PAPI Update Item Details

SECTION HEADING	VARIABLE NAME	UNIVERSE	QUESTION	RESPONSE OPTIONS	SOURCE	DIFFERENT FROM AN APPROVED NHIS INSTRUMENT	EXPLAINATION OF DIFFERENCES	ORIGINAL WORDING
Start Here			Please print today’s date. This should be the date this form was completed.	Numerical entry: Month-Day-Year		Yes	This item is not needed in the CAPI instrument because the date of interview is captured by the instrument	Not applicable - new item
A.You and Your Household (Version 1)	A1		Is this you?	Yes - Skip to A3 No - continue to A2		Yes	This item is not needed in the CAPI instrument because the interviewer asks the respondents name directly.	Not applicable - new item
A.You and Your Household (Version 1)	A2		This survey should be completed only by the person named above. Does this person currently live or stay at this address?	Yes - Give this form to that person and ask them to continue to A3 No-You do not need to complete this questionnaire. Please mark the "no" box and RETURN THIS QUESTIONNAIRE IN THE ENVELOPE PROVIDED.		Yes	This item is not needed in the CAPI instrument, because the household roster is completed with the assistance of a field interviewer.	Not applicable - new item
A.You and Your Household (Version 1)	A3		What is your sex, [SAMPLE ADULT NAME]?	Male Female		Yes	The currently approved NHIS item asks this question in a longer format that does not translate well to the shortened PAPI instrument.	Some of the questions in this survey are about topics like breast and prostate cancer, so it is important to know which questions apply. Are you male or female?
A.You and Your Household (Version 1)	A4		What is your age in years?	numeric entry		Yes	The currently approved NHIS item does not specify "in years".	What is your age?
A.You and Your Household (Version 1)	A5		In what month and year were you born?	numeric entry		Yes	This item is not included in the CAPI instrument, but was included in the PAPI to assist respondents in identifying the household member with the next birthday.	Not applicable - new item
A. You and Your Household (Version 2)			How many people, including yourself, live or stay at this address? INCLUDE… people who are not related to you people who are away on travel babies and small children people staying here who have no other place where they usually live or stay college students living in on-campus housing DO NOT INCLUDE anyone living somewhere else, such as… a college student living in off-campus housing someone in the Armed Forces on deployment Number of people	Numeric entry: Number of People	Adapted ACS format to NHIS inclusion criteria	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in completeing the household roster.	Not applicable - new item
A. You and Your Household (Version 2)			Fill out pages X-X for everyone, including yourself, who is living or staying at this address. If there are more than 6 people living or staying at this address, start with the OLDEST person, who we will call “Person 1” and continue with the next oldest until you have completed the section.		Instructions are adapted from the National Survey of Children's Health	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in completeing the household roster.	Not applicable - new item
A. You and Your Household (Version 2)	Person 1		Person 1: Name	Text entry: Last name, first name, MI	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.	Not applicable - new item
A. You and Your Household (Version 2)	Person 1		Person 1: Sex	Text entry: Male, Female	ACS	Yes	The currently approved NHIS item asks this question in a longer format that does not translate well to the shortened PAPI instrument.	Some of the questions in this survey are about topics like breast and prostate cancer, so it is important to know which questions apply. Are you male or female?
A. You and Your Household (Version 2)	Person 1		Person 1: Age	Numeric entry		Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 1		Person 1: Date of Birth	Numeric entry: Birth month and year	ACS	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in selecting the respondent for the sample adult questionnaire using the "last birthday" method for random selection.	Not applicable - new item
A. You and Your Household (Version 2)	Person 2		Person 2: Name	Text entry: Last name, first name, MI	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 2		Person 2: Sex	Male Female	ACS	Yes	The currently approved NHIS item asks this question in a longer format that does not translate well to the shortened PAPI instrument.	Some of the questions in this survey are about topics like breast and prostate cancer, so it is important to know which questions apply. Are you male or female?
A. You and Your Household (Version 2)	Person 2		Person 2: Age	Numeric entry	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 2		Person 2: Date of Birth	Numeric entry: Birth month and year	ACS	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in selecting the respondent for the sample adult questionnaire using the "last birthday" method for random selection.	Not applicable - new item
A. You and Your Household (Version 2)	Person 3		Person 3: Name	Text entry: Last name, first name, MI	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 3		Person 3: Sex	Male Female	ACS	Yes	The currently approved NHIS item asks this question in a longer format that does not translate well to the shortened PAPI instrument.	Some of the questions in this survey are about topics like breast and prostate cancer, so it is important to know which questions apply. Are you male or female?
A. You and Your Household (Version 2)	Person 3		Person 3: Age	Numeric entry	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 3		Person 3: Date of Birth	Numeric entry: Birth month and year	ACS	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in selecting the respondent for the sample adult questionnaire using the "last birthday" method for random selection.
A. You and Your Household (Version 2)	Person 4		Person 4: Name	Text entry: Last name, first name, MI	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 4		Person 4: Sex	Male Female	ACS	Yes	The currently approved NHIS item asks this question in a longer format that does not translate well to the shortened PAPI instrument.	Some of the questions in this survey are about topics like breast and prostate cancer, so it is important to know which questions apply. Are you male or female?
