The Research and Development Survey (RANDS 4 -- Telephone Sample)

Attachment 1: Questionnaire

Household Roster

ROSTER		Starting with yourself, please list the names of all the people who live in your household and indicate your relationship to them.
		NAME	RELATIONSHIP	GENDER	AGE
	1.		[SELF]
	2.
	3.
	4.
	...
	k.

Health Behaviors and Conditions

PHSTAT		Would you say your health in general is excellent, very good, good, fair, or poor?
	1.	Excellent
	2.	Very Good
	3.	Good
	4.	Fair
	5.	Poor
	77.	[Don’t Know]
	99.	[Refused]

PART1		About how often do you spend time with family or friends?
	1.	Never
	2.	Some days
	3.	Most days
	4.	Every day
	77.	[Don’t Know]
	99.	[Refused]

PART2		About how often do you get out of the house for fun, for example, to see a movie, to play or watch a game, or to visit a friend?
	1.	Never
	2.	Some days
	3.	Most days
	4.	Every day
	77.	[Don’t Know]
	99.	[Refused]

PART3		About how often do you get out of the house for work?
	1.	Never
	2.	Some days
	3.	Most days
	4.	Every day
	77.	[Don’t Know]
	99.	[Refused]

PART4		About how often do you run errands, such as shopping or going to doctor appointments?
	1.	Never
	2.	Some days
	3.	Most days
	4.	Every day
	77.	[Don’t Know]
	99.	[Refused]

AASMEV		Have you ever been told by a doctor or other health professional that you had asthma?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

PREDIB		Has a doctor or other health professional ever told you that you had prediabetes or borderline diabetes?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If GENDER=Female, continue to GESDIB; if GENDER!=Female, skip to DIBEV]

GESDIB		Has a doctor or other health professional ever told you that you had gestational diabetes, a type of diabetes that occurs only during pregnancy? [EST #7]
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

DIBEV		[Not including prediabetes or gestational diabetes] Has a doctor or other health professional ever told you that you had diabetes? [EST #7]
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

CANEV		Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind? [EST #5]
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

SMKEV		Have you smoked at least 100 cigarettes in your entire life? [EST #1]
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

SMKNOW		Do you now smoke cigarettes every day, some days, or not at all? [EST #2]
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

HEIGHTIN		How tall are you without shoes? [EST #3]
	1.	[Open – options for feet and inches, record inches]
	77.	[Don’t Know]
	99.	[Refused]

WEIGHTLB		How much do you weigh without shoes? [EST #4]
	1.	[Open – record pounds]
	77.	[Don’t Know]
	99.	[Refused]

Pain and Pain Management

RX12M		At any time in the past 12 months, did you take prescription medication?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

PAIFRQ3M		In the past three months, how often did you have pain? Would you say never, some days, most days, or every day?
	1.	Never
	2.	Some days
	3.	Most days
	4.	Every day
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If PAIFRQ3M = c(1,RF,DK), goto OPD12M, ELSE if PAIFRQ3M = c(2,3,4), goto PAIAMNT]

PAIAMNT		Thinking about the last time you had pain, how much pain did you have? [IF MODE=PHONE, READ: Would you say a little, a lot, or somewhere in between?]
	1.	A little
	2.	A lot
	3.	Somewhere in between a little and a lot
	77.	[Don’t Know]
	99.	[Refused]

PAIMOTHER		Over the past three months, what approaches did you use to manage your pain?
	1.	[Open Text/Verbatim. Allow 100 characters]
	77.	[Don’t Know]
	99.	[Refused]

Opioids

OPIOID1		Have you ever, in your entire life, taken opioid painkillers prescribed by a doctor or dentist for any kind of injury, surgery, or chronic condition? Examples include hydrocodone, Vicodin, Norco, Lortab, oxycodone, OxyContin, Percocet, Percodan, and Tramadol.  Please do not include over-the-counter pain relievers such as aspirin, Tylenol, Advil, or Aleve.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF OPIOID1 = c(2, DK, R), goto MISUSE, ELSE if OPIOID1 = 1, continue]

