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pdf2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
(01) excellent,
(02) very good,
(03) good,
(04) fair, or
(05) poor?
(-8) DON'T KNOW
(-9) REFUSED
HFA2 - COMPHLTH
(01) much better now than one year ago,
(02) somewhat better now than one year ago,
(03) about the same,
(04) somewhat worse now than one year ago, or
(05) much worse now than one year ago?
(-8) DON'T KNOW
(-9) REFUSED
HFA2B - FUTRHLTH
(01) it will get much better
(02) it will get somewhat better
(03) it will not change
(04) it will get somewhat worse
(05) it will get much worse
(-8) DON'T KNOW
(-9) REFUSED
DIS1 - DISHEAR
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
DIS2 - DISSEE
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HF1
HEALTH STATUS AND FUNCTIONING QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C002, C003, C004, C005, C006), administer after PVQ.
BOX HFBEG
GENHELTH
HFA1
routing
code one
GO TO HFA1 - GENHELTH
In general, compared to other people [your/(SP's)] age, would you say that [your/his/her] health is . . .
SHOW CARD HF1
COMPHLTH
HFA2
code one
Compared to one year ago, how would you rate [your/(SP's)] health in general now?
Would you say [your/(SP's)] health is . . .
SHOW CARD HF2
FUTRHLTH
HFA2B
code one
In the next 6 months, what do you think will happen to [your/(SP's)] overall health?
Now, I would like to ask you about [your/(SP's)] health.
DISHEAR
DIS1
yes/no
[Are you/Is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?
DISSEE
DIS2
yes/no
[Are you/Is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even when wearing glasses?
BOX HF1
routing
IF P_DISTEETH=YES, GO TO DIS3-DISDECISION.
ELSE GO TO DIS2A-DISTEETH.
DISTEETH
DIS2A
yes/no
[Have you/Has (SP)] lost all of [your/his/her] upper and lower natural (permanent) teeth?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
DIS3 - DISDECISION
DISDECISION
DIS3
yes/no
Because of a physical, mental, or emotional condition, [do you/does (SP)] have serious difficulty concentrating,
remembering, or making decisions?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
DIS4 - DISWALK
DISWALK
DIS4
yes/no
[Do you/Does (SP)] have serious difficulty walking or climbing stairs?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
DIS5 - DISBATH
Page 1 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
DISBATH
DIS5
yes/no
[Do you/Does (SP)] have difficulty dressing or bathing?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
DIS6 - DISERRANDS
DISERRANDS
DIS6
yes/no
Because of a physical, mental, or emotional condition, [do you/does (SP)] have difficulty doing errands alone
such as visiting a doctor's office or shopping?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFA3 - HELMTACT
(01) none of the time,
(02) some of the time,
(03) most of the time, or
(04) all of the time?
(-8) DON'T KNOW
(-9) REFUSED
HFB1-ECHELP
(01) YES
(02) NO
(03) SP IS BLIND
(-8) DON'T KNOW
(-9) REFUSED
(01) HFB2 - ECTROUB
(02) HFB2 - ECTROUB
(03) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
(01) NO TROUBLE SEEING
(02) A LITTLE TROUBLE SEEING
(03) A LOT OF TROUBLE SEEING
(04) NO USABLE VISION
(-8) DON'T KNOW
(-9) REFUSED
(01) HFB6 - EDOCEXAM
(02) HFB6 - EDOCEXAM
(03) HFB2A - ECLEGBLI
(04) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFB6 - EDOCEXAM
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) HFB7A - EDOCTYPE
(02) BOX HFC
(-8) BOX HFB1
(-9) BOX HFB1
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
(996) BOX HFB1
(01) - (12) HFB7A - EDOCTYPE
(-8) BOX HFB1
(-9) BOX HFB1
(01) OPTOMETRIST
(02) OPHTHALMOLOGIST
(91) OTHER DOCTOR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED
(01) H7B7B - EDOCDLAT
(02) H7B7B - EDOCDLAT
(91) HFB7 - EDOCTYOS
(-8) BOX HFB1
(-9) BOX HFB1
HELMTACT
HFA3
code one
How much of the time during the past month has [your/(SP's)] health limited [your/(SP's)] social activities, like
visiting with friends or close relatives?
Would you say . . .
Next we are going to ask some questions about [your/(SP's)] vision and hearing.
ECHELP
HFB1
yes/no
[Do you/Does (SP)] wear eyeglasses or contact lenses?
ECTROUB
HFB2
code one
ECLEGBLI
HFB2A
yes/no
Which statement best describes [your/(SP's)] vision [while wearing glasses or contact lenses]... no trouble
seeing, a little trouble, a lot of trouble, or no usable vision?
[Have you/Has (SP)] been told that [you are/he is/she is] legally blind?
[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with corrective lenses, they cannot
see well enough to drive.]
[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF MONTH YEAR)?
EDOCEXAM
HFB6
yes/no
INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
[IF NEEDED: Please include any eye exams that took place during a visit that you may have already told me
about.]
BOX HFC
EDOCLAST
HFB7
routing
code one
IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFB7-EDOCLAST.
ELSE GO TO BOX HFB1.
How long has it been since [your/(SP's)] last eye examination by an eye doctor?
I have a couple of questions about [your/(SP’s)] last eye examination.
EDOCTYPE
HFB7A
code one
Was the eye examination given by an optometrist, ophthalmologist or some other type of doctor or eye care
professional?
[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry (O.D.) who diagnoses and treats visual
health problems. An ophthalmologist is a doctor of medicine (M.D.) who specializes in surgery and diseases of
the eye.]
Page 2 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
EDOCTYOS
HFB7A
OTHER (SPECIFY)
H7B7B - EDOCDLAT
(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The drops often (-8) DON'T KNOW
(-9) REFUSED
make your eyes more sensitive to bright light and may cause temporary blurry vision.]
HFB7C - ECATARAC
verbatim text
Code List
Routing
Again, thinking about [your/(SP’s)] last eye examination, were dilating drops used in [your/(SP)’s] eyes?
EDOCDLAT
HFB7B
yes/no
I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
other health professional that [you/he/she] had any of these conditions.
ECATARAC
HFB7C
yes/no
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFB7C - EGLAUCOM
Cataracts?
EGLAUCOM
HFB7C
yes/no
Glaucoma?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFB7C - ERETINOP
ERETINOP
HFB7C
yes/no
Diabetic retinopathy?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFB7C - EMACULAR
EMACULAR
HFB7C
yes/no
Macular degeneration or age-related macular degeneration, also called AMD?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HFB1A
BOX HFB1A
routing
IF ECATARAC=02/NO, GO TO BOX HFB1. ELSE GO TO HFB10 - ECCATOP.
HFB10
yes/no
[Have you/Has (SP)] ever had an operation for cataracts?
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HFB1
BOX HFB1
routing
IF HFB7C - ERETINOP = 1/Yes OR HFB7C - EMACULAR = 1/Yes, GO TO HFB11 - ELASRSUR.
ELSE GO TO HFC1 - HCHELP.
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFC1 - HCHELP
(01) HFC2 - HCTROUB
(02) HFC2 - HCTROUB
(03) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
(01) HFD1A - FOODTRBL
(02) HFC3 - HCKNOWMC
(03) HFC3 - HCKNOWMC
(04) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
ECCATOP
Laser surgery to the back of the eye, or retina, is a commonly used treatment for diabetic retinopathy and
macular degeneration.
ELASRSUR
HFB11
yes/no
[Have you/Has (SP)] ever had laser surgery to the back of either eye for one of these conditions?
[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to the front of the eye used to correct vision.]
HCHELP
HFC1
yes/no
[Do you/Does (SP)] use a hearing aid?
(01) YES
(02) NO
(03) SP IS DEAF
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
(03) A LOT OF TROUBLE HEARING
(04) DEAF
(-8) DON'T KNOW
(-9) REFUSED
HCTROUB
HFC2
code one
Which statement best describes [your/(SP's)] hearing [with a hearing aid]: no trouble hearing, a little trouble, a
lot of trouble, or deaf?
HCKNOWMC
HFC3
code one
(01) NO TROUBLE
(02) A LITTLE TROUBLE
How much trouble [do you/does (SP)] have finding out things [you need/he needs/she needs] to know about
Medicare because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you have/she (03) A LOT OF TROUBLE
(-8) DON'T KNOW
has/he has] no trouble, a little trouble, or a lot of trouble?
(-9) REFUSED
HFC4 - HCCOMDOC
code one
How much trouble [do you/does (SP)] have communicating with [your/his/her] doctor or other health
professional because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you
have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED
HFD1A - FOODTRBL
HCCOMDOC
HFC4
Page 3 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
FOODTRBL
HFD1A
code one
How much trouble [do you/does (SP)] have eating solid foods because of problems with [your/his/her] mouth or
teeth? Would you say [you have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED
HFE1 - HEIGHTFT
HEIGHTFT
HFE1
numeric
How tall [are you/is (SP)]?
(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED
HFE1 - HEIGHTIN
HEIGHTIN
HFE1
numeric
How tall [are you/is (SP)]?
(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED
HFE1 - WEIGHT
WEIGHT
HFE1
numeric
(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED
LOSTWGHT
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
EATLESWK
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFHINTRO - DIFINTRO
(01) CONTINUE
(-7) Empty
HFH1 - DIFSTOOP
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
HFH2 - DIFLIFT
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
HFH3 - DIFREACH
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
HFH4 - DIFWRITE
How much [do you/does (SP)] weigh?
[WEIGHT SHOULD BE RECORDED IN POUNDS]
[Have you/Has (SP)] lost weight in the past 6 months without trying to lose this weight?
LOSTWGHT
LOSTWGHT
yes/no
IF RESPONDENT REPORTS A WEIGHT LOSS BUT THE WEIGHT WAS GAINED BACK, CONSIDER IT AS
NO WEIGHT LOSS.
[IF NEEDED: Is [your/(SP)'s] clothing fitting more loosely?]
[Have you/Has (SP)] been eating less than usual for more than a week?
EATLESWK
EATLESWK
yes/no
DIFINTRO
HFHINTRO
no entry
IF THE RESPONDENT REPORTS THAT THEY HAVE INTENTIONALLY BEEN EATING LESS (DIETING,
FASTING, ETC.) SELECT "YES" AT THIS SCREEN
Now, I'm going to ask about how difficult it is, on average, for [you/(SP)] to do certain kinds of activities. Please
tell me for each activity whether [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of
difficulty, or [is/are] not able to do it.
SHOW CARD HF3
DIFSTOOP
HFH1
code 1
How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or kneeling? Would you say [you
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or [is/are] not able to do it?
SHOW CARD HF3
DIFLIFT
HFH2
code 1
How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as heavy as 10 pounds, like a
heavy bag of groceries?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]
SHOW CARD HF3
DIFREACH
HFH3
code 1
What about reaching or extending arms above shoulder level?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]
Page 4 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
HFH5 - DIFWALK
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused
HFH10INT - PHYSACTINTRO
(01) CONTINUE
(-7) Empty
HFH10 - VIGUNIT
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
(01) HFH10 - VIGNUM
(02) HFH10 - VIGNUM
(03) HFH10 - VIGNUM
(04) HFH10 - VIGNUM
(96) HFH11 - MODUNIT
(-8) HFH11 - MODUNIT
(-9) HFH11 - MODUNIT
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
HFH11 - MODUNIT
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
(01) HFH11 - MODNUM
(02) HFH11 - MODNUM
(03) HFH11 - MODNUM
(04) HFH11 - MODNUM
(96) HFH12 - MUSUNIT
(-8) HFH12 - MUSUNIT
(-9) HFH12 - MUSUNIT
(01) continous answer
(01) HFH12 - MUSUNIT
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
(01) HFH12 - MUSNUM
(02) HFH12 - MUSNUM
(03) HFH12 - MUSNUM
(04) HFH12 - MUSNUM
(96) HFJINTRO - MEDCONDINTRO
(-8) HFJINTRO - MEDCONDINTRO
(-9) HFJINTRO - MEDCONDINTRO
In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength or
flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?
(01) Continunous answer
HFJINTRO - MEDCONDINTRO
(01) CONTINUE
(-7) Empty
BOX HFJ1
SHOW CARD HF3
DIFWRITE
HFH4
code 1
How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping small objects?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]
SHOW CARD HF3
DIFWALK
HFH5
code 1
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]
PHYSACTINTRO HFH10INT
VIGUNIT
HFH10
no entry
quantity unit
We are interested in two types of physical activity - vigorous and moderate. Vigorous activities cause large
increases in breathing or heart rate. Moderate activities cause small increases in breathing or heart rate. First I
will ask about the vigorous activities that [you do/(SP) does].
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart
rate?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
VIGNUM
HFH10
quantity unit
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart
rate?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
MODUNIT
HFH11
quantity unit
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
MODNUM
HFH11
numeric
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?
Now I’m going to ask you about activities [you/(SP)] may do to increase [your/(SP)'s] muscle strength or
flexibility.
MUSUNIT
MUSNUM
HFH12
HFH12
quantity unit
numeric
In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength or
flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
Next, I'm going to read a list of medical conditions. [Since (LAST HF MONTH YEAR) has/Has] a doctor or other
health professional [ever] told [you/(SP)] that [you/he/she] had any of these conditions?
MEDCONDINTRO HFJINTRO
no entry
[INTERVIEWER: IF THE SP IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE
RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE SP HAS THE CONDITION.]
Page 5 of 47
2021 MCBS Community Questionnaire
Variable Name
OCARTERY
HFQ- Health Status and Functioning
MR Screen Name Question Type
Question Text/Description
BOX HFJ1
routing
IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN A PREVIOUS ROUND
(sample_person.P_OCARTERY=1), GO TO HFJ2 - OCHBP.
ELSE GO TO HFJ1 - OCARTERY.
HFJ1
yes/no
[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...
hardening of the arteries or arteriosclerosis?
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ2 - OCHBP
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ2
(02) HFJ4 - OCMYOCAR
(-8) HFJ4 - OCMYOCAR
(-9) HFJ4 - OCMYOCAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ4 - OCMYOCAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ3
(02) HFJ6 - OCCHD
(-8) HFJ6 - OCCHD
(-9) HFJ6 - OCCHD
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] [still has/still have/had/has/have...]
OCHBP
HFJ2
yes/no
hypertension, sometimes called high blood pressure?
