CMS-P-0015A Nicotine Alcohol

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

2019_Nicotine_Alcohol_Use_NAQ

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

OMB: 0938-0568

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2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

NAQ -NICOTINE AND ALCOHOL USE

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

CIG100

NA1

no entry

These next questions are about cigarette smoking.

BOX NA1

routing

If SP previously reported smoking cigarettes (sample_person.P_CIG100=1), go to NA3-CIGNOW.
Else go to NA2-CIG100.

NA2

yes/no

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

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED

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

(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

NA4-SMKLSINT

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?

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

(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

NA7-CIGARINT

NA6

code one

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

CIGARINT

NA7

no entry

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.

routing

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

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.

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

BOX NA2

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED

SMKLSNOW

BOX NA3

BOX NA1

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

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

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED

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

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2019 MCBS Community Questionnaire

Variable Name

MR Screen Name

NAQ -NICOTINE AND ALCOHOL USE

Question Type

Question Text/Description

Code List

Routing

(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED

NA14-ECIGINT

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?

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 NA13PIPENOW=(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 ^= YES 0 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 NA26-CDOCSMOK.
ELSE GO TO NA17-ALCINT.

NA25

Has a doctor or other health professional ever talked to [you/(SP)] about [your/his/her] smoking?

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED

CDOCSMOK

NA26

Since (SAMPLE_PERSON.DATE_FALLRND) has a doctor or other health professional talked to [you/(SP)]
about [your/his/her] smoking?

(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED

ALCINT

NA17

BDOCSMOK

BOX NA6

no entry

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.

routing

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.

NA17-ALCINT

NA17-ALCINT

BOX NA6
BOX NA7

SHOWCARD NA1
ALCYEAR

ALCLIFE

NA18

yes/no

(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 mean a (-8) DON'T KNOW
12 oz. beer, a 5 oz. glass of wine, or one and a half ounces of liquor.
(-9) REFUSED

BOX NA7

routing

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.

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?

BOX NA7

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

(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

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.]

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2019 MCBS Community Questionnaire

Variable Name

ALC12MNU

MR Screen Name

NAQ -NICOTINE AND ALCOHOL USE

Question Type

NA20

quantity unit

BOX NA9

routing

Question Text/Description

Code List

Routing

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

BOX NA9

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

ALCDAY

NA21

numeric

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 of liquor.) (1) [continuous response]
(-8) DON'T KNOW
[ENTER NUMBER OF DRINKS.]
(-9) REFUSED
[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

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

NA22-ALCNDAYU

quantity unit

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

NA23-ALPERDAY

NA23

yes/no

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 of
alcoholic beverage almost every day?

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

BOX NA8

BOX NA8

routing

If the SP didn't drink in the last 12 months (NA20 -ALC12MN = 996), go to BOX ENDNAQ.
Else go to NA24 - ALC2HRS.

(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED

BOX ENDNAQ

NA22

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.]

ALCNDAYU

ALPERDAY

NA22

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?
ALC2HRS

NA24

numeric

Considering all types of alcoholic beverages, DURING THE PAST 30 DAYS, how many times did you have [5 or
more/4 or more] drinks on an occasion?
[ENTER QUANTITY.]
[ENTER '0' FOR NEVER.]
[ENTER '95' IF 95 OR MORE TIMES.]

BOX ENDNAQ

routing

GO TO SCQ.

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