Cms-p-0015a Mcbs

Medicare Current Beneficiary Survey (MCBS)

NAQ

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

OMB: 0938-0568

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Use of Nicotine and Alcohol (NAQ)
Variable Name
MR Screen Name
CIGINT
NA1
BOX NA1

Question type
no entry
routing

CIG100

NA2

yes/no

Question text/description
These next questions are about cigarette smoking.
If SP previously reported smoking cigarettes (sample_person.P_CIG100=1), go to NA3-CIGNOW.
Else go to NA2-CIG100.
[Have you/Has (SP)] smoked at least 100 cigarettes in [your/his/her] entire life?

CIGNOW

NA3

code one

[Do you/Does (SP)] now smoke cigarettes every day, some days, or not at all?

SMKLSINT

NA4

no entry

The next questions are about your use of “smokeless” tobacco such as snuff, dip, chewing tobacco, or “snus.”

BOX NA2

routing

If SP previously reported using smokeless tobacco (sample_person.P_SMKLSONE=1), go to NA6-SMKLSNOW.
Else go to NA5-SMKLS1.

SMKLSONE

NA5

yes/no

[Have you/Has (SP)] ever used “smokeless” tobacco, even once?

SMKLSNOW

NA6

code one

[Do you/Does (SP)] now use smokeless tobacco every day, some days, or not at all?

CIGARINT

NA7

no entry

BOX NA3

routing

CIGARONE

NA8

yes/no

CIGAR50

NA9

yes/no

CIGARNOW

NA10

yes/no

PIPEINT

NA11
BOX NA4

no entry
routing

The next questions are about smoking cigars. By cigars we mean any kind, including big cigars, cigarillos, and
even little cigars that look like cigarettes.
If SP never reported smoking cigars (sample_person.P_CIGARONE^=1), go to NA8-CIGARONE.
Else if SP previously reported smoking cigars (sample_person.P_CIGARONE=1) and smoked less than 50 cigars
(sample_person.P_CIGAR50^=1), go to NA9-CIGAR50.
Else if SP previously reported smoking cigars (sample_person.P_CIGARONE=1) and smoked more than 50
cigars (sample_person.P_CIGAR50=1), go to NA10-CIGARNOW.
[Have you/Has (SP)] ever smoked a cigar EVEN ONE TIME?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
[Have you/Has (SP)] smoked at least 50 cigars in [your/his/her] entire life?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
[Do you/Does (SP)] now smoke cigars every day, some days, or not at all?
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED
The next questions on tobacco products are about using a pipe to smoke tobacco.
If SP previously reported smoking tobacco in a pipe (sample_person.P_PIPEONE=1), go to NA13-PIPENOW.
Else go to NA12-PIPEONE.

Code list

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

Use of Nicotine and Alcohol (NAQ)
Variable Name
MR Screen Name
PIPEONE
NA12

Question type
yes/no

Question text/description
[Have you/Has (SP)] ever smoked tobacco in a pipe, even once?

PIPENOW

NA13

code one

[Do you/Does (SP)] now smoke tobacco in a pipe every day, some days, or not at all?

ECIGINT

NA14

no entry

BOX NA5

routing

ECIGONE

NA15

yes/no

The next questions are about electronic cigarettes, often called e-cigarettes. E-cigarettes look like regular
cigarettes, but
are battery-powered and produce vapor instead of smoke.
If SP previously reported using e-cigarettes (sample_person.P_ECIGONE=1), go to NA16-ECIGNOW.
Else go to NA15-ECIGONE.
[Have you/Has (SP)] ever used an e-cigarette, even once?

ECIGNOW

NA16

code one

[Do you/Does (SP)] now use e-cigarettes every day, some days, or not at all?

ALCINT

NA17

no entry

BOX NA6

routing

NA18

yes/no

BOX NA7

routing

ALCLIFE

NA19

yes/no

ALC12MN

NA20

numeric

The next questions are about drinking alcoholic beverages. Included are liquor (such as whiskey or gin), beer,
wine, wine coolers, and any other type of alcoholic beverage.
If SP reported having more than 12 alcoholic drinks in one year (sample_person.P_ALCYEAR=1), go to NA20ALC12MN.
Else go to NA18-ALCYEAR.
SHOWCARD NA1
(1) YES
(2) NO
In any one year, [have you/has (SP)] had at least 12 drinks of any type of alcoholic beverage? By a drink, I
(-8) DON'T KNOW
mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces of liquor.
(-9) REFUSED
If SP reported having more than 12 alcoholic drinks in his/her lifetime (sample_person.P_ALCLIFE=1), go to
NA20-ALC12MN.
Else go to NA19-ALCLIFE.
In [your/(SP)’s] entire life, [have you/has (he/she)] had at least 12 drinks of any type of alcoholic beverage? (1) YES
(2) NO
(-8) DON'T KNOW
(-9) REFUSED
In the past 12 months, how often did [you/(SP)] drink any type of alcoholic beverage?
(1) [continuous response]
(-8) DON'T KNOW
[PROBE IF NECESSARY: How many days per week, per month, or per year did [you/(SP]) drink?]
(-9) REFUSED

ALCYEAR

Code list
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

[ENTER QUANTITY AND UNIT.]
[ENTER '0' FOR NEVER.]
ALC12MNU

NA20

quantity unit

(1) WEEK
(2) MONTH
(3) YEAR
(-8) DON'T KNOW
(-9) REFUSED

Use of Nicotine and Alcohol (NAQ)
Variable Name
MR Screen Name
BOX NA6

Question type
routing

ALCDAY

numeric

NA21

Question text/description
If the SP didn't drink in the last 12 months (NA20 -ALC12MN = 0), go to NA23 - ALPERDAY.
Else go to NA21 - ALCDAY.
SHOWCARD NA1
In the past 12 months, on those days that [you/(SP)] drank alcoholic beverages, on the average, how many
drinks did [you/he/she] have? (By a drink, I mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces
of liquor.)

Code list

(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED

[ENTER NUMBER OF DRINKS.]
[ENTER '1' IF LESS THAN 1 DRINK.]
[ENTER '95' IF 95 OR MORE DRINKS.]
ALCNDAY

NA22

numeric

In the past 12 months, on how many days did [you/(SP)] have [5/4] or more drinks of any alcoholic
beverage?

(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED

PROBE IF NECESSARY: How many days per week, per month, or per year did [you/(SP)] have [5/4] or more
drinks in a single day?
[ENTER QUANTITY AND UNIT.]
[ENTER '0' FOR NONE.]
ALCNDAYU

NA22

quantity unit

ALPERDAY

NA23

yes/no

BOX NA8

routing

NA24

numeric

BOX ENDNAQ

routing

ALC2HRS

(1) WEEK
(2) MONTH
(3) YEAR
(-8) DON'T KNOW
(-9) REFUSED
Was there ever a time or times in [your/(SP)'s] life when [you/he/she] drank [5/4] or more drinks of any kind (1) YES
of alcoholic beverage almost every day?
(2) NO
(-8) DON'T KNOW
(-9) REFUSED
If the SP didn't drink in the last 12 months (NA20 -ALC12MN = 0), go to BOX ENDNAQ.
Else go to NA24 - ALC2HRS.
During the past 30 days, that is, since [DATEFILL], how many times did [you/(SP)] drink [5/4] or more drinks (1) [continuous response]
of any kind of alcohol in about two hours?
(-8) DON'T KNOW
(-9) REFUSED
[ENTER QUANTITY.]
[ENTER '0' FOR NEVER.]
[ENTER '95' IF 95 OR MORE TIMES.]
END SECTION


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File Modified2016-03-17
File Created2016-03-17

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