Attachment A R79 HFQ revisions (Feb 2017 non-sub change request)

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

Question text/description

GENHELTH

In general, compared to other people [your/(SP's)] age, would you say that [your/his/her] health is . . .

HFA1

SHOW CARD HF1
COMPHLTH

HFA2

Compared to one year ago, how would you rate [your/(SP's)] health in general now?
Would you say [your/(SP's)] health is . . .

SHOW CARD HF2
FUTRHLTH

HFA2B
In the next 6 months, what do you think will happen to [your/(SP's)] overall health?

Now, I would like to ask you about [your/(SP's)] health.
DISHEAR

DIS1
[Are you/Is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?

DISSEE

DIS2

[Are you/Is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even when wearing glasses?

DISDECISION

DIS3

Because of a physical, mental, or emotional condition, [do you/does (SP)] have serious difficulty
concentrating, remembering, or making decisions?

DISWALK

DIS4

[Do you/Does (SP)] have serious difficulty walking or climbing stairs?

DISBATH

DIS5

[Do you/Does (SP)] have difficulty dressing or bathing?

DISERRANDS

DIS6

Because of a physical, mental, or emotional condition, [do you/does (SP)] have difficulty doing errands alone
such as visiting a doctor's office or shopping?

Code list
(01) excellent,
(02) very good,
(03) good,
(04) fair, or
(05) poor?
(-8) DON'T KNOW
(-9) REFUSED
(01) much better now than one year ago,
(02) somewhat better now than one year ago,
(03) about the same,
(04) somewhat worse now than one year ago, or
(05) much worse now than one year ago?
(-8) DON'T KNOW
(-9) REFUSED
(01) it will get much better
(02) it will get somewhat better
(03) it will not change
(04) it will get somewhat worse
(05) it will get much worse
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HELMTACT

HFA3

ECHELP

HFB1

ECTROUB

HFB2

ECLEGBLI

HFB2A

EDOCEXAM

HFB6

EDOCLAST

HFB7

EDOCTYPE

HFB7A

EDOCTYOS

HFB7A

EDOCDLAT

HFB7B

(01) none of the time,
How much of the time during the past month has [your/(SP's)] health limited [your/(SP's)] social activities, like (02) some of the time,
visiting with friends or close relatives?
(03) most of the time, or
(04) all of the time?
Would you say . . .
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
[Do you/Does (SP)] wear eyeglasses or contact lenses?
(03) SP IS BLIND
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE SEEING
(02) A LITTLE TROUBLE SEEING
Which statement best describes [your/(SP's)] vision [while wearing glasses or contact lenses]... no trouble
(03) A LOT OF TROUBLE SEEING
seeing, a little trouble, a lot of trouble, or no usable vision?
(04) NO USABLE VISION
(-8) DON'T KNOW
(-9) REFUSED
[Have you/Has (SP)] been told that [you are/he is/she is] legally blind?
(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with corrective lenses, they cannot (-8) DON'T KNOW
see well enough to drive.]
(-9) REFUSED
(01) YES
[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF MONTH YEAR)?
(02) NO
(-8) DON'T KNOW
INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
(-9) REFUSED
(01) NEVER HAD EYE EXAM BY EYE DOCTOR
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 5 YEARS
How long has it been since [your/(SP's)] last eye examination by an eye doctor?
(04) 5 YEARS OR MORE
(-8) DON'T KNOW
(-9) REFUSED
I have a couple of questions about [your/(SP’s)] last eye examination.
Was the eye examination given by an optometrist, ophthalmologist or some other type of doctor or eye care
professional?

(01) OPTOMETRIST
(02) OPHTHALMOLOGIST
(91) OTHER DOCTOR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED

[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry (O.D.) who diagnoses and treats visual
health problems. An ophthalmologist is a doctor of medicine (M.D.) who specializes in surgery and diseases of
the eye.]
OTHER (SPECIFY)
Again, thinking about [your/(SP’s)] last eye examination, were dilating drops used in [your/(SP)’s] eyes?
(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The drops often (-8) DON'T KNOW
make your eyes more sensitive to bright light and may cause temporary blurry vision.]
(-9) REFUSED

I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
other health professional that [you/he/she] had any of these conditions.
ECATARAC

HFB7C

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…

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

Cataracts?
EGLAUCOM

HFB7C

Glaucoma?

ERETINOP

HFB7C

Diabetic retinopathy?

EMACULAR

HFB7C

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

BOX HFB1A

IF ECATARAC=02/NO, GO TO BOX HFB1. ELSE GO TO HFB10 - ECCATOP.

ECCATOP

HFB10

[Have you/Has (SP)] ever had an operation for cataracts?

BOX HFB1

IF HFB7C - ERETINOP = 1/Yes OR HFB7C - EMACULAR = 1/Yes, GO TO HFB11 - ELASRSUR.
ELSE GO TO HFC1 - HCHELP.
Laser surgery to the back of the eye, or retina, is a commonly used treatment for diabetic retinopathy and
macular degeneration.

ELASRSUR

HFB11

[Have you/Has (SP)] ever had laser surgery to the back of either eye for one of these conditions?

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

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

[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to the front of the eye used to correct vision.]

HCHELP

HFC1

HCTROUB

HFC2

(01) YES
(02) NO
[Do you/Does (SP)] use a hearing aid?
(03) SP IS DEAF
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
Which statement best describes [your/(SP's)] hearing [with a hearing aid]: no trouble hearing, a little trouble, (03) A LOT OF TROUBLE HEARING
a lot of trouble, or deaf?
(04) DEAF
(-8) DON'T KNOW
(-9) REFUSED

HCKNOWMC

HFC3

HCCOMDOC

HFC4

FOODTRBL

HFD1A

HEIGHTFT

HFE1

HEIGHTIN

HFE1

WEIGHT

HFE1

DIFINTRO

HFHINTRO

DIFSTOOP

HFH1

DIFLIFT

HFH2

(01) NO TROUBLE
How much trouble [do you/does (SP)] have finding out things [you need/he needs/she needs] to know about (02) A LITTLE TROUBLE
Medicare because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you
(03) A LOT OF TROUBLE
have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
How much trouble [do you/does (SP)] have communicating with [your/his/her] doctor or other health
(02) A LITTLE TROUBLE
professional because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you
(03) A LOT OF TROUBLE
have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
(02) A LITTLE TROUBLE
How much trouble [do you/does (SP)] have eating solid foods because of problems with [your/his/her] mouth
(03) A LOT OF TROUBLE
or teeth? Would you say [you have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
How tall [are you/is (SP)]?
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
How tall [are you/is (SP)]?
(-8) DON'T KNOW
(-9) REFUSED
How much [do you/does (SP)] weigh?
(01) continuous answer
(-8) DON'T KNOW
[WEIGHT SHOULD BE RECORDED IN POUNDS]
(-9) REFUSED
Now, I'm going to ask about how difficult it is, on average, for [you/(SP)] to do certain kinds of activities.
(01) CONTINUE
Please tell me for each activity whether [you have/(SP) has] no difficulty at all, a little difficulty, some
(-7) Empty
difficulty, a lot of difficulty, or [is/are] not able to do it.
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or kneeling? Would you say [you
(04) A LOT OF DIFFICULTY
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or [is/are] not able to do (05) NOT ABLE TO DO IT
it?
(-8) Don't Know
(-9) Refused
SHOW CARD HF3
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as heavy as 10 pounds, like a
(03) SOME DIFFICULTY
heavy bag of groceries?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, (-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about reaching or extending arms above shoulder level?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty,
(-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping small objects?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty,
(-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty,
(-8) Don't Know
a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
We are interested in two types of physical activity - vigorous and moderate. Vigorous activities cause large
(01) CONTINUE
increases in breathing or heart rate. Moderate activities cause small increases in breathing or heart rate. First I
(-7) Empty
will ask about the vigorous activities that [you do/(SP) does].
(01) NUMBER OF MINUTES PER DAY
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
(02) NUMBER OF HOURS PER DAY
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart (03) NUMBER OF HOURS PER WEEK
rate?
(04) NUMBER OF HOURS PER MONTH
(96) NONE
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(-8) Don't Know
(-9) Refused
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart (01) [Continuous answer.]
rate?
(-8) Don't Know
(-9) Refused
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
(03) NUMBER OF HOURS PER WEEK
bicycling, gardening, golf, swimming, or vacuuming?
(04) NUMBER OF HOURS PER MONTH
(96) NONE
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(-8) Don't Know
(-9) Refused
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
(01) continous answer
bicycling, gardening, golf, swimming, or vacuuming?
SHOW CARD HF3

