Adult Topical Modules - 2009 New Questions

Attachment 1 Adult Topical Modules--2009 New Questions

These questions will be embedded in the appropriate module in the full NHIS instrument.

Carbon Monoxide Detector

Question ID FIJ.181_00.010

Variable Name CARBON

Universe ALL

Universe-text ALL

Question Text A carbon monoxide or CO detector checks the level of carbon monoxide in your home. It is

different than a smoke detector. Do you have a carbon monoxide detector in your home?

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D> [goto FDMED12M]

STROKE

Question ID ACN.031_05.010

Variable Name FACE

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Which of the following would you say are the symptoms that someone may be having a

stroke? I am going to read a list. Please say yes or no to each one.

Sudden numbness or weakness of face, arm, or leg, especially on one side.

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D > [goto SPEAKING]

________________________________________________________________________________

Question ID ACN.031_05.020

Variable Name SPEAKING

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Which of the following would you say are the symptoms that someone may be having a

stroke? I am going to read a list. Please say yes or no to each one.

Sudden confusion or trouble speaking.

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D > [goto EYE]

Question ID ACN.031_05.030

Variable Name EYE

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Which of the following would you say are the symptoms that someone may be having a

stroke? I am going to read a list. Please say yes or no to each one.

Sudden trouble seeing in one or both eyes.

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D > [goto WALKING]

________________________________________________________________________________

Question ID ACN.031_05.040

Variable Name WALKING

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Which of the following would you say are the symptoms that someone may be having a

stroke? I am going to read a list. Please say yes or no to each one.

Sudden trouble walking, dizziness, or loss of balance.

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D > [goto HEADACHE]

Question ID ACN.031_05.050

Variable Name HEADACHE

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Which of the following would you say are the symptoms that someone may be having a

stroke? I am going to read a list. Please say yes or no to each one.

Sudden severe headache with no known cause.

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D > [goto ASTDO]

________________________________________________________________________________

Question ID ACN.031_05.060

Variable Name ASTDO

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text If you thought someone was having a stroke, what is the BEST thing to do right away?

Please give me a number from the card (show Card A4).

Answer Codes 1. Advise them to drive to the hospital

2. Advise them to call their physician

3. Call 9-1-1 (or another emergency number)

4. Call spouse or family member

5. Other

Refused

Don't know

Skip Instructions <1-5, 7, 9> [goto EPHEV] */ SHOULD CHANGE TO: <1-5,R,D>

CARD A4

1. Advise them to drive to the hospital

2. Advise them to call their physician

3. Call 9-1-1 (or another emergency number)

4. Call spouse or family member

5. Other

ARTHRITIS

Question ID ACN.265_00.010

Variable Name JNTPN

Universe HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and JNTSYMP(e)='1'

Universe-text Sample adults GE 18 years who have had any symptoms of pain, aching, or stiffness in or

around a joint during the past 30 days

Question Text Please think about the past 30 days, keeping in mind all of your joint pain or aching and

whether or not you have taken medication. DURING THE PAST 30 DAYS, how bad was

your joint pain ON AVERAGE? Please answer on a scale of 0 to 10 where 0 is no pain or

aching and 10 is pain or aching as bad as it can be.

Skip Instructions <0-10,R,D> [goto JNTCHR]

________________________________________________________________________________

Question ID ACN.290_00.010

Variable Name ARTHWT

Universe HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (JNTSYMP(e)='1' or

ARTH1(e)='1')

Universe-text Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis,

gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a

joint

Question Text Has a doctor or other health professional EVER suggested losing weight to help your

arthritis or joint symptoms?

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D> [goto ARTHPH]

________________________________________________________________________________

Question ID ACN.290_00.020

Variable Name ARTHPH

Universe HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (JNTSYMP(e)='1' or

ARTH1(e)='1')

Universe-text Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis,

gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a

joint

Question Text Has a doctor or other health professional EVER suggested physical activity or exercise to

help your arthritis or joint symptoms?

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D> [goto ARTHCLS]

Question ID ACN.290_00.030

Variable Name ARTHCLS

Universe HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (JNTSYMP(e)='1' or

ARTH1(e)='1')

Universe-text Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis,

gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a

joint

Question Text Have you EVER taken an educational course or class to teach you how to manage

problems related to your arthritis or joint symptoms?

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D> [goto ARTHLMT]

________________________________________________________________________________

Question ID ACN.295_00.010

Variable Name ARTHWRK

Universe HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (JNTSYMP(e)='1' or

ARTH1(e)='1')

Universe-text Sample adults GE 18 years who have ever been told they had arthritis, rheumatoid arthritis,

gout, lupus, or fibromyalgia, or any symptoms of pain, aching, or stiffness in or around a

joint

Question Text In this next question we are referring to work for pay.

Do arthritis or joint symptoms now affect whether you work, the type of work you do, or

the amount of work you do?

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D> [goto PAINECK]

HEALTH INFORMATION TECHNOLOGY

Question ID AAU.305_00.010

Variable Name HIT1

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Have you ever used computers for any of the following?

Looked up health information on the Internet

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1> [goto HIT2]

<2,R,D> [goto HIT3]

________________________________________________________________________________

Question ID AAU.305_00.020

Variable Name HIT2

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999') and HIT2 = '1')

Universe-text Sample Adults 18+ who have ever looked up health information on the Internet

Question Text Did you look up health information on the Internet in the past 12 months?

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D> [goto HIT3]

________________________________________________________________________________

Question ID AAU.305_00.030

Variable Name HIT3

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Used online chat groups to learn about health topics

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1> [goto HIT4]

<2,R,D> [goto HIT5]

Question ID AAU.305_00.040

Variable Name HIT4

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999') and HIT3 = '1')

Universe-text Sample Adults 18+ who have ever used online chat groups to learn about health topics

Question Text Did you use online chat groups to learn about health topics in the past 12 months?

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D> [goto HIT5]

________________________________________________________________________________

Question ID AAU.305_00.050

Variable Name HIT5

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Refilled a prescription on the internet

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1> [goto HIT6]

<2,R,D> [goto HIT7]

________________________________________________________________________________

Question ID AAU.305_00.060

Variable Name HIT6

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999') and HIT5 = '1')

Universe-text Sample Adults 18+ who ever refilled a prescription on the internet

Question Text Did you refill a prescription on the Internet in the past 12 months?

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D> [goto HIT7]

Question ID AAU.305_00.070

Variable Name HIT7

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Scheduled an appointment with a health care provider using the Internet

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1> [goto HIT8]

<2,R,D> [goto HIT9]

________________________________________________________________________________

Question ID AAU.305_00.080

Variable Name HIT8

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999') and HIT7 = '1')

Universe-text Sample Adults 18+ who ever scheduled an appointment with a health care provider using

the Internet

Question Text Did you schedule an appointment with a health care provider using the Internet in the past

12 months?

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D> [goto HIT9]

________________________________________________________________________________

Question ID AAU.305_00.090

Variable Name HIT9

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))

Universe-text Sample Adults 18+

Question Text Communicated with a health care provider over e-mail

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1> [goto HIT10]

<2,R,D> [goto SHTFLUYR]

Question ID AAU.305_00.100

Variable Name HIT10

Universe HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999') and HIT9 = '1')

Universe-text Sample Adults 18+ who ever communicated with a health care provider over e-mail

Question Text Did you communicate with a health care provider over e-mail in the past 12 months?

Answer Codes 1. Yes

2. No

Refused

Don't know

Question Type Yes/No

Skip Instructions <1,2,R,D> [goto SHTFLUYR]

IMMUNIZATION

Question ID AAU.465.010

Variable Name WRKHLTH

Universe HHSTAT4 = 'S' and AGE GE 18

Universe-text Sample adults 18+

Question Text Do you currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s office, nursing home or some other health-care facility? This includes part-time and unpaid work in a health care facility as well as professional nursing care provided in the home.

*Read if necessary: This includes non-health care professionals, such as administrative staff, who work in a health-care facility.

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1> [goto WRKDIR] <2,R,D> goto next section

Question ID AAU.470.010

Variable Name WRKDIR

Universe HHSTAT4 = 'S' and AGE GE 18 and WRKHLTH=1

Universe-text Sample adults 18+ who work or volunteer in a health-care setting

Question Text Do you provide direct patient care as part of your routine work? By direct patient care we mean physical or hands on contact with patients.

Answer Codes 1. Yes

2. No

Refused

Don't know

Skip Instructions <1,2,R,D> goto next section