INTROTX [IF AL01 = 1 OR ALREF = 1 OR MJ01 = 1 OR MJREF = 1 OR CC01 = 1 OR CCREF = 1 OR CK01 = 1 OR CKREF = 1 OR HE01 = 1 OR HEREF = 1 OR LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR LS01d = 1 OR LS01e = 1 OR LS01f =1 OR LSREF3 = 1 OR LS01h = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1 OR IN01a =1 OR IN01b =1 OR IN01c = 1 OR IN01d = 1 OR IN01e = 1OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1 OR ME01=1 OR MEREF=1 OR PRMISUSE12=1 OR PRL01=1 OR PRL02=1 OR TRMISUSE12=1 OR TRL01=1 OR TRL02=1 OR STMISUSE12=1 OR STL01=1 OR STL02=1 OR SVMISUSE12=1 OR SVL01=1 OR SVL02=1 ] These next questions deal with treatment for alcohol and drug problems, not including cigarettes. Please report treatment or counseling designed to help you reduce or stop your alcohol or drug use. Please include detoxification and any other treatment for medical problems associated with your alcohol or drug use.
Press [ENTER] to continue.
TX01 [IF AL01 = 1 OR ALREF = 1 OR MJ01 = 1 OR MJREF = 1 OR CC01 = 1 OR CCREF = 1 OR CK01 = 1 OR CKREF = 1 OR HE01 = 1 OR HEREF = 1 OR LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR LS01d = 1 OR LS01e = 1 OR LS01f = 1 OR LSREF3 = 1 OR LS01h = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1 OR IN01a =1 OR IN01b =1 OR IN01c = 1 OR IN01d = 1 OR IN01e = 1OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1 OR ME01=1 OR MEREF=1 OR PRMISUSE12=1 OR PRL01=1 OR PRL02=1 OR TRMISUSE12=1 OR TRL01=1 OR TRL02=1 OR STMISUSE12=1 OR STL01=1 OR STL02=1 OR SVMISUSE12=1 OR SVL01=1 OR SVL02=1 ] Have you ever received treatment or counseling for your use of alcohol or any drug, not counting cigarettes?
1 Yes
2 No
DK/REF
TX02 [IF TX01 = 1] During the past 12 months, that is, since [DATEFILL], have you received treatment or counseling for your use of alcohol or any drug, not counting cigarettes?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX03 [IF TX02 = 1] During the past 12 months when you received treatment, was the treatment for alcohol use only, drug use only, or both alcohol and drug use?
1 Alcohol use only
2 Drug use only
3 Both alcohol and drug use
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DEFINE TXFILL1:
IF TX03 = 1, TXFILL1 = alcohol use
IF TX03 = 2, TXFILL1 = drug use
IF TX03 = 3 OR DK/REF, TXFILL1 = alcohol or drug use
ELSE, TXFILL1 = BLANK
TX04a [IF TX03 NE BLANK ] During the past 12 months, have you received treatment for your [TXFILL1] in a hospital overnight as an inpatient?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04a1 [IF TX03 = 3 AND TX04a = 1] Was the treatment you received in a hospital overnight as an inpatient for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX04b [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in a residential drug or alcohol rehabilitation facility where you stayed overnight?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04b1 [IF TX03 = 3 AND TX04b = 1] Was the treatment you received in a residential drug or alcohol rehabilitation facility where you stayed overnight for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX04c [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in a drug or alcohol rehabilitation facility as an outpatient?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04c1 [IF TX03 = 3 AND TX04c = 1] Was the treatment you received in a drug or alcohol rehabilitation facility as an outpatient for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX04d [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in a mental health center or facility as an outpatient?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04d1 [IF TX03 = 3 AND TX04d = 1] Was the treatment you received in a mental health center or facility as an outpatient for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX04e [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in an emergency room?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04e1 [IF TX03 = 3 AND TX04e = 1] Was the treatment you received in an emergency room for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX04f [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in a private doctor’s office?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04f1 [IF TX03 = 3 AND TX04f = 1] Was the treatment you received in a private doctor’s office for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX04g [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in a prison or jail?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04g1 [IF TX03 = 3 AND TX04g = 1] Was the treatment you received in a prison or jail for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX04h [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in a self-help group such as Alcoholics Anonymous or Narcotics Anonymous?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04h1 [IF TX03 = 3 AND TX04h = 1] Was the treatment you received in a self-help group for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TXSBTELE [SUBUSE2= 1] During the past 12 months, have you received any professional counseling, medication or treatment for your alcohol or drug use over the phone, by email, or through video calling?
1 Yes
2 No
DK/REF
TXSBSRVS IF (TXSBTELE=1 OR TXSBJAIL=1 OR TXSBDTOX=1 OR TXSBPEER) AND ALCUSE=1 AND SUBUSE=1]When you received the following treatment services in the past 12 months, was it for your alcohol use only, your drug use only, or both your alcohol and drug use?
Treatment services received |
For Alcohol use only |
For Drug use only |
For both alcohol and drug use |
[If TXSBTELE=1] Professional treatment over the phone, by email, or through video calling |
|
|
|
TX04i [IF TX03 NE BLANK] During the past 12 months, have you received treatment for your [TXFILL1] in some other place besides these that have been listed?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX04iSP [IF TX04i = 1] Please type in a description of the place where you received treatment or counseling for your [TXFILL1] other than the places just mentioned. When you have finished typing your answer, press the [Enter] key to go to the next question.
_______________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX04iSP.
TX04i1 [IF TX03 = 3 AND TX04i = 1] Was the treatment you received in this other place for your alcohol use, your drug use, or both?
1 Alcohol use
2 Drug use
3 Both alcohol and drug use
DK/REF
TX05 [IF TX03 = 2 OR 3 AND (MJ01 = 1 OR MJREF = 1 OR CC01 = 1 OR CCREF = 1 OR CK01 = 1 OR CKREF = 1 OR HE01 = 1 OR HEREF = 1 OR LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR ME01 = 1 OR MEREF = 1)] During the past 12 months, that is, since [DATEFILL], did you visit a hospital emergency room to receive treatment for your use of cocaine, heroin, marijuana, PCP, LSD, or methamphetamine?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX06 [IF TX05 = 1] During the past 12 months, how many times did you visit a hospital emergency room to receive treatment for your use of cocaine, heroin, marijuana, PCP, LSD, or methamphetamine?
# OF TIMES: [RANGE: 1 - 90]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX07 [IF TX02 = 1 OR DK/REF] Are you currently receiving treatment or counseling for your [TXFILL1]?
1 Yes
2 No
DK/REF
TX08 [IF (TX01 = 2 OR DK/REF) OR ((TX02 =2 OR DK/REF) AND TX07 NE 1)] During the past 12 months, did you need treatment or counseling for your alcohol or drug use?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX09 [IF TX02 = 1 AND TX07 NE 1] During the past 12 months, did you need additional treatment or counseling for your alcohol or drug use?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX10 [IF TX09 = 1] During the past 12 months, for which of the following drugs did you need additional treatment or counseling?
Type the number of each drug for which you needed additional treatment or counseling during the past 12 months. To select more than one drug from the list, press the space bar between each number you type. When you have finished, press [ENTER].
Alcohol
Marijuana or hashish
Cocaine or ‘crack’
Heroin
Hallucinogens
Inhalants
Methamphetamine
Prescription pain relievers
Prescription tranquilizers
Prescription stimulants
Prescription sedatives
Some other drug
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX11 [IF (AL01 = 1 OR ALREF = 1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of alcohol?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX12 [IF (MJ01 = 1 OR MJREF = 1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of marijuana or hashish?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX13 [IF (CC01 = 1 OR CCREF = 1 OR CK01 =1 OR CKREF = 1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of cocaine or ‘crack’?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX14 [IF (HE01 = 1 OR HEREF = 1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of heroin?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX15 [IF (LS01a =1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR LS01d =1 OR LS01e = 1 OR LS01f =1 OR LSREF3 = 1 OR LS01h = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1) AND TX08 =1] During the past 12 months, did you need treatment or counseling for your use of hallucinogens?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX16 [IF (IN01a =1 OR IN01b =1 OR IN01c =1 OR IN01d = 1 OR IN01e = 1 OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of inhalants?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX16a [IF (ME01=1 OR ME01REF=1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of methamphetamine?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX17 [IF (PRMISUSE12=1 OR PRL01=1 OR PRL02=1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of prescription pain relievers?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX18 [IF (TRMISUSE12=1 OR TRL01=1 OR TRL02=1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of prescription tranquilizers?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX19 [IF STMISUSE12=1 OR STL01=1 OR STL02=1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of prescription stimulants?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX20 [IF (SVMISUSE12=1 OR SVL01=1 OR SVL02=1) AND TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of prescription sedatives?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX21 [IF TX08 = 1] During the past 12 months, did you need treatment or counseling for your use of some other drug besides the ones just listed?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX21SP1 [IF TX21 = 1] Please type in the name of one of the other drugs you needed treatment or counseling for during the past 12 months. If you’re not sure how to spell the drug name, just make your best guess. When you have finished typing your answer, press the [ENTER] key to go to the next question.
____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX21SP1.
TX21SP2 [IF TX21SP1 NE (BLANK OR DK/REF)] Please type in the name of any other drug that you needed treatment or counseling for during the past 12 months other than those you have already mentioned. If you have not needed treatment or counseling for your use of any other drugs, press the [ENTER] key to go to the next question.
____________
DK/REF
TX21SP3 [IF TX21SP2 NE (BLANK OR DK/REF)] Please type in the name of any other drug that you needed treatment or counseling for during the past 12 months other than those you have already mentioned. If you have not needed treatment or counseling for your use of any other drugs, press the [ENTER] key to go to the next question.
____________
DK/REF
TX21SP4 [IF TX21SP3 NE (BLANK OR DK/REF)] Please type in the name of any other drug that you needed treatment or counseling for during the past 12 months other than those you have already mentioned. If you have not needed treatment or counseling for your use of any other drugs, press the [ENTER] key to go to the next question.
____________
DK/REF
TX21SP5 [IF TX21SP4 NE (BLANK OR DK/REF)] Please type in the name of any other drug that you needed treatment or counseling for during the past 12 months other than those you have already mentioned. If you have not needed treatment or counseling for your use of any other drugs, press the [ENTER] key to go to the next question.
____________
DK/REF
DEFINE TXFILL2:
IF TX11 = 1 AND ALL OF TX12 - TX21 = 2 OR DK/REF, TXFILL2 = alcohol
IF TX11 = 2 OR DK/REF, AND ANY IN TX12 - TX21 = 1, TXFILL2 = any drug
ELSE, TXFILL2 = alcohol or any other drug
TX22 [IF TX08 = 1] During the past 12 months, did you make an effort to get treatment or counseling for your use of [TXFILL2]?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX22A [IF TX22 IS NOT BLANK] Which of these statements explain why you did not get the treatment or counseling you needed for your use of [TXFILL2]?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press [ENTER].
1 You had no health care coverage, and you couldn’t afford the cost.
2 You did have health care coverage, but it didn’t cover treatment for [TXFILL2], or didn’t cover the full cost.
3 You had no transportation to a program, or the programs were too far away, or the hours were not convenient.
4 You didn’t find a program that offered the type of treatment or counseling you wanted.
5 You were not ready to stop using [TXFILL2].
6 There were no openings in the programs.
7 You did not know where to go to get treatment.
8 You were concerned that getting treatment or counseling might cause your neighbors or community to have a negative opinion of you.
9 You were concerned that getting treatment or counseling might have a negative effect on your job.
10 Some other reason or reasons.
DK/REF
TX22B [IF ANY ENTRY IN TX22A = 10] Which of these statements explain why you did not get the treatment or counseling you needed for your use of [TXFILL2]?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press [ENTER].
1 You didn't think you needed treatment at the time.
2 You thought you could handle the problem without treatment.
3 You didn't think treatment would help.
4 You didn't have time (because of job, childcare, or other commitments).
5 You didn't want others to find out that you needed treatment.
6 Some other reason or reasons.
DK/REF
TX22SP [IF ANY ENTRY IN TX22B = 6 ] Please type in the most important other reason you did not get the treatment you needed. When you have finished typing your answer, press the [ENTER] key to go to the next question.
____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX22SP.
TX23 [IF TX09 = 1] During the past 12 months, did you make an effort to get additional treatment or counseling for your use of alcohol or any other drug?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX23A [IF TX23 IS NOT BLANK] Which of these statements explain why you did not get the additional treatment or counseling you needed for your use of alcohol or drugs?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press [ENTER].
1 You had no health care coverage, and you couldn’t afford the cost.
2 You did have health care coverage, but it didn’t cover treatment for alcohol or drugs, or didn’t cover the full cost.
3 You had no transportation to a program, or the programs were too far away, or the hours were not convenient.
4 You didn’t find a program that offered the type of treatment or counseling you wanted.
5 You were not ready to stop using alcohol or drugs.
6 There were no openings in the programs.
7 You did not know where to go to get treatment.
8 You were concerned that getting treatment or counseling might cause your neighbors or community to have a negative opinion of you.
9 You were concerned that getting treatment or counseling might have a negative effect on your job.
10 Some other reason or reasons.
DK/REF
TX23B [IF ANY ENTRY IN TX23A = 10] Which of these statements explain why you did not get the additional treatment or counseling you needed for your use of alcohol or drugs?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press [ENTER].
1 You didn't think you needed treatment at the time.
2 You thought you could handle the problem without treatment.
3 You didn't think treatment would help.
4 You didn't have time (because of job, childcare, or other commitments).
5 You didn't want others to find out that you needed treatment.
6 Some other reason or reasons.
DK/REF
TX23SP [IF ANY ENTRY IN TX23B = 6] Please type in the most important other reason you did not get the treatment you needed. When you have finished typing your answer, press the [ENTER] key to go to the next question.
____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX23SP.
TX24 [IF TX07 NE 1] How long has it been since you were last in treatment or counseling for your alcohol or drug use, not counting cigarettes?
1 Within the past 30 days -- that is, since [DATEFILL]
2 More than 30 days ago but within the past 12 months
3 More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX25 [IF TX01 = 1 AND TX07 NE 1 OR BLANK] What was the main place where you received treatment the last time you started treatment for your alcohol or other drug use, not counting cigarettes?
[IF TX01 = 1 AND TX07 = 1] What is the main place where you are currently receiving treatment for your alcohol or other drug use, not counting cigarettes?
1 A hospital overnight as an inpatient
2 A residential drug or alcohol rehabilitation facility where you stay at night
3 A drug or alcohol rehabilitation facility as an outpatient where you do not stay at night
4 A mental health center or facility as an outpatient
5 An emergency room
6 A private doctor’s office
7 A prison or jail
8 A self-help group
9 Some other place
DK/REF
TX25SP [IF TX01 = 1 AND TX07 NE BLANK AND TX25 = 9] Please type in a description of the place where you received treatment or counseling for your drug use other than the places just mentioned. When you have finished typing your answer, press the [Enter] key to go to the next question.
____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX25SP.
TX26 [IF (AL01 = 1 OR ALREF = 1) AND TX01 = 1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of alcohol?
[IF (AL01 = 1 OR ALREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of alcohol?
1 Yes
2 No
DK/REF
TX27 [IF (MJ01 =1 OR MJREF = 1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of marijuana or hashish?
[IF (MJ01 = 1 OR MJREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of marijuana or hashish?
1 Yes
2 No
DK/REF
TX28 [IF (CC01 =1 OR CCREF = 1 OR CK01 =1 OR CKREF = 1) AND TX01 = 1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of cocaine or ‘crack’?
[IF (CC01 = 1 OR CCREF = 1 OR CK01 =1 OR CKREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of cocaine or ‘crack’?
1 Yes
2 No
DK/REF
TX29 [IF (HE01 =1 OR HEREF = 1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of heroin?
[IF (HE01 = 1 OR HEREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of heroin?
1 Yes
2 No
DK/REF
TX30 [IF (LS01a =1 OR LSREF1 = 1 OR LS01b =1 OR LSREF2 = 1 OR LS01c =1 OR LS01d =1 OR LS01e =1 OR LS01f = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1 OR LSREF3 = 1 OR LS01h =1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of hallucinogens?
[IF (LS01a =1 OR LSREF1 = 1 OR LS01b =1 OR LSREF2 = 1 OR LS01c =1 OR LS01d = 1 OR LS01e = 1 OR LS01f = 1 OR LSREF3 = 1 OR LS01h =1 OR LS01i=1 OR LS01j=1 OR LS01k=1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of hallucinogens?
1 Yes
2 No
DK/REF
TX31 [IF (IN01a =1 OR IN01b =1 OR IN01c =1 OR IN01d = 1 OR IN01e = 1 OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of inhalants?
[IF (IN01a = 1 OR IN01b =1 OR IN01c =1 OR IN01d =1 OR IN01e = 1 OR IN01f =1 OR IN01g=1 OR IN01h =1 OR IN01h1=1 OR IN01i =1 OR IN01ii=1 OR IN01j =1 OR IN01l =1 OR INREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of inhalants?
1 Yes
2 No
DK/REF
TX31a [IF (ME01 =1 OR MEREF = 1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of methamphetamine?
[IF (ME01 = 1 OR MEREF = 1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of methamphetamine?
1 Yes
2 No
DK/REF
TX32 [IF ( PRMISUSE12=1 OR PRL01=1 OR PRL02=1) AND TX01 = 1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of prescription pain relievers?
[IF (PRMISUSE12=1 OR PRL01=1 OR PRL02=1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of prescription pain relievers?
1 Yes
2 No
DK/REF
TX33 [IF (TRMISUSE12=1 OR TRL01=1 OR TRL02=1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of prescription tranquilizers?
[IF (TRMISUSE12=1 OR TRL01=1 OR TRL02=1) AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of prescription tranquilizers?
1 Yes
2 No
DK/REF
TX34 [IF (STMISUSE12=1 OR STL01=1 OR STL02=1) AND TX01 =1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of prescription stimulants?
[IF (STMISUSE12=1 OR STL01=1 OR STL02=1)AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of prescription stimulants?
1 Yes
2 No
DK/REF
TX35 [IF (SVMISUSE12=1 OR SVL01=1 OR SVL02=1)AND TX01 = 1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of prescription sedatives?
[IF (SVMISUSE12=1 OR SVL01=1 OR SVL02=1)AND TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of prescription sedatives?
1 Yes
2 No
DK/REF
TX36 [IF TX01 = 1 AND TX07 NE 1 OR BLANK] The last time you entered treatment, did you receive treatment or counseling for your use of any other drug?
[IF TX01 = 1 AND TX07 = 1] Are you currently receiving treatment or counseling for your use of any other drug?
1 Yes
2 No
DK/REF
TX36SP1 [IF TX36 = 1 AND TX07 NE 1 OR BLANK] Please type in the name of one of the drugs you received treatment for the last time. If you’re not sure how to spell the name of the drug, just make your best guess.
When you have finished typing your answer, press the [ENTER] key to go to the next question.
[IF TX36 = 1 AND TX07 = 1] Please type in the name of one of the drugs for which you are currently being treated. If you’re not sure how to spell the name of the drug, just make your best guess.
When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX36SP1.
TX36SP2 [IF TX36SP1 NE (BLANK OR DK/REF) AND TX07 NE 1 OR BLANK] Please type in the name of any other drug you received treatment or counseling for the last time you entered treatment for your drug use. If there are no other drugs you received treatment or counseling for the last time, other than those you already mentioned, press the [ENTER] key to go to the next question.
[IF TX36SP1 NE (BLANK OR DK/REF) AND TX07 =1] Please type in the name of any other drug for which you are currently receiving treatment or counseling. If there are no other drugs you are currently receiving treatment or counseling for, other than those you already mentioned, press the [ENTER] key to go to the next question.
_____________
DK/REF
TX36SP3 [IF TX36SP2 NE (BLANK OR DK/REF) AND TX07 NE 1 OR BLANK] Please type in the name of any other drug you received treatment or counseling for the last time you entered treatment for your drug use. If there are no other drugs you received treatment or counseling for the last time, other than those you already mentioned, press the [ENTER] key to go to the next question.
[IF TX36SP2 NE (BLANK OR DK/REF) AND TX07 =1] Please type in the name of any other drug for which you are currently receiving treatment or counseling. If there are no other drugs you are currently receiving treatment or counseling for, other than those you already mentioned, press the [ENTER] key to go to the next question.
_____________
DK/REF
TX36SP4 [IF TX36SP3 NE (BLANK OR DK/REF) AND TX07 NE 1 OR BLANK] Please type in the name of any other drug you received treatment or counseling for the last time you entered treatment for your drug use. If there are no other drugs you received treatment or counseling for the last time, other than those you already mentioned, press the [ENTER] key to go to the next question.
[IF TX36SP3 NE (BLANK OR DK/REF) AND TX07 =1] Please type in the name of any other drug for which you are currently receiving treatment or counseling. If there are no other drugs you are currently receiving treatment or counseling for, other than those you already mentioned, press the [ENTER] key to go to the next question.
_____________
DK/REF
TX36SP5 [IF TX36SP4 NE (BLANK OR DK/REF) AND TX07 NE 1 OR BLANK] Please type in the name of any other drug you received treatment or counseling for the last time you entered treatment for your drug use. If there are no other drugs you received treatment or counseling for the last time, other than those you already mentioned, press the [ENTER] key to go to the next question.
[IF TX36SP4 NE (BLANK OR DK/REF) AND TX07 =1] Please type in the name of any other drug for which you are currently receiving treatment or counseling. If there are no other drugs you are currently receiving treatment or counseling for, other than those you already mentioned, press the [ENTER] key to go to the next question.
_____________
DK/REF
TX37 [IF MORE THAN 1 ITEM IN THE TX26 - TX36 SERIES = 1 OR DK/REF AND TX07 NE 1 OR BLANK] What was the main drug you entered treatment for the last time you were treated?
[IF MORE THAN 1 ITEM IN THE TX26 - TX36 SERIES = 1 OR DK/REF AND TX07 = 1] What is the main drug for which you are currently receiving treatment or counseling?
Alcohol
Marijuana or hashish
Cocaine or ‘crack’
Heroin
Hallucinogens
Inhalants
Methamphetamine
Prescription pain relievers
Prescription tranquilizers
Prescription stimulants
Prescription sedatives
Some other drug
DK/REF
TX38 [IF TX25 = 1 - 8 AND TX07 NE 1 OR BLANK] What was the outcome of the treatment or counseling you last received at [FILL IN ANSWER FROM TX25]?
[IF TX25 = DK/REF OR TX25 = 9 AND TX07 NE 1 OR BLANK] What was the outcome of the treatment or counseling you last received?
1 You are still in treatment
2 You successfully completed treatment
3 You left because you had a problem with the program
4 You left because you couldn’t afford to continue treatment
5 You left because your family needed you
6 You left because you began using drugs again
7 Your last treatment had some other outcome
DK/REF
TX38SP [IF TX38 = 7] Please type in a description of the outcome of your last treatment or counseling for drug use. You do not need to give a detailed description — just a few words will be sufficient.
When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX38SP.
TX39 [IF TX25 = 1- 8 AND TX38 = 2 - 7 OR DK/REF] How long did you stay in treatment for your alcohol or drug use during your last treatment at [FILL IN ANSWER FROM TX25]?
[IF (TX25 = 1 - 8 AND TX38 = 1) OR (TX07 = 1 AND TX25 = 1 - 8)] How long have you been in treatment for your alcohol or drug use at [FILL IN ANSWER FROM TX17]?
[IF TX25 = 9 OR DK/REF AND TX38 = 2 - 7 OR DK/REF] How long did you stay in treatment for your alcohol or drug use during your last treatment?
[IF (TX25 = 9 OR DK/REF AND TX38 = 1) OR TX07 = 1 AND TX25 = 9)] How long have you been in treatment for your alcohol or drug use so far?
Please indicate whether you want to give your answer in days, months, or years.
1 Days
2 Months
3 Years
DK/REF
TX40DAY1 [IF (TX38 = 1 OR TX07 = 1) AND TX39 = 1 OR DK/REF] How many days have you been in treatment for your alcohol or drug use so far?
# OF DAYS: [RANGE: 1 - 366]
DK/REF
TX40DAY2 [IF TX38 = 2 - 7 OR DK/REF AND TX39 = 1 OR DK/REF] How many days did you stay in treatment for your alcohol or drug use the last time?
# OF DAYS: [RANGE: 1 - 366]
DK/REF
TX41MON1 [IF (TX38 = 1 OR TX07 = 1) AND TX39 = 2] How many months have you been in treatment for your alcohol or drug use so far?
# OF MONTHS: [RANGE: 1 - 400]
DK/REF
TX41MON2 [IF TX38 = 2 - 7 OR DK/REF AND TX39 = 2] How many months did you stay in treatment for your alcohol or drug use the last time?
# OF MONTHS: [RANGE: 1 - 400]
DK/REF
TX41YR1 [IF (TX38 = 1 OR TX07 = 1) AND TX39 = 3] How many years have you been in treatment for your alcohol or drug use so far?
# OF YEARS: [RANGE: 1 - 60]
DK/REF
TX41YR2 [IF TX38 = 2 - 7 OR DK/REF AND TX39 = 3] How many years did you stay in treatment for your alcohol or drug use the last time?
# OF YEARS: [RANGE: 1 - 60]
DK/REF
TX42A [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did private health insurance pay for the last treatment you received, even if it paid only part of the cost?
[IF TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will private health insurance pay for the treatment you are currently receiving, even if it pays only part of the cost?
1 Yes
2 No
DK/REF
TX42B [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did Medicare pay for the last treatment you received, even if it paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will Medicare pay for the treatment you are currently receiving, even if it pays only part of the cost?
1 Yes
2 No
DK/REF
TX42C [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did Medicaid pay for the last treatment you received, even if it paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will Medicaid pay for the treatment you are currently receiving, even if it pays only part of the cost?
1 Yes
2 No
DK/REF
TX42D [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did a public assistance program other than Medicaid pay for the last treatment you received, even if it paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will a public assistance program other than Medicaid pay for the treatment you are currently receiving, even if it pays only part of the cost?
1 Yes
2 No
DK/REF
TX42E [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did you use your own savings or earnings to pay for the last treatment you received, even if you paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will you use your own savings or earnings to pay for the treatment you are currently receiving, even if you pay only part of the cost?
1 Yes
2 No
DK/REF
TX42F [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did family members pay for the last treatment you received, even if they paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will family members pay for the treatment you are currently receiving, even if they pay only part of the cost?
1 Yes
2 No
DK/REF
TX42G [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did the courts pay for the last treatment you received, even if it paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will the courts pay for the treatment you are currently receiving, even if it pays only part of the cost?
1 Yes
2 No
DK/REF
TX42H [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did CHAMPUS or TRICARE, CHAMPVA, the VA, or some other military health care pay for the last treatment you received, even if it paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will CHAMPUS or TRICARE, CHAMPVA, the VA, or some other military health care pay for the treatment you are currently receiving, even if it pays only part of the cost?
1 Yes
2 No
DK/REF
TX42I [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Did your employer pay for the last treatment you received, even if it paid only part of the cost?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will your employer pay for the treatment you are currently receiving, even if it pays only part of the cost?
1 Yes
2 No
DK/REF
TX42J [IF TX01 = 1 AND TX07 NE 1 OR BLANK] Was your last treatment paid for by some other source besides those that have been listed?
[IF (TX01 = 1 AND TX07 = 1) OR TX38 = 1] Will the treatment you are currently receiving be paid for by some other source besides those that have been listed?
1 Yes
2 No
DK/REF
TX42JSP [IF TX42J = 1 AND TX07 NE 1 OR BLANK] Please type in a description of the source that paid for your last treatment or counseling for alcohol or drug use. You do not need to give a detailed description — just a few words will be sufficient. When you have finished typing your answer, press the [ENTER] key to go to the next question.
[IF TX42J = 1 AND (TX07 = 1 OR TX38 = 1)] Please type in a description of the source that will pay for your current treatment or counseling for alcohol or drug use. You do not need to give a detailed description — just a few words will be sufficient. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN TX42JSP.
TX42K [IF TX42A - TX42J = 2 AND TX07 NE 1 OR BLANK] Was the last treatment you received free?
[IF TX42A - TX42J = 2 AND (TX07 = 1 OR TX38 = 1)] Is the treatment you are currently receiving free?
1 Yes
2 No
DK/REF
TX43 [IF TX01 = 1] Were you enrolled in a treatment program for your alcohol or drug use on October 1, [CURRENT YEAR – 1]?
For this question, please include only treatment you received at a hospital, drug rehabilitation facility, or mental health center.