DIFREACH

HFH3

DIFWRITE

HFH4

DIFWALK

HFH5

PHYSACTINTRO

HFH10INT

VIGUNIT

HFH10

VIGNUM

HFH10

MODUNIT

HFH11

MODNUM

HFH11

Now I’m going to ask you about activities [you/(SP)] may do to increase [your/(SP)'s] muscle strength or
flexibility.
MUSUNIT

MUSNUM

HFH12

HFH12

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused

In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength
or flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?

(01) Continunous answer

In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength
or flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
Next, I'm going to read a list of medical conditions. [Since (LAST HF MONTH YEAR) has/Has] a doctor or other
health professional [ever] told [you/(SP)] that [you/he/she] had any of these conditions?
MEDCONDINTRO HFJINTRO

BOX HFJ1

OCARTERY

OCHBP

HFJ1

HFJ2

BOX HFJ2

YRHBP

OCMYOCAR

HFJ3

HFJ4

BOX HFJ3

YRMYOCAR

HFJ5

[INTERVIEWER: IF THE SP IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE RESPONSE
RECORDED SHOULD BE "YES" TO INDICATE THAT THE SP HAS THE CONDITION.]
IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN A PREVIOUS ROUND
(sample_person.P_OCHPB=1), GO TO HFJ2 - OCHBP.
ELSE GO TO HFJ1 - OCARTERY.
[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...
hardening of the arteries or arteriosclerosis?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] [still has/still have/had/has/have...]
hypertension, sometimes called high blood pressure?
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ3 - YRHBP.
ELSE GO TO HFJ4 - OCMYOCAR.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] still
had hypertension or high blood pressure?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
a myocardial infarction or heart attack?
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ5 - YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.

(01) CONTINUE
(-7) Empty

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

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

(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (02) NO
myocardial infarction or heart attack?
(-8) Don't Know
(-9) Refused

OCCHD

HFJ6

BOX HFJ4

YRCHD

OCCFAIL

HFJ7

HFJ8

BOX HFJ5

YRCFAIL

HFJ9

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] angina pectoris or coronary heart disease?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ7 - YRCHD.
ELSE GO TO HFJ8 - OCCFAIL.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
an episode of angina pectoris or coronary heart disease?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] congestive heart failure?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ9 - YRCFAIL.
ELSE GO TO HFJ14 - OCOTHHRT.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
an episode of congestive heart failure?

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

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

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

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] any other heart condition?
OCHRTCND

HFJ14
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
the rhythm of the heartbeat, such as atrial fibrillation.]

BOX HFJ8

YRHRTCND

[DO NOT RECORD THE NAME OF THE CONDITION AT THIS QUESTION.]
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ15 - YRHRTCND.
ELSE GO TO HFJ16 - OCSTROKE.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
an episode of any other heart condition?

HFJ15
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
the rhythm of the heartbeat, such as atrial fibrillation.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]

OCSTROKE

HFJ16

a stroke, a brain hemorrhage, or a cerebrovascular accident?
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]

BOX HFJ9

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

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

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

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

YRSTROKE

HFJ17

OCCHOLES

HFJ17A

YRCHOLES

HFJ17B

OCCSKIN

HFJ18

BOX HFJ10

YRCSKIN

HFJ19

OCCANCER

HFJ20

BOX HFJ11

YRCANCER

HFJ21

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (01) YES
stroke, a brain hemorrhage, or a cerebrovascular accident?
(02) NO
(-8) Don't Know
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
(-9) Refused
(01) YES
(02) NO
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had high cholesterol?
(-8) Don't Know
(-9) Refused
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
high cholesterol?
(-8) Don't Know
(-9) Refused
[I've recorded that [you/(SP)] previously reported having had skin cancer.]
(01) YES
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(02) NO
[you/he/she] had...]
(-8) Don't Know
(-9) Refused
[a new occurrence of] skin cancer?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ19 - YRCSKIN.
ELSE GO TO HFJ20 - OCCANCER.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
an occurrence of skin cancer?
(-8) Don't Know
(-9) Refused
[I've recorded that [you/(SP)] previously reported having had a tumor, growth, malignancy, or cancer of the
[READ RESPONSES BELOW].]
(01) YES
(02) NO
[Since (LAST HF MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(-8) Don't Know
[you/he/she] had any [other] kind of cancer, malignancy, or tumor other than skin cancer?
(-9) Refused
INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - OCCCODE.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
any kind of cancer, malignancy, or tumor other than skin cancer?

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

SHOW CARD HF4

OCCCODE

HFJ22

[Since the first time a doctor or other health professional told [you/(SP)] that [you/he/she] had a cancer,
malignancy, or tumor, on/On] what part or parts of [your/(SP's)] body was the cancer or tumor other than
skin cancer found?
[PROBE: Any other part?]
CHECK ALL THAT APPLY

OCCOS

HFJ22
BOX HFJ13

OCARTHRH

HFJ24

BOX HFJ13B

OCOSARTH

HFJ24B

BOX HFJ14

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

(01) LUNG
(02) COLON (BOWEL)
(03) BREAST
(04) UTERUS
(05) PROSTATE
(06) BLADDER
(07) OVARY
(08) STOMACH
(09) CERVIX
(10) BRAIN
(11) KIDNEY
(12) THROAT
(16) BLOOD
(17) BONE
(18) ESOPHAGUS
(19) GALL BLADDER
(20) LARYNX (WINDPIPE)
(21) LEUKOCYTES (LEUKEMIA)
(22) LIVER
(23) LYMPH NODES (LYMPHOMA)
(24) MOUTH/TONGUE/LIP
(25) PANCREAS
(26) RECTUM
(27) SOFT TISSUE/FAT
(28) TESTIS
(29) THYROID
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]

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

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

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

YRARTHRD

HFJ25

BOX HFJ15

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.

HFJ26

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
arthritis, other than rheumatoid or osteoarthritis, in any part of [your/his/her] body?

