MEPS-HC Survey Instrument

Preventive Care (AP) Section
Beta
NOTE: ALL THE ALTERNATIVE/COMPLEMENTARY CARE QUESTIONS HAVE BEEN
OMITTED. THE "ALTERNATIVE" WAS DROPPED FROM THE SECTION TITLE.

AP12

Help Enabled (AP12Help)

Variable Name
PRND.OFTDENT

Comment Enabled

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Label
HOW OFTEN PERSON GETS DENTAL CHECKUP

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
The next few questions ask about the amounts and types of preventive care
(PERSON) may receive.
On average, how often (do/does) (PERSON) receive a dental check-up?
TWICE A YEAR OR MORE

1

ONCE A YEAR
LESS THAN ONCE A YEAR

2
3

NEVER GO TO DENTIST

4

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RF
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HELP AVAILABLE FOR DEFINITION OF DENTAL CHECK-UP.
ROUTING INSTRUCTION:
IF PERSON BEING ASKED ABOUT IS 18 YEARS OF AGE OR OLDER (OR IN
AGE CATEGORIES 4-9), CONTINUE WITH AP15
IF PERSON BEING ASKED ABOUT IS 16 OR 17 YEARS OF AGE, GO TO
AP32
OTHERWISE (THAT IS, PERSON BEING ASKED ABOUT IS LESS THAN 16
YEARS OF AGE OR IN AGE CATEGORIES 1-3), GO TO BOX_02

1

Preventive Care (AP) Section
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AP15

Help Enabled

Variable Name
PRND.BLDCK

Comment Enabled

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Label
HOW LONG SINCE BLOOD PRESSURE CHECK

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had (PERSON)'s blood pressure
checked by a doctor, nurse or other health professional?
WITHIN PAST YEAR
WITHIN PAST 2 YEARS

1
2

{AP15OV}
{AP15OV}

WITHIN PAST 3 YEARS
WITHIN PAST 5 YEARS

3
4

{AP16}
{AP16}

MORE THAN 5 YEARS
NEVER

5
6

{AP16}
{AP16}

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{AP16}
{AP16}

HELP AVAILABLE FOR DEFINITION OF BLOOD PRESSURE CHECK.

2

Preventive Care (AP) Section
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AP15OV

Help Enabled

Variable Name
PRND.BLDCHKMO

Comment Enabled

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Label
NUMBER OF MONTHS SINCE BLD PRS CK'D

Size
2

IF NOT ALREADY GIVEN, ASK: About how long ago in months has it been?
IF LESS THAN ONE MONTH AGO, ENTER 1.
NUMBER: _______

{AP16}

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Hard CHECK:
1 TO 24

3

{AP16}
{AP16}

Preventive Care (AP) Section
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AP16

Help Enabled (AP16Help)

Variable Name
PRND.APCHOLCK

Comment Enabled

Jump Back Enabled

Label
HOW LONG SINCE CHOLESTEROL LEVEL CHECKED

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had (PERSON)’s blood
cholesterol checked by a doctor or other health professional?
WITHIN PAST YEAR
WITHIN PAST 2 YEARS

1
2

{AP17}
{AP17}

WITHIN PAST 3 YEARS
WITHIN PAST 5 YEARS

3
4

{AP17}
{AP17}

MORE THAN 5 YEARS

5

{AP17}

NEVER

6

{AP17}

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Don't Know

RF
DK

{AP17}
{AP17}

HELP AVAILABLE FOR DEFINITION OF BLOOD CHOLESTEROL CHECK.

4

Preventive Care (AP) Section
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AP17

Help Enabled

Variable Name
PRND.APPHYSIC

Comment Enabled

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Label
HOW LONG SINCE HAD COMPLETE PHYSICAL

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
A routine check-up is a visit with a doctor or other health professional for
assessing overall health, usually not prompted by a specific illness or
complaint. It usually includes a blood pressure check, and may include taking
a blood sample for analysis and questions about health behaviors such as
smoking.
About how long has it been since (PERSON) had a routine check-up by a
doctor or other health professional?
WITHIN PAST YEAR

1

{AP17A}

WITHIN PAST 2 YEARS
WITHIN PAST 3 YEARS

2
3

{AP17A}
{AP17A}

WITHIN PAST 5 YEARS
MORE THAN 5 YEARS

4
5

{AP17A}
{AP17A}

NEVER

6

{AP17A}

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Refused
Don't Know

RF
DK

5

{AP18}
{AP18}

Preventive Care (AP) Section
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AP17A

Help Enabled

Comment Enabled

Jump Back Enabled

{PERSON'S FIRST MIDDLE AND LAST NAME}
Doctors or other health professionals often advise people to make a change to
their lifestyles to lower their risk of developing a number of diseases, including
heart disease.
Has a doctor or other health professional ever advised (PERSON) to...
1 = YES
2 = NO

6

Preventive Care (AP) Section
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AP17A_01

Help Enabled

Variable Name
PRND.HIGHFAT

Comment Enabled

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Label

Size
2

EAT FEWER HIGH FAT FOODS

...Eat fewer high fat or high cholesterol foods?

( )

{AP17A_02}

PROGRAMMER NOTES:
REFUSED (RF) AND DON'T KNOW (DK) ALLOWED.

AP17A_02

Help Enabled

Variable Name
PRND.EXERMORE

Comment Enabled

Jump Back Enabled

Label

Size
2

EXERCISE MORE

…Exercise more?

( )

PROGRAMMER NOTES:
REFUSED (RF) AND DON'T KNOW (DK) ALLOWED.

7

{AP18}

Preventive Care (AP) Section
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AP18

Help Enabled (AP18Help)

Variable Name
PRND.APFLUSHT

Comment Enabled

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Label

Size
2

HOW LONG SINCE HAD FLU SHOT

{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had a flu shot?
WITHIN PAST YEAR

1

{AP18A}

WITHIN PAST 2 YEARS
WITHIN PAST 3 YEARS

2
3

{AP18A}
{AP18A}

WITHIN PAST 5 YEARS
MORE THAN 5 YEARS

4
5

{AP18A}
{AP18A}

NEVER

6

{AP18A}

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RF
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{AP18A}
{AP18A}

HELP AVAILABLE FOR DEFINITION OF FLU SHOT.

8

Preventive Care (AP) Section
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AP18A

Help Enabled

Variable Name
PRND.ASPRNDAY

Comment Enabled

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Label

Size
2

TAKE AN ASPIRIN A DAY

{PERSON'S FIRST MIDDLE AND LAST NAME}
(Do/Does) (PERSON) take aspirin every day or every other day?

YES
NO

1
2

{AP18B}
{AP18AA}

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RF
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9

{AP18B}
{AP18B}

Preventive Care (AP) Section
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AP18AA

Help Enabled

Variable Name
PRND.ASPUNSF

Comment Enabled

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Label
HEALTH PROBLEM MAKES ASPIRIN UNSAFE

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
(Do/Does) (PERSON) have a health problem or condition that makes taking
aspirin unsafe for (PERSON)?
YES
NO

1
2

{AP18AAA}
{AP18B}

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RF
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10

{AP18B}
{AP18B}

Preventive Care (AP) Section
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AP18AAA

Help Enabled

Variable Name
PRND.STMCHREL

Comment Enabled

Jump Back Enabled

Label

Size
2

PROBLEM STOMACH RELATED

{PERSON'S FIRST MIDDLE AND LAST NAME}
Is that problem stomach related or something else?
STOMACH RELATED

1

{AP18B}

SOMETHING ELSE

2

{AP18B}

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RF
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11

{AP18B}
{AP18B}

Preventive Care (AP) Section
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AP18B

Help Enabled

Variable Name
PRND.LOSTEETH

Comment Enabled

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Label
HAS PERSON LOST ALL ADULT TEETH

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
(Have/Has) (PERSON) lost all of (PERSON)’s upper and lower natural
(permanent) teeth?
YES
NO

1
2

{BOX_01A}
{BOX_01A}

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{BOX_01A}
{BOX_01A}

BOX_01A
IF PERSON BEING ASKED ABOUT IS MALE AND IS 40 YEARS OF AGE OR OLDER (OR IN
AGE CATEGORIES 6-9), CONTINUE WITH AP19.
IF PERSON BEING ASKED ABOUT IS MALE AND IS LESS THAN 40 YEARS OF AGE (OR
IN AGE CATEGORIES 4-5), GO TO AP23.
OTHERWISE (I.E., PERSON BEING ASKED ABOUT IS FEMALE), GO TO AP20A

12

Preventive Care (AP) Section
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AP19

Help Enabled

Variable Name
PRND.PROSTEX

Comment Enabled

Jump Back Enabled

Label

Size
2

HOW LONG SINCE PROSTATE EXAM

{PERSON'S FIRST MIDDLE AND LAST NAME}
A "P-S-A" or prostate specific antigen is a blood test for prostate cancer.
About how long has it been since (PERSON) had a "P-S-A"?
WITHIN PAST YEAR
WITHIN PAST 2 YEARS

1
2

{AP23}
{AP23}

WITHIN PAST 3 YEARS
WITHIN PAST 5 YEARS

3
4

{AP23}
{AP23}

MORE THAN 5 YEARS
NEVER

5
6

{AP23}
{AP23}

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Refused
Don't Know

RF
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13

{AP23}
{AP23}

Preventive Care (AP) Section
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AP20A

Help Enabled (AP20AHelp)

Variable Name
PRND.HYSTERCT

Comment Enabled

Jump Back Enabled

Label

Size
2

HAS PERSON HAD A HYSTERECTOMY

{PERSON'S FIRST MIDDLE AND LAST NAME}
(Have/Has) (PERSON) had a hysterectomy?
YES

1

{AP20}

NO

2

{AP20}

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Refused
Don't Know

RF
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{AP20}
{AP20}

HELP AVAILABLE FOR DEFINITION OF HYSTERECTOMY.

14

Preventive Care (AP) Section
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AP20

Help Enabled (AP20Help)

Variable Name
PRND.PAPSMR

Comment Enabled

Jump Back Enabled

Label

Size
2

HOW LONG SINCE PAP SMEAR

{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had a pap smear test?
WITHIN PAST YEAR

1

{AP21}

WITHIN PAST 2 YEARS
WITHIN PAST 3 YEARS

2
3

{AP21}
{AP21}

WITHIN PAST 5 YEARS
MORE THAN 5 YEARS

4
5

{AP21}
{AP21}

NEVER

6

{AP21}

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Refused
Don't Know

RF
DK

{AP21}
{AP21}

HELP AVAILABLE FOR DEFINITION OF PAP SMEAR TEST.

15

Preventive Care (AP) Section
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AP21

Help Enabled

Variable Name
PRND.BREASTEX

Comment Enabled

Jump Back Enabled

Label

Size
2

HOW LONG SINCE BREAST EXAM

{PERSON'S FIRST MIDDLE AND LAST NAME}
During a breast exam a doctor or other health professional feels the breast for
lumps. About how long has it been since (PERSON) had a breast exam?
WITHIN PAST YEAR
WITHIN PAST 2 YEARS

1
2

WITHIN PAST 3 YEARS
WITHIN PAST 5 YEARS

3
4

MORE THAN 5 YEARS
NEVER

5
6

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Refused
Don't Know

RF
DK

ROUTING INSTRUCTION:
IF PERSON BEING ASKED ABOUT IS 30 YEARS OF AGE OR OLDER (OR IN
AGE CATEGORIES 5-9), CONTINUE WITH AP22
OTHERWISE, GO TO AP23

16

Preventive Care (AP) Section
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AP22

Help Enabled

Variable Name
PRND.MAMOGRAM

Comment Enabled

Jump Back Enabled

Label

Size
2

HOW LONG SINCE MAMMOGRAM

{PERSON'S FIRST MIDDLE AND LAST NAME}
A mammogram is an x-ray taken only of the breast by a machine that presses
the breast against a plate. About how long has it been since (PERSON) had a
mammogram?
WITHIN PAST YEAR
WITHIN PAST 2 YEARS

1
2

{AP23}
{AP23}

WITHIN PAST 3 YEARS
WITHIN PAST 5 YEARS

3
4

{AP23}
{AP23}

MORE THAN 5 YEARS

5

{AP23}

NEVER

6

{AP23}

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RF
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17

{AP23}
{AP23}

Preventive Care (AP) Section
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AP23

Help Enabled

Variable Name
PRND.BLDSTL

Comment Enabled

Jump Back Enabled

Label

Size
2

USED A BLOOD STOOL HOME KIT

{PERSON'S FIRST MIDDLE AND LAST NAME}
A blood stool test is a test that you do at home using a special kit or cards
provided by a doctor or other health professional to determine whether the
stool contains blood. (Have/Has) (PERSON) ever had this test using a home
kit?
YES
NO

1
2

{AP24}
{AP25}

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18

{AP25}
{AP25}

Preventive Care (AP) Section
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AP24

Help Enabled

Variable Name
PRND.LSTBLDST

Comment Enabled

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Label
LAST TIME USED BLOOD STOOL HOME KIT

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
When did (PERSON) have (PERSON)'s last blood stool test using a home kit?
WITHIN PAST YEAR

1

{AP25}

WITHIN PAST 2 YEARS
WITHIN PAST 3 YEARS

2
3

{AP25}
{AP25}

WITHIN PAST 5 YEARS
MORE THAN 5 YEARS

4
5

{AP25}
{AP25}

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Don't Know

RF
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19

{AP25}
{AP25}

Preventive Care (AP) Section
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AP25

Help Enabled

Variable Name
PRND.COLONOSC

Comment Enabled

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Label
HAD A SIGMOIDOSCOPY OR COLONOSCOPY

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
A sigmoidoscopy or colonoscopy is when a tube is inserted in the rectum to
view the bowel for signs of cancer or other health problems. (Have/Has)
(PERSON) ever had this exam?
YES
NO

1
2

{AP26}
{AP28}

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Refused
Don't Know

RF
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20

{AP28}
{AP28}

Preventive Care (AP) Section
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AP26

Help Enabled

Variable Name
PRND.LSTCOLON

Comment Enabled

Jump Back Enabled

Label
LAST HAD SIMOIDOSCOPY OR COLONOSCOPY

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME}
When did (PERSON) have (PERSON)'s last sigmoidoscopy or colonoscopy?
WITHIN PAST YEAR

1

{AP28}

WITHIN PAST 2 YEARS
WITHIN PAST 3 YEARS

2
3

{AP28}
{AP28}

WITHIN PAST 5 YEARS
MORE THAN 5 YEARS

4
5

{AP28}
{AP28}

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Refused
Don't Know

RF
DK

21

{AP28}
{AP28}

Preventive Care (AP) Section
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AP28

Help Enabled (AP28Help)

Variable Name
PRND.VIGPHYS

Comment Enabled

Jump Back Enabled

Label

Size
2

VIGOROUS PHYSICAL ACTIVITY

{PERSON'S FIRST MIDDLE AND LAST NAME}
(Do/Does) (PERSON) now spend half an hour or more in moderate or
vigorous physical activity at least three times a week?
YES
NO

1
2

{AP29}
{AP29}

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{AP29}
{AP29}

HELP AVAILABLE FOR DEFINITION OF MODERATE OR VIGOROUS
PHYSICAL ACTIVITY.

AP29

Help Enabled

Comment Enabled

{PERSON'S FIRST MIDDLE AND LAST NAME}
About how tall (are/is) (PERSON) without shoes?
PROBE FOR INCHES IF NOT REPORTED.

22

Jump Back Enabled

Preventive Care (AP) Section
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AP29_01

Help Enabled

Variable Name
PRND.APHGTFT

Comment Enabled

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Label

Size
2

PERSONS HEIGHT FEET

FEET: _______

{AP29_02}

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Refused
Don't Know

Soft CHECK:
SOFT RANGE CHECK:

RF
DK

2 TO 6

23

{AP30}
{AP30}

Preventive Care (AP) Section
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AP29_02

Help Enabled

Variable Name
PRND.APHGTIN

Comment Enabled

Jump Back Enabled

Label

Size
2

PERSONS HEIGHT INCHES

INCHES: _______

{AP30}

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Refused
Don't Know

Soft CHECK:
SOFT RANGE CHECK:

RF
DK

0 TO 12

24

{AP30}
{AP30}

Preventive Care (AP) Section
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AP30

Help Enabled

Variable Name
PRND.APWGT

Comment Enabled

Jump Back Enabled

Label

Size
3

AP WEIGHT

{PERSON'S FIRST MIDDLE AND LAST NAME}
About how much (do/does) (PERSON) weigh without shoes?
ENTER CURRENT WEIGHT TO THE NEAREST POUND.
POUNDS: _______

{AP32}

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Refused

RF

{AP32}

Don't Know

DK

{AP31}

Soft CHECK:
SOFT RANGE CHECK:

50 TO 500

25

Preventive Care (AP) Section
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AP31

Help Enabled

Variable Name
PRND.APWGTRNG

Comment Enabled

Jump Back Enabled

Label

Size
2

BEST GUESS OF WEIGHT

{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AP-1.
Looking at this card, what is your best guess of (PERSON)'s weight?
79 POUNDS OR LESS
80 TO 99 POUNDS

1
2

{AP32}
{AP32}

100 TO 119 POUNDS

3

{AP32}

120 TO 139 POUNDS
140 TO 159 POUNDS

4
5

{AP32}
{AP32}

160 TO 179 POUNDS
180 TO 199 POUNDS

6
7

{AP32}
{AP32}

200 TO 219 POUNDS

8

{AP32}

220 TO 239 POUNDS
240 TO 259 POUNDS

9
10

{AP32}
{AP32}

260 TO 279 POUNDS
280 TO 299 POUNDS

11
12

{AP32}
{AP32}

300 TO 319 POUNDS
320 TO 339 POUNDS

13
14

{AP32}
{AP32}

340 TO 359 POUNDS

15

{AP32}

360 TO 379 POUNDS
380 TO 399 POUNDS

16
17

{AP32}
{AP32}

400 POUNDS OR MORE

18

{AP32}

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Refused
Don't Know

RF
DK

26

{AP32}
{AP32}

Preventive Care (AP) Section
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AP32

Help Enabled

Variable Name
PRND.SEATBELT

Comment Enabled

Jump Back Enabled

Label

Size
2

PERSON WEARS SEAT BELT

{PERSON'S FIRST MIDDLE AND LAST NAME}
When (PERSON) drive(s) or ride(s) in a car, would (PERSON) say (PERSON)
wear(s) a seat belt...
IF VOLUNTEERED: NEVER DRIVES OR RIDES IN CAR/ ALWAYS USES
PUBLIC TRANSPORTATION/WALKS, SELECT 'NEVER DRIVES/RIDES IN
A CAR'.
Always,

1

{BOX_02}

Nearly Always,
Sometimes,

2
3

{BOX_02}
{BOX_02}

Seldom, or

4

{BOX_02}

Never?
NEVER DRIVES/RIDES IN A CAR

5
6

{BOX_02}
{BOX_02}

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Don't Know

RF
DK

BOX_02
GO TO NEXT QUESTIONNAIRE SECTION.

27

{BOX_02}
{BOX_02}