Form 9 Child cancer--Line 8

Attachment 3h Occupational Injury (2 minutes)
Page 1 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_00.010 Instrument Variable Name:

QuestionText:

24-Jul-09

MRECLONG

QuestionnaireFileName:

Sample Adult

Was this the longest-held job you reported earlier?

1

Yes
No
Refused
Don't know

2
7
9
UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, and worked
in the past 12 months

SkipInstructions:

<1> [gotoWRKArrNG]
<2> [goto WHOWRKPY]
[goto INJWCCLM]

Question ID:

ASD.210_00.020 Instrument Variable Name:

QuestionText:

WHOWRKPY

QuestionnaireFileName:

Sample Adult

? [F1]
For whom did you work at your main job or business in the PAST 12 MONTHS? (Name of company, business,
organization or employer)

UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, worked in
the past 12 months, and whose job in the past 12 months was not their longest-held job

SkipInstructions:

<90 char long,D,R> [goto KINDINPY]

Question ID:

ASD.210_00.030 Instrument Variable Name:

QuestionText:

KINDINPY

QuestionnaireFileName:

Sample Adult

? [F1]
What kind of business or industry was this? (For example: TV and radio management, retail shoe store, State Department
of Labor)

UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, worked in
the past 12 months, and whose job in the past 12 months was not their longest-held job

SkipInstructions:

<90 char long,D,R> [goto KINDWKPY]

Question ID:

ASD.210_00.040 Instrument Variable Name:

QuestionText:

KINDWKPY

QuestionnaireFileName:

Sample Adult

? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, worked in
the past 12 months, and whose job in the past 12 months was not their longest-held job

SkipInstructions:

<90 char long,D,R> [goto IMPACTPY]

Page 2 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_00.050 Instrument Variable Name:

QuestionText:

24-Jul-09

IMPACTPY

QuestionnaireFileName:

Sample Adult

? [F1]
What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press)

UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, worked in
the past 12 months, and whose job in the past 12 months was not their longest-held job

SkipInstructions:

<90 char long,D,R> [goto WRKCATPY]

Question ID:

ASD.210_00.060 Instrument Variable Name:

QuestionText:

(book) A2

WRKCATPY

QuestionnaireFileName:

Sample Adult

? [F1]

Looking at the card, which of these best describes the MAIN job you held in the PAST 12 MONTHS?
1

An employee of a PRIVATE company, business, or individual for wages, salary, or commission
A FEDERAL government employee
A STATE government employee
A LOCAL government employee
Self-employed in OWN business, professional practice or farm
Working WITHOUT PAY in family-owned business or farm
Refsued
Don't know

2
3
4
5
6
7
9
UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, worked in
the past 12 months, and whose job in the past 12 months was not their longest-held job

SkipInstructions:

<1-6,D,R>[goto WRKLGPYN]

Question ID:

ASD.210_00.080 Instrument Variable Name:

QuestionText:

WHOWRKLH

QuestionnaireFileName:

Sample Adult

? [F1]
Thinking of all the jobs or businesses you have ever had, including work done in the Armed Forces, for whom did you
work the longest? (Name of company, business, organization or employer)

UniverseText:

Sample adults 18+ whose current or most recent job was not the job they held the longest

SkipInstructions:

<90 char long,D,R> [goto KINDINLH]

Question ID:

ASD.210_00.090 Instrument Variable Name:

QuestionText:

KINDINLH

QuestionnaireFileName:

Sample Adult

? [F1]
What kind of business or industry was this? (For example: TV and radio management, retail shoe store, State Department
of Labor)

UniverseText:

Sample adults 18+ whose current or most recent job was not the job they held the longest

SkipInstructions:

<90 char long,D,R> [goto KINDWKLH]

Page 3 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_00.100 Instrument Variable Name:

QuestionText:

24-Jul-09

KINDWKLH

QuestionnaireFileName:

Sample Adult

? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

UniverseText:

Sample adults 18+ whose current or most recent job was not the job they held the longest

SkipInstructions:

<90 char long,D,R> [goto IMPACTLH]

Question ID:

ASD.210_00.110 Instrument Variable Name:

QuestionText:

IMPACTLH

QuestionnaireFileName:

Sample Adult

? [F1]
What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates
printing press)

UniverseText:

Sample adults 18+ whose current or most recent job was not the job they held the longest

SkipInstructions:

<90 char long,D,R> [goto WRKCATLH]

Question ID:

ASD.210_00.120 Instrument Variable Name:

QuestionText:

(book) A2

WRKCATLH

QuestionnaireFileName:

? [F1]

Looking at the card, which of these best describes the job you held for the longest time?
1
2
3
4
5
6
7
9