1 Yes
2 No
DK/REF
TX44 [IF TX03 NE BLANK] Think about all the treatment or counseling you received for your [TXFILL1] during the past 12 months. Was detoxification the only [TXFILL1] treatment you received during the past 12 months?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX45 [IF TX01=1 AND TX02=2 AND (AL01 = 1 OR ALREF = 1) AND MJ01 NE 1 AND MJREF NE 1 AND CC01 NE 1 AND CCREF NE 1 AND CK01 NE 1 AND CKREF NE 1 AND HE01 NE 1 AND HEREF NE 1 AND LS01a NE 1 AND LSREF1 NE 1 AND LS01b NE 1 AND LSREF2 NE 1 AND LS01c NE 1 AND LS01d NE 1 AND LS01e NE 1 AND LS01f NE1 AND LSREF3 NE 1 AND LS01h NE 1 AND LS01i NE 1 AND LS01j NE 1 AND LS01k NE 1 AND IN01a NE1 AND IN01b NE1 AND IN01c NE 1 AND IN01d NE 1 AND IN01e NE 1AND IN01f NE 1 AND IN01g NE 1 AND IN01h NE 1 AND IN01h1 NE 1 AND IN01i NE 1 AND IN01ii NE 1 AND IN01j NE 1 AND IN01l NE 1 AND INREF NE 1 AND ME01 NE 1 AND MEREF NE 1 AND (PRMISUSE12 NE 1 OR PRL01 NE 1 OR PRL02 NE 1) AND (TRMISUSE12 NE 1 OR TRL01 NE 1 OR TRL02 NE 1) AND (STMISUSE12 NE 12 OR STL01 NE 1 OR STL02 NE 1) AND (SVMISUSE12 NE 1 OR SVL01 NE 1 OR SVL02 NE 1)] Earlier you reported that at some time in your life you received treatment or counseling for your use of alcohol or any drug, not counting cigarettes. Have you ever received treatment for your alcohol use?
1 Yes
2 No
DK/REF
TX45a [IF TX45 = 1] How old were you when you first received treatment for your alcohol use?
_____________[RANGE: 1-110]
DK/REF
TX46 [IF TX01=1 AND TX02=2 AND (AL01 NE 1 AND ALREF NE1) AND MJ01 = 1 OR MJREF = 1 OR CC01 = 1 OR CCREF = 1 OR CK01 = 1 OR CKREF = 1 OR HE01 = 1 OR HEREF = 1 OR LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR LS01d = 1 OR LS01e = 1 OR LS01f =1 OR LSREF3 = 1 OR LS01h = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1 OR IN01a =1 OR IN01b =1 OR IN01c = 1 OR IN01d = 1 OR IN01e = 1OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1 OR ME01=1 OR MEREF=1 OR PRMISUSE12=1 OR PRL01=1 OR PRL02=1 OR TRMISUSE12=1 OR TRL01=1 OR TRL02=1 OR STMISUSE12=1 OR STL01=1 OR STL02=1 OR SVMISUSE12=1 OR SVL01=1 OR SVL02=1] Earlier you reported that at some time in your life you received treatment or counseling for your use of alcohol or any drug, not counting cigarettes. Have you ever received treatment or counseling for your drug use?
1 Yes
2 No
DK/REF
TX46a [IF TX46 = 1] How old were you when you first received treatment or counseling for your drug use?
_____________[RANGE: 1-110]
DK/REF
TX47 [IF TX01=1 AND TX02=2 AND (AL01 = 1 OR ALREF = 1) AND (MJ01 = 1 OR MJREF = 1 OR CC01 = 1 OR CCREF = 1 OR CK01 = 1 OR CKREF = 1 OR HE01 = 1 OR HEREF = 1 OR LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR LS01d = 1 OR LS01e = 1 OR LS01f =1 OR LSREF3 = 1 OR LS01h = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1 OR IN01a =1 OR IN01b =1 OR IN01c = 1 OR IN01d = 1 OR IN01e = 1OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1 OR ME01=1 OR MEREF=1 OR PRMISUSE12=1 OR PRL01=1 OR PRL02=1 OR TRMISUSE12=1 OR TRL01=1 OR TRL02=1 OR STMISUSE12=1 OR STL01=1 OR STL02=1 OR SVMISUSE12=1 OR SVL01=1 OR SVL02=1)] Earlier you reported that at some time in your life you received treatment or counseling for your use of alcohol or any drug, not counting cigarettes. Have you ever received treatment or counseling for your alcohol use?
1 Yes
2 No
DK/REF
TX47a [IF TX47 = 1] How old were you when you first received treatment or counseling for your alcohol use?
_____________[RANGE: 1-110]
DK/REF
TX48 [IF TX01=1 AND TX02=2 AND (AL01 = 1 OR ALREF = 1) AND (MJ01 = 1 OR MJREF = 1 OR CC01 = 1 OR CCREF = 1 OR CK01 = 1 OR CKREF = 1 OR HE01 = 1 OR HEREF = 1 OR LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR LS01d = 1 OR LS01e = 1 OR LS01f =1 OR LSREF3 = 1 OR LS01h = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1 OR IN01a =1 OR IN01b =1 OR IN01c = 1 OR IN01d = 1 OR IN01e = 1OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1 OR ME01=1 OR MEREF=1 OR PRMISUSE12=1 OR PRL01=1 OR PRL02=1 OR TRMISUSE12=1 OR TRL01=1 OR TRL02=1 OR STMISUSE12=1 OR STL01=1 OR STL02=1 OR SVMISUSE12=1 OR SVL01=1 OR SVL02=1)] Have you ever received treatment or counseling for your drug use?
1 Yes
2 No
DK/REF
TX48a [IF TX48 = 1] How old were you when you first received treatment or counseling for your drug use?
_____________[RANGE: 1-110]
DK/REF
TX49 [IF TX03 = 1] Earlier you reported that you received treatment or counseling for your use of alcohol during the past 12 months. How old were you when you first received treatment or counseling for your alcohol use?
_____________[RANGE: 1-110]
DK/REF
TX49a [IF TX03 = 1 AND (MJ01 = 1 OR MJREF = 1 OR CC01 = 1 OR CCREF = 1 OR CK01 = 1 OR CKREF = 1 OR HE01 = 1 OR HEREF = 1 OR LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR LS01d = 1 OR LS01e = 1 OR LS01f =1 OR LSREF3 = 1 OR LS01h = 1 OR LS01i=1 OR LS01j=1 OR LS01k=1 OR IN01a =1 OR IN01b =1 OR IN01c = 1 OR IN01d = 1 OR IN01e = 1OR IN01f = 1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR IN01l = 1 OR INREF = 1 OR ME01=1 OR MEREF=1 OR PRMISUSE12=1 OR PRL01=1 OR PRL02=1 OR TRMISUSE12=1 OR TRL01=1 OR TRL02=1 OR STMISUSE12=1 OR STL01=1 OR STL02=1 OR SVMISUSE12=1 OR SVL01=1 OR SVL02=1)] Have you ever received treatment or counseling for your use of any drug, not including cigarettes or alcohol?
1 Yes
2 No
DK/REF
TX49b [IF TX49a = 1] How old were you when you first received treatment or counseling for your drug use?
_____________[RANGE: 1-110]
DK/REF
TX50 [IF TX03 = 2] Earlier you reported that you received treatment or counseling for your drug use during the past 12 months. How old were you when you first received treatment or counseling for your drug use?
_____________[RANGE: 1-110]
DK/REF
TX50a [IF TX03 = 2 AND (AL01 = 1 OR ALREF = 1)] Have you ever received treatment or counseling for your alcohol use?
1 Yes
2 No
DK/REF
TX50b [IF TX50a = 1] How old were you when you first received treatment or counseling for your alcohol use?
_____________[RANGE: 1-110]
DK/REF
TX51 [IF TX03=3] Earlier, you reported that you received treatment or counseling for your drug and alcohol use during the past 12 months. How old were you when you first received treatment or counseling for your use of alcohol?
_____________[RANGE: 1-110]
DK/REF
TX51a [IF TX03=3] How old were you when you first received treatment or counseling for your drug use?
_____________[RANGE: 1-110]
DK/REF
TX52 [IF (TX01 NE BLANK) AND (TX04h NE 1)] The next question is about self-help groups. Some examples of self-help groups for alcohol or drug use are AA or Alcoholics Anonymous, NA or Narcotics Anonymous, CA or Cocaine Anonymous, and CMA or Crystal Meth Anonymous.
During the past 12 months, did you go to any self-help group meetings or 12-step programs to receive help for your own use of alcohol or any drug, not counting cigarettes?
Yes
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
TX53 [IF TX52 = 1] Did you go to the self-help group because of your alcohol use only, your drug use only, or because of both alcohol and drug use?
Alcohol use only
Drug use only
Both alcohol and drug use
DK/REF
HLTHINT These next questions are about your health and health care.
Press [ENTER] to continue.
HLTH02 [IF QD01 = 9 AND CURNTAGE = 12 - 44] Are you currently pregnant?
1 Yes
2 No
DK/REF
HLTH03 [IF HLTH02 = 1] How many months pregnant are you?
# OF MONTHS: ________ [RANGE: 1 - 9]
DK/REF
HLTH04 This question asks about your height.
To answer in feet and inches, press 1. To answer in meters and centimeters, press 2. To answer in inches only, press 3. To answer in centimeters only, press 4. Then press [ENTER] to continue.
I would rather answer in feet and inches
I would rather answer in meters and centimeters
I would rather answer only in inches
I would rather answer only in centimeters
DK/REF
HLTH05 [IF HLTH04=1] About how tall are you, without shoes? First, please type in the number of feet, then press [ENTER].
______feet [RANGE: 2-8]
DK/REF
HLTH06a [IF HLTH04 = 1 AND HLTH05 NE DK/RF] Please type in the number of inches and then press [ENTER].
