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pdfAttachment 4b - Main Questionnaire Adult Section
Form Approved OMB Number 0920-0214 Exp. Date: xx/xx/20xx
Assurance of confidentiality – We take your privacy very seriously. All information that relates to or describes
identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.
NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of
the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C.
242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public
Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is
subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY
identifiable information about you. In addition, NCHS complies with the Federal Cybersecurity Enhancement Act of
2015 (6 U.S.C. §§ 151 & 151 note). This law requires the federal government to protect federal computer networks
by using computer security programs to identify cybersecurity risks like hacking, internet attacks, and other security
weaknesses. If information sent through government networks triggers a cyber threat indicator, the information may
be intercepted and reviewed for cyber threats by computer network experts working for, or on behalf of, the
government.
Notice – Public reporting burden of this collection of information is estimated to average 15 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS
D-74, Atlanta, GA 30333. ATTN: PRA (0920-0214).
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Identification and Verification
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.005
Variable Name
SADULT
Universe
HHSTAT4 = 'S' and (ASTAT = empty or ASTAT = '2')
Universe-text
This is the Sample Adult and (the Sample Adult section has not been started or
completed).
Question Text
* The sample adult person is [fill: ALIAS of Sample Adult]. The next questions must be
answered by this person. Probe as necessary to determine the availability of [fill:
ALIAS of Sample Adult].
* If refused enter CTRL-R
Answer Codes
Question Type
1. Available
2. Not Available
3. Physical or Mental condition prohibits responding
Refused
Pick One - answer list pane
Field Pane Description
Sample Adult Available
Fill Instructions
Special Instructions Do not allow "Don't Know" as an answer.
Display the description of the answer code entered in this question to the right of the
answer box in the field pane, e.g., if '1' is entered, display 'Available'; if 'Refused' is
entered, display 'Refused'.
Skip Instructions
<1> if Sample Adult = demographics.hhc.RELRESP_A
[goto beginning of adult.asd]
elseif Sample Adult = demographics.hhc.HHRESP
[goto beginning of adult.asd]
else
[goto AIDVERF_S]
endif
<2> [goto callbk.ACALLBK1]
<3> [goto PROX1]
store '4' in ASTAT
if recontact.RCIFLAG ne '1'
[goto recontact.RCI_BEGIN procedure]
else
[goto back.OUTCOMEB1 procedure]
endif
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.010
Variable Name
PROX1
Universe
SADULT(e)='3'
Universe-text
The Sample Adult's physical or mental condition prohibits responding.
Question Text
* Proxy interviews can be done for sample adults that have a mental or physical
condition that
prevents them from responding for themselves.
Is a family member or caregiver that is knowledgeable about [fill: ALIAS of Sample
Adult]'s health available?
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Proxy Available
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the answer code entered in this question to the right of the
answer box in the field pane, e.g., if '2' is entered, display 'No'.
Skip Instructions
<1> [goto PROX2]
<2> [goto PROX3]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.015
Variable Name
PROX2
Universe
PROX1 = '1'
Universe-text
Knowledgeable proxy is available.
Question Text
* Ask if necessary.
What is this person's relationship to [fill: ALIAS of Sample Adult]?
Answer Codes
Question Type
1. Relative who lives in household
2. Relative who doesn't live in household
3. Other caregiver
4. Other
Pick One - answer list pane
Field Pane Description
Proxy's Relationship to Sample Adult
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Skip Instructions
<1-4> [goto AIDVERF_S]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.020
Variable Name
PROX3
Universe
PROX1 = '2'
Universe-text
Knowledgeable proxy is not available.
Question Text
*Ask if necessary.
Can a callback with someone knowledgeable about [fill: ALIAS of Sample Adult]'s
health be arranged?
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Arrange Proxy Callback
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the answer code entered in this question to the right of the
answer box in the field pane, e.g., if '1' is entered, display 'Yes'.
Skip Instructions
<1> [goto callbk.ACALLBK1]
<2> store '3' in ASTAT
if recontact.RCIFLAG ne '1'
[goto recontact.RCI_BEGIN procedure]
else
[goto back.OUTCOMEB1 procedure]
endif
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.025
Variable Name
SADATE
Universe
(SADULT = '1' (available)) or (SADULT = '3' (condition prohibits responding) and
PROX1 = '1' (yes) and PROX2 = response)
Universe-text
Sample Adult section has been started with either the Sample Adult or a proxy.
Question Text
Answer Codes
Question Type
Output Storage Variable
Field Pane Description
Fill Instructions
Special Instructions Set only if SADATE = empty
If SADULT = '1' (available)
set SADATE = CDATE (current date) (now called ComputationDate)
elseif SADULT = '3' (condition prohibits responding) and PROX1 = '1' (yes) and PROX2
= response
set SADATE = CDATE (current date) (now called ComputationDate)
endif
This is an output variable that should be in the format 'MMDDYYYY'.
Skip Instructions
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.026
Variable Name
SATIME
Universe
(SADULT = '1' (available)) or (SADULT = '3' (condition prohibits responding) and
PROX1 = '1' (yes) and PROX2 = response)
Universe-text
Sample Adult section has been started with either the Sample Adult or a proxy.
Question Text
Answer Codes
Question Type
Output Storage Variable
Field Pane Description
Fill Instructions
Special Instructions Set only if SATIME = empty
If SADULT = '1' (available)
set SATIME = current time
elseif SADULT = '3' (condition prohibits responding) and PROX1 = '1' (yes) and PROX2
= response
set SATIME = current time
endif
This is an output variable that should be in the format 'HH:MM [ fill:a.m./p.m.]'.
Skip Instructions
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.030
Variable Name
AIDVERF_S
Universe
(RELRESP_A ne Sample Adult and HHRESP ne Sample Adult) or PROX1 = '1'
Universe-text
Sample Adult is not the person entered in HHRESP or RELRESP_A. Or PROX1 =
'Yes'.
Question Text
* Please verify the following information about the sample adult before proceeding:
I have recorded your sex as [fill: Sex of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Verified Adult's Sex
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the most recently updated sex to the right of the answer box
in the field pane, e.g., if '1' is the current answer, display 'Male'.
Skip Instructions
<1> [goto AIDVERF_A]
<2> [goto AIDSEX]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.040
Variable Name
AIDSEX
Universe
AIDVERF_S = '2' (No)
Universe-text
Respondent said his/her sex is not correct.
Question Text
Are you Male or Female?
*If don't know or refused enter your best guess.
Answer Codes
Question Type
1. Male
2. Female
Pick One - answer list pane
Field Pane Description
Adult's Revised Sex
Fill Instructions
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the description of the sex for the answer entered in this question to the right of
the answer box in the field pane, e.g., if '2' is entered, display 'Female'.
Skip Instructions
<1,2> store AIDSEX in SEX
[goto ERR_AIDSEX]
reset AIDVERF_S
[goto AIDVERF_S]
Hard Edits
ERR_AIDSEX
*The gender will now be changed to [fill: AIDSEX].
goto AIDVERF_S (as the default goto)
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.045
Variable Name
AIDVERF_A
Universe
AIDVERF_S = '1'
Universe-text
Sample Adult said his/her sex is correct.
Question Text
* Please verify the following information about the sample adult before proceeding:
I have recorded your age as [fill: Age of Sample Adult] old. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Fill Instructions
Verified Adult's Age
If Sample Adult's age in AGE is > "0"
[fill: years]
else
[fill: less than a year]
endif
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the most recently updated age in years to the right of the answer box in the field
pane, e.g., if the age is '32' display '32 years old'. For the case where the age is '0'
years, display 'less than a year old'. This last situation should rarely, if ever, occur, but
it is here just in case.
Skip Instructions
<1> [goto AIDVERF_D]
<2> [goto AIDAGE]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.050
Variable Name
AIDAGE
Universe
AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her age is not correct
Question Text
How old are you?
Answer Codes
Question Type
Integer
Field Pane Description
Adult's Revised Age
Fill Instructions
Special Instructions Hard code the phrase 'year(s) old' to the right of the answer box in the field pane.
Skip Instructions
<0-120, Refused, Don't know>
if AIDAGE = 'Refused' or AIDAGE = 'Don't know' or AIDAGE = AGE
reset AIDVERF_A
[goto ERR_AIDAGE]
else
store AIDAGE in AGE
[goto AIDDOB_M]
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ERR_AIDAGE
*Age of [fill1: ALIAS of Sample Adult] remains [fill2: Age of Sample Adult] years old.
goto AIDVERF_A (whether suppressed or not)
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.055
Variable Name
AIDVERF_D
Universe
AIDVERF_A = '1'
Universe-text
Sample Adult said his/her age is correct.
Question Text
* Please verify the following information about the sample adult before proceeding:
I have recorded your birthday as [fill: Birthday of Sample Adult]. Is this correct?
*If respondent "refuses" or says "don't know", enter "1" for "yes".
Answer Codes
Question Type
1. Yes
2. No
Yes/No
Field Pane Description
Fill Instructions
Verified Adult's Date of Birth
[fill: , ] = date of birth, where should be filled with
the name of the month, not the number. For any part of the birth date that is "refused",
"don't know", or otherwise "blank", put a "?" for that field.
Special Instructions Do not allow "Don't Know" or "Refused" as an answer.
Display the Sample Adult's date of birth to the right of the answer box in the field pane.
For any part of the birth date that is "refused", "don't know", or otherwise "blank", put a
"?" for that field.
Skip Instructions
<1> if AGE of Sample Adult le '17'
[goto NO_MORE]
else
[goto beginning of adult.asd]
endif
<2> [goto AIDDOB_M]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.060_1
Variable Name
AIDDOB_M
Universe
AIDVERF_D = '2' (No) or AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her date of birth is not correct or his/her age is not correct
Question Text
1 of 3
What is your birthday?
*Enter month of birth.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Adult's Revised Month of Birth
Fill Instructions
Special Instructions Display the name of the month for the answer entered in this question to the right of the
answer box in the field pane, e.g., if '10' is entered, display 'October'. If 'Refused' or
'Don't know' is entered, do not display anything to the right of the answer box.
Skip Instructions
<01-12,R, D> [goto AIDDOB_D]
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.060_2
Variable Name
AIDDOB_D
Universe
AIDVERF_D = '2' (No) or AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her date of birth is not correct or his/her age is not correct
Question Text
2 of 3
*Enter day of birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Adult's Revised Day of Birth
[fill2: AIDDOB_M] = month of birth, where should be filled with the name
of the month, not the number.
Special Instructions Only allow valid days for month entered.
Skip Instructions
<01-31,R,D> [goto AIDDOB_Y]
If days not valid, [goto ERR_AIDDOB_D]
Hard Edits
ERR_AIDDOB_D
*[fill1: AIDDOB_D] is not a valid day for [fill2: AIDDOB_M].
*Please correct.
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.060_3
Variable Name
AIDDOB_Y
Universe
AIDVERF_D = '2' (No) or AIDVERF_A = '2' (No)
Universe-text
Respondent said his/her date of birth is not correct or his/her age is not correct
Question Text
3 of 3
*Enter year of birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Adult's Revised Year of Birth
[fill1: , ] = date of birth, where
should be filled with the name of the month, not the number. For any part of the birth
date that is "refused", "don't know", or otherwise "blank", put a "?" for that field.
[fill3: , ] = date of birth, where should be filled with
the name of the month, not the number. For any part of the birth date that is "refused",
"don't know", or otherwise "blank", put a "?" for that field.
Special Instructions
Skip Instructions
<1880-2020,R,D> if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
[goto AIDVERF_A]
elseif AIDVERF_D = '2' (No) then reset
AIDVERF_D to empty
[goto AIDVERF_D]
endif
(if year GT current year) or (if year = current year and month GT current month) or (if
year = current year and month = current month and day GT current day)
[goto ERR1_AIDDOB_Y]
endif
(if birth month = '02' and birth day = '29' and this is not a leap year)
[goto ERR2_AIDDOB_Y]
endif
(if AIDDOB_M = 'Ref' or 'DK') or (if AIDDOB_D = 'Re'f or 'DK') or (if AIDDOB_Y = 'Ref'
or 'DK')
goto ERR3_AIDDOB_Y
else
store AIDDOB_M in DOBM
store AIDDOB_D in DOBD
store AIDDOB_Y in DOBY
if AIDVERF_A = '2' (No) then reset AIDVERF_A to empty
goto AIDVERF_A
elseif AIDVERF_D = '2' (No) then reset AIDVERF_D to empty
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goto AIDVERF_D
endif
endif
Calculate age from AIDDOB_M, AIDDOB_D, and AIDDOB_Y.
if age from AIDDOB items is ne AGE and age from AIDDOB items is valid
reset AIDVERF_A or AIDVERF_D.
goto ERR4_AIDDOB_Y
endif
Hard Edits
ERR1_AIDDOB_Y
*Future date invalid: [fill1: , ]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR2_AIDDOB_Y
*Not a valid day: [fill1: , ]
*Please correct.
goto AIDDOB_M (whether suppressed or not)
ERR3_AIDDOB_Y
*DOB of [fill2: ALIAS of Sample Adult] remains [fill3: , ]
goto AIDVERF_A (whether suppressed or not)
ERR4_AIDDOB_Y
* Data mismatched. Please fix Age or Birthday.
* If still cannot reconcile, enter 'Don't know' for year of birth.
* Please correct.
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.070
Variable Name
NO_MORE
Universe
[(ASTAT = empty or ASTAT = '2') and HHSTAT4 = 'S' and AGE le '17']
Universe-text
Sample adult whose age is now less than or equal to 17
Question Text
* [fill: ALIAS of Sample Adult] is no longer the sample adult for this family.
* You may need to ask additional questions before continuing with the rest of the
interview.
Answer Codes
Question Type
1. Enter 1 to Continue
Enter 1 to Continue
Field Pane Description
This Person No Longer Sample Adult
Fill Instructions
Special Instructions
Skip Instructions
Do not allow "Don't Know" or "Refused" as an answer.
<1> (Search and count the number of persons in the family 18+ years old.)
[if (age is now 14-17 inclusive) and (person is married or living with a partner or
there is no one over 17 years old in the family)]
store 'E' in HHSTAT4
store '0' in ASTAT
if recontact.RCIFLAG ne '1'
[goto recontact.RCI_BEGIN procedure]
else
[goto back.OUTCOMEB1 procedure]
endif
else
store empty in HHSTAT4
store '0' in ASTAT
if recontact.RCIFLAG ne '1'
goto recontact.RCI_BEGIN procedure
else
goto back.OUTCOMEB1 procedure
endif
endif
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.075
Variable Name
AAGECHG
Universe
HHSTAT4 = 'S' and ((AIDAGE ne empty and AIDAGE ne original age) OR (AIDSEX ne
empty and AIDSEX ne original sex))
Universe-text
Person is SA and (there is a sex change or an age change)
Question Text
* Because you changed the Sample Adult's sex and / or sex, you may need to ask
additional questions before continuing with the rest of the interview.
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.082
Variable Name
LNKINTRO
Universe
HHSTAT4 = 'S'
Universe-text
Sample Adults 18+
Question Text
?[F1]
We would like the last four digits of your Social Security Number [Fill:]. This information
will help us link your survey data with health-related records of other government
agencies, and allow us to conduct additional research without taking up your time with
more questions. The National Center for Health Statistics (NCHS) uses this information
for research purposes only. Providing this information is voluntary. There will be no
effect on your benefits if you do not provide this information. Federal laws authorize us
to ask for this information. Like all other information you have provided, your answer to
this question will not be disclosed by NCHS or its agents, which includes the U.S.
Census Bureau.
* Read if necessary: The specific federal laws protecting your privacy and the
confidentiality of your data are the Public Health Service Act (Title 42, U.S.C., Section
242m(d)), the Confidential Information Protection and Statistical Efficiency Act (Title 5
of Public Law 107-347), and the Privacy Act of 1974 (5 U.S.C. § 552a). In addition,
NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§
151 & 151 note), which requires the federal government to protect federal computer
networks by using computer security programs to identify cybersecurity risks like
hacking, internet attacks, and other security weaknesses.
* Enter '1' to continue.
Answer Codes
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Linkage intro
Fill: If sample adult has Medicare (HIKIND=2 or HIKIND=3 or MCAREPRB=1), then
fill ", and the last four numbers and any letters of your Medicare number"
else
fill nothing
Special Instructions QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
Skip Instructions
<1,D> [goto SASSN4]
[goto SARLINK]
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H_LNKINTRO
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.082_H
Variable Name
H_LNKINTRO
Universe
Universe-text
Question Text
NHIS data have been linked with health-related records of government agencies such
as the Centers for Medicare and Medicaid Services and the Social Security
Administration. NHIS data have also been linked with death certificate data stored in
the National Death Index (NDI). The NDI is a database of death certificate information
provided to NCHS by State offices.
All personal identifying information is removed from the linked data files.
These are some examples of possible research studies using NHIS data together with
other health-related records or the NDI:
[blt] Predicting the number of disabled persons in the U.S. based on health conditions
reported in the NHIS.
[blt] Predicting the costs of Medicare based on health conditions reported in the NHIS.
[blt] Studying the risk of certain diseases for persons with and without health insurance.
[blt] Studying the health characteristics of people who retire early.
[blt] Calculating how long a person in the U.S. might live, based on his or her education,
income, or race and ethnicity.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
LNKINTRO
SARLINK
SASSN4
SCSSN4
SCRLINK
Skip Instructions
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Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.085
Variable Name
SASSN4
Universe
HHSTAT4 = S and (LNKINTRO= '1' or LNKINTRO = 'don't know')
Universe-text
Sample adults 18+ who answered "Enter 1 to continue" or "don’t know" at LNKINTRO
Question Text
?[F1]
What are the last four digits of your Social Security Number?
* Read if necessary: Providing this information is voluntary. There will be no effect on
your benefits if you do not provide this information. Federal laws authorize us to ask for
this information. Like all other information you have provided, your answer to this
question will not be disclosed by NCHS or its agents, which includes the U.S. Census
Bureau.
[Read if asked about specific laws]: The specific federal laws protecting your privacy
and the confidentiality of your data are the Public Health Service Act, which is Title 42,
U.S.C., Section 242m(d); the Confidential Information Protection and Statistical
Efficiency Act, which is Title 5 of Public Law 107-347; and the Privacy Act of 1974,
which is 5 U.S.C. § 552a. In addition, NCHS complies with the Federal Cybersecurity
Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note), which requires the federal
government to protect federal computer networks by using computer security programs
to identify cybersecurity risks like hacking, internet attacks, and other security
weaknesses.
* Enter 'N' if no Social Security Number.
Answer Codes
Question Type
Integer
Field Pane Description
SSN
Fill Instructions
Special Instructions Allow 4 digits. QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE
ADULT CORE AND SUPPLEMENT QUESTIONS.
NOTE: THIS QUESTION ACTUALLY APPEARS AT THE END OF THE SAMPLE
ADULT QUESTIONS INCLUDING ANY SUPPLEMENT QUESTIONS IN THE
INSTRUMENT. THIS IS LOCATED HERE BECAUSE NCHS WANTED THE OUTPUT
DATA TO CONTAIN THIS INFORMATION HERE.---T.M.
Skip Instructions
<0001-9999> if SCSSN4=SASSN4 goto ERR2_SASSN4];
else [goto SASSNRP4]
<0-999> [goto ERR_SASSN4]
<0000> [goto ERR3_SASSN4]
if HIKIND=2 or HIKIND = 3 or MCAREPRB=1
[goto SAMCNO4]
else
[goto SARLINK]
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Page 20 of 29
Hard Edits
ERR_SASSN4
* You must enter all four of the last four digits of the Social Security Number.
*Please correct.
ERR3_SASSN4
* The last 4 digits of a SSN may be between 0001-9999.
* Please correct.
* For a respondent who does not want to provide the SSN, enter 'Ctrl D' or 'Ctrl R' for
'Don't Know' or 'Refused.'
Soft Edits
ERR2_SASSN4
*The last four digits of [fill: ALIAS of Sample Adult]'s Social Security Number are the
same as the last four digits of [SC name]'s Social Security Number. Please verify.
*First goto change Sample Adult's SSN at SASSN4
*Second goto change Sample Child's SSN at SCSSN4
AssocHelp
H_LNKINTRO
Wednesday, June 14, 2017
Page 21 of 29
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.090
Variable Name
SASSNRP4
Universe
HHSTAT4 = S and ('0000' <= SASSN4 <='9999')
Universe-text
Sample adult reported the last four digits of the SSN at SASSN4
Question Text
* Enter how the last four digits of the Social Security Number were reported.
Answer Codes
1. From memory
2. From records
Question Type
Pick One - answer list pane
Field Pane Description
SSN memory or records
Fill Instructions
Special Instructions Do not allow Refused or Don't know
QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
Skip Instructions
<1,2> [goto SASSNTL4]
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Wednesday, June 14, 2017
Page 22 of 29
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.095
Variable Name
SASSNTL4
Universe
HHSTAT4 = S and (SASSNRP4 = 1 or 2)
Universe-text
Recorded how last four digits of the sample adult’s SSN were reported
Question Text
* Select one category below to indicate reporting of the last four digits of the Social
Security Number.
Answer Codes
1. In person
2. Telephone
Question Type
Pick One - answer list pane
Field Pane Description
SSN in person or phone
Fill Instructions
Special Instructions Do not allow Refused or Don't know
QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
NOTE: THIS IS LOCATED HERE BECAUSE NCHS WANTED THE OUTPUT DATA
TO CONTAIN THIS INFORMATION HERE.---T.M.
Skip Instructions
<1,2> if HIKIND= 2 or HIKIND = 3 or MCAREPRB=1
[goto SAMCNO4]
else
[goto AWB.AWEBUSE (AWB.010_00.000)]
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Wednesday, June 14, 2017
Page 23 of 29
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_1
Variable Name
SAMCNO4
Universe
HHSTAT4 = S and (LNKINTRO = 1 or LNKINTRO = don't kow) and (HIKIND = 2 or
HIKIND = 3 or MCAREPRB = 1)
Universe-text
Sample adult has Medicare
Question Text
? [F1]
1 of 2
May I please see your Medicare card to record the last four numbers and any letters of
the Health Insurance Claim Number?
* Read if necessary: Providing this information is voluntary. There will be no effect on
your benefits if you do not provide this information. Federal laws authorize us to ask for
this information. Like all other information you have provided, your answer to this
question will not be disclosed by NCHS or its agents, which includes the U.S. Census
Bureau.
[Read if asked about specific laws]: The specific federal laws protecting your privacy
and the confidentiality of your data are the Public Health Service Act, which is Title 42,
U.S.C., Section 242m(d); the Confidential Information Protection and Statistical
Efficiency Act, which is Title 5 of Public Law 107-347; and the Privacy Act of 1974,
which is 5 U.S.C. § 552a. In addition, NCHS complies with the Federal Cybersecurity
Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note), which requires the federal
government to protect federal computer networks by using computer security programs
to identify cybersecurity risks like hacking, internet attacks, and other security
weaknesses.
* Reports from memory are acceptable if the Medicare card (or some other form of
documentation) is not available.
* Enter the last four numbers.
Answer Codes
Question Type
Integer
Field Pane Description
Medicare number
Fill Instructions
Special Instructions Allow 4 digits. QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE
ADULT CORE AND SUPPLEMENT QUESTIONS.
If SAMCNO4 = 'Refused'
set SAMCNO4_FLG = 'R'
elseif SAMCNO4 = 'Don't know'
set SAMCNO4_FLG = 'D'
else
set SAMCNO4_FLG = empty
Wednesday, June 14, 2017
Page 24 of 29
endif
Skip Instructions
<0000-9999> [goto SAMCLET]
<0-999> [goto ERR_SAMCNO4]
[goto SARLINK]
Hard Edits
ERR_SAMCNO4
* You must enter all four of the last four numbers of the Medicare number.
* Please correct.
Soft Edits
AssocHelp
H_SAMCNO4
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_2
Variable Name
SAMCLET
Universe
HHSTAT4 = S and SAMCNO4 = 0000 - 9999
Universe-text
Sample adult has Medicare and reported the last four numbers of the Medicare number
Question Text
2 of 2
*Enter the letters that appear after the claim number.
Answer Codes
Question Type
empty, A - Z, AA - ZZ
Text
Field Pane Description
Letters
Fill Instructions
Special Instructions Allow up to 2 letters and allow 'empty'. QUESTION SHOULD APPEAR AT THE END
OF THE SAMPLE ADULT CORE AND SUPPLEMENT QUESTIONS.
Skip Instructions
if SASSN4 = 0000-9999
[goto AWB.AWEBUSE (AWB.010_00.000)]
elseif SASSN4 = 'N','Refused','Don't know'
[goto SARLINK]
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Wednesday, June 14, 2017
Page 25 of 29
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_3
Variable Name
SAMCNO4_FLG
Universe
Universe-text
Question Text
Answer Codes
Question Type
**Instrument variable**
Field Pane Description
Fill Instructions
Special Instructions If SAMCNO4 = 'Refused'
set SAMCNO4_FLG = 'R'
elseif SAMCNO4 = 'Don't know'
set SAMCNO4_FLG = 'D'
else
set SAMCNO4_FLG = empty
endif
Skip Instructions
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Wednesday, June 14, 2017
Page 26 of 29
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.100_H
Variable Name
H_SAMCNO4
Universe
Universe-text
Question Text
Medicare refers to the Federal health insurance coverage for persons 65+ years of age
and certain disabled persons under 65.
NHIS data have been linked with health-related records of government agencies such
as the Centers for Medicare and Medicaid Services and the Social Security
Administration. NHIS data have also been linked with death certificate data stored in
the National Death Index (NDI). The NDI is a database of death certificate information
provided to NCHS by State offices.
All personal identifying information is removed from the linked data files.
These are some examples of possible research studies using NHIS data together with
other health-related records or the NDI:
[blt] Predicting the number of disabled persons in the U.S. based on health conditions
reported in the NHIS.
[blt] Predicting the costs of Medicare based on health conditions reported in the NHIS.
[blt] Studying the risk of certain diseases for persons with and without health insurance.
[blt] Studying the health characteristics of people who retire early.
[blt] Calculating how long a person in the U.S. might live, based on his or her education,
income, or race and ethnicity.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: SAMCNO4
Skip Instructions
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Wednesday, June 14, 2017
Page 27 of 29
Module
14
Section Name
Adult Identification and Verification
Part
Question ID
AID.105
Variable Name
SARLINK
Universe
HHSTAT4 = S and (LNKINTRO=refused or SAMCNO4=refused or SAMCNO4=don't
know or SASSN4=no SSN or SASSN4=refused or SASSN4=don't know)
Universe-text
Version 2 and Sample Adult answered refused at LNKINTRO, or answered refused or
don't know at SAMCNO4 or answered no SSN or refused or don't know at SASSN4
Question Text
?[F1]
May we try to link your survey data without [Fill:]?
* Read if necessary:
Any data obtained are protected by strict federal laws, including the Public Health
Service Act, which is Title 42, U.S.C., Section 242m(d); the Confidential Information
Protection and Statistical Efficiency Act, which is Title 5 of Public Law 107-347; and the
Privacy Act of 1974, which is 5 U.S.C. § 552a. In addition, NCHS complies with the
Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 & 151 note), which
requires the federal government to protect federal computer networks by using
computer security programs to identify cybersecurity risks like hacking, internet attacks,
and other security weaknesses.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Permission to link
IF LNKINTRO = RF OR ((SASSN4 = 'N' OR SASSN4 = RF OR SASSN4 = DK) AND
(SAMCNO4 = RF OR SAMCNO4 = DK)) THEN
If ((Medicare IN FHI.ITYPE.ITYPE[SASEL].HIKIND) OR (Medigap IN
FHI.ITYPE.ITYPE[SASEL].HIKIND) OR
(FHI.ITYPE.ITYPE[SASEL].MCAREPRB=Yes)) THEN
Fill := 'Medicare and Social Security numbers'
else
Fill := 'a Social Security Number'
Endif
ELSEIF (SAMCNO4 = RF OR SAMCNO4 = DK) THEN
Fill := 'a Medicare number'
ELSEIF (SASSN4 = RF OR SASSN4 = DK or SASSN4 = 'N') THEN
Fill := 'a Social Security Number'
ENDIF
Special Instructions QUESTION SHOULD APPEAR AT THE END OF THE SAMPLE ADULT CORE AND
SUPPLEMENT QUESTIONS.
Skip Instructions
[goto AWB.AWEBUSE (AWB.010_00.000)]
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Wednesday, June 14, 2017
Page 28 of 29
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H_LNKINTRO
Wednesday, June 14, 2017
Page 29 of 29
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Socio-Demographic Background
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.050
Variable Name
WRKVER
Universe
HHSTAT4 = S and DOINGLW = 1-5
Universe-text
Sample adults 18+ who were working or not working last week
Question Text
Earlier I recorded that in the last week you were
(Fill1: working for pay at a job or business.)
(Fill2: with a job or business but not at work.)
(Fill3: looking for work.)
(Fill4: working, but not for pay, at a family-owned job or business.)
(Fill5: not working at a job or business and not looking for work.)
Is that correct?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Verify last week's work activity
Fill1: If DOINGLW
Fill2: If DOINGLW
Fill3: If DOINGLW
Fill4: If DOINGLW
Fill5: If DOINGLW
=1
=2
=3
=4
=5
Special Instructions Storage instructions: If WRKVER = 1 then
set DOINGLW2 = DOINGLW and WHYNOWK2 = WHYNOWRK
elseif WRKVER = Refused or Don't know then
set DOINGLW2 = WRKVER
endif
Skip Instructions
<1>if DOINGLW2 = 1,2,4 [goto WHOWRK]
else if DOINGLW2 = 3,5 [goto EVERWRK]
<2> [go to WRKCOR]
[go to EVERWRK]
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Wednesday, June 14, 2017
Page 1 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.060
Variable Name
WRKCOR
Universe
HHSTAT4 = S and [(WRKVER = 2) or (SASEL ne FAMRESP and (DOINGLW =
Refused or Don't know))]
Universe-text
Sample adults 18+ whose working status was incorrect or who were not the Family
Respondent and with an answer of D or R to DOINGLW.
Question Text
(book) A1
? [F1]
What is your correct working status?
* Read answer categories.
Answer Codes
Question Type
1. Working for pay at a job or business
2. With a job or business but not at work
3. Looking for work
4. Working, but not for pay, at a family-owned job or business
5. Not working at a job or business and not looking for work
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Correct working status
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Storage instructions: set DOINGLW2 = WRKCOR
Skip Instructions
<1,4> [goto to WHOWRK]
<2,5> [goto WHYNOWK2]
<3,R,D> [goto EVERWRK]
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H_WRKCOR
Wednesday, June 14, 2017
Page 2 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.060_H
Variable Name
H_WRKCOR
Universe
Universe-text
Question Text
A job exists when there is a definite arrangement for regular work on a continuing
basis, and the person holding the job receives pay or other compensation for his/her
work. The schedule of hours or days can be irregular as long as there is a definite
arrangement to work on a continuing basis.
A business exists when machinery or equipment of substantial value is used in
conducting the business; an office, store, or other place of business is maintained; or
the business is advertised to the public.
An individual is working for pay if he or worked for wages, salary, commission, tips,
piece-rates, or pay-in-kind (e.g., room-and-board); worked for profit in his/her own
business, practice or farm; worked as a civilian for the National Guard or Dept. of
Defense; or performed exchange or share work on a farm.
Have a job or business but not at work includes individuals on annual leave or vacation
(paid or unpaid); on maternity or family leave (paid or unpaid); at jury duty; involved in a
labor dispute that is taking place at his/her place of employment; on sick leave (paid or
unpaid); on a temporary lay-off (lasting less than 30 days), and the person expects to
be called back within that time period.
An individual is looking for work if he or she is conducting an active job search, which
includes filling out applications or sending out resumes; placing or answering classified
ads; checking union/professional registers; bidding on a contract or auditioning for a
part in a play; contacting friends or relatives about possible jobs; contacting
school/college university employment offices; contacting prospective employers
directly; contacting public or private employment offices.
Include as working, but not for pay at least 15 hours of work per week without pay or
compensation in a business or farm operated by a related household member.
Volunteer efforts should not be considered as working. Likewise, unpaid internships
are not considered as working.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKCOR
Skip Instructions
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Wednesday, June 14, 2017
Page 3 of 29
Soft Edits
AssocHelp
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.062
Variable Name
DOINGLW2
Universe
HHSTAT4 = S and Sample Adult (L_NO) = FAMRESP and (DOINGLW = Refused or
Don't know)
Universe-text
Sample Adults 18+ and also the family section respondent and said Refused or Don't
know to the working last week status question in the family section
Question Text
Corrected Employment Status Last Week: (not displayed)
Answer Codes
1. Working for pay at a job or business
2. With a job or business but not at work
3. Looking for work
4. Working, but not for pay, at a family-owned job or business
5. Not working at a job or business and not looking for work
Refused
Don't know
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions Storage Instructions:
If (DOINGLW = Refused or Don't know) and Sample Adult (L_NO) = FAMRESP then
set DOINGLW2 = DOINGLW
endif
Skip Instructions
if DOINGLW2 = Refused or Don't know then
[goto EVERWRK]
endif
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Wednesday, June 14, 2017
Page 4 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.065
Variable Name
WHYNOWK2
Universe
HHSTAT4 = S and WRKCOR = 2,5
Universe-text
Sample Adults 18+ whose corrected working status last week was not working at a job
or business and not looking for work or with a job or business but not at work
Question Text
? [F1]
(Fill1: What is the main reason you did not work last week?)
(Fill2: What is the main reason you did not have a job or business last week?)
Answer Codes
Question Type
1. Taking care of house or family
2. Going to school
3. Retired
4. On a planned vacation from work
5. On family or maternity leave
6. Temporarily unable to work for health reasons
7. Have job/contract and off-season
8. On layoff
9. Disabled
10. Other
Refused
Don't know
Other
Field Pane Description
Fill Instructions
Reason not working last week
Fill1: if WRKCOR = 2
Fill2: if WRKCOR = 5
Special Instructions
Skip Instructions
<1-10,D,R> if WRKCOR = 2 then
[goto WHOWRK]
else [goto EVERWRK]
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H_WHYNOWK2
Wednesday, June 14, 2017
Page 5 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.065_H
Variable Name
H_WHYNOWK2
Universe
Universe-text
Question Text
Taking care of house or family is any type of work around the house such as cleaning,
cooking, maintaining the yard, caring for children or family, etc.
Going to school means attending any type of public or private educational
establishment both in and out of the regular school system.
Retired, Temporarily unable to work for health reasons, and Disabled are respondent
defined.
On Layoff means that the person is waiting to be called back to a job from which they
have been temporarily laid-off or furloughed. Layoffs can be due to slack work, plant
retooling or remodeling, inventory taking, and the like. Do not consider a person who
was not working because of a labor dispute at his/her own place of employment as
being on layoff.
Have job/contract and off-season includes school personnel (teachers, administrators,
custodians, etc.) on summer vacation who have a definite arrangement, either written
or oral, to return to work in the fall, are not considered to be on layoff during the
summer. They may, however, be laid off from a summer job or looking for work for the
summer months (but this would NOT be considered their main job or employment
activity).
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:WRKCOR
Skip Instructions
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Wednesday, June 14, 2017
Page 6 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.066
Variable Name
EVERWRK
Universe
HHSTAT4 = S and DOINGLW2 = 3,5,Refused,or Don't know
Universe-text
Sample adults 18+ who were NOT working at a job or business and not looking for
work or looking for work last week or didn't know or refused to provide their
employment status last week
Question Text
Have you ever held a job or worked at a business?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever worked
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto WHOWRK]
<2,D,R> [goto SCHOOLYR]
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Wednesday, June 14, 2017
Page 7 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.070
Variable Name
WHOWRK
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
(Fill1:For whom did you work at your MAIN job or business? (Name of company,
business, organization or employer))
(Fill2: Thinking about the job you held the longest, for whom did you work? (Name of
company, business, organization or employer))
(Fill3: Thinking about the job you held most recently, for whom did you work? (Name of
company, business, organization or employer))
Answer Codes
Question Type
Text
Field Pane Description
Fill Instructions
Whom did you work for
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<90 char long,D,R> [goto KINDIND]
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H_WHOWRK
Wednesday, June 14, 2017
Page 8 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.070_H
Variable Name
H_WHOWRK
Universe
Universe-text
Question Text
Enter the sample adult's verbatim response for the name of his/her employer, business,
company, or organization.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WHOWRK, WHOWRKPY, WHOWRKLH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 9 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.080
Variable Name
KINDIND
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
What kind of business or industry was this? (For example: TV and radio mgt., retail
shoe store, State Department of Labor)
Answer Codes
Question Type
Text
Field Pane Description
What kind of business/industry
Fill Instructions
Special Instructions
Skip Instructions
<90 char long,D,R> [goto KINDWRK]
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H_KINDIND
Wednesday, June 14, 2017
Page 10 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.080_H
Variable Name
H_KINDIND
Universe
Universe-text
Question Text
Indicate both a general and specific function for employers and businesses. For
example, in "copper mine" the word "mine" is general and the word "copper" is specific.