BOX HFJ16

OCMENTAL

HFJ28

BOX HFJ16A

OCALZMER

HFJ29A

BOX HFJ16B

OCDEMENT

HFJ29B

OCDEPRSS

HFJ30AA

BOX HFJ17A

YRDEPRSS

arthritis, other than rheumatoid or osteoarthritis?

HFJ30BB

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

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

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ28 - OCMENTAL.
ELSE GO TO BOX HFJ16A.
[Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had...]
an intellectual disability?
[EXPLAIN IF NECESSARY:] This is also known as intellectual development disorder or a general learning
disability. It was formerly known as mental retardation.
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCALMER=1), GO TO HFJ30AA - OCDEPRSS.
ELSE GO TO HFJ29A - OCALZMER.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]

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

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

Alzheimer's disease?
IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS ROUND (sample_person.P_OCDEMENT=1), GO
TO HFJ30AA - OCDEPRSS.
ELSE GO TO HFJ29B - OCDEMENT.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
any type of dementia other than Alzheimer's disease?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
depression?
(-9) Refused
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ30BB - YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
depression?
(-8) Don't Know
(-9) Refused

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

HFJ30A

BOX HFJ17B

YRPSYCHO

HFJ31A

BOX HFJ19

OCOSTEOP

HFJ32

OCBRKHIP

HFJ33

BOX HFJ20

YRBRKHIP

HFJ34

BOX HFJ21

OCPARKIN

HFJ35

BOX HFJ22

OCEMPHYS

HFJ36

a mental or psychiatric disorder other than depression?

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

[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ31A - YRPSYCHO.
ELSE GO TO BOX HFJ19.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (01) YES
mental or psychiatric disorder other than depression?
(02) NO
(-8) Don't Know
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
(-9) Refused
IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND (sample_person.P_OCOSTEOP=1),
GO TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
osteoporosis, sometimes called fragile or soft bones?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]]
(02) NO
(-8) Don't Know
a broken hip?
(-9) Refused
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (02) NO
broken hip?
(-8) Don't Know
(-9) Refused
IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCPARKIN=1), GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
Parkinson's disease?
(-9) Refused
IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A PREVIOUS ROUND
(sample_person.P_OCEMPHYS=1), GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
(01) YES
(02) NO
emphysema, asthma, or COPD?
(-8) Don't Know
(-9) Refused
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE

OCPPARAL

HFJ37

BOX HFJ23

YRPPARAL

IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK. OTHERWISE,
ASK:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
complete or partial paralysis?
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.

HFJ38

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

BOX HFJ24

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

OCAMPUTE

HFJ39
What about absence or loss of an arm or a leg?
BOX HFJ25

HAVEPROS

HFJ40

YRPROST

HFJ41

[[Before (you/[SP]) had prostate surgery, did a doctor or other health professional ever tell/Since (LAST HF
MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that [you/he] had...]

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

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

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ41 - YRPROST.
ELSE GO TO HFJ41A - OCBETES.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he] had an
enlarged prostate or benign prostatic hypertrophy (BPH)?
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had any type of diabetes,
including:

OCBETES

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

IF SP IS FEMALE (ROSTSEX=2 or (roster.ROSTSEX=2 where ROSTNUM=1)), GO TO HFJ41A - OCBETES.
ELSE GO TO HFJ40 - HAVEPROS.

an enlarged prostate or benign prostatic hypertrophy (BPH)?
BOX HFJ26

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

HFJ41A
sugar diabetes, high blood sugar, (borderline diabetes, pre-diabetes, or pregnancy-related
diabetes/borderline diabetes, or pre-diabetes)?

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

SHOW CARD HF5
Looking at this card, please tell me which type of diabetes the doctor or other health professional said that
[you have/(SP) has].
OCDTYPE

HFJ41B

OCDTYPOS

HFJ41B

OCDVISIT

HFJ41C

BOX HFJ27

EMCOND

EMCAUSEVB

HFJ42

HFJ43
BOX HFJ28

(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST RECENT TYPE OF (04) PRE-DIABETES
DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
(05) GESTATIONAL (PREGNANCY-RELATED)
(91) SOME OTHER TYPE
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or “juvenile-onset” diabetes. This (-8) Don't Know
type of diabetes usually develops during childhood or adolescence; but, it also can develop in adults.
(-9) Refused
“Type 2” was formerly called “non-insulin dependent” or “adult-onset” diabetes. Until recently, this type of
diabetes was found only in adults; but, now it is also occurring in children.]
SOME OTHER TYPE (SPECIFY)
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST RECENT TYPE OF
DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
[Were you/Was (SP)] told on two or more different visits that [you/he/she] had diabetes?

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

IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT MEDICARE ELIGIBILITY WAS
UNDER 65 (sample_person.INTTYPE=3 and sample_person.AGECUREL<65 but not equal to 0) THEN
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO HFJ42 - EMCOND.
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 - EMCAUSEVB.
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT TIME OF CURRENT MEDICARE ELIGIBILITY
WAS NOT UNDER 65 THEN GO TO HFPINTRO - HLTHCAREINTRO.
You told me that [you have/(SP) has] had [READ CONDITIONS LISTED BELOW]. [Was this/Were any of these]
the original cause of [your/(SP's)] becoming eligible for Medicare?
[LIST ALL CONDITIONS WHERE "YES" ANSWER RECORDED AT HFJ1 THROUGH HFJ41C]
[NOTE THAT CONDITIONS MAY NOT BE DISPLAYED WITH THE EXACT CONDITION NAME THAT WAS USED
EARLIER IN THE INTERVIEW (E.G., HYPERTENSION CAN ALSO BE CALLED HIGH BLOOD PRESSURE AT
DIFFERENT QUESTIONS).]
What was the original cause of [your/(SP's)] becoming eligible for Medicare?
RECORD VERBATIM.
IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO HFPINTRO - HLTHCAREINTRO.
ELSE GO TO HFJ44 - EMCODE.

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

(01) [Continuous answer.]

EMCODE

HFJ44

EMOS

HFJ44

OTHER (SPECIFY)

(01) ARTERIES HARDENING
(02) HYPERTENSION
(03) HEART ATTACK
(04) HEART DISEASE
(05) CONGESTIVE HEART FAILURE
(06) HEART VALVE PROBLEM
(07) HEART RHYTHM PROBLEM
(08) OTHER HEART PROBLEM
(09) STROKE OR HEMORRHAGE
(10) SKIN CANCER
(11) CANCER/TUMOR
(12) RHEUMATOID ARTHRITIS
(26) OSTEOARTHRITIS
(13) OTHER ARTHRITIS
(14) INTELLECTUAL DISABILITY
(15) ALZHEIMER'S
(16) DEMENTIA
(17) DEPRESSION
(18) MENTAL DISORDER
(19) OSTEOPOROSIS
(20) BROKEN HIP
(21) PARKINSON'S
(22) EMPHYSEMA/ASTHMA/COPD
(23) PARALYSIS
(24) LOSS OF LIMB
(25) DIABETES
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]

HLTHCAREINTRO

HFPINTRO

Now I want to ask you about some things that [you/(SP)] may be doing to maintain [your/his/her] health,
either by getting tested for health problems or by taking care of conditions that [you have/she has/he has].

(01) CONTINUE
(-7) Empty

Which of these conditions was the cause of [your/(SP's)] becoming eligible for Medicare?

