ACBS Data Submission Layout - adult

Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS)

att5g ACBS Adult DataSbmssnLayout 20200805

ACBS Data Submission Layout - adult

OMB: 0920-1204

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Attachment 5g. Data Submission Layout BRFSS Asthma Survey – Adult Questionnaire “2020”

Field Size

Columns

Description of Field and SAS Variable Name

Comments and Values

2

1-2

State FIPS Code (_STATE)

As supplied by GENESYS on sample record.

6

3-8

Replicate Number (REPNUM)

2

9-10

File Month (FMONTH_f)


8

11-18

Interview Date (IDATE) MMDDYYYY

Date of original BRFSS interview.

2

19-20


Interview Month (IMONTH_f)


Month of follow-up

2

21-22

Interview Day (IDAY_f)

Day of follow-up

4

23-26

Interview Year (IYEAR_f)

Year of follow-up

5

27-31

Interviewer Id (INTVID_f)

Interviewer Id of follow-up

4

32-35

Final Disposition(DISPCODE_f)

Disposition code of follow-up

10

36-45

Annual Sequence Number (SEQNO)

As supplied by GENESYS on sample record. Value should be unique for a state within a year.

2

46-47

Number of Attempts (NATTMPTS_f)

Number of attempts of follow-up.






Shape2 Shape1

CDC estimates the average public reporting burden for this collection of information as 155 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (No. 0920-1204, Exp. Date 11/30/2020).

Form Approved

OMB Control No. 0920-1204

Exp. Date 11/30/2020


Section 1. Introduction

1

48


Q1.1 Are you {sample person’s first name or initials}? (Samp_name)


1 = Yes

2 = No


SKIP Q1.2, if Section 01, Q1.1 is coded 1 

1

49


Q1.2 May I speak with {sample person first name or initials}? (Samp_pers)



1 = Yes

2 = No



Q1.3 Enter time/date for return call


Section 2. Informed Consent


1

50


Q2.0 Check if correct person from core survey

is on phone. Ask “is this {sample person’s

name} and are you {sample person’s age} years

old. If yes, continue. If not the correct

respondent, ask to speak to that person, and

start over at section 1. Keep a disposition code

for this, (Repeat)

I would like to repeat the questions from the previous survey now to make sure you qualify for this study.

1 = Yes , Correct

2 = No, Not the Correct Person







1

51


Q2.1 Have you ever been told by a doctor or other health professional that you have asthma?

(EVER_ASTH)


1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused



1

52


Q2.2 Do you still have asthma?

(CUR_ASTH)



1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused



1

53


Q2.3 May we combine your answers to this survey with your answers from the survey you did a few weeks ago?

(PERMISS)



1 = Yes (Skip to Question 3)

2 = No (Go to Terminate)

7 = Don’t know/Not sure (Go to Terminate)

9 = Refused (Go to Terminate)



Section 3. Recent History


3

54-56

Q3.1 How old were you when you were first told by a doctor or other health professional that you had asthma?

(AGEDX)



___ Enter Age in Years

[Range check: 001-115, 777, 888, 999]

888 = Under one year old

777 = Don’t know

999 = Refused



1

57

Q3.2 How long ago was that? Was it ..” READ CATEGORIES

(INCIDNT)


1 = Within the past 12 months

2 = 1-5 years ago

3 = more than 5 yrs ago

7 = Don’t know

9 = Refused

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2

58-59

Q3.3 How long has it been since you last talked to a doctor or other health professional about your asthma? This could have been in your doctor’s office, the hospital, an emergency room or urgent care center.

(LAST_MD)

88 = Never

04 = Within the past year

05 = 1yr to less than 3 yrs ago

06 = 3 yrs to 5 yrs ago

07 = More than 5 yrs ago

77 = Don’t know

99 = Refused



2

60-61

Q3.4 How long has it been since you last took asthma medication?

(LAST_MED)

88 = Never

01 = Less than 1 day ago

02 = 1-6 days ago

03 = 1 week to less than 3 months ago

04 = 3 months to less than 1 year ago

05 = 1 year to less than 3 years ago

06 = 3 years to 5 years ago

07 = More than 5 yrs ago

77 = Don’t know

99 = Refused



2

62-63

Q3.5 How long has it been since you last had any symptoms of asthma?

(LASTSYMP)


88 = Never

01 = Less than 1 day ago

02 = 1-6 days ago

03 = 1 week to less than 3 months ago

04 = 3 months to less than 1 year ago

05 = 1 year to less than 3 years ago

06 = 3 years to 5 years ago

07 = More than 5 yrs ago

77 = Don’t know

99 = Refused




Section 4. History of Asthma (Symptoms & Episodes in past year)


2

64-65

Q4.1 During the past 30 days, on how many days did you have any symptoms of asthma? (SYMP_30D)

__ Days [Range Check:

(01-30, 77, 88, 99)]


88 = No symptoms in the

past 30 days

30 = Everyday

77 = Don’t know

99 = Refused


1

66

Q4.2 Do you have symptoms all the time? "All the time” means symptoms that continue throughout the day. It does not mean symptoms for a little while each day.

(DUR_30D)


1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


2

67-68

Q4.3 During the past 30 days, on how many days did symptoms of asthma make it difficult for you to stay asleep?

(ASLEEP30)

__ Days/Nights [Range check: (01-30, 77, 88, 99)]

88 = None

30 = Everyday

77 = Don’t know

99 = Refused


2

69-70

If LASTSYMP = 88 (never) or = 04, 05, 06, or 07 (more than 3 months ago) then have CATI code SYMPFREE = 14


If SYMP_30D = 88 (no symptoms in the past 30 days) then

have CATI code SYMPFREE = 14


Q4.4 During the past two weeks, on how many days were you completely symptom-free, that is no coughing, wheezing, or other symptoms of asthma? (SYMPFREE)



__ Days/Nights [Range check: (01-14, 77, 88, 99)]


88 = None

77 = Don’t know

99 = Refused



1

71

If last symptoms was 3 months to 1 year ago (LASTSYMP = 4) pick up here, symptoms within the past 3 months continue here as well


READ: Asthma attacks, sometimes called episodes, refer to periods of worsening asthma symptoms that make you limit your activity more than you usually do, or make you seek medical care.


Q4.5 During the past 12 months, have you had an episode of asthma or an asthma attack?

(EPIS_12M)


1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused



3

72-74

Q4.6 During the past three months, how many asthma episodes or attacks have you had?

(EPIS_TP)


[cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 AND 999 WERE NOT THE INTENT]


___ [Range check : (001-

100, 777, 888, 999)]


888 = None

777 = Don’t know

999 = Refused



3

75-77

Q4.7 How long did your most recent asthma episode or attack last? (DUR_ASTH)

1_ _ Minutes

2_ _ Hours

3_ _ Days

4_ _ Weeks

555 Never

777 Don’t know / Not sure

999 Refused


1

78

Q4.8 Compared with other episodes or attacks, was this most recent attack shorter, longer, or about the same? (COMPASTH)

1 = Shorter

2 = Longer

3 = About the same

4 = The Most recent attack was actually the

first attack

7 = Don’t know

9 = Refused




Section 5 Health Care Utilization



1

79

Q5.01 Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Medicaid?

(INS1)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

80

Q5.02 During the past 12 months was there any time that you did not have any health insurance or coverage?

(INS2)


1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


3

81-83

Q5.1 During the past 12 months how many times did you see a doctor or other health professional for a routine checkup for your asthma? (NER_TIME)


[cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT]

__ [Range check : (001-365, 777, 888, 999)]

888 = None

777 = Don’t know

999 = Refused



1

84

Q5.2 An urgent care center treats people with illnesses or injuries that must be addressed immediately and cannot wait for a regular medical appointment. During the past 12 months, have you had to visit an emergency room or urgent care center because of your asthma? (ER_VISIT)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused



3

85-87

Q5.3 During the past 12 months, how many times did you visit an emergency room or urgent care center because of your asthma? (ER_TIMES)


[cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT

___ Enter Number [Range check : (001-365, 777, 888, 999)]


888 = None

777 = Don’t know

999 = Refused



3

88-90

[IF ONE OR MORE ER VISITS (ER_TIMES (5.3)) INSERT “Besides those emergency room or urgent care center visits,”]

Q5.4 During the past 12 months, how many times did you see a doctor or other health professional for urgent treatment of worsening asthma symptoms or for an asthma episode or attack? (URG_TIME)

[cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT]

___ Enter Number [Range check : (001-365, 777, 888, 999)]


888 = None

777 = Don’t know

999 = Refused



1

91

Q5.5 During the past 12 months, that is since [1 YEAR AGO TODAY], have you had to stay overnight in a hospital because of your asthma? Do not include an overnight stay in the emergency room. (HOSP_VST)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


3

92-94

Q5.6A During the past 12 months, how many different times did you stay in any hospital overnight or longer because of your asthma?

(HOSPTIME)

[cati cHECK: iF RESPONSE = 77, 99 VERIFY THAT 777 or 999 WERE NOT THE INTENT

___ Times [Range check : (001-365, 777, 999)]

777 = Don’t know

999 = Refused



1

95

Q5.7 The last time you left the hospital, did a health professional talk with you about how to prevent serious attacks in the future?

(HOSPPLAN)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


3

96-98

Q5.8A During the past 12 months, how many days were you unable to work or carry out your usual activities because of your asthma? (MISS_DAY)

[cati cHECK: iF RESPONSE = 77, 88, 99 VERIFY THAT 777, 888 or 999 WERE NOT THE INTENT

___ Enter Days [Range check : (001-365, 777, 888, 999)]

888 = Zero

777 = Don’t know

999 = Refused


1

99

Q5.9 During just the past 30 days would you say you

limited your usual activities due to asthma not at all, a little,

a moderate amount, or a lot? Change 1/2012

(ACT_DAYS30)

1 = Not at All

2 = A Little

3 = A Moderate Amount

4 = A Lot

7 = Don’t know

9 = Refused


Section 6. Knowledge of Asthma/Management Plan


1

100

Has a doctor or other health professional ever taught you ...

Q6.1a How to recognize early signs or symptoms of an asthma episode? (TCH_SIGN)


1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

101

Has a doctor or other health professional ever taught you ...


Q6.2b What to do during an asthma episode or attack?

(TCH_RESP)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

102

A peak flow meter is a hand held device that measures how quickly you can blow air out of your lungs.

Has a doctor or other health professional ever taught you …

Q6.3c How to use a peak flow meter to adjust your daily medications? (TCH_MON)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

103

An asthma action plan, or asthma management plan, is a form with instructions about when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room.

Q6.4 Has a doctor or other health professional EVER given you an asthma action plan? (MGT_PLAN)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

104

Q6.5 Have you ever taken a course or class on how to manage your asthma? (MGT_CLAS)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


Section 7. Modifications to Environment


1

105

An air cleaner or air purifier can filter out pollutants like dust, mold and chemicals. It can be attached to the furnace or free standing. It is not, however, the same as a normal furnace filter.

Q7.1 Is an air cleaner or purifier regularly used inside your home? (AIRCLEANER)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused



1

106

Q7.2 Is a dehumidifier regularly used to reduce moisture inside your home? (DEHUMID)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

107

Q7.3 Is an exhaust fan that vents to the outside used regularly when cooking in your kitchen?

(KITC_FAN)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

108

Q7.4 Is gas used for cooking?

(COOK_GAS)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

109

Q7.5 In the past 30 days, has anyone seen or smelled mold or a musty odor inside your home? Do not include mold on food. (ENV_MOLD)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

110

Q7.6 Does your household have pets such as dogs, cats, hamsters, birds or other feathered or furry pets that spend time indoors? (ENV_PETS)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

111

Q7.7 Are pets allowed in your bedroom?

(PETBEDRM)

1 = Yes

2 = No

3 = Some are/Some aren’t

7 = Don’t know/Not sure

9 = Refused


1

112

Q7.8 In the past 30 days, has anyone seen a cockroach inside your home?

(C_ROACH)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

113

Q7.9 In the past 30 days, has anyone seen mice or rats inside your home? Do not include mice or rats kept as pets.

(C_RODENT)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

114

Q7.10 Is a wood burning fireplace or wood burning stove used in your home?

(WOOD_STOVE)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

115

Q7.11 Are unvented gas logs, unvented gas fireplace, or unvented gas stove used in your home?

(GAS_STOVE)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

116

Q7.12 In the past week, has anyone smoked inside your home? (S_INSIDE)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

117

Q7.13 Has a health professional ever advised you to change things in your home, school, or work to improve your asthma? (MOD_ENV)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

118

Q7.14 Do you use a mattress cover that is made especially for controlling dust mites? (MATTRESS)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

119

Q7.15 Do you use a pillow cover that is made especially for controlling dust mites? (E_PILLOW)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

120

Q7.16 Do you have carpeting or rugs in your bedroom? This does not include throw rugs small enough to be laundered.

(CARPET)

1 = Yes

2 = No

7 = Don’t know/Not sure

9 = Refused


1

121

Q7.17 Are your sheets and pillowcases washed in cold, warm, or hot water?

(HOTWATER)

1 = Cold

2 = Warm

3 = Hot

4 = Varies

7 = Don’t know/Not sure

9 = Refused


1

122

Q7.18 In your bathroom, do you regularly use an exhaust fan that vents to the outside?

(BATH_FAN)

1 = Yes

2 = No or “No Fan”

7 = Don’t know/Not sure

9 = Refused


Section 8. Medications


1

123

The next set of questions is about medications for asthma. The first few questions are very general, but later questions are very specific to your medication use.

Q8.1 Over-the-counter medication can be bought without a doctor’s order. Have you ever used over-the-counter medication for your asthma? (OTC)

1 = Yes

2 = No

7 = Don’t know

9 = Refused



1

124

Q8.2 Have you ever used a prescription inhaler?

(INHALERE)

1 = Yes

2 = No

7 = Don’t know

9 = Refused


1

125

Q8.3 Did a doctor or other health professional show you how to use the inhaler?

(INHALERH)

1 = Yes

2 = No

7 = Don’t know

9 = Refused


1

126

Q8.4 Did a doctor or other health professional watch you use the inhaler?

(INHALERW)

1 = Yes

2 = No

7 = Don’t know

9 = Refused


1

127

[IF LAST_MED = 88, 4, 5, 6, 7, 77, or 99, SKIP TO SECTION 9]

Now I am going to ask questions about specific prescription medications you may have taken for asthma in the past 3 months. I will be asking for the names, amount, and how often you take each medicine. I will ask separately about medication taken in various forms: pill or syrup, inhaler, and Nebulizer.

Q8.5 It will help to get your medicines so you can read the labels.

(SCR_MED1)


1 = Yes

2 = No

3 = Respondent knows the Meds

7 = Don’t know

9 = Refused



1

128

Q8.7 Do you have all the medications?

(SCR_MED3)

1 = Yes, I have all the medications

2 = Yes, I have some of the medications but not all

3 = No

7 = Don’t know

9 = Refused


1

129

Q8.8 In the past 3 months have you taken prescription asthma medicine using an inhaler?

(INH_SCR)

1 = Yes

2 = No

7 = Don’t know

9 = Refused


16

130-145

Q8.9 In the past 3 months, what prescription asthma medications did you take by inhaler? [MARK ALL THAT APPLY. PROBE: Any other prescription asthma inhaler medications?]

(INH_MEDS) (Limit=8 Inhaler Meds.)






SPELL THE NAME OF THE MEDICATION.]

Note: the yellow numbered items below are new medications added in 2008. Also, CATI programmers, note that the top ten items (in bold below) should be highlighted in the CATI system if possible so they can be

found more easily.




Medication

Pronunciation


01

Advair (+ A. Diskus)

ăd-vâr (or add-vair)


02

Aerobid

â-rō'bĭd (or air-row-bid)


03

Albuterol ( + A. sulfate or salbutamol)

ăl'-bu'ter-ōl (or al-BYOO-ter-ole) săl-byū'tə-môl'


04

Alupent

al-u-pent


43

Alvesco (+ Ciclesonide)

al-ves-co


40

Asmanex (twisthaler)

as-muh-neks twist-hey-ler


05

Atrovent

At-ro-vent


06

Azmacort

az-ma-cort


07

Beclomethasone dipropionate

bek"lo-meth'ah-son dī' pro’pe-o-nāt (or be-kloe-meth-a-sone)


08

Beclovent

be' klo-vent" (or be-klo-vent)


09

Bitolterol

bi-tōl'ter-ōl (or bye-tole-ter-ole)


10

Brethaire Discontinued - Delete

breth-air


11

Budesonide

byoo-des-oh-nide


12

Combivent

com-bi-vent


13

Cromolyn

kro'mŏ-lin (or KROE-moe-lin)


44

Dulera

do-lair-a


14

Flovent

flow-vent


15

Flovent Rotadisk

flow-vent row-ta-disk


16

Flunisolide

floo-nis'o-līd (or floo-NISS-oh-lide)


17

Fluticasone

flue-TICK-uh-zone


34

Foradil

FOUR-a-dil


35

Formoterol

for moh' te rol


18

Intal Discontinued - Delete

in-tel


19

Ipratropium Bromide

ĭp-rah-tro'pe-um bro'mīd (or ip-ra-TROE-pee-um)


37

Levalbuterol tartrate

lev-al-BYOU-ter-ohl


20

Maxair

măk-sâr


21

Metaproteronol

met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)


39

Mometasone furoate

moe-MET-a-sone


22

Nedocromil

ne-DOK-roe-mil


23

Pirbuterol

pēr-bu'ter-ōl (or peer-BYOO-ter-ole)


41

Pro-Air HFA

proh-air HFA


24

Proventil

pro"ven-til' (or pro-vent-il)


25

Pulmicort Flexhaler

pul-ma-cort flex-hail-er


36

QVAR

q -vâr (or q-vair)


03

Salbutamol (or Albuterol)

săl-byū'tə-môl'


26

Salmeterol

sal-ME-te-role


27

Serevent

Sair-a-vent


42

Symbicort

sim-buh-kohrt


28

Terbutaline (+ T. sulfate)

ter-bu'tah-lēn (or ter-BYOO-ta-leen)


29

Tilade Discontinued - Delete

tie-laid


30

Tornalate

tor-na-late


31

Triamcinolone acetonide

tri"am-sin'o-lōn as"ĕ-tō-nīd' (or trye-am-SIN-oh-lone)


32

Vanceril

van-sir-il


33

Ventolin

vent-o-lin


38

Xopenex HFA

ZOH-pen-ecks


66

Other, Please Specify

[SKIP TO OTH_I1]


77

Don’t know



88

No Inhalers



99

Refused




100


146-245

Q8.10 ENTER OTHER MEDICATION FROM (8.9) IN TEXT FIELD IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.

[LOOP BACK TO ILP01 AS NECESSARY TO ADMINSTER QUESTIONS ILP01 THRU ILP10 FOR EACH MEDICINE REPORTED IN INH_MEDS OTH_11

[FOR FILL [MEDICINE FROM INH_MEDS SERIES] FOR QUESTIONS ILP01 THROUGH ILP10]

[IF {MEDICINE FROM INH_MEDS SERIES} IS 03, 04, 21, 24, OR 33 ASK ILP01 ELSE SKIP TO ILP02

Text field – up to 100 characters



Section Repeated for Medication entry. (Limit=8)

Questions 8.11–8.19 will be repeated for each medication up to 8 times and saved in blocks of 15 columns (Two columns for the Med. Code and 13 columns for the 9 questions.) Columns 246-260 will hold the first series, columns and the eighth series in columns 351-365.


2

246-247

1st Inhaler value from “INH_MEDS” field

ILP_A (First Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66

13

248-260

Questions 8.11 through 8.19 for FIRST medication



1

248

Q8.11 Question has been removed, 2012.

Please leave this column blank. 1st Medication


1

249

Q8.12 Question has been removed, 2012.

Please leave this column blank. 1st Medication


1

250

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_A) 1st Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused

1

251

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_A) 1st Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused

1

252

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_A) 1st Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused

1

253

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_A) 1st Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

254-255

Q8.17 Question has been removed, 2012.

Please leave these columns blank. 1st Medication



3

256-258

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_A) 1st Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused

2

259-260

Q8.19 How many canisters of this inhaler have you used in the past 3 months? (ILP10_A)

1st Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused



2

261-262

2nd Inhaler value from “INH_MEDS” field

ILP_B (Second Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66



13

263-275

Questions 8.11 through 8.19 for SECOND medication


1

263

Q8.11 Question has been removed, 2012.

Please leave this column blank. 2nd Medication



1

264

Q8.12 Question has been removed, 2012.

Please leave this column blank. (ILP02_B) 2nd Medication


1

265

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_B) 2nd Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused


1

266

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_B) 2nd Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused

1

267

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_B) 2nd Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused

1

268

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_B) 2nd Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

269-270

Q8.17 Question has been removed, 2012.

Please leave these columns blank. 2nd Medication


3

271-273

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_B) 2nd Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused

2

274-275

Q8.19 How many canisters of this inhaler have you used in the past 3 months?

(ILP10_B) 2nd Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused


2

276-277

3rd Inhaler value from “INH_MEDS” field

ILP_C (Third Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66


13

278-290

Questions 8.11 through 8.19 for THIRD medication



1

278

Q8.11 Question has been removed, 2012.

Please leave this column blank. 3rd Medication


1

279

Q8.12 Question has been removed, 2012.

Please leave this column blank. 3rd Medication


1

280

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_C) 3rd Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused

1

281

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_C) 3rd Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused

1

282

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_C) 3rd Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused

1

283

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_C) 3rd Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

284-285

Q8.17 Question has been removed, 2012.

Please leave these columns blank. 3rd Medication


3

286-288

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_C) 3rd Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused


2

289-290

Q8.19 How many canisters of this inhaler have you used in the past 3 months?

(ILP10_C) 3rd Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused


2

291-292

4th Inhaler value from “INH_MEDS” field

ILP_D (Fourth Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66


13

293-305

Questions 8.11 through 8.19 for FOURTH medication



1

293

Q8.11 Question has been removed, 2012.

Please leave this column blank. 4th Medication


1

294

Q8.12 Question has been removed, 2012.

Please leave this column blank. 4th Medication


1

295

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_D) 4th Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused

1

296

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_D) 4th Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused

1

297

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_D) 4th Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused

1

298

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_D) 4th Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

299-300

Q8.17 Question has been removed, 2012.

Please leave this column blank. 4th Medication


3

301-303

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_D) 4th Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused

2

304-305

Q8.19 How many canisters of this inhaler have you used in the past 3 months?

(ILP10_D) 4th Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused


2

306-307

5th Inhaler value from “INH_MEDS” field

ILP_E (Fifth Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66


13

308-320

Questions 8.11 through 8.19 for FIFTH medication



1

308

Q8.11 Question has been removed, 2012.

Please leave this column blank. 5th Medication


1

309

Q8.12 Question has been removed, 2012.

Please leave this column blank. 5th Medication


1

310

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_E) 5th Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused

1

311

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_E) 5th Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused

1

312

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_E) 5th Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused

1

313

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_E) 5th Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused


2

314-315

Q8.17 Question has been removed, 2012.

Please leave these columns blank. 5th Medication



3

316-318

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_E) 5th Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused

2

319-320

Q8.19 How many canisters of this inhaler have you used in the past 3 months?

(ILP10_E) 5th Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused


2

321-322

6th Inhaler value from “INH_MEDS” field

ILP_F (Sixth Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66


13

323-335

Questions 8.11 through 8.19 for SIXTH medication



1

323

Q8.11 Question has been removed, 2012.

Please leave this column blank. 6th Medication


1

324

Q8.12 Question has been removed, 2012.

Please leave this column blank. 6th Medication


1

325

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_F) 6th Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused

1

326

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_F) 6th Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused

1

327

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_F) 6th Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused

1

328

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_F) 6th Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

329-330

Q8.17 Question has been removed, 2012.

Please leave these columns blank. 6th Medication





3

331-333

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_F) 6th Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused

2

334-335

Q8.19 How many canisters of this inhaler have you used in the past 3 months?

(ILP10_F) 6th Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused


2

336-337

7th Inhaler value from “INH_MEDS” field

ILP_G (Seventh Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66

13

338-350

Questions 8.11 through 8.19 for SEVENTH medication


1

338

Q8.11 Question has been removed, 2012.

Please leave this column blank. 7th Medication


1

339

Q8.12 Question has been removed, 2012.

Please leave this column blank. 7th Medication


1

340

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_G) 7th Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused

1

341

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_G) 7th Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused

1

342

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_G) 7th Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused

1

343

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_G) 7th Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

344-345

Q8.17 Question has been removed, 2012.

Please leave these columns blank. 7th Medication


3

346-348

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_G) 7th Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused

2

349-350

Q8.19 How many canisters of this inhaler have you used in the past 3 months?

(ILP10_G) 7th Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused


2

351-352

8th Inhaler value from “INH_MEDS” field

ILP_H (Eighth Inhaler Medication Value)

Valid Inhaler Meds: 01 – 44, 66

13

353-365

Questions 8.11 through 8.19 for EIGHTH medication


1

353

Q8.11 Question has been removed, 2012.

Please leave this column blank. 8th Medication



1

354

Q8.12 Question has been removed, 2012.

Please leave this column blank. 8th Medication



1

355

Q8.13 A spacer is a small attachment for an inhaler that makes it easier to use. Do you use a spacer with [MEDICINE FROM INH_MEDS SERIES]?

(ILP03_H) 8th Medication

1 = Yes

2 = No

3 = Medication is a dry powder inhaler or disk inhaler not a canister inhaler

4 = Medication has a built-in spacer/ does not need a spacer

7 = Don’t know

9 = Refused


1

356

Q8.14 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] when you had an asthma episode or attack?

(ILP04_H) 8th Medication

1 = Yes

2 = No

3 = No attack in past 3 months

7 = Don’t know

9 = Refused


1

357

Q8.15 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] before exercising?

(ILP05_H) 8th Medication

1 = Yes

2 = No

3 = Didn’t exercise in past 3 months

7 = Don’t know

9 = Refused


1

358

Q8.16 In the past 3 months, did you take [MEDICINE FROM INH_MEDS SERIES] on a regular schedule everyday? (ILP06_H) 8th Medication

1 = Yes

2 = No

7 = Don’t know

9 = Refused


2

359-360

Q8.17 Question has been removed, 2012.

Please leave these columns blank. 8th Medication



3

361-363

Q8.18 How many times per day or per week do you use [MEDICINE FROM INH_MEDS SERIES]?

(ILP08_H) 8th Medication

301-399 = Days

401-499 = Weeks

555 = Never

666 = Less often than once a week

777 = Don’ know

999 = Refused


2

364-365

Q8.19 How many canisters of this inhaler have you used in the past 3 months?

(ILP10_H) 8th Medication

[INTERVIEWER: IF RESPONDENT USED LESS THAN ONE FULL CANISTER IN THE PAST THREE MONTHS, CODE IT AS ‘88’]


__ = 01-76 Canisters

88 = None/Less than 1 full canister

77 = Don’ know

99 = Refused



2

366-367

Intentionally left blank2


1

368

Q8.20 In the past 3 months, have you taken any prescription medicine in pill form for your asthma?

(PILLS)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

10

369-378

Q8.21 What prescription medications do you take in pill form?

[MARK ALL THAT APPLY. PROBE: Any other prescription asthma pills?] (PILLS_MD)


These values will also be re-entered in columns below:

479-480 PILL_MD_A (First Pills Medication value)

482-483 PILL_MD_B (Second Pills Medication value)

485-486 PILL_MD_C (Third Pills Medication value)

488-489 PILL_MD_D (Fourth Pills Medication value)

491-492 PILL_MD_E (Fifth Pills Medication value)


88 = No Pills

77 = Don’t know

99 = Refused





[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.]

Note: the yellow numbered items below are new medications added in 2008. Also, CATI programmers, note that the top ten items (in bold below) should be highlighted in the CATI system if possible so they can be found more easily.




Medication

Pronunciation


01

Accolate

ac-o-late 


02

Aerolate

air-o-late


03

Albuterol

ăl'-bu'ter-ōl (or al-BYOO-ter-all)


04

Alupent

al-u-pent


05

Choledyl (oxtriphylline)

ko-led-il


07

Deltasone

del-ta-sone


08

Elixophyllin

e-licks-o-fil-in


11

Medrol

Med-rol


12

Metaprel

Met-a-prell


13

Metaproteronol

met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)


14

Methylpredinisolone

meth-ill-pred-niss-oh-lone (or meth-il-pred-NIS-oh-lone)


15

Montelukast

mont-e-lu-cast 


17

Pediapred

Pee-dee-a-pred


18

Prednisolone

pred-NISS-oh-lone


19

Prednisone

PRED-ni-sone


21

Proventil

pro-ven-til


23

Respid

res-pid


24

Singulair

sing-u-lair 


25

Slo-phyllin

slow- fil-in


26

Slo-bid

slow-bid


48

Terbutaline (+ T. sulfate)

ter byoo' ta leen


28

Theo-24

thee-o-24


30

Theochron

thee -o-kron


31

Theoclear

thee-o-clear


32

Theodur

thee-o-dur


33

Theo-Dur

thee-o-dur


35

Theophylline

thee-OFF-i-lin


37

Theospan

thee-o-span


40

T-Phyl

t-fil


42

Uniphyl

u-ni-fil


43

Ventolin

vent-o-lin


44

Volmax

vole-max


45

Zafirlukast

za-FIR-loo-kast


46

Zileuton

zye-loo-ton


47

Zyflo Filmtab

zye-flow film tab 






66

Other, please specify

[SKIP TO OTH_P1]


77

Don’t know



88

No Pills



99

Refused



100

379-478

(OTH_P1) IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.

Text field – up to 100 characters




Question 8.22 Repeated for Medication entry. (Limit=5)


Question 8.22 will be repeated for each medication up to 5 times. Column 577 will hold the first response, columns 578 the response to the second cycle, and the sixth cycle will be in column 582.

Valid Meds in Pill form: 01 – 48, 66

2

479-480

1st Pill value from “PILLS_MD_A” field

PILL01_A (First Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66

1

481

Q8.22 In the past 3 months, did you take

[MEDICATION LISTED IN PILLS_MD] on a regular

schedule every day?

(PILL01) 1st Pill

1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

482-483

2nd Pill value from “PILLS_MD_B” field

PILL01_B (Second Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66

1

484

Q8.22 In the past 3 months, did you take

[MEDICATION LISTED IN PILLS_MD] on a regular

schedule every day?

(PILL02) 2nd Pill

1 = Yes

2 = No

7 = Don’t know

9 = Refused


2

485-486

3rd Pill value from “PILLS_MD_C” field

PILL01_C (Third Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66


1

487

Q8.22 In the past 3 months, did you take

[MEDICATION LISTED IN PILLS_MD] on a regular

schedule every day?

(PILL03) 3rd Pill

1 = Yes

2 = No

7 = Don’t know

9 = Refused


2

488-489

4th Pill value from “PILLS_MD_D” field

PILL01_D (Fourth Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66


1

490

Q8.22 In the past 3 months, did you take

[MEDICATION LISTED IN PILLS_MD] on a regular

schedule every day?

(PILL04) 4th Pill

1 = Yes

2 = No

7 = Don’t know

9 = Refused


2

491-492

5th Pill value from “PILLS_MD_E” field

PILL01_E (Fifth Pill Medication value)

Valid Meds in Pill form: 01 – 48, 66


1

493

Q8.22 In the past 3 months, did you take

[MEDICATION LISTED IN PILLS_MD] on a regular

schedule every day?

(PILL05) 5th Pill

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

494

Q8.23 In the past 3 months, have you taken any prescription asthma medication in syrup form?

(SYRUP)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

8

495-502

Q8.24 What prescriptions asthma medications have you taken as a syrup? [MARK ALL THAT APPLY. PROBE: Any other prescription syrup medications for asthma?]]

(SYRUP_ID) (Limit = 4 Syrup Meds.)



Medication

01 = Aerolate (09)

02 = Albuterol

03 = Alupent (04)

04 = Metaproteronol

05 = Prednisolone

06 = Prelone (05)

07 = Proventil (02)

08 = Slo-Phyllin (09)

09 = Theophyllin

10 = Ventolin (02)

66 = Other, Please Specify:

88 = None

77 = Don’t know

99 = Refused



[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.]



Medication

Pronunciation

01

Aerolate

air-o-late

02

Albuterol

ăl'-bu'ter-ōl (or al-BYOO-ter-ole)

03

Alupent

al-u-pent

04

Metaproteronol

met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)

05

Prednisolone

pred-NISS-oh-lone

06

Prelone

pre-loan

07

Proventil

Pro-ven-til

08

Slo-Phyllin

slow-fil-in

09

Theophyllin

thee-OFF-i-lin

10

Ventolin

vent-o-lin

66

Other, Please Specify:


77

Don’t know


88

No Syrups


99

Refused


2

495-496

1st Syrup value from “SYRUP_ID” field

SYRUP_A (First Syrup Medication value)

Valid Meds in Syrup form: 01 – 10, 66


2

497-498

2nd Syrup value from “SYRUP_ID” field

SYRUP_B (Second Syrup Medication value)

Valid Meds in Syrup form: 01 – 10, 66

2

499-500

3rd Syrup value from “SYRUP_ID” field

SYRUP_C (Third Syrup Medication value)

Valid Meds in Syrup form: 01 – 10, 66

2

501-502

4th Syrup value from “SYRUP_ID” field

SYRUP_D (Fourth Syrup Medication value)

Valid Meds in Syrup form: 01 – 10, 66

1

503

Intentionally left blank3


100

504-603

(OTH_S1) IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.

Text field – up to 100 characters


1

604

Q8.25 Read: A nebulizer is a small machine with a tube and facemask or mouthpiece that you breathe through continuously. In the past 3 months, were any of your asthma medicines used with a nebulizer?

(NEB_SCR)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

605

Q8.26a I am going to read a list of places where you might have used a nebulizer. Please answer yes if you have used a nebulizer in the place I mention, otherwise answer no.

In the past 3 months did you use a nebulizer … At Home ?

(NEB_PLCa)

1 = Yes

2 = No

7 = Don’t know

9 = Refused


1

606

Q8.26b In the past 3 months did you use a nebulizer … At a Doctor’s Office ? (NEB_PLCb)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

607

Q8.26c In the past 3 months did you use a nebulizer … In an Emergency room? (NEB_PLCc)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

608

Q8.26d .In the past 3 months did you use a nebulizer … At work (or a school)? (NEB_PLCd)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

609

Q8.26e In the past 3 months did you use a nebulizer … At any other place? (NEB_PLCe)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

10

610-619

Q8.27 In the past 3 months, what prescriptions medications have you taken using a nebulizer?

(NEB_ID) (Limit = 5 Nebulizers Meds.)



These values will also be re-entered in columns below:

620-621 NEB_ID_A (First Nebulizer Medication value)

627-628 NEB_ID_B (Second Nebulizer Medication value)

634-635 NEB_ID_C (Third Nebulizer Medication value)

641-642 NEB_ID_D (Fourth Nebulizer Medication value)

648-649 NEB_ID_E (Fifth Nebulizer Medication value)


Medication

01 = Albuterol

02 = Alupent (11)

03 = Atrovent (09)

04 = Bitolterol

05 = Budesonide

06 = Cromolyn

07 = Duoneb (01 + 09)

08 = Intal (06)

09 = Ipratroprium bromide

10 = Levalbuterol

11 = Metaproteronol

12 = Proventil (01)

13 = Pulmicort (05)

14 = Tornalate (04)

15 = Ventolin (01)

16 = Xopenex (10)

17= Combivent Inhalation solution

18= Perforomist (Formoterol)

66 = Other, Please Specify:

88 = None

77 = Don’t know

99 = Refused



[INTERVIEWER: IF NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE MEDICATION.]



Medication

Pronunciation

01

Albuterol

ăl'-bu'ter-ōl (or al-BYOO-ter-ole)

02

Alupent

al-u-pent

03

Atrovent

At-ro-vent

04

Bitolterol

bi-tōl'ter-ōl (or bye-tole-ter-ole)

05

Budesonide

byoo-des-oh-nide

17

Combivent Inhalation solution

com-bi-vent 

06

Cromolyn

kro'mŏ-lin (or KROE-moe-lin)

07

DuoNeb

DUE-ow-neb

08

Intal

in-tel

09

Ipratroprium bromide

ĭp-rah-tro'pe-um bro'mīd (or ip-ra-TROE-pee-um)

10

Levalbuterol

lev al byoo' ter ol

11

Metaproteronol

met"ah-pro-ter'ĕ-nōl (or met-a-proe-TER-e-nole)

18

Perforomist (Formoterol)

per-form-ist

12

Proventil

Pro-ven-til

13

Pulmicort

pul-ma-cort

14

Tornalate

tor-na-late

15

Ventolin

vent-o-lin

16

Xopenex

ZOH-pen-ecks

66

Other, Please Specify:

[SKIP TO OTH_N1]

77

Don’t know


88

No Nebulizer


99

Refused


2

620-621

1st Nebulizer value from “NEB_ID” field

NEB_ID_A (First Nebulizer Medication value)

Valid Meds in Nebulizer form: 01 – 18, 66

1

622

Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack?

(NEB01_A) 1st Nebulizer

1 = Yes

2 = No

3 = No attack in past 3 months

7= Don’t know

9 = Refused

1

623

Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday?

(NEB02_A) 1st Nebulizer

1 = Yes

2 = No

7= Don’t know

9 = Refused

3

624-626

Q8.30 How many times per day or per week do you

use [MEDICINE FROM NEB_ID SERIES]?

(NEB03_A) 1st Nebulizer

3_ _DAYS

4_ _WEEKS

555 = NEVER

666 = LESS OFTEN THAN ONCE A WEEK

777 = Don’t know

999 = Refused

2

627-628

2nd Nebulizer value from “NEB_ID” field

NEB_ID_B (Second Nebulizer Medication value)

Valid Meds in Nebulizer form: 01 – 18, 66

1

629

Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack?

(NEB01_B) 2nd Nebulizer

1 = Yes

2 = No

3 = No attack in past 3 months

7= Don’t know

9 = Refused

1

630

Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday?

(NEB02_B) 2nd Nebulizer

1 = Yes

2 = No

7= Don’t know

9 = Refused

3

631-633

Q8.30 How many times per day or per week do you

use [MEDICINE FROM NEB_ID SERIES]?

(NEB03_B) 2nd Nebulizer

3_ _DAYS

4_ _WEEKS

555 = NEVER

666 = LESS OFTEN THAN ONCE A WEEK

777 = Don’t know

999 = Refused

2

634-635

3rd Nebulizer value from “NEB_ID” field

NEB_ID_C (Third Nebulizer Medication value)

Valid Meds in Nebulizer form: 01 – 18, 66

1

636

Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack?

(NEB01_C) 3rd Nebulizer

1 = Yes

2 = No

3 = No attack in past 3 months

7= Don’t know

9 = Refused

1

637

Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_IDS SERIES] on a regular schedule everyday?

(NEB02_C) 3rd Nebulizer

1 = Yes

2 = No

7= Don’t know

9 = Refused

3

638-640

Q8.30 How many times per day or per week do you

use [MEDICINE FROM NEB_ID SERIES]?

(NEB03_C) 3rd Nebulizer

3_ _DAYS

4_ _WEEKS

555 = NEVER

666 = LESS OFTEN THAN ONCE A WEEK

777 = Don’t know

999 = Refused

2

641-642

4th Nebulizer value from “NEB_ID” field

NEB_ID_D (Fourth Nebulizer Medication value)

Valid Meds in Nebulizer form: 01 – 18, 66

1

643

Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack?

(NEB01_D) 4th Nebulizer

1 = Yes

2 = No

3 = No attack in past 3 months

7= Don’t know

9 = Refused

1

644

Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday?

(NEB02_D) 4th Nebulizer

1 = Yes

2 = No

7= Don’t know

9 = Refused

3

645-647

Q8.30 How many times per day or per week do you

use [MEDICINE FROM NEB_ID SERIES]?

(NEB03_D) 4th Nebulizer

3_ _DAYS

4_ _WEEKS

555 = NEVER

666 = LESS OFTEN THAN ONCE A WEEK

777 = Don’t know

999 = Refused

2

648-649

5th Nebulizer value from “NEB_ID” field

NEB_ID_E (First Nebulizer Medication value)

Valid Meds in Nebulizer form: 01 – 18, 66

1

650

Q8.28 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] when you had an asthma episode or attack?

(NEB01_E) 5th Nebulizer

1 = Yes

2 = No

3 = No attack in past 3 months

7= Don’t know

9 = Refused

1

651

Q8.29 In the past 3 months, did you take [MEDICINE FROM NEB_ID SERIES] on a regular schedule everyday?

(NEB02_E) 5th Nebulizer

1 = Yes

2 = No

7= Don’t know

9 = Refused

3

652-654

Q8.30 How many times per day or per week do you

use [MEDICINE FROM NEB_ID SERIES]?

(NEB03_E) 5th Nebulizer

3_ _DAYS

4_ _WEEKS

555 = NEVER

666 = LESS OFTEN THAN ONCE A WEEK

777 = Don’t know

999 = Refused

100

655-754

OTH_N1 IF MORE THAN ONE MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.

Text field – up to 100 characters




Section 9. Cost of Care


1

755

Q9.1 Was there a time in the past 12 months when you

needed to see your primary care doctor for your asthma but

could not because of the cost?

(ASMDCOST)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

756

Q9.2 Was there a time in the past 12 months when you

were referred to a specialist for asthma care but could not

go because of the cost? (ASSPCOST)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

757

Q9.3 Was there a time in the past 12 months when you

need to buy medication for your asthma, but could not

because of the cost? (ASRXCOST)

1 = Yes

2 = No

7 = Don’t know

9 = Refused



Section 10. Work related Asthma


1

758

Q10.1 Next, we are interested in things that affect asthma

in the workplace. However, first I’d like to ask how you

would describe your current employment status? Would

you say … (EMP_STAT)

1 = Employed full-time

2 = Employed part-time

3 = Not Employed

7 = Don’t know

9 = Refused

2

759-760

Q10.2 What is the main reason you are not now

employed? (UNEMP_R)

01 = Keeping house

02 = Going to school

03 = Retired

04 = Disabled

05 = Unable to work for

other health reasons

06 = Looking for work

07 = Laid off

08 = Other

77 = Don’t know

99 = Refused


1

761

Q10.3 Have you ever been employed?

(EMP_EVER1)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

762

Q10.4 Are your asthma symptoms MADE WORSE by

things like chemicals, smoke, dust or mold in your

CURRENT job?

(WORKENV5)


1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

763

Q10.5 Was your asthma first CAUSED by things like

chemicals, smoke, dust or mold in your CURRENT job?

(WORKENV6)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

764

Q10.6 Were your asthma symptoms MADE WORSE by

things like chemicals, smoke, dust or mold in any previous

job you ever had?

(WORKENV7)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

765

Q10.7 Was your asthma first CAUSED by things like

chemicals, smoke, dust or mold in any PREVIOUS job

you ever had?

(WORKENV8)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

766

Q10.8 Did you ever lose or quit a job because things in the

workplace, like chemicals, smoke, dust or mold, caused

your asthma or made your asthma symptoms worse?

(WORKQUIT1)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

767

Q10.9 Did you and a doctor or other health professional

ever DISCUSS whether your asthma could have been

caused by, or your symptoms made worse by, any job you

ever had?

(WORKTALK)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

768

Q10.10 Have you ever been TOLD BY a doctor or other

health professional that your asthma was caused by, or

your symptoms made worse by, any job you ever had?

(WORKSEN3)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

769

Q10.11 Have you ever TOLD a doctor or other

health professional that your asthma was caused by, or

your symptoms made worse by, any job you ever had?

(WORKSEN4)

1 = Yes

2 = No

7 = Don’t know

9 = Refused



Section 11. Comorbid Conditions


1

770

Q11.1 Have you ever been told by a doctor or health

professional that you have chronic obstructive pulmonary

disease also known as COPD?

(COPD)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

771

Q11.2 Have you ever been told by a doctor or other health

professional that you have emphysema?

(EMPHY)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

772

Q11.3 Have you ever been told by a doctor or other health

Professional that you have Chronic Bronchitis?

(BRONCH)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

773

Q11.4 Have you ever been told by a doctor or other health

professional that you were depressed?

(DEPRESS)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

SECTION 12. Complimentary and Alternative Therapy

1

774

Sometimes people use methods other than prescription

medications to help treat or control their asthma. These

methods are called non-traditional, complementary, or

alternative health care. I am going to read a list of these

alternative methods. For each one I mention, please

answer “yes” if you have used it to control your own

asthma in the past 12 months. Answer “no” if you have not

used it in the past 12 months.

Q12.1 In the past 12 months, have you used (herbs) to

control your asthma? (CAM_HERB)

1 = Yes

2 = No

7 = Don’t know

9 = Refused


1

775

Q12.2 In the past 12 months, have you used (vitamins) to

control your asthma?

(CAM_VITA)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

776

Q12.3 In the past 12 months, have you used

(acupuncture) to control your asthma?

(CAM_PUNC)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

777

Q12.4 In the past 12 months, have you used

(acupressure) to control your asthma?

(CAM_PRES)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

778

Q12.5 In the past 12 months, have you used

(aromatherapy) to control your asthma?

(CAM_AROM)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

779

Q12.6 In the past 12 months, have you used

(homeopathy) to control your asthma?

(CAM_HOME)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

780

Q12.7 In the past 12 months, have you used

(reflexology) to control your asthma?

(CAM_REFL)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

781

Q12.8 In the past 12 months, have you used (yoga) to

control your asthma?

(CAM_YOGA)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

782

Q12.9 In the past 12 months, have you used (breathing

techniques) to control your asthma?

(CAM_BR)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

783

Q12.10 In the past 12 months, have you used

(naturopathy) to control your asthma?

(CAM_NATR)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

784

Q12.11 Besides the types I have just asked about, have

you used any other type of alternative care for your asthma

in the past 12 months?

(CAM_OTHR)

1 = Yes

2 = No

7 = Don’t know

9 = Refused

100

785-884

Q12.12 What else have you used? (CAM_TEXT)

[100 ALPHANUMERIC CHARACTER LIMIT]

ENTER OTHER ALTERNATIVE MEDICINE IN TEXT FIELD IF MORE THAN ONE IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.


80

885-964

Disposition codes for call attempts 1 through 20 with the first disposition code in columns 885-887, etc... (CATTMPTS_F)

4-digit disposition code for each of the first 20 call attempts

10

965-974

Intentionally left blank…


2

975-976

Questionnaire Versions Identifier.

Import value from BRFSS Columns 613-614

(QSTVER_F)


10 = Landline (No additional version)

11 = Landline (One additional version)

12 = Landline (Two additional versions)

13 = Landline (Three additional versions)

20 = Cell Phone (No additional version)

21 = Cell Phone (One additional version)

22 = Cell Phone (Two additional versions)

23 = Cell Phone (Three additional versions)

2

977-978

Language identifier: Language in which the interview was conducted.

Import value from BRFSS Columns 615-616



(QSTLANG_F)

1 = English

2 = Spanish

3-99 = Other

1

979

Asthma Callback Script

Import value from BRFSS Column 609

(CALLBACK_F)

1 = Yes

2 = No


1

980

Which person in the household was selected as the focus of the call-back?

Import value from BRFSS Column 610

(ADLTCHLD_F)

1 = Adult

2 = Child


1

981

Have you ever been told by a doctor, nurse or other health professional that you had asthma?

Import value from BRFSS Core Section 6 Question 4, Column 118

(ASTHMA3_F)


1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

982

Do you still have asthma?

Import value from BRFSS Core Section 6 Question 5, Column 119

(ASTHNOW_F)


1 = Yes

2 = No

7 = Don’t know

9 = Refused

1

983

Asthma Callback Script Test

(CALLBACK_Ver)


1 = Callback using Protocol (2 weeks)

2 = Callback conducted “Immediately”


1

984

Are you a resident of [STATE]?

Import value from BRFSS Column 085

(CSTATE_F)

Only for cellphones


1 = Yes

2 = No

7 = Don’t know

9 = Refused

2

985-986

State of Origin of the Call

Import value from BRFSS Column 000-000

(O_STATE_F)


2 digit state FIPSCODE


2

987-988

In what state do you live?

Import value from BRFSS Columns 86-87

(RSPSTATE_F)

Only for cellphones


2 digit state FIPSCODE


6

989-994

RESPDNUM

RESPONDENT NUMBER

25

995-1019

Intentionally left blank…


1

1020

End of File Marker…

PLEASE PLACE A “1” IN THIS FIELD


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