A. You and Your Household (Version 2)	Person 4		Person 4: Age	Numeric entry	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 4		Person 4: Date of Birth	Numeric entry: Birth month and year	ACS	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in selecting the respondent for the sample adult questionnaire using the "last birthday" method for random selection.	Not applicable - new item
A. You and Your Household (Version 2)	Person 5		Person 5: Name	Text entry: Last name, first name, MI	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 5		Person 5: Sex	Male Female	ACS	Yes	The currently approved NHIS item asks this question in a longer format that does not translate well to the shortened PAPI instrument.	Some of the questions in this survey are about topics like breast and prostate cancer, so it is important to know which questions apply. Are you male or female?
A. You and Your Household (Version 2)	Person 5		Person 5: Age	Numeric entry	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 5		Person 5: Date of Birth	Numeric entry: Birth month and year	ACS	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in selecting the respondent for the sample adult questionnaire using the "last birthday" method for random selection.	Not applicable - new item
A. You and Your Household (Version 2)	Person 6		Person 6: Name	Text entry: Last name, first name, MI	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 6		Person 6: Sex	Male Female	ACS	Yes	The currently approved NHIS item asks this question in a longer format that does not translate well to the shortened PAPI instrument.	Some of the questions in this survey are about topics like breast and prostate cancer, so it is important to know which questions apply. Are you male or female?
A. You and Your Household (Version 2)	Person 6		Person 6: Age	Numeric entry	ACS	Yes	This content is collection on the CATI instrument, but in a slightly different format due to the change in mode.
A. You and Your Household (Version 2)	Person 6		Person 6: Date of Birth	Numeric entry: Birth month and year	ACS	Yes	This item is not included in the CATI instrument, but was included in the PAPI to assist respondents in selecting the respondent for the sample adult questionnaire using the "last birthday" method for random selection.	Not applicable - new item
A. You and Your Household (Version 2)			Of the people listed, which adult age 18 or older will have the next birthday?	Write their name here:		Yes	This item was added to allow for random selection of a sample adult respondent. This process is automated in the CATI, and therefore no such item is needed.	Not applicable - new item
A. You and Your Household (Version 2)			Is this you?	Yes - Continue to B Your Health below. No - Give this form to the person named in A2 and ask them to continue to B Your Health Below		Yes	This item was added to allow for random selection of a sample adult respondent. This process is automated in the CATI, and therefore no such item is needed.	Not applicable - new item
B. Your Health	B1		Would you say your health in general is…	Excellent Very Good Good Fair Poor	NHIS (format like NSCH A1)	No
B. Your Health	B2		In general, how satisfied are you with your life?	Very Satisfied Satisfied Dissatisfied Very dissatisfied	NHIS (format like NSCH A1)	No
B. Your Health	B3		Have you EVER been told by a doctor or other health professional that you had hypertension or high blood pressure? If you take medication to control your hypertension or high blood pressure, please answer yes.	Yes No	NHIS (format like NSCH A8)	No
B. Your Health		If B3 = Yes	During the past 12 months, have you had hypertension or high blood pressure?	Yes No	NHIS (format like NSCH A8)	No
B. Your Health	B4		Have you EVER been told by a doctor or other health professional that you had high cholesterol? If you take medication to control your high cholesterol, please answer yes.	Yes No	NHIS (format like NSCH A8)	No
B. Your Health		If B4 = Yes	During the past 12 months, have you had high cholesterol?	Yes No	NHIS (format like NSCH A8)	No
B. Your Health	B5		Have you EVER been told by a doctor or other health professional that you had asthma?	Yes No	NHIS (format like NSCH C7)	No
B. Your Health		If B5 = Yes	Do you still have asthma?	Yes No	NHIS (format like NSCH C7)	No
B. Your Health		If B5 = Yes	During the past 12 months, have you had an episode of asthma or an asthma attack?	Yes No	NHIS (format like NSCH C7)	No
B. Your Health		If B5 = Yes	During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?	Yes No	NHIS (format like NSCH C7)	No
B. Your Health	B6		Have you EVER been told by a doctor or other health professional that you had… Mark (X) yes or no for each item.		NHIS (format like NSCH A3)	Yes	Instructional text was added to support the selection of a response option [Mark (X) yes or no]	Not applicable - new instructional text
B. Your Health			Coronary heart disease	Yes No	NHIS (format like NSCH A3)	No
B. Your Health			Angina, also called angina pectoris	Yes No	NHIS (format like NSCH A3)	No
B. Your Health			A heart attack, also called myocardial infarction	Yes No	NHIS (format like NSCH A3)	No
B. Your Health			A stroke	Yes No	NHIS (format like NSCH A3)	No
B. Your Health	B7		Have you EVER been told by a doctor or other health professional that you had… Mark (X) yes or no for each item.			Yes	Instructional text was added to support the selection of a response option [Mark (X) yes or no]	Not applicable - new instructional text
B. Your Health			COPD, emphysema, or chronic bronchitis	Yes No	NHIS (format like NSCH A3)	No
B. Your Health			Arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia	Yes No	NHIS (format like NSCH A3)	No
B. Your Health			Kidney problem, protein in the urine, or kidney disease	Yes No	NHIS (format like NSCH A3)	No
B. Your Health			Hepatitis	Yes No	NHIS (format like NSCH A3)	No
B. Your Health			Cirrhosis or any other kind of long-term liver condition	Yes No	NHIS (format like NSCH A3)	No
B. Your Health	B8		Have you EVER been told by a doctor or other health professional that you had cancer or a malignancy of any kind?	Yes No		No
