MEPS-HC Core Interview

MEPS FAMES P12R5/P13R3/P14R1 Preventive Care (AP) Section

December 8, 2008

Preventive Care (AP) Section

BOX_00A

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| THE AP SECTION IS ASKED IN ROUNDS 3 AND 5 ONLY. IF|

| IT IS ROUND 1, 2, OR 4, CONTINUE TO THE NEXT |

| SECTION. |

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BOX_00

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| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME. |

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AP01

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OMITTED.

AP02

====

OMITTED.

AP03

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OMITTED.

AP04

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OMITTED.

AP04A

=====

OMITTED.

AP05

====

OMITTED.

AP06

====

OMITTED.

AP07

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OMITTED.

AP08

====

OMITTED.

AP09

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OMITTED.

AP10

====

OMITTED.

AP11

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OMITTED.

AP11A

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OMITTED.

AP11B

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OMITTED.

AP11C

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OMITTED.

BOX_01

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OMITTED.

AP12

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{PERSON'S FIRST MIDDLE AND LAST NAME}

The next few questions ask about the amounts and types of

preventive care (PERSON) may receive.

On average, how often (do/does) (PERSON) receive a dental

check-up?

TWICE A YEAR OR MORE ................... 1

ONCE A YEAR ............................ 2

LESS THAN ONCE A YEAR .................. 3

NEVER GO TO DENTIST .................... 4

REF ................................... -7

DK .................................... -8

[Code One]

HELP AVAILABLE FOR DEFINITION OF DENTAL CHECK-UP.

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| IF PERSON BEING ASKED ABOUT IS 18 YEARS OF AGE OR |

| OLDER (OR IN AGE CATEGORIES 4-9), CONTINUE WITH |

| AP15 |

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| IF PERSON BEING ASKED ABOUT IS 16 OR 17 YEARS OF |

| AGE, GO TO AP32 |

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| OTHERWISE (THAT IS, PERSON BEING ASKED ABOUT IS |

| LESS THAN 16 YEARS OF AGE OR IN AGE CATEGORIES |

| 1-3), GO TO BOX_02 |

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AP13

====

OMITTED.

AP14

====

OMITTED.

AP15

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{PERSON'S FIRST MIDDLE AND LAST NAME}

About how long has it been since (PERSON) had (PERSON)’s blood

pressure checked by a doctor, nurse or other health professional?

WITHIN PAST YEAR ....................... 1 {AP15OV}

WITHIN PAST 2 YEARS .................... 2 {AP15OV}

WITHIN PAST 3 YEARS .................... 3 {AP16}

WITHIN PAST 5 YEARS .................... 4 {AP16}

MORE THAN 5 YEARS ...................... 5 {AP16}

NEVER .................................. 6 {AP16}

REF ................................... -7 {AP16}

DK .................................... -8 {AP16}

HELP AVAILABLE FOR DEFINITION OF BLOOD PRESSURE CHECK.

[Code One]

AP15OV

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IF NOT ALREADY GIVEN, ASK: About how long ago in months

has it been?

IF LESS THAN ONE MONTH AGO, ENTER 0.

NUMBER:

[Enter Small Number] ................... {AP16}

REF ................................... -7 {AP16}

DK .................................... -8 {AP16}

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| HARD CHECK: |

| 0 – 24 |

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AP16

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

About how long has it been since (PERSON) had (PERSON)’s blood

cholesterol checked by a doctor or other health professional?

WITHIN PAST YEAR ....................... 1 {AP17}

WITHIN PAST 2 YEARS .................... 2 {AP17}

WITHIN PAST 3 YEARS .................... 3 {AP17}

WITHIN PAST 5 YEARS .................... 4 {AP17}

MORE THAN 5 YEARS ...................... 5 {AP17}

NEVER .................................. 6 {AP17}

REF ................................... -7 {AP17}

DK .................................... -8 {AP17}

HELP AVAILABLE FOR DEFINITION OF BLOOD CHOLESTEROL CHECK.

[Code One]

AP17

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{PERSON'S FIRST MIDDLE AND LAST NAME}

A routine check-up is a visit with a doctor or other health

professional for assessing overall health, usually not prompted

by a specific illness or complaint. It usually includes a blood

pressure check, and may include taking a blood sample for

analysis and questions about health behaviors such as smoking.

About how long has it been since (PERSON) had a routine

check-up by a doctor or other health professional?

WITHIN PAST YEAR ....................... 1 {AP17A}

WITHIN PAST 2 YEARS .................... 2 {AP17A}

WITHIN PAST 3 YEARS .................... 3 {AP17A}

WITHIN PAST 5 YEARS .................... 4 {AP17A}

MORE THAN 5 YEARS ...................... 5 {AP17A}

NEVER .................................. 6 {AP17A}

REF ................................... -7 {AP17A}

DK .................................... -8 {AP17A}

[Code One]

AP17A

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{PERSON’S FIRST MIDDLE AND LAST NAME}

Doctors or other health professionals often advise people

to make a change to their lifestyles to lower their risk

of developing a number of diseases, including heart disease.

Has a doctor or other health professional ever advised

(PERSON) to...

YES NO

AP17A_01

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...Eat fewer high fat or high

cholesterol foods? 1 2 ( ) AP17A_02

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| REFUSED (-7) AND DON’T KNOW (-8) ALLOWED. |

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AP17A_02

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...Exercise more? 1 2 ( ) {AP18}

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| REFUSED (-7) AND DON’T KNOW (-8) ALLOWED. |

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AP18

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{PERSON'S FIRST MIDDLE AND LAST NAME}

About how long has it been since (PERSON) had a flu vaccination

(shot or nasal spray)?

WITHIN PAST YEAR ....................... 1 {AP18A}

WITHIN PAST 2 YEARS .................... 2 {AP18A}

WITHIN PAST 3 YEARS .................... 3 {AP18A}

WITHIN PAST 5 YEARS .................... 4 {AP18A}

MORE THAN 5 YEARS ...................... 5 {AP18A}

NEVER .................................. 6 {AP18A}

REF ................................... -7 {AP18A}

DK .................................... -8 {AP18A}

[Code One]

HELP AVAILABLE FOR DEFINITION OF FLU VACCINATION.

AP18A

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{PERSON'S FIRST MIDDLE AND LAST NAME}

(Do/Does) (PERSON) take aspirin every day or every other

day?

YES .................................... 1 {AP18B}

NO ..................................... 2 {AP18AA}

REF ................................... -7 {AP18B}

DK .................................... -8 {AP18B}

AP18AA

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{PERSON'S FIRST MIDDLE AND LAST NAME}

(Do/Does) (PERSON) have a health problem or condition that

makes taking aspirin unsafe for (PERSON)?

YES .................................... 1 {AP18AAA}

NO ..................................... 2 {AP18B}

REF ................................... -7 {AP18B}

DK .................................... -8 {AP18B}

AP18AAA

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{PERSON'S FIRST MIDDLE AND LAST NAME}

Is that problem stomach related or something else?

STOMACH RELATED ........................ 1 {AP18B}

SOMETHING ELSE ......................... 2 {AP18B}

REF ................................... -7 {AP18B}

DK .................................... -8 {AP18B}

[Code One]

AP18B

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{PERSON'S FIRST MIDDLE AND LAST NAME}

(Have/Has) (PERSON) lost all of (PERSON)’s upper and lower

natural (permanent) teeth?

YES .................................... 1 {BOX_01A}

NO ..................................... 2 {BOX_01A}

REF ................................... -7 {BOX_01A}

DK .................................... -8 {BOX_01A}

BOX_01A

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| IF PERSON BEING ASKED ABOUT IS MALE AND IS 40 |

| YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 6-9), |

| CONTINUE WITH AP19 |

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| IF PERSON BEING ASKED ABOUT IS MALE AND IS LESS |

| THAN 40 YEARS OF AGE (OR IN AGE CATEGORIES 4-5), |

| GO TO AP23 |

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| OTHERWISE (I.E., PERSON BEING ASKED ABOUT IS |

| FEMALE), GO TO AP20A |

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AP19

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

A "P-S-A" or prostate specific antigen is a blood test for

prostate cancer. About how long has it been since (PERSON) had a

"P-S-A"?

WITHIN PAST YEAR ....................... 1 {AP23}

WITHIN PAST 2 YEARS .................... 2 {AP23}

WITHIN PAST 3 YEARS .................... 3 {AP23}

WITHIN PAST 5 YEARS .................... 4 {AP23}

MORE THAN 5 YEARS ...................... 5 {AP23}

NEVER .................................. 6 {AP23}

REF ................................... -7 {AP23}

DK .................................... -8 {AP23}

[Code One]

AP20A

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{PERSON'S FIRST MIDDLE AND LAST NAME}

(Have/Has) (PERSON) had a hysterectomy?

YES .................................... 1 {AP20}

NO ..................................... 2 {AP20}

REF ................................... -7 {AP20}

DK .................................... -8 {AP20}

HELP AVAILABLE FOR DEFINITION OF HYSTERECTOMY.

AP20

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

About how long has it been since (PERSON) had a pap smear test?

WITHIN PAST YEAR ....................... 1 {AP21}

WITHIN PAST 2 YEARS .................... 2 {AP21}

WITHIN PAST 3 YEARS .................... 3 {AP21}

WITHIN PAST 5 YEARS .................... 4 {AP21}

MORE THAN 5 YEARS ...................... 5 {AP21}

NEVER .................................. 6 {AP21}

REF ................................... -7 {AP21}

DK .................................... -8 {AP21}

HELP AVAILABLE FOR DEFINITION OF PAP SMEAR TEST.

[Code One]

AP21

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

During a breast exam a doctor or other health professional feels

the breast for lumps. About how long has it been since (PERSON)

had a breast exam?

WITHIN PAST YEAR ....................... 1

WITHIN PAST 2 YEARS .................... 2

WITHIN PAST 3 YEARS .................... 3

WITHIN PAST 5 YEARS .................... 4

MORE THAN 5 YEARS ...................... 5

NEVER .................................. 6

REF ................................... -7

DK .................................... -8

[Code One]

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| IF PERSON BEING ASKED ABOUT IS 30 YEARS OF AGE OR |

| OLDER (OR IN AGE CATEGORIES 5-9), CONTINUE WITH |

| AP22 |

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| OTHERWISE, GO TO AP23 |

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AP22

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

A mammogram is an x-ray taken only of the breast by a machine

that presses the breast against a plate. About how long has it

been since (PERSON) had a mammogram?

WITHIN PAST YEAR ....................... 1 {AP23}

WITHIN PAST 2 YEARS .................... 2 {AP23}

WITHIN PAST 3 YEARS .................... 3 {AP23}

WITHIN PAST 5 YEARS .................... 4 {AP23}

MORE THAN 5 YEARS ...................... 5 {AP23}

NEVER .................................. 6 {AP23}

REF ................................... -7 {AP23}

DK .................................... -8 {AP23}

[Code One]

AP23

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

A blood stool test is a test that you do at home using a special

kit or cards provided by a doctor or other health professional

to determine whether the stool contains blood. (Have/Has)

(PERSON) ever had this test using a home kit?

YES .................................... 1 {AP24}

NO ..................................... 2 {AP25}

REF ................................... -7 {AP25}

DK .................................... -8 {AP25}

AP24

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

When did (PERSON) have (PERSON)'s last blood stool test using a

home kit?

WITHIN PAST YEAR ....................... 1 {AP25}

WITHIN PAST 2 YEARS .................... 2 {AP25}

WITHIN PAST 3 YEARS .................... 3 {AP25}

WITHIN PAST 5 YEARS .................... 4 {AP25}

MORE THAN 5 YEARS ...................... 5 {AP25}

REF ................................... -7 {AP25}

DK .................................... -8 {AP25}

[Code One]

AP25

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

A sigmoidoscopy or colonoscopy is when a tube is inserted in the

rectum to view the bowel for signs of cancer or other health

problems. (Have/Has) (PERSON) ever had this exam?

YES .................................... 1 {AP26}

NO ..................................... 2 {AP28}

REF ................................... -7 {AP28}

DK .................................... -8 {AP28}

AP26

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

When did (PERSON) have (PERSON)'s last sigmoidoscopy or

colonoscopy?

WITHIN PAST YEAR ....................... 1 {AP28}

WITHIN PAST 2 YEARS .................... 2 {AP28}

WITHIN PAST 3 YEARS .................... 3 {AP28}

WITHIN PAST 5 YEARS .................... 4 {AP28}

MORE THAN 5 YEARS ...................... 5 {AP28}

REF ................................... -7 {AP28}

DK .................................... -8 {AP28}

[Code One]

AP27

====

OMITTED.

AP28

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{PERSON'S FIRST MIDDLE AND LAST NAME}

(Do/Does) (PERSON) now spend half an hour or more in moderate

or vigorous physical activity at least three times a week?

YES .................................... 1 {AP29}

NO ..................................... 2 {AP29}

REF ................................... -7 {AP29}

DK .................................... -8 {AP29}

HELP AVAILABLE FOR DEFINITION OF MODERATE OR VIGOROUS

PHYSICAL ACTIVITY.

AP29

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{PERSON'S FIRST MIDDLE AND LAST NAME}

About how tall (are/is) (PERSON) without shoes?

PROBE FOR INCHES IF NOT REPORTED.

AP29_01

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FEET:

[Enter Feet] ........................... {AP29_02}

REF ................................... -7 {AP30}

DK .................................... -8 {AP30}

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| SOFT CHECK: |

| SOFT RANGE CHECK: 2 TO 6 |

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AP29_02

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INCHES:

[Enter Inches] ......................... {AP30}

REF ................................... –7 {AP30}

DK .................................... –8 {AP30}

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| HARD CHECK: |

| HARD RANGE CHECK: 0 TO 11 |

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AP30

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{PERSON'S FIRST MIDDLE AND LAST NAME}

About how much (do/does) (PERSON) weigh without shoes?

ENTER CURRENT WEIGHT TO THE NEAREST POUND.

[Enter Pounds] ......................... {AP32}

REF ................................... -7 {AP32}

DK .................................... -8 {AP31}

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| SOFT CHECK: |

| SOFT RANGE CHECK: 50 TO 500 |

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AP31

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

SHOW CARD AP-1.

Looking at this card, what is your best guess of (PERSON)'s

weight?

99 POUNDS OR LESS ..................... 1 {AP32}

100 - 149 POUNDS ...................... 2 {AP32}

150 - 199 POUNDS ...................... 3 {AP32}

200 - 249 POUNDS ...................... 4 {AP32}

250 - 299 POUNDS ...................... 5 {AP32}

300 POUNDS OR MORE .................... 6 {AP32}

REF ................................... -7 {AP32}

DK .................................... -8 {AP32}

[Code One]

AP32

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{PERSON'S FIRST MIDDLE AND LAST NAME}

When (PERSON) drive(s) or ride(s) in a car, would (PERSON) say

(PERSON) wear(s) a seat belt...

Always, ................................ 1 {BOX_02}

Nearly Always, ......................... 2 {BOX_02}

Sometimes, ............................. 3 {BOX_02}

Seldom, or ............................. 4 {BOX_02}

Never? ................................. 5 {BOX_02}

IF VOLUNTEERED: NEVER DRIVES OR RIDES

IN A CAR/ALWAYS USES PUBLIC

TRANSPORTATION OR WALKS ........... 6 {BOX_02}

REF ................................... -7 {BOX_02}

DK .................................... -8 {BOX_02}

[Code One]

BOX_02

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| GO TO NEXT QUESTIONNAIRE SECTION. |

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