Page 1 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.010_00.000 Instrument Variable Name: SMKEV QuestionnaireFileName: Sample Adult
QuestionText: These next questions are about cigarette smoking.
Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1>[goto SMKREG]
<2,R,D>[goto VIGNO]
Question ID: AHB.020_00.000 Instrument Variable Name: SMKREG QuestionnaireFileName: Sample Adult
QuestionText: How old were you when you FIRST started to smoke fairly regularly?
* Enter '6' if less than 6 years old.
* Enter '95' if 95 years old or older.
* Enter '96' if never smoked regularly.
06-84 6 - 84 years
85 85 years or older
96 Never smoked regularly
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions: <6-95,96,R,D> [goto SMKNOW]
[If SMKREG gt AGE and SMKREG ne <96>, goto ERR_SMKREG
Question ID: AHB.030_00.000 Instrument Variable Name: SMKNOW QuestionnaireFileName: Sample Adult
QuestionText: Do you NOW smoke cigarettes every day, some days or not at all?
1 Every day
2 Some days
3 Not at all
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who ever smoked 100 cigarettes
SkipInstructions: <1>[goto CIGSDA1]
<2> [goto CIGDAMO]
<3> [goto SMKQTNO]
<R,D> [goto VIGNO]
Page 2 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.040_01.000 Instrument Variable Name: SMKQTNO QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long has it been since you quit smoking cigarettes?
* Enter number for time since quit smoking.
* Enter '95' for 95 years old or older.
01-94 1 - 94
95 95+
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who quit smoking
SkipInstructions: <1-95> [goto SMKQTTP]
<R,D> [goto VIGNO]
Question ID: AHB.040_02.000 Instrument Variable Name: SMKQTTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time since quit smoking.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who quit smoking
SkipInstructions: <1-4> [goto VIGNO]
<4> [if SMKQTNO gt (AGE - <15>), goto ERR1_SMKQTTP
if (SMKREG + SMKQTNO gt AGE), goto ERR2_SMKQTTP
Question ID: AHB.050_00.000 Instrument Variable Name: CIGSDA1 QuestionnaireFileName: Sample Adult
QuestionText: On the average, how many cigarettes do you now smoke a day?
* Enter '1' if less than 1 cigarette.
* Enter '95' if 95 or more cigarettes.
01-94 1 - 94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who are current every day smokers
SkipInstructions: <1-95,R,D> [goto CIGQTYR]
Page 3 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.060_00.000 Instrument Variable Name: CIGDAMO QuestionnaireFileName: Sample Adult
QuestionText: On how many of the PAST 30 DAYS did you smoke a cigarette?
*Enter '0' for None.
00 None
01-30 1-30 days
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who are current some day smokers
SkipInstructions: <0>[goto CIGQTYR]
<1-30,R,D> [goto CIGSDA2]
Question ID: AHB.070_00.000 Instrument Variable Name: CIGSDA2 QuestionnaireFileName: Sample Adult
QuestionText: On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?
* Enter '1' if less than 1.
* Enter '95' if 95 or more cigarettes.
01-94 1-94 cigarettes
95 95+ cigarettes
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who are current some day smokers
SkipInstructions: <1-95,R,D> [goto CIGQTYR]
Question ID: AHB.080_00.000 Instrument Variable Name: CIGQTYR QuestionnaireFileName: Sample Adult
QuestionText: During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO
QUIT SMOKING?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who are every day or someday smokers
SkipInstructions: <1,2,R,D> [goto VIGNO]
Page 4 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.090_01.000 Instrument Variable Name: VIGNO QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
The next questions are about physical activities (exercise, sports, physically active hobbies...) that you may do in your
LEISURE time.
How often do you do VIGOROUS leisure-time physical activities for AT LEAST 10 MINUTES that cause HEAVY
sweating or LARGE increases in breathing or heart rate?
