Page 1 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.010_00.000 Instrument Variable Name: FINJ3M QuestionnaireFileName: Family
QuestionText: ? [F1]
The next set of questions is about INJURIES AND POISONINGS. People can be injured or poisoned unexpectedly,
accidentally or on purpose. They may have hurt themselves or others may have caused them to be hurt.
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: did you/did you or
anyone in your family] have an injury where any part of [fill3: your/the] body was hurt, for example, with a [fill4: (random
set of injury examples)]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families
SkipInstructions: <1> [if a single-person family, store the person number in WFINJ3M and goto TFINJ3M; else, goto WFINJ3M]
<2,R,D> [goto FPOI3M]
Question ID: FIJ.012_00.000 Instrument Variable Name: WFINJ3M QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons and at least one person was injured during the past 3 months
SkipInstructions: <R,D> [goto FPOI3M]
else, goto TFINJ3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FIJ.014_00.000 Instrument Variable Name: TFINJ3M QuestionnaireFileName: Family
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] injured?
01-91 1-91 times
97 Refused
99 Don't know
UniverseText: All persons injured during the past 3 months
SkipInstructions: <1-10,D> [goto MFINJ3M]
<R> [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury episode,
goto FPOI3M]
<11-91> [goto ERR_TFINJ3M]
Page 2 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.016_00.000 Instrument Variable Name: MFINJ3M QuestionnaireFileName: Family
QuestionText: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these
injuries/this injury/your injury or injuries/his injury or injuries/her injury or injuries]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons with at least one or an unknown number of injury episodes during the past 3 months
SkipInstructions: <1> [if TFINJ3M eq 1, fill "1" in MTFINJ3M and goto IPDATEM; else, goto MTFINJ3M]
<2,R,D> [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.018_00.000 Instrument Variable Name: MTFINJ3M QuestionnaireFileName: Family
QuestionText: ? [F1]
Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how many of
those times was the injury serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
UniverseText: All persons who consulted a medical professional for their injury episode(s)
SkipInstructions: <1-91> [If MTFINJ3M gt TFINJ3M, goto ERR1_MTFINJ3M; else, if MTFINJ3M gt 3 and TFINJ3M eq D, goto
ERR2_MTFINJ3M; else, goto IPDATEM]
<R,D> [goto TFINJ3M for the next person with a reported injury episode; if no more persons with an injury
episode, goto FPOI3M]
Question ID: FIJ.020_00.000 Instrument Variable Name: FPOI3M QuestionnaireFileName: Family
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, that is since [fill1: (date 91 days before today's date)], [fill2: were you/ were you
or anyone in your family] poisoned by swallowing or breathing in a harmful substance such as bleach, carbon monoxide, or
too many pills or drugs? Do not include food poisoning, sun poisoning, or poison ivy rashes.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families
SkipInstructions: <1> [if a single-person family, store the person number in WFPOI3M and goto TFPOI3M; else, goto WFPOI3M]
Page 3 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.022_00.000 Instrument Variable Name: WFPOI3M QuestionnaireFileName: Family
QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.
Who was this?
(Anyone else?)
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All families with two or more persons and at least one person was poisoned during the past 3 months
SkipInstructions: <R,D> [goto FDMED12M]
else, goto TFPOI3M
NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.
As shown above, each eligible person receives an edited response code in subsequent data processing.
Question ID: FIJ.024_00.000 Instrument Variable Name: TFPOI3M QuestionnaireFileName: Family
QuestionText: ? [F1]
DURING THE PAST THREE MONTHS, how many different times [fill: were you/was ALIAS] poisoned? Do not include
food poisoning, sun poisoning, or poison ivy rashes.
01-91 1-91 times
97 Refused
99 Don't know
UniverseText: All persons poisoned during the past 3 months
SkipInstructions: <1-10,D> [goto MFPOI3M]
<R> [goto TFPOI3M for next person with a reported poisoning episode; if no more persons with a poisoning
episode, goto FDMED12M]
<11-91> [goto ERR_TFPOI3M]
Question ID: FIJ.026_00.000 Instrument Variable Name: MFPOI3M QuestionnaireFileName: Family
QuestionText: ? [F1]
Did [fill1: you /ALIAS] talk to or see a medical professional about [fill2: any of these
poisonings/this poisoning/your poisoning or poisonings/his poisoning or poisonings/her poisoning or poisonings]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons with at least one or an unknown number of poisoning episodes during the past 3 months
SkipInstructions: <1> [if TFPOI3M eq 1, fill "1" in MTFPOI3M and goto IPDATEM; else, goto MTFPOI3M]
<2,R,D> [goto TFPOI3M for the next person with a reported poisoning episode; if no more persons with a
poisoning episode, goto FDMED12M]
Page 4 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.028_00.000 Instrument Variable Name: MTFPOI3M QuestionnaireFileName: Family
QuestionText: ? [F1]
Of [fill1: the ^TFPOI3M/all the] times that [fill2: you were/ALIAS was] poisoned, how many of
those times was the poisoning serious enough that a medical professional was consulted?