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
BOX HFJ2
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ3 - YRHBP.
ELSE GO TO HFJ4 - OCMYOCAR.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] still
had hypertension or high blood pressure?
YRHBP
HFJ3
yes/no
OCMYOCAR
HFJ4
yes/no
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
a myocardial infarction or heart attack?
BOX HFJ3
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ5 - YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.
YRMYOCAR
HFJ5
yes/no
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (02) NO
(-8) Don't Know
myocardial infarction or heart attack?
(-9) Refused
OCCHD
HFJ6
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] angina pectoris or coronary heart disease?
BOX HFJ4
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ7 - YRCHD.
ELSE GO TO HFJ8 - OCCFAIL.
YRCHD
HFJ7
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
an episode of angina pectoris or coronary heart disease?
OCCFAIL
HFJ8
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] congestive heart failure?
YRCFAIL
BOX HFJ5
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ9 - YRCFAIL.
ELSE GO TO HFJ14 - OCHRTCND.
HFJ9
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
an episode of congestive heart failure?
HFJ6 - OCCHD
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ4
(02) HFJ8 - OCCFAIL
(-8) HFJ8 - OCCFAIL
(-9) HFJ8 - OCCFAIL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ8 - OCCFAIL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ5
(02) HFJ14 - OCHRTCND
(-8) HFJ14 - OCHRTCND
(-9) HFJ14 - OCHRTCND
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ14 - OCHRTCND
Page 6 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ8
(02) HFJ16 - OCSTROKE
(-8) HFJ16 - OCSTROKE
(-9) HFJ16 - OCSTROKE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ16 - OCSTROKE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ9
(02) HFJ17A - OCCHOLES
(-8) HFJ17A - OCCHOLES
(-9) HFJ17A - OCCHOLES
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] any other heart condition?
OCHRTCND
HFJ14
yes/no
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
the rhythm of the heartbeat, such as atrial fibrillation.]
[DO NOT RECORD THE NAME OF THE CONDITION AT THIS QUESTION.]
BOX HFJ8
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ15 - YRHRTCND.
ELSE GO TO HFJ16 - OCSTROKE.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
an episode of any other heart condition?
YRHRTCND
HFJ15
yes/no
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
the rhythm of the heartbeat, such as atrial fibrillation.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
OCSTROKE
HFJ16
yes/no
a stroke, a brain hemorrhage, or a cerebrovascular accident?
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
YRSTROKE
BOX HFJ9
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ17 - YRSTROKE.
ELSE GO TO HFJ17A - OCCHOLES.
HFJ17
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (01) YES
(02) NO
stroke, a brain hemorrhage, or a cerebrovascular accident?
(-8) Don't Know
(-9) Refused
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had high cholesterol?
OCCHOLES
HFJ17A
yes/no
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
high cholesterol?
YRCHOLES
HFJ17B
yes/no
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]
HFJ17A - OCCHOLES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFJ17B - YRCHOLES
(2) BOX HFJ29
(-8) BOX HFJ29
(-9) BOX HFJ29
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ29
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ45-BLOSWGHT.
ELSE IF be P_EVRLWGHT ^= YES THEN GO TO HFJ46-CLOSWGHT.
ELSE GO TO HFJ18 - OCCSKIN.
BOX HFJ29
BLOSWGHT
HFJ45
yes/no
To lower risk for certain diseases, [have you/ has (SP)] ever been told by a doctor or health professional to
control weight or lose weight?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ18 - OCCSKIN
CLOSWGHT
HFJ46
yes/no
(01) YES
To lower risk for certain diseases, since (SAMPLE_PERSON.DATE_FALLRND) [have you/ has (SP)] been told (02) NO
(-8) Don't Know
by a doctor or health professional to control weight or lose weight?
(-9) Refused
HFJ18 - OCCSKIN
Page 7 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ10
(02) HFJ20 - EVRCANCR
(-8) HFJ20 - EVRCANCR
(-9) HFJ20 - EVRCANCR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ20 - EVRCANCR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ11
(02) BOX HFJ13
(-8) BOX HFJ13
(-9) BOX HFJ13
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ22 - OCCCODE
(06) BLADDER
(16) BLOOD
(17) BONE
(10) BRAIN
(03) BREAST
(09) CERVIX
(02) COLON (BOWEL)
(18) ESOPHAGUS
(19) GALL BLADDER
(11) KIDNEY
(20) LARYNX (WINDPIPE)
(21) LEUKOCYTES (LEUKEMIA)
(22) LIVER
(01) LUNG
(23) LYMPH NODES (LYMPHOMA)
(24) MOUTH/TONGUE/LIP
(07) OVARY
(25) PANCREAS
(05) PROSTATE
(26) RECTUM
(27) SOFT TISSUE/FAT
(08) STOMACH
(28) TESTIS
(12) THROAT
(29) THYROID
(04) UTERUS
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX HFJ13
(02) BOX HFJ13
(03) BOX HFJ13
(04) BOX HFJ13
(05) BOX HFJ13
(06) BOX HFJ13
(07) BOX HFJ13
(08) BOX HFJ13
(09) BOX HFJ13
(10) BOX HFJ13
(11) BOX HFJ13
(12) BOX HFJ13
(16) BOX HFJ13
(17) BOX HFJ13
(18) BOX HFJ13
(19) BOX HFJ13
(20) BOX HFJ13
(21) BOX HFJ13
(22) BOX HFJ13
(23) BOX HFJ13
(24) BOX HFJ13
(25) BOX HFJ13
(26) BOX HFJ13
(27) BOX HFJ13
(28) BOX HFJ13
(29) BOX HFJ13
(91) HFJ22 - OCCOS
(-8) BOX HFJ13
(-9) BOX HFJ13
(01) [Continuous answer.]
BOX HFJ13
[I've recorded that [you/(SP)] previously reported having had skin cancer.]
OCCSKIN
HFJ18
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new occurrence of] skin cancer?
YRCSKIN
BOX HFJ10
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ19 - YRCSKIN.
ELSE GO TO HFJ20 - EVRCANCR.
HFJ19
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
an occurrence of skin cancer?
[I've recorded that [you/(SP)] previously reported having had a tumor, growth, malignancy, or cancer of the
[READ RESPONSES BELOW].]
EVRCANCR
HFJ20
yes/no
[Since (LAST HF MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had any [other] kind of cancer, malignancy, or tumor other than skin cancer?
DO NOT INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.
YRCANCER
BOX HFJ11
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - EVRCODE.
HFJ21
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
any kind of cancer, malignancy, or tumor other than skin cancer?
SHOW CARD HF4
EVRCODE
HFJ22
code all
[Since the first time a doctor or other health professional told [you/(SP)] that [you/he/she] had a cancer,
malignancy, or tumor, on/On] what part or parts of [your/(SP's)] body was the cancer or tumor other than skin
cancer found?
[PROBE: Any other part?]
CHECK ALL THAT APPLY
EVROS
HFJ22
BOX HFJ13
verbatim text
Specify the part of parts of your body where the cancer or tumor was found.
routing
IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCARTHRH=1), GO TO BOX HFJ13B.
ELSE GO TO HFJ24 - OCARTHRH.
Page 8 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
OCARTHRH
HFJ24
yes/no
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ15
(02) BOX HFJ16
(-8) BOX HFJ16
(-9) BOX HFJ16
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ14
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ15
(02) BOX HFJ16
(-8) BOX HFJ16
(-9) BOX HFJ16
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ16
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ16A
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ16B
(02) BOX HFJ16B
(-8) BOX HFJ16B
(-9) BOX HFJ16B
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ30
rheumatoid arthritis?
OCOSARTH
BOX HFJ13B
routing
HFJ24B
yes/no
IF SP HAS EVER REPORTED HAVING OSTEOARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCOSARTH=1), GO TO BOX HFJ14.
ELSE GO TO HFJ24B-OCOSARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
osteoarthritis?
BOX HFJ14
routing
IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND [sample_person.P_OCARTH=1], GO TO BOX HFJ16.
ELSE GO TO HFJ25 - OCARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(you/he/she) had...]
OCARTH
YRARTHRD
HFJ25
yes/no
BOX HFJ15
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.
HFJ26
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
arthritis, other than rheumatoid or osteoarthritis, in any part of [your/his/her] body?
BOX HFJ16
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ28 - OCMENTAL.
ELSE GO TO BOX HFJ16A.
arthritis, other than rheumatoid or osteoarthritis?
[Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had...]
OCMENTAL
HFJ28
yes/no
an intellectual disability?
[EXPLAIN IF NECESSARY:] This is also known as intellectual development disorder or a general learning
disability. It was formerly known as mental retardation.
OCALZMER
BOX HFJ16A
routing
HFJ29A
yes/no
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCALZMER=1), GO TO BOX HFJ16B.
ELSE GO TO HFJ29A - OCALZMER.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
Alzheimer's disease?
OCDEMENT
BOX HFJ16B
routing
HFJ29B
yes/no
IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS ROUND
(sample_person.P_OCDEMENT=1), GO TO BOX HFJ30
ELSE GO TO HFJ29B - OCDEMENT.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
any type of dementia other than Alzheimer's disease?
BOX HFJ30
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ47-BASKDEPRS.
ELSE IF P_EVRDPRSS ^= YES THEN GO TO HFJ48-CASKDEPRS.
ELSE GO TO HFJ30AA - OCDEPRSS.
Page 9 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
BASKDEPRS
HFJ47
yes/no
Has a doctor or other health professional ever asked [you/(SP)] if there was a period of time when [you/he/she]
felt sad, empty, or depressed?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ30AA - OCDEPRSS
CASKDEPRS
HFJ48
yes/no
Since (SAMPLE_PERSON.DATE_FALLRND), has a doctor or other health professional asked [you/(SP)] if
there was a period of time when [you/he/she] felt sad, empty, or depressed?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ30AA - OCDEPRSS
OCDEPRSS
HFJ30AA
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ17A
(02) HFJ30A - OCPSYCHO
(-8) HFJ30A - OCPSYCHO
(-9) HFJ30A - OCPSYCHO
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ30A - OCPSYCHO
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ17B
(02) BOX HFJ19
(-8) BOX HFJ19
(-9) BOX HFJ19
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
depression?
YRDEPRSS
BOX HFJ17A
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ30BB - YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.
HFJ30BB
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
depression?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
OCPSYCHO
HFJ30A
yes/no
a mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
YRPSYCHO
OCOSTEOP
BOX HFJ17B
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ31A - YRPSYCHO.
ELSE GO TO BOX HFJ19.
HFJ31A
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (01) YES
(02) NO
mental or psychiatric disorder other than depression?
(-8) Don't Know
(-9) Refused
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
BOX HFJ19
routing
IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND
(sample_person.P_OCOSTEOP=1), GO TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.
HFJ32
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
osteoporosis, sometimes called fragile or soft bones?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]]
OCBRKHIP
HFJ33
yes/no
a broken hip?
YRBRKHIP
BOX HFJ19
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ33 - OCBRKHIP
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ20
(02) BOX HFJ21
(-8) BOX HFJ21
(-9) BOX HFJ21
BOX HFJ20
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.
HFJ34
yes/no
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (02) NO
broken hip?
(-8) Don't Know
(-9) Refused
BOX HFJ21
routing
IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCPARKIN=1), GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.
BOX HFJ21
Page 10 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
OCPARKIN
HFJ35
yes/no
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ22
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ37 - OCPPARAL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ23
(02) BOX HFJ24
(-8) BOX HFJ24
(-9) BOX HFJ24
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ24
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ25
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ26
(02) BOX HFCI
(-8) BOX HFCI
(-9) BOX HFCI
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCI
Parkinson's disease?
BOX HFJ22
routing
IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A PREVIOUS ROUND
(sample_person.P_OCEMPHYS=1), GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
OCEMPHYS
HFJ36
yes/no
emphysema, asthma, or COPD?
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE
OCPPARAL
HFJ37
yes/no
IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK.
OTHERWISE, ASK:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
complete or partial paralysis?
YRPPARAL
OCAMPUTE
BOX HFJ23
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.
HFJ38
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
complete or partial paralysis?
BOX HFJ24
routing
IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN A PREVIOUS ROUND
(sample_person.P_OCAMPUTE=1), GO TO BOX HFJ25.
ELSE GO TO HFJ39 - OCAMPUTE.
HFJ39
yes/no
IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT "YES" AND DO NOT ASK. OTHERWISE,
ASK:
What about absence or loss of an arm or a leg?
HAVEPROS
BOX HFJ25
routing
HFJ40
yes/no
IF SP IS FEMALE (ROSTSEX=2 or (roster.ROSTSEX=2 where ROSTNUM=1)), GO TO BOX HFCI.
ELSE GO TO HFJ40 - HAVEPROS.
[[Before (you/[SP]) had prostate surgery, did a doctor or other health professional ever tell/Since (LAST HF
MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that [you/he] had...]
an enlarged prostate or benign prostatic hypertrophy (BPH)?
YRPROST
OCKIDNY
BOX HFJ26
routing
IF SP IS IN THE BASELINE SAMPLE (sample_person.INTTYPE=3), GO TO HFJ41 - YRPROST.
ELSE GO TO BOX HFCI.
HFJ41
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he] had an
enlarged prostate or benign prostatic hypertrophy (BPH)?
BOX HFCI
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP16AOCKIDNY.
ELSE IF P_DKIDNY ^= YES, GO TO YRKID-YRKID.
ELSE GO TO HFCA.
HFP16A
yes/no
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you have/she has/he has]
chronic kidney disease?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCA
Page 11 of 47
2021 MCBS Community Questionnaire
Variable Name
YRKID
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
YRKID
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [Have you/Has (SP)] been told by a doctor or other health
professional that [you have/she has/he has] chronic kidney disease?
BOX HFCA
routing
IF P_OCBETES=YES, GO TO BOX HFCB.
ELSE IF SP IS IN THE BASELINE SAMPLE (sample_person.INTTYPE=3), GO TO HFJ41A-OCBETES.
ELSE GO TO YRBETES-YRBETES.
HFJ41A
yes/no
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had any type of diabetes,
including:
OCBETES
sugar diabetes, high blood sugar, [borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
diabetes, or pre-diabetes]?
Since [SAMPLE_PERSON.DATE_FALLRND], has a doctor or other health professional told [you/(SP)] that
[you/he/she] had any type of diabetes, including:
YRBETES
YRBETES
yes/no
sugar diabetes, high blood sugar, [borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
diabetes, or pre-diabetes]?
