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pdfAttachment 4d - New Supplement Questions
2016 Q1 NHIS Instrument Spec Report
Section name: Adult Adult Balance
Module
40
Section Name
Adult Adult Balance
Part
Question ID
BAL.010_00.000
Variable Name
BALEV
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
These next questions are about dizziness or balance problems. Have you EVER had a
problem with dizziness, lightheadedness, feeling as if you are going to pass out or faint,
or with unsteadiness or feeling off-balance? Do not include times when drinking
alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had balance problem
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BALAGE] <2,R,D> [goto BRPROB1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 1 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.020_00.000
Variable Name
BALAGE
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BALEV(e)='1'
Universe-text
Sample adults 18+ who have ever had a balance or dizziness problem
Question Text
At what age were you FIRST BOTHERED by dizziness, lightheadedness, feeling as if
you are going to pass out or faint, or with unsteadiness or feeling off-balance?
*Do not include times when drinking alcol.
*Enter '996' if since birth.
Answer Codes
<1-120, '996'>
Refused
Don't Know
Question Type
Integer
Field Pane Description
Age at first problem
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BALAGE] <2,R,D> [goto BDIZZ1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 2 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.040_00.000
Variable Name
BDIZZ1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
During the PAST 12 MONTHS, have you had a problem with dizziness or balance? Do
not include times when drinking alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Problem past 12 months
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRPROB1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 3 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.050_01.000
Variable Name
BRPROB1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
The next questions are about problems related to dizziness or balance. DURING THE
PAST 12 MONTHS, have you had any of the following problems? Do not include times
when drinking alcohol. Please say yes or no to each.
...Had severe fatigue
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fatigue
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRPROB2]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 4 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.050_02.000
Variable Name
BRPROB2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the
following problems? Do not include times when drinking alcohol. Please say yes or no
to each.
...Drifting to the side when trying to walk straight
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Drifting
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRPROB3]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 5 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.050_03.000
Variable Name
BRPROB3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the
following problems? Do not include times when drinking alcohol. Please say yes or no
to each.
...Bumping into one side or the other when walking through a doorway
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Doorway
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRPROB4]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 6 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.050_04.000
Variable Name
BRPROB4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the
following problems? Do not include times when drinking alcohol. Please say yes or no
to each.
...Difficulty walking in the dark without using support
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Dark
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRPROB5]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 7 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.050_05.000
Variable Name
BRPROB5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the
following problems? Do not include times when drinking alcohol. Please say yes or no
to each.
...Difficulty walking on uneven ground or surfaces
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Uneven ground
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRPROB6]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 8 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.050_06.000
Variable Name
BRPROB6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the
following problems? Do not include times when drinking alcohol. Please say yes or no
to each.
...Had fear of heights
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fear of heights
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BRPROB7]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 9 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.050_07.000
Variable Name
BRPROB7
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary. DURING THE PAST 12 MONTHS, have you had any of the
following problems? Do not include times when drinking alcohol. Please say yes or no
to each.
...Difficulty riding an escalator or moving walkway
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Escalator
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BALEV=2,R,D and BRPROB1 throughBRPROB7 all=2 then [goto BBIO1];
else if BALEV=1 and BDIZZ1=2 and BRPROB1 through BRPROB1 all=2 then [goto
BHOSP2]; else [goto BTYPE_1]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 10 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.060_01.000
Variable Name
BTYPE_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) =1) or
(any BRPROB1 -BRPROB7 = 1)
Universe-text
Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least
one balance related problem in the past 12 months
Question Text
This next question is about symptoms of dizziness or balance problems. Please tell me
if you have had any of these problems in the past 12 months. Please say yes or no to
each.
A spinning or vertigo sensation or other illusion of motion such as tipping, tilting, or
rocking
*Read if necessary: Vertigo is an illusion of rotation or other motion, as if riding a
carousel.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Vertigo
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTYPE_2]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 11 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.060_02.000
Variable Name
BTYPE_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) =1) or
(any BRPROB1 -BRPROB7 = 1)
Universe-text
Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least
one balance related problem in the past 12 months
Question Text
* Read if necessary. This next question is about symptoms of dizziness or balance
problems. Please tell me if you have had any of these problems in the past 12
months. Please say yes or no to each.
...A floating, spacey, or disconnected sensation
*Read if necessary: Your head doesn't feel quite right or normal.
* Read if necessary: Do not include times when drinking alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Spacey
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTYPE_3]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 12 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.060_03.000
Variable Name
BTYPE_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) =1) or
(any BRPROB1 -BRPROB7 = 1)
Universe-text
Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least
one balance related problem in the past 12 months
Question Text
* Read if necessary. This next question is about symptoms of dizziness or balance
problems. Please tell me if you have had any of these problems in the past 12
months. Please say yes or no to each.
...Feeling lightheaded, without a sense of motion
* Read if necessary: Do not include times when drinking alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Lightheaded
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTYPE_4]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 13 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.060_04.000
Variable Name
BTYPE_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) =1) or
(any BRPROB1 -BRPROB7 = 1)
Universe-text
Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least
one balance related problem in the past 12 months
Question Text
* Read if necessary. This next question is about symptoms of dizziness or balance
problems. Please tell me if you have had any of these problems in the past 12
months. Please say yes or no to each.
...Feeling as if you are going to pass out or faint
* Read if necessary: Do not include times when drinking alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Pass out
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTYPE_5]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 14 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.060_05.000
Variable Name
BTYPE_5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) =1) or
(any BRPROB1 -BRPROB7 = 1)
Universe-text
Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least
one balance related problem in the past 12 months
Question Text
* Read if necessary. This next question is about symptoms of dizziness or balance
problems. Please tell me if you have had any of these problems in the past 12
months. Please say yes or no to each.
...Blurring of your vision when you move your head
* Read if necessary: Do not include times when drinking alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Blurred vision
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTYPE_6]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 15 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.060_06.000
Variable Name
BTYPE_6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) =1) or
(any BRPROB1 -BRPROB7 = 1)
Universe-text
Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least
one balance related problem in the past 12 months
Question Text
* Read if necessary. This next question is about symptoms of dizziness or balance
problems. Please tell me if you have had any of these problems in the past 12
months. Please say yes or no to each.
...Feeling off-balance or unsteady
* Read if necessary: Do not include times when drinking alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Off balance
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTYPE_7]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 16 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.060_07.000
Variable Name
BTYPE_7
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) =1) or
(any BRPROB1 -BRPROB7 = 1)
Universe-text
Sample adults 18+ had a dizziness or balance problem in the last 12 months or at least
one balance related problem in the past 12 months
Question Text
* Read if necessary. This next question is about symptoms of dizziness or balance
problems. Please tell me if you have had any of these problems in the past 12
months. Please say yes or no to each.
...Other dizziness or balance problem.
* Read if necessary: Do not include times when drinking alcohol.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Other
if BDIZZ1=1 and (all BTYPE_1 -BTYPE_7 = 2,R,D) fill '7' in BBOTH1; else if only one
symptom identified in BTYPE_1-BTYPE_7 fill that value into BBOTH1
Special Instructions
Skip Instructions
<1,2,R,D> if BALEV=2,R,D and (all BTYPE_1 -BTYPE_7 = 2,R,D) [goto BBIO1];
else if BALEV=1 and (all BRPROB1-BRPROB7= 2,R,D) and (all BTYPE_1 -BTYPE_7
= 2,R,D) [goto BHOSP2]
else if BDIZZ1=1 and (all BTYPE_1 -BTYPE_7 = 2,R,D) fill '7' in BBOTH1 and [goto
BAGE1]
else if two or more BTYPE_1 - BTYPE_7 = 1 [goto BBOTH1];
else [goto BAGE1]
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Tuesday, September 22, 2015
Page 17 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.070_00.000
Variable Name
BBOTH1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and two or more
BTYPE_1(e) - BTYPE_7(e) = 1
Universe-text
Sample adults 18+ and more than one balance symptom
Question Text
DURING THE PAST 12 MONTHS, which ONE of these feelings of dizziness or
balance problems bothered you the most?
*Read answer categories below.
Answer Codes
SEE SPECIAL INSTRUCTIONS!
1. A spinning, vertigo, or motion sensation
2. A floating, spacey, or disconnected feeling
3. Feeling lightheaded
4. Feeling like you are about to pass out
5. Blurred vision
6. Unsteadiness
7. Other dizziness or balance problem
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Most bothersome
if BDIZZ1=1 and (all BTYPE_1 -BTYPE_7 = 2,R,D) fill '7' in BBOTH1; else if only one
symptom identified in BTYPE_1-BTYPE_7 fill that value into BBOTH1
Special Instructions Display only applicable Bolded Answer codes for the FR to read with the question.
Based upon the answers from BTYPE_1-BTYPE_07: DISPLAY AS FOLLOWS:
If BTYPE_01= 1 display "a spinning, vertigo, or motion sensation"
if BTYPE_02 = 1 display "A floating, spacey, or disconnected feeling"
if BTYPE_03 = 1 display "Feeling lightheaded"
if BTYPE_04 = 1 display "Feeling like you are about to pass out"
if BTYPE_05 = 1 display "Blurred vision"
if BTYPE_06 = 1display "Unsteadiness"
if BTYPE_07 = 1 display "Other dizziness or balance problem"
Skip Instructions
<1-7,R,D> [goto BAGE1]
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Tuesday, September 22, 2015
Page 18 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.080_00.000
Variable Name
BAGE1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
About how old were you when (Fill: most bothersome or only feeling) first happened?