For Government Agencies: If the title clearly designates the main function of the
agency, enter the name of the agency (e.g., the U.S. Census Bureau.) If the main
function is not clear from the title, ask for and report the division or branch for which the
person works.
For Firms with more than one business: If activities are carried on in separate places,
describe the business in which the person actually worked. If activities are carried on in
the same place, describe the main activity.
For household or domestic workers: Determine if the person works for a business or
private home. If it is a business, enter the name of the business. If it is a private home,
enter "private home".
Manufacturing: Makes and sells its products in large lots to other manufacturers,
wholesalers, or retailers.
Wholesale trade: Buys products in large quantities for resale to retailers, industrial
users, or to other wholesalers.
Retail trade: Sells primarily to individual consumers and seldom makes products.
Some other kinds of business: Any other type of establishment that renders a service to
individuals and/or organizations. Examples are hotels, dry cleaners, advertising
agencies, restaurants, and automobile repair shops.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: KINDIND, KINDINPY, KINDINLH
Skip Instructions
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AssocHelp
Wednesday, June 14, 2017
Page 11 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.090
Variable Name
KINDWRK
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
What kind of work were you doing? (For example: farming, mail clerk, computer
specialist.)
Answer Codes
Question Type
Text
Field Pane Description
What kind of work
Fill Instructions
Special Instructions
Skip Instructions
<90 char long,D,R> [goto IMPACT]
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AssocHelp
H_KINDWRK
Wednesday, June 14, 2017
Page 12 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.090_H
Variable Name
H_KINDWRK
Universe
Universe-text
Question Text
The entry should clearly state the kind of work or nature of duties performed by the
person. The occupation entry should describe what the person does (e.g., shipping
department supervisor, inventory clerk).
One word occupational descriptions are usually not adequate. For example, we need
to know what type of nurse, engineer, clerk, or teacher a person is.
For Example:
Inadequate
Adjuster
adjuster,
Adequate
Claims adjuster, brake adjuster, machine adjuster, merchandise
complaint adjuster, insurance adjuster
Engineer
Civil engineer, locomotive engineer, mechanical engineer,
aerospace engineer
Scientist
economist
Political scientist, physicist, sociologist, oceanographer, home
Teacher
Kindergarten teacher, High school teacher, Special education
teacher, College professor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: KINDIND, KINDWKPY, KINDWKLH
Skip Instructions
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AssocHelp
Wednesday, June 14, 2017
Page 13 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.100
Variable Name
IMPACT
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
What were your most important activities on this job or business? (For example: sells
cars, keeps account books, operates printing press.)
Answer Codes
Question Type
Text
Field Pane Description
Important activities
Fill Instructions
Special Instructions
Skip Instructions
<90 char long,D,R> [goto SUPERVIS]
Hard Edits
Soft Edits
AssocHelp
H_IMPACT
Wednesday, June 14, 2017
Page 14 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.100_H
Variable Name
H_IMPACT
Universe
Universe-text
Question Text
Detail the kind of work or duties the person performs.
The entry to this item must include enough additional information for a precise
occupational classification. Usually a few words telling what the person actually does or
the tools he/she uses will suffice.
For example, two people with the same job title, “Telephone Co. serviceman”, may
have different activities such as installing phones in homes or repairing telephone
transmission lines.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: IMPACT, IMPACTPY, IMPACTLH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.105_00.010
Variable Name
SUPERVIS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2 IN
('1','2','4') or EVERWRK='1')
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
Did you supervise other employees as part of your job?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Supervise
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto WRKCAT]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 16 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.110
Variable Name
WRKCAT
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(book) A2 ? [F1]
(Fill1: Looking at the card, which of these best describes your current job or work
situation?)
(Fill2: Looking at the card, which of these best describes the job you held for the
longest time?)
(Fill3: Looking at the card, which of these best describes the job you held most
recently?)
* Read answer choices if necessary.
Answer Codes
Question Type
1. An employee of a PRIVATE company, business, or individual for wages, salary, or
commission
2. A FEDERAL government employee
3. A STATE government employee
4. A LOCAL government employee
5. Self-employed in OWN business, professional practice or farm
6. Working WITHOUT PAY in family-owned business or farm
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Class of worker
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<1-4,6,D,R>[goto LOCALLNO]
<5> [goto BUSINC]
Hard Edits
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AssocHelp
H_WRKCAT
Wednesday, June 14, 2017
Page 17 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.110_H
Variable Name
H_WRKCAT
Universe
Universe-text
Question Text
Private company or business: This employer may be a large corporation or a single
individual, but must not be part of any government organization. This category also
includes work for private organizations doing contract work for government agencies.
Federal government: Include persons working for any branch of the federal government
including persons who were elected to paid federal offices and civilian employees of the
Armed Forces and some members of the National Guard. Include employees of
international organizations like the United Nations and employees of foreign
governments such as a person employed by the French embassy.
State government: Report this category for employees of State governments, which
include paid state officials, state police, employees of state universities and colleges,
and statewide JTPP administrators.
Local government: Report for employees of counties, cities, towns, and other local
areas. Included here would be city-owned bus lines, electrical power companies, water
and sewage services, etc. Employees of public elementary and secondary schools
who worked for local governments should also be here.
Self employed: Person working for profit or fees in their own business, shop, office,
farm, etc. Include persons who have their own tools or equipment and provide services
on a contract, subcontract, or job basis, such as carpenters, plumbers, independent
taxicab operators, or independent truckers.
Working without pay: Working on a farm on in a business operated by a related
member of the household, without receiving wages or salary for work performed.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKCAT, WRKCATPY, WRKCATLH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 18 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.112
Variable Name
BUSINC
Universe
HHSTAT4 = S and WRKCAT = 5
Universe-text
Sample adults 18+ who are self-employed
Question Text
Is this business incorporated?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Incorporated business
Fill Instructions
Special Instructions
Skip Instructions
<1,2,D,R> [goto LOCALLNO]
Hard Edits
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Wednesday, June 14, 2017
Page 19 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.120
Variable Name
LOCALLNO
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(book) A3
Thinking about
(Fill1: this MAIN job or business)
(Fill2: your last week at the job you held the longest)
(Fill3: your last week at the job you held most recently)
how many people (Fill4:work/Fill5: worked) at this location? Please include yourself.
* "People" includes both FULL- and PART-time employees.
* "Location" refers to the street address of the workplace.
Answer Codes
Question Type
1. 1 employee
2. 2-9 employees
3. 10-24 employees
4. 25-49 employees
5. 50-99 employees
6. 100-249 employees
7. 250-499 employees
8. 500-999 employees
9. 1000 employees or more
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Number of employees
Fill1: If [DOINGLW2 eq <1,2,4>]
Fill2: if [EVERWRK eq <1> and (WHYNOWK2 eq 03 or AGE ge 65)]
Fill3: if [EVERWRK eq <1> and WHYNOWK2 ne 03 and AGE lt 65]
Fill4: if [DOINGLW2 eq <1,2,4>
Fill5: if [EVERWRK eq 1]
Special Instructions
Skip Instructions
<1-9, R,D> [goto WRKLONGN]
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Wednesday, June 14, 2017
Page 20 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.140_01
Variable Name
WRKLONGN
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
? [F1]
1 of 2
About how long
(Fill1: have you worked at this MAIN job or business?)
(Fill2: did you work at the job you held the longest?)
(Fill3: did you work at the job you held most recently?)
* Enter number.
Answer Codes
Question Type
1-365
Refused
Don't know
Integer
Field Pane Description
Fill Instructions
Duration at this job: Number of units
Fill1: If DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = <1> and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = <1> and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions Store D,R in WRKLONGT
Skip Instructions
<1-365> [goto WRKLONGT]
if EVERWRK eq 1 and (WHYNOWK2 eq 03 or AGE GE 65)
[goto HOURPD] ;
Else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or
(DOINGLW2 = 1,2,4)
[goto WRKLONGH]
Hard Edits
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AssocHelp
H_WRKLONGN
Wednesday, June 14, 2017
Page 21 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.140_01_H
Variable Name
H_WRKLONGN
Universe
Universe-text
Question Text
Main job or business refers to the job or business which is the primary source of a
person's income.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKLONGN
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 22 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.140_02
Variable Name
WRKLONGT
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1) and WRKLONGN ne
Refused or Don't know
Universe-text
Sample adults 18+ (who were working last week, or who were with a job or business
but not at work, or who were working but not for pay at a family-owned job or business,
or who have ever worked) and who gave a number entry in WRKLONGN
Question Text
2 of 2
* Enter time period.
Answer Codes
Question Type
1. Days(s)
2. Week(s)
3. Month(s)
4. Year(s)
Pick One - answer list pane
Field Pane Description
Duration at this job: Time units
Fill Instructions
Special Instructions
Skip Instructions
<4> if WRKLONGN gt AGE then [goto ERR_WRKLONGT]
<1-4> if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65) then [goto HOURPD]
else if (EVERWRK eq 1 and WHYNOWK2 = 1,2,4-10, D,R," " and AGE lt 65) or
(DOINGLW2 = 1,2,4) [goto WRKLONGH]
Hard Edits
ERR_WRKLONGT
* Number of years is greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 23 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.146
Variable Name
WRKLONGH
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or (EVERWRK = 1 and WHYNOWK2 ne 3
and AGE lt 65))
Universe-text
Sample adults 18+ (who were working last week, or who were with a job or business
but not at work, or who were working but not for pay at a family-owned job or business,)
or (who have ever worked and are not retired and are less than 65 years of age.)
Question Text
? [F1]
(Fill1: Is this MAIN job or business the job you have held for the longest?)
(Fill2: Was your most recently held job also the job you held the longest?)
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Longest job
[Fill1: If DOINGLW2 eq 1,2,4, ]
[Fill2: if EVERWRK eq 1 and WHYNOWK2 ne 03 and AGE lt 65 ]
Special Instructions
Skip Instructions
<1,2,R,D> [goto HOURPD]
Hard Edits
Soft Edits
AssocHelp
H_WRKLONG
Wednesday, June 14, 2017
Page 24 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.150
Variable Name
HOURPD
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(Fill1: Are you paid by the hour at this MAIN job or business?)
(Fill2: Were you paid by the hour on the job you held the longest?)
(Fill3: Were you paid by the hour on the job you held most recently?)
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Paid by the hour
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<1,2,D,R> [goto PDSICK]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 25 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.160
Variable Name
PDSICK
Universe
HHSTAT4 = S and (DOINGLW2 = 1,2,4 or EVERWRK = 1)
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business, or
who have ever worked
Question Text
(Fill1: Do you have paid sick leave on this MAIN job or business?
(Fill2: Did you ever have paid sick leave on the job you held the longest?
(Fill3: Did you ever have paid sick leave on the job you held most recently?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Paid sick leave
Fill1: if DOINGLW2 = <1,2,4>
Fill2: if EVERWRK = 1 and (WHYNOWK2 = 3 or AGE ge 65)
Fill3: if EVERWRK = 1 and WHYNOWK2 ne 3 and AGE lt 65
Special Instructions
Skip Instructions
<1,2,D,R>
if DOINGLW2 = 1,2,4 then [goto ONEJOB];
else if DOINGLW2=3,5 then [goto WRKLYR2];
else if DOINGLW2=D, R then [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 26 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.170
Variable Name
ONEJOB
Universe
HHSTAT4 = S and DOINGLW2 = 1,2,4
Universe-text
Sample adults 18+ who were working last week, or who were with a job or business but
not at work, or who were working but not for pay at a family-owned job or business
Question Text
Do you have more than one job or business?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
More than one job
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 27 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.210_00.000
Variable Name
WRKLYR2
Universe
HHSTAT4 =’S’ and AGE ge ‘18’ and (DOINGLW2 IN (’3’, ‘5’))
Universe-text
Sample adults 18+ who were looking for work or who were not working at a job or
business AND who were not looking for work in the last week
Question Text
? [F1]
Although you did not work last week, did you have a job or business at any time in the
PAST 12 MONTHS?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Worked past 12 months
Fill Instructions
Special Instructions
Skip Instructions
<1,2,D,R> [goto next section]
Hard Edits
Soft Edits
AssocHelp
H_WRKLYR2
Wednesday, June 14, 2017
Page 28 of 29
Module
15
Section Name
Adult Socio-Demographic Background
Part
Question ID
ASD.210_00.000_H
Variable Name
H_WRKLYR2
Universe
Universe-text
Question Text
A job exists when there is a definite arrangement for regular work on a continuing
basis, and the person holding the job receives pay or other compensation for his/her
work. The schedule of hours or days can be irregular as long as there is a definite
arrangement to work on a continuing basis.
Include:
Persons who worked for wages, salary, commission, tips, piece-rates, or pay-in-kind.
Unpaid workers in a family business or farm, persons who worked without pay on a
farm or unincorporated business operated by a
related member of the household
A business exists when machinery or equipment of substantial value is used in
conducting the business; an office, store, or other place of business is maintained; or
the business is advertised to the public.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: WRKLYR2
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 29 of 29
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Conditions
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.010_00.000
Variable Name
HYPEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
?[F1]
Now I am going to ask you about certain medical conditions.
Have you EVER been told by a doctor or other health professional that you had
... Hypertension, also called high blood pressure?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Hypertension - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HYPDIFV]
<2,R,D> [goto CHLEV]
Hard Edits
Soft Edits
AssocHelp
H_HYPEV
Wednesday, June 14, 2017
Page 1 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.010_H
Variable Name
H_HYPEV
Universe
Universe-text
Question Text
Include only reports of hypertension/high blood pressure by a doctor or other health
care professional. Do not include home blood pressure testing and testing by a
machine in a mall, store or other commercial area. Do not include reports of potential
hypertension or borderline hypertension.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens
HYPEV
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 2 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.020_00.000
Variable Name
HYPDIFV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HYPEV(e)='1'
Universe-text
Sample adults 18+ who were told they had hypertension
Question Text
Were you told on two or more DIFFERENT visits that you had hypertension, also called
high blood pressure?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hypertension - 2+ visits
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1> [goto HYPYR]
<2,R,D> [goto HYPMDEV2]
Hard Edits
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Wednesday, June 14, 2017
Page 3 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.020_00.010
Variable Name
HYPYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HYPEV(e) = '1' and
HYPDIFV='1'
Universe-text
Sample adults 18+ who were ever told they had hypertension (2+ visits)
Question Text
DURING THE PAST 12 MONTHS, have you had hypertension, also called high blood
pressure?
* Enter '1' if respondent is taking medication to control his/her high blood pressure.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Past 12 months hypertension
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HYPMDEV2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 4 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.022_02.020
Variable Name
HYPMDEV2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and HYPEV(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had high blood pressure
Question Text
Was any medicine EVER prescribed by a doctor for your high blood pressure?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HYPMED2]
<2,R,D> [goto CHLEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 5 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.022_03.030
Variable Name
HYPMED2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and HYPMDEV2(e)='1'
Universe-text
Sample adults 18+ who were ever prescribed medicine for high blood pressure
Question Text
Are you NOW taking any medicine prescribed by a doctor for your high blood pressure?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHLEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 6 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_00.010
Variable Name
CHLEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had high
cholesterol?
* Enter '1' if respondent is taking medication to control his/her high cholesterol.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
High cholesterol-ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CHLYR]
<2,R,D> [goto CHDEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 7 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_00.020
Variable Name
CHLYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CHLEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had high cholesterol
Question Text
DURING THE PAST 12 MONTHS, have you had high cholesterol?
* Enter '1' if respondent is taking medication to control his/her high cholesterol.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
High cholesterol
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHLMDEV2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 8 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_03.030
Variable Name
CHLMDEV2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and CHLEV(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had high cholesterol
Question Text
Was any medication EVER prescribed by a doctor to help lower your cholesterol?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CHLMDNW2]
<2,R,D> [goto CHDEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 9 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_04.040
Variable Name
CHLMDNW2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))and CHLMDEV2(e)='1'
Universe-text
Sample adults 18+ who were ever prescribed medicine for high cholesterol
Question Text
Are you NOW taking any medicine prescribed by a doctor to help lower your
cholesterol?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHDEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 10 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_01.000
Variable Name
CHDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had
... Coronary heart disease?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Coronary heart disease -ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ANGEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 11 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_02.000
Variable Name
ANGEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
... Angina, also called angina pectoris?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Angina -ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MIEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 12 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_03.000
Variable Name
MIEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A heart attack (also called myocardial infarction)?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Heart attack - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HRTEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 13 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_03.005
Variable Name
QARNDM5
Universe
QAASK5 = 1
Universe-text
All families selected for QA question
Question Text
Random number generator
Answer Codes
(Allow 00-09)
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 14 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_04.000
Variable Name
HRTEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...Any kind of heart condition or heart disease (other than the ones I just asked about)?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Heart condition/disease - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto STREV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_04.001
Variable Name
QACHK5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN('997','999')) and QAASK5 = 1
Universe-text
Sample adults 18+ where QA question was selected
Question Text
*Please enter [Fill1: QARNDM5 ] for quality assurance.
Answer Codes
(Allow 0-9)
Question Type
Procedure
Field Pane Description
Fill Instructions
QA Check
Fill1: QARNDM5 is the number that was randomly selected is filled in here
Special Instructions
Skip Instructions
[goto STREV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 16 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_04.005
Variable Name
QACHNG5
Universe
QACHK5=0-9
Universe-text
All families selected for QA question
Question Text
Flag field to indicate whether or not the value entered by the FR matched or not.
' ' (empty) - if the check was not asked or answered
0 - if the check was asked and the value entered matches the random value
1 - if the check was asked and the value entered does NOT match the random
value (cannot be undone)
Answer Codes
' ', 0,1
Question Type
Flag
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 17 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_04_H
Variable Name
H_HRTEV
Universe
Universe-text
Question Text
Include as heart disease or heart condition any of the following: heart failure, chronic
heart condition, rheumatic heart disease, atrial or mitral valve disease/damage, etc.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens
HRTEV
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 18 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_05.000
Variable Name
STREV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...A stroke?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Stroke - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto EPHEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 19 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.031_06.000
Variable Name
EPHEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
Have you EVER been told by a doctor or other health professional that you had
...Emphysema?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Emphysema - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto COPDEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 20 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.035_00.000
Variable Name
COPDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had chronic
obstructive pulmonary disease, also called COPD?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
COPD - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [if AGE GE 40, goto ASPMEDEV
else goto AASMEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 21 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.010
Variable Name
ASPMEDEV
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999'))
Universe-text
Sample adults 40+
Question Text
Has a doctor or other health professional EVER told you to take a low-dose aspirin
each day to prevent or control heart disease?
* If the respondent volunteers they have been told to take an aspirin every other day or
“regularly” for these reasons, enter 1 for “yes.”
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Low-dose aspirin
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ASPMEDAD]
<2,R,D> [goto ASPONOWN]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 22 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.020
Variable Name
ASPMEDAD
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999')) and ASPMEDEV(e)='1'
Universe-text
Sample adults 40+ who have ever been advised to take a low-dose aspirin every day to
prevent or control heart disease
Question Text
Are you NOW following this advice?
* If the respondent provides an answer such as “sometimes,” “occasionally,” or “from
time to time,” enter 1 for “yes."
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Following advice
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto AASMEV]
<2> [goto ASPMDMED]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 23 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.030
Variable Name
ASPMDMED
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999')) and ASPMEDEV(e)='1'
and ASPMEDAD='2'
Universe-text
Sample adults 40+ who have ever been advised to take aspirin every day, but are not
currently following that advice
Question Text
Did a doctor or other health professional advise you to stop taking a low-dose aspirin
every day?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Stop taking low-dose aspirin
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AASMEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 24 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.040_00.040
Variable Name
ASPONOWN
Universe
HHSTAT4 = ‘S’ and (AGE GE '040' and AGE not IN('997','999') and ASPMEDEV(e)
IN('2','7','9')
Universe-text
Sample adults 40+ who have not been advised to take aspirin every day or Ref/DK if
they have been advised to take aspirin every day
Question Text
On your own, are you now taking a low-dose aspirin each day to prevent or control
heart disease?
* If the respondent volunteers they are taking an aspirin every other day or “regularly”
for these reasons, enter 1 for “yes.”
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Taking low-dose aspirin
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AASMEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 25 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.080_00.000
Variable Name
AASMEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
Have you EVER been told by a doctor or other health professional that you had asthma?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Asthma - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AASSTILL]
<2,R,D> [goto ULCEV]
Hard Edits
Soft Edits
AssocHelp
H_AASMEV
Wednesday, June 14, 2017
Page 26 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.080_H
Variable Name
H_AASMEV
Universe
Universe-text
Question Text
Accept asthma of any kind such as smoker's asthma, bronchial asthma, allergic
asthma, and the like. Do not accept self-diagnosed lung problems or conditions
reported by a person who is not a doctor
and not working with or for a doctor.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
AASMEV, AASMYR, AASMERYR, AASSTILL
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 27 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.085_00.000
Variable Name
AASSTILL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AASMEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they have asthma
Question Text
? [F1]
Do you still have asthma?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Asthma - still
Fill Instructions
Special Instructions
Skip Instructions
<1> [if DOINGLW2=1,2,4 or WRKLYR2=1 [goto AASAGE]
<2,R,D> [goto AASMYR]
Hard Edits
Soft Edits
AssocHelp
H_AASMEV
Wednesday, June 14, 2017
Page 28 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.085_00.010
Variable Name
AASAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months and still have asthma
Question Text
How old were you when you were first told you had asthma?
Answer Codes
001-120,
Refused
Don't know
Question Type
Integer
Field Pane Description
Asthma age
Fill Instructions
Special Instructions
Skip Instructions
If AASAGE ge AGE, then [got ERR_AASAGE]
<001-120> [goto AASMYR] [goto AASAGE16]
Hard Edits
ERR_AASAGE
* Number of years is greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 29 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.085_00.020
Variable Name
AASAGE16
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASAGE(e) IN ('997','999')
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, and refused or said don't know to question on age they
were first told they had asthma
Question Text
Were you less than 16 or 16 or older when you were first told you had asthma?
Answer Codes
1. Less than 16
2. 16 or older
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Told had asthma
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AASMYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 30 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.090_00.000
Variable Name
AASMYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AASMEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had asthma
Question Text
? [F1]
DURING THE PAST 12 MONTHS, have you had an episode of asthma or an asthma
attack?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Asthma - past 12 months
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AASMERYR]
Hard Edits
Soft Edits
AssocHelp
H_AASMEV
Wednesday, June 14, 2017
Page 31 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.000
Variable Name
AASMERYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AASMEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had asthma
Question Text
? [F1]
DURING THE PAST 12 MONTHS, have you had to visit an emergency room or urgent
care center because of asthma?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Asthma - ER past 12 months
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if AASSTILL=1 or AASMYR=1 [go to AASMHSP]; else [goto ULCEV]
Hard Edits
Soft Edits
AssocHelp
H_AASMEV
Wednesday, June 14, 2017
Page 32 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.010
Variable Name
AASMHSP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, have you stayed overnight in a hospital because of
asthma?
*If in hospital for asthma AND other reasons, enter '1'.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Past 12 months overnight in hospital for asthma
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AWZMSWK]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 33 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.030
Variable Name
AWZMSWK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, HOW MANY DAYS were you UNABLE to [fill1:
work/get work done around the house] because of your asthma?
*Enter '0' for none.
*Enter '996' if respondent is unable to do this activity.
Answer Codes
Question Type
Allow 0-365,996,R,D
Integer
Field Pane Description
Fill Instructions
Days unable to work because of asthma
Fill1: IF DOINGLW2=1,2,4 fill "work"; else if DOINGLW2=3,5,R,D fill "get work done
around the house"
Special Instructions
Skip Instructions
<0-100,996,R,D> [go to AASMPMED]
<101-365> [go to ERR1_AWZMSWK]
<366-994> [go to ERR2_AWZMSWK]
Hard Edits
if AWZMSWK = 366-994 then display ERR2_AWZMSWK:
"366-994 days not allowed in this field.
*Please correct."
Soft Edits
if AWZMSWK >100 and ne 996 then display ERR1_AWZMSWK:
"AWZMSWK is an unusually large number;
*Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 34 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.060
Variable Name
AASMPMED
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Now I'm going to ask you about two different kinds of ASTHMA medicine. One prevents
symptoms over the long term. The other is for quick relief of symptoms during an attack
or episode. This quick relief medicine is breathed in through your mouth using a
canister inhaler or a disk inhaler.
DURING THE PAST 3 MONTHS, have you used the kind of PRESCRIPTION asthma
inhaler that gives QUICK relief from asthma symptoms during an attack? Include only
medications prescribed by a health care professional.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Quick relief inhaler
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AASMTYP]
<2,R,D> [go to AASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 35 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.065
Variable Name
AASMTYP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and and
AASMPMED(e)='1'
Universe-text
Sample adults 18+ who have used a quick relief prescription asthma inhaler in the past
three months
Question Text
When you take your rescue prescription asthma medication, would you say that you
most often use an inhaler and/or disk, or do you most often use a nebulizer?
*Read if necessary: Both an inhaler or a disk inhaler are very portable canisters or
devices used to inhale medication in one or two breaths. A nebulizer is a machine that
turns liquid medication into a mist that you inhale into the lungs over a few minutes
Answer Codes
Question Type
1. Inhaler or disk
2. Nebulizer
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Prescription asthma medication
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to AASMCAN]
<2,R,D> [go to AASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 36 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.070
Variable Name
AASMCAN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and and
AASMTYP(e)='1'
Universe-text
Sample adults 18+ who have used a prescription asthma inhaler/disk most often in the
past three months
Question Text
DURING THE PAST 3 MONTHS, did you use more than three canisters or disks of this
type of quick relief inhaler?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
More than 3 canisters
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 37 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.090
Variable Name
AASMDTP2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
The second kind of asthma medication is different from inhalers used for quick relief. It
is the preventive kind that is used to protect your lungs and keep you from having
attacks. It can be either a pill or an inhaler.
Are you NOW taking a preventive asthma medication every day or almost every day,
less often, or never?
Answer Codes
Question Type
1. Every day or almost every day
2. Less often
3. Never
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Preventive asthma medication usage
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [go to AASWMP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 38 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.100
Variable Name
AASWMP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
An asthma action plan is a printed form with specific instructions based on your asthma
that tells when to change the amount or type of medicine, when to call the doctor for
advice, and when to go to the emergency room.
Has a doctor or other health professional EVER given you an asthma action plan?
*Read if necessary: Include nurses and asthma educators.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Action plan
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AASCLASS]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 39 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.110
Variable Name
AASCLASS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Have you ever taken a course or class on how to manage asthma yourself?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Course or class
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAS_REC]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 40 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.105_01.010
Variable Name
AAS_REC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Has a doctor or other health professional EVER taught you
...how to recognize early signs or symptoms of an asthma episode?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Recognize early signs
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAS_RES]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 41 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.105_02.020
Variable Name
AAS_RES
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
*Read if necessary: Has a doctor or other health professional EVER taught you
...how to respond to episodes of asthma?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Respond to episodes
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAS_MON]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 42 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.105_03.030
Variable Name
AAS_MON
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
*Read if necessary: Has a doctor or other health professional EVER taught you
...how to monitor peak flow for daily therapy?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Monitor peak flow
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAPENVLN]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 43 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.010
Variable Name
AAPENVLN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Has a doctor or other health professional EVER advised you to change things in your
home, school, or work environment to improve your asthma?
Answer Codes
1. Yes
2. No
3. Was told no changes needed
Don't know
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Advised you
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [go to AAROUTIN]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 44 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.020
Variable Name
AAROUTIN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, how many times did you see a doctor or other
health professional for a routine checkup for your asthma? Please do not include
emergency room visits, visits to urgent care centers, or other visits for acute care for an
asthma episode or attack.
*Enter '0' for none.
Answer Codes
Question Type
Allow 0-365,R,D
Integer
Field Pane Description
Number of times seeing doctor for asthma
Fill Instructions
Special Instructions
Skip Instructions
<0-50,R,D> [go to AASYMPT]
<51-365> [goto ERR_AAROUTIN]
Hard Edits
Soft Edits
ERR_AAROUTIN
[fill4: AAROUTIN] is an unusually large number.
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 45 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.030
Variable Name
AASYMPT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months and saw a doctor/health professional about their asthma in the past year
Question Text
The next three questions are about the last time you saw a doctor or other health care
professional for routine care or for any reason.
At your last visit, did your doctor or other health professional ask HOW OFTEN
….you had asthma symptoms?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Asked frequency asthma symtoms
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AARESCUE];
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 46 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.040
Variable Name
AARESCUE
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months and who use a quick relief inhaler and saw a doctor/health professional about
their asthma in the past year
Question Text
At your last visit, did your doctor or other health professional ask HOW OFTEN
….you used a quick relief inhaler?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Frequency quick relief inhaler
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAACTLIM]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 47 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.050
Variable Name
AAACTLIM
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AASSTILL(e)='1'
or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months and saw a doctor/health professional about their asthma in the past year
Question Text
At your last visit, did your doctor or other health professional ask HOW OFTEN
…asthma symptoms limited your daily activities?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Limit daily activities
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if DOINGLW2=1,2,4 or WRKLYR2=1 and AASAGE LE 15 or AASAGE16=1
[goto AASSTAT];
else if if DOINGLW2=1,2,4 or WRKLYR2=1 and AASAGE GE 16 or AASAGE16=2,R,D
[goto AASEMP];
else [goto ULCEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 48 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.060
Variable Name
AASSTAT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and (AASAGE(e) LE '015' or
AASAGE16(e)='1')
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, and were less than 16 years of age when they were told
they had asthma
Question Text
Compared to when you were first told you had asthma, would you say your asthma has
been better, worse, or about the same as an adult?
Answer Codes
1. Better
2. Worse
3. About the same
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Asthma status
Fill Instructions
Special Instructions
Skip Instructions
<1,3,R,D> [goto AASWKREL]<2> [goto AASEMP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 49 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.070
Variable Name
AASEMP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and ((AASAGE(e) GE '016') or
(AASAGE16(e) IN (‘2’,'7','9')) or AASSTAT(e)='2')
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, and were 16 years of age or older or less than 16 years
of age and their asthma has gotten worse as an adult or age at time of diagnosis is
unknown
Question Text
Were you employed when [fill 1: you first developed symptoms of asthma/your asthma
got worse]?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Employed
r AASAGE16=1) then fill “your asthma got worse”
Special Instructions
Skip Instructions
<1.2.R,D> [goto AASWKREL]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 50 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.080
Variable Name
AASWKREL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, were 16 years of age or older or less than 16 years of
age and their asthma has gotten worse as an adult or age at time of diagnosis is
unknown
Question Text
Have you been told by a doctor or other health professional that your asthma [fill: was
probably caused by your work/was probably made worse by your work/was ever made
worse by any job you have ever had]?”
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Told asthma job related
fill 1: if (AASAGE >= 16 or AASAGE16=2,D,R) and AASEMP=1 then fill “was
probably caused by your work”
else if (AASAGE < 16 or AASAGE16=1) and AASSTAT=2 and AASEMP=1 then fill
“was probably made worse by your work”
else fill “was ever made worse by any job you have ever had”
Special Instructions
Skip Instructions
<1> [goto ULCEV]
<2,R,D> [goto AASDWKRL]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 51 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.090
Variable Name
AASDWKRL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e) IN
('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASWKREL(e) IN (‘2’,’7’,’9’)
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, were 16 years of age or older or less than 16 years of
age and their asthma has gotten worse as an adult or age at time of diagnosis is
unknown
Question Text
Did YOU ever discuss with a doctor or other health professional whether your asthma
[fill: was probably caused by your work/was probably made worse by your work/was
ever made worse by any job you have ever had]?”
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Discussed asthma job related
fill 1: if (AASAGE >= 16 or AASAGE16=2,D,R) and AASEMP=1 then
fill “was probably caused by your work”
else if (AASAGE < 16 or AASAGE16=1) and AASSTAT=2 and AASEMP=1 then
fill “was probably made worse by your work”
else fill “was ever made worse by any job you have ever had”
Special Instructions
Skip Instructions
<1,2,D,R> [goto ULCEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 52 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.110_00.000
Variable Name
ULCEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had
...An ulcer
This could be a stomach, duodenal or peptic ulcer.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Ulcer - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ULCYR]
<2,R,D> [goto CANEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 53 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.120_00.000
Variable Name
ULCYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ULCEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had an ulcer
Question Text
DURING THE PAST 12 MONTHS have you had
... An ulcer?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Ulcer - past 12 months
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1,2,R,D> [goto CANEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 54 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.130_00.000
Variable Name
CANEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had
...Cancer or a malignancy of any kind?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Cancer - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CANKIND_1]
<2,R,D> [goto DIBEV1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 55 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.001
Variable Name
CANKIND_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANEV(e)='1'
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
What kind of cancer was it?
* Enter code for the first kind of cancer.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Kind of cancer_1
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Wednesday, June 14, 2017
Page 56 of 104
Skip Instructions
<1-30,R,D> [goto CANAGE_1]
IF SEX=1 (MALE) and No. <6,18,29> selected [goto ERR1_CANKIND_1]
IF SEX=2 (FEMALE) and No. <20,26> selected [goto ERR2_CANKIND_1]
Hard Edits
ERR1_CANKIND_1
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_1
* Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 57 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.002
Variable Name
CANKIND_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (CANAGE_1=1100, D or (CANAGE_1=R but CANKIND_1 ne R))
Universe-text
Sample adults 18+ who either provided an age for one kind of cancer or didn't know
how old they were when first diagnosed with that kind of cancer or else refused to
provide an age but had not refused to answer CANKIND_1.
Question Text
* Enter code for the second kind of cancer.
* Enter '96' for no more.
Answer Codes
Question Type
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Wednesday, June 14, 2017
Kind of cancer_2
Page 58 of 104
Fill Instructions
Special Instructions "Gray out" whatever option was selected in CANKIND_1 to indicate that that option is
now not available. Make sure that if this option is selected it triggers the error message
that this is an invalid option.
Indent this description to indicate that it is a "follow up" to CANEV.
Skip Instructions
<1-30,R,D>[goto CANAGE_2]
<96> [goto DIBEV1]
IF SEX=1 (MALE) and No. <6,18,29> selected [goto ERR1_CANKIND_2]
IF SEX=2 (FEMALE) and No. <20,26> selected [goto ERR2_CANKIND_2]
Hard Edits
ERR1_CANKIND_2
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_2
* Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 59 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.003
Variable Name
CANKIND_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (CANAGE_2=1100, D or (CANAGE_2=R but CANKIND_2 ne R))
Universe-text
Sample adults 18+ who either provided an age for a second kind of cancer or didn't
know how old they were when first diagnosed that kind of cancer or else refused to
provide an age but had not refused to answer CANKIND_2.
Question Text
* Enter code for the third kind of cancer.
* Enter '96' for no more.
Answer Codes
Question Type
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
96. No more
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Wednesday, June 14, 2017
Kind of cancer_3
Page 60 of 104
Fill Instructions
Special Instructions "Gray out" whatever options were selected in CANKIND_1 and CANKIND_2 to indicate
that those options are now not available. Make sure that if either of these options are
selected it triggers the error message that this is an invalid option.
Indent this description to indicate that it is a "follow up" to CANEV.
Skip Instructions
<1-30,R,D>[goto CANAGE_3]
<96> [goto DIBEV1]
IF SEX=1 (MALE) and No. <6,18,29> selected [goto ERR1_CANKIND_3]
IF SEX=2 (FEMALE) and No. <20,26> selected [goto ERR2_CANKIND_3]
Hard Edits
ERR1_CANKIND_3
* Code 6 or 18 or 29 is unavailable for males.
ERR2_CANKIND_3
* Code 20 or 26 is unavailable for females.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 61 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.140_00.004
Variable Name
CANKIND_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (CANAGE_3=1100, D or (CANAGE_3=R but CANKIND_3 ne R))
Universe-text
Sample adults 18+ who either provided an age for a third kind of cancer or didn't know
how old they were when first diagnosed that kind of cancer or else refused to provide
an age but had not refused to answer CANKIND_3
Question Text
* Enter '95' if respondent offers more than 3 kinds of cancer.
* Enter '96' for no more.
Answer Codes
1. Bladder
2. Blood
3. Bone
4. Brain
5. Breast
6. Cervix
7. Colon
8. Esophagus
9. Gallbladder
10. Kidney
11. Larynx-windpipe
12. Leukemia
13. Liver
14. Lung
15. Lymphoma
16. Melanoma
17. Mouth/tongue/lip
18. Ovary
19. Pancreas
20. Prostate
21. Rectum
22. Skin (non-melanoma )
23. Skin (don't know what kind)
24. Soft tissue (muscle or fat )
25. Stomach
26. Testis
27. Throat - pharynx
28. Thyroid
29. Uterus
30. Other
95. More than 3 kinds of cancer
96. No more
Question Type
Pick One - answer list pane
Field Pane Description
More than 3 kinds of cancer
Fill Instructions
Wednesday, June 14, 2017
Page 62 of 104
Special Instructions "Gray out" whatever options were selected in CANKIND_1, CANKIND_2 and
CANKIND_3 to indicate that those options were already chosen. The only valid options
for this question are 95 and 96.
