Additional COVID Questions

Att 1 - 2021 Sample Adult Covid-19 Vaccination Questions.pdf

[NCHS] National Health Interview Survey

Additional COVID Questions

OMB: 0920-0214

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Question ID: IMS.0061.00.3

Question Text:

Response:

Variable name: SHTCVD19_A

Interview module: IMS()

The next questions are about coronavirus or COVID-19 vaccination. Have you
had a COVID-19 vaccination?
Read if necessary: The COVID-19 vaccination has
been available since 2020.

1.
2.
DK:
RF:

Yes
No
Don't Know
Refused

Skip Instructions: <1> [goto SHTCVD19NM_A]
<2,RF,DK> [goto SHTPNUEV_A]

Question ID: IMS.0062.00.3

Variable name: SHTCVD19NM_A

Interview module: IMS()

Universe: SHTCVD19_A=1
Question Text:

Response:

How many COVID-19 vaccinations have you received?

1.
2.
3.
DK:
RF:

1 vaccination
2 vaccinations
More than 2 vaccinations
Don't Know
Refused

Skip Instructions: <1-3> [goto CVDVAC1M_A]
 [goto SHTPNUEV_A]

Question ID: IMS.0063.01.3

Variable name: CVDVAC1M_A

Interview module: IMS()

Universe: SHTCVD19NM_A=1,2,3
Question Text:

Response:

1 of 2 During what month and year did you receive your most recent COVID-19
vaccination? Enter month of most recent COVID-19 vaccination.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
DK:
RF:

January
February
March
April
May
June
July
August
September
October
November
December
Don't Know
Refused

Skip Instructions: <1-12,DK> [goto CVDVAC1Y_A]
 if SHTCVD19NM_A_C=2,3 [goto CVDVAC2M_A]
else if SHTCVD19NM_A=1 [goto SHTCVD19AV_A]

Question ID: IMS.0063.02.1

Variable name: CVDVAC1Y_A

Interview module: IMS()

Universe: ((CVDVAC1M_A GE 1 AND CVDVAC1M_A LE 12) OR CVDVAC1M_A=DK)
Question Text:

Response:

2 of 2

DK:
RF:

Enter year of most recent COVID-19 vaccination.

Don't Know
Refused

Skip Instructions:  and SHTCVD19NM_A=2,3
CVDVAC2M_A]
else [goto SHTCVD19AV_A]
if CVDVAC1M_A and CVDVAC1Y_A = a future date
ERR1_CVDVAC1Y_A];
if CVDVAC1M_A and CVDVAC1Y_A = a date prior to birth
ERR2_CVDVAC1Y_A];
if CVDVAC1M_A and CVDVAC1Y_A = a date prior to 2020
ERR3_CVDVAC1Y_A]

[goto

[goto
[goto
[goto

Check Name: ERR1_CVDVAC1Y_A

Text:

{check ERR1_CVDVAC1Y_A} Future date invalid

Hard / Soft Edit: Hard
Universe: (CVDVAC1Y_A gt current year) or (CVDVAC1Y_A=current year and
CVDVAC1M_A gt current month)

Check Name: ERR2_CVDVAC1Y_A

Text:

{check ERR2_CVDVAC1Y_A} Date prior to birth

Hard / Soft Edit: Hard
Universe: CVDVAC1M_A and CVDVAC1Y_A = date prior to birth date

Check Name: ERR3_CVDVAC1Y_A

Text:

{check ERR3_CVDVAC1Y_A} Date before 2020

Hard / Soft Edit: Hard
Universe: (CVDVAC1Y_A lt 2020)
Page 7 of 19

Question ID: IMS.0064.01.3

Variable name: CVDVAC2M_A

Interview module: IMS()

Universe: SHTCVD19NM_A=2,3
Question Text:

Response:

1 of 2 During what month and year did you receive your next most recent
COVID-19 vaccination?
Enter month of the next most recent COVID-19
vaccination.

1.
2.
3.
4.
5.
6.
7.
8.
9.

January
February
March
April
May
June
July
August
September

10.
11.
12.
DK:
RF:

October
November
December
Don't Know
Refused

Skip Instructions: <1-12,DK> [goto CVDVAC2Y_A]
 [goto SHTPNUEV_A]

Question ID: IMS.0064.02.3

Variable name: CVDVAC2Y_A

Interview module: IMS()

Universe: ((CVDVAC2M_A GE 1 AND CVDVAC2M_A LE 12) OR CVDVAC2M_A=DK)
Question Text:

Response:

2 of 2

DK:
RF:

Enter year of next most recent COVID vaccination.

Don't Know
Refused

Skip Instructions:  [goto SHTPNUEV_A]
If CVDVAC2M_A and CVDVAC2Y_A = a date in the future [goto
ERR1_CVDVAC2Y_A]
If CVDVAC2M_A and CVDVAC2Y_A = a date prior to birth [goto
ERR2_CVDVAC2Y_A]
If CVDVAC2M_A and CVDVAC2Y_A = a date prior to 2020
[goto ERR3_CVDVAC2Y_A]
If CVDVAC2M_A and CVDVAC2Y_A = a date more recent than answer given
in (CVDVAC1M_A and CVDVAC1Y_A) [goto ERR4_CVDVAC2Y_A]

Check Name: ERR1_CVDVAC2Y_A

Text:

{check ERR1_CVDVAC2Y_A}

Future date invalid

Hard / Soft Edit: Hard
Universe: (CVDVAC2Y_A gt current year) or (CVDVAC2Y_A=current year and
CVDVAC2M_A gt current month)

Check Name: ERR2_CVDVAC2Y_A

Text:

{check ERR2_CVDVAC2Y_A}

Date prior to birth

Hard / Soft Edit: Hard
Universe: CVDVAC2M_A and CVDVAC2Y_A = a date prior to birth

Check Name: ERR3_CVDVAC2Y_A

Text:

{check ERR3_CVDVAC2Y_A}

Date before 2020

Hard / Soft Edit: Hard
Universe: (CVDVAC2Y_A lt 2020)

Check Name: ERR4_CVDVAC2Y_A

Text:

{check ERR4_CVDVAC2Y_A} The date entered for the second most recent COVID
vaccination is after the date of the most recent COVID vaccination. Please verify.

Hard / Soft Edit: Soft
Universe: (CVDVAC2Y_A gt CVDVAC1Y_A) or (CVDVAC2Y_A=CVDVAC1Y_A and
CVDVAC2M_A gt CVDVAC1M_A)

Question ID: IMS.0065.00.3

Variable name: SHTCVD19AV_A

Interview module: IMS()

Universe: SHTCVD19NM_A=1
Question Text:

Did a doctor or other health professional tell you that you need an additional
dose of the COVID-19 vaccination?

Response:
1.
2.
DK:
RF:

Yes
No
Don't Know
Refused

Skip Instructions: <1,2,RF,DK> [goto SHTPNUEV_A]


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