Routing
BOX HFCA
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFJ41B - OCDTYPE
(02) BOX HFJ27
(-8) BOX HFJ27
(-9) BOX HFJ27
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFJ41B - OCDTYPE
(02) BOX HFJ27
(-8) BOX HFJ27
(-9) BOX HFJ27
SHOW CARD HF5
(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
(04) PRE-DIABETES
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
(05) GESTATIONAL (PREGNANCY-RELATED)
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
(91) SOME OTHER TYPE
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or “juvenile-onset” diabetes. This (-8) Don't Know
(-9) Refused
type of diabetes usually develops during childhood or adolescence; but, it also can develop in adults.
“Type 2” was formerly called “non-insulin dependent” or “adult-onset” diabetes. Until recently, this type of
diabetes was found only in adults; but, now it is also occurring in children.]
Looking at this card, please tell me which type of diabetes the doctor or other health professional said that [you
have/(SP) has].
OCDTYPE
HFJ41B
code 1
OCDTYPOS
HFJ41B
verbatim text
BOX HFCB
routing
IF (P_OCBETES ^= YES AND (OCBETES = YES or YRBETES = YES)) OR (P_OCBETES = YES AND
P_OCDVISIT ^= YES), GO TO HFJ41C-OCDVISIT.
ELSE GO TO BOX HFJ27.
HFJ41C
yes/no
[Were you/Was (SP)] told on two or more different visits that [you/he/she] had diabetes?
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT MEDICARE ELIGIBILITY
WAS UNDER 65 (sample_person.INTTYPE=3 and AGECALC<65 and greater than 0) THEN
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO HFJ42 - EMCOND.
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 - EMCAUSEVB.
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT TIME OF CURRENT MEDICARE
ELIGIBILITY WAS NOT UNDER 65 THEN GO TO HFPINTRO - HLTHCAREINTRO.
(01) BOX HFCB
(02) BOX HFCB
(03) BOX HFCB
(04) BOX HFCB
(05) BOX HFCB
(91) HFJ41B - OCDTYPOS
(-8) BOX HFCB
(-9) BOX HFCB
SOME OTHER TYPE (SPECIFY)
OCDVISIT
BOX HFJ27
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
(01) [Continuous answer.]
BOX HFCB
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ27
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ28
(02) HFJ43 - EMCAUSEVB
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO
(01) [Continuous answer.]
HFPINTRO - HLTHCAREINTRO
You told me that [you have/(SP) has] had [READ CONDITIONS LISTED BELOW]. [Was this/Were any of
these] the original cause of [your/(SP's)] becoming eligible for Medicare?
EMCOND
HFJ42
yes/no
[LIST ALL CONDITIONS WHERE "YES" ANSWER RECORDED AT HFJ1 THROUGH HFJ41C]
[NOTE THAT CONDITIONS MAY NOT BE DISPLAYED WITH THE EXACT CONDITION NAME THAT WAS
USED EARLIER IN THE INTERVIEW (E.G., HYPERTENSION CAN ALSO BE CALLED HIGH BLOOD
PRESSURE AT DIFFERENT QUESTIONS).]
EMCAUSEVB
HFJ43
verbatim text
What was the original cause of [your/(SP's)] becoming eligible for Medicare?
RECORD VERBATIM.
Page 12 of 47
2021 MCBS Community Questionnaire
Variable Name
HFQ- Health Status and Functioning
MR Screen Name Question Type
Question Text/Description
BOX HFJ28
IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO HFPINTRO - HLTHCAREINTRO.
ELSE GO TO HFJ44 - EMCODE.
routing
Which of these conditions was the cause of [your/(SP's)] becoming eligible for Medicare?
Code List
Routing
(01) ARTERIES HARDENING
(02) HYPERTENSION
(03) HEART ATTACK
(04) HEART DISEASE
(05) CONGESTIVE HEART FAILURE
(06) HEART VALVE PROBLEM
(07) HEART RHYTHM PROBLEM
(08) OTHER HEART PROBLEM
(09) STROKE OR HEMORRHAGE
(10) SKIN CANCER
(11) CANCER/TUMOR
(12) RHEUMATOID ARTHRITIS
(26) OSTEOARTHRITIS
(13) OTHER ARTHRITIS
(14) INTELLECTUAL DISABILITY
(15) ALZHEIMER'S
(16) DEMENTIA
(17) DEPRESSION
(18) MENTAL DISORDER
(19) OSTEOPOROSIS
(20) BROKEN HIP
(21) PARKINSON'S
(22) EMPHYSEMA/ASTHMA/COPD
(23) PARALYSIS
(24) LOSS OF LIMB
(25) DIABETES
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) HFPINTRO - HLTHCAREINTRO
(02) HFPINTRO - HLTHCAREINTRO
(03) HFPINTRO - HLTHCAREINTRO
(04) HFPINTRO - HLTHCAREINTRO
(05) HFPINTRO - HLTHCAREINTRO
(06) HFPINTRO - HLTHCAREINTRO
(07) HFPINTRO - HLTHCAREINTRO
(08) HFPINTRO - HLTHCAREINTRO
(09) HFPINTRO - HLTHCAREINTRO
(10) HFPINTRO - HLTHCAREINTRO
(11) HFPINTRO - HLTHCAREINTRO
(12) HFPINTRO - HLTHCAREINTRO
(26) HFPINTRO - HLTHCAREINTRO
(13)HFPINTRO - HLTHCAREINTRO
(14) HFPINTRO - HLTHCAREINTRO
(15) HFPINTRO - HLTHCAREINTRO
(16) HFPINTRO - HLTHCAREINTRO
(17) HFPINTRO - HLTHCAREINTRO
(18) HFPINTRO - HLTHCAREINTRO
(19) HFPINTRO - HLTHCAREINTRO
(20) HFPINTRO - HLTHCAREINTRO
(21) HFPINTRO - HLTHCAREINTRO
(22) HFPINTRO - HLTHCAREINTRO
(23) HFPINTRO - HLTHCAREINTRO
(24) HFPINTRO - HLTHCAREINTRO
(25) HFPINTRO - HLTHCAREINTRO
(91) HFJ44 - EMOS
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO
EMCODE
HFJ44
code all
EMOS
HFJ44
verbatim text
OTHER (SPECIFY)
(01) [Continuous answer.]
HFPINTRO - HLTHCAREINTRO
no entry
Now I want to ask you about some things that [you/(SP)] may be doing to maintain [your/his/her] health, either
by getting tested for health problems or by taking care of conditions that [you have/she has/he has].
(01) CONTINUE
(-7) Empty
BOX HFP1A
BOX HFP1A
routing
IF (P_OCBETES ^= 1/YES) AND (HFJ41A – OCBETES = 1/Yes or YRBETES - YRBETES = 1/YES) AND
(HFJ41B - OCDTYPE ^= 5/GESTATIONAL), GO TO HFP1 - DIAAGE.
ELSE IF P_OCBETES = 1/YES, GO TO HFP14A-DIAFEET.
ELSE GO TO BOX HFC2.
HFP1
numeric
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
BOX HFP2
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFC2
(02) HFP4 - DIAINSUL
(-8) BOX HFC2
(-9) BOX HFC2
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP4 - DIAMEDS
HLTHCAREINTR
HFPINTRO
O
DIAAGE
[PROBE: Any other condition?]
CHECK UP TO 8 CONDITIONS.
I recorded that [you were/(SP) was] told by a doctor or other health professional that [you have/she has/he has]
[Type 1 diabetes/Type 2 diabetes/borderline diabetes/pre-diabetes/diabetes].
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had diabetes?
BOX HFP2
routing
IF THE SP IS FEMALE (ROSTSEX=2) AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR (HFP1 – DIAAGE = DK
OR RF), GO TO HFP2 - DIAPRGNT.
ELSE GO TO HFP4 - DIAINSUL.
DIAPRGNT
HFP2
yes/no
Did [you/(SP)] have diabetes only during a pregnancy?
DIAINSUL
HFP4
list
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take insulin?
Page 13 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
DIAMEDS
HFP4
list
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP4 - DIATEST
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP4 - DIASORES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP4 - DIAPRESS
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP4 - DIAASPRN
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFP3
(01) HFP5 - INSUDAY
(02) HFP5 - INSUWEEK
(03) BOX HFP4
(-8) BOX HFP4
(-9) BOX HFP4
take prescription diabetes pills or oral diabetes medicine?
DIATEST
HFP4
list
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
test [your/his/her] blood for sugar or glucose?
DIASORES
HFP4
list
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
check for sores or irritations on [your/his/her] feet?
DIAPRESS
HFP4
list
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
measure [your/his/her] blood pressure at home?
DIAASPRN
HFP4
list
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take aspirin regularly for [your/his/her] diabetes?
BOX HFP3
routing
IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE.
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
INSUTAKE
HFP5
quantity unit
How often [do you/does (SP)] take insulin?
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) USE INSULIN PUMP
(-8) Don't Know
(-9) Refused
INSUDAY
HFP5
quantity unit
How often [do you/does (SP)] take insulin?
(01) [Continuous answer.]
BOX HFP4
INSUWEEK
HFP5
quantity unit
How often [do you/does (SP)] take insulin?
(01) [Continuous answer.]
BOX HFP4
BOX HFP4
routing
IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
MEDSTAKE
HFP6
quantity unit
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(-8) Don't Know
(-9) Refused
(01) HFP6 - MEDDAY
(02) HFP6 - MEDWEEK
(03) ) HFP6 - MEDMONTH
(-8) BOX HFP5
(-9) BOX HFP5
MEDDAY
HFP6
quantity unit
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(01) [Continuous answer.]
BOX HFP5
MEDWEEK
HFP6
quantity unit
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(01) [Continuous answer.]
BOX HFP5
MEDMONTH
HFP6
quantity unit
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(01) [Continuous answer.]
BOX HFP5
BOX HFP5
routing
IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is tested (04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
by a health professional.]
(-9) Refused
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
TESTTAKE
HFP7
quantity unit
(01) HFP7 - TESTDAY
(02) HFP7 - TESTWEEK
(03) HFP7 - TESTMNTH
(04) HFP7 - TESTYEAR
(-8) BOX HFP6
(-9) BOX HFP6
Page 14 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
TESTDAY
HFP7
quantity unit
TESTWEEK
HFP7
quantity unit
TESTMNTH
HFP7
quantity unit
TESTYEAR
HFP7
quantity unit
BOX HFP6
routing
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(04) NUMBER OF TIMES PER YEAR
(-8) Don't Know
(-9) Refused
(01) HFP8 - SOREDAY
(02) HFP8 - SOREWEEK
(03) HFP8 - SOREMNTH
(04) HFP8 - SOREYEAR
(-8) HFP10 - DIATENYR
(-9) HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is tested
by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is tested
by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is tested
by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is tested
by a health professional.]
IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
SORECHEK
HFP8
quantity unit
SOREDAY
HFP8
quantity unit
SOREWEEK
HFP8
quantity unit
SOREMNTH
HFP8
quantity unit
SOREYEAR
HFP8
quantity unit
DIATENYR
HFP10
yes/no
In the past year has a doctor or other health professional examined [your/his/her] feet for sores or irritations?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP11 - DIADRSAW
DIADRSAW
HFP11
numeric
About how many times in the past year [have you/has (SP)] seen a doctor or other health professional for
[your/his/her] diabetes?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
HFP13 - DIAHEMOC
DIAHEMOC
HFP13
numeric
A test of hemoglobin "A one C" measures the average level of blood sugar over the past three months. It is
usually done in a doctor's office. About how many times in the past year has a doctor or other health
professional checked [you/(SP)] for hemoglobin "A one C"?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
HFP14 - DIACTRLD
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
Page 15 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
DIACTRLD
HFP14
code 1
(01) ALL OF THE TIME
(02) MOST OF THE TIME
(03) SOME OF THE TIME
(04) A LITTLE OF THE TIME
Would you say that [your/(SP)'s] blood sugar is well controlled all of the time, most of the time, some of the
time, a little of the time, or none of the time? By "well controlled" we mean a recent hemoglobin "A one C" result (05) NONE OF THE TIME
(-8) Don't Know
of 7.5 or less or an average fasting blood test of 140 or less.
(-9) Refused
DIAHYPO
HFP14A1
yes/no
(01) YES
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood sugar or an insulin (02) NO
reaction?
(-8) Don't Know
(-9) Refused
Routing
SHOW CARD HF6
Please think about the most serious episode of hypoglycemia that [you have/(SP) has] experienced in the past
year.
DIAHYPTR
HFP14A2
code 1
[Were you/Was (SP)] able to treat [yourself/himself/herself] by taking some form of sugar, did [you/he/she]
require treatment from others, or did [you/he/she] require treatment by a hospital?
[EXPLAIN IF NECESSARY: Treatment by a hospital includes being treated in the emergency room or
outpatient department of a hospital, or being admitted as an inpatient.]
HFP14A1 - DIAHYPO
(01) HFP14A2 - DIAHYPTR
(02) BOX HFCC
(-8) BOX HFCC
(-9) BOX HFCC
(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
(03) HOSPITAL TREATMENT
(-8) Don't Know
(-9) Refused
BOX HFCC
BOX HFCC
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) , GO TO HFP14A3-DIAFTEVR.
ELSE GO TO HFP14A-DIAFEET.
DIAFTEVR
HFP14A3
yes/no
[Have you/Has (SP)] ever had any problems with [your/his/her] feet as a result of [your/his/her] diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFP14A - DIAFEET
(02) HFP15 - DIAEYPRB
(-8) HFP15 - DIAEYPRB
(-9) HFP15 - DIAEYPRB
DIAFEET
HFP14A
yes/no
[Do you/Does (SP)] currently have any problems with [your/his/her] feet as a result of [your/his/her] diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCD
BOX HFCD
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIANEURO.
ELSE IF P_DNEURO ^= YES, GO TO YRDNEURO-YRDNEURO.
ELSE GO TO BOX HFCE.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCE
People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
[your/his/her] feet as a result of [your/his/her] diabetes.
DIANEURO
HFP14B
list
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
Neuropathy or nerve damage, which may cause pain or numbness in the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/he/she] had any of the following problems with [your/his/her]
feet as a result of [your/his/her] diabetes.]
YRDNEURO
YRDNEURO
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/he/she] had…
Neuropathy or nerve damage, which may cause pain or numbness in the feet?
