Page 1 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.030_00.000 Instrument Variable Name: WRKLYR2 QuestionnaireFileName: Sample Adult
QuestionText: Although you did not work last week, did you have a job or business at any time in the PAST 12 MONTHS?
0 Had job last week
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who were looking for work or who were not working at a job or business AND who were not
looking for work in the last week
SkipInstructions: <1> [goto WKDAYR]
<2,R,D> [goto BEDDAYR]
Question ID: AHS.040_00.000 Instrument Variable Name: WKDAYR QuestionnaireFileName: Sample Adult
QuestionText: During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did you miss work at a job
or business because of illness or injury (do not include maternity leave)?
* Enter '0' for None.
000 None
001-366 1-366 days
997 Refused
999 Don't know
UniverseText: Sample adults 18+ who worked or had a job or business with or without pay in the last week or who had a job or
business in the past 12 months
SkipInstructions: <0-366,R,D> [goto BEDDAYR]
<120-366> [goto ERR_WKDAYR]
Question ID: AHS.050_00.000 Instrument Variable Name: BEDDAYR QuestionnaireFileName: Sample Adult
QuestionText: During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did illness or injury keep
you in bed more than half of the day (include days while an overnight patient in a hospital)?
* Enter '0' for None.
000 None
001-366 1-366 days
997 Refused
999 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-366,R,D> [goto AHSTATYR]
<120-366> [goto ERR_BEDDAYR]
Page 2 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.060_00.000 Instrument Variable Name: AHSTATYR QuestionnaireFileName: Sample Adult
QuestionText: Compared with 12 MONTHS AGO, would you say your health is better, worse, or about the same?
1 Better
2 Worse
3 About the same
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1-3,R,D> [goto SPECEQ]
Question ID: AHS.070_00.000 Instrument Variable Name: SPECEQ QuestionnaireFileName: Sample Adult
QuestionText: Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed,
or a special telephone?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1,2,R,D> [goto FLWALK]
Question ID: AHS.091_01.000 Instrument Variable Name: FLWALK QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
By yourself, and without using any special equipment, how difficult is it for you to...
...Walk a quarter of a mile - about 3 city blocks?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLCLIMB]
Page 3 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.091_02.000 Instrument Variable Name: FLCLIMB QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Walk up 10 steps without resting?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLSTAND]
Question ID: AHS.091_03.000 Instrument Variable Name: FLSTAND QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Stand or be on your feet for about 2 hours?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLSIT]
Page 4 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.091_04.000 Instrument Variable Name: FLSIT QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Sit for about 2 hours?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLSTOOP]
Question ID: AHS.091_05.000 Instrument Variable Name: FLSTOOP QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Stoop, bend, or kneel?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLREACH]
Page 5 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.091_06.000 Instrument Variable Name: FLREACH QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Reach up over your head?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLGRASP]
Question ID: AHS.141_01.000 Instrument Variable Name: FLGRASP QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Use your fingers to grasp or handle small objects?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLCARRY]
Page 6 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.141_02.000 Instrument Variable Name: FLCARRY QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLPUSH]
Question ID: AHS.141_03.000 Instrument Variable Name: FLPUSH QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Push or pull large objects like a living room chair?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLSHOP]
Page 7 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.171_01.000 Instrument Variable Name: FLSHOP QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Go out to things like shopping, movies, or sporting events?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLSOCL]
Question ID: AHS.171_02.000 Instrument Variable Name: FLSOCL QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <0-4,6,R,D> [goto FLRELAX]
Page 8 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.171_03.000 Instrument Variable Name: FLRELAX QuestionnaireFileName: Sample Adult
QuestionText: (book) A9
* Read lead-in if necessary.
By yourself, and without using any special equipment, how difficult is it for you to...
...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?
