CMS-P-0015A Comm2018R82NAQ

Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A)

Comm2018R82NAQ

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

OMB: 0938-0568

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Variable Name

MR Screen Name

Question type

Question text/description

Code list

Routing

NICOTINE AND ALCOHOL USE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after HFQ.
CIGINT

NA1

no entry

BOX NA1

routing

These next questions are about cigarette smoking.
If SP previously reported smoking cigarettes (sample_person.P_CIG100=1), go to NA3-CIGNOW.
Else go to NA2-CIG100.

CIG100

NA2

yes/no

[Have you/Has (SP)] smoked at least 100 cigarettes in [your/his/her] entire life?

CIGNOW

NA3

code one

[Do you/Does (SP)] now smoke cigarettes every day, some days, or not at all?

SMKLSINT

NA4

no entry

The next questions are about “smokeless” tobacco such as snuff, dip, chewing tobacco, or “snus.”

BOX NA2

routing

If SP previously reported using smokeless tobacco (sample_person.P_SMKLSONE=1), go to NA6-SMKLSNOW.
Else go to NA5-SMKLSONE.

SMKLSONE

NA5

yes/no

[Have you/Has (SP)] ever used “smokeless” tobacco, even once?

SMKLSNOW

NA6

code one

[Do you/Does (SP)] now use smokeless tobacco every day, some days, or not at all?

CIGARINT

NA7

no entry

BOX NA3

routing

BOX NA1

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

NA8

yes/no

[Have you/Has (SP)] ever smoked a cigar EVEN ONE TIME?

CIGAR50

NA9

yes/no

[Have you/Has (SP)] smoked at least 50 cigars in [your/his/her] entire life?

CIGARNOW

NA10

yes/no

[Do you/Does (SP)] now smoke cigars every day, some days, or not at all?

PIPEINT

NA11

no entry

The next questions on tobacco products are about using a pipe to smoke tobacco.

NA4-SMKLSINT

BOX NA2

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

The next questions are about smoking cigars. By cigars we mean any kind, including big cigars, cigarillos, and
even little cigars that look like cigarettes.
If SP never reported smoking cigars (sample_person.P_CIGARONE^=1), go to NA8-CIGARONE.
Else if SP previously reported smoking cigars (sample_person.P_CIGARONE=1) and smoked less than 50 cigars
(sample_person.P_CIGAR50^=1), go to NA9-CIGAR50.
Else if SP previously reported smoking cigars (sample_person.P_CIGARONE=1) and smoked more than 50
cigars (sample_person.P_CIGAR50=1), go to NA10-CIGARNOW.

CIGARONE

(1) NA3-CIGNOW
(2) NA4-SMKLSINT
(-8) NA4-SMKLSINT
(-9) NA4-SMKLSINT

(1) NA6-SMKLSNOW
(2) NA7-CIGARINT
(-8) NA7-CIGARINT
(-9) NA7-CIGARINT

NA7-CIGARINT

BOX NA3

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

(1) NA9-CIGAR50
(2) NA11-PIPEINT
(-8) NA11-PIPEINT
(-9) NA11-PIPEINT
NA10-CIGARNOW

NA11-PIPEINT

BOX NA4

Variable Name

MR Screen Name

Question type

Question text/description

BOX NA4

routing

If SP previously reported smoking tobacco in a pipe (sample_person.P_PIPEONE=1), go to NA13-PIPENOW.
Else go to NA12-PIPEONE.

PIPEONE

NA12

yes/no

[Have you/Has (SP)] ever smoked tobacco in a pipe, even once?

PIPENOW

NA13

code one

[Do you/Does (SP)] now smoke tobacco in a pipe every day, some days, or not at all?

ECIGINT

NA14

no entry

The next questions are about electronic cigarettes, often called e-cigarettes. E-cigarettes look like regular
cigarettes, but are battery-powered and produce vapor instead of smoke.

BOX NA5

routing

If SP previously reported using e-cigarettes (sample_person.P_ECIGONE=1), go to NA16-ECIGNOW.
Else go to NA15-ECIGONE.

ECIGONE

NA15

yes/no

[Have you/Has (SP)] ever used an e-cigarette, even once?

ECIGNOW

NA16

code one

[Do you/Does (SP)] now use e-cigarettes every day, some days, or not at all?

Code list

Routing

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

(1) NA13-PIPENOW
(2) NA14-ECIGINT
(-8) NA14-ECIGINT
(-9) NA14-ECIGINT

NA14-ECIGINT

BOX NA5

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

(1) NA16-ECIGNOW
(2) BOX NA5B
(-8) BOX NA5B
(-9) BOX NA5B

BOX NA5B

IF ROUND= FALL 2018 ROUND 82 AND [NA3-CIGNOW=(1) EVERY DAY OR (2) SOME DAYS OR NA10CIGARNOW=(1) EVERY DAY OR (2) SOME DAYS OR NA13-PIPENOW=(1) EVERY DAY OR (2) SOME DAYS OR
NA16-ECIGNOW=(1) EVERY DAY OR (2) SOME DAYS THEN GO TO NA25-BDOCSMOK.
ELSE IF SP IS IN THE BASELINE INTERVIEW (sample_person.INTTYPE=3) AND [NA3-CIGNOW=(1) EVERY DAY OR
(2) SOME DAYS OR NA10-CIGARNOW=(1) EVERY DAY OR (2) SOME DAYS OR NA13-PIPENOW=(1) EVERY DAY
OR (2) SOME DAYS OR NA16-ECIGNOW=(1) EVERY DAY OR (2) SOME DAYS THEN GO TO NA25-BDOCSMOK.

BOX NA5B

ELSE IF P_DOCSMOK=0 AND [NA3-CIGNOW=(1) EVERY DAY OR (2) SOME DAYS OR NA10-CIGARNOW=(1)
EVERY DAY OR (2) SOME DAYS OR NA13-PIPENOW=(1) EVERY DAY OR (2) SOME DAYS OR NA16-ECIGNOW=(1)
EVERY DAY OR (2) SOME DAYS, THEN GO TO NA26-CDOCSMOK.
ELSE GO TO NA17-ALCINT.

BDOCSMOK

NA25

CDOCSMOK

NA26

ALCINT

NA17

no entry

BOX NA6

routing

NA18

yes/no

BOX NA7

routing

ALCYEAR

(1) YES
(2) NO
Has a doctor or other health professional ever talked to [you/(SP)] about your smoking?
(-8) DON’T KNOW
(-9) REFUSED
(1) YES
Since (SAMPLE_PERSON.DATE_FALLRND) has a doctor or other health professional talked to [you/(SP)] about (2) NO
your smoking?
(-8) DON’T KNOW
(-9) REFUSED
The 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.
If SP reported having more than 12 alcoholic drinks in one year (sample_person.P_ALCYEAR=1), go to NA20ALC12MN.
Else go to NA18-ALCYEAR.
SHOWCARD NA1
(1) YES
(2) NO
In any one year, [have you/has (SP)] had at least 12 drinks of any type of alcoholic beverage? By a drink, I
(-8) DON'T KNOW
mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces of liquor.
(-9) REFUSED
If SP reported having more than 12 alcoholic drinks in his/her lifetime (ALCYEAR=1 or
sample_person.P_ALCLIFE=1), go to NA20-ALC12MN.
Else go to NA19-ALCLIFE.

NA17-ALCINT

NA17-ALCINT

BOX NA6

BOX NA7

Variable Name

MR Screen Name

Question type

Question text/description

ALCLIFE

NA19

yes/no

In [your/(SP)’s] entire life, [have you/has (he/she)] had at least 12 drinks of any type of alcoholic beverage?

Code list
(1) YES
(2) NO
(-8) DON'T KNOW
(-9) REFUSED

Routing
(1) NA20-ALC12MN
(2) BOX ENDNAQ
(-8) BOX ENDNAQ
(-9) BOX ENDNAQ

(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED
[996] NEVER / DOES NOT DRINK

NA20-ALC12MNU

(1) WEEK
(2) MONTH
(3) YEAR
(-8) DON'T KNOW
(-9) REFUSED

BOX NA9

In the past 12 months, how often did [you/(SP)] drink any type of alcoholic beverage?
[PROBE IF NECESSARY: How many days per week, per month, or per year did [you/(SP]) drink?]
ALC12MN

NA20

numeric

[ENTER QUANTITY AND UNIT.]
[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH QUANTITY AND
UNIT OF ALCOHOLIC BEVERAGES.]

ALC12MNU

ALCDAY

NA20

quantity unit

BOX NA9

routing

NA21

numeric

If the SP didn't drink in the last 12 months (NA20 -ALC12MN = 996), go to NA23 - ALPERDAY.
Else go to NA21 - ALCDAY.
SHOWCARD NA1
In the past 12 months, on those days that [you/(SP)] drank alcoholic beverages, on the average, how many
drinks did [you/he/she] have? (By a drink, I mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces
(1) [continuous response]
of liquor.)
(-8) DON'T KNOW
(-9) REFUSED
[ENTER NUMBER OF DRINKS.]
[ENTER '1' IF LESS THAN 1 DRINK.]
[ENTER '95' IF 95 OR MORE DRINKS.]

NA22-ALCNDAY

In the past 12 months, on how many days did [you/(SP)] have [5/4] or more drinks of any alcoholic beverage?
PROBE IF NECESSARY: How many days per week, per month, or per year did [you/(SP)] have [5/4] or more
drinks in a single day?
ALCNDAY

NA22

numeric

[ENTER QUANTITY AND UNIT.]

(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED
[996] NONE

NA22-ALCNDAYU

[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH QUANTITY AND
UNIT OF ALCOHOLIC BEVERAGES.]

ALCNDAYU

NA22

quantity unit

ALPERDAY

NA23

yes/no

BOX NA8

routing

NA24

numeric

BOX ENDNAQ

routing

ALC2HRS

(1) WEEK
(2) MONTH
(3) YEAR
(-8) DON'T KNOW
(-9) REFUSED
(1) YES
Was there ever a time or times in [your/(SP)'s] life when [you/he/she] drank [5/4] or more drinks of any kind (2) NO
of alcoholic beverage almost every day?
(-8) DON'T KNOW
(-9) REFUSED
If the SP didn't drink in the last 12 months (NA20 -ALC12MN = 996), go to BOX ENDNAQ.
Else go to NA24 - ALC2HRS.
During the past 30 days, that is, since [DATEFILL], how many times did [you/(SP)] drink [5/4] or more drinks
of any kind of alcohol in about two hours?
(1) [continuous response]
(-8) DON'T KNOW
[ENTER QUANTITY.]
(-9) REFUSED
[ENTER '0' FOR NEVER.]
[ENTER '95' IF 95 OR MORE TIMES.]
GO TO SCQ.

NA23-ALPERDAY

BOX NA8

BOX ENDNAQ


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AuthorSLA
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