ACBS Data Submission Layout

Attachment 5g – ACBS Data Submission Layout

Field Size	Columns	Description of Field and SAS Variable Name				Comments and Values
2	1-2	State FIPS Code (_STATE)				As supplied by GENESYS on sample record.
6	3-8	Replicate Number (REPNUM)
2	9-10	File Month (FMONTH_f)
8	11-18	Interview Date (IDATE) MMDDYYYY				Date of original BRFSS interview.
2	19-20	Interview Month (IMONTH_f)				Month of follow-up
2	21-22	Interview Day (IDAY_f)				Day of follow-up
4	23-26	Interview Year (IYEAR_f)				Year of follow-up
5	27-31	Interviewer Id (INTVID_f)				Interviewer Id of follow-up
4	32-35	Final Disposition(DISPCODE_f)				Disposition code of follow-up
10	36-45	Annual Sequence Number (SEQNO)				As supplied by GENESYS on sample record. Value should be unique for a state within a year.
2	46-47	Number of Attempts (NATTMPTS_f)				Number of attempts of follow-up.
CDC estimates the average public reporting burden for this collection of information as 3 hours per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx). Section 1. Introduction
1	48			Q1.1 Are you {sample person’s first name or initials}? (Samp_name)			1 = Yes 2 = No
SKIP Q1.2, if Section 01, Q1.1 is coded 1
1	49			Q1.2 May I speak with {sample person first name or initials}? (Samp_pers)			1 = Yes 2 = No
				Q1.3 Enter time/date for return call
Section 2. Informed Consent
1	50		Q2.0 Check if correct person from core survey is on phone. Ask “is this {sample person’s name} and are you {sample person’s age} years old. If yes, continue. If not the correct respondent, ask to speak to that person, and start over at section 1. Keep a disposition code for this, (Repeat) I would like to repeat the questions from the previous survey now to make sure you qualify for this study.				1 = Yes , Correct 2 = No, Not the Correct Person
1	51		Q2.1 Have you ever been told by a doctor or other health professional that you have asthma? (EVER_ASTH)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	52		Q2.2 Do you still have asthma? (CUR_ASTH)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	53		Q2.3 May we combine your answers to this survey with your answers from the survey you did a few weeks ago? (PERMISS)				1 = Yes (Skip to Question 3) 2 = No (Go to Terminate) 7 = Don’t know/Not sure (Go to Terminate) 9 = Refused (Go to Terminate)
Section 3. Recent History
3	54-56		Q3.1 How old were you when you were first told by a doctor or other health professional that you had asthma? (AGEDX)				___ Enter Age in Years [Range check: 001-115, 777, 888, 999] 888 = Under one year old 777 = Don’t know 999 = Refused
1	57		Q3.2 How long ago was that? Was it ..” READ CATEGORIES (INCIDNT)				1 = Within the past 12 months 2 = 1-5 years ago 3 = more than 5 yrs ago 7 = Don’t know 9 = Refused .ac.uk
2	58-59		Q3.3 How long has it been since you last talked to a doctor or other health professional about your asthma? This could have been in your doctor’s office, the hospital, an emergency room or urgent care center. (LAST_MD)				88 = Never 04 = Within the past year 05 = 1yr to less than 3 yrs ago 06 = 3 yrs to 5 yrs ago 07 = More than 5 yrs ago 77 = Don’t know 99 = Refused
2	60-61		Q3.4 How long has it been since you last took asthma medication? (LAST_MED)				88 = Never 01 = Less than 1 day ago 02 = 1-6 days ago 03 = 1 week to less than 3 months ago 04 = 3 months to less than 1 year ago 05 = 1 year to less than 3 years ago 06 = 3 years to 5 years ago 07 = More than 5 yrs ago 77 = Don’t know 99 = Refused
2	62-63		Q3.5 How long has it been since you last had any symptoms of asthma? (LASTSYMP)				88 = Never 01 = Less than 1 day ago 02 = 1-6 days ago 03 = 1 week to less than 3 months ago 04 = 3 months to less than 1 year ago 05 = 1 year to less than 3 years ago 06 = 3 years to 5 years ago 07 = More than 5 yrs ago 77 = Don’t know 99 = Refused
Section 4. History of Asthma (Symptoms & Episodes in past year)
2	64-65		Q4.1 During the past 30 days, on how many days did you have any symptoms of asthma? (SYMP_30D)				__ Days [Range Check: (01-30, 77, 88, 99)] 88 = No symptoms in the past 30 days 30 = Everyday 77 = Don’t know 99 = Refused
1	66		Q4.2 Do you have symptoms all the time? "All the time” means symptoms that continue throughout the day. It does not mean symptoms for a little while each day. (DUR_30D)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2	67-68		Q4.3 During the past 30 days, on how many days did symptoms of asthma make it difficult for you to stay asleep? (ASLEEP30)				__ Days/Nights [Range check: (01-30, 77, 88, 99)] 88 = None 30 = Everyday 77 = Don’t know 99 = Refused
2	69-70		If LASTSYMP = 88 (never) or = 04, 05, 06, or 07 (more than 3 months ago) then have CATI code SYMPFREE = 14 If SYMP_30D = 88 (no symptoms in the past 30 days) then have CATI code SYMPFREE = 14 Q4.4 During the past two weeks, on how many days were you completely symptom-free, that is no coughing, wheezing, or other symptoms of asthma? (SYMPFREE)				__ Days/Nights [Range check: (01-14, 77, 88, 99)] 88 = None 77 = Don’t know 99 = Refused
1	71		If last symptoms was 3 months to 1 year ago (LASTSYMP = 4) pick up here, symptoms within the past 3 months continue here as well READ: Asthma attacks, sometimes called episodes, refer to periods of worsening asthma symptoms that make you limit your activity more than you usually do, or make you seek medical care. Q4.5 During the past 12 months, have you had an episode of asthma or an asthma attack? (EPIS_12M)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
3	72-74		Q4.6 During the past three months, how many asthma episodes or attacks have you had? (EPIS_TP) [cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 AND 999 WERE NOT THE INTENT]				___ [Range check : (001- 100, 777, 888, 999)] 888 = None 777 = Don’t know 999 = Refused
3	75-77		Q4.7 How long did your most recent asthma episode or attack last? (DUR_ASTH)				1_ _ Minutes 2_ _ Hours 3_ _ Days 4_ _ Weeks 555 Never 777 Don’t know / Not sure 999 Refused
1	78		Q4.8 Compared with other episodes or attacks, was this most recent attack shorter, longer, or about the same? (COMPASTH)				1 = Shorter 2 = Longer 3 = About the same 4 = The Most recent attack was actually the first attack 7 = Don’t know 9 = Refused
			Section 5 Health Care Utilization
1	79		Q5.01 Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Medicaid? (INS1)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	80		Q5.02 During the past 12 months was there any time that you did not have any health insurance or coverage? (INS2)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
3	81-83		Q5.1 During the past 12 months how many times did you see a doctor or other health professional for a routine checkup for your asthma? (NER_TIME) [cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT]				__ [Range check : (001-365, 777, 888, 999)] 888 = None 777 = Don’t know 999 = Refused
1	84		Q5.2 An urgent care center treats people with illnesses or injuries that must be addressed immediately and cannot wait for a regular medical appointment. During the past 12 months, have you had to visit an emergency room or urgent care center because of your asthma? (ER_VISIT)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
3	85-87		Q5.3 During the past 12 months, how many times did you visit an emergency room or urgent care center because of your asthma? (ER_TIMES) [cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT				___ Enter Number [Range check : (001-365, 777, 888, 999)] 888 = None 777 = Don’t know 999 = Refused
3	88-90		[IF ONE OR MORE ER VISITS (ER_TIMES (5.3)) INSERT “Besides those emergency room or urgent care center visits,”] Q5.4 During the past 12 months, how many times did you see a doctor or other health professional for urgent treatment of worsening asthma symptoms or for an asthma episode or attack? (URG_TIME) [cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT]				___ Enter Number [Range check : (001-365, 777, 888, 999)] 888 = None 777 = Don’t know 999 = Refused
1	91		Q5.5 During the past 12 months, that is since [1 YEAR AGO TODAY], have you had to stay overnight in a hospital because of your asthma? Do not include an overnight stay in the emergency room. (HOSP_VST)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
3	92-94		Q5.6A During the past 12 months, how many different times did you stay in any hospital overnight or longer because of your asthma? (HOSPTIME) [cati cHECK: iF RESPONSE = 77, 99 VERIFY THAT 777 or 999 WERE NOT THE INTENT				___ Times [Range check : (001-365, 777, 999)] 777 = Don’t know 999 = Refused
1	95		Q5.7 The last time you left the hospital, did a health professional talk with you about how to prevent serious attacks in the future? (HOSPPLAN)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
3	96-98		Q5.8A During the past 12 months, how many days were you unable to work or carry out your usual activities because of your asthma? (MISS_DAY) [cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT				___ Enter Days [Range check : (001-365, 777, 888, 999)] 888 = Zero 777 = Don’t know 999 = Refused
1	99		Q5.9 During just the past 30 days would you say you limited your usual activities due to asthma not at all, a little, a moderate amount, or a lot? Change 1/2012 (ACT_DAYS30)				1 = Not at All 2 = A Little 3 = A Moderate Amount 4 = A Lot 7 = Don’t know 9 = Refused
Section 6. Knowledge of Asthma/Management Plan
1	100		Has a doctor or other health professional ever taught you ... Q6.1a How to recognize early signs or symptoms of an asthma episode? (TCH_SIGN)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	101		Has a doctor or other health professional ever taught you ... Q6.2b What to do during an asthma episode or attack? (TCH_RESP)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	102		A peak flow meter is a hand held device that measures how quickly you can blow air out of your lungs. Has a doctor or other health professional ever taught you … Q6.3c How to use a peak flow meter to adjust your daily medications? (TCH_MON)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	103		An asthma action plan, or asthma management plan, is a form with instructions about when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room. Q6.4 Has a doctor or other health professional EVER given you an asthma action plan? (MGT_PLAN)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	104		Q6.5 Have you ever taken a course or class on how to manage your asthma? (MGT_CLAS)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
Section 7. Modifications to Environment
1	105		An air cleaner or air purifier can filter out pollutants like dust, mold and chemicals. It can be attached to the furnace or free standing. It is not, however, the same as a normal furnace filter. Q7.1 Is an air cleaner or purifier regularly used inside your home? (AIRCLEANER)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	106		Q7.2 Is a dehumidifier regularly used to reduce moisture inside your home? (DEHUMID)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	107		Q7.3 Is an exhaust fan that vents to the outside used regularly when cooking in your kitchen? (KITC_FAN)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	108		Q7.4 Is gas used for cooking? (COOK_GAS)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	109		Q7.5 In the past 30 days, has anyone seen or smelled mold or a musty odor inside your home? Do not include mold on food. (ENV_MOLD)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	110		Q7.6 Does your household have pets such as dogs, cats, hamsters, birds or other feathered or furry pets that spend time indoors? (ENV_PETS)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	111		Q7.7 Are pets allowed in your bedroom? (PETBEDRM)				1 = Yes 2 = No 3 = Some are/Some aren’t 7 = Don’t know/Not sure 9 = Refused
1	112		Q7.8 In the past 30 days, has anyone seen a cockroach inside your home? (C_ROACH)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	113		Q7.9 In the past 30 days, has anyone seen mice or rats inside your home? Do not include mice or rats kept as pets. (C_RODENT)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	114		Q7.10 Is a wood burning fireplace or wood burning stove used in your home? (WOOD_STOVE)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	115		Q7.11 Are unvented gas logs, unvented gas fireplace, or unvented gas stove used in your home? (GAS_STOVE)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	116		Q7.12 In the past week, has anyone smoked inside your home? (S_INSIDE)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	117		Q7.13 Has a health professional ever advised you to change things in your home, school, or work to improve your asthma? (MOD_ENV)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	118		Q7.14 Do you use a mattress cover that is made especially for controlling dust mites? (MATTRESS)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	119		Q7.15 Do you use a pillow cover that is made especially for controlling dust mites? (E_PILLOW)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	120		Q7.16 Do you have carpeting or rugs in your bedroom? This does not include throw rugs small enough to be laundered. (CARPET)				1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1	121		Q7.17 Are your sheets and pillowcases washed in cold, warm, or hot water? (HOTWATER)				1 = Cold 2 = Warm 3 = Hot 4 = Varies 7 = Don’t know/Not sure 9 = Refused
1	122		Q7.18 In your bathroom, do you regularly use an exhaust fan that vents to the outside? (BATH_FAN)				1 = Yes 2 = No or “No Fan” 7 = Don’t know/Not sure 9 = Refused
Section 8. Medications
1	123		The next set of questions is about medications for asthma. The first few questions are very general, but later questions are very specific to your medication use. Q8.1 Over-the-counter medication can be bought without a doctor’s order. Have you ever used over-the-counter medication for your asthma? (OTC)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	124		Q8.2 Have you ever used a prescription inhaler? (INHALERE)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	125		Q8.3 Did a doctor or other health professional show you how to use the inhaler? (INHALERH)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	126		Q8.4 Did a doctor or other health professional watch you use the inhaler? (INHALERW)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	127		[IF LAST_MED = 88, 4, 5, 6, 7, 77, or 99, SKIP TO SECTION 9] Now I am going to ask questions about specific prescription medications you may have taken for asthma in the past 3 months. I will be asking for the names, amount, and how often you take each medicine. I will ask separately about medication taken in various forms: pill or syrup, inhaler, and Nebulizer. Q8.5 It will help to get your medicines so you can read the labels. (SCR_MED1)				1 = Yes 2 = No 3 = Respondent knows the Meds 7 = Don’t know 9 = Refused
1	128		Q8.7 Do you have all the medications? (SCR_MED3)				1 = Yes, I have all the medications 2 = Yes, I have some of the medications but not all 3 = No 7 = Don’t know 9 = Refused
1	129		Q8.8 In the past 3 months have you taken prescription asthma medicine using an inhaler? (INH_SCR)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
16	130-145		Q8.9 In the past 3 months, what prescription asthma medications did you take by inhaler? [MARK ALL THAT APPLY. PROBE: Any other prescription asthma inhaler medications?] (INH_MEDS) (Limit=8 Inhaler Meds.)
			SPELL THE NAME OF THE MEDICATION.] Note: the yellow numbered items below are new medications added in 2008. Also, CATI programmers, note that the top ten items (in bold below) should be highlighted in the CATI system if possible so they can be found more easily.
	Medication				Pronunciation
01	Advair (+ A. Diskus)				ăd-vâr (or add-vair)
02	Aerobid				â-rō'bĭd (or air-row-bid)
03	Albuterol ( + A. sulfate or salbutamol)				ăl'-bu'ter-ōl (or al-BYOO-ter-ole) săl-byū'tə-môl'
04	Alupent				al-u-pent
43	Alvesco (+ Ciclesonide)				al-ves-co
40	Asmanex (twisthaler)				as-muh-neks twist-hey-ler
05	Atrovent				At-ro-vent
06	Azmacort				az-ma-cort
07	Beclomethasone dipropionate				bek"lo-meth'ah-son dī' pro’pe-o-nāt (or be-kloe-meth-a-sone)
08	Beclovent				be' klo-vent" (or be-klo-vent)
09	Bitolterol				bi-tōl'ter-ōl (or bye-tole-ter-ole)
10	Brethaire Discontinued - Delete				breth-air
11	Budesonide				byoo-des-oh-nide
12	Combivent				com-bi-vent
13	Cromolyn				kro'mŏ-lin (or KROE-moe-lin)
44	Dulera				do-lair-a
14	Flovent				flow-vent
15	Flovent Rotadisk				flow-vent row-ta-disk
16	Flunisolide				floo-nis'o-līd (or floo-NISS-oh-lide)
17	Fluticasone				flue-TICK-uh-zone
34	Foradil				FOUR-a-dil
35	Formoterol				for moh' te rol
18	Intal Discontinued - Delete				in-tel
19	Ipratropium Bromide				ĭp-rah-tro'pe-um bro'mīd (or ip-ra-TROE-pee-um)
37	Levalbuterol tartrate				lev-al-BYOU-ter-ohl
20	Maxair				măk-sâr
21	Metaproteronol				met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
39	Mometasone furoate				moe-MET-a-sone
22	Nedocromil				ne-DOK-roe-mil
23	Pirbuterol				pēr-bu'ter-ōl (or peer-BYOO-ter-ole)
41	Pro-Air HFA				proh-air HFA
24	Proventil				pro"ven-til' (or pro-vent-il)
25	Pulmicort Flexhaler				pul-ma-cort flex-hail-er
36	QVAR				q -vâr (or q-vair)
03	Salbutamol (or Albuterol)				săl-byū'tə-môl'
26	Salmeterol				sal-ME-te-role
27	Serevent				Sair-a-vent
42	Symbicort				sim-buh-kohrt
28	Terbutaline (+ T. sulfate)				ter-bu'tah-lēn (or ter-BYOO-ta-leen)
29	Tilade Discontinued - Delete				tie-laid
30	Tornalate				tor-na-late
31	Triamcinolone acetonide				tri"am-sin'o-lōn as"ĕ-tō-nīd' (or trye-am-SIN-oh-lone)
32	Vanceril				van-sir-il
33	Ventolin				vent-o-lin
38	Xopenex HFA				ZOH-pen-ecks
66	Other, Please Specify				[SKIP TO OTH_I1]
77	Don’t know
88	No Inhalers
99	Refused

