CMS-P-0015A HFQ - Health Status and Functioning

Medicare Current Beneficiary Survey (MCBS) (CMS-P-0015A)

2024_Health_Status_HFQ

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

OMB: 0938-0568

Document [pdf]
Download: pdf | pdf
2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

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

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

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 . . .

FUTRHLTH

HFA2B

code one

TEETHGUM

TEETHGUM

code one

DISHEAR

DIS1

yes/no

SHOW CARD HF2
In the next 6 months, what do you think will happen to [your/(SP's)] overall health?

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?

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2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

DISSEE

DIS2

yes/no

[Are you/Is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even when wearing glasses or
contact lenses?

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

BOX HF1

BOX HF1

routing

IF P_DISTEETH=YES, GO TO DIS3-DISDECISION.
ELSE GO TO DIS2A-DISTEETH.

DISTEETH

DIS2A

yes/no

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

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

DIS3 - DISDECISION

DISDECISION

DIS3

yes/no

Because of a physical, mental, or emotional condition, [do you/does (SP)] have serious difficulty concentrating,
remembering, or making decisions?

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

DIS4 - DISWALK

DISWALK

DIS4

yes/no

[Do you/Does (SP)] have serious difficulty walking or climbing stairs?

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

DIS5 - DISBATH

DISBATH

DIS5

yes/no

[Do you/Does (SP)] have difficulty dressing or bathing?

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

DIS6 - DISERRANDS

DISERRANDS

DIS6

yes/no

Because of a physical, mental, or emotional condition, [do you/does (SP)] have difficulty doing errands alone
such as visiting a doctor's office or shopping?

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

HFA3 - HELMTACT

(01) none of the time,
(02) some of the time,
(03) most of the time, or
(04) all of the time?
(-8) DON'T KNOW
(-9) REFUSED

HFB1-ECHELP

HELMTACT

HFA3

code one

How much of the time during the past month has [your/(SP's)] health limited [your/(SP's)] social activities, like
visiting with friends or close relatives?
Would you say . . .

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2024 MCBS Community Questionnaire

Variable Name

ECHELP

MR Screen Name

HFB1

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

yes/no

ECTROUB

HFB2

code one

ECLEGBLI

HFB2A

yes/no

Question Text/Description

Next we are going to ask some questions about [your/(SP's)] vision and hearing.
[Do you/Does (SP)] wear eyeglasses or contact lenses?

Which statement best describes [your/(SP's)] vision [while wearing glasses or contact lenses]... no trouble
seeing, a little trouble, a lot of trouble, or no usable vision?

[Have you/Has (SP)] been told that [you are/he is/she is] legally blind?
[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with corrective lenses, they cannot
see well enough to drive.]

[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF MONTH YEAR)?
EDOCEXAM

HFB6

yes/no

INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
[IF NEEDED: Please include any eye exams that took place during a visit that you may have already told me
about.]

BOX HFC

EDOCLAST

HFB7

routing

code one

Code List

Routing

(01) YES
(02) NO
(03) SP IS BLIND
(-8) DON'T KNOW
(-9) REFUSED

(01) HFB2 - ECTROUB
(02) HFB2 - ECTROUB
(03) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM

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

(01) HFB6 - EDOCEXAM
(02) HFB6 - EDOCEXAM
(03) HFB2A - ECLEGBLI
(04) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM

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

HFB6 - EDOCEXAM

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

(01) HFB7A - EDOCTYPE
(02) BOX HFC
(-8) BOX HFB1
(-9) BOX HFB1

(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

(996) BOX HFB1
(01) - (12) HFB7A - EDOCTYPE
(-8) BOX HFB1
(-9) BOX HFB1

(01) OPTOMETRIST
(02) OPHTHALMOLOGIST
(91) OTHER DOCTOR SPECIALTY
(-8) DON'T KNOW
(-9) REFUSED

(01) H7B7B - EDOCDLAT
(02) H7B7B - EDOCDLAT
(91) HFB7 - EDOCTYOS
(-8) BOX HFB1
(-9) BOX HFB1

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

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

I have a couple of questions about [your/(SP’s)] last eye examination.

EDOCTYPE

HFB7A

code one

Was the eye examination given by an optometrist, ophthalmologist or some other type of doctor or eye care
professional?
[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry (O.D.) who diagnoses and treats visual
health problems. An ophthalmologist is a doctor of medicine (M.D.) who specializes in surgery and diseases of
the eye.]

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2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

EDOCTYOS

HFB7A

verbatim text

OTHER (SPECIFY)

EDOCDLAT

HFB7B

yes/no

(01) YES
(02) NO
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The drops often (-8) DON'T KNOW
make your eyes more sensitive to bright light and may cause temporary blurry vision.]
(-9) REFUSED

BOX HFB7

routing

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

Routing

H7B7B - EDOCDLAT

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

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.
CATAREVR

HFB7C

yes/no

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

BOX HFB7A

routing

HFB7C

yes/no

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

BOX HFB7B

routing

HFB7C

yes/no

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

BOX HFB7C

routing

BOX HFB7A

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

BOX HFB7B

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

BOX HFB7C

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

[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

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

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

[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

BOX HFB7

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

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

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.
MACULEVR

HFB7C

yes/no

[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.

HFB11

yes/no

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

[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

Code List

Routing

(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

(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

yes/no

[Do you/Does (SP)] use a hearing aid?

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

HFC4 - HCCOMDOC

HCTROUB

HFC2

code one

(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
Which statement best describes [your/(SP's)] hearing [with a hearing aid]: no trouble hearing, a little trouble, a lot (03) A LOT OF TROUBLE HEARING
of trouble, or deaf?
(04) DEAF
(-8) DON'T KNOW
(-9) REFUSED

HCKNOWMC

HFC3

code one

(01) NO TROUBLE
How much trouble [do you/does (SP)] have finding out things [you need/he needs/she needs] to know about
(02) A LITTLE TROUBLE
Medicare because [of (your/his/her) difficulty hearing [with a hearing aid]/(you are/he is/she is) deaf]? Would you (03) A LOT OF TROUBLE
say [you have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED

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2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

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 [with a hearing aid]/(you are/he is/she is) deaf]? Would you say [you (03) A LOT OF TROUBLE
have/she has/he has] 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
TOOTHSEN

TOOTHSEN

code one

[Since (LAST HF MONTH YEAR), how often [have you/ has (SP)] experienced any of the following problems?]
Tooth sensitivity to hot or cold food or drinks?
IF THE RESPONDENT HAS LOST ALL OF THEIR NATURAL TEETH, SELECT 'NOT APPLICAPLE'

ORALPAIN

ORALPAIN

code one

SHOW CARD HF4
Since [LAST HF MONTH YEAR], [have you/has (SP)] had painful aching in [your/their] mouth? Would you say:

SHOW CARD HF4
CHEWPROB

CHEWPROB

code one

Since [LAST HF MONTH YEAR], [have you/has(SP)] had difficulty chewing any foods because of problems, if
any, with [your/their] teeth, mouth, dentures, or jaw? Would you say:

SHOW CARD HF4
ORALLOOK

ORALLOOK

code one

Since [LAST HF MONTH YEAR], [have you/has (SP)] felt uncomfortable about the appearance of [your/their]
teeth, mouth, dentures, or jaws? Would you say:
[IF NEEDED: “Uncomfortable” can include a wide spectrum of emotions (embarrassment, anxiety, anger,
sadness, etc.).]

Code List

Routing

HFD1A - FOODTRBL

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

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 - HEIGHTF
ORALPAIN-ORALPAIN

(01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

CHEWPROB-CHEWPROB

(01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

ORALLOOK-ORALLOOK

(01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

JOBTEETH-JOBTEETH

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

SHOW CARD HF4

JOBTEETH

JOBTEETH

code one

(01) Never
(02) Hardly ever
Since [LAST HF MONTH YEAR], [have you/has (SP)] had difficulty doing [your/their] usual activities because of
(03) Occasionally
problems, if any, with [your/their] teeth, mouth, dentures, or jaws? Would you say:
(04) Fairly often
(05) Very often
[IF NEEDED: “Activities” may include going to a job, doing housework such as light cleaning, shopping, or
(-8) DON'T KNOW
running errands, preparing meals, etc.]
(-9) REFUSED

SHOW CARD HF4

LESSFLAV-LESSFLAV

(01) Never
(02) Hardly ever
(03) Occasionally
(04) Fairly often
(05) Very often
(-8) DON'T KNOW
(-9) REFUSED

HFE1-HEIGHTFT

LESSFLAV

LESSFLAV

code one

HEIGHTFT

HFE1

numeric

How tall [are you/is (SP)]?

(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED

HFE1 - HEIGHTIN

HEIGHTIN

HFE1

numeric

How tall [are you/is (SP)]?

(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED

HFE1 - WEIGHT

WEIGHT

HFE1

numeric

(01) continuous answer
(-8) DON'T KNOW
(-9) REFUSED

LOSTWGHT

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

EATLESWK

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

HFHINTRO - DIFINTRO

(01) CONTINUE
(-7) Empty

HFH1 - DIFSTOOP

Since [LAST HF MONTH YEAR], [have you/has (SP)] felt that there has been less flavor in [your/their] food
because of problems, if any, with [your/their] teeth, mouth, dentures, or jaws? Would you say:

How much [do you/does (SP)] weigh?
[WEIGHT SHOULD BE RECORDED IN POUNDS]

[Have you/Has (SP)] lost weight in the past 6 months without trying to lose this weight?
LOSTWGHT

LOSTWGHT

yes/no

IF RESPONDENT REPORTS A WEIGHT LOSS BUT THE WEIGHT WAS GAINED BACK, CONSIDER IT AS
NO WEIGHT LOSS.
[IF NEEDED: Is [your/(SP)'s] clothing fitting more loosely?]

[Have you/Has (SP)] been eating less than usual for more than a week?
EATLESWK

EATLESWK

yes/no

DIFINTRO

HFHINTRO

no entry

IF THE RESPONDENT REPORTS THAT THEY HAVE INTENTIONALLY BEEN EATING LESS (DIETING,
FASTING, ETC.) SELECT "YES" AT THIS SCREEN

Now, I'm going to ask about how difficult it is, on average, for [you/(SP)] to do certain kinds of activities. Please
tell me for each activity whether [you have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of
difficulty, or [is/are] not able to do it.

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

SHOW CARD HF3 HF5
DIFSTOOP

HFH1

code 1

How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or kneeling? Would you say [you
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or [is/are] not able to do it?

SHOW CARD HF3 HF5
DIFLIFT

HFH2

code 1

How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as heavy as 10 pounds, like a
heavy bag of groceries?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]

SHOW CARD HF3 HF5
DIFREACH

HFH3

code 1

What about reaching or extending arms above shoulder level?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]

SHOW CARD HF3 HF5
DIFWRITE

HFH4

code 1

How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping small objects?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]

SHOW CARD HF3 HF5
DIFWALK

HFH5

code 1

What about walking a quarter of a mile - that is, about 2 or 3 blocks?
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it?]

PHYSACTINTRO

VIGUNIT

HFH10INT

HFH10

no entry

quantity unit

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

In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart
rate?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

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

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused

HFH3 - DIFREACH

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused

HFH4 - DIFWRITE

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused

HFH5 - DIFWALK

(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
(-8) Don't Know
(-9) Refused

HFH10INT - PHYSACTINTRO

(01) CONTINUE
(-7) Empty

HFH10 - VIGUNIT

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused

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

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2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

VIGNUM

HFH10

quantity unit

In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or heart
rate?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFH11 - MODUNIT

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused

(01) HFH11 - MODNUM
(02) HFH11 - MODNUM
(03) HFH11 - MODNUM
(04) HFH11 - MODNUM
(96) HFH12 - MUSUNIT
(-8) HFH12 - MUSUNIT
(-9) HFH12 - MUSUNIT

(01) continous answer

(01) HFH12 - MUSUNIT

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused

(01) HFH12 - MUSNUM
(02) HFH12 - MUSNUM
(03) HFH12 - MUSNUM
(04) HFH12 - MUSNUM
(96) HFJINTRO - MEDCONDINTRO
(-8) HFJINTRO - MEDCONDINTRO
(-9) HFJINTRO - MEDCONDINTRO

In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength or
flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?

(01) Continunous answer

HFJINTRO - MEDCONDINTRO

(01) CONTINUE
(-7) Empty

BOX HFJ1

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

HFJ2 - OCHBP

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

MODUNIT

HFH11

quantity unit

In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

MODNUM

HFH11

numeric

In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?

Now I’m going to ask you about activities [you/(SP)] may do to increase [your/(SP)'s] muscle strength or
flexibility.
MUSUNIT

MUSNUM

HFH12

HFH12

quantity unit

numeric

In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength or
flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.

MEDCONDINTRO

OCARTERY

HFJINTRO

no entry

BOX HFJ1

routing

HFJ1

yes/no

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?
[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.]

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?

Page 9 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

[[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

OCMYOCAR

HFJ4

yes/no

Routing

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

(01) BOX HFJ2
(02) HFJ4 - OCMYOCAR
(-8) HFJ4 - OCMYOCAR
(-9) HFJ4 - OCMYOCAR

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

HFJ4 - OCMYOCAR

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

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

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

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) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
a myocardial infarction or heart attack?

BOX HFJ3

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ5 - YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.

YRMYOCAR

HFJ5

yes/no

(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (02) NO
myocardial infarction or heart attack?
(-8) Don't Know
(-9) Refused

OCCHD

HFJ6

yes/no

[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] angina pectoris or coronary heart disease?

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

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

(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had an (02) NO
episode of angina pectoris or coronary heart disease?
(-8) Don't Know
(-9) Refused

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?

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

HFJ6 - OCCHD

(01) BOX HFJ4
(02) HFJ8 - OCCFAIL
(-8) HFJ8 - OCCFAIL
(-9) HFJ8 - OCCFAIL

HFJ8 - OCCFAIL

(01) BOX HFJ5
(02) HFJ14 - OCHRTCND
(-8) HFJ14 - OCHRTCND
(-9) HFJ14 - OCHRTCND

Page 10 of 61

2024 MCBS Community Questionnaire

Variable Name

YRCFAIL

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

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?

Code List

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

Routing

HFJ14 - OCHRTCND

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

HFJ14

yes/no

(01) YES
(02) NO
(-8) Don't Know
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with the
(-9) Refused
rhythm of the heartbeat, such as atrial fibrillation.]
[a new episode of] any other heart condition?

(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

YRHRTCND

HFJ15

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ15 - YRHRTCND.
ELSE GO TO HFJ16 - OCSTROKE.

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had an
(01) YES
episode of any other heart condition?
(02) NO
(-8) Don't Know
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with the
(-9) Refused
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.]

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

BOX HFJ9

routing

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3] AND OCSTROKE=01/YES , GO TO HFJ17 YRSTROKE.
ELSE, IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFJ17A - OCCLSTRL.
ELSE GO TO HFJ17B - YRCLSTRL.

YRSTROKE

HFJ17

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (01) YES
stroke, a brain hemorrhage, or a cerebrovascular accident?
(02) NO
(-8) Don't Know
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
(-9) Refused

OCCLSTRL

HFJ17A

yes/no

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

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

HFJ16 - OCSTROKE

BOX HFJ9

HFJ17A - OCCLSTRL

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

Page 11 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

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

HFJ17B

yes/no

[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A
CONDITION, THE RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE
CONDITION.]

Code List

Routing

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

BOX HFJ29

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ45-BLOSWGHT.
ELSE IF be P_EVRLWGHT ^= YES THEN GO TO HFJ46-CLOSWGHT.
ELSE GO TO HFJ18 - OCCSKIN.

BOX HFJ29

BLOSWGHT

HFJ45

yes/no

To lower risk for certain diseases, [have you/ has (SP)] ever been told by a doctor or health professional to
control weight or lose weight?

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

HFJ18 - OCCSKIN

CLOSWGHT

HFJ46

yes/no

(01) YES
To lower risk for certain diseases, since (SAMPLE_PERSON.DATE_FALLRND) [have you/ has (SP)] been told (02) NO
by a doctor or health professional to control weight or lose weight?
(-8) Don't Know
(-9) Refused

HFJ18 - OCCSKIN

[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

(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had an (02) NO
occurrence of skin cancer?
(-8) Don't Know
(-9) Refused
[I've recorded that [you/(SP)] previously reported having had a tumor, growth, malignancy, or cancer of the
[READ RESPONSES BELOW].]

EVRCANCR

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

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?

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

(01) BOX HFJ10
(02) HFJ20 - EVRCANCR
(-8) HFJ20 - EVRCANCR
(-9) HFJ20 - EVRCANCR

HFJ20 - EVRCANCR

(01) BOX HFJ11
(02) BOX HFJ13
(-8) BOX HFJ13
(-9) BOX HFJ13

DO NOT INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.