BOX HFCE
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIACIRCF.
ELSE IF P_DCIRCF ^= YES, GO TO YRDCIRCF-YRDCIRCF.
ELSE GO TO BOX HFCF.
Page 16 of 47
2021 MCBS Community Questionnaire
Variable Name
DIACIRCF
MR Screen Name Question Type
HFP14B
list
HFQ- Health Status and Functioning
Question Text/Description
Code List
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
Routing
BOX HFCF.
Poor circulation or blood flow in the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/he/she] had any of the following problems with [your/his/her]
feet as a result of [your/his/her] diabetes.]
YRDCIRCF
YRDCIRCF
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/he/she] had…
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCF
Poor circulation or blood flow in the feet?
BOX HFCF
DIAULCER
HFP14B
routing
list
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIAULCER.
ELSE IF P_DULCER ^= YES, GO TO YRDULCER-YRDULCER.
ELSE GO TO BOX HFCG.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
BOX HFCG
Foot ulcers?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/he/she] had any of the following problems with [your/his/her]
feet as a result of [your/his/her] diabetes.]
YRDULCER
YRDULCER
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has (SP)] been told by a doctor or other health
professional that [you/he/she] had…
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCG
Foot ulcers?
BOX HFCG
DIASKINC
HFP14B
routing
list
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIASKINC.
ELSE IF P_DSKINC ^= YES, GO TO YRDSKINC-YRDSKINC.
ELSE GO TO HFP15-DIAEYPRB.
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
HFP15 - DIAEYPRB
Calluses, infections, or other skin changes affecting the feet?
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] been told
by a doctor or other health professional that [you/he/she] had any of the following problems with [your/his/her]
feet as a result of [your/his/her] diabetes.]
YRDSKINC
YRDSKINC
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health
professional that [you/he/she] had…
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP15 - DIAEYPRB
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFCH
Calluses, infections, or other skin changes affecting the feet?
DIAEYPRB
HFP15
yes/no
[Do you/Does (SP)] have any problems with [your/his/her] eyes as a result of [your/his/her] diabetes?
BOX HFCH
routing
IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP16A1-DIAKDPEV.
ELSE GO TO HFP16-DIAKDPRB.
Page 17 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
DIAKDPEV
HFP16A1
HFQ- Health Status and Functioning
Question Text/Description
[Have you/Has (SP)] ever had any problems with [your/his/her] kidneys as a result of [your/his/her] diabetes?
yes/no
[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFP16 - DIAKDPRB
(02) BOX HFC1
(-8) BOX HFC1
(-9) BOX HFC1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFC1
(02) BOX HFC1
(-8) BOX HFC1
(-9) BOX HFC1
HFP16
yes/no
[Do you/Does (SP)] currently have any problems with [your/his/her] kidneys as a result of [your/his/her]
diabetes?
BOX HFC1
routing
IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP17-DIAMNGE.
ELSE GO TO HFP17A-CDIAMNGE.
DIAMNGE
HFP17
yes/no
[Have you/Has (SP)] ever participated in a diabetes self-management course or class, or received special
training on how [you/he/she] can manage [your/his/her] diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFP18 - DIATRAIN
(02) BOX HFP7
(-8) BOX HFP7
(-9) BOX HFP7
CDIAMNGE
CDIAMNGE
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/has (SP)] participated in a diabetes self-management
course or class, or received special training on how [you/he/she] can manage [your/his/her] diabetes?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFP7
HFP18
code 1
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
When was the most recent time that [you/(SP)] participated in a diabetes self-management course or class or
(07) 6 YEARS TO LESS THAN 7 YEARS
received special training on how [you/he/she] can manage [your/his/her] diabetes?
(08) 7 YEARS TO LESS THAN 8 YEARS
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE MOST (09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
RECENT TIME.]
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
BOX HFP7
routing
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.
DIAKDPRB
DIATRAIN
SHOW CARD HF7
DIAKNOW
HFP19
code 1
How much do you think you know about managing your diabetes? Do you know . . .
DIASUPPS
HFP20
yes/no
Before today, did you know that Medicare now helps pay the cost of diabetic testing supplies and selfmanagement education for people with diabetes?
BOX HFP7
(01) just about everything you need to know,
(02) most of what you need to know,
(03) some of what you need to know,
(04) a little of what you need to know, or
(05) almost none of what you need to know about
managing your diabetes?
(-8) Don't Know
(-9) Refused
HFP20 - DIASUPPS
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFR1
Page 18 of 47
2021 MCBS Community Questionnaire
Variable Name
HFQ- Health Status and Functioning
MR Screen Name Question Type
Question Text/Description
BOX HFC2
IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP21-DIAEVERT.
ELSE GO TO HFP21A-CDIAEVER.
routing
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFP22 - DIARECNT
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFP24 - DIARISK
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
HFP24 - DIARISK
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP24 - DIARISK
[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you
have/she has/he has] diabetes.]
DIAEVERT
HFP21
yes/no
[Have you/Has (SP)] ever had a blood test to see if [you have/she has/he has] diabetes?
[IF NEEDED: This question is asking about whether [you have/(SP) has] ever had a blood test for diabetes, not
whether [you have/(SP) has] diabetes.]
[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you
have/she has/he has] diabetes.]
CDIAEVER
HFP21A
yes/no
Since [SAMPLE_PERSON.DATE_FALLRND, [have you/has (SP)] had a blood test to see if [you have/she
has/he has] diabetes?
[IF NEEDED: This question is asking about whether [you have/(SP) has] had a blood test since
[SAMPLE_PERSON.DATE_FALLRND for diabetes, not whether [you have/(SP) has] diabetes.]
DIARECNT
HFP22
code 1
When was the most recent time [you were/(SP) was] tested for diabetes?
BOX HFP8
routing
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP23 - DIAAWARE.
ELSE GO TO HFP24 - DIARISK.
DIAAWARE
HFP23
yes/no
Before today, were you aware that there is a blood test to determine if a person has diabetes?
DIARISK
HFP24
yes/no
Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for diabetes? (01) YES
(02) NO
[IF NEEDED: This question is asking about whether [you have/(SP) has] ever been told [you are/he is/she is] at (-8) Don't Know
(-9) Refused
risk for diabetes, not whether [you have/(SP) has] diabetes.]
In the past year, [have you/has (SP)] received any information about the signs, symptoms, or risk factors for
diabetes?
DIASIGNS
HFP25
yes/no
[IF NEEDED: This question is asking about whether [you have/(SP) has] received any information on diabetes,
not whether [you have/(SP) has] diabetes.]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP25 - DIASIGNS
BOX HFR1
IF [(SP HAS REPORTED HAVING COLON, RECTAL, OR BOWEL CANCER IN THE CURRENT ROUND
(EVRCODE = 02/COLON (BOWEL) OR 26/RECTUM)) OR (IN A PREVIOUS ROUND (P_OCCCOLON=1 or
P_OCCRECT=1)], GO TO BOX HFS1.
BOX HFR1
routing
ELSE, IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER (P_COLHEAR=1), GO TO
BOX HFC3.
ELSE, GO TO HFR1-COLHEAR.
Page 19 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
COLHEAR
HFR1
HFQ- Health Status and Functioning
Question Text/Description
Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower intestines.
yes/no
Before today, had [you/SP] ever heard of colorectal or colon cancer?
BOX HFC3
COLHTEST
HFR3
routing
yes/no
HFR3A
yes/no
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFC3
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFR5 - COLCARD
(02) BOX HFC4
(-8) BOX HFC4
(-9) BOX HFC4
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFR5 - COLCARD
(02) BOX HFC4
(-8) BOX HFC4
(-9) BOX HFC4
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR3 - COLHTEST.
ELSE GO TO HFR3A - CCOLHTES.
The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at
the patient’s home. The test is then sent to a laboratory for the results to be determined.
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for blood in the stool?
CCOLHTES
Code List
The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at
the patient’s home. The test is then sent to a laboratory for the results to be determined.
Since (SAMPLE_PERSON.DATE_FALLRND), Has a doctor or other health professional given [you/(SP)] a
home testing kit to test for blood in the stool?
BOX HFC4
routing
IF P_COLHKIT=YES, GO TO HFR4A - COLFDOC.
ELSE GO TO HFR4-COLHKIT.
COLHKIT
HFR4
yes/no
[Have you/Has SP] ever heard of this home testing kit?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFR4A - COLFDOC
COLFDOC
HFR4A
yes/no
Has a doctor or other health professional ever performed a fecal occult blood test to test for blood in the stool
while [you/(SP)] [were/was] at the doctor’s office?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFR7 - COLRECNT
(02) BOX HFC6
(-8) BOX HFC6
(-9) BOX HFC6
COLCARD
HFR5
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFC5
BOX HFC5
routing
Did [you/(SP)] complete the samples and return them for [your/his/her] most recent test?
[READ IF NECESSARY: The fecal occult blood test is a simple test for early signs of colon cancer. It detects
invisible traces of blood found in the stool.]
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR7 - COLRECNT.
ELSE GO TO BOX HFC6.
When did [you/(SP)] have [your/his/her] most recent blood stool test [(using a home testing kit)/(at the doctor's
office)]?
COLRECNT
HFR7
code 1
[READ IF NECESSARY: The fecal occult blood test is a simple test for early signs of colon cancer. It detects
invisible traces of blood found in the stool.]
BOX HFC6
routing
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
BOX HFC6
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO ]COLORECT-COLORECT.
ELSE GO TO CCOLOREC-CCOLOREC.
Page 20 of 47
2021 MCBS Community Questionnaire
Variable Name
COLORECT
HFQ- Health Status and Functioning
MR Screen Name Question Type
Question Text/Description
COLORECT
These next questions are about colorectal cancer screening. There are several different kinds of tests to check
for colon cancer.
Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a
tube into the rectum to look for polyps or cancer.
yes/no
[Have you/Has (SP)] ever had either of these exams?
For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the
doctor checks only part of the colon and you are fully awake.
CORECTYP
CORECTYP
code 1
[Have you/Has (SP)] ever had a colonoscopy, a sigmoidoscopy, or both?
CCOLOREC
CCOLOREC
yes/no
These next questions are about colorectal cancer screening. There are several different kinds of tests to check
for colon cancer.
Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a
tube into the rectum to look for polyps or cancer.
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had either of these exams?
For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the
doctor checks only part of the colon and you are fully awake.
CCORECTP
CCORECTP
code 1
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a colonoscopy, a sigmoidoscopy, or
both?
When did [you/(SP)] have [your/his/her] most recent sigmoidoscopy or colonoscopy?
WHENSCOP
HFR9
code 1
[IF NEEDED: If [you/(SP)] had both exams done, then please provide the date for the most recent exam]
HEARSIG
COLDRREC
BOX HFC7
routing
IF P_HEARSCOP=YES OR CCOLOREC=YES OR COLORECT=YES, GO TO BOX HFR2.
ELSE GO TO HFR10- HEARSIG.
HFR10
yes/no
Before today, had [you/(SP}] ever heard of a sigmoidoscopy or colonoscopy?
BOX HFR2
routing
IF HFR3 - COLHTEST = 1/Yes or HFR3A - CCOLHTES = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 COLSCRNS.
ELSE GO TO BOX HFS1.
HFR11
yes/no
Has a doctor or other health professional ever recommended that [you/(SP)] have this test?
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) CORECTYP
(02) BOX HFC7
(-8) BOX HFC7
(-9) BOX HFC7
(01) Colonoscopy
(02) Sigmoidoscopy
(03) Both
(-8) Don't Know
(-9) Refused
(01) HFR9 - WHENSCOP
(02) HFR9 - WHENSCOP
(03) HFR9 - WHENSCOP
(-8) BOX HFC7
(-9) BOX HFC7
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) CCORECTP
(02) BOX HFC7
(-8) BOX HFC7
(-9) BOX HFC7
(01) Colonoscopy
(02) Sigmoidoscopy
(03) Both
(-8) Don't Know
(-9) Refused
BOX HFC7
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
HFR13 - COLSCRNS
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFR11 - COLDRREC
(02) BOX HFR2
(-8) BOX HFR2
(-9) BOX HFR2
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFR13 - COLSCRNS
Page 21 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
COLSCRNS
HFR13
yes/no
Before today, did [you/(SP)] know that Medicare now pays the cost of screening tests for colorectal cancer?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFS1
BOX HFS1
routing
IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT ROUND OR IN A PREVIOUS
ROUND (OCOSTEOP=1 or sample_person.P_OCOSTEOP-=1 GO TO BOX HFC8.
ELSE GO TO HFSINTRO - OSTINTRO.
OSTINTRO
HFSINTRO
no entry
Now I'd like to talk about a disease called osteoporosis, which can be treated if found early. In osteoporosis, the (01) CONTINUE
bones lose their calcium and become fragile and more easily broken.
(-7) Empty
OSTEVERT
HFS1
yes/no
[Have you/Has (SP)] ever talked with [your/his/her] doctor or other health professional about osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS2 - OSTHRISK
(02) BOX HFC8
(-8) BOX HFC8
(-9) BOX HFC8
OSTHRISK
HFS2
yes/no
Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFS2A - OSTFRACT
OSTFRACT
HFS2A
yes/no
Have [you/(SP)] ever experienced a fracture that [your/his/her] doctor or other health professional told
[you/him/her] was related to osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFC8
BOX HFC8
routing
IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFS3-OSTTEST.
ELSE GO TO HFS3A-COSTTEST.
HFS3
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS5 - OSTRECNT
(02) BOX HFC9
(-8) BOX HFC9
(-9) BOX HFC9
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS6 - OSTMASS
(02) BOX HFC9
(-8) BOX HFC9
(-9) BOX HFC9
OSTTEST
There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?
There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
COSTTEST
HFS3A
yes/no
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a Bone Mass or Bone Density
Measurement test?
OSTHEAR
OSTRECNT
HFS1 - OSTEVERT
BOX HFC9
routing
IF P_OSTHEAR=YES, GO TO HFS6 - OSTMASS.
ELSE GO TO HFS4-OSTHEAR.
HFS4
yes/no
Before today, had you ever heard of this test?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFS6 - OSTMASS
(02) HFAC29 - HCTROUBL
(-8) HFAC29 - HCTROUBL
(-9) HFAC29 - HCTROUBL
When was the most recent time that [you/(SP)] had a Bone Mass or Bone Density Measurement test?