B. Your Health		If B8 = Yes	What kind of cancer was it? Mark all that apply		Use arrow from row 45 - like C7 in NSCH.	Yes	Instructional text was added to support the selection of a response option (Mark all that apply)	Not applicable - new instructional text
B. Your Health			Breast	check box	NHIS	No
B. Your Health			Lung	check box	NHIS	No
B. Your Health			Prostate	check box	NHIS	No
B. Your Health			Skin (melanoma)	check box	NHIS	No
B. Your Health			Colorectal	check box	NHIS	No
B. Your Health			Any other type of cancer - Please specify	check box and open response text box	NHIS	Yes	Instructional text was added to support the specifiation of a type (Please specify)	Not applicable - new instructional text
B. Your Health		If B8 = Yes	How old were you when a doctor or other health professional first told you that you had cancer?	Numeric entry: years old	NHIS	No
B. Your Health	B9		Has a doctor or other health professional EVER told you that you have diabetes? Do not include prediabetes, borderline diabetes, or gestational diabetes.	Yes No	NHIS	Yes	Instructional text was added (Do not include prediabetes, borderline diabetes, or gestational diabetes) in order to account for the absence of automatic skips in a PAPI, and reduced items in this section.	Not applicable - new instructional text
B. Your Health		If B9 = Yes	How old were you when a doctor or health professional FIRST told you that you had diabetes?	Numeric entry: years old	NHIS	No
B. Your Health	B10		How tall are you without shoes? Answer in feet and inches OR meters and centimeters. Your best estimate is fine.	Numeric entry: Feet/Inches OR Meters/Centimeters	NHIS (format like NSCH B2 - 2018 Questionnaire)	Yes	Instructional text was added (Answer in feet and inches OR meters and centimeters. Your best estimate is fine) in order to account for the absence of a trainer interviewer	How tall are you without shoes?
B. Your Health	B11		How much do you weigh? Answer in pounds OR kilograms. Your best estimate is fine.	Numeric entry: Pounds OR Kilograms	NHIS (format like NSCH B2 - 2018 Questionnaire)	Yes	Instructional text was added (Answer in pounds OR kilograms. Your best estimate is fine) in order to account for the absence of a trainer interviewer.	How much do you weigh?
C. Your Life Right Now	C1		How would you rate your quality of life, focusing on what matters to you the most?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C2		How would you rate your social and family connections?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C3		In general, how healthy is your overall diet?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C4		How would you rate your physical activity, compared with people in your age group?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C5		How would you rate your ability to manage stress?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C6		How would you rate your sleep?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C7		How would you rate your ability to find meaning and purpose in your daily life?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C8		How would you rate your ability to manage your health, focusing on aspects of your health that matter most to you?	Excellent Very good Good Fair Poor	NHIS (format like NSCH A1)	No
C. Your Life Right Now	C9		Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things?	Not at all Several days More than half the days Nearly every day	NHIS - PHQ-4 replacing the WG questions	No
C. Your Life Right Now	C10		Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?	Not at all Several days More than half the days Nearly every day	NHIS - PHQ-4 replacing the WG questions	No
C. Your Life Right Now	C11		Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge?	Not at all Several days More than half the days Nearly every day	NHIS - PHQ-4 replacing the WG questions	No
C. Your Life Right Now	C12		Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?	Not at all Several days More than half the days Nearly every day	NHIS - PHQ-4 replacing the WG questions	No
D. Your Day-to-Day Experiences	D1		Do you have difficulty seeing, even if wearing glasses or contact lenses?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Washington Group Short Set (format like NSCH D4 or A1)	No
D. Your Day-to-Day Experiences	D2		Do you have difficulty hearing, even if using a hearing aid(s)?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Washington Group Short Set (format like NSCH D4 or A1)	No
D. Your Day-to-Day Experiences	D3		Do you have difficulty walking or climbing steps?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Washington Group Short Set (format like NSCH D4 or A1)	No
D. Your Day-to-Day Experiences	D4		Do you have difficulty remembering or concentrating?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Washington Group Short Set (format like NSCH D4 or A1)	No
D. Your Day-to-Day Experiences	D5		Do you have difficulty with self-care, such as washing all over or dressing?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Washington Group Short Set (format like NSCH D4 or A1)	No
D. Your Day-to-Day Experiences	D6		Using your usual language, do you have difficulty communicating, for example understanding or being understood?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Washington Group Short Set (format like NSCH D4 or A1)	No
D. Your Day-to-Day Experiences	D7		Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Social functioning (format like NSCH D4)	No
D. Your Day-to-Day Experiences	D8		Because of a physical, mental, or emotional condition, do you have difficulty participating in social activities such as visiting friends, attending clubs and meetings, or going to parties?	No difficulty Some difficulty A lot of difficulty Cannot do at all	NHIS - Social functioning (format like NSCH D4)	No
D. Your Day-to-Day Experiences	D9		Are you limited in the kind OR amount of work you can do because of a physical, mental, or emotional problem? Work includes paid work, volunteer work, schoolwork, and homework.	Yes No	NHIS - Work related functioning (Format like NSCH A8 but with open ended box)	No
D. Your Day-to-Day Experiences	D10		During the past 12 months, about how many days of work did you miss because you had an illness, injury, or disability? Do not include family, maternity, or paternity leave.	Numeric entry: days		No
D. Your Day-to-Day Experiences	D11		In the past 3 months, how often did you have pain?	Never --- SKIP to Section E Some days Most days Every day	NHIS - Frequency, severity, and impact of pain	No
D. Your Day-to-Day Experiences	D12	If D11 = Some days, most days, or every day	Think about the last time you had pain, how much pain did you have?	A little A lot Somewhere between a little and a lot	NHIS - Frequency, severity, and impact of pain	No
D. Your Day-to-Day Experiences	D13	If D11 = Some days, most days, or every day	Over the past 3 months, how often did pain limit your life or work activities?	Never Some days Most days Every day	NHIS - Frequency, severity, and impact of pain	No
E. Your Health Care Coverage			The next questions are about health insurance. Include health insurance obtained through employment or purchased directly as well as government programs like Medicare, Medicaid, and Children’s Health Insurance Program that provide medical care or help pay medical bills.		NHIS Health Insurance	No
E. Your Health Care Coverage	E1		Are you covered by any kind of health insurance or some other kind of health care plan?	Yes No -- SKIP to question E4	NHIS Health Insurance	No
E. Your Health Care Coverage	E2	If E1 = Yes	What kind of health insurance or health care coverage do you have? Mark (X) yes or no for each item		NHIS Health Insurance	Yes	Instructional text was added to support the selection of a response option [Mark (X) yes or no]	Not applicable - new instructional text
E. Your Health Care Coverage		If E1 = Yes	Private health insurance	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	Medicare (including Medicare Advantage)	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	Medicare supplement (Medigap)	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	Medicaid	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	Children’s Health Insurance Program (CHIP)	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	Military related health care: TRICARE (CHAMPUS)	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	VA health care (CHAMP-VA)	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	Indian Health Service	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	State-sponsored health plan	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage		If E1 = Yes	Other government program	Yes No	NHIS Health Insurance	No
E. Your Health Care Coverage	E3	If E1 = Yes	Was any of your health insurance obtained through Healthcare.gov or the Health Insurance Marketplace? Healthcare.gov is a website for the Affordable Care Act, also known as Obamacare.	Yes No	NHIS Health Insurance	Yes	This item was modified from it's wording to account for a lack of automatic skips in the PAPI. It was previoulsy asked only of those on specific health plans; it will now be asked of anyone with health insurance.	Was your Medicaid obtained through Healthcare.gov or the marketplace?
E. Your Health Care Coverage		If E3 = Yes	What is the name of this plan?	Text entry		Yes	This item was modified from it's wording to account for a lack of automatic skips in the PAPI. It was previoulsy asked only of those on specific health plans; it will now be asked of anyone with health insurance.	What is the name of your Medicaid health plan?
E. Your Health Care Coverage	E4		At any time in the past 12 months, did you have health insurance through a current or former employer or union?	Yes No	New to NHIS	Yes	This item is being added to both the PAPI and CAPI instruments as the full CAPI insurance section can not be administered on a paper questionnaire. Including this item on both instruments will support direct comparisons in past year coverage that would not otherwise be possible.	Not applicable - new item
E. Your Health Care Coverage	E5		At any time in the past 12 months, did you have health insurance purchased through Healthcare.gov, the Health Insurance Marketplace, or a state-based health insurance exhange?	Yes No	New to NHIS	Yes	This item is being added to both the PAPI and CAPI instruments as the full CAPI insurance section can not be administered on a paper questionnaire. Including this item on both instruments will support direct comparisons in past year coverage that would not otherwise be possible.	Not applicable - new item
E. Your Health Care Coverage	E6		At any time in the past 12 months, did you have Medicaid, Medical Assistance, or the Children’s Health Insurance Program?	Yes No	New to NHIS	Yes	This item is being added to both the PAPI and CAPI instruments as the full CAPI insurance section can not be administered on a paper questionnaire. Including this item on both instruments will support direct comparisons in past year coverage that would not otherwise be possible.	Not applicable - new item
E. Your Health Care Coverage	E7		During the past 12 months, were you covered by health insurance for…	All of the year Some of the year None of the year	New for PAPI	Yes	The current NHIS CAPI instrument collects informaion on gaps in coverage using more items than would be feasible for a PAPI. This item was written to take the place of those items, and be approperiate for all respondents, regardless of the response given previously in this section.	In the past 12 months, was there any time when you did not have any health insurance coverage?
E. Your Health Care Coverage		If E7 = Some of the years	How many months did you have coverage?	Numeric entry: months	NHIS	Yes	This item is an adaptation of a current NHIS item. The modification was necessary in order to align with the content that preceeds in this this revised section.	In the past 12 months, about how many months were you without coverage?
F. Your Health Care	F1		About how long has it been since you last saw a doctor or other health professional about your health? Do not include appointments by video or phone. Do not include dental care. Include doctors seen while a patient in a hospital.	Within the past 12 months At least 1 year ago but less than 2 years ago 2 years ago or more Never	NHIS - Health care utilization and access	Yes	Instructional text was added in order to account for the absence of a trainer interviewer.	About how long has it been since you last saw a doctor or other health professional about your health?
F. Your Health Care	F2		About how long has it been since you last saw a doctor or other health professional for a wellness visit, physical, or general-purpose check-up? If a wellness exam was combined with a visit for some other reason, include this visit. An obstetrician/ gynecologist (OB/GYN) may perform this visit.	Within the past 12 months At least 1 year ago but less than 2 years ago 2 years ago or more Never	NHIS - Health care utilization and access	Yes	Instructional text was added in order to account for the absence of a trainer interviewer.	About how long has it been since you last saw a doctor or other health professional for a wellness visit, physical, or general-purpose check-up?
F. Your Health Care	F3		When was the last time you had your blood pressure checked by a doctor, nurse, or other health professional?	Within the past 12 months At least 1 year ago but less than 2 years ago 2 years ago or more Never	NHIS - Preventative Screening	No
F. Your Health Care	F4		When was the last time you had a blood test for high blood sugar or diabetes by a doctor, nurse, or other health professional?	Within the past 12 months At least 1 year ago but less than 3 years ago 3 years ago or more Never	NHIS - Preventative Screening	No
F. Your Health Care	F5		During the past 12 months, how many times have you gone to a retail health clinic about your health? Retail health clinics are located in a pharmacy, grocery store, or supercenter. These clinics can provide common services such as certain vaccination, as well as testing for or treatment of minor uncomplicated illnesses.	None 1 time 2 or 3 times 4 or more times	NHIS - Health care utilization and access	No
F. Your Health Care	F6		During the past 12 months, how many times have you gone to an urgent care center about your health? An urgent care center is located in its own building or space. These centers can provide services such as x-rays and stitches.	None 1 time 2 or 3 times 4 or more times	NHIS - Health care utilization and access	No
F. Your Health Care	F7		During the past 12 months, how many times have you gone to a hospital emergency room about your health? This includes emergency room visits that resulted in a hospital admission.	None 1 time 2 or 3 times 4 or more times	NHIS - Health care utilization and access	No
F. Your Health Care	F8		During the past 12 months, how many nights have you been hospitalized? Do not include an overnight stay in the emergency room.	None 1 night 2 or 3 nights 4 or more nights	NHIS - Health care utilization and access	Yes	This item was revised slightly to align with the structure and response options used in the preceeding items, as that is a particularly advantageous design for self-response modes.	During the past 12 months, have you been hospitalized overnight?
F. Your Health Care	F9		During the past 12 months, have you had an appointment with a doctor, nurse, or other health professional by video or by phone?	Yes No	NHIS - Health care utilization and access	No
F. Your Health Care	F10		During the past 12 months, have you had a dental examination or cleaning? Include cleanings from all types of dental care providers such as dentists, orthodontists, oral surgeons, dental hygienists, and all other dental specialists.	Yes No	NHIS - Health care utilization and access	No
F. Your Health Care	F11		During the past 12 months, have you had an eye exam from an eye specialist such as an optometrist, ophthalmologist, or eye doctor?	Yes No	NHIS - Health care utilization and access	No
F. Your Health Care	F12		During the past 12 months, did you receive counseling or therapy from a mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?	Yes No	NHIS - Health care utilization and access	No
F. Your Health Care	F13		During the past 12 months, have you had a flu vaccination? There are 2 types of flu vaccinations. One is a shot and the other is a spray, mist, or drop in the nose.	Yes No	NHIS - Health care utilization and access	No
F. Your Health Care			These next questions are about different types of colorectal cancer screening.			Yes	This instructional test was modified slightly to reduce words.
F. Your Health Care	F14		Have you ever had a colonoscopy or sigmoidoscopy? These are exams in which a doctor inserts a tube into the rectum to look for polyps or cancer.	Yes No	NHIS - Preventative Screening	No
F. Your Health Care		If F14 = Yes	About how long has it been since your MOST RECENT colonoscopy or sigmoidoscopy?	Within the past 12 months At least 1 year ago but less than 2 years ago At least 2 years ago but less than 3 years ago At least 3 years ago but less than 5 years ago At least 5 years ago but less than 10 years ago 10 years ago or more	NHIS - Preventative Screening	Yes	Two existing NHIS items were combined to reduce item count on the streamlined PAPI.	About how long has it been since your MOST RECENT colonoscopy? And When was your most recent sigmiodoscopy?
F. Your Health Care	F15		Have you ever had a CT colonography or virtual colonoscopy? CT colonography, sometimes called virtual colonoscopy, is a test that looks for cancer in the colon. Unlike regular colonoscopies, you do not need medication to make you sleepy during the test. In this test, your colon is filled with air and you are moved through a donut-shaped X-ray machine as you lie on your back and then your stomach.	Yes No	NHIS - Preventative Screening	No
F. Your Health Care		If F15 = Yes	When was your most recent CT colonography or virtual colonoscopy?	Within the past 12 months At least 1 year ago but less than 2 years ago At least 2 years ago but less than 3 years ago At least 3 years ago but less than 5 years ago At least 5 years ago but less than 10 years ago 10 years ago or more	NHIS - Preventative Screening	No
F. Your Health Care	F16		Have you ever had a blood stool or FIT test, using a HOME kit? These are tests to determine whether you have blood in your stool or bowel movement and can be done at home using a kit. You use a stick or brush to obtain a small amount of stool at home and send it back to the doctor or lab. This may also be called a fecal occult blood test or fecal immunochemical test.	Yes No	NHIS - Preventative Screening	No
F. Your Health Care	F16a	If F16 = Yes	When was you most recent blood stool or FIT test, using a home test kit?	Within the past 12 months At least 1 year ago but less than 2 years ago At least 2 years ago but less than 3 years ago At least 3 years ago but less than 5 years ago At least 5 years ago but less than 10 years ago 10 years ago or more	NHIS - Preventative Screening	No
F. Your Health Care	F17		Have you ever had a Cologuard test? The Cologuard test is another type of stool test for colon cancer. It tests for blood in your stool and DNA changes. With this test, you mail a whole bowel movement back in a container to be tested.	Yes No	NHIS - Preventative Screening	No
F. Your Health Care	F17a	If F17 = Yes	When was you most recent Cologuard test?	Within the past 12 months At least 1 year ago but less than 2 years ago At least 2 years ago but less than 3 years ago At least 3 years ago but less than 5 years ago At least 5 years ago but less than 10 years ago 10 years ago or more	NHIS - Preventative Screening	No
G. Your Health Care Costs	G1		During the past 12 months, have you DELAYED getting medical care because of cost? Do not include dental care.	Yes No	NHIS - Dental care	No
G. Your Health Care Costs	G2		During the past 12 months, was there any time when you needed medical care, but DID NOT GET IT because of the cost? Do not include dental care.	Yes No	NHIS - Dental care	Yes	Instructional text was added to the question in order to account for the absence of a trained interviewer.	During the past 12 months, was there any time when you needed medical care, but DID NOT GET IT because of the cost?
G. Your Health Care Costs	G3		During the past 12 months, have you DELAYED getting dental care because of cost?	Yes No	NHIS - Utilization	No
G. Your Health Care Costs	G4		During the past 12 months, was there any time when you needed dental care, but DID NOT GET IT because of the cost?	Yes No	NHIS - Utilization	No
G. Your Health Care Costs	G5		During the past 12 months, were any of the following true for you? Mark (X) yes or no for each item		NHIS - Prescription medications	Yes	Instrutional text was added	Not applicable - new instructional text
G. Your Health Care Costs			You skipped medication doses to save money	Yes No	NHIS - Prescription medications	No
G. Your Health Care Costs			You took less medication to save money.	Yes No	NHIS - Prescription medications	No
G. Your Health Care Costs			You DELAYED filling a prescription to save money.	Yes No	NHIS - Prescription medications	No
G. Your Health Care Costs	G6		During the past 12 months, was there any time when you needed prescription medication, but DID NOT GET IT because of the cost?	Yes No	NHIS - Prescription medications	No
G. Your Health Care Costs	G7		If you get sick or have an accident, how worried are you that you will be able to pay your medical bills?	Very worried Somewhat worried Not at all worried	NHIS - Difficulty Paying for Health Care	No
H. Your Prescription Medication	H1		At any time in the past 12 months, did you take prescription medication?	Yes No -- SKIP to Section I	NHIS - Prescription Medication	No
H. Your Prescription Medication	H2	If H1 = Yes	Are you NOW taking any medication prescribed by a doctor for high blood pressure?	Yes No	NHIS - Prescription Medication	No
H. Your Prescription Medication	H3	If H1 = Yes	Are you NOW taking any medication prescribed by a doctor to help lower cholesterol?	Yes No	NHIS - Prescription Medication	No
H. Your Prescription Medication	H4	If H1 = Yes	Are you NOW taking diabetic pills to lower blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.	Yes No	NHIS - Prescription Medication	No
H. Your Prescription Medication	H5	If H1 = Yes	Are you NOW taking insulin? Insulin can be taken by shot or pump.	Yes No	NHIS - Prescription Medication	No
H. Your Prescription Medication	H6	If H1 = Yes	Other than insulin, are you NOW taking any injectable medication to lower blood sugar or lose weight? These medications include GLP-1 injectables, such as Ozempic, Wegovy, Saxenda, Victoza, Trulicity, Mounjaro, and Byetta.	Yes No	NHIS - Prescription Medication	No
H. Your Prescription Medication	H7	If H1 = Yes	At any time in the past 12 months, did you take prescription medication to help you with your emotions or with your concentration, behavior, or mental health?	Yes No	NHIS - Prescription Medication	No
H. Your Prescription Medication		IF H7 = Yes	Are you NOW taking prescription medication for anxiety? Anxiety can include feeling worried, nervous, or anxious	Yes No	NHIS - Prescription Medication	Yes	The CAPI collects this information using slightly differnet wording.	Do you take prescription medication for these feelings?
H. Your Prescription Medication		If H7 = Yes	Are you NOW taking prescription medication for depression?	Yes No	NHIS - Prescription Medication	Yes	The CAPI collects this information using slightly differnet wording.	Do you take prescription medication for depression?
I. Women's Health	I1		What is your sex?	Male - Skip to J Your Physical Activity Female	NHIS - Preventative Screening	Yes	This information is collected elsewhere on the CAPI. It was added here in the PAPI to faciliate a skip pattern.
I. Women's Health	I2		Have you EVER HAD a mammogram? A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.	Yes No	NHIS - Preventative Screening	No
I. Women's Health		If I2 = Yes	If yes, about how long has it been since your MOST RECENT mammogram?	Within the past 12 months At least 1 year ago but less than 2 years ago At least 2 years ago but less than 3 years ago At least 3 years ago but less than 5 years ago At least 5 years ago but less than 10 years ago 10 years ago or more	NHIS - Preventative Screening	No
I. Women's Health	I3		There are 2 different kinds of tests to check for cervical cancer. One is a Pap smear or Pap test and the other is the HPV or Human Papillomavirus test. Have you EVER HAD a test or tests to check for cervical cancer? These are routine tests for women in which a doctor or other health professional takes a sample from the cervix through the vagina with a swab or brush and sends it to the lab.	Yes No	NHIS - Preventative Screening	No
I. Women's Health	I2a	If I2 = Yes	When did you have your MOST RECENT test to check for cervical cancer?	Within the past 12 months At least 1 year ago but less than 2 years ago At least 2 years ago but less than 3 years ago At least 3 years ago but less than 5 years ago At least 5 years ago but less than 10 years ago 10 years ago or more	NHIS - Preventative Screening	No
I. Women's Health	I3		Have you had a hysterectomy? A hysterectomy is when the uterus or womb is removed. This is different from having your tubes tied.	Yes No	NHIS - Preventative Screening	No
J. Your Physical Activity	J1		How often do you do MODERATE-INTENSITY LEISURE-TIME physical activities? Moderate-intensity activities cause moderate increases in breathing or heart rate.	Checkboxes: Never -- SKIP to J3 I am unable to do this type of activity -- SKIP to J3 Numeric entry: times per week OR times per month OR times per year	NHIS - Physical Activity	No
J. Your Physical Activity	J2	If neither checkbox selected on J1	About how long do you do these moderate leisure-time physical activities each time?	Numeric entry: minutes each time OR hours each time	NHIS - Physical Activity	No
J. Your Physical Activity	J3		How often do you do VIGOROUS-INTENSITY LEISURE-TIME physical activities? Vigorous-intensity activities cause large increases in breathing or heart rate.	Checkboxes: Never -- SKIP to J5 I am unable to do this type of activity -- SKIP to J5 Numeric entry: times per week OR times per month OR times per year	NHIS - Physical Activity	No
J. Your Physical Activity	J4	If neither checkbox selected on J3	About how long do you do these vigorous leisure-time physical activities each time?	Numeric entry: minutes each time OR hours each time	NHIS - Physical Activity	No
J. Your Physical Activity	J5		How often do you do LEISURE-TIME physical activities specifically designed to STRENGTHEN your muscles such as sit-ups, push-ups, or lifting weights? Include any muscle-strengthening activities you may have reported earlier as moderate-intensity or vigorous-intensity leisure-time physical activities.	Checkboxes: Never I am unable to do this type of activity Numeric entry: times per week OR times per month OR times per year	NHIS - Physical Activity	No
J. Your Physical Activity	J6		In the past 7 days, did you walk for transportation? This is walking you might have done to travel to and from work, to do errands, or to go from place to place.	Yes No	NHIS - Physical Activity	No
J. Your Physical Activity		If J6= Yes	Did you generally walk for at least 10 minutes at a time?	Yes No		Yes	This information is collected in the CAPI using a different format, and was adapted to a self-response mode with an dichtomous response option	On average, how long did those walks take?
J. Your Physical Activity	J7		Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. In the past 7 days, did you walk for any of these reasons? Do not include walking for transportation.	Yes No	NHIS - Physical Activity	No
J. Your Physical Activity		If J7 = Yes	Did you generally walk for at least 10 munutes at a time?	Yes No		Yes	This information is collected in the CAPI using a different format, and was adapted to a self-response mode with an dichtomous response option	On average, how long did those walks take?
J. Your Physical Activity	J8		On average, how many hours of sleep do you get in a 24-hour period?	Numeric entry: hours	NHIS - Physical Activity	No
K. Nicotine and Alcohol Use	K1		Have you smoked at least 100 cigarettes in your ENTIRE LIFE?	Yes No	NHIS - Cigarette smoking	No
K. Nicotine and Alcohol Use		If K1 = Yes	Do you NOW smoke cigarettes every day, some days, or not at all?	Every day Some days Not at all	NHIS - Cigarette smoking	No
K. Nicotine and Alcohol Use	K2		Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life? Include e-cigarettes used for nicotine. Do not include marijuana use.	Yes No	NHIS - Cigarette smoking	Yes	Instructional text was added to the question in order to account for the absence of a trained interviewer.	Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life?