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for vigorous leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0,996,R,D>[goto MODNO]
<1-995>[goto VIGTP]
Question ID: AHB.090_02.000 Instrument Variable Name: VIGTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for vigorous leisure-time physical activities.
0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions: <1-4> goto VIGLNGNO
[if (VIGNO gt <4> and VIGTP eq <1>) or
(VIGNO gt <28> and VIGTP eq <2>) or
(VIGNO gt <31> and VIGTP eq <3>) or
(VIGNO gt <365> and VIGTP eq <4>) goto ERR1_VIGTP]
Page 5 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.100_01.000 Instrument Variable Name: VIGLNGNO QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
About how long do you do these vigorous leisure-time physical activities each time?
* Enter number for length of vigorous leisure-time physical activities.
001-995 1-995
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions: <1-995>[goto VIGLNGTP]
<R,D>[goto MODNO]
Question ID: AHB.100_02.000 Instrument Variable Name: VIGLNGTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for length of vigorous leisure-time physical activities.
1 Minutes
2 Hours
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do vigorous activities
SkipInstructions: <1,2>goto MODNO
if VIGLNGNO lt <10> and VIGLNGTP eq <1> goto ERR1_VIGLNGTP;
if (VIGLNGNO gt <90> and VIGLNGTP eq <1>) or if VIGLNGNO gt <2> and VIGLNGTP eq <2> goto
ERR2_VIGLNGTP
Question ID: AHB.110_01.000 Instrument Variable Name: MODNO QuestionnaireFileName: Sample Adult
QuestionText: How often do you do LIGHT OR MODERATE LEISURE-TIME physical activities for AT LEAST 10 MINUTES that
cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?
* If necessary, prompt with: How many times per day, per week, per month, or per year do you do these activities?
* Enter number of light or moderate leisure-time physical activities.
* Enter '0' for Never.
* Enter '996' if unable to do this type of activity.
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1-995>[goto MODTP]
<0, 996, R,D>[goto STRNGNO]
Page 6 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.110_02.000 Instrument Variable Name: MODTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for light or moderate leisure-time physical activities
0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions: <1-4> goto MODLNGNO
[if (MODNO gt <4> and MODTP eq <1>) or
(MODNO gt <28> and MODTP eq <2>) or
(MODNO gt <31> and MODTP eq <3>) or
(MODNO gt <365> and MODTP eq <4>)] goto ERR_MODNO
Question ID: AHB.120_01.000 Instrument Variable Name: MODLNGNO QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
About how long do you do these light or moderate leisure-time physical activities each time?
* Enter number for length of light or moderate leisure-time physical activities.
001-995 1-995
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions: <1-995>[goto MODLNGTP]
<R,D>[goto STRNGNO]
Page 7 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.120_02.000 Instrument Variable Name: MODLNGTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for length of light or moderate leisure-time physical activities.
1 Minutes
2 Hours
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do light or moderate activities
SkipInstructions: <1,2> goto STRNGNO
if MODLNGNO lt <10> and MODLNGTP eq <1> goto ERR1_MODLNGTP
if MODLNGNO gt <90> and MODLNGTP eq <1> or if MODLNGNO gt <2> and MODLNGTP eq <2>goto
ERR2_MODLNGTP
Question ID: AHB.130_01.000 Instrument Variable Name: STRNGNO QuestionnaireFileName: Sample Adult
QuestionText: How often do you do LEISURE-TIME physical activities specifically designed to STRENGTHEN your muscles such as
lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)
* Read if necessary: How many times per day, per week, per month, or per year do you do these activities?
* Enter number for strengthening activities.
* Enter '0' for Never.
* Enter '996' for Unable to do this type activity
000 Never
001-995 1-995 time(s)
996 Unable to do this type activity
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1-995>[goto STRNGTP]
<0, 996,R,D>[goto ALC1YR]
Page 8 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.130_02.000 Instrument Variable Name: STRNGTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for strengthening activities
0 Never
1 Per day
2 Per week
3 Per month
4 Per year
6 Unable to do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who do strengthening activities
SkipInstructions: <1-4> goto ALC1YR
[If (STRNGNO gt <4> & STRNGTP = <1>) or (STRNGNO gt <28> & STRNGTP = <2>) or
(STRNGNO gt <31> & STRNGTP = <3>) or (STRNGNO gt <365> & STRNGTP = <4>) goto
ERR_STRNGTP]
Question ID: AHB.140_00.000 Instrument Variable Name: ALC1YR QuestionnaireFileName: Sample Adult
QuestionText: These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine
coolers, and any other type of alcoholic beverage.
In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1> [goto ALC12MNO]
<2,R,D> [goto ALCLIFE]
Question ID: AHB.150_00.000 Instrument Variable Name: ALCLIFE QuestionnaireFileName: Sample Adult
QuestionText: In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have not had 12 drinks in any one year or don't know if they did or refused to answer
SkipInstructions: <1> [goto ALC12MNO]
<2,R,D> [goto AHGT_FT]
Page 9 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.160_01.000 Instrument Variable Name: ALC12MNO QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
In the PAST YEAR, how often did you drink any type of alcoholic beverage?
* Read if necessary: "How many days per week, per month or per year did you drink?"
* Enter number for how often alcoholic beverages were consumed in the past year.
*Enter '0' for Never.
000 Never
001-365 1-365 day(s)
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who have had at least 12 drinks in any one year or at least 12 drinks in their entire life
SkipInstructions: <1-365>[goto ALC12MTP]
<0,R,D>[goto AHGT_FT]
Question ID: AHB.160_02.000 Instrument Variable Name: ALC12MTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for how often alcoholic beverages were consumed in the past year.
0 Never/None
1 Week
2 Month
3 Year
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who drank at least once in the past year
SkipInstructions: <1-3> [goto ALCAMT]
[If (ALC12MNO gt <7> & ALC12MTP = <1>) or (ALC12MNO gt <31> & ALC12MTP = <2>) or
(ALC12MNO gt <365> & ALC12MTP = <3>) goto ERR_ALC12MTP]
Page 10 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.170_00.000 Instrument Variable Name: ALCAMT QuestionnaireFileName: Sample Adult
QuestionText: In the PAST YEAR, on those days that you drank alcoholic
beverages, on the average, how many drinks did you have?
* Enter '1' if less than 1 drink.
* Enter '95' if 95 or more drinks.
01-94 1-94 drinks
95 95+ drinks
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions: <1-95,R,D> [goto ALC5UPNO]
<10-95>[goto ERR_ALCAMT]
Question ID: AHB.180_01.000 Instrument Variable Name: ALC5UPNO QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?
* Read if necessary:
How many days per week, per month or per year did you have 5 or more drinks in a single day?
* Enter number of days.
* Enter '0' for Never/None.
000 Never/None
001-365 1-365 day(s)
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who have had at least 1 drink in the past year
SkipInstructions: <1-365>[goto ALC5UPTP]
<0,R,D>[goto AHGT_FT]
Page 11 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.180_02.000 Instrument Variable Name: ALC5UPTP QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for days per week, per month or per year.
0 Never/None
1 Per week
2 Per month
3 Per year
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have had 5+ drinks in one day at least once in the past year
SkipInstructions: <1-3>goto AHGT_FT
[If (ALC5UPNO gt <7> & ALC5UPTP = <1>) or
(ALC5UPNO gt <31> & ALC5UPTP = <2>) or
(ALC5UPNO gt <365> & ALC5UPTP = <3>) goto ERR1_ALC5UPTP
[if number of days drank in the past year (calculated from ALC12MNO and ALC12MTP) lt number of days per year
with 5 or more drinks (calculated from ALC5UPNO and ALC5UPTP)] goto ERR2_ALC5UPTP]
Question ID: AHB.190_01.000 Instrument Variable Name: AHGT_FT QuestionnaireFileName: Sample Adult
QuestionText: How tall are you without shoes?
