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pdfAttachment 3a - New Supplement Questions
2017 Q1 NHIS Instrument Spec Report
Section name: Adult Complementary Health
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.010_00.000
Variable Name
NAT_USM1
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 about some health services you may have used.
DURING THE PAST 12 MONTHS, did you see a practitioner for naturopathy?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Naturopathy-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHE_USM1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 1 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.020_00.000
Variable Name
CHE_USM1
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, did you see a practitioner for chelation therapy?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Chelation Therapy-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto TRD_USM1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 2 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.030_00.000
Variable Name
TRD_USM1
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, did you see a practitioner for traditional medicine
such as a curandero (coo-rahn-DEHR-oh), Yerbero (yehr-BEHR-oh), sobador (so-bahDOHR), or Native American Healer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Healer-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto TRD_USM2] <,2,R,D> [goto HOM_USM1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 3 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.040_00.000
Variable Name
TRD_USM2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and TRD_USM1(e)='1''
Universe-text
Sample adults 18+ who have seen a traditional healer in the past 12 months
Question Text
Which practitioners for traditional healers did you see in the past 12 months?
*Enter all that apply, separate with commas.
Answer Codes
Question Type
1. Shaman (SHAH-man)
2. Curandero (coo-rahn-DEHR-oh), Machi (MAH-chee), or Parchero (pahr-CHEH-roh)
3. Yerbero (yehr-BEH-roh) or Hierbista (yehr-BEE-stah)
4. Sobador (so-bah-DOHR)
5. Native American Healer or Medicine Man
6. Other
Refused
Don't know
Enter all that apply
Field Pane Description
Healer-type
Fill Instructions
Special Instructions
Skip Instructions
<1-6,R,D> [goto HOM_USM1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 4 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.050_00.000
Variable Name
HOM_USM1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Practitioners of homeopathy (ho-mee-AH-puh-thee) recommend small pills or drops
that are often
placed under the tongue to treat health problems.
DURING THE PAST 12 MONTHS, did you see a practitioner for homeopathic
treatment?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Homeopathy-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MBO_MAN1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 5 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.060_00.000
Variable Name
MBO_MAN1
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, did you use...
Mantra Meditation, including Transcendental Meditation®, Relaxation Response, and
Clinically Standardized Meditation?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Mantra M-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MBO_MND1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 6 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.070_00.000
Variable Name
MBO_MND1
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, did you use...
Mindfulness meditation, including Vipassana (vih-PAS-sah-nah), Zen Buddhist
meditation, Mindfulness-based
Stress Reduction, and Mindfulness-based Cognitive Therapy?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Mindfulness M-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MBO_SPR1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 7 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.080_00.000
Variable Name
MBO_SPR1
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, did you use...
Spiritual meditation including Centering Prayer and Contemplative Meditation?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Spiritual M-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MBO_IMG1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 8 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.090_00.000
Variable Name
MBO_IMG1
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, did you use...
Guided imagery?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Guided Imagery-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto MBO_PRO1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 9 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.100_00.000
Variable Name
MBO_PRO1
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, did you use...
