CMS-P-0015A Background_Questionnaire MIssing Data

2022 MCBS Facility Instrument

Variable Name

BQM-Background Questionnaire Missing Data

MR Screen Name Question Type

Question Text/Description

Code List

Routing

(01) CONTINUE

(01) BOX BQM1

(01) AMERICAN INDIAN OR ALASKA NATIVE
(02) ASIAN
(03) BLACK OR AFRICAN AMERICAN
(04) NATIVE HAWAIIAN OR OTHER PACIFIC
ISLANDER
(05) WHITE
(91) ANOTHER RACE
(95) R NEVER WILL KNOW
(-8) Don't Know
(-9) Refused

(01) BOX BQM1A
(02) BOX BQM1A
(03) BOX BQM1A
(04) BOX BQM1A
(05) BOX BQM1A
(91) BQM1A - BQMRACOS
(95) BOX BQM2
(-8) BOX BQM2
(-9) BOX BQM2

(01) Continuous answer

(01) BOX BQM1A

(01) ASIAN INDIAN
(02) CHINESE
(03) FILIPINO
(04) JAPANESE
(05) KOREAN
(06) VIETNAMESE
(91) OTHER ASIAN GROUP
(-8) Don't Know
(-9) Refused

(01) BOX BQM1B
(02) BOX BQM1B
(03) BOX BQM1B
(04) BOX BQM1B
(05) BOX BQM1B
(06) BOX BQM1B
(91) BQM1AB - BMRACAOS
(-8) BOX BQM1B
(-9) BOX BQM1B

(01) Continuous answer

(01) BOX BQM1B

You can choose more than one group.
CHECK ALL THAT APPLY.

(01) NATIVE HAWAIIAN
(02) GUAMANIAN OR CHAMORRO
(03) SAMOAN
(91) OTHER PACIFIC ISLANDER GROUP
(-8) Don't Know
(-9) Refused

(01) BOX BQM2
(02) BOX BQM2
(03) BOX BQM2
(91) BQM1AC - BMRACPOS
(-8) BOX BQM2
(-9) BOX BQM2

OTHER PACIFIC ISLANDER GROUP (SPECIFY)

(01) Continuous answer

(01) BOX BQM2

BACKGROUND QUESTIONNAIRE MISSING DATA SECTION SPECIFICATIONS
CRITERIA
SAMPLE TYPE= CFC, IPR and at least one key Background Questionnaire (BQ) variable is DK, RF, or NULL
SEASON
If SAMPLE TYPE= CFC, then SEASON= ALL
If SAMPLE TYPE= IPR, then SEASON= FALL
PLACEMENT
Administered in flexible order after FQ, RH, and BQ sections are completed.

BQMISSNG

BOX BQMBEG

routing

BQMISS1

code one

GO TO BQMISS1 - BQMISSNG.
THE FOLLOWING ITEMS ARE MISSING FROM BQ. CONFIRM THAT RESPONDENT CAN ANSWER AT
LEAST ONE OF THESE ITEMS.
PRESS "1" TO CONTINUE.

BOX BQM1

routing

IF (BQ11A - BQRACE = DK OR RF) AND (BQM1A - BQMRACE = DK, EMPTY OR NULL), GO TO BQM1A BQMRACE.
ELSE, GO TO BOX BQM2.

SHOW CARD BQ1A
Please look at this card and tell me what (is/was) (SP's) race.

BQMRACE

BQM1A

code all

BQMRACOS

BQM1A

verbatim text

ANOTHER RACE (SPECIFY)

BOX BQM1A

routing

IF BQM1A-BQMRACE INCLUDES 2/Asian, GO TO BQM1AB - BMRACASD.
ELSE GO TO BOX BQM1B.

BMRACASD

BQM1AB

code all

SELECT ALL THAT APPLY, OR ENTER "95" R NEVER WILL KNOW.
SEPARATE RESPONSES BY USING THE SPACEBAR.

SHOW CARD BQ1B.
Looking at this card, (is/was) (SP) Asian Indian, Chinese, Filipino,
Japanese, Korean, Vietnamese or some other Asian group?
You can choose more than one group.
CHECK ALL THAT APPLY.

BMRACAOS

BQM1AB
BOX BQM1B

BMRACPID

BMRACPOS

BQM1AC

verbatim text

verbatim text

OTHER ASIAN GROUP (SPECIFY)

routing

IF BQM1A-BQMRACE INCLUDES 4/NativeHawaiianOrOtherPacificIslander, GO TO BQM1AC - BMRACPID.
ELSE GO TO BOX BQM2.

code all

verbatim text

SHOW CARD BQ1C.
Looking at this card, (is/was) (SP) Native Hawaiian, Guamanian
or Chamorro, Samoan, or some other Pacific Islander group?

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2022 MCBS Facility Instrument

Variable Name

BQM-Background Questionnaire Missing Data

MR Screen Name Question Type

Question Text/Description

BOX BQM2

IF (BQ13 - BMRJAN = DK OR RF) AND (BQM2A - BQMMARTL = DK, EMPTY OR NULL GO TO BQM2A BQMMARTL.
ELSE GO TO BOX BQMEND.

routing

Code List

Routing

(01) BQMEND - BQMSEND
(02) BQMEND - BQMSEND
(03) BQMEND - BQMSEND
(04) BQMEND - BQMSEND
(05) BQMEND - BQMSEND
(95) BQMEND - BQMSEND
(-8) BQMEND - BQMSEND
(-9) BQMEND - BQMSEND

(01) BOX BQMEND

BQMMARTL

BQM2A

code one

(Is/was) (SP) married, widowed, divorced, separated, or never married?
IF R NEVER WILL KNOW, ENTER "95".

(01) NEVER MARRIED
(02) MARRIED
(03) WIDOWED
(04) DIVORCED
(05) SEPARATED
(95) R NEVER WILL KNOW
(-8) Don't Know
(-9) Refused

BQMSEND

BQMEND

code one

YOU HAVE REACHED THE END OF THE SECTION FOR BACKGROUND QUESTIONNAIRE MISSING
DATA.
PRESS "1" TO RETURN TO FACILITY NAVIGATION SCREEN.

(01) CONTINUE

BOX BQMEND

routing

GO TO NAVIGATOR

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