CMS-P-0015A Health Status and Functioning Questionnaire Specificatio

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

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
TEETHGUM- TEETHGUM

(01) excellent,
(02) very good,
(03) good,
(04) fair,
(04) or poor?
(-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

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

DIS3 - DISDECISION

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?

TEETHGUM

TEETHGUM

code one

DISHEAR

DIS1

yes/no

In general, how would [you/(SP)] rate the health of [your/his/her] teeth and gums? Would you say . . .

Now, I would like to ask you about [your/(SP's)] health.
[Are you/Is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?

DISSEE

DISTEETH

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.

DIS2A

yes/no

[Have you/Has (SP)] lost all of [your/his/her] upper and lower natural (permanent) teeth?

Page 1 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

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

HELMTACT

HFA3

code one

(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

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

routing

IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFB7-EDOCLAST.
ELSE GO TO BOX HFB1.

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HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

EDOCLAST

MR Screen Name

HFB7

Question Type

code one

Question Text/Description

Code List

Routing

How long has it been since [your/(SP's)] last eye examination by an eye doctor?

(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

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.]

EDOCTYOS

HFB7A

verbatim text

OTHER (SPECIFY)

EDOCDLAT

HFB7B

yes/no

BOX HFB7

routing

IF P_CATAREVR^=YES, GO TO CATAREVR,
ELSE GO TO BOX HFB7A.

HFB7C

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.
(01) YES
(02) NO
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-8) DON'T KNOW
(-9) REFUSED
Cataracts?

BOX HFB7A

routing

IF P_GLCOMEVR^=YES, GO TO GLCOMEVR,
ELSE GO TO BOX HFB7B.

Again, thinking about [your/(SP’s)] last eye examination, were dilating drops used in [your/(SP)’s] eyes?

CATAREVR

[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The drops often
make your eyes more sensitive to bright light and may cause temporary blurry vision.]

[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.
GLCOMEVR

HFB7C

yes/no

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…]

H7B7B - EDOCDLAT

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX HFB7

BOX HFB7A

BOX HFB7B

Glaucoma?

BOX HFB7B

routing

IF P_RETINEVR^=YES, GO TO RETINEVR,
ELSE GO TO BOX HFB7C.

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HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

[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.
RETINEVR

HFB7C

yes/no

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…]

Code List

Routing

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX HFB7C

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX HFB1A

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

BOX HFB1

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED

HFC1 - HCHELP

Diabetic retinopathy?

BOX HFB7C

routing

HFB7C

yes/no

IF P_MACULEVR^=YES, GO TO MACULEVR,
ELSE GO TO BOX HFB1A.

[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.
MACULEVR

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…]
Macular degeneration or age-related macular degeneration, also called AMD?

CATAROP

BOX HFB1A

routing

IF CATAREVR=02/NO or P_CATAROP=YES, GO TO BOX HFB1.
ELSE GO TO HFB10 - CATAROP.

HFB10

yes/no

[Have you/Has (SP)] ever had an operation for cataracts?

BOX HFB1

routing

IF [HFB7C - RETINEVR = 1/Yes OR HFB7C - MACULEVR = 1/Yes] AND P_EYESURG^=YES, GO TO HFB11 EYESURG.
ELSE GO TO HFC1 - HCHELP.

Laser surgery to the back of the eye, or retina, is a commonly used treatment for diabetic retinopathy and macular
degeneration.
EYESURG

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) HFC2 - HCTROUB
(02) HFC2 - HCTROUB
(03) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL

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?

(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
(03) A LOT OF TROUBLE HEARING
(04) DEAF
(-8) DON'T KNOW
(-9) REFUSED

(01) HFD1A - FOODTRBL
(02) HFC3 - HCKNOWMC
(03) HFC3 - HCKNOWMC
(04) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL

HCKNOWMC

HFC3

code one

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
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

HFC4 - HCCOMDOC

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HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

HCCOMDOC

HFC4

code one

(01) NO TROUBLE
How much trouble [do you/does (SP)] have communicating with [your/his/her] doctor or other health professional
(02) A LITTLE TROUBLE
because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you have/she has/he has] (03) A LOT OF TROUBLE
no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED

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?

SHOW CARD HF3
DRYMOUTH

DRYMOUTH

code one

Since (LAST HF MONTH YEAR), how often [have you/ has (SP)] experienced any of the following problems?
Dry mouth?

SHOW CARD HF3
[Since (LAST HF MONTH YEAR), how often [have you/ has (SP)] experienced any of the following problems?]
TOOTHSEN

TOOTHSEN

code one
Tooth sensitivity to hot or cold food or drinks?
IF THE RESPONDENT HAS LOST ALL OF THEIR NATURAL TEETH, SELECT 'NOT APPLICAPLE'

Code List

Routing

HFD1A - FOODTRBL

(01) NO TROUBLE
(02) A LITTLE TROUBLE
(03) A LOT OF TROUBLE
(-8) DON'T KNOW
(-9) REFUSED

HFE1 - HEIGHTFT
DRYMOUTH-DRYMOUTH

(01) Never
(02) Rarely
(03) Sometimes
(04) Often
(05) Always
(-8) DON'T KNOW
(-9) REFUSED

TOOTHSEN-TOOTHSEN

(01) Never
(02) Rarely
(03) Sometimes
(04) Often
(05) Always
(06) NOT APPLICABLE
(-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

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
(01) CONTINUE
me for each activity whether [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of
(-7) Empty
difficulty, or [is/are] not able to do it.

HFH1 - DIFSTOOP

Page 5 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

SHOW CARD HF3 HF4
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?

