“Form Approved
OMB No. 0920-0214
Exp. Date________”
National Health Interview Survey
NOTICE – Information contained on this form which would permit identification of any individual or establishment has been collected with a guarantee that it will be held in strict confidence, will be used only for purposes stated for this study, and will not be disclosed or released to others without the consent of the individual or establishment in accordance with Section 308(d) of the Public Health Service Act (42 USC 242m). Public reporting burden of this collection of information is estimated to average 57 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports, Clearance Officer; Paperwork Reduction Project (0920-0214), 1600 Clifton Rd., MS D-74, Atlanta, GA 30333.
Page 1 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.010_01.000 Instrument Variable Name: NAME_FNAME QuestionnaireFileName: Household
Composition
QuestionText: [fill: What are the names of all the persons living or staying here?
Start with the name of the person, or one of the persons, who owns or rents this home.
/What is the name of the next person living or staying here?]
*Enter 999 if no more persons.
UniverseText: All persons
SkipInstructions: <999> if PCNT = 0, [goto ERR1_NAME_FNAME]
elseif POS2 or POS3 ne 0, [goto HHRESP]
else, [goto MISPERS_MCHILD]
<allow 20,R,D> if name on fake/false name list
[goto ERR2_NAME_FNAME];
else [goto NAME_MNAME]
Question ID: HHC.010_02.000 Instrument Variable Name: NAME_MNAME QuestionnaireFileName: Household
Composition
QuestionText: * Enter Middle Name.
* Probe for middle name or middle initial if not reported.
* Press "ENTER" to skip to last name if no middle name.
UniverseText: First name is not blank
SkipInstructions: <allow 20, R,D, null> GOTO NAME_LNAME
Question ID: HHC.010_03.000 Instrument Variable Name: NAME_LNAME QuestionnaireFileName: Household
Composition
QuestionText: * If last name is the same as displayed, press "ENTER", otherwise, enter the new last name.
*Enter Last Name.
UniverseText: There is a name entered for 'first name'
SkipInstructions: <999> GOTO ERR1_NAME_FNAME
<allow 20, R,D> if name on fake/false name list
goto ERR2_NAME_LNAME
else if NAME_FNAME and NAME_LNAME ne D, R
Set ALIAS = NAME_FNAME< >NAME _LNAME,
goto USUALRES
else goto ALIAS
Page 2 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.015_00.000 Instrument Variable Name: ALIAS QuestionnaireFileName: Household
Composition
QuestionText: How shall I refer to [fill: you/this person] for the rest of the interview?
UniverseText: Persons who don't know or refused to give first or last name.
SkipInstructions: <allow 41> [goto USUALRES]
Question ID: HHC.020_00.000 Instrument Variable Name: USUALRES QuestionnaireFileName: Household
Composition
QuestionText: [fill: Do you/Does ALIAS] usually live here?
1 Yes
2 No
7 Refusesd
9 Don't know
UniverseText: All non-deleted persons
SkipInstructions: <1> [goto NAME_FNAME]
<2,R,D> [goto ASKURE]
Question ID: HHC.030_00.000 Instrument Variable Name: ASKURE QuestionnaireFileName: Household
Composition
QuestionText: [fill1: Do you/Does ALIAS] have some other place where [fill2: he/she] usually lives?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: If the usual residence is not here, or 'don't know', or 'refused'.
SkipInstructions: <1> [goto NOLIST]
<2, R, D> [goto NAME_FNAME]
Question ID: HHC.035_00.000 Instrument Variable Name: NOLIST QuestionnaireFileName: Household
Composition
QuestionText: Since [fill1: you do/ALIAS does] not usually live here and [fill2: have/has] another residence elsewhere, [fill3: you/he/she]
will not be included in this interview.
* Enter <1> to continue to the next person.
1 To continue
UniverseText: Person living elsewhere
SkipInstructions: [goto NAME_FNAME]
Page 3 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.050_01.000 Instrument Variable Name: MISPERS_MCHILD QuestionnaireFileName: Household
Composition
QuestionText: I have listed living here ...
[fill roster]
Have I missed any babies or small children?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: After completing household roster
SkipInstructions: <1> empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
<2, R, D> goto MISPERS_MLODGE
Question ID: HHC.050_02.000 Instrument Variable Name: MISPERS_MLODGE QuestionnaireFileName: Household
Composition
QuestionText: * Read if necessary.
I have listed living here ...
[fill roster]
Have I missed any lodgers, boarders, or persons you employ who live here?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Not missing any children or R or D
SkipInstructions: <1> empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
<2,R,D> goto MISPERS_MAWAY
Page 4 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.050_03.000 Instrument Variable Name: MISPERS_MAWAY QuestionnaireFileName: Household
Composition
QuestionText: * Read if necessary.
I have listed living here...
[fill roster]
Have I missed anyone who USUALLY lives here, but is now away from home traveling or in a hospital?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: No 'lodgers' living here or R or D
SkipInstructions: <1> empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
<2,R,D> goto MISPERS_MELSE
Question ID: HHC.050_04.000 Instrument Variable Name: MISPERS_MELSE QuestionnaireFileName: Household
Composition
QuestionText: * Read if necessary.
I have listed living here...
[fill roster]
Have I missed anyone else staying here?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Nobody is away from home or R or D
SkipInstructions: <1> empty out '999' in NAME_FNAME
empty out MISPERS_CHILD
empty out MISPERS_MLODGE
empty out MISPERS_MAWAY
empty out MISPERS_MELSE
[goto NAME_FNAME]
<2,R,D> if PCNT = 0, goto EXIT
elseif PCNT = 1
store Yes (1) in LIVEAT, goto OTHLIV
else goto LIVEAT
Page 5 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.060_00.000 Instrument Variable Name: LIVEAT QuestionnaireFileName: Household
Composition
QuestionText: Do all the persons I have listed live AND eat together?
*Read names if necessary.
[fill roster]
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Person count is greater than one
SkipInstructions: <1,R,D> [goto OTHLIV]
<2> [goto XACCESS]
Question ID: HHC.070_00.000 Instrument Variable Name: XACCESS QuestionnaireFileName: Household
Composition
QuestionText: Do the people who do not live and eat here have direct access from the outside or through a common hallway to a separate
living quarters?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons don't eat and live together
SkipInstructions: <1> [goto TABX]
<2,R,D> [goto OTHLIV]
Question ID: HHC.090_00.000 Instrument Variable Name: OTHLIV QuestionnaireFileName: Household
Composition
QuestionText: Do members of any other household on the property live and eat with members of this household?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All
SkipInstructions: <1> [goto ERR_OTHLIV]
<2,R D> if PCNT = 1, [goto SEX]
else [goto HHRESP]
Page 6 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.100_00.000 Instrument Variable Name: HHRESP QuestionnaireFileName: Household
Composition
QuestionText: * Ask if necessary
With whom am I speaking?
* Enter the line number of the respondent. If more than one, enter the number of the one you consider to be the main
respondent.
UniverseText: All households with more than one nondeleted person in parent cases or more than one nondeleted person in spawn
cases and no household/family demographic respondent identified yet.
SkipInstructions: <1-25>
If deleted PX [goto ERR1_HHRESP]
elseif out of bound [goto ERR2_HHRESP]
elseif ADC = 1 [goto HHREF_A]
else [goto SEX]
Question ID: HHC.110_00.000 Instrument Variable Name: SEX QuestionnaireFileName: Household
Composition
QuestionText: * Ask if not apparent.
* If don’t know or refused enter your best guess.
[Are you/Is ALIAS] male or female?
1 Male
2 Female
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions: <1,2> [goto AGEDOB_1]
Question ID: HHC.120_01.000 Instrument Variable Name: AGEDOB_1 QuestionnaireFileName: Household
Composition
QuestionText: 1 of 5
What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions: <001-120> [goto AGEDOB_2]
<R,D> [goto AGEDOB_3]
Page 7 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.120_02.000 Instrument Variable Name: AGEDOB_2 QuestionnaireFileName: Household
Composition
QuestionText: 2 of 5
* Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions: <1-4> [goto AGEDOB_3]
Question ID: HHC.120_03.000 Instrument Variable Name: AGEDOB_3 QuestionnaireFileName: Household
Composition
QuestionText: 3 of 5
And what is [fill: your/ALIAS's] date of birth?
Please give month, day, and year for the date of birth.
* Enter month of birth.
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 nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions: <1-12,R,D> [goto AGEDOB_4]
Page 8 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.120_04.000 Instrument Variable Name: AGEDOB_4 QuestionnaireFileName: Household
Composition
QuestionText: 4 of 5
* Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions: <1-31,R,D>
Only allow valid days for month entered.
If days not valid, [goto ERR_AGEDOB_4]
ELSE [goto AGEDOB_5]
Question ID: HHC.120_05.000 Instrument Variable Name: AGEDOB_5 QuestionnaireFileName: Household
Composition
QuestionText: 5 of 5
* Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions: <1880 - 2030, R,D> [goto AGECAL]
Question ID: HHC.124_00.000 Instrument Variable Name: DOBVER QuestionnaireFileName: Household
Composition
QuestionText: There is a difference between the age the computer calculated from [fill: your/ALIAS's] date-of-birth and the age that you gave
me.
I recorded [fill: your/ALIAS's] date-of-birth as [AGEDOB_3] [AGEDOB_4], [AGEDOB _5]. Is that [fill: your/ALIAS's]
correct date-of-birth?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Age reported is not equal to age calculated from date of birth.
SkipInstructions: <1,R,D> [goto INTWKCK1]
<2> [goto AGEDOB_3]
Page 9 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.130_00.000 Instrument Variable Name: AGEPIC QuestionnaireFileName: Household
Composition
QuestionText: [fill1: Are you/Would you say ALIAS is] [fill2: less than 1 year old/AGE3 years old?]
1 AGE=AGE3 (or less than 1 years old)
2 AGE=AGE4
3 Neither is correct
7 Refused
9 Don't know
UniverseText: Able to narrow age to two options
SkipInstructions: <1,2> [goto INTWKCK1]
<3,R,D> if AGEDOB_1 = R, [goto AGEGES2]
elseif AGEDOB_1 = D, [goto AGEGES1_NUM]
Question ID: HHC.150_01.000 Instrument Variable Name: AGEGES1_NUM QuestionnaireFileName: Household
Composition
QuestionText: 1 of 2
What is your best guess of [fill: your/ALIAS's] age?
* If the respondent gives a range of ages, enter "C" to continue to the screen that will compute an age.
* If the respondent does not know the age, enter your best estimate of the person's age.
000-120 Age (number)
997 Refused
999 Don't know
C Compute from range
UniverseText: Age unknown and unable to narrow age down to two age choices and respondent did not refuse AGEDOB_1
SkipInstructions: <0-120> [goto AGEGES1_TP]
elseif outside range, [goto ERR_AGEGES1_NUM]
<C> [goto AGERNG_N1]
<R,D> [goto AGEGES2]
Question ID: HHC.150_02.000 Instrument Variable Name: AGEGES1_TP QuestionnaireFileName: Household
Composition
QuestionText: 2 of 2
* Enter time period for age guess.
3 Month(s)
4 Year(s)
UniverseText: Valid age number
SkipInstructions: <3, 4> If AGEDOB_5 = D, [goto YEARPIC]
else [goto INTWKCK1]
Page 10 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.152_00.000 Instrument Variable Name: AGEGES2 QuestionnaireFileName: Household
Composition
QuestionText: Certain sections of this interview depend on knowing if a person is 18 years old or older.
Could you please tell me if [fill: you are/ALIAS is] at least 18 years old?
1 Less than 18
2 18 or older
7 Refused
9 Don't know
UniverseText: (Age unknown and unable to narrow to two age choices and respondent refused or didn't know age at AGEDOB_1) or
(Refused to or did not guess age)
SkipInstructions: <1> [goto LESS18]
<2,R,D> [goto GREAT18]
Question ID: HHC.154_00.000 Instrument Variable Name: LESS18 QuestionnaireFileName: Household
Composition
QuestionText: * Enter your best estimate of [ALIAS's] age.
* Enter age "0" to 17
* Enter "0" if less than 1 year old.
000 Less than one year old
001 < 17 1 to 17 years of age
UniverseText: Person estimated less than eighteen years of age
SkipInstructions: <0-17> [goto AGEDOB_1, to collect information about next person in roster]
else, [goto INTWKCK1]
Question ID: HHC.156_00.000 Instrument Variable Name: GREAT18 QuestionnaireFileName: Household
Composition
QuestionText: * Enter your best estimate of [ALIAS’s] age.
* Enter age 18 or greater.
018-120 Age in years
UniverseText: Person estimated age (18 or older)
SkipInstructions: <18-120> [goto AGEDOB_1, to collect information about next person in roster]
else, [goto INTWKCK1]
Question ID: HHC.160_01.000 Instrument Variable Name: AGERNG_N1 QuestionnaireFileName: Household
Composition
QuestionText: 1 of 4
* Enter lower age of the range in months or years.
000-120 Age in years
UniverseText: Computing age when not given the year the subject was born or the subject's age.
SkipInstructions: <0-120> [goto AGERNG _T1]
Page 11 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.160_02.000 Instrument Variable Name: AGERNG_T1 QuestionnaireFileName: Household
Composition
QuestionText: 2 of 4
* Enter lower age time period.
3 Month(s)
4 Year(s)
UniverseText: First age number has been entered for range.
SkipInstructions: goto AGERNG_N2
Question ID: HHC.160_03.000 Instrument Variable Name: AGERNG_N2 QuestionnaireFileName: Household
Composition
QuestionText: 3 of 4
* Enter higher age of the range in months or years.
000-120 Age in years
UniverseText: First age number and time period has been entered for range.
SkipInstructions: <0-120> [goto AGERNG _T2]
Question ID: HHC.160_04.000 Instrument Variable Name: AGERNG_T2 QuestionnaireFileName: Household
Composition
QuestionText: 4 of 4
* Enter higher age time period.
3 Month(s)
4 Year(s)
UniverseText: Second age number has been entered for range.
SkipInstructions: If LOWER > HIGHER, [goto ERR_AGERNG_T2]
<3,4> if AGEDOB_5 = Don't know, [goto YEARPIC]
else, [goto INTWKCK1]
Question ID: HHC.165_01.000 Instrument Variable Name: YEARPIC QuestionnaireFileName: Household
Composition
QuestionText: Would you say that [fill: you were/ALIAS was] born in:
1 Low guess for year born
2 High guess for year born
3 Neither is correct
7 Refused
9 Don't know
UniverseText: Person's age is known and birth year answered with 'don't know'
SkipInstructions: <1,2,3,R,D> [goto AGEDOB_1, to collect information about next person in roster]
else, [goto INTWKCK1]
Page 12 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.165_03.000 Instrument Variable Name: INTWKCK QuestionnaireFileName: Household
Composition
QuestionText: Was [ALIAS] born on or after [STARTDATE]?
1 Yes
2 No
UniverseText: Child's age = 0 and date of birth not known
SkipInstructions: <1> [goto ERR_INTWKCK]
then, [goto AGEDOB_1 to collect information about next person in roster]
else, [goto NATOR]
<2> [goto AGEDOB_1 to collect information about next person in roster]
else, [goto NATOR]
Question ID: HHC.170_00.000 Instrument Variable Name: NATOR QuestionnaireFileName: Household
Composition
QuestionText: (book) H1.
[fill1: Do you/Does ALIAS] consider [fill2: yourself/himself/herself] to be Hispanic or Latino?
* Read if necessary.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American
Other Latin American
Other Hispanic/Latino
Where did [your/ALIAS's] ancestors come from?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions: <1> [goto HISPAN]
<2,R,D> [goto NATOR for next person in roster]
else [goto RACE]
Page 13 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.180_01.000 Instrument Variable Name: HISPAN QuestionnaireFileName: Household
Composition
QuestionText: (book) H1
Please give me the number of the group that represents [fill: your/ ALIAS’s] Hispanic origin or ancestry.
You may choose up to five (5), if applicable.
* If a nonhispanic group is named, backup to previous screen and change the answer from "yes" to "no".
Enter all that apply, separate with commas.
01 Puerto Rican
02 Cuban/Cuban American
03 Dominican (Republic)
04 Mexican
05 Mexican American
06 Central or South American
07 Other Latin American
08 Other Hispanic/Latino/Spanish
97 Refused
99 Don't know
UniverseText: National origin was answered yes to being Hispanic or Latino
SkipInstructions: <1-6> [goto NATOR (for the next person)] else [goto RACE]
<7> [goto HIS_SP2]
<8> [goto HIS_SP3]
Question ID: HHC.190_00.000 Instrument Variable Name: HIS_SP2 QuestionnaireFileName: Household
Composition
QuestionText: * Probe for the country.
* If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
* (F1) For a list of Central or South American countries.
* Specify the other Latin American.
UniverseText: HISPAN answered from selection 7 for Hispanic origin.
SkipInstructions: <allow 30> [goto NATOR (for the next person)]
else [goto RACE]
Page 14 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.195_00.000 Instrument Variable Name: HIS_SP3 QuestionnaireFileName: Household
Composition
QuestionText: * Probe for the country.
* If any of the following are mentioned, backup to previous screen and correct the entry.
Puerto Rican
Cuban/Cuban American
Dominican (Republic)
Mexican
Mexican American
Central or South American (REFER TO HELP SCREEN)
* (F1) For a list of Central or South American countries.
* Specify the other Hispanic/Latino.
UniverseText: HISPAN answer from selection 8 (other Hispanic/Latino) origin
SkipInstructions: <allow 30> [goto NATOR (for the next person)]
else [goto RACE]
Page 15 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.200_01.000 Instrument Variable Name: RACE QuestionnaireFileName: Household
Composition
QuestionText: ( Book) H2
What race or races [fill1: Do you/Does ALIAS] consider [fill2: yourself/himself/herself] to be? Please select 1 or more of
these categories.
* Enter all that apply, separate with commas.
01 White
02 Black/African American
03 Indian (American)
04 Alaska Native
05 Native Hawaiin
06 Guamanian
07 Samoan
08 Other Pacific Islander
09 Asian Indian
10 Chinese
11 Filipino
12 Japanese
13 Korean
14 Vietnamese
15 Other Asian
16 Some other race
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions: <1-7, 9-14> If more than one selected, [goto MLTRAC, then goto RACE for next person in roster]
else [goto NOWAF_A]
<8> [goto RAC_SP1]
<15> [goto RAC_SP2]
<16> [goto RAC_SP3]
<R,D> [goto RACE, for the next person in roster]
else [goto NOWAF_A]
Page 16 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.210_00.000 Instrument Variable Name: RAC_SP1 QuestionnaireFileName: Household
Composition
QuestionText: * Specify the other pacific islander.
REM * If any of the following are mentioned, go back to RACE screen to correct.
* If the respondent’s answer could not be found, clear entry, type ‘ZZ’.
White Asian Indian
Black/African American Chinese
Indian (American) Filipino
Alaska Native Japanese
Native Hawaiian Korean
Guamanian Vietnamese
Samoan
* If the respondent's answer could not be found, type 'ZZ' to enable you to type an entry.
UniverseText: RACE= 8 (other Pacific Islander)
SkipInstructions: <allow 30> If more than one selected, [goto MLTRAC]
If 'ZZ' entered [goto RAC_SP1A]
then [goto RACE for next person on the roster]
else [goto NOWAF_A]
Question ID: HHC.212_00.000 Instrument Variable Name: RAC_SP2 QuestionnaireFileName: Household
Composition
QuestionText: * Specify the other Asian.
* If any of the following are mentioned, backup to previous item and correct the entry.
White Asian Indian
Black/African American Chinese
Indian (American) Filipino
Alaska Native Japanese
Native Hawaiian Korean
uamanian Vietnamese
Samoan
* If the respondent's answer could not be found, type 'ZZ' to enable you to type an entry.
UniverseText: RACE = other Asian listed
SkipInstructions: <allow 30> If more than one selected [goto MLTRAC]
then [goto RACE] for next person on the roster
else [goto NOWAF_A]
Page 17 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.214_00.000 Instrument Variable Name: RAC_SP3 QuestionnaireFileName: Household
Composition
QuestionText: * Specify the other race.
* If any of the following are mentioned, backup to previous item and correct the entry.
White Asian Indian
Black/African American Chinese
Indian (American) Filipino
Alaska Native Japanese
Native Hawaiian Korean
Guamanian Vietnamese
Samoan
* If the respondent's answer could not be found, type 'ZZ' to enable you to type an entry.
UniverseText: RACE answered some other race.
SkipInstructions: <30 chars long> If more than one selected [goto MLTRAC] then [goto RACE] for next person on the roster
Else [goto NOWAF_A ]
Question ID: HHC.220_00.000 Instrument Variable Name: MLTRAC QuestionnaireFileName: Household
Composition
QuestionText: Which one of these groups, that is [Read Groups] would you say BEST represents [fill: your/ALIAS's] race?
01 White
02 Black/African American
03 Indian (American)
04 Alaska Native
05 Native Hawaiian
06 Guamanian
07 Samoan
08 Other Pacific Islander
09 Asian Indian
10 Chinese
11 Filipino
12 Japanese
13 Korean
14 Vietnamese
15 Other Asian
16 Other Race
97 Refused
99 Don't know
UniverseText: More than on race entered
SkipInstructions: <1-16,R,D> [goto NOWAF_A]
else, [goto ERR_MLTRAC]
Page 18 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.230_01.000 Instrument Variable Name: NOWAF_A QuestionnaireFileName: Household
Composition
QuestionText: [fill: Is anyone in the household/Are you/Is ALIAS] now on full-time active duty with the Armed Forces?
[display eligible persons]
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: If household contains 1 or more persons 18-64 years old
SkipInstructions: If no person eq (18-64) years of age [goto EXIT]
< 2,R,D> if POS2 or POS3 ne 0, [goto ADC]
else [goto HHREF_A]
if NOWAF_A eq <1> and ADULTCNT eq <1> [goto EXIT]
else [goto NOWAF2_B]
Question ID: HHC.230_03.000 Instrument Variable Name: NOWAF2_B QuestionnaireFileName: Household
Composition
QuestionText: Who is this? (Anyone else)
* Enter line numbers as appropriate.
* Enter all that apply, separate with commas.
1 Armed Forces
2 Not Armed Forces
7 Refused
UniverseText: At least 1 person in the AF & more than 1 person eligible to be in the AF
SkipInstructions: <1-25> if all PX have HHSTAT = D or HHSTAT3 = A [goto EXIT]
elseif POS2 and POS3 ne 0 [goto ADC]
else [goto HHREF_A]
Invalid person # selected [goto ERR_NOWAF2_B]
Question ID: HHC.240_00.000 Instrument Variable Name: EXIT QuestionnaireFileName: Household
Composition
QuestionText: Not every household in our survey is asked all questions. I have all the information about your household that I need at this
time. Thank you for your assistance.
* Enter (1) to proceed.
1 Proceed
UniverseText: All persons are in the Armed Forces or everybody is either deleted or in the AF or All non-Armed Forces persons are
not Black or Hispanic and not marked for an interview
SkipInstructions: <1> [goto VISITCNT]
Page 19 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.250_01.000 Instrument Variable Name: HHREF_A QuestionnaireFileName: Household
Composition
QuestionText: * [fill: You have/ALIAS has] has been selected as the household reference person. Is this household member an appropriate
choice? Preferably a civilian adult?
[Display all non-deleted household members ge 14 years of age]
* Press shift F1 to see full roster information.
1 Yes
2 No
UniverseText: If more than one non-deleted person in the HH
SkipInstructions: <1> [goto RPREL]
<2> [goto HHREF_B]
Question ID: HHC.250_02.000 Instrument Variable Name: HHREF_B QuestionnaireFileName: Household
Composition
QuestionText: * Select another household member for the reference person.
* Enter the line number of the Household Reference person.
UniverseText: Selecting another Reference person
SkipInstructions: <1-25> GOTO RPREL
Page 20 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.260_00.000 Instrument Variable Name: RPREL QuestionnaireFileName: Household
Composition
QuestionText: (book) H3.
What is [fill1: your/ALIAS's] relationship to [fill2: Reference Person's name/you]
01 Household reference person
02 Spouse (husband/wife)
03 Unmarried Partner
04 Child (biological/adoptive/in-law/step/foster)
05 Child of partner
06 Grandchild
07 Parent (biological/adoptive/in-law/step/foster)
08 Brother/sister (biological/adoptive/in-law/step/foster)
09 Grandparent (Grandmother/Grandfather)
10 Aunt/Uncle
11 Niece/Nephew
12 Other relative
13 Housemate/roommate
14 Roomer/Boarder
15 Other nonrelative
16 Legal guardian
17 Ward
97 Refused
99 Don't know
UniverseText: All where RPREL NE Reference Person
SkipInstructions: Loop through all non-deleted PX
<2, 3> if selected for more than one PX [goto ERR4_RPREL]
elseif AGE < 14 [goto ERR1_RPREL]
<4> [goto DEGREE1]
<5> if loop is completed and no PX has RPREL = 3 [goto ERR5_RPREL] endif
<6> if AGEDIFF < 25 [goto ERR2_RPREL] endif
<7> [goto DEGREE2]
<8> [goto DEGREE3]
<9> if AGEDIFF < 25 [goto ERR3_RPREL] endif
<10-17,R,D> end loop
if UNRELTAL > 1 [GOTO FAMNUM]
else [goto HHCHANGE]
Page 21 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.260_01.000 Instrument Variable Name: RPREL QuestionnaireFileName: Household
Composition
QuestionText: (book) H3.
What is [fill1: your/ALIAS's] relationship to [fill2: Reference Person's name/you]
UniverseText: All where RPREL NE Reference Person
SkipInstructions: Loop through all non-deleted PX
<2, 3> if selected for more than one PX [goto ERR4_RPREL]
elseif AGE < 14 [goto ERR1_RPREL]
<4> [goto DEGREE1]
<5> if loop is completed and no PX has RPREL = 3 [goto ERR5_RPREL] endif
<6> if AGEDIFF < 25 [goto ERR2_RPREL] endif
<7> [goto DEGREE2]
<8> [goto DEGREE3]
<9> if AGEDIFF < 25 [goto ERR3_RPREL] endif
<10-17,R,D> end loop
if UNRELTAL > 1 [GOTO FAMNUM]
else [goto HHCHANGE]
Question ID: HHC.270_00.000 Instrument Variable Name: DEGREE1 QuestionnaireFileName: Household
Composition
QuestionText: [fill1: Are you/Is ALIAS] [fill2: Reference Person's name's/your] biological (natural), adoptive, step, or foster [fill3:
son/daughter] or [fill4: son/daughter]-in-law?
1 Biological (natural) {son/daughter]
2 Adoptive {son/daughter}
3 Step {son/daughter]
4 Foster {son/daughter}
5 {son/daughter]-in-law
7 Refused
Refused
9 Don't know
UniverseText: RPREL=(4) child
SkipInstructions: <1> if AGEDIFF < 12 [goto ERR1_DEGREE1]
else [goto RPREL]
<2-5,R,D> [goto RPREL]
Page 22 of 22
2007 NHIS Questionnaire - Household Composition
Household Composition
Document Version Date: 12-Jul-06
Question ID: HHC.280_00.000 Instrument Variable Name: DEGREE2 QuestionnaireFileName: Household
Composition
QuestionText: [fill1: Are you/Is ALIAS] [fill2: Reference Person's name's/your] biological (natural), adoptive, step, or foster [fill3:
mother/father] or [fill4: mother/father]-in-law?
1 Biological (natural) {mother/father]
2 Adoptive {mother/father}
3 Step {mother/father]
4 Foster {mother/father}
5 {mother/father]-in-law
7 Refused
9 Don't know
UniverseText: RPREL=(7) parent
SkipInstructions: <1> if AGEDIFF <12 [goto ERR_DEGREE2]
elseif additional PX's remain [goto RPREL]
elseif UNRELTAL >1 [goto FAMNUM]
else [goto HHCHANGE]
<2-5,R,D> if additional PX's remain [goto RPREL]
elseif UNRELTAL >1 [goto FAMNUM]
else [goto HHCHANGE]
Question ID: HHC.290_01.000 Instrument Variable Name: DEGREE3 QuestionnaireFileName: Household
Composition
QuestionText: [fill1: Are you/Is ALIAS] [fill2: Reference Person's name's/your] full, half, adoptive, step, or foster [fill3: brother/sister] or
[fill4: brother/sister]-in-law?
1 Full {brother/sister}
2 Half {brother/sister}
3 Adopted {brother/sister}
4 Step {brother/sister]
5 Foster {brother/sister}
6 {brother/sister]-in-law
7 Refused
9 Don't know
UniverseText: All siblings
SkipInstructions: <1-6,R,D> [goto RPREL]
| File Type | application/msword |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |