Cms-p-0015a Mcbs

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFBEG
GENHELTH
HFA1

Question type
routing
code one

COMPHLTH

HFA2

code one

FUTRHLTH

HFA2B

code one

DISHEAR

DIS1

yes/no

DISSEE

DIS2

yes/no

DISDECISION

DIS3

yes/no

DISWALK

DIS4

yes/no

DISBATH

DIS5

yes/no

Question text/description
GO TO HFA1 - GENHELTH
In general, compared to other people [your/(SP's)] age, would you say that [your/his/her]
health is . . .

Code list

(01) excellent,
(02) very good,
(03) good,
(04) fair, or
(05) poor?
(-8) DON'T KNOW
(-9) REFUSED
SHOW CARD HF1
(01) much better now than one year ago,
(02) somewhat better now than one year ago,
Compared to one year ago, how would you rate [your/(SP's)] health in general now?
(03) about the same,
(04) somewhat worse now than one year ago,
Would you say [your/(SP's)] health is . . .
or
(05) much worse now than one year ago?
(-8) DON'T KNOW
(-9) REFUSED
SHOW CARD HF2
(01) it will get much better
(02) it will get somewhat better
In the next 6 months, what do you think will happen to [your/(SP's)] overall health?
(03) it will not change
(04) it will get somewhat worse
(05) it will get much worse
(-8) DON'T KNOW
(-9) REFUSED
Now, I would like to ask you about [your/(SP's)] health.
(01) YES
(02) NO
[Are you/Is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?
(-8) DON'T KNOW
(-9) REFUSED
[Are you/Is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even when wearing (01) YES
glasses?
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Because of a physical, mental, or emotional condition, [do you/does (SP)] have serious difficulty (01) YES
concentrating, remembering, or making decisions?
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Do you/Does (SP)] have serious difficulty walking or climbing stairs?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
[Do you/Does (SP)] have difficulty dressing or bathing?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
DISERRANDS
DIS6

Question type
yes/no

Question text/description
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?

HELMTACT

code one

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?

HFA3

Would you say . . .

BOX HFA1

routing

ECHELP

HFB1

yes/no

ECTROUB

HFB2

code one

ECLEGBLI

HFB2A

yes/no

EDOCEXAM

HFB6

yes/no

EDOCLAST

HFB7

code one

EDOCTYPE

HFB7A

code one

IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO BOX HFF1.
ELSE GO TO HFB1 - ECHELP.
[Do you/Does (SP)] wear eyeglasses or contact lenses?

Code list
(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
(-9) REFUSED
Which statement best describes [your/(SP's)] vision [while wearing glasses or contact lenses]... (01) NO TROUBLE SEEING
no trouble seeing, a little trouble, a lot of trouble, or no usable vision?
(02) A LITTLE TROUBLE SEEING
(03) A LOT OF TROUBLE SEEING
(04) NO USABLE VISION
(-8) DON'T KNOW
(-9) REFUSED
[Have you/Has (SP)] been told that [you are/he is/she is] legally blind?
(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with corrective lenses, (-8) DON'T KNOW
they cannot see well enough to drive.]
(-9) REFUSED
[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF MONTH YEAR)? (01) YES
(02) NO
INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
(-8) DON'T KNOW
(-9) REFUSED
How long has it been since [your/(SP's)] last eye examination by an eye doctor?
(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
I have a couple of questions about [your/(SP’s)] last eye examination.
(01) OPTOMETRIST
(02) OPTHAMOLOGIST
Was the eye examination given by an optometrist, ophthalmologist or some other type of
(91) OTHER DOCTOR SPECIALTY
doctor or eye care professional?
(-8) DON'T KNOW
(-9) REFUSED
[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.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
EDOCTYOS
HFB7A
EDOCDLAT
HFB7B

Question type
verbatim text
yes/no

ECATARAC

yes/no

HFB7C

Question text/description
OTHER (SPECIFY)
Again, thinking about [your/(SP’s)] last eye examination, were dilating drops used in
[your/(SP)’s] eyes?

(01) YES
(02) NO
(-8) DON'T KNOW
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The (-9) REFUSED
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 (01) YES
by a doctor that [you/he/she] had any of these conditions.
(02) NO
(-8) DON'T KNOW
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] (-9) REFUSED
had…

EGLAUCOM

HFB7C

yes/no

Cataracts?
Glaucoma?

ERETINOP

HFB7C

yes/no

Diabetic retinopathy?

EMACULAR

HFB7C

yes/no

Macular degeneration or age-related macular degeneration, also called AMD?

ECCATOP

BOX HFB1A
HFB10

routing
yes/no

IF ECATARAC=02/NO, GO TO BOX HFB1. ELSE GO TO HFB10 - ECCATOP.
[Have you/Has (SP)] ever had an operation for cataracts?

BOX HFB1

routing

HFB11

yes/no

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.

ELASRSUR

Code list

[Have you/Has (SP)] ever had laser surgery to the back of either eye for one of these
conditions?
[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to the front of the eye used to
correct vision.]

(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

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
HCHELP
HFC1

Question type
yes/no

Question text/description
[Do you/Does (SP)] use a hearing aid?

HCTROUB

HFC2

code one

Which statement best describes [your/(SP's)] hearing [with a hearing aid]: no trouble hearing, a
little trouble, a lot of trouble, or deaf?

HCKNOWMC

HFC3

code one

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?

HCCOMDOC

HFC4

code one

How much trouble [do you/does (SP)] have communicating with [your/his/her] doctor or other
medical personnel health professional 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?

FOODTRBL

HFD1A

code one

How much trouble [do you/does (SP)] have eating solid foods because of problems with
[your/his/her] mouth or teeth? Would you say [you have/she has/he has] no trouble, a little
trouble, or a lot of trouble?

HEIGHTFT

HFE1

numeric

How tall [are you/is (SP)]?

WEIGHT

HFE1

numeric

How much [do you/does (SP)] weigh?

PREVHLTHINTRO

HFFINTRO

no entry

These next few questions are about preventive health care measures some people take.

BPTAKEN

HFF1

code one

When was the most recent time [you/(SP)] had [your/his/her] blood pressure taken by a doctor
or other health professional?

Code list
(01) YES
(02) NO
(03) SP IS DEAF
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
(03) A LOT OF TROUBLE HEARING
(04) DEAF
(-8) DON'T KNOW
(-9) REFUSED
(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
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED
(01) CONTINUE
(-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
(-8) DON'T KNOW
(-9) REFUSED

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BCTAKEN
HFF2

MAMMOGRM

Question type
code one

Question text/description
When was the most recent time [you/(SP)] had [your/his/her] blood cholesterol checked?

Code list
(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
(-8) DON'T KNOW
(-9) REFUSED

BOX HFF1

routing

HFF3

yes/no

BOX HFF1A

routing

IF SP IS FEMALE, GO TO HFF3 - MAMMOGRM.
ELSE GO TO BOX HFF3.
These next few questions are about preventive health care measures some people take. [Have (01) YES
you/Has (SP)] had a mammogram or a breast X-ray since (LAST HF MONTH YEAR)?
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO HFF6 - PAPSMEAR.
ELSE GO TO HFF5 - MAMCODE.

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
MAMCODE
HFF5

Question type
code all

Question text/description
What is the reason that [you have/(SP) has] not had a mammogram since (LAST HF MONTH
YEAR)?
CHECK ALL THAT APPLY.

MAMNOTHS
PAPSMEAR

HFF5
HFF6

verbatim text
yes/no

OTHER (SPECIFY)
[Have you/Has (SP)] had a Pap smear test since (LAST HF MONTH YEAR)?

BOX HFF1B

routing

IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO BOX HFF2.
ELSE GO TO HFF8 - PAPCODE.

Code list
(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
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
PAPCODE
HFF8

Question type
code all

Question text/description
What is the reason that [you have/(SP) has] not had a Pap smear test since (LAST HF MONTH
YEAR)?
CHECK ALL THAT APPLY.

OTHER (SPECIFY)
IF RESPONSE TO HHF8 – PAPCODE DOES NOT INCLUDE 14/HadHysterectomy, GO TO HFF9 HYSTEREC.
ELSE GO TO BOX HFF3.
[Have you/Has (SP)] ever had a hysterectomy?

PAPNOTHS

HFF8
BOX HFF2

verbatim text
routing

HYSTEREC

HFF9

yes/no

BOX HFF3

routing

HFF10

yes/no

PROSSURG

Code list
(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

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

IF SP HAS EVER REPORTED HAVING PROSTATE SURGERY IN A PREVIOUS ROUND, GO TO HFF11 DIGTEXAM.
ELSE GO TO HFF10 - PROSSURG.
[Since (LAST HF MONTH YEAR), [have you/has (SP)/[Have you/has (SP)] ever] had surgery on
(01) YES
(your/his) prostate?
(02) NO
(-8) DON'T KNOW
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is typically used as a treatment for
(-9) REFUSED
prostate cancer or to correct urinary problems. Surgery can include complete or partial
removal of the prostate.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
DIGTEXAM
HFF11

BLOODTST

HFF12

Question type
yes/no

yes/no

Question text/description
Code list
These next few questions are about [preventive health care measures some people take/follow- (01) YES
up care sometimes prescribed after prostate surgery].
(02) NO
(-8) DON'T KNOW
[Have you/Has (SP)] had a digital rectal examination (of the prostate) since (LAST HF MONTH
(-9) REFUSED
YEAR)?
[EXPLAIN IF NECESSARY: The exam may be used to detect prostate cancer, to determine
whether cancer has spread beyond the prostate, and as part of follow-up care after prostate
surgery.]
[Have you/Has (SP)] had a blood test for detection of prostate cancer, known as a PSA, since
(LAST HF MONTH YEAR)?
PSA = PROSTATE-SPECIFIC ANTIGEN

BOX HFF3B

routing

[EXPLAIN IF NECESSARY: The test may be used to detect prostate cancer, to determine
whether cancer has spread beyond the prostate, and as part of follow-up care after prostate
surgery.]
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO HFF15 - FLUSHOT.
ELSE GO TO HFF14 - PRONCODE.

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
PRONCODE
HFF14

Question type
code all

Question text/description
What is the reason that [you have/(SP) has] not had a prostate blood test or PSA since (LAST HF
MONTH YEAR)?
CHECK ALL THAT APPLY.

PRONOTHS
FLUSHOT

verbatim text
yes/no

OTHER (SPECIFY)
Did [you/(SP)] have a seasonal flu shot for last winter?

HFF14
HFF15

[EXPLAIN IF NECESSARY: Did [you/(SP)] have a seasonal flu shot any time during the period
from September (PREVIOUS YEAR) through December (PREVIOUS YEAR)?]

Code list
(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
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
FLUCODE
HFF17

Question type
code all

Question text/description
Why didn't [you/(SP)] get a seasonal flu shot last winter?
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

FLUOTHOS

HFF17
BOX HFF4

verbatim text
routing

OTHER (SPECIFY)
IF RESPONSE TO HFF17 – FLUCODE DOES NOT INCLUDE 13/VaccineUnavailable, GO TO HFF21 NOVACINE.
ELSE GO TO BOX HFF5.

Code list
(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
(-9) REFUSED

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
FLUSITE
HFF18

Question type
code all

Question text/description
Where did [you/(SP)] go for [your/his/her] most recent seasonal flu shot, was that a managed
care plan or HMO center, a clinic, a doctor’s office, a hospital, a health fair, shopping mall, or
some other place?

FLUSITOS
VACPAID

verbatim text
yes/no

OTHER (SPECIFY)
Did [you/(SP)] pay some or all of the cost of the flu shot?

HFF18
HFF18A

Code list
(01) DOCTORS OFFICE OR GROUP PRACTICE
(02) MEDICAL CLINIC
(03) MANAGED CARE PLAN CENTER/HMO
(04) NEIGHBORHOOD/FAMILY HEALTH CENTER
[IF CLINIC, ASK: Was it a hospital outpatient clinic, or some other kind of clinic? IF SOME OTHER (05) FREESTANDING SURGICAL CENTER
PLACE, ASK: Where was this?]
(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
(18) LIBRARY
(19) HOSPITAL INPATIENT
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

Please include any monetary donations that you may have made to cover the cost of the flu
shot.
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?

VACSUPLY

HFF20

yes/no

NOVACINE

HFF21

yes/no

Was one reason that [you/(SP)] did not get a seasonal flu shot last winter because the vaccine
was in short supply or unavailable?

BOX HFF5

routing

HFF22

yes/no

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?

PNEUSHOT

(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

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFF5B

Question type
routing

PNUCODE

code all

HFF23

Question text/description
IF THIS IS ROUND 73 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE GO TO BOX HFG1.
ELSE GO TO HFF23 - PNUCODE.
Why [haven't you/hasn't (SP)] ever had a shot for pneumonia?
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

PNUOTHOS

HFF23
BOX HFG1

verbatim text
routing

EVERSMOK

HFG1

yes/no

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?

SMOKNOW

HFG2

yes/no

[Do you/Does (SP)] smoke cigarettes, cigars, or pipe tobacco now?

Code list

(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
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFG1A

Question type
routing

DIDSMOKE

HFG3

numeric

LASTSMOK

HFG4

code 1

HAVSMOKE

HFG5

numeric

HAVSMOKE_LESSON HFG5
E
DRQTSMOK
HFG5A

QUITSMOK

DRINKDAY

numeric
yes/no

BOX HFG1B

routing

HFG6

yes/no

BOX HFG1C

routing

HFG7

numeric

BOX HFG2

routing

Question text/description
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.
How many years did [you/(SP)] smoke?
[EXCLUDE BREAKS WHEN THE RESPONDENT DID NOT SMOKE BETWEEN YEARS OF SMOKING.]

Code list

(01) continuous answer
(-7) EMPTY
(-8) DON'T KNOW
(-9) REFUSED
About how long has it been since [you/(SP)] last smoked regularly?
(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
(-9) Refused
How many years [have you/has (SP)] smoked?
(01) [Continuous answer.]
[EXCLUDE BREAKS WHEN THE RESPONDENT DID NOT SMOKE BETWEEN YEARS OF SMOKING.] (-7) Empty
(-8) Don't Know
(-9) Refused
How many years [have you/has (SP)] smoked? [EXCLUDE BREAKS WHEN THE RESPONDENT DID (01) LESS THAN ONE YEAR
NOT SMOKE BETWEEN YEARS OF SMOKING.]
(-7) Empty
Since (LAST HF MONTH YEAR), has a doctor or other health professional advised [you/(SP)] to (01) YES
quit smoking?
(02) NO
(-8) Don't Know
(-9) Refused
IF THIS IS ROUND 67 73, GO TO HFG6 - QUITSMOK.
ELSE GO TO BOX HFG1C
During the past 12 months, [have you/has (SP)] stopped smoking for one day or longer because (01) YES
(you were/he was/she was) trying to quit smoking?
(02) NO
(-8) Don't Know
(-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 (01) [Continuous answer.]
or gin, mixed drinks, wine, beer, and any other type of alcoholic beverage.
(-8) Don't Know
(-9) Refused
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.

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
DRINKSPD
HFG8

Question type
numeric

FOURDRNK

HFG9

numeric

DIFINTRO

HFHINTRO

no entry

DIFSTOOP

HFH1

code 1

Question text/description
[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?

Code list
(01) [Continuous answer.]
(-7) LESS THAN ONE
(-8) Don't Know
(-9) Refused
[Please think about a typical month in the past year.] On how many days did [you/(SP)] have 4 (01) [Continuous answer.]
or more drinks in a single day?
(-8) Don't Know
ENTER "0" FOR "NEVER" OR "NONE".
(-9) Refused
Now, I'm going to ask about how difficult it is, on average, for [you/(SP)] to do certain kinds of (01) CONTINUE
activities. Please tell me for each activity whether [you have/(SP) has] no difficulty at all, a little (-7) Empty
difficulty, some difficulty, a lot of difficulty, or [is/are] not able to do it.
SHOW CARD HF3
How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or kneeling? Would
you say [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?

DIFLIFT

HFH2

code 1

SHOW CARD HF3
How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as heavy as 10
pounds, like a sack of potatoes heavy bag of groceries?

DIFREACH

HFH3

code 1

[PROBE IF NECESSARY: Would you say [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?]
SHOW CARD HF3
What about reaching or extending arms above shoulder level?
[PROBE IF NECESSARY: Would you say [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?]

DIFWRITE

HFH4

code 1

SHOW CARD HF3
How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping
small objects?
[PROBE IF NECESSARY: Would you say [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?]

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
DIFWALK
HFH5

Question type
code 1

Question text/description
SHOW CARD HF3
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
[PROBE IF NECESSARY: Would you say [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?]

BOX HFH1

routing

PHYSACTINTRO

HFH10INT

no entry

VIGUNIT

HFH10

quantity unit

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 (01) CONTINUE
cause large increases in breathing or heart rate. Moderate activities cause small increases in
(-7) Empty
breathing or heart rate. First I will ask about the vigorous activities that [you do/(SP) does].
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.

VIGNUM

HFH10

quantity unit

MODUNIT

HFH11

quantity unit

Code list
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused

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.
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.

MODNUM

HFH11

numeric

MUSUNIT

HFH12

quantity unit

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.

MUSNUM

HFH12

numeric

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
(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
(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) Continunous answer

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
MEDCONDINTRO
HFJINTRO

Question type
no entry

Question text/description
Next, I'm going to read a list of medical conditions. [Since (LAST HF MONTH YEAR) has/Has] a
doctor or other health professional [ever] told [you/(SP)] that [you/he/she] had any of these
conditions?

Code list
(01) CONTINUE
(-7) Empty

[INTERVIEWER: IF THE SP IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION,
THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE SP HAS THE CONDITION.]

OCARTERY

BOX HFJ1

routing

HFJ1

yes/no

IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN A PREVIOUS ROUND
(sample_person.P_OCHPB=1), GO TO HFJ2 - OCHBP.
ELSE GO TO HFJ1 - OCARTERY.
[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...

HFJ2

yes/no

hardening of the arteries or arteriosclerosis?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] [still has/still have/had/has/have...]

BOX HFJ2

routing

hypertension, sometimes called high blood pressure?
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ3 - YRHBP.
ELSE GO TO HFJ4 - OCMYOCAR.

YRHBP

HFJ3

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] still had hypertension or high blood pressure?

OCMYOCAR

HFJ4

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]

OCHBP

BOX HFJ3

routing

YRMYOCAR

HFJ5

yes/no

OCCHD

HFJ6

yes/no

BOX HFJ4

routing

a myocardial infarction or heart attack?
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ5 YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had a myocardial infarction or heart attack?

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
[a new episode of] angina pectoris or coronary heart disease?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ7 - YRCHD.
ELSE GO TO HFJ8 - OCCFAIL.

(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

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
YRCHD
HFJ7

Question type
yes/no

Question text/description
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had an episode of angina pectoris or coronary heart disease?

OCCFAIL

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]

HFJ8

[a new episode of] congestive heart failure?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ9 - YRCFAIL.
ELSE GO TO HFJ10 - OCCVALVE HFJ14 - OCOTHHRT.

BOX HFJ5

routing

YRCFAIL

HFJ9

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had an episode of congestive heart failure?

OCCVALVE

HFJ10

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that [you/he/she]
had...]

BOX HFJ6

routing

YRVALVE

HFJ11

yes/no

OCRHYTHM

HFJ12

yes/no

BOX HFJ7

routing

YRRHYTHM

HFJ13

yes/no

OCOTHHRT
OCOTHHR2

HFJ14

yes/no

([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.
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that [you/he/she] had an episode of
problems with the valves of the heart, such as aortic stenosis?

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that [you/he/she]
had...]
(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.
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that [you/he/she] had an episode of
problems with the rhythm of [your/his/her] heart, such as atrial fibrillation?

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
[a new episode of] any other heart condition?
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and
problems with the rhythm of the heartbeat, such as atrial fibrillation.]
[DO NOT RECORD THE NAME OF THE CONDITION AT THIS QUESTION.]

Code list
(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) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFJ8

YROTHHRT
YROTHHR2

OCSTROKE

HFJ15

HFJ16

Question type
routing

Question text/description
Code list
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ15 - YROTHHRT.
ELSE GO TO HFJ16 - OCSTROKE.

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had an episode of any other heart condition?

yes/no

[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and
problems with the rhythm of the heartbeat, such as atrial fibrillation.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
a stroke, a brain hemorrhage, or a cerebrovascular accident?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a
ministroke.]

YRSTROKE

BOX HFJ9

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ17 - YRSTROKE.
ELSE GO TO HFJ17A - OCCHOLES.

HFJ17

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had a stroke, a brain hemorrhage, or a cerebrovascular accident?
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a
ministroke.]
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had high
cholesterol?

OCCHOLES

HFJ17A

yes/no

YRCHOLES

HFJ17B

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had high cholesterol?

OCCSKIN

HFJ18

yes/no

[I've recorded that [you/(SP)] previously reported having had skin cancer.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]

YRCSKIN

BOX HFJ10

routing

HFJ19

yes/no

(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

[a new occurrence of] skin cancer?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ19 - YRCSKIN.
ELSE GO TO HFJ20 - OCCANCER.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had an occurrence of skin cancer?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
OCCANCER
HFJ20

Question type
yes/no

Question text/description
[I've recorded that [you/(SP)] previously reported having had a tumor, growth, malignancy, or
cancer of the [READ RESPONSES BELOW].]
[Since (LAST HF MONTH YEAR), has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had any [other] kind of cancer, malignancy, or tumor other than
skin cancer?

BOX HFJ11

routing

YRCANCER

HFJ21

yes/no

OCCCODE

HFJ22

code all

OCCOS

HFJ22

verbatim text

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - OCCCODE.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had any kind of cancer, malignancy, or tumor other than skin cancer?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
SHOW CARD HF4
(01) LUNG
(02) COLON (BOWEL), RECTUM, OR BOWEL
[Since the first time a doctor or other health professional told [you/(SP)] that [you/he/she] had (03) BREAST
a cancer, malignancy, or tumor, on/On] what part or parts of [your/(SP's)] body was the cancer (04) UTERUS
or tumor other than skin cancer found?
(05) PROSTATE
(06) BLADDER
[PROBE: Any other part?]
(07) OVARY
CHECK ALL THAT APPLY
(08) STOMACH
(09) CERVIX
(10) BRAIN
(11) KIDNEY
(12) THROAT
(13) HEAD
(14) BACK
(15) OTHER FEMALE REPRODUCTIVE ORGANS
(16) BLOOD
(17) BONE
(18) ESOPHAGUS
(19) GALL BLADDER
(20) LARYNX (WINDPIPE)
(21) LEUKOCYTES (LEUKEMIA)
(22) LIVER
(23) LYMPH NODES (LYMPHOMA)
(24) MOUTH/TONGUE/LIP
(25) PANCREAS
(26) RECTUM
(27) SOFT TISSUE/FAT
(28) TESTIS
(29) THYROID
OTHER (SPECIFY)
(01) [Continuous answer.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFJ13

Question type
routing

OCARTHRH

HFJ24

yes/no

BOX HFJ13B

routing

HFJ24B

yes/no

OCOSARTH

OCARTH

BOX HFJ14

routing

HFJ25

yes/no

Question text/description
IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCARTHRH=1), GO TO BOX HFJ14 HFJ13B.
ELSE GO TO HFJ24 - OCARTHRH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
rheumatoid arthritis?
IF SP HAS EVER REPORTED HAVING OSTEOARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCOSARTH=1), GO TO BOX HFJ14.
ELSE GO TO HFJ24B-OCOSARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
osteoarthritis?
IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND [sample_person.P_OCARTH=1], GO TO BOX HFJ16.
ELSE GO TO HFJ25 - OCARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that (you/he/she) had...]
arthritis, other than rheumatoid arthritis or osteoarthritis?

YRARTHRD

OCMENTAL

BOX HFJ15

routing

HFJ26

yes/no

BOX HFJ16

routing

HFJ28

yes/no

[EXPLAIN IF NECESSARY: This includes osteoarthritis.]
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had arthritis, other than rheumatoid arthritis or osteoarthritis, in any part of
[your/his/her] body?
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ28 OCMENTAL.
ELSE GO TO BOX HFJ16A.
[Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had...]
an intellectual disability, sometimes called mental retardation?

OCALZMER

BOX HFJ16A

routing

HFJ29A

yes/no

EXPLAIN IF NECESSARY: This is also known as intellectual development disorder or a general
learning disability. It was formerly known as mental retardation.
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCALMER=1), GO TO HFJ30AA - OCDEPRSS.
ELSE GO TO HFJ29A - OCALZMER.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
Alzheimer's disease?

Code list

(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

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFJ16B

Question type
routing

OCDEMENT

HFJ29B

yes/no

OCDEPRSS

HFJ30AA

yes/no

BOX HFJ17A

routing

YRDEPRSS

HFJ30BB

yes/no

OCPSYCHO

HFJ30A

yes/no

Question text/description
IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS ROUND
(sample_person.P_OCDEMENT=1), GO TO HFJ30AA - OCDEPRSS.
ELSE GO TO HFJ29B - OCDEMENT.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
any type of dementia other than Alzheimer's disease?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
depression?
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ30BB YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had depression?

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
a mental or psychiatric disorder other than depression?

YRPSYCHO

OCOSTEOP

OCBRKHIP

BOX HFJ17B

routing

HFJ31A

yes/no

BOX HFJ19

routing

HFJ32

yes/no

HFJ33

yes/no

[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ31A YRPSYCHO.
ELSE GO TO BOX HFJ19.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had a mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND
(sample_person.P_OCOSTEOP=1), GO TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]
osteoporosis, sometimes called fragile or soft bones?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]]
a broken hip?