Progressive relaxation?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Progressive R-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto YTQU_YG1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 10 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.110_00.000
Variable Name
YTQU_YG1
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, did you practice Yoga for yourself?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Yoga-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto YTQ_BTY1] <,2,R,D> [goto YTQU_TA1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 11 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.120_00.000
Variable Name
YTQ_BTY1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and YTQU_YG1(e)='1'
Universe-text
Sample adults 18+ who have practiced Yoga in the past 12 months
Question Text
Did you do breathing exercises as part of Yoga? Breathing exercises may involve
actively controlling the way air is
drawn in, or the rate or depth of breathing.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Yoga breathing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto YTQ_MDY1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 12 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.130_00.000
Variable Name
YTQ_MDY1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and YTQU_YG1(e)='1'
Universe-text
Sample adults 18+ who have practiced Yoga in the past 12 months
Question Text
Did you do meditation as part of Yoga?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Yoga meditation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto YTQU_TA1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 13 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.140_00.000
Variable Name
YTQU_TA1
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, did you practice Tai Chi (tie-CHEE) for yourself?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Tai-Chi-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto YTQ_BTT1] <2,R,D> [goto YTQU_QG1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 14 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.150_00.000
Variable Name
YTQ_BTT1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and YTQU_TA1(e)='1'
Universe-text
Sample adults 18+ who have practiced Tai-Chi in the past 12 months
Question Text
Did you do breathing exercises as part of Tai-Chi? Breathing exercises may involve
actively controlling the way air is
drawn in, or the rate or depth of breathing.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Tai-Chi breathing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto YTQ_MDT1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 15 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.160_00.000
Variable Name
YTQ_MDT1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and YTQU_TA1(e)='1'
Universe-text
Sample adults 18+ who have practiced Tai-Chi in the past 12 months
Question Text
Did you do meditation as part of Tai-Chi?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Tai-Chi meditation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto YTQU_QG1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 16 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.170_00.000
Variable Name
YTQU_QG1
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, did you practice Qi Gong (chee-GONG) for
yourself?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Qi Gong-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto YTQ_BTQ1] <,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 17 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.180_00.000
Variable Name
YTQ_BTQ1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and YTQU_QG1(e)='1'
Universe-text
Sample adults 18+ who have practiced Qi Gong in the past 12 months
Question Text
Did you do breathing exercises as part of Qi Gong? Breathing exercises may involve
actively controlling the way air is
drawn in, or the rate or depth of breathing.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Qi Gong breathing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto YTQ_MDQ1]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 18 of 19
Module
53
Section Name
Adult Complementary Health
Part
Question ID
ACH.190_00.000
Variable Name
YTQ_MDQ1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and YTQU_QG1(e)='1'
Universe-text
Sample adults 18+ who have practiced Qi Gong in the past 12 months
Question Text
Did you do meditation as part of Qi Gong?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Qi Gong meditation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 19 of 19
2017 Q1 NHIS Instrument Spec Report
Section name: Child Complementary Health
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.010_00.000
Variable Name
CNAT_USM
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
Now I am going to ask you about some health services {fill1: S.C. name} may have
used.
DURING THE PAST 12 MONTHS, di {fill1: S.C. name} see a practitioner for
naturopathy?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Naturopathy-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CCHE_USM]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 1 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.020_00.000
Variable Name
CCHE_USM
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} see a practitioner for
chelation therapy?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Chelation Therapy-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CTRD_USM]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 2 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.030_00.000
Variable Name
CTRD_USM
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} see a practitioner for
traditional medicine such as a curandero (coo-rahn-DEHR-oh), Yerbero (yehr-BEHRoh), sobador (so-bah-DOHR), or Native American Healer?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Healer-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CTRD_US1] <,2,R,D> [goto CHOM_USM]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 3 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.040_00.000
Variable Name
CTRD_US1
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999')) and
CTRD_USM(e)='1''
Universe-text
Sample children 4+ who have seen a traditional healer in the past 12 months
Question Text
Which practitioners for traditional healers did {fill1: S.C. name} see in the past 12
months?
*Enter all that apply, separate with commas.
Answer Codes
Question Type
1. Shaman (SHAH-man)
2. Curandero (coo-rahn-DEHR-oh), Machi (MAH-chee), or Parchero (pahr-CHEH-roh)
3. Yerbero (yehr-BEH-roh) or Hierbista (yehr-BEE-stah)
4. Sobador (so-bah-DOHR)
5. Native American Healer or Medicine Man
6. Other
Refused
Don't know
Enter all that apply
Field Pane Description
Healer-type
Fill Instructions
Special Instructions
Skip Instructions
<1-6,R,D> [goto CHOM_USM]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 4 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.050_00.000
Variable Name
CHOM_USM
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
Practitioners of homeopathy (ho-mee-AH-puh-thee) recommend small pills or drops
that are often
placed under the tongue to treat health problems.
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} see a practitioner for
homeopathic treatment?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Homeopathy-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CMBOU_MN]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 5 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.060_00.000
Variable Name
CMBOU_MN
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} use...
Mantra Meditation, including Transcendental Meditation®, Relaxation Response, and
Clinically Standardized Meditation?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Mantra M-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CMBOU_MD]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 6 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.070_00.000
Variable Name
CMBOU_MD
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} use...