* Read if necessary. If unsure, estimate as best you can.
* Enter '996' If since birth.
Answer Codes
(Allow 1-120, 996,R,D)
Refused
Don't Know
Question Type
Integer
Field Pane Description
Fill Instructions
Age of first problem
If BBOTH1 = 1 fill "the spinning, vertigo, or motion sensation"
else if BBOTH1 = 2 fill "the floating, spacey, or disconnected feeling"
else if BBOTH1 = 3 fill "the feeling of lightheaded"
else if BBOTH1 = 4 fill "the feeling like you are about to pass out"
else if BBOTH1 = 5 fill "blurred vision"
else if BBOTH1 = 6 fill "unsteadiness"
else if BBOTH1 = 7, DK, RF fill "this other dizziness or balance problem"
if BTYPE_1 - BTYPE_7 =< ' ', 2, R, D> fill "this other dizziness or balance problem"
If BBOTH1=R,D fill "this other dizziness or balance problem"
Special Instructions
Skip Instructions
<1-120> if BAGE1 gt AGE
[goto ERR2_BAGE1];
Else
[goto BOFTN]
<121-995> [goto ERR1_BAGE1]
<'996', R, D> [goto BOFTN]
Hard Edits
If BAGE1= 121-995 then display ERR1_BAGE1:
* 121-995 years not allowed in this field.
*Please correct.
If BAGE gt AGE, then display ERR2_BAGE:
* Time with condition cannot be greater than age.
* Please correct.
Soft Edits
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Tuesday, September 22, 2015
Page 19 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.100_01.000
Variable Name
BOFTN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
1 of 2
DURING THE PAST 12 MONTHS, about how often have you had the (Fill: most
bothersome or only feeling)?
*Please tell me the number of times per day, per week, per month.
*Enter '996' for 'Constantly' or 'Almost Always'.
Answer Codes
(Allow 1-365,996,R,D)
Question Type
Integer
Field Pane Description
Fill Instructions
Number
If BBOTH1 = 1 fill "the spinning, vertigo, or motion sensation"
else if BBOTH1 = 2 fill "the floating, spacey, or disconnected feeling"
else if BBOTH1 = 3 fill "the feeling of lightheaded"
else if BBOTH1 = 4 fill "the feeling like you are about to pass out"
else if BBOTH1 = 5 fill "blurred vision"
else if BBOTH1 = 6 fill "unsteadiness"
else if BBOTH1 = 7, DK, RF fill "this other dizziness or balance problem"
if BTYPE_1 - BTYPE_7 =< ' ', 2, R, D> fill "this other dizziness or balance problem"
If BBOTH1=R,D fill "this other dizziness or balance problem"
Special Instructions if BOFTN=996,R,D fill 996,R,D in BOFTT
Skip Instructions
<1-365> [goto BOFTT]
<996,R,D> [goto BLAST1]
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Tuesday, September 22, 2015
Page 20 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.100_02.000
Variable Name
BOFTT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and ('001'
<=BOFTN(e) <='365')
Universe-text
Sample adults 18+ who gave a number to how often they had the dizziness or balance
problem
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions if BOFTN=996,R,D fill 996,R,D in BOFTT
Skip Instructions
<1-4,R,D> [goto BLAST1]
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Tuesday, September 22, 2015
Page 21 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.110_00.000
Variable Name
BLAST1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
How long from beginning to end does each occurrence, i.e., episode, bout or "attack",
of (Fill: most bothersome or only feeling) usually last?
* Read if necessary. Only count the duration of individual spells or bouts, not a whole
cluster of them, and don't include other related symptoms. For example, do not include
nausea or vomiting.
*Probe if needed.
Answer Codes
1. Momentary, or less than two minutes
2. Two minutes to less than 20 minutes
3. 20 minutes to less than 8 hours
4. 8 hours to less than 24 hours
5. 1 day to less than 14 days
6. 2 weeks to less than 3 months
7. 3 months or longer
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Usually last
If BBOTH1 = 1 fill "the spinning, vertigo, or motion sensation"
else if BBOTH1 = 2 fill "the floating, spacey, or disconnected feeling"
else if BBOTH1 = 3 fill "the feeling of lightheaded"
else if BBOTH1 = 4 fill "the feeling like you are about to pass out"
else if BBOTH1 = 5 fill "blurred vision"
else if BBOTH1 = 6 fill "unsteadiness"
else if BBOTH1 = 7, DK, RF fill "this other dizziness or balance problem"
if BTYPE_1 - BTYPE_7 =< ' ', 2, R, D> fill "this other dizziness or balance problem"
If BBOTH1=R,D fill "this other dizziness or balance problem"
Special Instructions
Skip Instructions
<1-7, R,D> [goto BTRG_01]
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Tuesday, September 22, 2015
Page 22 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_01.000
Variable Name
BTRG_01
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
The next questions are about things that trigger your balance or dizziness problems.
Do any of the following usually cause or trigger your dizziness or balance problem(s)?
Please say yes or no to each.
...Looking up or down, leaning head back or bending forward
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Looking up
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_02]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 23 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_02.000
Variable Name
BTRG_02
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ have a dizziness or at least one balance symptom and does not
almost always have unsteadiness
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Rolling over in bed
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Rolling over
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_03]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 24 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_03.000
Variable Name
BTRG_03
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ have a dizziness or at least one balance symptom and does not
almost always have unsteadiness
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Getting up after sitting or lying down
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Getting up
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_04]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 25 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_04.000
Variable Name
BTRG_04
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ have a dizziness or at least one balance symptom and does not
almost always have unsteadiness
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Headache, including migraine
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Headache
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_05]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 26 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_05.000
Variable Name
BTRG_05
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ have a dizziness or at least one balance symptom and does not
almost always have unsteadiness
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...A visual problem such as double vision, or your eyes "jerk", "bounce", move rapidly or
oscillate
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Visual problem
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_06]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 27 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_06.000
Variable Name
BTRG_06
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Riding in a car, bus, airplane, boat, or train
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Riding
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_07]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 28 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_07.000
Variable Name
BTRG_07
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Walking down a grocery store aisle
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Grocery
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_08]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 29 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_08.000
Variable Name
BTRG_08
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Hearing loud sounds
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Loud sounds
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_09]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 30 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_09.000
Variable Name
BTRG_09
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Blowing your nose
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Blowing nose
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BTRG_10]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 31 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.120_10.000
Variable Name
BTRG_10
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following usually cause or trigger your (Fill: most
bothersome or only feeling)? Please say yes or no to each.
...Taking prescription medicines or drugs, or over-the-counter medications, e.g., for
allergy or sleep aids
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Meds
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BSAME]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 32 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.130_01.000
Variable Name
BSAME_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
Do any of the following problems happen around the same time as your dizziness or
balance problem(s)? Please say yes or no to each.
...Nausea or vomiting
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Nausea
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BONLY_1]
<2,R,D> [goto BSAME_2]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 33 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.130_02.000
Variable Name
BSAME_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following problems happen around the same time
as your dizziness or balance problem(s)? Please say yes or no to each.
...Hearing loss in only one ear
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Hearing loss
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BONLY_2]
<2,R,D> [goto BSAME_3]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 34 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.130_03.000
Variable Name
BSAME_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following problems happen around the same time
as your dizziness or balance problem(s)? Please say yes or no to each.
...Ringing, buzzing, or roaring in one ear-medical term is Tinnitus (TIN-uh-tus)
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Tinnitus
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BONLY_3]
<2,R,D> [goto BSAME_4]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 35 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.130_04.000
Variable Name
BSAME_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following problems happen around the same time
as your dizziness or balance problem(s)? Please say yes or no to each.
...Fullness, pressure, or stuffed-up feeling in one ear without pain ear without pain
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Pressure
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BONLY_4]
<2,R,D> [goto BSAME_5]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 36 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.130_05.000
Variable Name
BSAME_5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following problems happen around the same time
as your dizziness or balance problem(s)? Please say yes or no to each.
...Sinus congestion
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Sinus
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BONLY_5]
<2,R,D> [goto BSAME_6]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 37 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.130_06.000
Variable Name
BSAME_6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following problems happen around the same time
as your dizziness or balance problem(s)? Please say yes or no to each.
...Anxiety
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Anxiety
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BONLY_6];
<2,R,D> [goto BSAME_7]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 38 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.130_07.000
Variable Name
BSAME_7
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)=1 or
('01'<=BBOTH1(e)<='07')
Universe-text
Sample adults 18+ who had a dizziness or balance problem in the past 12 months or
who identified at least one symptom in the past 12 months
Question Text
* Read if necessary. Do any of the following problems happen around the same time
as your dizziness or balance problem(s)? Please say yes or no to each.
...Depression
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Depression
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BONLY_7];
<2,R,D> [goto BHOSP2]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 39 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.140_01.000
Variable Name
BONLY_1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BSAME_1(e)='1'
Universe-text
Sample adults 18+ who had nausea or vomiting around the same time as their
dizziness or balance problem
Question Text
Do you have nausea or vomiting only when you have dizziness or balance problem(s)
or do you have it regardless?