* Enter "M" to record metric measurements
02-07 2-7 feet
97 Refused
99 Don't know
M Metric
UniverseText: Sample adults 18+
SkipInstructions: <2-7> [goto AHGT_IN]
<R,D> [goto AWGT_LB]
<M> [goto AHGT_M]
[if AHGT_FT NE<2-7,D,R,M> goto ERR1_AHGT_FT]
[if AHGT_FT = <2,3> goto ERR2_AHGT_FT]
Question ID: AHB.190_02.000 Instrument Variable Name: AHGT_IN QuestionnaireFileName: Sample Adult
QuestionText: How tall are you without shoes?
* Enter '0' if exactly [fill1: AHGT_FT] feet tall.
00-11 0-11 inches
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who answered their height in feet
SkipInstructions: <0-11,R,D> [goto AWGT_LB]
<empty> [goto ERR_AHGT_IN]
Page 12 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.190_03.000 Instrument Variable Name: AHGT_M QuestionnaireFileName: Sample Adult
QuestionText: How tall are you without shoes?
* Enter height in metric.
0-2 0-2 meters
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who choose to give their height in metric measurements
SkipInstructions: <0-2> [goto AHGT_CM]
<R,D> [goto AWGT_LB]
<empty> [goto ERR_AHGT_M]
Question ID: AHB.190_04.000 Instrument Variable Name: AHGT_CM QuestionnaireFileName: Sample Adult
QuestionText:
000-241 0-241 centimeters
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who answered their height in meters
SkipInstructions: <0-241,R,D> goto AWGT_LB
[If AHGT_M eq <2> and AHGT_CM gt <41> or AHGT_M eq <1> and AHGT_CM gt <141>] goto
ERR1_AHGT_CM]
< > goto ERR2_AHGT_CM
[If AHGT_M eq <1> and AHGT_CM lt <20> or AHGT_M eq <0> and AHGT_CM lt
<120>] goto ERR3_AHGT_CM]
Question ID: AHB.200_01.000 Instrument Variable Name: AWGT_LB QuestionnaireFileName: Sample Adult
QuestionText: How much do you weigh without shoes?
* Enter "M" to record metric measurements
* Enter '500' for 500 pounds or more
050-500 50-500 pounds
997 Refused
999 Don't know
M Metric
UniverseText: Sample adults 18+
SkipInstructions: <50-500> [goto SLEEP]
[if AWGT_LB lt <50> or gt <500> goto ERR_AWGT_LB
<R,D>[goto SLEEP]
<M> [goto AWGT_KG]
Page 13 of 13
2007 NHIS Questionnaire - Sample Adult
Adult Health Behaviors
Document Version Date: 12-Jul-06
Question ID: AHB.200_02.000 Instrument Variable Name: AWGT_KG QuestionnaireFileName: Sample Adult
QuestionText: How much do you weigh without shoes?
* Enter weight in kilograms
022-226 22-226 kilograms
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who choose to give their weight in metric measurements
SkipInstructions: <22-226,R,D> [goto SLEEP]
[If AWGT_KG lt <22> or K gt <226>goto ERR_AWGT_KG]
Question ID: AHB.210_00.000 Instrument Variable Name: SLEEP QuestionnaireFileName: Sample Adult
QuestionText: On average, how many hours of sleep do you get in a 24-hour period?
* Enter hours of sleep in whole numbers, rounding 30 minutes (1/2 hour) or more UP to the next whole hour and dropping
29 or fewer minutes.
01-24 1-24 hours
97 Refused
99 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1-24,R,D> [goto next section]
[If SLEEP eq <1-5> goto ERR_SLEEP]
| File Type | application/msword |
| Author | Howard Riddick |
| Last Modified By | Howard Riddick |
| File Modified | 2006-09-29 |
| File Created | 2006-09-29 |