OPD12M		During the past 12 months, have you taken any opioid pain relievers prescribed by a doctor, dentist, or other health professional?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF OPD12M = c(2, DK, R), goto OPIOID9; ELSE if OPD12M = 1, continue]]

OPIOID3		Are you still taking any of these?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If OPIOID4 = c(2, DK, R), goto DISORDER1; ELSE if OPIOID3 = 1, continue]

OPIOID4		About how long have you been taking opioid pain medication?
	1.	Less than a week
	2.	1 to 4 weeks
	3.	1 to 6 months
	4.	6 months to a year
	5.	1 to 5 years
	6.	5 years or more
	77.	[Don’t Know]
	99.	[Refused]

OPIOID5		Was there a time when you were in so much pain that you needed to take more medication than was prescribed to help relieve your pain?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

OPIOID6		How concerned would you be to lose access to your medication?
	1.	Very concerned
	2.	A little concerned
	3.	Not at all concerned
	77.	[Don’t Know]
	99.	[Refused]

OPIOID7			If you stopped taking your medication, do you believe that you would…[mark all that apply]
	1.		Have intolerable pain
	2.		Be unable to sleep
	3.		Go through withdrawal
	77.		[Don’t Know]
	99.		[Refused]
DISORDER1				Was there ever a month or more that you spent a lot of your time getting or using opioid pain medication?
		1.		Yes
		2.		No
		77.		[Don’t Know]
		99.		[Refused]

DISORDER2		Did you ever try to set limits on how often or how much opioid pain medication you would use?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

DISORDER3		Did you ever need to use more opioid pain medication than you used to in order to get the effect you wanted?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

DISORDER4		During the past 12 months, did using prescription pain relievers cause you to give up or spend less time doing important activities such as working, going to school, taking care of children, or doing fun things?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

OPIOID8		Are you concerned that you may be addicted to opioids?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: ALL goto OPIOID11]

OPIOID9		About how long have you been taking opioid pain medication?
	1.	Less than a week
	2.	1 to 4 weeks
	3.	1 to 6 months
	4.	6 months to a year
	5.	1 to 5 years
	6.	5 years or more
	77.	[Don’t Know]
	99.	[Refused]

OPIOID10		Did you stop taking the painkillers because… [mark all that apply]
	1.	There was no longer a medical reason to take them
	2.	They were not helping
	3.	You could no longer get a prescription
	4.	You were worried about becoming addicted
	5.	You were addicted and wanted to quit
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF OPD12M = c(2, DK, R), goto MISUSE; ELSE IF OPD12M = 1, continue]

OPIOID11		In the past year, have you had any opioid pain medicine left over from a prescription?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If OPIOID11 = c(2, DK, R), goto OPIOID13; ELSE if OPIOID11 = 1 continue]

OPIOID12		What did you do with the leftover medicine?
	1.	Disposed of it
	2.	Kept it
	3.	Used it myself
	4.	Gave it to someone else to use
	5.	Sold it
	77.	[Don’t Know]
	99.	[Refused]

OPIOID13		About how often in the past 12 months did you take pain medicine more frequently or in higher doses than was prescribed to you?
	1.	Never  [Go To OPIOID16]
	2.	Once or twice in the year
	3.	Once or twice a month or so
	4.	Every day or nearly every day
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If OPIOID13 = c(1, DK, R), goto MISUSE; ELSE IF OPIOID13 = c(2-4) continue]

OPIOID14		What were the reasons you used the pain medicine more frequently or in higher doses than was prescribed?
	1.	To help with pain
	2.	To help with an injury or pain for which I never had a prescription
	3.	To get high
	4.	Because I am dependent on them and need to have them
	5.	To help with my energy level
	6.	Because of suicidal thoughts
	7.	Other reasons not already listed: (please specify):_______________
	77.	[Don’t Know]
	99.	[Refused]
MISUSE		The next question asks about using opioid pain relievers in any way a doctor did not direct you to use them. When you answer this question, please think only about your use of the drug in any way a doctor did not direct you to use it, including: • Using it without a prescription of your own • Using it in greater amounts, more often, or longer than you were told to take it • Using it in any other way a doctor did not direct you to use it Have you ever, even once, used any prescription pain reliever in any way a doctor did not direct you to use it?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

