0920-0222 (16AG) Appendix 1 - NHANES Questions for Cognitive Testing

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Appendix 1 – NHANES Questions for Cognitive Testing

1. New Q1. In the last 12 months, did you buy ready-made food at the supermarket or grocery store?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

2. NewQ4. In the last 12 months, did you buy ready-made food (to be defined) at convenience stores?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

3. NewQ7. In the last 12 months, did you buy food at all-you-can-eat buffet style restaurants?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

4. NewQ10. In the last 12 months, did you buy food at drinking establishments such as Starbucks?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

5. NewQ13. In the last 12 months, did you buy food or drinks at movie theaters, sports arenas, other places of recreation?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

6. CBQ535. The last time you ate out or bought food at a fast-food or pizza place, did you see calorie information?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

7. NewQ20. Which do you use more often when deciding to buy a food product—information on the food label about Percent Daily Value or about grams?

8. NewQ22. On packages containing two column labels, how often do you use the second column of information, the one containing nutrition information for the entire package? Would you say always, most of the time, sometimes, rarely, or never?

ELECTRONIC CIGARETTE QUESTIONS:

Electronic nicotine delivery systems, or ENDS, are battery-operated systems that heat a solution containing nicotine and produce a vapor or aerosol instead of smoke.  People use them in a manner that simulates smoking.  Examples of ENDs are e-cigarettes, e-hookahs and vape pens. 

1. During the last 7 days, {were you/was SP} in a place where someone was using an e-cigarette, e-hookah, vape-pen or other similar electronic product indoors?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

2. During the last 7 days, were {you were/SP was} riding in a car or motor vehicle where someone was using an e-cigarette, e-hookah, vape-pen or other similar electronic products?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

3. During the last 7 days, did you breathe the aerosol [vapor] from someone else who was using an e-cigarette, e-hookah, vape-pen or other similar electronic product in a public or private place?

YES.......................................................................    1

NO.........................................................................    2

REFUSED............................................................     7

DON'T KNOW......................................................    9

ALCOHOL USE QUESTIONS:

ALQ.120 Q/U

In the past 12 months, how often did {you/SP} drink any type of alcoholic beverage?

PROBE: How many days per week, per month, or per year did {you/SP} drink?

ENTER '0' FOR NEVER.

Range – 1-7 days/week, 1-32 days/month, 1-366 days/year

INTERVIEWER INSTRUCTION: IF QUANTITY CODED ‘0’, GO TO BOX 1.

|___|___|___|

ENTER QUANTITY

REFUSED 777 (BOX 1)

DON'T KNOW 999 (BOX 1)

|___|

ENTER UNIT

WEEK 1

MONTH 2

YEAR 3

BOX 1

CHECK ITEM ALQ.125:

IF RESPONDENT DIDN'T DRINK (CODED '0') IN ALQ.120, GO TO end.

OTHERWISE, CONTINUE WITH ALQ.130.

ALQ.130 In the past 12 months, on those days that {you/SP} drank alcoholic beverages, on the average, how many drinks did {you/he/she} have? (By a drink, I mean a 12 oz. beer, a 5 oz. glass of wine, or one and a half ounces of liquor.)

(SHOW FLASHCARD ALQ1)

IF LESS THAN 1 DRINK, ENTER '1'.

IF 95 DRINKS OR MORE, ENTER '95'.

INTERVIEWER INSTRUCTION:

IF RESPONSE >=20, THEN “YOU SAID ON THE DAYS THAT YOU DRINK YOU HAVE ON AVERAGE {FILL QUANTITY} DRINKS, IS THAT CORRECT?”

Range – 1-95

|___|___|___|

ENTER # OF DRINKS

REFUSED 777

DON'T KNOW 999

ALQ.141 Q/U In the past 12 months, on how many days did you have {4 if female OR 5 if male} or more drinks of any alcoholic beverage?

PROBE: How many days per week, per month, or per year did {you/SP} have {4 if

female OR 5 if male} or more drinks in a single day?

ENTER '0' FOR NONE.

Range – 1-7 days/week, 1-32 days/month, 1-366 days/year

|___|___|___|

ENTER QUANTITY

REFUSED 777 (ALQ.160)

DON'T KNOW 999 (ALQ.160)

|___|

ENTER UNIT

WEEK 1

MONTH 2

YEAR 3

ALQ.160 During the past 30 days, how many times did you drink {4 if female OR 5 if male} or more drinks of any kind of alcohol in about two hours?

ENTER '0' FOR NEVER.