______inch(es) [RANGE: 0-11.]
DK/REF
HLTH06b (IF HLTH04 = 3) About how tall are you, without shoes? Please type in the number of inches and then press [ENTER].
______inch(es) [RANGE: 24-96]
DK/REF
HLTH07 [IF HLTH04=2] About how tall are you, without shoes? First, please type in the number of meters, then press [ENTER].
_______ meters [RANGE: 0-2]
DK/REF
HLTH08a [IF HLTH04 = 2 AND HLTH07 NE DK/REF] Please type in the number of centimeters and then press [ENTER].
______centimeter(s) [RANGE: 0-99. ]
DK/REF
HLTH08b (IF HLTH04 = 4) About how tall are you, without shoes? Please type in the number of centimeters and then press [ENTER].
______centimeter(s) [RANGE: 60-250]
DK/REF
HLTH09 The next question asks about your weight.
To answer in pounds, press 1. To answer in kilograms, press 2. Then press [ENTER] to continue.
I would rather answer in pounds
I would rather answer in kilograms
DK/REF
HLTH10 [IF HLTH09=1 AND HLTH02 NE 1] About how much do you weigh? Please type in the number of pounds and then press [ENTER].
________pounds [RANGE: 40-999]
DK/REF
HLTH12 [IF HLTH09=2 AND HLTH02 NE 1] About how much do you weigh? Please type in the number of kilograms and then press [ENTER].
_______ kilograms [RANGE: 18.00-999.00]
DK/REF
HLTH13 [IF HLTH02=1 AND HLTH09=1] About how much did you weigh before you got pregnant? Please type in the number of pounds and then press [ENTER].
________pounds [RANGE: 40-999]
DK/REF
HLTH14 [IF HLTH02=1 AND HLTH09 =2] About how much did you weigh before you got pregnant? Please type in the number of kilograms and then press [ENTER].
_______ kilograms [RANGE: 18.00-999.00]
DK/REF
HLTH16 During the past 12 months, that is, since [DATEFILL], how many different times have you been treated in an emergency room for any reason?
# OF TIMES: ____________ [RANGE: 0 - 90]
DK/REF
SHOW 12-MONTH CALENDAR
HLTH17 During the past 12 months, have you stayed overnight or longer as an inpatient in a hospital?
1 Yes
2 No
DK/REF
SHOW 12-MONTH CALENDAR
HLTH18 [IF HLTH17 = 1] During the past 12 months, how many nights were you an inpatient in a hospital?
# OF NIGHTS: [RANGE: 1 - 366]
SHOW 12-MONTH CALENDAR
HLTH19 During the past 12 months, how many times have you visited a doctor, nurse, physician assistant or nurse practitioner about your own health at a doctor’s office, a clinic, or some other place?
NUMBER OF VISITS: [(RANGE: 0 - 366)]
DK/REF
SHOW 12-MONTH CALENDAR
HLTH19DK [IF HLTH19=DK/REF] What is your best guess of how many times you have visited a doctor, nurse, physician assistant or nurse practitioner about your own health at a doctor’s office, a clinic, or some other place in the past 12 months?
0. I have not visited a health care professional in the past 12 months
1. 1 time
2. 2-3 times
3. 4-5 times
4. 6-7 times
5. 8-9 times
6. 10-12 times
7. 13-15 times
8. 16 or more times
DK/REF
SHOW 12-MONTH CALENDAR
TELEHLTH During the past 12 months, have you talked to a doctor, physician assistant, or nurse practitioner about your own health over the phone, by email, or through video calling instead of going to an in-person appointment?
1 Yes
2 No
DEFINE VISITFILL:
IF HLTH16=1 THEN VISITFILL= “your visit to the Emergency Room”
IF HLTH16>1 THEN VISITFILL = “your visits to the Emergency Room”
IF HLTH17=1 THEN VISITFILL= “your hospitalization’
IF HLTH19=1 OR HLTH19DK=1 THEN VISITFILL = “the talk you had with a doctor or other health care professional”
IF HLTH19>1 OR HLTH19DK>1 THEN VISITFILL = “the talks you had with a doctor or other health care professional”
HLTH20 [IF HLTH16>0 OR HLTH17=1 OR HLTH19>0 OR HLTH19DK>0] During the past 12 months, did any doctor or other health care professional ask, either in person or on a form, if you:
a. Smoke cigarettes or use any other tobacco products? 1. Yes 2. No DK/REF
b. Drink alcohol? 1. Yes 2. No DK/REF
c. Use marijuana or other illegal drugs? 1. Yes 2. No DK/REF
HLTH21 [(IF HLTH16>0 OR HLTH17=1 OR HLTH19>0 OR HLTH19DK>0) AND (CG05 = 1 OR CG06=1 OR CG06DK=1 OR CG06RE=1 OR CG27=1 OR CG28=1 OR CG28DK=1 OR CG28RE=1 OR CG36=1 OR CG37=1 OR CG37DK=1 OR CG37RE=1 OR CG43=1)] During the past 12 months, did any doctor or other health care professional advise you to quit smoking cigarettes or quit using any other tobacco products?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
HLTH22 [((IF HLTH16>=1 AND (HLTH17=1 OR HLTH19>=1 OR HLTH19DK>=1)) OR (HLTH17=1 AND (HLTH16>=1 OR HLTH19>=1 OR HLTH19DK>=1)) OR ((HLTH19>=1 OR HLTH19DK>=1) AND (HLTH16>=1 OR HLTH17=1))) AND (ALLAST3=1 OR 2 OR ALRECDK=1 OR 2 OR ALRECRE=1 OR 2)] Please think about all of the talks you have had with a doctor or other health care professional during the past 12 months when you answer this question. Choose the statement or statements below that describe any discussions you may have had in person with a doctor or other health professional about your alcohol use.
[((IF HLTH16>=1 AND HLTH17 NE 1 AND HLTH19<1 AND HLTH19DK<1) OR (HLTH17 =1 AND HLTH16 = 0 AND HLTH19<1 AND HLTH19DK<1) OR ((HLTH19 >=1 OR HLTH19DK>=1) AND HLTH16 = 0 AND HLTH17 NE 1)) AND (ALLAST3=1 OR 2 OR ALRECDK=1 OR 2 OR ALRECRE=1 OR 2)] Please think about [VISITFILL] during the past 12 months when you answer this question. Choose the statement or statements below that describe any discussion you may have had in person with a doctor or other health professional about your alcohol use.
To select more than one statement, press the space bar between each number you type. When you have finished, press [ENTER].
The doctor asked how much I drink.
The doctor asked how often I drink.
The doctor asked if I have any problems because of my drinking.
The doctor advised me to cut down on my drinking.
The doctor offered to give me more information about alcohol use and treatment for problems with alcohol use.
The doctor didn’t discuss my alcohol use with me in the past 12 months.
DK/REF
HARD ERROR: [IF 95 AND AT LEAST ONE IN (1-5) SELECTED]: You have entered “The doctor didn’t discuss my alcohol use with me in the past 12 months,” but you have also entered one or more statements from the list. Press [Enter] to answer the question again.
HLTH23 [(IF HLTH16>0 OR HLTH17=1 OR HLTH19>0 OR HLTH19DK>0) AND [(MJLAST3=1 OR 2 OR MJRECDK=1 OR 2 OR MJRECRE=1 OR 2) OR COC12MON=1 OR CRK12MON=1 OR HER12MON=1 OR INH12MON = 1 OR HAL12MON = 1 OR MET12MON=1] During the past 12 months, did any doctor or other health care professional talk to you about your use of [FILLMARIJUANA/COCAINE/CRACK/HEROIN/ INHALANTS / HALLUCINOGENS/METHAMPHETAMINE]?
PROGRAMMERS: SEPARATE MULTIPLE FILLS WITH AN ‘OR’
1 Yes
2 No
DK/REF
HLTH24 These next questions are about certain medical conditions.
During the past 12 months, did you have a sexually transmitted disease such as chlamydia, gonorrhea, herpes or syphilis?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
HLTH25 Below is a list of health conditions that you may have had during your lifetime.
Please read the list and type in the numbers of all of the conditions that a doctor or other health care professional has ever told you that you had.
To select more than one condition, press the space bar between each number you type. When you have finished, press [ENTER].
Any kind of heart condition or heart disease
Diabetes or sugar diabetes
Chronic bronchitis, emphysema, chronic obstructive pulmonary disease, also called COPD
Cirrhosis of the liver
Hepatitis B or C
Kidney disease, not including bladder infection or incontinence
Asthma
HIV or AIDS
Cancer or a malignancy of any kind
Hypertension, also called high blood pressure
95 None of the above - I have never had any of these conditions
DK/REF
HARD ERROR: [IF 95 AND AT LEAST ONE IN (1-10) SELECTED]: You have entered “I have never had any of these conditions,” but you have also entered one or more health conditions from the list. Press [ENTER] to answer the question again.
DEFINE NONCACOUNT:
INITIALIZE NONCACOUNT TO 0.
ADD 1 TO NONCACOUNT FOR EVERY RESPONSE OF 1 TO 8 OR 10 IN HLTH25.
DEFINE NONCAFILL:
NONCAFILL LISTS SPECIFIC HEALTH CONDITIONS OTHER THAN CANCER WHEN ONLY 1 OTHER CONDITION BESIDES CANCER WAS REPORTED.