OPIOID15		Have you ever in your life taken someone else’s opioid medication?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If OPIOID15 = c(2, DK, R) AND OPIOID1 = 1, goto OPIOID18; ELSE if OPIOID15 = c(2, DK, R) and OPIOID1 = c(2, DK, R), goto PROBE_OPD; ELSE if OPIOID15 = 1, continue]

OPIOID16		About how often in the past 12 months did you take prescription pain relievers not prescribed to you?
	1.	Never
	2.	Once or twice in the year
	3.	Once or twice a month or so
	4.	Every day or nearly every day
	77.	[Don’t Know]
	99.	[Refused]

OPIOID17		What were the reasons you used opioid pain killers not prescribed to you?
	1.	Because I ran out of my prescription
	2.	To help with an injury or pain for which I never had a prescription
	3.	To get high
	4.	Because I am dependent on them and need to have them
	5.	To help with my energy level
	6.	Because of suicidal thoughts
	7.	Other reasons not already listed: (please specify):_______________
	77.	[Don’t Know]
	99.	[Refused]

OPIOID18		Have you ever experienced withdrawal symptoms or had trouble getting off an opioid?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If OPIOID18 = c(2, DK, R), goto PROBE_OPD, ELSE continue]

OPIOID19		Did you experience these withdrawal symptoms or have trouble getting off an opioid in the last year?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

PROBE_OPD		Please select the statements, if any, which apply to you [mark all that apply]
	1.	I have never taken an opioid painkiller in my life
	2.	I don’t like to take pills; I’m not a pill person
	3.	I have only taken opioid pills briefly to help recover from injury or medical surgery
	4.	I have pain that requires me to take opioid painkillers
	5.	I use opioid pain relievers responsibly
	6.	I’m addicted or used to be addicted to opioids
	7.	I have heard about the opioid crisis in the news
	8.	I know someone who has been hurt by opioid painkillers
	77.	[Don’t Know]
	99.	[Refused]

Disability

[Note: Each item to be administered for respondent and all other members of household more than 2 years old]

Activities of Daily Living Set (2015 NHIS)

FLAADL		Because of a physical, mental, or emotional problem, [fill1: do you/does anyone in the family] need the help of other persons with PERSONAL CARE NEEDS, such as eating, bathing, dressing, or getting around inside this home? [fill2: Do not include family members age 2 and under.]
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If FLAADL =1, AND if a single-person household, store the person number in PLAADL and goto LABATH; ELSE If FLAADL =1, AND if multiple person household, goto PLAADL; If FLAADL = c(2,R,D), goto AD8_Intro]

PLAADL		Who is this? (Anyone else?)
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[NOTE: Administer c(LABATH, LADRESS, LAEAT, LABED, LATOILET, LAHOME) to all reference people noted in PLAADL]

LABATH		[fill: Do you/Does ALIAS] need the help of other persons with... Bathing or showering?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

LADRESS		[fill: Do you/Does ALIAS] need the help of other persons with... Dressing?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

LAEAT		[fill: Do you/Does ALIAS] need the help of other persons with... Eating?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

LABED			[fill: Do you/Does ALIAS] need the help of other persons with... Getting in or out of bed or chairs?
	1.		Yes
	2.		No
	77.		[Don’t Know]
	99.		[Refused]
LATOILT				[fill: Do you/Does ALIAS] need the help of other persons with... Using the toilet, including getting to the toilet?
		1.		Yes
		2.		No
		77.		[Don’t Know]
		99.		[Refused]

LAHOME		[fill: Do you/Does ALIAS] need the help of other persons with... Getting around inside the home?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[NOTE TO NORC: Create ADL_DOV variable: 1 = At least 2 of (LABATH, LADRESS, LAEAT, LABED, LATOILET, LAHOME) = 1; 0 = <2 of (LABATH, LADRESS, LAEAT, LABED, LATOILET, LAHOME) = 1 ]

Functional Disability/Washington Group Modified Short Set (2019 NHIS)

DIFF			Do [fill:you/ALIAS]have difficulty walking or climbing steps? [IF MODE=PHONE, READ IF NECESSARY: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?]
	1.		No difficulty
	2.		Some difficulty
	3.		A lot of difficulty
	4.		Cannot do at all
	77.		[Don’t Know]
	99.		[Refused]
COMDIFF				Using [fill: your/their] usual language, do [fill:you/ALIAS] have difficulty communicating, for example, understanding or being understood? [IF MODE=PHONE, READ IF NECESSARY: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?]
		1.		No difficulty
		2.		Some difficulty
		3.		A lot of difficulty
		4.		Cannot do at all
		77.		[Don’t Know]
		99.		[Refused]

COGMEMDFF		Do [fill:you/ALIAS] have difficulty remembering or concentrating? [IF MODE=PHONE, READ: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?]
	1.	No difficulty
	2.	Some difficulty
	3.	A lot of difficulty
	4.	Cannot do at all
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If COGMEMDFF = c(1,RF,DK), goto UPPSLFCR; ELSE if COGMEMDFF = c(2-4), goto COGTYPEDFF]

COGTYPEDFF		Is that a difficulty with remembering, concentrating, or both?
	1.	Difficulty remembering only
	2.	Difficulty concentrating only
	3.	Difficulty with both remembering and concentrating
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF COGTYPEDFF = c(1,3), goto COGFRQDFF; ELSE if COGTYPEDFF = c(2,RF,DK), goto UPPSLFCR]

COGFRQDFF		How often do [fill:you/ALIAS] have difficulty remembering? [IF MODE=PHONE, READ Would you say sometimes, often or all of the time?]
	1.	Sometimes
	2.	Often
	3.	All of the time
	77.	[Don’t Know]
	99.	[Refused]

COGAMTDFF		Do [fill:you/ALIAS] have difficulty remembering a few things, a lot of things, or almost everything?
	1.	A few things
	2.	A lot of things
	3.	Almost everything
	77.	[Don’t Know]
	99.	[Refused]

SOCERRNDS		Because of a physical, mental, or emotional condition, do [fill:you/ALIAS] have difficulty doing errands alone such as visiting a doctor's office or shopping? [IF MODE=PHONE, READ IF NECESSARY: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?]
	1.	No difficulty
	2.	Some difficulty
	3.	A lot of difficulty
	4.	Cannot do at all
	77.	[Don’t Know]
	99.	[Refused]

SOCSCLPAR		Because of a physical, mental, or emotional condition, do [fill:you/ALIAS] have difficulty participating in social activities such as visiting friends, attending clubs and meetings, or going to parties? [IF MODE=PHONE, READ IF NECESSARY: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?]
	1.	No difficulty
	2.	Some difficulty
	3.	A lot of difficulty
	4.	Cannot do at all
	77.	[Don’t Know]
	99.	[Refused]

LEARNDFF		Do [fill:you/ALIAS] have difficulty learning how to do things most people your age can learn? [IF MODE=PHONE, READ IF NECESSARY: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?]
	1.	No difficulty
	2.	Some difficulty
	3.	A lot of difficulty
	4.	Cannot do at all
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: IF AGE/ALIAS AGE <22, goto ANXFREQ; IF AGE/ALIAS AGE >=22, continue]

AGEONSET		You said that [fill:you/ALIAS] had difficulty with [FILL if DIF, COGMEMDFF, COMDIFF = c(3,4), ADL_DOV = 1, or SOCERRNDS, LEARNDFF = c(2,3,4), walking/remembering or concentrating//communicating/self care/doing errands along/learning to do things] __, did [this difficulty/ any of these difficulties] begin before age 22?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