K. Nicotine and Alcohol Use		If K2 = Yes	Do you NOW use e-cigarettes or other electronic vaping products?	Every day Some days Not at all	NHIS - Cigarette smoking	No
K. Nicotine and Alcohol Use	K3		In your ENTIRE LIFE, have you had at least 1 drink of any kind of alcohol, not counting small tastes or sips? Alcohol includes beer, wine, wine coolers, liquors such as vodka, whiskey or rum, mixed drinks or cocktails with alcohol, and any other type of alcoholic drink.	Yes No	NHIS - ALC	No
K. Nicotine and Alcohol Use		If K3 = Yes	During the past 12 months, did you ever have 4 or more drinks in a day?	Yes No	NHIS - ALC	No
L. About You and Your Family	L1		Do you conisder yourself to be Hispanic or Latino?	Yes No		No
L. About You and Your Family	L2		What race or races do you consider yourself to be? Mark (X) for all that apply.	White Black or African American American Indian Alaska Native Native Hawaiian Pacific Islander Asian Some other race	2025 NHIS	No
L. About You and Your Family	L3		What is the HIGHEST level of school you have completed or the highest degree you hav received?	Never attended/ kindergarten only Grade 1-11 12th grace, no diploma GED or equivalent High School Graduate Some college, no degree Occupational, technical, or vocational program Two year or Associate degree Bachelor's degree (Example: BA, AB, BS, BBA) Master's degree (Example: MA, MS, Meng, Med, MBA) Professional School degree (Example: MD, DDS, DVM, JD) Doctoral degree (Example: PhD, EdD)	NHIS	No
L. About You and Your Family	L4		Did you ever serve on active duty in the U.S. Armed Forces, military Reserves, or National Guard?	Never served in the military Only on active duty for training in the Reserves or National Guard Now on active duty On active duty in the past, but not now	NHIS (Kid's Health J9)	Yes	Similar information is collected in the NHIS CAPI, but the PAPI uses a different format to collect this information that mirrors other paper surveys.	Are you now on full-time active duty with the Armed Forces?
L. About You and Your Family	L5		Is the place where you usually live owned or rented by you or someone in your family?	Owned or being bought Rented Other arrangements	NHIS	No
L. About You and Your Family	L6		Are you now living with a spouse or partner?	Yes No	NHIS	No
L. About You and Your Family	L7		What is your current legal marital status?	Married Widowed Divorced Separated Never married	NHIS	No
L. About You and Your Family	L8		Do you think of yourself as…	Lesbian or gay Straight, that is not lesbian or gay Bisexual Something else I don’t know the answer	NHIS	No
L. About You and Your Family	L9		Were you born in the United States or a U.S. territory?	Yes, born in a state or the District of Columbia Yes, born in a U.S. territory No	NHIS	No
L. About You and Your Family	L10		Which of the following best describes your current employment status? Mark 1 box.	Employed full-time Employed part-time Working WITHOUT pay at a family-owned business Not employed but looking for work Not employed and not looking for work Retired	ACS	Yes	This information is collected in the household roster section of the CAPI using a different format.
L. About You and Your Family	L11		How many of the people in your household are family members? For this survey, family refers to everybody living together who are related by birth, marriage, or adoption, as well as any unrelated children who are cared for by the family, such as foster children. Family also includes any people living together as a couple and their children. If you live alone or with unrelated roommates, just include yourself in these next questions.	Numeric entry: Number of people		Yes	This information is collected in the household roster section of the CAPI using a different format.
L. About You and Your Family	L12		In 2024, did you or any family member 18 or older receive income from any of the following sources? Mark (X) yes or no for each item.		NHIS (use NSCH formating)	Yes	Instructional text was added to support the selection of a response option [Mark (X) yes or no]	Not applicable - new instructional text
L. About You and Your Family			Wages, salaries, commissions, bonuses, tips, or self-employment.	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Interest-bearing accounts or investments	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Dividends from stocks or mutual funds	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Net rental income, royalty income, or income from estates and trusts	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Social Security or Railroad Retirement.	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Supplemental Security Income (SSI).	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Any public assistance or welfare payments from the state or local welfare office.	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Retirement income, pensions, survivors or disability income.	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family			Any other sources of income received regularly such as Veterans’ VA payments, unemployment compensation, child support or alimony.	Yes No	NHIS (use NSCH formating)	No
L. About You and Your Family	L13		What is your best estimate of the total income of all family members from all sources, before taxes, in 2024?	Text box	NHIS (use NSCH formating)	No
L. About You and Your Family	L14		What is your age today?	Numeric entry		Yes	This item was added to compare information provided on the roster with information about the sample adult as collected on the day of completion. The overarching topic (respondent's age) is collected in the current NHIS instrument, but in a different format.	Not applicable- new item
L. About You and Your Family	L15		Please print today’s date. This should be the date this form was completed.	Numeric entry		Yes	This infomration is collected automatically in the CAPI.	Not applicable- new item