Indent this description to indicate that it is a "follow up" to CANEV.
Skip Instructions
<95,96> [goto DIBEV1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 63 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_00.001
Variable Name
CANAGE_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANKIND_1=1-30,
D,R
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
? [F1]
How old were you when [Fill1: CANKIND_1 / Fill2: this cancer] was first diagnosed?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age_1
Fill2: if (CANKIND_1 = D,R)
Fill1: if (CANKIND_1 NE D,R)
Fills to be used for CANKIND_1:
bladder cancer if CANKIND_1 = 1
blood cancer if CANKIND_1 = 2
bone cancer if CANKIND_1 = 3
brain cancer if CANKIND_1 = 4
breast cancer if CANKIND_1 = 5
cervical cancer if CANKIND_1 = 6
colon cancer if CANKIND_1 = 7
esophageal cancer if CANKIND_1 = 8
gallbladder cancer if CANKIND_1 = 9
kidney cancer if CANKIND_1 = 10
larynx-windpipe cancer if CANKIND_1 = 11
leukemia if CANKIND_1 = 12
liver cancer if CANKIND_1 = 13
lung cancer if CANKIND_1 = 14
lymphoma if CANKIND_1 = 15
melanoma if CANKIND_1 = 16
mouth/tongue/lip cancer if CANKIND_1 = 17
ovarian cancer if CANKIND_1 = 18
pancreatic cancer if CANKIND_1 = 19
prostate cancer if CANKIND_1 = 20
rectal cancer if CANKIND_1 = 21
skin (non-melanoma) cancer if CANKIND_1 = 22
skin (don't know what kind) cancer if CANKIND_1 = 23
soft tissue (muscle or fat) cancer if CANKIND_1 = 24
stomach cancer if CANKIND_1 = 25
testicular cancer if CANKIND_1 = 26
throat/pharynx cancer if CANKIND_1 = 27
thyroid cancer if CANKIND_1 = 28
uterine cancer if CANKIND_1 = 29other cancer if CANKIND_1 = 30
Special Instructions
Wednesday, June 14, 2017
Page 64 of 104
Skip Instructions
<1-100, D> goto CANKIND_2
and at CANKIND_1 [goto DIBEV1]
and CANKIND_1 NE [goto CANKIND_2]
If number in CANAGE_1 greater than person years old (AGE) [goto ERR_ CANAGE_1]
Hard Edits
ERR_ CANAGE_1
* [Fill2: CANAGE_1] years old is older than age[fill3: AGE].
* Please correct.
Soft Edits
AssocHelp
H_CANAGE_1
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_00.002
Variable Name
CANAGE_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANKIND_2 = 130,D,R
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
? [F1]
How old were you when [Fill1: CANKIND_2/Fill2: this cancer] was first diagnosed?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age_2
Fill1: if (CANKIND_2 NE D,R)
Fill2: if (CANKIND_2 = D,R)
Special Instructions
Skip Instructions
<1-100, D> [goto CANKIND_3]
and at CANKIND_2 [goto DIBEV1]
and CANKIND_2 NE [goto CANKIND_3]
If number in CANAGE_2 greater than person years old (AGE) [goto ERR_ CANAGE_2]
Hard Edits
ERR_ CANAGE_2
* [Fill2: CANAGE_2] years old is older than your age[fill3: AGE].
* Please correct.
Soft Edits
AssocHelp
H_CANAGE_1
Wednesday, June 14, 2017
Page 65 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_00.003
Variable Name
CANAGE_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CANKIND_3=1-30,
D,R
Universe-text
Sample adults 18+ who were ever told they had cancer
Question Text
? [F1]
How old were you when [Fill1: CANKIND_3/Fill2: this cancer ] was first diagnosed?
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Age_3
Fill1: if (CANKIND_3 NE D,R)
Fill2: if (CANKIND_3 = D,R)
Special Instructions
Skip Instructions
<1-100, D> [goto CANKIND_4]
and at CANKIND_3 [goto DIBEV1]
and CANKIND_3 NE [goto CANKIND_4]
If number in CANAGE_3 greater than person years old (AGE) [goto ERR_ CANAGE_3]
Hard Edits
ERR_ CANAGE_3
* [Fill2: CANAGE_3] years old is older than your age[fill3: AGE].
* Please correct.
Soft Edits
AssocHelp
H_CANAGE_1
Wednesday, June 14, 2017
Page 66 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.150_1_H
Variable Name
H_CANAGE_1
Universe
Universe-text
Question Text
Probe for a specific age. Record a best estimate if that is what the sample adult gives
you.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CANAGE_1, CANAGE_2, CANAGE_3
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 67 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.160_00.000
Variable Name
DIBEV1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
?[F1]
[Fill1:Other than during pregnancy, have you EVER been told by a doctor or other
health professional that you have diabetes or sugar diabetes?]/
[Fill2:Have you EVER been told by a doctor or other health professional that you have
diabetes or sugar diabetes?]
Answer Codes
1. Yes
2. No
3. Borderline or prediabetes
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Diabetes - ever
Fill1: If SEX=2 fill “Other than during pregnancy, have you EVER been told by a doctor
or other health professional that you have diabetes or sugar diabetes?”; Else if SEX=1
fill “Have you EVER been told by a doctor or other health professional that you have
diabetes or sugar diabetes?”
Special Instructions ANSWER categories should appear vertically. If DIBEV1=3 fill “1” in DIBPRE1
Skip Instructions
<1> [goto DIBAGE]
<2,R,D> [goto DIBPRE1]
<3> [goto DIBPILL]
Hard Edits
Soft Edits
AssocHelp
H_DIBEV1
Wednesday, June 14, 2017
Page 68 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.160_H
Variable Name
H_DIBEV1
Universe
Universe-text
Question Text
Do not include a doctor's diagnosis of prediabetes or borderline diabetes.
Do not include a doctor's diagnosis of gestational diabetes or diabetes present only
when a woman is pregnant.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
DIBEV1
DIBAGE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 69 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.165_00.000
Variable Name
DIBPRE1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e) IN
('2','7','9')
Universe-text
Sample adults 18+ who were never told they had diabetes, or who refused or said don’t
know to having been told they had diabetes
Question Text
?[F1]
Have you EVER been told by a doctor or other health professional that you have any of
the following: prediabetes, impaired fasting glucose, impaired glucose tolerance,
borderline diabetes, or high blood sugar?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Pre-diabetic symptoms
Fill Instructions
Special Instructions If DIBEV1=3 (Borderline or prediabetes) fill 1 in DIBPRE1
Skip Instructions
<1> [goto DIBPILL]
<2,R,D> [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
H_DIBEV1
Wednesday, June 14, 2017
Page 70 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.170_00.000
Variable Name
DIBAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e)='1'
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy)
Question Text
?[F1]
How old were you when a doctor or other health professional FIRST told you that you
had diabetes or sugar diabetes?
Answer Codes
Question Type
Integer
Field Pane Description
Diabetes - age
Fill Instructions
Special Instructions
Skip Instructions
<1-100 R,D> [goto DIBPILL]
If number in DIBAGE greater than person years old (AGE) goto ERR_ DIBAGE
Hard Edits
ERR_ DIBAGE
* [Fill1: DIBAGE] years old is older than your age[fill2: AGE].
* Please correct.
Soft Edits
AssocHelp
H_DIBEV1
Wednesday, June 14, 2017
Page 71 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.180_00.000
Variable Name
DIBPILL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DIBEV1(e)='1') or
(DIBPRE1(e)='1')
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy) or who were told they had pre-diabetes, impaired fasting glucose,
impaired glucose tolderance, borderline diabetes, or high blood sugar
Question Text
Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes
called oral agents or oral hypoglycemic agents.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Diabetic pill - now
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto INSLN1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 72 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.190_00.000
Variable Name
INSLN1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DIBEV1(e)='1') or
(DIBPRE1(e)='1')
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy) or who were told they had prediabetes, impaired fasting glucose,
impaired glucose tolerance, borderline diabetes, or high blood sugar
Question Text
Insulin can be taken by shot or pump. Are you NOW taking insulin?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Insulin - now
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 73 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_01.000
Variable Name
AHAYFYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Hay fever?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Hay fever
Fill Instructions
Special Instructions "Past 12 mo." as a heading for this question as well as ACN.201_02 - ACN.201_05.
Indent all descriptions beneath the heading.
Skip Instructions
<1,2,R,D> [goto SINYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 74 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_02.000
Variable Name
SINYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Sinusitis?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Sinusitis
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBRCHYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 75 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_03.000
Variable Name
CBRCHYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Chronic bronchitis?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Chronic bronchitis
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto KIDWKYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 76 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_04.000
Variable Name
KIDWKYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
......Weak or failing kidneys? - Do not include kidney stones, bladder infections or
incontinence.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Weak/failing kidneys
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto LIVYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 77 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.201_05.000
Variable Name
LIVYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary:
DURING THE PAST 12 MONTHS, have you been told by a doctor or other health
professional that you had
...Any kind of liver condition?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Liver condition
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto JNTSYMP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 78 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.250_00.000
Variable Name
JNTSYMP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions refer to your joints. Please do NOT include the back or neck.
DURING THE PAST 30 DAYS, have you had any symptoms of pain, aching, or
stiffness in or around a joint?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Joint pain - past 30 days
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto JMTHP]
<2,R,D> [goto ARTH]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 79 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.260_00.000
Variable Name
JMTHP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and JNTSYMP(e)='1'
Universe-text
Sample adults 18+ who had joint pain in the past 30 days
Question Text
(book) A5
Which joints are affected?
* Enter all that apply, separate with commas.
Answer Codes
Question Type
1. Shoulder-right
2. Shoulder-left
3. Elbow-right
4. Elbow-left
5. Hip-right
6. Hip-left
7. Wrist-right
8. Wrist-left
9. Knee-right
10. Knee-left
11. Ankle-right
12. Ankle-left
13. Toes-right
14. Toes-left
15. Fingers/thumb-right
16. Fingers/thumb-left
17. Other joint not listed
Don't know
Refused
Enter All That Apply
Field Pane Description
Joints affected
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1-17,R,D> [goto JNTCHR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 80 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.270_00.000
Variable Name
JNTCHR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and JNTSYMP(e)='1'
Universe-text
Sample adults 18+ who had joint pain in the past 30 days
Question Text
Did your joint symptoms FIRST begin more than 3 months ago?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Symptoms appear 3+ months
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to JNTSYMP (ACN.250).
Skip Instructions
<1,2,R,D> [goto JNTHP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 81 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.280_00.000
Variable Name
JNTHP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and JNTSYMP(e)='1'
Universe-text
Sample adults 18+ who had joint pain in the past 30 days
Question Text
Have you EVER seen a doctor or other health professional for these joint symptoms?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever seen doctor/health professional
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to JNTSYMP (ACN.250).
Skip Instructions
<1,2,R,D> [goto ARTH]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 82 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.290_00.000
Variable Name
ARTH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
Have you EVER been told by a doctor or other health professional that you have some
form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia (fy-bro-my-AL-jee-uh)?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Arthritis - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ARTHLMT]
<2,R,D> if JNTSYMP = 1 [goto ARTHLMT];
elseif JNTSYMP ne 1 [goto PAINECK]
Hard Edits
Soft Edits
AssocHelp
H_ARTH
Wednesday, June 14, 2017
Page 83 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.290_H
Variable Name
H_ARTH
Universe
Universe-text
Question Text
Include the following as arthritis-related conditions:
-
rheumatism, polymyalgia rheumatica
osteoarthritis (not osteoporosis)
tendonitis, bursitis, bunion, tennis elbow
carpal tunnel syndrome, tarsal tunnel syndrome
joint infection, Reiter's syndrome
ankylosing spondylitis; spondylosis
rotator cuff syndrome
connective tissue disease, scleroderma, polymyositis, Raynaud's syndrome
vasculitis
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ARTH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 84 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.295_00.000
Variable Name
ARTHLMT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (JNTSYMP(e)='1'
or ARTH(e)='1')
Universe-text
Sample adults 18+ with joint pain or arthritis
Question Text
? [F1]
Are you now limited in any way in any of your usual activities because of arthritis or joint
symptoms?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Arthritis/joint symptoms - limitations
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to ARTH (ACN.290).
Skip Instructions
<1,2,R,D> [goto PAINECK]
Hard Edits
Soft Edits
AssocHelp
H_ARTHLMT
Wednesday, June 14, 2017
Page 85 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.295_H
Variable Name
H_ARTHLMT
Universe
Universe-text
Question Text
We want to know the sample adult's limitation of activities based on his/her condition
while taking any medications or treatments, if any, to counteract or relieve the arthritis
or joint symptoms.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ARTHLMT
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 86 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.300_00.000
Variable Name
PAINECK
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
The following questions are about pain you may have experienced in the PAST
THREE MONTHS. Please refer to pain that LASTED A WHOLE DAY OR MORE. Do
not report aches and pains that are fleeting or minor.
DURING THE PAST THREE MONTHS, did you have
... Neck pain?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Neck pain
Fill Instructions
Special Instructions "Past 3 months" as a heading for this question as well as ACN.310 - ACN.331_02
Indent all of the Field Pane Descriptions beneath the heading.
Skip Instructions
<1,2,R,D> [goto PAINLB]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 87 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.300_H
Variable Name
H_PAINECK
Universe
Universe-text
Question Text
Pain is sample adult defined, but must have lasted a whole day or more or have
occurred several (more than 3) times during the past 3 months.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
PAINECK, PAINLB, PAINLEG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 88 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.310_00.000
Variable Name
PAINLB
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if necessary.
DURING THE PAST THREE MONTHS, did you have
... Low back pain?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Low back pain
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PAINLEG]
<2,R,D> [goto PAINFACE]
Hard Edits
Soft Edits
AssocHelp
H_PAINECK
Wednesday, June 14, 2017
Page 89 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.320_00.000
Variable Name
PAINLEG
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and PAINLB(e)=1
Universe-text
Sample adults 18+ with low back pain in the past 3 months
Question Text
? [F1]
Did this pain spread down either leg to areas below the knees?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Pain down leg
Fill Instructions
Special Instructions Indent this description to indicate that it is a "follow up" to the previous question.
Skip Instructions
<1,2,R,D> [goto PAINFACE]
Hard Edits
Soft Edits
AssocHelp
H_PAINECK
Wednesday, June 14, 2017
Page 90 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.331_01.000
Variable Name
PAINFACE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST THREE MONTHS, did you have
... Facial ache or pain in the jaw muscles or the joint in front of the ear?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Jaw pain
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AMIGR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 91 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.331_02.000
Variable Name
AMIGR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if neccesary:
DURING THE PAST THREE MONTHS, did you have
...Severe headache or migraine?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Severe headache/migraine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ACOLD2W]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 92 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.350_00.000
Variable Name
ACOLD2W
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These next questions are about your recent health DURING THE LAST 2 WEEKS.
Did you have a head cold or chest cold that started DURING THE LAST 2 WEEKS?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Head/chest cold past 2 weeks
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AINTIL2W]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 93 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.360_00.000
Variable Name
AINTIL2W
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Did you have a stomach or intestinal illness with vomiting or diarrhea that started
DURING THE LAST TWO WEEKS?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Stomach problem - 2 weeks
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if SEX=2 and AGE 18-49 [goto PREGNOW];
else if SEX=1 or AGE >49 [goto HRAIDNOW]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 94 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.370_00.000
Variable Name
PREGNOW
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2'
Universe-text
Female sample adults 18-49 years of age
Question Text
Are you currently pregnant?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Currently pregnant
Fill Instructions
Special Instructions
Skip Instructions
<1> if INTERVIEW_MONTH=4,5,6,7 (April-July) [goto PREGFLYR];
else INTERVIEW_MONTH=1-3,8-12 [goto HRAIDNOW]
[goto HRAIDNOW]
<2,D> [goto PREGFLYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 95 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.370_00.010
Variable Name
PREGFLYR
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2' and (PREGNOW(e) IN('2','9')
or (PREGNOW(e)='1' and INTERVIEW_MONTH(e) IN ('04','05','06','07')))
Universe-text
Female sample adults 18-49 years of age who are not currently pregnant or who don't
know if they are currently pregnant and interviewed April - July
Question Text
[fill1: Were you pregnant any time since August 1st, [fill: LAST YEAR]?/Were you
pregnant any time from August [fill: LAST YEAR] through March [fill: CURYEAR]?/Were
you pregnant any time since August 1st, [fill: CURYEAR]?]
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
IF INTERVIEW_MONTH=1,2,3 (January-March) THEN
fill: “Were you pregnant any time since August 1st, [fill: LAST YEAR]?”
ELSE IF INTERVIEW_MONTH=4,5,6,7 (April-July) THEN
fill: “Were you pregnant any time from August [fill: LAST YEAR] through March [fill:
CURYEAR]?”
ELSE
fill: “Were you pregnant any time since August 1st, [fill: CURYEAR]?”
Special Instructions
Skip Instructions
<1,2,R,D> [goto HRAIDNOW]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 96 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.400_00.000
Variable Name
HRAIDNOW
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These next questions are about your hearing, vision, and teeth.
Do you now use a hearing aid(s)?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Hearing aid - now
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHEARST1]
<2,R,D> [goto HRAIDEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 97 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.410_00.000
Variable Name
HRAIDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HRAIDNOW(e)
IN('2','7','9')
Universe-text
Sample adults 18+ who do not now use a hearing aid or REF/DK whether they now use
a hearing aid
Question Text
Have you ever used a hearing aid(s) in the past?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hearing aid - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AHEARST1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 98 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.420_00.000
Variable Name
AHEARST1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
WITHOUT the use of hearing aids or other listening devices, is your hearing excellent,
good, a little trouble hearing, moderate trouble, a lot of trouble, or are you deaf?
Answer Codes
1. Excellent
2. Good
3. A little trouble hearing
4. Moderate trouble
5. A lot of trouble
6. Deaf
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Hearing status
Fill Instructions
Special Instructions
Skip Instructions
<1-6,R,D> [goto AVISION]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 99 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.430_00.000
Variable Name
AVISION
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have any trouble seeing, even when wearing glasses or contact lenses?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Trouble seeing
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ABLIND]
<2,R,D> [goto LUPPRT]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 100 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.000
Variable Name
ABLIND
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AVISION (e)='1'
Universe-text
Sample adults 18+ who have trouble seeing even when wearing glasses/contact lenses
Question Text
Are you blind or unable to see at all?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Blind
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto LUPPRT]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 101 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.451_00.000
Variable Name
LUPPRT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you lost all of your upper and lower natural (permanent) teeth?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Lost all teeth
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[CHPAIN6M]
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Wednesday, June 14, 2017
Page 102 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.460_00.010
Variable Name
CHPAIN6M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past six months, how often did you have pain? Would you say...
*Read answer categories below.
Answer Codes
Question Type
1. Never
2. Some days
3. Most days
4. Every day
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Chronic pain
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto next section]
<2,3,4> [goto PAINLMT]
Hard Edits
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Wednesday, June 14, 2017
Page 103 of 104
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.460_00.020
Variable Name
PAINLMT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CHPAIN6M(e)
IN('2','3','4')
Universe-text
Sample adults 18+ who had chronic pain in the past 6 months
Question Text
Over the past six months, how often did pain limit your life or work activities? Would
you say...
*Read answer categories below.
Answer Codes
Question Type
1. Never
2. Some days
3. Most days
4. Every day
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Pain limitations
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto the next section]
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Wednesday, June 14, 2017
Page 104 of 104
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Health Status and Limitation of Activities
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.040
Variable Name
WKDAYR
Universe
HHSTAT4='S' and AGE ge '18' and (DOINGLW2 = '1' ,'2', '4' or WRKLYR2 = '1') and
(EVERWRK ne 'No', 'Refused', or 'Don't know')
Universe-text
Sample adults 18+ who worked or had a job or business with or without pay in the last
week or who had a job or business in the past 12 months
Question Text
During the PAST 12 MONTHS ABOUT how many days did you miss work at a job or
business because of illness or injury (do not include maternity leave)?
* Enter '0' for None.
Answer Codes
Question Type
Integer
Field Pane Description
Work days missed
Fill Instructions
Special Instructions
Skip Instructions
<0-366,R,D> [goto BEDDAYR]
<120-366> [goto ERR_WKDAYR]
Hard Edits
Soft Edits
ERR_WKDAYR
* [Fill: WKDAYR] is an unusually large number.
* Please verify.
AssocHelp
H_WKDAYR
Wednesday, June 14, 2017
Page 1 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.040_H
Variable Name
H_WKDAYR
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
WKDAYR
Skip Instructions
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Soft Edits
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Wednesday, June 14, 2017
Page 2 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.050
Variable Name
BEDDAYR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
During the PAST 12 MONTHS ABOUT how many days did illness or injury keep you in
bed more than half of the day (include days while an overnight patient in a hospital)?
* Enter '0' for None.
Answer Codes
Question Type
Integer
Field Pane Description
Days in bed
Fill Instructions
Special Instructions
Skip Instructions
<0-366,R,D> [goto AHSTATYR]
<120-366> [goto ERR_BEDDAYR]
Hard Edits
Soft Edits
ERR_BEDDAYR
* [Fill: BEDDAYR] is an unusually large number.
* Please verify.
AssocHelp
H_BEDDAYR
Wednesday, June 14, 2017
Page 3 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.050_H
Variable Name
H_BEDDAYR
Universe
Universe-text
Question Text
Days in bed are any days during which the sample adult stayed in bed MORE than half
of the day because of illness or injury. "More than half of the day" is defined as more
than half of the hours that the sample adult is usually awake. Count as days in bed all
days a sample adult spent as an overnight patient in a hospital, sanitarium, nursing
home, etc., whether or not the patient was actually lying in bed, even if there was no
illness or injury.
A bed is anything used for lying down or sleeping, including a sofa, cot or mattress.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
BEDDAYR
Skip Instructions
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Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 4 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.060
Variable Name
AHSTATYR
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
Compared with 12 MONTHS AGO, would you say your health is better, worse, or about
the same?
Answer Codes
1. Better
2. Worse
3. About the same
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Health status
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1-3,R,D> [goto SPECEQ (AHS.070)]
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Wednesday, June 14, 2017
Page 5 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.070
Variable Name
SPECEQ
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
? [F1]
Do you now have any health problem that requires you to use special equipment, such
as a cane, a wheelchair, a special bed, or a special telephone?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don’t know
Yes/No
Field Pane Description
Special equipment
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1,2,R,D> [goto FLWALK_1]
Hard Edits
Soft Edits
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H_SPECEQ
Wednesday, June 14, 2017
Page 6 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.070_H
Variable Name
H_SPECEQ
Universe
Universe-text
Question Text
"Problem" is the sample adult's perception of a departure from physical, mental or
emotional well-being. This incudes specific health problems, such as a disease or
condition, a missing extremity or organ, or any type of impairment. It also includes
more vague disorders not always thought of as health related problems or illnesses
such as alcoholism, drug dependency or reaction, senility, depression, retardation, etc.
"Special Equipment" is any device, tool, utensil, instrument, implement, etc., used as an
aid in performing an activity because of a physical, mental or emotional problem. This
incudes the use of adult "diapers" for incontinence. For example: a spoon is not
normally considered as "special equipment"; however, a uniquely designed or
functioning one used for eating by a person because of
physical, mental, or emotional problems is considered "special equipment."
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screens:
SPECEQ
Skip Instructions
Hard Edits
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AssocHelp
SPECEQ
Wednesday, June 14, 2017
Page 7 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.080
Variable Name
FLWALK_1
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
The next questions ask about difficulties you may have doing certain activities because
of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or
emotional problem or illness [Fill1:(not including pregnancy) ].
Answer Codes
1. Enter 1 to continue
Question Type
Enter 1 to Continue
Field Pane Description
Fill Instructions
Continue
Fill1: If SEX=2 (female), then display the following text: (not including pregnancy)
Special Instructions
Skip Instructions
<1> [goto FLWALK]
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Wednesday, June 14, 2017
Page 8 of 103
Module
17
Section Name
Adult Health Status
Part
Question ID
AHS.091_05.000
Variable Name
QARNDM6
Universe
QAASK6 = 1
Universe-text
All families selected for QA question
Question Text
Random number generator
Answer Codes
(Allow 00-09)
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 9 of 103
Module
17
Section Name
Adult Health Status
Part
Question ID
AHS.091_05.001
Variable Name
QACHK6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN('997','999')) and QAASK6 = 1
Universe-text
Sample adults 18+ where QA question was selected
Question Text
* Please enter [Fill1: QARNDM6 ] for quality assurance.
Answer Codes
(Allow 0-9)
Question Type
Procedure
Field Pane Description
Fill Instructions
QA Check
Fill1: QARNDM6 is the number that was randomly selected is filled in here
Special Instructions
Skip Instructions
[goto FLREACH]
Hard Edits
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Wednesday, June 14, 2017
Page 10 of 103
Module
17
Section Name
Adult Health Status
Part
Question ID
AHS.091_05.002
Variable Name
QACHNG6
Universe
QACHK6=0-9
Universe-text
All families selected for QA question
Question Text
Flag field to indicate whether or not the value entered by the FR matched or not.
' ' (empty) - if the check was not asked or answered
0 - if the check was asked and the value entered matches the random value
1 - if the check was asked and the value entered does NOT match the random
value (cannot be undone)
Answer Codes
' ', 0,1
Question Type
Flag
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 11 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_1
Variable Name
FLWALK
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
By yourself, and without using any special equipment, how difficult is it for you to
...Walk a quarter of a mile - about 3 city blocks?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Walk a quarter of a mile
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLCLIMB]
Hard Edits
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H_FLWALK
Wednesday, June 14, 2017
Page 12 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_1_H
Variable Name
H_FLWALK
Universe
Universe-text
Question Text
Difficult is respondent defined.
"Problem" is the sample adult's perception of a departure from physical, mental or
emotional well-being. This includes specific health problems, such as a disease or
condition, a missing extremity or organ, or any type of impairment. It also includes
more vague disorders not always thought of as health related problems or illnesses
such as alcoholism, drug dependency or reaction, senility, depression, retardation, etc.
"Special Equipment" is any device, tool, utensil, instrument, implement, etc., used as an
aid in performing an activity because of a physical, mental or emotional problem. This
includes the use of adult "diapers" for incontinence. For example: a spoon is not
normally considered as "special equipment"; however, a uniquely designed or
functioning one used for eating by a person because of physical, mental, or emotional
problems is considered "special equipment."
"Difficult" is respondent defined.
If the sample adult gives an answer which does not match the categories
on the flashcard, reread the question emphasizing the wording of the
answer categories.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
FLWALK
FLCLIMB
FLSTAND
FLSIT
FLSTOOP
FLREACH
FLGRASP
FLCARRY
FLPUSH
FLSHOP
FLSOCL
FLRELAX
Skip Instructions
Wednesday, June 14, 2017
Page 13 of 103
Hard Edits
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Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_2
Variable Name
FLCLIMB
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Walk up 10 steps without resting?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Walk up 10 steps
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSTAND]
Hard Edits
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AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 14 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_3
Variable Name
FLSTAND
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Stand or be on your feet for about 2 hours?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Stand for 2 hours
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSIT]
Hard Edits
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AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 15 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_4
Variable Name
FLSIT
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Sit for about 2 hours?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Sit for 2 hours
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSTOOP]
Hard Edits
Soft Edits
AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 16 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_5
Variable Name
FLSTOOP
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Stoop, bend, or kneel?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Stoop, bend or kneel
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLREACH]
Hard Edits
Soft Edits
AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 17 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.091_6
Variable Name
FLREACH
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Reach up over your head?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Reach up overhead
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLGRASP]
Hard Edits
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AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 18 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.141_1
Variable Name
FLGRASP
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Use your fingers to grasp or handle small objects?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Grasp small objects
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLCARRY]
Hard Edits
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AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 19 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.141_2
Variable Name
FLCARRY
Universe
HHSTAT4 = 'S'and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Lift or carry 10 pounds
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLPUSH]
Hard Edits
Soft Edits
AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 20 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.141_3
Variable Name
FLPUSH
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Push or pull large objects like a living room chair?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Push or pull large objects
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSHOP]
Hard Edits
Soft Edits
AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 21 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.171_1
Variable Name
FLSHOP
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Go out to things like shopping, movies, or sporting events?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Go out to things
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLSOCL]
Hard Edits
Soft Edits
AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 22 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.171_2
Variable Name
FLSOCL
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Participate in social activities such as visiting friends, attending clubs and meetings,
going to parties?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Social activities
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<0-4,6,R,D> [goto FLRELAX]
Hard Edits
Soft Edits
AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 23 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.171_3
Variable Name
FLRELAX
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
(book) A5 ? [F1]
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to
...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to
music)?
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
Refused
Don’t know
Question Type
Repeating Series – Other
Field Pane Description
Relax at home
Fill Instructions
Special Instructions Answer name to the right. Blank line between Answer code 4 and Answer code 6.
Skip Instructions
<1-4 or FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND= 1-4 or FLSIT= 1-4 or
FLSTOOP= 1-4 or FLREACH= 1-4 or FLGRASP= 1-4 or FLCARRY= 1-4 or FLPUSH=
1-4 or FLSHOP= 1-4 or FLSOCL= 1-4> [goto AFLHCA]
Else [goto SMKEV] (next section)
Hard Edits
Soft Edits
AssocHelp
H_FLWALK
Wednesday, June 14, 2017
Page 24 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.200
Variable Name
AFLHCA
Universe
HHSTAT4 = 'S' and AGE GE 18 and (FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND=
1-4 or FLSIT= 1-4 or FLSTOOP= 1-4 or FLREACH= 1-4 or FLGRASP= 1-4 or
FLCARRY= 1-4 or FLPUSH= 1-4 or FLSHOP= 1-4 or FLSOCL= 1-4 or FLRELAX = 1-4)
Universe-text
Sample adults 18+ who, without using special equipment, have at least a little difficulty
walking a quarter mile; walking up 10 steps without resting; standing/being on feet for
about 2 hours; sitting for about 2 hours; stooping/bending/kneeling; reaching up over
head; using fingers to grasp/handle small objects; lifting/carrying 10 pounds;
pushing/pulling large objects;going out for things (shopping/movies); participating in
social activities; or relaxing at home (reading/sewing).
Question Text
(book) A6 ? [F1]
What condition or health problem causes you to have difficulty with [fill1: condition 1,
condition 2 or condition 3 (as specified in AHS.091_1 through AHS.171_3)][fill2: these
activities]?
* Enter condition number for all that apply, separate with commas.
* Do not probe, except to clarify answer.
Answer Codes
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. 5. Fracture or bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (for example, asthma and emphysema)
12. Cancer
13. Birth defect
14. Intellectual disability also known as mental retardation
15. Other developmental problem (for example cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
--------------------------------------[*/On bottom of Flashcard only: "Other
impairment/problem" /*]
------------------------------------- [*/ fix to add a divider line between 18 & 19 /*]
19. Missing limbs (fingers, toes or digits), amputee
20. Kidney, bladder or renal problems
21. Circulation problems (including blood clots)
22. Benign Tumors, cysts
23. Fibromyalgia, lupus
24. Osteoporosis, tendinitis
25. Epilepsy, seizures
26. Multiple Sclerosis (MS), Muscular Dystrophy (MD)
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Page 25 of 103
27. Polio(myelitis), paralysis, para/quadriplegia
28. Parkinson’s disease, other tremors
29. Other nerve damage, including carpal tunnel syndrome
30. Hernia
31. Ulcer
32. Varicose veins, hemorrhoids
33. Thyroid problems, Grave’s disease, gout
34. Knee problems (not arthritis (03), not joint injury(05))
35. Migraine headaches (not just headaches)
90. Other impairment/problem (Specify one)
91. Other impairment/problem (Specify one)
Refused
Don’t know/not sure
Question Type
Enter All That Apply
Field Pane Description
Fill Instructions
Condition numbers
Fill1 = [if the number of conditions indicated in questions AHS.091_1 - AHS.171_3 as
having at least a little bit of difficulty (i.e. answers are 1-4) is less than or equal to 3]
Fill2 = [if the number of conditions indicated in questions AHS.091_1 - AHS.171_3 as
having at least a little bit of difficulty (i.e. answers are 1-4) is greater than 3]
Special Instructions The fill to be applied in the question text for Fill 1 is conditional on how many of the
responses to questions AHS.091_1 through AHS.171_3 were either 1,2,3 or 4 (I.e. the
respondent had a least a little difficulty carrying out the particular activity/action). If only
one of these questions has an answer that meets the criteria (I.e. 1-4), then the
question text is "What condition or health problem causes you to have difficulty with
[condition 1]?". If only 2 questions had answers in the 1-4 range, the question text is
"What condition or health problem causes you to have difficulty with [condition 1] or
[condition 2]?". If 3 questions had such answers, use the question text provided.
Use the following phrases to fill in the question text when the conditions for Fill 1 apply:
FLWALK: walking a quarter of a mile
FLCLIMB: walking up 10 steps
FLSTAND: standing for 2 hours
FLSIT: sitting for 2 hours
FLSTOOP: stooping, bending or kneeling
FLREACH: reaching up overhead
FLGRASP: grasping or handling small objects
FLCARRY: lifting or carrying 10 pounds
FLPUSH: pushing or pulling large objects
FLSHOP: going out for things
FLSOCL: participating in social activities
FLRELAX: relaxing at home
Skip Instructions
[1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14NAHCL35N], in numerical order
<13> store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
<90> [goto AFLHCA_S1]
<91> [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
[goto SMKEV (next section)]
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Wednesday, June 14, 2017
Page 26 of 103
AssocHelp
H_AFLHCA
Module
17
Section Name
Part
Question ID
AHS.200_H
Variable Name
H_AFLHCA
Universe
Universe-text
Question Text
The terms "conditions" and "health problems" are respondent defined.
Do not read the precoded categories to the respondent.
Enter "90" or "91" if the respondent mentions a condition or health problem not listed
and then specify the condition exactly as the respondent states it.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AFLHCA
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 27 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.201_90
Variable Name
AFLHCA_S1
Universe
HHSTAT4 = 'S' and AGE GE 18 and 90 selected in AFLHCA
Universe-text
Sample adults 18+ whose difficulties performing activities listed in FLWALK through
FLRELAX is due to at least one condition not listed in AFLHCA
Question Text
* Enter other impairment/problem.
Answer Codes
Question Type
Text
Field Pane Description
Specify
Fill Instructions
Special Instructions */ need to add Descriptor name to Form Pane in front of the answer box of:
Specify one (1) [
Skip Instructions
] /* for either Q4 or 2005 fix
<50 chars> [goto AHCL90N]
>ENTER< only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14NAHCL35N], in numerical order, as specified in AFLHCA
Hard Edits
$ You should enter something specific.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 28 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.201_91
Variable Name
AFLHCA_S2
Universe
HHSTAT4 = 'S' and AGE GE 18 and 91 selected in AFLHCA
Universe-text
Sample adults 18+ whose difficulty performing activities listed in FLWALK through
FLRELAX is due to more than one condition that is not listed in AFLHCA
Question Text
* Enter other impairment/problem.
Answer Codes
Question Type
Text
Field Pane Description
Specify
Fill Instructions
Special Instructions */ need to add Descriptor name to Form Pane in front of the answer box of:
Specify one (2) [
Skip Instructions
] /* for either Q4 or 2005 fix
<50 chars> [goto AHCL91N]
>ENTER< only with no description [goto ERR1_AFLHCA_S1]
*/ need to add Descriptor name to Form Pane in front of the answer box of:
Specify one (2) [
] /* for either Q4 or 2005 fix
Hard Edits
$ You should enter something specific.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 29 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.300_1
Variable Name
AHCL01N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 1
Universe-text
Sample adults 18+ who had difficulty due to a vision problem or problem seeing
Question Text
1 of 2
How long have you had a vision problem or problem seeing?
* Enter number for time with your vision problem or problem seeing..
* Enter '95' for 95 or more.
* Enter '96' if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL01T]
[store "R" in AHCL01T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL01T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
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AssocHelp
Wednesday, June 14, 2017
Page 30 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.300_2
Variable Name
AHCL01T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL01N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with vision problem or problem seeing.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [ goto ERR2_AHCL01T]
[if [AHCL01N = Number greater than person years old and AHCL01T= 4]] goto
ERR1_AHCL01T
Hard Edits
ERR1_AHCL01T
*Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL01T
* "6" not selectable.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 31 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.301_1
Variable Name
AHCL02N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 2
Universe-text
Sample adults 18+ who had difficulty due to a hearing problem
Question Text
1 of 2
How long have you had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL02T]
[store "R" in AHCL02T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL02T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
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AssocHelp
Wednesday, June 14, 2017
Page 32 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.301_2
Variable Name
AHCL02T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL02N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with hearing problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL02T]
[if [AHCL02N = Number greater than person years old and AHCL02T= 4]] goto
ERR1_AHCL02T
Hard Edits
ERR1_AHCL02T
* Time with condition cannot be greater than age.
* Please correct.
ERR2_AHCL02T
* "6" not selectable.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 33 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.302_1
Variable Name
AHCL03N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 3
Universe-text
Sample adults 18+ who had difficulty due to arthritis or rheumatism
Question Text
1 of 2
How long have you had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL03T]
[store "R" in AHCL03T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL03T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
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AssocHelp
Wednesday, June 14, 2017
Page 34 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.302_2
Variable Name
AHCL03T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL03N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with arthritis or rheumatism.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL03T]
[if [AHCL03N = Number greater than person years old and AHCL03T= 4]] goto
ERR1_AHCL03T
Hard Edits
ERR_AHCL03T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 35 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.303_1
Variable Name
AHCL04N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 4
Universe-text
Sample adults 18+ who had difficulty due to a back or neck problem
Question Text
1 of 2
How long have you had a back or neck problem?
* Enter number for time with back or neck problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL04T]
[store "R" in AHCL04T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL04T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 36 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.303_2
Variable Name
AHCL04T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL04N= 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with back or neck problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL04T]
[if [AHCL04N = Number greater than person years old and AHCL04T= 4]] goto
ERR1_AHCL04T
Hard Edits
ERR_AHCL04T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 37 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.304_1
Variable Name
AHCL05N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 5
Universe-text
Sample adults 18+ who had difficulty due to a fracture, bone, or joint injury
Question Text
1 of 2
How long have you had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone, or joint injury.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL05T]
[store "R" in AHCL05T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL05T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 38 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.304_2
Variable Name
AHCL05T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL05N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with fracture, bone, or joint injury.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL05T]
[if [AHCL05N = Number greater than person years old and AHCL05T= 4]] goto
ERR1_AHCL05T
Hard Edits
ERR_AHCL05T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 39 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.305_1
Variable Name
AHCL06N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 6
Universe-text
Sample adults 18+ who had difficulty due to an injury other than a fracture, bone, or
joint injury
Question Text
1 of 2
How long have you had the (fill: other) injury that caused your limitation?
* Enter number for time with injury that caused your limitation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Fill Instructions
Number
Fill: [if condition 5 is selected at AFLHCA]
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL06T]
[store "R" in AHCL06T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL06T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 40 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.305_2
Variable Name
AHCL06T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL06N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with (fill: other) injury.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Integer
Field Pane Description
Fill Instructions
Time period
Fill: [if condition 5 is selected at AFLHCA]
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL06T]
[if [AHCL06N = Number greater than person years old and AHCL06T= 4]] goto
ERR1_AHCL06T
Hard Edits
ERR_AHCL06T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 41 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.306_1
Variable Name
AHCL07N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 7
Universe-text
Sample adults 18+ who had difficulty due to a heart problem
Question Text
1 of 2
How long have you had a heart problem?
* Enter number for time with a heart problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL07T]
[store "R" in AHCL07T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL07T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 42 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.306_2
Variable Name
AHCL07T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL07N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with heart problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Integer
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL07T]
[if [AHCL07N = Number greater than person years old and AHCL07T= 4]] goto
ERR1_AHCL07T
Hard Edits
ERR_AHCL07T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 43 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.307_1
Variable Name
AHCL08N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 8
Universe-text
Sample adults 18+ who had difficulty due to a stroke problem
Question Text
1 of 2
How long have you had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL08T]
[store "R" in AHCL08T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL08T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 44 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.307_2
Variable Name
AHCL08T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL08N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with stroke problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL08T]
[if [AHCL08N = Number greater than person years old and AHCL08T= 4]] goto
ERR1_AHCL08T
Hard Edits
ERR_AHCL08T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 45 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.308_1
Variable Name
AHCL09N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 9
Universe-text
Sample adults 18+ who had difficulty due to hypertension or high blood pressure
Question Text
1 of 2
How long have you had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL09T]
[store "R" in AHCL09T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL09T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 46 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.308_2
Variable Name
AHCL09T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL09N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with hypertension or high blood pressure.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL09T]
[if [AHCL09N = Number greater than person years old and AHCL09T= 4]] goto
ERR1_AHCL09T
Hard Edits
ERR_AHCL09T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 47 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.309_1
Variable Name
AHCL10N
Universe
HHSTAT4 = 'S'and AGE GE 18 and AFLHCA = 10
Universe-text
Sample adults 18+ who had difficulty due to diabetes
Question Text
1 of 2
How long have you had diabetes?
* Enter number for time with diabetes.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL10T]
[store "R" in AHCL10T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL10T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 48 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.309_2
Variable Name
AHCL10T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL10N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with diabetes.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL10T
[if [AHCL10N = Number greater than person years old and AHCL10T= 4]] goto
ERR1_AHCL10T
Hard Edits
ERR_AHCL10T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 49 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.310_1
Variable Name
AHCL11N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 11
Universe-text
Sample adults 18+ who had difficulty due to a lung or breathing problem
Question Text
1 of 2
How long have you had a lung or breathing problem (e.g. asthma and emphysema)?
* Enter number for time with a lung or breathing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL11T]
[store "R" in AHCL11T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL11T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 50 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.310_2
Variable Name
AHCL11T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL11N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with lung or breathing problem (e.g. asthma and
emphysema).
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL11T]
[if [AHCL11N = Number greater than person years old and AHCL11T= 4]] goto
ERR1_AHCL11T
Hard Edits
ERR_AHCL11T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 51 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.311_1
Variable Name
AHCL12N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 12
Universe-text
Sample adults 18+ who had difficulty due to cancer
Question Text
1 of 2
How long have you had cancer?
* Enter number for time with cancer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL12T]
[store "R" in AHCL12T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL12T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 52 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.311_2
Variable Name
AHCL12T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL12N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with cancer.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL12T]
[if [AHCL12N = Number greater than person years old and AHCL12T= 4]] goto
ERR1_AHCL12T
Hard Edits
ERR_AHCL12T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 53 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.312_1
Variable Name
AHCL13N
Universe
Universe-text
Question Text
Answer Codes
Question Type
Other
Field Pane Description
Fill Instructions
Special Instructions Storage variable for follow up to choice # 13 (birth defect) in AFLHCA
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 54 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.312_2
Variable Name
AHCL13T
Universe
Universe-text
Question Text
Answer Codes
Question Type
Other
Field Pane Description
Time period
Fill Instructions
Special Instructions Storage variable for follow up to choice # 13 (birth defect) in AFLHCA
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 55 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.313_1
Variable Name
AHCL14N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 14
Universe-text
Sample adults 18+ who had difficulty due to mental retardation
Question Text
1 of 2
How long have you had intellectual disability, also known as mental retardation?
* Enter number for time with intellectual disability/mental retardation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL14T]
[store "R" in AHCL14T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL14T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 56 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.313_2
Variable Name
AHCL14T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL14N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with intellectual disability/mental retardation.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL14T]
[if [AHCL14N = Number greater than person years old and AHCL14T= 4]] goto
ERR1_AHCL14T
Hard Edits
ERR_AHCL14T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 57 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.314_1
Variable Name
AHCL15N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 15
Universe-text
Sample adults 18+ who had difficulty due to a developmental problem
Question Text
1 of 2
How long have you had a developmental problem (e.g., cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL15T]
[store "R" in AHCL15T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL15T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 58 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.314_2
Variable Name
AHCL15T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL15N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with developmental problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL15T]
[if [AHCL15N = Number greater than person years old and AHCL15T= 4]] goto
ERR1_AHCL15T
Hard Edits
ERR_AHCL15T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 59 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.315_1
Variable Name
AHCL16N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 16
Universe-text
Sample adults 18+ who had difficulty due to senility
Question Text
1 of 2
How long have you had senility?
* Enter number for time with senility.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL16T]
[store "R" in AHCL16T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL16T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 60 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.315_2
Variable Name
AHCL16T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL16N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with senility.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL16T]
[if [AHCL16N = Number greater than person years old and AHCL16T= 4]] goto
ERR1_AHCL16T
Hard Edits
ERR_AHCL16T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 61 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.316_1
Variable Name
AHCL17N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 17
Universe-text
Sample adults 18+ who had difficulty due to depression, anxiety, or an emotional
problem
Question Text
1 of 2
How long have you had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety, or an emotional problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL17T]
[store "R" in AHCL17T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL17T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 62 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.316_2
Variable Name
AHCL17T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL17N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with depression, anxiety, or emotional problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL17T]
[if [AHCL17N = Number greater than person years old and AHCL17T= 4]] goto
ERR1_AHCL17T
Hard Edits
ERR_AHCL17T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 63 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.317_1
Variable Name
AHCL18N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 18
Universe-text
Sample adults 18+ who had difficulty due to a weight problem
Question Text
1 of 2
How long have you had a weight problem?
* Enter number for time with a weight problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL18T]
[store "R" in AHCL18T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL18T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 64 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.317_2
Variable Name
AHCL18T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL18N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with weight problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL18T]
[if [AHCL18N = Number greater than person years old and AHCL18T= 4]] goto
ERR1_AHCL18T
Hard Edits
ERR_AHCL18T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 65 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.318_1
Variable Name
AHCL19N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 19
Universe-text
Sample adults 18+ who had difficulty due to a missing limb
Question Text
1 of 2
How long have you had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL19T]
[store "R" in AHCL19T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL19T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 66 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.318_2
Variable Name
AHCL19T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL19N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with missing limb.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL19T]
[if [AHCL19N = Number greater than person years old and AHCL19T= 4]] goto
ERR1_AHCL19T
Hard Edits
ERR_AHCL19T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 67 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.319_1
Variable Name
AHCL20N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 20
Universe-text
Sample adults 18+ who had difficulty due to a kidney, bladder or renal problem
Question Text
1 of 2
How long have you had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL20T]
[store "R" in AHCL20T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL20T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 68 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.319_2
Variable Name
AHCL20T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL20N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with kidney, bladder or renal problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL20T]
[if [AHCL20N = Number greater than person years old and AHCL20T= 4]] goto
ERR1_AHCL20T
Hard Edits
ERR_AHCL20T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 69 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.320_1
Variable Name
AHCL21N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 21
Universe-text
Sample adults 18+ who had difficulty due to a circulation problem
Question Text
1 of 2
How long have you had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL21T]
[store "R" in AHCL21T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL21T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 70 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.320_2
Variable Name
AHCL21T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL21N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with circulation problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL21T]
[if [AHCL21N = Number greater than person years old and AHCL21T= 4]] goto
ERR1_AHCL21T
Hard Edits
ERR_AHCL21T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 71 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.321_1
Variable Name
AHCL22N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 22
Universe-text
Sample adults 18+ who had difficulty due to benign tumors or cysts
Question Text
1 of 2
How long have you had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL22T]
[store "R" in AHCL22T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL22T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 72 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.321_2
Variable Name
AHCL22T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL22N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with benign tumors or cysts.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D> [goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> [goto ERR2_AHCL22T]
[if [AHCL22N = Number greater than person years old and AHCL22T= 4]] goto
ERR1_AHCL22T
Hard Edits
ERR_AHCL22T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 73 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.322_1
Variable Name
AHCL23N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 23
Universe-text
Sample adults 18+ who had difficulty due to fibromyalgia or lupus
Question Text
1 of 2
How long have you had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D> [goto AHCL23T]
[store "R" in AHCL23T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96> [store "6" in AHCL23T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 74 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.322_2
Variable Name
AHCL23T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL23N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with fibromyalgia or lupus.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL23T
[if [AHCL23N = Number greater than person years old and AHCL23T= 4]] goto
ERR1_AHCL23T
Hard Edits
ERR_AHCL23T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 75 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.323_1
Variable Name
AHCL24N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 24
Universe-text
Sample adults 18+ who had difficulty due to osteoporosis or tendinitis
Question Text
1 of 2
How long have you had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL24T]
[store "R" in AHCL24T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL24T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 76 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.323_2
Variable Name
AHCL24T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL24N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with osteoporosis or tendinitis.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL24T
[if [AHCL24N = Number greater than person years old and AHCL24T= 4]] goto
ERR1_AHCL24T
Hard Edits
ERR_AHCL24T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 77 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.324_1
Variable Name
AHCL25N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 25
Universe-text
Sample adults 18+ who had difficulty due to epilepsy or seizures
Question Text
1 of 2
How long have you had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL25T]
[store "R" in AHCL25T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL25T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 78 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.324_2
Variable Name
AHCL25T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL25N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with epilepsy or seizures.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL25T
[if [AHCL25N = Number greater than person years old and AHCL25T= 4]] goto
ERR1_AHCL25T
Hard Edits
ERR_AHCL25T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 79 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.325_1
Variable Name
AHCL26N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 26
Universe-text
Sample adults 18+ who had difficulty due to multiple sclerosis or muscular dystrophy
Question Text
1 of 2
How long have you had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for fime with multiple sclerosis (MS) or muscular dystrophy (MD).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL26T]
[store "R" in AHCL26T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL26T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 80 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.325_2
Variable Name
AHCL26T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL26N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with multiple sclerosis or muscular dystrophy.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL26T
[if [AHCL26N = Number greater than person years old and AHCL26T= 4]] goto
ERR1_AHCL26T
Hard Edits
ERR_AHCL26T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 81 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.326_1
Variable Name
AHCL27N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 27
Universe-text
Sample adults 18+ who had difficulty due to polio(myelitis), paralysis or
para/quadriplegia
Question Text
1 of 2
How long have you had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis), paralysis or para/quadriplegia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL27T]
[store "R" in AHCL27T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL27T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 82 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.326_2
Variable Name
AHCL27T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL27N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL27T
[if [AHCL27N = Number greater than person years old and AHCL27T= 4]] goto
ERR1_AHCL27T
Hard Edits
ERR_AHCL27T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 83 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.327_1
Variable Name
AHCL28N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 28
Universe-text
Sample adults 18+ who had difficulty due to Parkinson's disease or tremors
Question Text
1 of 2
How long have you had Parkinson's disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL28T]
[store "R" in AHCL28T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL28T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 84 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.327_2
Variable Name
AHCL28T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL28N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with Parkinson's disease or tremors.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL28T
[if [AHCL28N = Number greater than person years old and AHCL28T= 4]] goto
ERR1_AHCL28T
Hard Edits
ERR_AHCL28T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 85 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.328_1
Variable Name
AHCL29N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 29
Universe-text
Sample adults 18+ who had difficulty due to nerve damage
Question Text
1 of 2
How long have you had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerver damage (including carpal tunnel syndrome).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL29T]
[store "R" in AHCL29T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL29T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 86 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.328_2
Variable Name
AHCL29T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL29N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with nerve damage.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL29T
[if [AHCL29N = Number greater than person years old and AHCL29T= 4]] goto
ERR1_AHCL29T
Hard Edits
ERR_AHCL29T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 87 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.329_1
Variable Name
AHCL30N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 30
Universe-text
Sample adults 18+ who had difficulty due to a hernia
Question Text
1 of 2
How long have you had a hernia?
* Enter number for time with a hernia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL30T]
[store "R" in AHCL30T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL30T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 88 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.329_2
Variable Name
AHCL30T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL30N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with hernia.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL30T
[if [AHCL30N = Number greater than person years old and AHCL30T= 4]] goto
ERR1_AHCL30T
Hard Edits
ERR_AHCL30T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 89 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.330_1
Variable Name
AHCL31N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 31
Universe-text
Sample adults 18+ who had difficulty due to an ulcer
Question Text
1 of 2
How long have you had an ulcer?
* Enter number for time with an ulcer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL31T]
[store "R" in AHCL31T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL31T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 90 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.330_2
Variable Name
AHCL31T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL31N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with ulcer.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions Answer name to the right.
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL31T
[if [AHCL31N = Number greater than person years old and AHCL31T= 4]] goto
ERR1_AHCL31T
Hard Edits
ERR_AHCL31T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 91 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.331_1
Variable Name
AHCL32N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 32
Universe-text
Sample adults 18+ who had difficulty due to varicose veins or hemorrhoids
Question Text
1 of 2
How long have you had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL32T]
[store "R" in AHCL32T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL32T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 92 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.331_2
Variable Name
AHCL32T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL32N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with varicose veins or hemorrhoids.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL32T
[if [AHCL32N = Number greater than person years old and AHCL32T= 4]] goto
ERR1_AHCL32T
Hard Edits
ERR_AHCL32T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 93 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.332_1
Variable Name
AHCL33N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 33
Universe-text
Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
Question Text
1 of 2
How long have you had a thyroid problem, Grave's disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL33T]
[store "R" in AHCL33T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL33T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 94 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.332_2
Variable Name
AHCL33T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL33N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with thyroid problem, Grave's disease or gout.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL33T
[if [AHCL33N = Number greater than person years old and AHCL33T= 4]] goto
ERR1_AHCL33T
Hard Edits
ERR_AHCL33T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 95 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.333_1
Variable Name
AHCL34N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 34
Universe-text
Sample adults 18+ who had difficulty due to a knee problem
Question Text
1 of 2
How long have you had a knee problem?
* Enter number for time with a knee problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL34T]
[store "R" in AHCL34T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL34T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 96 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.333_2
Variable Name
AHCL34T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL34N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with knee problem.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL34T
[if [AHCL34N = Number greater than person years old and AHCL34T= 4]] goto
ERR1_AHCL34T
Hard Edits
ERR1_AHCL34T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 97 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.334_1
Variable Name
AHCL35N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 35
Universe-text
Sample adults 18+ who had difficulty due to migraine headaches
Question Text
1 of 2
How long have you had migraine headaches?
* Enter number for time with migraine headaches.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL35T]
[store "R" in AHCL35T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL35T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 98 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.334_2
Variable Name
AHCL35T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL35N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with migraine headaches.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL35T
[if [AHCL35N = Number greater than person years old and AHCL35T= 4]] goto
ERR1_AHCL35T
Hard Edits
ERR1_AHCL35T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 99 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.335_1
Variable Name
AHCL90N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 90
Universe-text
Sample adults 18+ who had difficulty due to {problem in AFLHCA90}
Question Text
1 of 2
How long have you had {problem in AFLHCA80}?
* Enter number for time with {problem in AFLHCA80}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL90T]
[store "R" in AHCL90T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL90T] [goto the next condition, in numerical order, selected at
AFLHCA (AHS.200). If this is the last condition selected, goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 100 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.335_2
Variable Name
AHCL90T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL36N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with {problem in AFLHCA80}.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[[if 91 selected in AFLHCA goto AFLHCA_S2]
Else goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL90T
[if [AHCL90N = Number greater than person years old and AHCL90T= 4]] goto
ERR1_AHCL90T
Hard Edits
ERR_AHCL90T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 101 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.336_1
Variable Name
AHCL91N
Universe
HHSTAT4 = 'S' and AGE GE 18 and AFLHCA = 91
Universe-text
Sample adults 18+ who had difficulty due to {problem in AFLHCA91}
Question Text
1 of 2
How long have you had {problem in AFLHCA81}?
* Enter number for time with {problem in AFLHCA81}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
Answer Codes
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D>[goto AHCL36T]
[store "R" in AHCL36T] [goto SMKEV (next section)]
<96>[store "6" in AHCL36T] [goto SMKEV (next section)]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 102 of 103
Module
17
Section Name
Adult Health Status and Limitation of Activities
Part
Question ID
AHS.336_2
Variable Name
AHCL91T
Universe
HHSTAT4 = 'S' and AGE GE 18 and AHCL37N = 1-95, D
Universe-text
Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
Question Text
2 of 2
* Enter time period for time with {problem in AFLHCA81}.
Answer Codes
1. Days
2. Weeks
3. Months
4. Years
Since birth
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA
(AHS.200). If this is the last condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL37T
[if [AHCL91N = Number greater than person years old and AHCL91T= 4]] goto
ERR1_AHCL91T
Hard Edits
ERR_AHCL91T
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 103 of 103
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Health Behavior
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.010_00.000
Variable Name
SMKEV
Universe
HHSTAT4 = 'S' and AGE GE 18
Universe-text
Sample adults 18+
Question Text
? [F1]
These next questions are about cigarette smoking.
Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Ever smoked 100 cigarettes
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto SMKREG]
<2,R,D>[goto ECIGEV2]
Hard Edits
Soft Edits
AssocHelp
H_SMKEV
Wednesday, June 14, 2017
Page 1 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.010_00.000_H
Variable Name
H_SMKEV
Universe
Universe-text
Question Text
A cigarette is anything the sample adult reports except cigars of any kind or marijuana.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKEV
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 2 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.020_00.000
Variable Name
SMKREG
Universe
HHSTAT4 = 'S' and AGE GE 18 and SMKEV = 1
Universe-text
Sample adults 18+ who ever smoked 100 cigarettes
Question Text
? [F1]
How old were you when you FIRST started to smoke fairly regularly?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years old or older.
* Enter '96' if never smoked regularly.
Answer Codes
Question Type
Integer
Field Pane Description
Age started smoking
Fill Instructions
Special Instructions
Skip Instructions
<6-95,96,R,D> [goto SMKNOW]
[If SMKREG gt AGE and SMKREG ne <96>, goto ERR_SMKREG
Hard Edits
ERR_SMKREG
* Starting age exceeded current age.
* Please correct.
Soft Edits
AssocHelp
H_SMKREG
Wednesday, June 14, 2017
Page 3 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.020_00.000_H
Variable Name
H_SMKREG
Universe
Universe-text
Question Text
Always probe for an exact age. If the sample adult reports a range or interval, assist
the sample adult in making an estimate by probing. For example, you might ask "Could
you give me a more exact age?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKREG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 4 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.030_00.000
Variable Name
SMKNOW
Universe
HHSTAT4 = 'S' and AGE GE 18 and SMKEV = 1
Universe-text
Sample adults 18+ who ever smoked 100 cigarettes
Question Text
? [F1]
Do you NOW smoke cigarettes every day, some days or not at all?
Answer Codes
Question Type
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Now Smoke
Fill Instructions
Special Instructions Add answer name to the right of input.
Skip Instructions
<1>[goto CIGSDA1]
<2>[goto CIGDAMO]
<3>[goto SMKQTNO]
[goto ECIGEV2]
Hard Edits
Soft Edits
AssocHelp
H_SMKNOW
Wednesday, June 14, 2017
Page 5 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.030_00.000_H
Variable Name
H_SMKNOW
Universe
Universe-text
Question Text
If the sample adult gives an answer which does not match the categories read in the
question, reread the question emphasizing the wording of the answer categories.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKNOW
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 6 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.040_01.000
Variable Name
SMKQTNO
Universe
HHSTAT4 = 'S' and AGE GE 18 and SMKNOW= 3
Universe-text
Sample adults 18+ who quit smoking
Question Text
? [F1]
1 of 2
How long has it been since you quit smoking cigarettes?
* Enter number for time since quit smoking.
* Enter '95' for 95 years old or older.
Answer Codes
Question Type
Multi Part
Field Pane Description
Number
Fill Instructions
Special Instructions "Time since quit smoking" as a header for this question and AHB.040_2 (SMKQTTP).
Skip Instructions
<1-95> [goto SMKQTTP]
[goto ECIGEV2]
Hard Edits
Soft Edits
AssocHelp
H_SMKQT
Wednesday, June 14, 2017
Page 7 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.040_01.000_H
Variable Name
H_SMKQT
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
SMKQTNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 8 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.040_02.000
Variable Name
SMKQTTP
Universe
HHSTAT4 = 'S' and AGE GE 18 and SMKQTNO = 1-95
Universe-text
Sample adults 18+ who quit smoking
Question Text
2 of 2
* Enter time period for time since quit smoking.
Answer Codes
Question Type
1. Days
2. Weeks
3. Months
4. Years
Refused
Don't know
Multi Part
Field Pane Description
Time period
Fill Instructions
Special Instructions Flag when ERR2_SMKQTTP is triggered. Place answer box to the right of that for
AHB.040_1 (SMKQTNO). Show answer name on the right.
Skip Instructions
<1-4> [goto ECIGEV2]
<4> [if SMKQTNO gt (AGE - <15>), goto ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), goto ERR2_SMKQTTP.
Hard Edits
ERR2_SMKQTTP
* Age started ([Fill1: SMKREG]) + years since quit ([Fill2: SMKQTNO]) exceeds current
age ([Fill3: AGE]).
* Please correct.
Soft Edits
ERR1_SMKQTTP
* Respondent quit smoking before age 15?
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 9 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.050_00.000
Variable Name
CIGSDA1
Universe
HHSTAT4 = 'S' and AGE GE 18 and SMKNOW = 1
Universe-text
Sample adults 18+ who are current every day smokers
Question Text
? [F1]
On the average, how many cigarettes do you now smoke a day?
* Enter '1' if less than 1 cigarette.
* Enter '95' if 95 or more cigarettes.
Answer Codes
Question Type
Integer
Field Pane Description
Average number of cigarettes daily
Fill Instructions
Special Instructions "Every day smokers" as a header.
Skip Instructions
<1-95,D,R> [goto CIGQTYR]
Hard Edits
Soft Edits
AssocHelp
H_CIGSDA1
Wednesday, June 14, 2017
Page 10 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.050_00.000_H
Variable Name
H_CIGSDA1
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
If the response is given in packs rather than as a number of cigarettes, multiply the
number of packs by 20, verify the result with the sample adult and enter the number of
cigarettes per day.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CIGSDA1
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 11 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.060_00.000
Variable Name
CIGDAMO
Universe
HHSTAT4 = 'S' and AGE GE 18 and SMKNOW = 2
Universe-text
Sample adults 18+ who are current some day smokers
Question Text
? [F1]
On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.
Answer Codes
Question Type
Integer
Field Pane Description
Number of days smoked
Fill Instructions
Special Instructions "Some day smokers - past 30 days" as a header for this question and AHB.070
Skip Instructions
<0>[goto CIGQTYR]
<1-30,R,D> [goto CIGSDA2]
Hard Edits
Soft Edits
AssocHelp
H_CIGDAMO
Wednesday, June 14, 2017
Page 12 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.060_00.000_H
Variable Name
H_CIGDAMO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Asociated Screens:
CIGDAMO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 13 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.070_00.000
Variable Name
CIGSDA2
Universe
HHSTAT4 = 'S' and AGE GE 18 and [ CIGDAMO=1-30,D,R) ]
Universe-text
Sample adults 18+ who are current some day smokers
Question Text
? [F1]
On the average, when you smoked during the PAST 30 DAYS, about how many
cigarettes did you smoke a day?
* Enter '1' if less than 1.
* Enter '95' if 95 or more cigarettes.
Answer Codes
Question Type
Integer
Field Pane Description
Average number of cigarettes on days smoked
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.060
(CIGDAMO).
Skip Instructions
<1-95,D,R> [goto CIGQTYR]
Hard Edits
Soft Edits
AssocHelp
H_CIGSDA2
Wednesday, June 14, 2017
Page 14 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.070_00.000_H
Variable Name
H_CIGSDA2
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
If the response is given in packs rather than as a number of cigarettes, multiply the
number of packs by 20, verify the result with the sample adult and enter the number of
cigarettes per day.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CIGSDA2
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.080_00.000
Variable Name
CIGQTYR
Universe
HHSTAT4 = 'S' and AGE GE 18 and SMKNOW = 1,2
Universe-text
Sample adults 18+ who are every day or someday smokers
Question Text
? [F1]
During the PAST 12 MONTHS, have you stopped smoking for more than one day
BECAUSE YOU WERE TRYING TO QUIT SMOKING?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Tried to quit
Fill Instructions
Special Instructions
Skip Instructions
<1,2,D,R> [goto ECIGEV2]
Hard Edits
Soft Edits
AssocHelp
H_CIGQTYR
Wednesday, June 14, 2017
Page 16 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.080_00.000_H
Variable Name
H_CIGQTYR
Universe
Universe-text
Question Text
"Trying" means making an effort, not simply thinking about it or desiring it.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
CIGQTYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 17 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.010
Variable Name
ECIGEV2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next question is about electronic cigarettes or e-cigarettes. You may also know
them as vape-pens, hookah-pens, e-hookahs, or e-vaporizers. Some look like
cigarettes, and others look like pens or small pipes. These are battery-powered,
usually contain liquid nicotine, and produce vapor instead of smoke.
Have you EVER used an e-cigarette EVEN ONE TIME?
*Read if necessary: E-cigarettes and similar products can be bought as one-time,
disposable products, as re-usable kits with a cartridge, or with refillable chambers.
These usually contain a liquid, often called an “e-liquid” or “e-juice.” Popular brands
include NJOY, BLU, LOGIC, and VUSE.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ECIGCUR2]
<2,R,D> [goto CIGAREV2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 18 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.020
Variable Name
ECIGCUR2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ECIGEV2(e)='1'
Universe-text
Sample adults 18+ who have ever used e-cigarettes
Question Text
Do you now use e-cigarettes every day, some days, or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [go to CIGAREV2]
<2,3> [go to ECIG30D2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 19 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.030
Variable Name
ECIG30D2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ECIGCUR2(e) IN
('2','3')
Universe-text
Sample adults 18+ who now use e-cigarettes some days or not at all
Question Text
On how many of the PAST 30 DAYS have you used e-cigarettes?
Answer Codes
Allow 0-30,R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-30,R,D> [goto CIGAREV2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 20 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.040
Variable Name
CIGAREV2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you ever smoked a regular cigar, cigarillo, or a little filtered cigar EVEN ONE
TIME?
*Read if necessary: “Cigarillos” are medium cigars that sometimes are sold with plastic
or wooden tips. Some common brands are Black and Mild, Swisher Sweets, Dutch
Masters and Phillies Blunts. Cigarillos are usually sold individually or in packs of 5 or
fewer. Little filtered cigars look like cigarettes and are usually brown in color. Like
cigarettes, little filtered cigars have a spongy filter and are sold in packs of 20. Some
common brands are Prime Time and Winchester.
*Read if necessary: Do not include electronic cigars or e-cigars.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CIGCUR2]
<2, R, D> [goto PIPEV2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 21 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.050
Variable Name
CIGCUR2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CIGAREV2(e)='1'
Universe-text
Sample adults 18+ who have ever smoked a regular cigar, cigarillo, or filtered cigar
Question Text
Do you now smoke regular cigars, cigarillos, or little filtered cigars every day, some
days, or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1 R,D> [go to PIPEV2]
<2,3> [go to CIG30D2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 22 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.060
Variable Name
CIG30D2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CIGCUR2 (e) IN
('2','3')
Universe-text
Sample adults 18+ who now smoke a regular cigar, cigarillo, or little filtered cigar some
days or not at all
Question Text
On how many of the PAST 30 DAYS have you smoked a regular cigar, cigarillo, or little
filtered cigar?
Answer Codes
Allow 0-30,R,D
Question Type
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-30,R,D> [goto PIPEV2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 23 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.070
Variable Name
PIPEV2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER smoked a pipe filled with tobacco-either a regular pipe, water pipe, or
hookah EVEN ONE TIME?
*Read if necessary: A hookah is a type of water pipe. It is sometimes called a
“narghile” (NAR-ge-lee) pipe. Do not include electronic hookah or e-hookahs.
*Read if necessary: Do not include electronic pipes or e-pipes.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PIPECUR2]
<2,R,D> [goto SMKLSTB1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 24 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.080
Variable Name
PIPECUR2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and PIPEV2(e)='1'
Universe-text
Sample adults 18+ who have ever smoked a regular pipe, water pipe or hookah filled
with tobacco
Question Text
Do you now smoke pipes filled with tobacco – either regular pipes, water pipes, or
hookahs, every day, some days, or not at all?
*Read if necessary: Do not include pipes filled with substances other than tobacco.
Answer Codes
Question Type
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto SMKLSTB1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 25 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.090
Variable Name
SMKLSTB1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Smokeless tobacco products are placed in the mouth or nose and can include chewing
tobacco, snuff, dip, snus (SNOOSE), or dissolvable tobacco.
Have you ever used smokeless tobacco products EVEN ONE TIME?
*Read if necessary: Do not include nicotine replacement therapy products (such as
patch, gum, lozenge, or spray, which are considered smoking cessation treatments.)
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SMKLSCR2]
<2,R,D> [goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 26 of 70
Module
18
Section Name
Adult Health Behavior
Part
A
Question ID
AHB.085_00.100
Variable Name
SMKLSCR2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SMKLSTB1(e)='1'
Universe-text
Sample adults 18+ who have ever used smokeless tobacco products
Question Text
Do you NOW use smokeless tobacco products every day, some days, or not at all?
Answer Codes
1. Every day
2. Some days
3. Not at all
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto VIGNO]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 27 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.090_1
Variable Name
VIGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')
Universe-text
Sample adults 18+
Question Text
? [F1]
1 of 2
The next questions are about physical activities (exercise, sports, physically active
hobbies...) that you may do in your LEISURE time.
How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10
MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?
* Read if necessary: How many times per day, per week, per month, or per year do you
do these activities?
* Enter number for vigorous leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
Answer Codes
Question Type
Multi Part
Field Pane Description
How often - number
Fill Instructions
Special Instructions "Vigorous activities for at least 10 minutes" as a header for this question, AHB.090_2,
AHB.100_1 and AHB.100_2.
Skip Instructions
<0,996,R,D>[goto MODNO]
<1-995>[goto VIGTP]
Hard Edits
Soft Edits
AssocHelp
H_VIGNO
Wednesday, June 14, 2017
Page 28 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.090_1_H
Variable Name
H_VIGNO
Universe
Universe-text
Question Text
Exercise, sports, or physically active hobbies are respondent defined.
Vigorous activities might include fast walking, fast bicycling, jogging,strenuous
swimming or sports play, vigorous aerobic dance, and strenuous gardening.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
VIGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 29 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.090_2
Variable Name
VIGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and VIGNO = 1-995
Universe-text
Sample adults 18+ who do vigorous activities
Question Text
2 of 2
* Enter time period for vigorous leisure-time physical activities.
Answer Codes
Question Type
1. Day
2. Week
3. Month
4. Year
Multi Part
Field Pane Description
How often - time period
Fill Instructions
Special Instructions Show answer name on the right. Do not allow "Refused" or "Don't know" answers.
Skip Instructions
<1-4> goto VIGLNGNO
[if (VIGNO gt <4> and VIGTP eq <1>) or
(VIGNO gt <28> and VIGTP eq <2>) or
(VIGNO gt <31> and VIGTP eq <3>) or
(VIGNO gt <365> and VIGTP eq <4>) goto ERR1_VIGTP]
Hard Edits
Soft Edits
ERR1_VIGTP
* [Fill1: VIGNO] times per [Fill2: VIGTP] is unusually high.
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 30 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.100_1
Variable Name
VIGLNGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') AND VIGTP = 1 - 4
Universe-text
Sample adults 18+ who do vigorous activities
Question Text
? [F1]
1 of 2
About how long do you do these vigorous leisure-time physical activities each time?
* Enter number for length of vigorous leisure-time physical activities.
Answer Codes
Question Type
Multi Part
Field Pane Description
How long - number
Fill Instructions
Special Instructions
Skip Instructions
<1-995>[goto VIGLNGTP]
[goto MODNO]
Hard Edits
Soft Edits
AssocHelp
H_VIGLNGNO
Wednesday, June 14, 2017
Page 31 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.100_1_H
Variable Name
H_VIGLNGNO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
VIGLNGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 32 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.100_2
Variable Name
VIGLNGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and VIGLNGNO = 1- 995
Universe-text
Sample adults 18+ who do vigorous activities
Question Text
2 of 2
* Enter time period for length of vigorous leisure-time physical activities.
Answer Codes
Question Type
1. Minutes
2. Hours
Multi Part
Field Pane Description
Fill Instructions
How long- time period
Fill1: [if VIGLNGTP = 1]
Fill2: [if VIGLNGTP = 2]
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.100_1
(VIGLNGNO). Show answer name on the right. Do not allow "Refused" or "Don't know"
answers.
Skip Instructions
<1,2>goto MODNO
if VIGLNGNO lt <10> and VIGLNGTP eq <1> goto ERR1_VIGLNGTP;
if (VIGLNGNO gt <90> and VIGLNGTP eq <1>) or if VIGLNGNO gt <2> and
VIGLNGTP eq <2> goto ERR2_VIGLNGTP
Hard Edits
ERR1_VIGLNGTP
* Question asked for activities lasting at least 10 minutes.
* Please correct.
Soft Edits
ERR2_VIGLNGTP
* [Fill1: VIGLNGNO] [fill2: VIGLNGTP] is unusually high.
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 33 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.110_1
Variable Name
MODNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')
Universe-text
Sample adults 18+
Question Text
? [F1]
1 of 2
How often do you do LIGHT OR MODERATE LEISURE-TIME physical activities for AT
LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE
increase in breathing or heart rate?
* If necessary, prompt with: How many times per day, per week, per month, or per year
do you do these activities?
* Enter number of light or moderate leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
Answer Codes
Question Type
Multi Part
Field Pane Description
How often - number
Fill Instructions
Special Instructions "Light or moderate activities for at least 10 minutes" as a header for this question,
AHB.110_2, AHB.120_1 and AHB.120_2.
Skip Instructions
<1-995>[goto MODTP]
<0, 996, R,D>[goto STRNGNO]
Hard Edits
Soft Edits
AssocHelp
H_MODNO
Wednesday, June 14, 2017
Page 34 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.110_1_H
Variable Name
H_MODNO
Universe
Universe-text
Question Text
This question is asking about physical activities (exercise, sports, physically active
hobbies) that the sample adult may do in his/her
LEISURE time.
Light or moderate activities include such activities as leisurely walking or bicycling, slow
swimming or dancing, and simple gardening.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
MODNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 35 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.110_2
Variable Name
MODTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and MODNO = 1-995
Universe-text
Sample adults 18+ who do light or moderate activities
Question Text
2 of 2
* Enter time period for light or moderate leisure-time physical activities
Answer Codes
Question Type
1. Day
2. Week
3. Month
4. Year
Multi Part
Field Pane Description
How often - time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.110_1
(MODNO). Show answer name on the right. Do not allow "Refused" or "Don't know"
answers.
Skip Instructions
<1-4> goto MODLNGNO
[if (MODNO gt <4> and MODTP eq <1>) or
(MODNO gt <28> and MODTP eq <2>) or
(MODNO gt <31> and MODTP eq <3>) or
(MODNO gt <365> and MODTP eq <4>)] goto ERR_MODNO
Hard Edits
Soft Edits
ERR_MODNO
* [Fill1: MODNO] times per [fill2: MODTP] is unusually high.
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 36 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.120_1
Variable Name
MODLNGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and MODTP = 1 - 4
Universe-text
Sample adults 18+ who do light or moderate activities
Question Text
? [F1]
1 of 2
About how long do you do these light or moderate leisure-time physical activities each
time?
* Enter number for length of light or moderate leisure-time physical activities.
Answer Codes
Question Type
Multi Part
Field Pane Description
How long - number
Fill Instructions
Special Instructions
Skip Instructions
<1-995>[goto MODLNGTP]
[goto STRNGNO]
Hard Edits
Soft Edits
AssocHelp
H_MODLNGNO
Wednesday, June 14, 2017
Page 37 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.120_1_H
Variable Name
H_MODLNGNO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
MODLNGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 38 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.120_2
Variable Name
MODLNGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and MODLNGNO = 1 995
Universe-text
Sample adults 18+ who do light or moderate activities
Question Text
2 of 2
* Enter time period for length of light or moderate leisure-time physical activities.
Answer Codes
Question Type
1. Minutes
2. Hours
Multi Part
Field Pane Description
How long - time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.120_1
(MODLNGNO). Show answer name on the right. Do not allow "Refused" or "Don't
know" answers.
Skip Instructions
<1,2> goto STRNGNO
if MODLNGNO lt <10> and MODLNGTP eq <1> goto ERR1_MODLNGTP
if MODLNGNO gt <90> and MODLNGTP eq <1> or if MODLNGNO gt <2> and
MODLNGTP eq <2>goto ERR2_MODLNGTP
Hard Edits
ERR1_MODLNGTP
* Question asked for activities lasting at least 10 minutes.
* Please correct.
Soft Edits
ERR2_MODLNGTP
* [Fill1: MODLNGNO] [Fill2: MODLNGTP] is unusually high.
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 39 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.130_1
Variable Name
STRNGNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')
Universe-text
Sample adults 18+
Question Text
? [F1]
How often do you do LEISURE-TIME physical activities specifically designed to
STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all
such activities even if you have mentioned them before.)
* Read if necessary: How many times per day, per week, per month, or per year do you
do these activities?
* Enter number for strengthening acativities.
* Enter '0' for Never.
* Enter '996' for Unable to do this type activity
Answer Codes
Question Type
Multi Part
Field Pane Description
Strengthening - number
Fill Instructions
Special Instructions "Strengthening activities" as a header for this question, and AHB.130_2.
Skip Instructions
<1-995>[goto STRNGTP]
<0, 996,R,D>[goto ALC1YR]
Hard Edits
Soft Edits
AssocHelp
H_STRNGNO
Wednesday, June 14, 2017
Page 40 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.130_1_H
Variable Name
H_STRNGNO
Universe
Universe-text
Question Text
This question is asking about physical activities (exercise, sports, physically active
hobbies) that the sample adult may do in his/her
LEISURE time.
Exercises to strengthen muscles are activities that require strenuous muscular
contractions such as weight lifting, resistance training, push-ups, sit-ups, etc.
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
STRNGNO
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 41 of 70
Module
18
Section Name
Adult Health Behavior
Part
B
Question ID
AHB.130_2
Variable Name
STRNGTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and STRNGNO = 1-995
Universe-text
Sample adults 18+ who do strengthening activities
Question Text
2 of 2
* Enter time period for strengthening activities
Answer Codes
Question Type
1. Day
2. Week
3. Month
4. Year
Multi Part
Field Pane Description
Time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.130_1
(STRNGNO). Show answer name on the right. Do not allow "Refused" or "Don't know"
answers
Skip Instructions
<1-4> [goto ALC1YR]
[If (STRNGNO gt <4> & STRNGTP = <1>) or (STRNGNO gt <28> & STRNGTP = <2>)
or
(STRNGNO gt <31> & STRNGTP = <3>) or (STRNGNO gt <365> & STRNGTP =
<4>) goto ERR_STRNGTP]
Hard Edits
Soft Edits
ERR_STRNGTP
* [Fill1: STRNGNO] times per [Fill2: STRNGTP] is unusually high.
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 42 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.140
Variable Name
ALC1YR
Universe
HHSTAT4 = 'S'and AGE GE 18
Universe-text
Sample adults 18+
Question Text
? [F1]
These next questions are about drinking alcoholic beverages. Included are liquor such
as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.
In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Any ONE year 12 drinks
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ALC12MNO]
<2,R,D> [goto ALCLIFE]
Hard Edits
Soft Edits
AssocHelp
H_ALC1YR
Wednesday, June 14, 2017
Page 43 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.140_H
Variable Name
H_ALC1YR
Universe
Universe-text
Question Text
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALC1YR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 44 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.150
Variable Name
ALCLIFE
Universe
ASTATFLG=1 and AGE GE 18 and ALC1YR = 2, D, R
Universe-text
Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did
or refused to answer
Question Text
? [F1]
In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic
beverage?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Entire life 12 drinks
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ALC12MNO]
<2,R,D> [goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_ALCLIFE
Wednesday, June 14, 2017
Page 45 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.150_H
Variable Name
H_ALCLIFE
Universe
Universe-text
Question Text
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALCLIFE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 46 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.160_1
Variable Name
ALC12MNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and (ALC1YR = 1 or
ALCLIFE = 1)
Universe-text
Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks
in their entire life
Question Text
? [F1]
1 of 2
In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcohoilic berveages were consumed in the past year.
*Enter '0' for Never.
Answer Codes
Question Type
Multi Part
Field Pane Description
How often - number
Fill Instructions
Special Instructions "Past year" as a header or this question, AHB.160_2, AHB.170, AHB.180_1 and
AHB.180_2.
Skip Instructions
<1-365>[goto ALC12MTP]
<0,D,R>[goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_ALC12MNO
Wednesday, June 14, 2017
Page 47 of 70
Module
18
Section Name
Adult Health Behavior
Part
Question ID
AHB.160_1_H
Variable Name
H_ALC12MNO
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALC12M
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 48 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.160_2
Variable Name
ALC12MTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and ALC12MNO = 1 365
Universe-text
Sample adults 18+ who drank at least once in the past year
Question Text
2 of 2
* Enter time period for how often alcoholic beverages were consumed in the past year.
Answer Codes
Question Type
1. Week
2. Month
3. Year
Multi Part
Field Pane Description
How often - time period
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.160_1
(ALC12MNO). Show answer name on the right.
Skip Instructions
<1-3> [goto ALCAMT]
[If (ALC12MNO gt <7> & ALC12MTP = <1>) or (ALC12MNO gt <31> & ALC12MTP =
<2>) or
(ALC12MNO gt <365> & ALC12MTP = <3>) goto ERR_ALC12MTP]
Hard Edits
ERR_ALC12MTP
* [Fill1: ALC12MNO] days per [Fill2: ALC12MTP] exceeds number possible in this time
period.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 49 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.170
Variable Name
ALCAMT
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and ALC12MTP = 1-3
Universe-text
Sample adults 18+ who have had at least 1 drink in the past year
Question Text
? [F1]
In the PAST YEAR, on those days that you drank alcoholic
beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.
Answer Codes
Question Type
Integer
Field Pane Description
Average # of drinks/day
Fill Instructions
Special Instructions
Skip Instructions
<1-95,D,R>[goto ALC5UPNO]
<10-95>[goto ERR_ALCAMT]
Hard Edits
Soft Edits
ERR_ALCAMT
* [Fill: ALCAMT] drinks is an unusually high number.
* Please verify.
* Do not probe
AssocHelp
H_ALCAMT
Wednesday, June 14, 2017
Page 50 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.170_H
Variable Name
H_ALCAMT
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALCAMT
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 51 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.180_1
Variable Name
ALC5UPNO
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and ALC12MNO = 1-365
Universe-text
Sample adults 18+ who have had at least 1 drink in the past year
Question Text
? [F1]
1 of 2
In the PAST YEAR, on how many DAYS did you have [fill: 5 or more/4 or more] drinks
of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have [fill: 5 or more/4 or more]
drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.
Answer Codes
Question Type
Multi Part
Field Pane Description
Fill Instructions
Fill, see instructions
If SEX=1 fill “Days with 5 or more drinks”; else if SEX=2 fill “Days with 4 or more drinks”
Special Instructions "Days with 5 or more drinks " as a header for this question and AHB.180_2.
Skip Instructions
<1-365>[goto ALC5UPTP]
<0,R,D>[goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_ALC5UP
Wednesday, June 14, 2017
Page 52 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.180_1_H
Variable Name
H_ALC5UP
Universe
Universe-text
Question Text
Always probe for an exact number. If the sample adult reports a range or interval,
assist the sample adult in making an estimate by probing. For example, you might ask
"Could you give me a more exact number?"
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.)
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
ALC5UP
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 53 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.180_2
Variable Name
ALC5UPTP
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and ALC5UPNO = 1-365.
Universe-text
Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least
once in the past year
Question Text
2 of 2
* Enter time period for days per week, per month or per year.
Answer Codes
Question Type
1. Week
2. Month
3. Year
Multi Part
Field Pane Description
Fill Instructions
Time period
(For Hard Edit): If SEX=1 fill “5 or more”; else if SEX=2 fill “4 or more”
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.180_1
(ALC5UPNO). Show answer name on the right.
Skip Instructions
<1-3> [goto BINGE1]
[If (ALC5UPNO gt <7> & ALC5UPTP = <1>) or
(ALC5UPNO gt <31> & ALC5UPTP = <2>) or
(ALC5UPNO gt <365> & ALC5UPTP = <3>) goto ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP)
lt number of days per year with 5 or more (for males)/4+ (females) drinks (calculated
from ALC5UPNO and ALC5UPTP)] goto ERR2_ALC5UPTP]
Hard Edits
ERR1_ALC5UPTP
* [Fill1: ALC5UPNO] days per [Fill2: ALC5UPTP] exceeds number possible in this time
period.
* Please correct
ERR2_ALC5UPTP
* Number of days had [fill: 5 or more/4 or more] drinks exceeds number of days drank.
* Please correct.
* Do not probe.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 54 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.181
Variable Name
BINGE1
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and ALC5UPNO = 1-365
Universe-text
Sample adults 18+ who have had 5+ (males) or 4+ (females) drinks in one day at least
once in the past year
Question Text
? [F1]
Considering all types of alcoholic beverages, DURING THE PAST 30 DAYS, how many
times did you have [fill: 5 or more/4 or more] drinks on an occasion?
* Enter '0' if none.
* Enter '60' if 60 or more times.
Answer Codes
Question Type
(Allow 0-60,R,D)
Integer
Field Pane Description
Fill Instructions
Number
If SEX=1 fill “5 or more”; else if SEX=2 fill “4 or more”
Special Instructions "Days with 5 or more drinks " as a header for this question and AHB.180_2.
Skip Instructions
<0-60,R,D> [goto AHGT_FT]
Hard Edits
Soft Edits
AssocHelp
H_BINGE
Wednesday, June 14, 2017
Page 55 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.181_H
Variable Name
H_BINGE
Universe
Universe-text
Question Text
Include as alcohol all types of beer (including stout, ale, malt liquor, or light beer, but
does not include alcohol-free beer), wine (including port, sherry, sangria wine coolers,
and champagne), and liquor (including brandy, liqueurs, scotch, whiskeys, tequila and
gin.
One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or one and onehalf ounces of liquor
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
BINGE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
H_BINGE
Wednesday, June 14, 2017
Page 56 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_01
Variable Name
AHGT_FT
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')
Universe-text
Sample adults 18+
Question Text
How tall are you without shoes?
* Enter "M" to record metric measurements
Answer Codes
Question Type
Integer
Field Pane Description
Current height
Fill Instructions
Special Instructions "Current height" to the left. "feet" to the right.
Don't allow a '.' (a period) after a number. This is a 2 character field and will be picked
up in output
Skip Instructions
<2-7> [goto AHGT_IN]
[goto AWGT_LB]
[goto AHGT_M]
[if AHGT_FT NE<2-7,R,D,M> goto ERR1_AHGT_FT]
[if AHGT_FT = <2,3> goto ERR2_AHGT_FT]
Hard Edits
ERR1_AHGT_FT
* Only 2-7, Don't Know/Refused or M allowed in this field.
* Please correct.
Soft Edits
ERR2_AHGT_FT
* Respondent's height in feet is [fill: AHGT_FT]?
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 57 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_02
Variable Name
AHGT_IN
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and AHGT_FT = 2-7
Universe-text
Sample adults 18+ who answered their height in feet
Question Text
How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.
Answer Codes
Question Type
Integer
Field Pane Description
Inches
Fill Instructions
Special Instructions Locate the Variable Description and answer box to the right of that for AHB.190_01
(AHGT_FT). Show "inches" on the right.
If AHGT_FT = M, Refused, or Don’t know, do not calculate a value for AHTINCH
Create variable AHTINCH as follows: (AHGT_FT * 12) + AHGT_IN = AHTINCH
If AHGT_IN = Refused or Don’t know use ‘0’ for AHGT_IN when calculating AHTINCH
If ERR2_AHGT_IN is displayed, set AHGT_FLG = ‘1’
If ERR2_AHGT_IN is closed or you goto another screen from it, leave AHGT_FLG = ‘1’
If ERR2_AHGT_IN is suppressed, reset AHGT_FLG = ‘2’
Skip Instructions
goto ERR_AHGT_IN
<0-11,R,D> if (SEX = ‘1’ and (AHTINCH lt ‘61’ or AHTINCH gt ‘75’)) or
(SEX = ‘2’ and (AHTINCH lt ‘56’ or AHTINCH gt ‘69’))
goto ERR2_AHGT_IN
else
goto AWGT_LB
Hard Edits
ERR1_AHGT_IN
* If [fill: AHGT_FT] feet exactly, enter "0"; otherwise enter number of inches.
Soft Edits
ERR2_AHGT_IN
* Please verify that the height was entered correctly. Probe only if necessary.
AssocHelp
Wednesday, June 14, 2017
Page 58 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_03
Variable Name
AHGT_M
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and AHGT_FT = M
Universe-text
Sample adults 18+ who choose to give their height in metric measurements
Question Text
How tall are you without shoes?
* Enter height in metric.
Answer Codes
Question Type
Integer
Field Pane Description
Current height
Fill Instructions
Special Instructions "meters" to the right.
Skip Instructions
goto ERR_AHGT_M
<0-2> goto AHGT_CM
goto AWGT_LB
Hard Edits
ERR_AHGT_M
* If height is being given in centimeters only, enter "0"; otherwise enter number of
meters.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 59 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_04
Variable Name
AHGT_CM
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and AHGT_M = 0-2
Universe-text
Sample adults 18+ who answered their height in meters
Question Text
*Enter centimeters.
Answer Codes
Question Type
Integer
Field Pane Description
Centimeters
Fill Instructions
Special Instructions "centimeters" to the right.
If AHGT_M = Refused or Don’t know, do not calculate a value for AHTCM
Create variable AHTCM as follows: (AHGT_M * 100) + AHGT_CM = AHTCM
If AHGT_CM = Refused or Don’t know use ‘0’ for AHGT_CM when checking if height
exceeds maximum allowed, when checking if height is very small, or when calculating
AHTCM
If ERR3_AHGT_CM is displayed, set AHGT_FLG = ‘1’
If ERR3_AHGT_CM is closed or you goto another screen from it, leave AHGT_FLG =
‘1’
If ERR3_AHGT_CM is suppressed, reset AHGT_FLG = ‘2’
Skip Instructions
goto ERR2_AHGT_CM
<0-241,R,D> if (AHGT_M eq ‘2’ and AHGT_CM gt ‘41’) or (AHGT_M eq ‘1’ and
AHGT_CM gt ‘141’)
goto ERR1_AHGT_CM
elseif (SEX = ‘1’ and (AHTCM lt ‘156’ or AHTCM gt ‘192’)) or
(SEX = ‘2’ and (AHTCM lt ‘143’ or AHTCM gt ‘176’))
goto ERR3_AHGT_CM
else
goto AWGT_LB
Hard Edits
ERR1_AHGT_CM
* Total height exceeds maximum allowed.
* Please correct.
ERR2_AHGT_CM
* If [fill: AHGT_M] meters exactly, enter "0"; otherwise enter number of centimeters.
Soft Edits
ERR3_AHGT_CM
* Please verify that the height was entered correctly. Probe only if necessary.
AssocHelp
Wednesday, June 14, 2017
Page 60 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_05
Variable Name
AHTINCH
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If AHGT_FT = M, Refused or Don’t know, do not calculate a value for AHTINCH
Create variable AHTINCH as follows: (AHGT_FT * 12) + AHGT_IN = AHTINCH
If AHGT_IN = Refused or Don’t know, use ‘0’ for AHGT_IN when calculating AHTINCH
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 61 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_06
Variable Name
AHTCM
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If AHGT_M = Refused or Don’t know, do not calculate a value for AHTCM
Create variable AHTCM as follows: (AHGT_M * 100) + AHGT_CM = AHTCM
If AHGT_CM = Refused or Don’t know use ‘0’ for AHGT_CM when calculating AHTCM
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 62 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_07
Variable Name
AHGT_FLG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
blank,1,2
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If ERR2_AHGT_IN or ERR3_AHGT_CM is displayed, set AHGT_FLG = ‘1’
If ERR2_AHGT_IN or ERR3_AHGT_CM is closed or you goto another screen from it,
leave AHGT_FLG = ‘1’
If ERR2_AHGT_IN or ERR3_AHGT_CM is suppressed, reset AHGT_FLG = ‘2’
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 63 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.190_08
Variable Name
AMETERS
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Create variable AMETERS as follows:
if AHTINCH ne ‘empty’
set AMETERS = AHTINCH/39.37008
elseif AHTCM ne ‘empty’
set AMETERS = AHTCM/100
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 64 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_01
Variable Name
AWGT_LB
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999')
Universe-text
Sample adults 18+
Question Text
How much do you weigh without shoes?
* Enter "M" to record metric measurements
* Enter '500' for 500 pounds or more
Answer Codes
Question Type
Integer
Field Pane Description
Current weight
Fill Instructions
Special Instructions "pounds" on the right.
If ERR2_AWGT_LB is displayed, set AWGT_FLG = ‘1’
If ERR2_AWGT_LB is closed or you goto another screen from it, leave AWGT_FLG =
‘1’
If ERR2_AWGT_LB is suppressed, reset AWGT_FLG = ‘2’
Skip Instructions
<50-500> if AWGT_LB lt ‘50’ or AWGT_LB gt ‘500’
goto ERR1_AWGT_LB
elseif ((SEX = ‘1’ and (AWGT_LB lt ’113’ or AWGT_LB gt ‘316’)) or
((SEX = ‘2’ and (AWGT_LB lt ’96’ or AWGT_LB gt ‘293’))
goto ERR2_AWGT_LB
elseif AHGT_FLG = ‘1’ and AWGT_FLG = ‘1’
[goto next section]
else
calculate the BMI (Body Mass Index) - See BMI spec page
[goto next section]
Hard Edits
ERR1_AWGT_LB
* Weight is out of range (50-500).
* Please correct.
Soft Edits
ERR2_AWGT_LB
* Please verify that the weight was entered correctly. Probe only if necessary.
AssocHelp
Wednesday, June 14, 2017
Page 65 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_02
Variable Name
AWGT_KG
Universe
HHSTAT4='S' and AGE GE '018' and AGE not IN ('997','999') and AWGT_LB = M
Universe-text
Sample adults 18+ who choose to give their weight in metric measurements
Question Text
How much do you weigh without shoes?
* Enter weight in kilograms
Answer Codes
Question Type
<23-226>
Refused
Don't know
Integer
Field Pane Description
Current weight
Fill Instructions
Special Instructions "kilograms" to the right.
If ERR2_AWGT_KG is displayed, set AWGT_FLG = ‘1’
If ERR2_AWGT_KG is closed or you goto another screen from it, leave AWGT_FLG =
‘1’
If ERR2_AWGT_KG is suppressed, reset AWGT_FLG = ‘2’
Skip Instructions
<23-226> if AWGT_KG lt ‘23’ or AWGT_KG gt ‘226’
goto ERR1_AWGT_KG
elseif ((SEX = ‘1’ and (AWGT_KG lt ’51’ or AWGT_KG gt ‘143’)) or
((SEX = ‘2’ and (AWGT_KG lt ’43’ or AWGT_KG gt ‘133’))
goto ERR2_AWGT_KG
elseif AHGT_FLG = ‘1’ and AWGT_FLG = ‘1’
goto next section
else
calculate the BMI (Body Mass Index) - See BMI spec page
goto next section
Hard Edits
ERR1_AWGT_KG
*Weight is out of range (23-226).
* Please correct.
Soft Edits
ERR2_AWGT_KG
* Please verify that the weight was entered correctly. Probe only if necessary.
AssocHelp
Wednesday, June 14, 2017
Page 66 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_03
Variable Name
AWGT_FLG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
blank,1,2
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If ERR2_AWGT_LB or ERR2_AWGT_KG is displayed, set AWGT_FLG = ‘1’
If ERR2_AWGT_LB or ERR2_AWGT_KG is closed or you goto another screen from it,
leave AWGT_FLG = ‘1’
If ERR2_AWGT_LB or ERR2_AWGT_KG is suppressed, reset AWGT_FLG = ‘2’
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 67 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_04
Variable Name
AKG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Create variable AKG as follows:
If AWGT_LB ne ‘M’, ‘Refused’, ‘Don’t know’, or ‘empty’
set AKG = AWGT_LB/2.20462
elseif AWGT_KG ne ‘Refused’, ‘Don’t know’, or ‘empty’
set AKG = AWGT_KG
Skip Instructions
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 68 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_05
Variable Name
ABMI
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions Create variable ABMI as follows: (AKG/(AMETERS * AMETERS)) = ABMI
If ERR_ABMI is displayed, set ABMI_FLG = ‘1’
f ERR_ABMI is closed or you goto another screen from it, leave ABMI_FLG = ‘1’
If ERR_ABMI is suppressed, reset ABMI_FLG = ‘2’
Skip Instructions
if (SEX = ‘1’ and (ABMI lt ‘18’ or ABMI gt ‘44’)) or
(SEX = ‘2’ and (ABMI lt ‘17’ or ABMI gt ‘49’))
goto ERR_ABMI
else
[goto next section]
Hard Edits
Soft Edits
ERR_ABMI
* Please verify that the entries for height and weight were entered correctly. Probe only
if necessary.
AssocHelp
Wednesday, June 14, 2017
Page 69 of 70
Module
18
Section Name
Adult Health Behavior
Part
C
Question ID
AHB.200_06
Variable Name
ABMI_FLG
Universe
Universe-text
Question Text
**OUT VARIABLE**
Answer Codes
blank,1,2
Question Type
Instrument Out Variable
Field Pane Description
Fill Instructions
Special Instructions If ERR_ABMI is displayed, set ABMI_FLG = ‘1’
If ERR_ABMI is closed or you goto another screen from it, leave ABMI_FLG = ‘1’
If ERR_ABMI is suppressed, reset ABMI_FLG = ‘2’
Skip Instructions
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Soft Edits
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Wednesday, June 14, 2017
Page 70 of 70
2018 Q1 NHIS Instrument Spec Report
Section name: Health Care Access and Utilization
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.020
Variable Name
AUSUALPL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
The next questions are about health care.
Is there a place that you USUALLY go to when you are sick or need advice about your
health?
Answer Codes
Question Type
1. Yes
2. There is NO place
3. There is MORE THAN ONE place
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Usually go when sick
Fill Instructions
Special Instructions Answer on the right.
Skip Instructions
<1,3> [go to APLKIND]
<2,R,D> [go to AHCPLKND]
Hard Edits
Soft Edits
AssocHelp
H_AUSUALPL
Wednesday, June 14, 2017
Page 1 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.020_H
Variable Name
H_AUSUALPL
Universe
Universe-text
Question Text
A place to USUALLY go when sick or in need of advice about one's health includes:
Walk-in clinic
Doctor's office
Clinic
Health Center
Health Maintenance Organization
Hospital - Emergency room or outpatient clinic
Military or VA health care facility
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AUSUALPL
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 2 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.030
Variable Name
APLKIND
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AUSUALPL(e)
IN('1','3')
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice
Question Text
? [F1]
[Fill1: What kind of place is it - a clinic, doctor's office, emergency room, or some other
place?
[Fill2: What kind of place do you go to most often - a clinic, doctor's office, emergency
room, or some other place?]
Answer Codes
Question Type
1. Clinic or health center
2. Doctor's office or HMO
3. Hospital emergency room
4. Hospital outpatient department
5. Some other place
6. Doesn’t go to one place most often
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Go to most often
Fill 1 = [If AUSUALPL (AAU.020) = 1]
Fill2 = [If AUSUALPL (AAU.020) = 3 ]
Special Instructions
Skip Instructions
<1-5> [go to AHCPLROU]
<6,R,D> [go to AHCPLKND]
Hard Edits
Soft Edits
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H_APLKIND
Wednesday, June 14, 2017
Page 3 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.030_H
Variable Name
H_APLKIND
Universe
Universe-text
Question Text
"Doctor" includes medical doctors, as well as other health care professionals, such as
general practitioners, psychologists, nurses, chiropractors, etc.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
APLKIND
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
H_APLKIND
Wednesday, June 14, 2017
Page 4 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.035
Variable Name
AHCPLROU
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('1'
<=APLKIND(e) <='5')
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who
reported place goes most often as a clinic or health center, doctor's office or HMO,
hospital emergency room, hospital outpatient department, or some other place
Question Text
? [F1]
Is that {fill: place from (APLKIND)} the same place you USUALLY go when you need
routine or preventive care, such as a physical examination or check up?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Routine/prev. care place
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHCCHGYR]
<2,R,D> [go to AHCPLKND]
Hard Edits
Soft Edits
AssocHelp
H_AHCPLROU
Wednesday, June 14, 2017
Page 5 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.035_H
Variable Name
H_AHCPLROU
Universe
Universe-text
Question Text
Routine or preventive care is a health procedure or series of health procedures done to
help a person avoid illness or to detect problems
early.
A general physical exam or check-up is an examination not for a specific condition or
problem. This may include the following: a periodic health examination, a complete
medical examination, an annual health check-up or a comprehensive physical
examination. It does NOT include dental exams and vision tests.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
AHCPLROU
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 6 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.037
Variable Name
AHCPLKND
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AUSUALPL(e)
IN('2','7','9') or APLKIND(e) IN('6','7','9') or AHCPLROU(e) IN('2','7','9'))
Universe-text
Sample Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a
usual source of sick care; who have a usual source of sick care but do not go to one
place most often or Ref/DK what kind of place; who have a usual source of sick care,
but it is not same place as usual source of routine/preventive care; who have a usual
source of sick care but Ref/DK if it is same place as usual source of routine/preventive
care.
Question Text
What kind of place do you USUALLY go to when you need routine or preventive care,
such as a physical examination or check-up?
Answer Codes
0. Doesn't get preventive care anywhere
1. Clinic or health center
2. Doctor's office or HMO
3. Hospital emergency room
4. Hospital outpatient department
5. Some other place
6. Doesn't go to one place most often
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Usually go for routine/prev. care
Fill Instructions
Special Instructions
Skip Instructions
<0-6,R,D>
if AUSUALPL=2,R,D [goto AHCDLY_1]
ELSE if AUSUALPL=1 [goto AHCCHGYR]
Hard Edits
Soft Edits
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H_AHCPLROU
Wednesday, June 14, 2017
Page 7 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.040
Variable Name
AHCCHGYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (AUSUALPL(e)
IN('1','3') OR AHCPLROU(e)='1')
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who
reported same place as usual source of routine/preventive care]
Question Text
? [F1]
At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you
USUALLY go for health care?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Changed health care place
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto AHCCHGHI]
<2,R,D>[goto AHCDLY_1]
Hard Edits
Soft Edits
AssocHelp
H_AHCCHGYR
Wednesday, June 14, 2017
Page 8 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.040_H
Variable Name
H_AHCCHGYR
Universe
Universe-text
Question Text
"Change the place" refers to a change in health care providers, not a change of
address for a current provider.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCCHGYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 9 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.050
Variable Name
AHCCHGHI
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCCHGYR(e) =
'1'
Universe-text
Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who
CHANGED their USUAL place for health care in past 12 months
Question Text
Was this change for a reason related to health insurance?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Change due to health ins.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AHCDLY_1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 10 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_1
Variable Name
AHCDLY_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
There are many reasons people delay getting medical care.
Have you delayed getting care for any of the following reasons in the PAST 12
MONTHS?
...You couldn't get through on the telephone.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Couldn't get through on phone
Fill Instructions
Special Instructions "Past 12 months" as a header for this question as well as AAU061_2 - AAU.061_5.
Skip Instructions
<1,2,R,D>[goto AHCDLY_2]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Wednesday, June 14, 2017
Page 11 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_1_H
Variable Name
H_AHCDLY_1
Universe
Universe-text
Question Text
"Delayed" assumes that medical care has been or will eventually be received.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCDLY_1, AHCDLY_2, AHCDLY_4 and AHCDLY_5
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 12 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_2
Variable Name
AHCDLY_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...You couldn't get an appointment soon enough.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
No appt. soon enough
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCDLY_3]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Wednesday, June 14, 2017
Page 13 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_3
Variable Name
AHCDLY_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...Once you get there, you have to wait too long to see the doctor.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Wait too long to see Dr.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCDLY_4]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_3
Wednesday, June 14, 2017
Page 14 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_3_H
Variable Name
H_AHCDLY_3
Universe
Universe-text
Question Text
"Delayed" assumes that medical care has been or will eventually be received.
Waiting time to see the doctor includes only time from arrival until the health care
provider is seen.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCDLY_3
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_4
Variable Name
AHCDLY_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...The (clinic/doctor's) office wasn't open when you could get there.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Clinic/office not open
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCDLY_5]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Wednesday, June 14, 2017
Page 16 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.061_5
Variable Name
AHCDLY_5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
There are many reasons people delay getting medical care. Have you delayed getting
care for any of the following reasons in the PAST 12 MONTHS?
...You didn't have transportation.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
No transportation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_1]
Hard Edits
Soft Edits
AssocHelp
H_AHCDLY_1
Wednesday, June 14, 2017
Page 17 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_1
Variable Name
AHCAFY_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Prescription medicines.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Prescription medicines
Fill Instructions
Special Instructions "Past 12 mo. (needed but can't aford)" as a header for this question as well as
AAU.111_2 - AAU.111_4.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<1,2,R,D>[goto AHCAFY_2]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_1
Wednesday, June 14, 2017
Page 18 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_1_H
Variable Name
H_AHCAFY_1
Universe
Universe-text
Question Text
Include all types of financial limitations that prevented the person from getting medical
services.
Prescription Medicines are medication which can only be obtained with the approval of
a licensed health care professional. The medication is usually obtained through a
pharmacy using a written note or telephoned instructions from the health care
professional to the pharmacy.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCAFY_1
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 19 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_2
Variable Name
AHCAFY_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Mental health care or counseling.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Mental health care/counselling
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_3]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_2
Wednesday, June 14, 2017
Page 20 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_2_H
Variable Name
H_AHCAFY_2
Universe
Universe-text
Question Text
Include all types of financial limitations that prevented the person from getting medical
services.
Mental Health Care is respondent defined.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCAFY_2
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 21 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_3
Variable Name
AHCAFY_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Dental care (including check ups).
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Dental care
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AHCAFY_4]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_3
Wednesday, June 14, 2017
Page 22 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_3_H
Variable Name
H_AHCAFY_3
Universe
Universe-text
Question Text
Include all types of financial limitations that prevented the person from getting medical
services.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCAFY_3, AHCAFY_4
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 23 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.111_4
Variable Name
AHCAFY_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
* Read if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the
following, but didn't get it because you couldn't afford it?
...Eyeglasses.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Eyeglasses
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto AWORPAY]
Hard Edits
Soft Edits
AssocHelp
H_AHCAFY_3
Wednesday, June 14, 2017
Page 24 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.113_00.010
Variable Name
AWORPAY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
If you get sick or have an accident, how worried are you that you will be able to pay your
medical bills? Are you very worried, somewhat worried, or not at all worried?
Answer Codes
1. Very worried
2. Somewhat worried
3. Not at all worried
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D>[goto ARX12MO]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 25 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.126_01.010
Variable Name
ARX12MO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, were you prescribed medication by a doctor or other
health professional?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Past 12 months prescriptions
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto ARX12_1]
<2,R,D> [goto ARX12_5]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 26 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_01.010
Variable Name
ARX12_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You skipped medication doses to save money.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Past 12 months skipped medication
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 27 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_02.010
Variable Name
ARX12_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You took less medicine to save money.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Took less medicine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_3]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 28 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_03.010
Variable Name
ARX12_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You delayed filling a prescription to save money.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Delayed filling prescription
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_4]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 29 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_04.010
Variable Name
ARX12_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ARX12MO (e)='1'
Universe-text
Sample adults 18+ who had been prescribed medication in the past 12 months
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You asked your doctor for a lower cost medication to save money.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Lower cost medication
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_5]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 30 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_05.010
Variable Name
ARX12_5
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You bought prescription drugs from another country to save money.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Drugs from another country
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ARX12_6]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 31 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.127_06.010
Variable Name
ARX12_6
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, were any of the following true for you?
…You used alternative therapies to save money.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Used alternative therapies
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto ADENLONG]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 32 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.135
Variable Name
ADENLONG
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A7
About how long has it been since you last saw a dentist? Include all types of dentists,
such as orthodontists, oral surgeons, and all other dental specialists, as well as dental
hygienists.
Answer Codes
Question Type
0. Never
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Last saw dentist
Fill Instructions
Special Instructions Answer on the right.
Skip Instructions
<0-5,R,D>[ goto AHCSY1_1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 33 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_1
Variable Name
AHCSY1_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse,
or clinical social worker.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Mental health professional
Fill Instructions
Special Instructions "Past 12 mo. (seen/talked to)" as a header for this question as well as AAU.141_2 AAU.230.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<1,2,R,D>[ goto AHCSY1_2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 34 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_2
Variable Name
AHCSY1_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...An optometrist, ophthalmologist (AHF-thal-MOL-oh-jist), or eye doctor (someone who
prescribes eyeglasses).
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Eye doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_3]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 35 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_3
Variable Name
AHCSY1_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A foot doctor.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Foot doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_4]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 36 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_4
Variable Name
AHCSY1_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A chiropractor.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Chiropractor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_5]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 37 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_5
Variable Name
AHCSY1_5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1}
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A physical therapist, speech therapist, respiratory therapist, audiologist, or
occupational therapist.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Physical/speech/resp. therapist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[ goto AHCSY1_6]
Hard Edits
Soft Edits
AssocHelp
H_AHCSY1_5
Wednesday, June 14, 2017
Page 38 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_5_H
Variable Name
H_AHCSY1_5
Universe
Universe-text
Question Text
A "physical therapist" is a health care professional skilled in working with persons with
health problems resulting from injury, disease, or developmental problems. A physical
therapist diagnoses muscle and joint problems and provides exercises and treatments.
A "speech therapist" is a health care professional skilled in working with communication
and language disorders. Speech pathologists diagnose speech and language
problems and provide therapy including treatment for stuttering, impaired articulation, or
language or voice impairment.
A "respiratory therapist" is a health care professional skilled in working with persons
with respiratory difficulties. Respiratory therapists treat and manage the care of
persons with respiratory diseases. This may include administration of breathing
treatments, oxygen, and education of patients in regards to respiratory treatment
procedures.
An "audiologist" is a health care professional skilled in working with hearing problems.
An audiologist diagnoses hearing problems and their nature, and determines if a
person can benefit from using hearing aids.
An "occupational therapist" is a health care professional skilled in working with health
problems resulting from injury, disease, or developmental problems. Occupational
therapy involves working on functional activities such as dressing, feeding, and writing.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCSY1_5
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 39 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_6
Variable Name
AHCSY1_6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1}
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
{Fill1: ...A nurse practitioner, physician assistant, or midwife.
Or Filll2: ...A nurse practitioner or physician assistant.}
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Fill Instructions
Nurse prac./phys. asst./midwife
fill1: If SEX=2 Fill1: ...A nurse practitioner, physician assistant, or midwife”
Else if SEX=1 Fill2: ...A nurse practitioner or physician assistant.
Special Instructions
Skip Instructions
<1,2,R,D>[if SEX=1goto AHCSY8_8;
else if SEX=2 goto AHCSYR7]
Hard Edits
Soft Edits
AssocHelp
H_AHCSY1_6
Wednesday, June 14, 2017
Page 40 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.141_6_H
Variable Name
H_AHCSY1_6
Universe
Universe-text
Question Text
A nurse practitioner is a registered nurse who has completed an advanced program of
study leading to an expanded role in health care. Nurse practitioners are able to take
health histories, perform physical examinations, order tests, and prescribe treatments
including medications. Nurse practitioners work under the supervision of a doctor, but
not necessarily in the presence of the doctor.
A nurse midwife is a registered nurse who has completed an advanced program of
study leading to an expanded role in health care for women. Nurse midwives provide
gynecological, pregnancy and delivery care to women. Nurse midwives work under the
supervision of a doctor, but not necessarily in the presence of the doctor.
A physician assistant works under the supervision of a physician to provide diagnostic,
preventative, and therapeutic health care services. Duties may include examining
patients, interpreting and ordering x-rays and lab tests, and the diagnosis and treatment
of minor injuries.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCSY1_6
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 41 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.200
Variable Name
AHCSYR7
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX = '2'
Universe-text
Sample adults 18+ who are female
Question Text
? [F1}
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A doctor who specializes in women's health (an obstetrician/gynecologist).
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
OB/GYN
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AHCSY8_ 8]
Hard Edits
Soft Edits
AssocHelp
H_AHCSYR7
Wednesday, June 14, 2017
Page 42 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.200_H
Variable Name
H_AHCSYR7
Universe
Universe-text
Question Text
An Obstetrician/Gynecologist is a medical doctor who treats women, pregnancy, and
diseases of he female reproductive system, including the breasts.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCSYR7
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 43 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.211_1
Variable Name
AHCSY8_8
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A medical doctor who specializes in a particular medical disease or problem (other
than obstetrician/gynecologist, psychiatrist, or ophthalmologist (AHF-thal-MOL-oh-jist)).
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Specialist doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AHCSY8_ 9]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 44 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.211_2
Variable Name
AHCSY8_9
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if Necessary.
DURING THE PAST 12 MONTHS have you seen or talked to any of the following
health care providers about your own health?
...A general doctor who treats a variety of illnesses (a doctor in general practice, family
medicine, or internal medicine)?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
General doctor
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AHCSYR10]
<2,R,D> [goto AHERNOYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 45 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.230
Variable Name
AHCSYR10
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCSY8_9(e)='1'
Universe-text
Sample adults 18+ who have seen or talked to a general doctor during the past 12
months
Question Text
Does that doctor treat children and adults (a doctor in general practice or family
medicine)?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Doctor treats children and adults
Fill Instructions
Special Instructions Indent to indicate that this is a follow on from the previous question.
Skip Instructions
<1,2,R,D> [go to AHERNOYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 46 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.240
Variable Name
AHERNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A8 ? [F1]
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL
EMERGENCY ROOM about your own health (This includes emergency room visits that
resulted in a hospital admission.)?
Answer Codes
Question Type
0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Number of times in ER
Fill Instructions
Special Instructions "Past 12 months as a header for this question as well as AAU.250 - AAU.280.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<0,R,D> [go to AHCHYR]
<1-8> [goto AERVISND]
Hard Edits
Soft Edits
AssocHelp
H_AHERNOYR
Wednesday, June 14, 2017
Page 47 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.240_H
Variable Name
H_AHERNOYR
Universe
Universe-text
Question Text
Hospital Emergency Room is an emergency care facility at a hospital.
Do NOT include emergency care received at a clinic or HMO. Include emergency room
visits which resulted in admission for inpatient care.
Do not include visits to outpatient clinics, urgent care facilities and the like.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHERNOYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 48 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.250
Variable Name
AHCHYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
? [F1]
DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or
other health care professional?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Home care - nurse/hlth. prof.
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto AHCHMOYR]
<2,R,D>[goto AHCNOYR]
Hard Edits
Soft Edits
AssocHelp
H_AHCHYR
Wednesday, June 14, 2017
Page 49 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.250_H
Variable Name
H_AHCHYR
Universe
Universe-text
Question Text
At HOME refers to the sample adult's own home and everyone else's home in which
the sample adult was staying at the time. This could be a house, apartment, motor
home, houseboat, trailer, or other dwelling. Do not include visits by a doctor while the
sample person was in a hospital or institutionalized.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCHYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 50 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.260
Variable Name
AHCHMOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCHYR(e) = '1'
Universe-text
Sample adults 18+ who received home care from a health professional during the past
12 months
Question Text
? [F1]
During how many of the PAST 12 MONTHS did you receive care AT HOME from a
health care professional?
Answer Codes
Question Type
Integer
Field Pane Description
Number of months
Fill Instructions
Special Instructions Indent to indicate that this is a follow up from the previous question.
Skip Instructions
<1-12,R,D>[goto AHCHNOYR]
Hard Edits
Soft Edits
AssocHelp
H_AHCHMOYR
Wednesday, June 14, 2017
Page 51 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.260_H
Variable Name
H_AHCHMOYR
Universe
Universe-text
Question Text
At HOME refers to the sample adult's own home and everyone else's home in which
the sample adult was staying at the time. This could be a house, apartment, motor
home, houseboat, trailer, or other dwelling. Do not include visits by a doctor while the
sample person was in a hospital or institutionalized.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCHMOYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 52 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.270
Variable Name
AHCHNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHCHYR(e) = '1'
Universe-text
Sample adults 18+ who received home care from a health professional during the past
12 months
Question Text
(book) A9
What was the total number of home visits received during {Fill1: that month/Fill2: those
months}?
Answer Codes
Question Type
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Number of visits
Fill1: if [AHCHMOYR = 1]
Fill2: if [AHCHMOYR NE 1]
Special Instructions Indent to indicate that this is a follow up from AAU.270.
Skip Instructions
<1-8,R,D>[goto AHCNOYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 53 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.280
Variable Name
AHCNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A8 ? [F1]
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or
other health care professional about your own health at a DOCTOR’S OFFICE, A
CLINIC, OR SOME OTHER PLACE? Do not include times you were hospitalized
overnight, visits to hospital emergency rooms, home visits, dental visits, or telephone
calls.
Answer Codes
Question Type
0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Number of office visits
Fill Instructions
Special Instructions
Skip Instructions
<0-8,R,D>[goto ASRGYR]
Hard Edits
Soft Edits
AssocHelp
H_AHCNOYR
Wednesday, June 14, 2017
Page 54 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.280_H
Variable Name
H_AHCNOYR
Universe
Universe-text
Question Text
"Doctor" includes medical doctors as well as other health care professionals, such as
general practitioners, psychologist, nurses, chiropractors, etc.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AHCNOYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 55 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.290
Variable Name
ASRGYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical
procedures either as an inpatient or outpatient?
* Read if necessary: This includes both major surgery and minor procedures such as
setting bones or removing growths.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Surgery/surgical procedures
Fill Instructions
Special Instructions "Past 12 months as a header for this question as well as AAU.300 and AAU.305.
Indent all related Field Pane Descriptions under the heading.
Skip Instructions
<1> [goto ASRGNOYR]
<2,R,D> [goto AMDLONG].
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 56 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.300
Variable Name
ASRGNOYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ASRGYR(e) = '1'
Universe-text
Sample adults 18+ who had surgery or surgical procedures during past 12 months
Question Text
Including any times you may have already told me about, HOW MANY DIFFERENT
TIMES have you had surgery during the PAST 12 MONTHS?
* Enter "95" for 95 or more times.
Answer Codes
Question Type
Integer
Field Pane Description
Number of surgeries
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Skip Instructions
<1-95,R,D> [goto AMDLONG].
<11-95>[goto ERR_ASGYR]
Hard Edits
Soft Edits
* {ASRGYR} is an unusually large number.
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 57 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.305
Variable Name
AMDLONG
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A7 ? [F1]
About how long has it been since you last saw or talked to a doctor or other health care
professional about your own health? Include doctors seen while a patient in a hospital.
Answer Codes
Question Type
0. Never
1. 6 months or less
2. More than 6 months but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Last saw/talked with doctor/hlth. prof.
Fill Instructions
Special Instructions Answer name on the right.
Skip Instructions
<0-5,R,D> [goto HIT1A]
Hard Edits
Soft Edits
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H_AMDLONG
Wednesday, June 14, 2017
Page 58 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
C
Question ID
AAU.305_H
Variable Name
H_AMDLONG
Universe
Universe-text
Question Text
"Medical doctor" refers to both medical doctors (M.D.s) and osteopathic physicians
(D.O.s), including general practitioners and all types of specialists; and their assistants.
Do not include person who do not have an M.D. or D.O. degree, such as dentists, oral
surgeons, chiropractors, chiropodists, podiatrists, naturopaths, Christian Science
healers, opticians, optometrists, psychologists, etc., unless they assist an M.D. or D.O.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens: AMDLONG
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 59 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.010
Variable Name
HIT1A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Look up health information on the Internet.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HIT2A]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 60 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.020
Variable Name
HIT2A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Fill a prescription.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HIT3A]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 61 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.030
Variable Name
HIT3A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Schedule an appointment with a health care provider.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HIT4A]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 62 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.309_00.040
Variable Name
HIT4A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary..
DURING THE PAST 12 MONTHS, have you ever used computers for any of the
following
…Communicate with a health care provider by email.
Answer Codes
Question Type
1.Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto FLUVACYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 63 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.310_00.000
Variable Name
FLUVACYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
?[F1]
There are two types of flu vaccinations. One is a shot and the other is a spray mist, or
drop in the nose.
DURING THE PAST 12 MONTHS, have you had a flu vaccination? A flu vaccination is
usually given in the fall and protects against influenza for the flu season.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Flu vaccination - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto FLUVAC_M]
<2,R,D> [ goto SHTPNUYR]
Hard Edits
Soft Edits
AssocHelp
H_FLUVACYR
Wednesday, June 14, 2017
Page 64 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.310_H
Variable Name
H_FLUVACYR
Universe
FLUVACYR
Universe-text
Question Text
This includes a new type of flu shot called the Fluzone Intradermal vaccine that features
an ultra-fine needle that is 90 percent shorter than the typical needle used for flu
injections.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated Screen:
FLUVACYR
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 65 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.312_01.000
Variable Name
FLUVAC_M
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and FLUVACTP(e)
IN('1','2','7','9')
Universe-text
Sample adults 18+ who have had a flu vaccination in the past 12 months, regardless of
type
Question Text
1 of 2
During what month and year did you receive your most recent flu vaccination?
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Flu vaccination-month
Fill Instructions
Special Instructions
Skip Instructions
<1-12,D> [ goto FLUVAC_Y]
if FLUVACTP=1 and PREGNOW=1 and INTERVIEW_MONTH=1-3,8-12 [goto
FLUSHPG1];
else if FLUVACTP=1 PREGNOW=1 and INTERVIEW_MONTH=4-7 or PREGFLYR=1
[goto FLUSHPG2];
else [goto SHTPNUYR]
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Wednesday, June 14, 2017
Page 66 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.312_02.000
Variable Name
FLUVAC_Y
Universe
HHSTAT4 = 'S' and AGE GE 18 and ('01' <= FLUVAC_M <= '12','99')
Universe-text
Sample adults 18+ who gave a month for their last flu vaccination or who didn’t know
the month
Question Text
2 of 2
*Enter year of most recent flu vaccination.
Answer Codes
Question Type
Integer
Field Pane Description
Flu vaccination-year
Fill Instructions
Special Instructions
Skip Instructions
if FLUVACTP=1 and PREGNOW=1 and INTERVIEW_MONTH=1-3,812 [goto FLUSHPG1];
else if FLUVACTP=1 and PREGNOW=1 and INTERVIEW_MONTH=4-7 or
PREGFLYR=1 [goto FLUSHPG2];
else [goto SHTPNUYR]
[If FLUVAC_M and FLUVAC_Y = a future date [goto ERR1_FLUVAC_Y]
[If FLUVAC_M and FLUVAC_Y = a date prior to birth [goto ERR2_FLUVAC_Y ]
[If FLUVAC_M and FLUVAC_Y = a date before 12 months ago [goto
ERR3_FLUVAC_Y ]
Hard Edits
ERR1_FLUVAC_Y
*Future date invalid
ERR2_FLUVAC_Y
*Date before birth
ERR3_FLUVAC_Y
*Date more than 12 months ago
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 67 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.313_00.000
Variable Name
FLUSHPG1
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2' and FLUVACTP(e)='1' and
PREGNOW(e)='1' and INTERVIEW_MONTH(e) IN ('01','02','03','08','09','10','11','12')
Universe-text
Female sample adults 18-49 who are currently pregnant and are interviewed JanuaryMarch or August-December and received a flu vaccination in the past 12 months
Question Text
Did you get a flu vaccination before or during your current pregnancy?
Answer Codes
1. Before this pregnancy
2. During this pregnancy
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Current pregnancy flu vaccination
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto SHTPNUYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 68 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
Question ID
AAU.314_00.000
Variable Name
FLUSHPG2
Universe
HHSTAT4='S' and ('018' <= AGE <= '049') and SEX = '2' and FLUVACTP(e)='1' and
PREGFLYR(e)='1'
Universe-text
Female sample adults 18-49 who are currently pregnant and were interviewed AprilJuly or who have been determined to be pregnant at a specific point in the past year
and received a flu vaccination in the past 12 months
Question Text
[Fill1: Earlier you said you were pregnant sometime since August 1st, [last year]. Did
you
get a flu vaccination before, during or after this pregnancy?/
Earlier you said you were pregnant sometime between August [last year] and March
[current year].
Did you get a flu vaccination before, during or after this pregnancy?/
Earlier you said you were pregnant sometime between August [last year] and March
[current year].
Did you get a flu shot before, during or after this pregnancy?/
Answer Codes
Question Type
1. Before this pregnancy
2. During this pregnancy
3. After this pregnancy
Refused
Don't Know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Recent pregnancy flu vaccination
IF INTERVIEW_MONTH = 1,2,3 THEN
fill: Earlier you said you were pregnant sometime since August 1st, [fill: LASTYEAR].
Did you get a flu shot before, during or after this pregnancy?
ELSE IF INTERVIEW_MONTH = 4,5,6,7 THEN
fill: Earlier you said you were pregnant sometime between August [fill: LASTYEAR]
and March [fill: CURYEAR]. Did you get a flu shot before, during or after this
pregnancy?
ELSE
fill: Earlier you said you were pregnant sometime since August 1st, [fill: CURYEAR].
Did you get a flu shot before, during or after this pregnancy?
Special Instructions
Skip Instructions
<1-3,R,D> [goto SHTPNUYR]
Hard Edits
Wednesday, June 14, 2017
Page 69 of 91
Soft Edits
AssocHelp
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.320
Variable Name
SHTPNUYR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER had a pneumonia shot?
This shot is usually given only once or twice in a person's lifetime and is different from
the flu shot. It is also called the pneumococcal vaccine.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Pneumonia shot - ever
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APOX]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 70 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.330
Variable Name
APOX
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER had chickenpox?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Chickenpox - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto APOX12MO]
<2,R,D> [goto AHEP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 71 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.340
Variable Name
APOX12MO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and APOX(e)='1'
Universe-text
Sample adults 18+ who have ever had chickenpox
Question Text
Have you had chickenpox in the PAST 12 MONTHS?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Chickenpox - past 12 mo.
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Skip Instructions
<1,2,R,D> [goto AHEP]
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Wednesday, June 14, 2017
Page 72 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.350
Variable Name
AHEP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER had hepatitis?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Hepatitis - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SHTHEPB]
<2,R,D> [goto AHEPLIV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 73 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.360
Variable Name
AHEPLIV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AHEP(e)
IN('2','7','9')
Universe-text
Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
Question Text
Have you ever lived with someone who had hepatitis?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Lived w/ someone w/ hepatitis
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Skip Instructions
<1,2,R,D> [goto SHTHEPB]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 74 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.370
Variable Name
SHTHEPB
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available
since 1991. It is recommended for newborn infants, adolescents, and people such as
health care workers, who may be exposed to the hepatitis B virus.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Hepatitis B vaccine - ever
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SHEPDOS]
<2,R,D> [goto SHTHEPA]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 75 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.380
Variable Name
SHEPDOS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTHEPB(e) = '1'
Universe-text
Sample adults 18+ who have ever received the Hepatitis B vaccine
Question Text
Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?
Answer Codes
1. Received at least 3 doses
2. Received less than 3 doses
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Hepatitis B vaccine - # of doses
Fill Instructions
Special Instructions Indent to indicate that this is a follow up to the previous question.
Answer name on the right.
Skip Instructions
<1,2,R,D> [goto SHTHEPA]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 76 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.390.010
Variable Name
SHTHEPA
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The hepatitis A vaccine is given as a two dose series routinely to some children starting
at 1 year of age, and to some adults and people who travel outside the United States.
Although it can be given as a combination vaccine with hepatitis B, it is different from
the hepatitis B shot, and has only been available since 1995. Have you ever received
the hepatitis A vaccine?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Had Hep A vaccine
Fill Instructions
Special Instructions
Skip Instructions
<1> goto SHEPANUM
<2,R,D> if AGE GE 50 [goto SHINGLES]; else [goto SHTTD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 77 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.400.010
Variable Name
SHEPANUM
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTHEPA(e)='1'
Universe-text
Sample adults 18+ who have had a hepatitis A vaccine
Question Text
How many hepatitis A shots did you receive?
*Enter '96' if all shots were received
Answer Codes
Question Type
Integer
Field Pane Description
Number of Hep A shots
Fill Instructions
Special Instructions
Skip Instructions
<1-95,96,R,D> if AGE GE 50 [goto SHINGLES]; else [goto SHTTD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 78 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.410.010
Variable Name
SHINGLES
Universe
HHSTAT4 = 'S' and (AGE GE '050' and AGE not IN ('997','999'))
Universe-text
Sample adults 50+
Question Text
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 face. Shingles is caused
by the chicken pox virus. A vaccine for shingles has been available since May 2006.
Have you ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Had shingles vaccine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto SHTTD
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 79 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.420.010
Variable Name
SHTTD
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you received a tetanus shot in the past 10 years?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Had tetanus shot, past 10 years
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SHTTDAP ]
<2,R,D> and AGE >64 [goto LIVEV]
Else if <2,R,D> and AGE<65 [goto SHTHPV2]
Hard Edits
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Wednesday, June 14, 2017
Page 80 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.440.010
Variable Name
SHTTDAP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SHTTD(e) = '1'
Universe-text
Sample adults who have had a tetanus shot in 2005 or beyond or refused to say if they
had a tetanus shot in 2005 or beyond
Question Text
There are currently two types of tetanus shots available today. One is the Td or
tetanus-diphtheria vaccine and the other is called Tdap or Adacel (trademark) or
Boostrix (trademark). They are similar except the Tdap shot also includes a pertussis
(per-TUH-sis) or whooping cough vaccine. Thinking back to your most recent tetanus
shot, did your health care provider tell you or did the vaccine information sheet say the
vaccine included the pertussis or whooping cough vaccine? The shot is often called
Tdap or ADACEL (trademark) or BOOSTRIX (trademark).
Answer Codes
1. Yes-included pertussis
2. No-did not include pertussis
3. Doctor did not say
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Combo tetanus/pertussis shot
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> if age le 64 [goto SHTHPV2];
else [goto LIVEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 81 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.446.010
Variable Name
SHTHPV2
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999'))
Universe-text
Sample adults age LE 64
Question Text
Have you ever received an HPV shot or vaccine?
*HPV stands for human papillomavirus (pap-uh-LOW-muh-vi-rus).
*The vaccines are sometimes called CERVARIX (trademark) or GARDASIL
(trademark).
Answer Codes
Question Type
1. Yes
2. No
3. Doctor refused when asked
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Had HPV shot
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SHHPVDOS]
<2,3,R,D> [goto LIVEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 82 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.448.010
Variable Name
SHHPVDOS
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999')) and SHTHPV2(e)='1'
Universe-text
Sample adults age LE 64 who have had an HPV shot
Question Text
How many HPV shots did you receive?
* Enter '50' if 50 or more shots
* Enter '96' for all shots
Answer Codes
Question Type
Integer
Field Pane Description
Number of shots
Fill Instructions
Special Instructions Allow 1-50,96, Refused, Don't know
Skip Instructions
<1-50,96,R,D> [goto AHPVAGE]
<51-95> [goto ERR_SHHPVDOS]
Hard Edits
ERR_SHHPVDOS
* Shots should be in the range 1-50 or 96 for all shots.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 83 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.449.010
Variable Name
AHPVAGE
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999')) and SHTHPV2(e)='1'
Universe-text
Sample adults age LE 64 who have had an HPV shot
Question Text
How old were you when you received your first HPV shot?
Answer Codes
(Allow 8-current age,Refused, Don’t know)
Question Type
Integer
Field Pane Description
Age at first shot/vaccine
Fill Instructions
Special Instructions
Skip Instructions
<8-120,R,D> [goto LIVEV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 84 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.450.010
Variable Name
LIVEV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Has a doctor or other health professional ever told you that you had any kind of chronic,
or long-term liver condition?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever had liver problems
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto TRAVEL
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 85 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.460.010
Variable Name
TRAVEL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you ever traveled outside of the United States to countries other than Europe,
Japan, Australia, New Zealand or Canada, since 1995?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Traveled since 1995-selected countries
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto WRKHLTH]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 86 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.465.010
Variable Name
WRKHLTH
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s
office, nursing home or some other health-care facility? This includes emergency
responders and public safety personnel, part-time and unpaid work in a health care
facility as well as professional nursing care provided in the home.
*Read if necessary: This includes non-health care professionals, such as administrative
staff, who work in a health-care facility.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Work
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto WRKDIR]
<2,R,D> [goto APSBPCHK]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 87 of 91
Module
19
Section Name
Health Care Access and Utilization
Part
D
Question ID
AAU.470.010
Variable Name
WRKDIR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and WRKHLTH(e)='1'
Universe-text
Sample adults 18+ who work or volunteer in a health-care setting
Question Text
Do you provide direct patient care as part of your routine work? By direct patient care
we MEAN PHYSICAL OR HANDS ON CONTACT WITH PATIENTS.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Direct care
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APSBPCHK]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 88 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.500_00.010
Variable Name
APSBPCHK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you had your blood pressure checked by a
doctor, nurse, or other health professional?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APSCHCHK]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 89 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.510_00.010
Variable Name
APSCHCHK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you had your blood cholesterol checked by a
doctor, nurse, or other health professional?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto APSBSCHK]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 90 of 91
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.520_00.010
Variable Name
APSBSCHK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you had a fasting test for high blood sugar or diabetes DURING THE PAST 12
MONTHS?
Answer Codes
1.Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 91 of 91
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Selected Items
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.005_00.000
Variable Name
ASIINTRO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*You are about to enter the Sexual Orientation and Lifestyle questions section. This
section includes questions on computer use, the respondent’s neighborhood, sexual
orientation, financial worries, mental health, and HIV testing.
*Enter 1 to Continue.
Answer Codes
Question Type
1. Enter 1 to Continue
Enter 1 to Continue
Field Pane Description
Fill Instructions
Special Instructions Do not allow don't know or refused for this screen.
Skip Instructions
<1> goto ACICPUSE
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 1 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.130_00.000
Variable Name
ACICPUSE
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These questions are about you and your neighborhood.
How often do you use a computer?
*Read answer categories.
Answer Codes
Question Type
1. Never or almost never
2. Some days
3. Most days
4. Every day
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-4,R,D> [goto ACISATHC]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 2 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.140_00.000
Variable Name
ACISATHC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In general, how satisfied are you with the health care you received in the past 12
months?
*Read answer categories.
Answer Codes
Question Type
1. Very satisfied
2. Somewhat satisfied
3. Somewhat dissatisfied
4. Very dissatisfied
5. You haven’t had health care in the past 12 months
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-5,R,D> [goto ACITENUR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 3 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.150_00.000
Variable Name
ACITENUR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
About how long have you lived in your present neighborhood?
Answer Codes
1. Less than 1 year
2. 1-3 years
3. 4-10 years
4. 11-20 years
5. More than 20 years
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACINHELP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 4 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.160_00.000
Variable Name
ACINHELP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How much do you agree or disagree with the following statements about your
neighborhood?
People in this neighborhood help each other out.
Would you say…
*Read answer categories.
Answer Codes
Question Type
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-4,R,D> [goto ACINCNTO]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 5 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.170_00.000
Variable Name
ACINCNTO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
How much do you agree or disagree with the following statements about your
neighborhood?
There are people I can count on in this neighborhood.
Would you say…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACINTRU]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 6 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.180_00.000
Variable Name
ACINTRU
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
How much do you agree or disagree with the following statements about your
neighborhood?
People in this neighborhood can be trusted.
Would you say…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACINKNT]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 7 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.190_00.000
Variable Name
ACINKNT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
How much do you agree or disagree with the following statements about your
neighborhood?
This is a close-knit neighborhood.
Would you say…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Definitely agree
2. Somewhat agree
3. Somewhat disagree
4. Definitely disagree
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D>
[if SEX=1, goto ACISIM;
elseif SEX=2, goto ACISIF]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 8 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.220_00.000
Variable Name
ACISIM
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=1
Universe-text
Male sample adults 18+
Question Text
(book) ASI1
Which of the following best represents how you think of yourself?
Answer Codes
Question Type
1. Gay
2. Straight, that is, not gay
3. Bisexual
4. Something else
5. I don't know the answer
Refused
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R> [goto ACIRETR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 9 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.240_00.000
Variable Name
ACISIF
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=2
Universe-text
Female sample adults 18+
Question Text
(book) ASI2
Which of the following best represents how you think of yourself?
Answer Codes
Question Type
1. Lesbian or gay
2. Straight, that is, not lesbian or gay
3. Bisexual
4. Something else
5. I don't know the answer
Refused
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R> [goto ACIRETR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 10 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.260_00.000
Variable Name
ACIRETR
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions ask how worried you are right now about financial matters.
How worried are you right now about not having enough money for retirement? Are
you…
*Read answer categories.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions Display the answer codes in the answer pane in bold black.
Skip Instructions
<1-4,R,D> [goto ACIMEDC]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 11 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.270_00.000
Variable Name
ACIMEDC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to pay medical costs of a serious
illness or accident? Are you…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACISTLV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 12 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.280_00.000
Variable Name
ACISTLV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to maintain the standard of living
you enjoy? Are you…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACICNHC]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 13 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.290_00.000
Variable Name
ACICNHC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to pay medical costs for normal
healthcare? Are you…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACICCOLL]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 14 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.300_00.000
Variable Name
ACICCOLL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not having enough money to pay for your
children's college? Are you…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
5. This does not apply to me
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACINBILL]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.310_00.000
Variable Name
ACINBILL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not having enough to pay your normal monthly
bills? Are you…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACIHCST]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 16 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.320_00.000
Variable Name
ACIHCST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to pay your rent, mortgage, or other
housing costs? Are you…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACICCMP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 17 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.330_00.000
Variable Name
ACICCMP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How worried are you right now about not being able to make the minimum payments on
your credit cards? Are you…
*Read answer categories if necessary.
Answer Codes
Question Type
1. Very worried
2. Moderately worried
3. Not too worried
4. Not worried at all
5. I don't have credit cards
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACISLEEP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 18 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.340_00.000
Variable Name
ACISLEEP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
On average, how many hours of sleep do you get in a 24-hour period?
*Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more UP to
the next whole hour and dropping 29 or fewer minutes.
Answer Codes
Question Type
Allow 1-24, R, D
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5>[goto ERR_SLEEP];
<1-24, R,D>[goto ACISLPFL]
Hard Edits
Soft Edits
ERR_SLEEP
*Average number of hours of sleep is [ACISLEEP].
* Please verify.
AssocHelp
Wednesday, June 14, 2017
Page 19 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.350_00.000
Variable Name
ACISLPFL
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, how many times did you have trouble falling asleep?
*Enter '0' if respondent did not have trouble falling asleep in the past week.
*Enter '7' for 7 or more times.
Answer Codes
Question Type
Allow 0-7, R, D
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto ACISLPST]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 20 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.360_00.000
Variable Name
ACISLPST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, how many times did you have trouble staying asleep?
*Enter '0' if respondent did not have trouble staying asleep in the past week.
*Enter '7' for 7 or more times.
Answer Codes
Question Type
Allow 0-7, R, D
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto ACISLPMD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 21 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.370_00.000
Variable Name
ACISLPMD
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, how many times did you take medication to help you fall asleep or
stay asleep?
*Enter '0' if respondent did not take medication to help sleep in the past week.
*Enter '7' for 7 or more times.
Answer Codes
Question Type
Allow 0-7, R, D
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto ACIREST]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 22 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.380_00.000
Variable Name
ACIREST
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past week, on how many days did you wake up feeling well rested?
*Enter '0' if respondent never felt well rested in the past week.
Answer Codes
Question Type
Allow 0-7, R, D
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-7,R,D> [goto MHSAD_CK]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 23 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.390_00.000
Variable Name
MHSAD_CK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Now I am going to ask you some questions about feelings you may have experienced
over the PAST 30 DAYS.
Answer Codes
1. Enter 1 to Continue
Question Type
Enter 1 to Continue
Field Pane Description
Continue
Fill Instructions
Special Instructions Do not allow Don't know or Refused.
Skip Instructions
<1> [goto ACISAD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 24 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.390_01.000
Variable Name
ACISAD
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI3
DURING THE PAST 30 DAYS, how often did you feel
...So sad that nothing could cheer you up?
Answer Codes
Question Type
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACINERV]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 25 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.390_02.000
Variable Name
ACINERV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI3
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Nervous?
Answer Codes
Question Type
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIRSTLS]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 26 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.390_03.000
Variable Name
ACIRSTLS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI3
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Restless or fidgety?
Answer Codes
Question Type
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIHOPLS]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 27 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.390_04.000
Variable Name
ACIHOPLS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI3
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Hopeless?
Answer Codes
Question Type
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIEFFRT]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 28 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.390_05.000
Variable Name
ACIEFFRT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI3
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...That everything was an effort?
Answer Codes
Question Type
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto ACIWTHLS]
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Wednesday, June 14, 2017
Page 29 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.390_06.000
Variable Name
ACIWTHLS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) ASI3
* Read if necessary:
During the PAST 30 DAYS, how often did you feel
...Worthless?
Answer Codes
Question Type
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D>
if ACISAD or ACINERV or ACIRSTLS or ACIHOPLS or ACIEFFRT or
ACIWTHLS=1-3 [goto ACIMUCH];
else [goto ACIHIVT]
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Wednesday, June 14, 2017
Page 30 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.400_00.000
Variable Name
ACIMUCH
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (ACISAD(e)
IN('1','2','3') or ACINERV(e) IN('1','2','3') or ACIRSTLS(e) IN('1','2','3') or ACIHOPLS(e)
IN('1','2','3') or ACIEFFRT (e) IN('1','2','3') or ACIWTHLS(e) IN('1','2','3'))
Universe-text
Sample adults 18+ who at least some of the time have felt sad, nervous, restless or
fidgety, hopeless, that everything was an effort, or worthless, in the past 30 days
Question Text
We just talked about a number of feelings you had during the PAST 30 DAYS.
Altogether, how MUCH did these feelings interfere with your life or activities: a lot,
some, a little, or not at all?
Answer Codes
1. A lot
2. Some
3. A little
4. Not at all
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto ACIHIVT]
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Wednesday, June 14, 2017
Page 31 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.410_00.000
Variable Name
ACIHIVT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next question is about the test for HIV, the virus that causes AIDS. Except for tests
you may have had as part of blood donations, have you ever been tested for HIV?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto next section]
<2> [goto ACIHIVWN]
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Wednesday, June 14, 2017
Page 32 of 35
Module
52
Section Name
Adult Selected Items
Part
Question ID
ASI.420_00.000
Variable Name
ACIHIVWN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ACIHIVT=’2’
Universe-text
Sample adults 18+ who have never been tested for HIV
Question Text
(book) ASI4
I am going to show you a list of reasons why some people have not been tested for HIV
(the virus that causes AIDS).
Which one of these would you say is the MAIN reason why you have not been tested?
Answer Codes
1. It's unlikely you've been exposed to HIV
2. You were afraid to find out if you were HIV positive (that you had HIV)
3. You didn't want to think about HIV or about being HIV positive
4. You were worried your name would be reported to the government if you tested
positive
5. You didn't know where to get tested
6. You don't like needles
7. You were afraid of losing job, insurance, housing, friends, family, if people knew you
were positive for AIDS infection
8. Some other reason
9. No particular reason
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Why not tested for HIV/AIDS
Fill Instructions
Special Instructions
Skip Instructions
<1-9,R,D> [goto next section]
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Wednesday, June 14, 2017
Page 33 of 35
Module
52
Section Name
FRT
Part
Question ID
FRT.000
Variable Name
QA_DRUM_ROLL
Universe
Universe-text
QA (Quality Assurance) check
Question Text
1. For clarification, here is the section that each QA check is located in:
1 - Family - Food Security
2 - Family - Functioning and Disability
3 - Child - Mental Health (actually 2 checks, 1 for male, 1 for female)
4 - Child - Health Status and Limitations (actually 2 checks, 1 for age < 3, 1 for age
>= 3
5 - Adult - ABCs of Heart Disease and Stroke
6 - Adult - Health Status and Limitations
71 - Adult -Adult Complementary Health
2. The QAASK# (1-71) fields are located at the datamodel level of the instrument.
QAASK# = 1 if the question was selected, and empty if not selection
3. The QARNDM# (1,2,3F,3M,4,41,5,6,71) (the random # 0 to 9 selected for the fill),
QACHK# (1,2,3F,3M,4,41,5,6,71) (the field that is asked of the FR), and
QACHNG# (1,2,3F,3M,4,41,5,6,71) (note: M=male and F=Female)
(flag field to indicate the value entered by the FR did not match the random # (cannot
be undone))
fields are located inside the block where the check is actually asked (FDB, CHS, etc.)
4. I've made the change to the setting of QACHNG# so that it will be:
empty - if the check was not asked or answered
0 - if the check was asked and the value entered matches the random value
1 - if the check was asked and the value entered does NOT match the random
value (cannot be undone)
5. For the child mental health check, there are actually 2 checks that are needed, 1 for
the male path, 1 for the female path (much like there's a CMHAGM11_1 vs
CMHAGF11_1). So I named the female fields as QARNDM3F, QACHK3F,
QACHNG3F. I named the male fields as QARNDM3M, QACHK3M, QACHNG3M.
Both can still use same QAASK3 as the flag to bring up the check.
6. For the child health status and limitations check, there are actually 2 checks that are
needed, 1 for the age < 3 path, 1 for the age >= 3 path (much like there's a
CCONDT1_1 vs CCONDT_1). So I named the age < 3 fields as QARNDM41,
QACHK41, QACHNG41. I named the age >= 3 fields as QARNDM4, QACHK4,
QACHNG4. Both can still use same QAASK4 as the flag to bring up the check.
Example:
1. In the FDB block, the check will appear between P2DFDRES and P2DFERR.
2. The allowable codes are only for the random number (QARNDM#) that will appear in
the fill for the question text, "Please enter # for quality assurance." The input box
correctly allows the FR to enter any digit between 0-9. If they enter the wrong value,
then QACHNG# is set to 1 (and can't be unset even if they back up and change their
answer).
Wednesday, June 14, 2017
Page 34 of 35
3. The universe for asking a check would be that the previous question has an answer
and the specific QAASK# field is set. For example, for QACHK2 (the one in FDB block)
I have coded the universe as:
QAASK2 = 1 AND ( (AGE >= 5 AND P2DFDRES <> EMPTY) OR (AGE < 5 AND
P2DFSEE <> EMPTY))
QAASK# = 1 if the question was selected, and empty if not selection
Answer Codes
Question Type
Procedure
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Module
52
Section Name
ASI
Part
Question ID
FRT.003_02
Variable Name
INTERVIEW_QUARTER
Universe
Universe-text
Question Text
Answer Codes
Question Type
Other
Field Pane Description
Fill Instructions
Special Instructions Determined from the assignment period on the SCIF.
Skip Instructions
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Wednesday, June 14, 2017
Page 35 of 35
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Functioning and Disability
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.090_00.000
Variable Name
VIS_0
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Now I am going to ask you some questions about your ability to do different activities,
and how you have been feeling. Although some of these questions may seem similar
to ones you have already answered, it is important that we ask them all.
Do you wear glasses?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Glasses
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto VIS_SS
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Wednesday, June 14, 2017
Page 1 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.100_00.000
Variable Name
VIS_SS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have difficulty seeing [fill: , even when wearing your glasses]? Would you say no
difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Seeing
if VIS_0=1, then fill ", even when wearing your glasses"; else leave blank.
Special Instructions
Skip Instructions
<1,2,R,D> goto HEAR_1
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Wednesday, June 14, 2017
Page 2 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.140_00.000
Variable Name
HEAR_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you use a hearing aid?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hearing aid
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto HEAR_2]
<2,R,D> [goto HEAR_SS]
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Wednesday, June 14, 2017
Page 3 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.145_00.000
Variable Name
HEAR_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HEAR_1(e)='1'
Universe-text
Sample adults 18+ who use a hearing aid
Question Text
How often do you use your hearing aid(s)? Would you say all of the time, some of the
time, rarely, or never?
Answer Codes
1. All of the time
2. Some of the time
3. Rarely
4. Never
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Often
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto HEAR_SS
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Wednesday, June 14, 2017
Page 4 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.150_00.000
Variable Name
HEAR_SS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have difficulty hearing [fill: , even when using your hearing aid(s)]? Would you
say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Hearing
if HEAR_1=1, fill ", even when using your hearing aid(s)"; else leave blank.
Special Instructions
Skip Instructions
<1-3,R,D>[goto HEAR_3]
<4> [goto MOB_SS]
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Wednesday, June 14, 2017
Page 5 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.170_00.000
Variable Name
HEAR_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HEAR_SS(e) IN
('1','2','3','7','9')
Universe-text
Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or
don't know if they have difficulty hearing, even when using a hearing aid
Question Text
Do you have difficulty hearing what is said in a conversation with one other person in a
quiet room [fill: even when using your hearing aid(s)]? Would you say no difficulty,
some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Quiet room
if HEAR_1=1, fill "even when using your hearing aid(s)"; else fill blank.
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-3,R,D>[goto HEAR_4]
<4>[goto MOB_SS]
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Wednesday, June 14, 2017
Page 6 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.170_00.001
Variable Name
HEAR_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and HEAR_3(e) IN
('1','2','3','7','9')
Universe-text
Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refuse or
don't know if they have difficulty hearing what is said in a conversation with one other
person in a quiet room (even when wearing their hearing aid(s))
Question Text
Do you have difficulty hearing what is said in a conversation with one other person in a
noisier room [fill: even when using your hearing aid(s)]? Would you say no difficulty,
some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Noisier room
if HEAR_1=1, fill "even when using your hearing aid(s)"; else fill blank.
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-4,R,D>[goto MOB_SS]
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Wednesday, June 14, 2017
Page 7 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.180_00.000
Variable Name
MOB_SS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have difficulty walking or climbing steps? Would you say no difficulty, some
difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Mobility
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> goto MOB_2
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Wednesday, June 14, 2017
Page 8 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.000
Variable Name
MOB_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you use any equipment or receive help for getting around?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Equipment
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto MOB_3A]
<2,R,D>[goto MOB_4]
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Wednesday, June 14, 2017
Page 9 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.001
Variable Name
MOB_3A
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1'
Universe-text
Sample adults 18+ who use equipment or receive help for getting around
Question Text
Do you use any of the following…
Cane or walking stick?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Cane
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto MOB_3B
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Wednesday, June 14, 2017
Page 10 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.002
Variable Name
MOB_3B
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1'
Universe-text
Sample adults 18+ who and use equipment or receive help for getting around
Question Text
*Read if necessary.
Do you use any of the following…
Walker or Zimmer frame?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Walker
Fill Instructions
Special Instructions Display the text "Do you use any of the following…" in GRAY text.
Skip Instructions
<1,2,R,D> goto MOB_3C
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Wednesday, June 14, 2017
Page 11 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.003
Variable Name
MOB_3C
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1'
Universe-text
Sample adults 18+ who use equipment or receive help for getting around
Question Text
*Read if necessary.
Do you use any of the following…
Crutches?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Crutches
Fill Instructions
Special Instructions Display the text "Do you use any of the following…" in GRAY text.
Skip Instructions
<1,2,R,D> goto MOB_3D
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Wednesday, June 14, 2017
Page 12 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.004
Variable Name
MOB_3D
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1'
Universe-text
Sample adults 18+ who use equipment or receive help for getting around
Question Text
*Read if necessary.
Do you use any of the following…
Wheelchair or scooter?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Wheelchair
Fill Instructions
Special Instructions Display the text "Do you use any of the following…" in GRAY text.
Skip Instructions
<1,2,R,D> goto MOB_3E
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Wednesday, June 14, 2017
Page 13 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.005
Variable Name
MOB_3E
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1'
Universe-text
Sample adults 18+ who use equipment or receive help for getting around
Question Text
*Read if necessary.
Do you use any of the following…
Artificial limb (leg/foot)?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Artificial limb
Fill Instructions
Special Instructions Display the text "Do you use any of the following…" in GRAY text.
Skip Instructions
<1,2,R,D> goto MOB_3F
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Wednesday, June 14, 2017
Page 14 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.006
Variable Name
MOB_3F
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1'
Universe-text
Sample adults 18+ who use equipment or receive help for getting around
Question Text
*Read if necessary.
Do you use any of the following…
Someone's assistance?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Assistance
Fill Instructions
Special Instructions Display the text "Do you use any of the following…" in GRAY text.
Skip Instructions
<1,2,R,D> goto MOB_3G
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Wednesday, June 14, 2017
Page 15 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.200_00.007
Variable Name
MOB_3G
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1'
Universe-text
Sample adults 18+ who and use equipment or receive help for getting around
Question Text
*Read if necessary.
Do you use any of the following…
Other type of equipment or help?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Other equipment
Fill Instructions
Special Instructions Display the text "Do you use any of the following…" in GRAY text.
Skip Instructions
<1,2,R,D> if MOB_3D=1, [goto COM_SS];
else if MOB_3D=2,R,D [goto MOB_4]
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Wednesday, June 14, 2017
Page 16 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.210_00.000
Variable Name
MOB_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (MOB_2(e) IN
('2','7','9') or MOB_3D(e) IN ('2','7','9'))
Universe-text
Sample adults 18+ who do not use a wheelchair or scooter
Question Text
Do you have difficulty walking 100 yards on level ground, that would be about the length
of one football field or one city block [fill: without the use of your aid(s)]? Would you say
no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Walking 100 yards
if MOB_2=1, fill "without the use of your aid(s)"; else fill blank.
Special Instructions
Skip Instructions
<1-3,R,D>[goto MOB_5]
<4>[goto MOB_6]
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Wednesday, June 14, 2017
Page 17 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.220_00.000
Variable Name
MOB_5
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_3D(e) NE '1'
and MOB_4(e) IN ('1','2','3','7','9')
Universe-text
Sample adults 18+ who do not use a wheelchair or scooter, and have no difficulty,
some difficulty, a lot of difficulty, or refused or don't know if they have difficulty walking
100 yards on level ground (without the use of their aid)
Question Text
Do you have difficulty walking a third of a mile on level ground, that would be the length
of five football fields or five city blocks [fill: without the use of your aid(s)]? Would you
say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Walking 1/3 mile
if MOB_2=1, fill "without the use of your aid(s)"; else fill blank.
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-4,R,D> goto MOB_6
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Wednesday, June 14, 2017
Page 18 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.230_00.000
Variable Name
MOB_6
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (MOB_2(e) IN
('2','7','9') or MOB_3D(e) IN ('2','7','9'))
Universe-text
Sample adults 18+ who do not use a wheelchair or scooter
Question Text
Do you have difficulty walking up or down 12 steps? Would you say no difficulty, some
difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Walking 12 steps
Fill Instructions
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-4,R,D> if MOB_2 IN (2,R,D) [goto COM_SS];
else if MOB_2=1 [goto MOB_7]
Hard Edits
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Wednesday, June 14, 2017
Page 19 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.240_00.000
Variable Name
MOB_7
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1' and
MOB_3D(e) NE '1'
Universe-text
Sample adults 18+ who use equipment or receive help for getting around but do not
use a wheelchair or scooter
Question Text
Do you have difficulty walking 100 yards on level ground, that would be about the length
of one football field or one city block, when using your aid(s)? Would you say no
difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
100 yards with aid
Fill Instructions
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-3,R,D>[goto MOB_8]
<4>[goto COM_SS]
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Wednesday, June 14, 2017
Page 20 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.250_00.000
Variable Name
MOB_8
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and MOB_2(e)='1' and
MOB_3D(e) NE '1' and MOB_7(e) IN ('1','2','3','7','9')
Universe-text
Sample adults 18+ who use equipment or receive help for getting around but do not
use a wheelchair or scooter, and who have no difficulty, some difficulty, a lot of
difficulty, or refused or don't know if they have difficulty walking 100 yards on level
ground, when using their aid
Question Text
Do you have difficulty walking a third of a mile on level ground, that would be the length
of five football fields or five city blocks, when using your aid(s)? Would you say no
difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
1/3 mile with aid
Fill Instructions
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-4,R,D> goto COM_SS
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Wednesday, June 14, 2017
Page 21 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.270_00.000
Variable Name
COM_SS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Using your usual language, do you have difficulty communicating, for example,
understanding or being understood? Would you say no difficulty, some difficulty, a lot of
difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Communication
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> goto COM_2
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Wednesday, June 14, 2017
Page 22 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.290_00.000
Variable Name
COM_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you use sign language?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Signing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> goto COG_SS
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Wednesday, June 14, 2017
Page 23 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.300_00.000
Variable Name
COG_SS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have difficulty remembering or concentrating? Would you say no difficulty,
some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Cognitive
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto UB_SS]
<2-4,R,D>[goto COG_1]
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Wednesday, June 14, 2017
Page 24 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.310_00.000
Variable Name
COG_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and COG_SS(e) IN
('2','3','4','7','9')
Universe-text
Sample adults 18+ who have some difficulty, a lot of difficulty, or are unable to
remember or concentrate, or don't know or refused if they are able to remember or
concentrate
Question Text
Do you have difficulty remembering, concentrating, or both?
Answer Codes
1. Difficulty remembering only
2. Difficulty concentrating only
3. Difficulty with both remembering and concentrating
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Remembering
Fill Instructions
Special Instructions
Skip Instructions
<1,3,R,D>[goto COG_2]
<2>[goto UB_SS]
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Wednesday, June 14, 2017
Page 25 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.320_00.000
Variable Name
COG_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and COG_SS(e) IN
('2','3','4','7','9') and COG_1(e) IN ('1','3','7','9')
Universe-text
Sample adults 18+ who have difficulty remembering or don't know or refused if they
have difficulty remembering
Question Text
How often do you have difficulty remembering? Would you say sometimes, often or all
of the time?
Answer Codes
1. Sometimes
2. Often
3. All of the time
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Often
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> goto COG_3
Hard Edits
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Wednesday, June 14, 2017
Page 26 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.330_00.000
Variable Name
COG_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and COG_SS(e) IN
('2','3','4','7','9') and COG_1(e) IN ('1','3','7','9')
Universe-text
Sample adults 18+ who have difficulty remembering or don't know or refused if they
have difficulty remembering
Question Text
Do you have difficulty remembering a few things, a lot of things, or almost everything?
Answer Codes
1. A few things
2. A lot of things
3. Almost everything
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Difficulty
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> goto UB_SS
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Soft Edits
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Wednesday, June 14, 2017
Page 27 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.360_00.000
Variable Name
UB_SS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have difficulty with self care, such as washing all over or dressing? Would you
say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Self care
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> goto UB_1
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Wednesday, June 14, 2017
Page 28 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.370_00.000
Variable Name
UB_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have difficulty raising a 2 liter bottle of water or soda from waist to eye level?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do
this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Lifting
Fill Instructions
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-4,R,D> goto UB_2
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Wednesday, June 14, 2017
Page 29 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.380_00.000
Variable Name
UB_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you have difficulty using your hands and fingers, such as picking up small objects,
for example, a button or pencil, or opening or closing containers or bottles? Would you
say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?
Answer Codes
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all / Unable to do
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Grasping
Fill Instructions
Special Instructions Please grey out the text "Would you say no difficulty, some difficulty, a lot of difficulty, or
are you unable to do this?" so that it appears as optional text.
Skip Instructions
<1-4,R,D> goto ANX_1
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Wednesday, June 14, 2017
Page 30 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.410_00.000
Variable Name
ANX_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How often do you feel worried, nervous or anxious? Would you say daily, weekly,
monthly, a few times a year, or never?
Answer Codes
1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Anxiety
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> goto ANX_2
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Wednesday, June 14, 2017
Page 31 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.420_00.000
Variable Name
ANX_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you take medication for these feelings?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Medication
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto ANX_3]
<2> if ANX_1=5 [goto DEP_1];
else [goto ANX_3]
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Wednesday, June 14, 2017
Page 32 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.430_00.000
Variable Name
ANX_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (ANX_1(e) IN
('1','2','3','4','7','9') or ANX_2(e) IN ('1','7','9'))
Universe-text
Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, monthly, a few
times a year or don't know or refused how often OR who do take medication for these
feelings or don't know or refused if they take medication for these feelings
Question Text
Thinking about the last time you felt worried, nervous or anxious, how would you
describe the level of these feelings? Would you say a little, a lot, or somewhere in
between?
Answer Codes
1. A little
2. A lot
3. Somewhere in between a little and a lot
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Feelings
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> goto DEP_1
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 33 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.450_00.000
Variable Name
DEP_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
How often do you feel depressed? Would you say daily, weekly, monthly, a few times a
year, or never?
Answer Codes
1. Daily
2. Weekly
3. Monthly
4. A few times a year
5. Never
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Depression
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> goto DEP_2
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 34 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.460_00.000
Variable Name
DEP_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you take medication for depression?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Medication
Fill Instructions
Special Instructions
Skip Instructions
<1,R,D> [goto DEP_3]
<2> if DEP_1=5 and CHPAIN6M=2-4,R,D [goto PAIN_2];
else [goto TIRED_1];
else [goto DEP_3]
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Wednesday, June 14, 2017
Page 35 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.470_00.000
Variable Name
DEP_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DEP_1(e) IN
('1','2','3','4','7','9') or (DEP_2(e) IN ('1','7','9')))
Universe-text
Sample adults 18+ who feel depressed daily, weekly, monthly, a few times a year or
refused or don't know how often they feel depressed OR who do take medication or
refused or don't know if they take medication for depression.
Question Text
Thinking about the last time you felt depressed, how depressed did you feel? Would
you say a little, a lot, or somewhere in between?
Answer Codes
1. A little
2. A lot
3. Somewhere in between a little and a lot
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
How much
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> if CHPAIN6M=2-4,R,D [goto PAIN_2];
else [goto TIRED_1]
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Wednesday, June 14, 2017
Page 36 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.500_00.000
Variable Name
PAIN_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CHPAIN6M(e)
IN(‘2’,’3’,’4’,’7’,’9’)
Universe-text
Sample adults 18+ who previously indicated that they had pain in the past 6 months
Question Text
In the past 3 months, how often did you have pain? Would you say never, some days,
most days, or every day?
Answer Codes
1. Never
2. Some days
3. Most days
4. Every day
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Often
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto TIRED_1]
<2,3,4,R,D> [goto PAIN_4]
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Wednesday, June 14, 2017
Page 37 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.520_00.000
Variable Name
PAIN_4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and PAIN_2(e) IN
('2','3','4','7','9')
Universe-text
Sample adults 18+ who have had pain some days, most days, every day, or refused or
don't know how often they have had pain in the past 3 months
Question Text
Thinking about the last time you had pain, how much pain did you have? Would you say
a little, a lot, or somewhere in between?
Answer Codes
1 A little
2 A lot
3 Somewhere in between a little and a lot
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Last
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> goto TIRED_1
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Wednesday, June 14, 2017
Page 38 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.540_00.000
Variable Name
TIRED_1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past 3 months, how often did you feel very tired or exhausted? Would you say
never, some days, most days, or every day?
Answer Codes
1. Never
2. Some days
3. Most days
4. Every day
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Tired
Fill Instructions
Special Instructions
Skip Instructions
<1>[goto next section]
<2-4,R,D>[goto TIRED_2]
Hard Edits
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Wednesday, June 14, 2017
Page 39 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.550_00.000
Variable Name
TIRED_2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and TIRED_1(e) IN
('2','3','4','7','9')
Universe-text
Sample adults 18+ who felt very tired or exhausted some days, most days, every day,
or refused or don't know how often they felt very tired or exhausted in the past 3 months
Question Text
Thinking about the last time you felt very tired or exhausted, how long did it last? Would
you say some of the day, most of the day, or all of the day?
Answer Codes
1. Some of the day
2. Most of the day
3. All of the day
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
How long
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> goto TIRED_3
Hard Edits
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Wednesday, June 14, 2017
Page 40 of 41
Module
41
Section Name
Adult Functioning and Disability
Part
Question ID
AFD.560_00.000
Variable Name
TIRED_3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and TIRED_1(e) IN
('2','3','4','7','9')
Universe-text
Sample adults 18+ who felt very tired or exhausted some days, most days, every day,
or refused or don't know how often they felt very tired or exhausted in the past 3 months
Question Text
Thinking about the last time you felt this way, how would you describe the level of
tiredness? Would you say a little, a lot, or somewhere in between?
Answer Codes
1. A little
2. A lot
3. Somewhere in between a little and a lot
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Level
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> goto next section
Hard Edits
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Wednesday, June 14, 2017
Page 41 of 41
2018 Q1 NHIS Instrument Spec Report
Section name: Adult Internet and Email Usage
Module
44
Section Name
Adult Internet and Email Usage
Part
Question ID
AWB.010_00.000
Variable Name
AWEBUSE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions are about your Internet and email use.
Do you use the Internet?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Internet
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AWEBOFNO]
<2,R,D> [goto AWEBEML]
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Wednesday, June 14, 2017
Page 1 of 7
Module
44
Section Name
Adult Internet and Email Usage
Part
Question ID
AWB.020_01.000
Variable Name
AWEBOFNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AWEBUSE(e)='1'
Universe-text
Sample adults 18+ who use the Internet
Question Text
1 of 2
How often do you use the Internet?
*Read if necessary: How many times per day, per week, per month, or per year do you
use the Internet?
*Enter number.
Answer Codes
Question Type
Allow 1-995,R,D
Integer
Field Pane Description
Often - Number
Fill Instructions
Special Instructions
Skip Instructions
<1-995> [goto AWEBOFTP]
[goto AWEBEML]
Hard Edits
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Wednesday, June 14, 2017
Page 2 of 7
Module
44
Section Name
Adult Internet and Email Usage
Part
Question ID
AWB.020_02.000
Variable Name
AWEBOFTP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
('001'<=AWEBOFNO(e)<='995')
Universe-text
Sample adults 18+ who use the Internet and gave a valid value for the number portion
of this question
Question Text
2 of 2
*Enter time period for how often Internet is used.
Answer Codes
Question Type
1. Per day
2. Per week
3. Per month
4. Per year
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Often - Time period
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto AWEBEML]
Hard Edits
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AssocHelp
Wednesday, June 14, 2017
Page 3 of 7
Module
44
Section Name
Adult Internet and Email Usage
Part
Question ID
AWB.030_00.000
Variable Name
AWEBEML
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Do you send or receive emails?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Email - Use
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AWEBEMAD]
<2,R,D> [goto Back or Recontact section]
Hard Edits
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Wednesday, June 14, 2017
Page 4 of 7
Module
44
Section Name
Adult Internet and Email Usage
Part
Question ID
AWB.040_00.000
Variable Name
AWEBEMAD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AWEBEML(e)='1'
Universe-text
Sample adults 18+ who send or receive email
Question Text
We may want to contact you to obtain additional health-related information.
May I have your email address?
*Enter email address.
*Enter 'N' for none.
Answer Codes
Question Type
Verbatim
Field Pane Description
Email - Address
Fill Instructions
Special Instructions
Skip Instructions
[goto AWBEMNO]
[goto Back or Recontact section]
Hard Edits
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Wednesday, June 14, 2017
Page 5 of 7
Module
44
Section Name
Adult Internet and Email Usage
Part
Question ID
AWB.050_01.000
Variable Name
AWEBMNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AWEBEMAD(e)
not IN('N','7','9')
Universe-text
Sample adults 18+ who gave an email address
Question Text
1 of 2
How often do you check this email account?
*Read if necessary: How many times per day, per week, per month, or per year do you
check this email account?
*Enter number.
Answer Codes
Question Type
Allow 1-995,R,D
Integer
Field Pane Description
Email - Number
Fill Instructions
Special Instructions
Skip Instructions
<1-995> [goto AWBEMTP]
[goto Back or Recontact section]
Hard Edits
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Wednesday, June 14, 2017
Page 6 of 7
Module
44
Section Name
Adult Internet and Email Usage
Part
Question ID
AWB.050_02.000
Variable Name
AWEBMTP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
('001'<=AWBEMNO(e)<='995')
Universe-text
Sample adults 18+ who gave an email address and gave a valid value for the number
portion of this question
Question Text
2 of 2
*Enter time period for how often email is checked.
Answer Codes
Question Type
1. Per day
2. Per week
3. Per month
4. Per year
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Email - Time Period
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto Back or Recontact section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 7 of 7
2018 Q1 NHIS Instrument Spec Report
Section name: Cancer Screening
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.130_00.000
Variable Name
PAPHAD1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults 18+
Question Text
Have you EVER HAD a Pap smear or Pap test?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the
cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to
the lab.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had Pap
Fill Instructions
Special Instructions Display the text "A Pap smear or Pap test is a routine test for women in which the
doctor examines the cervix, takes a cell sample from the cervix with a small stick or
brush, and sends it to the lab." in BOLD GRAY text.
Skip Instructions
<1> [goto RPAP1_MT]
<2> [goto PAPNOT2]
[goto HYST]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 1 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.150_01.000
Variable Name
RPAP1_M1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1'
Universe-text
Female sample adults 18+ who have ever had a Pap test
Question Text
1 of 2
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Month
Fill Instructions
Special Instructions if RPAP1_M1 = store 'R' in RPAP1_Y1
if RPAP1_M1 = <96> store '9996' in RPAP1_Y1
Skip Instructions
<1-12,D> [goto RPAP1_Y1]
store "R' in RPAP1_Y1 [goto RPAP21]
<96> store "9996" in RPAP1_Y1 [goto RPAP1N1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 2 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.150_02.000
Variable Name
RPAP1_Y1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and ('01' <= RPAP1_M1 <= '12' or RPAP1_M1='99')
Universe-text
Female sample adults age 18+ who answered month of last Pap test test or didn't know
month of last Pap test test
Question Text
2 of 2
*Enter year of last Pap test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RPAP1_Y1 gt current year or (RPAP1_Y1=current year and RPAP1_M1
gt current month)
[goto ERR1_ RPAP1_Y1 (future date)]
elseif RPAP1_Y1 lt DOBY or (RPAP1_Y1=DOBY and RPAP1_M1 lt DOBM)
[goto ERR2_ RPAP1_Y1 (prior to birth date)]
elseif RPAP1_M1=D
[goto RPAP21]
elseif RPAP1_M1=1-12 [goto HPVPAP]
[goto RPAP21]
Hard Edits
ERR1_ RPAP1_Y1
* Future date invalid. Please correct.
ERR2_ RPAP1_Y1
* Date before birth. Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 3 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.160_01.000
Variable Name
RPAP1N1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and RPAP1_M1(e)='96'
Universe-text
Female sample adults 18+ who selected number and time period format for most
recent Pap test test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT Pap test?
*Enter number for time since last Pap test.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95,R,D
Refused
Don't Know
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RPAP1N1 = store 'R' in RPAP1T1
if RPAP1N1 = store 'D' in RPAP1T1
Skip Instructions
<1-95> [goto RPAP1T1]
store "R,D" in RPAP1T1 [goto RPAP21]
Hard Edits
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Wednesday, June 14, 2017
Page 4 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.160_02.000
Variable Name
RPAP1T1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and RPAP1_M1(e)='96' and ('01' <= RPAP1N1 <= '95')
Universe-text
Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent Pap test.
Answer Codes
Question Type
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions If RPAP1N1 gt 5 and RPAP1T1=4, store '5' in RPAP21.
If RPAP1N1=4 and RPAP1T1=4, store '4' in RPAP21.
Skip Instructions
<1-3> [goto HPVPAP]
<4> (if RPAP1N1=4, set RPAP21=4 [goto HPVPAP];
elseif RPAP1N1 gt 5 and RPAP1N1 gt AGE, [goto ERR_RPAP1T1 (greater than
persons age)]
elseif RPAP1N1 gt 5 and RPAP1N1 le AGE, set RPAP21=5 and [goto HPVPAP]
elseif RPAP1N1=1,2,3,5, [goto RPAP21]
[goto RPAP21]
Hard Edits
ERR_RPAP1T1
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 5 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.165_00.000
Variable Name
RPAP21
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and (RPAP1_M1(e) IN ('97','98','99') or RPAP1_Y1(e) IN
('9997','9998','9999') or RPAP1N1(e) IN ('97','98','99') or RPAP1T1(e) IN ('7','8','9') or
(RPAP1T1(e) = '4' and RPAP1N1 IN ('1','2','3','5')))
Universe-text
Female sample adults 18+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last Pap test test
was over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years ago
3. More than 2 years but not more than 3 years ago
4. More than 3 years but not more than 5 years ago
5. Over 5 years ago
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RPAP1N1 gt 5 and RPAP1T1=4, store '5' in RPAP21 and don't ask question.
If RPAP1N1=4 and RPAP1T1=4, store '4' in RPAP21 and don't ask question.
Based upon prior answers:
if RPAP1N1 = 1 and RPAP1T1 = '4', gray out answer codes 3,4,5
if RPAP1N1 = 2 and RPAP1T1 = '4', gray out answer codes 1,4,5
if RPAP1N1 = 3 and RPAP1T1 = '4', gray out answer codes 1,2,5
if RPAP1N1 = 5 and RPAP1T1 = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RPAP21;
else [goto HPVPAP]
Hard Edits
ERR_RPAP21
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 6 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.168_00.000
Variable Name
HPVPAP
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999')) and PAPHAD1(e)='1'
Universe-text
Female sample adult who have ever had a Pap test
Question Text
An HPV test is sometimes given with the Pap test for cervical cancer screening. Did
you have an HPV test with your most recent Pap?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
HPV-Pap
Fill Instructions
Special Instructions
Skip Instructions
<1-2,R,D> if (RPAP21 = 1,2,3) or (RPAP1T1 = 1,2) or
(RPAP1_Y1 = (current year – 3) and RPAP1_M1 ge current month) or (RPAP1_Y1 gt
(current year – 3))
or (RPAP1T1 = 3 and RPAP1N1 le 36) [goto PAPABN3]; elseif (RPAP21 = 5) or
(RPAP1_Y1 = (current year – 5) and RPAP1_M1 lt current month) or
(RPAP1_Y1 lt (current year – 5)) or (RPAP1T1 = 3 and RPAP1N1 gt 60) [goto
PAPNOT2] elseif RPAP21 = R,D [goto HYST]
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Wednesday, June 14, 2017
Page 7 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.180_00.000
Variable Name
PAPABN3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and ((RPAP21 IN (‘1’,’2’,’3’) or (RPAP1T1 IN (‘1’,’2’) or (RPAP1_Y1 =
(current year – 3) and RPAP1_M1 ge current month) or (RPAP1_Y1 gt (current year –
3) and RPAP1_Y1 not IN ('9996','9997','9999')) or (RPAP1T1 = '3' and RPAP1N1 le
'36') or (RPAP1T1 = '4' and RPAP1N1 IN ('1','2','3')))
Universe-text
Female sample adults 18+ who have had a Pap test in the past 3 years
Question Text
Have you had a [fill1: Pap/Pap or HPV] test in the LAST 3 YEARS where the results
were NOT normal?
Answer Codes
1. Yes, Pap test not normal
2. Yes, HPV test not normal
3. Yes, both were not normal
4. No
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Abnormal Pap
Fill1: if HPVPAP=1 fill "Pap or HPV"; else fill "Pap"
Special Instructions
Skip Instructions
<1-4,R,D> [goto HYST]
Hard Edits
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Wednesday, June 14, 2017
Page 8 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.210_00.000
Variable Name
PAPNOT2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
((PAPHAD1 = '2') or (RPAP21 IN ('5')) or (RPAP1_Y1 = (current year – 5) and
RPAP1_M1 lt current month) or (RPAP1_Y1 lt (current year – 5)) or (RPAP1T1 = '3'
and RPAP1N1 gt '60') or (RPAP1T1 = '4' and RPAP1N1 gt '5' ))
Universe-text
Female sample adults 18+ who have never had a Pap test, or who have not had a Pap
test in the last 5 years
Question Text
What is the most important reason you have [Fill1: NEVER had a Pap test/NEVER had
a Pap or HPV test/
NOT had a Pap test in the LAST 5 YEARS/
NOT had a Pap or HPV test in the LAST 5 YEARS]?
*Put response into correct category below.
Answer Codes
Question Type
1. No reason/never thought about it
2. Didn't need it/didn't know I needed this type of test
3. Doctor didn't order it/didn't say I needed it
4. Haven't had any problems
5. Put it off/didn't get around to it
6. Too expensive/no insurance/cost
7. Too painful, unpleasant, or embarrassing
8. Had hysterectomy
9. Don't have doctor
10. Had HPV vaccine
11. Other
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Why no Pap
[fill 1] if PAPHAD1 = '2' fill 'NEVER had a Pap test';
else if PAPHAD1=1 and HPVPAP=1 fill "NOT had a Pap or HPV test in the LAST 5
YEARS";
else if PAPHAD1=1 and HPVPAP is ne '1', fill "NOT had a Pap test in the LAST 5
YEARS"
Special Instructions if PAPNOT2 = <8> store '1' in HYST and do not ask HYST question
Skip Instructions
<1-7,9-11,R,D> [goto HYST]
<8> if AGE GE 30 [goto MAMHAD1] else [goto next section]
Hard Edits
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Wednesday, June 14, 2017
Page 9 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.220_00.000
Variable Name
HYST
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPNOT2(e) ne '08'
Universe-text
Female sample adults 18+ who have not already indicated they have had a
hysterectomy
Question Text
Have you had a hysterectomy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had hysterectomy
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if AGE GE 30 [goto MAMHAD1] else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 10 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.230_00.000
Variable Name
MAMHAD
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults age 30+
Question Text
Have you EVER HAD a mammogram?
*Read if necessary.
A mammogram is an x-ray taken only of the breast by a machine that presses against
the breast.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had mammogram
Fill Instructions
Special Instructions Display the text " A mammogram is an x-ray taken only of the breast by a machine that
presses against the breast." in BOLD GRAY text.
Skip Instructions
<1> [goto RMAM1_MT]
<2> [goto MAMNOT1]
if AGE GE 40 [goto COLHAD];
else [goto next section]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 11 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.260_01.000
Variable Name
RMAM1_MT
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
1 of 2
When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if RMAM1_MT = store 'R' in RMAM1_YR
if RMAM1_MT = <96> store '9996' in RMAM1_YR
Skip Instructions
<1-12,D> [goto RMAM1_YR]
store "R' in RMAM1_YR [goto RMAM2]
<96> store "9996" in RMAM1_YR [goto RMAM1N]
Hard Edits
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Wednesday, June 14, 2017
Page 12 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.260_02.000
Variable Name
RMAM1_YR
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and ('01' <= RMAM1_MT <= '12' or RMAM1_MT='99')
Universe-text
Female sample adults age 30+ who answered month of last mammogram or didn't
know month of last mammogram
Question Text
2 of 2
*Enter year of last mammogram.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RMAM1_YR gt current year or (RMAM1_YR=current year and
RMAM1_MT gt current month)
[goto ERR1_ RMAM1_YR (future date]
elseif RMAM1_YR lt DOBY or (RMAM1_YR=DOBY and RMAM1_MT lt DOBM)
[goto ERR2_ RMAM1_YR (prior to birth date)]
elseif RMAM1_MT=D
[goto RMAM2]
elseif RMAM1_MT=1-12
[goto MAMREAS]
goto RMAM2
Hard Edits
ERR1_ RMAM1_YR
* Future date invalid. Please correct.
ERR2_ RMAM1_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 13 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.270_01.000
Variable Name
RMAM1N
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and RMAM1_MT(e)='96'
Universe-text
Female sample adults 30+ who selected number and time period format for most
recent mammogram from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RMAM1N = store 'R' in RMAM1T
if RMAM1N = store 'D' in RMAM1T
Skip Instructions
<1-95> [goto RMAM1T]
store "R,D" in RMAM1T [goto RMAM2]
Hard Edits
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Wednesday, June 14, 2017
Page 14 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.270_02.000
Variable Name
RMAM1T
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and RMAM1_MT(e)='96' and ('01' <= RMAM1N <= '95')
Universe-text
Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent mammogram.
Answer Codes
Question Type
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions if RMAM1N gt 5 and RMAM1T=4, store '5' in RMAM2.
if RMAM1N=4 and RMAM1T=4, store '4' in RMAM2.
Skip Instructions
<1-3> goto MAMREAS
<4> if RMAM1N=4
set RMAM2=4
goto MAMREAS
elseif RMAM1N gt 5 and RMAM1N gt AGE
goto ERR_RMAM1T (greater than persons age)
elseif RMAM1N gt 5 and RMAM1N le AGE
set RMAM2=5
goto MAMREAS
elseif RMAM1N=1,2,3,5
goto RMAM2
goto RMAM2
Hard Edits
ERR_RMAM1T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 15 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.275_00.000
Variable Name
RMAM2
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and (RMAM1_MT(e) IN ('97','98','99') or RMAM1_YR(e) IN
('9997','9998','9999') or RMAM1N(e) IN ('97','98','99') or RMAM1T(e) IN ('7','8','9') or
(RMAM1T(e) = '4' and RMAM1N IN ('1','2','3','5')))
Universe-text
Female sample adults 30+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last mammogram
was over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RMAM1N gt 5 and RMAM1T=4, store '5' in RMAM2 and don't ask question.
If RMAM1N=4 and RMAM1T=4, store '4' in RMAM2 and don't ask question.
Based upon prior answers:
if RMAM1N = 1 and RMAM1T = '4', gray out answer codes 3,4,5
if RMAM1N = 2 and RMAM1T = '4', gray out answer codes 1,4,5
if RMAM1N = 3 and RMAM1T = '4', gray out answer codes 1,2,5
if RMAM1N = 5 and RMAM1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RMAM2]
else [goto MAMREAS]
Hard Edits
ERR_RMAM2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 16 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.310_00.000
Variable Name
MAMREAS
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
What was the MAIN reason you had this mammogram -- was it part of a routine exam,
because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Reason for mammogram
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto MAMABN1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 17 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.320_00.000
Variable Name
MAMABN1
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
After your MOST RECENT mammogram, were you advised to have more tests?
*Read if necessary: More tests may include another mammogram, a sonogram, an
MRI, a biopsy, or something else to check for problems in your breast.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
More tests
Fill Instructions
Special Instructions Display the text "More tests may include another mammogram, a sonogram, an MRI, a
biopsy, or something else to check for problems in your breast." in BOLD GRAY text.
Skip Instructions
<1> [goto MFOLLOW1]
<2,R,D> if (RMAM21 = 3,4,5) or (RMAM1_Y1 = (current year – 2) and RMAM1_M1 lt
current month) or
(RMAM1_Y1 lt (current year – 2)) or (RMAM1T1 = 3 and RMAM1N1 gt 24) [goto
MAMNOT1]; else if
AGE GE 40 [goto COLHAD];else [goto next section]
Hard Edits
Soft Edits
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Wednesday, June 14, 2017
Page 18 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.325_00.000
Variable Name
MFOLLOW1
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and MAMABN1(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram and was recommended
to have more tests
Question Text
Which tests did you actually have?
*Enter all that apply, separate with commas.
Answer Codes
Question Type
0. None
1. Ultrasound
2. Breast MRI
3. Additional mammogram(s)
4. Biopsy
5. Other
Refused
Don’t know
Enter all that apply
Field Pane Description
Which test(s)
Fill Instructions
Special Instructions Do not allow '0' with other answer categories.
Skip Instructions
<0-5,R,D> if (RMAM21 = 3,4,5) or (RMAM1_Y1 = (current year – 2) and RMAM1_M1 lt
current month) or
(RMAM1_Y1 lt (current year – 2)) or (RMAM1T1 = 3 and RMAM1N1 gt 24) [goto
MAMNOT1]; else if
AGE GE 40 [goto COLHAD];else [goto next section]
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Wednesday, June 14, 2017
Page 19 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.330_00.000
Variable Name
MAMNOT1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
((MAMHAD = '2')
or (RMAM21 IN (''3','4','5')) or (RMAM1_Y1 = (current year – 2) and RMAM1_M1 lt
current month) or (RMAM1_Y1 lt (current year – 2))
or (RMAM1T1 = '3' and RMAM1N1 gt '24') or (RMAM1T1 = '4' and RMAM1N1 gt '2'
Universe-text
Female sample adults 30+ who have never had a mammogram or not had a
mammogram in the past 2 years
Question Text
What is the most important reason why you have [fill1: NEVER had a
mammogram/NOT had a mammogram in the PAST 2 YEARS]?
*Put response into correct category below.
Answer Codes
Question Type
1. No reason/never thought about it
2. Didn't need it/didn't know I needed this type of test
3. Doctor didn't order it/didn't say I needed it
4. Haven't had any problems
5. Put it off/Didn't get around to it
6. Too expensive/no insurance/cost
7. Too painful, unpleasant or embarrassing
8. I'm too young
9. Don't have doctor
10. Other
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Fill Instructions
Why no mammogram
[fill 1] if MAMHAD = '2' fill 'NEVER had a mammogram';
else fill 'NOT had a mammogram in the PAST 2 YEARS'
Special Instructions
Skip Instructions
<1-10,R,D> if AGE GE 40 [goto COLHAD]; else [goto next section]
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Wednesday, June 14, 2017
Page 20 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.430_00.000
Variable Name
PSAHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999') and SEX='1')
Universe-text
Male sample adults 40+
Question Text
Have you EVER HAD a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also
called a prostate-specific antigen test.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had PSA test
Fill Instructions
Special Instructions Display the text "A PSA test is a blood test to detect prostate cancer. It is also called a
prostate-specific antigen test. " in BOLD GRAY text.
Skip Instructions
<1> [goto RPSA1_MT]
<2,R,D> [goto PSAADV]
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Wednesday, June 14, 2017
Page 21 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_00.000
Variable Name
RPSA1_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
1 of 2
When did you have your MOST RECENT PSA test?
* Enter month of last PSA test.
* Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if RPSA1_MT = store 'R' in RPSA1_YR
if RPSA1_MT = <96> store '9996' in RPSA1_YR
Skip Instructions
<1-12,D> [goto RPSA1_YR]
store "R' in RPSA1_YR [goto RPSA2]
<96> store "9996" in RPSA1_YR [goto RPSA1N]
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Wednesday, June 14, 2017
Page 22 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_01.000
Variable Name
RPSA1_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and ('01' <= RPSA1_MT <= '12' or RSPA1_MT='99')
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
2 of 2
* Enter year of last PSA test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RPSA1_YR gt current year or (RPSA1_YR=current year and RPSA1_MT
gt current month)
goto ERR1_ RPSA1_YR (future date)
elseif RPSA1_YR lt DOBY or (RPSA1_YR=DOBY and RPSA1_MT lt DOBM)
goto ERR2_ RPSA1_YR (prior to birth date)
elseif RPSA1_MT=D
goto RPSA2
elseif RPSA1_MT=1-12
goto PSAREAS
goto RPSA2
Hard Edits
ERR1_ RPSA1_YR
* Future date invalid. Please correct.
ERR2_ RPSA1_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 23 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_02.000
Variable Name
RPSA1N
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and RPSA1_MT(e)='96'
Universe-text
Male sample adults 40+ who have selected number and time period format for most
recent PSA test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT PSA test?
* Enter number for time since last PSA test.
* Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RPSA1N = store 'R' in RPSA1T
if RPSA1N = store 'D' in RPSA1T
Skip Instructions
<1-95> [goto RPSA1T]
store "R,D" in RPSA1T [goto RPSA2]
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Wednesday, June 14, 2017
Page 24 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_03.000
Variable Name
RPSA1T
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and RPSA1_MT(e)='96' and ('01' <= RPSA1N <= '95')
Universe-text
Male sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
* Enter time period for time since most recent PSA test.
Answer Codes
Question Type
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If RPSA1N gt 5 and RPSA1T=4, store '5' in RPSA2.
If RPSA1N=4 and RPSA1T=4, store '4' in RPSA2.
Skip Instructions
<1-3> goto PSAREAS
<4> if RPSA1N=4
set RPSA2=4
goto PSAREAS
elseif RPSA1N gt 5 and RPSA1N gt AGE
goto ERR_RPSA1T (greater than persons age)
elseif RPSA1N gt 5 and RPSA1N le AGE
set RPSA2=5
goto PSAREAS
elseif RPSA1N=1,2,3,5
goto RPSA2
goto RPSA2
Hard Edits
ERR_RPSA1T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 25 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_04.000
Variable Name
RPSA2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and (RPSA1_MT(e) IN ('97','98','99') or RPSA1_YR(e) IN
('9997','9998','9999') or RPSA1N(e) IN ('97','98','99') or RPSA1T(e) IN ('7','8','9') or
(RPSA1T(e) = '4' and RPSA1N IN ('1','2','3','5')))
Universe-text
Male sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last PSA test was
over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RPSA1N gt 5 and RPSA1T=4, store '5' in RPSA2 and don't ask question.
If RPSA1N=4 and RPSA1T=4, store '4' in RPSA2 and don't ask question.
Based upon prior answers:
if RPSA1N = 1 and RPSA1T = '4', gray out answer codes 3,4,5
if RPSA1N = 2 and RPSA1T = '4', gray out answer codes 1,4,5
if RPSA1N = 3 and RPSA1T = '4', gray out answer codes 1,2,5
if RPSA1N = 5 and RPSA1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RPSA2]
else [goto PSAREAS]
Hard Edits
ERR_RPSA2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 26 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.441_00.000
Variable Name
PSAREAS
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
What was the MAIN reason you had this PSA test - was it part of a routine exam,
because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Reason for PSA test
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto PSASUGG]
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AssocHelp
Wednesday, June 14, 2017
Page 27 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.445_00.000
Variable Name
PSASUGG
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
Who first suggested the PSA test: you, your doctor, or someone else?
Answer Codes
1. Self
2. Doctor
3. Someone else
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Suggested PSA
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto PSADISC]
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Wednesday, June 14, 2017
Page 28 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.450_00.000
Variable Name
PSADISC
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
Did the doctor discuss the advantages and disadvantages of this test with you before
doing it?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Discuss test
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PSAADV]
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Wednesday, June 14, 2017
Page 29 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.455_00.000
Variable Name
PSAADV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 40+
Question Text
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the
advantages of [fill 2: it/the PSA test]?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
PSA advantages
[fill 1] If PSAHAD=1 fill "Before you had the PSA test did" else fill "Did"
[fill 2] if PSAHAD=1 fill "it" else fill "the PSA test"
Special Instructions
Skip Instructions
<1,2,R,D> [goto PSADISAV]
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Wednesday, June 14, 2017
Page 30 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.460_00.000
Variable Name
PSADISAV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 40+
Question Text
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the
disadvantages of [fill 2: it/the PSA test]?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
PSA disadvantages
[fill 1] If PSAHAD=1 fill "Before you had the PSA test did" else fill "Did"
[fill 2] if PSAHAD=1 fill "it" else fill "the PSA test"
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLHAD]
Hard Edits
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AssocHelp
Wednesday, June 14, 2017
Page 31 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.540_00.000
Variable Name
COLHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
There are several different kinds of tests to check for colon cancer. Colonoscopy
(colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor
inserts a tube into the rectum to look for polyps or cancer. For a colonoscopy, the
doctor checks the entire colon, and you are given medication through a needle in your
arm to make you sleepy, and told to have someone drive you home. For a
Sigmoidoscopy, the doctor checks only part of the colon and you are fully awake.
Have you EVER HAD a colonoscopy?
*Read if necessary:
A polyp is a small growth that develops on the inside of the colon or rectum.
Before these tests, you are asked to take a medication that causes diarrhea.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had colonoscopy
Fill Instructions
Special Instructions Display the text "A polyp is a small growth that develops on the inside of the colon or
rectum." in BOLD GRAY text.
Display the text "Before these tests, you are asked to take a medication that causes
diarrhea." in BOLD GRAY text.
Skip Instructions
<1> [goto COL_MT]
<2,R,D> [goto SIGHAD]
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Wednesday, June 14, 2017
Page 32 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.560_01.000
Variable Name
COL_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
Universe-text
Sample adults 40+ who have ever had a colonoscopy
Question Text
1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if COL_MT = store 'R' in COL_YR
if COL_MT = <96> store '9996' in COL_YR
Skip Instructions
<1-12,D> [goto COL_YR]
store "R" in COL_YR [goto COL2]
<96> store "9996" in COL_YR [goto COLN]
Hard Edits
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AssocHelp
Wednesday, June 14, 2017
Page 33 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.560_02.000
Variable Name
COL_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and ('01' <= COL_MT <= '12' or COL_MT='99')
Universe-text
Sample adults age 40+ who answered month of last colonoscopy or didn't know month
of last colonoscopy
Question Text
2 of 2
*Enter year of last colonoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if COL_YR gt current year or (COL_YR=current year and COL_MT gt
current month)
goto ERR1_ COL_YR (future date)
elseif COL_YR lt DOBY or (COL_YR=DOBY and COL_MT lt DOBM)
goto ERR2_ COL_YR (prior to birth date)
elseif COL_MT=D
goto COL2
elseif COL_MT=1-12
goto COLPAY
goto COL2
Hard Edits
ERR1_ COL_YR
* Future date invalid. Please correct.
ERR2_ COL_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 34 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.570_01.000
Variable Name
COLN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and COL_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent
colonoscopy from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT colonoscopy?
*Enter number for time since last colonoscopy.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if COLN = store 'R' in COLT
If COLN = store 'D' in COLT
Skip Instructions
<1-95> [goto COLT]
store "R,D" in COLT [goto COL2]
Hard Edits
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Wednesday, June 14, 2017
Page 35 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.570_02.000
Variable Name
COLT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and COL_MT(e)='96' and ('01' <= COLN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent colonoscopy.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If COLN gt 10 and COLT=4, store '6' in COL2.
If COLN=6,7,8,9 and COLT=4, store '5' in COL2.
If COLN=4 and COLT=4, store '4' in COL2.
Skip Instructions
<1-3> goto COLPAY
<4> if COLN=4
set COL2=4
goto COLPAY
elseif COLN=6,7,8,9
set COL2=5
goto COLPAY
elseif COLN gt 10 and COLN gt AGE
goto ERR_COLT (greater than persons age)
elseif COLN gt 10 and COLN le AGE
set COL2=6
goto COLPAY
elseif COLN=1,2,3,5,10
goto COL2
goto COL2
Hard Edits
ERR_COLT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Wednesday, June 14, 2017
Page 36 of 73
AssocHelp
Wednesday, June 14, 2017
Page 37 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.575_00.000
Variable Name
COL2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and (COL_MT(e) IN ('97','98','99') or COL_YR(e) IN ('9997','9998','9999') or COLN(e)
IN ('97','98','99') or COLT(e) IN ('7','8','9') or (COLT(e)='4' and COLN IN
('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last colonoscopy was 6-9 or over
10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If COLN gt 10 and COLT=4, store '6' in COL2 and don't ask question.
If COLN=6,7,8,9 and COLT=4, store '5' in COL2 and don't ask question.
If COLN=4 and COLT=4, store '4' in COL2 and don't ask question.
Based upon prior answers:
if COLN = 1 and COLT = '4', gray out answer codes 3,4,5,6
if COLN = 2 and COLT = '4', gray out answer codes 1,4,5,6
if COLN = 3 and COLT = '4', gray out answer codes 1,2,5,6
if COLN = 5 and COLT = '4', gray out answer codes 1,2,3,6
if COLN = 10 and COLT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_COL2]
else [goto COLPAY]
Hard Edits
ERR_COL2
*That is not a valid response.
*Please correct.
Wednesday, June 14, 2017
Page 38 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.590_00.010
Variable Name
COLPAY
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
Universe-text
Sample adults 40+ who who have ever had a colonoscopy
Question Text
How much did you pay out of pocket for your most recent colonoscopy -- was it NONE,
PART, or ALL of the cost?
Answer Codes
1. None of the cost
2. Part of the cost
3. All of the cost
Refused
Don't Know
Question Type
Pick one-answer list pane
Field Pane Description
How much paid
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto SIGHAD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 39 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.591_00.000
Variable Name
SIGHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Recall that a sigmoidoscopy is similar to a colonoscopy but the doctor checks only part
of the colon and you are fully awake. Have you EVER HAD a sigmoidoscopy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had sigmoidoscopy
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SIG_MT]
<2,R,D> [goto CTHEARD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 40 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.592_01.000
Variable Name
SIG_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
Universe-text
Sample adults 40+ who have ever had a sigmoidoscopy
Question Text
1 of 2
When did you have your MOST RECENT sigmoidoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if SIG_MT = store 'R' in SIG_YR
if SIG_MT = <96> store '9996' in SIG_YR
Skip Instructions
<1-12,D> [goto SIG_YR]
store "R' in SIG_YR [goto SIG2]
<96> store "9996" in SIG_YR [goto SIGN]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 41 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.593_02.000
Variable Name
SIG_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
('01' <= SIG_MT <= '12' or SIG_MT='99')
Universe-text
Sample adults age 40+ who answered month of last sigmoidoscopy or didn't know
month of last sigmoidoscopy
Question Text
2 of 2
*Enter year of last sigmoidoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if SIG_YR gt current year or (SIG_YR=current year and SIG_MT gt current
month)
goto ERR1_ SIG_YR (future date)
elseif SIG_YR lt DOBY or (SIG_YR=DOBY and SIG_MT lt DOBM)
goto ERR2_ SIG_YR (prior to birth date)
elseif SIG_MT=D
goto SIG2
elseif SIG_MT=1-12
goto CTHEARD
goto SIG2
Hard Edits
ERR1_ SIG_YR
* Future date invalid. Please correct.
ERR2_ SIG_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 42 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.594_01.000
Variable Name
SIGN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
SIG_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent
sigmoidoscopy from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT sigmoidoscopy?
*Enter number for time since last sigmoidoscopy.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if SIGN = store 'R' in SIGT
If SIGN = store 'D' in SIGT
Skip Instructions
<1-95> [goto SIGT]
store "R,D" in SIGT [goto SIG2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 43 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.595_02.000
Variable Name
SIGT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
SIG_MT(e)='96' and ('01' <= SIGN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent sigmoidoscopy.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If SIGN gt 10 and SIGT=4, store '6' in SIG2.
If SIGN=6,7,8,9 and SIGT=4, store '5' in SIG2.
If SIGN=4 and SIGT=4, store '4' in SIG2.
Skip Instructions
<1-3> goto CTHEARD
<4> if SIGN=4
set SIG2=4
goto CTHEARD
elseif SIGN=6,7,8,9
set SIG2=5
goto CTHEARD
elseif SIGN gt 10 and SIGN gt AGE
goto ERR_SIGT (greater than persons age)
elseif SIGN gt 10 and SIGN le AGE
set SIG2=6
goto CTHEARD
elseif SIGN=1,2,3,5,10
goto SIG2
goto SIG2
Hard Edits
ERR_SIGT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Wednesday, June 14, 2017
Page 44 of 73
AssocHelp
Wednesday, June 14, 2017
Page 45 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.596_00.000
Variable Name
SIG2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1' and
(SIG_MT(e) IN ('97','98','99') or SIG_YR(e) IN ('9997','9998','9999') or SIGN(e) IN
('97','98','99') or SIGT(e) IN ('7','8','9') or (SIGT(e)='4' and SIGN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last sigmoidoscopy was 6-9 or
over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If SIGN gt 10 and SIGT=4, store '6' in SIG2 and don't ask question.
If SIGN=6,7,8,9 and SIGT=4, store '5' in SIG2 and don't ask question.
If SIGN=4 and SIGT=4, store '4' in SIG2 and don't ask question.
Based upon prior answers:
if SIGN = 1 and SIGT = '4', gray out answer codes 3,4,5,6
if SIGN = 2 and SIGT = '4', gray out answer codes 1,4,5,6
if SIGN = 3 and SIGT = '4', gray out answer codes 1,2,5,6
if SIGN = 5 and SIGT = '4', gray out answer codes 1,2,3,6
if SIGN = 10 and SIGT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out {goto ERR_SIG2]
else [goto CTHEARD]
Hard Edits
ERR_SIG2
*That is not a valid response.
*Please correct.
Wednesday, June 14, 2017
Page 46 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.611_00.000
Variable Name
CTHEARD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
CT colonography, sometimes called virtual colonoscopy, is a new type of test that looks
for cancer in the colon. Unlike regular colonoscopies, you do not need medication to
make you sleepy during the test. In this new test, your colon is filled with air and you are
moved through a donut-shaped X-ray machine as you lie on your back and then your
stomach.
Before today, HAD YOU EVER HEARD of CT colonography or virtual colonoscopy?
*Read if necessary:
This is not the same as a colonoscopy or a sigmoidoscopy.
Unlike CT tests for other purposes, you DO take laxatives to clean out your colon for
this test.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Heard of CT Colonography
Fill Instructions
Special Instructions Display the text "This is not the same as a colonoscopy or a sigmoidoscopy. " in BOLD
GRAY text.
Display the text " Unlike CT tests for other purposes, you DO take laxatives to clean out
your colon for this test." in BOLD GRAY text.
Skip Instructions
<1> [goto CTHADEV]
<2,R,D> [goto COLTOLD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 47 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.612_00.000
Variable Name
CTHADEV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHEARD(e)='1'
Universe-text
Sample adults 40+ who have ever heard of a CT colonography or a virtual colonoscopy
Question Text
Have you EVER HAD a CT colonography or virtual colonoscopy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had CT Colonography
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CT_MT]
<2,R,D> [goto COLTOLD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 48 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.613_01.000
Variable Name
CT_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
Universe-text
Sample adults 40+ who have ever had a CT colonography or virtual colonoscopy
Question Text
1 of 2
When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter month of last CT colonography or virtual colonoscopy.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if CT_MT = store 'R' in CT_YR
if CT_MT = <96> store '9996' in CT_YR
Skip Instructions
<1-12,D> [goto CT_YR]
store "R' in CT_YR [goto CT2]
<96> store "9996" in CT_YR [goto CTN]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 49 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.614_02.000
Variable Name
CT_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and ('01' <= CT_MT <= '12' or CT_MT='99')
Universe-text
Sample adults age 40+ who answered month of last CT colonography or virtual
colonoscopy or didn't know month of last CT colonography or virtual colonoscopy
Question Text
2 of 2
*Enter year of last CT colonography or virtual colonoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if CT_YR gt current year or (CT_YR=current year and CT_MT gt current
month)
goto ERR1_ CT_YR (future date)
elseif CT_YR lt DOBY or (CT_YR=DOBY and CT_MT lt DOBM)
goto ERR2_ CT_YR (prior to birth date)
elseif CT_MT=D
goto CT2
elseif CT_MT=1-12
goto COLTOLD
goto CT2
Hard Edits
ERR1_ CT_YR
* Future date invalid. Please correct.
ERR2_ CT_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 50 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.615_01.000
Variable Name
CTN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and CT_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent CT
colonography or virtual colonoscopy from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT CT colonography or
virtual colonoscopy?
*Enter number for time since last CT colonography or virtual colonoscopy.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if CTN = store 'R' in CTT
If CTN = store 'D' in CTT
Skip Instructions
<1-95> [goto CTT]
store "R,D" in CTT [goto CT2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 51 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.616_02.000
Variable Name
CTT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and CT_MT(e)='96' and ('01' <= CTN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent CT colonography or virtual colonoscopy.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If CTN gt 10 and CTT=4, store '6' in CT2.
If CTN=6,7,8,9 and CTT=4, store '5' in CT2.
If CTN=4 and CTT=4, store '4' in CT2.
Skip Instructions
<1-3> goto COLTOLD
<4> if CTN=4
set CT2=4
goto COLTOLD
elseif CTN=6,7,8,9
set CT2=5
goto COLTOLD
elseif CTN gt 10 and CTN gt AGE
goto ERR_CTT (greater than persons age)
elseif CTN gt 10 and CTN le AGE
set CT2=6
goto COLTOLD
elseif CTN=1,2,3,5,10
goto CT2
goto CT2
Hard Edits
ERR_CTT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Wednesday, June 14, 2017
Page 52 of 73
AssocHelp
Wednesday, June 14, 2017
Page 53 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.617_00.000
Variable Name
CT2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and (CT_MT(e) IN ('97','98','99') or CT_YR(e) IN ('9997','9998','9999') or CTN(e) IN
('97','98','99') or CTT(e) IN ('7','8','9') or (CTT(e) = '4' and CTN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last CT colonography or virtual
colonoscopy was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If CTN gt 10 and CTT=4, store '6' in CT2 and don't ask question.
If CTN=6,7,8,9 and CTT=4, store '5' in CT2 and don't ask question.
If CTN=4 and CTT=4, store '4' in CT2 and don't ask question.
Based upon prior answers:
if CTN = 1 and CTT = '4', gray out answer codes 3,4,5,6
if CTN = 2 and CTT = '4', gray out answer codes 1,4,5,6
if CTN = 3 and CTT = '4', gray out answer codes 1,2,5,6
if CTN = 5 and CTT = '4', gray out answer codes 1,2,3,6
if CTN = 10 and CTT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_CT2]
else [goto COLTOLD]
Hard Edits
ERR_CT2
*That is not a valid response.
*Please correct.
Wednesday, June 14, 2017
Page 54 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.619_00.000
Variable Name
COLTOLD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
The following questions are about another type of test to check for colon cancer - the
blood stool or occult blood test, or fecal immunochemical or FIT test, tests to determine
whether you have blood in your stool or bowel movement. These tests can be done at
home using a kit. You use a stick or brush to obtain a small amount of stool at home
and send it back to the doctor or lab.
Has your doctor or other health professional EVER told you about these tests for blood
in the stool to check for colon cancer?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Told about blood stool tests
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto COLTOLD]
<2,R,D] [goto HFOBHAD1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 55 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.620_00.000
Variable Name
HFOBHAD1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Have you EVER HAD a blood stool or FIT test, using a HOME test kit?
*Read if necessary: Do not include tests done at the doctor's office.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had home test
Fill Instructions
Special Instructions Display the text "Do not include tests done at the doctor's office." In BOLD GRAY text.
Skip Instructions
<1> goto RHFO2_MT
<2,R,D> [goto COLGDHAD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 56 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.640_01.000
Variable Name
RHFO2_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1='1'
Universe-text
Sample adults 40+ who have ever had a home blood stool or FIT test
Question Text
1 of 2
When did you have your MOST RECENT blood stool or FIT test using a kit at home?
*Enter month of last home blood stool or FIT test.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if RHFO2_MT = store 'R' in RHFO2_YR
if RHFO2_MT = <96> store '9996' in RHFO2_YR
Skip Instructions
<1-12,D> goto RHFO2_YR
store "R" in RHFO2_YR and goto RHFO2
<96> store "9996" in RHFO2_YR and goto RHFO2N
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 57 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.640_02.000
Variable Name
RHFO2_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and ('01' <= RHFO2_MT <= '12' or RHFO2_MT='99')
Universe-text
Sample adults age 40+ who answered month of last home blood stool or FIT test or
didn't know month of last test
Question Text
2 of 2
*Enter year of last home blood stool or FIT test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RHFO2_YR gt current year or (RHFO2_YR=current year and
RHRO1_MT gt current month)
goto ERR1_RHFO2_YR (future date)
elseif RHFO2_YR lt DOBY or (RHFO2_YR=DOBY and RHFO2_MT lt
DOBM)
goto ERR2_RHFO2_YR (prior to birth date)
elseif RHFO2_MT=D
goto RHFO2
elseif RHFO2_MT=1-12
goto COLGDHAD
goto RHFO2
Hard Edits
ERR1_ RHFO2_YR
* Future date invalid. Please correct.
ERR2_ RHFO2_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 58 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.650_01.000
Variable Name
RHFO2N
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and RHFO2_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent home
blood stool or FIT test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT blood stool or FIT test
using a kit at home?
*Enter number for time since last home blood stool or FIT test.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RHFO2N = store 'R' in RHFO2T
If RHFO2N = store 'D' in RHFO2T
Skip Instructions
<1-95> [goto RHFO2T]
store "R,D" in RHFO2T [goto RHFO2]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 59 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.650_02.000
Variable Name
RHFO2T
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and RHFO2_MT(e)='96' and ('01' <= RHFO2N <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent home blood stool or FIT test.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If RHFO2N gt 10 and RHFO2T=4, store '6' in RHFO2.
If RHFO2N=6,7,8,9 and RHFO2T=4, store '5' in RHFO2.
If RHFO2N=4 and RHFO2T=4, store '4' in RHFO2.
Skip Instructions
<1-3> [goto COLGDHAD]
<4> if RHFO2N=4
set RHFO2=4
goto COLGDHAD
elseif RHFO2N=6,7,8,9
set RHFO2=5
goto COLGDHAD
elseif RHFO2N gt 10 and RHFO2N gt AGE
goto ERR_RHFO2T (greater than persons age)
elseif RHFO2N gt 10 and RHFO2N le AGE
set RHFO2=6
[goto COLGDHAD]
elseif RHFO2N=1,2,3,5,10
goto RHFO2
goto RHFO2
Hard Edits
ERR_RHFO2T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Wednesday, June 14, 2017
Page 60 of 73
AssocHelp
Wednesday, June 14, 2017
Page 61 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.655_00.000
Variable Name
RHFO2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1(e)='1'
and (RHFO2_MT(e) IN ('97','98','99') or RHFO2_YR(e) IN ('9997','9998','9999') or
RHFO2N(e) IN ('97','98','99') or RHFO2T(e) IN ('7','8','9') or (RHFO2T(e) = '4' and
RHFO2N IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last home blood stool or FIT test
was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If RHFO2N gt 10 and RHFO2T=4, store '6' in RHFO2 and don't ask question.
If RHFO2N=6,7,8,9 and RHFO2T=4, store '5' in RHFO2 and don't ask question.
If RHFO2N=4 and RHFO2T=4, store '4' in RHFO2 and don't ask question.
Based upon prior answers:
if RHFO2N = 1 and RHFO2T = '4', gray out answer codes 3,4,5,6
if RHFO2N = 2 and RHFO2T = '4', gray out answer codes 1,4,5,6
if RHFO2N = 3 and RHFO2T = '4', gray out answer codes 1,2,5,6
if RHFO2N = 5 and RHFO2T = '4', gray out answer codes 1,2,3,6
if RHFO2N = 10 and RHFO2T = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_RHFO2]
else [goto COLGDHAD]
Hard Edits
ERR_RHFO2
*That is not a valid response.
*Please correct.
Wednesday, June 14, 2017
Page 62 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.660_00.000
Variable Name
COLGDHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Cologuard is a new type of stool test to check for colon cancer. Unlike other stool tests,
Cologuard looks for changes in DNA in addition to checking for blood in your stool. The
Cologuard test is shipped to your home in a box that includes a container for your stool
sample.
Have you ever had a Cologuard test?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had Cologuard test
Fill Instructions
Special Instructions
Skip Instructions
<1> if HFOBHAD1=1 [goto COLGDPRT]; else [goto COLGD_MT]
<2,R,D]if COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt
current month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current year
– 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60 or
CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2 and
RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D [goto
COLPROB1]; else [goto next section]
Hard Edits
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Wednesday, June 14, 2017
Page 63 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.662_00.000
Variable Name
COLGDPRT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ((HFOBHAD1 = '1')
and (COLGDHAD(e)=-'1')
Universe-text
Sample adults 40+ who have ever had a home blood stool or FIT test and a Cologuard
test
Question Text
Was the blood stool or FIT test your reported earlier conducted as part of a Cologuard
test?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Earlier test part of Cologuard
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLGD_MT]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 64 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.665_01.000
Variable Name
COLGD_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLGDHAD='1'
Universe-text
Sample adults 40+ who have ever had a Cologuard test
Question Text
1 of 2
When did you have your MOST RECENT Cologuard test?
*Enter month of last Cologuard test.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if COLGD_MT = store 'R' in COLGD_YR
if COLGD_MT = <96> store '9996' in COLGD_YR
Skip Instructions
<1-12,D> goto COLGD_YR
store "R" in COLGD_YR and goto COLGD2
<96> store "9996" in COLGD_YR and goto COLGDN
Hard Edits
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Wednesday, June 14, 2017
Page 65 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.665_02.000
Variable Name
COLGD_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLGDHAD(e)='1'
and ('01' <= COLGD_MT <= '12' or COLGD_MT='99')
Universe-text
Sample adults age 40+ who answered month of last Cologuard test or didn't know
month of last test
Question Text
2 of 2
*Enter year of last Cologuard test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if COLGD_YR gt current year or (COLGD_YR =current year and
COLGD_MT gt current month)
[goto ERR1_ COLGD_YR (future date)] elseif COLGD_YR lt DOBY or (COLGD_YR
=DOBY and COLGD_MT lt DOBM)
[goto ERR2_ COLGD_YR (prior to birth date)] elseif COLGD_MT =D [goto COLGD2]
elseif COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt current
month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current year
– 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60 or
CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2 and
RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D and
COLGD_MT lt current month
or COLGD_YR lt (current year -1)[goto COLPROB1]; else [goto next section]
[goto COLGD2]
Hard Edits
ERR1_ COLDG_YR
* Future date invalid. Please correct.
ERR2_ COLDG_YR
* Date before birth. Please correct.
Wednesday, June 14, 2017
Page 66 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.670_01.000
Variable Name
COLGDN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLGDHAD(e)='1'
and COLGD_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent home
blood stool or FIT test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT Cologuard test?
*Enter number for time since last Cologuard test.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if COLGDN = store 'R' in COLGDT
If COLGDN = store 'D' in COLGDT
Skip Instructions
<1-95> [goto COLGDT]
store "R,D" in COLGDT [goto COLGD2]
Hard Edits
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Wednesday, June 14, 2017
Page 67 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.670_02.000
Variable Name
COLGDT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLGDHAD(e)='1'
and COLDG_MT(e)='96' and ('01' <= COLGDN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most Cologuard test
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If COLGDN gt 10 and COLGDT =4, store '6' in COLGD2
If COLGDN =6,7,8,9 and COLGDT =4, store '5' in COLGD2
If COLGDN =4 and COLGDT =4, store '4' in COLGD2
Skip Instructions
<1-3> if COLGD_YR gt current year or (COLGD_YR =current year and COLGD_MT gt
current month)
[goto ERR1_ COLGD_YR (future date)] elseif COLGD_YR lt DOBY or (COLGD_YR
=DOBY and COLGD_MT lt DOBM)
[goto ERR2_ COLGD_YR (prior to birth date)] elseif COLGD_MT =D [goto COLGD2]
elseif COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt current
month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current year
– 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60 or
CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2 and
RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D and
COLGDHAD=2 or COLGD_MT lt current month
or COLGD_YR lt (current year -1) or COLDGDT=3 and COLDGDN gt 12 [goto
COLPROB1]; else [goto next section] [goto COLGD2]
<4> if COLGDN =4
set COLGD2=4
Wednesday, June 14, 2017
Page 68 of 73
goto COLPROB1
elseif COLGDN =6,7,8,9
set COLGD2=5
goto COLPROB1
elseif COLGDN gt 10 and COLGDN gt AGE
goto ERR_ COLGDT (greater than persons age)
elseif COLGDN gt 10 and COLGDN le AGE
set COLGD2=6
goto COLPROB1
elseif COLGDN =1,2,3,5,10
goto COLGD2
goto COLGD2
Hard Edits
ERR_COLGDT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 69 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.675_00.000
Variable Name
COLGD2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLGDHAD(e)='1'
and (COLGD_MT(e) IN ('97','98','99') or COLDG_YR(e) IN ('9997','9998','9999') or
COLDG(e) IN ('97','98','99') or COLDG(e) IN ('7','8','9') or (COLGDT(e) = '4' and
COLGDN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year format
or failed to give a complete date in the number and time period format, or entered years
ago in the time period format (excluding those whose last home blood stool or FIT test
was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If COLGDN gt 10 and COLGDT=4, store '6' in COLGD2 and don't ask question.
If COLGDN=6,7,8,9 and COLGDT=4, store '5' in COLGD2 and don't ask question.
If COLGDN=4 and COLGDT=4, store '4' in COLGD2 and don't ask question.
Based upon prior answers:
if COLGDN = 1 and COLGDT = '4', gray out answer codes 3,4,5,6
if COLGDN = 2 and COLGDT = '4', gray out answer codes 1,4,5,6
if COLGDN = 3 and COLGDT = '4', gray out answer codes 1,2,5,6
if COLGDN = 5 and COLGDT = '4', gray out answer codes 1,2,3,6
if COLGDN = 10 and COLGDT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_ COLGD2]
else f COLGD_YR gt current year or (COLGD_YR =current year and COLGD_MT gt
current month)
[goto ERR1_ COLGD_YR (future date)] elseif COLGD_YR lt DOBY or (COLGD_YR
=DOBY and COLGD_MT lt DOBM)
[goto ERR2_ COLGD_YR (prior to birth date)] elseif COLGD_MT =D [goto COLGD2]
elseif COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt current
Wednesday, June 14, 2017
Page 70 of 73
month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current year
– 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60 or
CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2 and
RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D and
COLGDHAD=2 or COLGD =2,3,4,5,6 or COLGD_YR=(current year – 1)
and COLGD_MT lt current month or COLGD_YR lt (current year – 1) or COLGDT=2
and COLGDN gt 52 or COLGDT=3
and COLGDN gt 12 or COLGDT=4 and COLGDN ge 2 and COLGD2=R,D [goto
COLPROB1] else [goto next section]
Hard Edits
ERR_COLGD2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 71 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.750_00.000
Variable Name
COLPROB1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999') and
((COLHAD = ‘2’) or (COL2 = ‘6’) or (COL_YR = (current year – 10) and COL_MT lt
current month) or (COL_YR lt (current year – 10)) or (COLT = '4' and COLN ge '11' and
COL2 IN ('7','9'))) and
((SIGHAD = ‘2’) or (SIG2 IN (‘5’,’6’)) or (SIG_YR = (current year – 5) and SIG_MT lt
current month) or (SIG_YR lt (current year – 5)) or (SIGT = ‘3’ and SIGN gt ‘60’) or
(SIGT = '4' and SIGN ge '6' and SIG2 IN ('7','9'))) and
((CTHEARD = 2) or (CTHADEV = 2) or (CT2 IN (‘5’,’6’)) or (CT_YR = (current year – 5)
and CT_MT lt current month) or (CT_YR lt (current year – 5)) or (CTT = ‘3’ and CTN gt
‘60’) or (CTT = '4' and CTN ge '6' and CT2 IN ('7','9'))) and
((HFOBHAD = ‘2’) or (RHFO2 IN (‘2’,’3’,’4’,’5’,’6’)) or (RHFO2_YR = (current year – 1)
and RHFO2_MT lt current month) or (RHFO2_YR lt (current year – 1)) or (RHFO2T =
‘2’ and RHFO2N gt ‘52’) or (RHFO2T = ‘3’ and RHFO2N gt ‘12’) or (RHFO2T = '4' and
RHFO2N ge '2' and RHFO2 IN ('7','9')))
Universe-text
Sample adults 40+ who have NOT had a colonoscopy in the past 10 years,
sigmoidoscopy in the past 5 years, CT colonography in the past 5 years, or home blood
stool/FIT test in the last year
Question Text
In the PAST 12 MONTHS, did a doctor or other health professional RECOMMEND that
you be tested to look for problems in your colon or rectum?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Recommend colorectal test
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto COLKIND1]
<2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 72 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.770_00.000
Variable Name
COLKIND1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLPROB1(e)='1'
Universe-text
Sample adults 40+ who have had particular tests recommended to look for problems in
the colon and who have NOT had a colonoscopy in the past 10 years, sigmoidoscopy in
the past 5 years, CT colonography in the past 5 years, or home blood stool/FIT test in
the last year and who had another type of test recommended
Question Text
Which tests to check for colon cancer did the doctor or other health professional
recommend to you? Possible tests include stool blood or fecal occult blood or FIT test;
sigmoidoscopy; colonoscopy; CT colonography or virtual colonoscopy; or other.
*Enter all that apply, separate with commas.
Answer Codes
Question Type
1. Stool blood test/fecal occult blood/FIT test
2. Sigmoidoscopy
3. Colonoscopy
4. CT colonography/virtual colonoscopy
5. Other
Refused
Don't know
Enter all that apply
Field Pane Description
Which test(s)
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, June 14, 2017
Page 73 of 73
| File Type | application/pdf |
| File Modified | 2017-11-01 |
| File Created | 2017-06-15 |