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED
HFS6 - OSTMASS
HFS5
code 1
Page 22 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
OSTMASS
HFS6
yes/no
Before today, did you know that Medicare would pay for Bone Mass or Bone Density Measurement tests for
Medicare beneficiaries who are at risk for osteoporosis?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFAC29 - HCTROUBL
HCTROUBL
HFAC29
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC30A - HCTCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
(01) SP DOES NOT HAVE MONEY
(02) COST IS TOO HIGH
(03) SERVICES/SUPPLIES NOT COVERED
(04) NEEDED TRANSPORTATION TO
DOCTOR/HOSPITAL
(05) DIFFICULTY GETTING HOME HEALTH CARE
(06) NO TREATMENT AVAILABLE/DOCTOR WON’T
TREAT
(07) WAIT TOO LONG/DOCTOR TOO BUSY
(08) OWN DOCTOR DOESN’T ACCEPT
MEDICARE/COULDN’T FIND DOCTOR WHO
ACCEPTS MEDICARE
(09) NOT ELIGIBLE FOR PUBLIC COVERAGE
(10) DIFFICULTY GETTING APPOINTMENT/ DELAYS
BECAUSE SP ON MEDICARE
(11) DOCTOR REFERRED SP TO SPECIALIST OR
OTHER DOCTOR
(12) HMO REFERRAL PROCESS (DIFFICULTY
GETTING)
(13) PROBLEMS WITH HMO DOCTORS NOT GOOD
OR AVAILABLE
(14) HMO WOULD NOT COVER OR PROVIDE
SERVICE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX HFF6
(02) BOX HFF6
(03) BOX HFF6
(04) BOX HFF6
(05) BOX HFF6
(06) BOX HFF6
(07) BOX HFF6
(08) BOX HFF6
(09) BOX HFF6
(10) BOX HFF6
(11) BOX HFF6
(12) BOX HFF6
(13) BOX HFF6
(14) BOX HFF6
(91) HFAC30A - HCTOTHOS
(-8) BOX HFF6
(-9) BOX HFF6
(01) [Continuous answer.]
BOX HFF6
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC30C - CGETCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
(01) DOCTOR DOES NOT ACCEPT INSURANCE
PLAN
(02) ALL OF DOCTORS APPOINTMENTS WERE FULL
(03) DOCTOR IS NOT ACCEPTING ANY NEW
PATIENTS
(04) DOCTOR IS NOT ACCEPTING NEW MEDICARE
PATIENTS
(05) DOCTORS HOURS CONFLICTED WITH
REQUIREMENTS OF SP
(06) DOCTOR DOES NOT ACCEPT MEDICAID
(07) DOCTOR DOES NOT ACCEPT MEDICARE AT
ALL
(08) DOCTOR DOES NOT ACCEPT MEDICARE
ASSIGNMENT
(09) DOCTOR FELT ANOTHER PROVIDER WOULD
BE BETTER FOR SP
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX HFF7
(02) BOX HFF7
(03) BOX HFF7
(04) BOX HFF7
(05) BOX HFF7
(06) BOX HFF7
(07) BOX HFF7
(08) BOX HFF7
(09) BOX HFF7
(91) HFAC30C - CGETOTOS
(-8) BOX HFF7
(-9) BOX HFF7
Next, we are going to ask some questions about [your/(SP's)] health care needs during the past year.
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that [you/he/she]
wanted or needed?
Why was that?
HCTCODE
HFAC30A
code all
HCTOTHOS
HFAC30A
verbatim text
OTHER (SPECIFY)
BOX HFF6
routing
IF RESPONSE TO HFAC30A - HCTCODE INCLUDES 8/DrDoesNotAcceptMedicare OR
10/DifficultyGettingAppt, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC30B - CGETAPPT.
HFAC30B
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office that they cannot schedule
an appointment with [you/(SP)]?
CGETAPPT
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
What were the reasons the doctor’s office offered as an explanation for not scheduling an appointment with
[you/(SP)]?
CGETCODE
HFAC30C
code all
[PROBE: Any other reason?]
CHECK ALL THAT APPLY
Page 23 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
CGETOTOS
CGETOTOS
verbatim text
Please specify the other reason.
(01) [Continuous answer.]
BOX HFF7
BOX HFF7
routing
IF RESPONSE TO HFAC30C - CGETCODE INCLUDES 4/DocNotAcceptNewMedicare OR
7/DocNotAcceptMCAR, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.
OFFEXPLN
HFAC30D
yes/no
Did the doctor’s office explain why [it is difficult for Medicare patients to get an appointment/Medicare is not
accepted] at that practice?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC30E - OFFEXVB
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
OFFEXVB
HFAC30E
verbatim text
What was that explanation?
RECORD VERBATIM.
(01) [Continuous answer.]
HFAC31 - HCDELAY
HCDELAY
HFAC31
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care because (you were/he
was/she was) worried about the cost?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFAC32 A-PAYPROB
PAYPROB
HFAC32A
yes/no
Since (LAST HF MONTH YEAR) [have you/has (SP)] had problems paying or were unable to pay any medical
bills?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC32 - COLLAGNCY
(02) HFKINTRO - IADLINTRO
(-8) HFKINTRO - IADLINTRO
(-9) HFKINTRO - IADLINTRO
COLLAGNCY
HFAC32
yes/no
(01) YES
Because of problems paying medical bills since (LAST HF MONTH YEAR), [have you/has (SP)] been contacted (02) NO
by a collection agency?
(-8) Don't Know
(-9) Refused
PAYOVRTM
HFAC32B
yes/no
[Do you /Does (SP)] currently have any medical bills that are being paid off over time?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFKINTRO - IADLINTRO
IADLINTRO
HFKINTRO
no entry
Health problems can include physical, mental, emotional, or memory problems. I'd now like to ask you about
how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d like to know
whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself].
(01) CONTINUE
(-7) Empty
HFKA1 - PRBTELE
PRBTELE
HFKA1
code 1
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFKB1 - PRBLHWK
(02) HFKB1 - PRBLHWK
(03) HFKA2 - DONTTELE
(-8) HFKB1 - PRBLHWK
(-9) HFKB1 - PRBLHWK
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFKB1 - PRBLHWK
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFKC1 - PRBHHWK
(02) HFKC1 - PRBHHWK
(03) HFKB2 - DONTLHWK
(-8) HFKC1 - PRBHHWK
(-9) HFKC1 - PRBHHWK
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFKC1 - PRBHHWK
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
using the telephone?
[You said that using the telephone is something that [you don't/(SP) doesn't] do.]
DONTTELE
HFKA2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBLHWK
HFKB1
code 1
doing light housework (like washing dishes, straightening up, or light cleaning)?
DONTLHWK
HFKB2
yes/no
[You said that doing light housework (like washing dishes, straightening up, or light cleaning) is something that
[you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
HFAC32B- PAYOVRTM
Page 24 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
PRBHHWK
HFKC1
HFQ- Health Status and Functioning
Question Text/Description
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
code 1
doing heavy housework (like scrubbing floors or washing windows)?
DONTHHWK
HFKC2
yes/no
[You said that doing heavy housework (like scrubbing floors or washing windows) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBMEAL
HFKD1
code 1
preparing [your/his/her] own meals?
[You said that preparing [your/his/her] own meals is something that [you don't/(SP) doesn't] do.]
DONTMEAL
HFKD2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBSHOP
HFKE1
code 1
shopping for personal items (such as toilet items or medicines)?
DONTSHOP
HFKE2
yes/no
[You said that shopping for personal items (such as toilet items or medicines) is something that [you don't/(SP)
doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBBILS
HFKF1
code 1
managing money (like keeping track of expenses or paying bills)?
DONTBILS
Routing
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFKD1 - PRBMEAL
(02) HFKD1 - PRBMEAL
(03) HFKC2 - DONTHHWK
(-8) HFKD1 - PRBMEAL
(-9) HFKD1 - PRBMEAL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFKD1 - PRBMEAL
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFKE1 - PRBSHOP
(02) HFKE1 - PRBSHOP
(03) HFKD2 - DONTMEAL
(-8) HFKE1 - PRBSHOP
(-9) HFKE1 - PRBSHOP
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFKE1 - PRBSHOP
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFKF1 - PRBBILS
(02) HFKF1 - PRBBILS
(03) HFKE2 - DONTSHOP
(-8) HFKF1 - PRBBILS
(-9) HFKF1 - PRBBILS
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFKF1 - PRBBILS
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) BOX HFKA1
(02) BOX HFKA1
(03) HFKF2 - DONTBILS
(-8) BOX HFKA1
(-9) BOX HFKA1
HFKF2
yes/no
[You said that managing money (like keeping track of expenses or paying bills) is something that [you don't/(SP) (01) YES
(02) NO
doesn't] do.]
(-8) Don't Know
(-9) Refused
Is this because of a physical, mental, emotional, or memory problem?
BOX HFKA1
routing
IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO HFKA3 - HELPTELE.
ELSE GO TO BOX HFKB1.
[[You said that [your/(SP's)] health makes using the telephone difficult./You said that using the telephone is
something that [you don't do/(SP) doesn't do].]]
HELPTELE
Code List
HFKA3
yes/no
[Do you/Does (SP)] receive help from another person with...
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFKA1
(01) HFKA4 - PERSON_HLPRTELE
(02) BOX HFKB1
(-8) BOX HFKB1
(-9) BOX HFKB1
using the telephone?
Page 25 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
PERSON_HLPRT
HFKA4
ELE
roster
You mentioned that [you receive/(SP) receives] help with using the telephone. Who gives that help?
ENTER ALL HELPERS.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
Routing
IF PERSON_HLPRTELE = (N+1), GO TO HFKA4_NEWROSTFNAM,
ELSE GO TO BOX HFKB1
ROSTFNAM
HFKA4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKA4_NEW - ROSTLNAM
ROSTLNAM
HFKA4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKA4_NEW - ROSTREL
ROSTREL
HFKA4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKA4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKB1
routing
IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO HFKB3 - HELPLHWK.
ELSE GO TO BOX HFKC1.
[[You said that [your/(SP's)] health makes doing light housework (like washing dishes, straightening up, or light
cleaning) difficult./You said that doing light housework (like washing dishes, straightening up, or light cleaning)
is something that [you don't do/(SP) doesn't do].]]
HELPLHWK
HFKB3
yes/no
[Do you/Does (SP)] receive help from another person with...
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKB1
(03) BOX HFKB1
(04) BOX HFKB1
(05) BOX HFKB1
(06) BOX HFKB1
(07) BOX HFKB1
(08) BOX HFKB1
(09) BOX HFKB1
(10) BOX HFKB1
(11) BOX HFKB1
(12) BOX HFKB1
(13) BOX HFKB1
(14) BOX HFKB1
(50) DO NOT DISPLAY
(51) BOX HFKB1
(52) BOX HFKB1
(53) BOX HFKB1
(54) BOX HFKB1
(55) BOX HFKB1
(56) BOX HFKB1
(57) BOX HFKB1
(91) HFKA4_NEW - ROSTREOS
(-8) BOX HFKB1
(-9) BOX HFKB1
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
BOX HFKB1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKB4 - PERSON_HLPRLHWK
(02) BOX HFKC1
(-8) BOX HFKC1
(-9) BOX HFKC1
doing light housework (like washing dishes, straightening up, or light cleaning)?
Page 26 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
Routing
IF PERSON_HLPRLHWK = (N+1), GO TO
HFKB4_NEW-ROSTFNAM,
ELSE GO TO BOX HFKC1
PERSON_HLPRL
HFKB4
HWK
roster
You mentioned that [you receive/(SP) receives] help with doing light housework (like washing dishes,
straightening up, or light cleaning). Who gives that help?
ROSTFNAM
HFKB4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKB4_NEW - ROSTLNAM
ROSTLNAM
HFKB4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKB4_NEW - ROSTREL
ROSTREL
HFKB4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKB4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKC1
routing
IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 - HELPHHWK.
ELSE GO TO BOX HFKD1
[[You said that [your/(SP's)] health makes doing heavy housework (like scrubbing floors or washing windows)
difficult./You said that heavy housework (like scrubbing floors or washing windows) is something that [you don't
do/(SP) doesn't do].]]
HELPHHWK
HFKC3
yes/no
[Do you/Does (SP)] receive help from another person with...
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKC1
(03) BOX HFKC1
(04) BOX HFKC1
(05) BOX HFKC1
(06) BOX HFKC1
(07) BOX HFKC1
(08) BOX HFKC1
(09) BOX HFKC1
(10) BOX HFKC1
(11) BOX HFKC1
(12) BOX HFKC1
(13) BOX HFKC1
(14) BOX HFKC1
(50) DO NOT DISPLAY
(51) BOX HFKC1
(52) BOX HFKC1
(53) BOX HFKC1
(54) BOX HFKC1
(55) BOX HFKC1
(56) BOX HFKC1
(57) BOX HFKC1
(91) HFKB4_NEW - ROSTREOS
(-8) BOX HFKC1
(-9) BOX HFKC1
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
BOX HFKC1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKC4 - PERSON_HLPRHHWK
(02) BOX HFKD1
(-8) BOX HFKD1
(-9) BOX HFKD1
doing heavy housework (like scrubbing floors or washing windows)?
Page 27 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
Routing
IF PERSON_HLPRHHWK = (N+1), GO TO
HFKC4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKD1.
PERSON_HLPRH
HFKC4
HWK
roster
You mentioned that [you receive/(SP) receives] help with doing heavy housework (like scrubbing floors or
washing windows). Who gives that help?
ENTER ALL HELPERS.
ROSTFNAM
HFKC4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKC4_NEW - ROSTLNAM
ROSTLNAM
HFKC4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKC4_NEW - ROSTREL
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKD1
(03) BOX HFKD1
(04) BOX HFKD1
(05) BOX HFKD1
(06) BOX HFKD1
(07) BOX HFKD1
(08) BOX HFKD1
(09) BOX HFKD1
(10) BOX HFKD1
(11) BOX HFKD1
(12) BOX HFKD1
(13) BOX HFKD1
(14) BOX HFKD1
(50) DO NOT DISPLAY
(51) BOX HFKD1
(52) BOX HFKD1
(53) BOX HFKD1
(54) BOX HFKD1
(55) BOX HFKD1
(56) BOX HFKD1
(57) BOX HFKD1
(91) HFKC4_NEW - ROSTREOS
(-8) BOX HFKD1
(-9) BOX HFKD1
ROSTREL
HFKC4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKC4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKD1
routing
IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO HFKD3 - HELPMEAL.
