Section 5. Health Care Utilization
|
|
1
|
81
|
Q5.1 Does {child’s
name} 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
|
82
|
Q5.2 What
kind of health care coverage, does {child’s name} have? Is
it a parent’s employer paid insurance plan, Medicaid,
Medicare, CHIP {replace with state specific name} or some other
type of insurance?
(INS_TYP)
|
1 = Parent’s
employer
2
= Medicaid/Medicare
3
= CHIP {replace with State specific name}
4
= Other
7
= Don’t know
9 = Refused
|
|
1
|
83
|
Q5.3 During
the past 12 months
was there any time that {child’s name} did not have any
health insurance or coverage? (INS2)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
84
|
Q5.4 A
flu shot is an influenza vaccine injected in your arm. During
the past 12 months, did {CHILD’S NAME} have a flu shot?
(FLU_SHOT)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
85
|
Q5.5 A
flu vaccine that is sprayed in the nose is called FluMistTM.
During the past 12 months, did {CHILD’S NAME} have a flu
vaccine that was sprayed in his/her nose? (FLU_SPRAY)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
86
|
Q5.6
During just the
past 30 days, would
you say {child’s name} limited {his/her}
usual activities
due to asthma not at all, a little, a moderate amount, or a lot?
(ACT_DAYS30)
|
1 = Not at all
2
= A little
3
= Moderate amounts
4
= A lot
7
= Don’t know/Not sure
9 = Refused
|
|
3
|
87-89
|
Q5.7 During
the past 12 months
how many times did {child’s name} see a doctor or other
health professional for a routine checkup for {his/her} asthma?
(NER_TIME)
|
____[Range check: 001-365,
777, 888,999]
777
= Don’t know
888
= None
999 = Refused
|
|
1
|
90
|
Q5.8 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,
has {child’s name} had to visit an emergency room or urgent
care center because of {his/her} asthma? (ER_VISIT)
|
1 = Yes
2
= No
7
= Don’t know
9
= Refused
|
|
3
|
91-93
|
Q5.9 During
the past 12 months,
how many times did{child’s name}
visit an
emergency room or urgent care center because of {his/her} asthma?
(ER_TIMES)
|
____[Range check: 001-365,
777,888,999]
888
= None
777
= Don’t know
999 = Refused
|
|
3
|
94-96
|
Q5.10 During
the past 12 months,
how many times did {child’s name} see a doctor or other
health professional for urgent treatment of worsening asthma
symptoms or an asthma episode or attack? (URG_TIME)
|
____[Range check: 001-365,
777,888, 999]
888
= None
777
= Don’t know
999 = Refused
|
|
1
|
97
|
Q5.11 During
the past 12 months,
that is since [1 YEAR AGO TODAY], has {child’s name} had to
stay overnight in a hospital because of {his/her} asthma? Do not
include an overnight stay in the emergency room. (HOSP_VST)
|
1 = Yes
2
= No
7
= Don’t know
9 = Refused
|
|
3
|
98-100
|
Q5.12 During
the past 12 months,
how many different
times did {child’s
name} stay
in any hospital overnight or longer because of {his/her}
asthma? (HOSPTIME)
|
____[Range check: 001-365,
777, 999]
777
= Don’t know
999 = Refused
|
|
1
|
101
|
Q5.13 The last time
{child’s name} left the hospital, did a health professional
talk with you
or {child’s name} about how to prevent serious attacks in
the future? (HOSPPLAN)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
Section 6. Knowledge of Asthma/Management Plan
|
|
1
|
102
|
Q6.1 Has a doctor or
other health professional ever taught you
or {child’s name}....
a.
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
|
103
|
Q6.2 Has a doctor or
other health professional ever taught you
or {child’s name}....
b. What to do during
an asthma episode or attack?(TCH_RESP)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
104
|
Q6.3 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
or {child’s name}....
c.
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
|
105
|
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 or
{child’s name}....an
asthma action plan?
(MGT_PLAN)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
106
|
Q6.5 Have you or
{child’s name} ever
taken a course or class on how to manage {his/her}
asthma?
(MGT_CLAS)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
Section 7. Modifications to Environment
|
|
1
|
107
|
An air cleaner or
purifier filters pollutants like dust, pollen, mold and chemicals
out of the indoor air. 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 {child’s
name} home?
(AIRCLEANER)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
108
|
Q7.2 Is a dehumidifier
regularly used to reduce moisture inside {child’s
name} home?
(DEHUMID)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
109
|
Q7.3 Is an exhaust fan
that vents to the outside used regularly when cooking in the
kitchen in {child’s
name} home?
(KITC_FAN)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
110
|
Q7.4 Is gas used for
cooking in {child’s
name} home?
(COOK_GAS)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
111
|
Q7.5 In the past 30
days, has anyone seen or smelled mold or a musty odor inside in
{child’s
name} home? Do not
include mold on food.