BOX HFP1A

DIAAGE

HFP1

BOX HFP2

DIAPRGNT

HFP2

[PROBE: Any other condition?]
CHECK UP TO 8 CONDITIONS.

IF (HFJ41A – OCBETES = 1/Yes) AND (HFJ41B - OCDTYPE = 1/TypeOne, 2/TypeTwo, 3/Borderline,
4/PreDiabetes, 91/Other, DK, or RF), GO TO HFP1 - DIAAGE.
ELSE GO TO HFP21 - DIAEVERT.
I recorded that [you were/(SP) was] told by a doctor or other health professional that [you have/she has/he
has] [Type 1 diabetes/Type 2 diabetes/borderline diabetes/pre-diabetes/diabetes].
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had diabetes?
IF THE SP IS FEMALE (ROSTSEX=2) AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR (HFP1 – DIAAGE = DK OR RF),
GO TO HFP2 - DIAPRGNT.
ELSE GO TO HFP4 - DIAINSUL.
Did [you/(SP)] have diabetes only during a pregnancy?

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

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

DIAINSUL

DIAMEDS

DIATEST

DIASORES

DIAPRESS

DIAASPRN

HFP4

HFP4

HFP4

HFP4

HFP4

HFP4

BOX HFP3

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take insulin?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take prescription diabetes pills or oral diabetes medicine?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
test [your/his/her] blood for sugar or glucose?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
check for sores or irritations on [your/his/her] feet?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
measure [your/his/her] blood pressure at home?
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take aspirin regularly for [your/his/her] diabetes?
IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE.
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

INSUTAKE

HFP5

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

INSUDAY
INSUWEEK

HFP5
HFP5

How often [do you/does (SP)] take insulin?
How often [do you/does (SP)] take insulin?
IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

BOX HFP4

MEDSTAKE

HFP6

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

MEDDAY
MEDWEEK

HFP6
HFP6

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

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

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) USE INSULIN PUMP
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) [Continuous answer.]

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) [Continuous answer.]

MEDMONTH

HFP6
BOX HFP5

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?

TESTTAKE

HFP7

[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]

(01) [Continuous answer.]

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused

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

HFP7

TESTWEEK

HFP7

TESTMNTH

HFP7

TESTYEAR

HFP7

BOX HFP6

[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?

SORECHEK

HFP8

[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]

(01) [Continuous answer.]

(01) [Continuous answer.]

(01) [Continuous answer.]

(01) [Continuous answer.]

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused

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

HFP8

SOREWEEK

HFP8

SOREMNTH

HFP8

[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]

(01) [Continuous answer.]

(01) [Continuous answer.]

(01) [Continuous answer.]

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

HFP8

DIATENYR

HFP10

DIADRSAW

HFP11

DIAHEMOC

HFP13

DIACTRLD

HFP14

DIAHYPO

HFP14A1

DIAHYPTR

HFP14A2

DIAFTEVR

HFP14A3

DIAFEET

HFP14A

[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]

(01) [Continuous answer.]

(01) YES
(02) NO
In the past year has a doctor or other health professional examined [your/his/her] feet for sores or irritations?
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
About how many times in the past year [have you/has (SP)] seen a doctor or other health professional for
(-8) Don't Know
[your/his/her] diabetes?
(-9) Refused
A test of hemoglobin "A one C" measures the average level of blood sugar over the past three months. It is
(01) [Continuous answer.]
usually done in a doctor's office. About how many times in the past year has a doctor or other health
(-8) Don't Know
professional checked [you/(SP)] for hemoglobin "A one C"?
(-9) Refused
(01) ALL OF THE TIME
SHOW CARD HF6
(02) MOST OF THE TIME
(03) SOME OF THE TIME
Would you say that [your/(SP)'s] blood sugar is well controlled all of the time, most of the time, some of the (04) A LITTLE OF THE TIME
time, a little of the time, or none of the time? By "well controlled" we mean a recent hemoglobin "A one C" (05) NONE OF THE TIME
result of 7.5 or less or an average fasting blood test of 140 or less.
(-8) Don't Know
(-9) Refused
(01) YES
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood sugar or an
(02) NO
insulin reaction?
(-8) Don't Know
(-9) Refused
Please think about the most serious episode of hypoglycemia that [you have/(SP) has] experienced in the past
year.
(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
[Were you/Was (SP)] able to treat [yourself/himself/herself] by taking some form of sugar, did [you/he/she]
(03) HOSPITAL TREATMENT
require treatment from others, or did [you/he/she] require treatment by a hospital?
(-8) Don't Know
(-9) Refused
[EXPLAIN IF NECESSARY: Treatment by a hospital includes being treated in the emergency room or outpatient
department of a hospital, or being admitted as an inpatient.]
(01) YES
(02) NO
[Have you/Has (SP)] ever had any problems with [your/his/her] feet as a result of [your/his/her] diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
[Do you/Does (SP)] currently have any problems with [your/his/her] feet as a result of [your/his/her]
(02) NO
diabetes?
(-8) Don't Know
(-9) Refused

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

HFP14B
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
Neuropathy or nerve damage, which may cause pain or numbness in the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]

DIACIRCF

HFP14B
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
Poor circulation or blood flow in the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]

DIAULCER

HFP14B
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
Foot ulcers?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.]

DIASKINC

HFP14B
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…

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

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

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

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

Calluses, infections, or other skin changes affecting the feet?
DIAEYPRB

HFP15

DIAKDPEV

HFP16A1

DIAKDPRB

HFP16

DIAKIDNY

HFP16A

(01) YES
(02) NO
[Do you/Does (SP)] have any problems with [your/his/her] eyes as a result of [your/his/her] diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
[Have you/Has (SP)] ever had any problems with [your/his/her] kidneys as a result of [your/his/her] diabetes?
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]
(-9) Refused
(01) YES
[Do you/Does (SP)] currently have any problems with [your/his/her] kidneys as a result of [your/his/her]
(02) NO
diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you have/she has/he has]
(02) NO
chronic kidney disease?
(-8) Don't Know
(-9) Refused

DIAMNGE

HFP17

DIATRAIN

HFP18

BOX HFP7

DIAKNOW

HFP19

DIASUPPS

HFP20

DIAEVERT

HFP21

DIARECNT

HFP22

BOX HFP8

DIAAWARE

HFP23

DIARISK

HFP24

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
When was the most recent time that [you/(SP)] participated in a diabetes self-management course or class or (02) 1 YEAR TO LESS THAN 2 YEARS AGO
received special training on how [you/he/she] can manage [your/his/her] diabetes?
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE MOST RECENT (05) 5 OR MORE YEARS AGO
TIME.]
(-8) Don't Know
(-9) Refused
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.
(01) just about everything you need to know,
(02) most of what you need to know,
(03) some of what you need to know,
SHOW CARD HF7
(04) a little of what you need to know, or
(05) almost none of what you need to know about
How much do you think you know about managing your diabetes? Do you know . . .
managing your diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
Before today, did you know that Medicare now helps pay the cost of diabetic testing supplies and self(02) NO
management education for people with diabetes?
(-8) Don't Know
(-9) Refused
[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you
(01) YES
have/she has/he has] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever had a blood test to see if [you have/she has/he has] diabetes?
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
When was the most recent time [you were/(SP) was] tested for diabetes?
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP23 - DIAAWARE.
ELSE GO TO HFP24 - DIARISK.
(01) YES
(02) NO
Before today, were you aware that there is a blood test to determine if a person has diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
(02) NO
diabetes?
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever participated in a diabetes self-management course or class, or received special
training on how [you/he/she] can manage [your/his/her] diabetes?

