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pdf2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IMQ-IMMUNIZATION
Question Text/Description
Code List
Routing
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) SHNGTIME
(02) NSHNGWHY
(-8) BOX IM3
(-9) BOX IM3
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM2
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM2
(01) PHARMACY/DRUG STORE
(02) DOCTORS OFFICE OR GROUP PRACTICE
(03) CLINIC (MEDICAL
CLINIC/NEIGHBORHOOD/FAMILY HEALTH
CENTER/RURAL HEALTH CLINIC/COMPANY
CLINIC/WORKPLACE)
(04) HOSPITAL/WALK-IN URGENT CENTER
(05) VA FACILITY
(06) COMMUNITY SITE (HEALTH FAIR/SHOPPING
MALL/CHURCH/SCHOOL/LIBRARY)
(07) AT HOME
(08) SENIOR CENTER
(91) OTHER, SPECIFY
(-8) DON'T KNOW
(-9) REFUSED
(01)-(08) SHINGCOST
(91) SHNGSTOS
IMMUNIZATION QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=ALL
SPALIVE=1
SEASON=WINTER
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
Administer after PVQ.
BOX IM1
SHINGVAC
PV6
routing
yes/no
IF SP HAS NEVER BEEN ASKED SHINGVAC (P_SHINGVAC=.), GO TO SHINGVAC.
ELSE IF SP HAS NEVER REPORTED RECEIVING SHINGLES VACCINE (P_SHINGVAC^=1), GO TO
SHINGYR.
ELSE GO TO BOX IM3.
Shingles is an illness that results in a rash or blisters on the skin and is usually painful. There are two vaccines
that have been used to prevent shingles. The first was Zostavax®, which was available in the U.S. from 2006
through 2020 and required one shot. The other is Shingrix®, which has been available since 2017 and requires
two shots.
[Have you/Has (SP)] ever had a vaccine for Shingles?
IF THE RESPONDENT HAD ONE DOSE OF A SHINGLES VACCINE, SELECT YES.
SHNGTIME
SHINGYR
SHNGTIME
SHINGYR
code one
yes/no
Did [you/(SP)] get [you/their] Shingles vaccine since January 1, 2023?
Shingles is an illness that results in a rash or blisters on the skin and is usually painful. There are two vaccines
that have been used to prevent shingles. The first was Zostavax®, which was available in the U.S. from 2006
through 2020 and required one shot. The other is Shingrix®, which has been available since 2017 and requires
two shots.
Since (LAST IM MONTH YEAR), [have you/has (SP)] had a vaccine for Shingles?
IF THE RESPONDENT HAD ONE DOSE OF A SHINGLES VACCINE, SELECT YES.
BOX IM2
routing
If SHINGVAC=YES or SHINGYR=YES, go to SHNGSITE.
ELSE GO TO NSHNGWHY.
SHNGSITE
SHNGSITE
code one
Where did [you/(SP)] go for [your/(SP)'s] Shingles vaccine?
SHNGSTOS
SHNGSTOS
verbatim text
OTHER (SPECIFY)
SHINGCOST
SHINGCOST
yes/no
Did [you/(SP)] pay some or all of the cost of the Shingles vaccine?
SHINGCOST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM3
Page 1 of 4
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IMQ-IMMUNIZATION
Question Text/Description
For what reason didn't [you/(SP)] get a Shingles vaccine?
NSHNGWHY
NSHNGWHY
BOX IM3
code all
routing
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
PNEUTIME
PV7
PNEUTIME
yes/no
code one
This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also
called the pneumococcal vaccine. There are two types of pneumonia shots: polysaccharide, also known as
Pneumovax®23, and conjugate, also known as Prevnar®20 or Vaxneuvance®.
Did [you/(SP)] get [your/their] pneumonia vaccine since January 1, 2023?
Since (LAST IM MONTH YEAR), [have you/has (SP)] EVER had a pneumonia shot?
PNEUYR
PNEUYR
yes/no
BOX IM4
routing
This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also
called the pneumococcal vaccine. There are two types of pneumonia shots: polysaccharide, also known as
Pneumovax®23, and conjugate, also known as Prevnar®20 or Vaxneuvance®.