ELSE GO TO BOX HFKE1.
[[You said that [your/(SP's)] health makes preparing [your/his/her] own meals difficult./You said that preparing
[your/his/her] own meals is something that [you don't do/(SP) doesn't do].]]
HELPMEAL
HFKD3
yes/no
[Do you/Does (SP)] receive help from another person with...
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
BOX HFKD1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKD4 - PERSON_HLPRMEAL
(02) BOX HFKE1
(-8) BOX HFKE1
(-9) BOX HFKE1
preparing [your/his/her] own meals?
Page 28 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
Routing
IF PERSON_HLPRMEAL = (N+1), GO TO
HFKD4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKE1.
PERSON_HLPRM
HFKD4
EAL
roster
You mentioned that [you receive/(SP) receives] help with preparing [your/his/her] own meals. Who gives that
help?
ENTER ALL HELPERS.
ROSTFNAM
HFKD4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKD4_NEW - ROSTLNAM
ROSTLNAM
HFKD4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKD4_NEW - ROSTREL
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKE1
(03) BOX HFKE1
(04) BOX HFKE1
(05) BOX HFKE1
(06) BOX HFKE1
(07) BOX HFKE1
(08) BOX HFKE1
(09) BOX HFKE1
(10) BOX HFKE1
(11) BOX HFKE1
(12) BOX HFKE1
(13) BOX HFKE1
(14) BOX HFKE1
(50) DO NOT DISPLAY
(51) BOX HFKE1
(52) BOX HFKE1
(53) BOX HFKE1
(54) BOX HFKE1
(55) BOX HFKE1
(56) BOX HFKE1
(57) BOX HFKE1
(91) HFKD4_NEW - ROSTREOS
(-8) BOX HFKE1
(-9) BOX HFKE1
ROSTREL
HFKD4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKD4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKE1
routing
IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO HFKE3 - HELPSHOP.
ELSE GO TO BOX HFKF1.
[[You said that [your/(SP's)] health makes shopping for personal items (such as toilet items or medicines)
difficult./You said that shopping for personal items (such as toilet items or medicines) is something that [you
don't do/(SP) doesn't do].]]
HELPSHOP
HFKE3
yes/no
[Do you/Does (SP)] receive help from another person with...
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
BOX HFKE1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKE4 - PERSON_HLPRSHOP
(02) BOX HFKF1
(-8) BOX HFKF1
(-9) BOX HFKF1
shopping for personal items (such as toilet items or medicines)?
Page 29 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
PERSON_HLPRS
HFKE4
HOP
roster
HFQ- Health Status and Functioning
Question Text/Description
You mentioned that [you receive/(SP) receives] help with shopping for personal items (such as toilet items or
medicines). Who gives that help?
ENTER ALL HELPERS.
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
Routing
IF PERSON_HLPRSHOP = (N+1), GO TO
HFKE4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKF1.
ROSTFNAM
HFKE4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKE4_NEW - ROSTLNAM
ROSTLNAM
HFKE4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKE4_NEW - ROSTREL
ROSTREL
HFKE4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKE4_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFKF1
routing
IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO HFKF3 - HELPBILS.
ELSE GO TO HFLINTRO - ADLSINTRO.
[[You said that [your/(SP's)] health makes managing money (like keeping track of expenses or paying bills)
difficult./You said that managing money (like keeping track of expenses or paying bills) is something that [you
don't do/(SP) doesn't do].]]
HELPBILS
HFKF3
yes/no
[Do you/Does (SP)] receive help from another person with...
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFKF1
(03) BOX HFKF1
(04) BOX HFKF1
(05) BOX HFKF1
(06) BOX HFKF1
(07) BOX HFKF1
(08) BOX HFKF1
(09) BOX HFKF1
(10) BOX HFKF1
(11) BOX HFKF1
(12) BOX HFKF1
(13) BOX HFKF1
(14) BOX HFKF1
(50) DO NOT DISPLAY
(51) BOX HFKF1
(52) BOX HFKF1
(53) BOX HFKF1
(54) BOX HFKF1
(55) BOX HFKF1
(56) BOX HFKF1
(57) BOX HFKF1
(91) HFKE4_NEW - ROSTREOS
(-8) BOX HFKF1
(-9) BOX HFKF1
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
BOX HFKF1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKF4 - PERSON_HLPRBILS
(02) HFLINTRO - ADLSINTRO
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO
managing money (like keeping track of expenses or paying bills)?
Page 30 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
Routing
IF PERSON_HLPRBILS = (N+1), GO TO HFKF4_NEWROSTFNAM.
ELSE GO TO HFLINTRO - ADLSINTRO.
PERSON_HLPRB
HFKF4
ILS
roster
You mentioned that [you receive/(SP) receives] help with managing money (like keeping track of expenses or
paying bills). Who gives that help?
ENTER ALL HELPERS.
ROSTFNAM
HFKF4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKF4_NEW - ROSTLNAM
ROSTLNAM
HFKF4_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFKF4_NEW - ROSTREL
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
ROSTREL
HFKF4_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFKF4_NEW
text
[What is the name of the person and relationship to (SP)?]
ADLSINTRO
HFLINTRO
no entry
Remembering that health problems can include physical, mental, emotional, or memory problems, I'd now like to
ask you about how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d (01) CONTINUE
like to know whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself] and
(-7) Empty
without special equipment.
HPPDBATH
HFLA1
code 1
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
bathing or showering?
[You said that bathing or showering is something that [you don't/(SP) doesn't] do.]
DONTBATH
HFLA2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) HFLINTRO - ADLSINTRO
(03) HFLINTRO - ADLSINTRO
(04) HFLINTRO - ADLSINTRO
(05) HFLINTRO - ADLSINTRO
(06) HFLINTRO - ADLSINTRO
(07) HFLINTRO - ADLSINTRO
(08) HFLINTRO - ADLSINTRO
(09) HFLINTRO - ADLSINTRO
(10) HFLINTRO - ADLSINTRO
(11) HFLINTRO - ADLSINTRO
(12) HFLINTRO - ADLSINTRO
(13) HFLINTRO - ADLSINTRO
(14) HFLINTRO - ADLSINTRO
(50) DO NOT DISPLAY
(51) HFLINTRO - ADLSINTRO
(52) HFLINTRO - ADLSINTRO
(53) HFLINTRO - ADLSINTRO
(54) HFLINTRO - ADLSINTRO
(55) HFLINTRO - ADLSINTRO
(56) HFLINTRO - ADLSINTRO
(57) HFLINTRO - ADLSINTRO
(91) HFKF4_NEW - ROSTREOS
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO
HFLINTRO - ADLSINTRO
HFLA1 - HPPDBATH
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFLB1 - HPPDDRES
(02) HFLB1 - HPPDDRES
(03) HFLA2 - DONTBATH
(-8) HFLB1 - HPPDDRES
(-9) HFLB1 - HPPDDRES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLB1 - HPPDDRES
Page 31 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDDRES
HFLB1
code 1
dressing?
[You said that dressing is something that [you don't/(SP) doesn't] do.]
DONTDRES
HFLB2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDEAT
HFLC1
code 1
eating?
[You said that eating is something that [you don't/(SP) doesn't] do.]
DONTEAT
HFLC2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDCHAR
HFLD1
code 1
getting in or out of bed or chairs?
[You said that getting in or out of bed or chairs is something that [you don't/(SP) doesn't] do.]
DONTCHAR
HFLD2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDWALK
HFLE1
code 1
walking?
[You said that walking is something that [you don't/(SP) doesn't] do.]
DONTWALK
HFLE2
code 1
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDTOIL
HFLF1
code 1
using the toilet, including getting up and down?
[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
DONTTOIL
HFLF2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
HELPBATH
BOX HFLA1
routing
HFLA3
yes/no
Code List
Routing
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFLC1 - HPPDEAT
(02) HFLC1 - HPPDEAT
(03) HFLB2 - DONTDRES
(-8) HFLC1 - HPPDEAT
(-9) HFLC1 - HPPDEAT
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLC1 - HPPDEAT
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFLD1 - HPPDCHAR
(02) HFLD1 - HPPDCHAR
(03) HFLC2 - DONTEAT
(-8) HFLD1 - HPPDCHAR
(-9) HFLD1 - HPPDCHAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLD1 - HPPDCHAR
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFLE1 - HPPDWALK
(02) HFLE1 - HPPDWALK
(03) HFLD2 - DONTCHAR
(-8) HFLE1 - HPPDWALK
(-9) HFLE1 - HPPDWALK
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLE1 - HPPDWALK
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) HFLF1 - HPPDTOIL
(02) HFLF1 - HPPDTOIL
(03) HFLE2 - DONTWALK
(-8) HFLF1 - HPPDTOIL
(-9) HFLF1 - HPPDTOIL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLF1 - HPPDTOIL
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) BOX HFLA1
(02) BOX HFLA1
(03) HFLF2 - DONTTOIL
(-8) BOX HFLA1
(-9) BOX HFLA1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLA1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLA5 - EQIPBATH
(02) HFLA4 - PCHKBATH
(-8) HFLA4 - PCHKBATH
(-9) HFLA4 - PCHKBATH
IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO HFLA3 - HELPBATH.
ELSE GO TO BOX HFLB1.
[[You said [your/(SP's)] health makes bathing or showering difficult./You said that bathing or showering is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or showering?
Page 32 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
PCHKBATH
HFLA4
HFQ- Health Status and Functioning
Question Text/Description
Does someone usually stay nearby just in case [you need/(SP) needs] help with bathing or showering?
yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
EQIPBATH
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLA5 - EQIPBATH
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLA2
HFLA5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with bathing or showering?
BOX HFLA2
routing
IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH.
ELSE GO TO BOX HFLB1.
LONGBATH
HFLA6
code 1
How long [have you/has (SP)] needed help with bathing or showering? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLA7 - STILBATH
(02) BOX HFLB1
(03) BOX HFLB1
(-8) BOX HFLB1
(-9) BOX HFLB1
STILBATH
HFLA7
yes/no
Do you expect that [you/(SP)] will still need help with bathing or showering three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLB1
BOX HFLB1
routing
IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO HFLB3 - HELPDRES.
ELSE GO TO BOX HFLC1.
HFLB3
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLB5 - EQIPDRES
(02) HFLB4 - PCHKDRES
(-8) HFLB4 - PCHKDRES
(-9) HFLB4 - PCHKDRES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLB5 - EQIPDRES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLB2
(01) HFLB7 - STILDRES
(02) BOX HFLC1
(03) BOX HFLC1
(-8) BOX HFLC1
(-9) BOX HFLC1
BOX HFLC1
HELPDRES
[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is something [you don't/(SP)
doesn't] do.]]
[Do you/Does (SP)] receive help from another person with dressing?
Does someone usually stay nearby just in case [you need/(SP) needs] help with dressing?
PCHKDRES
HFLB4
yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
EQIPDRES
HFLB5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with dressing?
BOX HFLB2
routing
IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES.
ELSE GO TO BOX HFLC1.
LONGDRES
HFLB6
code 1
How long [have you/has (SP)] needed help with dressing? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
STILDRES
HFLB7
yes/no
Do you expect that [you/(SP)] will still need help with dressing three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLC1
routing
IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 - HELPEAT.
ELSE GO TO BOX HFLD1.
Page 33 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HELPEAT
HFLC3
yes/no
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you don't/(SP) doesn't]
do.]]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLC5 - EQIPEAT
(02) HFLC4 - PCHKEAT
(-8) HFLC4 - PCHKEAT
(-9) HFLC4 - PCHKEAT
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLC5 - EQIPEAT
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLC2
[Do you/Does (SP)] receive help from another person with eating?
Does someone usually stay nearby just in case [you need/(SP) needs] help with eating?
PCHKEAT
HFLC4
yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
EQIPEAT
HFLC5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with eating?
BOX HFLC2
routing
IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.
LONGEAT
HFLC6
code 1
How long [have you/has (SP)] needed help with eating? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLC7 - STILEAT
(02) BOX HFLD1
(03) BOX HFLD1
(-8) BOX HFLD1
(-9) BOX HFLD1
STILEAT
HFLC7
yes/no
Do you expect that [you/(SP)] will still need help with eating three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLD1
BOX HFLD1
routing
IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO HFLD3 - HELPCHAR.
ELSE GO TO BOX HFLE1.
HFLD3
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLD5 - EQIPCHAR
(02) HFLD4 - PCHKCHAR
(-8) HFLD4 - PCHKCHAR
(-9) HFLD4 - PCHKCHAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLD5 - EQIPCHAR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLD2
(01) HFLD7 - STILCHAR
(02) BOX HFLE1
(03) BOX HFLE1
(-8) BOX HFLE1
(-9) BOX HFLE1
BOX HFLE1
HELPCHAR
[[You said [your/(SP's)] health makes getting in or out of bed or chairs difficult./You said that getting in or out of
bed or chairs is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?
PCHKCHAR
HFLD4
yes/no
Does someone usually stay nearby just in case [you need/(SP) needs] help with getting in or out of bed or
chairs?
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
EQIPCHAR
HFLD5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with getting in or out of bed or chairs?
BOX HFLD2
routing
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.
LONGCHAR
HFLD6
code 1
How long [have you/has (SP)] needed help with getting in or out of bed or chairs? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
STILCHAR
HFLD7
yes/no
Do you expect that [you/(SP)] will still need help with getting in or out of bed or chairs three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLE1
routing
IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 - HELPWALK.
ELSE GO TO BOX HFLF1.
Page 34 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
[IF R IS IN A WHEELCHAIR OR CANNOT STAND DUE TO PERMANENT DISABILITY ONLY, SELECT "NO"
WITHOUT READING TEXT BELOW.]
HELPWALK
HFLE3
yes/no
[[You said [your/(SP's)] health makes walking difficult./You said that walking is something [you don't/(SP)
doesn't] do.]]
Code List
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLE5 - EQIPWALK
(02) HFLE4 - PCHKWALK
(-8) HFLE4 - PCHKWALK
(-9) HFLE4 - PCHKWALK
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLE5 - EQIPWALK
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLE2
[Do you/Does (SP)] receive help from another person with walking?
