NHIS 2007 Family Core Questionnaire

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	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
Page 9 of 9
2007  NHIS Questionnaire - Family
Family Identification
Document Version Date: 12-Jul-06
Question ID:	FID.400_00.000	Instrument Variable Name:	FMSSN	QuestionnaireFileName:	Family
QuestionText:	* Read to respondent:
	
	We also need your Social Security Number.  The National Center for Health Statistics will use 
	your Social Security Number to conduct health-related research by linking your survey data with 
	vital statistics and other records.  We may also use it if we need to recontact you or your 
	family.  Except for these purposes, the National Center for Health Statistics will not release your
	 Social Security Number to anyone, including any government agency.  Providing this 
	information is voluntary and is collected under the authority of the Public Health Service Act.  
	There will be no effect on your benefits if you do not provide it.
	
	* Read if necessary.
	
	The Public Health Service Act is Title 42, United States Code, Section 242K.
	
	What is your Social Security Number?
	
	* Enter 'N' if no Social Security Number.
001010000-799999999    Number
       R                                      Refused                    	
       D                                      Don’t know
	
UniverseText:	 Only asked of the family respondent if the family respondent is not the sample adult

SkipInstructions:                   < 001010000-799999999> goto FMSSNREP
	<000000000-999999999> goto ERR_FMSSN_2
	<R, D> goto ERR_FMSSN_1, if suppressed goto beginning of Sample Child, Sample Adult, or
	 Back section
	<N> goto beginning of Sample Child, Sample Adult, or Recontact

	
Question ID:	FID.405_00.000	Instrument Variable Name:	FMSSNREP	QuestionnaireFileName:	Family
QuestionText:	* Enter how Social Security number was reported.

	
	 1	From memory	
          2	From records
         	
UniverseText:	SSN was given at FMSSN

SkipInstructions:                    <1,2> goto FMSSNTEL
	
Question ID:	FID.410_00.000	Instrument Variable Name:	FMSSNTEL	QuestionnaireFileName:	Family
QuestionText:	* Select one category below to indicate reporting of Social Security number.

	
	 1	In person	
          2	Telephone
         	
UniverseText:	Recorded how SSN was reported

SkipInstructions:                    <1,2> goto beginning of Sample Child, Sample Adult, or Back section