0 Not at all difficult
1 Only a little difficult
2 Somewhat difficult
3 Very difficult
4 Can't do at all
6 Do not do this activity
7 Refused
9 Don't know
UniverseText: Sample adults 18+
SkipInstructions: <1-4 or FLWALK= 1-4 or FLCLIMB= 1-4 or FLSTAND= 1-4 or FLSIT= 1-4 or FLSTOOP= 1-4 or
FLREACH= 1-4 or FLGRASP= 1-4 or FLCARRY= 1-4 or FLPUSH= 1-4 or FLSHOP= 1-4 or FLSOCL= 1-
4>[goto AFLHCA]
Page 9 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.200_00.000 Instrument Variable Name: AFLHCA QuestionnaireFileName: Sample Adult
QuestionText: (book) A10
What condition or health problem causes you to have difficulty with [fill1: condition 1, condition 2 or condition 3 (as
specified in AHS.091_1 through AHS.171_3)][fill2: these activities]?
* Enter condition number for all that apply, separate with commas.
* Do not probe, except to clarify answer.
01 Vision/problem seeing
02 Hearing problem
03 Arthritis/rheumatism
04 Back or neck problem
05 Fracture, bone/joint injury
06 Other injury
07 Heart problem
08 Stroke problem
09 Hypertension/high blood pressure
10 Diabetes
11 Lung/breathing problem(e.g., asthma and emphysema)
12 Cancer
13 Birth defect
14 Mental retardation
15 Other developmental problem (e.g., cerebral palsy)
16 Senility
17 Depression/anxiety/emotional problem
18 Weight problem
19 Missing limbs (fingers, toes or digits), amputee
20 Kidney, bladder or renal problems
21 Circulation problems (including blood clots)
22 Benign Tumors, Cysts
23 Fibromyalgia, lupus
24 Osteoporosis, tendinitis
25 Epilepsy, seizures
26 Multiple Sclerosis (MS), Muscular Dystrophy (MD)
27 Polio(myelitis), paralysis, para/quadriplegia
28 Parkinson's disease, other tremors
29 Other nerve damage, including carpal tunnel syndrome
30 Hernia
31 Ulcer
32 Varicose veins, hemorrhoids
33 Thyroid problems, Grave's disease, gout
34 Knee problems (not arthritis (03), not joint injury(05))
35 Migraine headaches (not just headaches)
90 Other impairment/problem (Specify one)
91 Other impairment/problem (Specify one)
97 Refused
99 Don't know/Not sure
Page 10 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
UniverseText: Sample adults 18+ who, without using special equipment, have at least a little difficulty walking a quarter mile;
walking up 10 steps without resting; standing/being on feet for about 2 hours; sitting for about 2 hours;
stooping/bending/kneeling; reaching up over head; using fingers to grasp/handle small objects; lifting/carrying 10
pounds; pushing/pulling large objects;going out for things (shopping/movies); participating in social activities; or
relaxing at home (reading/sewing).
SkipInstructions: [1- 12, 14 - 35] goto the appropriate follow up question AHCL01N-AHCL12N, AHCL14N-AHCL35N], in
numerical order
<13> store "96" in AHCL13N and "6" IN AHCL13T[goto SMKEV ]
<90> [goto AFLHCA_S1]
<91> [goto AFLHCA_S2]
Roster through all AFLHCA entries. Once exhausted goto SMKEV (next section)
< R,D> [goto SMKEV (next section)]
Question ID: AHS.201_90.000 Instrument Variable Name: AFLHCA_S1 QuestionnaireFileName: Sample Adult
QuestionText: * Enter other impairment/problem.
7 Refused
9 Don't know
Verbatim Verbatim Response
UniverseText: Sample adults 18+ whose difficulties performing activities listed in FLWALK through FLRELAX is due to at least
one condition not listed in AFLHCA
SkipInstructions: <50 chars>[goto AHCL90N]
>ENTER< only with no description [goto ERR1_AFLHCA_S1]
Else goto the appropriate follow-up questions AHCL01N-AHCL12N, AHCL14N-AHCL35N], in numerical order, as
specified in AFLHCA
Question ID: AHS.201_91.000 Instrument Variable Name: AFLHCA_S2 QuestionnaireFileName: Sample Adult
QuestionText: * Enter other impairment/problem.
7 Refused
9 Don't know
Verbatim Verbatim Response
UniverseText: Sample adults 18+ whose difficulty performing activities listed in FLWALK through FLRELAX is due to more than
one condition that is not listed in AFLHCA
SkipInstructions: <50 chars>[goto AHCL91N]
>ENTER< only with no description [goto ERR1_AFLHCA_S1]
Page 11 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.300_01.000 Instrument Variable Name: AHCL01N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a vision problem or problem seeing?
* Enter number for time with your vision problem or problem seeing..
* Enter '95' for 95 or more.
* Enter '96' if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a vision problem or problem seeing
SkipInstructions: <1-95,D>[goto AHCL01T]
<R>[store "R" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL01T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.300_02.000 Instrument Variable Name: AHCL01T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with vision problem or problem seeing.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL01T
[if [AHCL01N = Number greater than person years old and AHCL01T= 4]] goto
ERR1_AHCL01T
Page 12 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.301_01.000 Instrument Variable Name: AHCL02N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a hearing problem?
* Enter number for time with a hearing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a hearing problem
SkipInstructions: <1-95,D>[goto AHCL02T]
<R>[store "R" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL02T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.301_02.000 Instrument Variable Name: AHCL02T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with hearing problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL02T
[if [AHCL02N = Number greater than person years old and AHCL02T= 4]] goto
ERR1_AHCL02T
Page 13 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.302_01.000 Instrument Variable Name: AHCL03N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had arthritis or rheumatism?
* Enter number for time with arthritis or rheumatism.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to arthritis or rheumatism
SkipInstructions: <1-95,D>[goto AHCL03T]
<R>[store "R" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL03T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.302_02.000 Instrument Variable Name: AHCL03T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with arthritis or rheumatism.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL03T
[if [AHCL03N = Number greater than person years old and AHCL03T= 4]] goto
ERR1_AHCL03T
Page 14 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.303_01.000 Instrument Variable Name: AHCL04N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a back or neck problem?
* Enter number for time with back or neck problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a back or neck problem
SkipInstructions: <1-95,D>[goto AHCL04T]
<R>[store "R" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL04T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.303_02.000 Instrument Variable Name: AHCL04T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with back or neck problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't Know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL04T
[if [AHCL04N = Number greater than person years old and AHCL04T= 4]] goto
ERR1_AHCL04T
Page 15 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.304_01.000 Instrument Variable Name: AHCL05N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a fracture, bone, or joint injury?
* Enter number for time with a fracture, bone, or joint injury.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a fracture, bone, or joint injury
SkipInstructions: <1-95,D>[goto AHCL05T]
<R>[store "R" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL05T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.304_02.000 Instrument Variable Name: AHCL05T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with fracture, bone, or joint injury.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL05T
[if [AHCL05N = Number greater than person years old and AHCL05T= 4]] goto
ERR1_AHCL05T
Page 16 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.305_01.000 Instrument Variable Name: AHCL06N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had the (fill: other) injury that caused your limitation?
* Enter number for time with injury that caused your limitation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to an injury other than a fracture, bone, or joint injury
SkipInstructions: <1-95,D>[goto AHCL06T]
<R>[store "R" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL06T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.305_02.000 Instrument Variable Name: AHCL06T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with (fill: other) injury.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL06T
[if [AHCL06N = Number greater than person years old and AHCL06T= 4]] goto
ERR1_AHCL06T
Page 17 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.306_01.000 Instrument Variable Name: AHCL07N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a heart problem?
* Enter number for time with a heart problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a heart problem
SkipInstructions: <1-95,D>[goto AHCL07T]
<R>[store "R" in AHCL07T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL07T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.306_02.000 Instrument Variable Name: AHCL07T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with heart problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL07T
[if [AHCL07N = Number greater than person years old and AHCL07T= 4]] goto
ERR1_AHCL07T
Page 18 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.307_01.000 Instrument Variable Name: AHCL08N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a stroke problem?
* Enter number for time with a stroke problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a stroke problem
SkipInstructions: <1-95,D>[goto AHCL08T]
<R>[store "R" in AHCL08T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL08T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.307_02.000 Instrument Variable Name: AHCL08T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with stroke problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL08T
[if [AHCL08N = Number greater than person years old and AHCL08T= 4]] goto
ERR1_AHCL08T
Page 19 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.308_01.000 Instrument Variable Name: AHCL09N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had hypertension or high blood pressure?
* Enter number for time with hypertension or high blood pressure.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to hypertension or high blood pressure
SkipInstructions: <1-95,D>[goto AHCL09T]
<R>[store "R" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL09T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.308_02.000 Instrument Variable Name: AHCL09T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with hypertension or high blood pressure.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL09T
[if [AHCL09N = Number greater than person years old and AHCL09T= 4]] goto
ERR1_AHCL09T
Page 20 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.309_01.000 Instrument Variable Name: AHCL10N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had diabetes?
* Enter number for time with diabetes.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to diabetes
SkipInstructions: <1-95,D>[goto AHCL10T]
<R>[store "R" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL10T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.309_02.000 Instrument Variable Name: AHCL10T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with diabetes.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL10T
[if [AHCL10N = Number greater than person years old and AHCL10T= 4]] goto
ERR1_AHCL10T
Page 21 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.310_01.000 Instrument Variable Name: AHCL11N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a lung or breathing problem (e.g. asthma and emphysema)?
* Enter number for time with a lung or breathing problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a lung or breathing problem
SkipInstructions: <1-95,D>[goto AHCL11T]
<R>[store "R" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL11T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.310_02.000 Instrument Variable Name: AHCL11T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with lung or breathing problem (e.g. asthma and emphysema).
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL11T
[if [AHCL11N = Number greater than person years old and AHCL11T= 4]] goto
ERR1_AHCL11T
Page 22 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.311_01.000 Instrument Variable Name: AHCL12N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had cancer?
* Enter number for time with cancer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to cancer
SkipInstructions: <1-95,D>[goto AHCL12T]
<R>[store "R" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL12T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.311_02.000 Instrument Variable Name: AHCL12T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with cancer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL12T
[if [AHCL12N = Number greater than person years old and AHCL12T= 4]] goto
ERR1_AHCL12T
Page 23 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.313_01.000 Instrument Variable Name: AHCL14N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had mental retardation?
* Enter number for time with mental retardation.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to mental retardation
SkipInstructions: <1-95,D>[goto AHCL14T]
<R>[store "R" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL14T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.313_02.000 Instrument Variable Name: AHCL14T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with mental retardation.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL14T
[if [AHCL14N = Number greater than person years old and AHCL14T= 4]] goto
ERR1_AHCL14T
Page 24 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.314_01.000 Instrument Variable Name: AHCL15N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a developmental problem (e.g., cerebral palsy)?
* Enter number for time with a developmental problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a developmental problem
SkipInstructions: <1-95,D>[goto AHCL15T]
<R>[store "R" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL15T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.314_02.000 Instrument Variable Name: AHCL15T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with developmental problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL15T
[if [AHCL15N = Number greater than person years old and AHCL15T= 4]] goto
ERR1_AHCL15T
Page 25 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.315_01.000 Instrument Variable Name: AHCL16N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had senility?
* Enter number for time with senility.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to senility
SkipInstructions: <1-95,D>[goto AHCL16T]
<R>[store "R" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL16T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.315_02.000 Instrument Variable Name: AHCL16T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with senility.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL16T
[if [AHCL16N = Number greater than person years old and AHCL16T= 4]] goto
ERR1_AHCL16T
Page 26 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.316_01.000 Instrument Variable Name: AHCL17N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had depression, anxiety, or an emotional problem?
* Enter number for time with depression, anxiety, or an emotional problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to depression, anxiety, or an emotional problem
SkipInstructions: <1-95,D>[goto AHCL17T]
<R>[store "R" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL17T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.316_02.000 Instrument Variable Name: AHCL17T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with depression, anxiety, or emotional problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL17T
[if [AHCL17N = Number greater than person years old and AHCL17T= 4]] goto
ERR1_AHCL17T
Page 27 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.317_01.000 Instrument Variable Name: AHCL18N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a weight problem?
* Enter number for time with a weight problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a weight problem
SkipInstructions: <1-95,D>[goto AHCL18T]
<R>[store "R" in AHCL18T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL18T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.317_02.000 Instrument Variable Name: AHCL18T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with weight problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL18T
[if [AHCL18N = Number greater than person years old and AHCL18T= 4]] goto
ERR1_AHCL18T
Page 28 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.318_01.000 Instrument Variable Name: AHCL19N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a missing limb (finger, toe, or digit)?
* Enter number for time with a missing limb.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a missing limb
SkipInstructions: <1-95,D>[goto AHCL19T]
<R>[store "R" in AHCL19T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL19T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.318_02.000 Instrument Variable Name: AHCL19T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with missing limb.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL19T
[if [AHCL19N = Number greater than person years old and AHCL19T= 4]] goto
ERR1_AHCL19T
Page 29 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.319_01.000 Instrument Variable Name: AHCL20N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a kidney, bladder or renal problem?
* Enter number for time with a kidney, bladder or renal problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a kidney, bladder or renal problem
SkipInstructions: <1-95,D>[goto AHCL20T]
<R>[store "R" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL20T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.319_02.000 Instrument Variable Name: AHCL20T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with kidney, bladder or renal problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL20T
[if [AHCL20N = Number greater than person years old and AHCL20T= 4]] goto
ERR1_AHCL20T
Page 30 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.320_01.000 Instrument Variable Name: AHCL21N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a circulation problem (including blood clots)?
* Enter number for time with a circulation problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a circulation problem
SkipInstructions: <1-95,D>[goto AHCL21T]
<R>[store "R" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL21T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.320_02.000 Instrument Variable Name: AHCL21T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with circulation problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL21T
[if [AHCL21N = Number greater than person years old and AHCL21T= 4]] goto
ERR1_AHCL21T
Page 31 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.321_01.000 Instrument Variable Name: AHCL22N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had benign tumors or cysts?
* Enter number for time with benign tumors or cysts.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to benign tumors or cysts
SkipInstructions: <1-95,D>[goto AHCL22T]
<R>[store "R" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL22T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.321_02.000 Instrument Variable Name: AHCL22T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with benign tumors or cysts.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL22T
[if [AHCL22N = Number greater than person years old and AHCL22T= 4]] goto
ERR1_AHCL22T
Page 32 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.322_01.000 Instrument Variable Name: AHCL23N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had fibromyalgia or lupus?
* Enter number for time with fibromyalgia or lupus.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to fibromyalgia or lupus
SkipInstructions: <1-95,D>[goto AHCL23T]
<R>[store "R" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL23T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.322_02.000 Instrument Variable Name: AHCL23T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with fibromyalgia or lupus.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL23T
[if [AHCL23N = Number greater than person years old and AHCL23T= 4]] goto
ERR1_AHCL23T
Page 33 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.323_01.000 Instrument Variable Name: AHCL24N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had osteoporosis or tendinitis?
* Enter number for time with osteoporosis or tendinitis.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to osteoporosis or tendinitis
SkipInstructions: <1-95,D>[goto AHCL24T]
<R>[store "R" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL24T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.323_02.000 Instrument Variable Name: AHCL24T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with osteoporosis or tendinitis.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL24T
[if [AHCL24N = Number greater than person years old and AHCL24T= 4]] goto
ERR1_AHCL24T
Page 34 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.324_01.000 Instrument Variable Name: AHCL25N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had epilepsy or seizures?
* Enter number for time with epilepsy or seizures.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to epilepsy or seizures
SkipInstructions: <1-95,D>[goto AHCL25T]
<R>[store "R" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL25T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.324_02.000 Instrument Variable Name: AHCL25T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with epilepsy or seizures.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL25T
[if [AHCL25N = Number greater than person years old and AHCL25T= 4]] goto
ERR1_AHCL25T
Page 35 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.325_01.000 Instrument Variable Name: AHCL26N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had multiple sclerosis (MS) or muscular dystrophy (MD)?
* Enter number for time with multiple sclerosis (MS) or muscular dystrophy (MD).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to multiple sclerosis or muscular dystrophy
SkipInstructions: <1-95,D>[goto AHCL26T]
<R>[store "R" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL26T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.325_02.000 Instrument Variable Name: AHCL26T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with multiple sclerosis or muscular dystrophy.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL26T
[if [AHCL26N = Number greater than person years old and AHCL26T= 4]] goto
ERR1_AHCL26T
Page 36 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.326_01.000 Instrument Variable Name: AHCL27N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had polio(myelitis), paralysis or para/quadriplegia?
* Enter number for time with polio (myelitis), paralysis or para/quadriplegia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to polio(myelitis), paralysis or para/quadriplegia
SkipInstructions: <1-95,D>[goto AHCL27T]
<R>[store "R" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL27T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.326_02.000 Instrument Variable Name: AHCL27T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with polio(myelitis), paralysis or para/quadriplegia.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL27T
[if [AHCL27N = Number greater than person years old and AHCL27T= 4]] goto
ERR1_AHCL27T
Page 37 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.327_01.000 Instrument Variable Name: AHCL28N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had Parkinson's disease or tremors?
* Enter number for time with Parkinson's disease or tremors.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to Parkinson's disease or tremors
SkipInstructions: <1-95,D>[goto AHCL28T]
<R>[store "R" in AHCL28T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL28T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.327_02.000 Instrument Variable Name: AHCL28T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with Parkinson's disease or tremors.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL28T
[if [AHCL28N = Number greater than person years old and AHCL28T= 4]] goto
ERR1_AHCL28T
Page 38 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.328_01.000 Instrument Variable Name: AHCL29N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had nerve damage (including carpal tunnel syndrome)?
* Enter number for time with nerver damage (including carpal tunnel syndrome).
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to nerve damage
SkipInstructions: <1-95,D>[goto AHCL29T]
<R>[store "R" in AHCL29T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL29T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.328_02.000 Instrument Variable Name: AHCL29T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with nerve damage.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL29T
[if [AHCL29N = Number greater than person years old and AHCL29T= 4]] goto
ERR1_AHCL29T
Page 39 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.329_01.000 Instrument Variable Name: AHCL30N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a hernia?
* Enter number for time with a hernia.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a hernia
SkipInstructions: <1-95,D>[goto AHCL30T]
<R>[store "R" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL30T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.329_02.000 Instrument Variable Name: AHCL30T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with hernia.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL30T
[if [AHCL30N = Number greater than person years old and AHCL30T= 4]] goto
ERR1_AHCL30T
Page 40 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.330_01.000 Instrument Variable Name: AHCL31N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had an ulcer?
* Enter number for time with an ulcer.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to an ulcer
SkipInstructions: <1-95,D>[goto AHCL31T]
<R>[store "R" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL31T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.330_02.000 Instrument Variable Name: AHCL31T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with ulcer.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL31T
[if [AHCL31N = Number greater than person years old and AHCL31T= 4]] goto
ERR1_AHCL31T
Page 41 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.331_01.000 Instrument Variable Name: AHCL32N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had varicose veins or hemorrhoids?
* Enter number for time with varicose veins or hemorrhoids.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to varicose veins or hemorrhoids
SkipInstructions: <1-95,D>[goto AHCL32T]
<R>[store "R" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL32T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.331_02.000 Instrument Variable Name: AHCL32T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with varicose veins or hemorrhoids.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL32T
[if [AHCL32N = Number greater than person years old and AHCL32T= 4]] goto
ERR1_AHCL32T
Page 42 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.332_01.000 Instrument Variable Name: AHCL33N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a thyroid problem, Grave's disease or gout?
* Enter number for time with a thyroid problem, Grave's disease or gout.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a thyroid problem, Grave's disease or gout
SkipInstructions: <1-95,D>[goto AHCL33T]
<R>[store "R" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL33T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.332_02.000 Instrument Variable Name: AHCL33T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with thyroid problem, Grave's disease or gout.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL33T
[if [AHCL33N = Number greater than person years old and AHCL33T= 4]] goto
ERR1_AHCL33T
Page 43 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.333_01.000 Instrument Variable Name: AHCL34N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had a knee problem?
* Enter number for time with a knee problem.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to a knee problem
SkipInstructions: <1-95,D>[goto AHCL34T]
<R>[store "R" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL34T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.333_02.000 Instrument Variable Name: AHCL34T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with knee problem.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL34T
[if [AHCL34N = Number greater than person years old and AHCL34T= 4]] goto
ERR1_AHCL34T
Page 44 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.334_01.000 Instrument Variable Name: AHCL35N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had migraine headaches?
* Enter number for time with migraine headaches.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to migraine headaches
SkipInstructions: <1-95,D>[goto AHCL35T]
<R>[store "R" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL35T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.334_02.000 Instrument Variable Name: AHCL35T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with migraine headaches.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL35T
[if [AHCL35N = Number greater than person years old and AHCL35T= 4]] goto
ERR1_AHCL35T
Page 45 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.335_01.000 Instrument Variable Name: AHCL90N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had {problem in AFLHCA90}?
* Enter number for time with {problem in AFLHCA90}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 01-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA90}
SkipInstructions: <1-95,D>[goto AHCL90T]
<R>[store "R" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
<96>[store "6" in AHCL90T] [goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this
is the last condition selected, goto SMKEV (next section)]
Question ID: AHS.335_02.000 Instrument Variable Name: AHCL90T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with {problem in AFLHCA90}.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[[if 91 selected in AFLHCA goto AFLHCA_S2]
Else goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last condition
selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL90T
[if [AHCL90N = Number greater than person years old and AHCL90T= 4]] goto
ERR1_AHCL90T
Page 46 of 46
2007 NHIS Questionnaire - Sample Adult
Adult Health Status & Limitations
Document Version Date: 12-Jul-06
Question ID: AHS.336_01.000 Instrument Variable Name: AHCL91N QuestionnaireFileName: Sample Adult
QuestionText: 1 of 2
How long have you had {problem in AFLHCA91}?
* Enter number for time with {problem in AFLHCA91}.
* Enter '95'' for 95 or more.
* Enter "96" if since birth.
01-94 1-94
95 95+
96 Since birth
97 Refused
99 Don't know
UniverseText: Sample adults 18+ who had difficulty due to {problem in AFLHCA91}
SkipInstructions: <1-95,D>[goto AHCL91T]
<R>[store "R" in AHCL91T] [goto SMKEV (next section)]
<96>[store "6" in AHCL91T] [goto SMKEV (next section)]
Question ID: AHS.336_02.000 Instrument Variable Name: AHCL91T QuestionnaireFileName: Sample Adult
QuestionText: 2 of 2
* Enter time period for time with {problem in AFLHCA91}.
1 Day(s)
2 Week(s)
3 Month(s)
4 Year(s)
6 Since Birth
7 Refused
9 Don't know
UniverseText: Sample adults 18+ who answered 1-95, D for the "number" part of this 2-part question
SkipInstructions: <1- 4, R,D>[goto the next condition, in numerical order, selected at AFLHCA (AHS.200). If this is the last
condition selected, goto SMKEV (next section)]
<6> goto ERR2_AHCL91T
[if [AHCL91N = Number greater than person years old and AHCL91T= 4]] goto
ERR1_AHCL91T
| File Type | application/msword |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |