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pdfHealth Functioning and Status (HFQ)
Variable Name
MR Screen Name Question type Question text/description
GO TO HFA1 - GENHELTH
BOX HFBEG
routing
Now, I would like to ask you about [your/(SP's)] health.
GENHELTH
HFA1
code one
In general, compared to other people [your/(SP's)] age, would you say that
(your/his/her) health is . . .
SHOW CARD HFX HF1
Compared to one year ago, how would you rate [your/(SP's)] health in general
now?
COMPHLTH
HFA2
code one
Would you say [your/(SP's)] health is . . .
SHOW CARD HFX HF2
FUTRHLTH
HFA2B
code one
In the next 6 months, what do you think will happen to [your/(SP's)] overall
health?
Now, I would like to ask you about [your/(SP's)] health.
DISHEAR
DISSEE
DIS1
DIS2
yes/no
[Are you/is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?
yes/no
[Are you/is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even
when wearing glasses?
DISDECISION
DIS3
yes/no
Because of a physical, mental, or emotional condition, [do you/does (SP)] have
serious difficulty concentrating, remembering, or making decisions?
DISWALK
DIS4
yes/no
[Do you/Does (SP)] have serious difficulty walking or climbing stairs?
DISBATH
DIS5
yes/no
[Do you/Does (SP)] have difficulty dressing or bathing?
yes/no
Because of a physical, mental, or emotional condition, [do you/does (SP)] have
difficulty doing errands alone such as visiting a doctor's office or shopping?
DISERRANDS
DIS6
How much of the time during the past month has [your/(SP's)] health limited
[your/(SP's)] social activities, like visiting with friends or close relatives?
HELMTACT
ECHELP
ECTROUB
HFA3
code one
BOX HFA1
routing
HFB1
HFB2
yes/no
code one
Would you say . . .
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO BOX
HFF1.
ELSE GO TO HFB1 - ECHELP.
EDOCEXAM
HFB2A
HFB6
(01) excellent,
(02) very good,
(03) good,
(04) fair, or
(05) poor?
(-8) DON'T KNOW
(-9) REFUSED
(01) much better now than one year ago,
(02) somewhat better now than one year ago,
(03) about the same,
(04) somewhat worse now than one year ago, or
(05) much worse now than one year ago?
(-8) DON'T KNOW
(-9) REFUSED
(01) it will get much better
(02) it will get somewhat better
(03) it will not change
(04) it will get somewhat worse
(05) it will get much worse
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) none of the time,
(02) some of the time,
(03) most of the time, or
(04) all of the time?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(03) SP IS BLIND
(-8) DON'T KNOW
[Do you/Does (SP)] wear eyeglasses or contact lenses?
(-9) REFUSED
(01) NO TROUBLE SEEING
(02) A LITTLE TROUBLE SEEING
(03) A LOT OF TROUBLE SEEING
Which statement best describes [your/(SP's)] vision [while wearing glasses or
(04) NO USABLE VISION
contact lenses]... no trouble seeing, a little trouble, a lot of trouble, or no usable (-8) DON'T KNOW
vision?
(-9) REFUSED
[Have you/Has (SP)] been told that (you are/he is/she is) legally blind?
ECLEGBLI
Code list
yes/no
[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with
corrective lenses, they cannot see well enough to drive.]
yes/no
[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF
MONTH YEAR)?
INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Text Fill Logic
Input mask
Routing
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
HFA2 - COMPHLTH
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
HFA3 - HELMTACT HFA2B- FUTRHLTH
[your] respondent is SP
[(SP's)] respondent is proxy
[Are you] respondent is SP
[is (SP)] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[Are you] respondent is SP
[is (SP)] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
DIS1
DIS2
DIS3
[do you] respondent is SP
[does (SP)] respondent is proxy
DIS4
[Do you] respondent is SP
[Does (SP)] respondent is proxy
DIS5
[Do you] respondent is SP
[Does (SP)] respondent is proxy
DIS6
[do you] respondent is SP
[does (SP)] respondent is proxy
HFA3 - HELMTACT
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
HFB1-ECHELP BOX HFA1
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[while wearing glasses or contact lenses] SP wears glasses or
contact lenses
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you are] respondent is SP
[he is] respondent is proxy, SP male
[she is] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
(01) HFB2 - ECTROUB
(02) HFB2 - ECTROUB
(03) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
(01) HFB6 - EDOCEXAM
(02) HFB6 - EDOCEXAM
(03) HFB2A - ECLEGBLI
(04) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
HFB6 - EDOCEXAM
(01) HFB7A - EDOCTYPE
(02) HFB7 - EDOCLAST
(-8) BOX HFB1
(-9) BOX HFB1
EDOCLAST
HFB7
code one
How long has it been since [your/(SP's)] last eye examination by an eye doctor?
I have a couple of questions about [your/(SP’s)] last eye examination.
Was the eye examination given by an optometrist, ophthalmologist or some
other type of doctor or eye care professional?
EDOCTYPE
EDOCTYOS
EDOCDLAT
HFB7A
HFB7A
HFB7B
code one
verbatim text
yes/no
[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry (O.D.) who
diagnoses and treats visual health problems. An ophthalmologist is a doctor of
medicine (M.D.) who specializes in surgery and diseases of the eye.]
OTHER (SPECIFY)
Again, thinking about [your/(SP’s)] last eye examination, were dilating drops
used in [your/(SP)’s] eyes?
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye
examinations. The drops often make your eyes more sensitive to bright light
and may cause temporary blurry vision.]
I am going to read a list of eye conditions. Please tell me if [you have/(SP) has]
ever been told by a doctor that (you/he/she) had any of these conditions.
ECATARAC
HFB7C
yes/no
[Have you/Has (SP)] ever been told by a doctor that (you/he/she)
had…Cataracts?
EGLAUCOM
HFB7C
yes/no
Glaucoma?
ERETINOP
HFB7C
yes/no
Diabetic retinopathy?
EMACULAR
ECCATOP
ELASRSUR
HCHELP
HCTROUB
HFB7C
BOX HFB1A
yes/no
routing
HFB10
yes/no
BOX HFB1
routing
HFB11
HFC1
HFC2
yes/no
yes/no
code one
Macular degeneration or age-related macular degeneration, also called AMD?
IF ECATARAC=02/NO, GO TO BOX HFB1. ELSE GO TO HFB10 - ECCATOP.
[Have you/Has (SP)] ever had an operation for cataracts?
IF HFB7C - ERETINOP = 1/Yes OR HFB7C - EMACULAR = 1/Yes, GO TO HFB11 ELASRSUR.
ELSE GO TO HFC1 - HCHELP.
Laser surgery to the back of the eye, or retina, is a commonly used treatment for
diabetic retinopathy and macular degeneration.
(01) NEVER HAD EYE EXAM BY EYE DOCTOR
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 5 YEARS
(04) 5 YEARS OR MORE
(-8) DON'T KNOW
(-9) REFUSED
(01) OPTOMETRIST
(02) OPTHAMOLOGIST
(91) OTHER DOCTOR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Have [you/(SP)] [Have you/Has (SP)] ever had laser surgery to the back of
(01) YES
either eye for one of these conditions?
(02) NO
[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to the (-8) DON'T KNOW
front of the eye used to correct vision.]
(-9) REFUSED
(01) YES
(02) NO
(03) SP IS DEAF
(-8) DON'T KNOW
[Do you/Does (SP)] use a hearing aid?
(-9) REFUSED
(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
(03) A LOT OF TROUBLE HEARING
(04) DEAF
Which statement best describes [your/(SP's)] hearing (with a hearing aid): no
(-8) DON'T KNOW
trouble hearing, a little trouble, a lot of trouble, or deaf?
(-9) REFUSED
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[you have] respondent is SP
[(SP) has] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
(01) BOX HFB1
(02) HFB7A - EDOCTYPE
(03) HFB7A - EDOCTYPE
(04) HFB7A - EDOCTYPE
(-8) BOX HFB1
(-9) BOX HFB1
(01) H7B7B - EDOCDLAT
(02) H7B7B - EDOCDLAT
(91) HFB7 - EDOCTYOS
(-8) BOX HFB1
(-9) BOX HFB1
H7B7B - EDOCDLAT
HFB7C - ECATARAC
HFB7C - EGLAUCOM
HFB7C - ERETINOP
HFB7C - EMACULAR
HFB10 - ECCATOP
BOX HFB1A
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
BOX HFB1
HFC1 - HCHELP
(01) HFC2 - HCTROUB
(02) HFC2 - HCTROUB
(03) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
(01) HFD1A - FOODTRBL
(02) HFC3 - HCKNOWMC
(03) HFC3 - HCKNOWMC
(04) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
HCKNOWMC
HCCOMDOC
FOODTRBL
HEIGHTFT
HFC3
HFC4
HFD1A
HFE1
code one
code one
code one
numeric
WEIGHT
HFE1
numeric
PREVHLTHINTRO
HFFINTRO
no entry
BPTAKEN
BCTAKEN
MAMMOGRM
HFF1
code one
HFF2
code one
BOX HFF1
routing
HFF3
yes/no
BOX HFF1A
routing
How much trouble [do you/does (SP)] have finding out things (you need/he
needs/she needs) to know about Medicare because [of (your/his/her) difficulty
hearing/(you are/he is/she is) deaf]? Would you say (you have/she has/he has)
no trouble, a little trouble, or a lot of trouble?
(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED
How much trouble [do you/does (SP)] have communicating with (your/his/her)
doctor or other medical personnel because [of (your/his/her) difficulty
hearing/(you are/he is/she is) deaf]? Would you say (you have/she has/he has)
no trouble, a little trouble, or a lot of trouble?
(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
(02) A LITTLE TROUBLE
How much trouble [do you/does (SP)] have eating solid foods because of
(03) A LOT OF TROUBLE
problems with (your/his/her) mouth or teeth? Would you say (you have/she
(-8) DON'T KNOW
has/he has) no trouble, a little trouble, or a lot of trouble?
(-9) REFUSED
(01) continuous answer
(-8) DON'T KNOW
How tall [are you/is (SP)]?
(-9) REFUSED
(01) continuous answer
(-8) DON'T KNOW
How much [do you/does (SP)] weigh?
(-9) REFUSED
These next few questions are about preventive health care measures some
(01) CONTINUE
people take.
(-7) EMPTY
(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD BLOOD PRESSURE TAKEN
When was the most recent time [you/(SP)] had (your/his/her) blood pressure
(-8) DON'T KNOW
taken by a doctor or other health professional?
(-9) REFUSED
(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD CHOLESTEROL CHECKED
When was the most recent time [you/(SP)] had (your/his/her) blood cholesterol (-8) DON'T KNOW
checked?
(-9) REFUSED
IF SP IS FEMALE, GO TO HFF3 - MAMMOGRM.
ELSE GO TO BOX HFF3.
(01) YES
(These next few questions are about preventive health care measures some
(02) NO
people take). [Have you/Has (SP)] had a mammogram or a breast X-ray since
(-8) DON'T KNOW
(LAST HF MONTH YEAR)?
(-9) REFUSED
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO HFF6
- PAPSMEAR.
ELSE GO TO HFF5 - MAMCODE.
[do you] respondent is SP
[does (SP)] respondent is proxy
[you need] respondent is SP
[he needs] respondent is proxy, SP male
[she needs] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you are] respondent is SP
[he is] respondent is proxy, SP male
[she is] respondent is proxy, SP female
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
[do you] respondent is SP
[does (SP)] respondent is proxy
[you need] respondent is SP
[he needs] respondent is proxy, SP male
[she needs] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you are] respondent is SP
[he is] respondent is proxy, SP male
[she is] respondent is proxy, SP female
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
[do you] respondent is SP
[does (SP)] respondent is proxy
[you need] respondent is SP
[he needs] respondent is proxy, SP male
[she needs] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you are] respondent is SP
[he is] respondent is proxy, SP male
[she is] respondent is proxy, SP female
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
HFC4 - HCCOMDOC
HFD1A - FOODTRBL
HFE1 - HEIGHTFT
[are you] respondent is SP
[is (SP)] respondent is proxy
HFE1 - HEIGHTIN
[do you] respondent is SP
[does (SP)] respondent is proxy
HFFINTRO - PREVHLTHINTRO
HFF1 - BPTAKEN
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
HFF2 - BCTAKEN
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
BOX HFF1
[Have you] respondent is SP
[Has (SP)] respondent is proxy
(01) HFF6 - PAPSMEAR
(02) BOX HFF1A HFF5 - MAMCODE
(-8) HFF6 - PAPSMEAR
(-9) HFF6 - PAPSMEAR
MAMCODE
MAMNOTHS
PAPSMEAR
PAPCODE
PAPNOTHS
HYSTEREC
HFF5
HFF5
code all
verbatim text
HFF6
yes/no
BOX HFF1B
routing
HFF8
HFF8
code all
verbatim text
BOX HFF2
routing
HFF9
yes/no
BOX HFF3
routing
What is the reason that [you have/(SP) has] not had a mammogram since (LAST
HF MONTH YEAR)?
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
[Have you/Has (SP)] had a Pap smear test since (LAST HF MONTH YEAR)?
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO BOX
HFF2.
ELSE GO TO HFF8 - PAPCODE.
(01) DIDN’T KNOW IT WAS NEEDED/NO
NEED/NOTHING WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A
DIFFERENT SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT BREAST
CANCER/COULD GET BREAST CANCER ANYWAY/TEST IS
USELESS
(04) NOT AT RISK FOR BREAST CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE MAMMOGRAMS/PAIN, SORENESS,
DISCOMFORT OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
LOCATION/TRANSPORTATION DIFFICULTY
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF MAMMOGRAM/INSURANCE DOESN’T
COVER COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) MAMMOGRAM RADIATION COULD CAUSE
CANCER/ILL EFFECTS
(13) NEVER HEARD OF MAMMOGRAM
(14) APPOINTMENT SCHEDULED FOR FUTURE DATE
(15) MASTECTOMY/BREASTS REMOVED
(16) TOO ILL, PHYSICALLY/MENTALLY
(91) OTHER
(-8) DON'T KNOW
[you have] respondent is SP
(-9) REFUSED
[(SP) has] respondent is proxy
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Have you] respondent is SP
[Has (SP)] respondent is proxy
(01) DIDN’T KNOW IT WAS NEEDED/NO
NEED/NOTHING WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A
DIFFERENT SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT CANCER/COULD
GET CANCER ANYWAY/TEST IS USELESS
(04) NOT AT RISK FOR CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE PAP SMEAR/PAIN, SORENESS,
DISCOMFORT OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
LOCATION/TRANSPORTATION DIFFICULTY
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF PAP SMEAR/INSURANCE DOESN’T COVER
COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) NEVER HEARD OF PAP SMEAR
(13) APPOINTMENT SCHEDULED FOR FUTURE DATE
(14) HAD HYSTERECTOMY/NO UTERUS, OVARIES
(15) TOO ILL, PHYSICALLY/MENTALLY
(91) OTHER
What is the reason that [you have/(SP) has] not had a Pap smear test since (LAST (-8) DON'T KNOW
HF MONTH YEAR)?
(-9) REFUSED
[you have] respondent is SP
CHECK ALL THAT APPLY.
[(SP) has] respondent is proxy
OTHER (SPECIFY)
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND RESPONSE TO HHF8 – PAPCODE
DOES NOT INCLUDE 14/HadHysterectomy, GO TO HFF9 - HYSTEREC.
ELSE GO TO BOX HFF3.
(01) YES
(02) NO
(-8) DON'T KNOW
[Have you] respondent is SP
[Have you/Has (SP)] ever had a hysterectomy?
(-9) REFUSED
[Has (SP)] respondent is proxy
IF SP HAS EVER REPORTED HAVING PROSTATE SURGERY IN A PREVIOUS ROUND,
GO TO HFF11 - DIGTEXAM.
ELSE GO TO HFF10 - PROSSURG.
(01) HFF6 - PAPSMEAR
(02) HFF6 - PAPSMEAR
(03) HFF6 - PAPSMEAR
(04) HFF6 - PAPSMEAR
(05) HFF6 - PAPSMEAR
(06) HFF6 - PAPSMEAR
(07) HFF6 - PAPSMEAR
(08) HFF6 - PAPSMEAR
(09) HFF6 - PAPSMEAR
(10) HFF6 - PAPSMEAR
(11) HFF6 - PAPSMEAR
(12) HFF6 - PAPSMEAR
(13) HFF6 - PAPSMEAR
(14) HFF6 - PAPSMEAR
(15) HFF6 - PAPSMEAR
(16) HFF6 - PAPSMEAR
(91) HFF5 - MAMNOTHS
(-8) HFF6 - PAPSMEAR
(-9) HFF6 - PAPSMEAR
HFF6 - PAPSMEAR
(01) BOX HFF2
(02) BOX HFF1B HFF8 - PAPCODE
(-8) BOX HFF2
(-9) BOX HFF2
(01) BOX HFF2
(02) BOX HFF2
(03) BOX HFF2
(04) BOX HFF2
(05) BOX HFF2
(06) BOX HFF2
(07) BOX HFF2
(08) BOX HFF2
(09) BOX HFF2
(10) BOX HFF2
(11) BOX HFF2
(12) BOX HFF2
(13) BOX HFF2
(14) BOX HFF2
(15) BOX HFF2
(91) HFF8 - PAPNOTHS
(-8) BOX HFF2
(-9) BOX HFF2
BOX HFF2
HFF15 - FLUSHOT
[Since (LAST HF MONTH YEAR), [have you/has (SP)/[Have you/has (SP)] ever] had
surgery on (your/his) prostate?
PROSSURG
HFF10
yes/no
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is typically used as a
treatment for prostate cancer or to correct urinary problems. Surgery can
include complete or partial removal of the prostate.]
These next few questions are about [preventive health care measures some
people take/follow-up care sometimes prescribed after prostate surgery].
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Have you/Has (SP)] had a digital rectal examination (of the prostate) since (LAST
HF MONTH YEAR)?
DIGTEXAM
HFF11
yes/no
(01) YES
[EXPLAIN IF NECESSARY: The exam may be used to detect prostate cancer, to
(02) NO
determine whether cancer has spread beyond the prostate, and as part of follow- (-8) DON'T KNOW
up care after prostate surgery.]
(-9) REFUSED
[Have you/Has (SP)] had a blood test for detection of prostate cancer, known as
a PSA, since (LAST HF MONTH YEAR)?
[Since (LAST HF MONTH YEAR)] second or more time through
loop
[have you] respondent is SP, second or more time through
loop
[has (SP)] respondent is proxy, second or more time through
loop
[Have you ever] respondent is SP, first time through loop
[Has (SP) ever] respondent is proxy, first time through loop
[your] respondent is SP
[his] respondent is proxy
[Since (LAST HF MONTH YEAR), have you] HFQ has been
completed before in a previous round and the respondent is
SP
[Since (LAST HF MONTH YEAR), has (SP)] HFQ has been
completed before in a previous round and the respondent is
proxy
[Have you ever] respondent is SP, first time through the HFQ
section ever
[Has (SP) ever] respondent is proxy, first time through the HFQ
section ever
[your] respondent is SP
[his] respondent is proxy
HFF11 - DIGTEXAM
[preventive health care measures some people take]
PROSSURG in(02,-8,-9)
[follow-up care sometimes prescribed after prostate surgery]
PROSSURG = 01 or P_PROSSURG=1
[Have you] respondent is SP
[Has (SP)] respondent is proxy
HFF12 - BLOODTST
[Have you] respondent is SP
[Has (SP)] respondent is proxy
(01) HFF15 - FLUSHOT
(02) BOX HFF3B HFF14 - PRONCODE
(-8) HFF15 - FLUSHOT
(-9) HFF15 - FLUSHOT
PSA = PROSTATE-SPECIFIC ANTIGEN
BLOODTST
PRONCODE
PRONOTHS
FLUSHOT
HFF12
yes/no
BOX HFF3B
routing
HFF14
HFF14
HFF15
code all
verbatim text
yes/no
(01) YES
[EXPLAIN IF NECESSARY: The test may be used to detect prostate cancer, to
(02) NO
determine whether cancer has spread beyond the prostate, and as part of follow- (-8) DON'T KNOW
up care after prostate surgery.]
(-9) REFUSED
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO
HFF15 - FLUSHOT.
ELSE GO TO HFF14 - PRONCODE.
(01) DIDN’T KNOW IT WAS NEEDED/NO
NEED/NOTHING WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A
DIFFERENT SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT CANCER/COULD
GET CANCER ANYWAY/TEST IS USELESS
(04) NOT AT RISK FOR CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE BLOOD TESTS/PAIN, SORENESS,
DISCOMFORT OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
LOCATION/TRANSPORTATION DIFFICULTY
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF TEST/INSURANCE DOESN’T COVER
COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) NEVER HEARD OF PSA
(13) APPOINTMENT SCHEDULED FOR FUTURE DATE
(14) PROSTATECTOMY/PROSTATE REMOVED
What is the reason that [you have/(SP) has] not had a prostate blood test or PSA (91) OTHER
since (LAST HF MONTH YEAR)?
(-8) DON'T KNOW
[you have] respondent is SP
CHECK ALL THAT APPLY.
(-9) REFUSED
[(SP) has] respondent is proxy
OTHER (SPECIFY)
Did [you/(SP)] have a seasonal flu shot for last winter?
(01) YES
[you] respondent is SP
[EXPLAIN IF NECESSARY: Did [you/(SP)] have a seasonal flu shot any time during (02) NO
[(SP)] respondent is proxy
the period from September (PREVIOUS YEAR) through December (PREVIOUS
(-8) DON'T KNOW
[you] respondent is SP
YEAR)?]
(-9) REFUSED
[(SP)] respondent is proxy
(01) HFF15 - FLUSHOT
(02) HFF15 - FLUSHOT
(03) HFF15 - FLUSHOT
(04) HFF15 - FLUSHOT
(05) HFF15 - FLUSHOT
(06) HFF15 - FLUSHOT
(07) HFF15 - FLUSHOT
(08) HFF15 - FLUSHOT
(09) HFF15 - FLUSHOT
(10) HFF15 - FLUSHOT
(11) HFF15 - FLUSHOT
(12) HFF15 - FLUSHOT
(13) HFF15 - FLUSHOT
(14) HFF15 - FLUSHOT
(91) HFF14 - PRONOTHS
(-8) HFF15 - FLUSHOT
(-9) HFF15 - FLUSHOT
HFF15 - FLUSHOT
(01) HFF18 - FLUSITE
(02) HFF17 - FLUCODE
(-8) BOX HFF5
(-9) BOX HFF5
Why didn't [you/(SP)] get a seasonal flu shot last winter?
FLUCODE
FLUOTHOS
FLUSITE
FLUSITOS
VACPAID
VACSUPLY
NOVACINE
PNEUSHOT
HFF17
HFF17
code all
verbatim text
BOX HFF4
routing
HFF18
HFF18
HFF18A
HFF20
code all
verbatim text
yes/no
yes/no
HFF21
yes/no
BOX HFF5
routing
HFF22
yes/no
BOX HFF5B
routing
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
IF RESPONSE TO HFF17 – FLUCODE DOES NOT INCLUDE 13/VaccineUnavailable,
GO TO HFF21 - NOVACINE.
ELSE GO TO BOX HFF5.
(01) DIDN’T KNOW IT WAS NEEDED
(02) SHOT COULD CAUSE FLU
(03) SHOT COULD HAVE SIDE EFFECTS OR CAUSE
DISEASE
(04) DIDN’T THINK IT WOULD PREVENT THE FLU/COULD
GET THE FLU ANYWAY
(05) FLU NOT SERIOUS/WOULD NOT GET FLU
ANYWAY/NOT AT RISK
(06) DOCTOR DID NOT RECOMMEND THE SHOT
(07) DOCTOR RECOMMENDED AGAINST GETTING
SHOT/ALLERGIC TO SHOT/MEDICAL REASONS
(08) DON’T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT
SORENESS OR RASH/LOCAL REACTIONS
(09) INCONVENIENT TO GET SHOT/UNABLE TO GET TO
LOCATION
(10) DIDN’T THINK ABOUT IT/FORGOT/MISSED IT
(11) COST OF SHOT/NOT WORTH THE MONEY
(12) HAD SHOT BEFORE/DIDN’T NEED IT AGAIN
(13) VACCINE UNAVAILABLE/VACCINE SHORTAGE
(91) OTHER
(-8) DON'T KNOW
[you] respondent is SP
(-9) REFUSED
[(SP)] respondent is proxy
(01) DOCTORS OFFICE OR GROUP PRACTICE
(02) MEDICAL CLINIC
(03) MANAGED CARE PLAN CENTER/HMO
(04) NEIGHBORHOOD/FAMILY HEALTH CENTER
(05) FREESTANDING SURGICAL CENTER
(06) RURAL HEALTH CLINIC
(07) COMPANY CLINIC
(08) OTHER CLINIC
(09) WALK-IN URGENT CENTER
(10) HOSPITAL EMERGENCY ROOM
(11) HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
(12) VA FACILITY
(13) HEALTH FAIR
(14) SHOPPING MALL/OTHER STORE
(15) SENIOR CENTER
(16) AT HOME
(17) CHURCH/SCHOOL
Where did [you/(SP)] go for (your/his/her) most recent seasonal flu shot, was
(18) LIBRARY
that a managed care plan or HMO center, a clinic, a doctor’s office, a hospital, a (19) HOSPITAL INPATIENT
health fair, shopping mall, or some other place?
(91) OTHER
(-8) DON'T KNOW
[IF CLINIC, ASK: Was it a hospital outpatient clinic, or some other kind of clinic? (-9) REFUSED
IF SOME OTHER PLACE, ASK: Where was this?]
OTHER (SPECIFY)
Did [you/(SP)] pay some or all of the cost of the flu shot?
(01) YES
(02) NO
Please include any monetary donations that you may have made to cover the
(-8) DON'T KNOW
cost of the flu shot.
(-9) REFUSED
Did [you/(SP)] have any trouble getting a seasonal flu shot when (you/he/she)
wanted to because the vaccine was in short supply or unavailable?
Was one reason that [you/(SP)] did not get a seasonal flu shot last winter
because the vaccine was in short supply or unavailable?
IF SP HAS EVER REPORTED HAVING A PNEUMONIA SHOT IN A PREVIOUS ROUND,
GO TO BOX HFG1.
ELSE GO TO HFF22 - PNEUSHOT.
[Have you/Has (SP)] ever had a shot for pneumonia?
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO BOX
HFG1.
ELSE GO TO HFF23 - PNUCODE.
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
(01) BOX HFF4
(02) BOX HFF4
(03) BOX HFF4
(04) BOX HFF4
(05) BOX HFF4
(06) BOX HFF4
(07) BOX HFF4
(08) BOX HFF4
(09) BOX HFF4
(10) BOX HFF4
(11) BOX HFF4
(12) BOX HFF4
(13) BOX HFF4
(91) HFF17 - FLUOTHOS
(-8) BOX HFF4
(-9) BOX HFF4
BOX HFF4
(01) HFF18A - VACPAID
(02) HFF18A - VACPAID
(03) HFF18A - VACPAID
(04) HFF18A - VACPAID
(05) HFF18A - VACPAID
(06) HFF18A - VACPAID
(07) HFF18A - VACPAID
(08) HFF18A - VACPAID
(09) HFF18A - VACPAID
(10) HFF18A - VACPAID
(11) HFF18A - VACPAID
(12) HFF18A - VACPAID
(13) HFF18A - VACPAID
(14) HFF18A - VACPAID
(15) HFF18A - VACPAID
(16) HFF18A - VACPAID
(17) HFF18A - VACPAID
(18) HFF18A - VACPAID
(19) HFF18A - VACPAID
(91) HFF18 - FLUSITOS
(-8) HFF18A - VACPAID
(-9) HFF18A - VACPAID
HFF18A - VACPAID
HFF20 - VACSUPLY
BOX HFF5
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFF5
[Have you] respondent is SP
[Has (SP)] respondent is proxy
(01) BOX HFG1
(02) BOX HFF5B HFF23 PNUCODE
(-8) BOX HFG1
(-9) BOX HFG1
Why [haven't you/hasn't (SP)] ever had a shot for pneumonia?
PNUCODE
PNUOTHOS
EVERSMOK
SMOKNOW
HFF23
HFF23
code all
verbatim text
BOX HFG1
routing
HFG1
yes/no
HFG2
yes/no
BOX HFG1A
routing
DIDSMOKE
HFG3
numeric
LASTSMOK
HFG4
code 1
HAVSMOKE
HFG5
numeric
HAVSMOKE_LESSONE
HFG5
numeric
DRQTSMOK
QUITSMOK
DRINKDAY
HFG5A
yes/no
BOX HFG1B
routing
HFG6
yes/no
BOX HFG1C
routing
HFG7
numeric
BOX HFG2
routing
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
IF SP WAS ASKED IF HE/SHE NOW SMOKES CIGARETTES, CIGARS, OR PIPE
TOBACCO IN A PREVIOUS ROUND, GO TO HFG2 - SMOKNOW.
ELSE GO TO HFG1 - EVERSMOK.
[Have you/Has (SP)] ever smoked cigarettes, cigars, or pipe tobacco?
[Do you/Does (SP)] smoke cigarettes, cigars, or pipe tobacco now?
IF THIS IS ROUND 73 THEN
IF HFG2-SMOKNOW = 2/No, GO TO HFG3 - DIDSMOKE.
ELSE GO TO HFG5 - HAVSMOKE.
ELSE IF THIS IS NOT ROUND 73 THEN
IF HFG2-SMOKNOW = 2/No, GO TO BOX HFG1C.
ELSE GO TO HFG5A - DRQTSMOK.
(01) DIDN'T KNOW IT WAS NEEDED
(02) SHOT COULD CAUSE PNEUMONIA
(03) SHOT COULD HAVE SIDE EFFECTS OR CAUSE
DISEASE
(04) DIDN'T THINK IT WOULD PREVENT
PNEUMONIA/COULD GET PNEUMONIA ANYWAY
(05) PNEUMONIA NOT SERIOUS/WOULD NOT GET
PNEUMONIA ANYWAY/NOT AT RISK
(06) DOCTOR DID NOT RECOMMEND THE SHOT
(07) DOCTOR RECOMMENDED AGAINST GETTING
SHOT/ALLERGIC TO SHOT/MEDICAL REASONS
(08) DON'T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT
SORENESS OR RASH/LOCAL REACTIONS
(09) INCONVENIENT TO GET SHOT/UNABLE TO GET TO
LOCATION
(10) DIDN'T THINK ABOUT IT/FORGOT/MISSED IT
(11) COST OF SHOT/NOT WORTH THE MONEY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Have you] respondent is SP
[Has (SP)] respondent is proxy
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Do you] respondent is SP
[Does (SP)] respondent is proxy
(01) HFG2 - SMOKNOW
(02) BOX HFG1C
(-8) BOX HFG1C
(-9) BOX HFG1C
(01) BOX HFG1A
(02) BOX HFG1A
(03) BOX HFG1C
(-8) BOX HFG1C
(-9) BOX HFG1C
[you] respondent is SP
[(SP)] respondent is proxy
HFG3 - DIDSMOKE_LESSONE
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFG1C
(01) continuous answer
How many years did [you/(SP)] smoke?
(-7) EMPTY
[EXCLUDE BREAKS WHEN THE RESPONDENT DID NOT SMOKE BETWEEN YEARS (-8) DON'T KNOW
OF SMOKING.]
(-9) REFUSED
(01) WITHIN THE LAST MONTH
(02) 1 MONTH TO LESS THAN 6 MONTHS AGO
(03) 6 MONTHS TO LESS THAN 1 YEAR AGO
(04) 1 YEAR TO LESS THAN 5 YEARS AGO
(05) 5 YEARS TO LESS THAN 10 YEARS AGO
(06) 10 OR MORE YEARS AGO
(-8) Don't Know
About how long has it been since [you/(SP)] last smoked regularly?
(-9) Refused
(01) [Continuous answer.]
How many years [have you/has (SP)] smoked?
(-7) Empty
[EXCLUDE BREAKS WHEN THE RESPONDENT DID NOT SMOKE BETWEEN YEARS (-8) Don't Know
OF SMOKING.]
(-9) Refused
How many years [have you/has (SP)] smoked? [EXCLUDE BREAKS WHEN THE
(01) LESS THAN ONE YEAR
RESPONDENT DID NOT SMOKE BETWEEN YEARS OF SMOKING.]
(-7) Empty
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), has a doctor or other health professional advised (-8) Don't Know
[you/(SP)] to quit smoking?
(-9) Refused
IF THIS IS ROUND 67 73, GO TO HFG6 - QUITSMOK.
ELSE GO TO BOX HFG1C
(01) YES
(02) NO
During the past 12 months, [have you/has (SP)] stopped smoking for one day or (-8) Don't Know
longer because (you were/he was/she was) trying to quit smoking?
(-9) Refused
IF THIS IS ROUND 73, GO TO HFG7 - DRINKDAY.
ELSE GO TO HFHINTRO - DIFINTRO.
The next questions are about drinking alcoholic beverages. Included are liquor
such as whiskey or gin, mixed drinks, wine, beer, and any other type of alcoholic
beverage.
Please think about a typical month in the past year. On how many days did
[you/(SP)] drink any type of alcoholic beverage?
ENTER "0" FOR "NEVER DRANK" OR "NONE".
IF HFG7 - DRINKDAY = 0, GO TO HFHINTRO - DIFINTRO.
ELSE GO TO HFG8 - DRINKSPD.
[you] respondent is SP
[(SP)] respondent is proxy
[haven't you] respondent is SP
[hasn't (SP)] respondent is proxy
(01) BOX HFG1
(02) BOX HFG1
(03) BOX HFG1
(04) BOX HFG1
(05) BOX HFG1
(06) BOX HFG1
(07) BOX HFG1
(08) BOX HFG1
(09) IBOX HFG1
(10) BOX HFG1
(11) BOX HFG1
(91) HFF23 - PNUOTHOS
(-8) BOX HFG1
(-9) BOX HFG1
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
[have you] respondent is SP
[(SP)] respondent is proxy
[have you] respondent is SP
[(SP)] respondent is proxy
HFG5 - HAVSMOKE_LESSONE
HFG5A - DRQTSMOK
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFG1B
[have you] respondent is SP
[has (SP)] respondent is proxy
[you were] respondent is SP
[he was] respondent is proxy, SP male
[she was] respondent is proxy, SP female
BOX HFG1C HFG7 - DRINKDAY
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFG2
DRINKSPD
FOURDRNK
HFG8
HFG9
numeric
[Please think about a typical month in the past year.] On those days that
[you/(SP)] drank alcohol, how many drinks did (you/he/she) have?
[Please think about a typical month in the past year.] On how many days did
[you/(SP)] have 4 or more drinks in a single day?
ENTER "0" FOR "NEVER" OR "NONE".
no entry
Now, I'm going to ask about how difficult it is, on the average, for [you/(SP)] to
do certain kinds of activities. Please tell me for each activity whether [you
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of
difficulty, or (is/are) not able to do it.
numeric
(01) [Continuous answer.]
(-7) LESS THAN ONE
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
HFH5
code 1
BOX HFH1
routing
PHYSACTINTRO
HFH10INT
no entry
VIGUNIT
HFH10
quantity unit
(01) CONTINUE
(-7) Empty
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
SHOW CARD HF1 HF3
(04) A LOT OF DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or
(05) NOT ABLE TO DO IT
kneeling? Would you say [you have/(SP) has] no difficulty at all, a little difficulty, (-8) Don't Know
some difficulty, a lot of difficulty, or (is/are) not able to do it?
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF1 HF3
(02) A LITTLE DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as (03) SOME DIFFICULTY
heavy as 10 pounds, like a sack of potatoes?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a (-8) Don't Know
little difficulty, some difficulty, a lot of difficulty, or (is/are) not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
SHOW CARD HF1 HF3
(03) SOME DIFFICULTY
What about reaching or extending arms above shoulder level?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a (-8) Don't Know
little difficulty, some difficulty, a lot of difficulty, or (is/are) not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF1 HF3
(02) A LITTLE DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have either writing or handling
(03) SOME DIFFICULTY
and grasping small objects?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a (-8) Don't Know
little difficulty, some difficulty, a lot of difficulty, or (is/are) not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF1 HF3
(02) A LITTLE DIFFICULTY
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a (-8) Don't Know
little difficulty, some difficulty, a lot of difficulty, or (is/are) not able to do it?]
(-9) Refused
IF THIS IS ROUND 73, GO TO HFH10INT - PHYSACTINTRO.
ELSE GO TO HFJINTRO - MEDCONDINTRO.
We are interested in two types of physical activity - vigorous and moderate.
Vigorous activities cause large increases in breathing or heart rate. Moderate
activities cause small increases in breathing or heart rate. First I will ask about
(01) CONTINUE
the vigorous activities that [you do/(SP) does].
(-7) Empty
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
In a typical week, how much time [do you/does (SP)] spend doing vigorous
(04) NUMBER OF HOURS PER MONTH
activities, such as team sports, running, aerobics, heavy house or yard work, or (96) NONE
anything else that causes large increases in breathing or heart rate?
(-8) Don't Know
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR. (-9) Refused
quantity unit
In a typical week, how much time [do you/does (SP)] spend doing vigorous
activities, such as team sports, running, aerobics, heavy house or yard work, or
anything else that causes large increases in breathing or heart rate?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
DIFINTRO
DIFSTOOP
DIFLIFT
DIFREACH
DIFWRITE
DIFWALK
VIGNUM
HFHINTRO
HFH1
HFH2
HFH3
HFH4
HFH10
code 1
code 1
code 1
code 1
MODUNIT
HFH11
quantity unit
MODNUM
HFH11
numeric
In a typical week, how much time [do you/does (SP)] spend doing moderate
activities, such as brisk walking, bicycling, gardening, golf, swimming, or
vacuuming?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
In a typical week, how much time [do you/does (SP)] spend doing moderate
activities, such as brisk walking, bicycling, gardening, golf, swimming, or
vacuuming?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
(01)continous answer
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[you have] respondent is SP
[(SP) has] respondent is proxy
[is] respondent is proxy
[are] respondent is SP
HFG9 - FOURDRNK
HFHINTRO - DIFINTRO
HFH1 - DIFSTOOP
[ do you] respondent is SP
[does (SP)] respondent is proxy
[you have] respondent is SP
[(SP) has] respondent is proxy
[is] respondent is proxy
[are] respondent is SP
HFH2 - DIFLIFT
[ do you] respondent is SP
[does (SP)] respondent is proxy
[you have] respondent is SP
[(SP) has] respondent is proxy
[is] respondent is proxy
[are] respondent is SP
HFH3 - DIFREACH
[you have] respondent is SP
[(SP) has] respondent is proxy
[is] respondent is proxy
[are] respondent is SP
HFH4 - DIFWRITE
[ do you] respondent is SP
[does (SP)] respondent is proxy
[you have] respondent is SP
[(SP) has] respondent is proxy
[is] respondent is proxy
[are] respondent is SP
HFH5 - DIFWALK
[you have] respondent is SP
[(SP) has] respondent is proxy
[is] respondent is proxy
[are] respondent is SP
BOX HFH1
[you do] respondent is SP
[(SP) does] respondent is proxy
[ do you] respondent is SP
[does (SP)] respondent is proxy
[ do you] respondent is SP
[does (SP)] respondent is proxy
[ do you] respondent is SP
[does (SP)] respondent is proxy
HFH10 - VIGUNIT
(01) HFH10 - VIGNUM
(02) HFH10 - VIGNUM
(03) HFH10 - VIGNUM
(04) HFH10 - VIGNUM
(96) HFH11 - MODUNIT
(-8) HFH11 - MODUNIT
(-9) HFH11 - MODUNIT
HFH11 - MODUNIT
(01) HFH11 - MODNUM
(02) HFH11 - MODNUM
(03) HFH11 - MODNUM
(04) HFH11 - MODNUM
(96) HFH12 - MUSUNIT
(-8) HFH12 - MUSUNIT
(-9) HFH12 - MUSUNIT
(01) HFH12 - MUSUNIT
MUSUNIT
HFH12
quantity unit
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
MUSNUM
HFH12
numeric
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(01) Continunous answer
Next, I'm going to read a list of medical conditions. [Since (LAST HF MONTH
YEAR) has/Has] a doctor (ever) told [you/(SP)] that (you/he/she) had any of
these conditions?
MEDCONDINTRO
HFJINTRO
no entry
BOX HFJ1
routing
[INTERVIEWER: IF THE SP IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT
(01) CONTINUE
THE SP HAS THE CONDITION.]
(-7) Empty
IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN A PREVIOUS
ROUND, GO TO HFJ2 - OCHBP.
ELSE GO TO HFJ1 - OCARTERY.
[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...
OCARTERY
HFJ1
yes/no
hardening of the arteries or arteriosclerosis?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor [ever] told [you/(SP)] that
[you/he/she] (still have/[still has/still have/had/has/have)...]
OCHBP
YRHBP
HFJ2
yes/no
BOX HFJ2
routing
HFJ3
yes/no
hypertension, sometimes called high blood pressure?
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ3 - YRHBP.
ELSE GO TO HFJ4 - OCMYOCAR.
YRMYOCAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) still (-8) Don't Know
had hypertension or high blood pressure?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCMYOCAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ4
yes/no
BOX HFJ3
routing
a myocardial infarction or heart attack?
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ5 - YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.
yes/no
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
a myocardial infarction or heart attack?
(-9) Refused
HFJ5
[ do you] respondent is SP
[does (SP)] respondent is proxy
(01) HFH12 - MUSNUM
(02) HFH12 - MUSNUM
(03) HFH12 - MUSNUM
(04) HFH12 - MUSNUM
(96) HFJINTRO - MEDCONDINTRO
(-8) HFJINTRO - MEDCONDINTRO
(-9) HFJINTRO - MEDCONDINTRO
HFJINTRO - MEDCONDINTRO
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[still has] respondent is proxy, SP is alive, P_OCHBP = 1
[still have] respondent is SP, P_OCHBP = 1
[had] respondent is proxy, SP is deceased, P_OCHBP = 1
[has] respondent is proxy, SP is alive, P_OCHBP = 0
[have] respondent is SP, P_OCHBP = 0
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
BOX HFJ1
HFJ2 - OCHBP
(01) BOX HFJ2
(02) HFJ4 - OCMYOCAR
(-8) HFJ4 - OCMYOCAR
(-9) HFJ4 - OCMYOCAR
HFJ4 - OCMYOCAR
(01) BOX HFJ3
(02) HFJ6 - OCCHD
(-8) HFJ6 - OCCHD
(-9) HFJ6 - OCCHD
HFJ6 - OCCHD
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCCHD
YRCHD
HFJ6
yes/no
BOX HFJ4
routing
HFJ7
yes/no
([a new episode of]) angina pectoris or coronary heart disease?
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ7 - YRCHD.
ELSE GO TO HFJ8 - OCCFAIL.
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
an episode of angina pectoris or coronary heart disease?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCCFAIL
YRCFAIL
HFJ8
yes/no
BOX HFJ5
routing
HFJ9
yes/no
[(a new episode of)] congestive heart failure?
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ9 - YRCFAIL.
ELSE GO TO HFJ10 - OCCVALVE.
YRVALVE
YRRHYTHM
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ10
yes/no
BOX HFJ6
routing
([a new episode of]) problems with the valves of the heart, such as aortic
stenosis?
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ11 - YRVALVE.
ELSE GO TO HFJ12 - OCRHYTHM.
yes/no
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
an episode of problems with the valves of the heart, such as aortic stenosis?
(-9) Refused
HFJ11
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCRHYTHM
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
an episode of congestive heart failure?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCCVALVE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ12
yes/no
BOX HFJ7
routing
HFJ13
yes/no
(a new episode of) problems with the rhythm of (your/his/her) heartbeat, such
as atrial fibrillation?
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ13 - YRRHYTHM.
ELSE GO TO HFJ14 - OCOTHHRT.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (02) NO
an episode of problems with the rhythm of (your/his/her) heart, such as atrial
(-8) Don't Know
fibrillation?
(-9) Refused
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[a new episode of] P_OCCHD = 1
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[a new episode of] P_OCCFAIL = 1
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[a new episode of] P_OCCVALVE = 1
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
(01) BOX HFJ4
(02) HFJ8 - OCCFAIL
(-8) HFJ8 - OCCFAIL
(-9) HFJ8 - OCCFAIL
HFJ8 - OCCFAIL
(01) BOX HFJ5
(02) HFJ10 - OCCVALVE
(-8) HFJ10 - OCCVALVE
(-9) HFJ10 - OCCVALVE
HFJ10 - OCCVALVE
(01) BOX HFJ6
(02) HFJ12 - OCRHYTHM
(-8) HFJ12 - OCRHYTHM
(-9) HFJ12 - OCRHYTHM
HFJ12 - OCRHYTHM
(01) BOX HFJ7
(02) HFJ14 - OCOTHHRT
(-8) HFJ14 - OCOTHHRT
(-9) HFJ14 - OCOTHHRT
HFJ14 - OCOTHHRT
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCOTHHRT
YROTHHRT
HFJ14
yes/no
BOX HFJ8
routing
HFJ15
yes/no
(a new episode of) any other heart condition?
[DO NOT RECORD THE NAME OF THE CONDITION AT THIS QUESTION.]
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ15 - YROTHHRT.
ELSE GO TO HFJ16 - OCSTROKE.
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
an episode of any other heart condition?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCSTROKE
YRSTROKE
OCCHOLES
YRCHOLES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ16
yes/no
BOX HFJ9
routing
a stroke, a brain hemorrhage, or a cerebrovascular accident?
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ17 - YRSTROKE.
ELSE GO TO HFJ17A - OCCHOLES.
yes/no
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
a stroke, a brain hemorrhage, or a cerebrovascular accident?
(-9) Refused
yes/no
Has a doctor ever told [you/(SP)] that (you/he/she) had high cholesterol?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
yes/no
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
high cholesterol?
(-9) Refused
HFJ17
HFJ17A
HFJ17B
[I've recorded that [you/(SP)] previously reported having had skin cancer.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCCSKIN
YRCSKIN
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ18
yes/no
BOX HFJ10
routing
(a new occurrence of) skin cancer?
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ19 - YRCSKIN.
ELSE GO TO HFJ20 - OCCANCER.
yes/no
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
an occurrence of skin cancer?
(-9) Refused
HFJ19
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[I've recorded that [you] previously reported having had skin
cancer] OCCSKIN = 1 in a previous round for SP, respondent is
SP. second or more time through loop
[I've recorded that [(SP)] previously reported having had skin
cancer] OCCSKIN = 1 in a previous round for SP, respondent is
proxy, second or more time through loop
[Since (LAST HF MONTH YEAR) has] HFQ has been completed
in a previous round for this respondent second or more time
through loop
[Has] HFQ has not been completed in a previous round for
this respondent first time through loop
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[a new occurrence] second or more time through loop
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
(01) BOX HFJ8
(02) HFJ16 - OCSTROKE
(-8) HFJ16 - OCSTROKE
(-9) HFJ16 - OCSTROKE
HFJ16 - OCSTROKE
(01) BOX HFJ9
(02) HFJ17A - OCCHOLES
(-8) HFJ17A - OCCHOLES
(-9) HFJ17A - OCCHOLES
HFJ17A - OCCHOLES
(01) HFJ17B - YRCHOLES
(02) HFJ18 - OCCSKIN
(-8) HFJ18 - OCCSKIN
(-9) HFJ18 - OCCSKIN
HFJ18 - OCCSKIN
(01) BOX HFJ10
(02) HFJ20 - OCCANCER
(-8) HFJ20 - OCCANCER
(-9) HFJ20 - OCCANCER
HFJ20 - OCCANCER
[I've recorded that [you/(SP)] previously reported having had a tumor, growth,
or cancer of the [READ RESPONSES BELOW].]
OCCANCER
HFJ20
yes/no
BOX HFJ11
routing
YRCANCER
HFJ21
yes/no
OCCCODE
OCCOS
HFJ22
HFJ22
code all
verbatim text
BOX HFJ13
routing
[Has a doctor (ever) told [you/(SP)] that (you/he/she) had/Since (LAST HF
MONTH YEAR), has a doctor told [you/(SP)] that (you/he/she) had] any (other)
kind of cancer, malignancy, or tumor other than skin cancer?
INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - OCCCODE.
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
any kind of cancer, malignancy, or tumor other than skin cancer?
(-9) Refused
(01) LUNG
(02) COLON, RECTUM, OR BOWEL
(03) BREAST
(04) UTERUS
(05) PROSTATE
(06) BLADDER
(07) OVARY
(08) STOMACH
(09) CERVIX
(10) BRAIN
(11) KIDNEY
(12) THROAT
[Since the first time a doctor told [you/(SP)] that (you/he/she) had a cancer,
(13) HEAD
malignancy, or tumor, on/On] what part or parts of [your/(SP's)] body was the
(14) BACK
cancer or tumor other than skin cancer found?
(15) OTHER FEMALE REPRODUCTIVE ORGANS
(91) OTHER
[PROBE: Any other part?]
(-8) Don't Know
CHECK ALL THAT APPLY
(-9) Refused
OTHER (SPECIFY)
(01) [Continuous answer.]
IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A PREVIOUS
ROUND, GO TO BOX HFJ14.
ELSE GO TO HFJ24 - OCARTHRH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCARTHRH
HFJ24
yes/no
BOX HFJ14
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
rheumatoid arthritis?
IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN RHEUMATOID
ARTHRITIS IN A PREVIOUS ROUND, GO TO BOX HFJ16.
ELSE GO TO HFJ25 - OCARTH.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[I've recorded that [you]] respondent is SP, second or more
time throug loop, tumor, growth or cancer previously
reported
[I've recorded that [SP]] respondent is proxy, second or more
time through loop, tumor, growth or cancer previously
reported
[Has a doctor ever told] first time through loop
[I've recorded that [you] previously reported having had a
tumor, growth, or cancer of the [READ RESPONSES BELOW].]
SP has OCCANCER = 1 in a previous round, respondent is SP
[I've recorded that [(SP)] previously reported having had a
tumor, growth, or cancer of the [READ RESPONSES BELOW].]
SP has OCCANCER =1 in a previous round, respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR)] second or mor time through
loop
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[other] SP has OCCANCER = 1 in a previous round second or
more time through loop, tumor, growth or cancer reported
previously
[you] respondent is SP
[(SP)] respondent is proxy
[you] reespondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
(01) BOX HFJ11
(02) BOX HFJ13
(-8) BOX HFJ13
(-9) BOX HFJ13
HFJ22 - OCCCODE
(01) BOX HFJ13
(02) BOX HFJ13
(03) BOX HFJ13
(04) BOX HFJ13
(05) BOX HFJ13
(06) BOX HFJ13
(07) BOX HFJ13
(08) BOX HFJ13
(09) BOX HFJ13
(10) BOX HFJ13
(11) BOX HFJ13
(12) BOX HFJ13
(13) BOX HFJ13
(14) BOX HFJ13
(15) BOX HFJ13
(91) HFJ22 - OCCOS
(-8) BOX HFJ13
(-9) BOX HFJ13
BOX HFJ13
BOX HFJ14
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
BOX HFJ16
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
BOX HFJ16
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
BOX HFJ16A
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
(01) HFJ30AA - OCDEPRSS
(02) BOX HFJ16B
(-8) BOX HFJ16B
(-9) BOX HFJ16B
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
arthritis, other than rheumatoid arthritis?
OCARTH
YRARTHRD
HFJ25
yes/no
BOX HFJ15
routing
HFJ26
yes/no
BOX HFJ16
routing
[EXPLAIN IF NECESSARY: This includes osteoarthritis.]
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
arthritis, other than rheumatoid arthritis, in any part of (your/his/her) body?
(-9) Refused
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ28 - OCMENTAL.
ELSE GO TO BOX HFJ16A.
[Has a doctor ever told [you/(SP)] that (you/he/she) had...]
OCMENTAL
HFJ28
yes/no
BOX HFJ16A
routing
an intellectual disability, sometimes called mental retardation?
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A PREVIOUS
ROUND, GO TO HFJ30AA - OCDEPRSS.
ELSE GO TO HFJ29A - OCALZMER.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCALZMER
HFJ29A
yes/no
BOX HFJ16B
routing
Alzheimer's disease?
IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS ROUND, GO TO
HFJ30AA - OCDEPRSS.
ELSE GO TO HFJ29B - OCDEMENT.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCDEMENT
HFJ29B
yes/no
any type of dementia other than Alzheimer's disease?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCDEPRSS
HFJ30AA
yes/no
BOX HFJ17A
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
depression?
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ30BB - YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
HFJ30AA - OCDEPRSS
(01) BOX HFJ17A
(02) HFJ30A - OCPSYCHO
(-8) HFJ30A - OCPSYCHO
(-9) HFJ30A - OCPSYCHO
YRDEPRSS
HFJ30BB
yes/no
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
depression?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCPSYCHO
YRPSYCHO
HFJ30A
yes/no
BOX HFJ17B
routing
HFJ31A
yes/no
BOX HFJ19
routing
a mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ31A - YRPSYCHO.
ELSE GO TO BOX HFJ19.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (02) NO
a mental or psychiatric disorder other than depression?
(-8) Don't Know
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
(-9) Refused
IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND, GO
TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCOSTEOP
HFJ32
yes/no
osteoporosis, sometimes called fragile or soft bones?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]]
a broken hip?
OCBRKHIP
YRBRKHIP
HFJ33
yes/no
BOX HFJ20
routing
HFJ34
yes/no
BOX HFJ21
routing
HFJ35
yes/no
BOX HFJ22
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
HFJ30A - OCPSYCHO
(01) BOX HFJ17B
(02) BOX HFJ19
(-8) BOX HFJ19
(-9) BOX HFJ19
BOX HFJ19
HFJ33 - OCBRKHIP
(01) BOX HFJ20
(02) BOX HFJ21
(-8) BOX HFJ21
(-9) BOX HFJ21
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
a broken hip?
(-9) Refused
IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS
ROUND, GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCPARKIN
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
Parkinson's disease?
IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A
PREVIOUS ROUND, GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
BOX HFJ21
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
BOX HFJ22
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCEMPHYS
HFJ36
yes/no
emphysema, asthma, or COPD?
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE
IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY PARALYZED, SELECT "YES" AND
DO NOT ASK. OTHERWISE, ASK:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had...]
OCPPARAL
YRPPARAL
OCAMPUTE
HAVEPROS
YRPROST
HFJ37
yes/no
BOX HFJ23
routing
HFJ38
yes/no
BOX HFJ24
routing
HFJ39
yes/no
BOX HFJ25
routing
HFJ40
yes/no
BOX HFJ26
routing
HFJ41
yes/no
complete or partial paralysis?
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he) had an
enlarged prostate or benign prostatic hypertrophy (BPH)?
OCDTYPE
HFJ41B
code 1
OCDTYPOS
HFJ41B
verbatim text
yes/no
[Were you/Was (SP)] told on two or more different visits that (you/he/she) had
diabetes?
OCDVISIT
HFJ41A
HFJ41C
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that (you/he/she) had (-8) Don't Know
complete or partial paralysis?
(-9) Refused
IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN A PREVIOUS
ROUND, GO TO BOX HFJ25.
ELSE GO TO HFJ39 - OCAMPUTE.
(01) YES
IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT "YES" AND DO NOT (02) NO
ASK. OTHERWISE, ASK:
(-8) Don't Know
What about absence or loss of an arm or a leg?
(-9) Refused
IF SP IS FEMALE, GO TO HFJ41A - OCBETES.
ELSE GO TO HFJ40 - HAVEPROS.
[[Before [you/(SP)] had prostate surgery, did a doctor ever tell/Since (LAST HF
(01) YES
MONTH YEAR), has/Has]] a doctor (ever) told ] [you/(SP)] that (you/he) had...]
(02) NO
(-8) Don't Know
an enlarged prostate or benign prostatic hypertrophy (BPH)?
(-9) Refused
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ41 - YRPROST.
ELSE GO TO HFJ41A - OCBETES.
Has a doctor ever told [you/(SP)] that (you/he/she) had any type of diabetes,
including: sugar diabetes, high blood sugar, (borderline diabetes, pre-diabetes,
or pregnancy-related diabetes/borderline diabetes, or pre-diabetes)?
SHOW CARD HF6 HF4
Looking at this card, please tell me which type of diabetes the doctor said that
[you have/(SP) has].
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR
THE MOST RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT
HE/SHE HAS.]
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or
“juvenile-onset” diabetes. This type of diabetes usually develops during
childhood or adolescence; but, it also can develop in adults.
“Type 2” was formerly called “non-insulin dependent” or “adult-onset” diabetes.
Until recently, this type of diabetes was found only in adults; but, now it is also
occurring in children.]
SOME OTHER TYPE (SPECIFY)
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR
THE MOST RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT
HE/SHE HAS.]
OCBETES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
(04) PRE-DIABETES
(05) GESTATIONAL (PREGNANCY-RELATED)
(91) SOME OTHER TYPE
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Since (LAST HF MONTH YEAR) has] second or more time
through loop HFQ has been completed in a previous round for
this respondent
[Has] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[(SP)] respondent is proxy
[ever] first time through loop HFQ has never been completed
in a previous round for this respondent
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
HFJ37 - OCPPARAL
(01) BOX HFJ23
(02) BOX HFJ24
(-8) BOX HFJ24
(-9) BOX HFJ24
BOX HFJ24
BOX HFJ25
(01) BOX HFJ26
(02) HFJ41A - OCBETES
(-8) HFJ41A - OCBETES
(-9) HFJ41A - OCBETES
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you have] respondent is SP
[(SP) has] respondent is proxy
HFJ41A - OCBETES
(01) HFJ41B - OCDTYPE
(02) BOX HFJ27
(-8) BOX HFJ27
(-9) BOX HFJ27
(01) HFJ41C - OCDVISIT
(02) HFJ41C - OCDVISIT
(03) HFJ41C - OCDVISIT
(04) HFJ41C - OCDVISIT
(05) HFJ41C - OCDVISIT
(91) HFJ41B - OCDTYPOS
(-8) HFJ41C - OCDVISIT
(-9) HFJ41C - OCDVISIT
HFJ41C - OCDVISIT
[Were you] respondent is SP
[Was (SP)] respondent is proxy
BOX HFJ27
BOX HFJ27
routing
EMCOND
HFJ42
yes/no
EMCAUSEVB
HFJ43
verbatim text
BOX HFJ28
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT
MEDICARE ELIGIBILITY WAS UNDER 65 THEN
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO HFJ42 EMCOND.
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 EMCAUSEVB.
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT TIME OF
CURRENT MEDICARE ELIGIBILITY WAS NOT UNDER 65 THEN GO TO BOX HFP0.
You told me that [you have/(SP) has] had [READ CONDITIONS LISTED BELOW].
(Was this/Were any of these) the original cause of [your/(SP's)] becoming
eligible for Medicare?
[NOTE THAT CONDITIONS MAY NOT BE DISPLAYED WITH THE EXACT CONDITION
NAME THAT WAS USED EARLIER IN THE INTERVIEW (E.G., HYPERTENSION CAN
ALSO BE CALLED HIGH BLOOD PRESSURE AT DIFFERENT QUESTIONS).]
What was the original cause of [your/(SP's)] becoming eligible for Medicare?
RECORD VERBATIM.
IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO BOX HFP0.
ELSE GO TO HFJ44 - EMCODE.
Which of these conditions was the cause of [your/(SP's)] becoming eligible for
Medicare?
EMCODE
EMOS
HLTHCAREINTRO
HFJ44
HFJ44
code all
verbatim text
BOX HFP0
routing
HFPINTRO
no entry
BOX HFP1A
routing
[PROBE: Any other condition?]
CHECK UP TO 8 CONDITIONS.
OTHER (SPECIFY)
IF THIS IS ROUND 67 73, GO TO BOX HFR1.
ELSE GO TO HFPINTRO - HLTHCAREINTRO.
Now I want to ask you about some things that [you/(SP)] may be doing to
maintain (your/his/her) health, either by getting tested for health problems or
by taking care of conditions that (you have/she has/he has).
IF (HFJ41A – OCBETES = 1/Yes) AND (HFJ41B - OCDTYPE = 1/TypeOne,
2/TypeTwo, 3/Borderline, 4/PreDiabetes, 91/Other, DK, or RF), GO TO HFP1 DIAAGE.
ELSE GO TO HFP21 - DIAEVERT.
I recorded that [you were/(SP) was] told by a doctor that (you have/she has/he
has) (Type 1 diabetes/Type 2 diabetes/borderline diabetes/prediabetes/diabetes).
DIAAGE
HFP1
numeric
How old [were you/was (SP)] when (you were/he was/she was) first told that
(you/he/she) had diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) ARTERIES HARDENING
(02) HYPERTENSION
(03) HEART ATTACK
(04) HEART DISEASE
(05) CONGESTIVE HEART FAILURE
(06) HEART VALVE PROBLEM
(07) HEART RHYTHM PROBLEM
(08) OTHER HEART PROBLEM
(09) STROKE OR HEMORRHAGE
(10) SKIN CANCER
(11) CANCER/TUMOR
(12) RHEUMATOID ARTHRITIS
(13) OTHER ARTHRITIS
(14) MENTAL RETARDATION
(15) ALZHEIMER'S
(16) DEMENTIA
(17) DEPRESSION
(18) MENTAL DISORDER
(19) OSTEOPOROSIS
(20) BROKEN HIP
(21) PARKINSON'S
(22) EMPHYSEMA/ASTHMA/COPD
(23) PARALYSIS
(24) LOSS OF LIMB
(25) DIABETES
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
[you have] respondent is SP
[(SP) has] respondent is proxy
[Was this] one condition
[Were any of these] more than one condition
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
(01) BOX HFJ28
(02) HFJ43 - EMCAUSEVB
(-8) BOX HFP0
(-9) BOX HFP0
BOX HFP0
(01) BOX HFP0
(02) BOX HFP0
(03) BOX HFP0
(04) BOX HFP0
(05) BOX HFP0
(06) BOX HFP0
(07) BOX HFP0
(08) BOX HFP0
(09) BOX HFP0
(10) BOX HFP0
(11) BOX HFP0
(12) BOX HFP0
(13) BOX HFP0
(14) BOX HFP0
(15) BOX HFP0
(16) BOX HFP0
(17) BOX HFP0
(18) BOX HFP0
(19) BOX HFP0
(20) BOX HFP0
(21) BOX HFP0
(22) BOX HFP0
(23) BOX HFP0
(24) BOX HFP0
(25) BOX HFP0
(91) HFJ44 - EMOS
(-8) BOX HFP0
(-9) BOX HFP0
BOX HFP0
(01) CONTINUE
(-7) Empty
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
BOX HFP1A
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
[you were] respondent is SP
[(SP) was] respondent is proxy
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
[Type I diabetes] type I diabetes recorded
[Type II diabetes] type II diabetes recorded
[borderline diabetes] borderline diabetes recorded
[pre-diabetes] pre-diabetes recorded
[diabetes] diabetes recorded
[were you] respondent is SP
[was (SP)] respondent is proxy
[you were] respondent is SP
[he was] respondent is proxy, SP males
[she was] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
HFP1 - DIAAGE_LESSONE
BOX HFP2
DIAPRGNT
HFP2
routing
yes/no
IF THE SP IS FEMALE AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR (HFP1 –
DIAAGE = DK OR RF), GO TO HFP2 - DIAPRGNT.
ELSE GO TO HFP4 - DIAINSUL.
Did [you/(SP)] have diabetes only during a pregnancy?
Please tell me whether (you use/SP uses) any of the following ways to manage
(your/his/her) diabetes. [Do you/Does (SP)]…
DIAINSUL
HFP4
list
take insulin?
Please tell me whether (you use/SP uses) any of the following ways to manage
(your/his/her) diabetes. [Do you/Does (SP)]…
DIAMEDS
HFP4
list
take prescription diabetes pills or oral diabetes medicine?
Please tell me whether (you use/SP uses) any of the following ways to manage
(your/his/her) diabetes. [Do you/Does (SP)]…
DIATEST
HFP4
list
test (your/his/her) blood for sugar or glucose?
Please tell me whether (you use/SP uses) any of the following ways to manage
(your/his/her) diabetes. [Do you/Does (SP)]…
DIASORES
HFP4
list
check for sores or irritations on (your/his/her) feet?
Please tell me whether (you use/SP uses) any of the following ways to manage
(your/his/her) diabetes. [Do you/Does (SP)]…
DIAPRESS
HFP4
list
measure (your/his/her) blood pressure at home?
Please tell me whether (you use/SP uses) any of the following ways to manage
(your/his/her) diabetes. [Do you/Does (SP)]…
DIAASPRN
HFP4
list
BOX HFP3
routing
take aspirin regularly for (your/his/her) diabetes?
IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE.
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
INSUTAKE
HFP5
quantity unit
How often [do you/does (SP)] take insulin?
INSUDAY
HFP5
quantity unit
BOX HFP4
routing
How often [do you/does (SP)] take insulin?
IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) USE INSULIN PUMP
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
[you] respondent is SP
[(SP)] respondent is proxy
[you use] respondent is SP
[(SP) uses] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you use] respondent is SP
[(SP) uses] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you use] respondent is SP
[(SP) uses] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you use] respondent is SP
[(SP) uses] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you use] respondent is SP
[(SP) uses] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you use] respondent is SP
[(SP) uses] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
(01) HFP21 - DIAEVERT
(02) HFP4 - DIAINSUL
(-8) HFP21 - DIAEVERT
(-9) HFP21 - DIAEVERT
HFP4 - DIAMEDS
HFP4 - DIATEST
HFP4 - DIASORES
HFP4 - DIAPRESS
HFP4 - DIAASPRN
BOX HFP3
(01) HFP5 - INSUDAY
(02) HFP5 - INSUWEEK
(03) BOX HFP4
(-8) BOX HFP4
(-9) BOX HFP4
BOX HFP4
MEDSTAKE
HFP6
quantity unit
MEDDAY
HFP6
quantity unit
MEDWEEK
HFP6
quantity unit
MEDMONTH
HFP6
quantity unit
BOX HFP5
routing
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes
medicine?
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes
medicine?
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes
medicine?
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes
medicine?
IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
How often [do you/does (SP)] test (your/his/her) blood for sugar or glucose?
TESTTAKE
HFP7
quantity unit
[PROBE: Include times when it is tested by a family member or friend, but do
not include times when it is tested by a health professional.]
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) [Continuous answer.]
(01) [Continuous answer.]
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] test (your/his/her) blood for sugar or glucose?
TESTDAY
HFP7
quantity unit
[PROBE: Include times when it is tested by a family member or friend, but do
not include times when it is tested by a health professional.]
(01) [Continuous answer.]
How often [do you/does (SP)] test (your/his/her) blood for sugar or glucose?
TESTWEEK
HFP7
quantity unit
[PROBE: Include times when it is tested by a family member or friend, but do
not include times when it is tested by a health professional.]
(01) [Continuous answer.]
How often [do you/does (SP)] test (your/his/her) blood for sugar or glucose?
TESTMNTH
HFP7
quantity unit
[PROBE: Include times when it is tested by a family member or friend, but do
not include times when it is tested by a health professional.]
(01) [Continuous answer.]
How often [do you/does (SP)] test (your/his/her) blood for sugar or glucose?
TESTYEAR
HFP7
quantity unit
BOX HFP6
routing
[PROBE: Include times when it is tested by a family member or friend, but do
not include times when it is tested by a health professional.]
IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
How often [do you/does (SP)] check (your/his/her) feet for sores or irritations?
SORECHEK
HFP8
quantity unit
[PROBE: Include times when they are checked by a family member or friend,
but do not include times when they are checked by a health professional.]
(01) [Continuous answer.]
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] check (your/his/her) feet for sores or irritations?
SOREDAY
HFP8
quantity unit
[PROBE: Include times when they are checked by a family member or friend,
but do not include times when they are checked by a health professional.]
(01) [Continuous answer.]
How often [do you/does (SP)] check (your/his/her) feet for sores or irritations?
SOREWEEK
HFP8
quantity unit
[PROBE: Include times when they are checked by a family member or friend,
but do not include times when they are checked by a health professional.]
(01) [Continuous answer.]
How often [do you/does (SP)] check (your/his/her) feet for sores or irritations?
SOREMNTH
HFP8
quantity unit
[PROBE: Include times when they are checked by a family member or friend,
but do not include times when they are checked by a health professional.]
(01) [Continuous answer.]
How often [do you/does (SP)] check (your/his/her) feet for sores or irritations?
HEST.SOREYEAR
DIATENYR
DIADRSAW
HFP8
HFP10
HFP11
quantity unit
[PROBE: Include times when they are checked by a family member or friend,
but do not include times when they are checked by a health professional.]
yes/no
In the past year has a doctor or other medical professional examined
(your/his/her) feet for sores or irritations?
(01) [Continuous answer.]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
About how many times in the past year [have you/has (SP)] seen a doctor or
other health professional for (your/his/her) diabetes?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
numeric
[do you] respondent is SP
[does (SP)] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[have you] respondent is SP
[has (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) HFP6 - MEDDAY
(02) HFP6 - MEDWEEK
(03) ) HFP6 - MEDMONTH
(-8) BOX HFP5
(-9) BOX HFP5
BOX HFP5
BOX HFP5
BOX HFP5
(01) HFP7 - TESTDAY
(02) HFP7 - TESTWEEK
(03) HFP7 - TESTMNTH
(04) HFP7 - TESTYEAR
(-8) BOX HFP6
(-9) BOX HFP6
BOX HFP6
BOX HFP6
BOX HFP6
BOX HFP6
(01) HFP8 - SOREDAY
(02) HFP8 - SOREWEEK
(03) HFP8 - SOREMNTH
(04) HFP8 - SOREYEAR
(-8) HFP10 - DIATENYR
(-9) HFP10 - DIATENYR
HFP10 - DIATENYR
HFP10 - DIATENYR
HFP10 - DIATENYR
HFP10 - DIATENYR
HFP11 - DIADRSAW
HFP13 - DIAHEMOC
DIAHEMOC
HFP13
numeric
DIACTRLD
HFP14
code 1
DIAHYPO
HFP14A1
yes/no
A test of hemoglobin "A one C" measures the average level of blood sugar over
the past three months. It is usually done in a doctor's office. About how many
times in the past year has a doctor or other health professional checked
[you/(SP)] for hemoglobin "A one C"?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) ALL OF THE TIME
(02) MOST OF THE TIME
SHOW CARD HF4 HF5
(03) SOME OF THE TIME
Would you say that [your/(SP's)] blood sugar is well controlled all of the time,
(04) A LITTLE OF THE TIME
most of the time, some of the time, a little of the time, or none of the time? By (05) NONE OF THE TIME
"well controlled" we mean a recent hemoglobin "A one C" result of 7.5 or less or (-8) Don't Know
an average fasting blood test of 140 or less.
(-9) Refused
(01) YES
(02) NO
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes
(-8) Don't Know
called low blood sugar or an insulin reaction?
(-9) Refused
Please think about the most serious episode of hypoglycemia that [you
have/(SP)has] experienced in the past year.
[Were you/Was (SP)] able to treat (yourself/himself/herself) by taking some
form of sugar, did (you/he/she) require treatment from others, or did
(you/he/she) require treatment by a hospital?
DIAHYPTR
DIAFTEVR
DIAFEET
HFP14A2
HFP14A3
HFP14A
(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
(03) HOSPITAL TREATMENT
(-8) Don't Know
(-9) Refused
code 1
[EXPLAIN IF NECESSARY: Treatment by a hospital includes being treated in the
emergency room or outpatient department of a hospital, or being admitted as
an inpatient.]
yes/no
(01) YES
(02) NO
[Have you/Has (SP)] ever had any problems with (your/his/her) feet as a result of (-8) Don't Know
(your/his/her) diabetes?
(-9) Refused
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] currently have any problems with (your/his/her) feet as a
result of (your/his/her) diabetes?
People with diabetes can develop many different foot problems. Please tell me if
[you have/(SP) has] ever been told by a doctor that (you/he/she) had any of the
following problems with (your/his/her) feet as a result of (your/his/her)
diabetes.
[Have you/Has (SP)] ever been told by a doctor that (you/he/she) had…
DIANEURO
HFP14B
list
Neuropathy or nerve damage , which may cause pain or numbness in the feet?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
People with diabetes can develop many different foot problems. Please tell me if
[you have/(SP) has] ever been told by a doctor that (you/he/she) had any of the
following problems with (your/his/her) feet as a result of (your/his/her)
diabetes.
[Have you/Has (SP)] ever been told by a doctor that (you/he/she) had…
DIACIRCF
HFP14B
list
Poor circulation or blood flow in the feet?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[have you] respondent is SP
[has (SP)] respondent is proxy
[you have] respondent is SP
[(SP) has] respondent is proxy
[Were you] respondent is SP
[Was (SP)] respondent is proxy
[yourself] respondent is SP
[himself] respondent is proxy, SP male
[herself] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[have you] respondent is SP
[has (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you have] respondent is SP
[(SP) has] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you have] respondent is SP
[(SP) has] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
HFP14 - DIACTRLD
HFP14A1 - DIAHYPO
(01) HFP14A2 - DIAHYPTR
(02) HFP14A - DIAFEET
(-8) HFP14A - DIAFEET
(-9) HFP14A - DIAFEET
HFP14A3 - DIAFTEVR
(01) HFP14A - DIAFEET
(02) HFP15 - DIAEYPRB
(-8) HFP15 - DIAEYPRB
(-9) HFP15 - DIAEYPRB
HFP14B - DIANEURO
HFP14B - DIACIRCF
HFP14B - DIAULCER
People with diabetes can develop many different foot problems. Please tell me if
[you have/(SP) has] ever been told by a doctor that (you/he/she) had any of the
following problems with (your/his/her) feet as a result of (your/his/her)
diabetes.
[Have you/Has (SP)] ever been told by a doctor that (you/he/she) had…
DIAULCER
HFP14B
list
Foot ulcers?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
People with diabetes can develop many different foot problems. Please tell me if
[you have/(SP) has] ever been told by a doctor that (you/he/she) had any of the
following problems with (your/his/her) feet as a result of (your/his/her)
diabetes.
Calluses, infections, or other skin changes affecting the feet?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] have any problems with (your/his/her) eyes as a result of
(your/his/her) diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever been told by a doctor that (you/he/she) had…
DIASKINC
DIAEYPRB
HFP14B
HFP15
list
yes/no
[Have you/Has (SP)] ever had any problems with (your/his/her) kidneys as a
result of (your/his/her) diabetes?
DIAKDPEV
DIAKDPRB
DIAKIDNY
DIAMNGE
DIATRAIN
HFP16A1
HFP16
HFP16A
HFP17
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
yes/no
[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]
yes/no
(01) YES
(02) NO
[Do you/Does (SP)] currently have any problems with (your/his/her) kidneys as a (-8) Don't Know
result of (your/his/her) diabetes?
(-9) Refused
yes/no
[Have you/Has (SP)] ever been told by a doctor that (you have/she has/he has)
chronic kidney disease?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever participated in a diabetes self-management course or
class, or received special training on how (you/he/she) can manage
(your/his/her) diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
yes/no
HFP18
code 1
BOX HFP7
routing
When was the most recent time that [you/(SP)] participated in a diabetes selfmanagement course or class or received special training on how (you/he/she)
can manage (your/his/her) diabetes?
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING,
PROBE FOR THE MOST RECENT TIME.]
IF THE SP IS THE RESPONDENT, GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
[you have] respondent is SP
[(SP) has] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you have] respondent is SP
[(SP) has] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] resppndent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] resppndent is proxy, SP male
[her] respondent is proxy, SP female
HFP14B - DIASKINC
HFP15 - DIAEYPRB
HFP16A1 - DIAKDPEV
(01) HFP16 - DIAKDPRB
(02) HFP17 - DIAMNGE
(-8) HFP17 - DIAMNGE
(-9) HFP17 - DIAMNGE
(01) HFP16A - DIAKIDNY
(02) HFP17 - DIAMNGE
(-8) HFP17 - DIAMNGE
(-9) HFP17 - DIAMNGE
HFP17 - DIAMNGE
(01) HFP18 - DIATRAIN
(02) BOX HFP7
(-8) BOX HFP7
(-9) BOX HFP7
BOX HFP7
DIAKNOW
HFP19
code 1
DIASUPPS
HFP20
yes/no
(01) just about everything you need to know,
(02) most of what you need to know,
(03) some of what you need to know,
(04) a little of what you need to know, or
(05) almost none of what you need to know about
SHOW CARD HF3 HF6
managing your diabetes?
How much do you think you know about managing your diabetes? Do you know (-8) Don't Know
...
(-9) Refused
(01) YES
(02) NO
Before today, did you know that Medicare now helps pay the cost of diabetic
(-8) Don't Know
testing supplies and self-management education for people with diabetes?
(-9) Refused
[I have recorded that [you have/(SP) has] never been told by a doctor that (you
have/she has/he has) diabetes.]
DIAEVERT
DIARECNT
DIAAWARE
HFP21
yes/no
[Have you/Has (SP)] ever had a blood test to see if (you have/she has/he has)
diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
HFP22
code 1
BOX HFP8
routing
When was the most recent time [you were/(SP) was] tested for diabetes?
IF THE SP IS THE RESPONDENT, GO TO HFP23 - DIAAWARE.
ELSE GO TO HFP24 - DIARISK.
yes/no
(01) YES
(02) NO
Before today, were you aware that there is a blood test to determine if a person (-8) Don't Know
has diabetes?
(-9) Refused
HFP23
DIARISK
HFP24
yes/no
Has a doctor or other health professional ever told [you/(SP)] that (you are/he
is/she is) at high risk for diabetes?
DIASIGNS
HFP25
yes/no
In the past year, [have you/has (SP)] received any information about the signs,
symptoms, or risk factors for diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
COLHTEST
HFR3
yes/no
COLHKIT
HFR4
yes/no
COLFDOC
HFR4A
yes/no
IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS UNKNOWN)
AND (SP HAS NOT REPORTED HAVING COLON, RECTAL OR BOWEL CANCER IN
THE CURRENT ROUND OR IN A PREVIOUS ROUND), GO TO HFR1 - COLHEAR.
ELSE GO TO BOX HFS0.
Now I'd like to talk about a different illness, colorectal or colon cancer, a disease (01) YES
of the lower intestines.
(02) NO
(-8) Don't Know
Before today, had you ever heard of colorectal or colon cancer?
(-9) Refused
The fecal occult blood test is a simple test for early signs of colon cancer. It
detects invisible traces of blood found in the stool. The doctor or other health
professional can give the patient a kit to collect stool samples at the patient’s
home. The test is then sent to a laboratory for the results to be determined.
(01) YES
(02) NO
Has a doctor or other health professional ever given [you/(SP)] a home testing
(-8) Don't Know
kit to test for blood in the stool?
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
Have you ever heard of this home testing kit?
(-9) Refused
(01) YES
Has a doctor or other health professional ever performed a fecal occult blood
(02) NO
test to test for blood in the stool while [you/(SP)] [were/was] at the doctor’s
(-8) Don't Know
office?
(-9) Refused
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
COLHEAR
COLCARD
BOX HFR1
routing
HFR1
yes/no
HFR5
Did [you/(SP)] complete the samples and return them for (your/his/her) most
recent test?
HFP20 - DIASUPPS
BOX HFR1
[I have recorded that [you have/(SP) has] never been told
by a doctor that (you have/she has/he has) diabetes.]
OCBETES = 02
[you have] respondent is SP
[(SP) has] respondent is proxy
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you have] respondent is SP
[she has] respondent is proxy, SP female
[he has] respondent is proxy, SP male
(01) HFP22 - DIARECNT
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8
[you were] respondent is SP
[(SP) was] respondent is proxy
HFP24 - DIARISK
HFP24 - DIARISK
[you] respondent is SP
[(SP)] respondent is proxy
[you are] respondent is SP
[he is] respondent is proxy, SP male
[she is] respondent is proxy, SP female
HFP25 - DIASIGNS
[have you] respondent is SP
[has (SP)] respondent is proxy
BOX HFR1
HFR3 - COLHTEST
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) HFR5 - COLCARD
(02) HFR4 - COLHKIT
(-8) HFR4 - COLHKIT
(-9) HFR4 - COLHKIT
HFR4A - COLFDOC
(01) HFR7 - COLRECNT
(02) HFR8 - COLSCOPY
(-8) HFR8 - COLSCOPY
(-9) HFR8 - COLSCOPY
HFR7 - COLRECNT
COLRECNT
COLSCOPY
HFR7
HFR8
code 1
yes/no
WHENSCOP
HFR9
code 1
HEARSCOP
HFR10
yes/no
BOX HFR2
routing
COLDRREC
HFR11
yes/no
COLSCRNS
HFR13
yes/no
BOX HFS0
routing
BOX HFS1
routing
HFSINTRO
no entry
OSTINTRO
OSTEVERT
OSTHRISK
HFS1
HFS2
yes/no
yes/no
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
When did [you/(SP)] have (your/his/her) most recent blood stool test( using a
home testing kit)?
Another test for early signs of colon cancer is performed in the doctor's office.
The doctor uses a flexible lighted tube to examine the colon and rectum directly. (01) YES
This is called a sigmoidoscopy or colonoscopy.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever had this exam?
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
When did [you/(SP)] have (your/his/her) most recent sigmoidoscopy or
(-8) Don't Know
colonoscopy?
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
Before today, had you ever heard of a sigmoidoscopy or colonoscopy?
(-9) Refused
IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 COLSCRNS.
ELSE GO TO BOX HFS0.
(01) YES
(02) NO
(-8) Don't Know
Has a doctor ever recommended that [you/(SP)] have this test?
(-9) Refused
(01) YES
(02) NO
Before today, did you know that Medicare now pays the cost of screening tests (-8) Don't Know
for colorectal cancer?
(-9) Refused
IF THIS IS ROUND 67 73, GO TO HFAC29 - HCTROUBL.
ELSE GO TO BOX HFS1.
IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT ROUND OR
IN A PREVIOUS ROUND, GO TO HFS3 - OSTTEST.
ELSE GO TO HFSINTRO - OSTINTRO
Now I'd like to talk about a disease called osteoporosis, which can be treated if
found early. In osteoporosis, the bones lose their calcium and become fragile
(01) CONTINUE
and more easily broken.
(-7) Empty
[Have you/Has (SP)] ever talked with (your/his/her) doctor or other health
professional about osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Has a doctor or other health professional ever told [you/(SP)] that (you are/he
is/she is) at high risk for osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Have [you/(SP)] ever experienced a fracture that (your/his/her) doctor told
(you/him/her) was related to osteoporosis?
There is a test to detect osteoporosis at an early stage, called Bone Mass
Measurement or Bone Density Measurement, or DEXA scan.
OSTFRACT
HFS2A
yes/no
OSTTEST
HFS3
yes/no
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?
OSTHEAR
HFS4
yes/no
Before today, had you ever heard of this test?
OSTRECNT
HFS5
code 1
When was the most recent time that [you/(SP)] had a Bone Mass or Bone
Density Measurement test?
yes/no
Before today, did you know that Medicare would pay for Bone Mass or Bone
Density Measurement tests for Medicare beneficiaries who are at risk for
osteoporosis?
OSTMASS
HFS6
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
HFR8 - COLSCOPY
HFR10 - HEARSCOP
(01) YES--> WHENSCOP
(02) NO--> HEARSCOP
(8) Don't Know->HEARSCOP
(9) Refused->HEARSCOP
HFR13 - COLSCRNS
(01) HFR11 - COLDRREC
(02) BOX HFR2
(-8) BOX HFR2
(-9) BOX HFR2
HFR13 - COLSCRNS
BOX HFS0
HFS1 - OSTEVERT
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you are] respondent is SP
[he is] respondent is proxy, SP male
[she is] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
(01) HFS2 - OSTHRISK
(02) HFS3 - OSTTEST
(-8) HFS3 - OSTTEST
(-9) HFS3 - OSTTEST
HFS2A - OSTFRACT
HFS3 - OSTTEST
(01) HFS5 - OSTRECNT
(02) HFS4 - OSTHEAR
(-8) HFS4 - OSTHEAR
(-9) HFS4 - OSTHEAR
(01) HFS6 - OSTMASS
(02) HFAC29 - HCTROUBL
(-8) HFAC29 - HCTROUBL
(-9) HFAC29 - HCTROUBL
HFS6 - OSTMASS
HFAC29 - HCTROUBL
Next, we are going to ask some questions about [your/(SP's)] health care needs
during the past year.
HCTROUBL
HFAC29
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting
health care that (you/he/she) wanted or needed?
Why was that?
HCTCODE
HCTOTHOS
CGETAPPT
CGETCODE
HFAC30A
HFAC30A
code all
verbatim text
BOX HFF6
routing
HFAC30B
yes/no
HFAC30C
code all
BOX HFF7
routing
OFFEXPLN
HFAC30D
yes/no
OFFEXVB
HFAC30E
verbatim text
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
IF RESPONSE TO HFAC30A - HCTCODE INCLUDES 8/DrDoesNotAcceptMedicare
OR 10/DifficultyGettingAppt, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC30B - CGETAPPT.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) SP DOES NOT HAVE MONEY
(02) COST IS TOO HIGH
(03) SERVICES/SUPPLIES NOT COVERED
(04) NEEDED TRANSPORTATION TO DOCTOR/HOSPITAL
(05) DIFFICULTY GETTING HOME HEALTH CARE
(06) NO TREATMENT AVAILABLE/DOCTOR WON’T
TREAT
(07) WAIT TOO LONG/DOCTOR TOO BUSY
(08) OWN DOCTOR DOESN’T ACCEPT
MEDICARE/COULDN’T FIND DOCTOR WHO ACCEPTS
MEDICARE
(09) NOT ELIGIBLE FOR PUBLIC COVERAGE
(10) DIFFICULTY GETTING APPOINTMENT/ DELAYS
BECAUSE SP ON MEDICARE
(11) DOCTOR REFERRED SP TO SPECIALIST OR OTHER
DOCTOR
(12) HMO REFERRAL PROCESS (DIFFICULTY GETTING)
(13) PROBLEMS WITH HMO DOCTORS NOT GOOD OR
AVAILABLE
(14) HMO WOULD NOT COVER OR PROVIDE SERVICE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office (-8) Don't Know
that they cannot schedule an appointment with [you/(SP)]?
(-9) Refused
(01) DOCTOR DOES NOT ACCEPT INSURANCE PLAN
(02) ALL OF DOCTORS APPOINTMENTS WERE FULL
(03) DOCTOR IS NOT ACCEPTING ANY NEW PATIENTS
(04) DOCTOR IS NOT ACCEPTING NEW MEDICARE
PATIENTS
(05) DOCTRS HOURS CONFLICTED WITH
REQUIREMENTS OF SP
(06) DOCTOR DOES NOT ACCEPT MEDICAID
(07) DOCTOR DOES NOT ACCEPT MEDICARE AT ALL
(08) DOCTOR DOES NOT ACCEPT MEDICARE
ASSIGNMENT
What were the reasons the doctor’s office offered as an explanation for not
(09) DOCTOR FELT ANOTHER PROVIDER WOULD BE
scheduling an appointment with [you/(SP)]?
BETTER FOR SP
(91) OTHER
[PROBE: Any other reason?]
(-8) Don't Know
CHECK ALL THAT APPLY
(-9) Refused
IF RESPONSE TO HFAC30C - CGETCODE INCLUDES
4/DocNotAcceptNewMedicare OR 7/DocNotAcceptMCAR, GO TO HFAC30D OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.
(01) YES
(02) NO
Did the doctor’s office explain why [it is difficult for Medicare patients to get an (-8) Don't Know
appointment/Medicare is not accepted] at that practice?
(-9) Refused
What was that explanation?
RECORD VERBATIM.
(01) [Continuous answer.]
HCDELAY
HFAC31
yes/no
(01) YES
(02) NO
Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care (-8) Don't Know
because (you were/he was/she was) worried about the cost?
(-9) Refused
IADLINTRO
HFKINTRO
no entry
Now I'm going to ask about some everyday activities and whether [you
have/(SP) has] any difficulty doing them by (yourself/himself/herself).
PRBTELE
HFKA1
code 1
[your] respondent is SP
[(SP's)] respondent is proxy
[have you] respondent is SP
[has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
(01) CONTINUE
(-7) Empty
(01) YES
(02) NO
Because of a health or physical problem, [do you/does (SP)] have any difficulty... (03) DOESN'T DO
(-8) Don't Know
using the telephone?
(-9) Refused
(01) HFAC30A - HCTCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
(01) BOX HFF6
(02) BOX HFF6
(03) BOX HFF6
(04) BOX HFF6
(05) BOX HFF6
(06) BOX HFF6
(07) BOX HFF6
(08) BOX HFF6
(09) BOX HFF6
(10) BOX HFF6
(11) BOX HFF6
(12) BOX HFF6
(13) BOX HFF6
(14) BOX HFF6
(91) HFAC30A - HCTOTHOS
(-8) BOX HFF6
(-9) BOX HFF6
BOX HFF6
[have you] respondent is SP
[has (SP)] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
(01) HFAC30C - CGETCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
[you] respondent is SP
[(SP)] respondent is proxy
(01) BOX HFF7
(02) BOX HFF7
(03) BOX HFF7
(04) BOX HFF7
(05) BOX HFF7
(06) BOX HFF7
(07) BOX HFF7
(08) BOX HFF7
(09) BOX HFF7
(91) HFAC30C - CGETOTOS
(-8) BOX HFF7
(-9) BOX HFF7
[it is difficult for Medicare patients to get an appointment]
Medicare accepted
[Medicare is not accepted] Medicare not accepted
(01) HFAC30E - OFFEXVB
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
HFAC31 - HCDELAY
[have you] respondent is SP
[has (SP)] respondent is proxy
[you were] respondent is SP
[he was] respondent is proxy, SP male
[she was] respondent is proxy, SP female
[you have] respondent is SP
[(SP) has] respondent is proxy
[yourself] respondent is SP
[himself] respondent is proxy, SP male
[herself] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
HFKINTRO - IADLINTRO
HFKA1 - PRBTELE
(01) HFKB1 - PRBLHWK
(02) HFKB1 - PRBLHWK
(03) HFKA2 - DONTTELE
(-8) HFKB1 - PRBLHWK
(-9) HFKB1 - PRBLHWK
[You said that using the telephone is something that [you don't/(SP) doesn't]
do.]
DONTTELE
HFKA2
yes/no
PRBLHWK
HFKB1
code 1
DONTLHWK
HFKB2
yes/no
PRBHHWK
HFKC1
code 1
DONTHHWK
HFKC2
yes/no
PRBMEAL
HFKD1
code 1
(01) YES
(02) NO
(-8) Don't Know
Is this because of a health or physical problem?
(-9) Refused
(01) YES
(02) NO
Because of a health or physical problem, [do you/does (SP)] have any difficulty... (03) DOESN'T DO
(-8) Don't Know
doing light housework (like washing dishes, straightening up, or light cleaning)? (-9) Refused
[You said that doing light housework (like washing dishes, straightening up, or
(01) YES
light cleaning) is something that [you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem?
(-9) Refused
(01) YES
(02) NO
Because of a health or physical problem, [do you/does (SP)] have any difficulty... (03) DOESN'T DO
(-8) Don't Know
doing heavy housework (like scrubbing floors or washing windows)?
(-9) Refused
[You said that doing heavy housework (like scrubbing floors or washing
(01) YES
windows) is something that [you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem?
(-9) Refused
(01) YES
(02) NO
Because of a health or physical problem, [do you/does (SP)] have any difficulty... (03) DOESN'T DO
(-8) Don't Know
preparing (your/his/her) own meals?
(-9) Refused
[You said that preparing (your/his/her) own meals is something that [you
don't/(SP) doesn't] do.]
DONTMEAL
PRBSHOP
HFKD2
HFKE1
yes/no
code 1
DONTSHOP
HFKE2
yes/no
PRBBILS
HFKF1
code 1
DONTBILS
HFKF2
yes/no
BOX HFKA1
routing
(01) YES
(02) NO
(-8) Don't Know
Is this because of a health or physical problem?
(-9) Refused
(01) YES
(02) NO
Because of a health or physical problem, [do you/does (SP)] have any difficulty... (03) DOESN'T DO
(-8) Don't Know
shopping for personal items (such as toilet items or medicines)?
(-9) Refused
[You said that shopping for personal items (such as toilet items or medicines) is (01) YES
something that [you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem?
(-9) Refused
(01) YES
(02) NO
Because of a health or physical problem, [do you/does (SP)] have any difficulty... (03) DOESN'T DO
(-8) Don't Know
managing money (like keeping track of expenses or paying bills)?
(-9) Refused
[You said that managing money (like keeping track of expenses or paying bills) is (01) YES
something that [you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem?
(-9) Refused
IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO HFKA3 HELPTELE.
ELSE GO TO BOX HFKB1.
HELPTELE
HFKA3
yes/no
PERSON_HLPRTELE
HFKA4
roster
BOX HFKB1
routing
using the telephone?
You mentioned that [you receive/(SP) receives] help with using the telephone.
Who gives that help?
ENTER ALL HELPERS.
IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO HFKB3 HELPLHWK.
ELSE GO TO BOX HFKC1.
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
HFKB1 - PRBLHWK
(01) HFKC1 - PRBHHWK
(02) HFKC1 - PRBHHWK
(03) HFKB2 - DONTLHWK
(-8) HFKC1 - PRBHHWK
(-9) HFKC1 - PRBHHWK
HFKC1 - PRBHHWK
(01) HFKD1 - PRBMEAL
(02) HFKD1 - PRBMEAL
(03) HFKC2 - DONTHHWK
(-8) HFKD1 - PRBMEAL
(-9) HFKD1 - PRBMEAL
HFKD1 - PRBMEAL
(01) HFKE1 - PRBSHOP
(02) HFKE1 - PRBSHOP
(03) HFKD2 - DONTMEAL
(-8) HFKE1 - PRBSHOP
(-9) HFKE1 - PRBSHOP
HFKE1 - PRBSHOP
(01) HFKF1 - PRBBILS
(02) HFKF1 - PRBBILS
(03) HFKE2 - DONTSHOP
(-8) HFKF1 - PRBBILS
(-9) HFKF1 - PRBBILS
[do you] respondent is SP
[does (SP)] respondent is proxy
HFKF1 - PRBBILS
(01) BOX HFKA1
(02) BOX HFKA1
(03) HFKF2 - DONTBILS
(-8) BOX HFKA1
(-9) BOX HFKA1
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
BOX HFKA1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[You said that [your] health makes using the telephone
difficult] respondent is SP, SP uses telephone
[You said that [(SP's)] health makes using the telephone
difficult] respondent is proxy, SP uses telephone
[You said that using the telephone is something that [you
don't do]] respondent is SP, SP doesn't use telephone
[You said that using the telephone is something that [(SP)
doesn't do]] respondent is proxy, SP doesn't use telephone
[Do you] respondent is SP
[Does (SP)] respondent is proxy
(01) HFKA4 - PERSON_HLPRTELE
(02) BOX HFKB1
(-8) BOX HFKB1
(-9) BOX HFKB1
(01) [Continuous answer.]
[you receive] respondent is SP
[(SP) receives] respondent is proxy
BOX HFKB1
[[You said that [your/(SP's)] health makes using the telephone difficult./You said
that using the telephone is something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[[You said that [your/(SP's)] health makes doing light housework (like washing
dishes, straightening up, or light cleaning) difficult./You said that doing light
housework (like washing dishes, straightening up, or light cleaning) is something
that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
HELPLHWK
HFKB3
yes/no
PERSON_HLPRLHWK
HFKB4
roster
BOX HFKC1
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
doing light housework (like washing dishes, straightening up, or light cleaning)?
You mentioned that [you receive/(SP) receives] help with doing light housework
(like washing dishes, straightening up, or light cleaning). Who gives that help? (01) [Continuous answer.]
IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 HELPHHWK.
ELSE GO TO BOX HFKD1
HELPHHWK
PERSON_HLPRHHWK
HFKC3
yes/no
HFKC4
roster
BOX HFKD1
routing
doing heavy housework (like scrubbing floors or washing windows)?
You mentioned that [you receive/(SP) receives] help with doing heavy
housework (like scrubbing floors or washing windows). Who gives that help?
ENTER ALL HELPERS.
IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO HFKD3 HELPMEAL.
ELSE GO TO BOX HFKE1.
HELPMEAL
PERSON_HLPRMEAL
HFKD3
yes/no
HFKD4
roster
BOX HFKE1
routing
preparing (your/his/her) own meals?
You mentioned that [you receive/(SP) receives] help with preparing
(your/his/her) own meals. Who gives that help?
ENTER ALL HELPERS.
IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO HFKE3 HELPSHOP.
ELSE GO TO BOX HFKF1.
(01) HFKC4 - PERSON_HLPRHHWK
(02) BOX HFKD1
(-8) BOX HFKD1
(-9) BOX HFKD1
(01) [Continuous answer.]
[you receive] respondent is SP
[(SP) receives] respondent is proxy
BOX HFKD1
(01) [Continuous answer.]
[You said that [your] health makes preparing [your] own meals
difficult] respondent is SP, SP makes meals
[You said that [(SP's)] health makes preparing [his] own meals
difficult] respondent is proxy, SP male,SP makes meals
[You said that [(SP's)] health makes preparing [her] own meals
difficult] respondent is proxy, SP female, SP makes meals
[You said that preparing [your] own meals is something that
[you don't do]] respondent is SP, SP doesn't make meals
[You said that preparing [his] own meals is something that
[(SP) doesn't do] respondent is proxy, SP male, SP doesn't
make meals
[You said that preparing [her] own meals is something that
[(SP) doesn't do] respondent is proxy, SP female, SP doesn't
make meals
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you receive] respondent is SP
[(SP) receives] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[You said that [your] health makes shopping for personal
items (such as toilet items or medicines) difficult.] respondent
is SP, SP shops
[You said that [(SP's)] health makes shopping for personal
items (such as toilet items or medicines) difficult.] respondent
is proxy, SP shops
[You said that shopping for personal items (such as toilet
items or medicines) is something that [you don't do]]
respondent is SP, SP doesn't shop
[You said that shopping for personal items (such as toilet
items or medicines) is something that [(SP) doesn't do]]
respondent is proxy, SP doesn't do shop
[Do you] respondent is SP
[Does (SP)] respondent is proxy
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[[You said that [your/(SP's)] health makes shopping for personal items (such as
toilet items or medicines) difficult./You said that shopping for personal items
(such as toilet items or medicines) is something that [you don't do/(SP) doesn't
do].]]
[Do you/Does (SP)] receive help from another person with...
HELPSHOP
HFKE3
yes/no
shopping for personal items (such as toilet items or medicines)?
BOX HFKC1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[[You said that [your/(SP's)] health makes preparing (your/his/her) own meals
difficult./You said that preparing (your/his/her) own meals is something that
[you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
(01) HFKB4 - PERSON_HLPRLHWK
(02) BOX HFKC1
(-8) BOX HFKC1
(-9) BOX HFKC1
[You said that [your] health makes doing heavy housework
(like scrubbing floors or washing windows) difficult]
respondent is SP, SP does housework
[You said that [(SP's)] health makes doing heavy housework
(like scrubbing floors or washing windows) difficult]
respondent is proxy, SP does housework
[You said that doing heavy housework (like scrubbing floors or
washing windows) is something that [you don't do]]
respondent is SP, SP doesn't do housework
[You said that doing heavy housework (like scrubbing floors or
washing windows) is something that [(SP) doesn't do]]
respondent is proxy, SP doesn't do housework
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[[You said that [your/(SP's)] health makes doing heavy housework (like scrubbing
floors or washing windows) difficult./You said that heavy housework (like
scrubbing floors or washing windows) is something that [you don't do/(SP)
doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
[You said that [your] health makes doing light housework (like
washing dishes, straightening up, or light cleaning) difficult]
respondent is SP, SP does housework
[You said that [(SP's)] health makes doing light housework (like
washing dishes, straightening up, or light cleaning) difficult]
respondent is proxy, SP does housework
[You said that doing light housework (like washing dishes,
straightening up, or light cleaning) is something that [you
don't do]] respondent is SP, SP doesn't do housework
[You said that doing light housework (like washing dishes,
straightening up, or light cleaning)is something that [(SP)
doesn't do]] respondent is proxy, SP doesn't do housework
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you receive] respondent is SP
[(SP) receives] respondent is proxy
(01) HFKD4 - PERSON_HLPRMEAL
(02) BOX HFKE1
(-8) BOX HFKE1
(-9) BOX HFKE1
BOX HFKE1
(01) HFKE4 - PERSON_HLPRSHOP
(02) BOX HFKF1
(-8) BOX HFKF1
(-9) BOX HFKF1
PERSON_HLPRSHOP
HFKE4
roster
BOX HFKF1
routing
You mentioned that [you receive/(SP) receives] help with shopping for personal
items (such as toilet items or medicines). Who gives that help?
ENTER ALL HELPERS.
(01) [Continuous answer.]
IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO HFKF3 HELPBILS.
ELSE GO TO HFLINTRO - ADLSINTRO.
[[You said that [your/(SP's)] health makes managing money (like keeping track of
expenses or paying bills) difficult./You said that managing money (like keeping
track of expenses or paying bills) is something that [you don't do/(SP) doesn't
do].]]
[Do you/Does (SP)] receive help from another person with...
HELPBILS
PERSON_HLPRBILS
ADLSINTRO
HFKF3
HFKF4
HFLINTRO
roster
managing money (like keeping track of expenses or paying bills)?
You mentioned that [you receive/(SP) receives] help with managing money (like
keeping track of expenses or paying bills). Who gives that help?
ENTER ALL HELPERS.
(01) [Continuous answer.]
no entry
Now I'll ask about some other everyday activities. I'd like to know whether [you
have/(SP) has] any difficulty doing each one by (yourself/himself/herself) and
without special equipment.
yes/no
Because of a health or physical problem, [do you/does (SP)] have any difficulty...
HPPDBATH
DONTBATH
HFLA1
HFLA2
code 1
yes/no
bathing or showering?
[You said that bathing or showering is something that [you don't/(SP) doesn't]
do.]
Is this because of a health or physical problem?
Because of a health or physical problem, [do you/does (SP)] have any difficulty...
HPPDDRES
HFLB1
code 1
dressing?
[You said that dressing is something that [you don't/(SP) doesn't] do.]
DONTDRES
HFLB2
yes/no
Is this because of a health or physical problem?
Because of a health or physical problem, [do you/does (SP)] have any difficulty...
HPPDEAT
HFLC1
code 1
eating?
[You said that eating is something that [you don't/(SP) doesn't] do.]
DONTEAT
HFLC2
yes/no
Is this because of a health or physical problem?
Because of a health or physical problem, [do you/does (SP)] have any difficulty...
HPPDCHAR
HFLD1
code 1
getting in or out of bed or chairs?
[You said that getting in or out of bed or chairs is something that [you don't/(SP)
doesn't] do.]
DONTCHAR
HFLD2
yes/no
Is this because of a health or physical problem?
Because of a health or physical problem, [do you/does (SP)] have any difficulty...
HPPDWALK
HFLE1
code 1
walking?
[You said that walking is something that [you don't/(SP) doesn't] do.]
DONTWALK
HFLE2
code 1
Is this because of a health or physical problem?
Because of a health or physical problem, [do you/does (SP)] have any difficulty...
HPPDTOIL
HFLF1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
code 1
using the toilet?
(01) CONTINUE
(-7) Empty
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
[you receive] respondent is SP
[(SP) receives] respondent is proxy
BOX HFKF1
[You said that [your] health makes managing money (like
keeping track of expenses or paying bills) difficult.] respondent
is SP, SP does manage money
[You said that [(SP's)] health makes managing money (like
keeping track of expenses or paying bills) difficult.] respondent
is proxy, SP does manage money
[You said that managing money (like keeping track of
expenses or paying bills) is something that [you don't do]]
respondent is SP, SP doesn't manage money
[You said that managing money (like keeping track of
expenses or paying bills) is something that [(SP) doesn't do]]
respondent is proxy, SP doesn't manage money
[Do you] respondent is SP
[Does (SP)] respondent is proxy
(01) HFKF4 - PERSON_HLPRBILS
(02) HFLINTRO - ADLSINTRO
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO
[you receive] respondent is SP
[(SP) recieves] respondent is proxy
[you have] respondent is SP
[(SP) has] respondent is proxy
[yourself] respondent is SP
[himself] respondent is proxy, SP male
[herself] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[do you] respondent is SP
[does (SP)] respondent is proxy
HFLINTRO - ADLSINTRO
HFLA1 - HPPDBATH
(01) HFLB1 - HPPDDRES
(02) HFLB1 - HPPDDRES
(03) HFLA2 - DONTBATH
(-8) HFLB1 - HPPDDRES
(-9) HFLB1 - HPPDDRES
HFLB1 - HPPDDRES
(01) HFLC1 - HPPDEAT
(02) HFLC1 - HPPDEAT
(03) HFLB2 - DONTDRES
(-8) HFLC1 - HPPDEAT
(-9) HFLC1 - HPPDEAT
HFLC1 - HPPDEAT
(01) HFLD1 - HPPDCHAR
(02) HFLD1 - HPPDCHAR
(03) HFLC2 - DONTEAT
(-8) HFLD1 - HPPDCHAR
(-9) HFLD1 - HPPDCHAR
HFLD1 - HPPDCHAR
(01) HFLE1 - HPPDWALK
(02) HFLE1 - HPPDWALK
(03) HFLD2 - DONTCHAR
(-8) HFLE1 - HPPDWALK
(-9) HFLE1 - HPPDWALK
HFLE1 - HPPDWALK
(01) HFLF1 - HPPDTOIL
(02) HFLF1 - HPPDTOIL
(03) HFLE2 - DONTWALK
(-8) HFLF1 - HPPDTOIL
(-9) HFLF1 - HPPDTOIL
HFLF1 - HPPDTOIL
(01) BOX HFLA1
(02) BOX HFLA1
(03) HFLF2 - DONTTOIL
(-8) BOX HFLA1
(-9) BOX HFLA1
[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
DONTTOIL
HFLF2
yes/no
BOX HFLA1
routing
Is this because of a health or physical problem?
IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO HFLA3 HELPBATH.
ELSE GO TO BOX HFLB1.
[[You said [your/(SP's)] health makes bathing or showering difficult./You said
that bathing or showering is something [you don't/(SP) doesn't] do.]]
HELPBATH
PCHKBATH
EQIPBATH
HFLA3
HFLA4
yes/no
yes/no
HFLA5
yes/no
BOX HFLA2
routing
LONGBATH
HFLA6
code 1
STILBATH
HFLA7
yes/no
BOX HFLB1
routing
[Do you/Does (SP)] receive help from another person with bathing or
showering?
Does someone usually stay nearby just in case [you need/(SP) needs] help with
bathing or showering?
[That is, does someone usually stay or come into the room to check on
(you/him/her)?]
[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with
bathing or showering?
IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH.
ELSE GO TO BOX HFLB1.
PCHKDRES
EQIPDRES
LONGDRES
STILDRES
HFLB3
HFLB4
yes/no
yes/no
HFLB5
yes/no
BOX HFLB2
routing
HFLB6
code 1
HFLB7
yes/no
BOX HFLC1
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
How long [have you/has (SP)] needed help with bathing or showering? Has it
(-8) Don't Know
been . . .
(-9) Refused
(01) YES
(02) NO
Do you expect that [you/(SP)] will still need help with bathing or showering three (-8) Don't Know
months from now?
(-9) Refused
IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO HFLB3 HELPDRES.
ELSE GO TO BOX HFLC1.
[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is
something [you don't/(SP) doesn't] do.]]
HELPDRES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] receive help from another person with dressing?
Does someone usually stay nearby just in case [you need/(SP) needs] help with
dressing?
[That is, does someone usually stay or come into the room to check on
(you/him/her)?]
[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with
dressing?
IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES.
ELSE GO TO BOX HFLC1.
How long [have you/has (SP)] needed help with dressing? Has it been . . .
Do you expect that [you/(SP)] will still need help with dressing three months
from now?
IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 HELPEAT.
ELSE GO TO BOX HFLD1.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[you don't] respondent is SP
[(SP) doesn't] respondent is proxy
[You said that [your] health makes bathing or showering
difficult.] respondent is SP, SP bathes or showers
[You said that [(SP's)] health makes bathing or showering
difficult.] respondent is proxy, SP bathes or showers
[You said that bathing or showering is something that [you
don't do]] respondent is SP, SP doesn't bathe or shower
[You said that bathing or showering is something that [(SP)
doesn't do]] respondent is proxy, SP doesn't bathe or shower
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you need] respondent is SP
[(SP) needs] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
BOX HFLA1
(01) HFLA5 - EQIPBATH
(02) HFLA4 - PCHKBATH
(-8) HFLA4 - PCHKBATH
(-9) HFLA4 - PCHKBATH
HFLA5 - EQIPBATH
BOX HFLA2
[have you] respondent is SP
[has (SP)] respondent is proxy
(01) HFLA7 - STILBATH
(02) BOX HFLB1
(03) BOX HFLB1
(-8) BOX HFLB1
(-9) BOX HFLB1
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFLB1
[You said that [your] health makes dressing difficult.]
respondent is SP, SP dresses
[You said that [(SP's)] health makes dressing difficult.]
respondent is proxy, SP dresses
[You said that dressing is something that [you don't do]]
respondent is SP, SP doesn't dress
[You said that dressing is something that [(SP) doesn't do]]
respondent is proxy, SP doesn't dress
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you need] respondent is SP
[(SP) needs] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) HFLB5 - EQIPDRES
(02) HFLB4 - PCHKDRES
(-8) HFLB4 - PCHKDRES
(-9) HFLB4 - PCHKDRES
HFLB5 - EQIPDRES
BOX HFLB2
[have you] respondent is SP
[has (SP)] respondent is proxy
(01) HFLB7 - STILDRES
(02) BOX HFLC1
(03) BOX HFLC1
(-8) BOX HFLC1
(-9) BOX HFLC1
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFLC1
[[You said [your/(SP's)] health makes eating difficult./You said that eating is
something [you don't/(SP) doesn't] do.]]
HELPEAT
PCHKEAT
EQIPEAT
HFLC3
HFLC4
yes/no
yes/no
HFLC5
yes/no
BOX HFLC2
routing
LONGEAT
HFLC6
code 1
STILEAT
HFLC7
yes/no
BOX HFLD1
routing
[Do you/Does (SP)] receive help from another person with eating?
Does someone usually stay nearby just in case [you need/(SP) needs] help with
eating?
[That is, does someone usually stay or come into the room to check on
(you/him/her)?]
[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with
eating?
IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.
HFLD3
yes/no
PCHKCHAR
HFLD4
yes/no
EQIPCHAR
HFLD5
yes/no
BOX HFLD2
routing
LONGCHAR
STILCHAR
HFLD6
code 1
HFLD7
yes/no
BOX HFLE1
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
How long [have you/has (SP)] needed help with eating? Has it been . . .
(-9) Refused
(01) YES
(02) NO
Do you expect that [you/(SP)] will still need help with eating three months from (-8) Don't Know
now?
(-9) Refused
IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO HFLD3 HELPCHAR.
ELSE GO TO BOX HFLE1.
[[You said [your/(SP's)] health makes getting in or out of bed or chairs
difficult./You said that getting in or out of bed or chairs is something [you
don't/(SP) doesn't] do.]]
HELPCHAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] receive help from another person with getting in or out of
bed or chairs?
Does someone usually stay nearby just in case [you need/(SP) needs] help with
getting in or out of bed or chairs?
[That is, does someone usually stay or come into the room to check on
(you/him/her)?]
[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with
getting in or out of bed or chairs?
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
How long [have you/has (SP)] needed help with getting in or out of bed or
(-8) Don't Know
chairs? Has it been . . .
(-9) Refused
(01) YES
(02) NO
Do you expect that [you/(SP)] will still need help with getting in or out of bed or (-8) Don't Know
chairs three months from now?
(-9) Refused
IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 HELPWALK.
ELSE GO TO BOX HFLF1.
[You said that [your] health makes eating difficult.]
respondent is SP, SP eats
[You said that [(SP's)] health makes eating difficult.]
respondent is proxy, SP eats
[You said that eating is something that [you don't do]]
respondent is SP, SP doesn't eat
[You said that eating is something that [(SP) doesn't do]]
respondent is proxy, SP doesn't eat
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you need] respondent is SP
[(SP) needs] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) HFLC5 - EQIPEAT
(02) HFLC4 - PCHKEAT
(-8) HFLC4 - PCHKEAT
(-9) HFLC4 - PCHKEAT
HFLC5 - EQIPEAT
BOX HFLC2
[have you] respondent is SP
[has (SP)] respondent is proxy
(01) HFLC7 - STILEAT
(02) BOX HFLD1
(03) BOX HFLD1
(-8) BOX HFLD1
(-9) BOX HFLD1
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFLD1
[You said that [your] health makes getting in or out of bed or
chairs difficult.] respondent is SP, SP gets in or out of bed or
chairs
[You said that [(SP's)] health makes getting in or out of bed or
chairs difficult.] respondent is proxy, SP gets in or out of bed
or chairs
[You said that getting in or out of bed or chairs is something
that [you don't do]] respondent is SP, SP doesn't get in or our
of bed or chairs
[You said that getting in or out of bed or chairs is something
that [(SP) doesn't do]] respondent is proxy, SP doesn't get in or
out of bed or chairs
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you need] respondent is SP
[(SP) needs] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) HFLD5 - EQIPCHAR
(02) HFLD4 - PCHKCHAR
(-8) HFLD4 - PCHKCHAR
(-9) HFLD4 - PCHKCHAR
HFLD5 - EQIPCHAR
[Do you] respondent is SP
[Does (SP)] respondent is proxy
BOX HFLD2
[have you] respondent is SP
[has (SP)] respondent is proxy
(01) HFLD7 - STILCHAR
(02) BOX HFLE1
(03) BOX HFLE1
(-8) BOX HFLE1
(-9) BOX HFLE1
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFLE1
[[You said [your/(SP's)] health makes walking difficult./You said that walking is
something [you don't/(SP) doesn't] do.]]
HELPWALK
PCHKWALK
EQIPWALK
LONGWALK
STILWALK
HFLE3
HFLE4
yes/no
yes/no
HFLE5
yes/no
BOX HFLE2
routing
HFLE6
code 1
HFLE7
yes/no
BOX HFLF1
routing
HELPTOIL
HFLF3
yes/no
PCHKTOIL
HFLF4
yes/no
EQIPTOIL
LONGTOIL
STILTOIL
PERSON_HLPRBATH
PERSON_HLPRDRES
PERSON_HLPREAT
HFLF5
yes/no
BOX HFLF2
routing
HFLF6
code 1
HFLF7
yes/no
BOX HFLA3
routing
HFLA9
roster
BOX HFLB3
routing
HFLB9
roster
BOX HFLC3
routing
HFLC9
roster
BOX HFLD3
routing
[Do you/Does (SP)] receive help from another person with walking?
Does someone usually stay nearby just in case [you need/(SP) needs] help with
walking?
[That is, does someone usually stay or come into the room to check on
(you/him/her)?]
[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with
walking?
IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
How long [have you/has (SP)] needed help with walking? Has it been . . .
(-9) Refused
(01) YES
(02) NO
Do you expect that [you/(SP)] will still need help with walking three months from (-8) Don't Know
now?
(-9) Refused
IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO HFLF3 HELPTOIL.
ELSE GO TO BOX HFLA3.
[[You said [your/(SP's)] health makes using the toilet difficult./You said that using (01) YES
the toilet is something [you don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with using the toilet?
(-9) Refused
Does someone usually stay nearby just in case [you need/(SP) needs] help with
using the toilet?
(01) YES
(02) NO
[That is, does someone usually stay or come into the room to check on
(-8) Don't Know
(you/him/her)?]
(-9) Refused
(01) YES
(02) NO
[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with
(-8) Don't Know
using the toilet?
(-9) Refused
IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
How long [have you/has (SP)] needed help with using the toilet? Has it been . . . (-9) Refused
(01) YES
(02) NO
Do you expect that [you/(SP)] will still need help with using the toilet three
(-8) Don't Know
months from now?
(-9) Refused
IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH.
ELSE GO TO BOX HFLB3.
You mentioned that [you receive/(SP) receives] help with bathing and
showering. Who gives that help?
ENTER ALL HELPERS.
(01) [Continuous answer.]
IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES.
ELSE GO TO BOX HFLC3.
You mentioned that [you receive/(SP) receives] help with dressing. Who gives
that help?
ENTER ALL HELPERS.
(01) [Continuous answer.]
IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT.
ELSE GO TO BOX HFLD3.
You mentioned that [you receive/(SP) receives] help with eating. Who gives that
help?
ENTER ALL HELPERS.
(01) [Continuous answer.]
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.
[You said that [your] health makes walking difficult.]
respondent is SP, SP walks
[You said that [(SP's)] health makes walking difficult.]
respondent is proxy, SP walks
[You said that walking is something that [you don't do]]
respondent is SP, SP doesn't walk
[You said that waking is something that [(SP) doesn't do]]
respondent is proxy, SP doesn't walk
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you need] respondent is SP
[(SP) needs] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) HFLE5 - EQIPWALK
(02) HFLE4 - PCHKWALK
(-8) HFLE4 - PCHKWALK
(-9) HFLE4 - PCHKWALK
HFLE5 - EQIPWALK
[Do you] respondent is SP
[Does (SP)] respondent is proxy
BOX HFLE2
[have you] respondent is SP
[has (SP)] respondent is proxy
(01) HFLE7 - STILWALK
(02) BOX HFLF1
(03) BOX HFLF1
(-8) BOX HFLF1
(-9) BOX HFLF1
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFLF1
[You said that [your] health makes using the toilet difficult.]
respondent is SP, SP uses toilet
[You said that [(SP's)] health makes using the toilet difficult.]
respondent is proxy, SP uses toilet
[You said that using the toilet is something that [you don't
do]] respondent is SP, SP doesn't use toilet
[You said that using the toilet is something that [(SP) doesn't
do]] respondent is proxy, SP doesn't use toilet
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[you need] respondent is SP
[(SP) needs] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
(01) HFLF5 - EQIPTOIL
(02) HFLF4 - PCHKTOIL
(-8) HFLF4 - PCHKTOIL
(-9) HFLF4 - PCHKTOIL
HFLF5 - EQIPTOIL
[Do you] respondent is SP
[Does (SP)] respondent is proxy
BOX HFLF2
[have you] respondent is SP
[has (SP)] respondent is proxy
(01) HFLF7 - STILTOIL
(02) BOX HFLA3
(03) BOX HFLA3
(-8) BOX HFLA3
(-9) BOX HFLA3
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFLA3
[you receive] respondent is SP
[(SP) recieves] respondent is proxy
BOX HFLB3
[you receive] respondent is SP
[(SP) recieves] respondent is proxy
BOX HFLC3
[you receive] respondent is SP
[(SP) recieves] respondent is proxy
BOX HFLD3
PERSON_HLPRCHAR
PERSON_HLPRWALK
PERSON_HLPRTOIL
PERSON_HLPRMOST
HFLD9
roster
BOX HFLE3
routing
HFLE9
roster
BOX HFLF3
routing
HFLF9
roster
BOX HFL4
routing
HFL10
roster
BOX HFM1
routing
FALLANY
HFM1
yes/no
FALLTIME
HFM2
numeric
FALLHELP
FALCODE
FALOTHOS
FALLIMIT
FALLBACK
FALLFEAR
HFM3A
HFM3B
HFM3B
HFM3C
HFM3D
HFM3E
yes/no
code all
verbatim text
yes/no
You mentioned that [you receive/(SP) receives] help with getting in or out of bed
or chairs. Who gives that help?
ENTER ALL HELPERS.
IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK.
ELSE GO TO BOX HFLF3.
You mentioned that [you receive/(SP) receives] help with walking. Who gives
that help?
ENTER ALL HELPERS.
IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL.
ELSE GO TO BOX HFL4.
You mentioned that [you receive/(SP) receives] help with using the toilet. Who
gives that help?
ENTER ALL HELPERS.
IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9, HFLD9, HFLE9,
AND/OR HFLF9, GO TO HFL10 - PERSON_HLPRMOST.
ELSE GO TO BOX HFM1.
Which of these persons gives [you/(SP)] the most help with these things?
SELECT ONLY ONE.
IF THIS IS ROUND 67 73, GO TO HFM1 - FALLANY.
ELSE GO TO HFN1 - MEMLOSS.
(01) [Continuous answer.]
[you receive] respondent is SP
[(SP) recieves] respondent is proxy
BOX HFLE3
(01) [Continuous answer.]
[you receive] respondent is SP
[(SP) recieves] respondent is proxy
BOX HFLF3
(01) [Continuous answer.]
[you receive] respondent is SP
[(SP) recieves] respondent is proxy
BOX HFL4
(01) [Continuous answer.]
[you] respondent is SP
[(SP)] respondent is proxy
BOX HFM1
[have you] respondent is SP
[has (SP)] respondent is proxy
(01) HFM2 - FALLTIME
(02) HFN1 - MEMLOSS
(-8) HFN1 - MEMLOSS
(-9) HFN1 - MEMLOSS
(01) YES
(02) NO
(-8) Don't Know
Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?
(-9) Refused
[Continuous answer.]
Since (LAST HF MONTH YEAR), how many times [have you/has (SP)] fallen down? Don't Know
ENTER "95" IF 95 OR MORE FALLS REPORTED.
Refused
(01) YES
(02) NO
Thinking about the [most recent) time that [you/(SP)] fell, did (you/he/she) hurt (-8) Don't Know
(yourself/himself/herself) badly enough to get medical help?
(-9) Refused
(01) BROKEN BONE/FRACTURE
(02) SPRAIN/STRAIN
(03) BRUISE
(04) CUT/WOUND/LACERATION
(05) CONCUSSION
(06) DISLOCATION
What kind of injury did [you/(SP)] have in that (most recent) fall?
(91) OTHER
(96) NO INJURY
[PROBE: Anything else?]
(-8) Don't Know
CHECK ALL THAT APPLY.
(-9) Refused
OTHER (SPECIFY)
(01) [Continuous answer.]
Did [your/(SP's)] (most recent) fall cause (you/him/her) to limit (your/his/her)
regular acivities?
code 1
How long did it take [you/(SP)] to get back to regular activities after
(your/his/her) (most recent) fall?
numeric
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6, where 1 is
"Not at all afraid of falling" and 6 is "Extremely afraid of falling"?
MEMLOSS
HFN1
yes/no
[Do you/Does (SP)] experience memory loss such that it interferes with daily
activities?
PROBDECS
HFN2
yes/no
[Do you/Does (SP)] have problems making decisions to the point that it
interferes with daily activities?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN ONE WEEK
(02) ONE WEEK OR MORE
(03) NEVER RESUMED REGULAR ACTIVITIES
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[have you] respondent is SP
[has (SP)] respondent is proxy
[most recent] SP fell more than once
[you] respondent is SP
[(SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[yourself] respondent is SP
[himself] respondent is proxy, SP male
[herself] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[most recent] SP fell more than once
[your] respondent is SP
[(SP's)] respondent is proxy
[most recent] SP fell more than once
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[most recent] SP fell more than once
HFM3A - FALLHELP
HFM3B - FALCODE
(01) HFM3C - FALLIMIT
(02) HFM3C - FALLIMIT
(03) HFM3C - FALLIMIT
(04) HFM3C - FALLIMIT
(05) HFM3C - FALLIMIT
(06) HFM3C - FALLIMIT
(91) HFM3B - FALOTHOS
(96) HFM3C - FALLIMIT
(-8) HFM3C - FALLIMIT
(-9) HFM3C - FALLIMIT
HFM3C - FALLIMIT
(01) HFM3D - FALLBACK
(02) HFM3E - FALLFEAR
(-8) HFM3E - FALLFEAR
(-9) HFM3E - FALLFEAR
HFM3E - FALLFEAR
[your] respondent is SP
[(SP's)] respondent is proxy
HFN1 - MEMLOSS
[Do you] respondent is SP
[Does (SP)] respondent is proxy
HFN2 - PROBDECS
[Do you] respondent is SP
[Does (SP)] respondent is proxy
HFN3 - TROBCONC
TROBCONC
TIMESAD
LOSTINTR
HFN3
HFN4
HFN5
yes/no
[Do you/Does (SP)] have trouble concentrating or keeping (your/his/her) mind
on what (you are/he is/she is) doing?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
code 1
SHOW CARD HF4 HF5
In the past 12 months, how much of the time did [you/(SP)] feel sad, blue, or
depressed? Would you say [you were/(SP) was] sad or depressed all of the time,
most of the time, some of the time, a little of the time, or none of the time?
[WE ARE ASKING FOR A SUBJECTIVE EVALUATION OF THE RESPONDENT'S
EMOTIONAL STATE; WE ARE NOT LOOKING FOR A MEDICAL DIAGNOSIS AT THIS
QUESTION.]
(01) ALL OF THE TIME
(02) MOST OF THE TIME
(03) SOME OF THE TIME
(04) A LITTLE OF THE TIME
(05) NONE OF THE TIME
(-8) Don't Know
(-9) Refused
yes/no
In the past 12 months, [have you/has (SP)] had 2 weeks or more when
(you/he/she) lost interest or pleasure in things that (you/he/she) usually cared
about or enjoyed?
LOSTURIN
HFQ1
code 1
TALKURIN
HFQ2
yes/no
FEELURIN
REASURIN
SURGURIN
HFQ3
HFQ4
yes/no
yes/no
HFQ5
yes/no
BOX HFT0
routing
BOX HFT1
routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) MORE THAN ONCE A WEEK
(02) ABOUT ONCE A WEEK
(03) 2-3 TIMES A MONTH
(04) ABOUT ONCE A MONTH
(05) EVERY 2-3 MONTHS
(06) ONCE OR TWICE A YEAR
SHOW CARD HF2 HF7
(07) NOT AT ALL
I'd like to ask about a health problem that is more common than people think. (08) SP IS ON DIALYSIS OR CATHETERIZATION OR
Please look at this card and tell me how often, if at all, since (LAST HF MONTH
UROSTOMY OR BLADDER BAG
YEAR) [you have/(SP) has] lost urine because (you/he/she) could not control
(-8) Don't Know
(your/his/her) bladder.
(-9) Refused
(01) YES
(02) NO
[Have you/Has (SP)] talked about this problem with [your/(SP’s)] doctor or other (-8) Don't Know
medical professional?
(-9) Refused
Has [your/(SP’s)] doctor or other medical professional asked (you/him/her)
about how (you/he/she) (feel/feels) about this problem?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Has [your/(SP’s)] doctor or other medical professional examined (you/him/her)
to figure out why (you/he/she) (lose/loses) urine?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Has [your/(SP’s)] doctor or other medical professional talked with (you/him/her) (-8) Don't Know
about taking medicine or having surgery for this problem?
(-9) Refused
IF THIS IS ROUND 67 73, GO TO BOX HFT1.
ELSE GO TO BOX HFEND.
IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD.
ELSE GO TO BOX HFEND.
We have recorded that [you were/(SP) was] told by a doctor that (you had/he
had/she had) hypertension, also called high blood pressure.
[Were you/Was (SP)] told on two or more different medical visits that
(you/he/she) had high blood pressure or hypertension?
HYPETOLD
HFT1
code 1
[EXPLAIN IF NECESSARY: We are interested in knowing whether [your/(SP’s)]
blood pressure was high for more than one reading.]
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[[you are] respondent is SP
[he is] respondent is proxy, SP male
[she is] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[you were] respondent is SP
[(SP) was] respondent is proxy
[have you] respondent is SP
[has (SP)] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[you have] respondent is SP
[(SP) has] respondent is proxy
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[feel] respondent is SP
[feels] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[lose] respondent is SP
[loses] respondent is proxy
[your] respondent is SP
[(SP's)] respondent is proxy
[you] respondent is SP
[him] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you were] respondent is SP
[(SP) was] respondent is proxy
[you had] respondent is SP
[he had] respondent is proxy, SP male
[she had] respondent is proxy, SP female
[Were you] respondent is SP
(01) YES
[Was (SP)] respondent is proxy
(02) NO
[you] respondent is SP
(03) SP NEVER HAD HIGH BLOOD PRESSURE/PREVIOUS [he] respondent is proxy, SP male
RESPONSE ENTERED IN ERROR
[she] respondent is proxy, SP female
(-8) Don't Know
[your] respondent is SP
(-9) Refused
[(SP's)] respondent is proxy
HFN4 - TIMESAD
HFN5 - LOSTINTR
HFQ1 - LOSTURIN
(01) HFQ2 - TALKURIN
(02) HFQ2 - TALKURIN
(03) HFQ2 - TALKURIN
(04) HFQ2 - TALKURIN
(05) HFQ2 - TALKURIN
(06) HFQ2 - TALKURIN
(07) BOX HFT0
(08) BOX HFT0
(-8) BOX HFT0
(-9) BOX HFT0
(01) HFQ3 - FEELURIN
(02) BOX HFT0
(-8) BOX HFT0
(-9) BOX HFT0
HFQ4 - REASURIN
HFQ5 - SURGURIN
BOX HFT0
(01) HFT2 - HYPEAGE
(02) HFT2 - HYPEAGE
(03) BOX HFEND
(-8) HFT2 - HYPEAGE
(-9) HFT2 - HYPEAGE
HYPEAGE
HYPEAGE_LESSONE
HYPEHOME
HYPEMEDS
HYPEDRNK
HYPELONG
HYPEMANY
HYPECOND
HYPECTRL
HFT2
HFT2
HFT6D
HFT6G
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
numeric
How old [were you/was (SP)] when (you were/he was/she was) first told that
(you/he/she) had high blood pressure?
(01) LESS THAN ONE YEAR OLD
(-7) Empty
Because of (your/his/her) high blood pressure, [are you/is (SP)] now measuring
(your/his/her) blood pressure at home?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Because of (your/his/her) high blood pressure, [are you/is (SP)] now taking
prescribed medicine for (your/his/her) high blood pressure?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
yes/no
yes/no
yes/no
BOX HFT2
routing
HFT7
numeric
BOX HFT3
routing
HFT11A
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
[have you] respondent is SP
[has (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
numeric
How old [were you/was (SP)] when (you were/he was/she was) first told that
(you/he/she) had high blood pressure?
HFT6J
HFT8
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[were you] respondent is SP
[was (SP)] respondent is proxy
[you were] respondent is SP
[he was] respondent is proxy, SP male
[she was] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[were you] respondent is SP
[was (SP)] respondent is proxy
[you were] respondent is SP
[he was] respondent is proxy, SP male
[she was] respondent is proxy, SP female
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[are you] respondent is SP
[is (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[are you] respondent is SP
[is (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[you] respondent is SP
[(SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Have you] respondent is SP
[Has (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
numeric
code 1
HFT12A
code 1
BOX HFT4
routing
(You mentioned that in a typical month in the past year [you/(SP)] did not drink
alcohol. Is that because of (your/his/her) high blood pressure?/[Have you/Has
(SP)] cut down on drinking alcoholic beverages because of (your/his/her) high
blood pressure?)
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG.
ELSE GO TO HFT12A - HYPECTRL.
How long [have you/has (SP)] been treated with prescribed medicines for
(your/his/her) high blood pressure?
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFT8 - HYPEMANY.
ELSE GO TO HFT11A - HYPECOND.
How many different prescribed medicines [do you/does (SP)] take for
(your/his/her) high blood pressure?
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR
(01) [Continuous answer.]
HIGH BLOOD PRESSURE ARE TAKEN BY THE RESPONDENT, NOT THE NUMBER OF (-8) Don't Know
PILLS THEY MIGHT TAKE IN ONE DAY.]
(-9) Refused
How often [do you/does (SP)] have trouble with side effects from (your/his/her)
blood pressure (medicine/medicines)? Please tell me if (you/he/she) always,
(01) ALWAYS
sometimes, or never (have/has) trouble with side effects.
(02) SOMETIMES
(03) NEVER
[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any (-8) Don't Know
condition such as fatigue, headache, or coughing.]
(-9) Refused
Doctors often recommend changing your habits or lifestyle, such as changing
(01) VERY CONFIDENT
your diet, or getting regular exercise in order to control blood pressure. How
(02) CONFIDENT
confident are you that [you/(SP)] can follow these recommendation?
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
Would you say that you are very confident, confident, somewhat confident, or (-8) Don't Know
not at all confident?
(-9) Refused
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[do you] respondent is SP
[does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[medicine] SP takes one medicine
[medicines] SP takes more than one medicine
[you] respondent is SP
[he] respondent is proxy, SP male
[she] respondent is proxy, SP female
[have] respondent is SP
[has] respondent is proxy
[you] respondent is SP
[(SP)] respondent is proxy
HFT2 - HYPEAGE_LESSONE
HFT6D - HYPEHOME
HFT6G - HYPEMEDS
HFT6J - HYPEDRNK
BOX HFT2
HFT7 - HYPELONG_LESSONE
HFT11A - HYPECOND
HFT12A - HYPECTRL
BOX HFT4
HYPEPAY
HYPESKIP
HFT13
HFT14
yes/no
yes/no
[Do you/Does (SP)] have difficulty paying for the (medicine/medicines)
(your/his/her) doctor prescribes for (your/his/her) high blood pressure?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] ever skip taking (your/his/her) medicine, take less medicine
than prescribed, or share medicine because of the cost of the medicine?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[medicine] SP only takes one medicine
[medicines] SP takes more than one medicine
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
[Do you] respondent is SP
[Does (SP)] respondent is proxy
[your] respondent is SP
[his] respondent is proxy, SP male
[her] respondent is proxy, SP female
HFT14 - HYPESKIP
BOX HFEND
| File Type | application/pdf |
| Author | NORC |
| File Modified | 2015-06-15 |
| File Created | 2015-06-15 |