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

HFH2 - DIFLIFT

SHOW CARD HF3 HF4

DIFLIFT

HFH2

code 1

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a (-8) Don't Know
lot of difficulty, or [is/are] not able to do it?]
(-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
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a
(-8) Don't Know
lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

HFH4 - DIFWRITE

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping small objects?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a
(-8) Don't Know
lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

HFH5 - DIFWALK

HFH10INT - PHYSACTINTRO

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?

SHOW CARD HF3 HF4
DIFREACH

HFH3

code 1

What about reaching or extending arms above shoulder level?

SHOW CARD HF3 HF4
DIFWRITE

HFH4

code 1

DIFWALK

HFH5

code 1

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a
(-8) Don't Know
lot of difficulty, or [is/are] not able to do it?]
(-9) Refused

PHYSACTINTRO

HFH10INT

no entry

We are interested in two types of physical activity - vigorous and moderate. Vigorous activities cause large
(01) CONTINUE
increases in breathing or heart rate. Moderate activities cause small increases in breathing or heart rate. First I will
(-7) Empty
ask about the vigorous activities that [you do/(SP) does].

HFH10 - VIGUNIT

(01) HFH10 - VIGNUM
(02) HFH10 - VIGNUM
(03) HFH10 - VIGNUM
(04) HFH10 - VIGNUM
(96) HFH11 - MODUNIT
(-8) HFH11 - MODUNIT
(-9) HFH11 - MODUNIT

HFH11 - MODUNIT

SHOW CARD HF3 HF4

VIGUNIT

HFH10

quantity unit

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports, running,
(03) NUMBER OF HOURS PER WEEK
aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart rate?
(04) NUMBER OF HOURS PER MONTH
(96) NONE
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(-8) Don't Know
(-9) Refused

VIGNUM

HFH10

quantity unit

In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports, running,
(01) [Continuous answer.]
aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart rate?
(-8) Don't Know
(-9) Refused
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

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HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MODUNIT

MR Screen Name

HFH11

Question Type

quantity unit

Question Text/Description

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

HFH12

quantity unit

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.

MUSNUM

HFH12

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?

Code List

Routing

(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

(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

(01) Continunous answer

HFJINTRO - MEDCONDINTRO

(01) CONTINUE
(-7) Empty

BOX HFJ1

(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

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.]

OCARTERY

BOX HFJ1

routing

HFJ1

yes/no

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.

[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?

[[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

HFJ3

yes/no

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

[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.]

Page 7 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

OCMYOCAR

HFJ4

yes/no

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 HFJ3
(02) HFJ6 - OCCHD
(-8) HFJ6 - OCCHD
(-9) HFJ6 - OCCHD

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

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

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

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a
myocardial infarction or heart attack?

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?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ14 - OCHRTCND

[[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.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFJ8
(02) HFJ16 - OCSTROKE
(-8) HFJ16 - OCSTROKE
(-9) HFJ16 - OCSTROKE

[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.

Page 8 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

YRHRTCND

HFJ15

yes/no

Question Text/Description

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?
[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

HFJ17

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a
stroke, a brain hemorrhage, or a cerebrovascular accident?

Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had high cholesterol?
HFJ17A

yes/no

YRCHOLES

HFJ17B

yes/no

Routing

(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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFJ17A - OCCHOLES

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFJ17B - YRCHOLES
(2) BOX HFJ29
(-8) BOX HFJ29
(-9) BOX HFJ29

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ17 - YRSTROKE.
ELSE GO TO HFJ17A - OCCHOLES.

[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]

OCCHOLES

Code List

[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
(01) YES
cholesterol?
(02) NO
(-8) Don't Know
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION,
(-9) Refused
THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE CONDITION.]

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 by (02) NO
a doctor or health professional to control weight or lose weight?
(-8) Don't Know
(-9) Refused

HFJ18 - OCCSKIN

Page 9 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

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 - EVRCODE

[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?

Page 10 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

SHOW CARD HF4 HF5

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

OCARTHRH

HFJ22

verbatim text

Specify the part of parts of your body where the cancer or tumor was found.

BOX HFJ13

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.

HFJ24

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
rheumatoid arthritis?

OCOSARTH

BOX HFJ13B

routing

HFJ24B

yes/no

OCARTH

routing

HFJ25

yes/no

Routing

(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 -EVROS
(-8) BOX HFJ13
(-9) BOX HFJ13

(01) [Continuous answer.]

BOX HFJ13

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ13B

(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

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

Code List

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...]
arthritis, other than rheumatoid or osteoarthritis?

Page 11 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

YRARTHRD

MR Screen Name

Question Type

Question Text/Description

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.

HFJ28

yes/no

Code List

Routing

(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

[Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had...]
OCMENTAL

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.

BASKDEPRS

HFJ47

yes/no

(01) YES
Has a doctor or other health professional ever asked [you/(SP)] if there was a period of time when [you/he/she] felt (02) NO
sad, empty, or depressed?
(-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

Page 12 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

OCDEPRSS

HFJ30AA

yes/no

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 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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFJ21

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

BOX HFJ17B

routing

HFJ31A

yes/no

IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ31A - YRPSYCHO.
ELSE GO TO BOX HFJ19.

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a
mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]

OCOSTEOP

BOX HFJ19

routing

HFJ32

yes/no

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.

[[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 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

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a
broken hip?

Page 13 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

OCPARKIN

MR Screen Name

Question Type

Question Text/Description

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.

HFJ35

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
Parkinson's disease?

BOX HFJ22

routing

HFJ36

yes/no

Routing

(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

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

Code List

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

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:
OCAMPUTE

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)?

Page 14 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

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 HFP16A-OCKIDNY.
ELSE IF P_DKIDNY ^= YES, GO TO YRKID-YRKID.
ELSE GO TO HFCA.

OCKIDNY

HFP16A

yes/no

(01) YES
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you have/she has/he has] chronic (02) NO
kidney disease?
(-8) Don't Know
(-9) Refused

YRKID

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.