(ENV_MOLD)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
112
|
Q7.6 Does {child’s
name} home 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
|
113
|
Q7.7 Is the pet allowed
in {child’s
name} bedroom?
(PETBEDRM)
|
1 = Yes
2
= No
3
= Some are/Some aren’t
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
114
|
Q7.8 In the past 30
days, has anyone seen cockroaches inside {child’s
name} home?
(C_ROACH)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
115
|
Q7.9 In the past 30
days, has anyone seen mice or rats inside {child’s
name} 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
|
116
|
Q7.10 Is a wood burning
fireplace or wood
burning stove used
in {child’s
name} home?
(WOOD_STOVE)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
117
|
Q7.11 Are unvented gas
logs, an unvented gas
fireplace, or an unvented gas
stove used in {child’s
name} home?
(GAS_STOVE)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
118
|
Q7.12 In the past week,
has anyone smoked inside {child’s
name} home?
(S_INSIDE)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
119
|
Q7.13 Has a health
professional ever advised you to change things in {child’s
name} home, school,
or work to improve his/her asthma?
(MOD_ENV)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
120
|
Q7.14 Does {child’s
name} 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
|
121
|
Q7.15 Does
{child’s name} 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
|
122
|
Q7.16 Does {child’s
name} have
carpeting or rugs in {his/her} 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
|
123
|
Q7.17 Are {child’s
name} 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
|
124
|
Q7.18 In
{child’s name} bathroom,
does {child’s
name} 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
|
125
|
Q8.1 Over-the-counter
medication can be bought without a doctor’s order. Has
{child’s
name} ever used over-the-counter medication for {his/her} asthma?
(OTC)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
126
|
Q8.2 Has
{child’s
name} ever used a prescription
inhaler?
(INHALERE)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
127
|
Q8.3 Did a health
professional show {child’s name} how to use the inhaler?
(INHALERH)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
128
|
Q8.4 Did a doctor or
other health professional watch {child’s name} use the
inhaler?
(INHALERW)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
129
|
[Now I am going to ask
questions about specific prescription medications {child’s
name} may have taken for asthma in
the past 3 months.
I will be asking for the names, amount, and how often {child’s
name} takes
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 {child’s name} medicines so you can
read the labels.
(SCR_MED1)
|
1 = Yes
2
= No
3
= Respondent know the meds
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
130
|
Q8.7 Do you have all the
medications?
(SCR_MED3)
|
1 = Yes
I have all of the medications
2
= Yes I have some
of the medications but not all
3
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
131
|
Q8.8 In
the past 3 months has
{child’s name} taken prescription asthma medicine using an
inhaler?
(INH_SCR)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
16
|
132-147
|
Q8.9 In
the past 3 months,
what medications did {child’s name} take by inhaler? [MARK
ALL THAT APPLY. PROBE: Any other medications?]
(INH_MEDS)
(Limit=8
Inhalers)
|
88
= No Prescription Inhalers
77
= Don’ 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
|
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
|
[SKIP TO PILLS]
|
|
88
|
No Prescription Inhalers
|
[SKIP TO PILLS]
|
|
99
|
Refused
|
[SKIP TO PILLS]
|
100
|
148-247
|
Q8.10 ENTER OTHER
MEDICATION FROM (8.9) IN TEXT FIELD. IF MORE THAT ONE MEDICATION
IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.
[LOOP
BACK TO ILP01 AS NECESSARY (UP TO 6 TIMES FOR SIX SEPARATE
MEDICATIONS) TO ADMINSTER QUESTIONS ILP01 THRU ILP10 FOR EACH
MEDICINE REPORTED IN INH_MEDS
[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
(OTH_I1)
|
Text field – up to
100 characters
|
|
|
|
Section Repeated for
Medication entry. (Limit=8
Inhalers)
Questions
8.11–8.19 will be repeated for each medication up to 8
times and saved in blocks of 15 columns, two for the Med. Code,
and 13 columns for the 9 questions. Columns 248-262 will hold the
first series and the eighth series in 353-367.
|
|
|
2
|
248-249
|
1st
Inhaler value from “INH_MEDS” field
ILP_A
(First Inhaler Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
250-262
|
Questions 8.11 through
8.19 for FIRST medication
|
|
|
1
|
250
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
1st
Medication
|
|
|
1
|
251
|
Q8.12
Question has
been removed, 2012.
Please
leave this column blank.
1st
Medication
|
|
|
1
|
252
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
253
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_A) 1st
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
254
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_A) 1st
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
255
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_A) 1st
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
256-257
|
Q8.17
Question has been removed, 2012.
Please
leave these columns blank.
1st
Medication
|
|
|
3
|
258-260
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
261-262
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_A) 1st
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
2
|
263-264
|
2nd
Inhaler value from “INH_MEDS” field
ILP_B (Second
Inhaler Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
265-277
|
Questions 8.11 through
8.19 for SECOND medication
|
|
|
1
|
265
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
2nd
Medication
|
|
|
1
|
266
|
Q8.12
Question has been removed, 2012.
Please
leave this column blank.
2nd
Medication
|
|
|
1
|
267
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
268
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_B) 2nd
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
269
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_B) 2nd
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
270
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_B) 2nd
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
271-272
|
Q8.17
Question has been
removed, 2012.
Please
leave these columns blank.
(ILP07_B)
2nd
Medication
|
|
|
3
|
273-275
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
276-277
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_B) 2nd
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
2
|
278-279
|
3rd Inhaler value from
“INH_MEDS” field
ILP_C (Third Inhaler
Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
280-292
|
Questions 8.11 through
8.19 for THIRD medication
|
|
|
1
|
280
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
3rd
Medication
|
|
|
1
|
281
|
Q8.12
Question has been removed, 2012.
Please
leave this column blank.
3rd
Medication
|
|
|
1
|
282
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
283
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_C) 3rd
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
284
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_C) 3rd
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
285
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_C) 3rd
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
286-287
|
Q8.17
Question has been
removed, 2012.
Please
leave these columns blank.
(ILP07_C)
3rd
Medication
|
|
|
3
|
288-290
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
291-292
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_C) 3rd
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
2
|
293-294
|
4th
Inhaler value from “INH_MEDS” field
ILP_D (Fourth
Inhaler Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
295-307
|
Questions 8.11 through
8.19 for FOURTH medication
|
|
|
1
|
295
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
4th
Medication
|
|
|
1
|
296
|
Q8.12
Question has been removed, 2012.
Please
leave this column blank.
4th
Medication
|
|
|
1
|
297
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
298
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_D) 4th
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
299
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_D) 4th
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
300
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_D) 4th
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
301-302
|
Q8.17
Question
has been removed, 2012.
Please
leave these columns blank.
(ILP07_D)
4th
Medication
|
|
|
3
|
303-305
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
306-307
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_D) 4th
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
2
|
308-309
|
5th
Inhaler value from “INH_MEDS” field
ILP_E (Fifth Inhaler
Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
310-322
|
Questions 8.11 through
8.19 for FIFTH medication
|
|
|
1
|
310
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
5th
Medication
|
|
|
1
|
311
|
Q8.12
Question has been removed, 2012.
Please
leave this column blank.
5th
Medication
|
|
|
1
|
312
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
313
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_E) 5th
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
314
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_E) 5th
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
315
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_E) 5th
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
316-317
|
Q8.17
Question
has been removed, 2012.
Please
leave these columns blank.
(ILP07_E)
5th
Medication
|
|
|
3
|
318-320
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
321-322
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_E) 5th
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
2
|
323-324
|
6th Inhaler value from
“INH_MEDS” field
ILP_F (Sixth Inhaler
Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
325-337
|
Questions 8.11 through
8.19 for SIXTH medication
|
|
|
1
|
325
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
6th
Medication
|
|
|
1
|
326
|
Q8.12
Question has been removed, 2012.
Please
leave this column blank.
6th
Medication
|
|
|
1
|
327
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
328
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_F) 6th
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
329
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_F) 6th
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
330
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_F) 6th
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
331-332
|
Q8.17
Question has been
removed, 2012.
Please
leave these columns blank.
(ILP07_F)
6th
Medication
|
|
|
3
|
333-335
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
336-337
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_F) 6th
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
2
|
338-339
|
7th Inhaler value from
“INH_MEDS” field
ILP_G (Seventh
Inhaler Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
340-352
|
Questions 8.11 through
8.19 for SEVENTH medication
|
|
|
1
|
340
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
7th
Medication
|
|
|
1
|
341
|
Q8.12
Question has been removed, 2012.
Please
leave this column blank.
7th
Medication
|
|
|
1
|
342
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
343
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_G) 7th
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
344
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_G) 7th
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
345
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_G) 7th
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
346-347
|
Q8.17
Question
has been removed, 2012.
Please
leave these columns blank.
(ILP07_G)
7th
Medication
|
|
|
3
|
348-350
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
351-352
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_G) 7th
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
2
|
353-354
|
8th Inhaler value from
“INH_MEDS” field
ILP_H (Eighth
Inhaler Medication Value)
|
Valid Inhaler Meds:
01 - 43,
66
|
|
13
|
355-367
|
Questions 8.11 through
8.19 for EIGHTH medication
|
|
|
1
|
355
|
Q8.11
Question has been removed, 2012.
Please
leave this column blank.
8th
Medication
|
|
|
1
|
356
|
Q8.12
Question has been removed, 2012.
Please
leave this column blank.
8th
Medication
|
|
|
1
|
357
|
Q8.13 A
spacer is a small attachment for an inhaler that makes it easier
to use. Does {child’s name} 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/Not sure
9 = Refused
|
|
1
|
358
|
Q8.14 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
when he/she had an asthma episode or attack?
(ILP04_H) 8th
Medication
|
1 = Yes
2
= No
3
= No attack in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
359
|
Q8.15 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
before exercising?
(ILP05_H) 8th
Medication
|
1 = Yes
2
= No
3
= Didn’t exercise in the past 3 mths
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
360
|
Q8.16 In
the past 3 months,
did {child’s name} take [MEDICINE
FROM INH_MEDS SERIES]
on a regular schedule everyday?
(ILP06_H) 8th
Medication
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
361-362
|
Q8.17
Question
has been removed, 2012.
Please
leave these columns blank.
8th
Medication
|
|
|
3
|
363-365
|
Q8.18 How
many times per day or per week did {child’s name} 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
|
366-367
|
Q8.19 How
many canisters of this inhaler has {child’s name} used in
the past 3 months?
(ILP10_H) 8th
Medication
|
___ Canisters [RANGE
CHECK: (01-76, 77, 88, 99)]
77
= Don’t know/Not sure
88
= None
99 = Refused
|
|
1
|
368
|
Intentionally
left blank2
|
|
|
1
|
369
|
Q8.20 In
the past 3 months,
has {child’s name} taken any prescription medicine in pill
form for his/her asthma?
(PILLS)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
10
|
370-379
|
Q8.21 What prescription
asthma medications does {child’s
name} take in
pill form?
[MARK
ALL THAT APPLY. PROBE: Any other prescription asthma pills?]
(PILLS_MD)
(Limit=5)
These
values will also be re-entered in columns below:
480-481
PILL_MD_A
(First Pills Medication value)
483-484
PILL_MD_B
(Second Pills Medication value)
486-487
PILL_MD_C
(Third Pills Medication value)
489-490
PILL_MD_D
(Fourth Pills Medication value)
492-493
PILL_MD_E
(Fifth Pills Medication value)
|
___ Enter Response
[IF
RESPONDENT SELECTS ANY ANSWER FROM 01-47, SKIP TO PILL01]
88
= No Pills
77
= Don’t know/Not sure
99 = Refused
|
|
|
|
What PRESCRIPTION asthma
medications does {child’s
name} take in
pill form?
[MARK
ALL THAT APPLY. PROBE: Any other PRESCRIPTION
asthma pills?]
[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
|
|
49
|
Brethine
|
breth-een
|
|
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
|
[SKIP TO SYRUP]
|
|
88
|
No Pills
|
[SKIP TO SYRUP]
|
|
99
|
Refused
|
[SKIP TO SYRUP]
|
100
|
380-479
|
[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)
|
|
|
2
|
480-481
|
1st Pill value from
“PILLS_MD” field
PILL01_A
(First
Pill Medication Value)
|
Valid Meds in Pill
form: 01 - 49, 66
|
|
1
|
482
|
Q8.22
In the past 3 months, did {child’s name} take [MEDICATION
LISTED IN PILLS_MD] on a regular schedule every day?
(PILL01)
1st
Pill
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
|
|
2
|
483-484
|
2nd Pill value from
“PILLS_MD” field
PILL01_B
(Second
Pill Medication Value)
|
Valid Meds in Pill
form: 01 - 49, 66
|
|
1
|
485
|
Q8.22
In the past 3 months, did {child’s name} take [MEDICATION
LISTED IN PILLS_MD] on a regular schedule every day?
(PILL02)
2nd
Pill
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
|
|
2
|
486-487
|
3rd Pill value from
“PILLS_MD” field
PILL01_C
(Third Pill Medication Value)
|
Valid Meds in Pill
form: 01 - 49, 66
|
|
1
|
488
|
Q8.22
In the past 3 months, did {child’s name} take [MEDICATION
LISTED IN PILLS_MD] on a regular schedule every day?
(PILL03)
3rd
Pill
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
|
|
2
|
489-490
|
4th Pill value from
“PILLS_MD” field
PILL01_D
(Fourth
Pill Medication Value)
|
Valid Meds in Pill
form: 01 - 49, 66
|
|
1
|
491
|
Q8.22
In the past 3 months, did {child’s name} take [MEDICATION
LISTED IN PILLS_MD] on a regular schedule every day?
(PILL04)
4th
Pill
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
|
|
2
|
492-493
|
5th Pill value from
“PILLS_MD” field
PILL01_E
(Fifth
Pill Medication Value)
|
Valid Meds in Pill
form: 01 - 49, 66
|
|
1
|
494
|
Q8.22
In the past 3 months, did {child’s name} take [MEDICATION
LISTED IN PILLS_MD] on a regular schedule every day?
(PILL05)
5th
Pill
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
|
|
1
|
495
|
Q8.23 In
the past 3 months,
has {child’s name} taken prescription medicine in syrup
form?
(SYRUP)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
8
|
496-503
|
Q8.24 What prescriptions
asthma medications has {child’s
name} taken as
a syrup? [MARK
ALL THAT APPLY. PROBE: Any other prescription syrup medications
for asthma?] (SYRUP_ID) (Limit=4)
|
Medication
01
= Aerolate (09)
02
= Albuterol
03
= Alupent (04)
04
= Metaproteronol
05
= Prednisolone
06
= Prelone (05)
07
= Proventil (02)
08
= Slo-Phyllin (09)
09
= Theophylline
10
= Ventolin (02)
66
= Other, Please specify:
77
= Don’t know
88
= No Syrup
99 = Refused
|
|
|
|
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:
|
[SKIP TO OTH_S1]
|
|
77
|
Don’t know
|
[SKIP TO NEB_SCR]
|
|
88
|
No Syrup
|
[SKIP TO NEB_SCR]
|
|
99
|
Refused
|
[SKIP TO NEB_SCR]
|
2
|
496-497
|
1st Syrup value from
“SYRUP_ID” field
SYRUP_A (1st Syrup
Medication Value)
|
Valid Meds in Syrup
form: 01 - 10, 66
|
|
2
|
498-499
|
1st Syrup value from
“SYRUP_ID” field
SYRUP_B (2nd
Syrup Medication Value)
|
Valid Meds in Syrup
form: 01 - 10, 66
|
|
2
|
500-501
|
1st Syrup value from
“SYRUP_ID” field
SYRUP_C (3rd Syrup
Medication Value)
|
Valid Meds in Syrup
form: 01 - 10, 66
|
|
2
|
502-503
|
1st Syrup value from
“SYRUP_ID” field
SYRUP_D (4th Syrup
Medication Value)
|
Valid Meds in Syrup
form: 01 - 10, 66
|
|
100
|
504-603
|
(OTH_S1) ENTER
OTHER MEDICATION.
IF MORE THAN ONE
MEDICATION IS GIVEN, ENTER ALL MEDICATIONS ON ONE LINE.
|
Text field – up to
100 characters
|
|
1
|
604
|
Q8.25 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
{child’s name} prescription asthma medicines used with a
nebulizer? (NEB_SCR)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
605
|
Q8.26a I am going to
read a list of places where your child might have used a
nebulizer. Please answer yes if your child has used a nebulizer
in the place I mention, otherwise answer no. In the past 3
months did your child use a nebulizer At
Home?
(NEB_PLCa)
|
1 = Yes
2
= No
7
= Don’t know
9 = Refused
|
|
1
|
606
|
Q8.26b I am going to
read a list of places where your child might have used a
nebulizer. Please answer yes if your child has used a nebulizer
in the place I mention, otherwise answer no. In the past 3
months did your child use a nebulizer At
a Doctor’s Office?
(NEB_PLCb)
|
1 = Yes
2
= No
7
= Don’t know
9 = Refused
|
|
1
|
607
|
Q8.26c I am going to
read a list of places where your child might have used a
nebulizer. Please answer yes if your child has used a nebulizer
in the place I mention, otherwise answer no. In the past 3
months did your child use a nebulizer In
an Emergency room?
(NEB_PLCc)
|
1 = Yes
2
= No
7
= Don’t know
9 = Refused
|
|
1
|
608
|
Q8.26d I am going to
read a list of places where your child might have used a
nebulizer. Please answer yes if your child has used a nebulizer
in the place I mention, otherwise answer no. In the past 3
months did your child use a nebulizer At
work or at school?
(NEB_PLCd)
|
1 = Yes
2
= No
7
= Don’t know
9 = Refused
|
|
1
|
609
|
Q8.26e I am going to
read a list of places where your child might have used a
nebulizer. Please answer yes if your child has used a nebulizer
in the place I mention, otherwise answer no. In the past 3
months did your child 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 asthma medications has {child’s name}
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:
77
= Don’t know
88
= None
99 = Refused
|
|
|
|
[INTERVIEWER: IF
NECESSARY, ASK THE RESPONDENT TO SPELL THE NAME OF THE
MEDICATION.]
[MARK
ALL THAT APPLY. PROBE: Has your child taken any other
prescription
ASTHMA
medications
with a nebulizer in the past 3 months
|
|
|
|
|
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
|
[SKIP TO Section 9]
|
|
88
|
No Syrups
|
[SKIP TO Section 9]
|
|
99
|
Refused:
|
[SKIP TO Section 9]
|
2
|
620-621
|
1st Nebulizer value
from “NEB_ID” field
NEB_ID_A
(1st
Nebulizer Medication Value)
|
Valid Meds in Nebulizer
form: 01 - 18,
66
|
|
1
|
622
|
Q8.28
In
the past 3 months, did {child’s name} take [MEDICINE FROM
NEB_ID SERIES] when he/she 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/Not Sure
9
= Refused
|
|
1
|
623
|
Q8.29
In
the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES]
on a regular schedule everyday?
(NEB02_A)
1st
Nebulizer
|
1 =
Yes
2
= No
7=
Don’t know/Not Sure
9
= Refused
|
|
3
|
624-626
|
Q8.30
How
many times per day or per
week
does he/she 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/Not Sure
999
= Refused
|
|
2
|
627-628
|
2nd Nebulizer value
from “NEB_ID” field
NEB_ID_B
(2nd
Nebulizer Medication Value)
|
Valid Meds in Nebulizer
form: 01 - 18,
66
|
|
1
|
629
|
Q8.28
In
the past 3 months, did {child’s name} take [MEDICINE FROM
NEB_ID SERIES] when he/she 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/Not Sure
9
= Refused
|
|
1
|
630
|
Q8.29
In
the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES]
on a regular schedule everyday?
(NEB02_B)
2nd
Nebulizer
|
1 =
Yes
2
= No
7=
Don’t know/Not Sure
9
= Refused
|
|
3
|
631-633
|
Q8.30
How
many times per day or per
week
does he/she 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/Not Sure
999
= Refused
|
|
2
|
634-635
|
3rd Nebulizer value
from “NEB_ID” field
NEB_ID_C
(3rd Nebulizer Medication Value)
|
Valid Meds in Nebulizer
form: 01 - 18,
66
|
|
1
|
636
|
Q8.28
In
the past 3 months, did {child’s name} take [MEDICINE FROM
NEB_ID SERIES] when he/she 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/Not Sure
9
= Refused
|
|
1
|
637
|
Q8.29
In
the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES]
on a regular schedule everyday?
(NEB02_C)
3rd
Nebulizer
|
1 =
Yes
2
= No
7=
Don’t know/Not Sure
9
= Refused
|
|
3
|
638-640
|
Q8.30
How
many times per day or per
week
does he/she 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/Not Sure
999
= Refused
|
|
2
|
641-642
|
4th Nebulizer value
from “NEB_ID” field
NEB_ID_D
(4th Nebulizer Medication Value)
|
Valid Meds in Nebulizer
form: 01 - 18,
66
|
|
1
|
643
|
Q8.28
In
the past 3 months, did {child’s name} take [MEDICINE FROM
NEB_ID SERIES] when he/she 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/Not Sure
9
= Refused
|
|
1
|
644
|
Q8.29
In
the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES]
on a regular schedule everyday?
(NEB02_D)
4th
Nebulizer
|
1 =
Yes
2
= No
7=
Don’t know/Not Sure
9
= Refused
|
|
3
|
645-647
|
Q8.30
How
many times per day or per
week
does he/she 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/Not Sure
999
= Refused
|
|
2
|
648-649
|
5th Nebulizer value
from “NEB_ID” field
NEB_ID_E
(5th
Nebulizer Medication Value)
|
Valid Meds in Nebulizer
form: 01 - 18,
66
|
|
1
|
650
|
Q8.28
In
the past 3 months, did {child’s name} take [MEDICINE FROM
NEB_ID SERIES] when he/she 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/Not Sure
9
= Refused
|
|
1
|
651
|
Q8.29
In
the past 3 months, did he/she take [MEDICINE FROM NEB_ID SERIES]
on a regular schedule everyday?
(NEB02_E)
5th
Nebulizer
|
1 =
Yes
2
= No
7=
Don’t know/Not Sure
9
= Refused
|
|
3
|
652-654
|
Q8.30
How
many times per day or per
week
does he/she 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/Not Sure
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 {child’s name} needed to see his/her
primary care doctor for
asthma but
could not because of the cost?
(ASMDCOST)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
756
|
Q9.2 Was
there a time in the past 12 months when you were referred to a
specialist for
{child’s name} asthma care
but could not go because of the cost?
(ASSPCOST)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
757
|
Q9.3 Was
there a time in the past 12 months when {child’s name}
needed medication for
his/her asthma
but you could not buy it because of the cost?
(ASRXCOST)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
Section
10. School Related Asthma
|
|
1
|
758
|
Q10.1 Next, we are
interested in things that might affect {child’s name}
asthma when he/she is not at home. Does {child’s name}
currently go to school or pre school outside the home?
(SCH_STAT)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
759
|
Q10.2 What is the main
reason {child’s name} is not now in school? READ RESPONSE
CATEGORIES
(NO_SCHL)
|
1 = Not old enough
2
= Home schooled
3
= Unable to attend for health reason
4
= On vacation or break
5
= Other
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
760
|
Q10.3 Has {child’s
name} gone to school in the past 12 months?
(SCHL_12)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
2
|
761-762
|
Q10.4 [IF
SCHL_12 = 1]
What
grade was {child’s name} in the last time he/she was in
school?
[IF
SCH_STAT = 1 OR NO_SCHL = 2]
What
grade is {child’s name} in?
(SCHGRADE)
|
88 = Pre-School
66
= Kindergarten
__
= Enter Grade 01-12
77
= Don’t know/Not sure
99 = Refused
|
|
3
|
763-765
|
Q10.5 During
the past 12 months, about how
many days of school did {child’s name} miss because of
{his/her} asthma?
(MISS_SCHL)
|
___ Enter Number of Days
[RANGE
CHECK: (001-365, 777, 888, 999)]
888
= Zero/None
777
= Don’t know/Not sure
999 = Refused
|
|
1
|
766
|
Q10.6 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.
Does {child’s
name} have a written asthma action plan or asthma management plan
on file at school? (SCH_APL)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
767
|
Q10.7 Is {child’s
name} allowed to carry his/her asthma medicine with him/her at
school?
(SCH_MED)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
768
|
Q10.8 Are there any pets
such as dogs, cats, hamsters, birds or other feathered or furry
pets in {child’s name} classroom?
(SCH_ANML)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
769
|
Q10.9 Are you aware of
any mold problems in {child’s name} school?
(SCH_MOLD)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
770
|
Q10.10 [IF
CHLDAGE2 >
10 SKIP TO SECTION 11]
Does
{child’s name} go to day care outside his/her home?
(DAYCARE)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
771
|
Q10.11 Has {child’s
name} gone to daycare in the past 12 months?
(DAYCARE1)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
3
|
772-774
|
Q10.12 During
the past 12 months, about how
many days of daycare did {child’s name} miss because of
{his/her} asthma?
(MISS_DCAR)
|
___ Enter Number of Days
[Range
Check: (001-365, 777, 888, 999)]
888
= Zero/None
777
= Don’t know/Not sure
999 = Refused
|
|
1
|
775
|
Q10.13 Does {child’s
name} have a written asthma action plan or asthma management plan
on file at daycare?
(DCARE_APL)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
776
|
Q10.14 Are there any
pets such as dogs, cats, hamsters, birds or other feathered or
furry pets in {child’s name} room at daycare?
(DCARE_ANML)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
777
|
Q10.15 Are you aware of
any mold problems in {child’s name} daycare?
(DCARE_MLD)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
778
|
Q10.16 Is smoking
allowed at {child’s name} daycare?
(DCARE_SMK)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
SECTION 11. Complimentary
and Alternative Therapy
|
|
1
|
779
|
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
{child’s
name} has used it
to control
asthma in
the past 12 months.
Answer “no” if
{child’s name} has
not used it in the past 12
months.
Q11.1 In
the past 12 months, has {child’s
name}
used (herbs)
to control asthma?
(CAM_HERB)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
780
|
Q11.2 In
the past 12 months has {child’s
name}
used (vitamins)
to control asthma?
(CAM_VITA)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
781
|
Q11.3 In
the past 12 months, has {child’s
name}
used (acupuncture)
to control
asthma?
(CAM_PUNC)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
782
|
Q11.4 In
the past 12 months, has {child’s
name}
used
(acupressure)
to control
asthma?
(CAM_PRES)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
783
|
Q11.5 In the past 12
months, has {child’s
name}
used (aromatherapy)
to control
asthma?
(CAM_AROM)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
784
|
Q11.6 In the past 12
months, has {child’s
name}
used (homeopathy)
to control
asthma?
(CAM_HOME)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
785
|
Q11.7 In the past 12
months, has {child’s
name}
used (reflexology)
to control
asthma?
(CAM_REFL)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
786
|
Q11.8 In
the past 12 months, has {child’s
name}
used (yoga)
to control
asthma?
(CAM_YOGA)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
787
|
Q11.9 In
the past 12 months, has {child’s
name}
used (breathing
techniques) to
control asthma?
(CAM_BR)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
788
|
Q11.10 In
the past 12 months, has {child’s
name} used
(naturopathy) to
control asthma?
(CAM_NATR)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
789
|
Q11.11 Besides
the types I have just asked
about, has
your child used any
other
type of
alternative care for
asthma in the past 12 months?
(CAM_OTHR)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
100
|
790-889
|
Q11.12 What else has
your child 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.
|
|
|
Section
12. Additional Child Demographics
|
|
4
|
890-893
|
Q12.1 How tall is
{child’s name}?
(HEIGHT1)
Note:
If respondent answers in metrics, put “9”in
column 890.
CATI
Note: In the first space for the height (highlighted in yellow),
if the respondent answers in feet/inches enter “0”,
in column 890.
If
respondent answers in metric, put “9”
in the first space, column 890.
Note:
Column 891,
please put feet in this column. Columns 892-893,
please put inches in these two columns, inches can be no more
than a value of 11.
|
_
_ _ _ = Height (feet/inches or centimeters)
7777
= Don’t know/Not sure
9999
= Refused
|
|
4
|
894-897
|
Q12.2 How much does
{child’s name} weigh?
(WEIGHT1)
Note:
If respondent answers in metrics, put “9”
in column 894.
CATI
Note: In the first space for the weight (highlighted in yellow),
if the respondent answers in pounds, enter “0”,
in column 894.
If
respondent answers in kilograms,
put “9”
in the first space, column 894.
|
_
_ _ _ = Weight (pounds/kilograms)
7777
= Don’t know/Not sure
9999 = Refused
|
|
6
|
898-903
|
Q12.3 How much did
{child’s name}] weigh at birth? (BIRTHW1)
CATI
note: If the respondent gives pounds
and ounces: from left to right, positions one and two will hold
“0
0”;
positions three
and four will hold the value of pounds from 0 to 30; and the last
two positions
will hold 00 to 15 ounces.
If
the respondent gives kilograms
and grams: from left to right, position one will hold
“9”;
positions
two and three will hold the value of kilograms 1-30;
and
the last three positions will hold the number of grams.
|
_ _ _ _ = Weight
(pounds/ounces or kilograms/grams)
Two
leading zeroes for pounds/ounces (i.e. 5 pounds 12 ounces =
000512)
A
leading 9 for kilograms/grams (i.e. 2 kilograms 500 grams =
902500)
777777
= Don’t know/Not sure
999999 = Refused
|
|
1
|
904
|
Q12.4 At birth, did
{child’s name} weigh less than 5 ½ pounds?
(BIRTHRF)
[INTERVIEWER NOTE: 5 ½
pounds = 2500 GRAMS
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
80
|
905-984
|
Disposition codes for call
attempts 1 through 20
with the first disposition code in columns 905-907, etc...
(CATTMPTS)
|
4-digit
disposition code
for each of
the first
20 call
attempts.
|
|
7
|
985-991
|
Intentionally
left blank…
|
|
|
1
|
992
|
Q1.5a
Tracking of BRFSS MKP Appendix A. survey respondent:
Are
you the parent or guardian in the household
who
knows most about {CHILDName’s} asthma?
(MOSTKNOW)
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
(MKP)
identified at the BRFSS Level
|
|
1
|
993
|
Q1.5b
Tracking of BRFSS MKP Appendix A. survey respondent:
If
parent or guardian request to transfer to another person who is
more knowledgeable about the child’s asthma, then mark the
transfer.
(PRESENTALT)
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
(ALT)
identified at the BRFSS Level
|
|
1
|
994
|
Q1.5a
Tracking of CALLBACK MKP Appendix B. survey respondent:
Are
you the parent or guardian in the household
who
knows most about {CHILDName’s} asthma?
(KNOWMOST)
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
(MKP)
identified at the CALLBACK Level
|
|
1
|
995
|
Q1.5b
Tracking of CALLBACK MKP Appendix B. survey respondent:
If
parent or guardian request to transfer to another person who is
more knowledgeable about the child’s asthma, then mark the
transfer.
(ALTPRESENT)
|
1 =
Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
(ALT)
identified at the CALLBACK Level
|
|
2
|
996-997
|
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
|
998-999
|
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
|
1000
|
Asthma
Callback Script
Import
value from BRFSS Column
609
(CALLBACK_F)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9
= Refused
|
|
1
|
1001
|
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
|
1002
|
Has a
doctor or other medical professional EVER said that the child has
asthma?
Import
value from BRFSS
Module
31 Question 1, Column 666
(CASTHDX2_F)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
1003
|
Does
the child still have asthma?
Import
value from BRFSS
Module
31 Question 2, Column 608
(CASTHNO2_F)
|
1 = Yes
2
= No
7
= Don’t know/Not sure
9 = Refused
|
|
1
|
1004
|
Asthma
Callback Script Test
(CallBack_Ver)
|
1 =
Callback using Protocol (2 weeks)
2
= Callback conducted “Immediately”
|
|
1
|
1005
|
Are
you a resident of [STATE]?
Import
value from BRFSS Column
085
(CSTATE_F)
|
1 =
Yes
2 =
No
7 =
Don’t know/Not sure
9
= Refused
|
|
2
|
1006-1007
|
State
of Origin of the Call
Import
value from BRFSS Columns
000-000
(O_STATE_F)
|
2
digit state FIPSCODE
|
|
2
|
1008-1009
|
In
what state do you live?
Import
value from BRFSS Columns
86-87
(RSPSTATE_F)
|
2
digit state FIPSCODE
|
|
6
|
1010-1015
|
RESPDNUM
|
RESPONDENT
NUMBER
|
|
4
|
1016-1019
|
Intentionally
left blank…
|
|
|
1
|
1020
|
End
of file marker…
|
PLEASE
PUT A “1” IN THIS FIELD
|
|