IF RESPONSE IS > 60 TIMES, “YOU SAID THAT IN THE PAST 30 DAYS, YOU HAD {4 if female OR 5 if male} OR MORE DRINKS OF ANY KIND OF ALCOHOL IN ABOUT TWO HOURS, (FILL QUANTITY) TIMES. IS THAT CORRECT”?

|___|___|

ENTER QUANTITY

REFUSED 777

DON'T KNOW 999

AHB.181_00.000

Considering all types of alcoholic beverages, DURING THE PAST 30 DAYS, how many times did you have [fill: 5 or more/4 or more] drinks on an occasion?

* Enter '0' if none.

* Enter '60' if 60 or more times.

00-60 0-60

97 Refused

99 Don't know

N2AQ4A (SHOW FLASHCARD 24)

During the last 12 months, about how often did you drink any kind of alcoholic beverage?

1  Every day

2  Nearly every day

3  3 to 4 times a week

4  2 times a week

5  Once a week

6  2 to 3 times a month

7  Once a month

8  7 to 11 times in the last year

9  3 to 6 times in the last year

10  1 or 2 times in the last year

N2AQ4B

How many drinks did you USUALLY have on days when you drank during the last 12 months?

Number

N2AQ4F

(SHOW FLASHCARD 23) IF FEMALE During the last 12 months, about how often did you drink FOUR OR MORE drinks in a single day?

1 2 3 4 5 6 7 8 9 10 11

 Every day  Nearly every day  3 to 4 times a week  2 times a week  Once a week  2 to 3 times a month  Once a month  7 to 11 times in the last year  3 to 6 times in the last year  1 or 2 times in the last year  Never in the last year (SKIP to N2AQ4C)

N2AQ4H

(SHOW FLASHCARD 23) IF MALE During the last 12 months, about how often did you drink FIVE OR MORE drinks in a single day?

1 2 3 4 5 6 7 8 9 10 11

 Every day  Nearly every day  3 to 4 times a week  2 times a week  Once a week  2 to 3 times a month  Once a month  7 to 11 times in the last year  3 to 6 times in the last year  1 or 2 times in the last year  Never in the last year (SKIP to N2AQ4C)

N2AQ4I	(SHOW FLASHCARD 23) And during the last 12 months, about how often did you drink (FOUR or more if female OR FIVE or more if male) drinks in a period of TWO HOURS OR LESS?	1 2 3 4 5 6 7 8 9 10 11	 Every day  Nearly every day  3 to 4 times a week  2 times a week  Once a week  2 to 3 times a month  Once a month  7 to 11 times in the last year  3 to 6 times in the last year  1 or 2 times in the last year  Never in the last year
N2AQ4C

During the last 12 months, what was the LARGEST number of drinks that you drank in a single day?

Number

N2AQ4D (SHOW FLASHCARD 25)

APPROXIMATELY what was the largest number of drinks that you drank in a single day?

1  1-2 drinks

2  3-4 drinks

3  5-7 drinks

4  8-11 drinks

5  12-23 drinks

6  24+ drinks

N2AQ4E (SHOW FLASHCARD 24)

(Not counting times when you drank LESS than usual, about/About) how often during the last 12 months did you drink (number of drinks reported in N2AQ4C /this largest number of drinks) in a single day?

1  Every day

2  Nearly every day

3  3 to 4 times a week

4  2 times a week

5  Once a week

6  2 to 3 times a month

7  Once a month

8  7 to 11 times in the last year

9  3 to 6 times in the last year

10  1 or 2 times in the last year

FLASHCARD #ALQ1

See attached Adobe file

FLASHCARD #23

Questions: N2AQ4F, N2AQ4H, N2AQ4I

1  Every day

2  Nearly every day

3  3 to 4 times a week

4  2 times a week

5  Once a week

6  2 to 3 times a month

7  Once a month

8  7 to 11 times in the last year

9  3 to 6 times in the last year

10  1 or 2 times in the last year

11  Never in the last year

FLASHCARD #24

Questions: N2AQ4A, N2AQ4E

1  Every day

2  Nearly every day

3  3 to 4 times a week

4  2 times a week

5  Once a week

6  2 to 3 times a month

7  Once a month

8  7 to 11 times in the last year

9  3 to 6 times in the last year

10  1 or 2 times in the last year

FLASHCARD #25

Question: N2AQ4D

1  1-2 drinks

2  3-4 drinks

3  5-7 drinks

4  8-11 drinks

5  12-23 drinks

6  24+ drinks

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