OCBETES

HFJ41A

yes/no

Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had any type of diabetes, including: (01) YES
(02) NO
sugar diabetes, high blood sugar, [borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
(-8) Don't Know
diabetes, or pre-diabetes]?
(-9) Refused

YRBETES

YRBETES

yes/no

YRPROST

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:
sugar diabetes, high blood sugar, [borderline diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
diabetes, or pre-diabetes]?

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCI

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCA

BOX HFCA

(01) HFJ41B - OCDTYPE
(02) AUTOIMRX-AUTOIMRX
(-8) AUTOIMRX-AUTOIMRX
(-9) AUTOIMRX-AUTOIMRX

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFJ41B - OCDTYPE
(02) AUTOIMRX-AUTOIMRX
(-8) AUTOIMRX-AUTOIMRX
(-9) AUTOIMRX-AUTOIMRX

(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
(04) PRE-DIABETES
(05) GESTATIONAL (PREGNANCY-RELATED)
(91) SOME OTHER TYPE
(-8) Don't Know
(-9) Refused

(01) BOX HFCB
(02) BOX HFCB
(03) BOX HFCB
(04) BOX HFCB
(05) BOX HFCB
(91) HFJ41B - OCDTYPOS
(-8) BOX HFCB
(-9) BOX HFCB

(01) [Continuous answer.]

BOX HFCB

SHOW CARD HF5 HF6
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

[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.]
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or “juvenile-onset” diabetes. This
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.]

SOME OTHER TYPE (SPECIFY)
OCDTYPOS

HFJ41B

verbatim text

[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.]

Page 15 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

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 AUTOIMRX-AUTOIMRX .

OCDVISIT

HFJ41C

yes/no

[Were you/Was (SP)] told on two or more different visits that [you/he/she] had diabetes?

AUTOIMRX

AUTOIMRX

yes/no

Since (REFERENCE DATE), [have you/has (SP)] taken prescription medication or had any medical treatments that (01) YES
a doctor or other health professional told [you/him/her] would weaken [your/his/her] immune system?
(02) NO
(-8) DON’T KNOW
[IF NEEDED: This question is asking about both long-term and short-term effects on the immune system.]
(-7) REFUSED

WEAKIMM

WEAKIMM

yes/no

[Do you/Does (SP)] currently have a health condition that a doctor or other health professional told [you/him/her]
weakens the immune system?
[IF NEEDED: Please include any health conditions you may have already told me about.]

BOX HFJ27

routing

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

AUTOIMRX-AUTOIMRX

WEAKIMM-WEAKIMM

(01) YES
(02) NO
(-8) DON’T KNOW
(-7) 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

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.

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.

BOX HFJ28

routing

IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO HFPINTRO - HLTHCAREINTRO.
ELSE GO TO HFJ44 - EMCODE.

Page 16 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

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
(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
(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

HLTHCAREINTRO

HFPINTRO

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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFP4 - DIATEST

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?

DIAMEDS

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 prescription diabetes pills or oral diabetes medicine?

Page 17 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

DIATEST

HFP4

list

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 - 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

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

(01) HFP5 - INSUDAY
(02) HFP5 - INSUWEEK
(03) BOX HFP4
(-8) BOX HFP4
(-9) BOX HFP4

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

Page 18 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

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.

TESTTAKE

HFP7

quantity unit

TESTDAY

HFP7

quantity unit

TESTWEEK

HFP7

quantity unit

TESTMNTH

HFP7

quantity unit

TESTYEAR

HFP7

quantity unit

BOX HFP6

routing

Code List

(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 by (04) NUMBER OF TIMES PER YEAR
a health professional.]
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?

Routing

(01) HFP7 - TESTDAY
(02) HFP7 - TESTWEEK
(03) HFP7 - TESTMNTH
(04) HFP7 - TESTYEAR
(-8) BOX HFP6
(-9) BOX HFP6

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.]

(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

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

[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 19 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

SOREMNTH

HFP8

quantity unit

SOREYEAR

HFP8

quantity unit

DIATENYR

HFP10

yes/no

DIADRSAW

HFP11

DIAHEMOC

HFP13

Question Text/Description

Code List

Routing

(01) [Continuous answer.]

HFP10 - DIATENYR

(01) [Continuous answer.]

HFP10 - DIATENYR

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

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

numeric

A test of hemoglobin "A one C" measures the average level of blood sugar over the past three months. It is usually (01) [Continuous answer.]
done in a doctor's office. About how many times in the past year has a doctor or other health professional checked (-8) Don't Know
[you/(SP)] for hemoglobin "A one C"?
(-9) Refused

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.]

SHOW CARD HF6 HF7
DIACTRLD

HFP14

code 1

DIAHYPO

HFP14A1

yes/no

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 of 7.5 or
less or an average fasting blood test of 140 or less.

In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood sugar or an insulin
reaction?

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.]

DIAFTEVR

BOX HFCC

routing

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) , GO TO HFP14A3-DIAFTEVR.
ELSE GO TO HFP14A-DIAFEET.

HFP14A3

yes/no

[Have you/Has (SP)] ever had any problems with [your/his/her] feet as a result of [your/his/her] diabetes?

HFP14 - DIACTRLD

(01) ALL OF THE TIME
(02) MOST OF THE TIME
(03) SOME OF THE TIME
(04) A LITTLE OF THE TIME
(05) NONE OF THE TIME
(-8) Don't Know
(-9) Refused

HFP14A1 - DIAHYPO

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFP14A - DIAFEET
(02) HFP15 - DIAEYPRB
(-8) HFP15 - DIAEYPRB
(-9) HFP15 - DIAEYPRB

Page 20 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

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?