DIASIGNS

HFP25

In the past year, [have you/has (SP)] received any information about the signs, symptoms, or risk factors for
diabetes?

BOX HFR1

IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS UNKNOWN P_COLHEAR=.) AND (SP HAS
NOT REPORTED HAVING COLON, RECTAL OR BOWEL CANCER IN THE CURRENT ROUND OR IN A PREVIOUS
ROUND (OCCCODE not in 02 and P_OCCCOLON^=1), GO TO HFR1 - COLHEAR.
ELSE GO TO BOX HFS1.
Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower intestines.

COLHEAR

HFR1
Before today, had you ever heard of colorectal or colon cancer?

COLHTEST

HFR3

COLHKIT

HFR4

COLFDOC

HFR4A

COLCARD

HFR5

COLRECNT

HFR7

COLSCOPY

HFR8

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

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

The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at (01) YES
the patient’s home. The test is then sent to a laboratory for the results to be determined.
(02) NO
(-8) Don't Know
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for blood in the
(-9) Refused
stool?
(01) YES
(02) NO
Have you ever heard of this home testing kit?
(-8) Don't Know
(-9) Refused
(01) YES
Has a doctor or other health professional ever performed a fecal occult blood test to test for blood in the stool (02) NO
while [you/(SP)] [were/was] at the doctor’s office?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Did [you/(SP)] complete the samples and return them for [your/his/her] most recent test?
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
When did [you/(SP)] have [your/his/her] most recent blood stool test (using a home testing kit)?
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
Another test for early signs of colon cancer is performed in the doctor's office. The doctor uses a flexible
(01) YES
lighted tube to examine the colon and rectum directly. This is called a sigmoidoscopy or colonoscopy.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever had this exam?
(-9) Refused

WHENSCOP

HFR9

When did [you/(SP)] have [your/his/her] most recent sigmoidoscopy or colonoscopy?

HEARSCOP

HFR10

Before today, had you ever heard of a sigmoidoscopy or colonoscopy?

BOX HFR2

IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 - COLSCRNS.
ELSE GO TO BOX HFS1.

COLDRREC

HFR11

Has a doctor or other health professional ever recommended that [you/(SP)] have this test?

COLSCRNS

HFR13

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

BOX HFS1

IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT ROUND OR IN A PREVIOUS ROUND
(OCOSTEOP=1 or sample_person.P_OCOSTEOP-=1 GO TO HFS3 - OSTTEST.
ELSE GO TO HFSINTRO - OSTINTRO.
Now I'd like to talk about a disease called osteoporosis, which can be treated if found early. In osteoporosis,
the bones lose their calcium and become fragile and more easily broken.

OSTINTRO

HFSINTRO

OSTEVERT

HFS1

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

OSTHRISK

HFS2

Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
osteoporosis?

OSTFRACT

HFS2A

Have [you/(SP)] ever experienced a fracture that [your/his/her] doctor or other health professional told
[you/him/her] was related to osteoporosis?

OSTTEST

HFS3

There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?

OSTHEAR

HFS4

Before today, had you ever heard of this test?

(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

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

(01) CONTINUE
(-7) Empty
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

OSTRECNT

HFS5

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

OSTMASS

HFS6

Before today, did you know that Medicare would pay for Bone Mass or Bone Density Measurement tests for
Medicare beneficiaries who are at risk for osteoporosis?
Next, we are going to ask some questions about [your/(SP's)] health care needs during the past year.

HCTROUBL

HFAC29

Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that [you/he/she]
wanted or needed?

Why was that?
HCTCODE

HFAC30A

HCTOTHOS

HFAC30A
BOX HFF6

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

OTHER (SPECIFY)
IF RESPONSE TO HFAC30A - HCTCODE INCLUDES 8/DrDoesNotAcceptMedicare OR 10/DifficultyGettingAppt,
GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC30B - CGETAPPT.

(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) SP DOES NOT HAVE MONEY
(02) COST IS TOO HIGH
(03) SERVICES/SUPPLIES NOT COVERED
(04) NEEDED TRANSPORTATION TO
DOCTOR/HOSPITAL
(05) DIFFICULTY GETTING HOME HEALTH CARE
(06) NO TREATMENT AVAILABLE/DOCTOR WON’T
TREAT
(07) WAIT TOO LONG/DOCTOR TOO BUSY
(08) OWN DOCTOR DOESN’T ACCEPT
MEDICARE/COULDN’T FIND DOCTOR WHO ACCEPTS
MEDICARE
(09) NOT ELIGIBLE FOR PUBLIC COVERAGE
(10) DIFFICULTY GETTING APPOINTMENT/ DELAYS
BECAUSE SP ON MEDICARE
(11) DOCTOR REFERRED SP TO SPECIALIST OR OTHER
DOCTOR
(12) HMO REFERRAL PROCESS (DIFFICULTY GETTING)
(13) PROBLEMS WITH HMO DOCTORS NOT GOOD OR
AVAILABLE
(14) HMO WOULD NOT COVER OR PROVIDE SERVICE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]

CGETAPPT

HFAC30B

(01) YES
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office that they cannot schedule an (02) NO
appointment with [you/(SP)]?
(-8) Don't Know
(-9) Refused

What were the reasons the doctor’s office offered as an explanation for not scheduling an appointment with
[you/(SP)]?
CGETCODE

HFAC30C
[PROBE: Any other reason?]
CHECK ALL THAT APPLY

CGETOTOS

CGETOTOS
BOX HFF7

OFFEXPLN

HFAC30D

OFFEXVB

HFAC30E

HCDELAY

HFAC31

PAYPROB

HFAC32A

COLLAGNCY

HFAC32

PAYOVRTM

HFAC32B

(01) DOCTOR DOES NOT ACCEPT INSURANCE PLAN
(02) ALL OF DOCTORS APPOINTMENTS WERE FULL
(03) DOCTOR IS NOT ACCEPTING ANY NEW PATIENTS
(04) DOCTOR IS NOT ACCEPTING NEW MEDICARE
PATIENTS
(05) DOCTRS HOURS CONFLICTED WITH
REQUIREMENTS OF SP
(06) DOCTOR DOES NOT ACCEPT MEDICAID
(07) DOCTOR DOES NOT ACCEPT MEDICARE AT ALL
(08) DOCTOR DOES NOT ACCEPT MEDICARE
ASSIGNMENT
(09) DOCTOR FELT ANOTHER PROVIDER WOULD BE
BETTER FOR SP
(91) OTHER
(-8) Don't Know
(-9) Refused