100	146-245	Q8.10 ENTER OTHER MEDICATION FROM (8.9) IN TEXT FIELD IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE. [LOOP BACK TO ILP01 AS NECESSARY TO ADMINSTER QUESTIONS ILP01 THRU ILP10 FOR EACH MEDICINE REPORTED IN INH_MEDS OTH_11 [FOR FILL [MEDICINE FROM INH_MEDS SERIES] FOR QUESTIONS ILP03 THROUGH ILP10] [IF {MEDICINE FROM INH_MEDS SERIES} IS 03, 04, 21, 24, OR 33 ASK ILP01 ELSE SKIP TO ILP02	Text field – up to 100 characters
		Section Repeated for Medication entry. (Limit=8) Questions 8.11–8.19 will be repeated for each medication up to 8 times and saved in blocks of 15 columns (Two columns for the Med. Code and 13 columns for the 9 questions.) Columns 246-260 will hold the first series, columns and the eighth series in columns 351-365.

2	246-247	1st Inhaler value from “INH_MEDS” field ILP_A (First Inhaler Medication Value)	Valid Inhaler Meds: 01 – 44, 66
13	248-260	Questions 8.11 through 8.19 for FIRST medication

1	248	Q8.11 Question has been removed, 2012. Please leave this column blank. 1st Medication
1	249	Q8.12 Question has been removed, 2012. Please leave this column blank. 1st Medication
1	250	Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_A) 1st Medication	1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused
1	251	Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_A) 1st Medication	1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused
1	252	Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_A) 1st Medication	1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused
1	253	Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_A) 1st Medication	1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	254-255	Q8.17 Question has been removed, 2012. Please leave these columns blank. 1st Medication
3	256-258	Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_A) 1st Medication	301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2	259-260	Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_A) 1st Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]	__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused

2

261-262

2nd Inhaler value from “INH_MEDS” field ILP_B (Second Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66

13	263-275	Questions 8.11 through 8.19 for SECOND medication
1	263	Q8.11 Question has been removed, 2012. Please leave this column blank. 2nd Medication

1	264	Q8.12 Question has been removed, 2012. Please leave this column blank. (ILP02_B) 2nd Medication
1	265	Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_B) 2nd Medication	1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused

1	266	Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_B) 2nd Medication	1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused
1	267	Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_B) 2nd Medication	1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused
1	268	Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_B) 2nd Medication	1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	269-270	Q8.17 Question has been removed, 2012. Please leave these columns blank. 2nd Medication
3	271-273	Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_B) 2nd Medication	301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2	274-275	Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_B) 2nd Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]	__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused
2	276-277	3rd Inhaler value from “INH_MEDS” field ILP_C (Third Inhaler Medication Value)	Valid Inhaler Meds: 01 – 44, 66

13

278-290

Questions 8.11 through 8.19 for THIRD medication

1	278	Q8.11 Question has been removed, 2012. Please leave this column blank. 3rd Medication
1	279	Q8.12 Question has been removed, 2012. Please leave this column blank. 3rd Medication
1	280	Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_C) 3rd Medication	1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused
1	281	Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_C) 3rd Medication	1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused
1	282	Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_C) 3rd Medication	1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused
1	283	Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_C) 3rd Medication	1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	284-285	Q8.17 Question has been removed, 2012. Please leave these columns blank. 3rd Medication
3	286-288	Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_C) 3rd Medication	301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2	289-290	Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_C) 3rd Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]	__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused
2	291-292	4th Inhaler value from “INH_MEDS” field ILP_D (Fourth Inhaler Medication Value)	Valid Inhaler Meds: 01 – 44, 66

13

293-305

Questions 8.11 through 8.19 for FOURTH medication

1	293	Q8.11 Question has been removed, 2012. Please leave this column blank. 4th Medication
1	294	Q8.12 Question has been removed, 2012. Please leave this column blank. 4th Medication
1	295	Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_D) 4th Medication	1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused
1	296	Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_D) 4th Medication	1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused
1	297	Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_D) 4th Medication	1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused
1	298	Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_D) 4th Medication	1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	299-300	Q8.17 Question has been removed, 2012. Please leave this column blank. 4th Medication
3	301-303	Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_D) 4th Medication	301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2	304-305	Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_D) 4th Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]	__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused
2	306-307	5th Inhaler value from “INH_MEDS” field ILP_E (Fifth Inhaler Medication Value)	Valid Inhaler Meds: 01 – 44, 66

13

308-320

Questions 8.11 through 8.19 for FIFTH medication

1	308	Q8.11 Question has been removed, 2012. Please leave this column blank. 5th Medication
1	309	Q8.12 Question has been removed, 2012. Please leave this column blank. 5th Medication
1	310	Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_E) 5th Medication	1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused
1	311	Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_E) 5th Medication	1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused
1	312	Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_E) 5th Medication	1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused
1	313	Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_E) 5th Medication	1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	314-315	Q8.17 Question has been removed, 2012. Please leave these columns blank. 5th Medication
3	316-318	Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_E) 5th Medication	301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2	319-320	Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_E) 5th Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]	__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused
2	321-322	6th Inhaler value from “INH_MEDS” field ILP_F (Sixth Inhaler Medication Value)	Valid Inhaler Meds: 01 – 44, 66

13

323-335

Questions 8.11 through 8.19 for SIXTH medication

1	323	Q8.11 Question has been removed, 2012. Please leave this column blank. 6th Medication
1	324	Q8.12 Question has been removed, 2012. Please leave this column blank. 6th Medication
1	325	Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_F) 6th Medication	1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused
1	326	Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_F) 6th Medication	1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused
1	327	Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_F) 6th Medication	1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused
1	328	Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_F) 6th Medication	1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	329-330	Q8.17 Question has been removed, 2012. Please leave these columns blank. 6th Medication
3	331-333	Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_F) 6th Medication	301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2	334-335	Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_F) 6th Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]	__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused
2	336-337	7th Inhaler value from “INH_MEDS” field ILP_G (Seventh Inhaler Medication Value)	Valid Inhaler Meds: 01 – 44, 66
13	338-350	Questions 8.11 through 8.19 for SEVENTH medication
1	338	Q8.11 Question has been removed, 2012. Please leave this column blank. 7th Medication
1	339	Q8.12 Question has been removed, 2012. Please leave this column blank. 7th Medication
1	340	Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_G) 7th Medication	1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused
1	341	Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_G) 7th Medication	1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused
1	342	Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_G) 7th Medication	1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused
1	343	Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_G) 7th Medication	1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	344-345	Q8.17 Question has been removed, 2012. Please leave these columns blank. 7th Medication
3	346-348	Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_G) 7th Medication	301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2	349-350	Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_G) 7th Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]	__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused
2	351-352	8th Inhaler value from “INH_MEDS” field ILP_H (Eighth Inhaler Medication Value)	Valid Inhaler Meds: 01 – 44, 66
13	353-365	Questions 8.11 through 8.19 for EIGHTH medication
1	353	Q8.11 Question has been removed, 2012. Please leave this column blank. 8th Medication