* Read if necessary. We mean around the same time, or just before, during or
following
Answer Codes
1. Only
2. Regardless
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Nausea followup
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BSAME_2]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 40 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.140_02.000
Variable Name
BONLY_2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BSAME_2(e)='1'
Universe-text
Sample adults 18+ who had hearing loss around the same time as their dizziness or
balance problem
Question Text
Do you have hearing loss only when you have dizziness or balance problem(s) or do
you have it regardless?
* Read if necessary. We mean around the same time, or just before, during or
following
Answer Codes
1. Only
2. Regardless
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Hearing loss followup
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BSAME_3]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 41 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.140_03.000
Variable Name
BONLY_3
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BSAME_3(e)='1'
Universe-text
Sample adults 18+ who had tinnitus around the same time as their dizziness or balance
problem
Question Text
Do you have ringing in your ear or tinnitus only when you have dizziness or balance
problem(s) or do you have it regardless?
* Read if necessary. We mean around the same time, or just before, during or
following
Answer Codes
1. Only
2. Regardless
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Tinnitus followup
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BSAME_4]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 42 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.140_04.000
Variable Name
BONLY_4
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BSAME_4(e)='1'
Universe-text
Sample adults 18+ who had fullness, pressure, or stuffiness in their ear around the
same time as their dizziness or balance problem
Question Text
Do you have fullness, pressure, or stuffiness in your ear only when you have dizziness
or balance problem(s) or do you have it regardless?
* Read if necessary. We mean around the same time, or just before, during or
following
Answer Codes
1. Only
2. Regardless
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Ear pressure followup
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BSAME_5]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 43 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.140_05.000
Variable Name
BONLY_5
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BSAME_5(e)='1'
Universe-text
Sample adults 18+ who had sinus congestion around the same time as their dizziness
or balance problem
Question Text
Do you have sinus congestion only when you have the dizziness or balance problem(s)
or do you have it regardless?
* Read if necessary. We mean around the same time, or just before, during or
following
Answer Codes
1. Only
2. Regardless
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Sinus followup
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BSAME_6]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 44 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.140_06.000
Variable Name
BONLY_6
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BSAME_6(e)='1'
Universe-text
Sample adults 18+ who had anxiety around the same time as their dizziness or balance
problem
Question Text
Do you have anxiety only when you have the dizziness or balance problem(s) or do you
have it regardless?
* Read if necessary. We mean around the same time, or just before, during or
following
Answer Codes
1. Only
2. Regardless
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Anxiety followup
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BSAME_7]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 45 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.140_07.000
Variable Name
BONLY_7
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BSAME_7(e)='1'
Universe-text
Sample adults 18+ who had depression around the same time as their dizziness or
balance problem
Question Text
Do you have depression only when you have the dizziness or balance problem(s) or do
you have it regardless?
* Read if necessary. We mean around the same time, or just before, during or
following
Answer Codes
1. Only
2. Regardless
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Depression followup
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BHOSP2]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 46 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.150_00.000
Variable Name
BHOSP2
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BALEV=1 or
(BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who have ever had a balance or dizziness problem or who had at
least one symptom in the past 12 months
Question Text
Have you ever gone to a hospital or emergency room about a dizziness or balance
problem?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
ER
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BHOSPNO1]
<2, R, D> [goto BHP1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 47 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.160_00.000
Variable Name
BHOSPNO1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BHOSP2(e)='1'
Universe-text
Sample adults 18+ and ever been to ER about dizziness
Question Text
DURING THE PAST 5 YEARS, about how many times have you gone to a hospital
emergency room about a dizziness or balance problem?
Answer Codes
0. None
1. 1 time
2. 2 times
3. 3-4 times
4. 5-9 times
5. 10-14 times
6. 15 or more times
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Times gone to ER
Fill Instructions
Special Instructions
Skip Instructions
<0-6, R,D> [goto BHP1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 48 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.170_00.000
Variable Name
BHP1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BALEV(e)='1' or
(BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who have ever had a balance or dizziness problem or who had at
least one symptom in the past 12 months
Question Text
Have you EVER seen a doctor or other health professional, except for in the
emergency room, about a dizziness or balance problem?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever seen doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BALEV=1 and BDIZZ1=2,R,D and all from
BTYPE_1-BTYPE_7=2,R,D [goto BBIO1];
else if BDIZZ1=1 or any from BTYPE_1-BTYPE_7=1 and BHP1=2,R,D and
BHOSP2=2,R,D [goto BTRET1];
else if BDIZZ1=1 or any from BTYPE_1-BTYPE_7=1 and BHP1=2,R,D and
BHOSP2=1 [goto BFIRST1];
else if BDIZZ1=1 or any from BTYPE_1-BTYPE_7=1 and BHP1=1 [goto BHP1_01]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 49 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_01.000
Variable Name
BHP1_01
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIZZ1(e)='1' or
(BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
DURING THE PAST 5 YEARS, have you seen any of the following types of doctors or
health professionals about your dizziness or balance problem(s)? Please say yes or no
to each.
... Family doctor, internal medicine doctor or general practitioner
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
GP
Fill Instructions
Special Instructions
Skip Instructions
< 1, 2, R,D> [goto BHP1_02
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 50 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_02.000
Variable Name
BHP1_02
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Cardiologist or heart specialist
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Cardiologist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_03]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 51 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_02_H
Variable Name
H_BHP_02
Universe
Universe-text
Question Text
Cardiologist: a doctor skilled in the diagnosis and treatment of heart disease
Neurologist: a doctor skilled in the diagnosis and treatment of disease of the nervous
system
Osteopath: They are fully licensed doctors who carry a D.O. instead of an M.D. degree.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 52 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_03.000
Variable Name
BHP1_03
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Ear, nose, and throat doctor
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
ENT
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_04]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 53 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_04.000
Variable Name
BHP1_04
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Neurologist
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Neurologist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_05]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 54 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_05.000
Variable Name
BHP1_05
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
... Eye doctor, optometrist, or ophthalmologist (AHF-thal-MOL-oh-jist)
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Eye doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_06]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 55 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_06.000
Variable Name
BHP1_06
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Dentist, orthodontist or oral surgeon
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Dentist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> and SEX =2 [goto BHP1_07];
Else if SEX=1 [goto BHP1_08]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 56 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_07.000
Variable Name
BHP1_07
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=2 and
(BDIZZ1(e)='1') or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or
(BTYPE_4(e)='1') or (BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and
BHP1(e)='1'
Universe-text
Female sample adults 18+ who had a balance or dizziness problem in the past 12
months or who had at least one symptom in the past 12 months and who ever saw a
doctor or other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Gynecologist or OB/GYN
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Gyn
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_08]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 57 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_08.000
Variable Name
BHP1_08
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Psychiatrist, psychologist or social worker
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Psychiatrist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_09]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 58 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_09.000
Variable Name
BHP1_09
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Osteopath (OS-te-o-path) or doctor of osteopathy (os-tee-OP-uh-thee)
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Osteopath
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_10]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 59 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_10.000
Variable Name
BHP1_10
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Occupational therapist, physical therapist or rehabilitation ("rehab") specialist/doctor
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Physical therapist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_11]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 60 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_11.000
Variable Name
BHP1_11
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Physician assistant or nurse practitioner
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Nurse
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_12]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 61 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_12.000
Variable Name
BHP1_12
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Nutritionist or dietician
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Nutritionist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_13]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 62 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_13.000
Variable Name
BHP1_13
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Audiologist
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Audiologist
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_14]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 63 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_14.000
Variable Name
BHP1_14
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Foot doctor
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Food doctor
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BHP1_15]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 64 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.180_15.000
Variable Name
BHP1_15
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
* Read if necessary: DURING THE PAST 5 YEARS, have you seen any of the
following types of doctors or health professionals about your dizziness or balance
problem(s)?
Please say yes or no to each.
...Some other health professional
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Other professional
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto B5YRS1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 65 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.190_00.000
Variable Name
B5YRS1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and BHP1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional about a dizziness or balance problem
Question Text
DURING THE PAST 5 YEARS, about how many times have you seen a doctor or other
health professional about your dizziness or balance problem(s)?
Answer Codes
0. None
1. 1 time
2. 2 times
3. 3-4 times
4. 5-9 times
5. 10-14 times
6. 15 or more times
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Times seen doctor
Fill Instructions
Special Instructions
Skip Instructions
< 0-6,R,D> [goto BFIRST]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 66 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.200_00.000
Variable Name
BFIRST1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1') or
(BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and (BHOSP2(e)='1' or
BHP1(e)='1')
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional (including ER) about a dizziness or balance problem
Question Text
How long ago did you FIRST see a doctor or other health professional, including
emergency room physicians about your dizziness or balance problem(s)?
Answer Codes
1. Less than 12 months
2. 12 months to less than 3 years
3. 3 years to less than 5 years
4. 5 years to less than 10 years
5. 10 years to less than 15 years
6. 15 years or more
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
First see doctor
Fill Instructions
Special Instructions
Skip Instructions
< 1-6,R,D> [goto BHELP1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 67 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.220_00.000
Variable Name
BHELP1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1') or
(BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and (BHOSP2(e)='1' or
BHP1(e)='1')
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional (including ER) about a dizziness or balance problem
Question Text
How much do you feel these doctor or other health professionals helped your dizziness
or balance problem(s)? Would you say...
*Read answer categories below.
Answer Codes
1. No help at all
2. A little help
3. Moderate help
4. A lot of help
5. Problem was cured or no longer exists
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Any help
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BTHLP_N]
<2,R,D> [goto BDIAG1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 68 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.230_01.000
Variable Name
BTHLP_N
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BHELP1(e)
IN('2','3','4','5')
Universe-text
Sample adults 18+ who feel doctor or other health professional helped dizziness at
least a little
Question Text
1 of 2
About how long was it between the first time you saw a doctor or other health
professional about your dizziness or balance problem(s) until you began to feel helped
by treatments or advice you received?
Please tell me the number of days, weeks, months or years.
Answer Codes
(Allow 1-365,R, D)
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions If BTHLP_N ='R', then fill 'R' in BTHLP_T
Skip Instructions
<1-365, D> [goto BTHLP_T];
[goto BDIAG1]
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Tuesday, September 22, 2015
Page 69 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.230_02.000
Variable Name
BTHLP_T
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(001<=BTHLP_N(e)<='365','999')
Universe-text
Sample adults 18+ who gave a number to the time between when first saw doctor and
began to feel help, or said DK to the number part of this question
Question Text
2 of 2
*Enter time period for time since last saw a doctor or other health professional.
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year(s)
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions If BTHLP_N ='R', then fill 'R' in BTHLP_T
Skip Instructions
<1-3,R,D> [goto BDIAG1]
<4> if (BTHLP_T gt AGE and BTHLP_T=4) [goto ERR_BTHLP_T]
else [goto BDIAG1]
Hard Edits
* Time with condition cannot be greater than age.
* Please correct
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 70 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.240_00.000
Variable Name
BDIAG1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1') or
(BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1')) and (BHOSP2(e)='1' or
BHP1(e)='1')
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and who ever saw a doctor or
other health professional (including ER) about a dizziness or balance problem
Question Text
Did any of the doctors or health care professionals tell you the cause or give you a
diagnosis for your dizziness or balance problem(s)?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Cause
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BCAUS1]
<2,R,D> [goto BTRET1]
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Tuesday, September 22, 2015
Page 71 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.250_00.000
Variable Name
BCAUS1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BDIAG1(e)='1'
Universe-text
Sample adults 18+ who were told cause of dizziness or balance problem
Question Text
What did the doctor(s) or health care professional(s) tell you was the cause or causes
of your dizziness or balance problem(s)?
* Enter all that apply, separate with commas.
* Read the list if necessary.
Answer Codes
1. Allergies
2. Anxiety or depression
3. Benign positional vertigo (BPV or BPPV)
4. Crystals-loose or dislodged in ear
5. Diabetes
6. Headache or migraines
7. Head or neck trauma or concussion
8. Heart disease
9. Inner ear infection, viral labrynthitis
10. Ménière’s (Men-e-AIRZ) disease
11. Neurological-multiple sclerosis (MS), seizures, etc.
12. Side effects from medications (antibiotics, cancer treatments, etc.)
13. Stroke
14. Other health problem(s)
Refused
Don't Know
Question Type
Enter All That Apply
Field Pane Description
What was cause
Fill Instructions
Special Instructions
Skip Instructions
<1-14,R,D> [goto BTRET1]
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Tuesday, September 22, 2015
Page 72 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.260_00.000
Variable Name
BTRET1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
Have you EVER taken or tried anything to treat your dizziness or balance problem(s)
such as physical therapy, certain exercises, avoiding certain foods, taking medicines,
surgery, or wearing magnets or wristbands?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Treated
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BTRT1_01]
<2,R,D> [goto BSTAT1]
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Tuesday, September 22, 2015
Page 73 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_01.000
Variable Name
BTRT1_01
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
Have you ever tried any of the following treatments? Please say yes or no to each.
...Exercises or physical therapy
* Do not include Tai Chi, Yoga, or Qi Gong.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Exercise
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_02]
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Tuesday, September 22, 2015
Page 74 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_02.000
Variable Name
BTRT1_02
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Bed rest for several hours or days
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Bed rest
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_03]
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Tuesday, September 22, 2015
Page 75 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_03.000
Variable Name
BTRT1_03
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
... Head rolling maneuver by a doctor or therapist (Epley maneuver)
* Do not include treatment by a chiropractor.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Head rolling
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_04]
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Tuesday, September 22, 2015
Page 76 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_04.000
Variable Name
BTRT1_04
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
... Steroid injections into the ear
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Steroid
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_05]
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Tuesday, September 22, 2015
Page 77 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_05.000
Variable Name
BTRT1_05
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Gentamicin (jen-tah-MI-sin) injection into the ear
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ear injection
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_06]
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Tuesday, September 22, 2015
Page 78 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_06.000
Variable Name
BTRT1_06
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Surgery
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Surgery
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_07]
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Tuesday, September 22, 2015
Page 79 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_07.000
Variable Name
BTRT1_07
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Low salt diet
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Low salt
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_08]
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Tuesday, September 22, 2015
Page 80 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_08.000
Variable Name
BTRT1_08
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Avoiding or cutting back on certain foods or drinks such as chocolate, coffee, or
alcohol
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Avoid foods
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> if SMKEV=1 [goto BTRT1_09]; else [goto BTRT1_10]
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Tuesday, September 22, 2015
Page 81 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_09.000
Variable Name
BTRT1_09
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
and SMKEV(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem who have ever smoked
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Quitting or reducing use of tobacco or cigarettes
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Cigarette use
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_10]
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Tuesday, September 22, 2015
Page 82 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_10.000
Variable Name
BTRT1_10
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Prescription medicine or drugs
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Prescriptions
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_11]
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Tuesday, September 22, 2015
Page 83 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_11.000
Variable Name
BTRT1_11
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Over-the-counter medicines such as allergy medications or sleep aids or Dramamin
patches
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Over the counter
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_12]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 84 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_12.000
Variable Name
BTRT1_12
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Psychiatric treatment
* Enter '2' for non-smokers.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Psychiatric
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_13]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 85 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_13.000
Variable Name
BTRT1_13
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Massage therapy or chiropractic treatment or manipulation
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Massage
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_14]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 86 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_14.000
Variable Name
BTRT1_14
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Acupuncture
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Acupuncture
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_15]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 87 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_15.000
Variable Name
BTRT1_15
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Herbal remedy such as feverfew leaf, ginger or ginkgo biloba (GIN-ko bye-LO-bah)
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Herbal
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BTRT1_16]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 88 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.270_16.000
Variable Name
BTRT1_16
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTRET1(e)='1'
Universe-text
Sample adults 18+ treated for dizziness or balance problem
Question Text
* Read if necessary. Have you ever tried any of the following treatments? Please say
yes or no to each.
...Wearing magnets or acupressure wristband
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Wristband
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BSTAT1]
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Soft Edits
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Tuesday, September 22, 2015
Page 89 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.280_00.000
Variable Name
BSTAT1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, have your dizziness or balance problem(s) gotten
worse, stayed the same, improved somewhat, or improved greatly?
Answer Codes
1. Gotten worse
2. Stayed the same
3. Improved somewhat
4. Improved greatly
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Status
Fill Instructions
Special Instructions
Skip Instructions
<1-4, R, D> [goto BMEDIC1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 90 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.300_00.000
Variable Name
BMEDIC1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
Do you regularly take any medicine that makes your dizziness or balance problem(s)
worse?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Meds make worse
Fill Instructions
Special Instructions
Skip Instructions
< 1,2, R, D> [goto BCHNG1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 91 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.310_00.000
Variable Name
BCHNG1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
Do your dizziness or balance problems prevent you in any way from doing things you
otherwise could do?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Prevent from doing things
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BCHG1_01]
<2, R,D> [goto BM12WS_N]
Hard Edits
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Tuesday, September 22, 2015
Page 92 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.320_01.000
Variable Name
BCHG1_01
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BCHNG1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and whose problem prevents
them from doing things
Question Text
Have your dizziness or balance problems caused you to change or cut back on any of
the following activities? Please say yes or no to each.
...Driving a motor vehicle
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Driving
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BCHNG_02]
Hard Edits
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AssocHelp
Tuesday, September 22, 2015
Page 93 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.320_02.000
Variable Name
BCHG1_02
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BCHNG1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and whose problem prevents
them from doing things
Question Text
* Read if necessary. Have your dizziness or balance problems caused you to change
or cut back on any of the following activities? Please say yes or no to each.
...Riding in a car, bus, airplane, boat or train
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Riding
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BCHNG_03]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 94 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.320_03.000
Variable Name
BCHG1_03
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BCHNG1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and whose problem prevents
them from doing things
Question Text
* Read if necessary. Have your dizziness or balance problems caused you to change
or cut back on any of the following activities? Please say yes or no to each.
....Exercising or taking walks
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Exercising
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BCHNG_04]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 95 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.320_04.000
Variable Name
BCHG1_04
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BCHNG1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and whose problem prevents
them from doing things
Question Text
* Read if necessary. Have your dizziness or balance problems caused you to change
or cut back on any of the following activities? Please say yes or no to each.
...Walking down a flight of stairs
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Walking down stairs
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BCHNG_05]
Hard Edits
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AssocHelp
Tuesday, September 22, 2015
Page 96 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.320_05.000
Variable Name
BCHG1_05
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BCHNG1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and whose problem prevents
them from doing things
Question Text
* Read if necessary. Have your dizziness or balance problems caused you to change
or cut back on any of the following activities? Please say yes or no to each.
...Participating in social activities outside your home
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Going outside
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BCHNG_06]
Hard Edits
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AssocHelp
Tuesday, September 22, 2015
Page 97 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.320_06.000
Variable Name
BCHG1_06
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BCHNG1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and whose problem prevents
them from doing things
Question Text
* Read if necessary. Have your dizziness or balance problems caused you to change
or cut back on any of the following activities? Please say yes or no to each.
... Performing household chores, such as cleaning or laundry
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Social activities
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BCHNG_07]
Hard Edits
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Tuesday, September 22, 2015
Page 98 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.320_07.000
Variable Name
BCHG1_07
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BCHNG1(e)='1'
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months and whose problem prevents
them from doing things
Question Text
* Read if necessary. Have your dizziness or balance problems caused you to change
or cut back on any of the following activities? Please say yes or no to each.
... Going to the toilet
* If respondent is unable to do this activity for reasons OTHER than dizziness or
balance, Enter '2'
Examples include respondents who are in a wheelchair, are deaf, blind, don’t have a
driver’s license, etc.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Bathing
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BM12WS_N]
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Tuesday, September 22, 2015
Page 99 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.350_00.000
Variable Name
BM12WS
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, how many days of work or school have you missed
because of your dizziness or balance problems?
Enter '0' for none.
Answer Codes
(Allow 0-365,R,D)
Question Type
Integer
Field Pane Description
Days missed W/S
Fill Instructions
Special Instructions
Skip Instructions
<0-365,R,D> [goto BM12RA]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 100 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.355_00.000
Variable Name
BM12RA
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, how many days of other regularly scheduled
activities - excluding work and school days - have you missed because of your
dizziness or balance problems?
Enter '0' for none.
Answer Codes
(Allow 0-365,R,D)
Question Type
Integer
Field Pane Description
Days missed RA
Fill Instructions
Special Instructions
Skip Instructions
<0-365,R,D> [goto BPROB1]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 101 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.360_00.000
Variable Name
BPROB1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, how much of a problem was your dizziness or
balance condition? Would you say it was no problem, a small problem, a moderate
problem, a big problem, or a very big problem?
Answer Codes
1. No problem
2. A small problem
3. A moderate problem
4. A big problem
5. A very big problem
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
How big was problem
Fill Instructions
Special Instructions
Skip Instructions
< 1-5,R,D> [goto BMED_1]
Hard Edits
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Tuesday, September 22, 2015
Page 102 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.370_01.000
Variable Name
BMED_1
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
Have you ever taken or had any of the following medications or treatments for ANY
health conditions or problems. Please say yes or no to each.
...Meclizine or Antivert™ for dizziness, nausea or vomiting
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Meclizine
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BMED_2]
Hard Edits
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Tuesday, September 22, 2015
Page 103 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.370_02.000
Variable Name
BMED_2
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
* Read if necessary. Have you ever taken or had any of the following medications or
treatments for ANY health conditions or problems. Please say yes or no to each.
...Other medicine or patches for motion sickness, nausea or vomiting
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Other nausea meds
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BMED_3]
Hard Edits
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Tuesday, September 22, 2015
Page 104 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.370_03.000
Variable Name
BMED_3
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
* Read if necessary. Have you ever taken or had any of the following medications or
treatments for ANY health conditions or problems. Please say yes or no to each.
...Medicines for anxiety or depression
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Meds for anxiety
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BMED_4]
Hard Edits
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Tuesday, September 22, 2015
Page 105 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.370_04.000
Variable Name
BMED_4
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
* Read if necessary. Have you ever taken or had any of the following medications or
treatments for ANY health conditions or problems. Please say yes or no to each.
...Chemotherapy (ke-mo-THER-ah-pe) drugs
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Chemotherapy drugs
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> [goto BBIO1]
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Tuesday, September 22, 2015
Page 106 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.380_00.000
Variable Name
BBIO1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have any of your biological, that is, BLOOD relatives such as parents, brothers, sisters,
or children had a problem with dizziness, balance, or falling, NOT related to aging?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Relatives
Fill Instructions
Special Instructions
Skip Instructions
< 1,2,R,D> if BDIZZ1=1 or any from BTYPE_1-BTYPE_7=1 [goto BFALL5Y]; else [goto
BFALL12M]
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Tuesday, September 22, 2015
Page 107 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.385_00.000
Variable Name
BFALL12M
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e) ne
'1') and (BTYPE_1(e) ne '1') and (BTYPE_2(e) ne '1') and (BTYPE_3(e) ne '1') and
(BTYPE_4(e) ne '1') and (BTYPE_5(e) ne '1') and (BTYPE_6(e) ne '1') and
(BTYPE_7(e) ne '1'))
Universe-text
Sample adults 18+ who did not have a balance or dizziness problem in the past 12
months and did not have at least one symptom in the past 12 months
Question Text
This next questions are about falls or falling. By falls or falling, we mean unexpectedly
dropping to the floor or ground from a standing, walking or bending position. DURING
THE PAST YEAR, have you fallen at least one time?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fallen past 12m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto next section]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 108 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.390_00.000
Variable Name
BFALL5Y
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
These next questions are about falls or falling. By falls or falling, we mean
unexpectedly dropping to the floor or ground from a standing, walking or bending
position. DURING THE PAST 5 YEARS, have you fallen at least one time?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fallen past 5y
Fill Instructions
Special Instructions
Skip Instructions
<1> if BTYPE_1 [goto BFL1_01];
else if BTYPE_2 [goto BFL1_02];
else if BTYPE_3 [goto BFL1_03];
else if BTYPE_4 [goto BFL1_04];
else if BTYPE_5 [goto BFL1_05];
else if BTYPE_6 [goto BFL1_06];
else if BTYPE_7 [goto BFL1_07];
<2,R,D> [goto BNRFALL]
Hard Edits
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Tuesday, September 22, 2015
Page 109 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.400_01.000
Variable Name
BFL1_01
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTYPE_1(e)='1'
and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who have a balance symptom of feeling a sense of spinning or
other movement sensation and have fallen past 5 years
Question Text
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the
time you were feeling a sense of spinning or other movement sensation?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Spinning
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BTYPE_2 [goto BFL1_02];
else if BTYPE_3 [goto BFL1_03];
else if BTYPE_4 [goto BFL1_04];
else if BTYPE_5 [goto BFL1_05];
else if BTYPE_6 [goto BFL1_06];
else if BTYPE_7 [goto BFL1_07];
else [goto BFALL12A]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 110 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.400_02.000
Variable Name
BFL1_02
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTYPE_2(e)='1'
and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who have a balance symptom of a floating, spacey, or disconnected
feeling and have fallen past 5 years
Question Text
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the
time you were having a floating, spacey, or disconnected feeling?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Spacey
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BTYPE_3 [goto BFL1_03];
else if BTYPE_4 [goto BFL1_04];
else if BTYPE_5 [goto BFL1_05];
else if BTYPE_6 [goto BFL1_06];
else if BTYPE_7 [goto BFL1_07];
else [goto BFALL12A]
Hard Edits
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AssocHelp
Tuesday, September 22, 2015
Page 111 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.400_03.000
Variable Name
BFL1_03
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTYPE_3(e)='1'
and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who have a balance symptom of feeling lightheaded and have fallen
past 5 years
Question Text
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the
time you were feeling lightheaded?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Lightheaded
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BTYPE_4 [goto BFL1_04];
else if BTYPE_5 [goto BFL1_05];
else if BTYPE_6 [goto BFL1_06];
else if BTYPE_7 [goto BFL1_07];
else [goto BFALL12A]
Hard Edits
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Tuesday, September 22, 2015
Page 112 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.400_04.000
Variable Name
BFL1_04
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTYPE_4(e)='1'
and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who have a balance symptom of feeling like they are about to pass
out and have fallen past 5 years
Question Text
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the
time you were feeling like you are about to pass out?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Pass out
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BTYPE_5 [goto BFL1_05];
else if BTYPE_6 [goto BFL1_06];
else if BTYPE_7 [goto BFL1_07];
else [goto BFALL12A]
Hard Edits
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Tuesday, September 22, 2015
Page 113 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.400_05.000
Variable Name
BFL1_05
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTYPE_5(e)='1'
and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who have a balance symptom of blurred vision and have fallen past
5 years
Question Text
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the
time you were having blurred vision?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Blurred vision
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BTYPE_6 [goto BFL1_06];
else if BTYPE_7 [goto BFL1_07];
else [goto BFALL12A]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 114 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.400_06.000
Variable Name
BFL1_06
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTYPE_6(e)='1'
and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who have a balance symptom of unsteadiness and have fallen past
5 years
Question Text
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the
time you were having a general feeling of being unsteady or off-balance?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Unsteadiness
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BTYPE_6 [goto BFL1_06];
else if BTYPE_7 [goto BFL1_07];
else [goto BFALL12A]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 115 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.400_07.000
Variable Name
BFL1_07
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BTYPE_7(e)='1'
and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who have an other or general balance symptom and have fallen
past 5 years
Question Text
DURING THE PAST 5 YEARS, did any of your falls occur just before or around the
time you were having and other or general problem with dizziness or imbalance?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Other/General imbalance
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if BTYPE_7 [goto BFL1_07];
else [goto BFALL12A]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 116 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.410_00.000
Variable Name
BFALL12A
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL5Y(e)='1'
Universe-text
Sample adults 18+ who had a fall in past 5 years
Question Text
DURING THE PAST 12 MONTHS, have you fallen at least once a month on average?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fall once a month
Fill Instructions
Special Instructions
Skip Instructions
<1> go to BF12M_NO]
<2,R,D> [goto BFTIME1]
Hard Edits
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Tuesday, September 22, 2015
Page 117 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.420_01.000
Variable Name
BF12M_NO
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in last 12 months
Question Text
1 of 2
DURING THE PAST 12 MONTHS, about how many times per day, week, or month
have you fallen?