Please specify the other reason.
(01) [Continuous answer.]
IF RESPONSE TO HFAC30C - CGETCODE INCLUDES 4/DocNotAcceptNewMedicare OR 7/DocNotAcceptMCAR,
GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.
(01) YES
Did the doctor’s office explain why [it is difficult for Medicare patients to get an appointment/Medicare is not (02) NO
accepted] at that practice?
(-8) Don't Know
(-9) Refused
What was that explanation?
(01) [Continuous answer.]
RECORD VERBATIM.
(01) YES
Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care because (you were/he
(02) NO
was/she was) worried about the cost?
(-8) Don't Know
(-9) Refused
(01) YES
Since (LAST HF MONTH YEAR) [have you/has (SP)] had problems paying or were unable to pay any medical
(02) NO
bills?
(-8) Don't Know
(-9) Refused
(01) YES
Because of problems paying medical bills since (LAST HF MONTH YEAR), [have you/has (SP)] been contacted (02) NO
by a collection agency?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
[Do you /Does (SP)] currently have any medical bills that are being paid off over time?
(-8) Don't Know
(-9) Refused

IADLINTRO

HFKINTRO

PRBTELE

HFKA1

DONTTELE

HFKA2

PRBLHWK

HFKB1

DONTLHWK

HFKB2

PRBHHWK

HFKC1

DONTHHWK

HFKC2

PRBMEAL

HFKD1

DONTMEAL

HFKD2

PRBSHOP

HFKE1

Health problems can include physical, mental, emotional, or memory problems. I'd now like to ask you about
(01) CONTINUE
how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d like to
(-7) Empty
know whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself].
(01) YES
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
(02) NO
(03) DOESN'T DO
using the telephone?
(-8) Don't Know
(-9) Refused
(01) YES
[You said that using the telephone is something that [you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused
(01) YES
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
doing light housework (like washing dishes, straightening up, or light cleaning)?
(-8) Don't Know
(-9) Refused
[You said that doing light housework (like washing dishes, straightening up, or light cleaning) is something that (01) YES
[you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused
(01) YES
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
doing heavy housework (like scrubbing floors or washing windows)?
(-8) Don't Know
(-9) Refused
[You said that doing heavy housework (like scrubbing floors or washing windows) is something that [you
(01) YES
don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused
(01) YES
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
preparing [your/his/her] own meals?
(-8) Don't Know
(-9) Refused
(01) YES
[You said that preparing [your/his/her] own meals is something that [you don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused
(01) YES
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
(02) NO
(03) DOESN'T DO
shopping for personal items (such as toilet items or medicines)?
(-8) Don't Know
(-9) Refused

DONTSHOP

HFKE2

[You said that shopping for personal items (such as toilet items or medicines) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

PRBBILS

HFKF1
managing money (like keeping track of expenses or paying bills)?

DONTBILS

HFKF2

BOX HFKA1

HELPTELE

HFKA3

PERSON_HLPRTEL
HFKA4
E
BOX HFKB1

HELPLHWK

[You said that managing money (like keeping track of expenses or paying bills) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO HFKA3 - HELPTELE.
ELSE GO TO BOX HFKB1.
[[You said that [your/(SP's)] health makes using the telephone difficult./You said that using the telephone is
something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
using the telephone?
You mentioned that [you receive/(SP) receives] help with using the telephone. Who gives that help?
ENTER ALL HELPERS.
IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO HFKB3 - HELPLHWK.
ELSE GO TO BOX HFKC1.
[[You said that [your/(SP's)] health makes doing light housework (like washing dishes, straightening up, or
light cleaning) difficult./You said that doing light housework (like washing dishes, straightening up, or light
cleaning) is something that [you don't do/(SP) doesn't do].]]

HFKB3
[Do you/Does (SP)] receive help from another person with...

PERSON_HLPRLH
WK

HFKB4
BOX HFKC1

HELPHHWK

HFKC3

PERSON_HLPRHH
HFKC4
WK

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

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

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

doing light housework (like washing dishes, straightening up, or light cleaning)?
You mentioned that [you receive/(SP) receives] help with doing light housework (like washing dishes,
(01) [Continuous answer.]
straightening up, or light cleaning). Who gives that help?
IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 - HELPHHWK.
ELSE GO TO BOX HFKD1
[[You said that [your/(SP's)] health makes doing heavy housework (like scrubbing floors or washing windows)
difficult./You said that heavy housework (like scrubbing floors or washing windows) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
doing heavy housework (like scrubbing floors or washing windows)?
You mentioned that [you receive/(SP) receives] help with doing heavy housework (like scrubbing floors or
washing windows). Who gives that help?
ENTER ALL HELPERS.

(01) [Continuous answer.]

BOX HFKD1

HELPMEAL

HFKD3

PERSON_HLPRME
HFKD4
AL
BOX HFKE1

HELPSHOP

HFKE3

PERSON_HLPRSH
HFKE4
OP
BOX HFKF1

HELPBILS

HFKF3

PERSON_HLPRBILS HFKF4

ADLSINTRO

HFLINTRO

HPPDBATH

HFLA1

IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO HFKD3 - HELPMEAL.
ELSE GO TO BOX HFKE1.
[[You said that [your/(SP's)] health makes preparing [your/his/her] own meals difficult./You said that
preparing [your/his/her] own meals is something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...

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

preparing [your/his/her] own meals?
You mentioned that [you receive/(SP) receives] help with preparing [your/his/her] own meals. Who gives that
help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO HFKE3 - HELPSHOP.
ELSE GO TO BOX HFKF1.
[[You said that [your/(SP's)] health makes shopping for personal items (such as toilet items or medicines)
difficult./You said that shopping for personal items (such as toilet items or medicines) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
shopping for personal items (such as toilet items or medicines)?
You mentioned that [you receive/(SP) receives] help with shopping for personal items (such as toilet items or
medicines). Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO HFKF3 - HELPBILS.
ELSE GO TO HFLINTRO - ADLSINTRO.
[[You said that [your/(SP's)] health makes managing money (like keeping track of expenses or paying bills)
difficult./You said that managing money (like keeping track of expenses or paying bills) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
managing money (like keeping track of expenses or paying bills)?
You mentioned that [you receive/(SP) receives] help with managing money (like keeping track of expenses or
paying bills). Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
Remembering that health problems can include physical, mental, emotional, or memory problems, I'd now
like to ask you about how health problems may affect [your/(SP)'s] ability to perform some other everyday
(01) CONTINUE
activities. I’d like to know whether [you have/(SP) has] any difficulty doing each activity by
(-7) Empty
[yourself/himself/herself] and without special equipment.
(01) YES
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
(02) NO
(03) DOESN'T DO
bathing or showering?
(-8) Don't Know
(-9) Refused

[You said that bathing or showering is something that [you don't/(SP) doesn't] do.]
DONTBATH

HFLA2
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

HPPDDRES

HFLB1
dressing?
[You said that dressing is something that [you don't/(SP) doesn't] do.]

DONTDRES

HFLB2
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

HPPDEAT

HFLC1
eating?
[You said that eating is something that [you don't/(SP) doesn't] do.]

DONTEAT

HFLC2
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

HPPDCHAR

HFLD1
getting in or out of bed or chairs?
[You said that getting in or out of bed or chairs is something that [you don't/(SP) doesn't] do.]

DONTCHAR

HFLD2
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

HPPDWALK

HFLE1
walking?
[You said that walking is something that [you don't/(SP) doesn't] do.]

DONTWALK

HFLE2
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

HPPDTOIL

HFLF1
using the toilet, including getting up and down?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
DONTTOIL

HFLF2
Is this because of a physical, mental, emotional, or memory problem?
BOX HFLA1

HELPBATH

HFLA3

IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO HFLA3 - HELPBATH.
ELSE GO TO BOX HFLB1.
[[You said [your/(SP's)] health makes bathing or showering difficult./You said that bathing or showering is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or showering?
Does someone usually stay nearby just in case [you need/(SP) needs] help with bathing or showering?

PCHKBATH

HFLA4
[That is, does someone usually stay or come into the room to check on [you/him/her]?]

EQIPBATH

LONGBATH

STILBATH

HFLA5

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

BOX HFLA2

IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH.
ELSE GO TO BOX HFLB1.

HFLA6

HFLA7

BOX HFLB1

HELPDRES

HFLB3

How long [have you/has (SP)] needed help with bathing or showering? Has it been . . .

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

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

IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO HFLB3 - HELPDRES.
ELSE GO TO BOX HFLC1.
[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is something [you don't/(SP)
doesn't] do.]]

Does someone usually stay nearby just in case [you need/(SP) needs] help with dressing?
HFLB4
[That is, does someone usually stay or come into the room to check on [you/him/her]?]

EQIPDRES

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

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

[Do you/Does (SP)] receive help from another person with dressing?
PCHKDRES

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

HFLB5

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

BOX HFLB2

IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES.
ELSE GO TO BOX HFLC1.

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

LONGDRES

STILDRES

HFLB6

HFLB7

BOX HFLC1

HELPEAT

HFLC3

How long [have you/has (SP)] needed help with dressing? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

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

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

IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 - HELPEAT.
ELSE GO TO BOX HFLD1.
[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you don't/(SP)
doesn't] do.]]
[Do you/Does (SP)] receive help from another person with eating?
Does someone usually stay nearby just in case [you need/(SP) needs] help with eating?

PCHKEAT

HFLC4
[That is, does someone usually stay or come into the room to check on [you/him/her]?]

EQIPEAT

LONGEAT

STILEAT

HFLC5

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

BOX HFLC2

IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.

HFLC6

HFLC7

BOX HFLD1

HELPCHAR

HFLD3

PCHKCHAR

HFLD4

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

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

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

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

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

IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO HFLD3 - HELPCHAR.
ELSE GO TO BOX HFLE1.
[[You said [your/(SP's)] health makes getting in or out of bed or chairs difficult./You said that getting in or out (01) YES
of bed or chairs is something [you don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?
(-9) Refused
Does someone usually stay nearby just in case [you need/(SP) needs] help with getting in or out of bed or
(01) YES
chairs?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
(-9) Refused

EQIPCHAR

LONGCHAR

STILCHAR

HFLD5

[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with getting in or out of bed or
chairs?

BOX HFLD2

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.

HFLD6

HFLD7

BOX HFLE1

HELPWALK

HFLE3

How long [have you/has (SP)] needed help with getting in or out of bed or chairs? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

Do you expect that [you/(SP)] will still need help with getting in or out of bed or chairs three months from
now?

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

IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 - HELPWALK.
ELSE GO TO BOX HFLF1.
[[You said [your/(SP's)] health makes walking difficult./You said that walking is something [you don't/(SP)
doesn't] do.]]
[Do you/Does (SP)] receive help from another person with walking?
Does someone usually stay nearby just in case [you need/(SP) needs] help with walking?

PCHKWALK

HFLE4
[That is, does someone usually stay or come into the room to check on (you/him/her)?]

EQIPWALK

LONGWALK

STILWALK

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

HFLE5

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

BOX HFLE2

IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.

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

How long [have you/has (SP)] needed help with walking? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

HFLE7

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

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

BOX HFLF1

IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO HFLF3 - HELPTOIL.
ELSE GO TO BOX HFLA3.

HFLE6

HELPTOIL

HFLF3

PCHKTOIL

HFLF4

EQIPTOIL

HFLF5

BOX HFLF2

LONGTOIL

STILTOIL

HFLF6

HFLF7

BOX HFLA3
PERSON_HLPRBAT
HFLA9
H
BOX HFLB3
PERSON_HLPRDRE
HFLB9
S
BOX HFLC3

[[You said [your/(SP's)] health makes using the toilet difficult./You said that using the toilet is something [you (01) YES
don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with using the toilet, including getting up and down?
(-9) Refused
Does someone usually stay nearby just in case [you need/(SP) needs] help with using the toilet, including
(01) YES
getting up and down?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(-9) Refused
(01) YES
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with using the toilet, including getting (02) NO
up and down?
(-8) Don't Know
(-9) Refused
IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.

How long [have you/has (SP)] needed help with using the toilet? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

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

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

IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH.
ELSE GO TO BOX HFLB3.
You mentioned that [you receive/(SP) receives] help with bathing and showering. Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES.
ELSE GO TO BOX HFLC3.
You mentioned that [you receive/(SP) receives] help with dressing. Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT.
ELSE GO TO BOX HFLD3.
You mentioned that [you receive/(SP) receives] help with eating. Who gives that help?

PERSON_HLPREAT HFLC9
BOX HFLD3
PERSON_HLPRCH
HFLD9
AR
BOX HFLE3

(01) [Continuous answer.]
ENTER ALL HELPERS.
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.
You mentioned that [you receive/(SP) receives] help with getting in or out of bed or chairs. Who gives that
help?
ENTER ALL HELPERS.
IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK.
ELSE GO TO BOX HFLF3.

(01) [Continuous answer.]

PERSON_HLPRWA
HFLE9
LK
BOX HFLF3
PERSON_HLPRTOI
HFLF9
L
BOX HFL4
PERSON_HLPRMO
HFL10
ST

FALLANY

HFM1

You mentioned that [you receive/(SP) receives] help with walking. Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL.
ELSE GO TO BOX HFL4.
You mentioned that [you receive/(SP) receives] help with using the toilet. Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9, HFLD9, HFLE9, AND/OR HFLF9, GO TO
HFL10 - PERSON_HLPRMOST.
ELSE GO TO HFM1 - FALLANY.
Which of these persons gives [you/(SP)] the most help with these things?
(01) [Continuous answer.]
SELECT ONLY ONE.
Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?
Since (LAST HF MONTH YEAR), how many times [have you/has (SP)] fallen down?

FALLTIME

HFM2
ENTER "95" IF 95 OR MORE FALLS REPORTED.

FALLHELP

HFM3A

Thinking about the [most recent) time that [you/(SP)] fell, did [you/he/she] hurt [yourself/himself/herself]
badly enough to get medical help?

What kind of injury did [you/(SP)] have in that [most recent] fall?
FALCODE

HFM3B

[PROBE: Anything else?]
CHECK ALL THAT APPLY.

FALOTHOS

HFM3B

OTHER (SPECIFY)

FALLIMIT

HFM3C

Did [your/(SP's)] [most recent] fall cause [you/him/her] to limit [your/his/her] regular acivities?

FALLBACK

HFM3D

How long did it take [you/(SP)] to get back to regular activities after [your/his/her] [most recent] fall?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Continuous answer.]
Don't Know
Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BROKEN BONE/FRACTURE
(02) SPRAIN/STRAIN
(03) BRUISE
(04) CUT/WOUND/LACERATION
(05) CONCUSSION
(06) DISLOCATION
(91) OTHER
(96) NO INJURY
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN ONE WEEK
(02) ONE WEEK OR MORE
(03) NEVER RESUMED REGULAR ACTIVITIES
(-8) Don't Know
(-9) Refused

FALLFEAR

HFM3E
BOX MH1

HFGAD1

HFN1

HFGAD2

HFN2

HFPHQ1

HFN3

HFPHQ2

HFN4

HFPHQ3

HFN5

HFPHQ4

HFN6

(01) [Continuous answer.]
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6, where 1 is "Not at all afraid of falling" and
(-8) Don't Know
6 is "Extremely afraid of falling"?
(-9) Refused
If the respondent is a proxy (SPPROXY=2), go to HFQ1 - LOSTURIN.
Else go to HFN1 - HFGAD1.
The next few questions ask about the last two weeks.
(01) NOT AT ALL
(02) SEVERAL DAYS
SHOW CARD HF8
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
Over the last 2 weeks, how often have you been bothered by the following problems?
(-8) REFUSED
(-9) DON’T KNOW
Feeling nervous, anxious, or on edge
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems?]
(04) NEARLY EVERY DAY
(-8) REFUSED
Not being able to stop or control worrying.
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
little interest or pleasure in doing things? Would you say…
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling down, depressed, or hopeless?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
trouble falling or staying asleep, or sleeping too much?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling tired or having little energy?
(-9) DON’T KNOW

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
poor appetite or overeating?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling bad about yourself – or that you are a failure or have let yourself or your family down?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
trouble concentrating on things, such as reading the newspaper or watching TV?
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or
(-8) REFUSED
restless that you have been moving around a lot more than usual?
(-9) DON’T KNOW
(01) Not at all difficult,
SHOW CARD HF9
(02) Somewhat difficult,
(03) Very difficult,
How difficult have these problems made it for you to do your work, take care of things at home, or get along (04) Extremely difficult?
with people?
(-8) REFUSED
(-9) DON’T KNOW
(01) MORE THAN ONCE A WEEK
(02) ABOUT ONCE A WEEK
(03) 2-3 TIMES A MONTH
SHOW CARD HF10
(04) ABOUT ONCE A MONTH
(05) EVERY 2-3 MONTHS
I'd like to ask about a health problem that is more common than people think. Please look at this card and tell (06) ONCE OR TWICE A YEAR
me how often, if at all, since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine because [you/he/she]
(07) NOT AT ALL
could not control [your/his/her] bladder.
(08) SP IS ON DIALYSIS OR CATHETERIZATION OR
UROSTOMY OR BLADDER BAG
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
[Have you/Has (SP)] talked about this problem with [your/(SP’s)] doctor or other health professional?
(-8) Don't Know
(-9) Refused
SHOW CARD HF8

HFPHQ5

HFN7

HFPHQ6

HFN8

HFPHQ7

HFN9

HFPHQ8

HFN10

HFPHQ10

HFN11

LOSTURIN

HFQ1

TALKURIN

HFQ2

FEELURIN

HFQ3

REASURIN

HFQ4

SURGURIN

HFQ5

BOX HFT1

HYPETOLD

HFT1

HYPEAGE

HFT2

HYPEAGE_LESSON
HFT2
E
HYPEHOME

HFT6D

HYPEMEDS

HFT6G

HYPEDRNK

HFT6J

BOX HFT2
HYPELONG

HFT7

HYPELONG_LESSO
HFT7
NE

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
Has [your/(SP’s)] doctor or other health professional examined [you/him/her] to figure out why [you/he/she] (02) NO
[lose/loses] urine?
(-8) Don't Know
(-9) Refused
(01) YES
Has [your/(SP’s)] doctor or other health professional talked with [you/him/her] about taking medicine or
(02) NO
having surgery for this problem?
(-8) Don't Know
(-9) Refused
IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD.
ELSE GO TO BOX HFEND.
We have recorded that [you were/(SP) was] told by a doctor or other health professional that [you had/he
had/she had] hypertension, also called high blood pressure.
(01) YES
(02) NO
[Were you/Was (SP)] told on two or more different medical visits that [you/he/she] had high blood pressure (03) SP NEVER HAD HIGH BLOOD
or hypertension?
PRESSURE/PREVIOUS RESPONSE ENTERED IN ERROR
(-8) Don't Know
[EXPLAIN IF NECESSARY: We are interested in knowing whether [your/(SP’s)] blood pressure was high for
(-9) Refused
more than one reading.]
(01) [Continuous answer.]
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had high blood
(-8) Don't Know
pressure?
(-9) Refused
How old [were you/was (SP)] when (you were/he was/she was) first told that [you/he/she] had high blood
(01) LESS THAN ONE YEAR OLD
pressure?
(-7) Empty
(01) YES
Because of [your/his/her] high blood pressure, [are you/is (SP)] now measuring [your/his/her] blood pressure (02) NO
at home?
(-8) Don't Know
(-9) Refused
(01) YES
Because of [your/his/her] high blood pressure, [are you/is (SP)] now taking prescribed medicine for
(02) NO
[your/his/her] high blood pressure?
(-8) Don't Know
(-9) Refused
(01) YES
[You mentioned that in a typical month in the past year [you/(SP)] did not drink alcohol. Is that because of
(02) NO
[your/his/her] high blood pressure?/[Have you/Has (SP)] cut down on drinking alcoholic beverages because of
(-8) Don't Know
[your/his/her] high blood pressure?]
(-9) Refused
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG.
ELSE GO TO HFT12A - HYPECTRL.
(01) [Continuous answer.]
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood pressure? (-8) Don't Know
(-9) Refused
(01) LESS THAN ONE YEAR
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood pressure?
(-7) Empty
Has [your/(SP’s)] doctor or other health professional asked [you/him/her] about how [you/he/she] feel[s]
about this problem?

BOX HFT3

HYPEMANY

HYPECOND

HYPECTRL

HFT8

HFT11A

HFT12A

IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFT8 - HYPEMANY.
ELSE GO TO HFT11A - HYPECOND.
How many different prescribed medicines [do you/does (SP)] take for [your/his/her] high blood pressure?
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR HIGH BLOOD PRESSURE ARE
TAKEN BY THE RESPONDENT, NOT THE NUMBER OF PILLS THEY MIGHT TAKE IN ONE DAY.]

How often [do you/does (SP)] have trouble with side effects from [your/his/her] blood pressure medicines[s]? (01) ALWAYS
Please tell me if [you/he/she] always, sometimes, or never [have/has] trouble with side effects.
(02) SOMETIMES
(03) NEVER
[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any condition such as fatigue,
(-8) Don't Know
headache, or coughing.]
(-9) Refused
Doctors and other health professionals often recommend changing your habits or lifestyle, such as changing
your diet, or getting regular exercise in order to control blood pressure. How confident are you that
[you/(SP)] can follow these recommendation?
Would you say that you are very confident, confident, somewhat confident, or not at all confident?

BOX HFT4

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

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.

HYPEPAY

HFT13

[Do you/Does (SP)] have difficulty paying for the medicine[s] [your/his/her] doctor or other health
professional prescribes for [your/his/her] high blood pressure?

HYPESKIP

HFT14

[Do you/Does (SP)] ever skip taking [your/his/her] medicine, take less medicine than prescribed, or share
medicine because of the cost of the medicine?

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