YRDNEURO

YRDNEURO

yes/no

[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.]
(01) YES
(02) NO
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health professional (-8) Don't Know
that [you/he/she] had…
(-9) Refused

BOX HFCE

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.

[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.]
DIACIRCF

HFP14B

list
[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

BOX HFCF.

Poor circulation or blood flow in the feet?

YRDCIRCF

YRDCIRCF

yes/no

[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.]
(01) YES
(02) NO
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health professional (-8) Don't Know
that [you/he/she] had…
(-9) Refused

BOX HFCF

Poor circulation or blood flow in the feet?

BOX HFCF

routing

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.

Page 21 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

[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.]
DIAULCER

HFP14B

list
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCG

Foot ulcers?

YRDULCER

YRDULCER

yes/no

[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.]
(01) YES
(02) NO
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has (SP)] been told by a doctor or other health
(-8) Don't Know
professional that [you/he/she] had…
(-9) Refused

BOX HFCG

Foot ulcers?

BOX HFCG

routing

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 [your/his/her]
feet as a result of [your/his/her] diabetes.]
DIASKINC

HFP14B

list
[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

HFP15 - DIAEYPRB

Calluses, infections, or other skin changes affecting the feet?

YRDSKINC

YRDSKINC

yes/no

[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.]
(01) YES
(02) NO
Since [SAMPLE_PERSON.DATE_FALLRND], [have you/Has SP] been told by a doctor or other health professional (-8) Don't Know
that [you/he/she] had…
(-9) Refused

HFP15 - DIAEYPRB

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.

HFP16A1

yes/no

[Have you/Has (SP)] ever had any problems with [your/his/her] kidneys as a result of [your/his/her] diabetes?
DIAKDPEV

[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFCH

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFP16 - DIAKDPRB
(02) BOX HFC1
(-8) BOX HFC1
(-9) BOX HFC1

Page 22 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

DIAKDPRB

HFP16

yes/no

[Do you/Does (SP)] currently have any problems with [your/his/her] kidneys as a result of [your/his/her] diabetes?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) BOX HFC1
(02) BOX HFC1
(-8) BOX HFC1
(-9) BOX HFC1

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

(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 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

When was the most recent time that [you/(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?
DIATRAIN

HFP18

code 1
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE MOST
RECENT TIME.]

BOX HFP7

routing

IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.

SHOW CARD HF7 HF8
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 HFC2

routing

IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP21-DIAEVERT.
ELSE GO TO HFP21A-CDIAEVER.

Page 23 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

[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.]

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.]

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

DIASIGNS

HFP25

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 risk (-8) Don't Know
for diabetes, not whether [you have/(SP) has] diabetes.]
(-9) Refused

In the past year, [have you/has (SP)] received any information about the signs, symptoms, or risk factors for
diabetes?
[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

Page 24 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFC3

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.

Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower intestines.
COLHEAR

HFR1

yes/no
Before today, had [you/SP] ever heard of colorectal or colon cancer?

BOX HFC3

routing

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR3 - COLHTEST.
ELSE GO TO HFR3A - CCOLHTES.

COLHTEST

HFR3

yes/no

The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood found
(01) YES
in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at the
(02) NO
patient’s home. The test is then sent to a laboratory for the results to be determined.
(-8) Don't Know
(-9) Refused
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for blood in the stool?

(01) HFR5 - COLCARD
(02) BOX HFC4
(-8) BOX HFC4
(-9) BOX HFC4

CCOLHTES

HFR3A

yes/no

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
(01) YES
patient’s home. The test is then sent to a laboratory for the results to be determined.
(02) NO
(-8) Don't Know
Since (SAMPLE_PERSON.DATE_FALLRND), Has a doctor or other health professional given [you/(SP)] a home
(-9) Refused
testing kit to test for blood in the stool?

(01) HFR5 - COLCARD
(02) BOX HFC4
(-8) BOX HFC4
(-9) BOX HFC4

BOX HFC4

routing

IF P_COLHKIT=YES, GO TO HFR4A - COLFDOC.
ELSE GO TO HFR4-COLHKIT.

COLHKIT

HFR4

yes/no

Before today, [have you/has SP] ever heard of this home testing kit?

COLFDOC

HFR4A

yes/no

(01) YES
Has a doctor or other health professional ever performed a fecal occult blood test to test for blood in the stool while (02) NO
[you/(SP)] [were/was] at the doctor’s office?
(-8) Don't Know
(-9) Refused

COLCARD

HFR5

yes/no

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.]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFR4A - COLFDOC

(01) HFR7 - COLRECNT
(02) BOX HFC6
(-8) BOX HFC6
(-9) BOX HFC6

BOX HFC5

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFR7 - COLRECNT.
ELSE GO TO BOX HFC6.

Page 25 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

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

COLORECT

COLORECT

routing

yes/no

CCOLOREC

CORECTYP

CCOLOREC

code 1

yes/no

(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

Routing

BOX HFC6

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO COLORECT-COLORECT.
ELSE GO TO CCOLOREC-CCOLOREC.

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.
[Have you/Has (SP)] ever had either of these exams?

CORECTYP

Code List

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
(01) Colonoscopy
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the doctor
(02) Sigmoidoscopy
checks only part of the colon and you are fully awake.
(03) Both
(-8) Don't Know
[Have you/Has (SP)] ever had a colonoscopy, a sigmoidoscopy, or both?
(-9) Refused

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.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) CORECTYP
(02) BOX HFC7
(-8) BOX HFC7
(-9) BOX HFC7

(01) HFR9 - WHENSCOP
(02) HFR9 - WHENSCOP
(03) HFR9 - WHENSCOP
(-8) BOX HFC7
(-9) BOX HFC7

(01) CCORECTP
(02) BOX HFC7
(-8) BOX HFC7
(-9) BOX HFC7

Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had either of these exams?