01-91 1-91 times
97 Refused
99 Don't know
UniverseText: All persons who consulted a medical professional for their poisoning episode(s)
SkipInstructions: <1-91> [If MTFPOI3M gt TFPOI3M, goto ERR1_MTFPOI3M; else, if MTFPOI3M gt 3 and TFPOI3M eq D,
goto ERR2_MTFPOI3M; else, goto IPDATEM]
<R,D> [goto TFPOI3M for the next person with a reported poisoning episode; if no more persons with a poisoning
episode, goto FDMED12M]
Page 5 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.050_01.000 Instrument Variable Name: IPDATEM QuestionnaireFileName: Family
QuestionText: 1 of 3
* Please hand the calendar card to the respondent.
{if only 1 injury/poisoning episode for the person}
When did [fill1: your/ALIAS’s] [fill2: injury/poisoning] happen for which a medical professional was consulted?
{first of multiple injury/poisoning episodes for the person}
Now I’m going to ask a few questions about the [fill3: ^MTFINJ3M/^MTFPOI3M] times [fill4: you were/ALIAS was]
[fill5: injured/poisoned] for which a medical professional was consulted. Starting with the most recent time, when did this
[fill2: injury/poisoning] happen?
{second plus of multiple injury/poisoning episodes for the person}
You just told me about [fill1: your/ALIAS’s] [fill6: (month, day of previous event)] [fill7:most recent/second most
recent/third most recent/fourth most recent][fill2: injury/poisoning]. What was the date of the [fill2: injury/poisoning] before
that for which a medical professional was consulted?
* Enter month.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1-12> [goto IPDATED]
<R> [goto IPHOW]
<D> [goto IPDATENO]
Question ID: FIJ.050_02.000 Instrument Variable Name: IPDATED QuestionnaireFileName: Family
QuestionText: 2 of 3
* Enter day.
01-31 1-31
97 Refused
99 Don't know
UniverseText: All injury/poisoning episodes where a valid month of episode was entered
SkipInstructions: <1-31> [goto IPDATEY]
<R> [goto IPHOW]
<D> [goto IPDATEMT]
Page 6 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.050_03.000 Instrument Variable Name: IPDATEY QuestionnaireFileName: Family
QuestionText: 3 of 3
* Enter year.
2003 2003
2004 2004
9997 Refused
9999 Don't know
UniverseText: All injury/poisoning episodes where a valid day of episode was enetered
SkipInstructions: if IPDATEM, IPDATED and IPDATEY result in a future date; goto ERR_IPDATEY; else, if IPDATEM,
IPDATED and IPDATEY result in a date prior to the start date of the 91 day reference period, goto
ERR1_IPDATEY; else, goto IPHOW
Question ID: FIJ.051_01.000 Instrument Variable Name: IPDATENO QuestionnaireFileName: Family
QuestionText: 1 of 2
Can you tell me approximately how long ago [fill1: your/ALIAS’s] [fill2: injury/poisoning] happened?
*Enter number for time since event.
01-91 1-91
97 Refused
99 Don't know
UniverseText: All injury/poisoning episodes where don't know was entered for month of episode
SkipInstructions: <1-91> [goto IPDATETP]
<R,D> [goto IPHOW]
Question ID: FIJ.051_02.000 Instrument Variable Name: IPDATETP QuestionnaireFileName: Family
QuestionText: 2 of 2
*Enter number for time period since event.
^IPDATENO…
1 Days
2 Weeks
3 Months
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes where don't know was entered for month of episode and 1-91 was entered for the
"number" part of this two-part question
SkipInstructions: goto IPHOW
Page 7 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.052_00.000 Instrument Variable Name: IPDATEMT QuestionnaireFileName: Family
QuestionText: (book) F3 ? [F1]
Was this in the beginning of [fill: ^IPDATEM (text)], the middle of [fill: ^IPDATEM (text)], or the end of [fill:
^IPDATEM (text)]?
1 Beginning
2 Middle
3 End
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes where don't know was entered for day of episode
SkipInstructions: gotoIPHOW
Question ID: FIJ.060_00.000 Instrument Variable Name: IPHOW QuestionnaireFileName: Family
QuestionText: ? [F1]
[fill1: How did [fill2: your/ALIAS’s] [fill3: injury/poisoning] on [fill4: ^IPDATEM ^IPDATED (starting with most recent
if multiple)] happen?/How did this [fill3: injury/poisoning] happen?] Please describe fully the circumstances or events
leading to the [fill3: injury/poisoning], and any objects, substances, or other people involved.
* Enter the verbatim response, probing for as much detail as possible, including specifically what the person was doing at
the time and all circumstances surrounding the event. Record all volunteered information.
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <verbatim> [if an injury episode, goto ICAUS; else, if a poisoning episode, goto PPCC]
<R> [if an injury episode, fill "R" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]
<D> [if an injury episode, fill "D" in ICAUS and goto IJBODY; else, if a poisoning episode, goto PPCC]
Page 8 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.065_00.000 Instrument Variable Name: ICAUS QuestionnaireFileName: Family
QuestionText: ? [F1]
* Do not read.
* Enter the number which best describes the cause of the person’s injury from the list below.
01 In a motor vehicle
02 On a bike, scooter, skateboard, skates, skis, horse, etc.
03 Pedestrian who was struck by a vehicle such as a car or bicycle
04 In a boat, train, or plane
05 Fall
06 Burned or scalded by substances such as hot objects or liquids, fire, or chemicals
07 Other
97 Refused
99 Don't know
UniverseText: All injury episodes for which a medical professional was consulted and don't know or refused was not entered at
IPHOW
SkipInstructions: goto IJBODY
Page 9 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.070_00.000 Instrument Variable Name: IJBODY QuestionnaireFileName: Family
QuestionText: (book) F4
* Enter up to 4 responses, separate with commas.
* Ask or verify.
In this injury, what parts of [fill: your/ALIAS’s] body were hurt?
01 Ankle
02 Back
03 Buttocks
04 Chest
05 Ear
06 Elbow
07 Eye
08 Face
09 Finger/thumb
10 Foot
11 Forearm
12 Groin
13 Hand
14 Head (not face)
15 Hip
16 Jaw
17 Knee
18 Lower leg
19 Mouth
20 Neck
21 Nose
22 Shoulder
23 Stomach
24 Teeth
25 Thigh
26 Toe
27 Upper arm
28 Wrist
29 Other, specify
97 Refused
99 Don't know
UniverseText: All injury episodes for which a medical professional was consulted
SkipInstructions: <1-28> [goto IJTYPE1]
<29> [goto IJBODYOS]
<R,D> [goto IPEV]
Page 10 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.071_00.000 Instrument Variable Name: IJBODYOS QuestionnaireFileName: Family
QuestionText: *Read if necessary.
What other parts of the body were hurt?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All injury episodes where some "other" part of the body was hurt
SkipInstructions: goto IJTYPE1
Question ID: FIJ.072_00.000 Instrument Variable Name: IJTYPE1 QuestionnaireFileName: Family
QuestionText: (book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify.
In what way was [fill1: your/ALIAS’s] [fill2: first entry--^IJBODY (text) or ^IJBODYOS] hurt?
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
UniverseText: All injury episodes where at least one part of the body was hurt
SkipInstructions: <1-8,D> [goto IJTYPE2 for next body part entered at IJBODY; if no more body parts, goto IPEV]
<9> [goto IJTYP1OS]
<R> [goto IPEV]
Question ID: FIJ.073_00.000 Instrument Variable Name: IJTYP1OS QuestionnaireFileName: Family
QuestionText: ? [F1]
* Read if necessary.
How was [fill1: your/ALIAS’s] [fill2: first entry -- ^IJBODY (text) or ^IJBODYOS] hurt?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All injury episodes where the first body part was hurt in some "other" way
SkipInstructions: goto IJTYPE2 for next body part; if no more body parts, goto IPEV
Page 11 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.074_00.000 Instrument Variable Name: IJTYPE2 QuestionnaireFileName: Family
QuestionText: (book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify.
In what way was [fill1: your/ALIAS’s] [fill2: second entry--^IJBODY (text) or ^IJBODYOS] hurt?
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
UniverseText: All injury episodes where at least two body parts were hurt and the type of injury or don't know was entered for the
first body part at IJTYPE1
SkipInstructions: <1-8,D> [goto IJTYPE3 for next body part entered at IJBODY; if no more body parts, goto IPEV]
<9> [goto IJTYP2OS]
<R> [goto IPEV]
Question ID: FIJ.075_00.000 Instrument Variable Name: IJTYP2OS QuestionnaireFileName: Family
QuestionText: * Read if necessary.
How else was [fill1: your/ALIAS’s] [fill2: second entry -- ^IJBODY (text) or ^IJBODYOS] hurt?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All injury episodes where the second body part was hurt in some "other" way
SkipInstructions: goto IJTYPE3 for next body part; if no more body parts, goto IPEV
Page 12 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.076_00.000 Instrument Variable Name: IJTYPE3 QuestionnaireFileName: Family
QuestionText: (book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify.
In what way was [fill1: your/ALIAS’s] [fill2: third entry--^IJBODY (text) or ^IJBODYOS] hurt?
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
UniverseText: All injury episodes where at least three body parts were hurt and type of injury or don't know was entered for the
second body part at IJTYPE2
SkipInstructions: <1-8,D> [goto IJTYPE4 for next body part entered at IJBODY; if no more body parts, goto IPEV]
<9> [goto IJTYP3OS]
<R> [goto IPEV]
Question ID: FIJ.077_00.000 Instrument Variable Name: IJTYP3OS QuestionnaireFileName: Family
QuestionText: * Read if necessary.
How else was [fill1: your/ALIAS’s] [fill2: third entry -- ^IJBODY (text) or ^IJBODYOS] hurt?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All injury episodes where the third body part was hurt in some "other" way
SkipInstructions: goto IJTYPE4 for next body part; if no more body parts, goto IPEV
Page 13 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.078_00.000 Instrument Variable Name: IJTYPE4 QuestionnaireFileName: Family
QuestionText: (book) F5
*Enter up to 2 responses, separate with a comma.
* Ask or verify.
In what way was [fill1: your/ALIAS’s] [fill2: fourth entry--^IJBODY (text) or ^IJBODYOS] hurt?
01 Broken bone or fracture
02 Sprain, strain, or twist
03 Cut
04 Scrape
05 Bruise
06 Burn
07 Insect bite
08 Animal bite
09 Other, specify
97 Refused
99 Don't know
UniverseText: All injury episodes where four body parts were hurt and type of injury or don't know was entered for the third body
part at IJTYPE3
SkipInstructions: <1-8,R,D> [goto IPEV]
<9> [goto IJTYP4OS]
Question ID: FIJ.079_00.000 Instrument Variable Name: IJTYP4OS QuestionnaireFileName: Family
QuestionText: * Read if necessary.
How else was [fill1: your/ALIAS’s] [fill2: fourth entry -- ^IJBODY (text) or ^IJBODYOS] hurt?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All injury episodes where the fourth body part was hurt in some "other" way
SkipInstructions: if a poisoning episode, goto PPCC; else, goto IPEV
Question ID: FIJ.080_01.000 Instrument Variable Name: PPCC QuestionnaireFileName: Family
QuestionText: Did [fill: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this poisoning from..
A phone call to a poison control center?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All poisoning episodes for which a medical professional was consulted
SkipInstructions: <1,2,D> [goto IPEV]
<R> [goto IPHOSP]
Page 14 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.080_02.000 Instrument Variable Name: IPEV QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:
injury/poisoning]?
An emergency vehicle, such as an ambulance or fire truck
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1,2,D> [goto IPER]
<R> [goto IPHOSP]
Question ID: FIJ.080_03.000 Instrument Variable Name: IPER QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:
injury/poisoning]?
A visit to an emergency room
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1,2,D> [goto IPDO]
<R> [goto IPHOSP]
Question ID: FIJ.080_04.000 Instrument Variable Name: IPDO QuestionnaireFileName: Family
QuestionText: ? [F1]
* Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:
injury/poisoning]?
A visit to a doctor’s office or other health clinic
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1,2,D> [goto IPPCHCP]
<R> [goto IPHOSP]
Page 15 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.080_05.000 Instrument Variable Name: IPPCHCP QuestionnaireFileName: Family
QuestionText: ? [F1]
* Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:
injury/poisoning]?
A phone call to a doctor, nurse, or other health care professional
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1,2,D> [goto IPOTH]
<R> [goto IPHOSP]
Question ID: FIJ.080_06.000 Instrument Variable Name: IPOTH QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:
injury/poisoning]?
Any place else?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1> [goto IPOTHOS]
if [MTFINJ3M= 01-91 and IPEV=2] goto IPVER
<2> [if poisoning and episode and PPCC eq 2 and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2,
goto IPVER; else if an injury episode and IPEV eq 2 and IPER eq 2 and IPDO eq 2 and IPPCHCP eq 2, goto
IPVER; else goto IPHOSP]
<R,D> [goto IPHOSP]
Question ID: FIJ.081_00.000 Instrument Variable Name: IPOTHOS QuestionnaireFileName: Family
QuestionText: * Read lead-in if necessary.
Where else did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE for this [fill2:
injury/poisoning]?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All injury/poisoning episodes where medical advice, treatment, or follow-up care was received from some "other" place
SkipInstructions: goto IPHOSP
Page 16 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.082_00.000 Instrument Variable Name: IPVER QuestionnaireFileName: Family
QuestionText: * Please verify.
[fill1: You/ALIAS] DID NOT receive any medical advice, treatment, or follow-up for this [fill2: injury/poisoning]. Is that
correct?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted, but no source of medical advice,
treatment, or follow-up care was selected
SkipInstructions: <1>[if the person has more injury/poisoning episodes, goto IPDATEM; else, if the person does not have more
injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an injury/poisoning; else, if no more
family members with an injury/poisoning, go to FPOI3M/FDMED12M]
<2> [if a poisoning episode, goto PPCC for new entries; else, if an injury episode, goto IPEV for new entries]
Question ID: FIJ.090_00.000 Instrument Variable Name: IPHOSP QuestionnaireFileName: Family
QuestionText: ? [F1]
[fill1: Were you/Was ALIAS] hospitalized for at least one night as a result of this [fill2: injury/poisoning]?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1> [goto IPIHNO]
<2,R,D> [if an injury episode, goto IMTRAF; if a poisoning episode, goto PPOIS]
Question ID: FIJ.091_00.000 Instrument Variable Name: IPIHNO QuestionnaireFileName: Family
QuestionText: ? [F1]
How many nights [fill: were you/was ALIAS] in the hospital?
* If still in hospital, ask how many nights up to today.
* Enter '95' for 95 or more nights.
01-94 1-94 nights
95 95+ nights
97 Refused
99 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted and resulted in hospitalization
SkipInstructions: <1-60,R,D> [if ICAUS eq 1-3, goto IMTRAF; else, if ICAUS eq 4-7,R,D, goto IPWHAT; else, if ICAUS eq 5,
goto IFALL]
<61-95> [goto ERR_IPIHNO]
Page 17 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.109_00.000 Instrument Variable Name: IMTRAF QuestionnaireFileName: Family
QuestionText: ? [F1]
* Ask or verify.
Did this accident occur on a public highway, street, or road?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All medically-consulted injury episodes that occurred while in a motor vehicle; on a bike, scooter, skateboard,
skates, skis, horse, etc.; or as a pedestrian who was struck by a vehicle such as a car or bicycle
SkipInstructions: goto IMVWHO
Question ID: FIJ.110_00.000 Instrument Variable Name: IMVWHO QuestionnaireFileName: Family
QuestionText: *Read all categories.
* Ask or verify.
[fill: Were you/Was ALIAS] injured as:
* Read answer categories.
1 The driver of a motor vehicle
2 A passenger in a motor vehicle
3 A pedestrian
4 A bicycle rider or tricycle rider
5 The rider of a scooter, skateboard, skates, or other non-motorized vehicle
7 Refused
9 Don't know
UniverseText: All medically-consulted injury episodes that occurred while in a motor vehicle; on a bike, scooter, skateboard,
skates, skis, horse, etc.; or as a pedestrian who was struck by a vehicle such as a car or bicycle
SkipInstructions: <1,2> [goto IMVTYP]
<4,5> [goto IHELMT]
<3,R,D> [goto IPWHAT]
Page 18 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.111_00.000 Instrument Variable Name: IMVTYP QuestionnaireFileName: Family
QuestionText: (book) F6 ? [F1]
* Ask or verify.
What type of vehicle [fill: were you/was ALIAS] in?
01 Passenger car
02 Passenger truck, such as a pickup truck, van, or SUV
03 Bus
04 Large commercial truck, such as a semi-truck, big rig, or 18 wheeler
05 Motorcycle (including mopeds and minibikes)
06 All terrain vehicle or ski/snow-mobile
07 Farm equipment (such as a tractor)
08 Industrial or construction vehicle
09 Other
97 Refused
99 Don't know
UniverseText: All medically-consulted injury episodes that occurred while a driver or passenger of a vehicle
SkipInstructions: <1,2,4> [goto ISBELT]
<5,6> [goto IHELMT]
<3,7,8,9,R,D> [goto IPWHAT]
Question ID: FIJ.112_00.000 Instrument Variable Name: ISBELT QuestionnaireFileName: Family
QuestionText: ? [F1]
* Ask or verify.
[fill: Were you/Was ALIAS] restrained at the time of the accident?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All medically-consulted injury episodes that occurred while a driver or passenger of a car or truck
SkipInstructions: goto IPWHAT
Page 19 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.113_00.000 Instrument Variable Name: IHELMT QuestionnaireFileName: Family
QuestionText: ? [F1]
* Ask or verify.
[fill: Were you/Was ALIAS] wearing a helmet at the time of the accident?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All medically-consulted injury episodes that occurred while riding a bicycle, tricycle, scooter, skateboard, skates, or
other nonmotorized vehicle; a motorcycle; or an all terrain vehicle or ski/snow-mobile
SkipInstructions: goto IPWHAT
Question ID: FIJ.130_00.000 Instrument Variable Name: IFALL QuestionnaireFileName: Family
QuestionText: (book) F7
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
UniverseText: All medically-consulted injury episodes that occurred due to a fall
SkipInstructions: goto IFALLWHY
Page 20 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.131_00.000 Instrument Variable Name: IFALLWHY QuestionnaireFileName: Family
QuestionText: (book) F8
* Ask or verify.
What caused [fill: you/ALIAS] to fall?
1 Slipping or tripping
2 Jumping or diving
3 Bumping into an object or another person
4 Being shoved or pushed by another person
5 Losing balance or having dizziness (becoming faint or having a seizure)
6 Other
7 Refused
9 Don't know
UniverseText: All medically-consulted injury episodes that occurred due to a fall
SkipInstructions: goto IPWHAT
Question ID: FIJ.140_00.000 Instrument Variable Name: PPOIS QuestionnaireFileName: Family
QuestionText: (book) F9 ? [F1]
* Ask or verify.
What did [fill: your/ALIAS’s] poisoning result from?
1 Swallowing a drug or medical substance mistakenly or in overdose
2 Swallowing or touching a harmful solid or liquid substance
3 Inhaling harmful gases or vapors
4 Eating a poisonous plant or other substance mistaken for food
5 Being bitten by a poisonous animal
6 Other, please specify
7 Refused
9 Don't know
UniverseText: All poisoning episodes for which a medical professional was consulted
SkipInstructions: <1-5,R,D> [goto IPWHAT]
<6> [goto PPOISOS]
Question ID: FIJ.141_00.000 Instrument Variable Name: PPOISOS QuestionnaireFileName: Family
QuestionText: * Read if necessary.
How did [fill: your/ALIAS’s] poisoning occur?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All medically-consulted poisoning episodes where the poisoning resulted from some "other" reason
SkipInstructions: goto IPWHAT
Page 21 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.150_00.000 Instrument Variable Name: IPWHAT QuestionnaireFileName: Family
QuestionText: (book) F10 ? [F1]
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
What activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: injury/poisoning]?
01 Driving or riding in a motor vehicle
02 Working at a paid job
03 Working around the house or yard
04 Attending school
05 Unpaid work (such as volunteer work)
06 Sports and exercise
07 Leisure activity (excluding sports)
08 Sleeping, resting, eating, or drinking
09 Cooking
10 Being cared for (hands-on care from other person)
11 Other, please specify
97 Refused
99 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: <1-10,R,D> [goto IPWHER]
<11> [goto IPWHATOT]
Question ID: FIJ.151_00.000 Instrument Variable Name: IPWHATOT QuestionnaireFileName: Family
QuestionText: * Read if necessary.
What other activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: injury/poisoning]?
7 Refused
9 Don't know
Verbatim Verbatim response
UniverseText: All medically-consulted injury/poisoning episodes that occurred in some "other" place
SkipInstructions: goto IPWHER
Page 22 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.160_00.000 Instrument Variable Name: IPWHER QuestionnaireFileName: Family
QuestionText: (book) F11 ? [F1]
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
Where [fill1: were you/was ALIAS] when the [fill2: injury/poisoning] happened?
01 Home (inside)
02 Home (outside)
03 School (not residential)
04 Child care center or preschool
05 Residential institution (excluding hospital)
06 Health care facility (including hospital)
07 Street or highway
08 Sidewalk
09 Parking lot
10 Sport facility, athletic field, or playground
11 Shopping center, restaurant, store, bank, gas station, or other place of business
12 Farm
13 Park or recreation area (include bike or jog path)
14 River, lake, stream, or ocean
15 Industrial or construction area
16 Other public building
17 Other
97 Refused
99 Don't know
UniverseText: All injury/poisoning episodes for which a medical professional was consulted
SkipInstructions: if AGE lt 5 and the person has more injury/poisoning episodes, goto IPDATEM; else, if AGE lt 5 and the person
does not have more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an
injury/poisoning episode; else, if AGE lt 5 and no more family members with an injury/poisoning, goto
FPOI3M/FDMED12M; else, if AGE ge 13, goto IPEMP; else, if AGE ge 5 and AGE le 12, goto IPSTU
Question ID: FIJ.170_00.000 Instrument Variable Name: IPEMP QuestionnaireFileName: Family
QuestionText: ? [F1]
At the time of this [fill1: injury/poisoning], [fill2: were you/was ALIAS] employed full-time, part-time, or not employed?
1 Full-time
2 Part-time
3 Not employed
7 Refused
9 Don't know
UniverseText: All medically-consulted injury/poisoning episodes for persons 13 years of age or older
SkipInstructions: <1,2> [goto IPWKLS]
<3,R,D> [goto IPSTU]
Page 23 of 23
2007 NHIS Questionnaire - Family
Injuries & Poisoning
Document Version Date: 12-Jul-06
Question ID: FIJ.171_00.000 Instrument Variable Name: IPWKLS QuestionnaireFileName: Family
QuestionText: As a result of this [fill1: injury/poisoning], how many days of work did [fill2: you/ALIAS] miss?
1 None
2 Less than one day
3 One to five days
4 Six or more days
7 Refused
9 Don't know
UniverseText: All medically-consulted injury/poisoning episodes for persons 13 years of age or older who were employed at the
time of the episode
SkipInstructions: goto IPSTU
Question ID: FIJ.180_00.000 Instrument Variable Name: IPSTU QuestionnaireFileName: Family
QuestionText: The person is a student if they are enrolled in school at the time of the injury. The question is NOT asking if they were at
school at the time of the injury.
1 Full-time
2 Part-time
3 Not a student
7 Refused
9 Don't know
UniverseText: All medically-consulted injury/poisoning episodes for persons 5 years of age or older
SkipInstructions: <1,2> [goto IPSCLS]
<3,R,D> [if person has more injury/poisoning episodes, goto IPDATEM for that person; else if person does not have
more injury/poisoning episodes, goto TFINJ3M/TFPOI3M for next person with an injury/poisoning episode; else if
no more family members with an injury/poisoning, goto FPOI3M/FAU.010]
Question ID: FIJ.181_00.000 Instrument Variable Name: IPSCLS QuestionnaireFileName: Family
QuestionText: As a result of this [fill1: injury/poisoning], how many days of school did [fill2: you/ALIAS] miss?
1 None
2 Less than one day
3 One to five days
4 Six or more days
7 Refused
9 Don't know
UniverseText: All medically-consulted injury/poisoning episodes for persons 5 years of age or older who were students at the time
of the episode
SkipInstructions: if the person has more injury/poisoning episodes, goto IPDATEM; else, if the person does not have more
injury/poisoning episodes, goto TFINJ3M/TFPOI3M for the next person with an injury/poisoning episode; else, if
no more family members with an injury/poisoning episode, goto FPOI3M/FDMED12M
| File Type | application/msword |
| Author | Howard Riddick |
| Last Modified By | Howard Riddick |
| File Modified | 2006-09-29 |
| File Created | 2006-09-29 |