Answer Codes
<1-500>
Refused
Don't Know
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions If BF12M_NO ='R', then fill 'R' in BF12M_TP
Skip Instructions
<1-500,D> [goto BF12M_TP]
[goto BINJ1]
Hard Edits
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Tuesday, September 22, 2015
Page 118 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.420_02.000
Variable Name
BF12M_TP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12(e)='1'
and ('001<=BF12M_NO(e)<='365','999')
Universe-text
Sample adults 18+ who have fallen at least once a month in the last 12 months and
gave a number for time fallen or said DK to number part of this question
Question Text
2 of 2
* Enter time period for time fallen.
Answer Codes
1. Day
2. Week
3. Month
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions If BF12M_NO ='R', then fill 'R' in BF12M_TP
Skip Instructions
If (BF12M_NO ge 10 and BF12M_TP='1'), then [goto ERR_BF12M_TP];
If (BF12M_NO ge 50 and BF12M_TP='2'), then [goto ERR_BF12M_TP];
If (BF12M_NO ge 200 and BF12M_TP='3'), then [goto ERR_BF12M_TP];
<1-3,R,D> [goto BINJ1]
Hard Edits
Soft Edits
If (BF12M_NO ge 10 and BF12M_TP='1') or (BF12M_NO ge 50 and BF12M_TP='2') or
(BF12M_NO ge 200 and BF12M_TP='3'),
then ERR_BF12M_TP:
* [Fill1: BF12M_NO] times per [Fill2: BF12M_TP] is unusually high.
* Please verify.
AssocHelp
Tuesday, September 22, 2015
Page 119 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.430_00.000
Variable Name
BFTIME1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)
IN('2','7','9')
Universe-text
Sample adults 18+ who haven't fallen at least once a month in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, how many times have you fallen?
*Read if necessary. If unsure, estimate as best you can.
Answer Codes
0. None
1. 1 time
2. 2 times
3. 3-4 times
4. 5-7 times
5. 8 or more times
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Number fall past 12m
Fill Instructions
Special Instructions
Skip Instructions
<0> [goto BNRFALL]
<1-5, R,D> [goto BINJ1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 120 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.440_00.000
Variable Name
BINJ1
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, did you have an injury as a result of a fall? For
example, with a bruise, cut or wound, sprain, dislocation, fracture, broken bones, back
pain, head or neck injury.
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Injured
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BINJWS]
<2,R,D> [goto BFWH_01]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 121 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.450_00.000
Variable Name
BINJWS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BINJ1(e)='1'
Universe-text
Sample adults 18+ who were injured by fall(s) in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, how many days of work or school did you miss
because of injury from falls?
* Enter '996 if doesn't work or go to school.
Answer Codes
(Allow 0-365, 996,R,D)
'996' Doesn't work or go to school
Refused
Don't Know
Question Type
Integer
Field Pane Description
Days missed work/school
Fill Instructions
Special Instructions
Skip Instructions
<0-365,R,D> [goto BINJHP]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 122 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.455_00.000
Variable Name
BINJHP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BINJ1(e)='1'
Universe-text
Sample adults 18+ who were injured by fall(s) in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, did you talk to or see a doctor or other health
professional about any injuries that you had as a result of a fall or falling?
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Talk to HP about fall
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto BINJHPN] <2,R,D> [goto BFWH_01]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 123 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.457_00.000
Variable Name
BINJHPN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BINJHP(e)='1'
Universe-text
Sample adults 18+ who talked to a doctor or other health professional about falls or
falling in the past 12 months
Question Text
Thinking about your worst injury that resulted from a fall or falling DURING THE PAST
12 MONTHS, how many times did you talk to or see a medical professional about that
injury?
Answer Codes
0. None
1. 1 time
2. 2 times
3. 3-4 times
4. 5-9 times
5. 10-14 times
6. 15 or more times
Refused
Don't know
Question Type
Pick One-Answer List Pane
Field Pane Description
Number of HP
Fill Instructions
Special Instructions
Skip Instructions
<0-6,R,D> [goto BFWH_01]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 124 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_01.000
Variable Name
BFWH_01
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
Have you fallen during the past 12 months due to any of the following reasons? Please
say yes or no to each.
...You tripped, stumbled, or slipped
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Tripped
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_02]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 125 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_02.000
Variable Name
BFWH_02
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You blacked out or fainted
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fainted
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_03]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 126 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_03.000
Variable Name
BFWH_03
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You were playing sports or exercising
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Sports
Fill Instructions
Special Instructions
Skip Instructions
<1,2 R,D> [goto BFWH_04]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 127 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_04_000
Variable Name
BFWH_04
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You had a problem with vision
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Vision
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_05]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 128 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_05.000
Variable Name
BFWH_05
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You had weakness or numbness in one or both legs
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Weakness
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_06]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 129 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_06.000
Variable Name
BFWH_06
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You had not eaten recently or you had low blood sugar
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
No food
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_07]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 130 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_07.000
Variable Name
BFWH_07
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You drank too much alcohol
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Alcohol
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_08]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 131 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_08.000
Variable Name
BFWH_08
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You had a problem using a walker, cane, or other aid that helps you get around
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Problem with cane
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_09]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 132 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_09.000
Variable Name
BFWH_09
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...You had a problem with shoes, sandals or socks
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Shoes
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BFWH_10]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 133 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.460_10.000
Variable Name
BFWH_10
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and BFALL12A(e)='1'
Universe-text
Sample adults 18+ who have fallen at least once a month in the past 12 months
Question Text
* Read if necessary. Have you fallen during the past 12 months due to any of the
following reasons? Please say yes or no to each.
...Some other reason
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Other reason
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BNRFALL]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 134 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.470_00.000
Variable Name
BNRFALL
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, how many times have you slipped or lost your
balance and caught yourself WITHOUT falling?
Answer Codes
0. None
1. 1 time
2. 2 times
3. 3 to 4 times
4. 5 to 7 times
5. 8 or more times
Question Type
Pick One-Answer List Pane
Field Pane Description
Near fall
Fill Instructions
Special Instructions
Skip Instructions
<0-5,R,D> [goto BINTHI]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 135 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.475_01.000
Variable Name
BINTHI
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
DURING THE PAST 12 MONTHS, have you used the Internet for any of the following
reasons? Please say yes or no to each.
...To look up health information on your dizziness or balance problems
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Health information
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BINTTR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 136 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.475_02.000
Variable Name
BINTTR
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
*Read if necessary. DURING THE PAST 12 MONTHS, have you used the Internet for
any of the following reasons? Please say yes or no to each.
...To learn about medical or other recommended treatments for your dizziness or
balance problems
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Treatments
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto BINTRS]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 137 of 138
Module
40
Section Name
Adult Balance
Part
Question ID
BAL.475_03.000
Variable Name
BINTRS
Universe
HHHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and (BDIZZ1(e)='1')
or (BTYPE_1(e)='1') or (BTYPE_2(e)='1') or (BTYPE_3(e)='1') or (BTYPE_4(e)='1') or
(BTYPE_5(e)='1') or (BTYPE_6(e)='1') or (BTYPE_7(e)='1'))
Universe-text
Sample adults 18+ who had a balance or dizziness problem in the past 12 months or
who had at least one symptom in the past 12 months
Question Text
*Read if necessary. DURING THE PAST 12 MONTHS, have you used the Internet for
any of the following reasons? Please say yes or no to each.
...To learn about rehabilitation services or intervention programs for your dizziness or
balance problems
Answer Codes
1.Yes
2.No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Rehabilitation
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>
If FDRN_FLG= '1' [goto VIS_0 / AFD.090_00.000]
Else if FDRN_FLG= '2' [goto AWEBUSE / AWB.010_00.000]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 138 of 138
2016 Q1 NHIS Instrument Spec Report
Section name: Child Balance
Module
46
Section Name
Child Balance
Part
Question ID
CBL.010_00.000
Variable Name
CBALWLK
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
At what age did {fill1: S.C. name} take {fill2: his/her} first steps without support?
Answer Codes
1. 6 to 8 months
2. 9 to 11 months
3. 12 to 14 months
4. 15 to 17 months
5. 18 to 23 months
6. 24 months (2 years) or later
7. Cannot walk
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Age first steps
Fill Instructions
Special Instructions
Skip Instructions
<1-7,R,D> [goto CBALVRTG]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 1 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.020_00.000
Variable Name
CBALVRTG
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
These next questions are about balance problems or disorders that children may
experience such as feeling unsteady, dizzy, light headed, or woozy or having body or
motor coordination problems.
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of
any of the following dizziness or balance problems?
...a spinning or vertigo feeling with a sense of movement, such as rocking of oneself or
riding a Merry-Go-Round?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Vertigo - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALSTED]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 2 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.025_00.000
Variable Name
CBALSTED
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of
any of the following dizziness or balance problems?
… poor balance, an unsteady or woozy feeling that makes it difficult to stand up or
walk?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Poor balance - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALMOTR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 3 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.027_00.000
Variable Name
CBALMOTR
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of
any of the following dizziness or balance problems?
… problems with body or motor coordination or clumsiness ?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Poor coordination - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALFALL]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 4 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.030_00.000
Variable Name
CBALFALL
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of
any of the following dizziness or balance problems?
...frequent, unexpected falls?
*If asked, specify: if falls EVER happened more often than once a week.
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Falls - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALPASS]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 5 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.035_00.000
Variable Name
CBALPASS
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of
any of the following dizziness or balance problems?
...feeling light-headed, fainting, or feeling {fill: he/she} is about to pass out?
*If child does faint or pass out, enter ‘1’ for yes.
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Pass out - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALBLR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 6 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.037_00.000
Variable Name
CBALBLR
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of
any of the following dizziness or balance problems?
… blurred vision when head is moving, or rapid eye movements known as “bouncing”
eyes causing disorientation?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Blurred vision - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALOTH]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 7 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.039_00.000
Variable Name
CBALOTH
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by episodes of
any of the following dizziness or balance problems?
… any other type of balance or dizziness problems?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Other - past 12 mo.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if CBALVRTG=1 or CBALSTED=1 or CBALMOTR=1 or CBALFALL=1 or
CBALPASS=1 or CBALBLR=1 or CBALOTH=1 [goto CBALBHD]; else [goto CBALHDIJ]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 8 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.040_00.000
Variable Name
CBALBHD
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALBLR(e)='1' or CBALOTH(e)='1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} been bothered by headaches
or migraines around the same time as {fill: his/her} dizziness or balance problem(s)?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Headaches with balance prob.
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALBHR]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 9 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.041_00.000
Variable Name
CBALBHR
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALBLR(e)='1' or CBALOTH(e)='1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} had hearing changes or
problems such as blocked ears or ringing in the ears around the same time as {fill:
his/her} dizziness or balance problem(s)?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Hearing problems w/balance
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALAGE]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 10 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.042_00.000
Variable Name
CBALAGE
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALBLR(e)='1' or CBALOTH(e)='1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
How old was {fill: S.C. name} when the FIRST episode, bout or “attack” of dizziness or
balance problem occurred?
*Read if necessary: : If uncertain of exact age, estimate to the best of your recollection.
Answer Codes
(Allow 0-17,R,D)
Question Type
Integer
Field Pane Description
Age balance prob. Began
Fill Instructions
Special Instructions
Skip Instructions
<0-17,R,D> [goto CBALOFTN]
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Soft Edits
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Tuesday, September 22, 2015
Page 11 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.043_01.000
Variable Name
CBALOFTN
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALBLR(e)='1' or CBALOTH(e)='1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
1 of 2
DURING THE PAST 12 MONTHS, how often did {fill: S.C. name}’s episodes, bouts or
“attacks” of dizziness or balance problems occur?
*Enter '96' for 'Constantly'.
*Do not include the time to get over feelings of nausea or vomiting that may accompany
the episode, bout, or attack of dizziness or balance problem.
Answer Codes
(Allow 0-95,96,R,D)
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions
Skip Instructions
<1-95> [goto CBALOFTT] <96,R,D> [goto CBALDUR]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 12 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.043_02.000
Variable Name
CBALOFTT
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and ('01' <= CBALOFTN(e) <= '95')
Universe-text
Sample children 3+ who gave a number for how often balance problems occurred in
the past 12 months
Question Text
2 of 2
*Enter time period.
Answer Codes
1. Day(s)
2. Week(s)
3. Month(s)
4. Year
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto CBALDUR]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 13 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.044_00.000
Variable Name
CBALDUR
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALBLR(e)='1' or CBALOTH(e)='1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
How long does (or did) a typical episode, bout or “attack” of dizziness or balance
problem last?
Answer Codes
1. Momentary, or less than 2 minutes
2. Two minutes to less than 20 minutes
3. 20 minutes to less than 8 hours
4. 8 hours to less than 24 hours
5. 1 day to less than 14 days
6. 2 weeks to less than 3 months
7. 3 months or longer
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Duration of problem
Fill Instructions
Special Instructions
Skip Instructions
<1-7,R,D> [goto CBALDGHP]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 14 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.045_00.000
Variable Name
CBALDGHP
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALOTH(e)='1' or CBALBLR(e) = '1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
Did a doctor or other health professional EVER tell you a diagnosis or reason for {fill1:
S.C. name}'s dizziness or balance problems?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Ever diagnosed
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CBALDGN2] <2,R,D> [goto CBALPART]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 15 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.050_00.000
Variable Name
CBALDGN2
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and CBALDGHP(e)='1'
Universe-text
Sample children 3+ who have ever been told a diagnosis for their balance or dizziness
problems
Question Text
What diagnoses or reasons were you told caused {fill1: S.C. name}'s balance or
dizziness problems?
*Enter all that apply, separate with commas.
Answer Codes
1. Anxiety, including panic syndrome
2. Benign positional or paroxysmal vertigo (BPV)
3. Blurred vision with head motion, “bouncing” or rapid eye movements
4. Crystals – loose or dislodged in the ear
5. Depression or child psychiatric disorder
6. Developmental motor coordination disorder (“clumsy” child)
7. Diabetes (“juvenile diabetes”)
8. Ear infection(s) – otitis media, fluid, viral labrynthitis
9. Genetic syndrome, such as Usher’s or Waardenburg Syndrome
10 Headache, including migraine
11. Head/neck injury or concussion
12. Low blood pressure (hypotension)
13. Malformation of the ear
14. Meniere’s disease
15. Neurological, such as cerebral palsy, seizure(s), etc.
16. Nutritional, such as low blood sugar (metabolic problem)
17. Side effects from medications (antibiotics, etc.)
18. Other health condition or cause
Refused
Don't Know
Question Type
Enter all that apply
Field Pane Description
Diagnoses
Fill Instructions
Special Instructions
Skip Instructions
<1-18,R,D> [goto CBALPART]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 16 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.055_00.000
Variable Name
CBALPART
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALOTH(e)='1' or CBALBLR(e) = '1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
Did any of these episodes of dizziness or balance problems keep {fill1: S.C. name}
from participating in home, school, {fill2: work,} or recreational activities?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Problems participating
fill2: age GE 16 fill "work,"
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALPROB]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 17 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.060_00.000
Variable Name
CBALPROB
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALOTH(e)='1' or CBALBLR(e) = '1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
DURING THE PAST 12 MONTHS, how much of a problem were these episodes of
dizziness or imbalance for {fill1: S.C. name}? Would you say it was...
*Read categories below.
Answer Codes
1. No problem
2. A small problem
3. A moderate problem
4. A big problem
5. A very big problem
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
How much problem
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto CBALHPYR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 18 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.065_00.000
Variable Name
CBALHPYR
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALOTH(e)='1' or CBALBLR(e) = '1')
Universe-text
Sample children 3+ who have had episodes of balance or dizziness in the past 12
months
Question Text
DURING THE PAST 12 MONTHS, has {fill1: S.C name} seen a doctor, physical or
occupational therapist, or other health care professional about these episodes of
dizziness or balance problems? Include visits to the Emergency Room, hospital, or
health clinics.
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Health care pro visit
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto CBALTRET]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 19 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.070_00.000
Variable Name
CBALTRET
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and (CBALVRTG(e)='1' or
CBALSTED(e)='1' or CBALMOTR(e)='1' or CBALFALL(e)='1' or CBALPASS(e)='1' or
CBALOTH(e)='1' or CBALBLR(e) = '1')
Universe-text
Sample children 3+ who have had episodes of balance the past 12 months
Question Text
DURING THE PAST 12 MONTHS, has {fill1: S.C. name} tried methods recommended
by a doctor, physical or occupational therapist, or other health care professional for
treating {fill2: his/her} episodes of dizziness or balance problems?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Methods
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>[goto CBALHDIJ]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 20 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.075_00.000
Variable Name
CBALHDIJ
Universe
HHSTAT4='C' and ('003' <= AGE <= '017')
Universe-text
Sample children 3+
Question Text
IN {fill: his/her} LIFETIME, has {fill1: S.C. name} EVER had a significant head injury or
concussion?
Answer Codes
1. Yes
2. No
Refused
Don’t know
Question Type
Yes/No
Field Pane Description
Head Injury
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CBALHDNO] <2,R,D> if AGE=4-17 goto CMHCOPY; else goto CH1N1_1]
Hard Edits
Soft Edits
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Tuesday, September 22, 2015
Page 21 of 22
Module
46
Section Name
Child Balance
Part
Question ID
CBL.080_00.000
Variable Name
CBALHDNO
Universe
HHSTAT4='C' and ('003' <= AGE <= '017') and CBALHDIJ(e)='1'
Universe-text
Sample children 3+ who have ever had a significant head injury or concussion
Question Text
IN {fill: his/her} LIFETIME, how many significant head injuries or concussions has {fill1:
S.C. name} had?
