Supplements

Attachment 3e Supplements/New Core Questions (12 minutes)
2014 NHIS- New Questions/Topics
2014 Question Content

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.
(00-10)____
Refused
Don't know
Has a doctor or other health professional
EVER suggested losing weight to help your
arthritis or joint symptoms?
1. Yes
2. No
Refused
Don’t know
Have you EVER taken an educational course
or class to teach you how to manage
problems related to your arthritis or joint
symptoms?
1. Yes
2. No
Refused
Don’t know
Has a doctor or other health professional
EVER suggested physical activity or exercise
to help your arthritis or joint symptoms?
1. Yes
2. No
Refused
Don’t know
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?

Prior Year(s)
on NHIS
Arthritis
2009
2006
2003

Similar NHIS Previous or Current Question Content

All five supplement items for 2014 identical to questions
from these years

1. Yes
2. No
Refused
Don’t know
Heart Disease and Stroke
About how long has it been since you had your
blood pressure checked by a doctor, nurse, or
other health professional?

2008

__Number
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't know
At that time, were you told that your blood
pressure was high, normal, or low?
1. Not told
2. High
3. Normal
4. Low
5. Borderline
Refused
Don't know
About how long has it been since you had your
blood cholesterol checked by a doctor, nurse, or
other health professional?

2008

2008

__Number
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't know

Which of the following would you say are the
symptoms that someone may be having a heart
attack? I am going to read a list. Please say yes
or no to each one.
1. Yes
2. No
Refused
Don’t know

2008

2014 questions identical to questions from these years

...Pain or discomfort in the jaw, neck or
back.
…Feeling weak, lightheaded or faint.
…Chest pain or discomfort.
…Pain or discomfort in the arms or
shoulder.
…Shortness of breath.
If you thought someone was having a heart
attack, what is the BEST thing to do right away?

2008

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
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.

2009

1. Yes
2. No
Refused
Don’t know
... Sudden numbness or weakness of face,
arm, or leg, especially on one side.
… Sudden confusion or trouble speaking.
… Sudden trouble seeing in one or both
eyes.
... Sudden trouble walking, dizziness, or loss
of balance.
... Sudden severe headache with no known
cause.
If you thought someone was having a stroke,
what is the BEST thing to do right away?
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

2009

Was any medicine EVER prescribed by a doctor
for your high blood pressure?
1. Yes
2. No
Refused
Don’t know
Are you NOW taking any medicine prescribed by
a doctor for your high blood pressure?

Million Hearts
2008
2014 questions identical to questions from these years

2008

1. Yes
2. No
Refused
Don’t know
Have you EVER been told by a doctor or other
health professional that you had high
cholesterol?

2012

*Enter '1' if respondent is taking medication to
control his/her high cholesterol.
1. Yes
2. No
Refused
Don’t know
Was any medication EVER prescribed by a
doctor to help lower your cholesterol?

2008

1. Yes
2. No
Refused
Don’t know
Are you NOW taking any medicine prescribed by
a doctor to help lower your cholesterol?

2008

1. Yes
2. No
Refused
Don’t know
Child and Adult Hearing
Child: These next questions are about [fill: SC
name]'s hearing WITHOUT the use of hearing
aids or other listening devices.
Which statement best describes [fill: SC name]'s
hearing: Excellent, good, a little trouble hearing,

2007

Child 2007 version: Which statement best describes [fill:
S.C. name]'s hearing without a hearing aid: Good, a little
trouble, a lot of trouble, or deaf?
1. Good
2. A little trouble

moderate trouble, a lot of trouble, or is [fill: SC's
name] deaf?

3. A lot of trouble
4. Deaf
Refused
Don't know

1. Excellent
2. Good
3. A little trouble hearing
4. Moderate trouble
5. A lot of trouble
6. Deaf
Refused
Don't know
Adult: These next questions are about your
hearing WITHOUT the use of hearing aids or
other listening devices.

2007

Adult 2007 version identical to 2014 version.

2007

Adult 2007 version: Is your hearing WORSE in one ear
than the other?

Is your hearing excellent, good, a little trouble
hearing, moderate trouble, a lot of trouble, or
are you deaf?
1. Excellent
2. Good
3. A little trouble hearing
4. Moderate trouble
5. A lot of trouble
6. Deaf
Refused
Don't know
Child: Without a hearing aid…Is [fill: SC name]'s
hearing WORSE in one ear than the other?

1. Yes
2. No
Refused
Don't know

1. Yes
2. No
Refused
Don't know
Adult: Without a hearing aid ...
Is your hearing WORSE in one ear than the
other?
1. Yes
2. No
Refused
Don't know
Adult: Which ear is worse?
1. The right ear
2. The left ear
Refused
Don't know

2007

Adult 2007 version identical to 2014 version.

Child: *Read if necessary:
Without a hearing aid…Is [fill: SC name]'s
hearing in [fill: his/her] WORSE ear excellent,
good, a little trouble hearing, moderate trouble,
a lot of trouble, or is [fill: he/she] deaf?
Adult: Is your hearing in your RIGHT ear
excellent, good, a little trouble hearing,
moderate trouble, a lot of trouble, or are you
deaf?

2007

Adult 2007 version identical to 2014 version.

2007

Adult 2007 version identical to 2014 version.

2007

Adult 2007 version: Can you usually HEAR AND
UNDERSTAND what a person says without seeing his or
her face if that person WHISPERS to you from across a
quiet room?

1. Excellent
2. Good
3. A little trouble hearing
4. Moderate trouble
5. A lot of trouble
6. Deaf
Refused
Don't know
Adult: Is your hearing in your LEFT ear excellent,
good, a little trouble hearing, moderate trouble,
a lot of trouble, or are you deaf?
1. Excellent
2. Good
3. A little trouble hearing
4. Moderate trouble
5. A lot of trouble
6. Deaf
Refused
Don't know
Child: Without a hearing aid…
Can [fill: SC name] usually HEAR AND
UNDERSTAND what a person says without
seeing his or her face if that person WHISPERS
to [fill: him/her] from across a QUIET
room?Without a hearing aid ...
1. Yes
2. No
Refused
Don't know
Adult: Without a hearing aid…Can you usually
HEAR AND UNDERSTAND what a person says
without seeing his or her face if that person
WHISPERS to you from across a QUIET room?
1. Yes
2. No
Refused
Don't know

1. Yes
2. No
Refused
Don't know

Child: Can [fill: SC name]'s usually HEAR AND
UNDERSTAND what a person says without
seeing his or her face if that person TALKS IN A
NORMAL VOICE to [fill: him/her] from across a
QUIET room?Without a hearing aid ...
1. Yes
2. No
Refused
Don't know
Adult: Can you usually HEAR AND UNDERSTAND
what a person says without seeing his or her
face if that person TALKS IN A NORMAL VOICE
to you from across a QUIET room?

