Household Interview Hand Cards

Att_3e_HH SP Family_Hand Cards 081718.docx

National Health and Nutrition Examination Survey

Household Interview Hand Cards

OMB: 0920-0950

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Attachment 3e

Household Interview Hand Cards




Table of Contents

Sample Person (SP) Hand Cards 2

Family Hand Cards 60












Sample Person (SP) Hand Cards





SP Hand Cards; 7/1/2018

Introductory Hand Card

Suggested script: (example)

During the interview, I will ask if I can see the containers for all the dietary supplements and prescription medication (you take/SP NAME takes) to enter them in my computer. To save time, would you please collect the containers for all of the items in this list that you take, while I set up my computer for the interview? Thank you. (Present the laminated card to the SP or proxy)



(Laminated card for participants 2 years and older)



Containers from past 30 days



Vitamins, minerals, herbals, or other dietary supplements



Antacids



Prescription medications









(Laminated card for participants 0-24 months)



Containers from past 2 weeks

Infant formulas

Toddler formulas



Containers from past 30 days

Vitamins, minerals, herbals, or other dietary supplements



Antacids



Prescription medications







MCQ1

Shape1













MCQ2

Shape2

























FNQ1




No difficulty


Some difficulty


A lot of difficulty


Cannot do at all



FNQ2




Some difficulty


A lot of difficulty


Cannot do at all



FNQ3




No difficulty


Some difficulty


A lot of difficulty


Cannot do at all
































OSQ3

Shape3





Hip replacement

Knee replacement

Plates or pins to fix a broken bone

Dental implants (posts)

Metal sutures or clips Stents

Pacemakers























HEQ1

Shape4



Prescribed Medicines for Hepatitis B


Adefovir

Alinia

Baraclude Entecavir

Epivir

Epivir HBV

Hepsera

Interferon / Peginterferon

Intron A

Lamivudine

Nitazoxanide

Olysio (simeprevir) Pegasys

Pegintron

Roferon-A

Sovaldi (sofosbuvir) Telbivudine

Tenofovir

Tyzeka

Vemlidy

Viread



HEQ2

Shape5

Prescribed Medicines for Hepatitis C

Alinia

Boceprevir

Copegus

Daklinza (Daclatasvir)

Epclusa

Harvoni

Incivek

Infergen

Interferon / Peginterferon

Intron A

Ledipasvir

Mayvret

Nitazoxanide

Olysio (simeprevir)

Pegasys

Pegintron

Rebetol

Rebetron

Ribapak

Ribasphere

Ribatab

Ribavirin

Roferon-A

Sovaldi (sofosbuvir)

Sylatron

Technivie

Telaprevir

Victrelis

Viekira Pak

Virazole

Vosevi

Zepatier

DLQ1

Shape6





No difficulty

Some difficult

A lot of difficulty

Unable to do







































DIQ1

Shape7



Prediabetes


Impaired fasting glucose


Impaired glucose tolerance


Borderline diabetes







































DIQ3

Shape8



Less than 6

Less than 7

Less than 8

Less than 9

Less than 10

Provider did not specify a goal





























CDQ1

Shape9











OSQ1

Shape10









OSQ2

Shape11


Prescribed Medicines for Osteoporosis


Fosamax, Alendronate

Boniva, Ibandronate

Actonel, Atelvia, Risedronate Reclast, Zoledronic acid

Fortical, Miacalcin, Calcitonin Evista, Raloxifene

Forteo, Teriparatide

Duavee, Bazedoxifene

Prolia, Denosumab











AUQ1

Shape12



Genetic/hereditary causes


Ear infections (including fluid in ears)


Ear diseases (otosclerosis, menieres, tumor) Illness/infections (measles, meningitis, mumps) Drugs/medications

Head or neck injury/trauma


Loud brief explosive noise sounds


Noise exposure, long-term (machinery, etc.) Aging, getting older













AUQ2

Shape13


Speech-language Reading

Hearing or listening skills Intellectual disability

Movement or mobility difficulties


Other developmental or disability problems

























AUQ3

Shape14





Always

Usually

About half the time Seldom

Never





































AUQ4

Shape15





Always

Usually

About half the time Seldom

Never

No noise exposure past 12 months























DEQ2

Shape16



Always


Most of the time


Sometimes


Rarely


Never

































OHQ1

Shape17


Went in on own for check-up, examination or cleaning


Was called in by the dentist for check-up, examination or cleaning


Something was wrong, bothering or hurting


Went for treatment of a condition that dentist discovered at earlier check-up or examination



























OHQ2

Shape18

Could not afford the cost

Did not want to spend the money

Insurance did not cover recommended procedures

Dental office is too far away

Dental office is not open at convenient times Another dentist recommended not doing it

Afraid or do not like dentists

Unable to take time off from work

Too busy

I did not think anything serious was wrong/expected dental problems to go away















OHQ3

Shape19





Very often

Fairly often Occasionally Hardly ever

Never





























OHQ4

Shape20







  1. Full load






  1. Half load






  1. Pea size






  1. Smear









Shape21

BAQ 1









Getting up after sitting or lying down



Bending down or leaning over



Looking up or leaning head back



Looking at moving objects – passing traffic or a train



Being in a place with a lot of people moving around



Being in wide-open spaces



Motion sickness from riding in a car or moving vehicle



Quick head movement from side-to-side



Rolling over in bed



Standing on your feet for a long time



Shape22

BAQ 2









Nausea or vomiting



Migraine or severe headache



Tinnitus (ringing, buzzing or roaring in ears or head)



Sinus congestion



Depression



Ear fullness, pressure or stuffed-up feeling, without pain



Hearing trouble (worse hearing)

















Shape23

BAQ 3







Anemia



Anxiety or panic attacks



Diabetes



Heart disease



Hormonal changes (including pregnancy)



Low blood pressure or hypotension



Low blood sugar or hypoglycemia



Stroke



None of these





Shape24

BAQ 4







Auto-immune disease, such as rheumatoroid arthritis, lupus, sjogren’s



Benign positional vertigo (bpv or bppv)



Crystals—loose or dislodged in ear



Head or neck trauma or concussion



Inner ear infection, viral labrynthitis



Ménière’s (men-e-airz) disease



Migraines or headaches



Neurological condition, such as multiple sclerosis, parkinson’s



Side effects from medications, such as cancer treatments, antibiotics



None of these

Shape25

BAQ 5







Exercises at home, which were not begun in a clinic



Exercises or physical therapy begun in a clinic



Bed rest for several hours or days



Head rolling or epley maneuver by a doctor or therapist



Steroid injections into the ear



Gentamicin (jen-tah-mi-sin) injections into the ear



Prescription medicines



Psychiatric or psychological treatment



Surgery to the ear



Some other type of surgery

None of these

Shape26

BAQ 6







Over-the-counter medicines or drugs

Dietary restrictions: slow salt diet, avoiding certain foods or drinks, such as chocolate, coffee, or alcohol



Quitting or reducing use of tobacco or cigarettes



Massage therapy or chiropractic treatments or manipulations



Herbal remedy: feverfew leaf, ginger, ginkgo biloba, etc



Wearing magnets or acupressure wristband



Counseling or stress management



Acupuncture



None of these



Shape27

BAQ 7







Anxiety or panic attacks



Auto-immune disease, such as rheumatoroid arthritis, lupus, sjogren’s



Cognitive problems, such as memory, attention, learning



Depression



Head injury or concussion



Heart rythem problems or heart failure





Migraine(s) or severe headaches



Numbness in the hands or feet lasting days or longer



Neurological disorder, such as parkinson’s, multiple scherosis, seizures



Severe head injury or concussion (with or without loss of consciousness)



No—none of these

SLQ1

Shape28

Never


Rarely – 1 time a month

Sometimes – 2 to 4 times a month Often – 5 to 15 times a month

Almost always – 16 to 30 times a month





































DEQ1

Shape29















Always


Most of the time


Sometimes


Rarely


Never























DBQ2

Shape30



Never

0-3 months

4-5 months

6-7 months

8-9 months

10-11 months

12 months or older

























DBQ3

Shape31

Nut butters

Shape32

_________________________________________________

Nut and seed products

Shape33











______________________________________________________

Nuts

__________________________________________________

Seeds







DBQ4



Never

Rarely – less than once a week

Sometimes – once a week or more, but

less than once a day

Often – once a day or more

































DBQ5

Shape34







A regular milk drinker for most or all

of lifetime, including childhood


Never has been a regular milk drinker


Milk drinking has varied over lifetime – sometimes has been a regular milk drinker and sometimes has not been a regular milk drinker



































DBQ6

Shape35








Never

Rarely – less than once a week Sometimes – once a week or more,

but less than once a day

Often – once a day or more

























FSQ1

Shape36



Child does not qualify for WIC (family income too high)

Child does not need WIC because family receives support from relatives or friends

Child does not need WIC because family receives support SNAP, a food bank, or another program

Never thought about applying for WIC

Parent/caregiver cannot find time to get to the WIC clinic

Parent/caregiver does not have transportation to get to WIC

The stores that accept WIC are not close to family’s home

WIC foods are difficult to find in the grocery store

Using WIC at the grocery store is uncomfortable

Another reason (describe)















FSQ2

Shape37


Child no longer qualifies for WIC (family income too high)

Child no longer needs WIC because family receives support from relatives or friends

Child no longer needs WIC because family receives support from SNAP, a food bank, or another program

Parent/caregiver could not find time to go to the WIC clinic

Parent/caregiver could not find transportation to get to WIC

WIC clinic wait times were too long

The stores that accept WIC were not close to family’s home

WIC foods were difficult to find in the grocery store

Using WIC at the grocery store was uncomfortable

Checking out at the store with WIC foods took a long time

Child did not like the WIC foods

Another reason (describe)











DBQ74DBQ7

Shape38




EXAMPLES OF FROZEN MEALS & FROZEN PIZZAS









WHQ1

Shape39





SMQ1

Shape40







ACQ1

Shape41





Only Spanish


More Spanish than English


Both equally


More English than Spanish


Only English

































ACQ2

Shape42



English

Chinese Farsi/Persian

Hindi

Japanese

Khmer/Cambodian Korean

Tagalog/Filipino

Urdu

Vietnamese Other























DMQ1

Shape43



Never attended/kindergarten only

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade, no diploma High school graduate GED or equivalent

Some college, no degree

Associate degree: Occupational, technical, or vocational program

Associate degree: Academic program

Bachelor’s degree (example: BA, AB, BS, BBA)

Master’s degree (example: MA, MS, MEng, MEd, MBA)

Professional school degree (example: MD, DDS, DVM, JD)

Doctoral degree (example: PhD, EdD)














DMQ4

Shape44




American Indian or Alaska

Native Asian

Black or African American


Native Hawaiian or Pacific Islander

White

























DMQ5

Shape45




    1. Native Hawaiian


    1. Guamanian or Chamorro


    1. Samoan


    1. Other Pacific Islander








































DMQ8

Shape46





Examples of what we learned when matching NHANES data to other data sources such as Medicare and Medicaid:


    • How housing environment may affect the levels of lead in children’s blood

    • Higher vitamin D in the blood lowers the risk of broken bones

    • Consuming high amount of sugar can increase the risk of heart diseases

    • People who live or work with smokers have a higher risk of heart attack

    • Adults who exercise, eat healthy diets, and do not smoke have a lower chance of dying

















HIQ1

Shape47



Private health insurance


Medicare


Medi-gap


Medicaid


Children’s Health Insurance Program (CHIP)


Military Related Health Care: Tricare (CHAMPUS)/VA HEALTH CARE/ Champ-VA


Indian Health Service


State-sponsored health plan


Other government program


No coverage of any type







HIQ2

Shape48



Shape49






































DSQ1b

Shape50








EXAMPLES OF ANTACIDS


Tums

Rolaids Maalox Mylanta























































Family Hand Cards



DMQ1

Shape51


Never attended/kindergarten only

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade, no diploma

High school graduate

GED or equivalent

Some college, no degree

Associate degree: Occupational, technical, or vocational program

Associate degree: Academic program

Bachelor’s degree (example: BA, AB, BS, BBA)

Master’s degree (example: MA, MS, MEng, MEd, MBA)

Professional school degree (example: MD, DDS, DVM, JD)

Doctoral degree (example: PhD, EdD)






HOQ1

Shape52





A one-family house detached from any other house

A one-family house attached to one or more houses

A building with 2 apartments

A building with 3 or 4 apartments

A building with 5 to 9 apartments

A building with 10 to 19 apartments

A building with 20 to 49 apartments

A building with 50 or more apartments



A mobile home, trailer, or manufactured home

A dormitory or similar boarding house



HOQ2

Shape53





Brita or other pitcher water filter

Ceramic or charcoal filter

Water softener

Aerator

Reverse osmosis

































CBQ1

Shape54





EXAMPLES OF PLACES OTHER THAN GROCERY STORES



Convenience Stores (7-11, Mini Mart)


Wholesale Stores (Costco, Sam’s Club,

BJ’s)


Target/ Wal-Mart/ Kmart


Dollar Store


Bakeries


Meat Markets


Vegetable stands


Farmer’s Markets

INQ1

Shape55





U.

$20,000 - $20,999

JJ.

$35,000 - $39,999

V.

$21,000 - $21,999

KK.

$40,000 - $44,999

W.

$22,000 - $22,999

LL.

$45,000 - $49,999

X.

$23,000 - $23,999

MM.

$50,000 - $54,999

Y.

$24,000 - $24,999

NN.

$55,000 - $59,999

Z.

$25,000 - $25,999

OO.

$60,000 - $64,999

AA.

$26,000 - $26,999

PP.

$65,000 - $69,999

BB.

$27,000 - $27,999

QQ.

$70,000 - $74,999

CC.

$28,000 - $28,999

RR.

$75,000 - $79,999

DD.

$29,000 - $29,999

SS.

$80,000 - $84,999

EE.

$30,000 - $30,999

TT.

$85,000 - $89,999

FF.

$31,000 - $31,999

UU.

$90,000 - $94,999

GG.

$32,000 - $32,999

VV.

$95,000 - $99,999

HH.

$33,000 - $33,999

WW.

$100,000 and over

II.

$34,000 - $34,999



INQ2

Shape56



A.

Less than $1,000

K. $10,000 - $10,999

B.

$1,000 - $1,999

L. $11,000 - $11,999

C.

$2,000 - $2,999

M. $12,000 - $12,999

D.

$3,000 - $3,999

N. $13,000 - $13,999

E.

$4,000 - $4,999

O. $14,000 - $14,999

F.

$5,000 - $5,999

P. $15,000 - $15,999

G.

$6,000 - $6,999

Q. $16,000 - $16,999

H.

$7,000 - $7,999

R. $17,000 - $17,999

I.

$8,000 - $8,999

S. $18,000 - $18,999

J.

$9,000 - $9,999

T. $19,000 - $19,999

INQ3

Shape57





Cash

Checking account Saving accounts

CDs (Certificates of deposit)

Retirement accounts (such as IRAs, 401K, etc.) Stocks

Bonds Mutual funds

INQ4

Shape58





A: $0 - $3,000


B: $3,001 - $5,000

C: $5,001 - $10,000

D: $10,001 - $15,000 E: $15,001 - $20,000

Shape59


Cash

Checking account Saving accounts

CDs (Certificates of deposit)

Retirement accounts (such as IRAs, 401K, etc.) Stocks

Bonds

Mutual funds

INQ5

Shape60





In my car


In a car that belongs to someone I live with


In a car that belongs to someone who lives

elsewhere


Walk


Ride bicycle


Bus, subway or other public transit


Taxi or other paid driver


Someone else delivers groceries


Other





FSQ1

Shape61







Often true

Sometimes true

Never true












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AuthorFrenk, Steven M. (CDC/OPHSS/NCHS)
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