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pdf2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
NAQ-NICOTINE AND ALCOHOL USE
Question Type
Question Text/Description
Code List
Routing
NICOTINE AND ALCOHOL USE QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after HFQ.
CIGINT
CIG100
NA1
no entry
These next questions are about cigarette smoking.
BOX NA1
routing
If SP previously reported smoking cigarettes (sample_person.P_CIG100=1), go to NA3-CIGNOW.
Else go to NA2-CIG100.
NA2
yes/no
[Have you/Has (SP)] smoked at least 100 cigarettes in [your/his/her] entire life?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) NA3-CIGNOW
(2) NA4-SMKLSINT
(-8) NA4-SMKLSINT
(-9) NA4-SMKLSINT
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED
NA4-SMKLSINT
CIGNOW
NA3
code one
[Do you/Does (SP)] now smoke cigarettes every day, some days, or not at all?
SMKLSINT
NA4
no entry
The next questions are about “smokeless” tobacco such as snuff, dip, chewing tobacco, or “snus.”
BOX NA2
routing
If SP previously reported using smokeless tobacco (sample_person.P_SMKLSONE=1), go to NA6-SMKLSNOW.
Else go to NA5-SMKLSONE.
SMKLSONE
NA5
yes/no
[Have you/Has (SP)] ever used “smokeless” tobacco, even once?
(1) NA6-SMKLSNOW
(2) NA7-CIGARINT
(-8) NA7-CIGARINT
(-9) NA7-CIGARINT
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED
NA7-CIGARINT
NA6
code one
[Do you/Does (SP)] now use smokeless tobacco every day, some days, or not at all?
CIGARINT
NA7
no entry
The next questions are about smoking cigars. By cigars we mean any kind, including big cigars, cigarillos, and
even little cigars that look like cigarettes.
routing
If SP never reported smoking cigars (sample_person.P_CIGARONE^=1), go to NA8-CIGARONE.
Else if SP previously reported smoking cigars (sample_person.P_CIGARONE=1) and smoked less than 50 cigars
(sample_person.P_CIGAR50^=1), go to NA9-CIGAR50.
Else if SP previously reported smoking cigars (sample_person.P_CIGARONE=1) and smoked more than 50
cigars (sample_person.P_CIGAR50=1), go to NA10-CIGARNOW.
CIGARONE
CIGAR50
NA8
NA9
yes/no
yes/no
BOX NA2
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
SMKLSNOW
BOX NA3
BOX NA1
BOX NA3
[Have you/Has (SP)] ever smoked a cigar EVEN ONE TIME?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) NA9-CIGAR50
(2) NA11-PIPEINT
(-8) NA11-PIPEINT
(-9) NA11-PIPEINT
[Have you/Has (SP)] smoked at least 50 cigars in [your/his/her] entire life?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
NA10-CIGARNOW
Page 1 of 3
2021 MCBS Community Questionnaire
Variable Name
MR Screen Name
NAQ-NICOTINE AND ALCOHOL USE
Question Type
Question Text/Description
Code List
Routing
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED
NA11-PIPEINT
CIGARNOW
NA10
yes/no
[Do you/Does (SP)] now smoke cigars every day, some days, or not at all?
PIPEINT
NA11
no entry
The next questions on tobacco products are about using a pipe to smoke tobacco.
BOX NA4
routing
If SP previously reported smoking tobacco in a pipe (sample_person.P_PIPEONE=1), go to NA13-PIPENOW.
Else go to NA12-PIPEONE.
PIPEONE
NA12
yes/no
BOX NA4
[Have you/Has (SP)] ever smoked tobacco in a pipe, even once?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) NA13-PIPENOW
(2) NA14-ECIGINT
(-8) NA14-ECIGINT
(-9) NA14-ECIGINT
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED
NA14-ECIGINT
PIPENOW
NA13
code one
[Do you/Does (SP)] now smoke tobacco in a pipe every day, some days, or not at all?
ECIGINT
NA14
no entry
The next questions are about electronic cigarettes, often called e-cigarettes. E-cigarettes look like regular
cigarettes, but are battery-powered and produce vapor instead of smoke.
BOX NA5
routing
If SP previously reported using e-cigarettes (sample_person.P_ECIGONE=1), go to NA16-ECIGNOW.
Else go to NA15-ECIGONE.
BOX NA5
[Have you/Has (SP)] ever used an e-cigarette, even once?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
(1) NA16-ECIGNOW
(2) BOX NA5B
(-8) BOX NA5B
(-9) BOX NA5B
[Do you/Does (SP)] now use e-cigarettes every day, some days, or not at all?
(1) EVERY DAY
(2) SOME DAYS
(3) NOT AT ALL
(-8) DON'T KNOW
(-9) REFUSED
BOX NA5B
NA25
Has a doctor or other health professional ever talked to [you/(SP)] about [your/his/her] smoking?
(1) YES
(2) NO
(-8) DON’T KNOW
(-9) REFUSED
NA17-ALCINT
CDOCSMOK
NA26
(1) YES
Since (SAMPLE_PERSON.DATE_FALLRND) has a doctor or other health professional talked to [you/(SP)] about (2) NO
(-8) DON’T KNOW
[your/his/her] smoking?
(-9) REFUSED
NA17-ALCINT
ALCINT
NA17
no entry
The next questions are about drinking alcoholic beverages. Included are liquor (such as whiskey or gin), beer,
wine, wine coolers, and any other type of alcoholic beverage.
BOX NA7
BOX NA7
routing
If SP reported having more than 12 alcoholic drinks in his/her lifetime (sample_person.P_ALCLIFE=1), go to
NA20-ALC12MN.
Else go to NA19-ALCLIFE.
ECIGONE
ECIGNOW
NA15
NA16
yes/no
code one
IF SP IS IN THE BASELINE INTERVIEW (sample_person.INTTYPE=3) AND [NA3-CIGNOW=(1) EVERY DAY
OR (2) SOME DAYS OR NA10-CIGARNOW=(1) EVERY DAY OR (2) SOME DAYS OR NA13-PIPENOW=(1)
EVERY DAY OR (2) SOME DAYS OR NA16-ECIGNOW=(1) EVERY DAY OR (2) SOME DAYS THEN GO TO
NA25-BDOCSMOK.
BOX NA5B
ELSE IF P_DOCSMOK ^= 1 AND [NA3-CIGNOW=(1) EVERY DAY OR (2) SOME DAYS OR NA10CIGARNOW=(1) EVERY DAY OR (2) SOME DAYS OR NA13-PIPENOW=(1) EVERY DAY OR (2) SOME DAYS
OR NA16-ECIGNOW=(1) EVERY DAY OR (2) SOME DAYS, THEN GO TO NA26-CDOCSMOK.
ELSE GO TO NA17-ALCINT.
BDOCSMOK
Page 2 of 3
2021 MCBS Community Questionnaire
Variable Name
ALCLIFE
MR Screen Name
NA19
NAQ-NICOTINE AND ALCOHOL USE
Question Type
yes/no
Question Text/Description
Code List
Routing
In [your/(SP)’s] entire life, [have you/has (he/she)] had at least 12 drinks of any type of alcoholic beverage?
(1) YES
(2) NO
(-8) DON'T KNOW
(-9) REFUSED
(1) NA20-ALC12MN
(2) BOX ENDNAQ
(-8) BOX ENDNAQ
(-9) BOX ENDNAQ
(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED
[996] NEVER / DOES NOT DRINK
NA20-ALC12MNU
(1) WEEK
(2) MONTH
(3) YEAR
(-8) DON'T KNOW
(-9) REFUSED
BOX NA9
In the past 12 months, how often did [you/(SP)] drink any type of alcoholic beverage?
[PROBE IF NECESSARY: How many days per week, per month, or per year did [you/(SP]) drink?]
ALC12MN
NA20
numeric
[ENTER QUANTITY AND UNIT.]
[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH
QUANTITY AND UNIT OF ALCOHOLIC BEVERAGES.]
ALC12MNU
NA20
quantity unit
BOX NA9
routing
If the SP didn't drink in the last 12 months (NA20 -ALC12MN = 996), go to NA23 - ALPERDAY.
Else go to NA21 - ALCDAY.
SHOWCARD NA1
ALCDAY
NA21
numeric
In the past 12 months, on those days that [you/(SP)] drank alcoholic beverages, on the average, how many drinks
did [you/he/she] have? (By a drink, I mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces of liquor.) (1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED
[ENTER NUMBER OF DRINKS.]
[ENTER '1' IF LESS THAN 1 DRINK.]
[ENTER '95' IF 95 OR MORE DRINKS.]
NA22-ALCNDAY
In the past 12 months, on how many days did [you/(SP)] have [5/4] or more drinks of any alcoholic beverage?
ALCNDAY
NA22
numeric
PROBE IF NECESSARY: How many days per week, per month, or per year did [you/(SP)] have [5/4] or more
drinks in a single day?
[ENTER QUANTITY AND UNIT.]
(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED
[996] NONE
NA22-ALCNDAYU
(1) WEEK
(2) MONTH
(3) YEAR
(-8) DON'T KNOW
(-9) REFUSED
NA23-ALPERDAY
(1) YES
(2) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX NA8
(1) [continuous response]
(-8) DON'T KNOW
(-9) REFUSED
BOX ENDNAQ
[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH
QUANTITY AND UNIT OF ALCOHOLIC BEVERAGES.]
ALCNDAYU
ALPERDAY
NA22
quantity unit
NA23
yes/no
Was there ever a time or times in [your/(SP)'s] life when [you/he/she] drank [5/4] or more drinks of any kind of
alcoholic beverage almost every day?
BOX NA8
routing
If the SP didn't drink in the last 12 months (NA20 -ALC12MN = 996), go to BOX ENDNAQ.
Else go to NA24 - ALCTIME
Considering all types of alcoholic beverages, DURING THE PAST 30 DAYS, how many times did [you/SP] have [5
or more/4 or more] drinks on an occasion?
ALCTIME
NA24
numeric
BOX ENDNAQ
routing
[ENTER QUANTITY.]
[ENTER '0' FOR NEVER.]
[ENTER '95' IF 95 OR MORE TIMES.]
GO TO SCQ.
Page 3 of 3
| File Type | application/pdf |
| File Title | Medicare Current Beneficiary Survey Section Specifications for NAQ |
| Subject | Medicare beneficiaries, MCBS community questionnaire, 2021, Nicotine and alcohol use, NAQ |
| Author | NORC |
| File Modified | 2021-08-16 |
| File Created | 2021-08-11 |