BOX HFJ11

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - EVRCODE.

Page 12 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

YRCANCER

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?

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

HFJ22 - EVRCODE

(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

SHOW CARD HF4 HF6

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

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?

Page 13 of 61

2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFJ14

routing

IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND [sample_person.P_OCARTH=1], GO TO BOX HFJ16.
ELSE GO TO HFJ25 - OCARTH.

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

YRARTHRD

HFJ25

yes/no

BOX HFJ15

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.

HFJ26

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
arthritis, other than rheumatoid or osteoarthritis, in any part of [your/his/her] body?

BOX HFJ16

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ28 - OCMENTAL.
ELSE GO TO BOX HFJ16A.

arthritis, other than rheumatoid or osteoarthritis?

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

HFJ28

yes/no

an intellectual disability?
[EXPLAIN IF NECESSARY:] This is also known as intellectual development disorder or a general learning
disability. It was formerly known as mental retardation.

OCALZMER

BOX HFJ16A

routing

HFJ29A

yes/no

OCDEMENT

routing

HFJ29B

yes/no

Routing

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

(01) BOX HFJ15
(02) BOX HFJ16
(-8) BOX HFJ16
(-9) BOX HFJ16

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

BOX HFJ16

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

BOX HFJ16A

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

(01) BOX HFJ16B
(02) BOX HFJ16B
(-8) BOX HFJ16B
(-9) BOX HFJ16B

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

BOX HFJ30

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?

BOX HFJ16B

Code List

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?

Page 14 of 61

2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

Has a doctor or other health professional ever asked [you/(SP)] if there was a period of time when [you/he/she]
felt sad, empty, or depressed?

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

HFJ30AA - OCDEPRSS

CASKDEPRS

HFJ48

yes/no

(01) YES
Since (SAMPLE_PERSON.DATE_FALLRND), has a doctor or other health professional asked [you/(SP)] if there (02) NO
was a period of time when [you/he/she] felt sad, empty, or depressed?
(-8) Don't Know
(-9) Refused

HFJ30AA - OCDEPRSS

OCDEPRSS

HFJ30AA

yes/no

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

YRDEPRSS

BOX HFJ17A

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ30BB - YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.

HFJ30BB

yes/no

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

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

HFJ30A

yes/no

a mental or psychiatric disorder other than depression?
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]

BOX HFJ17B

routing

(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

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

Page 15 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

YRPSYCHO

HFJ31A

yes/no

Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (01) YES
mental or psychiatric disorder other than depression?
(02) NO
(-8) Don't Know
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
(-9) Refused

BOX HFJ19

routing

IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND
(sample_person.P_OCOSTEOP=1), GO TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.

HFJ32

yes/no

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?

OCBRKHIP

YRBRKHIP

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

Code List

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

HFJ33

yes/no

BOX HFJ20

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.

HFJ34

yes/no

(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had a (02) NO
broken hip?
(-8) Don't Know
(-9) Refused

BOX HFJ21

routing

IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCPARKIN=1), GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.

a broken hip?

Routing

BOX HFJ21

Page 16 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

OCPARKIN

HFJ35

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

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

Parkinson's disease?

BOX HFJ22

routing

IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A PREVIOUS ROUND
(sample_person.P_OCEMPHYS=1), GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.

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

HFJ36

yes/no

emphysema, asthma, or COPD?
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE

OCPPARAL

HFJ37

yes/no

IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK.
OTHERWISE, ASK:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
complete or partial paralysis?

YRPPARAL

OCAMPUTE

BOX HFJ23

routing

IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.

HFJ38

yes/no

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

BOX HFJ24

routing

IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN A PREVIOUS ROUND
(sample_person.P_OCAMPUTE=1), GO TO BOX HFJ25.
ELSE GO TO HFJ39 - OCAMPUTE.

HFJ39

yes/no

IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT "YES" AND DO NOT ASK. OTHERWISE,
ASK:
What about absence or loss of an arm or a leg?

HAVEPROS

BOX HFJ25

routing

HFJ40

yes/no

IF SP IS FEMALE (ROSTSEX=2 or (roster.ROSTSEX=2 where ROSTNUM=1)), GO TO BOX HFCI.
ELSE GO TO HFJ40 - HAVEPROS.

[[Before (you/[SP]) had prostate surgery, did a doctor or other health professional ever tell/Since (LAST HF
MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that [you/he] had...]
an enlarged prostate or benign prostatic hypertrophy (BPH)?

Page 17 of 61

2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

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

[Have you/Has (SP)] ever been told by a doctor or other health professional that [you have/she has/he has]
chronic kidney disease?

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

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?

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

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.

YRPROST

OCBETES

HFJ41A

yes/no

YRBETES

YRBETES

yes/no

Has a doctor or other health professional ever 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]?

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

BOX HFCA

BOX HFCA

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

(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

SHOW CARD HF5 HF7
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

(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST
(04) PRE-DIABETES
RECENT TYPE OF DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
(05) GESTATIONAL (PREGNANCY-RELATED)
(91) SOME OTHER TYPE
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or “juvenile-onset” diabetes. This (-8) Don't Know
type of diabetes usually develops during childhood or adolescence; but, it also can develop in adults.
(-9) Refused
“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.]

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

Page 18 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

OCDTYPOS

HFJ41B

verbatim text

BOX HFCB

routing

IF (P_OCBETES ^= YES AND (OCBETES = YES or YRBETES = YES)) OR (P_OCBETES = YES AND
P_OCDVISIT ^= YES), GO TO HFJ41C-OCDVISIT.
ELSE GO TO 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

Code List

Routing

(01) [Continuous answer.]

BOX HFCB

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

AUTOIMRX-AUTOIMRX

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

WEAKIMM-WEAKIMM

SOME OTHER TYPE (SPECIFY)
[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.]

Since (REFERENCE DATE), [have you/has (SP)] taken prescription medication or had any medical treatments
that a doctor or other health professional told [you/him/her] would weaken [your/his/her] immune system?
[IF NEEDED: This question is asking about both long-term and short-term effects on the immune system.]

WEAKIMM

WEAKIMM

BOX HFJ27

yes/no

[Do you/Does (SP)] currently have a health condition that a doctor or other health professional told [you/him/her] (01) YES
weakens the immune system?
(02) NO
(-8) DON’T KNOW
[IF NEEDED: Please include any health conditions you may have already told me about.]
(-9) REFUSED

routing

IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT MEDICARE ELIGIBILITY
WAS UNDER 65 (sample_person.INTTYPE=3 and AGECALC<65 and greater than 0) THEN
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO HFJ42 - EMCOND.
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 - EMCAUSEVB.
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT TIME OF CURRENT MEDICARE
ELIGIBILITY WAS NOT UNDER 65 THEN GO TO HFPINTRO - HLTHCAREINTRO.

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 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

Page 19 of 61

2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFJ28

routing

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

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

(01) [Continuous answer.]

HFPINTRO - HLTHCAREINTRO

EMCODE

HFJ44

code all

EMOS

HFJ44

verbatim text

OTHER (SPECIFY)

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 (01) CONTINUE
getting tested for health problems or by taking care of conditions that [you have/she has/he has].
(-7) Empty

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

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?

(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused

BOX HFP1A

BOX HFP2

Page 20 of 61

2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

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?

DIATEST

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
test [your/his/her] blood for sugar or glucose?

DIASORES

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
check for sores or irritations on [your/his/her] feet?

DIAPRESS

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
measure [your/his/her] blood pressure at home?

DIAASPRN

HFP4

list

Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do
you/Does (SP)]…
take aspirin regularly for [your/his/her] diabetes?

Code List

Routing

(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

(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

Page 21 of 61

2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

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 - TESTTAKN.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

Code List

Routing

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

INSUTAKE

HFP5

quantity unit

How often [do you/does (SP)] take insulin?

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) USE INSULIN PUMP
(-8) Don't Know
(-9) Refused

INSUDAY

HFP5

quantity unit

How often [do you/does (SP)] take insulin?

(01) [Continuous answer.]

BOX HFP4

INSUWEEK

HFP5

quantity unit

How often [do you/does (SP)] take insulin?

(01) [Continuous answer.]

BOX HFP4

BOX HFP4

routing

IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKN.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

MEDSTAKE

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
(-8) Don't Know
(-9) Refused

(01) HFP6 - MEDDAY
(02) HFP6 - MEDWEEK
(03) ) HFP6 - MEDMONTH
(-8) BOX HFP5
(-9) BOX HFP5

MEDDAY

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) [Continuous answer.]

BOX HFP5

MEDWEEK

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) [Continuous answer.]

BOX HFP5

MEDMONTH

HFP6

quantity unit

How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?

(01) [Continuous answer.]

BOX HFP5

BOX HFP5

routing

IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKN.
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

Page 22 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

(01) [Continuous answer.]
[996] RESPONDENT USES A CONTINUOUS
GLUCOSE MONITORING SYSTEM
(-8) Don't Know
(-9) Refused

HFP7- TESTTAKE

(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

BOX HFP6

How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?

TESTTAKN

HFP7

numeric

[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.]
[ENTER QUANTITY AND UNIT.]
[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH
QUANTITY AND UNIT OF GLUCOSE TESTS.]

How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?

TESTTAKE

HFP7

quantity unit

[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.]
[ENTER QUANTITY AND UNIT.]
[FOR RESPONSES OF DON'T KNOW OR REFUSED, ENTER DON'T KNOW/REFUSED FOR BOTH
QUANTITY AND UNIT OF GLUCOSE TESTS.]

BOX HFP6

routing

IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.

(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
[PROBE: Include times when they are checked by a family member or friend, but do not include times when they (04) NUMBER OF TIMES PER YEAR
are checked by a health professional.]
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?

SORECHEK

HFP8

quantity unit

SOREDAY

HFP8

quantity unit

SOREWEEK

HFP8

quantity unit

SOREMNTH

HFP8

quantity unit

(01) HFP8 - SOREDAY
(02) HFP8 - SOREWEEK
(03) HFP8 - SOREMNTH
(04) HFP8 - SOREYEAR
(-8) HFP10 - DIATENYR
(-9) HFP10 - DIATENYR

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.]

(01) [Continuous answer.]

HFP10 - DIATENYR

(01) [Continuous answer.]

HFP10 - DIATENYR

(01) [Continuous answer.]

HFP10 - DIATENYR

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 23 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

SOREYEAR

HFP8

quantity unit

DIATENYR

HFP10

yes/no

DIADRSAW

HFP11

DIAHEMOC

HFP13

Question Text/Description

Code List

Routing

(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 done in a doctor's office. About how many times in the past year has a doctor or other health
professional checked [you/(SP)] for hemoglobin "A one C"?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFP14 - DIACTRLD

HFP14A1 - DIAHYPO

(01) HFP14A2 - DIAHYPTR
(02) BOX HFCC
(-8) BOX HFCC
(-9) BOX HFCC

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.]

DIACTRLD

HFP14

code 1

(01) ALL OF THE TIME
(02) MOST OF THE TIME
(03) SOME OF THE TIME
Would you say that [your/(SP)'s] blood sugar is well controlled all of the time, most of the time, some of the time, (04) A LITTLE 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 (05) NONE OF THE TIME
or less or an average fasting blood test of 140 or less.
(-8) Don't Know
(-9) Refused

DIAHYPO

HFP14A1

yes/no

(01) YES
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood sugar or an insulin (02) NO
reaction?
(-8) Don't Know
(-9) Refused

SHOW CARD HF6 HF8

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.]

(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
(03) HOSPITAL TREATMENT
(-8) Don't Know
(-9) Refused

BOX HFCC

Page 24 of 61

2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFCC

routing

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

DIAFTEVR

HFP14A3

yes/no

DIAFEET

HFP14A

BOX HFCD

DIANEURO

HFP14B

Code List

Routing

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

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

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

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

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.

list

People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused

BOX HFCE

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]
(01) YES
feet as a result of [your/his/her] diabetes.]
(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 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.

Page 25 of 61

2024 MCBS Community Questionnaire

Variable Name

DIACIRCF

MR Screen Name

HFP14B

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

list

Question Text/Description

Code List

[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused

Routing

BOX HFCF.

Poor circulation or blood flow in the feet?

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
(-8) Don't Know
professional that [you/he/she] had…
(-9) Refused

BOX HFCF

Poor circulation or blood flow in the feet?

BOX HFCF

DIAULCER

HFP14B

routing

list

IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3), GO TO HFP14B-DIAULCER.
ELSE IF P_DULCER ^= YES, GO TO YRDULCER-YRDULCER.
ELSE GO TO BOX HFCG.

[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused

BOX HFCG

Foot ulcers?

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.

Page 26 of 61

2024 MCBS Community Questionnaire

Variable Name

DIASKINC

MR Screen Name

HFP14B

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

list

Question Text/Description

Code List

[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever been
told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused

Routing

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
(-8) Don't Know
professional 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.

DIAKDPEV

HFP16A1

yes/no

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?

BOX HFC1

routing

IF SP IS IN THE BASELINE SAMPLE [SAMPLE.PERSON.INTTYPE=3], GO TO HFP17-DIAMNGE.
ELSE GO TO HFP17A-CDIAMNGE.

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?

DIAMNGE

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

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

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

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

(01) HFP18 - DIATRAIN
(02) BOX HFP7
(-8) BOX HFP7
(-9) BOX HFP7

Page 27 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

CDIAMNGE

CDIAMNGE

yes/no

Since [SAMPLE_PERSON.DATE_FALLRND], [have you/has (SP)] participated in a diabetes self-management
course or class, or received special training on how [you/he/she] can manage [your/his/her] diabetes?

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

BOX HFP7

HFP18

code 1

(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
When was the most recent time that [you/(SP)] participated in a diabetes self-management course or class or
(07) 6 YEARS TO LESS THAN 7 YEARS
received special training on how [you/he/she] can manage [your/his/her] diabetes?
(08) 7 YEARS TO LESS THAN 8 YEARS
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE MOST (09) 8 YEARS TO LESS THAN 9 YEARS
RECENT TIME.]
(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

routing

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

DIATRAIN

SHOW CARD HF7 HF9

DIAKNOW

HFP19

code 1

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.

How much do you think you know about managing your diabetes? Do you know . . .

[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.]

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

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

(01) HFP22 - DIARECNT
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8

Page 28 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

(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

Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for diabetes? (01) YES
(02) NO
[IF NEEDED: This question is asking about whether [you have/(SP) has] ever been told [you are/he is/she is] at (-8) Don't Know
risk for diabetes, not whether [you have/(SP) has] diabetes.]
(-9) Refused

DIASIGNS

HFP25

yes/no

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 29 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

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

BOX HFC3

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

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

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

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

IF [(SP 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.

COLHEAR

COLHTEST

HFR1

yes/no

BOX HFC3

routing

HFR3

yes/no

Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower intestines.
Before today, had [you/SP] ever heard of colorectal or colon cancer?

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

The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples at
the patient’s home. The test is then sent to a laboratory for the results to be determined.
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for blood in the stool?

CCOLHTES

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 patient’s home. The test is then sent to a laboratory for the results to be determined.
Since (SAMPLE_PERSON.DATE_FALLRND), Has a doctor or other health professional given [you/(SP)] a
home testing kit to test for blood in the stool?

BOX HFC4

routing

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

COLHKIT

HFR4

yes/no

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

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

HFR4A - COLFDOC

COLFDOC

HFR4A

yes/no

Has a doctor or other health professional ever performed a fecal occult blood test to test for blood in the stool
while [you/(SP)] [were/was] at the doctor’s office?

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

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

Page 30 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

COLCARD

HFR5

yes/no

BOX HFC5

routing

COLRECNT

COLORECT

CORECTYP

HFR7

code 1

BOX HFC6

routing

COLORECT

CORECTYP

yes/no

code 1

Question Text/Description

Code List

Routing

Did [you/(SP)] complete the samples and return them for [your/his/her] most recent test?

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

BOX HFC5

[READ IF NECESSARY: The fecal occult blood test is a simple test for early signs of colon cancer. It detects
invisible traces of blood found in the stool.]

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

When did [you/(SP)] have [your/his/her] most recent blood stool test [(using a home testing kit)/(at the doctor's
office)]?
[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.]

CCOLOREC

yes/no

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.
(01) YES
Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a tube
(02) NO
into the rectum to look for polyps or cancer.
(-8) Don't Know
(-9) Refused
[Have you/Has (SP)] ever had either of these exams?

For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the
doctor checks only part of the colon and you are fully awake.
[Have you/Has (SP)] ever had a colonoscopy, a sigmoidoscopy, or both?

CCOLOREC

(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

(01) Colonoscopy
(02) Sigmoidoscopy
(03) Both
(-8) Don't Know
(-9) Refused

These next questions are about colorectal cancer screening. There are several different kinds of tests to check
(01) YES
for colon cancer.
Colonoscopy (colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor inserts a tube (02) NO
into the rectum to look for polyps or cancer.
(-8) Don't Know
(-9) Refused
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had either of these exams?

(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

Page 31 of 61

2024 MCBS Community Questionnaire

Variable Name

CCORECTP

MR Screen Name

CCORECTP

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

code 1

Question Text/Description

For a colonoscopy, the doctor checks the entire colon, and you are given medication through a
needle in your arm to make you sleepy, and told to have someone take you home. For a sigmoidoscopy, the
doctor checks only part of the colon and you are fully awake.
Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a colonoscopy, a sigmoidoscopy, or
both?

When did [you/(SP)] have [your/his/her] most recent sigmoidoscopy or colonoscopy?
WHENSCOP

Code List

Routing

(01) Colonoscopy
(02) Sigmoidoscopy
(03) Both
(-8) Don't Know
(-9) Refused

BOX HFC7

(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 3 YEARS
(04) 3 YEARS TO LESS THAN 4 YEARS
(05) 4 YEARS TO LESS THAN 5 YEARS
(06) 5 YEARS TO LESS THAN 6 YEARS
(07) 6 YEARS TO LESS THAN 7 YEARS
(08) 7 YEARS TO LESS THAN 8 YEARS
(09) 8 YEARS TO LESS THAN 9 YEARS
(10) 9 YEARS TO LESS THAN 10 YEARS
(11) 10 YEARS AGO OR MORE
(12) 5 YEARS AGO OR MORE
(996) NEVER HAD EXAM
(-8) DON'T KNOW
(-9) REFUSED

HFR13 - COLSCRNS

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

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

HFR9

code 1

BOX HFC7

routing

IF P_HEARSCOP=YES OR CCOLOREC=YES OR COLORECT=YES, GO TO BOX HFR2.
ELSE GO TO HFR10-HEARSIG.

HFR10

yes/no

Before today, had [you/(SP}] ever heard of a sigmoidoscopy or colonoscopy?

BOX HFR2

routing

IF HFR3 - COLHTEST = 1/Yes or HFR3A - CCOLHTES = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 COLSCRNS.
ELSE GO TO BOX HFS1.

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 (01) CONTINUE
bones lose their calcium and become fragile and more easily broken.
(-7) Empty

OSTEVERT

HFS1

yes/no

[Have you/Has (SP)] ever talked with [your/his/her] doctor or other health professional about osteoporosis?

HEARSIG

[IF NEEDED: If [you/(SP)] had both exams done, then please provide the date for the most recent exam]

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

HFS1 - OSTEVERT

(01) HFS2 - OSTHRISK
(02) BOX HFC8
(-8) BOX HFC8
(-9) BOX HFC8

Page 32 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

OSTHRISK

HFS2

yes/no

Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
osteoporosis?

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

HFS2A - OSTFRACT

OSTFRACT

HFS2A

yes/no

Have [you/(SP)] ever experienced a fracture that [your/his/her] doctor or other health professional told
[you/him/her] was related to osteoporosis?

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

BOX HFC8

BOX HFC8

routing

IF SP IS IN THE BASELINE SAMPLE [sample_person.INTTYPE=3], GO TO HFS3-OSTTEST.
ELSE GO TO HFS3A-COSTTEST.

HFS3

yes/no

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

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

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

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

OSTTEST

There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?

COSTTEST

OSTHEAR

There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
Measurement, or DEXA scan.

HFS3A

yes/no

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

Since (SAMPLE_PERSON.DATE_FALLRND), [have you/has (SP)] had a Bone Mass or Bone Density
Measurement test?

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

HFAC29 - HCTROUBL

HCTROUBL

HFAC29

yes/no

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

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

Next, we are going to ask some questions about [your/(SP's)] health care needs during the past year.
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that [you/he/she]
wanted or needed?

Page 33 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Why was that?

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

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

(01) YES
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office that they cannot schedule an (02) NO
appointment with [you/(SP)]?
(-8) Don't Know
(-9) Refused

CGETAPPT

CGETCODE

HFAC30C

code all

[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)]?
[PROBE: Any other reason?]
CHECK ALL THAT APPLY

(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) HFAC30C - CGETCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY

(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

Page 34 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

CGETOTOS

CGETOTOS

verbatim text

Please specify the other reason.

(01) [Continuous answer.]

BOX HFF7

BOX HFF7

routing

IF RESPONSE TO HFAC30C - CGETCODE INCLUDES 4/DocNotAcceptNewMedicare OR
7/DocNotAcceptMCAR, GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.

OFFEXPLN

HFAC30D

yes/no

Did the doctor’s office explain why [it is difficult for Medicare patients to get an appointment/Medicare is not
accepted] at that practice?

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

(01) HFAC30E - OFFEXVB
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY

OFFEXVB

HFAC30E

verbatim text

What was that explanation?
RECORD VERBATIM.

(01) [Continuous answer.]

HFAC31 - HCDELAY

HCDELAY

HFAC31

yes/no

Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care because (you were/he
was/she was) worried about the cost?

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

HFAC32 A-PAYPROB

PAYPROB

HFAC32A

yes/no

Since (LAST HF MONTH YEAR) [have you/has (SP)] had problems paying or were unable to pay any medical
bills?

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

(01) HFAC32 - COLLAGNCY
(02) HFKINTRO - IADLINTRO
(-8) HFKINTRO - IADLINTRO
(-9) HFKINTRO - IADLINTRO

COLLAGNCY

HFAC32

yes/no

(01) YES
Because of problems paying medical bills since (LAST HF MONTH YEAR), [have you/has (SP)] been contacted (02) NO
by a collection agency?
(-8) Don't Know
(-9) Refused

PAYOVRTM

HFAC32B

yes/no

[Do you /Does (SP)] currently have any medical bills that are being paid off over time?

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

HFKINTRO - IADLINTRO

IADLINTRO

HFKINTRO

no entry

Health problems can include physical, mental, emotional, or memory problems. I'd now like to ask you about
how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d like to know
whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself].

(01) CONTINUE
(-7) Empty

HFKA1 - PRBTELE

(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

PRBTELE

HFKA1

code 1

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

HFAC32B- PAYOVRTM

Page 35 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

DONTTELE

HFKA2

yes/no

PRBLHWK

HFKB1

code 1

DONTLHWK

HFKB2

yes/no

Question Text/Description

[You said that using the telephone 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…]
doing light housework (like washing dishes, straightening up, or light cleaning)?

[You said that doing light housework (like washing dishes, straightening up, or light cleaning) is something that
[you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

PRBHHWK

HFKC1

code 1

DONTHHWK

HFKC2

yes/no

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
doing heavy housework (like scrubbing floors or washing windows)?

[You said that doing heavy housework (like scrubbing floors or washing windows) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?

PRBMEAL

HFKD1

code 1

DONTMEAL

HFKD2

yes/no

PRBSHOP

HFKE1

code 1

DONTSHOP

HFKE2

yes/no

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
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.]
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…]
shopping for personal items (such as toilet items or medicines)?

[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?

PRBBILS

HFKF1

code 1

[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
managing money (like keeping track of expenses or paying bills)?

Code List

Routing

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

HFKB1 - PRBLHWK

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKC1 - PRBHHWK
(02) HFKC1 - PRBHHWK
(03) HFKB2 - DONTLHWK
(-8) HFKC1 - PRBHHWK
(-9) HFKC1 - PRBHHWK

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

HFKC1 - PRBHHWK

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

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

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

HFKD1 - PRBMEAL

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKE1 - PRBSHOP
(02) HFKE1 - PRBSHOP
(03) HFKD2 - DONTMEAL
(-8) HFKE1 - PRBSHOP
(-9) HFKE1 - PRBSHOP

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

HFKE1 - PRBSHOP

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) HFKF1 - PRBBILS
(02) HFKF1 - PRBBILS
(03) HFKE2 - DONTSHOP
(-8) HFKF1 - PRBBILS
(-9) HFKF1 - PRBBILS

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

HFKF1 - PRBBILS

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) BOX HFKA1
(02) BOX HFKA1
(03) HFKF2 - DONTBILS
(-8) BOX HFKA1
(-9) BOX HFKA1

Page 36 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

DONTBILS

HFKF2

yes/no

[You said that managing money (like keeping track of expenses or paying bills) is something that [you don't/(SP) (01) YES
doesn't] do.]
(02) NO
(-8) Don't Know
Is this because of a physical, mental, emotional, or memory problem?
(-9) Refused

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...
using the telephone?

Code List

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

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

Routing

BOX HFKA1

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

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

routing

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

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

BOX HFKB1

Page 37 of 61

2024 MCBS Community Questionnaire

Variable Name

HELPLHWK

MR Screen Name

HFKB3

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

yes/no

Question Text/Description

Code List

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

Routing

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

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

PERSON_HLPRLHWK

HFKB4

roster

You mentioned that [you receive/(SP) receives] help with doing light housework (like washing dishes,
straightening up, or light cleaning). Who gives that help?

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
IF PERSON_HLPRLHWK = (N+1), GO TO
(N+1) ADD ANOTHER
HFKB4_NEW-ROSTFNAM,
ELSE GO TO BOX HFKC1
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.

ROSTFNAM

HFKB4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKB4_NEW - ROSTLNAM

ROSTLNAM

HFKB4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKB4_NEW - ROSTREL

ROSTREL

HFKB4_NEW

code one

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

ROSTREOS

HFKB4_NEW

text

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

BOX HFKC1

routing

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

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

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

(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

BOX HFKC1

Page 38 of 61

2024 MCBS Community Questionnaire

Variable Name

HELPHHWK

MR Screen Name

HFKC3

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

yes/no

Question Text/Description

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

Code List

Routing

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

(01) HFKC4 - PERSON_HLPRHHWK
(02) BOX HFKD1
(-8) BOX HFKD1
(-9) BOX HFKD1

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

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_HLPRHHWK = (N+1), GO TO
HFKC4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKD1.

PERSON_HLPRHHWK

HFKC4

roster

You mentioned that [you receive/(SP) receives] help with doing heavy housework (like scrubbing floors or
washing windows). Who gives that help?
ENTER ALL HELPERS.

ROSTFNAM

HFKC4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKC4_NEW - ROSTLNAM

ROSTLNAM

HFKC4_NEW

text

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

(01) CONTINUOUS ANSWER

HFKC4_NEW - ROSTREL

(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

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

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

routing

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

BOX HFKD1

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

[[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?

Code List

Routing

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

(01) HFKD4 - PERSON_HLPRMEAL
(02) BOX HFKE1
(-8) BOX HFKE1
(-9) BOX HFKE1

PERSON_HLPRMEAL

HFKD4

roster

You mentioned that [you receive/(SP) receives] help with preparing [your/his/her] own meals. Who gives that
help?
ENTER ALL HELPERS.

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
IF PERSON_HLPRMEAL = (N+1), GO TO
(N+1) ADD ANOTHER
HFKD4_NEW-ROSTFNAM.
ELSE GO TO BOX HFKE1.
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.

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

routing

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

BOX HFKE1

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2024 MCBS Community Questionnaire

Variable Name

HELPSHOP

MR Screen Name

HFKE3

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

yes/no

Question Text/Description

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

Code List

Routing

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

(01) HFKE4 - PERSON_HLPRSHOP
(02) BOX HFKF1
(-8) BOX HFKF1
(-9) BOX HFKF1

shopping for personal items (such as toilet items or medicines)?

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.

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
IF PERSON_HLPRSHOP = (N+1), GO TO
(N+1) ADD ANOTHER
HFKE4_NEW-ROSTFNAM.
ELSE GO TO 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.

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

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.

BOX HFKF1

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2024 MCBS Community Questionnaire

Variable Name

HELPBILS

MR Screen Name

HFKF3

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

yes/no

Question Text/Description

[[You said that [your/(SP's)] health makes managing money (like keeping track of expenses or paying bills)
difficult./You said that managing money (like keeping track of expenses or paying bills) is something that [you
don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...

Code List

Routing

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

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

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

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.

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
IF PERSON_HLPRBILS = (N+1), GO TO HFKF4_NEW(N+1) ADD ANOTHER
ROSTFNAM.
ELSE GO TO 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.

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

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

ROSTREL

HFKF4_NEW

code one

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

ROSTREOS

HFKF4_NEW

text

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

ADLSINTRO

HFLINTRO

no entry

Remembering that health problems can include physical, mental, emotional, or memory problems, I'd now like to
ask you about how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d (01) CONTINUE
like to know whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself] and
(-7) Empty
without special equipment.

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

(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

HFLINTRO - ADLSINTRO

HFLA1 - HPPDBATH

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2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

HPPDBATH

HFLA1

code 1

DONTBATH

HFLA2

yes/no

HPPDDRES

HFLB1

code 1

DONTDRES

HFLB2

yes/no

HPPDEAT

HFLC1

code 1

DONTEAT

HFLC2

yes/no

HPPDCHAR

HFLD1

code 1

DONTCHAR

HFLD2

yes/no

HPPDWALK

HFLE1

code 1

Question Text/Description

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.]
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…]
dressing?

[You said that dressing 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…]
eating?

[You said that eating 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…]
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.]
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…]
walking?

Code List

Routing

(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

(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

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2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

DONTWALK

HFLE2

code 1

HPPDTOIL

HFLF1

code 1

DONTTOIL

HFLF2

yes/no

BOX HFLA1

routing

HFLA3

yes/no

HELPBATH

Question Text/Description

[You said that walking 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…]
using the toilet, including getting up and down?

[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?

Code List

Routing

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

HFLF1 - HPPDTOIL

(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused

(01) BOX HFLA1
(02) BOX HFLA1
(03) HFLF2 - DONTTOIL
(-8) BOX HFLA1
(-9) BOX HFLA1

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

BOX HFLA1

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

(01) HFLA5 - EQIPBATH
(02) HFLA4 - PCHKBATH
(-8) HFLA4 - PCHKBATH
(-9) HFLA4 - PCHKBATH

(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.

[[You said [your/(SP's)] health makes bathing or showering difficult./You said that bathing or showering is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or showering?

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

PCHKBATH

HFLA4

yes/no

EQIPBATH

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

[That is, does someone usually stay or come into the room to check on [you/him/her]?]

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2024 MCBS Community Questionnaire

Variable Name

HELPDRES

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFLB1

routing

IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO HFLB3 - HELPDRES.
ELSE GO TO BOX HFLC1.

HFLB3

yes/no

[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is something [you don't/(SP)
doesn't] do.]]
[Do you/Does (SP)] receive help from another person with dressing?

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

Code List

Routing

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

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

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

HFLB5 - EQIPDRES

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

BOX HFLB2

PCHKDRES

HFLB4

yes/no

EQIPDRES

HFLB5

yes/no

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

BOX HFLB2

routing

IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES.
ELSE GO TO BOX HFLC1.

LONGDRES

HFLB6

code 1

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

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(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

HELPEAT

[That is, does someone usually stay or come into the room to check on [you/him/her]?]

[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you don't/(SP) doesn't]
do.]]
[Do you/Does (SP)] receive help from another person with eating?

PCHKEAT

HFLC4

yes/no

EQIPEAT

HFLC5

yes/no

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

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

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2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFLC2

routing

IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.

Code List

Routing

(01) HFLC7 - STILEAT
(02) BOX HFLD1
(03) BOX HFLD1
(-8) BOX HFLD1
(-9) 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

STILEAT

HFLC7

yes/no

Do you expect that [you/(SP)] will still need help with eating three months from now?

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

BOX HFLD1

BOX HFLD1

routing

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

HFLD3

yes/no

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

(01) HFLD5 - EQIPCHAR
(02) HFLD4 - PCHKCHAR
(-8) HFLD4 - PCHKCHAR
(-9) HFLD4 - PCHKCHAR

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

HFLD5 - EQIPCHAR

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

BOX HFLD2

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

BOX HFLE1

HELPCHAR

[[You said [your/(SP's)] health makes getting in or out of bed or chairs difficult./You said that getting in or out of
bed or chairs is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?

PCHKCHAR

HFLD4

yes/no

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

EQIPCHAR

HFLD5

yes/no

[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with getting in or out of bed or chairs?

BOX HFLD2

routing

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.

LONGCHAR

HFLD6

code 1

How long [have you/has (SP)] needed help with getting in or out of bed or chairs? Has it been . . .

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

STILCHAR

HFLD7

yes/no

Do you expect that [you/(SP)] will still need help with getting in or out of bed or chairs three months from now?

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

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2024 MCBS Community Questionnaire

Variable Name

HFQ-HEALTH STATUS AND FUNCTIONING

MR Screen Name

Question Type

Question Text/Description

BOX HFLE1

routing

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

[IF R IS IN A WHEELCHAIR OR CANNOT STAND DUE TO PERMANENT DISABILITY ONLY, SELECT "NO"
WITHOUT READING TEXT BELOW.]
HELPWALK

HFLE3

yes/no

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

Code List

Routing

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

(01) HFLE5 - EQIPWALK
(02) HFLE4 - PCHKWALK
(-8) HFLE4 - PCHKWALK
(-9) HFLE4 - PCHKWALK

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

HFLE5 - EQIPWALK

[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)?]

HFLE5

yes/no

[IF R IS IN A WHEELCHAIR OR CANNOT STAND DUE TO PERMANENT DISABILITY ONLY, SELECT "YES" (01) YES
(02) NO
WITHOUT READING TEXT BELOW.]
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with walking?

BOX HFLE2

routing

IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.

LONGWALK

HFLE6

code 1

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

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLE7 - STILWALK
(02) BOX HFLF1
(03) BOX HFLF1
(-8) BOX HFLF1
(-9) BOX HFLF1

STILWALK

HFLE7

yes/no

Do you expect that [you/(SP)] will still need help with walking three months from now?

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

BOX HFLF1

BOX HFLF1

routing

IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO HFLF3 - HELPTOIL.
ELSE GO TO BOX HFLA3.

HFLF3

yes/no

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

(01) HFLF5 - EQIPTOIL
(02) HFLF4 - PCHKTOIL
(-8) HFLF4 - PCHKTOIL
(-9) HFLF4 - PCHKTOIL

EQIPWALK

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 (01) YES
up and down?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
(-9) Refused

BOX HFLE2

HFLF5 - EQIPTOIL

Page 47 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

EQIPTOIL

HFLF5

yes/no

(01) YES
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with using the toilet, including getting up (02) NO
and down?
(-8) Don't Know
(-9) Refused

BOX HFLF2

routing

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

LONGTOIL

HFLF6

code 1

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

(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused

(01) HFLF7 - STILTOIL
(02) BOX HFLA3
(03) BOX HFLA3
(-8) BOX HFLA3
(-9) BOX HFLA3

STILTOIL

HFLF7

yes/no

Do you expect that [you/(SP)] will still need help with using the toilet three months from now?

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

BOX HFLA3

BOX HFLA3

routing

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

You mentioned that [you receive/(SP) receives] help with bathing and showering. Who gives that help?

Code List

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

Routing

BOX HFLF2

IF PERSON_HLPRBATH = (N+1) , GO TO
HFLA9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLB3.

PERSON_HLPRBATH

HFLA9

roster

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

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.

Page 48 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

(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

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.

You mentioned that [you receive/(SP) receives] help with dressing. Who gives that help?

BOX HFLB3

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
IF PERSON_HLPRBATH = (N+1), GO TO HFLB9_NEW(N+1) ADD ANOTHER
ROSTFNAM.
ELSE GO TO BOX HFLC3.
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.

PERSON_HLPRDRES

HFLB9

roster

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

[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

(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

ENTER ALL HELPERS.

Page 49 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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

BOX HFLC3

routing

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

You mentioned that [you receive/(SP) receives] help with eating. Who gives that help?

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

PERSON_HLPREAT

HFLC9

roster

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

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.

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.

Page 50 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

You mentioned that [you receive/(SP) receives] help with getting in or out of bed or chairs. Who gives that help?

Code List

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
(N+1) ADD ANOTHER

Routing

IF PERSON_HLPRCHAR = (N+1) , GO TO
HFLD9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLE3.

PERSON_HLPRCHAR

HFLD9

roster

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

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.

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

BOX HFLE3

routing

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

PERSON_HLPRWALK

HFLE9

roster

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

DISPLAY PERSON ROSTER AS RESPONSE
OPTIONS:
1. [PERSON 1]
2. [PERSON 2]
…
(01-N) LIST ALL PERSONS AS RESPONSE OPTIONS
IF PERSON_HLPRWALK = (N+1), GO TO
(N+1) ADD ANOTHER
HFLE9_NEW-ROSTFNAM.
ELSE GO TO BOX HFLF3.
DISPLAY:
1 First Name Display ROST.ROSTFNAM.
2 Last Name Display ROST.ROSTLNAM.
3 Relationship to SP Display relationship:
If ROST.ROSTREL=91/Other, display
ROST.ROSTREOS.
Else display ROST.ROSTREL relationship.

Page 51 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

Variable Name

MR Screen Name

Question Type

Question Text/Description

Code List

Routing

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.

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

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

PERSON_HLPRTOIL

HFLF9

roster

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

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.

Page 52 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

(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.

PERSON_HLPRMOST

HFL10

roster

FALLANY

HFM1

yes/no

FALLTIME

HFM2

numeric

FALLHELP

HFM3A

yes/no

Which of these persons gives [you/(SP)] the most help with these things?
SELECT ONLY ONE.

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.

Thinking about the [most recent) time that [you/(SP)] fell, did [you/he/she] hurt [yourself/himself/herself] badly
enough to get medical help?

Display all persons selected at HFLA9, HFLB9, HFLC9,
HFM1 - FALLANY
HFLD9, HFLE9 and HFLF9 rosters.

(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

Page 53 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

What kind of injury did [you/(SP)] have in that [most recent] fall?
FALCODE

HFM3B

code all

[PROBE: Anything else?]
CHECK ALL THAT APPLY.

Code List

Routing

(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

FALOTHOS

HFM3B

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer.]

HFM3C - FALLIMIT

FALLIMIT

HFM3C

yes/no

Did [your/(SP's)] [most recent] fall cause [you/him/her] to limit [your/his/her] regular activities?

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

(01) HFM3D - FALLBACK
(02) HFM3E - FALLFEAR
(-8) HFM3E - FALLFEAR
(-9) HFM3E - FALLFEAR

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

(01) [Continuous answer.]
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
(-8) Don't Know
"Extremely afraid of falling"?
(-9) Refused

DISUPPYR

SHOW CARD HF8 HF10
This card lists some examples of different types of dietary supplements.
DISUPPYR

DISUPPYR

yes/no

Since (LAST HF MONTH YEAR), [have you/has (SP)] used or taken any vitamins, minerals, herbals or other
dietary supplements? Include prescription and non-prescription supplements.

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

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

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

VITSUPYR

[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 type multivitamins?
[IF NEEDED: Multivitamins may be pills, liquids, or packets]
[IF NEEDED: Include any multivitamins that you have already told me about.]

Page 54 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

SHOW CARD HF9 HF11
Please look at the vitamins and dietary supplements listed on this card. Since (LAST HF MONTH YEAR), what
vitamins and dietary supplements did [you/(SP)] take at least once?
Do not include vitamins and dietary supplements that are taken as part of a multivitamin.
VITSUPYR

VITSUPYR

select all

[IF NEEDED: Include any vitamins or dietary supplements (that are not part of a multivitamin) that you have
already told me about.]
IF RESPONDENT HAS PROVIDED YOU WITH SUPPLEMENT BOTTLES YOU MAY USE THOSE TO
ANSWER THE QUESTION IF THE SUPPLEMENT WAS TAKEN SINCE (LAST HF MONTH YEAR).
SELECT ALL THAT APPLY

Code List

Routing

(01) Calcium (with or without vitamin D)
(02) Choline
(03) Coenzyme Q
(04) Eye health supplement (such as Ocuvite
PreserVision or I-Caps)
(05) Fiber supplement (such as Metamucil or Benefiber)
(06) Folate or folic acid
(07) Garlic supplement
(08) Iron
(09) Joint supplement (such as glucosamine, with or
without chondroitin or other ingredients)
(10) Magnesium
(11) Melatonin
(12) Niacin
(13) Omega-3 (ALA/DHA/EPA) or fish oil
(14) Potassium
(15) Probiotics (in pill, powder, or liquid form)
(16) Saw palmetto
(17) Vitamin A
(18) Vitamin B-12
(19) Vitamin B-complex
(20) Vitamin C
(21) Vitamin D (NOT as part of a calcium supplement)
(22) Vitamin E
(23) Zinc
(91) Other Supplement(s)
(-8) Don't Know
(-9) Refused

(01)-(23) BOX MH1
(91) VITOTHOS
(-8) BOX MH1
(-9) BOX MH1

(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).
DO NOT INCLUDE MEDICATIONS (E.G., ASPIRIN, ALLEGRA, TYLENOL, ETC.)
[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.

Page 55 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

The next few questions ask about the last two weeks.
HFGAD1

HFN1

list

SHOW CARD HF10 HF12
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious, or on edge

SHOW CARD HF10 HF12
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 HF12
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 HF12
HFPHQ2

HFN4

list

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

SHOW CARD HF10 HF12
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 HF12
HFPHQ4

HFN6

list

[Over the last 2 weeks, how often have you been bothered by the following problems:]
feeling tired or having little energy?

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

HFN2 - HFGAD2

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN3 - HFPHQ1

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN4 - HFPHQ2

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN5 - HFPHQ3

(01) NOT AT ALL
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
(-8) REFUSED
(-9) DON’T KNOW

HFN6 - HFPHQ4

(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

Page 56 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

SHOW CARD HF10 HF12
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 HF12
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 HF12
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 HF12
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

PHQ9QS10

HFN11

SOCISOLA

Routing

(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

routing

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 – SOCISOLA.

code one

SHOW CARD HF11 HF13
(01) Not at all difficult,
You mentioned that you have been bothered by the following problems over the last 2 weeks:
(02) Somewhat difficult,
[LIST ALL CONDITIONS WHERE ANSWER RECORDED DOES NOT EQUAL 1/NOT AT ALL, -8/REFUSED, or - (03) Very difficult,
9/DON’T KNOW, AT HFPHQ1 THROUGH HFPHQ8]
(04) Extremely difficult?
(-8) REFUSED
How difficult have these problems made it for you to do your work, take care of things at home, or get along with (-9) DON’T KNOW
people?

SHOW CARD HF12 HF14
SOCISOLA

Code List

code 1

Since (LAST HF MONTH YEAR), how often have you felt lonely or isolated from those around you? Would you
say...

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

SOCISOLA-SOCISOLA

HFQ1 - LOSTURIN

Page 57 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

SHOW CARD HF13 HF15

Code List

Routing

(01) MORE THAN ONCE A WEEK
(02) ABOUT ONCE A WEEK
(03) 2-3 TIMES A MONTH
(04) ABOUT ONCE A MONTH
(05) EVERY 2-3 MONTHS
(06) ONCE OR TWICE A YEAR
(07) NOT AT ALL
(08) SP IS ON DIALYSIS OR CATHETERIZATION OR
UROSTOMY OR BLADDER BAG
(-8) Don't Know
(-9) Refused

(01) HFQ2 - TALKURIN
(02) HFQ2 - TALKURIN
(03) HFQ2 - TALKURIN
(04) HFQ2 - TALKURIN
(05) HFQ2 - TALKURIN
(06) HFQ2 - TALKURIN
(07) BOX HFT1 HFQBI-PROBFECE
(08) BOX HFT1 HFQBI-PROBFECE
(-8) BOX HFT1 HFQBI-PROBFECE
(-9) BOX HFT1 HFQBI-PROBFECE

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 HFQBI-PROBFECE
(-8) BOX HFT1 HFQBI-PROBFECE
(-9) BOX HFT1 HFQBI-PROBFECE

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
HFQBI-PROBFECE

(01) YES
(02) NO
(-8) Don't Know
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
(-9) Refused
SUCH AS THE FLU OR A VIRUS.

HFQBI- SMLSTOOL

We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements. Since (LAST HF MONTH YEAR), [have you/has (SP)] had any of the following problems?
PROBFECE

HFQBI

grid

[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]

Leaking gas?

We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements. Since (LAST HF MONTH YEAR), have [you/(SP)] had any of the following problems?
SMLSTOOL

HFQBI

grid

(01) YES
(02) NO
(-8) Don't Know
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
(-9) Refused
SUCH AS THE FLU OR A VIRUS.
[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]

HFQBI-MODSTOOL

Leaking a small ammount of stool?

Page 58 of 61

2024 MCBS Community Questionnaire

Variable Name

MR Screen Name

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

Code List

Routing

We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements. Since (LAST HF MONTH YEAR), have [you/(SP)] had any of the following problems?
MODSTOOL

HFQBI

grid

(01) YES
(02) NO
(-8) Don't Know
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
(-9) Refused
SUCH AS THE FLU OR A VIRUS.
[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]

HFQBI-LRGSTOOL

Leaking a moderate amount of stool, requiring a change of underwear?

We are now going to ask you some questions about [your/(SP's)] ability to control [your/his/her] bowel
movements. Since (LAST HF MONTH YEAR), have [you/(SP)] had any of the following problems?
LRGSTOOL

HFQBI

grid

(01) YES
(02) NO
(-8) Don't Know
SELECT 'NO' IF THE RESPONDENT HAD ANY PROBLEMS DUE TO SHORT-TERM DIARRHEAL ILLNESSES
(-9) Refused
SUCH AS THE FLU OR A VIRUS.
[IF NEEDED: Was that because [you/(SP)] [were/was] sick?]

BOX HFQBI

Leaking a large amount of liquid stool, requiring a complete change of clothes?

TALKFECE

BOX HFQBI

routing

TALKFECE

yes/no

IF AT LEAST ONE TYPE OF STOOL LEAKAGE IS SELECTED IN HFQBI GRID (PROBFECE=1 OR
SMLSTOOL=1 OR MODSTOOL= 1 OR LRGSTOOL=1), GO TO TALKFECE-TALKFECE
ELSE, GO TO BOX HFT1.

[Have you/Has (SP)] talked about [your/his/her] problem with stool leakage with [your/his/her] doctor or other
health professional?
[IF NECESSARY: This is also referred to as bowel or fecal incontinence.]

BOX HFT1

routing

HFT1

code 1

BOX HFT1

(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

IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD.
ELSE GO TO BOX HFEND.

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

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

[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

How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had high blood
pressure?

(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused

HFT2 - HYPEAGE_LESSONE

HYPEAGE_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

HFT6D - HYPEHOME

Page 59 of 61

2024 MCBS Community Questionnaire

HFQ-HEALTH STATUS AND FUNCTIONING

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

(01) YES
Because of [your/his/her] high blood pressure, [are you/is (SP)] now taking prescribed medicine for [your/his/her] (02) NO
high blood pressure?
(-8) Don't Know
(-9) Refused

HYPEDRNK

HFT6J - HYPEDRNK

(01) YES
(02) NO
(03) NOT APPLICABLE; RESPONDENT DOES NOT
DRINK ALCOHOL
(-8) Don't Know
(-9) Refused

BOX HFT2

HFT6J

yes/no

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

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.

HFT8

numeric

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

HYPECOND

HFT11A

code 1

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

How often [do you/does (SP)] have trouble with side effects from [your/his/her] blood pressure medicines[s]?
Please tell me if [you/he/she] always, sometimes, or never [have/has] trouble with side effects.
[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any condition such as fatigue,
headache, or coughing.]

(01) ALWAYS
(02) SOMETIMES
(03) NEVER
(-8) Don't Know
(-9) Refused

HFT11A - HYPECOND

HFT12A - HYPECTRL

Page 60 of 61

2024 MCBS Community Questionnaire

Variable Name

HYPECTRL

MR Screen Name

HFT12A

HFQ-HEALTH STATUS AND FUNCTIONING

Question Type

Question Text/Description

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?

Code List

Routing

(01) VERY CONFIDENT
(02) CONFIDENT
(03) SOMEWHAT CONFIDENT
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
(-9) Refused

BOX HFT4

BOX HFT4

routing

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

HYPEPAY

HFT13

yes/no

[Do you/Does (SP)] have difficulty paying for the medicine[s] [your/his/her] doctor or other health professional
prescribes for [your/his/her] high blood pressure?

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

HFT14 - HYPESKIP

HYPESKIP

HFT14

yes/no

[Do you/Does (SP)] ever skip taking [your/his/her] medicine, take less medicine than prescribed, or share
medicine because of the cost of the medicine?

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

BOX HFEND

BOX HFEND

routing

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

Page 61 of 61


File Typeapplication/pdf
File TitleMedicare Current Beneficiary Survey Section Specifications for HFQ
SubjectMedicare beneficiaries, MCBS community questionnaire, 2024, Health status and functioning, HFQ
AuthorNORC
File Modified2022-12-19
File Created2022-12-19

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