Page 1 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.020_00.000 Instrument Variable Name: AUSUALPL QuestionnaireFileName: Sample Adult
QuestionText: Is there a place that you USUALLY go to when you are sick or need advice about your health?
1 Yes
2 There is NO place
3 There is MORE THAN ONE place
7 Refused
9 Don't know
UniverseText: Sample adults GE 18 years
SkipInstructions: <1,3> [go to APLKIND]
<2,D,R> [go to AHCPLKND]
Question ID: AAU.030_00.000 Instrument Variable Name: APLKIND QuestionnaireFileName: Sample Adult
QuestionText: ['If AUSUALPL = 1] What kind of place is it - a clinic, doctor's office, emergency room, or some other place? ['Else, if
AUSUALPL = 3] What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other
place?
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice
SkipInstructions: <1 - 5> [go to AHCPLROU]
<6,R,D> [go to AHCPLKND]
Question ID: AAU.035_00.000 Instrument Variable Name: AHCPLROU QuestionnaireFileName: Sample Adult
QuestionText: Is that {fill: place from (APLKIND)} the same place you USUALLY go when you need routine or preventive care, such as
a physical examination or check up?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who reported place goes most often as
a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some
other place
SkipInstructions: <1> [goto AHCCHGYR]
<2,R,D> [go to AHCPLKND]
Page 2 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.037_00.000 Instrument Variable Name: AHCPLKND QuestionnaireFileName: Sample Adult
QuestionText: What kind of place do you USUALLY go to when you need routine or preventive care, such as a physical examination or
check-up?
0 Doesn't get preventive care anywhere
1 Clinic or health center
2 Doctor's office or HMO
3 Hospital emergency room
4 Hospital outpatient department
5 Some other place
6 Doesn't go to one place most often
7 Refused
9 Don't know
UniverseText: Sample Adults 18+ who do not have a usual source of sick care; who Ref/DK if have a usual source of sick care; who
have a usual source of sick care but do not go to one place most often or Ref/DK what kind of place; who have a
usual source of sick care, but it is not same place as usual source of routine/preventive care; who have a usual source
of sick care but Ref/DK if it is same place as usual source of routine/preventive care.
SkipInstructions: <0-6,R,D> if AUSUALPL = 2,R,D goto AHCDLY_1
ELSE goto AHCCHGYR
Question ID: AAU.040_00.000 Instrument Variable Name: AHCCHGYR QuestionnaireFileName: Sample Adult
QuestionText: At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice [or who reported same place as usual
source of routine/preventive care]
SkipInstructions: <1>[goto AHCCHGHI]
<2,R,D>[goto AHCDLY_1]
Question ID: AAU.050_00.000 Instrument Variable Name: AHCCHGHI QuestionnaireFileName: Sample Adult
QuestionText: Was this change for a reason related to health insurance?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ with 1+ usual place(s) to go when sick/need health advice who CHANGED their USUAL place
for health care in past 12 months
SkipInstructions: <1,2,R,D>[goto AHCDLY_1]
Page 3 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.061_01.000 Instrument Variable Name: AHCDLY_1 QuestionnaireFileName: Sample Adult
QuestionText: There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in
the PAST 12 MONTHS? ..... You couldn't get through on the telephone
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCDLY_2]
Question ID: AAU.061_02.000 Instrument Variable Name: AHCDLY_2 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in
the PAST 12 MONTHS?
...You couldn't get an appointment soon enough.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCDLY_3]
Question ID: AAU.061_03.000 Instrument Variable Name: AHCDLY_3 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in
the PAST 12 MONTHS?
...Once you get there, you have to wait too long to see the doctor.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCDLY_4]
Page 4 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.061_04.000 Instrument Variable Name: AHCDLY_4 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in
the PAST 12 MONTHS?
...The (clinic/doctor's) office wasn't open when you could get there.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCDLY_5]
Question ID: AAU.061_05.000 Instrument Variable Name: AHCDLY_5 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary
There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in
the PAST 12 MONTHS?
...You didn't have transportation.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCAFY_1]
Question ID: AAU.111_01.000 Instrument Variable Name: AHCAFY_1 QuestionnaireFileName: Sample Adult
QuestionText: DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because
you couldn't afford it?
...Prescription medicines.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCAFY_2]
Page 5 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.111_02.000 Instrument Variable Name: AHCAFY_2 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because
you couldn't afford it?
...Mental health care or counseling.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCAFY_3]
Question ID: AAU.111_03.000 Instrument Variable Name: AHCAFY_3 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because
you couldn't afford it?
...Dental care (including check ups).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto AHCAFY_4]
Question ID: AAU.111_04.000 Instrument Variable Name: AHCAFY_4 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, was there any time when you needed any of the following, but didn't get it because
you couldn't afford it?
...Eyeglasses.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[goto ADENLONG]
Page 6 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.135_00.000 Instrument Variable Name: ADENLONG QuestionnaireFileName: Sample Adult
QuestionText: (book) A11
About how long has it been since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons,
and all other dental specialists, as well as dental hygienists.
0 Never
1 6 months or less
2 More than 6 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-5,R,D>[ goto AHCSY1_1]
Question ID: AAU.141_01.000 Instrument Variable Name: AHCSY1_1 QuestionnaireFileName: Sample Adult
QuestionText: DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[ goto AHCSY1_2]
Question ID: AAU.141_02.000 Instrument Variable Name: AHCSY1_2 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[ goto AHCSY1_3]
Page 7 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.141_03.000 Instrument Variable Name: AHCSY1_3 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A foot doctor.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[ goto AHCSY1_4]
Question ID: AAU.141_04.000 Instrument Variable Name: AHCSY1_4 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A chiropractor.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[ goto AHCSY1_5]
Question ID: AAU.141_05.000 Instrument Variable Name: AHCSY1_5 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[ goto AHCSY1_6]
Page 8 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.141_06.000 Instrument Variable Name: AHCSY1_6 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A nurse practitioner, physician assistant, or midwife.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D>[if SEX=1goto AHCSY8_8; else if SEX=2 goto AHCSYR7]
Question ID: AAU.200_00.000 Instrument Variable Name: AHCSYR7 QuestionnaireFileName: Sample Adult
QuestionText: * Read lead-in if necessary
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A doctor who specializes in women's health (an obstetrician/gynecologist).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who are female
SkipInstructions: <1,2,R,D> [go to AHCSY8_ 8]
Question ID: AAU.211_01.000 Instrument Variable Name: AHCSY8_ 8 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist,
psychiatrist, or ophthalmologist).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D> [go to AHCSY8_ 9]
Page 9 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.211_02.000 Instrument Variable Name: AHCSY8_ 9 QuestionnaireFileName: Sample Adult
QuestionText: * Read Lead-in if Necessary.
DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following
health care providers about your own health?
...A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1> [goto AHCSYR10]
<2,R,D> [goto AHERNOYR]
Question ID: AAU.230_00.000 Instrument Variable Name: AHCSYR10 QuestionnaireFileName: Sample Adult
QuestionText: Does that doctor treat children and adults (a doctor in general practice or family medicine)?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have seen or talked to a general doctor during the past 12 months
SkipInstructions: <1,2,R,D> [go to AHERNOYR]
Question ID: AAU.240_00.000 Instrument Variable Name: AHERNOYR QuestionnaireFileName: Sample Adult
QuestionText: (book) A12
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about
your own health (This includes emergency room visits that resulted in a hospital admission.)?
00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0 - 8,R,D> [go to AHCHYR]
Page 10 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.250_00.000 Instrument Variable Name: AHCHYR QuestionnaireFileName: Sample Adult
QuestionText: DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1>[goto AHCHMOYR]
<2,R,D>[goto AHCNOYR]
Question ID: AAU.260_00.000 Instrument Variable Name: AHCHMOYR QuestionnaireFileName: Sample Adult
QuestionText: During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?
01-12 01-12 months
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions: <1-12,R,D>[goto AHCHNOYR]
Question ID: AAU.270_00.000 Instrument Variable Name: AHCHNOYR QuestionnaireFileName: Sample Adult
QuestionText: (book) A13
What was the total number of home visits received during {Fill1: that month/Fill2: those months}?
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who received home care from a health professional during the past 12 months
SkipInstructions: <1-8,R,D>[goto AHCNOYR]
Page 11 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.280_00.000 Instrument Variable Name: AHCNOYR QuestionnaireFileName: Sample Adult
QuestionText: (book) A12
DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about
your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER PLACE? DO NOT INCLUDE TIMES YOU
WERE HOSPITALIZED OVERNIGHT, VISITS TO HOSPITAL EMERGENCY ROOMS, HOME VISITS, DENTAL
VISITS, OR TELEPHONE CALLS.
00 None
01 1
02 2-3
03 4-5
04 6-7
05 8-9
06 10-12
07 13-15
08 16 or more
97 Refused
99 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-8,R,D>[goto ASRGYR]
Question ID: AAU.290_00.000 Instrument Variable Name: ASRGYR QuestionnaireFileName: Sample Adult
QuestionText: DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or
outpatient?
* Read if necessary: This includes both major surgery and minor procedures such as setting bones or removing growths.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1>[goto ASRGNOYR]
<2,R,D> [goto AMDLONG]
Question ID: AAU.300_00.000 Instrument Variable Name: ASRGNOYR QuestionnaireFileName: Sample Adult
QuestionText: Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during
the PAST 12 MONTHS?
* Enter "95" for 95 or more times.
01-94 1-94 Times
95 95+ times
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had surgery or surgical procedures during past 12 months
SkipInstructions: <1-95,R,D> [goto AMDLONG]
<11-95> [goto ERR_ASGYR]
Page 12 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.305_00.000 Instrument Variable Name: AMDLONG QuestionnaireFileName: Sample Adult
QuestionText: (book) A11 ? [F1]
About how long has it been since you last saw or talked to a doctor or other health care professional about your own health?
Include doctors seen while a patient in a hospital.
0 Never
1 6 months or less
2 More than 6 mos, but not more than 1 yr ago
3 More than 1 yr, but not more than 2 yrs ago
4 More than 2 yrs, but not more than 5 yrs ago
5 More than 5 years ago
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-5,R,D> [goto SHTFLUYR]
Question ID: AAU.310_00.000 Instrument Variable Name: SHTFLUYR QuestionnaireFileName: Sample Adult
QuestionText: DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against
influenza for the flu season.
* Read if necessary: A flu shot is injected in the arm. Do not include an influenza vaccine sprayed in the nose.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1> [goto ASHFLU_M] <2,R,D> [ goto SPRFLUYR ]
Page 13 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.312_01.000 Instrument Variable Name: ASHFLU_M QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
During what month and year did you receive your most recent flu shot?
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: Sample adults 18+ who have had a flu shot
SkipInstructions: <1-12,D> [ goto ASHFLU_Y] <R> [goto SPRFLUYR]
Question ID: AAU.312_02.000 Instrument Variable Name: ASHFLU_Y QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
*Enter year of most recent flu shot.
2004 2004
2005 2005
2006 2006
9997 Refused
9999 Don't know
UniverseText: Sample adults 18+ who gave a month for their last flu shot or who didn’t know the month
SkipInstructions: <valid year,R,D> [goto SPRFLUYR]
[If ASHFLU_M and ASHFLU_Y = a future date] goto ERR1_ASHFLU_Y
[If ASHFLU_M and ASHFLU_Y = a date prior to birth] goto ERR2_ASHFLU_Y
[If ASHFLU_M and ASHFLU_Y = a date before 12 months ago] goto ERR3_ASHFLU_Y
Page 14 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.315_00.000 Instrument Variable Name: SPRFLUYR QuestionnaireFileName: Sample Adult
QuestionText: DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health
professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects against
influenza for the flu season.
* Read if necessary: This influenza vaccine is called FluMist (trademark).
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1> [goto ASPFLU_M]
[if SHTFLUYR =1 and SPRFLUYR=1] goto ERR1_SPRFLUYR
[if AGE GE 50] goto ERR2_SPRFLUYR
<2,D,R> [goto SHTPNUYR]
Question ID: AAU.318_01.000 Instrument Variable Name: ASPFLU_M QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
During what month and year did you receive your most recent flu nasal spray?
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: Sample adults 18+ who have had a flu nasal vaccine
SkipInstructions: <1-12,D> [ goto ASPFLU_Y] <R> [goto SHTPNUYR]
Page 15 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.318_02.000 Instrument Variable Name: ASPFLU_Y QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
*Enter year of most recent flu nasal spray.
2004 2004
2005 2005
2006 2006
9997 Refused
9999 Don't know
UniverseText: Sample adults 18+ who gave a month for their flu nasal vaccine or who didn’t know the month
SkipInstructions: <valid year, R,D> [goto SHTPNUYR]
[If ASPFLU_M and ASPFLU_Y = a future date] goto ERR1_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date prior to birth] goto ERR2_ASPFLU_Y
[If ASPFLU_M and ASPFLU_Y = a date before 12 months ago] goto ERR3_ASPFLU_Y
Question ID: AAU.320_00.000 Instrument Variable Name: SHTPNUYR QuestionnaireFileName: Sample Adult
QuestionText: Have you EVER had a pneumonia shot?
This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the
pneumococcal vaccine.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,D,R> [goto APOX]
Question ID: AAU.330_00.000 Instrument Variable Name: APOX QuestionnaireFileName: Sample Adult
QuestionText: Have you EVER had chickenpox?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1> [goto APOX12MO]
<2,R,D> [goto AHEP]
Page 16 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.340_00.000 Instrument Variable Name: APOX12MO QuestionnaireFileName: Sample Adult
QuestionText: Have you had chickenpox in the PAST 12 MONTHS?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have ever had chickenpox
SkipInstructions: <1,2,R,D> [goto AHEP]
Question ID: AAU.350_00.000 Instrument Variable Name: AHEP QuestionnaireFileName: Sample Adult
QuestionText: Have you EVER had hepatitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1> [goto SHTHEPB]
<2,R,D> [goto AHEPLIV]
Question ID: AAU.360_00.000 Instrument Variable Name: AHEPLIV QuestionnaireFileName: Sample Adult
QuestionText: Have you ever lived with someone who had hepatitis?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have never had hepatitis; Ref/DK if ever had hepatitis
SkipInstructions: <1,2,R,D> [goto SHTHEPB]
Question ID: AAU.370_00.000 Instrument Variable Name: SHTHEPB QuestionnaireFileName: Sample Adult
QuestionText: Have you EVER received the hepatitis B vaccine?
* Read if necessary: This is given in three separate doses and has been available since 1991. It is recommended for newborn
infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1> [goto SHEPDOS]
<2,R,D> [goto next section]
Page 17 of 17
2007 NHIS Questionnaire - Sample Adult
Adult Access to Health Care & Utilization
Document Version Date: 12-Jul-06
Question ID: AAU.380_00.000 Instrument Variable Name: SHEPDOS QuestionnaireFileName: Sample Adult
QuestionText: Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?
1 Received at least 3 doses
2 Received less than 3 doses
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who have ever received the Hepatitis B vaccine
SkipInstructions: <1,2,R,D> [goto next section]
| File Type | application/msword |
| Author | Howard Riddick |
| Last Modified By | Howard Riddick |
| File Modified | 2006-09-29 |
| File Created | 2006-09-29 |