1

354

Q8.12 Question has been removed, 2012. Please leave this column blank. 8th Medication

1

355

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_H) 8th Medication

1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know 9 = Refused

1

356

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack? (ILP04_H) 8th Medication

1 = Yes 2 = No 3 = No attack in past 3 months 7 = Don’t know 9 = Refused

1

357

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_H) 8th Medication

1 = Yes 2 = No 3 = Didn’t exercise in past 3 months 7 = Don’t know 9 = Refused

1

358

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_H) 8th Medication

1 = Yes 2 = No 7 = Don’t know 9 = Refused

2

359-360

Q8.17 Question has been removed, 2012. Please leave these columns blank. 8th Medication

3

361-363

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_H) 8th Medication

301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused

2

364-365

Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_H) 8th Medication [INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]

__ = 01-76 Canisters 88 = None/Less than 1 full canister 77 = Don’ know 99 = Refused

2	366-367	Intentionally left blank2
1	368	Q8.20 In the past 3 months, have you taken any prescription medicine in pill form for your asthma? (PILLS)	1 = Yes 2 = No 7 = Don’t know 9 = Refused
10	369-378	Q8.21 What prescription medications do you take in pill form? [MARK ALL THAT APPLY. PROBE: Any other prescription asthma pills?] (PILLS_MD) These values will also be re-entered in columns below: 479-480 PILL_MD_A (First Pills Medication value) 482-483 PILL_MD_B (Second Pills Medication value) 485-486 PILL_MD_C (Third Pills Medication value) 488-489 PILL_MD_D (Fourth Pills Medication value) 491-492 PILL_MD_E (Fifth Pills Medication value)	88 = No Pills 77 = Don’t know 99 = Refused

				[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.] Note: the yellow numbered items below are new medications added in 2008. Also, CATI programmers, note that the top ten items (in bold below) should be highlighted in the CATI system if possible so they can be found more easily.
	Medication					Pronunciation
01	Accolate					ac-o-late
02	Aerolate					air-o-late
03	Albuterol					ăl'-bu'ter-ōl (or al-BYOO-ter-all)
04	Alupent					al-u-pent
05	Choledyl (oxtriphylline)					ko-led-il
07	Deltasone					del-ta-sone
08	Elixophyllin					e-licks-o-fil-in
11	Medrol					Med-rol
12	Metaprel					Met-a-prell
13	Metaproteronol					met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
14	Methylpredinisolone					meth-ill-pred-niss-oh-lone (or meth-il-pred-NIS-oh-lone)
15	Montelukast					mont-e-lu-cast
17	Pediapred					Pee-dee-a-pred
18	Prednisolone					pred-NISS-oh-lone
19	Prednisone					PRED-ni-sone
21	Proventil					pro-ven-til
23	Respid					res-pid
24	Singulair					sing-u-lair
25	Slo-phyllin					slow- fil-in
26	Slo-bid					slow-bid
48	Terbutaline (+ T. sulfate)					ter byoo' ta leen
28	Theo-24					thee-o-24
30	Theochron					thee -o-kron
31	Theoclear					thee-o-clear
32	Theodur					thee-o-dur
33	Theo-Dur					thee-o-dur
35	Theophylline					thee-OFF-i-lin
37	Theospan					thee-o-span
40	T-Phyl					t-fil
42	Uniphyl					u-ni-fil
43	Ventolin					vent-o-lin
44	Volmax					vole-max
45	Zafirlukast					za-FIR-loo-kast
46	Zileuton					zye-loo-ton
47	Zyflo Filmtab					zye-flow film tab
66	Other, please specify					[SKIP TO OTH_P1]
77	Don’t know
88	No Pills
99	Refused
100			379-478		(OTH_P1) IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.			Text field – up to 100 characters
					Question 8.22 Repeated for Medication entry. (Limit=5) Question 8.22 will be repeated for each medication up to 5 times. Column 577 will hold the first response, columns 578 the response to the second cycle, and the sixth cycle will be in column 582.			Valid Meds in Pill form: 01 – 48, 66
2			479-480		1st Pill value from “PILLS_MD_A” field PILL01_A (First Pill Medication value)			Valid Meds in Pill form: 01 – 48, 66
1			481		Q8.22 In the past 3 months, did you take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL01) 1st Pill			1 = Yes 2 = No 7 = Don’t know 9 = Refused
2			482-483		2nd Pill value from “PILLS_MD_B” field PILL01_B (Second Pill Medication value)			Valid Meds in Pill form: 01 – 48, 66
1			484		Q8.22 In the past 3 months, did you take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL02) 2nd Pill			1 = Yes 2 = No 7 = Don’t know 9 = Refused

2

485-486

3rd Pill value from “PILLS_MD_C” field PILL01_C (Third Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66

1

487

Q8.22 In the past 3 months, did you take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL03) 3rd Pill

1 = Yes 2 = No 7 = Don’t know 9 = Refused

2

488-489

4th Pill value from “PILLS_MD_D” field PILL01_D (Fourth Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66

1

490

Q8.22 In the past 3 months, did you take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL04) 4th Pill

1 = Yes 2 = No 7 = Don’t know 9 = Refused

2

491-492

5th Pill value from “PILLS_MD_E” field PILL01_E (Fifth Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66

1	493		Q8.22 In the past 3 months, did you take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL05) 5th Pill				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	494		Q8.23 In the past 3 months, have you taken any prescription asthma medication in syrup form? (SYRUP)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
8	495-502		Q8.24 What prescriptions asthma medications have you taken as a syrup? [MARK ALL THAT APPLY. PROBE: Any other prescription syrup medications for asthma?]] (SYRUP_ID) (Limit = 4 Syrup Meds.)				Medication 01 = Aerolate (09) 02 = Albuterol 03 = Alupent (04) 04 = Metaproteronol 05 = Prednisolone 06 = Prelone (05) 07 = Proventil (02) 08 = Slo-Phyllin (09) 09 = Theophyllin 10 = Ventolin (02) 66 = Other, Please Specify: 88 = None 77 = Don’t know 99 = Refused
			[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.]
	Medication			Pronunciation
01	Aerolate			air-o-late
02	Albuterol			ăl'-bu'ter-ōl (or al-BYOO-ter-ole)
03	Alupent			al-u-pent
04	Metaproteronol			met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
05	Prednisolone			pred-NISS-oh-lone
06	Prelone			pre-loan
07	Proventil			Pro-ven-til
08	Slo-Phyllin			slow-fil-in
09	Theophyllin			thee-OFF-i-lin
10	Ventolin			vent-o-lin
66	Other, Please Specify:
77	Don’t know
88	No Syrups
99	Refused
2	495-496		1st Syrup value from “SYRUP_ID” field SYRUP_A (First Syrup Medication value)				Valid Meds in Syrup form: 01 – 10, 66
2	497-498		2nd Syrup value from “SYRUP_ID” field SYRUP_B (Second Syrup Medication value)				Valid Meds in Syrup form: 01 – 10, 66
2	499-500		3rd Syrup value from “SYRUP_ID” field SYRUP_C (Third Syrup Medication value)				Valid Meds in Syrup form: 01 – 10, 66
2	501-502		4th Syrup value from “SYRUP_ID” field SYRUP_D (Fourth Syrup Medication value)				Valid Meds in Syrup form: 01 – 10, 66
1	503		Intentionally left blank3
100	504-603		(OTH_S1) IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.				Text field – up to 100 characters
1	604		Q8.25 Read: A nebulizer is a small machine with a tube and facemask or mouthpiece that you breathe through continuously. In the past 3 months, were any of your asthma medicines used with a nebulizer? (NEB_SCR)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	605		Q8.26a I am going to read a list of places where you might have used a nebulizer. Please answer yes if you have used a nebulizer in the place I mention, otherwise answer no. In the past 3 months did you use a nebulizer … At Home ? (NEB_PLCa)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	606		Q8.26b In the past 3 months did you use a nebulizer … At a Doctor’s Office ? (NEB_PLCb)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	607		Q8.26c In the past 3 months did you use a nebulizer … In an Emergency room? (NEB_PLCc)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	608		Q8.26d .In the past 3 months did you use a nebulizer … At work (or a school)? (NEB_PLCd)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	609		Q8.26e In the past 3 months did you use a nebulizer … At any other place? (NEB_PLCe)				1 = Yes 2 = No 7 = Don’t know 9 = Refused
10	610-619		Q8.27 In the past 3 months, what prescriptions medications have you taken using a nebulizer? (NEB_ID) (Limit = 5 Nebulizers Meds.) These values will also be re-entered in columns below: 620-621 NEB_ID_A (First Nebulizer Medication value) 627-628 NEB_ID_B (Second Nebulizer Medication value) 634-635 NEB_ID_C (Third Nebulizer Medication value) 641-642 NEB_ID_D (Fourth Nebulizer Medication value) 648-649 NEB_ID_E (Fifth Nebulizer Medication value)				Medication 01 = Albuterol 02 = Alupent (11) 03 = Atrovent (09) 04 = Bitolterol 05 = Budesonide 06 = Cromolyn 07 = Duoneb (01 + 09) 08 = Intal (06) 09 = Ipratroprium bromide 10 = Levalbuterol 11 = Metaproteronol 12 = Proventil (01) 13 = Pulmicort (05) 14 = Tornalate (04) 15 = Ventolin (01) 16 = Xopenex (10) 17= Combivent Inhalation solution 18= Perforomist (Formoterol) 66 = Other, Please Specify: 88 = None 77 = Don’t know 99 = Refused
			[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.]
		Medication			Pronunciation
01		Albuterol			ăl'-bu'ter-ōl (or al-BYOO-ter-ole)
02		Alupent			al-u-pent
03		Atrovent			At-ro-vent
04		Bitolterol			bi-tōl'ter-ōl (or bye-tole-ter-ole)
05		Budesonide			byoo-des-oh-nide
17		Combivent Inhalation solution			com-bi-vent
06		Cromolyn			kro'mŏ-lin (or KROE-moe-lin)
07		DuoNeb			DUE-ow-neb
08		Intal			in-tel
09		Ipratroprium bromide			ĭp-rah-tro'pe-um bro'mīd (or ip-ra-TROE-pee-um)
10		Levalbuterol			lev al byoo' ter ol
11		Metaproteronol			met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
18		Perforomist (Formoterol)			per-form-ist
12		Proventil			Pro-ven-til
13		Pulmicort			pul-ma-cort
14		Tornalate			tor-na-late
15		Ventolin			vent-o-lin
16		Xopenex			ZOH-pen-ecks
66		Other, Please Specify:			[SKIP TO OTH_N1]
77		Don’t know
88		No Nebulizer
99		Refused
2	620-621		1st Nebulizer value from “NEB_ID” field NEB_ID_A (First Nebulizer Medication value)				Valid Meds in Nebulizer form: 01 – 18, 66
1	622		Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack? (NEB01_A) 1st Nebulizer				1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know 9 = Refused
1	623		Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_A) 1st Nebulizer				1 = Yes 2 = No 7= Don’t know 9 = Refused
3	624-626		Q8.30 How many times per day or per week do you use [MEDICINE FROM NEB_ID SERIES]? (NEB03_A) 1st Nebulizer				3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know 999 = Refused
2	627-628		2nd Nebulizer value from “NEB_ID” field NEB_ID_B (Second Nebulizer Medication value)				Valid Meds in Nebulizer form: 01 – 18, 66
1	629		Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack? (NEB01_B) 2nd Nebulizer				1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know 9 = Refused
1	630		Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_B) 2nd Nebulizer				1 = Yes 2 = No 7= Don’t know 9 = Refused
3	631-633		Q8.30 How many times per day or per week do you use [MEDICINE FROM NEB_ID SERIES]? (NEB03_B) 2nd Nebulizer				3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know 999 = Refused
2	634-635		3rd Nebulizer value from “NEB_ID” field NEB_ID_C (Third Nebulizer Medication value)				Valid Meds in Nebulizer form: 01 – 18, 66
1	636		Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack? (NEB01_C) 3rd Nebulizer				1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know 9 = Refused
1	637		Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_IDS SERIES] on a regular schedule everyday? (NEB02_C) 3rd Nebulizer				1 = Yes 2 = No 7= Don’t know 9 = Refused
3	638-640		Q8.30 How many times per day or per week do you use [MEDICINE FROM NEB_ID SERIES]? (NEB03_C) 3rd Nebulizer				3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know 999 = Refused
2	641-642		4th Nebulizer value from “NEB_ID” field NEB_ID_D (Fourth Nebulizer Medication value)				Valid Meds in Nebulizer form: 01 – 18, 66
1	643		Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack? (NEB01_D) 4th Nebulizer				1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know 9 = Refused
1	644		Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_D) 4th Nebulizer				1 = Yes 2 = No 7= Don’t know 9 = Refused
3	645-647		Q8.30 How many times per day or per week do you use [MEDICINE FROM NEB_ID SERIES]? (NEB03_D) 4th Nebulizer				3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know 999 = Refused
2	648-649		5th Nebulizer value from “NEB_ID” field NEB_ID_E (First Nebulizer Medication value)				Valid Meds in Nebulizer form: 01 – 18, 66
1	650		Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack? (NEB01_E) 5th Nebulizer				1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know 9 = Refused
1	651		Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_E) 5th Nebulizer				1 = Yes 2 = No 7= Don’t know 9 = Refused
3	652-654		Q8.30 How many times per day or per week do you use [MEDICINE FROM NEB_ID SERIES]? (NEB03_E) 5th Nebulizer				3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know 999 = Refused
100	655-754		OTH_N1 IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.			Text field – up to 100 characters
			Section 9. Cost of Care
1	755		Q9.1 Was there a time in the past 12 months when you needed to see your primary care doctor for your asthma but could not because of the cost? (ASMDCOST)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	756		Q9.2 Was there a time in the past 12 months when you were referred to a specialist for asthma care but could not go because of the cost? (ASSPCOST)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	757		Q9.3 Was there a time in the past 12 months when you need to buy medication for your asthma, but could not because of the cost? (ASRXCOST)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
			Section 10. Work related Asthma
1	758		Q10.1 Next, we are interested in things that affect asthma in the workplace. However, first I’d like to ask how you would describe your current employment status? Would you say … (EMP_STAT)			1 = Employed full-time 2 = Employed part-time 3 = Not Employed 7 = Don’t know 9 = Refused
2	759-760		Q10.2 What is the main reason you are not now employed? (UNEMP_R)			01 = Keeping house 02 = Going to school 03 = Retired 04 = Disabled 05 = Unable to work for other health reasons 06 = Looking for work 07 = Laid off 08 = Other 77 = Don’t know 99 = Refused
1	761		Q10.3 Have you ever been employed? (EMP_EVER1)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	762		Q10.4 Are your asthma symptoms MADE WORSE by things like chemicals, smoke, dust or mold in your CURRENT job? (WORKENV5)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	763		Q10.5 Was your asthma first CAUSED by things like chemicals, smoke, dust or mold in your CURRENT job? (WORKENV6)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	764		Q10.6 Were your asthma symptoms MADE WORSE by things like chemicals, smoke, dust or mold in any previous job you ever had? (WORKENV7)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	765		Q10.7 Was your asthma first CAUSED by things like chemicals, smoke, dust or mold in any PREVIOUS job you ever had? (WORKENV8)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	766		Q10.8 Did you ever lose or quit a job because things in the workplace, like chemicals, smoke, dust or mold, caused your asthma or made your asthma symptoms worse? (WORKQUIT1)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	767		Q10.9 Did you and a doctor or other health professional ever DISCUSS whether your asthma could have been caused by, or your symptoms made worse by, any job you ever had? (WORKTALK)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	768		Q10.10 Have you ever been TOLD BY a doctor or other health professional that your asthma was caused by, or your symptoms made worse by, any job you ever had? (WORKSEN3)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	769		Q10.11 Have you ever TOLD a doctor or other health professional that your asthma was caused by, or your symptoms made worse by, any job you ever had? (WORKSEN4)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
			Section 11. Comorbid Conditions
1	770		Q11.1 Have you ever been told by a doctor or health professional that you have chronic obstructive pulmonary disease also known as COPD? (COPD)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	771		Q11.2 Have you ever been told by a doctor or other health professional that you have emphysema? (EMPHY)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	772		Q11.3 Have you ever been told by a doctor or other health Professional that you have Chronic Bronchitis? (BRONCH)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	773		Q11.4 Have you ever been told by a doctor or other health professional that you were depressed? (DEPRESS)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
SECTION 12. Complimentary and Alternative Therapy
1	774		Sometimes people use methods other than prescription medications to help treat or control their asthma. These methods are called non-traditional, complementary, or alternative health care. I am going to read a list of these alternative methods. For each one I mention, please answer “yes” if you have used it to control your own asthma in the past 12 months. Answer “no” if you have not used it in the past 12 months. Q12.1 In the past 12 months, have you used (herbs) to control your asthma? (CAM_HERB)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	775		Q12.2 In the past 12 months, have you used (vitamins) to control your asthma? (CAM_VITA)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	776		Q12.3 In the past 12 months, have you used (acupuncture) to control your asthma? (CAM_PUNC)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	777		Q12.4 In the past 12 months, have you used (acupressure) to control your asthma? (CAM_PRES)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	778		Q12.5 In the past 12 months, have you used (aromatherapy) to control your asthma? (CAM_AROM)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	779		Q12.6 In the past 12 months, have you used (homeopathy) to control your asthma? (CAM_HOME)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	780		Q12.7 In the past 12 months, have you used (reflexology) to control your asthma? (CAM_REFL)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	781		Q12.8 In the past 12 months, have you used (yoga) to control your asthma? (CAM_YOGA)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	782		Q12.9 In the past 12 months, have you used (breathing techniques) to control your asthma? (CAM_BR)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	783		Q12.10 In the past 12 months, have you used (naturopathy) to control your asthma? (CAM_NATR)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	784		Q12.11 Besides the types I have just asked about, have you used any other type of alternative care for your asthma in the past 12 months? (CAM_OTHR)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
100	785-884		Q12.12 What else have you used? (CAM_TEXT) [100 ALPHANUMERIC CHARACTER LIMIT] ENTER OTHER ALTERNATIVE MEDICINE IN TEXT FIELD IF MORE THAN ONE IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.
80	885-964		Disposition codes for call attempts 1 through 20 with the first disposition code in columns 885-887, etc... (CATTMPTS_F)			4-digit disposition code for each of the first 20 call attempts
10	965-974		Intentionally left blank…
2	975-976		Questionnaire Versions Identifier. Import value from BRFSS Columns 592-593 (QSTVER_F)			10 = Landline (No additional version) 11 = Landline (One additional version) 12 = Landline (Two additional versions) 13 = Landline (Three additional versions) 20 = Cell Phone (No additional version) 21 = Cell Phone (One additional version) 22 = Cell Phone (Two additional versions) 23 = Cell Phone (Three additional versions)
2	977-978		Language identifier: Language in which the interview was conducted. Import value from BRFSS Columns 594 - 595 (QSTLANG_F)			1 = English 2 = Spanish 3-99 = Other
1	979		Asthma Callback Script Import value from BRFSS Column 534 (CALLBACK)			1 = Yes 2 = No
1	980		Which person in the household was selected as the focus of the call-back? Import value from BRFSS Column 535 (ADLTCHLD)			1 = Adult 2 = Child
1	981		Have you ever been told by a doctor, nurse or other health professional that you had asthma? Import value from BRFSS Core Section 7 Question 4, Column 101 (ASTHMA3)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	982		Do you still have asthma? Import value from BRFSS Core Section 7 Question 5, Column 102 (ASTHNOW)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
1	983		Asthma Callback Script Test (CALLBACK_Ver)			1 = Callback using Protocol (2 weeks) 2 = Callback conducted “Immediately”
1	984		Are you a resident of [STATE]? Import value from BRFSS Column 585 (CSTATE)			1 = Yes 2 = No 7 = Don’t know 9 = Refused
2	985-986		State of Origin of the Call Import value from BRFSS Columns 1375-1376 (O_STATE)			2 digit state FIPSCODE
2	987-988		In what state do you live? Import value from BRFSS Columns 586-587 (RSPSTATE) Only for cellphones			2 digit state FIPSCODE
31	989-1019		Intentionally left blank…
1	1020		End of File Marker…			1

Attachment 5g – ACBS Data Submission Layout

Child Questionnaire “2013”

`Field Size			Columns			Description of Field and SAS Variable Name					Comments and Values
2			1-2			State FIPS Code (_STATE)					As supplied by GENESYS on sample record.
6			3-8			Replicate Number (REPNUM)
2			9-10			File Month (FMONTH_f)					File month of the follow-up
8			11-18			Interview Date (IDATE) MMDDYYYY					Date of original BRFSS interview
2			19-20			Interview Month (IMONTH_f)					Month of follow-up
2			21-22			Interview Day (IDAY_f)					Day of follow-up
4			23-26			Interview Year (IYEAR_f)					Year of follow-up
5			27-31			Interviewer Id (INTVID_f)					Interviewer id of follow-up
4			32-35			Final Disposition(DISPCODE_f)					Disposition of follow-up
10			36-45			Annual Sequence Number (SEQNO)					As supplied by GENESYS on sample record. Value should be unique for a state for a year.
2			46-47			Number of Attempts (NATTMPTS_f)					Number of attempts of follow-up
Section 1. Introduction
1		48				Q1.1 Are you {Most Knowledgeable Person’s first name or initials}? (MKP_name)						1 = Yes 2 = No
SKIP Q1.2, if Section 01, Q1.1 is coded 1
1		49				Q1.2 May I speak with {Most Knowledgeable Person first name or initials}? (MKP_pers)						1 = Yes 2 = Person not available
1		992				Q1.5a Tracking of BRFSS MKP Appendix A. survey respondent: Are you the parent or guardian in the household who knows most about {CHILDName’s} asthma? (MOSTKNOW)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (MKP) identified at the BRFSS Level
1		993				Q1.5b Tracking of BRFSS MKP Appendix A. survey respondent: If parent or guardian request to transfer to another person who is more knowledgeable about the child’s asthma, then mark the transfer. (PRESENTALT)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (ALT) identified at the BRFSS Level
1		994				Q1.5a Tracking of CALLBACK MKP Appendix B. survey respondent: Are you the parent or guardian in the household who knows most about {CHILDName’s} asthma? (KNOWMOST)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (MKP) identified at the CALLBACK Level
1		995				Q1.5b Tracking of CALLBACK MKP Appendix B. survey respondent: If parent or guardian request to transfer to another person who is more knowledgeable about the child’s asthma, then mark the transfer. (ALTPRESENT)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (ALT) identified at the CALLBACK Level
Section 2. Informed Consent
1		50				Q2.0 Check if correct person from core survey is on phone. Ask “is this {sample person’s name} and are you {sample person’s age} years old. If yes, continue. If not the correct respondent, ask to speak to that person, and start over at section 1. Keep a disposition code for this, (REPEAT) I would like to repeat the questions from the previous survey now to make sure {sample child’s name} qualifies for this study.						1 = Yes 2 = No
1		51				Q2.1 Have you ever been told by a doctor or other health professional that {child’s name} had asthma? (EVER_ASTH)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
1		52				Q2.2 Does {child’s name} still have asthma? (CUR_ASTH)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		53				Q2.3 What is your relationship to {child’s name}? (RELATION)						1 = Mother (Birth/Adoptive/Step) [Go to Read] 2 = Father (Birth/Adoptive/Step) [Go to Read] 3 = Brother/Sister (Step/Foster/Half/Adoptive) 4 = Grandparent (Father/Mother) 5 = Other Relative 6 = Unrelated 7 = Don’t know/Not sure 9 = Refused
1		54				Q2.4 Are you the legal guardian for {child’s name} (GUARDIAN)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
1		55				Q2.5 May we combine your answers to this survey with your answers from the survey you did a few weeks ago? (PERMISS)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
Section 3. Recent History
3		56-58				Q3.1 How old was {child’s name} when a doctor or other health professional first said {he/she} had asthma? (AGEDX)						____ Enter age in years [Range check: 001-018, 777, 888,999] 777 = Don’t know 888 = Under 1 year old 999 = Refused
1		59				Q3.2 How long ago was that? Was it ..” READ CATEGORIES (INCIDNT)						1 = Within the past 12 months 2 = 1-5 years ago 3 = more than 5 years ago 7 = Don’t know 9 = Refused
2		60-61				Q3.3 How long has it been since you last talked to a doctor or other health professional about {child’s name} asthma? This could have been in a doctor’s office, the hospital, an emergency room or urgent care center. (LAST_MD)						04 = Within the past year 05 = 1 year to less than 3 years ago 06 = 3 years to 5 years ago 07 = More than 5 years ago 88 = Never 77 = Don’t know 99 = Refused
2		62-63				Q3.4 How long has it been since {child’s name} last took asthma medication? (LAST_MED)						01 = Less than 1 day ago 02 = 1-6 days ago 03 = 1 week to less than 3 months ago 04 = 3 months to less than 1 year ago 05 = 1 year to less than 3 years ago 06 = 3 years to 5 years ago 07 = More than 5 years ago 88 = Never 77 = Don’t know 99 = Refused
2		64-65				Q3.5 How long has it been since {child’s name} last had any symptoms of asthma? (LASTSYMP)						01 = Less than 1day ago 02 = 1-6 days ago 03 = 1 week to less than 3 months ago 04 = 3 months to less than 1 year ago 05 = 1 year to less than 3 years ago 06 = 3 years to 5 years ago 07 = More than 5 years ago 88 = Never 77 = Don’t know 99 = Refused
SECTION 4. HISTORY OF ASTHMA (SYMPTOMS & EPISODES in Past year)
2		66-67				Q4.1 During the past 30 days, on how many days did {child’s name} have any symptoms of asthma? (SYMP_30D)						__ Days [Range check: 01-30, 77, 88, 99] 30 = Every day 88 = No Symptoms in the past 30 days 77 = Don’t know 99 = Refused
1		68				Q4.2 Does {child’s name} have symptoms all the time? "All the time” means symptoms that continue throughout the day. It does not mean symptoms for a little while each day. (DUR_30D)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		69-70				Q4.3 During the past 30 days, on how many days did symptoms of asthma make it difficult for {child’s name} to stay asleep? (ASLEEP30)						__ Days/Nights [Range check: 01-30, 77, 88, 99] 88 = None 77 = Don’t know 99 = Refused
2		71-72				If LASTSYMP = 88 (never) or = 04, 05, 06, or 07 (more than 3 months ago) then have CATI code SYMPFREE = 14 If SYMP_30D = 88 (no symptoms in the past 30 days) then have CATI code SYMPFREE = 14 Q4.4 During the past two weeks, on how many days was {child’s name} completely symptom-free, that is no coughing, wheezing, or other symptoms of asthma? (SYMPFREE)						__ Number of days [Range check: 01-14, 77, 88, 99] 88 = None 77 = Don’t know 99 = Refused
1		73				Q4.5 During the past 12 months’ has {child’s name} had an episode of asthma or an asthma attack? (EPIS_12M)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
3		74-76				Q4.6 During the past three months, how many asthma episodes or attacks has {child’s name} had? (EPIS_TP)						____[Range check: 001-100, 777, 888, 999] 888 = None 777 = Don’t know 999 = Refused
3		77-79				Q4.7 How long did {child’s name} most recent asthma episode or attack last? (DUR_ASTH)						1_ _ Minutes 2_ _ Hours 3_ _ Days 4_ _ Weeks 5 5 5 Never 7 7 7 Don’t know / Not sure 9 9 9 Refused
1		80				Q4.8 Compared with other episodes or attacks, was this most recent attack shorter, longer, or about the same? (COMPASTH)						1 = Shorter 2 = Longer 3 = About the same 4 = The most recent attack was actually the first attack 7 = Don’t know 9 = Refused
Section 5. Health Care Utilization
1		81				Q5.1 Does {child’s name} have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Medicaid? (INS1)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		82				Q5.2 What kind of health care coverage, does {child’s name} have? Is it a parent’s employer paid insurance plan, Medicaid, Medicare, CHIP {replace with state specific name} or some other type of insurance? (INS_TYP)						1 = Parent’s employer 2 = Medicaid/Medicare 3 = CHIP {replace with State specific name} 4 = Other 7 = Don’t know 9 = Refused
1		83				Q5.3 During the past 12 months was there any time that {child’s name} did not have any health insurance or coverage? (INS2)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		84				Q5.4 A flu shot is an influenza vaccine injected in your arm. During the past 12 months, did {CHILD’S NAME} have a flu shot? (FLU_SHOT)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		85				Q5.5 A flu vaccine that is sprayed in the nose is called FluMistTM. During the past 12 months, did {CHILD’S NAME} have a flu vaccine that was sprayed in his/her nose? (FLU_SPRAY)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		86				Q5.6 During just the past 30 days, would you say {child’s name} limited {his/her} usual activities due to asthma not at all, a little, a moderate amount, or a lot? (ACT_DAYS30)						1 = Not at all 2 = A little 3 = Moderate amounts 4 = A lot 7 = Don’t know/Not sure 9 = Refused
3		87-89				Q5.7 During the past 12 months how many times did {child’s name} see a doctor or other health professional for a routine checkup for {his/her} asthma? (NER_TIME)						____[Range check: 001-365, 777, 888,999] 777 = Don’t know 888 = None 999 = Refused
1		90				Q5.8 An urgent care center treats people with illnesses or injuries that must be addressed immediately and cannot wait for a regular medical appointment. During the past 12 months, has {child’s name} had to visit an emergency room or urgent care center because of {his/her} asthma? (ER_VISIT)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
3		91-93				Q5.9 During the past 12 months, how many times did{child’s name} visit an emergency room or urgent care center because of {his/her} asthma? (ER_TIMES)						____[Range check: 001-365, 777,888,999] 888 = None 777 = Don’t know 999 = Refused
3		94-96				Q5.10 During the past 12 months, how many times did {child’s name} see a doctor or other health professional for urgent treatment of worsening asthma symptoms or an asthma episode or attack? (URG_TIME)						____[Range check: 001-365, 777,888, 999] 888 = None 777 = Don’t know 999 = Refused
1		97				Q5.11 During the past 12 months, that is since [1 YEAR AGO TODAY], has {child’s name} had to stay overnight in a hospital because of {his/her} asthma? Do not include an overnight stay in the emergency room. (HOSP_VST)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
3		98-100				Q5.12 During the past 12 months, how many different times did {child’s name} stay in any hospital overnight or longer because of {his/her} asthma? (HOSPTIME)						____[Range check: 001-365, 777, 999] 777 = Don’t know 999 = Refused
1		101				Q5.13 The last time {child’s name} left the hospital, did a health professional talk with you or {child’s name} about how to prevent serious attacks in the future? (HOSPPLAN)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
Section 6. Knowledge of Asthma/Management Plan
1		102				Q6.1 Has a doctor or other health professional ever taught you or {child’s name}.... a. How to recognize early signs or symptoms of an asthma episode? (TCH_SIGN)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		103				Q6.2 Has a doctor or other health professional ever taught you or {child’s name}.... b. What to do during an asthma episode or attack?(TCH_RESP)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		104				Q6.3 A peak flow meter is a hand held device that measures how quickly you can blow air out of your lungs. Has a doctor or other health professional ever taught you or {child’s name}.... c. How to use a peak flow meter to adjust your daily medications? (TCH_MON)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		105				An asthma action plan, or asthma management plan, is a form with instructions about when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room. Q6.4 Has a doctor or other health professional EVER given you or {child’s name}....an asthma action plan? (MGT_PLAN)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		106				Q6.5 Have you or {child’s name} ever taken a course or class on how to manage {his/her} asthma? (MGT_CLAS)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
Section 7. Modifications to Environment
1		107				An air cleaner or purifier filters pollutants like dust, pollen, mold and chemicals out of the indoor air. It can be attached to the furnace or free standing. It is not, however, the same as a normal furnace filter. Q7.1 Is an air cleaner or purifier regularly used inside {child’s name} home? (AIRCLEANER)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		108				Q7.2 Is a dehumidifier regularly used to reduce moisture inside {child’s name} home? (DEHUMID)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		109				Q7.3 Is an exhaust fan that vents to the outside used regularly when cooking in the kitchen in {child’s name} home? (KITC_FAN)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		110				Q7.4 Is gas used for cooking in {child’s name} home? (COOK_GAS)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		111				Q7.5 In the past 30 days, has anyone seen or smelled mold or a musty odor inside in {child’s name} home? Do not include mold on food. (ENV_MOLD)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		112				Q7.6 Does {child’s name} home have pets such as dogs, cats, hamsters, birds or other feathered or furry pets that spend time indoors? (ENV_PETS)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		113				Q7.7 Is the pet allowed in {child’s name} bedroom? (PETBEDRM)						1 = Yes 2 = No 3 = Some are/Some aren’t 7 = Don’t know/Not sure 9 = Refused
1		114				Q7.8 In the past 30 days, has anyone seen cockroaches inside {child’s name} home? (C_ROACH)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		115				Q7.9 In the past 30 days, has anyone seen mice or rats inside {child’s name} home? Do not include mice or rats kept as pets. (C_RODENT)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		116				Q7.10 Is a wood burning fireplace or wood burning stove used in {child’s name} home? (WOOD_STOVE)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		117				Q7.11 Are unvented gas logs, an unvented gas fireplace, or an unvented gas stove used in {child’s name} home? (GAS_STOVE)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		118				Q7.12 In the past week, has anyone smoked inside {child’s name} home? (S_INSIDE)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		119				Q7.13 Has a health professional ever advised you to change things in {child’s name} home, school, or work to improve his/her asthma? (MOD_ENV)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		120				Q7.14 Does {child’s name} use a mattress cover that is made especially for controlling dust mites? (MATTRESS)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		121				Q7.15 Does {child’s name} use a pillow cover that is made especially for controlling dust mites? (E_PILLOW)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		122				Q7.16 Does {child’s name} have carpeting or rugs in {his/her} bedroom? This does not include throw rugs small enough to be laundered. (CARPET)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		123				Q7.17 Are {child’s name} sheets and pillowcases washed in cold, warm, or hot water? (HOTWATER)						1 = Cold 2 = Warm 3 = Hot 4 = Varies 7 = Don’t know/Not sure 9 = Refused
1		124				Q7.18 In {child’s name} bathroom, does {child’s name} regularly use an exhaust fan that vents to the outside? (BATH_FAN)						1 = Yes 2 = No OR “No Fan” 7 = Don’t know/Not sure 9 = Refused
Section 8. Medications
1		125				Q8.1 Over-the-counter medication can be bought without a doctor’s order. Has {child’s name} ever used over-the-counter medication for {his/her} asthma? (OTC)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		126				Q8.2 Has {child’s name} ever used a prescription inhaler? (INHALERE)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		127				Q8.3 Did a health professional show {child’s name} how to use the inhaler? (INHALERH)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		128				Q8.4 Did a doctor or other health professional watch {child’s name} use the inhaler? (INHALERW)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		129				[Now I am going to ask questions about specific prescription medications {child’s name} may have taken for asthma in the past 3 months. I will be asking for the names, amount, and how often {child’s name} takes each medicine. I will ask separately about medication taken in various forms: pill or syrup, inhaler, and Nebulizer. Q8.5 It will help to get {child’s name} medicines so you can read the labels. (SCR_MED1)						1 = Yes 2 = No 3 = Respondent know the meds 7 = Don’t know/Not sure 9 = Refused
1		130				Q8.7 Do you have all the medications? (SCR_MED3)						1 = Yes I have all of the medications 2 = Yes I have some of the medications but not all 3 = No 7 = Don’t know/Not sure 9 = Refused
1		131				Q8.8 In the past 3 months has {child’s name} taken prescription asthma medicine using an inhaler? (INH_SCR)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
16		132-147				Q8.9 In the past 3 months, what medications did {child’s name} take by inhaler? [MARK ALL THAT APPLY. PROBE: Any other medications?] (INH_MEDS) (Limit=8 Inhalers)						88 = No Prescription Inhalers 77 = Don’ know 99 = Refused
						[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.] Note: the yellow numbered items below are new medications added in 2008. Also, CATI programmers, note that the top ten items (in bold below) should be highlighted in the CATI system if possible so they can be found more easily.
				Medication					Pronunciation
	01			Advair (+ A. Diskus)					ăd-vâr (or add-vair)
	02			Aerobid					â-rō'bĭd (or air-row-bid)
	03			Albuterol ( + A. sulfate or salbutamol)					ăl'-bu'ter-ōl (or al-BYOO-ter-ole) săl-byū'tə-môl'
	04			Alupent					al-u-pent
	43			Alvesco (+ Ciclesonide)					al-ves-co
	40			Asmanex (twisthaler)					as-muh-neks twist-hey-ler
	05			Atrovent					At-ro-vent
	06			Azmacort					az-ma-cort
	07			Beclomethasone dipropionate					bek"lo-meth'ah-son dī' pro’pe-o-nāt (or be-kloe-meth-a-sone)
	08			Beclovent					be' klo-vent" (or be-klo-vent)
	09			Bitolterol					bi-tōl'ter-ōl (or bye-tole-ter-ole)
	10			Brethaire Discontinued - Delete					breth-air
	11			Budesonide					byoo-des-oh-nide
	12			Combivent					com-bi-vent
	13			Cromolyn					kro'mŏ-lin (or KROE-moe-lin)
	44			Dulera					do-lair-a
	14			Flovent					flow-vent
	15			Flovent Rotadisk					flow-vent row-ta-disk
	16			Flunisolide					floo-nis'o-līd (or floo-NISS-oh-lide)
	17			Fluticasone					flue-TICK-uh-zone
	34			Foradil					FOUR-a-dil
	35			Formoterol					for moh' te rol
	18			Intal Discontinued - Delete					in-tel
	19			Ipratropium Bromide					ĭp-rah-tro'pe-um bro'mīd (or ip-ra-TROE-pee-um)
	37			Levalbuterol tartrate					lev-al-BYOU-ter-ohl
	20			Maxair					măk-sâr
	21			Metaproteronol					met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
	39			Mometasone furoate					moe-MET-a-sone
	22			Nedocromil					ne-DOK-roe-mil
	23			Pirbuterol					pēr-bu'ter-ōl (or peer-BYOO-ter-ole)
	41			Pro-Air HFA					proh-air HFA
	24			Proventil					pro"ven-til' (or pro-vent-il)
	25			Pulmicort Flexhaler					pul-ma-cort flex-hail-er
	36			QVAR					q -vâr (or q-vair)
	03			Salbutamol (or Albuterol)					săl-byū'tə-môl'
	26			Salmeterol					sal-ME-te-role
	27			Serevent					Sair-a-vent
	42			Symbicort					sim-buh-kohrt
	28			Terbutaline (+ T. sulfate)					ter-bu'tah-lēn (or ter-BYOO-ta-leen)
	29			Tilade Discontinued - delete					tie-laid
	30			Tornalate					tor-na-late
	31			Triamcinolone acetonide					tri"am-sin'o-lōn as"ĕ-tō-nīd' (or trye-am-SIN-oh-lone)
	32			Vanceril					van-sir-il
	33			Ventolin					vent-o-lin
	38			Xopenex HFA					ZOH-pen-ecks
	66			Other, Please Specify					[SKIP TO OTH_I1]
	77			Don’t know					[SKIP TO PILLS]
	88			No Prescription Inhalers					[SKIP TO PILLS]
	99			Refused					[SKIP TO PILLS]
100		148-247				Q8.10 ENTER OTHER MEDICATION FROM (8.9) IN TEXT FIELD. IF MORE THAT ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE. [LOOP BACK TO ILP01 AS NECESSARY (UP TO 6 TIMES FOR SIX SEPARATE MEDICATIONS) TO ADMINSTER QUESTIONS ILP01 THRU ILP10 FOR EACH MEDICINE REPORTED IN INH_MEDS [FOR FILL [MEDICINE FROM INH_MEDS SERIES] FOR QUESTIONS ILP01 THROUGH ILP10] [IF {MEDICINE FROM INH_MEDS SERIES} IS 03, 04, 21, 24, OR 33 ASK ILP01 ELSE SKIP TO ILP02 (OTH_I1)						Text field – up to 100 characters
						Section Repeated for Medication entry. (Limit=8 Inhalers) Questions 8.11–8.19 will be repeated for each medication up to 8 times and saved in blocks of 15 columns, two for the Med. Code, and 13 columns for the 9 questions. Columns 248-262 will hold the first series and the eighth series in 353-367.
2		248-249				1st Inhaler value from “INH_MEDS” field ILP_A (First Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		250-262				Questions 8.11 through 8.19 for FIRST medication
1		250				Q8.11 Question has been removed, 2012. Please leave this column blank. 1st Medication
1		251				Q8.12 Question has been removed, 2012. Please leave this column blank. 1st Medication
1		252				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_A) 1st Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		253				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_A) 1st Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		254				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_A) 1st Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		255				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_A) 1st Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		256-257				Q8.17 Question has been removed, 2012. Please leave these columns blank. 1st Medication
3		258-260				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_A) 1st Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		261-262				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_A) 1st Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
2		263-264				2nd Inhaler value from “INH_MEDS” field ILP_B (Second Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		265-277				Questions 8.11 through 8.19 for SECOND medication
1		265				Q8.11 Question has been removed, 2012. Please leave this column blank. 2nd Medication
1		266				Q8.12 Question has been removed, 2012. Please leave this column blank. 2nd Medication
1		267				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_B) 2nd Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		268				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_B) 2nd Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		269				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_B) 2nd Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		270				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_B) 2nd Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		271-272				Q8.17 Question has been removed, 2012. Please leave these columns blank. (ILP07_B) 2nd Medication
3		273-275				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_B) 2nd Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		276-277				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_B) 2nd Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
2		278-279				3rd Inhaler value from “INH_MEDS” field ILP_C (Third Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		280-292				Questions 8.11 through 8.19 for THIRD medication
1		280				Q8.11 Question has been removed, 2012. Please leave this column blank. 3rd Medication
1		281				Q8.12 Question has been removed, 2012. Please leave this column blank. 3rd Medication
1		282				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_C) 3rd Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		283				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_C) 3rd Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		284				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_C) 3rd Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		285				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_C) 3rd Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		286-287				Q8.17 Question has been removed, 2012. Please leave these columns blank. (ILP07_C) 3rd Medication
3		288-290				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_C) 3rd Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		291-292				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_C) 3rd Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
2		293-294				4th Inhaler value from “INH_MEDS” field ILP_D (Fourth Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		295-307				Questions 8.11 through 8.19 for FOURTH medication
1		295				Q8.11 Question has been removed, 2012. Please leave this column blank. 4th Medication
1		296				Q8.12 Question has been removed, 2012. Please leave this column blank. 4th Medication
1		297				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_D) 4th Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		298				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_D) 4th Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		299				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_D) 4th Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		300				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_D) 4th Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		301-302				Q8.17 Question has been removed, 2012. Please leave these columns blank. (ILP07_D) 4th Medication
3		303-305				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_D) 4th Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		306-307				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_D) 4th Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
2		308-309				5th Inhaler value from “INH_MEDS” field ILP_E (Fifth Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		310-322				Questions 8.11 through 8.19 for FIFTH medication
1		310				Q8.11 Question has been removed, 2012. Please leave this column blank. 5th Medication
1		311				Q8.12 Question has been removed, 2012. Please leave this column blank. 5th Medication
1		312				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_E) 5th Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		313				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_E) 5th Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		314				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_E) 5th Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		315				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_E) 5th Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		316-317				Q8.17 Question has been removed, 2012. Please leave these columns blank. (ILP07_E) 5th Medication
3		318-320				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_E) 5th Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		321-322				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_E) 5th Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
2		323-324				6th Inhaler value from “INH_MEDS” field ILP_F (Sixth Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		325-337				Questions 8.11 through 8.19 for SIXTH medication
1		325				Q8.11 Question has been removed, 2012. Please leave this column blank. 6th Medication
1		326				Q8.12 Question has been removed, 2012. Please leave this column blank. 6th Medication
1		327				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_F) 6th Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		328				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_F) 6th Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		329				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_F) 6th Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		330				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_F) 6th Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		331-332				Q8.17 Question has been removed, 2012. Please leave these columns blank. (ILP07_F) 6th Medication
3		333-335				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_F) 6th Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		336-337				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_F) 6th Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
2		338-339				7th Inhaler value from “INH_MEDS” field ILP_G (Seventh Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		340-352				Questions 8.11 through 8.19 for SEVENTH medication
1		340				Q8.11 Question has been removed, 2012. Please leave this column blank. 7th Medication
1		341				Q8.12 Question has been removed, 2012. Please leave this column blank. 7th Medication
1		342				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_G) 7th Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		343				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_G) 7th Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		344				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_G) 7th Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		345				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_G) 7th Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		346-347				Q8.17 Question has been removed, 2012. Please leave these columns blank. (ILP07_G) 7th Medication
3		348-350				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_G) 7th Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		351-352				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_G) 7th Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
2		353-354				8th Inhaler value from “INH_MEDS” field ILP_H (Eighth Inhaler Medication Value)						Valid Inhaler Meds: 01 - 43, 66
13		355-367				Questions 8.11 through 8.19 for EIGHTH medication
1		355				Q8.11 Question has been removed, 2012. Please leave this column blank. 8th Medication
1		356				Q8.12 Question has been removed, 2012. Please leave this column blank. 8th Medication
1		357				Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Does {child’s name} use a spacer with [MEDICINE FROM INH_MEDS SERIES]? (ILP03_H) 8th Medication						1 = Yes 2 = No 3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler 4 = Medication has a built-in spacer/ does not need a spacer 7 = Don’t know/Not sure 9 = Refused
1		358				Q8.14 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] when he/she had an asthma episode or attack? (ILP04_H) 8th Medication						1 = Yes 2 = No 3 = No attack in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		359				Q8.15 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] before exercising? (ILP05_H) 8th Medication						1 = Yes 2 = No 3 = Didn’t exercise in the past 3 mths 7 = Don’t know/Not sure 9 = Refused
1		360				Q8.16 In the past 3 months, did {child’s name} take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_H) 8th Medication						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		361-362				Q8.17 Question has been removed, 2012. Please leave these columns blank. 8th Medication
3		363-365				Q8.18 How many times per day or per week did {child’s name} use [MEDICINE FROM INH_MEDS SERIES]? (ILP08_H) 8th Medication						301-399 = Days 401-499 = Weeks 555 = Never 666 = Less often than once a week 777 = Don’ know 999 = Refused
2		366-367				Q8.19 How many canisters of this inhaler has {child’s name} used in the past 3 months? (ILP10_H) 8th Medication						___ Canisters [RANGE CHECK: (01-76, 77, 88, 99)] 77 = Don’t know/Not sure 88 = None 99 = Refused
1		368				Intentionally left blank2
1		369				Q8.20 In the past 3 months, has {child’s name} taken any prescription medicine in pill form for his/her asthma? (PILLS)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
10		370-379				Q8.21 What prescription asthma medications does {child’s name} take in pill form? [MARK ALL THAT APPLY. PROBE: Any other prescription asthma pills?] (PILLS_MD) (Limit=5) These values will also be re-entered in columns below: 480-481 PILL_MD_A (First Pills Medication value) 483-484 PILL_MD_B (Second Pills Medication value) 486-487 PILL_MD_C (Third Pills Medication value) 489-490 PILL_MD_D (Fourth Pills Medication value) 492-493 PILL_MD_E (Fifth Pills Medication value)						___ Enter Response [IF RESPONDENT SELECTS ANY ANSWER FROM 01-47, SKIP TO PILL01] 88 = No Pills 77 = Don’t know/Not sure 99 = Refused
						What PRESCRIPTION asthma medications does {child’s name} take in pill form? [MARK ALL THAT APPLY. PROBE: Any other PRESCRIPTION asthma pills?] [INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.] Note: the yellow numbered items below are new medications added in 2008. Also, CATI programmers, note that the top ten items (in bold below) should be highlighted in the CATI system if possible so they can be found more easily.
			Medication				Pronunciation
	01		Accolate				ac-o-late
	02		Aerolate				air-o-late
	03		Albuterol				ăl'-bu'ter-ōl (or al-BYOO-ter-all)
	04		Alupent				al-u-pent
	49		Brethine				breth-een
	05		Choledyl (oxtriphylline)				ko-led-il
	07		Deltasone				del-ta-sone
	08		Elixophyllin				e-licks-o-fil-in
	11		Medrol				Med-rol
	12		Metaprel				Met-a-prell
	13		Metaproteronol				met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
	14		Methylpredinisolone				meth-ill-pred-niss-oh-lone (or meth-il-pred-NIS-oh-lone)
	15		Montelukast				mont-e-lu-cast
	17		Pediapred				Pee-dee-a-pred
	18		Prednisolone				pred-NISS-oh-lone
	19		Prednisone				PRED-ni-sone
	21		Proventil				pro-ven-til
	23		Respid				res-pid
	24		Singulair				sing-u-lair
	25		Slo-phyllin				slow- fil-in
	26		Slo-bid				slow-bid
	48		Terbutaline (+ T. sulfate)				ter byoo' ta leen
	28		Theo-24				thee-o-24
	30		Theochron				thee -o-kron
	31		Theoclear				thee-o-clear
	32		Theodur				thee-o-dur
	33		Theo-Dur				thee-o-dur
	35		Theophylline				thee-OFF-i-lin
	37		Theospan				thee-o-span
	40		T-Phyl				t-fil
	42		Uniphyl				u-ni-fil
	43		Ventolin				vent-o-lin
	44		Volmax				vole-max
	45		Zafirlukast				za-FIR-loo-kast
	46		Zileuton				zye-loo-ton
	47		Zyflo Filmtab				zye-flow film tab
	66		Other, please specify				[SKIP TO OTH_P1]
	77		Don’t know				[SKIP TO SYRUP]
	88		No Pills				[SKIP TO SYRUP]
	99		Refused				[SKIP TO SYRUP]
100		380-479				[OTH_P1] IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.						Text field – up to 100 characters
						Question 8.22 Repeated for Medication entry. (Limit=5)
2		480-481				1st Pill value from “PILLS_MD” field PILL01_A (First Pill Medication Value)						Valid Meds in Pill form: 01 - 49, 66
1		482				Q8.22 In the past 3 months, did {child’s name} take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL01) 1st Pill						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		483-484				2nd Pill value from “PILLS_MD” field PILL01_B (Second Pill Medication Value)						Valid Meds in Pill form: 01 - 49, 66
1		485				Q8.22 In the past 3 months, did {child’s name} take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL02) 2nd Pill						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		486-487				3rd Pill value from “PILLS_MD” field PILL01_C (Third Pill Medication Value)						Valid Meds in Pill form: 01 - 49, 66
1		488				Q8.22 In the past 3 months, did {child’s name} take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL03) 3rd Pill						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		489-490				4th Pill value from “PILLS_MD” field PILL01_D (Fourth Pill Medication Value)						Valid Meds in Pill form: 01 - 49, 66
1		491				Q8.22 In the past 3 months, did {child’s name} take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL04) 4th Pill						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		492-493				5th Pill value from “PILLS_MD” field PILL01_E (Fifth Pill Medication Value)						Valid Meds in Pill form: 01 - 49, 66
1		494				Q8.22 In the past 3 months, did {child’s name} take [MEDICATION LISTED IN PILLS_MD] on a regular schedule every day? (PILL05) 5th Pill						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		495				Q8.23 In the past 3 months, has {child’s name} taken prescription medicine in syrup form? (SYRUP)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
8		496-503				Q8.24 What prescriptions asthma medications has {child’s name} taken as a syrup? [MARK ALL THAT APPLY. PROBE: Any other prescription syrup medications for asthma?] (SYRUP_ID) (Limit=4)						Medication 01 = Aerolate (09) 02 = Albuterol 03 = Alupent (04) 04 = Metaproteronol 05 = Prednisolone 06 = Prelone (05) 07 = Proventil (02) 08 = Slo-Phyllin (09) 09 = Theophylline 10 = Ventolin (02) 66 = Other, Please specify: 77 = Don’t know 88 = No Syrup 99 = Refused
				Medication				Pronunciation
	01			Aerolate				air-o-late
	02			Albuterol				ăl'-bu'ter-ōl (or al-BYOO-ter-ole)
	03			Alupent				al-u-pent
	04			Metaproteronol				met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
	05			Prednisolone				pred-NISS-oh-lone
	06			Prelone				pre-loan
	07			Proventil				Pro-ven-til
	08			Slo-Phyllin				slow-fil-in
	09			Theophyllin				thee-OFF-i-lin
	10			Ventolin				vent-o-lin
	66			Other, Please Specify:				[SKIP TO OTH_S1]
	77			Don’t know				[SKIP TO NEB_SCR]
	88			No Syrup				[SKIP TO NEB_SCR]
	99			Refused				[SKIP TO NEB_SCR]
2		496-497				1st Syrup value from “SYRUP_ID” field SYRUP_A (1st Syrup Medication Value)						Valid Meds in Syrup form: 01 - 10, 66
2		498-499				1st Syrup value from “SYRUP_ID” field SYRUP_B (2nd Syrup Medication Value)						Valid Meds in Syrup form: 01 - 10, 66
2		500-501				1st Syrup value from “SYRUP_ID” field SYRUP_C (3rd Syrup Medication Value)						Valid Meds in Syrup form: 01 - 10, 66
2		502-503				1st Syrup value from “SYRUP_ID” field SYRUP_D (4th Syrup Medication Value)						Valid Meds in Syrup form: 01 - 10, 66
100		504-603				(OTH_S1) ENTER OTHER MEDICATION. IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.						Text field – up to 100 characters
1		604				Q8.25 A nebulizer is a small machine with a tube and facemask or mouthpiece that you breathe through continuously. In the past 3 months, were any of {child’s name} prescription asthma medicines used with a nebulizer? (NEB_SCR)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		605				Q8.26a I am going to read a list of places where your child might have used a nebulizer. Please answer yes if your child has used a nebulizer in the place I mention, otherwise answer no. In the past 3 months did your child use a nebulizer At Home? (NEB_PLCa)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
1		606				Q8.26b I am going to read a list of places where your child might have used a nebulizer. Please answer yes if your child has used a nebulizer in the place I mention, otherwise answer no. In the past 3 months did your child use a nebulizer At a Doctor’s Office? (NEB_PLCb)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
1		607				Q8.26c I am going to read a list of places where your child might have used a nebulizer. Please answer yes if your child has used a nebulizer in the place I mention, otherwise answer no. In the past 3 months did your child use a nebulizer In an Emergency room? (NEB_PLCc)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
1		608				Q8.26d I am going to read a list of places where your child might have used a nebulizer. Please answer yes if your child has used a nebulizer in the place I mention, otherwise answer no. In the past 3 months did your child use a nebulizer At work or at school? (NEB_PLCd)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
1		609				Q8.26e I am going to read a list of places where your child might have used a nebulizer. Please answer yes if your child has used a nebulizer in the place I mention, otherwise answer no. In the past 3 months did your child use a nebulizer At any other place? (NEB_PLCe)						1 = Yes 2 = No 7 = Don’t know 9 = Refused
10		610-619				Q8.27 In the past 3 months, what prescriptions asthma medications has {child’s name} taken using a nebulizer? (NEB_ID) (Limit = 5 Nebulizers Meds.) These values will also be re-entered in columns below: 620-621 NEB_ID_A (First Nebulizer Medication value) 627-628 NEB_ID_B (Second Nebulizer Medication value) 634-635 NEB_ID_C (Third Nebulizer Medication value) 641-642 NEB_ID_D (Fourth Nebulizer Medication value) 648-649 NEB_ID_E (Fifth Nebulizer Medication value)						Medication 01 = Albuterol 02 = Alupent (11) 03 = Atrovent (09) 04 = Bitolterol 05 = Budesonide 06 = Cromolyn 07 = Duoneb (01 + 09) 08 = Intal (06) 09 = Ipratroprium bromide 10 = Levalbuterol 11 = Metaproteronol 12 = Proventil (01) 13 = Pulmicort (05) 14 = Tornalate (04) 15 = Ventolin (01) 16 = Xopenex (10) 17 = Combivent Inhalation solution 18 = Perforomist (Formoterol) 66 = Other, Please Specify: 77 = Don’t know 88 = None 99 = Refused
						[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.] [MARK ALL THAT APPLY. PROBE: Has your child taken any other prescription ASTHMA medications with a nebulizer in the past 3 months
					Medication					Pronunciation
	01				Albuterol					ăl'-bu'ter-ōl (or al-BYOO-ter-ole)
	02				Alupent					al-u-pent
	03				Atrovent					At-ro-vent
	04				Bitolterol					bi-tōl'ter-ōl (or bye-tole-ter-ole)
	05				Budesonide					byoo-des-oh-nide
	17				Combivent Inhalation solution					com-bi-vent
	06				Cromolyn					kro'mŏ-lin (or KROE-moe-lin)
	07				DuoNeb					DUE-ow-neb
	08				Intal					in-tel
	09				Ipratroprium bromide					ĭp-rah-tro'pe-um bro'mīd (or ip-ra-TROE-pee-um)
	10				Levalbuterol					lev al byoo' ter ol
	11				Metaproteronol					met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)
	18				Perforomist (Formoterol)					per-form-ist
	12				Proventil					Pro-ven-til
	13				Pulmicort					pul-ma-cort
	14				Tornalate					tor-na-late
	15				Ventolin					vent-o-lin
	16				Xopenex					ZOH-pen-ecks
	66				Other, Please Specify:					[SKIP TO OTH_N1]
	77				Don’t know					[SKIP TO Section 9]
	88				No Syrups					[SKIP TO Section 9]
	99				Refused:					[SKIP TO Section 9]
2		620-621				1st Nebulizer value from “NEB_ID” field NEB_ID_A (1st Nebulizer Medication Value)						Valid Meds in Nebulizer form: 01 - 18, 66
1		622				Q8.28 In the past 3 months, did {child’s name} take [MEDICINE FROM NEB_ID SERIES] when he/she had an asthma episode or attack? (NEB01_A) 1st Nebulizer						1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know/Not Sure 9 = Refused
1		623				Q8.29 In the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_A) 1st Nebulizer						1 = Yes 2 = No 7= Don’t know/Not Sure 9 = Refused
3		624-626				Q8.30 How many times per day or per week does he/she use [MEDICINE FROM NEB_ID SERIES]? (NEB03_A) 1st Nebulizer						3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know/Not Sure 999 = Refused
2		627-628				2nd Nebulizer value from “NEB_ID” field NEB_ID_B (2nd Nebulizer Medication Value)						Valid Meds in Nebulizer form: 01 - 18, 66
1		629				Q8.28 In the past 3 months, did {child’s name} take [MEDICINE FROM NEB_ID SERIES] when he/she had an asthma episode or attack? (NEB01_B) 2nd Nebulizer						1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know/Not Sure 9 = Refused
1		630				Q8.29 In the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_B) 2nd Nebulizer						1 = Yes 2 = No 7= Don’t know/Not Sure 9 = Refused
3		631-633				Q8.30 How many times per day or per week does he/she use [MEDICINE FROM NEB_ID SERIES]? (NEB03_B) 2nd Nebulizer						3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know/Not Sure 999 = Refused
2		634-635				3rd Nebulizer value from “NEB_ID” field NEB_ID_C (3rd Nebulizer Medication Value)						Valid Meds in Nebulizer form: 01 - 18, 66
1		636				Q8.28 In the past 3 months, did {child’s name} take [MEDICINE FROM NEB_ID SERIES] when he/she had an asthma episode or attack? (NEB01_C) 3rd Nebulizer						1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know/Not Sure 9 = Refused
1		637				Q8.29 In the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_C) 3rd Nebulizer						1 = Yes 2 = No 7= Don’t know/Not Sure 9 = Refused
3		638-640				Q8.30 How many times per day or per week does he/she use [MEDICINE FROM NEB_ID SERIES]? (NEB03_C) 3rd Nebulizer						3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know/Not Sure 999 = Refused
2		641-642				4th Nebulizer value from “NEB_ID” field NEB_ID_D (4th Nebulizer Medication Value)						Valid Meds in Nebulizer form: 01 - 18, 66
1		643				Q8.28 In the past 3 months, did {child’s name} take [MEDICINE FROM NEB_ID SERIES] when he/she had an asthma episode or attack? (NEB01_D) 4th Nebulizer						1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know/Not Sure 9 = Refused
1		644				Q8.29 In the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_D) 4th Nebulizer						1 = Yes 2 = No 7= Don’t know/Not Sure 9 = Refused
3		645-647				Q8.30 How many times per day or per week does he/she use [MEDICINE FROM NEB_ID SERIES]? (NEB03_D) 4th Nebulizer						3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know/Not Sure 999 = Refused
2		648-649				5th Nebulizer value from “NEB_ID” field NEB_ID_E (5th Nebulizer Medication Value)						Valid Meds in Nebulizer form: 01 - 18, 66
1		650				Q8.28 In the past 3 months, did {child’s name} take [MEDICINE FROM NEB_ID SERIES] when he/she had an asthma episode or attack? (NEB01_E) 5th Nebulizer						1 = Yes 2 = No 3 = No attack in past 3 months 7= Don’t know/Not Sure 9 = Refused
1		651				Q8.29 In the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday? (NEB02_E) 5th Nebulizer						1 = Yes 2 = No 7= Don’t know/Not Sure 9 = Refused
3		652-654				Q8.30 How many times per day or per week does he/she use [MEDICINE FROM NEB_ID SERIES]? (NEB03_E) 5th Nebulizer						3_ _DAYS 4_ _WEEKS 555 = NEVER 666 = LESS OFTEN THAN ONCE A WEEK 777 = Don’t know/Not Sure 999 = Refused
100		655-754				(OTH_N1) IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE						Text field – up to 100 characters
Section 9. Cost of Care
1		755				Q9.1 Was there a time in the past 12 months when {child’s name} needed to see his/her primary care doctor for asthma but could not because of the cost? (ASMDCOST)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		756				Q9.2 Was there a time in the past 12 months when you were referred to a specialist for {child’s name} asthma care but could not go because of the cost? (ASSPCOST)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		757				Q9.3 Was there a time in the past 12 months when {child’s name} needed medication for his/her asthma but you could not buy it because of the cost? (ASRXCOST)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
Section 10. School Related Asthma
1		758				Q10.1 Next, we are interested in things that might affect {child’s name} asthma when he/she is not at home. Does {child’s name} currently go to school or pre school outside the home? (SCH_STAT)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		759				Q10.2 What is the main reason {child’s name} is not now in school? READ RESPONSE CATEGORIES (NO_SCHL)						1 = Not old enough 2 = Home schooled 3 = Unable to attend for health reason 4 = On vacation or break 5 = Other 7 = Don’t know/Not sure 9 = Refused
1		760				Q10.3 Has {child’s name} gone to school in the past 12 months? (SCHL_12)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		761-762				Q10.4 [IF SCHL_12 = 1] What grade was {child’s name} in the last time he/she was in school? [IF SCH_STAT = 1 OR NO_SCHL = 2] What grade is {child’s name} in? (SCHGRADE)						88 = Pre-School 66 = Kindergarten __ = Enter Grade 01-12 77 = Don’t know/Not sure 99 = Refused
3		763-765				Q10.5 During the past 12 months, about how many days of school did {child’s name} miss because of {his/her} asthma? (MISS_SCHL)						___ Enter Number of Days [RANGE CHECK: (001-365, 777, 888, 999)] 888 = Zero/None 777 = Don’t know/Not sure 999 = Refused
1		766				Q10.6 An asthma action plan, or asthma management plan, is a form with instructions about when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room. Does {child’s name} have a written asthma action plan or asthma management plan on file at school? (SCH_APL)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		767				Q10.7 Is {child’s name} allowed to carry his/her asthma medicine with him/her at school? (SCH_MED)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		768				Q10.8 Are there any pets such as dogs, cats, hamsters, birds or other feathered or furry pets in {child’s name} classroom? (SCH_ANML)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		769				Q10.9 Are you aware of any mold problems in {child’s name} school? (SCH_MOLD)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		770				Q10.10 [IF CHLDAGE2 > 10 SKIP TO SECTION 11] Does {child’s name} go to day care outside his/her home? (DAYCARE)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		771				Q10.11 Has {child’s name} gone to daycare in the past 12 months? (DAYCARE1)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
3		772-774				Q10.12 During the past 12 months, about how many days of daycare did {child’s name} miss because of {his/her} asthma? (MISS_DCAR)						___ Enter Number of Days [Range Check: (001-365, 777, 888, 999)] 888 = Zero/None 777 = Don’t know/Not sure 999 = Refused
1		775				Q10.13 Does {child’s name} have a written asthma action plan or asthma management plan on file at daycare? (DCARE_APL)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		776				Q10.14 Are there any pets such as dogs, cats, hamsters, birds or other feathered or furry pets in {child’s name} room at daycare? (DCARE_ANML)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		777				Q10.15 Are you aware of any mold problems in {child’s name} daycare? (DCARE_MLD)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		778				Q10.16 Is smoking allowed at {child’s name} daycare? (DCARE_SMK)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
SECTION 11. Complimentary and Alternative Therapy
1		779				Sometimes people use methods other than prescription medications to help treat or control their asthma. These methods are called non- traditional, complementary, or alternative health care. I am going to read a list of these alternative methods. For each one I mention, please answer “yes” if {child’s name} has used it to control asthma in the past 12 months. Answer “no” if {child’s name} has not used it in the past 12 months. Q11.1 In the past 12 months, has {child’s name} used (herbs) to control asthma? (CAM_HERB)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		780				Q11.2 In the past 12 months has {child’s name} used (vitamins) to control asthma? (CAM_VITA)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		781				Q11.3 In the past 12 months, has {child’s name} used (acupuncture) to control asthma? (CAM_PUNC)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		782				Q11.4 In the past 12 months, has {child’s name} used (acupressure) to control asthma? (CAM_PRES)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		783				Q11.5 In the past 12 months, has {child’s name} used (aromatherapy) to control asthma? (CAM_AROM)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		784				Q11.6 In the past 12 months, has {child’s name} used (homeopathy) to control asthma? (CAM_HOME)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		785				Q11.7 In the past 12 months, has {child’s name} used (reflexology) to control asthma? (CAM_REFL)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		786				Q11.8 In the past 12 months, has {child’s name} used (yoga) to control asthma? (CAM_YOGA)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		787				Q11.9 In the past 12 months, has {child’s name} used (breathing techniques) to control asthma? (CAM_BR)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		788				Q11.10 In the past 12 months, has {child’s name} used (naturopathy) to control asthma? (CAM_NATR)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		789				Q11.11 Besides the types I have just asked about, has your child used any other type of alternative care for asthma in the past 12 months? (CAM_OTHR)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
100		790-889				Q11.12 What else has your child used? (CAM_TEXT) [100 ALPHANUMERIC CHARACTER LIMIT] ENTER OTHER ALTERNATIVE MEDICINE IN TEXT FIELD IF MORE THAN ONE IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.
Section 12. Additional Child Demographics
4		890-893				Q12.1 How tall is {child’s name}? (HEIGHT1) Note: If respondent answers in metrics, put “9”in column 890. CATI Note: In the first space for the height (highlighted in yellow), if the respondent answers in feet/inches enter “0”, in column 890. If respondent answers in metric, put “9” in the first space, column 890. Note: Column 891, please put feet in this column. Columns 892-893, please put inches in these two columns, inches can be no more than a value of 11.						_ _ _ _ = Height (feet/inches or centimeters) 7777 = Don’t know/Not sure 9999 = Refused
4		894-897				Q12.2 How much does {child’s name} weigh? (WEIGHT1) Note: If respondent answers in metrics, put “9” in column 894. CATI Note: In the first space for the weight (highlighted in yellow), if the respondent answers in pounds, enter “0”, in column 894. If respondent answers in kilograms, put “9” in the first space, column 894.						_ _ _ _ = Weight (pounds/kilograms) 7777 = Don’t know/Not sure 9999 = Refused
6		898-903				Q12.3 How much did {child’s name}] weigh at birth? (BIRTHW1) CATI note: If the respondent gives pounds and ounces: from left to right, positions one and two will hold “0 0”; positions three and four will hold the value of pounds from 0 to 30; and the last two positions will hold 00 to 15 ounces. If the respondent gives kilograms and grams: from left to right, position one will hold “9”; positions two and three will hold the value of kilograms 1-30; and the last three positions will hold the number of grams.						_ _ _ _ = Weight (pounds/ounces or kilograms/grams) Two leading zeroes for pounds/ounces (i.e. 5 pounds 12 ounces = 000512) A leading 9 for kilograms/grams (i.e. 2 kilograms 500 grams = 902500) 777777 = Don’t know/Not sure 999999 = Refused
1		904				Q12.4 At birth, did {child’s name} weigh less than 5 ½ pounds? (BIRTHRF) [INTERVIEWER NOTE: 5 ½ pounds = 2500 GRAMS						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
80		905-984				Disposition codes for call attempts 1 through 20 with the first disposition code in columns 905-907, etc... (CATTMPTS)						4-digit disposition code for each of the first 20 call attempts.
7		985-991				Intentionally left blank…
1		992				Q1.5a Tracking of BRFSS MKP Appendix A. survey respondent: Are you the parent or guardian in the household who knows most about {CHILDName’s} asthma? (MOSTKNOW)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (MKP) identified at the BRFSS Level
1		993				Q1.5b Tracking of BRFSS MKP Appendix A. survey respondent: If parent or guardian request to transfer to another person who is more knowledgeable about the child’s asthma, then mark the transfer. (PRESENTALT)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (ALT) identified at the BRFSS Level
1		994				Q1.5a Tracking of CALLBACK MKP Appendix B. survey respondent: Are you the parent or guardian in the household who knows most about {CHILDName’s} asthma? (KNOWMOST)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (MKP) identified at the CALLBACK Level
1		995				Q1.5b Tracking of CALLBACK MKP Appendix B. survey respondent: If parent or guardian request to transfer to another person who is more knowledgeable about the child’s asthma, then mark the transfer. (ALTPRESENT)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused (ALT) identified at the CALLBACK Level
2		996-997				Questionnaire Versions Identifier. Import value from BRFSS Columns 592-593 (QSTVER_F)						10 = Landline (No additional version) 11 = Landline (One additional version) 12 = Landline (Two additional versions) 13 = Landline (Three additional versions) 20 = Cell Phone (No additional version) 21 = Cell Phone (One additional version) 22 = Cell Phone (Two additional versions) 23 = Cell Phone (Three additional versions)
2		998-999				Language identifier: Language in which the interview was conducted. Import value from BRFSS Columns 594 - 595 (QSTLANG_F)						1 = English 2 = Spanish 3-99 = Other
1		1000				Asthma Callback Script Import value from BRFSS Column 534 (CALLBACK_F)
1		1001				Which person in the household was selected as the focus of the call-back? Import value from BRFSS Column 535 (ADLTCHLD_F)						1 = Adult 2 = Child
1		1002				Has a doctor or other medical professional EVER said that the child has asthma? Import value from BRFSS Module 21 Question 1, Column 530 (CASTHDX2_F)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		1003				Does the child still have asthma? Import value from BRFSS Module 21 Question 2, Column 531 (CASTHNO2_F)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
1		1004				Asthma Callback Script Test (CallBack_Ver)						1 = Callback using Protocol (2 weeks) 2 = Callback conducted “Immediately”
1		1005				Are you a resident of [STATE]? Import value from BRFSS Column 585 (CSTATE)						1 = Yes 2 = No 7 = Don’t know/Not sure 9 = Refused
2		1006-1007				State of Origin of the Call Import value from BRFSS Columns 1375-1376 (O_STATE)						2 digit state FIPSCODE
2		1008-1009				In what state do you live? Import value from BRFSS Columns 586-587 (RSPSTATE)						2 digit state FIPSCODE
10		1010-1019				Intentionally left blank…
1		1020				End of file marker…						1

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