CMS-P-0015A Comm2019R85PVQ

Preventive Care (PVQ)
Variable Name

MR Screen Name

Question type

Question text/description

Code list

Routing

PVQ SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=1
SEASON=ALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after MBQ.

PVINTRO

BOX PVBEG

routing

PVINT

No entry

IF RESPONDENT IS DECEASED, GO TO BOX PVEND.
ELSE IF SEASON=FALL, GO TO PV8 - PREVHLTHINTRO.
ELSE IF (SEASON=WINTER), GO TO PVINT-PVINTRO.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1-FLUSHOT^=1/YES), GO TO PVINTPVINTRO.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1-FLUSHOT=1/YES), GO TO BOX PV4.
IF SEASON=WINTER, FILL "Now I’d like to ask you some questions about the seasonal flu vaccine."
ELSE IF SEASON=SUMMER, FILL "At the time of the last interview, we recorded that [you/(SP)] had not gotten
a flu vaccination for the [CURRENT YEAR MINUS 1] - [CURRENT YEAR] flu season."
Since [July 1st, (CURRENT YEAR MINUS 1)/[MREFDATE]], [have you/has (SP)] had a seasonal flu vaccination?

FLUSHOT

PVF1

yes/no
IF THE RESPONDENT MENTIONS A SHORT NEEDLE OR NEEDLELESS INJECTOR, CODE AS “YES”.

BOX PV1

routing

PVF2

code all

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

(01) PVF5-VACSUPLY
(02) BOX PV1
(-8) BOX PV4
(-9) BOX PV4

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

(01) BOX PV2
(02) BOX PV2
(03) BOX PV2
(04) BOX PV2
(05) BOX PV2
(06) BOX PV2
(07) BOX PV2
(08) BOX PV2
(09) BOX PV2
(10) BOX PV2
(11) BOX PV2
(12) BOX PV2
(13) BOX PV2
(14) BOX PV2
(15) BOX PV2
(16) BOX PV2
(17) BOX PV2
(18) BOX PV2
(91) PVF2 - FLUOTHOS
(-8) BOX PV2
(-9) BOX PV2

IF SEASON=WINTER GO TO PVF2-FLUCODE.
ELSE GO TO BOX PV4.

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

PVF1-FLUSHOT

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

FLUOTHOS

PVF2

verbatim text

BOX PV2

routing

OTHER (SPECIFY)
IF MORE THAN ONE RESPONSE SELECTED AS YES AT PVF2-FLUCODE, GO TO PVF3-PVFLU3, ELSE GO TO BOX
PV3
Of the reasons you listed, what is the main reason [you/(SP)] did not get a flu vaccination this flu season?

PVFLU3

PVF3

code 1
READ LIST TO RESPONDENT. IF RESPONDENT SELECTS MORE THAN ONE REASON PROBE FOR MAIN REASON.

BOX PV3

routing

NOVACINE

PVF4

yes/no

VACSUPLY

PVF5

yes/no

BOX PV4

SHINGVAC

PV6

BOX PV5

routing

yes/no

routing

[LIST ALL RESPONSES SELECTED AT PVF2-FLUCODE]
_ _ [ENTER MAIN REASON]
(-8) DON’T KNOW
(-9) REFUSED

BOX PV3

IF RESPONSE TO PVF2-FLUCODE DOES NOT INCLUDE 13, GO TO PVF4-NOVACINE.
ELSE GO TO BOX PV4.
(01) YES
Was one reason that [you/(SP)] did not get a seasonal flu vaccination since July 1st, [CURRENT YEAR MINUS 1] (02) NO
because the vaccine was in short supply or unavailable?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
Did [you/(SP)] have any trouble getting a seasonal flu shot when (you/he/she) wanted to because the vaccine (02) NO
was in short supply or unavailable?
(-8) DON'T KNOW
(-9) REFUSED

BOX PV4

BOX PV4

IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED RECEIVING THE SHINGLES VACCINE
(P_SHINGVAC^=1) AND RESPONDENT IS AGE 60 OR ABOVE (AGECALC ≥ 60), GO TO PV6-SHINGVAC.
ELSE GO TO BOX PV5.
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/Has (SP)] ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?
IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED RECEIVING THE PNEUMONIA VACCINE
(PNEUSHOT^=1), GO TO PV7-PNEUSHOT.
ELSE GO TO BOX PVEND.
[Have you/Has (SP)] EVER had a pneumonia shot?

PNEUSHOT

PV7

yes/no

PREVHLTHINTRO

PV8

no entry

These next few questions are about preventive health care measures some people take.

BPTAKEN

PV9

code one

When was the most recent time [you/(SP)] had [your/his/her] blood pressure taken by a doctor or other
health professional?

BCTAKEN

PV10

code one

When was the most recent time [you/(SP)] had [your/his/her] cholesterol checked?

BOX PV19

BOX PV2

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.

IF ROUND= FALL 2019 ROUND 85, GO TO PV19-BTSTHIV.
ELSE IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO PV19-BTSTHIV. IF P_EVRHIV=0
THEN GO TO PV20-CTSTHIV. ELSE GO TO BOX PV6.

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

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) CONTINUE
(-7) EMPTY
(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD BLOOD PRESSURE TAKEN
(-8) DON'T KNOW
(-9) REFUSED
(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD CHOLESTEROL CHECKED
(-8) DON'T KNOW
(-9) REFUSED

BOX PV5

BOX PVEND

PV9 - BPTAKEN

PV10 - BCTAKEN

BOX PV6 BOX PV19

BTSTHIV

CTSTHIV

RCNTHIV

WHYNHIV

MAMMOGRM

The next question is about the test for HIV, the virus that causes AIDS. Except for tests [you/(SP)] may have
had as part of blood donations, have [you/he/she] ever been tested for HIV?

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

(01) PV21-RCNTHIV
(02) PV22-WHYNHIV
(03) PV22-WHYNHIV
(04) PV22-WHYNHIV

The next question is about the test for HIV, the virus that causes AIDS. Except for tests [you/(SP)] may have
had as part of blood donations, since (SAMPLE_PERSON.DATE_FALLRND) have [you/he/she] been tested for
HIV?

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

(01) PV21-RCNTHIV
(02) PV22-WHYNHIV
(03) PV22-WHYNHIV
(04) PV22-WHYNHIV

code one

When did [you/(SP)] have [your/his/her] most recent HIV test?

(01) LESS THAN 6 MONTHS AGO
(02) 6 MONTHS TO LESS THAN 1 YEAR AGO
(03) 1 YEAR TO LESS THAN 2 YEARS AGO
(04) 2 YEARS AGO TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(06) NEVER HAD HIV TEST
(-8) DON'T KNOW
(-9) REFUSED

BOX PV6

PV22

code one

(01) IT’S UNLIKELY YOU’VE BEEN EXPOSED TO HIV
(02) YOU WERE AFRAID TO FIND OUT IF YOU WERE
HIV POSITIVE (THAT YOU HAD HIV)
(03) DR. DID NOT PRESCRIBE OR RECOMMEND IT
(04) YOU DIDN’T WANT TO THINK ABOUT HIV OR
ABOUT BEING HIV POSITIVE
(05) YOU WERE WORRIED YOUR NAME WOULD BE
REPORTED TO THE GOVERNMENT IF YOU TESTED
I am going to show you a list of reasons why some people have not been tested for HIV (the virus that causes POSITIVE
(06) YOU DIDN’T KNOW WHERE TO GET TESTED
AIDS). Which one of these would you say is the MAIN reason why [you/(SP)] have not been tested?
(07) YOU DON’T LIKE NEEDLES
(08) YOU WERE AFRAID OF LOSING JOB, INSURANCE,
HOUSING, FRIENDS, FAMILY, IF PEOPLE KNEW YOU
WERE POSITIVE FOR AIDS INFECTION
(09) SOME OTHER REASON
(10) NO PARTICULAR REASON
(-8) REFUSED
(-9) DON’T KNOW

BOX PV6

routing

IF SP IS FEMALE, GO TO PV11 - MAMMOGRM.
ELSE GO TO BOX PV8.

PV19

yes/no

PV20

PV21

PV11

yes/no

[Have you/Has (SP)] had a mammogram or a breast X-ray since (SAMPLE_PERSON.DATE_FALLRND)?

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

BOX PV6

(01) PV12 - PAPSMEAR
(02) PV11 - MAMCODE
(-8) PV12 - PAPSMEAR
(-9) PV12 - PAPSMEAR

MAMCODE

PV11

code all

What is the reason that [you have/(SP) has] not had a mammogram since
((SAMPLE_PERSON.DATE_FALLRND)?
CHECK ALL THAT APPLY.

MAMNOTHS

PV11

verbatim text

OTHER (SPECIFY)

PAPSMEAR

PV12

yes/no

[Have you/Has (SP)] had a Pap smear test since ((SAMPLE_PERSON.DATE_FALLRND)?

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

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

(01) PV12 - PAPSMEAR
(02) PV12 - PAPSMEAR
(03) PV12 - PAPSMEAR
(04) PV12 - PAPSMEAR
(05) PV12 - PAPSMEAR
(06) PV12 - PAPSMEAR
(07) PV12 - PAPSMEAR
(08) PV12 - PAPSMEAR
(09) PV12 - PAPSMEAR
(10) PV12 - PAPSMEAR
(11) PV12 - PAPSMEAR
(12) PV12 - PAPSMEAR
(13) PV12 - PAPSMEAR
(14) PV12 - PAPSMEAR
(15) PV12 - PAPSMEAR
(16) PV12 - PAPSMEAR
(91) PV11 - MAMNOTHS
(-8) PV12 - PAPSMEAR
(-9) PV12 - PAPSMEAR

PV12 - PAPSMEAR
(01) BOX PV7
(02) PV13 - PAPCODE
(-8) BOX PV7
(-9) BOX PV7

PAPCODE

PV13

code all

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

PAPNOTHS

PV13

verbatim text

OTHER (SPECIFY)

routing

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

BOX PV7

HYSTEREC

PV14

yes/no

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

BOX PV8

routing

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

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

(01) BOX PV7
(02) BOX PV7
(03) BOX PV7
(04) BOX PV7
(05) BOX PV7
(06) BOX PV7
(07) BOX PV7
(08) BOX PV7
(09) BOX PV7
(10) BOX PV7
(11) BOX PV7
(12) BOX PV7
(13) BOX PV7
(14) BOX PV7
(15) BOX PV7
(91) PV13 - PAPNOTHS
(-8) BOX PV7
(-9) BOX PV7

BOX PV7

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

BOX PVEND

[Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)/[Have you/has (SP)] ever] had surgery on
(your/his) prostate?
PROSSURG

PV15

yes/no

(01) YES
(02) NO
(-8) DON'T KNOW
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is typically used as a treatment for prostate cancer or
(-9) REFUSED
to correct urinary problems. Surgery can include complete or partial removal of the prostate.]

PV16 - DIGTEXAM

[These next few questions are about follow-up care sometimes prescribed after prostate surgery].

DIGTEXAM

PV16

yes/no

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

BLOODTST

PV17

yes/no

PSA = PROSTATE-SPECIFIC ANTIGEN
[EXPLAIN IF NECESSARY: The test may be used to detect prostate cancer, to determine whether cancer has
spread beyond the prostate, and as part of follow-up care after prostate surgery.]

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

PV17 - BLOODTST

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

(01) BOX PVEND
(02) PV18 - PRONCODE
(-8) BOX PVEND
(-9) BOX PVEND

PRONCODE

PV18

code all

PRONOTHS

PV18

verbatim text

BOX PVEND

routing

What is the reason that [you have/(SP) has] not had a prostate blood test or PSA since
(SAMPLE_PERSON.DATE_FALLRND)?
CHECK ALL THAT APPLY.

OTHER (SPECIFY)
IF SEASON=FALL AND INTTYPE in(C001, C002, C003, C004, C005, C006), GO TO HFQ.
IF SEASON=WINTER, GO TO KNQ.
IF SEASON=SUMMER, GO TO IAQ.

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

(01) BOX PVEND
(02) BOX PVEND
(03) BOX PVEND
(04) BOX PVEND
(05) BOX PVEND
(06) BOX PVEND
(07) BOX PVEND
(08) BOX PVEND
(09) BOX PVEND
(10) BOX PVEND
(11) BOX PVEND
(12) BOX PVEND
(13) BOX PVEND
(14) BOX PVEND
(91) PV18 - PRONOTHS
(-8) BOX PVEND
(-9) BOX PVEND

BOX PVEND