2007

Adult 2007 version identical to 2014 version.

2007

Adult 2007 version identical to 2014 version.

2007

Adult 2007 version identical to 2014 version.

1. Yes
2. No
Refused
Don't know
Child: Can [fill: SC name]'s usually HEAR AND
UNDERSTAND what a person says without
seeing his or her face if that person SHOUTS to
[fill: him/her] from across a QUIET room?
1. Yes
2. No
Refused
Don't know
Adult: Can you usually HEAR AND UNDERSTAND
what a person says without seeing his or her
face if that person SHOUTS to you from across a
QUIET room?
1. Yes
2. No
Refused
Don't know
Child: Can [fill: SC name]'s usually HEAR AND
UNDERSTAND what a person says without
seeing his or her face if that person SPEAKS
LOUDLY into [fill: his/her] [fill1: ear/better ear]
1. Yes
2. No
Refused
Don't know
Adult: Can you usually HEAR AND UNDERSTAND
what a person says without seeing his or her

face if that person SPEAKS LOUDLY into your
[fill1: ear/better ear]?
1. Yes
2. No
Refused
Don't know
Child: A cochlear (KOH-klee-uhr) implant is an
electrical device that a surgeon puts in a
person's ear(s) if they have severe hearing loss
or are almost totally deaf. Has a doctor or other
health care professional ever recommended a
cochlear implant for [fill: SC name]?
1. Yes
2. No
Refused
Don't know
Adult: A cochlear (KOH-klee-uhr) implant is an
electrical device that a surgeon puts in a
person's ear(s) if they have severe hearing loss
or are almost totally deaf. Has a doctor or other
health care professional ever recommended a
cochlear implant to you?

2007

Adult 2007 version: Has a hearing specialist, your doctor,
or other health care professional ever recommended a
cochlear (KOH-klee-uhr) implant to you?
1. Yes
2. No
Refused
Don't know

1. Yes
2. No
Refused
Don't know
Child: Has [fill: SC name] had cochlear implant
surgery?
1. Yes
2. No
Refused
Don't know
Adult: Have you had cochlear implant surgery?
1. Yes
2. No
Refused
Don't know

Child: Has anyone, friends, relatives, teachers or
others, ever told you that [fill: SC name] has a
hearing problem?
1. Yes

2007

Adult 2007 version: Do you now use a cochlear implant?
1. Yes
2. No
Refused
Don't know

2. No
Refused
Don't know

Adult: Has anyone, friends, relatives or others,
ever told you that you have a hearing problem?
1. Yes
2. No
Refused
Don't know
Child: When you speak directly to [fill: SC
name], how often does [fill: he/she] hear
something different from what you said?
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Child: How often does [fill: SC name] have
difficulty understanding what people say to
her/him?
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Child: How often does [fill: SC name] have
difficulty understanding a conversation if there
is background NOISE, for example, when other
people are talking, TV or radio is on, or children
are playing close by?
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

2007

Adult 2007 version: Have any of your friends or relatives
ever told you that you have a hearing problem?
1. Yes
2. No
Refused
Don't know

Adult: How often do you find it difficult to
follow a conversation if there is background
NOISE, for example, when other people are
talking, TV or radio is on, or children are playing
close by? Would you say...

2007

*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: How often does your hearing cause you
to feel frustrated when talking to your friends or
relatives? Would you say…

2007

*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Child: How old was [fill: SC name] when [fill:
he/she] began to have ANY [fill: hearing
loss/hearing loss in either ear]?
1. At birth
2. 0 to 2 years of age
3. 3 to 5 years of age
4. 6 to 8 years of age
5. 9 to 11 years of age
6. 12 to 14 years of age
7. 15 to 17 years of age

Adult 2007 version: How often does your hearing cause
you to feel frustrated when talking to members of your
family or to friends? Would you say...
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: How often does your hearing cause you
to worry about your safety while working or
doing other activities? Would you say…

Adult 2007 version: How often do you find it difficult to
follow a conversation if there is background noise, for
example, when other people are talking, TV or radio is on,
or children are playing? Would you say...

2007

Adult 2007 version identical to 2014 version.

Refused
Don't know
Adult: How old were you when you began to
have ANY [fill1: hearing loss/hearing loss in
either ear]?

2007

Adult 2007 version: How old were you when you began to
have ANY permanent [fill: hearing loss/hearing loss in
either ear]?
1. At birth
2. 0 to 2 years of age
3. 3 to 5 years of age
4. 6 to 11 years of age
5. 12 to 19 years of age
6. 20 to 39 years of age
7. 40 to 59 years of age
8. 60 to 69 years of age
9. 70 or more years of age
Refused
Don't know

1. At birth
2. 0 to 2 years of age
3. 3 to 5 years of age
4. 6 to 11 years of age
5. 12 to 19 years of age
6. 20 to 29 years of age
7. 30 to 39 years of age
8. 40 to 49 years of age
9. 50 to 59 years of age
10. 60 to 69 years of age
11. 70 to 79 years of age
12. 80 or more years of age
Refused
Don't know
Child: What is the MAIN cause of [fill: SC
name]’s hearing loss?
1. Mother had infection while pregnant, e.g.,
cytomegalovirus (CMV), rubella
2. Genetic reason(s)
3. Born very early, preterm birth or low birth
weight
4. Child had infectious disease after birth
(measles, meningitis, mumps, etc.)
5. Ear infections (fluid in middle ear, otitis, glue
ear, etc.)
6. Ear injury or head/neck trauma
7. Ear disease or surgery
8. Medications/drugs, such as gentamicin
(aminoglycosides), cisplatin (cancer drugs),
antibiotics, anti-inflammatory drugs, diuretics
9. Loud, brief noise from firecrackers, nearby
fireworks, gunfire, blasts, or explosions
10. Sudden hearing loss, unexplained by loud,
brief noise or other known causes
11. Long term noise exposure from machinery,
aircraft, power tools, loud music, loud toys,
appliances, personal stereos or MP3 players,
hair dryers, etc.
12. Other
Refused
Don't know
Adult: What is the MAIN cause of your hearing
loss?

2007

Adult 2007 version: What is the MAIN cause of your
hearing loss?
1. Present at birth because mother had German measles

1. Present at birth because mother had
infectious disease, for example, German
measles (rubella), cytomegalovirus (CMV),
toxoplasmosis, etc.
2. Present at birth for a genetic reason
3. Present at birth for other reason, e.g.,
preterm birth (NOT genetic or infectious
disease)
4. After birth due to an infectious disease
(measles, meningitis, mumps, etc.)
5. Ear infections or otitis media, fluid in middle
ear space, ear drum burst (perforation)
6. Ear injury or head/neck trauma
7. Ear surgery
8. Medications/drugs, such as gentamicin
(aminoglycosides), cisplatin (cancer drugs),
antibiotics, anti-inflammatory drugs, diuretic
9. Ear disease such as Meniere's disease or
otosclerosis
10. Brain tumor (acoustic neuroma/vestibular
schwannoma, etc)
11. Loud, brief noise from gunfire, hand
grenade, IED, other blasts or explosions
12. Sudden hearing loss, unexplained by loud,
brief noise or other known causes
13. Long term noise exposure from machinery,
aircraft, power tools, loud music, appliances,
personal stereos or MP3 players, hair dryers,
etc.
14. Getting older/aging
15. Some other cause
Refused
Don't know

(Rubella) or Cytomegalovirus (CMV)
2. Present at birth for a genetic reason
3. Present at birth for some other reason, not including
genetic or infectious disease
4. Infectious disease after birth (measles, meningitis, etc.)
5. Ear infections or Otitis Media
6. Ear injury (holes in the eardrum, etc.)
7. Ear surgery
8. Ear disease such as Meniere's Disease or Otosclerosis
9. Brain tumor (Acoustic Neuroma, etc)
10. Loud, brief noise from gunfire, blasts, or explosions
11. Noise exposure from machinery, aircraft, power tools,
loud music, appliances, personal stereos or MP3 players,
hairdryers, etc.
12. Getting older/aging
13.Some other cause
Refused
Don't know

Child: When was the LAST time [fill: SC name]
saw a doctor or other health care professional
about any hearing or ear problems?
0. Never
1. In the past year
2. 1 to 2 years ago
3. 3 to 4 years ago
4. 5 to 9 years ago
5. 10 to 14 years ago
6. 15 or more years ago
Refused
Don't know
Adult: When was the LAST time you saw a
doctor or other health care professional about
any hearing or ear problems?
0. Never
1. In the past year

2007

Adult 2007 version identical to 2014 version.

2. 1 to 2 years ago
3. 3 to 4 years ago
4. 5 to 9 years ago
5. 10 to 14 years ago
6. 15 or more years ago
Refused
Don't know
Child: IN THE PAST 5 YEARS, has [fill: SC name]
seen or been referred by your doctor or other
health care professional to a...Hearing specialist,
such as an Ear, Nose, and Throat (ENT) doctor,
or to an audiologist?
*Read if necessary.
Include Otolaryngologist (OH-toh-LAYR-ehnGAHL-oh-jist) or Otologist (OH-tol-o-jist).
1. Yes
2. No
Refused
Don't know
Adult: IN THE PAST 5 YEARS, have you seen or
been referred by your doctor or other health
care professional to a...

2007

Hearing specialist, such as an Ear, Nose, and
Throat (ENT) doctor?

Adult 2007 version: IN THE PAST 5 YEARS, have you seen
or been referred by your doctor or other health care
professional to a ...Hearing specialist, such as an Ear,
Nose, and Throat doctor?
*Read if necessary. Include an Otolaryngologist (OH-tohLAYR-ehn-GAHL-oh-jist) or Otologist (OH-tol-o-jist).

*Read if necessary:
Include an Otolaryngologist (OH-toh-LAYR-ehnGAHL-oh-jist), or Neuro-Otologist (OH-tol-o-jist)

1. Yes
2. No
Refused
Don't know

1. Yes
2. No
Refused
Don't know
*Read if necessary:
Adult: IN THE PAST 5 YEARS, have you seen or
been referred by your doctor or other health
care professional to

2007

Adult 2007 question identical to 2014 version.

...an audiologist or hearing aid dispenser?
1. Yes
2. No
Refused
Don't know
Child: Was [fill: SC name] checked with a
screening test, for example, with an otoacoustic
emissions test (OAE), or auditory brainstem

No similar adult question in 2014 or 2007 for next 7 child
questions.

response (ABR) test for hearing loss at birth?
1. Yes
2. No
Refused
Don't know
Child: At what age did [fill: SC name] FIRST have
an earache or an ear infection?
0. Never
1. Less than 6 months old
2. 6 to 11 months of age
3. 2 to 17 months of age
4. 18 to 23 months of age
5. 2 to 3 years of age
6. 4 to 5 years of age
7. 6 to 8 years of age
8. 9 years or older
Refused
Don't know
Child: Did [fill: SC name] EVER have a tube
placed in one or both ears to drain fluid from
the ear(s)?
1. Yes
2. No
Refused
Don't know
Child: At what age did [fill: SC name] FIRST have
an ear tube placed in one or both ears to drain
fluid from the ear(s)?
1. Less than 6 months old
2. 6 to 11 months of age
3. 2 to 17 months of age
4. 18 to 23 months of age
5. 2 to 3 years of age
6. 4 to 5 years of age
7. 6 to 8 years of age
8. 9 years or older
Refused
Don't know
Child: Has [fill: SC name] EVER had a hearing
test at school?
1. Yes
2. No
Refused
Don't know
Child: Has [fill: SC name] had [his/her] hearing

tested more than once at school?
1. Yes
2. No
Refused
Don't know
Child: When did [fill: SC name]'s have [his/her]
most recent hearing test at school?
1. Less than 1 year ago
2. 1 to 2 years ago
3. 3 to 4 years ago
4. 5 to 9 years ago
5. 10 or more years ago
Refused
Don't know
Child: A hearing test by a specialist is done in a
sound-treated booth or room, or with
headphones. Hearing specialists include
audiologists, ear-nose-throat (ENT) doctors and
trained health technicians or nurses (include
hearing exams conducted in schools). When
was the last time [fill: SC name] had [fill:
his/her] hearing tested by a hearing specialist?
0. Never
1. In the past year
2. 1 to 2 years ago
3. 3 to 4 years ago
4. 5 to 9 years ago
5. 10 to 14 years ago
6. 15 or more years ago
Refused
Don't know
Adult: A hearing test by a specialist is one that is
done in a sound proof booth or room, or with
headphones. Hearing specialists include
audiologists, ear nose and throat (ENT) doctors,
and trained health technicians or occupational
nurses. When was the last time you had your
hearing tested by a hearing specialist?
0. Never
1. In the past year
2. 1 to 2 years ago
3. 3 to 4 years ago
4. 5 to 9 years ago
5. 10 to 14 years ago
6. 15 or more years ago
Refused
Don't know

2007

Adult 2007 version: When was the last time you had your
hearing tested?
0. Never
1. In the past year
2. 1 to 2 years ago
3. 3 to 4 years ago
4. 5 to 9 years ago
5. 10 to 14 years ago
6. 15 or more years ago
Refused
Don't know

Child: A hearing aid is a small electronic device
that amplifies the sounds you hear. It is worn in
or behind the ear to help children and adults
hear. Does [fill: SC name] NOW use a hearing
aid(s)?
1. Yes
2. No
Refused
Don't know
Adult: A hearing aid is a small electronic device
that amplifies the sounds you hear. It is worn in
or behind the ear to help you hear. Do you
NOW use a hearing aid(s)?