IF HLTH25=9 AND HLTH25=1 AND NONCACOUNT=1 THEN NONCAFILL = “your heart condition or heart disease”
ELSE IF HLTH25=9 AND HLTH25=2 AND NONCACOUNT=1 THEN NONCAFILL = “your diabetes or sugar diabetes”
ELSE IF HLTH25=9 AND HLTH25=3 AND NONCACOUNT=1 THEN NONCAFILL = “your chronic bronchitis, emphysema, or chronic obstructive pulmonary disease, also called COPD”
ELSE IF HLTH25=9 AND HLTH25=4 AND NONCACOUNT=1 THEN NONCAFILL = “your cirrhosis of the liver”
ELSE IF HLTH25=9 AND HLTH25=5 AND NONCACOUNT=1 THEN NONCAFILL = “your hepatitis”
ELSE IF HLTH25=9 AND HLTH25=6 AND NONCACOUNT=1 THEN NONCAFILL = “your kidney disease”
ELSE IF HLTH25=9 AND HLTH25=7 AND NONCACOUNT=1 THEN NONCAFILL = “your asthma”
ELSE IF HLTH25=9 AND HLTH25=8 AND NONCACOUNT=1 THEN NONCAFILL = “your HIV or AIDS”
ELSE IF HLTH25=9 AND HLTH25=10 AND NONCACOUNT=1 THEN NONCAFILL = “your high blood pressure”
ELSE IF HLTH25=9 AND NONCACOUNT >1 THEN NONCAFILL = “the other health conditions you reported”
HLTH26 [IF HLTH25=9] What kind of cancer was it? Enter all that apply.
To select more than one category, press the space bar between the numbers. When you have finished, press [ENTER].
Bladder
Blood
Bone
Brain
Breast
[IF QD01 = 9] Cervix
Colon
Esophagus
Gallbladder
Kidney
Larynx/windpipe
Leukemia
Liver
Lung
Lymphoma
Melanoma
Mouth/tongue/lip
[IF QD01 = 9] Ovary
Pancreas
[IF QD01 = 5] Prostate
Rectum
Skin (not melanoma)
Skin (don’t know which kind)
Soft tissue (muscle or fat)
Stomach
[IF QD01 = 5] Testis
Throat/pharynx
Thyroid
[IF QD01 = 9] Uterus
Other
HLTH26othr [IF HLTH26=30] Please tell me which other kind of cancer you had.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN HTLH26othr.
HLTH27 [IF HLTH26=1] How old were you when your bladder cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH27 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28a [IF HLTH26=2] How old were you when your blood cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28a > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28b [IF HLTH26=3] How old were you when your bone cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28b > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28c [IF HLTH26=4] How old were you when your brain cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28c > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28d [IF HLTH26=5] How old were you when your breast cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28d > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28e [IF HLTH26=6] How old were you when your cervical cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28e > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28f [IF HLTH26=7] How old were you when your colon cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28f > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28g [IF HLTH26=8] How old were you when your esophageal cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28g > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28h [IF HLTH26=9] How old were you when your gallbladder cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28h > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28i [IF HLTH26=10] How old were you when your kidney cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28i > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28j [IF HLTH26=11] How old were you when your larynx/windpipe cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28j > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28k [IF HLTH26=12] How old were you when your leukemia was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28k > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28l [IF HLTH26=13] How old were you when your liver cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28l > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28m [IF HLTH26=14] How old were you when your lung cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28m > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28n [IF HLTH26=15] How old were you when your lymphoma was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28n > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28o [IF HLTH26=16] How old were you when your melanoma was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28o > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28p [IF HLTH26=17] How old were you when your mouth/tongue/lip cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28p > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28q [IF HLTH26=18] How old were you when your ovarian cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28q > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28r [IF HLTH26=19] How old were you when your pancreatic cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28r > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28s [IF HLTH26=20] How old were you when your prostate cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28s > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28t [IF HLTH26=21] How old were you when your rectal cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28t > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28u [IF HLTH26=22] How old were you when your skin [not melanoma] cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28u > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28v [IF HLTH26=23] How old were you when your skin cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28v > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28w [IF HLTH26=24] How old were you when your soft tissue cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28w > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28x [IF HLTH26=25] How old were you when your stomach cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28x > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28y [IF HLTH26=26] How old were you when your testicular cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28y > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28z [IF HLTH26=27] How old were you when your throat/pharynx cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28z > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28aa [IF HLTH26=28] How old were you when your thyroid cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28aa > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28bb [IF HLTH26=29] How old were you when your uterine cancer was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28bb > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH28cc [IF HLTH26=30] How old were you when the type of cancer listed below was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
[FILL HLTH26othr]
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH28cc > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH29 [IF HLTH25=9 AND HLTH27 AND HLTH28a AND HLTH28b AND HLTH28c AND HLTH28c AND HLTH28d AND HLTH28e AND HLTH28f AND HLTH28g AND HLTH28h AND HLTH28i AND HLTH28j AND HLTH28k AND HLTH28l AND HLTH28m AND HLTH28n AND HLTH28o AND HLTH28p AND HLTH28q AND HLTH28r AND HLTH28s AND HLTH28t AND HLTH28u AND HLTH28v AND HLTH28w AND HLTH28x AND HLTH28y AND HLTH28z AND HLTH28aa AND HLTH28bb AND HLTH28cc NE CALCAGE] Did you have cancer during the past 12 months?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
HLTHOTHint [IF HLTH25=9 AND (NONCACOUNT > 1 OR (NONCACOUNT = 1 AND (NONCAFILL = “your heart condition or heart disease” OR NONCAFILL = “your asthma” OR NONCAFILL = “your high blood pressure”))] The next questions are about [NONCAFILL].
[IF HLTH25=9 AND NONCACOUNT = 1 AND NONCAFILL NE “your heart condition or heart disease” AND NONCAFILL NE “your asthma” AND NONCAFILL NE “your high blood pressure”] The next question is about [NONCAFILL].
Press [ENTER] to continue.
HLTH30 [IF HLTH25=1] How old were you when your heart condition or heart disease was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH30 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH31 [IF HLTH25=1 AND HLTH30 NE CALCAGE] Did you have any kind of heart condition or heart disease in the past 12 months?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
HLTH32 [IF HLTH25=2] How old were you when your diabetes or sugar diabetes was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH32 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH33 [IF HLTH25=3] How old were you when your chronic bronchitis, emphysema, or chronic obstructive pulmonary disease, also called COPD were first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH33 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH34 [IF HLTH25=4] How old were you when your cirrhosis of the liver was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH34 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH35 [IF HLTH25=5] How old were you when your hepatitis was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH35 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH36 [IF HLTH25=6] How old were you when your kidney disease was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH36 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH37 [IF HLTH25=7] How old were you when your asthma was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH37 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH38 [IF HLTH25=7] Do you still have asthma?
1 Yes
2 No
DK/REF
HLTH39 [IF HLTH25=8] How old were you when you found out you had HIV/AIDS?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH39 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
HLTH40 [IF HLTH25=10] Are you currently taking prescription medicine for your high blood pressure?
1 Yes
2 No
DK/REF
HLTH41 [IF HLTH40=1] How old were you when your high blood pressure was first diagnosed?
If you were first diagnosed before you were 1 year old, please enter 1.
Age: _____________________ [RANGE: 1-CURNTAGE]
DK/REF
HARD ERROR: [HLTH41 > CURNTAGE] The age you entered when you were first diagnosed is older than your current age. Press [Enter] to answer the question again.
(Questions Administered only to respondents 18 or older)
ADINTRO [IF CURNTAGE = 18 OR OLDER] These next questions are about treatment and counseling for problems with emotions, nerves or mental health. [IF TX01 = 1 OR DK/REF] Please do not include treatment for alcohol or drug use.
Press [ENTER] to continue.
ADMT01 [IF CURNTAGE = 18 OR OLDER] During the past 12 months, have you stayed overnight or longer in a hospital or other facility to receive treatment or counseling for any problem you were having with your emotions, nerves, or mental health? [IF TX01 = 1 OR DK/REF] Please do not include treatment for alcohol or drug use.
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMTREF1 [IF ADMT01 = REF] The answers that people give us about mental health treatment are important to this study’s success. We know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: During the past 12 months, have you stayed overnight or longer in a hospital or other facility to receive treatment or counseling for any problem you were having with your emotions, nerves, or mental health? [IF TX01 = 1 OR DK/REF] Please do not include treatment for alcohol or drug use.
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT02 [IF ADMT01 = 1 OR ADMTREF1 = 1] Where did you stay overnight or longer to receive mental health treatment or counseling during the past 12 months?
To select more than one place, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 A private or public psychiatric hospital
2 A psychiatric unit of a general hospital
3 A medical unit of a general hospital
4 Another type of hospital
5 A residential treatment center
6 Some other type of facility
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT04 [IF ADMT02 = 1] During the past 12 months, how many nights did you spend in a private or public psychiatric hospital for mental health care?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT05 [IF ADMT02 = 2] During the past 12 months, how many nights did you spend in the psychiatric unit of a general hospital for mental health care?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT06 [IF ADMT02 = 3] During the past 12 months, how many nights did you spend in the medical unit of a general hospital for mental health care?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT07 [IF ADMT02 = 4] During the past 12 months, how many nights did you spend in some other type of hospital for mental health care?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT08 [IF ADMT02 = 5] During the past 12 months, how many nights did you spend in a residential treatment center for mental health care?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT09 [IF ADMT02 = 6] During the past 12 months, how many nights did you spend in some other type of facility for mental health care?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT10 [IF ADMT02 NE BLANK] Who paid or will pay for the inpatient mental health care you received during the past 12 months?
To select more than one answer, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 Self or a family member living with you
2 A family member who does not live with you
3 Private health insurance
4 Medicare
5 Medicaid
6 Rehabilitation program
7 Employer
8 VA or other military program
9 Other public source
10 Other private source
11 No one paid because the treatment was free
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT11 [IF MORE THAN 1 RESPONSE SELECTED IN ADMT10 AND ADMT02 NE DK/REF] Who paid or will pay most of the cost for the inpatient mental health care you received during the past 12 months?
Please select only one answer from those that are shown in blue below.
[NOTE TO PROGRAMMERS: RESPONSES CHOSEN IN ADMT10 SHOULD BE SHOWN IN BLUE. IMPLEMENT AN ERROR MESSAGE IF THE RESPONDENT SELECTS ONE OF THE OTHER RESPONSES.]
1 Self or a family member living with you
2 A family member who does not live with you
3 Private health insurance
4 Medicare
5 Medicaid
6 Rehabilitation program
7 Employer
8 VA or other military program
9 Other public source
10 Other private source
11 No one paid because the treatment was free
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT12 [IF ADMT10 = 1 AND ADMT02 NE DK/REF] How much did you or your family pay for the inpatient mental health care you received during the past 12 months? Do not count any money that has been or will be reimbursed by insurance or any other source.
[IF ADMT10 = 2 AND NE 1 AND ADMT02 NE DK/REF] How much did your family pay for the inpatient mental health care you received during the past 12 months? Do not count any money that has been or will be reimbursed by insurance or any other source.
1 Less than $100
2 $100 to $200
3 $201 to $500
4 $501 to $900
5 $901 to $1,500
6 $1,501 to $2,000
7 $2,001 to $5,000
8 $5,001 to $7,500
9 $7,501 to $10,000
10 More than $10,000
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT13 [IF CURNTAGE = 18 OR OLDER] The list below includes some of the places where people can get outpatient treatment or counseling for problems with their emotions, nerves, or mental health.
During the past 12 months, did you receive any outpatient treatment or counseling for any problem you were having with your emotions, nerves, or mental health at any of the places listed below? [IF TX01 = 1 OR DK/REF] Please do not include treatment for alcohol or drug use.
• An outpatient mental health clinic or center
• The office of a private therapist, psychologist, psychiatrist, social worker, or counselor that was not part of a clinic
• A doctor’s office that was not part of a clinic
• An outpatient medical clinic
• A partial day hospital or day treatment program
• Some other place
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMTREF13 [IF ADMT13 = REF] The answers that people give us about mental health treatment are important to this study’s success. We know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: During the past 12 months, did you receive any outpatient treatment or counseling for any problem you were having with your emotions, nerves, or mental health at any of the places listed below? [IF TX01 = 1 OR DK/REF] Please do not include treatment for alcohol or drug use.
• An outpatient mental health clinic or center
• The office of a private therapist, psychologist, psychiatrist, social worker, or counselor that was not part of a clinic
• A doctor’s office that was not part of a clinic
• An outpatient medical clinic
• A partial day hospital or day treatment program
• Some other place
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT14 [IF ADMT13 = 1 OR ADMTREF13 = 1] Where did you receive outpatient mental health treatment or counseling during the past 12 months?
To select more than one place, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 An outpatient mental health clinic or center
2 The office of a private therapist, psychologist, psychiatrist, social worker, or counselor that was not part of a clinic
3 A doctor’s office that was not part of a clinic
4 An outpatient medical clinic
5 A partial day hospital or day treatment program
6 Some other place
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT15 [IF ADMT14 = 6] Please type in a description of this other place where you received outpatient mental health treatment or counseling. When you have finished, press the [ENTER] key to go to the next question.
________________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN ADMT15.
ADMT16 [IF ADMT14 = 1] During the past 12 months, how many visits did you make to an outpatient mental health clinic or center for mental health care?
# OF VISITS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT17 [IF ADMT14 = 2] During the past 12 months, how many outpatient visits did you make to a private therapist, psychologist, psychiatrist, social worker, or counselor for mental health care?
# OF VISITS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT18 [IF ADMT14 = 3] During the past 12 months, how many outpatient visits did you make to a doctor’s office for mental health care?
# OF VISITS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT19 [IF ADMT14 = 4] During the past 12 months, how many outpatient visits did you make to an outpatient medical clinic for mental health care?
# OF VISITS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT20 [IF ADMT14 = 5] During the past 12 months, how many outpatient visits did you make to a partial day hospital or day treatment program for mental health care?
# OF VISITS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT21 [IF ADMT14 = 6] During the past 12 months, how many outpatient visits did you make to some other type of facility for mental health care?
# OF VISITS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT22 [IF ADMT14 NE BLANK] Who paid or will pay for the outpatient mental health care you received during the past 12 months?
To select more than one answer, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 Self or a family member living with you
2 A family member who does not live with you
3 Private health insurance
4 Medicare
5 Medicaid
6 Rehabilitation program
7 Employer
8 VA or other military program
9 Other public source
10 Other private source
11 No one paid because the treatment was free
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT23 [IF MORE THAN 1 RESPONSE SELECTED IN ADMT22 AND ADMT14 NE DK/REF] Who paid or will pay most of the cost for the outpatient mental health care you received during the past 12 months?
Please select only one answer from those that are shown in blue below.
[NOTE TO PROGRAMMERS: RESPONSES CHOSEN IN ADMT22 SHOULD BE SHOWN IN BLUE. IMPLEMENT AN ERROR MESSAGE IF THE RESPONDENT SELECTS ONE OF THE OTHER RESPONSES.]
1 Self or a family member living with you
2 A family member who does not live with you
3 Private health insurance
4 Medicare
5 Medicaid
6 Rehabilitation program
7 Employer
8 VA or other military program
9 Other public source
10 Other private source
11 No one paid because the treatment was free
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT24 [IF ADMT22 = 1 AND ADMT14 NE DK/REF] How much did you or your family pay for the outpatient mental health care you received during the past 12 months? Do not count any money that has been or will be reimbursed by insurance or any other source.
[IF ADMT22 = 2 AND NE 1 AND ADMT14 NE DK/REF] How much did your family pay for the outpatient mental health care you received during the past 12 months? Do not count any money that has been or will be reimbursed by insurance or any other source.
1 Less than $100
2 $100 to $200
3 $201 to $500
4 $501 to $900
5 $901 to $1,500
6 $1,501 to $2,000
7 $2,001 to $5,000
8 More than $5,000
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ATXMHTEL [IF CURNTAGE = 18 OR OLDER] During the past 12 months have you received any professional counseling, medication or treatment for your mental health, emotions, or behavior over the phone, by email, or through video calling?
1 Yes
2 No
DK/REF
ADMT25 [IF CURNTAGE = 18 OR OLDER] During the past 12 months, did you take any prescription medication that was prescribed for you to treat a mental or emotional condition?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMTREF25 [IF ADMT25 = REF] The answers that people give us about their use of prescription medications are important to this study’s success. We know that this information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: During the past 12 months, did you take any prescription medication that was prescribed for you to treat a mental or emotional condition?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT26 [IF CURNTAGE = 18 OR OLDER] During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn’t get it?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT27 [IF ADMT26 = 1] Which of these statements explain why you did not get the mental health treatment or counseling you needed?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press [ENTER].
1 You couldn’t afford the cost.
2 You were concerned that getting mental health treatment or counseling might cause your neighbors or community to have a negative opinion of you.
3 You were concerned that getting mental health treatment or counseling might have a negative effect on your job.
4 Your health insurance does not cover any mental health treatment or counseling.
5 Your health insurance does not pay enough for mental health treatment or counseling.
6 You did not know where to go to get services.
7 You were concerned that the information you gave the counselor might not be kept confidential.
8 You were concerned that you might be committed to a psychiatric hospital or might have to take medicine.
9 Some other reason or reasons.
DK/REF
ADMT27A [IF ANY ENTRY IN ADMT27 = 9] Which of these statements explain why you did not get the mental health treatment or counseling you needed?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press [ENTER].
1 You didn't think you needed treatment at the time.
2 You thought you could handle the problem without treatment.
3 You didn't think treatment would help.
4 You didn't have time (because of job, childcare, or other commitments).
5 You didn't want others to find out that you needed treatment.
6 You had no transportation, or treatment was too far away, or the hours were not convenient.
7 Some other reason or reasons.
DK/REF
ADMT27SP [IF ADMT27A = 7] Please type in the most important other reason you did not get the mental health treatment or counseling you needed. When you have finished, press the [ENTER] key to go to the next question.
__________________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN ADMT27SP.
ADMT29a [IF CURNTAGE = 18 OR OLDER] Earlier, we asked whether you have received prescription medicines, inpatient treatment or outpatient treatment for your emotions, nerves or mental health. The list below contains possible sources of treatment, counseling or support that were not mentioned before.
Acupuncturist or acupressurist
Chiropractor
Herbalist
In-person support group or self-help group
Internet support group or chat room
Spiritual or religious advisor, such as a pastor, priest, rabbi
Telephone hotline
Massage therapist
Did you receive treatment, counseling or support from any other sources such as these during the past 12 months?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT29b [IF ADMT29a = 1] From what source did you receive other treatment, counseling or support for problems with your emotions, nerves or mental health in the past 12 months?
To select more than one source from the list, press the space bar between each number you type. When you have finished, press [ENTER].
1 Acupuncturist or acupressurist
2 Chiropractor
3 Herbalist
4 In-person support group or self-help group
5 Internet support group or chat room
6 Spiritual or religious advisor, such as a pastor, priest, rabbi
7 Telephone hotline
8 Massage therapist
9 Other (specify)
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ADMT29bSP [IF ADMT29b = 9] Please type in the source of the other treatment, counseling or support you received. When you have finished, press the [ENTER] key to go to the next question.
____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN ADMT29bSP.
ADMT30 [IF ADMT01 = 1 OR ADMTREF1 = 1 OR ADMT13 = 1 OR ADMTREF13 = 1 OR ADMT25 = 1 OR ADMTREF25 = 1 OR ADMT29a=1] Please think about the mental health treatment or counseling you received during the past 12 months. Which of these statements best describes how you were prompted to get treatment?
I decided on my own to get treatment
I got treatment mainly because someone else thought I should
I was ordered to get treatment
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
(Section Administered to 12 - 17 Year Old Respondents Only)
INTROYSU [IF CURNTAGE = 12 - 17] These next questions are about treatment and counseling for problems with your behaviors or emotions that were not caused by alcohol or drugs.
Press [ENTER] to continue.
YSU01 [IF CURNTAGE = 12 - 17] During the past 12 months, have you stayed overnight or longer in any type of hospital to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU02 [IF YSU01 = 1] During the past 12 months, how many nights altogether did you stay in a hospital to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU03 [IF YSU01 = 1] Think about the last time you stayed overnight or longer in a hospital to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason you were admitted there?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU03a [IF ANY ENTRY IN YSU03 = 6] What was the other emotional or behavioral problem for which you last stayed overnight in a hospital?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU03SP [IF ANY ENTRY IN YSU03a = 7] Please type in the most important other reason for your last overnight stay in a hospital to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_______________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU03SP.
YSU04 [IF CURNTAGE = 12 - 17] During the past 12 months, did you stay overnight or longer in a residential treatment center to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU05 [IF YSU04=1] During the past 12 months, how many nights altogether did you stay in a residential treatment center to receive treatment for emotional or behavioral problems that were not caused by alcohol or drugs?
# OF NIGHTS: _________ [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU06 [IF YSU04=1] Think about the last time you stayed overnight or longer in a residential treatment center to receive treatment for emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason you were admitted there?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU06a [IF ANY ENTRY IN YSU06 = 6] What was the other emotional or behavioral problem for which you last stayed overnight in a residential treatment center?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU06SP [IF ANY ENTRY IN YSU06a=7] Please type in the most important other reason for your last overnight stay in a residential treatment center to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU06SP.
YSU07 [IF CURNTAGE = 12 - 17] During the past 12 months, did you stay overnight or longer in foster care or in a therapeutic foster care home because you had emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU08 [IF YSU07 = 1] During the past 12 months, how many nights altogether did you stay in foster care or in a therapeutic foster care home because you had emotional or behavioral problems that were not caused by alcohol or drugs?
# OF NIGHTS: _________ [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU09 [IF YSU07=1] Think about the last time you stayed overnight or longer in foster care or in a therapeutic foster care home because you had emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason you were placed there?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU09a [IF ANY ENTRY IN YSU09 = 6] What was the other emotional or behavioral problem for which you last stayed overnight or longer in foster care or a therapeutic foster care home?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU09SP [IF ANY ENTRY IN YSU09a =7] Please type in the most important other reason for your last overnight stay in foster care or in a therapeutic foster care home to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU09SP.
YSU10 [IF CURNTAGE = 12 - 17] During the past 12 months, did you receive treatment or counseling at a partial day hospital or day treatment program because you had problems with your behavior or emotions that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU11 [IF YSU10 = 1] During the past 12 months, how many times did you visit a partial day hospital or day treatment program because you had emotional or behavioral problems that were not caused by alcohol or drugs?
# OF TIMES: _________ [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU12 [IF YSU10 =1] Think about the last time you visited a partial day hospital or day treatment program because you had emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason for your visit?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU12a [IF ANY ENTRY IN YSU12 = 6] What was the other emotional or behavioral problem for which you last visited a partial day hospital or day treatment program?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU12SP [IF ANY ENTRY IN YSU12a =7] Please type in the most important other reason for your last visit to a partial day hospital or day treatment program to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU12SP.
YSU13 [IF CURNTAGE = 12 - 17] During the past 12 months, did you receive treatment or counseling at a mental health clinic or center because you had problems with your behavior or emotions that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU14 [IF YSU13 = 1] During the past 12 months, how many times did you visit a mental health clinic or center to receive treatment or counseling because you had emotional or behavioral problems that were not caused by alcohol or drugs?
# OF TIMES: _________ [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU15 [IF YSU13 =1] Think about the last time you visited a mental health clinic or center to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason for your visit?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU15a [IF ANY ENTRY IN YSU15 = 6] What was the other emotional or behavioral problem for which you last visited a mental health clinic or center?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU15SP [IF ANY ENTRY IN YSU15a =7] Please type in the most important other reason for your last visit to a mental health clinic or center to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU15SP.
YSU16 [IF CURNTAGE = 12 - 17] During the past 12 months, did you receive treatment or counseling from a private therapist, psychologist, psychiatrist, social worker, or counselor for emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU17 [IF YSU16 = 1] During the past 12 months, how many times did you receive treatment or counseling from a private therapist, psychologist, psychiatrist, social worker, or counselor for emotional or behavioral problems that were not caused by alcohol or drugs?
# OF TIMES: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU18 [IF YSU16 = 1] Think about the last time you visited a private therapist, psychologist, psychiatrist, social worker, or counselor to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason for your visit?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU18a [IF ANY ENTRY IN YSU18 = 6] What was the other emotional or behavioral problem for which you last visited a private therapist, psychologist, psychiatrist, social worker or counselor?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU18SP [IF ANY ENTRY IN YSU18a =7] Please type in the most important other reason for your last visit to a private therapist, psychologist, psychiatrist, social worker, or counselor for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU18SP.
YSU19 [IF CURNTAGE = 12 -17] During the past 12 months, did you receive treatment or counseling from an in-home therapist, counselor, or family preservation worker for emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU20 [IF YSU19 = 1] During the past 12 months, how many times did you receive treatment or counseling from an in-home therapist, counselor, or family preservation worker for emotional or behavioral problems that were not caused by alcohol or drugs?
# OF TIMES: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU21 [IF YSU19 = 1] Think about the last time you saw an in-home therapist, counselor, or family preservation worker to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason for this visit?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU21a [IF ANY ENTRY IN YSU21 = 6] What was the other emotional or behavioral problem for which you last saw an in-home therapist, counselor, or family preservation worker?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU21SP [IF ANY ENTRY IN YSU21a=7] Please type in the most important other reason you last saw an in-home therapist, counselor, or family preservation worker for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU21SP.
YSU22 [IF CURNTAGE = 12 -17] During the past 12 months, did you receive treatment or counseling from a pediatrician or other family doctor for emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU23 [IF YSU22 = 1] During the past 12 months, how many times did you receive treatment or counseling from a pediatrician or other family doctor for emotional or behavioral problems that were not caused by alcohol or drugs?
# OF TIMES: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU24 [IF YSU22 = 1] Think about the last time you visited a pediatrician or other family doctor to receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason for your visit?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU24a [IF ANY ENTRY IN YSU24 = 6] What was the other emotional or behavioral problem for which you last visited a pediatrician or other family doctor?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU24SP [IF ANY ENTRY IN YSU24a=7] Please type in the most important other reason for your last visit to a pediatrician or other family doctor for emotional or behavioral problems that were not caused by alcohol or drugs. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU24SP.
YSU30 [IF CURNTAGE = 12 – 17 and YE09=1] Sometimes students get treatment or counseling through the school system. This counseling is often provided by school social workers, school psychologists or school counselors.
During the past 12 months, that is, since [DATEFILL], did you receive any treatment or counseling from a school social worker, a school psychologist, or a school counselor for emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU31 [IF YSU30 = 1] Think about the last time you talked with a school social worker, school psychologist, or school counselor about emotional or behavioral problems that were not caused by alcohol or drugs. What was the reason for your talk?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You thought about killing yourself or tried to kill yourself.
2 You felt depressed
3 You felt very afraid and tense
4 You were breaking rules and “acting out”
5 You had eating problems
6 Some other reason
DK/REF
YSU31a [IF ANY ENTRY IN YSU31 = 6] What was the other reason for your last talk with a school social worker, school psychologist or school counselor ?
To select more than one reason from the list, press the space bar between each number you type. When you have finished, press the [ENTER] key to go to the next question.
1 You had trouble controlling your anger
2 You had gotten into physical fights
3 You had problems at home or in your family
4 You had problems with your friends
5 You had problems with people other than your friends or family
6 You had problems at school
7 Some other reason
DK/REF
YSU31SP [IF ANY ENTRY IN YSU31a=7] Please type in the most important other reason for your last talk with a school social worker, school psychologist or school counselor. You do not need to give a detailed description — just a few words will be okay. When you have finished typing your answer, press the [ENTER] key to go to the next question.
_____________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN YSU31SP.
YSU32 [IF CURNTAGE = 12 – 17 AND YE09=1] At any time during the past 12 months, that is since [DATEFILL], did you attend a school for students with emotional or behavioral problems?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU33 [IF CURNTAGE = 12 – 17 and YSU32=2 or DK/ref] Regular schools sometimes provide programs for students with emotional or behavioral problems.
At any time during the past 12 months, did you participate in a school program that was just for students with emotional or behavioral problems?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU34 [IF CURNTAGE = 12 – 17 ] These next questions are about experiences with the justice system.
During the past 12 months, that is, since [DATEFILL], did you stay overnight or longer in any type of juvenile detention center, sometimes called “juvie”, prison, or jail?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU35 [IF YSU34=1] During the past 12 months, how many nights altogether did you stay in any type of juvenile detention center, prison or jail?
# OF NIGHTS: [RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YSU36 [IF YSU34 = 1] Sometimes, the court system provides treatment or counseling in juvenile detention centers, prisons or jails. These services are often provided by psychiatrists, psychologists, social workers or counselors who work for the court system.
While you were in a juvenile detention center, prison or jail during the past 12 months, did you receive treatment or counseling for emotional or behavioral problems that were not caused by alcohol or drugs?
1 Yes
2 No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
YTXMHTEL [IF CURNTAGE = 12 – 17] During the past 12 months have you received any professional counseling, medication or treatment for your mental health, emotions, or behavior over the phone, by email, or through video calling?
1 Yes
2 No
DK/REF
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | McHenry, Gretchen |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |