)

06 Health care facility (including hospital)

07 Street or highway

08 Sidewalk

09 Parking lot

10 Sport facility, athletic field, or playground

11 Shopping center, restaurant, store, bank, gas station, or other place of business

12 Farm

13 Park or recreation area (include bike or jog path)

14 River, lake, stream, or ocean

15 Industrial or construction area

16 Other public building

17 Other

97 Refused

99 Don't know

UniverseText: All injury/poisoning episodes for which a medical professional was consulted

SkipInstructions: if AGE lt 5 and the person has more injury/poisoning episodes, goto IPDATEM; else, if AGE lt 5 and the person

does not have more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an

injury/poisoning episode; else, if AGE lt 5 and no more family members with an injury/poisoning, goto

FPOI3M/FDMED12M; else, if AGE ge 13, goto IPEMP; else, if AGE ge 5 and AGE le 12, goto IPSTU

Question ID: FIJ.170_00.000 Instrument Variable Name: IPEMP QuestionnaireFileName: Family

QuestionText: ? [F1]

At the time of this [fill1: injury/poisoning], [fill2: were you/was ALIAS] employed full-time, part-time, or not employed?

1 Full-time

2 Part-time

3 Not employed

7 Refused

9 Don't know

UniverseText: All medically-consulted injury/poisoning episodes for persons 13 years of age or older

SkipInstructions: <1,2> [goto IPWKLS]

<3,R,D> [goto IPSTU]

Page 23 of 23

2007 NHIS Questionnaire - Family

Injuries & Poisoning

Document Version Date: 12-Jul-06

Question ID: FIJ.171_00.000 Instrument Variable Name: IPWKLS QuestionnaireFileName: Family

QuestionText: As a result of this [fill1: injury/poisoning], how many days of work did [fill2: you/ALIAS] miss?

1 None

2 Less than one day

3 One to five days

4 Six or more days

7 Refused

9 Don't know

UniverseText: All medically-consulted injury/poisoning episodes for persons 13 years of age or older who were employed at the

time of the episode

SkipInstructions: goto IPSTU

Question ID: FIJ.180_00.000 Instrument Variable Name: IPSTU QuestionnaireFileName: Family

QuestionText: The person is a student if they are enrolled in school at the time of the injury. The question is NOT asking if they were at

school at the time of the injury.

1 Full-time

2 Part-time

3 Not a student

7 Refused

9 Don't know

UniverseText: All medically-consulted injury/poisoning episodes for persons 5 years of age or older

SkipInstructions: <1,2> [goto IPSCLS]

<3,R,D> [if person has more injury/poisoning episodes, goto IPDATEM for that person; else if person does not have

more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for next person with an injury/poisoning episode; else if

no more family members with an injury/poisoning, goto FPOI3M/FAU.010]

Question ID: FIJ.181_00.000 Instrument Variable Name: IPSCLS QuestionnaireFileName: Family

QuestionText: As a result of this [fill1: injury/poisoning], how many days of school did [fill2: you/ALIAS] miss?

1 None

2 Less than one day

3 One to five days

4 Six or more days

7 Refused

9 Don't know

UniverseText: All medically-consulted injury/poisoning episodes for persons 5 years of age or older who were students at the time

of the episode

SkipInstructions: if the person has more injury/poisoning episodes, goto IPDATEM; else, if the person does not have more

injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an injury/poisoning episode; else, if

no more family members with an injury/poisoning episode, goto FPOI3M/FDMED12M

File Typeapplication/msword
AuthorHoward Riddick
Last Modified ByHoward Riddick
File Modified2006-09-29
File Created2006-09-29

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