2007

Adult 2007 version: Do you now use a hearing aid(s)?
1. Yes
2. No
Refused
Don't know

1. Yes
2. No
Refused
Don't know
Child: How long has [fill: SC name] used a
hearing aid(s)?
1. Less than 6 weeks
2. 6 weeks to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more
Refused
Don't know
Adult: How long have you used a hearing aid(s)?
1. Less than 6 weeks
2. 6 weeks to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more
Refused
Don't know
Child: Think about how much [fill: SC name]
used [his/her] present hearing aid(s) over the
past two weeks. On an average day, how many
hours did [fill: he/she] use a hearing aid(s)?
0. None
1. Less than 1 hour a day
2. 1 to 3 hours a day

2007

Adult 2007 version identical to 2014 version.

3. 4 to 7 hours a day
4. 8 or more hours per day
Refused
Don't know
Adult: Think about how much you used your
present hearing aid(s) over the past two weeks.
On an average day, how many hours did you use
your hearing aid(s)?

2007

Adult 2007 version: IN THE PAST 12 MONTHS, how often
did you use a hearing aid(s)? Would you say...
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

0. None
1. Less than 1 hour a day
2. 1 to 3 hours a day
3. 4 to 7 hours a day
4. 8 or more hours per day
Refused
Don't know
Adult: Think about the situation where you
most wanted to hear better, before you got
your present hearing aid(s). OVER THE PAST 2
WEEKS, how much has the hearing aid helped in
those situations?
*Read categories below.
1. Helped not at all
2. Helped slightly
3. Helped moderately
4. Helped quite a lot
5. Helped very much
Refused
Don't know
Child: Has [fill: SC name] ever used a hearing
aid(s) in the past?
1. Yes
2. No
Refused
Don't know
Adult: Have you ever used a hearing aid(s) in
the past?
1. Yes
2. No
Refused
Don't know
Child: Has a hearing specialist, a doctor, or
other health care professional ever
recommended a hearing aid(s) for [fill: SC
name]?

2007

2007 Adult version identical to 2014 version.

1. Yes
2. No
Refused
Don't know
Adult: Has a hearing specialist, your doctor, or
other health care professional ever
recommended a hearing aid(s) to you?

2007

2007 Adult version identical to 2014 version.

2007

2007 Adult version identical to 2014 version.

2007

Adult 2007 version: During this time, how often did you
use a hearing aid(s)? Would you say...

1. Yes
2. No
Refused
Don't know
Child: How long did [fill: SC name] use a hearing
aid(s) in the past?
1. Less than 6 weeks
2. 6 weeks to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more
Refused
Don't know
Adult: How long did you use a hearing aid(s) in
the past?
1. Less than 6 weeks
2. 6 weeks to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more
Refused
Don't know
Child: When [fill: SC name] used to wear a
hearing aid, on an average day, how many hours
did [he/she] use it?
0. None
1. Less than 1 hour a day
2. 1 to 3 hours a day
3. 4 to 7 hours a day
4. 8 or more hours per day
Refused
Don't know
Adult: When you used to wear a hearing aid, on
an average day, how many hours did you use

your hearing aid?

*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

0. None
1. Less than 1 hour a day
2. 1 to 3 hours a day
3. 4 to 7 hours a day
4. 8 or more hours per day
Refused
Don't know
Child: Why did [fill: SC name] decide not to use
a hearing aid(s)?
*Enter all that apply, separate with commas.
1. It didn't help
2. It made everything too loud
3. Didn't like the way it sounded (unwanted
sounds such as whistling or other noises)
4. She/he didn’t like the way her/his voice
sounded when wearing the hearing aid
5. It was uncomfortable
6. It had frequent breakdowns/Needed repairs
7. Didn't like the way it looked
8. It cost too much
9. She/he didn’t think she/he needed a hearing
aid
10. It was misplaced or lost
11. Other reason
Refused
Don't know
Adult: Why have you decided not to use a
hearing aid(s)?

2007

Adult 2007 version: Why have you decided not to use a
hearing aid(s)?

*Enter all that apply, separate with commas.

*Enter all that apply, separate with commas.

1. It didn't help
2. It made everything too loud
3. Didn't like the way it sounded (unwanted
sounds such as whistling or other noises)
4. Didn’t like the way I sounded (my own voice
when wearing the hearing aid)
5. It was uncomfortable
6. It had frequent breakdowns/Needed repairs
7. Didn't like the way it looked
8. It cost too much
9. Don't think I need a hearing aid
10. It was misplaced or lost
11. Other reason
Refused
Don't know

1. It didn't help
2. Didn't like the way it sounded
3. Whistling sounds
4. It was uncomfortable
5. It had frequent breakdowns/Needed repairs
6. Didn't like the way it looked
7. It cost too much
8. Don't think I need a hearing aid
9. Other
Refused
Don't know

Child: Auditory training includes learning how to
use visual cues to enhance your listening skills,

placing yourself in the best listening situation in
a room, or for example, if you use a hearing aid,
learning how to use it in specific circumstances,
such as on the telephone or in a noisy place.
Did [fill: SC name] ever receive instruction or
training to improve [his/her] ability to hear?
1. Yes
2. No
Refused
Don't know
Adult: Auditory training includes learning how
to use visual cues to enhance your listening
skills, placing yourself in the best listening
situation in a room, or for example, if you use a
hearing aid, learning how to use it in specific
circumstances, such as on the telephone or in a
noisy place. Did you ever receive instruction or
training to improve your ability to hear?

No similar adult or child question.

1. Yes
2. No
Refused
Don't know
Child: BECAUSE OF [fill: SC name]’s HEARING,
has [he/she] EVER used assistive technology to
communicate, such as FM systems, instant or
text messages, classroom amplification systems,
headsets, closed-caption television, amplified
telephone, relay services, or live video
streaming?
1. Yes
2. No
Refused
Don't know
Adult: BECAUSE OF YOUR HEARING, have you
ever used assistive technology to communicate,
such as FM systems, instant or text messages,
headsets, closed-caption television, amplified
telephone, relay services, or live video
streaming?
1. Yes
2. No
Refused
Don't know
Child: What assistive technology devices or
types has [fill: SC name] EVER used?

2007

Adult 2007 version: Because of your hearing, have you
ever used assistive listening devices (ALDs), such as FM
systems, closed-caption television, or amplified telephone
or relay services?
1. Yes
2. No
Refused
Don't know

*Enter all that apply, separate with commas.
1. FM system, pocket talker or other personal
listening device
2. Instant or text messages
3. Classroom amplification systems
4. Amplified telephone
5. Amplified or vibrating alarm clock
6. Notification or signaling alarm system (light
signaler for doorbell, etc.)
7. Headset with Television/Theater or closedcaptioned TV
8. TTY (teletypewriter), TDD
(telecommunications device for the deaf), or
telephone relay service
9. Video relay service
10. Live video streaming (for example, video on
computers or phones) using sign language or
other means to communicate
11. Sign language interpreter
12. Other
Refused
Don't know
Adult: What types of assistive technology have
you EVER used?

2007

*Enter all that apply, separate with commas.

*Enter all that apply, separate with commas.
1. Pocket talker or other personal listening device
2. Amplified telephone
3. Amplified or vibrating alarm clock
4. Notification or signaling alarm system (light signaler for
doorbell, baby cry monitor, etc.)
5. Television/Theater headset or closed-captioned TV
6. TTY (teletypewriter), TDD (telecommunications device
for the deaf), or telephone relay service
7. Video relay service
8. Sign language interpreter
9. Other
Refused
Don't know

1. FM system pocket talker or other personal
listening device
2. Instant or text messages
3. Amplified telephone
4. Amplified or vibrating alarm clock
5. Notification or signaling alarm (light signaler
for doorbell, baby cry monitor, etc.)
6. Headset with Television/Theater or closedcaptioned TV
7. TTY (teletypewriter), TDD
(telecommunications device for the deaf), or
telephone relay service
8. Video relay service
9. Live video streaming (video on computers or
phones) using sign language or other means to
communicate
10. Sign language interpreter
11. Other
Refused
Don't know
Adult: DURING THE PAST 12 MONTHS, have you
had a problem with dizziness, lightheadedness,
feeling as if you are going to pass out or faint,
unsteadiness or imbalance?

Adult 2007 version: Which of the following assistive
listening devices (ALDs) have you ever used?

2008

Adult 2008 version: During the PAST 12 MONTHS, have
you had a problem with dizziness or balance? Do not
include times when drinking alcohol.
1. Yes

Do not include times when drinking alcohol.

2. No
Refused
Don't know

1. Yes
2. No
Refused
Don't know
Adult: DURING THE PAST 12 MONTHS, have you
been bothered by ringing, roaring, or buzzing in
your ears or head that lasts for 5 minutes or
more?

2007

2007 version identical to 2014 version.

2007

2007 version identical to 2014 version.

2007

2007 version identical to 2014 version.

2007

2007 version identical to 2014 version.

*Read if necessary:
Tinnitus (TIN-uh-tus) is the medical term for
ringing, roaring or buzzing in the ears or head.
1. Yes
2. No
Refused
Don't know
Adult: DURING THE PAST 12 MONTHS, how
often have you had this ringing, roaring, or
buzzing in your ears or head? Would you say...
*Read categories below.
1. Almost always
2. At least once a day
3. At least once a week
4. At least once a month
5. Less frequently than once a month
Refused
Don't know
Adult: How long have you been bothered by
this ringing, roaring, or buzzing in your ears or
head?
1. Less than 3 months
2. 3 to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more
Refused
Don't know
Adult: Are you bothered by ringing, roaring, or
buzzing in your ears or head ONLY after
listening to loud sounds or loud music?
1. Yes

2. No
Refused
Don't know
Adult: Are you bothered by ringing, roaring, or
buzzing in your ears or head when going to
sleep?

2007

2007 version identical to 2014 version.

2007

2007 version identical to 2014 version.

2007

2007 version identical to 2014 version.

1. Yes
2. No
Refused
Don't know
Adult: How much of a problem is this ringing,
roaring, or buzzing in your ears or head? Would
you say it is...
*Read categories below.
1. No problem
2. A small problem
3. A moderate problem
4. A big problem
5. A very big problem
Refused
Don’t know
Adult: Have you ever discussed this ringing,
roaring or buzzing in your ears or head with
your doctor or other health care professional?
1. Yes
2. No
Refused
Don't know
Adult: IN THE PAST 5 YEARS, have you been
evaluated or treated for the ringing, roaring or
buzzing in your ears or head by a medical
specialist in hearing, such as an Ear, Nose and
Throat (ENT) doctor, audiologist, neurologist, or
psychiatrist?

New for 2014.

*Include otolaryngologist, otologist and neurootologist.
1. Yes
2. No
Refused
Don't know
Adult: Have you ever tried any remedies or
treatments for this ringing, roaring, or buzzing
in your ears or head?

2007

2007 version identical to 2014 version.

1. Yes
2. No
Refused
Don't know
Adult: What remedies or treatments have you
tried?

2007

Adult 2007 version: Which of the following treatments
have you tried?

*Enter all that apply, separate with commas.

*Enter all that apply, separate with commas.

1. Started or taking drugs or medications
2. Stopped or reduced use of drugs or
medications, such as aspirin, diuretics, etc.
3. Hearing aids/amplification
4. Masking device(s)
5. Surgical or other medical procedures
6. Relaxation therapy, stress reduction
techniques
7. Tinnitus Retraining Therapy (TRT)
8. Music Therapy
9. Avoided irritants, such as caffeine, salt,
smoking (tobacco)
10. Nutritional supplements, such as niacin or
zinc
11. Alternative methods (hypnosis,
acupuncture, etc.)
12. Other
Refused
Don’t know

1. Amplification/Hearing aids
2. Masking with wearable device (with or without hearing
aids)
3. Masking with non-wearable device (sound generators
to help with sleep)
4. Cognitive therapy with counseling
5. Stress reduction or relaxation methods
6. Biofeedback
7. Tinnitus retraining therapy (TRT)
8. Psychiatric treatment
9. Surgery to cut the hearing nerve
10. Drugs or medications
11. Nutritional supplements
12. Music therapy
13. Temporal mandibular joint treatment
14. Alternative methods (hypnosis, acupuncture, etc.)
15. Other
Refused
Don't know

Adult: How much have remedies or treatments
helped with the ringing, roaring, or buzzing in
your ears or head? Would you say they…

New for 2014.

*Read categories below.
1. Helped not at all
2. Helped slightly
3. Helped moderately
4. Helped quite a lot
5. Helped very much
Refused
Don't know
Adult: Some people are bothered by everyday
sounds or noises that don’t bother most people.
Do every day sounds, such as from a hair dryer,
vacuum cleaner, lawnmower, or siren, seem too
loud or annoying to you?
1. Yes
2. No
Refused

New for 2014.

Don't know
Adult: DURING THE PAST 12 MONTHS, how
much of a problem have you had because every
day sounds seem unbearably loud? Would you
say it was...

New for 2014.

*Read categories below.
1. No problem
2. A small problem
3. A moderate problem
4. A big problem
5. A very big problem
Refused
Don’t know
Child: The next questions are about [fill: SC
name]'s exposure to loud sounds or noises.
Has [fill: SC name] ever shot a gun or been close
to others who were using firearms for any
reason? Close means standing next to or nearby
to others who were using firearms.
1. Yes
2. No
Don't know
Refused
Adult: The next few questions are about your
current or previous exposure to loud sounds or
noises.

2007

Have you EVER used guns or firearms for any
reason?

Have you ever used firearms for any reason?
*Include target shooting, hunting, your job (including
military service).
*Firearms include pistols, shotguns, rifles, and other
types of guns. Do not include BB or pellet guns.

*Include target shooting, hunting, your job
(including military service).
*Firearms include pistols, shotguns, rifles, and
other types of guns. Do not include BB or pellet
guns.

1. Yes
2. No
Don't know
Refused

1. Yes
2. No
Don't know
Refused
Adult: Was this for work, leisure, or both?
1. Work
2. Leisure
3. Both work and leisure
Refused
Don't know

Adult 2007 version: The next few questions are about
your current or previous exposure to loud sounds or
noises.

2007

2007 version identical to 2014 version.

Child: Has [fill: SC name] ever lit firecrackers,
been nearby to others lighting firecrackers, or
close to explosive sounds such as fireworks
displays or other explosive noises?
1. Yes
2. No
Don't know
Refused
Child: About how many TOTAL explosive events
has [fill: SC name] experienced, including gun
shots, firecrackers going off, nearby fireworks
explosions, and any other explosive noises?
*Read categories if necessary.
*Include target shooting, hunting, lighting
firecrackers, other explosive noises.
*One “event” equals one shot, one firecracker,
one fireworks explosion, etc.
1. 1 to less than 100 events
2. 100 to less than 1000 events
3. 1000 to less than 10,000 events
4. 10,000 to less than 50,000 events
5. 50,000 events or more
Refused
Don't know
Child: When [fill1: shooting guns,] lighting
firecrackers or being close to others who were
[fill: shooting guns,] lighting firecrackers, or
when explosive sounds occurred, how often did
[fill: SC name] wear hearing protection, such as
earplugs or ear muffs? Would you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: When did you use guns or firearms…
during the last 12 months, before then, or both
during and before the last 12 months?
*Include target shooting, hunting, your job
(including military service).
*Firearms include pistols, shotguns, rifles, and
other types of guns. Do not include BB or pellet

guns.
1. During the last 12 months
2. Before the last 12 months
3. Both during and before the last 12 months
Refused
Don't know
DURING THE PAST 12 MONTHS, about how
many rounds have you fired?

2007

Adult 2007 version: IN THE PAST 12 MONTHS, about how
many rounds have you fired?

*Read categories if necessary.
*Include target shooting, hunting, your job
(including military service).
*One round equals one shot.

*Read categories if necessary.
*Include target shooting, hunting, your job (including
military service).
*One round equals one shot.

1. 1 to less than 100 rounds
2. 100 to less than 1000 rounds
3. 1000 to less than 10,000 rounds
4. 10,000 rounds or more
Refused
Don't know

0. None
1. 1 to less than 100 rounds
2. 100 to less than 1000 rounds
3. 1000 to less than 10,000 rounds
4. 10,000 rounds or more
Refused
Don't know

Adult: DURING THE PAST 12 MONTHS, when
shooting firearms how often have you worn
hearing protection, such as ear plugs or ear
muffs? Would you say…

2007

*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: How many TOTAL rounds have you ever
fired?
*Read categories if necessary.
*Include target shooting, hunting, your job
(including military service).
*One round equals one shot.
1. 1 to less than 100 rounds
2. 100 to less than 1000 rounds
3. 1000 to less than 10,000 rounds
4. 10,000 to less than 50,000 rounds
5. 50,000 rounds or more
Refused
Don't know

Adult 2007 version: IN THE PAST 12 MONTHS, when
shooting firearms how often have you worn ear plugs or
ear muffs? Would you say...

2007

2007 version identical to 2014 version.

Adult: Before THE PAST 12 MONTHS, when
shooting firearms how often have you worn
hearing protection, such as ear plugs or ear
muffs? Would you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Child: Has [fill: SC name] ever had a job, or
combination of jobs or chores, where she/he
was exposed to VERY LOUD sounds or noise for
4 or more hours a day, several days a week?
VERY LOUD means so loud that one must shout
in order to be understood by a person standing
3 feet (arm’s length) away.
1. Yes
2. No
Don't know
Refused
Adult: Have you ever had a job, or combination
of jobs, where you were exposed to VERY LOUD
sounds or noise for 4 OR MORE HOURS A DAY,
SEVERAL DAYS A WEEK?
VERY LOUD means so loud that you must
SHOUT in order to be understood by someone
standing 3 feet (arm’s length) away from you.
1. Yes
2. No
Don't know
Refused
Adult: Have you ever had a job, or combination
of jobs, where you were exposed to LOUD
sounds or noise for 4 OR MORE HOURS A DAY,
SEVERAL DAYS A WEEK?
Loud means so loud that you must SPEAK IN A
RAISED VOICE to be heard.
1. Yes
2. No
Don't know
Refused

2007

Adult 2007 version identical to 2014 version.

Child: In working on a job or doing chores, how
many months or years has [fill: SC name] been
exposed to VERY LOUD sounds or noise for 4 or
more hours a day, several days a week?
VERY LOUD means so loud that one must shout
in order to be understood by a person standing
3 feet (arm’s length) away.
1. Less than 3 months
2. 3 to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more
Refused
Don't know
Adult: In your work, how many months or years
have you been exposed at work to VERY LOUD
sounds or noise for 4 or more hours a day,
several days a week?
*Read if necessary: VERY LOUD means so loud
that you must SHOUT in order to be understood
by someone standing 3 feet (arm’s length) away
from you.
1. Less than 3 months
2. 3 to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more
Refused
Don't know
Adult: When were you exposed to VERY LOUD
sounds or noise at work… during the last 12
months, before then, or both during and before
the last 12 months?
1. During the last 12 months
2. Before the last 12 months
3. Both during and before the last 12 months
Refused
Don't know
Child: About how often did [fill: SC name] wear
hearing protection, such as ear plugs or ear
muffs when exposed to VERY LOUD sounds or
noise at work or while doing chores? Would

you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: DURING THE PAST 12 MONTHS, how
often did you wear hearing protection, such as
ear plugs or ear muffs when exposed to VERY
LOUD sounds or noise at work? Would you
say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: BEFORE THE LAST 12 MONTHS, when
exposed at work to VERY LOUD sounds or noise,
how often DID you wear hearing protection,
such as ear plugs or ear muffs? Would you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: For how many months or years have you
been exposed at work to LOUD sounds or noise
for 4 or more hours a day, several days a week?
LOUD means so loud that you must speak in a
RAISED VOICE TO BE HEARD.
1. Less than 3 months
2. 3 to 11 months
3. 1 to 2 years
4. 3 to 4 years
5. 5 to 9 years
6. 10 to 14 years
7. 15 years or more

2007

2007 Adult version identical to 2014 version.

Refused
Don't know
Adult: When were you exposed to LOUD sounds
or noise at work… during the last 12 months,
before then, or both during and before the last
12 months?

2007

1. Yes
2. No
Don't know
Refused

1. During the last 12 months
2. Before the last 12 months
3. Both during and before the last 12 months
Refused
Don't know
Adult: DURING THE PAST 12 MONTHS, how
often did you wear hearing protection, such as
ear plugs or ear muffs when exposed to LOUD
sounds or noise at work? Would you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: BEFORE THE LAST 12 MONTHS, when
exposed at work to LOUD sounds or noise, how
often DID you wear hearing protection, such as
ear plugs or ear muffs? Would you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Child: [fill: Outside of working on a job or doing
chores, has/Has] [fill: SC name] ever been
exposed to VERY LOUD sounds or noise 10 or
more times a year? This includes noise from
extremely loud toys, gunfire, fireworks, power
tools or machinery, very loud music, sporting
events, recreational vehicles, racing or
speedways, some household appliances, or
other things?]
*Read if necessary.
VERY LOUD means so loud that one must shout

Adult 2007 version: Was any of this exposure to loud
sounds or noise IN THE PAST 12 MONTHS?

2007

Adult 2007 version: IN THE PAST 12 MONTHS, how often
did you wear ear plugs or ear muffs when exposed to
loud sounds or noise at work? Would you say...
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

in order to be understood by a person standing
3 feet (arm’s length) away.
1. Yes
2. No
Don't know
Refused
Adult: Outside of work, have you ever been
exposed to VERY LOUD sounds or noise 10 or
more times a year? This includes noise from
power tools, machinery, recreational vehicles,
racing or speedways, rock concerts, some
sporting events, and other things?
VERY LOUD means so loud that you must
SHOUT in order to be understood by someone
standing 3 feet (arm’s length) away from you.
1. Yes
2. No
Don't know
Refused
Child: What types of VERY LOUD activities has
[fill: SC name] ever been exposed to 10 or more
times a year?
*Enter all that apply, separate with commas.
1. Motorcycles/auto racing/snowmobile/motor
boat/recreational vehicles
2. Operating farm machinery
3. Woodworking, other workshop power tools
4. Lawn mower, electric trimmer, leaf/snow
blower, chain saw
5. Guns, firearms
6. Firecrackers or fireworks
7. Very loud household appliances (vacuum
cleaners, hair dryers, etc.)
8. CD Player/MP3 Player/iPod, etc.
9. Playing a musical instrument
10. Extremely loud toys
11. Other music-related activities: Rock
concerts, stereos, disco/clubs or bars
12. Other activities (such as computer/video
games, home theater, loud sporting events)
Refused
Don't know
Adult: What VERY LOUD activities have you
EVER been exposed to 10 or more times a year?
*Enter all that apply, separate with commas.

1. Lawn mower, electric trimmer, leaf/snow
blower, etc.
2. Power tools, e.g., for woodworking, cutting
down trees, etc.
3. Household appliances: blender/mixer, food
processor, vacuum cleaner, hairdryer, etc.
4. Recreational vehicles, e.g., motorcycles/auto
racing/snowmobile/motor boats
5. Rock concerts, disco/clubs or bars, other very
loud music exposure
6. Very loud music, including from CD
Player/MP3 Player/iPod, etc.
7. Very loud sporting events
8. Guns, firearms
9. Video/computer games, home theater
10. Other
Refused
Don't know
Adult: Outside of work, have you ever been
exposed to LOUD sounds or noise 10 or more
times a year? This includes noise from lawn
mowers, some household appliances, loud
music, video games, and other things?

2007

LOUD means so loud that you must speak in a
RAISED VOICE TO BE HEARD.

*Read if necessary.
Loud means so loud that you must speak in a raised voice
to be heard.

1. Yes
2. No
Don't know
Refused
Adult: What LOUD activities have you EVER
been exposed to 10 or more times a year?

Adult 2007 version: [Fill: Outside of work, have you ever
been exposed to loud sounds or noise 10 or more times a
year? This includes noise from power tools, loud music,
racing or speedways, household appliances, or other
things

1. Yes
2. No
Don't know
Refused
2007

Adult 2007 version: Which of the following activities have
you ever been exposed to 10 or more times for a year?

*Enter all that apply, separate with commas.

*Enter all that apply, separate with commas.

1. Lawn mower, electric trimmer, leaf/snow
blower, etc.
2. Power tools, e.g., for woodworking, cutting
down trees, etc.
3. Household appliances: blender/mixer, food
processor, vacuum cleaner, hairdryer, etc.
4. Recreational vehicles, e.g., motorcycles/auto
racing/snowmobile/motor boats
5. Rock concerts, disco/clubs or bars, other loud
music exposure
6. Loud music, including from CD Player/MP3
Player/iPod, etc.
7. Loud sporting events
8. Guns, firearms
9. Video/computer games, home theater
10. Other

1. Motorcycles/Auto racing/Snowmobile/Motor boat 2.
Operating farm machinery
3. Wood cutting, woodworking, other workshop power
tools
4. Lawn mower, electric trimmer, leaf/snow blower
5. Firearms
6. Household appliances: Blender/Mixer, food processor,
vacuum cleaner, hair dryer, etc.
7. MP3 Player/iPod Playing in a music group
8. Other music-related activities: Rock concerts, stereos,
disco/clubs or bars
9. Other noisy., non-work-related activities
Refused
Don't know

Refused
Don't know
When were you exposed to [fill1: LOUD/VERY
LOUD] sounds or noise during leisure time, nonoccupational activities, that is, during the last 12
months, before then, or both during and before
the last 12 months?
1. During the last 12 months
2. Before the last 12 months
3. Both during and before the last 12 months
Refused
Don't know
Child: When [fill: SC name] was exposed to
VERY LOUD noise or music from activities
outside of work, about how often did [he/she]
wear hearing protection, such as ear plugs or
ear muffs? Would you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: DURING THE PAST 12 MONTHS, when
exposed to [fill1: LOUD/VERY LOUD] noise or
music [fill2: outside of work], how often have
you worn hearing protection, such as ear plugs
or ear muffs to reduce noise? Would you say…
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Adult: BEFORE THE LAST 12 MONTHS, when
exposed [Fill1: outside of work] to [Fill2:
LOUD/VERY LOUD] noise or music, how often
did you wear hearing protection, such as ear
plugs or ear muffs to reduce noise? Would you
say…
*Read categories below.
1. Always

2007

Adult 2007 version: IN THE PAST 12 MONTHS, when
exposed to loud noise or music [fill: outside of work], how
often have you worn ear plugs or ear muffs? Would you
say...
*Read categories below.
1. Always
2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know

2. Usually
3. About half the time
4. Seldom
5. Never
Refused
Don't know
Child: DURING THE PAST 12 MONTHS, did
anyone get information from the internet
about [fill: SC name]’s health, medical
treatments, or rehabilitation services?
1. Yes
2. No
Don't know
Refused
Adult: DURING THE PAST 12 MONTHS, did you
get information from the internet about your
health, medical treatments, or rehabilitation
services?
1. Yes
2. No
Don't know
Refused
Child: DURING THE PAST 12 MONTHS, did
anyone get information from the internet on…
Hearing loss for [fill: SC name]
1. Yes
2. No
Don't know
Refused
Adult: DURING THE PAST 12 MONTHS, did you
or others get information from the internet on…
Hearing loss for you
1. Yes
2. No
Don't know
Refused
Child: DURING THE PAST 12 MONTHS, did
anyone get information from the internet on…
Hearing aids, including cochlear implants or
other devices or assistive technology for [fill: SC
name]

2012

Identical to question from 2012 Voice, Speech, and
Language Supplement: DURING THE PAST 12 MONTHS,
did you get information from the Internet about your
health, medical treatments, or rehabilitation services?
1. Yes
2. No
Don't know
Refused

1. Yes
2. No
Don't know
Refused
Adult: DURING THE PAST 12 MONTHS, did you
or others get information from the internet on…
Hearing aids, including cochlear implants or
other devices for you
1. Yes
2. No
Don't know
Refused
Adult: DURING THE PAST 12 MONTHS, did you
or others get information from the internet on…
Ringing, roaring, or buzzing sounds in the ears
or head (tinnitus) for you
1. Yes
2. No
Don't know
Refused
Adult: DURING THE PAST 12 MONTHS, did you
or others get information from the internet on…
Dizziness or balance problems for you
1. Yes
2. No
Don't know
Refused
Child: DURING THE PAST 12 MONTHS, did
anyone get information from the internet on…
Hearing protection such as ear plugs or
earmuffs for [fill: SC name]
1. Yes
2. No
Don't know
Refused
Adult: DURING THE PAST 12 MONTHS, did you
or others get information from the internet on…
Hearing protection such as ear plugs or ear
muffs for you
1. Yes

2. No
Don't know
Refused
Was any of this information written by a doctor,
other health professionals, medical associations,
or other health-related organizations?
1. Yes
2. No
Don't know
Refused

2012

Identical to question from 2012 Voice, Speech and
Language Supplement: Was any of this information
written by a doctor, other health professionals, medical
associations, or other health-related organizations?
1. Yes
2. No
Don't know
Refused

Questions to Measure the Impact of the Affordable Care Act (Health Insurance Exchange Questions)

Was [fill1:your/ALIAS’s] Medicaid obtained
through the [fill1: health insurance
marketplace/ name of exchange program]
program?
1. Yes
2. No
Don't know
Refused
Under [fill1: your/ALIAS’s] Medicaid plan is
there an enrollment fee or premium?
1. Yes
2. No
Don't know
Refused

Is the premium paid for this Medicaid plan
based on income?
1. Yes
2. No
Don't know
Refused
Was this plan obtained through the [fill1: health
insurance marketplace/ name of exchange
program] program?
1. Yes
2. No
Don't know
Refused
Is the premium paid for this plan based on

Identical to question on 2013Q4 NHIS

income?
1. Yes
2. No
Don't know
Refused
Was [fill1:your/ALIAS’s] CHIP plan obtained
through the [fill1: health insurance
marketplace/ name of exchange program]
program?
1. Yes
2. No
Don't know
Refused
Under this [fill1: ^STNAME1/this CHIP plan is
there an enrollment fee or premium?
1. Yes
2. No
Don't know
Refused

Is the premium paid for [fill: STNAME1/this
CHIP plan] based on income?
1. Yes
2. No
Don't know
Refused
Was [fill1:your/ALIAS’s] state sponsored health
plan obtained through the [fill1: health
insurance marketplace/ name of exchange
program] program?
1. Yes
2. No
Don't know
Refused
Under this [fill1: ^STNAME2/this state
sponsored plan] is there an enrollment fee or
premium?
1. Yes
2. No
Don't know
Refused

Is the premium paid for [fill: STNAME2/this

state sponsored plan] based on income?
1. Yes
2. No
Don't know
Refused
Was [fill1:your/ALIAS’s] other government
program obtained through the [fill1: health
insurance marketplace/ name of exchange
program] program?
1. Yes
2. No
Don't know
Refused
Under this [fill1: ^STNAME3/this other
government plan is there an enrollment fee or
premium ?
1. Yes
2. No
Don't know
Refused

Is the premium paid for [fill: STNAME3/this
other government plan] based on income?
1. Yes
2. No
Don't know
Refused
Have you looked into purchasing health
insurance coverage through the Health
Insurance Marketplace/{fill name of state plan}?
1. Yes
2. No
Don't know
Refused

The next questions are about electronic
cigarettes, often called e-cigarettes. E-cigarettes
look like regular cigarettes, but are batterypowered and produce vapor instead of smoke.
Have you ever used an e-cigarette, even one
time?
1. Yes
2. No
Don't know

Identical to question on 2013Q4 NHIS

E-Cigarette Use

Refused
Do you now use e-cigarettes every day, some
days, or not at all?
1. Every day
2. Some days
3. Not at all
Refused
Don't know

New Core Question on Child Autism

Has a doctor or health professional ever told
you that [fill: S.C. name] had...
Autism, Asperger’s disorder, pervasive
developmental disorder, or autism spectrum
disorder?]
1. Yes
2. No
Don't know
Refused

2013 (and
previous
years)

Question from prior versions: Looking at this list, has a
doctor or health professional ever told you that [fill: S.C.
name] had any of these conditions?
*Read if necessary.

Down syndrome
Cerebral palsy
Muscular dystrophy
Cystic fibrosis
Sickle cell anemia
Autism/Autism spectrum disorder
Diabetes
Arthritis
Congenital heart disease
Other heart condition
New Core Question on Binge Drinking

DURING THE PAST 30 DAYS, how many times
did you have [fill: 5 or more/4 or more] drinks in
about TWO HOURS?
* Enter '1' if less than 1 drink.
* Enter '60' if 60 or more drinks.
_____Times

New Core Question on Web Panels

Research companies invite people to become
members of online research panels where they
regularly respond to surveys online. Are you
currently a member of an online research
panel?
1. Yes
2. No
Don't know
Refused