CCORECTP

CCORECTP

code 1

For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
(01) Colonoscopy
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the doctor (02) Sigmoidoscopy
checks only part of the colon and you are fully awake.
(03) Both
(-8) Don't Know
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a colonoscopy, a sigmoidoscopy, or both? (-9) Refused

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]

(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 HFC7

HFR13 - COLSCRNS

Page 26 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFR11 - COLDRREC
(02) BOX HFR2
(-8) BOX HFR2
(-9) BOX HFR2

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.

COLDRREC

HFR11

yes/no

Has a doctor or other health professional ever recommended that [you/(SP)] have this test?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFR13 - COLSCRNS

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
bones lose their calcium and become fragile and more easily broken.

(01) CONTINUE
(-7) Empty

HFS1 - OSTEVERT

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

(01) YES
Have [you/(SP)] ever experienced a fracture that [your/his/her] doctor or other health professional told [you/him/her] (02) NO
was related to osteoporosis?
(-8) Don't Know
(-9) Refused

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

HEARSIG

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?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFC8

(01) HFS5 - OSTRECNT
(02) BOX HFC9
(-8) BOX HFC9
(-9) BOX HFC9

Page 27 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

COSTTEST

HFS3A

yes/no

Question Text/Description

There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a Bone Mass or Bone Density
Measurement test?

OSTHEAR

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFS6 - OSTMASS
(02) BOX HFC9
(-8) BOX HFC9
(-9) BOX HFC9

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

HFS6 - OSTMASS

HFAC29 - HCTROUBL

OSTRECNT

HFS5

code 1

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

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

HCTROUBL

HFAC29

yes/no

Next, we are going to ask some questions about [your/(SP's)] health care needs during the past year.

(01) YES
(02) NO
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that [you/he/she] wanted (-8) Don't Know
or needed?
(-9) Refused

(01) HFAC30A - HCTCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY

Page 28 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

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

CGETOTOS

CGETOTOS

verbatim text

Please specify the other reason.

Code List

Routing

(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

(01) [Continuous answer.]

BOX HFF7

Page 29 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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 by (02) NO
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

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?

HFAC32B- PAYOVRTM

Page 30 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

PRBLHWK

HFKB1

code 1

Question Text/Description

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
doing light housework (like washing dishes, straightening up, or light cleaning)?

DONTLHWK

HFKB2

yes/no

PRBHHWK

HFKC1

code 1
doing heavy housework (like scrubbing floors or washing windows)?

HFKC2

yes/no

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.]
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

HFKF2

yes/no

(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
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

[You said that doing heavy housework (like scrubbing floors or washing windows) is something that [you don't/(SP) (01) YES
doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

DONTMEAL

Routing

[You said that doing light housework (like washing dishes, straightening up, or light cleaning) is something that [you (01) YES
don't/(SP) doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]

DONTHHWK

Code List

[You said that managing money (like keeping track of expenses or paying bills) is something that [you don't/(SP)
doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

HFKC1 - PRBHHWK

(01) HFKD1 - PRBMEAL
(02) HFKD1 - PRBMEAL
(03) HFKC2 - DONTHHWK
(-8) HFKD1 - PRBMEAL
(-9) HFKD1 - PRBMEAL

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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFKA1

Page 31 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

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

HFKA3

yes/no

[Do you/Does (SP)] receive help from another person with...

Code List

Routing

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKA4 - PERSON_HLPRTELE
(02) BOX HFKB1
(-8) BOX HFKB1
(-9) BOX HFKB1

using the telephone?

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
IF PERSON_HLPRTELE = (N+1), GO TO HFKA4_NEWROSTFNAM,
ELSE GO TO BOX HFKB1

PERSON_HLPRTELE

HFKA4

roster

You mentioned that [you receive/(SP) receives] help with using the telephone. Who gives that help?
ENTER ALL HELPERS.

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

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.

ROSTREL

HFKA4_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKA4_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKB1

BOX HFKB1

routing

IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO HFKB3 - HELPLHWK.
ELSE GO TO BOX HFKC1.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKB4 - PERSON_HLPRLHWK
(02) BOX HFKC1
(-8) BOX HFKC1
(-9) 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...

(01) DO NOT DISPLAY
(02) BOX HFKB1
(56) BOX HFKB1
(91) HFKA4_NEW - ROSTREOS
(-8) BOX HFKB1
(-9) BOX HFKB1

doing light housework (like washing dishes, straightening up, or light cleaning)?

Page 32 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with doing light housework (like washing dishes, straightening
DISPLAY:
up, or light cleaning). Who gives that help?
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.

IF PERSON_HLPRLHWK = (N+1), GO TO HFKB4_NEWROSTFNAM,
ELSE GO TO BOX HFKC1

PERSON_HLPRLHWK

HFKB4

roster

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

(01) DO NOT DISPLAY
(02) BOX HFKC1
(56) BOX HFKC1
(58) BOX HFKC1
(59) BOX HFKC1
(60) BOX HFKC1
(61) BOX HFKC1
(91) HFKB4_NEW - ROSTREOS
(-8) BOX HFKC1
(-9) BOX HFKC1

ROSTREL

HFKB4_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKB4_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKC1

BOX HFKC1

routing

IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 - HELPHHWK.
ELSE GO TO BOX HFKD1

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKC4 - PERSON_HLPRHHWK
(02) BOX HFKD1
(-8) BOX HFKD1
(-9) 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...
doing heavy housework (like scrubbing floors or washing windows)?

Page 33 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with doing heavy housework (like scrubbing floors or washing
windows). Who gives that help?
DISPLAY:
ENTER ALL HELPERS.
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.

IF PERSON_HLPRHHWK = (N+1), GO TO HFKC4_NEWROSTFNAM.
ELSE GO TO BOX HFKD1.

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER

HFKC4_NEW - ROSTLNAM

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER

HFKC4_NEW - ROSTREL

(01) DO NOT DISPLAY
(02) BOX HFKD1
(56) BOX HFKD1
(58) BOX HFKD1
(59) BOX HFKD1
(60) BOX HFKD1
(61) BOX HFKD1
(91) HFKC4_NEW - ROSTREOS
(-8) BOX HFKD1
(-9) BOX HFKD1

PERSON_HLPRHHWK

HFKC4

roster

ROSTFNAM

HFKC4_NEW

ROSTLNAM

HFKC4_NEW

ROSTREL

HFKC4_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKC4_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKD1

BOX HFKD1

routing

IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO HFKD3 - HELPMEAL.
ELSE GO TO BOX HFKE1.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKD4 - PERSON_HLPRMEAL
(02) BOX HFKE1
(-8) BOX HFKE1
(-9) 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...
preparing [your/his/her] own meals?

Page 34 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with preparing [your/his/her] own meals. Who gives that help?
DISPLAY:
ENTER ALL HELPERS.
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.

IF PERSON_HLPRMEAL = (N+1), GO TO HFKD4_NEWROSTFNAM.
ELSE GO TO BOX HFKE1.

PERSON_HLPRMEAL

HFKD4

roster

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

(01) DO NOT DISPLAY
(02) BOX HFKE1
(56) BOX HFKE1
(58) BOX HFKE1
(59) BOX HFKE1
(60) BOX HFKE1
(61) 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)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKD4_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKE1

BOX HFKE1

routing

IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO HFKE3 - HELPSHOP.
ELSE GO TO BOX HFKF1.

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFKE4 - PERSON_HLPRSHOP
(02) BOX HFKF1
(-8) BOX HFKF1
(-9) 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...
shopping for personal items (such as toilet items or medicines)?

Page 35 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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_HLPRSHOP

HFKE4

roster

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.

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

(01) DO NOT DISPLAY
(02) BOX HFKF1
(56) BOX HFKF1
(58) BOX HFKF1
(59) BOX HFKF1
(60) BOX HFKF1
(61) BOX HFKF1
(91) HFKE4_NEW - ROSTREOS
(-8) BOX HFKF1
(-9) BOX HFKF1

BOX HFKF1

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.

ROSTREL

HFKE4_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKE4_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFKF1

routing

IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO HFKF3 - HELPBILS.
ELSE GO TO HFLINTRO - ADLSINTRO.

HELPBILS

HFKF3

yes/no

[[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
(01) YES
do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused

IF PERSON_HLPRSHOP = (N+1), GO TO HFKE4_NEWROSTFNAM.
ELSE GO TO BOX HFKF1.

(01) HFKF4 - PERSON_HLPRBILS
(02) HFLINTRO - ADLSINTRO
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO

managing money (like keeping track of expenses or paying bills)?

Page 36 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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_HLPRBILS

HFKF4

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

(01) DO NOT DISPLAY
(02) HFLINTRO - ADLSINTRO
(56) HFLINTRO - ADLSINTRO
(58) HFLINTRO - ADLSINTRO
(59) HFLINTRO - ADLSINTRO
(60) HFLINTRO - ADLSINTRO
(61) HFLINTRO - ADLSINTRO
(91) HFKF4_NEW - ROSTREOS
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO

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.

IF PERSON_HLPRBILS = (N+1), GO TO HFKF4_NEWROSTFNAM.
ELSE GO TO HFLINTRO - ADLSINTRO.

ROSTREL

HFKF4_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFKF4_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

HFLINTRO - ADLSINTRO

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
like to know whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself] and without
special equipment.

(01) CONTINUE
(-7) Empty

HFLA1 - HPPDBATH

HPPDBATH

HFLA1

code 1

(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

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?

Page 37 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

HPPDDRES

HFLB1

code 1

Question Text/Description

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
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?

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

Page 38 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

DONTTOIL

HFLF2

yes/no

Question Text/Description

[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

HELPBATH

BOX HFLA1

routing

HFLA3

yes/no

[[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.]]

Does someone usually stay nearby just in case [you need/(SP) needs] help with bathing or showering?
HFLA4

yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]

EQIPBATH

Routing

(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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFLA5 - EQIPBATH

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLA2

IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO HFLA3 - HELPBATH.
ELSE GO TO BOX HFLB1.

[Do you/Does (SP)] receive help from another person with bathing or showering?

PCHKBATH

Code List

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.

HELPDRES

HFLB3

yes/no

[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is something [you don't/(SP) doesn't] (01) YES
do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with dressing?
(-9) Refused

PCHKDRES

HFLB4

yes/no

Does someone usually stay nearby just in case [you need/(SP) needs] help with dressing?
[That is, does someone usually stay or come into the room to check on [you/him/her]?]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFLB5 - EQIPDRES
(02) HFLB4 - PCHKDRES
(-8) HFLB4 - PCHKDRES
(-9) HFLB4 - PCHKDRES

HFLB5 - EQIPDRES

Page 39 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

EQIPDRES

HFLB5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with dressing?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLB2

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

(01) HFLB7 - STILDRES
(02) BOX HFLC1
(03) BOX HFLC1
(-8) BOX HFLC1
(-9) BOX HFLC1

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

BOX HFLC1

routing

IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 - HELPEAT.
ELSE GO TO BOX HFLD1.

HFLC3

yes/no

(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

[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you don't/(SP) doesn't] do.]]
HELPEAT

[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

Page 40 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

BOX HFLD1

routing

IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO HFLD3 - HELPCHAR.
ELSE GO TO BOX HFLE1.

HELPCHAR

HFLD3

yes/no

[[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 (01) YES
or chairs is something [you don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?
(-9) Refused

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

Code List

Routing

(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

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

(01) HFLD7 - STILCHAR
(02) BOX HFLE1
(03) BOX HFLE1
(-8) BOX HFLE1
(-9) BOX HFLE1

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

BOX HFLE1

routing

IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 - HELPWALK.
ELSE GO TO BOX HFLF1.

(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

[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.]]
[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)?]

Page 41 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

EQIPWALK

HFLE5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with walking?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLE2

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

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFLF2

(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

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]?]

EQIPTOIL

LONGTOIL

HFLF5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with using the toilet, including getting up
and down?

BOX HFLF2

routing

IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.

HFLF6

code 1

How long [have you/has (SP)] needed help with using the toilet? Has it been . . .

Page 42 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

BOX HFLA3

routing

IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH.
ELSE GO TO BOX HFLB3.

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with bathing and showering. Who gives that help?
PERSON_HLPRBATH

HFLA9

roster
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.

IF PERSON_HLPRBATH = (N+1) , GO TO HFLA9_NEWROSTFNAM.
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

(01) DO NOT DISPLAY
(02) BOX HFLB3
(56) BOX HFLB3
(58) BOX HFLB3
(59) BOX HFLB3
(60) BOX HFLB3
(61) BOX HFLB3
(91) HFLA9_NEW - ROSTREOS
(-8) BOX HFLB3
(-9) BOX HFLB3

BOX HFLB3

ROSTREL

HFLA9_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFLA9_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFLB3

routing

IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES.
ELSE GO TO BOX HFLC3.

Page 43 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with dressing. Who gives that help?
PERSON_HLPRDRES

HFLB9

roster
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.

IF PERSON_HLPRBATH = (N+1), GO TO HFLB9_NEWROSTFNAM.
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

(01) DO NOT DISPLAY
(02) BOX HFLC3
(56) BOX HFLC3
(58) BOX HFLC3
(59) BOX HFLC3
(60) BOX HFLC3
(61) 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)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFLB9_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFLC3

routing

IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT.
ELSE GO TO BOX HFLD3.

BOX HFLC3

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with eating. Who gives that help?
PERSON_HLPREAT

HFLC9

roster
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.

IF PERSON_HLPREAT = (N+1) GO TO HFLC9_NEWROSTFNAM.
ELSE GO TO BOX HFLD3.

Page 44 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

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

(01) DO NOT DISPLAY
(02) BOX HFLD3
(56) BOX HFLD3
(58) BOX HFLD3
(59) BOX HFLD3
(60) BOX HFLD3
(61) BOX HFLD3
(91) HFLC9_NEW - ROSTREOS
(-8) BOX HFLD3
(-9) BOX HFLD3

BOX HFLD3

ROSTREL

HFLC9_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFLC9_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFLD3

routing

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with getting in or out of bed or chairs. Who gives that help?
PERSON_HLPRCHAR

HFLD9

roster
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.

IF PERSON_HLPRCHAR = (N+1) , GO TO HFLD9_NEWROSTFNAM.
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

(01) DO NOT DISPLAY
(02) BOX HFLE3
(56) BOX HFLE3
(58) BOX HFLE3
(59) BOX HFLE3
(60) BOX HFLE3
(61) BOX HFLE3
(91) HFLD9_NEW - ROSTREOS
(-8) BOX HFLE3
(-9) BOX HFLE3

BOX HFLE3

ROSTREL

HFLD9_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFLD9_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

Page 45 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

BOX HFLE3

routing

IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK.
ELSE GO TO BOX HFLF3.

Code List

Routing

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with walking. Who gives that help?
PERSON_HLPRWALK

HFLE9

roster
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.

IF PERSON_HLPRWALK = (N+1), GO TO HFLE9_NEWROSTFNAM.
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

(01) DO NOT DISPLAY
(02) BOX HFLF3
(56) BOX HFLF3
(58) BOX HFLF3
(59) BOX HFLF3
(60) BOX HFLF3
(61) BOX HFLF3
(91) HFLE9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3

BOX HFLF3

ROSTREL

HFLE9_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFLE9_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

BOX HFLF3

routing

IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL.
ELSE GO TO BOX HFL4.

DISPLAY PERSON ROSTER AS RESPONSE OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER
You mentioned that [you receive/(SP) receives] help with using the toilet. Who gives that help?
PERSON_HLPRTOIL

HFLF9

roster
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.

IF PERSON_HLPRTOIL = (N+1), GO TO HFLF9_NEWROSTFNAM.
ELSE GO TO BOX HFLG3.

Page 46 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

(01) DO NOT DISPLAY
(02) BOX HFLF3
(56) BOX HFLF3
(58) BOX HFLF3
(59) BOX HFLF3
(60) BOX HFLF3
(61) BOX HFLF3
(91) HFLF9_NEW - ROSTREOS
(-8) BOX HFLF3
(-9) BOX HFLF3

BOX HFLF3

ROSTREL

HFLF9_NEW

code one

[What is the name of the person and relationship to (SP)?]

(02) SPOUSE
(56) PARTNER
(58) CHILD
(59) GRANDCHILD
(60) PARENT
(61) SIBLING
(91) OTHER
(-8) Don't Know
(-9) Refused

ROSTREOS

HFLF9_NEW

text

[What is the name of the person and relationship to (SP)?]

(01) CONTINUOUS ANSWER
(-8) Don't Know
(-9) Refused

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.

HFL10

roster

Which of these persons gives [you/(SP)] the most help with these things?
PERSON_HLPRMOST

Display all persons selected at HFLA9, HFLB9, HFLC9,
HFLD9, HFLE9 and HFLF9 rosters.

HFM1 - FALLANY

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) HFM2 - FALLTIME
(02) DISUPPYR
(-8) DISUPPYR
(-9) DISUPPYR

[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

(01) [Continuous answer.]

HFM3C - FALLIMIT

SELECT ONLY ONE.

FALLANY

HFM1

yes/no

FALLTIME

HFM2

numeric

Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?

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)

Page 47 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

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 HF9
This card lists some examples of different types of dietary supplements.
DISUPPYR

DISUPPYR

yes/no

(01) YES
(02) NO
Since (LAST HF MONTH YEAR), [have you/has (SP)] used or taken any vitamins, minerals, herbals or other dietary (-8) Don't Know
supplements? Include prescription and non-prescription supplements.
(-9) Refused

(01) MULTVTYR
(02) BOX MH1
(-8) BOX MH1
(-9) BOX MH1

[IF NEEDED: Include any supplements that you have already told me about.]

MULTVTYR

MULTVTYR

yes/no

Since (LAST HF MONTH YEAR), did [you/(SP)] take any multivitamins, such as One a Day, Theragran, or Centrum
(01) YES
type multivitamins?
(02) NO
(-8) Don't Know
[IF NEEDED: Multivitamins may be pills, liquids, or packets]
(-9) Refused

VITSUPYR

[IF NEEDED: Include any multivitamins that you have already told me about.]

VITSUPYR

VITSUPYR

select all

(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
SHOW CARD HF9 HF10
(07) Garlic supplement
(08) Iron
Please look at the vitamins and dietary supplements listed on this card. Since (LAST HF MONTH YEAR), what
(09) Joint supplement (such as glucosamine, with or
vitamins and dietary supplements did [you/(SP)] take at least once?
without chondroitin or other ingredients)
(10) Magnesium
Do not include vitamins and dietary supplements that are taken as part of a multivitamin.
(11) Melatonin
(12) Niacin
[IF NEEDED: Include any vitamins or dietary supplements (that are not part of a multivitamin) that you have already
(13) Omega-3 (ALA/DHA/EPA) or fish oil
told me about.]
(14) Potassium
(15) Probiotics (in pill, powder, or liquid form)
IF RESPONDENT HAS PROVIDED YOU WITH SUPPLEMENT BOTTLES YOU MAY USE THOSE TO ANSWER
(16) Saw palmetto
THE QUESTION IF THE SUPPLEMENT WAS TAKEN SINCE (LAST HF MONTH YEAR).
(17) Vitamin A
(18) Vitamin B-12
SELECT ALL THAT APPLY
(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

Page 48 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

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

The next few questions ask about the last two weeks.
SHOW CARD HF10 HF11
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 HF11
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 HF11
HFPHQ1

HFN3

list

Now, we will ask you about how the following problems have affected you overall, if any at all. 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 HF11
HFPHQ2

HFN4

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling down, depressed, or hopeless?

Page 49 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

SHOW CARD HF10 HF11
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?

SHOW CARD HF10 HF11
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 HF11
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 HF11
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 HF11
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 HF11
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

HFN6 - HFPHQ4

(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

(01) Not at all difficult,
(02) Somewhat difficult,
(03) Very difficult,
(04) Extremely difficult?
(-8) REFUSED
(-9) DON’T KNOW

SOCISOLA-SOCISOLA

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 HF12

PHQ9QS10

HFN11

code one

You mentioned that you have been bothered by the following problems over the last 2 weeks:
[LIST ALL CONDITIONS WHERE ANSWER RECORDED DOES NOT EQUAL 1/NOT AT ALL, -8/REFUSED, or 9/DON’T KNOW, AT HFPHQ1 THROUGH HFPHQ8]
How difficult have these problems made it for you to do your work, take care of things at home, or get along with
people?

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HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

SHOW CARD HF3 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...

SHOW CARD HF13

Code List

Routing

(01) Never
(02) Rarely
(03) Sometimes
(04) Often
(05) Always
(-8) Don’t know
(-9) Refused

HFQ1 - LOSTURIN

(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.]

HYPEAGE

HFT2

numeric

(01) [Continuous answer.]
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had high blood pressure? (-8) Don't Know
(-9) Refused

HYPEAGE_LESSONE

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) LESS THAN ONE YEAR OLD
(-7) Empty

HFT2 - HYPEAGE_LESSONE

HFT6D - HYPEHOME

Page 51 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

Because of [your/his/her] high blood pressure, [are you/is (SP)] now taking prescribed medicine for [your/his/her]
high blood pressure?

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

HFT6J - HYPEDRNK

HYPEDRNK

HFT6J

yes/no

[Have you/Has (SP)] cut down on drinking alcoholic beverages because of [your/his/her] high blood pressure?]

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

BOX HFT2

BOX HFT2

routing

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG.
ELSE GO TO HFT12A - HYPECTRL.

HYPELONG

HFT7

numeric

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

HYPELONG_LESSONE

HFT7

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.

HYPEMANY

HFT8

numeric

HYPECOND

HFT11A

code 1

How many different prescribed medicines [do you/does (SP)] take for [your/his/her] high blood pressure?

(01) [Continuous answer.]
(-8) Don't Know
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR HIGH BLOOD PRESSURE
(-9) Refused
ARE TAKEN BY THE RESPONDENT, NOT THE NUMBER OF PILLS THEY MIGHT TAKE IN ONE 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.
[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?

BOX HFT4

routing

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

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.

Page 52 of 53

HFQ-HEALTH STATUS AND FUNCTIONING

2023 MCBS Community Questionnaire

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

(01) YES
[Do you/Does (SP)] ever skip taking [your/his/her] medicine, take less medicine than prescribed, or share medicine (02) NO
because of the cost of the medicine?
(-8) Don't Know
(-9) Refused

BOX HFEND

routing

If INTTYPE in (C003), GO TO PXQ
ELSE, GO TO NAQ.

BOX HFEND

Page 53 of 53