Cms-p-0015a Mcbs

Preventive Care (PVQ)
Variable Name
MR Screen Name

Question type

BOX PVBEG

routing

PVINTRO

PVINT

No entry

FLUSHOT

PVF1

yes/no

BOX PV1

routing

Question text/description
Code list
IF RESPONDENT IS DECEASED, GO TO BOX PVEND.
ELSE IF SEASON=FALL, GO TO PV8 - PREVHLTHINTRO.
ELSE IF (SEASON=WINTER), GO TO PVINT-PVINTRO.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1FLUSHOT^=1/YES), GO TO PVINT-PVINTRO.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1FLUSHOT=1/YES), GO TO BOX PV4.
IF SEASON=WINTER, FILL "Now I’d like to ask you some questions about the
seasonal flu vaccine."
ELSE IF SEASON=SUMMER, FILL "Last time we interviewed you, you told us
that you had not gotten a flu vaccination for the [CURRENT YEAR MINUS 1] [CURRENT YEAR] flu season."
Since [July 1st, (CURRENT YEAR MINUS 1)/[MREFDATE]], [have you/has (SP)]
(01) YES
had a seasonal flu vaccination?
(02) NO
(-8) DON’T KNOW
IF THE RESPONDENT MENTIONS A SHORT NEEDLE OR NEEDLELESS
(-9) REFUSED
INJECTOR, CODE AS “YES”.
IF SEASON=WINTER GO TO PVF2-FLUCODE.
ELSE GO TO BOX PV4.

Preventive Care (PVQ)
Variable Name
MR Screen Name

Question type

Question text/description

For what reason didn't [you/(SP)] get a seasonal flu vaccination since July
1st?
FLUCODE

PVF2

code all
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

FLUOTHOS

PVFLU3

NOVACINE

PVF2

verbatim text

BOX PV2

routing

PVF3

code 1

BOX PV3

routing

PVF4

yes/no

Code list
(01) DIDN’T KNOW IT WAS NEEDED
(02) SHOT COULD CAUSE FLU
(03) SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
(04) DIDN’T THINK IT WOULD PREVENT THE FLU/COULD GET
THE FLU ANYWAY
(05) FLU NOT SERIOUS/WOULD NOT GET FLU ANYWAY/NOT
AT RISK/NEVER GET THE FLU
(06) DOCTOR DID NOT RECOMMEND THE SHOT
(07) DOCTOR RECOMMENDED AGAINST GETTING VACCINE
(08) DON'T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT
SORENESS OR RASH/LOCAL REACTIONS
(09) INCONVENIENT TO GET SHOT/UNABLE TO GET TO
LOCATION
(10) DIDN’T THINK ABOUT IT/FORGOT/MISSED IT
(11) COST OF VACCINE
(12) HAD VACCINE BEFORE/DIDN’T NEED IT AGAIN
(13) VACCINE UNAVAILABLE/VACCINE SHORTAGE
(14) NOT WORTH THE MONEY
(15) DIDN'T HAVE TIME
(16) NOT IN HIGH RISK/PRIORITY GROUP
(17) ONGOING HEALTH CONDITION PREVENTING
VACCINE/ALLERGIC TO SHOT/MEDICAL REASONS
(18) DON'T TRUST WHAT GOVERNMENT SAYS ABOUT
VACCINE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

OTHER (SPECIFY)
IF MORE THAN ONE RESPONSE SELECTED AS YES AT PVF2-FLUCODE, GO TO
PVF3-PVFLU3, ELSE GO TO BOX PV3
Of the reasons you listed, what is the main reason [you/(SP)] did not get a flu
[LIST ALL RESPONSES SELECTED AT PVF2-FLUCODE]
vaccination this flu season?
_ _ [ENTER MAIN REASON]
(-8) DON’T KNOW
READ LIST TO RESPONDENT. IF RESPONDENT SELECTS MORE THAN ONE
(-9) REFUSED
REASON PROBE FOR MAIN REASON.
IF RESPONSE TO PVF2-FLUCODE DOES NOT INCLUDE 13, GO TO PVF4NOVACINE.
ELSE GO TO BOX PV4.
(01) YES
Was one reason that [you/(SP)] did not get a seasonal flu vaccination since
(02) NO
July 1st, [CURRENT YEAR MINUS 1] because the vaccine was in short supply
(-8) DON'T KNOW
or unavailable?
(-9) REFUSED

Preventive Care (PVQ)
Variable Name
MR Screen Name
VACSUPLY

PVF5

BOX PV4

SHINGVAC

Question type

Question text/description

yes/no

Did [you/(SP)] have any trouble getting a seasonal flu shot when
(you/he/she) wanted to because the vaccine was in short supply or
unavailable?

routing

IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED
RECEIVING THE SHINGLES VACCINE (P_SHINGVAC^=1) AND RESPONDENT IS
AGE 60 OR ABOVE (AGECALC ≥ 60), GO TO PV6-SHINGVAC.
ELSE GO TO BOX PV5.

PV6

yes/no

BOX PV5

routing

PNEUSHOT

PV7

yes/no

PREVHLTHINTRO

PV8

no entry

BPTAKEN

PV9

code one

BCTAKEN

PV10

code one

BOX PV6

routing

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

Shingles is an outbreak of a rash or blisters on the skin that may be
associated with severe pain. The pain is generally on one side of the body or
(01) YES
face. Shingles is caused by the chicken pox virus. A vaccine for shingles has
(02) NO
been available since May 2006.
(-8) DON'T KNOW
(-9) REFUSED
[Have you/Has (SP)] ever had the Zoster (ZOSS-ter) or Shingles vaccine, also
called Zostavax®?
IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED
RECEIVING THE PNEUMONIA VACCINE (PNEUSHOT^=1), GO TO PV7PNEUSHOT.
ELSE GO TO BOX PVEND.
[Have you/Has (SP)] EVER had a pneumonia shot?
(01) YES
(02) NO
This shot is usually given only once or twice in a person's lifetime and is
(-8) DON'T KNOW
different from the flu shot. It is also called the pneumococcal vaccine.
(-9) REFUSED
These next few questions are about preventive health care measures some (01) CONTINUE
people take.
(-7) EMPTY
(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
When was the most recent time [you/(SP)] had (your/his/her) blood pressure (04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
taken by a doctor or other health professional?
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD BLOOD PRESSURE TAKEN
(-8) DON'T KNOW
(-9) REFUSED
(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
When was the most recent time [you/(SP)] had (your/his/her) blood
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
cholesterol checked?
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD CHOLESTEROL CHECKED
(-8) DON'T KNOW
(-9) REFUSED
IF SP IS FEMALE, GO TO PV11 - MAMMOGRM.
ELSE GO TO BOX PV8.

Preventive Care (PVQ)
Variable Name
MR Screen Name

Question type

MAMMOGRM

PV11

yes/no

MAMCODE

PV11

code all

MAMNOTHS

PV11

verbatim text

PAPSMEAR

PV12

yes/no

Question text/description

Code list
(01) YES
These next few questions are about preventive health care measures some
(02) NO
people take. [Have you/Has (SP)] had a mammogram or a breast X-ray since
(-8) DON'T KNOW
(LAST HF MONTH YEAR, sample_person.DATE_FALLRND)?
(-9) REFUSED
(01) DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING
WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT
SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT BREAST
CANCER/COULD GET BREAST CANCER ANYWAY/TEST IS
USELESS
(04) NOT AT RISK FOR BREAST CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE MAMMOGRAMS/PAIN, SORENESS,
DISCOMFORT OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
What is the reason that [you have/(SP) has] not had a mammogram since
LOCATION/TRANSPORTATION DIFFICULTY
(LAST HF MONTH YEAR, sample_person.DATE_FALLRND)?
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
CHECK ALL THAT APPLY.
IT/PROCRASTINATED
(10) COST OF MAMMOGRAM/INSURANCE DOESN’T COVER
COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) MAMMOGRAM RADIATION COULD CAUSE CANCER/ILL
EFFECTS
(13) NEVER HEARD OF MAMMOGRAM
(14) APPOINTMENT SCHEDULED FOR FUTURE DATE
(15) MASTECTOMY/BREASTS REMOVED
(16) TOO ILL, PHYSICALLY/MENTALLY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
OTHER (SPECIFY)
(01) YES
[Have you/Has (SP)] had a Pap smear test since (LAST HF MONTH YEAR,
(02) NO
sample_person.DATE_FALLRND)?
(-8) DON'T KNOW
(-9) REFUSED

Preventive Care (PVQ)
Variable Name
MR Screen Name

Question type

Question text/description

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

PAPCODE

PV13

code all

PAPNOTHS

PV13

verbatim text

BOX PV7

routing

HYSTEREC

PV14

BOX PV8

Code list
(01) DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING
WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT
SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT CANCER/COULD GET
CANCER ANYWAY/TEST IS USELESS
(04) NOT AT RISK FOR CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE PAP SMEAR/PAIN, SORENESS, DISCOMFORT
OR REACTIONS
(08) INCONVENIENT/UNABLE TO GET TO
LOCATION/TRANSPORTATION DIFFICULTY
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF PAP SMEAR/INSURANCE DOESN’T COVER
COST/NOT WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) NEVER HEARD OF PAP SMEAR
(13) APPOINTMENT SCHEDULED FOR FUTURE DATE
(14) HAD HYSTERECTOMY/NO UTERUS, OVARIES
(15) TOO ILL, PHYSICALLY/MENTALLY
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

OTHER (SPECIFY)
IF RESPONDENT HAS NOT PREVIOUSLY REPORTED HYSTERECTOMY
(SAMPLE_PERSON.P_HYSTEREC^=1) AND RESPONSE TO PV13 – PAPCODE
DOES NOT INCLUDE 14/HadHysterectomy, GO TO PV14 - HYSTEREC.
ELSE GO TO BOX PVEND.

yes/no

[Have you/Has (SP)] ever had a hysterectomy?

routing

IF SP HAS EVER REPORTED HAVING PROSTATE SURGERY IN A PREVIOUS
ROUND (sample_person.P_PROSSURG=1), GO TO PV16 - DIGTEXAM.
ELSE GO TO PV15 - PROSSURG.

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

Preventive Care (PVQ)
Variable Name
MR Screen Name

Question type

Question text/description

Code list

[Since (LAST HF MONTH YEAR, sample_person.DATE_FALLRND), [have
you/has (SP)/[Have you/has (SP)] ever] had surgery on (your/his) prostate?
PROSSURG

PV15

yes/no

(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is typically used as a (-8) DON'T KNOW
treatment for prostate cancer or to correct urinary problems. Surgery can
(-9) REFUSED
include complete or partial removal of the prostate.]
[These next few questions are about [preventive health care measures some
people take/follow-up care sometimes prescribed after prostate surgery].

DIGTEXAM

PV16

yes/no

[Have you/Has (SP)] had a digital rectal examination (of the prostate) since
(LAST HF MONTH YEAR, sample_person.DATE_FALLRND)?
[EXPLAIN IF NECESSARY: The exam may be used to detect prostate cancer,
to determine whether cancer has spread beyond the prostate, and as part of
follow-up care after prostate surgery.]

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

[Have you/Has (SP)] had a blood test for detection of prostate cancer, known
as a PSA, since (LAST HF MONTH YEAR, sample_person.DATE_FALLRND)?
BLOODTST

PV17

yes/no

(01) YES
(02) NO
(-8) DON'T KNOW
[EXPLAIN IF NECESSARY: The test may be used to detect prostate cancer, to (-9) REFUSED
determine whether cancer has spread beyond the prostate, and as part of
follow-up care after prostate surgery.]
PSA = PROSTATE-SPECIFIC ANTIGEN

Preventive Care (PVQ)
Variable Name
MR Screen Name

Question type

PRONCODE

PV18

code all

PRONOTHS

PV18
BOX PVEND

verbatim text
routing

Question text/description

Code list
(01) DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING
WRONG
(02) NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT
SCREENING SCHEDULE
(03) DIDN’T THINK IT WOULD PREVENT CANCER/COULD GET
CANCER ANYWAY/TEST IS USELESS
(04) NOT AT RISK FOR CANCER
(05) DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
(06) DOCTOR RECOMMENDED AGAINST GETTING IT
(07) DON’T LIKE BLOOD TESTS/PAIN, SORENESS, DISCOMFORT
OR REACTIONS
What is the reason that [you have/(SP) has] not had a prostate blood test or
(08) INCONVENIENT/UNABLE TO GET TO
PSA since (LAST HF MONTH YEAR, sample_person.DATE_FALLRND)?
LOCATION/TRANSPORTATION DIFFICULTY
CHECK ALL THAT APPLY.
(09) DIDN’T THINK ABOUT IT/FORGOT/MISSED
IT/PROCRASTINATED
(10) COST OF TEST/INSURANCE DOESN’T COVER COST/NOT
WORTH THE MONEY
(11) AFRAID OF RESULTS/DON’T WANT TO KNOW
(12) NEVER HEARD OF PSA
(13) APPOINTMENT SCHEDULED FOR FUTURE DATE
(14) PROSTATECTOMY/PROSTATE REMOVED
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED
OTHER (SPECIFY)
GO TO NEXT SECTION.