Code list

(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

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFJ20

Question type
routing

Question text/description
Code list
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.

YRBRKHIP

HFJ34

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had a broken hip?

BOX HFJ21

routing

HFJ35

yes/no

IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCPARKIN=1), GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]

OCPARKIN

OCEMPHYS

OCPPARAL

YRPPARAL

OCAMPUTE

BOX HFJ22

routing

HFJ36

yes/no

HFJ37

yes/no

Parkinson's disease?
IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A PREVIOUS ROUND
(sample_person.P_OCEMPHYS=1), GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

emphysema, asthma, or COPD?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

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 or other health professional [ever] told
[you/(SP)] that [you/he/she] had...]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

complete or partial paralysis?
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.

BOX HFJ23

routing

HFJ38

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he/she] had complete or partial paralysis?

BOX HFJ24

routing

HFJ39

yes/no

IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN A PREVIOUS ROUND
(sample_person.P_OCAMPUTE=1), GO TO BOX HFJ25.
ELSE GO TO HFJ39 - OCAMPUTE.
IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT "YES" AND DO NOT ASK.
OTHERWISE, ASK:
What about absence or loss of an arm or a leg?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFJ25

Question type
routing

HAVEPROS

yes/no

HFJ40

Question text/description
IF SP IS FEMALE (ROSTSEX=2 or (roster.ROSTSEX=2 where ROSTNUM=1)), GO TO HFJ41A OCBETES.
ELSE GO TO HFJ40 - HAVEPROS.
[[Before [you/(SP)] had prostate surgery, did a doctor or other health professional ever
tell/Since (LAST HF MONTH YEAR), has/Has]] a doctor or other health professional [ever] told ]
[you/(SP)] that [you/he] had...]

routing

YRPROST

HFJ41

yes/no

OCBETES

HFJ41A

yes/no

OCDTYPE

HFJ41B

code 1

OCDTYPOS

HFJ41B

verbatim text

SOME OTHER TYPE (SPECIFY)

yes/no

[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.]
[Were you/Was (SP)] told on two or more different visits that [you/he/she] had diabetes?

HFJ41C

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

an enlarged prostate or benign prostatic hypertrophy (BPH)?
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ41 - YRPROST.
ELSE GO TO HFJ41A - OCBETES.

BOX HFJ26

OCDVISIT

Code list

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that
[you/he] had an enlarged prostate or benign prostatic hypertrophy (BPH)?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had any type of (01) YES
diabetes, including: sugar diabetes, high blood sugar, (borderline diabetes, pre-diabetes, or
(02) NO
pregnancy-related diabetes/borderline diabetes, or pre-diabetes)?
(-8) Don't Know
(-9) Refused
SHOW CARD HF4 HF5
(01) TYPE 1
(02) TYPE 2
Looking at this card, please tell me which type of diabetes the doctor or other health
(03) BORDERLINE
professional said that [you have/(SP) has].
(04) PRE-DIABETES
(05) GESTATIONAL (PREGNANCY-RELATED)
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
(91) SOME OTHER TYPE
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
(-8) Don't Know
(-9) Refused
[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.]
(01) [Continuous answer.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFJ27

Question type
routing

EMCOND

yes/no

EMCAUSEVB

HFJ42

HFJ43

verbatim text

BOX HFJ28

routing

Question text/description
Code list
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT MEDICARE
ELIGIBILITY WAS UNDER 65 (sample_person.INTTYPE=3 and sample_person.AGECUREL<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 HFPINTRO HLTHCAREINTRO.
You told me that [you have/(SP) has] had [READ CONDITIONS LISTED BELOW]. [Was this/Were (01) YES
any of these] the original cause of [your/(SP's)] becoming eligible for Medicare?
(02) NO
(-8) Don't Know
[LIST ALL CONDITIONS WHERE "YES" ANSWER RECORDED AT HFJ1 THROUGH HFJ41C]
(-9) Refused
[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 HFPINTRO HLTHCAREINTRO.
ELSE GO TO HFJ44 - EMCODE.

(01) [Continuous answer.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
EMCODE
HFJ44

Question type
code all

Question text/description
Which of these conditions was the cause of [your/(SP's)] becoming eligible for Medicare?
[PROBE: Any other condition?]
CHECK UP TO 8 CONDITIONS.

EMOS

HFJ44
BOX HFP0

verbatim text
routing

HLTHCAREINTRO

HFPINTRO

no entry

BOX HFP1A

routing

HFP1

numeric

DIAAGE

OTHER (SPECIFY)
IF THIS IS ROUND 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 or other health professional that [you
have/she has/he has] [Type 1 diabetes/Type 2 diabetes/borderline diabetes/prediabetes/diabetes].
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had
diabetes?

Code list
(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
(26) OSTEOARTHRITIS
(13) OTHER ARTHRITIS
(14) MENTAL RETARDATION INTELLECTUAL
DISABILITY
(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
(01) [Continuous answer.]

(01) CONTINUE
(-7) Empty

(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFP2

Question type
routing

DIAPRGNT

HFP2

yes/no

DIAINSUL

HFP4

list

Question text/description
IF THE SP IS FEMALE (ROSTSEX=2) 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)]…

DIAMEDS

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)]…

DIATEST

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)]…

DIASORES

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)]…

DIAPRESS

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)]…

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)]…

BOX HFP3

routing

INSUTAKE

HFP5

quantity unit

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.
How often [do you/does (SP)] take insulin?

INSUDAY

HFP5

quantity unit

How often [do you/does (SP)] take insulin?

DIAASPRN

Code list

(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.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFP4

Question type
routing

MEDSTAKE

HFP6

quantity unit

MEDDAY
MEDWEEK
MEDMONTH

HFP6
HFP6
HFP6
BOX HFP5

quantity unit
quantity unit
quantity unit
routing

TESTTAKE

HFP7

quantity unit

TESTDAY

HFP7

quantity unit

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
[PROBE: Include times when it is tested by a family member or friend, but do not include times (03) NUMBER OF TIMES PER MONTH
when it is tested by a health professional.]
(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?
(01) [Continuous answer.]

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.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
(01) [Continuous answer.]

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.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
(01) [Continuous answer.]

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.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
(01) [Continuous answer.]

TESTWEEK

TESTMNTH

TESTYEAR

SORECHEK

HFP7

HFP7

HFP7

BOX HFP6

routing

HFP8

quantity unit

Question text/description
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.
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?

Code list

(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.]

[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?
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
[PROBE: Include times when they are checked by a family member or friend, but do not include (03) NUMBER OF TIMES PER MONTH
times when they are checked by a health professional.]
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
SOREDAY
HFP8

SOREWEEK

SOREMNTH

HEST.SOREYEAR

HFP8

HFP8

HFP8

Question type
quantity unit

Question text/description
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?

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.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
(01) [Continuous answer.]

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.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
(01) [Continuous answer.]

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.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
(01) [Continuous answer.]

DIATENYR

HFP10

yes/no

DIADRSAW

HFP11

numeric

DIAHEMOC

HFP13

numeric

DIACTRLD

HFP14

code 1

DIAHYPO

HFP14A1

yes/no

Code list
(01) [Continuous answer.]

[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.]
In the past year has a doctor or other medical health professional examined [your/his/her] feet (01) YES
for sores or irritations?
(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
(01) [Continuous answer.]
professional for [your/his/her] diabetes?
(-8) Don't Know
(-9) Refused
A test of hemoglobin "A one C" measures the average level of blood sugar over the past three (01) [Continuous answer.]
months. It is usually done in a doctor's office. About how many times in the past year has a
(-8) Don't Know
doctor or other health professional checked [you/(SP)] for hemoglobin "A one C"?
(-9) Refused
SHOW CARD HF5 HF6

(01) ALL OF THE TIME
(02) MOST OF THE TIME
Would you say that [your/(SP)'s] blood sugar is well controlled all of the time, most of the time, (03) SOME OF THE TIME
some of the time, a little of the time, or none of the time? By "well controlled" we mean a
(04) A LITTLE OF THE TIME
recent hemoglobin "A one C" result of 7.5 or less or an average fasting blood test of 140 or less. (05) NONE OF THE TIME
(-8) Don't Know
(-9) Refused
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood
(01) YES
sugar or an insulin reaction?
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
DIAHYPTR
HFP14A2

Question type
code 1

DIAFTEVR

HFP14A3

yes/no

DIAFEET

HFP14A

yes/no

DIANEURO

HFP14B

list

Question text/description
Please think about the most serious episode of hypoglycemia that [you have/(SP) has]
experienced in the past year.

Code list
(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
(03) HOSPITAL TREATMENT
[Were you/Was (SP)] able to treat [yourself/himself/herself] by taking some form of sugar, did (-8) Don't Know
[you/he/she] require treatment from others, or did [you/he/she] require treatment by a
(-9) Refused
hospital?
[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.]
[Have you/Has (SP)] ever had any problems with [your/his/her] feet as a result of [your/his/her] (01) YES
diabetes?
(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
(01) YES
[your/his/her] diabetes?
(02) NO
(-8) Don't Know
(-9) Refused
People with diabetes can develop many different foot problems. Please tell me if [you
(01) YES
have/(SP) has] ever been told by a doctor or other health professional that [you/he/she] had
(02) NO
any of the following problems with [your/his/her] feet as a result of [your/his/her] diabetes.
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she]
had…
Neuropathy or nerve damage, which may cause pain or numbness in the feet?

DIACIRCF

HFP14B

list

People with diabetes can develop many different foot problems. Please tell me if [you
have/(SP) has] ever been told by a doctor or other health professional that [you/he/she] had
any of the following problems with [your/his/her] feet 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 or other health professional that [you/he/she]
had…
Poor circulation or blood flow in the feet?
DIAULCER

HFP14B

list

People with diabetes can develop many different foot problems. Please tell me if [you
have/(SP) has] ever been told by a doctor or other health professional 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 or other health professional that [you/he/she]
had…
Foot ulcers?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
DIASKINC
HFP14B

Question type
list

Question text/description
People with diabetes can develop many different foot problems. Please tell me if [you
have/(SP) has] ever been told by a doctor or other health professional that [you/he/she] had
any of the following problems with [your/his/her] feet as a result of [your/his/her] diabetes.

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she]
had…
Calluses, infections, or other skin changes affecting the feet?
DIAEYPRB

HFP15

yes/no

DIAKDPEV

HFP16A1

yes/no

DIAKDPRB

HFP16

yes/no

DIAKIDNY

HFP16A

yes/no

DIAMNGE

HFP17

yes/no

DIATRAIN

HFP18

code 1

BOX HFP7

routing

[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 had any problems with [your/his/her] kidneys as a result of
(01) YES
[your/his/her] diabetes?
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]
(-9) Refused
[Do you/Does (SP)] currently have any problems with [your/his/her] kidneys as a result of
(01) YES
[your/his/her] diabetes?
(02) NO
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever been told by a doctor or other health professional that (you have/she (01) YES
has/he has) chronic kidney disease?
(02) NO
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever participated in a diabetes self-management course or class, or
(01) YES
received special training on how [you/he/she] can manage [your/his/her] diabetes?
(02) NO
(-8) Don't Know
(-9) Refused
When was the most recent time that [you/(SP)] participated in a diabetes self-management
(01) LESS THAN 1 YEAR AGO
course or class or received special training on how [you/he/she] can manage [your/his/her]
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
diabetes?
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE (05) 5 OR MORE YEARS AGO
MOST RECENT TIME.]
(-8) Don't Know
(-9) Refused
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
DIAKNOW
HFP19

Question type
code 1

Question text/description
SHOW CARD HF6 HF7
How much do you think you know about managing your diabetes? Do you know . . .

DIASUPPS

HFP20

yes/no

Before today, did you know that Medicare now helps pay the cost of diabetic testing supplies
and self-management education for people with diabetes?

DIAEVERT

HFP21

yes/no

[I have recorded that [you have/(SP) has] never been told by a doctor or other health
professional that [you have/she has/he has] diabetes.]

DIARECNT

HFP22

code 1

BOX HFP8

routing

DIAAWARE

HFP23

yes/no

DIARISK

HFP24

yes/no

DIASIGNS

HFP25

yes/no

BOX HFR1

routing

[Have you/Has (SP)] ever had a blood test to see if [you have/she has/he has] diabetes?
When was the most recent time [you were/(SP) was] tested for diabetes?

Code list
(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 managing your diabetes?
(-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

IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP23 - DIAAWARE.
ELSE GO TO HFP24 - DIARISK.
Before today, were you aware that there is a blood test to determine if a person has diabetes? (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 (01) YES
risk for diabetes?
(02) NO
(-8) Don't Know
(-9) Refused
In the past year, [have you/has (SP)] received any information about the signs, symptoms, or
(01) YES
risk factors for diabetes?
(02) NO
(-8) Don't Know
(-9) Refused
IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS UNKNOWN P_COLHEAR=.)
AND (SP HAS NOT REPORTED HAVING COLON, RECTAL OR BOWEL CANCER IN THE CURRENT
ROUND OR IN A PREVIOUS ROUND (OCCCODE not in 02 and P_OCCCOLON^=1), GO TO HFR1 COLHEAR.
ELSE GO TO BOX HFS0 BOX HFS1.

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
COLHEAR
HFR1

Question type
yes/no

COLHTEST

yes/no

HFR3

COLHKIT

HFR4

yes/no

COLFDOC

HFR4A

yes/no

COLCARD

HFR5

yes/no

COLRECNT

HFR7

code 1

COLSCOPY

HFR8

yes/no

WHENSCOP

HFR9

code 1

Question text/description
Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower
intestines.

Code list
(01) YES
(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
(01) YES
traces of blood found in the stool. The doctor or other health professional can give the patient a (02) NO
kit to collect stool samples at the patient’s home. The test is then sent to a laboratory for the (-8) Don't Know
results to be determined.
(-9) Refused
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for
blood in the stool?
Have you ever heard of this home testing kit?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Has a doctor or other health professional ever performed a fecal occult blood test to test for
(01) YES
blood in the stool while [you/(SP)] [were/was] at the doctor’s office?
(02) NO
(-8) Don't Know
(-9) Refused
Did [you/(SP)] complete the samples and return them for [your/his/her] most recent test?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
When did [you/(SP)] have [your/his/her] most recent blood stool test (using a home testing
(01) LESS THAN 1 YEAR AGO
kit)?
(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
Another test for early signs of colon cancer is performed in the doctor's office. The doctor uses (01) YES
a flexible lighted tube to examine the colon and rectum directly. This is called a sigmoidoscopy (02) NO
or colonoscopy.
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever had this exam?
When did [you/(SP)] have [your/his/her] most recent sigmoidoscopy or colonoscopy?
(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

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
HEARSCOP
HFR10

Question type
yes/no

Question text/description
Before today, had you ever heard of a sigmoidoscopy or colonoscopy?

BOX HFR2

routing

COLDRREC

HFR11

yes/no

IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 - COLSCRNS.
ELSE GO TO BOX HFS0 BOX HFS1.
Has a doctor or other health professional ever recommended that [you/(SP)] have this test?

COLSCRNS

HFR13

yes/no

Before today, did you know that Medicare now pays the cost of screening tests for colorectal
cancer?

BOX HFS0

routing

BOX HFS1

routing

IF THIS IS ROUND 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 (OCOSTEOP=1 or sample_person.P_OCOSTEOP-=1 GO TO HFS3 - OSTTEST.
ELSE GO TO HFSINTRO - OSTINTRO.

OSTINTRO

HFSINTRO

no entry

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 and more easily broken.

OSTEVERT

HFS1

yes/no

[Have you/Has (SP)] ever talked with [your/his/her] doctor or other health professional about
osteoporosis?

OSTHRISK

HFS2

yes/no

OSTFRACT

HFS2A

yes/no

OSTTEST

HFS3

yes/no

OSTHEAR

HFS4

yes/no

Code list
(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) CONTINUE
(-7) Empty

(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 (01) YES
risk for osteoporosis?
(02) NO
(-8) Don't Know
(-9) Refused
Have [you/(SP)] ever experienced a fracture that [your/his/her] doctor or other health
(01) YES
professional told [you/him/her] was related to osteoporosis?
(02) NO
(-8) Don't Know
(-9) Refused
There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone (01) YES
Density Measurement, or DEXA scan.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?
(-9) Refused
Before today, had you ever heard of this test?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
OSTRECNT
HFS5

Question type
code 1

OSTMASS

HFS6

yes/no

HCTROUBL

HFAC29

yes/no

HCTCODE

HFAC30A

code all

HCTOTHOS

HFAC30A

verbatim text

Question text/description
When was the most recent time that [you/(SP)] had a Bone Mass or Bone Density
Measurement test?

Code list
(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
Before today, did you know that Medicare would pay for Bone Mass or Bone Density
(01) YES
Measurement tests for Medicare beneficiaries who are at risk for osteoporosis?
(02) NO
(-8) Don't Know
(-9) Refused
Next, we are going to ask some questions about [your/(SP's)] health care needs during the past (01) YES
year.
(02) NO
(-8) Don't Know
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that
(-9) Refused
[you/he/she] wanted or needed?
Why was that?
(01) SP DOES NOT HAVE MONEY
(02) COST IS TOO HIGH
[PROBE: Any other reason?]
(03) SERVICES/SUPPLIES NOT COVERED
CHECK ALL THAT APPLY.
(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
OTHER (SPECIFY)

(01) [Continuous answer.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFF6

Question type
routing

CGETAPPT

HFAC30B

yes/no

CGETCODE

HFAC30C

code all

Question text/description
IF RESPONSE TO HFAC30A - HCTCODE INCLUDES 8/DrDoesNotAcceptMedicare OR
10/DifficultyGettingAppt, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC30B - CGETAPPT.
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office that they
cannot schedule an appointment with [you/(SP)]?

What were the reasons the doctor’s office offered as an explanation for not scheduling an
appointment with [you/(SP)]?
[PROBE: Any other reason?]
CHECK ALL THAT APPLY

BOX HFF7

routing

OFFEXPLN

HFAC30D

yes/no

OFFEXVB

HFAC30E

verbatim text

HCDELAY

HFAC31

yes/no

COLLAGNCY

HFAC32

yes/no

IF RESPONSE TO HFAC30C - CGETCODE INCLUDES 4/DocNotAcceptNewMedicare OR
7/DocNotAcceptMCAR, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.
Did the doctor’s office explain why [it is difficult for Medicare patients to get an
appointment/Medicare is not accepted] at that practice?

What was that explanation?
RECORD VERBATIM.
Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care because (you
were/he was/she was) worried about the cost?

Because of problems paying medical bills since (LAST HF MONTH YEAR) during the past 12
months, [have you/has (SP)] been contacted by a collection agency?

Code list

(01) YES
(02) NO
(-8) Don't Know
(-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
(09) DOCTOR FELT ANOTHER PROVIDER WOULD
BE BETTER FOR SP
(91) OTHER
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
IADLINTRO
HFKINTRO

Question type
no entry

PRBTELE

HFKA1

code 1

DONTTELE

HFKA2

yes/no

PRBLHWK

HFKB1

code 1

DONTLHWK

HFKB2

yes/no

PRBHHWK

HFKC1

code 1

DONTHHWK

HFKC2

yes/no

PRBMEAL

HFKD1

code 1

DONTMEAL

HFKD2

yes/no

Question text/description
Now I'm going to ask about some everyday activities and whether [you have/(SP) has] any
difficulty doing them by (yourself/himself/herself). Health problems can include physical,
mental, emotional, or memory problems. I'd now like to ask [you/(SP)] about how health
problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d like to
know whether [you have/(SP) has] any difficulty doing each activity by
(yourself/himself/herself).
Because of a health or physical problem, Because of a physical, mental, emotional, or memory
problem, [do you/does (SP)] have any difficulty...

Code list
(01) CONTINUE
(-7) Empty

(01) YES
(02) NO
(03) DOESN'T DO
using the telephone?
(-8) Don't Know
(-9) Refused
[You said that using the telephone is something that [you don't/(SP) doesn't] do.]
(01) YES
(02) NO
Is this because of a health or physical problem physical, mental, emotional, or memory
(-8) Don't Know
problem?
(-9) Refused
Because of a health or physical problem, [Because of a physical, mental, emotional, or memory (01) YES
problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
doing light housework (like washing dishes, straightening up, or light cleaning)?
(-8) Don't Know
(-9) Refused
[You said that doing light housework (like washing dishes, straightening up, or light cleaning) 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 physical, mental, emotional, or memory
(-9) Refused
problem?
Because of a health or physical problem, [Because of a physical, mental, emotional, or memory (01) YES
problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
doing heavy housework (like scrubbing floors or washing windows)?
(-8) Don't Know
(-9) Refused
[You said that doing heavy housework (like scrubbing floors or washing windows) is something (01) YES
that [you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem physical, mental, emotional, or memory
(-9) Refused
problem?
Because of a health or physical problem, [Because of a physical, mental, emotional, or memory (01) YES
problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
preparing [your/his/her] own meals?
(-8) Don't Know
(-9) Refused
[You said that preparing [your/his/her] own meals is something that [you don't/(SP) doesn't]
(01) YES
do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem physical, mental, emotional, or memory
(-9) Refused
problem?

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
PRBSHOP
HFKE1

Question type
code 1

DONTSHOP

HFKE2

yes/no

PRBBILS

HFKF1

code 1

DONTBILS

HFKF2

yes/no

BOX HFKA1

routing

HELPTELE

HFKA3

yes/no

PERSON_HLPRTELE

HFKA4

roster

BOX HFKB1

routing

HFKB3

yes/no

HELPLHWK

Question text/description
Code list
Because of a health or physical problem, [Because of a physical, mental, emotional, or memory (01) YES
problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
shopping for personal items (such as toilet items or medicines)?
(-8) Don't Know
(-9) Refused
[You said that shopping for personal items (such as toilet items or medicines) is something that (01) YES
[you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem physical, mental, emotional, or memory
(-9) Refused
problem?
Because of a health or physical problem, [Because of a physical, mental, emotional, or memory (01) YES
problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
managing money (like keeping track of expenses or paying bills)?
(-8) Don't Know
(-9) Refused
[You said that managing money (like keeping track of expenses or paying bills) is something that (01) YES
[you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a health or physical problem physical, mental, emotional, or memory
(-9) Refused
problem?
IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO HFKA3 - HELPTELE.
ELSE GO TO BOX HFKB1.
[[You said that [your/(SP's)] health makes using the telephone difficult./You said that using the (01) YES
telephone is something that [you don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
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.
[[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].]]

(01) [Continuous answer.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[Do you/Does (SP)] receive help from another person with...
doing light housework (like washing dishes, straightening up, or light cleaning)?
PERSON_HLPRLHWK HFKB4
BOX HFKC1

roster
routing

You mentioned that [you receive/(SP) receives] help with doing light housework (like washing
dishes, straightening up, or light cleaning). Who gives that help?
IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 - HELPHHWK.
ELSE GO TO BOX HFKD1

(01) [Continuous answer.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
HELPHHWK
HFKC3

Question type
yes/no

Question text/description
[[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].]]

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[Do you/Does (SP)] receive help from another person with...

PERSON_HLPRHHWK HFKC4

HELPMEAL

roster

BOX HFKD1

routing

HFKD3

yes/no

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.
[[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].]]

(01) [Continuous answer.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[Do you/Does (SP)] receive help from another person with...

PERSON_HLPRMEAL HFKD4

HELPSHOP

roster

BOX HFKE1

routing

HFKE3

yes/no

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.
[[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].]]

(01) [Continuous answer.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

[Do you/Does (SP)] receive help from another person with...

PERSON_HLPRSHOP HFKE4

HELPBILS

roster

BOX HFKF1

routing

HFKF3

yes/no

shopping for personal items (such as toilet items or medicines)?
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.
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...
managing money (like keeping track of expenses or paying bills)?

(01) [Continuous answer.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
PERSON_HLPRBILS HFKF4

Question type
roster

ADLSINTRO

HFLINTRO

no entry

HPPDBATH

HFLA1

code 1

DONTBATH

HFLA2

yes/no

HPPDDRES

HFLB1

code 1

DONTDRES

HFLB2

yes/no

HPPDEAT

HFLC1

code 1

DONTEAT

HFLC2

yes/no

HPPDCHAR

HFLD1

code 1

DONTCHAR

HFLD2

yes/no

Question text/description
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.
Now I'll ask about some other everyday activities. Remembering that health problems can
include physical, mental, emotional, or memory problems, I'd now like to ask [you/(SP)] about
how health problems may affect [your/(SP)'s] ability to perform some other everyday activities.
I’d like to know whether [you have/(SP) has] any difficulty doing each one activity by
[yourself/himself/herself] and without special equipment.
Because of a health or physical problem, physical, mental, emotional, or memory problem, [do
you/does (SP)] have any difficulty...

Code list
(01) [Continuous answer.]

(01) CONTINUE
(-7) Empty

(01) YES
(02) NO
(03) DOESN'T DO
bathing or showering?
(-8) Don't Know
(-9) Refused
[You said that bathing or showering is something that [you don't/(SP) doesn't] do.]
(01) YES
(02) NO
Is this because of a health or physical problem physical, mental, emotional, or memory
(-8) Don't Know
problem?
(-9) Refused
[Because of a health or physical problem, physical, mental, emotional, or memory problem, [do (01) YES
you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
dressing?
(-8) Don't Know
(-9) Refused
[You said that dressing is something that [you don't/(SP) doesn't] do.]
(01) YES
(02) NO
Is this because of a health or physical problem physical, mental, emotional, or memory
(-8) Don't Know
problem?
(-9) Refused
[Because of a health or physical problem, physical, mental, emotional, or memory problem, [do (01) YES
you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
eating?
(-8) Don't Know
(-9) Refused
[You said that eating is something that [you don't/(SP) doesn't] do.]
(01) YES
(02) NO
Is this because of a health or physical problem physical, mental, emotional, or memory
(-8) Don't Know
problem?
(-9) Refused
[Because of a health or physical problem, physical, mental, emotional, or memory problem, [do (01) YES
you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
getting in or out of bed or chairs?
(-8) Don't Know
(-9) Refused
[You said that getting in or out of bed or chairs is something that [you don't/(SP) doesn't] do.] (01) YES
(02) NO
Is this because of a health or physical problem physical, mental, emotional, or memory
(-8) Don't Know
problem?
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
HPPDWALK
HFLE1

Question type
code 1

DONTWALK

HFLE2

code 1

HPPDTOIL

HFLF1

code 1

DONTTOIL

HFLF2

yes/no

BOX HFLA1

routing

HELPBATH

HFLA3

yes/no

PCHKBATH

HFLA4

yes/no

EQIPBATH

HFLA5

yes/no

BOX HFLA2

routing

LONGBATH

HFLA6

code 1

STILBATH

HFLA7

yes/no

Question text/description
Code list
[Because of a health or physical problem, physical, mental, emotional, or memory problem, [do (01) YES
you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
walking?
(-8) Don't Know
(-9) Refused
[You said that walking is something that [you don't/(SP) doesn't] do.]
(01) YES
(02) NO
Is this because of a health or physical problem physical, mental, emotional, or memory
(-8) Don't Know
problem?
(-9) Refused
[Because of a health or physical problem, physical, mental, emotional, or memory problem, [do (01) YES
you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
using the toilet, including getting up and down?
(-8) Don't Know
(-9) Refused
[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
(01) YES
(02) NO
Is this because of a health or physical problem physical, mental, emotional, or memory
(-8) Don't Know
problem?
(-9) Refused
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
(01) YES
showering 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 bathing or showering?
(-9) Refused
Does someone usually stay nearby just in case [you need/(SP) needs] help with bathing or
(01) YES
showering?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(-9) Refused
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with bathing or
(01) YES
showering?
(02) NO
(-8) Don't Know
(-9) Refused
IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH.
ELSE GO TO BOX HFLB1.
How long [have you/has (SP)] needed help with bathing or showering? Has it been . . .
(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
Do you expect that [you/(SP)] will still need help with bathing or showering three months from (01) YES
now?
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
BOX HFLB1

Question type
routing

HELPDRES

HFLB3

yes/no

PCHKDRES

HFLB4

yes/no

EQIPDRES

HFLB5

yes/no

BOX HFLB2

routing

LONGDRES

HFLB6

code 1

STILDRES

HFLB7

yes/no

BOX HFLC1

routing

HELPEAT

HFLC3

yes/no

PCHKEAT

HFLC4

yes/no

EQIPEAT

HFLC5

yes/no

BOX HFLC2

routing

Question text/description
Code list
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 (01) YES
don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with dressing?
(-9) Refused
Does someone usually stay nearby just in case [you need/(SP) needs] help with dressing?
(01) YES
(02) NO
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with dressing?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
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 . . .
(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
Do you expect that [you/(SP)] will still need help with dressing three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 - HELPEAT.
ELSE GO TO BOX HFLD1.
[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you
(01) YES
don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with eating?
(-9) Refused
Does someone usually stay nearby just in case [you need/(SP) needs] help with eating?
(01) YES
(02) NO
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with eating?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
LONGEAT
HFLC6

Question type
code 1

Question text/description
How long [have you/has (SP)] needed help with eating? Has it been . . .

STILEAT

HFLC7

yes/no

Do you expect that [you/(SP)] will still need help with eating three months from now?

BOX HFLD1

routing

HFLD3

yes/no

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

[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?
PCHKCHAR

HFLD4

yes/no

EQIPCHAR

HFLD5

yes/no

BOX HFLD2

routing

LONGCHAR

HFLD6

code 1

STILCHAR

HFLD7

yes/no

BOX HFLE1

routing

HFLE3

yes/no

HELPWALK

Code list
(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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

Does someone usually stay nearby just in case [you need/(SP) needs] help with getting in or out (01) YES
of bed or chairs?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
(-9) Refused
[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with getting in or out (01) YES
of bed or chairs?
(02) NO
(-8) Don't Know
(-9) Refused
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.
How long [have you/has (SP)] needed help with getting in or out of bed or chairs? Has it been . . (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
Do you expect that [you/(SP)] will still need help with getting in or out of bed or chairs three
(01) YES
months from now?
(02) NO
(-8) Don't Know
(-9) Refused
IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 - HELPWALK.
ELSE GO TO BOX HFLF1.
[[You said [your/(SP's)] health makes walking difficult./You said that walking is something [you (01) YES
don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with walking?
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
PCHKWALK
HFLE4

Question type
yes/no

Question text/description
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)?]

EQIPWALK

HFLE5

yes/no

[Do you/Does (SP)] use special equipment or aids to help (you/him/her) with walking?

BOX HFLE2

routing

LONGWALK

HFLE6

code 1

IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.
How long [have you/has (SP)] needed help with walking? Has it been . . .

STILWALK

HFLE7

yes/no

Do you expect that [you/(SP)] will still need help with walking three months from now?

BOX HFLF1

routing

HELPTOIL

HFLF3

yes/no

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 the toilet is
something [you don't/(SP) doesn't] do.]]

PCHKTOIL

HFLF4

yes/no

EQIPTOIL

HFLF5

yes/no

BOX HFLF2

routing

HFLF6

code 1

LONGTOIL

Code list
(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

(01) YES
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with using the toilet, including getting up (-9) Refused
and down?
Does someone usually stay nearby just in case [you need/(SP) needs] help with using the toilet, (01) YES
including getting up and down?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(-9) Refused
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with using the toilet,
(01) YES
including getting up and down?
(02) NO
(-8) Don't Know
(-9) Refused
IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.
How long [have you/has (SP)] needed help with using the toilet? Has it been . . .
(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

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
STILTOIL
HFLF7

BOX HFLA3
PERSON_HLPRBATH HFLA9

BOX HFLB3
PERSON_HLPRDRES HFLB9

PERSON_HLPREAT

routing
roster

routing
roster

BOX HFLC3

routing

HFLC9

roster

BOX HFLD3

routing

PERSON_HLPRCHAR HFLD9

BOX HFLE3
PERSON_HLPRWALK HFLE9

PERSON_HLPRTOIL

Question type
yes/no

roster

routing
roster

BOX HFLF3

routing

HFLF9

roster

Question text/description
Code list
Do you expect that [you/(SP)] will still need help with using the toilet three months from now? (01) YES
(02) NO
(-8) Don't Know
(-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
(01) [Continuous answer.]
that help?
ENTER ALL HELPERS.
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?

(01) [Continuous answer.]

ENTER ALL HELPERS.
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?

(01) [Continuous answer.]

ENTER ALL HELPERS.
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.
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?

(01) [Continuous answer.]

(01) [Continuous answer.]

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? (01) [Continuous answer.]
ENTER ALL HELPERS.

BOX HFL4

PERSON_HLPRMOST HFL10

BOX HFM1

routing

roster

routing

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 HFM1 - FALLANY.
Which of these persons gives [you/(SP)] the most help with these things?
SELECT ONLY ONE.
IF THIS IS ROUND 73, GO TO HFM1 - FALLANY.
ELSE GO TO HFN1 - MEMLOSS.

(01) [Continuous answer.]

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
FALLANY
HFM1

Question type
yes/no

FALLTIME

HFM2

numeric

FALLHELP

HFM3A

yes/no

FALCODE

HFM3B

code all

FALOTHOS
FALLIMIT

HFM3B
HFM3C

verbatim text
yes/no

FALLBACK

HFM3D

code 1

FALLFEAR

HFM3E

numeric

MEMLOSS

HFN1

yes/no

PROBDECS

HFN2

yes/no

Question text/description
Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Since (LAST HF MONTH YEAR), how many times [have you/has (SP)] fallen down?
[Continuous answer.]
Don't Know
ENTER "95" IF 95 OR MORE FALLS REPORTED.
Refused
Thinking about the [most recent) time that [you/(SP)] fell, did [you/he/she] hurt
(01) YES
[yourself/himself/herself] badly enough to get medical help?
(02) NO
(-8) Don't Know
(-9) Refused
What kind of injury did [you/(SP)] have in that [most recent] fall?
(01) BROKEN BONE/FRACTURE
(02) SPRAIN/STRAIN
[PROBE: Anything else?]
(03) BRUISE
(04) CUT/WOUND/LACERATION
CHECK ALL THAT APPLY.
(05) CONCUSSION
(06) DISLOCATION
(91) OTHER
(96) NO INJURY
(-8) Don't Know
(-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? (01) YES
(02) NO
(-8) Don't Know
(-9) Refused
How long did it take [you/(SP)] to get back to regular activities after [your/his/her] [most
(01) LESS THAN ONE WEEK
recent] fall?
(02) ONE WEEK OR MORE
(03) NEVER RESUMED REGULAR ACTIVITIES
(-8) Don't Know
(-9) Refused
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6, where 1 is "Not at all afraid (01) [Continuous answer.]
of falling" and 6 is "Extremely afraid of falling"?
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] experience memory loss such that it interferes with daily activities?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] have problems making decisions to the point that it interferes with daily
(01) YES
activities?
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
TROBCONC
HFN3

Question type
yes/no

TIMESAD

HFN4

code 1

LOSTINTR

HFN5

yes/no

BOX MH1

routing

HFGAD1

HFN1

list

HFGAD2

HFN2

list

HFPHQ1

HFN3

list

HFPHQ2

HFN4

list

Question text/description
[Do you/Does (SP)] have trouble concentrating or keeping [your/his/her] mind on what (you
are/he is/she is) doing?

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
SHOW CARD HF5
(01) ALL OF THE TIME
In the past 12 months, how much of the time did [you/(SP)] feel sad, blue, or depressed?
(02) MOST OF THE TIME
Would you say [you were/(SP) was] sad or depressed all of the time, most of the time, some of (03) SOME OF THE TIME
the time, a little of the time, or none of the time?
(04) A LITTLE OF THE TIME
[WE ARE ASKING FOR A SUBJECTIVE EVALUATION OF THE RESPONDENT'S EMOTIONAL STATE; (05) NONE OF THE TIME
WE ARE NOT LOOKING FOR A MEDICAL DIAGNOSIS AT THIS QUESTION.]
(-8) Don't Know
(-9) Refused
In the past 12 months, [have you/has (SP)] had 2 weeks or more when [you/he/she] lost
(01) YES
interest or pleasure in things that [you/he/she] usually cared about or enjoyed?
(02) NO
(-8) Don't Know
(-9) Refused
If the respondent is a proxy (SPPROXY=2), go to HFQ1 - LOSTURIN.
Else go to HFN1 - HFGAD1.
The next few questions ask about the last two weeks.
(01) NOT AT ALL
(02) SEVERAL DAYS
SHOW CARD HF8
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
Over the last 2 weeks, how often have you been bothered by the following problems?
(-8) REFUSED
(-9) DON’T KNOW
Feeling nervous, anxious, or on edge
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems?]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
Not being able to stop or control worrying.
(-8) REFUSED
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
little interest or pleasure in doing things? Would you say…
(-8) REFUSED
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
feeling down, depressed, or hopeless?
(-8) REFUSED
(-9) DON’T KNOW

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
HFPHQ3
HFN5

Question type
list

HFPHQ4

HFN6

list

HFPHQ5

HFN7

list

HFPHQ6

HFN8

list

HFPHQ7

HFN9

list

HFPHQ8

HFN10

list

HFPHQ10

HFN11

code one

Question text/description
SHOW CARD HF8

Code list
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
trouble falling or staying asleep, or sleeping too much?
(-8) REFUSED
(-9) DON’T KNOW
SHOW CARD HFXX
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
feeling tired or having little energy?
(-8) REFUSED
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
poor appetite or overeating?
(-8) REFUSED
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
feeling bad about yourself – or that you are a failure or have let yourself or your family down? (-8) REFUSED
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
trouble concentrating on things, such as reading the newspaper or watching TV?
(-8) REFUSED
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
moving or speaking so slowly that other people could have noticed? Or the opposite – being so (-8) REFUSED
fidgety or restless that you have been moving around a lot more than usual?
(-9) DON’T KNOW
SHOW CARD HF9
(01) Not at all difficult,
(02) Somewhat difficult,
How difficult have these problems made it for you to do your work, take care of things at home, (03) Very difficult,
or get along with people?
(04) Extremely difficult?
(-8) REFUSED
(-9) DON’T KNOW

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
LOSTURIN
HFQ1

Question type
code 1

Question text/description
SHOW CARD HF7 HF10
I'd like to ask about a health problem that is more common than people think. Please look at
this card and tell me how often, if at all, since (LAST HF MONTH YEAR) [you have/(SP) has] lost
urine because [you/he/she] could not control [your/his/her] bladder.

TALKURIN

HFQ2

yes/no

[Have you/Has (SP)] talked about this problem with [your/(SP’s)] doctor or other medical
professional?

FEELURIN

HFQ3

yes/no

Has [your/(SP’s)] doctor or other medical professional asked [you/him/her] about how
[you/he/she] feel[s] about this problem?

REASURIN

HFQ4

yes/no

Has [your/(SP’s)] doctor or other medical professional examined [you/him/her] to figure out
why [you/he/she] [lose/loses] urine?

SURGURIN

HFQ5

yes/no

Has [your/(SP’s)] doctor or other medical professional talked with [you/him/her] about taking
medicine or having surgery for this problem?

BOX HFT0

routing

BOX HFT1

routing

HFT1

code 1

IF THIS IS ROUND 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 or other health professional that
[you had/he had/she had] hypertension, also called high blood pressure.

HYPETOLD

[Were you/Was (SP)] told on two or more different medical visits that [you/he/she] had high
blood pressure or hypertension?

HYPEAGE

HFT2

numeric

HYPEAGE_LESSONE HFT2

numeric

Code list
(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
(07) NOT AT ALL
(08) SP IS ON DIALYSIS OR CATHETERIZATION
OR UROSTOMY OR BLADDER BAG
(-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
(03) SP NEVER HAD HIGH BLOOD
PRESSURE/PREVIOUS RESPONSE ENTERED IN
ERROR
(-8) Don't Know
(-9) Refused

[EXPLAIN IF NECESSARY: We are interested in knowing whether [your/(SP’s)] blood pressure
was high for more than one reading.]
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had (01) [Continuous answer.]
high blood pressure?
(-8) Don't Know
(-9) Refused
How old [were you/was (SP)] when (you were/he was/she was) first told that [you/he/she] had (01) LESS THAN ONE YEAR OLD
high blood pressure?
(-7) Empty

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
HYPEHOME
HFT6D

Question type
yes/no

HYPEMEDS

HFT6G

yes/no

HYPEDRNK

HFT6J

yes/no

BOX HFT2

routing

HFT7

numeric

BOX HFT3

routing

HYPEMANY

HFT8

numeric

HYPECOND

HFT11A

code 1

HYPECTRL

HFT12A

code 1

BOX HFT4

routing

HFT13

yes/no

HYPELONG

HYPEPAY

Question text/description
Because of [your/his/her] high blood pressure, [are you/is (SP)] now measuring [your/his/her]
blood pressure at home?

Code list
(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 (01) YES
for [your/his/her] high blood pressure?
(02) NO
(-8) Don't Know
(-9) Refused
[You mentioned that in a typical month in the past year [you/(SP)] did not drink alcohol.] Is that (01) YES
because of [your/his/her] high blood pressure?/[Have you/Has (SP)] cut down on drinking
(02) NO
alcoholic beverages because of [your/his/her] high blood pressure?]
(-8) Don't Know
(-9) Refused
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
(01) [Continuous answer.]
blood pressure?
(-8) Don't Know
(-9) Refused
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), 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 (01) [Continuous answer.]
pressure?
(-8) Don't Know
(-9) Refused
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR HIGH BLOOD
PRESSURE ARE TAKEN BY THE RESPONDENT, NOT THE NUMBER OF PILLS THEY MIGHT TAKE IN
ONE DAY.]
How often [do you/does (SP)] have trouble with side effects from [your/his/her] blood pressure (01) ALWAYS
medicines[s]? Please tell me if [you/he/she] always, sometimes, or never [have/has] trouble
(02) SOMETIMES
with side effects.
(03) NEVER
(-8) Don't Know
[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any condition such (-9) Refused
as fatigue, headache, or coughing.]
Doctors and other health professionals often recommend changing your habits or lifestyle, such (01) VERY CONFIDENT
as changing 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 not at all
(-8) Don't Know
confident?
(-9) Refused
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.
[Do you/Does (SP)] have difficulty paying for the medicine[s] [your/his/her] doctor or other
(01) YES
health professional prescribes for [your/his/her] high blood pressure?
(02) NO
(-8) Don't Know
(-9) Refused

Health Status and Functioning (HFQ)
Variable Name
MR Screen Name
HYPESKIP
HFT14

BOX HFEND

Question type
yes/no

Question text/description
[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?

routing

GO TO NEXT SECTION

Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused