Interview Questionnaire

Appendix 1—Questionnaire for First Round of Cognitive Interviews (Interviewer Administered NHIS Questions)

OMB No. 0920-0222: Approval expires 07/31/2018

The Public Health Service Act provides us with the authority to do this research (42 United States Code 242k). All information which would permit identification of any individual, a practice, or an establishment will be held confidential, will be used for statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).

Public reporting burden for this collection of information is estimated to average 60 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; 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0222).

The National Center for Health Statistics, part of the Centers for Disease Control and Prevention, is conducting a study and we need your help. We are interested in your health and wellness, and will be asking you a series of questions about your health history, behaviors, and opinions. This should take about 60 minutes or less to complete. Participation in this survey is completely voluntary, and you may skip any question(s) you do not want to answer and may quit the survey at any time. You will not receive any monetary reward or incentive for participating in this survey. The information being collected is for research purposes only, and will assist NCHS and CDC in their ongoing efforts to track the health of the American public. Your data will be held confidential, will be used for statistical purposes only, and will not be disclosed or released to other persons without your consent in accordance with Section 308(d) of the Public Health Service Act and the Confidential Information and Statistical Efficiency Act.

If you have any questions about this study, please call the office of the Ethics Review Board at the National Center for Health Statistics, toll-free at 1-800-223-8118. Please leave a brief message with your name and phone number. Say that you are calling about Protocol #2010-19-XX [Note: The amendment number will be inserted into the form once NCHS ERB approval has been received]. Your call will be returned as soon as possible.

Click the “Next” button below to begin.

PHSTAT	Question Text
Would you say [fill: your/ALIAS’s] health in general is excellent, very good, good, fair, or poor?
Answer Categories (Select Only 1)
Excellent		Very good		Good		Fair
Poor			<Don’t Know>		<Refused>
Question Universe		All Sample Respondents
Skip Instructions		GO TO FSRUNOUT

FSRUNOUT	Question Text
I worried whether my food would run out before I got money to buy more
Answer Categories (Select Only 1)
Often True		Sometimes True	Never True	<Don’t Know>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,DK,R> GO TO FSLAST

FSLAST	Question Text
The food that I bought just didn't last, and I didn't have money to get more.
Answer Categories (Select Only 1)
Often True		Sometimes True	Never True	<Don’t Know>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,DK,R> GO TO FSBALANC

FSBALANC	Question Text
I couldn't afford to eat balanced meals.?
Answer Categories (Select Only 1)
Often True		Sometimes True	Never True	<Don’t Know>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,DK,R> GO TO FSSKIP

FSSKIP	Question Text
In the last 30 days, did you ever cut the size of your meals or skip meals because there wasn't enough money for food?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,DK,R> GO TO FSLESS

FSLESS	Question Text
In the last 30 days, did you ever eat less than you felt you should because there wasn't enough money for food?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,DK,R> GO TO FSHUNGRY

FSHUNGRY	Question Text
In the last 30 days, were you ever hungry but didn't eat because there wasn't enough money for food?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,DK,R> GO TO FSWEIGHT

FSWEIGHT	Question Text
In the last 30 days, did you lose weight because there wasn't enough money for food?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,DK,R> GO TO FHCDV2W

FHCDV2W	Question Text
During the last 2 weeks, did you see a doctor or other health care professional at a doctor's office, a clinic, an emergency room, or some other place?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1> GO TO PHCDVN2W; <2,DK,R> GO TO F10DVYR

PHCDVN2W	Question Text
How many times did you visit a doctor or other health care professional during the last 2 weeks?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to FHCDV2W
Skip Instructions		GO TO F10DVYR

F10DVYR	Question Text
During the past 12 months, did you receive care from doctors or other health care professionals 10 or more times? Do not include telephone calls.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		GO TO FHICOV

FHICOV	Question Text
The next few questions are about health insurance, including health insurance obtained through employment, purchased directly, as well as government programs like Medicare and Medicaid that provide Medical care or help pay medical bills. Are you covered by any kind of health insurance or some other kind of health care plan?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1, DK,R> GO TO HIKIND; <2> GO TO WRKCOR
HIKIND	Question Text
What kinds of health insurance or health care coverage do you have? Include those plans that pay for only one type of service, such as nursing home care, accidents, or dental care. Exclude private plans that only provide extra cash while hospitalized. You may more than one answer.
Answer Categories (Select One or More)
Private Health Insurance		Medicare	Medi-Gap	Medicaid
SCHIP (CHIP/Children's Health Insurance Program)		Military health care (TRICARE/VA/CHAMP-VA)	Indian Health Service	State-sponsored health plan
Other government program		Single service plan (e.g., dental, vision, prescriptions)	No coverage of any type	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1,DK,R> to FHICOV
Skip Instructions		<1> GO TO PLNMGD; <2,3,4,5,6,7,8,9,10,11,DK,R> GO TO WRKCOR

PLNMGD	Question Text
What type of private plan do you have?
Answer Categories (Select Only 1)
HMO (Health Maintenance Organization)		IPA (Individual Practice Plan)	PPO (Preferred Provider Organization)	POS (Point of Service)	Fee-for-Service
Indemnity		Some Other Kind of Plan		<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to HIKIND
Skip Instructions		<1,2,3,4,5,6,DK,R> GO TO MGCHMD

MGCHMD	Question Text
Under you private plan, can you choose any doctor or must you choose one from a specific group or list of doctors?
Answer Categories (Select Only 1)
Choose Any Doctor		Choose from a Group or List	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1,DK,R> to FHICOV
Skip Instructions		<1,2,DK,R> GO TO PCPREQ

PCPREQ	Question Text
Does this plan require you to have a primary care doctor who approves all your care?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to HIKIND
Skip Instructions		GO TO GO TO WRKCOR

WRKCOR	Question Text
Which of the following were you doing last week?
Answer Categories (Select Only 1)
Working for pay at a job or business		With a job or business but not at work		Looking for work		Working, but not for pay, at a family-owned job or business
Not working at a job or business and not looking for work			<Don’t Know>		<Refused>
Question Universe		All Sample Respondents
Skip Instructions		<1,DK,R> GO TO HYPEV; <2,3,4,5> GO TO WHYNOWK2

WHYNOWK2	Question Text
What is the main reason you did not work last week?
Answer Categories (Select Only 1)
Taking care of house or family		Going to school	Retired	On a planned vacation from work
On family or maternity leave		Temporarily unable to work for health reasons	Have job or contract and off-season	On layoff
Disabled		Other	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <2,3,4,5> to WRKCOR
Skip Instructions		GO TO HYPEV

HYPEV	Question Text
Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1> GO TO HYPMDEV2; <2, DK, R> GO TO EPHEV

HYPMDEV2	Question Text
Has a doctor ever proscribed any medicine for you high blood pressure?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All respondents who answered <1> to HYPEV
Skip Instructions		GO TO HYPMED2

HYPMED2	Question Text
Are you now taking any medicine prescribed by a doctor for your high blood pressure?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All respondents who answered <1> to HYPEV
Skip Instructions		GO TO EPHEV

EPHEV	Question Text
Have you ever been told by a doctor or other health professional that you had emphysema?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe
Skip Instructions		GO TO COPDEV

COPDEV	Question Text
Have you ever been told by a doctor or other health professional that you had chronic obstructive pulmonary disease, also called COPD?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe
Skip Instructions		GO TO AASMEV

AASMEV	Question Text
Have you ever been told by a doctor or other health professional that you had asthma?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		<1, DK, R> GO TO AASSTILL; <2> GO TO DIBEV

AASSTILL	Question Text
Do you still have asthma?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1,DK,R> to AASMEV
Skip Instructions		GO TO AASMYR

AASMYR	Question Text
During the past 12 months have you had an episode of asthma, or an asthma attack?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1,DK,R> to AASMEV
Skip Instructions		GO TO AASMERYR

AASMERYR	Question Text
During the past 12 months have you had to visit an emergency room or urgent care center because of asthma?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1,DK,R> to AASMEV
Skip Instructions		GO TO DIBEV

DIBEV	Question Text
[Fill1 for female respondents: Other than during pregnancy, have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?]/[Fill2 for male respondents: Have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?]
Answer Categories (Select Only 1)
Yes		No		Borderline	<Don’t Know>	<Refused>
Question Universe			All sample respondents
Skip Instructions			<1> GO TO DIBAGE; <2,DK,R> GO TO DIBPRE1; <3> GO TO INSLN

DIBPRE1	Question Text
Have you ever been told by a doctor or other health professional that you have any of the following: prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or high blood sugar?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <2,DK,R> to DIBEV
Skip Instructions		<1> GO TO INSLN; <2,DK,R> GO TO CBRCHYR

DIBAGE	Question Text
How old were you when a doctor or other health professional first told you that you had diabetes or sugar diabetes?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to DIBEV
Skip Instructions		GO TO INSLN

INSLN	Question Text
Are you now taking insulin?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to DIBEV; or answered <1> to DIBRE1
Skip Instructions		GO TO DIBPILL

DIBPILL	Question Text
Are you now taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to DIBEV; or answered <1> to DIBRE1
Skip Instructions		GO TO CBRCHYR

CBRCHYR	Question Text
Have you ever been told by a doctor or other health professional that you had chronic bronchitis?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe
Skip Instructions		GO TO SMKEV

SMKEV	Question Text
These next questions are about cigarette smoking. Have you smoked at least 100 cigarettes in your entire life?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		<1> GO TO SMKNOW; <2,DK,R> GO TO SMKANY

SMKNOW	Question Text
How often do you now smoke cigarettes? Every day, some days or not at all?
Answer Categories (Select Only 1)
Every Day		Some Days		Not At All	<Don’t Know>	<Refused>
Question Universe			Respondents who answered <1> to SMKEV
Skip Instructions			<1,2> GO TO CIGQTYR; <3> GO TO SMKQTNO; <DK,R> GO TO VIGNO

SMKQTNO	Question Text
How long has it been since you quit smoking cigarettes?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		Respondents who answered <3> to SMKNOW
Skip Instructions		GO TO VIGNO

CIGQTYR	Question Text
During the past 12 months, have you stopped smoking for more than one day because you were trying to quit smoking?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1,2> to SMKNOW
Skip Instructions		GO TO VIGNO

SMKANY	Question Text
Have you ever smoked a cigarette even one time?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		Respondents who answered <2,DK,R> to SMKEV
Skip Instructions		GO TO VIGNO

VIGNO	Question Text
How often do you do vigorous leisure-time physical activities for at least 10 minutes that cause heave sweating or large increases in breathing or heart rate?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE][ADD DROP DOWN FOR UNIT OF MEASUREMENT (HOUR/DAY/WEEK/MONTH/YEAR)]			<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		GO TO MODNO

MODNO	Question Text
How often do you do light or moderate leisure time physical activities for at least 10 minutes that cause only light sweating or a slight to moderate increase in breathing or heart rate?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE][ADD DROP DOWN FOR UNIT OF MEASUREMENT (HOUR/DAY/WEEK/MONTH/YEAR)			<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		GO TO STRNGNO

STRNGNO	Question Text
How often do you do leisure time physical activities specifically designed to strengthen your muscles such as lifting weights or doing calisthenics?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE][ADD DROP DOWN FOR UNIT OF MEASUREMENT (HOUR/DAY/WEEK/MONTH/YEAR)			<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		GO TO ALC1YR

ALC1YR	Question Text
In any one year, have you had at least 12 drinks of any type of alcoholic beverage?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1> GO TO ALC12MNO; <2,DK,R> GO TO ALCLIFE

ALCLIFE	Question Text
In your entire life, have you had at least 12 drinks of any type of alcoholic beverage?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1> GO TO ALC12MNO; <2,DK,R> GO TO AHGT_FT

ALC12MNO	Question Text
In the past year, how often did you drink any type of alcoholic beverage?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to ALCLIFE
Skip Instructions		GO TO ALCAMT

ALCAMT	Question Text
On those days that you drank alcoholic beverages in the past year, , how many drinks did you have on the average?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to ALCLIFE
Skip Instructions		GO TO ALC5UPNO

ALC5UPNO	Question Text
In the past year, on how many days did you have [FILL BASED ON GENDER (MALE AND FEMALE, RESPECTIVELY): 5 or more/4 or more} drinks of any alcoholic beverage?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to ALCLIFE
Skip Instructions		GO TO BINGE

BINGE	Question Text
Considering all types of alcoholic beverages, during the past 30 days, how many times did you have [FILL BASED ON GENDER (MALE AND FEMALE, RESPECTIVELY): 5 or more/4 or more] drinks on an occasion
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		Respondents who answered <1> to ALCLIFE
Skip Instructions		GO TO AHGT_FT

AHGT_FT	Question Text
How tall are you without shoes?
Answer Categories (Select Only 1)
[OPEN RESPONSE?]			<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		GO TO AWGT_LB

AWGT_LB	Question Text
How much do you weigh without shoes?
Answer Categories (Select Only 1)
[OPEN RESPONSE?]			<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		GO TO AHCDLY_1

AHCDLY_1	Question Text
You couldn't get through on the telephone.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCDLY_2

AHCDLY_2	Question Text
You couldn't get an appointment soon enough.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCDLY_3

AHCDLY_3	Question Text
Once you get there, you have to wait too long to see the doctor.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCDLY_4

AHCDLY_4	Question Text
The clinic or doctor’s office wasn't open when you could get there.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCDLY_5

AHCDLY_5	Question Text
You didn't have transportation.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCAFY_1

AHCAFY_1	Question Text
Prescription medicines.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCAFY_2

AHCAFY_2	Question Text
Mental health care or counseling.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCAFY_3

AHCAFY_3	Question Text
Dental care (including checkups).
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCAFY_4

AHCAFY_4	Question Text
Eyeglasses.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCAFY_5

AHCAFY_5	Question Text
To see a specialist.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,DK,R> GO TO AHCAFY_6

AHCAFY_6	Question Text
Follow-up care.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		GO TO HIT1A

HIT1A	Question Text
Look up health information on the Internet.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		GO TO HIT3A

HIT3A	Question Text
Schedule an appointment with a health care provider.
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		GO TO ACISAD

ACISAD	Question Text
So sad that nothing could cheer you up?
Answer Categories (Select Only 1)
[OPEN RESPONSE?]			<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		GO TO ACINERV

ACINERV	Question Text
Nervous?
Answer Categories (Select Only 1)
All of the time		Most of the time			Some of the time		A little of the time
NONE of the time				<Don’t Know>		<Refused>
Question Universe			All Sample Respondents
Skip Instructions			GO TO ACIRSTLS

ACIRSTLS	Question Text
Restless or fidgety?
Answer Categories (Select Only 1)
All of the time		Most of the time		Some of the time	A little of the time
NONE of the time				<Don’t Know>	<Refused>
Question Universe			All Sample Respondents
Skip Instructions			GO TO ACIHOPLS

ACIHOPLS	Question Text
Hopeless?
Answer Categories (Select Only 1)
All of the time		Most of the time		Some of the time	A little of the time
NONE of the time				<Don’t Know>	<Refused>
Question Universe			All Sample Respondents
Skip Instructions			GO TO ACIEFFRT

ACIEFFRT	Question Text
That everything was an effort?
Answer Categories (Select Only 1)
All of the time			Most of the time				Some of the time		A little of the time
NONE of the time							<Don’t Know>		<Refused>
Question Universe					All Sample Respondents
Skip Instructions					GO TO ACIWTHLS
ACIWTHLS		Question Text
Worthless?
Answer Categories (Select Only 1)
All of the time				Most of the time				Some of the time		A little of the time
NONE of the time								<Don’t Know>		<Refused>
Question Universe						All Sample Respondents
Skip Instructions						GO TO AWEBOFNO

AWEBOFNO	Question Text
How often do you use the Internet?
Answer Categories (Select Only 1)
[OPEN NUMERIC RESPONSE]			<Don’t Know>	<Refused>
Question Universe		All Sample Respondents
Skip Instructions		GO TO ANX_1

ANX_1	Question Text
How often do you feel worried, nervous or anxious? Would you say daily, weekly, monthly, a few times a year, or never?
Answer Categories (Select Only 1)
Daily		Weekly		Monthly		A Few Times a Year
Never			<Don’t Know>		<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,2,3,4,DK,R> GO TO ANX_2

ANX_2	Question Text
Do you take medication for these feelings?
Answer Categories (Select Only 1)
Yes		No	<Don’t Know>	<Refused>
Question Universe		All sample respondents
Skip Instructions		<1,DK,R> OR <1,2,3,4,DK,R> to ANX_1 GO TO ANX_3; <4> AND <5> to ANX_1 END

ANX_3	Question Text
Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings? Would you say a little, a lot, or somewhere in between?
Answer Categories (Select Only 1)
A Little			A Lot		Somewhere in Between a Little and a Lot
<Don’t Know>				<Refused>
Question Universe		Respondents who answered <1,2,3,4,DK,R> to ANX_1 OR Respondents who answered <1,DK,R> to ANX_2
Skip Instructions		<1,2,3, DK, R> END