PNEUSITE
code one
Where did [you/(SP)] go for [your/(SP)'s] pneumonia shot?
PNEUSTOS
PNEUSTOS
verbatim text
OTHER (SPECIFY)
PNEUCOST
yes/no
(01) WORRIED ABOUT SIDE EFFECTS/ALLERGIC TO
INGREDIENTS IN VACCINE/MEDICAL REASON FOR
NOT GETTING VACCINE
(02) VACCINE IS NOT NEEDED OR NECESSARY
(03) FORGOT/TOO BUSY
(04) SHOT COULD BE PAINFUL/DON'T LIKE
NEEDLES
(05) COULDN'T AFFORD VACCINE/OTHER COSTRELATED CONCERNS
(06) INTEND TO GET VACCINE BUT HAVE NOT YET
BOX IM3
GOTTEN IT
(07) PROVIDER DID NOT RECOMMEND VACCINE
(08) VACCINE NOT AVAILABLE/COULDN'T FIND A
PLACE OFFERING THE VACCINE
(09) DIFFICULTY MAKING AN
APPOINTMENT/TRANSPORTATION PROBLEMS
(10) DISEASE IS NOT SERIOUS
(11) DOESN'T TRUST THE GOVERNMENT
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) PNEUTIME
(02) NPNEUWHY
(-8) BOX IM5
(-9) BOX IM5
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM4
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM4
(01) PHARMACY/DRUG STORE
(02) DOCTORS OFFICE OR GROUP PRACTICE
(03) CLINIC (MEDICAL
CLINIC/NEIGHBORHOOD/FAMILY HEALTH
CENTER/RURAL HEALTH CLINIC/COMPANY
CLINIC/WORKPLACE)
(04) HOSPITAL/WALK-IN URGENT CENTER
(05) VA FACILITY
(06) COMMUNITY SITE (HEALTH FAIR/SHOPPING
MALL/CHURCH/SCHOOL/LIBRARY)
(07) AT HOME
(08) SENIOR CENTER
(91) OTHER, SPECIFY
(-8) DON'T KNOW
(-9) REFUSED
(01)-(09) PNEUCOST
(91) PNEUSTOS
If PNEUSHOT=YES or PNEUYR=YES, go to PNEUSITE.
ELSE GO TO NPNEUWHY.
PNEUSITE
PNEUCOST
Routing
IF SP HAS NEVER BEEN ASKED PNEUSHOT (P_PNEUSHOT=.), GO TO PNEUSHOT.
ELSE IF SP HAS NEVER REPORTED RECEIVING PNEUMONIA VACCINE (P_PNEUSHOT^=1), GO TO
PNEUYR.
ELSE GO TO BOX IM5.
[Have you/Has (SP)] EVER had a pneumonia shot?
PNEUSHOT
Code List
Did [you/(SP)] pay some or all of the cost of the pneumonia shot?
PNEUCOST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM5
Page 2 of 4
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IMQ-IMMUNIZATION
Question Text/Description
For what reason didn't [you/(SP)] get a pneumonia shot?
NPNEUWHY
RSVVAC
NPNEUWHY
code all
BOX IM5
routing
RSVVAC
yes/no
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
RSVYR
RSVTIME
RSVYR
code one
yes/no
Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, coldlike symptoms. Adults aged 60 years and older may receive a single dose of RSV vaccine.
Did [you/(SP)] get [your/their] RSV vaccine since January 1, 2023?
Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, coldlike symptoms. Adults aged 60 years and older may receive a single dose of RSV vaccine
Since (LAST IM MONTH YEAR), [have you/has (SP)] had a vaccine for RSV?
BOX IM6
routing
RSVSITE
code one
Where did [you/(SP)] go for [your/(SP)'s] RSV vaccine?
RSVSTOS
RSVSTOS
verbatim text
OTHER (SPECIFY)
RSVCOST
yes/no
(01) WORRIED ABOUT SIDE EFFECTS/ALLERGIC TO
INGREDIENTS IN VACCINE/MEDICAL REASON FOR
NOT GETTING VACCINE
(02) VACCINE IS NOT NEEDED OR NECESSARY
(03) FORGOT/TOO BUSY
(04) SHOT COULD BE PAINFUL/DON'T LIKE
NEEDLES
(05) COULDN'T AFFORD VACCINE/OTHER COSTRELATED CONCERNS
(06) INTEND TO GET VACCINE BUT HAVE NOT YET
BOX IM5
GOTTEN IT
(07) PROVIDER DID NOT RECOMMEND VACCINE
(08) VACCINE NOT AVAILABLE/COULDN'T FIND A
PLACE OFFERING THE VACCINE
(09) DIFFICULTY MAKING AN
APPOINTMENT/TRANSPORTATION PROBLEMS
(10) DISEASE IS NOT SERIOUS
(11) DOESN'T TRUST THE GOVERNMENT
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) RSVTIME
(02) NRSVWHY
(-8) BOX IM7
(-9) BOX IM7
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM6
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IM6
If RSVVAC=YES or RSVYR=YES, go to RSVSITE.
ELSE GO TO NRSVWHY.
RSVSITE
RSVCOST
Routing
IF SP HAS NEVER BEEN ASKED RSVVAC (P_RSVVAC=.), GO TO RSVVAC.
ELSE IF SP HAS NEVER REPORTED RECEIVING RSV VACCINE (P_RSVVAC^=1), GO TO RSVYR.
ELSE GO TO BOX IM7.
[Have you/Has (SP)] EVER had a vaccine for RSV?
RSVTIME
Code List
Did [you/(SP)] pay some or all of the cost of the RSV vaccine?
(01) PHARMACY/DRUG STORE
(02) DOCTORS OFFICE OR GROUP PRACTICE
(03) CLINIC (MEDICAL
CLINIC/NEIGHBORHOOD/FAMILY HEALTH
CENTER/RURAL HEALTH CLINIC/COMPANY
CLINIC/WORKPLACE)
(04) HOSPITAL/WALK-IN URGENT CENTER
(05) VA FACILITY
(06) COMMUNITY SITE (HEALTH FAIR/SHOPPING
MALL/CHURCH/SCHOOL/LIBRARY)
(07) AT HOME
(08) SENIOR CENTER
(91) OTHER, SPECIFY
(-8) DON'T KNOW
(-9) REFUSED
(01)-(09) RSVCOST
(91) RSVSTOS
RSVCOST
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX IMEND
Page 3 of 4
2025 MCBS Community Questionnaire
Variable Name
MR Screen Name
Question Type
IMQ-IMMUNIZATION
Question Text/Description
For what reason didn't [you/(SP)] get an RSV vaccine?
NRSVWHY
NRSVWHY
code all
BOX IMEND
routing
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
Code List
Routing
(01) WORRIED ABOUT SIDE EFFECTS/ALLERGIC TO
INGREDIENTS IN VACCINE/MEDICAL REASON FOR
NOT GETTING VACCINE
(02) VACCINE IS NOT NEEDED OR NECESSARY
(03) FORGOT/TOO BUSY
(04) SHOT COULD BE PAINFUL/DON'T LIKE
NEEDLES
(05) COULDN'T AFFORD VACCINE/OTHER COSTRELATED CONCERNS
(06) INTEND TO GET VACCINE BUT HAVE NOT YET
BOX IMEND
GOTTEN IT
(07) PROVIDER DID NOT RECOMMEND VACCINE
(08) VACCINE NOT AVAILABLE/COULDN'T FIND A
PLACE OFFERING THE VACCINE
(09) DIFFICULTY MAKING AN
APPOINTMENT/TRANSPORTATION PROBLEMS
(10) DISEASE IS NOT SERIOUS
(11) DOESN'T TRUST THE GOVERNMENT
(-8) DON'T KNOW
(-9) REFUSED
GO TO CVQ.
Page 4 of 4
| File Type | application/pdf |
| Author | NORC |
| File Modified | 2024-06-26 |
| File Created | 2024-06-26 |