Mindfulness meditation, including Vipassana (vih-PAS-sah-nah), Zen Buddhist
meditation, Mindfulness-based
Stress Reduction, and Mindfulness-based Cognitive Therapy?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Mindfulness M-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CMBOU_SP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 7 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.080_00.000
Variable Name
CMBOU_SP
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} use...
Spiritual meditation including Centering Prayer and Contemplative Meditation?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Spiritual M-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CMBOU_IM]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 8 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.090_00.000
Variable Name
CMBOU_IM
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} use...
Guided imagery?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Guided Imagery-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CMBOU_PR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 9 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.100_00.000
Variable Name
CMBOU_PR
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} use...
Progressive relaxation?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Progressive R-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CYTQU_YG]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 10 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.110_00.000
Variable Name
CYTQU_YG
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} practice Yoga for {fill2:
himself/herself}?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Yoga-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CYTQ_BTY] <,2,R,D> [gotoC YTQU_TA]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 11 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.120_00.000
Variable Name
CYTQ_BTY
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999')) and CYTQU_YG(e)='1'
Universe-text
Sample children 4+ who have practiced Yoga in the past 12 months
Question Text
Did {fill1: S.C. name} do breathing exercises as part of Yoga? Breathing exercises
may involve actively controlling the way air is
drawn in, or the rate or depth of breathing.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Yoga breathing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CYTQ_MDY]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 12 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.130_00.000
Variable Name
CYTQ_MDY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CYTQU_YG(e)='1'
Universe-text
Sample children 4+ who have practiced Yoga in the past 12 months
Question Text
Did {fill1: S.C. name} do meditation as part of Yoga?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Yoga meditation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto C YTQU_TA]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 13 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.140_00.000
Variable Name
CYTQU_TA
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} practice Tai Chi (tie-CHEE)
for {fill2: himself/herself}?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Tai-Chi-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CYTQ_BTT] <,2,R,D> [goto CYTQU_QG]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 14 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.150_00.000
Variable Name
CYTQ_BTT
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999')) and CYTQU_TA(e)='1'
Universe-text
Sample children 4+ who have practiced Tai-Chi in the past 12 months
Question Text
Did {fill1: S.C. name} do breathing exercises as part of Tai-Chi? Breathing exercises
may involve actively controlling the way air is
drawn in, or the rate or depth of breathing.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Tai-Chi breathing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CYTQ_MDT]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 15 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.160_00.000
Variable Name
CYTQ_MDT
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999')) and CYTQU_TA(e)='1'
Universe-text
Sample children 4+ who have practiced Tai-Chi in the past 12 months
Question Text
Did {fill1: S.C. name} do meditation as part of Tai-Chi?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Tai-Chi meditation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CYTQU_QG]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 16 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.170_00.000
Variable Name
CYTQU_QG
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999'))
Universe-text
Sample children 4+
Question Text
DURING THE PAST 12 MONTHS, did {fill1: S.C. name} practice Qi Gong (cheeGONG) for {fill2: himself/herself}?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Qi Gong-past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CYTQ_BTQ] <,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 17 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.180_00.000
Variable Name
CYTQ_BTQ
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999')) and CYTQU_QG(e)='1'
Universe-text
Sample children 4+ who have practiced Qi Gong in the past 12 months
Question Text
Did {fill1: S.C. name} do breathing exercises as part of Qi Gong? Breathing exercises
may involve actively controlling the way air is
drawn in, or the rate or depth of breathing.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Qi Gong breathing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [gotoC YTQ_MDQ]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 18 of 19
Module
35
Section Name
Child Complementary Health
Part
Question ID
CCH.190_00.000
Variable Name
CYTQ_MDQ
Universe
HHSTAT4='C' and (AGE GE '004' and AGE not IN ('997','999')) and CYTQU_QG(e)='1'
Universe-text
Sample children 4+ who have practiced Qi Gong in the past 12 months
Question Text
Did {fill1: S.C. name} do meditation as part of Qi Gong?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Qi Gong meditation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 19 of 19
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.199_00.010
Variable Name
EPILEP1
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 have a
seizure disorder or epilepsy?
Answer Codes
1. Yes
2. No
3. Borderline or prediabetes
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Epilepsy
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto EPILEP2]
<2,R,D> [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 89 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.199_00.020
Variable Name
EPILEP2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had epilepsy
Question Text
Are you currently taking any medicine to control your seizure disorder or epilepsy?
Answer Codes
1. Yes
2. No
3. Borderline or prediabetes
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Medicine
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto EPILEP3]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 90 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.199_00.030
Variable Name
EPILEP3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had epilepsy
Question Text
Today is [fill: Current Date]. Think back to last year about the same time. About how
many seizures of any type have you had in the past year?
*Read if necessary: Some people may call it “convulsion,” “fit,” “falling out spell,”
“episode,” “attack,” “drop attack,” “staring spell,” or “out-of-touch.”
*If the respondent mentions and counts “auras” as seizures accept the response. If a
respondent indicates that he/she has had nothing more than an aura and is unsure
about counting the aura(s), do NOT count auras as seizures.
Answer Codes
Question Type
0. None
1. One
2. Two or three
3. Between four and ten
4. More than 10
Refused
Don't know
Pick one - answer list pane
Field Pane Description
Seizures
Fill Instructions
[fill: Current Date]
Comes from the Long date format:
CDATE_C / FRT.380
Special Instructions
[fill: Current Date
Long date format
CDATE_C / FRT.380
Skip Instructions
<0-4,R,D> [goto EPILEP4]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 91 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.199_00.040
Variable Name
EPILEP4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had epilepsy
Question Text
In the past year have you seen a neurologist or epilepsy specialist for your epilepsy or
seizure disorder?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Seen specialist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto EPILEP5]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 92 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.199_00.050
Variable Name
EPILEP5
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and EPILEP1(e)='1'
Universe-text
Sample adults 18+ who have ever been told they had epilepsy
Question Text
DURING THE PAST 30 DAYS, to what extent has epilepsy or its treatment interfered
with your normal activities like working, school, or socializing with family or friends?
Would you say…
*Read categories below.
Answer Codes
Question Type
1. Not at all
2. Slightly
3. Moderately
4. Quite a bit
5. Extremely
Refused
Don't know
Pick one - answer list pane
Field Pane Description
Effects
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 93 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.021_01.010
Variable Name
HYBPCKNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
About how long has it been since you had your blood pressure checked by a doctor,
nurse, or other health professional?
*Enter '0' for Never.
*Enter '95' for 95 or more.
Answer Codes
Question Type
(Allow 00,01-95,97,99)
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<0,R,D> if HYPEV=1 [goto HYPMDEV2];
else [goto CHLEV]
<1-95> [goto HYBPCKTP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 5 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.021_02.010
Variable Name
HYBPCKTP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
('01'<=HYBPCKNO='95')
Universe-text
Sample adults 18+ who have ever had their blood pressure checked
Question Text
2 of 2
*Enter time period for time since last blood pressure check.
Answer Codes
Question Type
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
If (HYBPCKNO gt AGE and HYBPCKTP=4), {goto ERR_HYBPCKTP]
<1-4> [goto HYBPLEV]
if HYPEV=1 [goto HYPMDEV2];
else [goto CHLEV]
Hard Edits
If (HYBPCKNO gt AGE and HYBPCKTP=4), display:
*Time period for last blood pressure check cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 6 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_01.010
Variable Name
CLCKNO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
1 of 2
About how long has it been since you had your blood cholesterol checked by a doctor,
nurse, or other health professional?
*Enter '0' for Never.
*Enter '95' for 95 or more.
Answer Codes
Question Type
(Allow 00,01-95,97,99)
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<0,R,D> If CHLEV(e)='1', [goto CHLMDEV2]
Else [goto CHDEV]
<1-95> [goto CLCKTP]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 12 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.023_02.010
Variable Name
CLCKTP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and
('01'<=CLCKNO='95')
Universe-text
Sample adults 18+ who have ever had their blood cholesterol checked
Question Text
2 of 2
*Enter time period for time since last blood cholesterol check.
Answer Codes
Question Type
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
If (CLCKNO gt AGE and CLCKTP=4), {goto ERR_CLCKTP]
<1-4,R,D> If CHLEV=1 [goto CHLMDEV2]
Else [goto CHDEV]
Hard Edits
If (CLCKNO gt AGE and CLCKTP=4), display:
*Time period for last blood cholesterol check cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 13 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.032_01.010
Variable Name
JAWP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Which of the following would you say are the symptoms that someone may be having
a heart attack? I am going to read a list. Please say yes or no to each one.
...Pain or discomfort in the jaw, neck or back.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
HA symptoms - jaw pain
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto WEA]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 27 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.032_02.020
Variable Name
WEA
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a heart attack?
…Feeling weak, lightheaded or faint.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
HA symptoms - weak
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CHE]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 28 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.032_03.030
Variable Name
CHE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a heart attack?
…Chest pain or discomfort.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
HA symptoms - chest pain
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ARM]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 29 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.032_04.040
Variable Name
ARM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a heart attack?
…Pain or discomfort in the arms or shoulder.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
HA symptoms - arm pain
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRTH]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 30 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.032_05.050
Variable Name
BRTH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a heart attack?
…Shortness of breath.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
HA symptoms - short breath
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AHADO]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 31 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.032_06.060
Variable Name
AHADO
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
(book) A4
If you thought someone was having a heart attack, what is the BEST thing to do right
away?
Answer Codes
Question Type
1. Advise them to drive to the hospital
2. Advise them to call their physician
3. Call 9-1-1 (or another emergency number)
4. Call spouse or family member
5. Other
Refused
Don't know
Pick one answer list
Field Pane Description
Best thing for heart attack
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto FACE]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 32 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.033_01.010
Variable Name
FACE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Which of the following would you say are the symptoms that someone may be having
a stroke? I am going to read a list. Please say yes or no to each one.
... Sudden numbness or weakness of face, arm, or leg, especially on one side.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Stroke symptoms-face
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto SPEAKING]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 33 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.033_02.020
Variable Name
SPEAKING
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a stroke?
… Sudden confusion or trouble speaking.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Stroke symptoms-speaking
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto EYE]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 34 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.033_03.030
Variable Name
EYE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a stroke?
… Sudden trouble seeing in one or both eyes.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Stroke symptoms-eye
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto WALKING]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 35 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.033_04.040
Variable Name
WALKING
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a stroke?
... Sudden trouble walking, dizziness, or loss of balance.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Stroke symptoms-walking
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto HEADACHE]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 36 of 147
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.033_05.050
Variable Name
HEADACHE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary:
Which of the following would you say are the symptoms that someone may be having
a stroke?
... Sudden severe headache with no known cause.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Stroke symptoms-headache
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ASTDO]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 37 of 147
Module
36
Section Name
Family Disability: Version 2
Part
Question ID
FDB.060_00.000
Variable Name
P2DFCON
Universe
AGE >= 5 and FDRN_FLG=2
Universe-text
All persons 5 or older
Question Text
Because of a physical, mental, or emotional condition, [fill 1: do you/does ALIAS] have
serious difficulty concentrating, remembering, or making decisions?
Answer Codes
1. Yes
2. No
Don't know
Refused
Question Type
Yes/No
Field Pane Description
Fill Instructions
Difficulty concentrating
1. If subject=respondent fill: [do you]; else fill: [does ALIAS]
Special Instructions Loop through FDB.020--FDB.135 for one person and then repeat for next person on the
roster.
Skip Instructions
<1,2,D,R> goto P2DFWALK
Hard Edits
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AssocHelp
Wednesday, August 03, 2016
Page 3 of 11
Module
36
Section Name
Family Disability: Version 2
Part
Question ID
FDB.130_00.000
Variable Name
PDFCAUSE
Universe
AGE >= 5 and FDRN_FLG=2 and PDFCON(e)='1'
Universe-text
All persons 5 or older who have difficulty concentrating or remembering
Question Text
What is the MAIN reason for [fill 1: your/ALIAS's] difficulty concentrating, remembering
or making decisions?
Answer Codes
1. Intellectual disability (formerly known as mental retardation)
2. Developmental disability (such as cerebral palsy or autism)
3. Dementia or Alzheimer’s disease
4. Learning disability or ADHD
5. Education level
6. Mental illness (such as depression, anxiety, post-traumatic stress disorder,
emotional problem)
7. Traumatic brain injury or stroke
8. Age-related changes
9. Chronic health condition (such as diabetes, high blood pressure, heart disease,
cancer, multiple sclerosis, Parkinson’s disease, epilepsy)
10. Drugs or medications
11. Other (specify)
Refused
Don't know
2. No
Don't know
Refused
Question Type
Pick one answer list pane
Field Pane Description
Fill Instructions
Cause of difficulty
1. If subject=respondent fill: [your]; else fill: [ALIAS'S]
Special Instructions Loop through FDB.020--FDB.135 for one person and then repeat for next person on the
roster.
Skip Instructions
<1-10,D,R> if no more persons age 15 or older, goto next section; <11> [goto
PDFSPEC];
else return to P2DFHEAR for next person age 1 or older
Hard Edits
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AssocHelp
Wednesday, August 03, 2016
Page 10 of 11
Module
36
Section Name
Family Disability: Version 2
Part
Question ID
FDB.135_00.000
Variable Name
PDFSPEC
Universe
AGE >= 5 and FDRN_FLG=2 and PDFCAUSE(e)='11'
Universe-text
All persons 5 or older who have difficulty concentrating or remembering and the cause
was given as other
Question Text
*Enter the other reason for difficulty with concentrating, remembering or making
decisions?
Answer Codes
Verbatim
Refused
Don’t know
Question Type
Verbatim
Field Pane Description
Other cause
Fill Instructions
Special Instructions Loop through FDB.020--FDB.135 for one person and then repeat for next person on the
roster.
Skip Instructions
<1-10,D,R> if no more persons age 15 or older, goto next section; <11> [goto
PDFOTHER];
else return to P2DFHEAR for next person age 1 or older
Hard Edits
Soft Edits
AssocHelp
Wednesday, August 03, 2016
Page 11 of 11
AssocHelp
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.610_00.010
Variable Name
CLAS1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AMDLONG = ‘1,2’
Universe-text
Sample adults 18+
Question Text
The following questions are about your experiences with health care providers in the
past year.
Some people think it is important for their providers to understand or share their race or
ethnicity or gender or religion or beliefs or native language. How important is it to you that your
health care providers understand or are similar to you in any of these ways? Would you say...
Answer Codes
Question Type
1. Very important
2. Somewhat important
3. Slightly important
4. Not important at all
Refused
Don’t know
Pick One Answer List Pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,3> [goto CLAS2] <4,R,D> [goto CLAS3]
Hard Edits
Soft Edits
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Wednesday, July 06, 2016
Page 126 of 130
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.610_00.020
Variable Name
CLAS2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and CLAS1(e)
IN('1','2','3') and AMDLONG = ‘1,2’
Universe-text
Sample adults 18+ who think it is at least slightly important that health care providers
share a culture
Question Text
How often were you able to see health care providers who were similar to you in any
of these ways? Would you say...
Answer Codes
1. Always
2. Most of the time
3. Some of the time
4. None of the time
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 CLAS3]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 127 of 130
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.610_00.030
Variable Name
CLAS3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AMDLONG = ‘1,2’
Universe-text
Sample adults 18+
Question Text
How often were you treated with respect by your health care providers?
Answer Codes
1. Always
2. Most of the time
3. Some of the time
4. None of the time
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 CLAS4]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 128 of 130
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.610_00.040
Variable Name
CLAS4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AMDLONG = ‘1,2’
Universe-text
Sample adults 18+
Question Text
How often did your health care providers ask for your opinions or beliefs about your medical care or
treatment? For example, what kind of tests, procedures, or medications you prefer. Would you say...
Answer Codes
1. Always
2. Most of the time
3. Some of the time
4. None of the time
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 CLAS5]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 129 of 130
Module
19
Section Name
Adult Access to Health Care & Utilization
Part
Question ID
AAU.610_00.050
Variable Name
CLAS5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and AMDLONG = ‘1,2’
Universe-text
Sample adults 18+
Question Text
How often did your health care providers tell or give you information about your health
and health care that was easy to understand?
Answer Codes
1. Always
2. Most of the time
3. Some of the time
4. None of the time
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 next section]
Hard Edits
Soft Edits
AssocHelp
Wednesday, July 06, 2016
Page 130 of 130
| File Type | application/pdf |
| File Modified | 2016-11-15 |
| File Created | 2016-07-07 |