[IF R IS IN A WHEELCHAIR OR CANNOT STAND DUE TO PERMANENT DISABILITY ONLY, SELECT "NO"
WITHOUT READING TEXT BELOW.]
PCHKWALK
HFLE4
yes/no
Does someone usually stay nearby just in case [you need/(SP) needs] help with walking?
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
EQIPWALK
HFLE5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with walking?
BOX HFLE2
routing
IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.
LONGWALK
HFLE6
code 1
How long [have you/has (SP)] needed help with walking? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLE7 - STILWALK
(02) BOX HFLF1
(03) BOX HFLF1
(-8) BOX HFLF1
(-9) BOX HFLF1
STILWALK
HFLE7
yes/no
Do you expect that [you/(SP)] will still need help with walking three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLF1
BOX HFLF1
routing
IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO HFLF3 - HELPTOIL.
ELSE GO TO BOX HFLA3.
HFLF3
yes/no
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLF5 - EQIPTOIL
(02) HFLF4 - PCHKTOIL
(-8) HFLF4 - PCHKTOIL
(-9) HFLF4 - PCHKTOIL
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLF5 - EQIPTOIL
HELPTOIL
[[You said [your/(SP's)] health makes using the toilet difficult./You said that using the toilet is something [you
don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with using the toilet, including getting up and down?
PCHKTOIL
HFLF4
yes/no
Does someone usually stay nearby just in case [you need/(SP) needs] help with using the toilet, including
getting up and down?
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
HFLF5
yes/no
(01) YES
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with using the toilet, including getting up (02) NO
and down?
(-8) Don't Know
(-9) Refused
BOX HFLF2
routing
IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.
LONGTOIL
HFLF6
code 1
How long [have you/has (SP)] needed help with using the toilet? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLF7 - STILTOIL
(02) BOX HFLA3
(03) BOX HFLA3
(-8) BOX HFLA3
(-9) BOX HFLA3
STILTOIL
HFLF7
yes/no
Do you expect that [you/(SP)] will still need help with using the toilet three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLA3
EQIPTOIL
BOX HFLF2
Page 35 of 47
2021 MCBS Community Questionnaire
Variable Name
HFQ- Health Status and Functioning
MR Screen Name Question Type
Question Text/Description
BOX HFLA3
IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH.
ELSE GO TO BOX HFLB3.
PERSON_HLPRB
HFLA9
ATH
routing
You mentioned that [you receive/(SP) receives] help with bathing and showering. Who gives that help?
roster
ENTER ALL HELPERS.
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
Routing
IF PERSON_HLPRBATH = (N+1) , GO TO
HFLA9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLB3.
ROSTFNAM
HFLA9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLA9_NEW - ROSTLNAM
ROSTLNAM
HFLA9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLA9_NEW - ROSTREL
ROSTREL
HFLA9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLA9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLB3
routing
IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES.
ELSE GO TO BOX HFLC3.
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLB3
(03) BOX HFLB3
(04) BOX HFLB3
(05) BOX HFLB3
(06) BOX HFLB3
(07) BOX HFLB3
(08) BOX HFLB3
(09) BOX HFLB3
(10) BOX HFLB3
(11) BOX HFLB3
(12) BOX HFLB3
(13) BOX HFLB3
(14) BOX HFLB3
(50) DO NOT DISPLAY
(51) BOX HFLB3
(52) BOX HFLB3
(53) BOX HFLB3
(54) BOX HFLB3
(55) BOX HFLB3
(56) BOX HFLB3
(57) BOX HFLB3
(91) HFLA9_NEW - ROSTREOS
(-8) BOX HFLB3
(-9) BOX HFLB3
BOX HFLB3
Page 36 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
PERSON_HLPRD
HFLB9
RES
HFQ- Health Status and Functioning
Question Text/Description
You mentioned that [you receive/(SP) receives] help with dressing. Who gives that help?
roster
ENTER ALL HELPERS.
Code List
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
Routing
IF PERSON_HLPRBATH = (N+1), GO TO
HFLB9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLC3.
ROSTFNAM
HFLB9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLB9_NEW - ROSTLNAM
ROSTLNAM
HFLB9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLB9_NEW - ROSTREL
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLC3
(03) BOX HFLC3
(04) BOX HFLC3
(05) BOX HFLC3
(06) BOX HFLC3
(07) BOX HFLC3
(08) BOX HFLC3
(09) BOX HFLC3
(10) BOX HFLC3
(11) BOX HFLC3
(12) BOX HFLC3
(13) BOX HFLC3
(14) BOX HFLC3
(50) DO NOT DISPLAY
(51) BOX HFLC3
(52) BOX HFLC3
(53) BOX HFLC3
(54) BOX HFLC3
(55) BOX HFLC3
(56) BOX HFLC3
(57) BOX HFLC3
(91) HFLB9_NEW - ROSTREOS
(-8) BOX HFLC3
(-9) BOX HFLC3
ROSTREL
HFLB9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLB9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLC3
routing
IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT.
ELSE GO TO BOX HFLD3.
PERSON_HLPRE
HFLC9
AT
You mentioned that [you receive/(SP) receives] help with eating. Who gives that help?
roster
ENTER ALL HELPERS.
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
BOX HFLC3
IF PERSON_HLPREAT = (N+1) GO TO HFLC9_NEWROSTFNAM.
ELSE GO TO BOX HFLD3.
Page 37 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
ROSTFNAM
HFLC9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLC9_NEW - ROSTLNAM
ROSTLNAM
HFLC9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLC9_NEW - ROSTREL
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLD3
(03) BOX HFLD3
(04) BOX HFLD3
(05) BOX HFLD3
(06) BOX HFLD3
(07) BOX HFLD3
(08) BOX HFLD3
(09) BOX HFLD3
(10) BOX HFLD3
(11) BOX HFLD3
(12) BOX HFLD3
(13) BOX HFLD3
(14) BOX HFLD3
(50) DO NOT DISPLAY
(51) BOX HFLD3
(52) BOX HFLD3
(53) BOX HFLD3
(54) BOX HFLD3
(55) BOX HFLD3
(56) BOX HFLD3
(57) BOX HFLD3
(91) HFLC9_NEW - ROSTREOS
(-8) BOX HFLD3
(-9) BOX HFLD3
ROSTREL
HFLC9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLC9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLD3
routing
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.
PERSON_HLPRC
HFLD9
HAR
roster
You mentioned that [you receive/(SP) receives] help with getting in or out of bed or chairs. Who gives that
help?
ENTER ALL HELPERS.
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
BOX HFLD3
IF PERSON_HLPRCHAR = (N+1) , GO TO
HFLD9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLE3.
ROSTFNAM
HFLD9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLD9_NEW - ROSTLNAM
ROSTLNAM
HFLD9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLD9_NEW - ROSTREL
Page 38 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
ROSTREL
HFLD9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLD9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLE3
routing
IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK.
ELSE GO TO BOX HFLF3.
PERSON_HLPR
WALK
You mentioned that [you receive/(SP) receives] help with walking. Who gives that help?
HFLE9
roster
ENTER ALL HELPERS.
Code List
Routing
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLE3
(03) BOX HFLE3
(04) BOX HFLE3
(05) BOX HFLE3
(06) BOX HFLE3
(07) BOX HFLE3
(08) BOX HFLE3
(09) BOX HFLE3
(10) BOX HFLE3
(11) BOX HFLE3
(12) BOX HFLE3
(13) BOX HFLE3
(14) BOX HFLE3
(50) DO NOT DISPLAY
(51) BOX HFLE3
(52) BOX HFLE3
(53) BOX HFLE3
(54) BOX HFLE3
(55) BOX HFLE3
(56) BOX HFLE3
(57) BOX HFLE3
(91) HFLD9_NEW - ROSTREOS
(-8) BOX HFLE3
(-9) BOX HFLE3
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
BOX HFLE3
IF PERSON_HLPRWALK = (N+1), GO TO
HFLE9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLF3.
ROSTFNAM
HFLE9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLE9_NEW - ROSTLNAM
ROSTLNAM
HFLE9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLE9_NEW - ROSTREL
Page 39 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
ROSTREL
HFLE9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLE9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFLF3
routing
IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL.
ELSE GO TO BOX HFL4.
PERSON_HLPRT
HFLF9
OIL
You mentioned that [you receive/(SP) receives] help with using the toilet. Who gives that help?
roster
ENTER ALL HELPERS.
Code List
Routing
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLF3
(03) BOX HFLF3
(04) BOX HFLF3
(05) BOX HFLF3
(06) BOX HFLF3
(07) BOX HFLF3
(08) BOX HFLF3
(09) BOX HFLF3
(10) BOX HFLF3
(11) BOX HFLF3
(12) BOX HFLF3
(13) BOX HFLF3
(14) BOX HFLF3
(50) DO NOT DISPLAY
(51) BOX HFLF3
(52) BOX HFLF3
(53) BOX HFLF3
(54) BOX HFLF3
(55) BOX HFLF3
(56) BOX HFLF3
(57) BOX HFLF3
(91) HFLE9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
BOX HFLF3
IF PERSON_HLPRTOIL = (N+1), GO TO HFLF9_NEWROSTFNAM.
ELSE GO TO BOX HFLG3.
ROSTFNAM
HFLF9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLF9_NEW - ROSTLNAM
ROSTLNAM
HFLF9_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLF9_NEW - ROSTREL
Page 40 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
ROSTREL
HFLF9_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFLF9_NEW
text
[What is the name of the person and relationship to (SP)?]
BOX HFL4
routing
IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9, HFLD9, HFLE9, AND/OR HFLF9, GO
TO HFL10 - PERSON_HLPRMOST.
ELSE GO TO HFM1 - FALLANY.
Which of these persons gives [you/(SP)] the most help with these things?
Code List
Routing
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) BOX HFLF3
(03) BOX HFLF3
(04) BOX HFLF3
(05) BOX HFLF3
(06) BOX HFLF3
(07) BOX HFLF3
(08) BOX HFLF3
(09) BOX HFLF3
(10) BOX HFLF3
(11) BOX HFLF3
(12) BOX HFLF3
(13) BOX HFLF3
(14) BOX HFLF3
(50) DO NOT DISPLAY
(51) BOX HFLF3
(52) BOX HFLF3
(53) BOX HFLF3
(54) BOX HFLF3
(55) BOX HFLF3
(56) BOX HFLF3
(57) BOX HFLF3
(91) HFLF9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
BOX HFLF3
IF PERSON_HLPRMOST = (N+1), GO TO
HFLF10_NEW-ROSTFNAM.
ELSE GO TO HFM1 - FALLANY.
PERSON_HLPRM
HFL10
OST
roster
ROSTFNAM
HFL10_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLF10_NEW - ROSTLNAM
ROSTLNAM
HFL10_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
HFLF10_NEW - ROSTREL
SELECT ONLY ONE.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.
Page 41 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
(02) SPOUSE
(03) SON
(04) DAUGHTER
(05) BROTHER
(06) SISTER
(07) FATHER
(08) MOTHER
(09) SON-IN-LAW
(10) DAUGHTER-IN-LAW
(11) GRANDSON
(12) GRANDDAUGHTER
(13) NEPHEW
(14) NIECE
(51) FRIEND/NEIGHBOR
(52) BOARDER
(53) NURSE/NURSE'S AIDE
(54) LEGAL/FINANCIAL OFFICER
(55) GUARDIAN
(56) PARTNER
(57) ROOMMATE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) DO NOT DISPLAY
(02) HFM1 - FALLANY
(03) HFM1 - FALLANY
(04) HFM1 - FALLANY
(05) HFM1 - FALLANY
(06) HFM1 - FALLANY
(07) HFM1 - FALLANY
(08) HFM1 - FALLANY
(09) HFM1 - FALLANY
(10) HFM1 - FALLANY
(11) HFM1 - FALLANY
(12) HFM1 - FALLANY
(13) HFM1 - FALLANY
(14) HFM1 - FALLANY
(50) DO NOT DISPLAY
(51) HFM1 - FALLANY
(52) HFM1 - FALLANY
(53) HFM1 - FALLANY
(54) HFM1 - FALLANY
(55) HFM1 - FALLANY
(56) HFM1 - FALLANY
(57) HFM1 - FALLANY
(91) HFLF10_NEW - ROSTREOS
(-8) HFM1 - FALLANY
(-9) HFM1 - FALLANY
ROSTREL
HFL10_NEW
code one
[What is the name of the person and relationship to (SP)?]
ROSTREOS
HFL10_NEW
text
[What is the name of the person and relationship to (SP)?]
(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused
HFM1 - FALLANY
FALLANY
HFM1
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFM2 - FALLTIME
(02) BOX MH1
(-8) BOX MH1
(-9) BOX MH1
FALLTIME
HFM2
numeric
[Continuous answer.]
Don't Know
Refused
HFM3A - FALLHELP
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFM3B - FALCODE
(01) BROKEN BONE/FRACTURE
(02) SPRAIN/STRAIN
(03) BRUISE
(04) CUT/WOUND/LACERATION
(05) CONCUSSION
(06) DISLOCATION
(91) OTHER
(96) NO INJURY
(-8) Don't Know
(-9) Refused
(01) HFM3C - FALLIMIT
(02) HFM3C - FALLIMIT
(03) HFM3C - FALLIMIT
(04) HFM3C - FALLIMIT
(05) HFM3C - FALLIMIT
(06) HFM3C - FALLIMIT
(91) HFM3B - FALOTHOS
(96) HFM3C - FALLIMIT
(-8) HFM3C - FALLIMIT
(-9) HFM3C - FALLIMIT
Since (LAST HF MONTH YEAR), how many times [have you/has (SP)] fallen down?
ENTER "95" IF 95 OR MORE FALLS REPORTED.
FALLHELP
HFM3A
yes/no
Thinking about the [most recent) time that [you/(SP)] fell, did [you/he/she] hurt [yourself/himself/herself] badly
enough to get medical help?
What kind of injury did [you/(SP)] have in that [most recent] fall?
FALCODE
HFM3B
code all
[PROBE: Anything else?]
CHECK ALL THAT APPLY.
FALOTHOS
HFM3B
verbatim text
OTHER (SPECIFY)
(01) [Continuous answer.]
HFM3C - FALLIMIT
FALLIMIT
HFM3C
yes/no
Did [your/(SP's)] [most recent] fall cause [you/him/her] to limit [your/his/her] regular activities?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFM3D - FALLBACK
(02) HFM3E - FALLFEAR
(-8) HFM3E - FALLFEAR
(-9) HFM3E - FALLFEAR
Page 42 of 47
2021 MCBS Community Questionnaire
HFQ- Health Status and Functioning
Variable Name
MR Screen Name Question Type
Question Text/Description
Code List
Routing
FALLBACK
HFM3D
code 1
How long did it take [you/(SP)] to get back to regular activities after [your/his/her] [most recent] fall?
(01) LESS THAN ONE WEEK
(02) ONE WEEK OR MORE
(03) NEVER RESUMED REGULAR ACTIVITIES
(-8) Don't Know
(-9) Refused
HFM3E - FALLFEAR
FALLFEAR
HFM3E
numeric
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6, where 1 is "Not at all afraid of falling" and 6
is "Extremely afraid of falling"?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
DISUPPYR
SHOW CARD HF8
This card lists some examples of different types of dietary supplements.
DISUPPYR
DISUPPYR
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] used or taken any vitamins, minerals, herbals or other
dietary supplements? Include prescription and non-prescription supplements.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) MULTVTYR
(02) BOX MH1
(-8) BOX MH1
(-9) BOX MH1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
VITSUPYR
(01) Calcium (with or without vitamin D)
(02) Choline
(03) Coenzyme Q
(04) Eye health supplement (such as Ocuvite
PreserVision or I-Caps)
(05) Fiber supplement (such as Metamucil or Benefiber)
(06) Folate or folic acid
(07) Garlic supplement
(08) Iron
(09) Joint supplement (such as glucosamine, with or
without chondroitin or other ingredients)
(10) Magnesium
(11) Melatonin
(12) Niacin
(13) Omega-3 (ALA/DHA/EPA) or fish oil
(14) Potassium
(15) Probiotics (in pill, powder, or liquid form)
(16) Saw palmetto
(17) Vitamin A
(18) Vitamin B-12
(19) Vitamin B-complex
(20) Vitamin C
(21) Vitamin D (NOT as part of a calcium supplement)
(22) Vitamin E
(23) Zinc
(91) Other Supplement(s)
(-8) Don't Know
(-9) Refused
(01)-(23) BOX MH1
(91) VITOTHOS
(-8) BOX MH1
(-9) BOX MH1
[IF NEEDED: Include any supplements that you have already told me about.]
Since (LAST HF MONTH YEAR), did [you/(SP)] take any multivitamins, such as One a Day, Theragran, or
Centrum type multivitamins?
MULTVTYR
MULTVTYR
yes/no
[IF NEEDED: Multivitamins may be pills, liquids, or packets]
[IF NEEDED: Include any multivitamins that you have already told me about.]
SHOW CARD HF9
Please look at the vitamins and dietary supplements listed on this card. Since (LAST HF MONTH YEAR), what
vitamins and dietary supplements did [you/(SP)] take at least once?
Do not include vitamins and dietary supplements that are taken as part of a multivitamin.
VITSUPYR
VITSUPYR
select all
[IF NEEDED: Include any vitamins or dietary supplements (that are not part of a multivitamin) that you have
already told me about.]
IF RESPONDENT HAS PROVIDED YOU WITH SUPPLEMENT BOTTLES YOU MAY USE THOSE TO
ANSWER THE QUESTION IF THE SUPPLEMENT WAS TAKEN SINCE (LAST HF MONTH YEAR).
SELECT ALL THAT APPLY
Page 43 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
Code List
Routing
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
VITOTHO2
What were the names of those other supplements?
ENTER UP TO 5 ADDITIONAL SUPPLEMENTS AT THIS SCREEN.
VITOTHOS
VITOTHOS
text
IF RESPONDENT REPORTS MORE THAN 5 OTHER SUPPLEMENTS, ENTER THE SUPPLEMENTS THAT
WERE TAKEN THE MOST OFTEN SINCE (LAST HF MONTH YEAR).
[INSERT TEXT BOX 1 FOR SUPPLEMENT 1]
VITOTHO2
VITOTHOS
text
[INSERT TEXT BOX 2 FOR SUPPLEMENT 2]
(01) [Continuous answer.]
(-7) Empty
VITOTHO3
VITOTHO3
VITOTHOS
text
[INSERT TEXT BOX 3 FOR SUPPLEMENT 3]
(01) [Continuous answer.]
(-7) Empty
VITOTHO4
VITOTHO4
VITOTHOS
text
[INSERT TEXT BOX 4 FOR SUPPLEMENT 4]
(01) [Continuous answer.]
(-7) Empty
VITOTHO5
VITOTHO5
VITOTHOS
text
[INSERT TEXT BOX 5 FOR SUPPLEMENT 5]
(01) [Continuous answer.]
(-7) Empty
BOX MH1
BOX MH1
routing
If the respondent is a proxy (SPPROXY=2), go to HFQ1 - LOSTURIN.
Else go to HFN1 - HFGAD1.
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN2 - HFGAD2
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN3 - HFPHQ1
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN4 - HFPHQ2
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN5 - HFPHQ3
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN6 - HFPHQ4
The next few questions ask about the last two weeks.
SHOW CARD HF10
HFGAD1
HFN1
list
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious, or on edge
SHOW CARD HF10
HFGAD2
HFN2
list
[Over the last 2 weeks, how often have you been bothered by the following problems?]
Not being able to stop or control worrying.
SHOW CARD HF10
HFPHQ1
HFN3
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
little interest or pleasure in doing things? Would you say…
SHOW CARD HF10
HFPHQ2
HFN4
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling down, depressed, or hopeless?
SHOW CARD HF10
HFPHQ3
HFN5
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
trouble falling or staying asleep, or sleeping too much?
Page 44 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
SHOW CARD HF10
HFPHQ4
HFN6
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling tired or having little energy?
SHOW CARD HF10
HFPHQ5
HFN7
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
poor appetite or overeating?
SHOW CARD HF10
HFPHQ6
HFN8
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling bad about yourself – or that you are a failure or have let yourself or your family down?
SHOW CARD HF10
HFPHQ7
HFN9
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
trouble concentrating on things, such as reading the newspaper or watching TV?
SHOW CARD HF10
HFPHQ8
HFN10
list
[Over the last 2 weeks, how often have you been bothered by the following problems:]
moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or
restless that you have been moving around a lot more than usual?
BOX HFPHQ
routing
Code List
Routing
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN7 - HFPHQ5
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN8 - HFPHQ6
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN9 - HFPHQ7
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
HFN10 - HFPHQ8
(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW
BOX HFPHQ
IF SP REPORTED [(02/Several Days), (03/More than half the days), or (04/Nearly Every Day)] TO AT LEAST
ONE ITEM IN HFPHQ1 THROUGH HFPHQ8, GO TO HFN11-PHQ9QS10.
ELSE GO TO HFQ1 – LOSTURIN.
SHOW CARD HF11
PHQ9QS10
HFN11
code one
(01) Not at all difficult,
You mentioned that you have been bothered by the following problems over the last 2 weeks:
(02) Somewhat difficult,
[LIST ALL CONDITIONS WHERE ANSWER RECORDED DOES NOT EQUAL 1/NOT AT ALL, -8/REFUSED, or - (03) Very difficult,
(04) Extremely difficult?
9/DON’T KNOW, AT HFPHQ1 THROUGH HFPHQ8]
(-8) REFUSED
How difficult have these problems made it for you to do your work, take care of things at home, or get along with (-9) DON’T KNOW
people?
SHOW CARD HF12
SOCISOLA
SOCISOLA
code 1
Since (LAST HF MONTH YEAR), how often have you felt lonely or isolated from those around you? Would you
say...
(01) Never
(02) Rarely
(03) Sometimes
(04) Often
(05) Always
(-8) Don’t know
(-9) Refused
SOCISOLA-SOCISOLA
HFQ1 - LOSTURIN
Page 45 of 47
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name Question Type
HFQ- Health Status and Functioning
Question Text/Description
SHOW CARD HF13
Code List
Routing
(01) MORE THAN ONCE A WEEK
(02) ABOUT ONCE A WEEK
(03) 2-3 TIMES A MONTH
(04) ABOUT ONCE A MONTH
(05) EVERY 2-3 MONTHS
(06) ONCE OR TWICE A YEAR
(07) NOT AT ALL
(08) SP IS ON DIALYSIS OR CATHETERIZATION OR
UROSTOMY OR BLADDER BAG
(-8) Don't Know
(-9) Refused
(01) HFQ2 - TALKURIN
(02) HFQ2 - TALKURIN
(03) HFQ2 - TALKURIN
(04) HFQ2 - TALKURIN
(05) HFQ2 - TALKURIN
(06) HFQ2 - TALKURIN
(07) BOX HFT1
(08) BOX HFT1
(-8) BOX HFT1
(-9) BOX HFT1
LOSTURIN
HFQ1
code 1
I'd like to ask about a health problem that is more common than people think. Please look at this card and tell
me how often, if at all, since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine because [you/he/she]
could not control [your/his/her] bladder.
TALKURIN
HFQ2
yes/no
[Have you/Has (SP)] talked about this problem with [your/(SP’s)] doctor or other health professional?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFQ3 - FEELURIN
(02) BOX HFT1
(-8) BOX HFT1
(-9) BOX HFT1
FEELURIN
HFQ3
yes/no
Has [your/(SP’s)] doctor or other health professional asked [you/him/her] about how [you/he/she] feel[s] about
this problem?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFQ4 - REASURIN
REASURIN
HFQ4
yes/no
Has [your/(SP’s)] doctor or other health professional examined [you/him/her] to figure out why [you/he/she]
[lose/loses] urine?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFQ5 - SURGURIN
SURGURIN
HFQ5
yes/no
Has [your/(SP’s)] doctor or other health professional talked with [you/him/her] about taking medicine or having
surgery for this problem?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFT1
BOX HFT1
routing
IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD.
ELSE GO TO BOX HFEND.
(01) YES
(02) NO
(03) SP NEVER HAD HIGH BLOOD
PRESSURE/PREVIOUS RESPONSE ENTERED IN
ERROR
(-8) Don't Know
(-9) Refused
(01) HFT2 - HYPEAGE
(02) HFT2 - HYPEAGE
(03) BOX HFEND
(-8) HFT2 - HYPEAGE
(-9) HFT2 - HYPEAGE
We have recorded that [you were/(SP) was] told by a doctor or other health professional that [you had/he
had/she had] hypertension, also called high blood pressure.
HYPETOLD
HFT1
code 1
[Were you/Was (SP)] told on two or more different medical visits that [you/he/she] had high blood pressure or
hypertension?
[EXPLAIN IF NECESSARY: We are interested in knowing whether [your/(SP’s)] blood pressure was high for
more than one reading.]
HFT2
numeric
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had high blood
pressure?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
HFT2 - HYPEAGE_LESSONE
HYPEAGE_LESS
HFT2
ONE
numeric
How old [were you/was (SP)] when (you were/he was/she was) first told that [you/he/she] had high blood
pressure?
(01) LESS THAN ONE YEAR OLD
(-7) Empty
HFT6D - HYPEHOME
HYPEHOME
HFT6D
yes/no
Because of [your/his/her] high blood pressure, [are you/is (SP)] now measuring [your/his/her] blood pressure at
home?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFT6G - HYPEMEDS
HYPEMEDS
HFT6G
yes/no
(01) YES
Because of [your/his/her] high blood pressure, [are you/is (SP)] now taking prescribed medicine for [your/his/her] (02) NO
high blood pressure?
(-8) Don't Know
(-9) Refused
HYPEDRNK
HFT6J
yes/no
[Have you/Has (SP)] cut down on drinking alcoholic beverages because of [your/his/her] high blood pressure?]
HYPEAGE
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFT6J - HYPEDRNK
BOX HFT2
Page 46 of 47
2021 MCBS Community Questionnaire
Variable Name
HFQ- Health Status and Functioning
MR Screen Name Question Type
Question Text/Description
BOX HFT2
routing
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG.
ELSE GO TO HFT12A - HYPECTRL.
HFT7
numeric
HYPELONG_LES
HFT7
SONE
HYPELONG
Code List
Routing
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood pressure?
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
HFT7 - HYPELONG_LESSONE
numeric
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood pressure?
(01) LESS THAN ONE YEAR
(-7) Empty
BOX HFT3
BOX HFT3
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFT8 - HYPEMANY.
ELSE GO TO HFT11A - HYPECOND.
HFT8
numeric
How many different prescribed medicines [do you/does (SP)] take for [your/his/her] high blood pressure?
HYPEMANY
(01) [Continuous answer.]
(-8) Don't Know
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR HIGH BLOOD
PRESSURE ARE TAKEN BY THE RESPONDENT, NOT THE NUMBER OF PILLS THEY MIGHT TAKE IN ONE (-9) Refused
DAY.]
How often [do you/does (SP)] have trouble with side effects from [your/his/her] blood pressure medicines[s]?
Please tell me if [you/he/she] always, sometimes, or never [have/has] trouble with side effects.
HYPECOND
HFT11A
code 1
[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any condition such as fatigue,
headache, or coughing.]
HYPECTRL
HFT12A
code 1
Doctors and other health professionals often recommend changing your habits or lifestyle, such as changing
your diet, or getting regular exercise in order to control blood pressure. How confident are you that [you/(SP)]
can follow these recommendation?
Would you say that you are very confident, confident, somewhat confident, or not at all confident?
HFT11A - HYPECOND
(01) ALWAYS
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused
HFT12A - HYPECTRL
(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused
BOX HFT4
BOX HFT4
routing
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.
HYPEPAY
HFT13
yes/no
[Do you/Does (SP)] have difficulty paying for the medicine[s] [your/his/her] doctor or other health professional
prescribes for [your/his/her] high blood pressure?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFT14 - HYPESKIP
HYPESKIP
HFT14
yes/no
[Do you/Does (SP)] ever skip taking [your/his/her] medicine, take less medicine than prescribed, or share
medicine because of the cost of the medicine?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFEND
BOX HFEND
routing
If INTTYPE in(C003), go to PXQ
Else, GO TO NAQ.
Page 47 of 47
| File Type | application/pdf |
| File Title | HFQ.xlsx |
| Author | Wishart-Marisa |
| File Modified | 2020-11-10 |
| File Created | 2020-11-10 |