An employee of a PRIVATE company, business, or individual for wages, salary, or commission
A FEDERAL government employee
A STATE government employee
A LOCAL government employee
Self-employed in OWN business, professional practice or farm
Working WITHOUT PAY in family-owned business or farm
Refused
Don't know

UniverseText:

Sample adults 18+ whose current or most recent job was not the job they held the longest

SkipInstructions:

<1-6,D,R>[goto WRKLGLHN]

Sample Adult

Page 4 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_00.140 Instrument Variable Name:

QuestionText:

24-Jul-09

WRKARRNG

QuestionnaireFileName:

Sample Adult

The next few questions refer to your job as a [fill1: NAME of current, MAIN job/MAIN job in past 12 months] with
[fill2: NAME of employer of current, MAIN job/MAIN job in past 12 months]. Which of the following best [fill 3:
describes/described] your work arrangement?
* Read answer categories.

1

I [work/worked] as an independent contractor, independent consultant, or freelance worker
I [am/was] on-call, and [fill3: work/worked] only when called to work
I [am/was] paid by a temporary agency
I [work/worked] for a contractor who provides workers and services to others under contract
I [am/was] a regular, permanent employee (standard work arrangement)
Other
Refused
Don't know

2
3
4
5
6
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1-6,D,R>[goto WRKTEMP]

Question ID:

ASD.210_00.150 Instrument Variable Name:

QuestionText:

WRKTEMP

QuestionnaireFileName:

Sample Adult

Some people are in temporary jobs that last only for a limited time or until the completion of a project. [fill1: Is your/Was
your] job temporary?

1

Yes
No
Refused
Don't know

2
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1,2,D,R>[goto WRKSCHED]

Question ID:

ASD.210_00.160 Instrument Variable Name:

QuestionText:

WRKSCHED

QuestionnaireFileName:

Sample Adult

? [F1]
Which of the following best describes the hours you usually [fill1: work/worked]?
* Read answer categories.

1
2
3
4
5
7
9

A regular daytime schedule
A regular evening shift
A regular night shift
A rotating shift
Some other schedule
Refused
Don't know

UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1-5,D,R>[goto WORUNEMP]

Page 5 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_00.170 Instrument Variable Name:

QuestionText:

24-Jul-09

WORUNEMP

QuestionnaireFileName:

Sample Adult

Now I'm going to read two statements that may or may not [fill1: apply/have applied] to your job as a [fill2: NAME of
current, MAIN job/MAIN job in past 12 months] with [NAME of employer of current, MAIN job/MAIN job in past 12
months]. Please tell me whether you strongly agree, agree, disagree, or strongly disagree with each of these statements.
…I [fill3: am/was] worried about becoming unemployed.

1

Strongly agree
Agree
Disagree
Strongly disagree
Refused
Don't know

2
3
4
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1-4,D,R>[goto WORKWFAM]

Question ID:

ASD.210_00.180 Instrument Variable Name:

QuestionText:

WORKWFAM

QuestionnaireFileName:

Sample Adult

READ IF NECESSARY: Please tell me whether you strongly agree, agree, disagree, or strongly disagree with each of
these statements.
…It [fill1: is/was] easy for me to combine work with family responsibilities.

1

Strongly agree
Agree
Disagree
Strongly disagree
Refused
Don't know

2
3
4
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1-4,D,R>[goto HARASSED]

Question ID:

ASD.210_00.190 Instrument Variable Name:

QuestionText:

1
2
7
9

HARASSED

QuestionnaireFileName:

Sample Adult

Again, think about your job as a [fill1: NAME of current, MAIN job/MAIN job in past 12 months] with [fill2: NAME of
employer of current, MAIN job/MAIN job in past 12 months]. DURING THE PAST 12 MONTHS were you threatened,
bullied, or harassed by anyone while you were on the job?
Yes
No
Refused
Don't know

UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1,2,D,R> [goto CHEMEXP]

Page 6 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_00.200 Instrument Variable Name:

QuestionText:

24-Jul-09

CHEMEXP

QuestionnaireFileName:

Sample Adult

The next few questions ask about possible exposures to hazards at your job as a [fill1: NAME of current, MAIN
job/MAIN job in past 12 months] with [fill2: NAME of employer of current, MAIN job/MAIN job in past 12 months].
Please tell me if regularly, that is, twice a week or more,
…you [fill3: handle/handled] or [fill4: are/were] in skin contact with chemical products or substances at work?

1

Yes
No
Refused
Don't know

2
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1,2,D,R> [goto SMOKEXP]

Question ID:

ASD.210_00.210 Instrument Variable Name:

QuestionText:

SMOKEXP

QuestionnaireFileName:

Sample Adult

READ IF NECESSARY: Please tell me if regularly, that is, twice a week or more,
…you [fill1: are/were] exposed to tobacco smoke from other people at work?

1

Yes
No
Refused
Don't know

2
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1,2,D,R> [goto WRKOUTDR]

Question ID:

ASD.210_00.220 Instrument Variable Name:

QuestionText:

WRKOUTDR

QuestionnaireFileName:

Sample Adult

READ IF NECESSARY: Please tell me if regularly, that is, twice a week or more,
…you [fill1: work/worked] outdoors?

1
2
7
9

Yes
No
Refused
Don't know

UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1,2,D,R> [goto VAPOREXP]

Page 7 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_00.230 Instrument Variable Name:

QuestionText:

24-Jul-09

VAPOREXP

QuestionnaireFileName:

Sample Adult

[fill1: This next question refers to your job as a [fill2: NAME of current, MAIN job/MAIN job in past 12 months] with
[fill3: NAME of employer of current, MAIN job/MAIN job in past 12 months]. Again, please tell me if regularly, that is,
twice a week or more, /
READ IF NECESSARY: Please tell me if regularly, that is, twice a week or more,]
…you [fill4: are/were] exposed to vapors, gas, dust, or fumes at work?

1

Yes
No
Refused
Don't know

2
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months

SkipInstructions:

<1,2,D,R> [if CTSYR=1 goto CTSAGE; else if

Question ID:

ASD.210_00.240 Instrument Variable Name:

QuestionText:

INJWCCLM

QuestionnaireFileName:

Sample Adult

Now I'm going to ask about on-the-job injuries. Earlier I recorded that you were injured in the past three months while
working at a paid job. Did you file a workers' compensation claim for your injury or injuries?

1

Yes
No
No injuries
Refused
Don't know

2
3
7
9
UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months and suffered an
injury in the past three months while working at a paid job

SkipInstructions:

<1> [goto INJWCBEN]
<2,3,D,R> [goto HYPEV]

Question ID:

ASD.210_00.250 Instrument Variable Name:

QuestionText:
1
2
7
9

INJWCBEN

QuestionnaireFileName:

Sample Adult

Did you receive workers' compensation benefits for your injury or injuries?
Yes
No
Refused
Don't know

UniverseText:

Sample adults 18+ who are currently employed or employed at some time in the past 12 months, suffered an injury
in the past three months while working at a paid job, and filed a workers' compensation claim

SkipInstructions:

<1,2,D,R> [goto HYPEV]

Page 8 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_01.070 Instrument Variable Name:

QuestionText:

24-Jul-09

WRKLGPYN

QuestionnaireFileName:

Sample Adult

? [F1]
1 of 2
About how long did you work at this job?
* Enter number.

001-365

1-365
Refused
Don't know

997
999
UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, worked in
the past 12 months, and whose job in the past 12 months was not their longest-held job

SkipInstructions:

<1-365>[goto WRKLGPYT]
[goto WRKARRNG]

Question ID:

ASD.210_01.130 Instrument Variable Name:

QuestionText:

WRKLGLHN

QuestionnaireFileName:

Sample Adult

? [F1]
1 of 2
About how long did you work at the job you held the longest?
* Enter number.

001-365

1-365
Refused
Don't know

997
999
UniverseText:

Sample adults 18+ whose current or most recent job was not the job they held the longest

SkipInstructions:

<1-365>[goto WRKLGLHT]
[goto WRKARRNG]

Question ID:

ASD.210_02.070 Instrument Variable Name:

QuestionText:

WRKLGPYT

QuestionnaireFileName:

Sample Adult

2 of 2
READ IF NECESSARY: About how long did you work at this job?
* Enter time period.

1
2
3
4
7
9

Day(s)
Week(s)
Month(s)
Year(s)
Refused
Don't know

UniverseText:

Sample adults who are not currently employed but worked at some point, are retired or are 65 or older, worked in
the past 12 months, whose job in the past 12 months was not their longest-held job, and who gave a number entry
at WRKLGPYN

SkipInstructions:

<1-4,D,R>[goto WRKARRNG]

Page 9 of 9

DRAFT 2010 NHIS Questionnaire - Sample Adult
Adult Socio-Demographic
Document Version Date:
Question ID:

ASD.210_02.130 Instrument Variable Name:

QuestionText:

24-Jul-09

WRKLGLHT

QuestionnaireFileName:

Sample Adult

2 of 2
READ IF NECESSARY: About how long did you work at the job you held the longest?
* Enter time period.

1
2
3
4
7
9

Day(s)
Week(s)
Month(s)
Year(s)
Refused
Don't know

UniverseText:

Sample adults 18+ whose current or most recent job was not the job they held the longest and who gave a number
entry at WRKLGLHN

SkipInstructions:

<1-4,D,R>[goto WRKARRNG]

1
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module
Section Name

16
Adult Conditions

Part
Question ID

ACN.105_00.010

Variable Name

AASAGE

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months and still have asthma

Question Text
Answer Codes

How old were you when you were first told you had asthma?

Question Type

Integer

001-120,
Refused
Don't know

Field Pane Description

Asthma age

Fill Instructions
Special Instructions
Skip Instructions

If AASAGE ge AGE, then [got ERR_AASAGE]
<001-015> [goto AASSTAT]
<016-120> [goto AASEMP]
[goto AASAGE16]

Hard Edits

ERR_AASAGE
* Number of years is greater than age.
* Please correct.

Soft Edits
AssocHelp

2
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.015

Variable Name

AASAGE16

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASAGE(e) IN ('997','999')

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, and refused or said don't know to question on age they were
first told they had asthma

Question Text
Answer Codes

Were you less than 16 or 16 or older when you were first told you had asthma?

Question Type

Pick One - answer list pane

1. Less than 16
2. 16 or older
Refused
Don't know

Field Pane Description

Told had asthma

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto AASSTAT]
<2,D,R> [goto AASEMP]

3
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.020

Variable Name

AASSTAT

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and (AASAGE(e) LE '015' or
AASAGE16(e)='1')

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, and were less than 16 years of age when they were told they
had asthma

Question Text

Compared to when you were first told you had asthma, would you say your asthma has
been better, worse, or about the same as an adult?

Answer Codes

1. Better
2. Worse
3. About the same
Refused
Don't know

Question Type

Pick One - answer list pane

Field Pane Description

Asthma status

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,3,D,R> [goto AASWKREL]
<2> [goto AASEMP]

4
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.030

Variable Name

AASEMP

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and ((AASAGE(e) GE '016') or
(AASAGE16(e) IN (‘2’,'7','9')) or AASSTAT(e)='2')

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, and were 16 years of age or older or less than 16 years of age
and their asthma has gotten worse as an adult or age at time of diagnosis is unknown

Question Text

Were you employed when [fill 1: you first developed symptoms of asthma/your asthma got
worse]?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description
Fill Instructions

Employed

if (AASAGE < 16 or AASAGE16=1) then fill “your asthma got worse”
else fill “you first developed symptoms of asthma”
Note: */ else= ( 16<= AASAGE <= 100) and AASAGE16 = 2,D,R /*

Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto AASCJOB]
<2,D,R> [goto AASWKREL]

5
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.040

Variable Name

AASCJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASEMP(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown, and
were employed when they first developed symptoms/asthma got worse

Question Text

? [F1]
Was this [Fill 1: ]

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Pick One - answer list pane

Field Pane Description
Fill Instructions

Job status

[Fill 1:]
if DOINGLW2=1,2,4 and WHOWRK=response and KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK)"
elseif DOINGLW2=1,2,4 and (WHOWRK=D,R or KINDWRK=D,R)
fill = "your current, MAIN job"
elseif WRKLYR2=1 and WHYNOWK2 ne 3 and AGE lt 65 and WHOWRK=response and
KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK)"
elseif WRKLYR2=1 and WHYNOWK2 ne 3 and AGE lt 65 and (WHOWRK=D,R or
KINDWRK=D,R)
fill = “the job you held most recently”
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=1 and
WHOWRK=response and KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK)"
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=1 and
(WHOWRK=D,R or KINDWRK=D,R)
fill = “the job you held most recently”
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=D,R
fill = “the job you held most recently”
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=2 and
WHOWRKPY=response and KINDWRKPY=response
fill = "your job as a (KINDWRKPY) with (WHOWRKPY)"
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=2 and
(WHOWRKPY=D,R or KINDWRKPY=D,R)
fill = “the job you held most recently”

6
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Special Instructions
Skip Instructions

<1,D,R> [goto AASWKREL]
<2>
If and (WRKLONGH=2 or MRECLONG=2,D,R)
[goto AASLHJOB]
Else (WRKLONGH=1,D,R) or (MRECLONG=1)
[goto AASHOWK]

7
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.045

Variable Name

AASLHJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASEMP(e)='1' and
AASCJOB(e)='2' and (WRKLONGH='2' or MRECLONG IN ('2','7','9'))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, reported still having asthma and whose current job or job in the past 12 months
was not their longest-held job and was not the cause of their asthma

Question Text
Answer Codes

Was this [Fill 1:]

Question Type

Yes/No

1. Yes
2. No
Refused
Don't know

Field Pane Description
Fill Instructions

Longest-held job

[Fill 1:]
if WRKLONGH=2 and WHOWRKLH=response and KINDWKLH=response
fill = "your job as a (KINDWKLH) with (WHOWRKLH).”
elseif WRKLONGH=2 and (WHOWRKLH=D,R or KINDWKLH=D,R)
fill = "the job you held the longest.”
elseif MRECLONG=2,D,R and WHOWRK=response and KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK).”
elseif MRECLONG=2,D,R and (WHOWRK=D,R or KINDWRK=D,R)
fill = "the job you held the longest."

Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,D,R> [goto AASWKREL]
<2> [goto AASWHOWK]

8
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.050

Variable Name

AASWHOWK

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASEMP(e)='1' and
((AASCJOB(e)='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG = ’1’)) or
(AASLHJOB=’2’))

Universe-text
Question Text

For whom did you work when [fill 1: you first developed symptoms of asthma/your asthma
got worse]? (Name of company, business, organization, or employer)

Answer Codes
Question Type

Verbatim

Field Pane Description
Fill Instructions

Whom did you work for

fill1: if AASAGE >= 016 then fill "you first developed symptoms of asthma";
else fill "your asthma got worse"

Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto AASKIND]

9
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.060

Variable Name

AASKIND

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASEMP(e)='1' and
((AASCJOB(e)='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG = ’1’)) or
(AASLHJOB=’2’))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown, were
employed when they first developed symptoms/asthma got worse, and their symptoms first
developed or got worse at some other job than their current/most recent and longest-held
jobs

Question Text

What kind of business or industry was this? (For example: TV and radio mgt., retail shoe
store, State Department of Labor)

Answer Codes
Question Type

Verbatim

Field Pane Description

What kind of business/industry

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto AASKWORK]

10
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.070

Variable Name

AASKWORK

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASEMP(e)='1' and
((AASCJOB(e)='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG = ’1’)) or
(AASLHJOB=’2’))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown, were
employed when they first developed symptoms/asthma got worse, and their symptoms first
developed or got worse at some other job than their current/most recent and longest-held
jobs

Question Text

What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

Answer Codes
Question Type

Verbatim

Field Pane Description

What kind of work

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto AASIMPAC]

11
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.080

Variable Name

AASIMPAC

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASEMP(e)='1' and
((AASCJOB(e)='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG = ’1’)) or
(AASLHJOB=’2’))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown, were
employed when they first developed symptoms/asthma got worse, and their symptoms first
developed or got worse at some other job than their current/most recent and longest-held
jobs

Question Text

What were your most important activities on this job or business? (For example: sells cars,
keeps account books, operates printing press)

Answer Codes
Question Type

Verbatim

Field Pane Description

Important activities

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto AASWKREL]

12
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.100

Variable Name

AASWKREL

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown

Question Text

Have you been told by a doctor or other health professional that your asthma [fill: was
probably caused by your work/was probably made worse by your work/was ever made
worse by any job you have ever had]?”

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description
Fill Instructions

Told asthma job related

fill 1: if (AASAGE >= 16 or AASAGE16=2,D,R) and AASEMP=1 then fill “was
probably caused by your work”
else if (AASAGE < 16 or AASAGE16=1) and AASSTAT=2 and AASEMP=1 then fill
“was probably made worse by your work”
else fill “was ever made worse by any job you have ever had”

Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto AASWCCLM]
<2,D,R> [goto AASDWKRL]

13
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.110

Variable Name

AASDWKRL

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASWKREL(e) IN (‘2’,’7’,’9’)

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown

Question Text

Did YOU ever discuss with a doctor or other health professional whether your asthma [fill:
was probably caused by your work/was probably made worse by your work/was ever
made worse by any job you have ever had]?”

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description
Fill Instructions

Discussed asthma job related

fill 1: if (AASAGE >= 16 or AASAGE16=2,D,R) and AASEMP=1 then
fill “was probably caused by your work”
else if (AASAGE < 16 or AASAGE16=1) and AASSTAT=2 and AASEMP=1 then
fill “was probably made worse by your work”
else fill “was ever made worse by any job you have ever had”

Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,2,D,R> [goto AASWCCLM]

14
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.120

Variable Name

AASWCCLM

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown

Question Text

? [F1]
Have you ever filed a workers' compensation claim for your asthma?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description

Compensation claim

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto AASWCBEN]
<2,D,R> [goto AASWKDAY]

15
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.130

Variable Name

AASWCBEN

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASWCCLM(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown, and filed
a workers' compensation claim for their asthma

Question Text

? [F1]
Have you ever received workers' compensation benefits for your asthma?

Answer Codes

1. Yes
2. No
3. Claim(s) in process
Refused
Don't know

Question Type

Yes/No

Field Pane Description

Received benefit

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,2,3,D,R> [goto AASWKDAY]

16
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.140

Variable Name

AASWKDAY

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown

Question Text

DURING THE PAST 12 MONTHS, how many full days did you miss from work because of
your asthma?
* Enter '0' for None.

Answer Codes

000-366
Refused
Don't know

Question Type

Integer

Field Pane Description

Work days missed

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<000-366,D,R> [goto AASCHJOB]

17
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.105_00.150

Variable Name

AASCHJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, still have asthma, were 16 years of age or older or less than 16 years of age and
their asthma has gotten worse as an adult or age at time of diagnosis is unknown

Question Text

DURING THE PAST 12 MONTHS, did you stop working, change jobs, or make a major
change in your work activities, such as taking on lighter duties, because of your asthma?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description

Change job/activities

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,2,D,R> [goto ULCEV]

18
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.210_00.010

Variable Name

DRMYR

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text

Sample adults 18+

Question Text

? [F1]
DURING THE PAST 12 MONTHS, have you had dermatitis, eczema, or any other red,
inflamed skin rash?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description

Skin problems

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto DRMBODY]
<2,D,R> [goto JNTSYMP (ACN.250)]

19
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.215_00.010

Variable Name

DRMBODY

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DRMYR(e)='1'

Universe-text

Sample adults 18+ who reported having dermatitis, eczema, or any other red, inflamed skin
rash in the past 12 months

Question Text

What parts of your body were affected by this skin condition?
* Enter all that apply, separate with commas.

Answer Codes

1. Hands
2. Arms
3. Head, face or neck
4. Other
Refused
Don't know

Question Type

Enter all that apply

Field Pane Description

Part of body

Fill Instructions
Special Instructions
Skip Instructions

Hard Edits
Soft Edits
AssocHelp

<1-4,D,R>
If DOINGLW2 = D,R [goto JNTSYMP];
Else [goto DRMTRET]

20
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.217_00.010

Variable Name

DRMTRET

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, who reported having dermatitis, eczema, or any other red, inflamed skin rash in
the past 12 months

Question Text
Answer Codes

Have you ever seen a doctor or other health professional for your skin condition?

Question Type

Yes/No

1. Yes
2. No
Refused
Don't know

Field Pane Description

Seen doctor for skin condition

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto DRMWKREL]
<2,D,R> [goto DRMWKDAY]

21
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.217_00.020

Variable Name

DRMWKREL

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and
DRMTRET(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, who reported having dermatitis, eczema, or any other red, inflamed skin rash in
the past 12 months, and who received treatment for their skin condition

Question Text

Have you been told by a doctor or other health professional that your skin condition was
probably work-related?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description

Told skin condition job related

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto DRMCJOB] <2,D,R> [goto DRMWCCLM]

22
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Question ID

ACN.220_00.020

Variable Name

DRMCJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and and DRMWKREL(e)=’1’

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, who reported having dermatitis, eczema, or any other red, inflamed skin rash in
the past 12 monthswho reported having dermatitis, eczema, or any other red, inflamed skin
rash in the past 12 months and who have been told by a doctor or other health professional
that their skin condition was probably work related

Question Text

? [F1]
Was this [fill 1: ]?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description
Fill Instructions

Job status

[Fill 1:]
if DOINGLW2=1,2,4 and WHOWRK=response and KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK)"
elseif DOINGLW2=1,2,4 and (WHOWRK=D,R or KINDWRK=D,R)
fill = "your current, MAIN job"
elseif WRKLYR2=1 and WHYNOWK2 ne 3 and AGE lt 65 and WHOWRK=response and
KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK)"
elseif WRKLYR2=1 and WHYNOWK2 ne 3 and AGE lt 65 and (WHOWRK=D,R or
KINDWRK=D,R)
fill = “the job you held most recently”
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=1 and
WHOWRK=response and KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK)"
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=1 and
(WHOWRK=D,R or KINDWRK=D,R)
fill = “the job you held most recently”
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=D,R
fill = “the job you held most recently”
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=2 and
WHOWRKPY=response and KINDWRKPY=response
fill = "your job as a (KINDWRKPY) with (WHOWRKPY)"
elseif WRKLYR2=1 and (WHYNOWK2=3 or AGE ge 65) and MRECLONG=2 and
(WHOWRKPY=D,R or KINDWRKPY=D,R)

23
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09
fill = “the job you held most recently”

Special Instructions
Skip Instructions

<1,D,R> [goto DRMWCCLM]
<2> if (WRKLONGH=2 or MRECLONG=2, D, R)
[goto DRMLHJOB]
Else if (WRKLONGH=1,D,R or MRECLONG=1)
[goto DRMWHOWRK]

Hard Edits
Soft Edits
AssocHelp

24
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.030

Variable Name

DRMLHJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and DRMWKREL(e)=’1’ and
DRMCJOB='2' and (WRKLONGH='2' or MRECLONG IN ('2', '7', '9' ))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, reported having dermatitis, eczema, or any other red, inflamed skin rash in the
past 12 months, who have been told by a doctor or other health professional that their skin
condition was probably work related, and whose current job or job in the past 12 months
was not their longest-held job and was not the cause of their skin condition

Question Text

Was this your job as a
[fill 1: NAME of longest-held job with NAME of employer of longest-held job]?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description
Fill Instructions

Longest-held job

[Fill 1:]
if WRKLONGH=2 and WHOWRKLH=response and KINDWKLH=response
fill = "your job as a (KINDWKLH) with (WHOWRKLH).”
elseif WRKLONGH=2 and (WHOWRKLH=D,R or KINDWKLH=D,R)
fill = "the job you held the longest.”
elseif MRECLONG=2,D,R and WHOWRK=response and KINDWRK=response
fill = "your job as a (KINDWRK) with (WHOWRK).”
elseif MRECLONG=2,D,R and (WHOWRK=D,R or KINDWRK=D,R)
fill = "the job you held the longest."

Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,D,R> [goto DRMWCCLM]
<2> [goto DRMWHOWRK]

25
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.040

Variable Name

DRMWHOWRK

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and DRMWKREL(e)=’1’ and
((DRMCJOB='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG IN (’1’,’7’,’9’))) or
(DRMLHJOB='2'))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, reported having dermatitis, eczema, or any other red, inflamed skin rash in the
past 12 months, who have been told by a doctor or other health professional that their skin
condition was probably work related, and whose current job or job in the past 12 months
and their longest-held job, if different from their current job or job in the past 12 months,
was not the cause of their skin condition

Question Text

For whom did you work when you developed your skin condition? (Name of company,
business, organization, or employer)

Answer Codes
Question Type

Verbatim

Field Pane Description

Whom did you work for

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto DRMKIND]

26
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.050

Variable Name

DRMKIND

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and DRMWKREL(e)=’1’ and
((DRMCJOB='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG IN (’1’,’7’,’9’))) or
(DRMLHJOB='2'))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, reported having dermatitis, eczema, or any other red, inflamed skin rash in the
past 12 months, who have been told by a doctor or other health professional that their skin
condition was probably work related, and whose current job or job in the past 12 months
and their longest-held job, if different from their current job or job in the past 12 months,
was not the cause of their skin condition

Question Text

What kind of business or industry was this? (For example: TV and radio mgt., retail shoe
store, State Department of Labor)

Answer Codes
Question Type

Verbatim

Field Pane Description

What kind of business/industry

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto DRMKWRK]

27
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.060

Variable Name

DRMKWRK

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and DRMWKREL(e)=’1’ and
((DRMCJOB='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG IN (’1’,’7’,’9’))) or
(DRMLHJOB='2'))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, reported having dermatitis, eczema, or any other red, inflamed skin rash in the
past 12 months, who have been told by a doctor or other health professional that their skin
condition was probably work related, and whose current job or job in the past 12 months
and their longest-held job, if different from their current job or job in the past 12 months,
was not the cause of their skin condition

Question Text

What kind of work were you doing? (For example: farming, mail clerk, computer specialist)

Answer Codes
Question Type

Verbatim

Field Pane Description

What kind of work

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto DRMIMPAC]

28
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.070

Variable Name

DRMIMPAC

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and DRMWKREL(e)=’1’ and
((DRMCJOB='2' and (WRKLONGH IN (’1’,’7’,’9’) or MRECLONG IN (’1’,’7’,’9’))) or
(DRMLHJOB='2'))

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, reported having dermatitis, eczema, or any other red, inflamed skin rash in the
past 12 months, who have been told by a doctor or other health professional that their skin
condition was probably work related, and whose current job or job in the past 12 months
and their longest-held job, if different from their current job or job in the past 12 months,
was not the cause of their skin condition

Question Text

What were your most important activities on this job or business? (For example: sells cars,
keeps account books, operates printing press)

Answer Codes
Question Type

Verbatim

Field Pane Description

Important activities

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<90 char long,D,R> [goto DRMWCCLM]

29
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.100

Variable Name

DRMWCCLM

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and DRMTRET(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, who reported having dermatitis, eczema, or any other red, inflamed skin rash in
the past 12 months, and who received treatment for their skin condition

Question Text
Answer Codes

Have you ever filed a workers' compensation claim for your skin condition?

Question Type

Yes/No

1. Yes
2. No
Refused
Don't know

Field Pane Description

Compensation claim

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto DRMWCBEN]
<2,D,R> [DRMWKDAY]

30
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.110

Variable Name

DRMWCBEN

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1' and DRMTRET(e)='1' and
DRMWCCLM(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months, who reported having dermatitis, eczema, or any other red, inflamed skin rash in
the past 12 months, who received treatment for their skin condition, and who filed a
workers' compensation claim

Question Text

? [F1]
Have you ever received workers' compensation benefits for your skin condition?

Answer Codes

1. Yes
2. No
3. Claim(s) in process
Refused
Don't know

Question Type

Pick One - answer list pane

Field Pane Description

Received benefit

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,2,3,D,R> [goto DRMWKDAY]

31
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.120

Variable Name

DRMWKDAY

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months and reported having dermatitis, eczema, or any other red, inflamed skin rash in the
past 12 months

Question Text

DURING THE PAST 12 MONTHS, how many full days did you miss from work because of
your skin condition?
* Enter '0' for None.

Answer Codes

Refused
Don't know

Question Type

Integer

Field Pane Description

Work days missed

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<000-366,D,R> [goto DRMCHJOB]

32
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.220_00.130

Variable Name

DRMCHJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and DRMYR(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months and reported having dermatitis, eczema, or any other red, inflamed skin rash in the
past 12 months

Question Text

DURING THE PAST 12 MONTHS, did you stop working, change jobs, or make a major
change in your work activities, such as taking on lighter duties, because of your skin
condition?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description

Change job/activities

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1,2,D,R> [goto JNTSYMP]

33
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.296_00.010

Variable Name

CTSEVER

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text

Sample adults 18+

Question Text

Have you EVER been told by a doctor or other health professional that you have a
condition affecting the wrist and hand called carpal tunnel syndrome?

Answer Codes

1. Yes
2. No
Refused
Don't know

Question Type

Yes/No

Field Pane Description

Carpal tunnel condition

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<1> [goto CTSYR]
<2,D,R> [goto PAINECK]

34
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.296_00.020

Variable Name

CTSYR

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CTSEVER(e)='1'

Universe-text

Sample adults 18+ who have ever been diagnosed with carpal tunnel syndrome

Question Text
Answer Codes

DURING THE PAST 12 MONTHS have you had carpal tunnel syndrome?

Question Type

Yes/No

1. Yes
2. No
Refused
Don't know

Field Pane Description

Current carpal tunnel problems

Fill Instructions
Special Instructions
Skip Instructions

Hard Edits
Soft Edits
AssocHelp

If DOINGLW2 = D, R [goto PAINECK]
Else
<1> [goto CTSAGE]
<2,D,R> [goto PAINECK]

35
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.010

Variable Name

CTSAGE

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1'

Universe-text

Sample adults 18+ who are currently employed or employed at some time in the past 12
months and who also reported having carpal tunnel syndrome in the past 12 months

Question Text
Answer Codes

How old were you when you were first told you had carpal tunnel syndrome?

Question Type

Integer

001-120
Refused
Don't know

Field Pane Description

Age told

Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp

<001-014> [goto PAINECK]
<015-120,D,R> [goto CTSWKREL]

36
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.015

Variable Name

CTSWKREL

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSCJOB] <2,D,R> [goto CTSWCCLM]

37
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.030

Variable Name

CTSCJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSWCCLM]
<2> if (WRKLONGH=2 or MRECLONG=2,D,R)
[goto CTSLHJOB]
Else (WRKLONGH=1,D,R) or (MRECLONG=1)
[goto CTSWHOWK]

39
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.040

Variable Name

CTSLHJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSWCCLM]
<2> [goto CTSWHOWK]

40
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.050

Variable Name

CTSWHOWK

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSKIND]

41
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.060

Variable Name

CTSKIND

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSKWRK]

42
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.070

Variable Name

CTSKWRK

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSIMPAC]

43
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.080

Variable Name

CTSIMPAC

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSWCCLM]

44
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.100

Variable Name

CTSWCCLM

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and ('014' [goto CTSWCBEN]
<2,D,R> [goto CTSWKDAY]

45
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.110

Variable Name

CTSWCBEN

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSWKDAY]

46
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.120

Variable Name

CTSWKDAY

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto CTSCHJOB]

47
DRAFT 2010 NHIS Questionnaire – Sample Adult
Adult Conditions
Document Version Date: 30-Dec-09

Module

16

Section Name

Adult Conditions

Part
Question ID

ACN.297_00.130

Variable Name

CTSCHJOB

Universe

HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and CTSYR(e)='1' and ('014' [goto PAINECK]