ANXFREQ		How often do [fill:you/ALIAS] feel worried, nervous or anxious? Would you say daily, weekly, monthly, a few times a year, or never?
	1.	Daily
	2.	Weekly
	3.	Monthly
	4.	A few times a year
	5.	Never
	77.	[Don’t Know]
	99.	[Refused]

ANXMED		Do [fill:you/ALIAS] take prescription medication for these feelings?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If ANXMED = c(1,RF,DK), goto ANXLEVEL; ELSE if ANXMED = 2 AND if ANXFREQ = 5, goto DEPFREQ; ELSE if ANXMED =2 AND if ANXFREQ = c(1-4, RF, DK), goto ANXLEVEL]

ANXLEVEL		Thinking about the last time you felt worried, nervous or anxious, how would [fill:you/ALIAS] describe the level of these feelings? [IF MODE=PHONE, READ: Would you say a little, a lot, or somewhere in between?]
	1.	A little
	2.	A lot
	3.	Somewhere in between a little and a lot
	77.	[Don’t Know]
	99.	[Refused]

DEPFREQ		How often do [fill:you/ALIAS] feel depressed? Would you say daily, weekly, monthly, a few times a year, or never?
	1.	Daily
	2.	Weekly
	3.	Monthly
	4.	A few times a year
	5.	Never
	77.	[Don’t Know]
	99.	[Refused]

DEPMED		Do [fill:you/ALIAS] take prescription medication for depression?
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

[SKIP: If DEPMED = c(1,RF,DK), goto DEPLEVEL; ELSE if DEPMED = 2 AND if DEPFREQ = 5, goto FLAADL; ELSE if DEPMED =2 AND if DEPFREQ = c(1-4, RF, DK), goto DEPLEVEL]

DEPLEVEL		Thinking about the last time [fill:you/ALIAS] felt depressed, how depressed did [fill: you/they] feel? [IF MODE=PHONE, READ: Would you say a little, a lot, or somewhere in between?]
	1.	A little
	2.	A lot
	3.	Somewhere in between a little and a lot
	77.	[Don’t Know]
	99.	[Refused]

AD-8

[If answering about self or if roster relationship is familial, REFERNCEPERIOD = “in the last several years”; if roster relationship is not familial, REFERENCEPERIOD = “since you have known him/her”]

AD8_Intro		[IF MODE = PHONE, read: “I’ll now read some statements about [fill: you/him/her]. If there has been a change [fill: REFERENCEPERIOD] caused by [fill: you/him/her] thinking or memory problems, please say ‘yes.’”] [IF MODE = WEB, display: “Please read the following statements and indicate whether [fill: you have experience/you have noticed] a change [fill: REFERENCEPERIOD] caused by thinking or memory problems.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_1		[IF MODE = PHONE, read if needed: “Has there been a change in”] remember the month or year.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_2		[IF MODE = PHONE, read if needed: “Has there been a change in”] repeating questions, stories, or statements.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_3		[IF MODE = PHONE, read if needed: “Has there been a change in”] amount of difficulty remembering appointments.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_4		[IF MODE = PHONE, read if needed: “Has there been a change in”] amount of interest in hobbies or activities.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_5		[IF MODE = PHONE, read if needed: “Has there been a change in”] amount of difficulty handling money matters like balancing a checkbook or paying bills.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_6		[IF MODE = PHONE, read if needed: “Has there been a change in”] amount of trouble learning how to use a tool, appliance or gadget, for example a TV remote control or microwave.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_7		[IF MODE = PHONE, read if needed: “Has there been a change in”] problems in judgement, for example falling for scams or buying inappropriate gifts.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]

AD8_8		[IF MODE = PHONE, read if needed: “Has there been a change in”] daily problems with thinking or memory.
	1.	Yes
	2.	No
	77.	[Don’t Know]
	99.	[Refused]