Answer Codes
(allow 1-95,R,D)
Question Type
Integer
Field Pane Description
Number of injuries
Fill Instructions
Special Instructions
Skip Instructions
<1-95,R,D> if AGE=4-17 goto CMHCOPY; else goto CH1N1_1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 22 of 22
2016 Q1 NHIS Instrument Spec Report
Section name: Adult Sexual Identity and Lifestyle Questions
Module
52
Section Name
Adult Sexual Identity and Lifestyle Questions
Part
Question ID
ASI.405_00.000
Variable Name
ACIBLD12
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Now, I am going to ask about giving blood donations to a blood bank such as the
American Red Cross.
During the PAST 12 MONTHS, have you donated blood?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Blood donation, past 12 m
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto ACIHIVT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 1 of 1
2016 Q1 NHIS Instrument Spec Report
Section name: Adult Conditions
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.154_00.010
Variable Name
PREGEVER
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX=2
Universe-text
Female Sample adults 18+
Question Text
Have you ever been pregnant?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever been pregnant
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DBHVPAY]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 1 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.155_00.010
Variable Name
DBHVPAY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
DURING THE PAST 12 MONTHS, have you been told by a doctor or health
professional to do any of the following ...
Increase your physical activity or exercise?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Physical activity-12M
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DBHVCLY]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 2 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.155_00.020
Variable Name
DBHVCLY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, have you been told by a doctor or health
professional to do any of the following...
Reduce the amount of fat or calories in your diet?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Reducing fat/calories-12M
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DBHVWLY]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 3 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.155_00.030
Variable Name
DBHVWLY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
DURING THE PAST 12 MONTHS, have you been told by a doctor or health
professional to do any of the following...
Participate in a weight loss program?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Weight loss prog-12M
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DBHVPAN]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 4 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.155_00.040
Variable Name
DBHVPAN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Are you NOW doing any of the following...
Increasing your physical activity or exercise?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Physical activity-now
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DBHVCLN]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 5 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.155_00.050
Variable Name
DBHVCLN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
Are you NOW doing any of the following...
Reducing the amount of fat or calories in your diet?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Reducing fat/calories-now
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DBHVWLN]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 6 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.155_00.060
Variable Name
DBHVWLN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
*Read if necessary.
Are you NOW doing any of the following...
Participating in a weight loss program?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Weight loss prog-now
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DIBREL]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 7 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.155_00.070
Variable Name
DIBREL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Has your mother, father, brother, or sister EVER been told by a doctor or other health
professional that they have diabetes or sugar diabetes?
*Include only blood relatives. Do not include step-relatives or those unrelated by blood.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Diabetes relatives
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DIBEV1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 8 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.160_00.000
Variable Name
DIBEV1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
?[F1]
[Fill1:Other than during pregnancy, have you EVER been told by a doctor or other
health professional that you have diabetes or sugar diabetes?]/[Fill2:Have you EVER
been told by a doctor or other health professional that you have diabetes or sugar
diabetes?]
Answer Codes
1. Yes
2. No
3. Borderline or prediabetes
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Diabetes - ever
Fill1: [If PREGEVER=1 (ever been pregnant)]
Fill2: [if SEX ne 2 or PREGEVER ne 1]
Special Instructions ANSWER categories should appear vertically. If DIBEV1=3 fill “1” in DIBPRE1
Skip Instructions
<1> [goto DIBAGE]
<2,R,D> [goto DIBPRE1]
<3> [goto DIBTEST]
Hard Edits
Soft Edits
AssocHelp
H_DIBEV1
Tuesday, September 22, 2015
Page 9 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.160_H
Variable Name
H_DIBEV1
Universe
Universe-text
Question Text
Do not include a doctor's diagnosis of prediabetes or borderline diabetes.
Do not include a doctor's diagnosis of gestational diabetes or diabetes present only
when a woman is pregnant.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions Associated screens:
DIBEV1
DIBAGE
Skip Instructions
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 10 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.165_00.000
Variable Name
DIBPRE1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e) IN
('2','7','9')
Universe-text
Sample adults 18+ who were never told they had diabetes, or who refused or said don’t
know to having been told they had diabetes
Question Text
?[F1]
Have you EVER been told by a doctor or other health professional that you have any of
the following: prediabetes, impaired fasting glucose, impaired glucose tolerance,
borderline diabetes, or high blood sugar?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Pre-diabetic symptoms
Fill Instructions
Special Instructions If DIBEV1=3 (Borderline or prediabetes) fill 1 in DIBPRE1
Skip Instructions
<1,2,R,D> [goto DIBTEST]
Hard Edits
Soft Edits
AssocHelp
H_DIBEV1
Tuesday, September 22, 2015
Page 11 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.167_00.000
Variable Name
DIBTEST
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBPRE1(e) IN
('1','2','7','9')
Universe-text
Sample adults 18+ who do not have diabetes
Question Text
About how long has it been since you last had a blood test for high blood sugar or
diabetes?
Answer Codes
1. 1 year ago or less
2. More than 1 year, but not more than 2 years ago
3. More than 2 years, but not more than 3 years ago
4. More than 3 years ago
5. Never
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Diabetes test
Fill Instructions
Special Instructions Universe includes those who said prediabetes/borderline diabetes at DIBEV1; these
people would have had a '1' filled into the DIBPRE1 question and are captured in that
universe for this question
Skip Instructions
<1-5,R,D> if DIBPRE1='1' [goto DIBPILL];
else if SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto DIBPRGM];
else (SEX=2 and PREGEVER=1) [goto DIBGDM]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 12 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.170_00.000
Variable Name
DIBAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e)='1'
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy)
Question Text
?[F1]
How old were you when a doctor or other health professional FIRST told you that you
had diabetes or sugar diabetes?
Answer Codes
Question Type
Integer
Field Pane Description
Diabetes - age
Fill Instructions
Special Instructions
Skip Instructions
<1-100 R,D> [goto DIBTYPE]
If number in DIBAGE greater than person years old (AGE) goto ERR_ DIBAGE
Hard Edits
ERR_ DIBAGE
* [Fill1: DIBAGE] years old is older than your age[fill2: AGE].
* Please correct.
Soft Edits
AssocHelp
H_DIBEV1
Tuesday, September 22, 2015
Page 13 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.175_00.010
Variable Name
DIBTYPE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e)='1'
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy)
Question Text
What type of diabetes do you have?
*Read answer categories below.
Answer Codes
1. Type 1
2. Type 2
3. Other
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Diabetes type
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto DIBPILL]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 14 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.180_00.000
Variable Name
DIBPILL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DIBEV1(e)='1') or
(DIBPRE1(e)='1')
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy) or who were told they had pre-diabetes, impaired fasting glucose,
impaired glucose tolderance, borderline diabetes, or high blood sugar
Question Text
Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes
called oral agents or oral hypoglycemic agents.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Diabetic pill - now
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto INSLN1]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 15 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.190_00.000
Variable Name
INSLN1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DIBEV1(e)='1') or
(DIBPRE1(e)='1')
Universe-text
Sample adults 18+ who were told they had diabetes or sugar diabetes (other than
during pregnancy) or who were told they had prediabetes, impaired fasting glucose,
impaired glucose tolerance, borderline diabetes, or high blood sugar
Question Text
Insulin can be taken by shot or pump. Are you NOW taking insulin?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Insulin - now
Fill Instructions
Special Instructions
Skip Instructions
<1> if DIBEV1=1 and INSLN1=1 [goto DIBINS2] else if DIBEV1 ne 1 and (SEX=2 and
PREGEVER=1) [goto DIBGDM] else DIBEV1 ne 1 and SEX=1 or (SEX=2 and
PREGEVER=2,R,D) [goto DIBPRGM] <2,R,D> SEX=2 and PREGEVER=1 [goto
DIBGDM] else if DIBEV1=1 and SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto
AHAYFYR] else if DIBEV1 ne 1 and SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto
DIBPRGM]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 16 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.190_00.010
Variable Name
DIBINS2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e)='1' and
INSLN1(e)='1'
Universe-text
Sample adults 18+ with diabetes who have ever taken insulin by shot or pump
Question Text
Thinking back to when you were first diagnosed with diabetes, how long was it before
you started taking insulin?
Answer Codes
1. Less than 1 month
2. 1 month to less than 6 months
3. 6 months to less than 1 year
4. 1 year or more
Refused
Don’t know
Question Type
Pick One - answer list pane
Field Pane Description
Insulin-how long
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto DIBINS3]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 17 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.190_00.020
Variable Name
DIBINS3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e)='1' and
INSLN1(e)='1'
Universe-text
Sample adults 18+ with diabetes who have ever taken insulin by shot or pump
Question Text
Since you started taking insulin, have you ever stopped taking it for more than 6
months?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Insulin-stopped
Fill Instructions
Special Instructions
Skip Instructions
<1> if DIBINS2=1,2,3 [goto DIBINS4]; else if SEX=1 or SEX=2 and PREGEVER=2,R,D
[goto AHAYFYR]; else (SEX=2 and PREGEVER=1) [goto DIBGDM] <2,R,D> if (SEX=2
and PREGEVER=1) [goto DIBGDM] else [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 18 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.190_00.030
Variable Name
DIBINS4
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DIBINS2(e)
IN('1','2','3')) and (DIBINS3(e)='1')
Universe-text
Sample adults 18+ who started taking insulin within a year of being diagnosed with
diabetes and stopped taking it for more than six months
Question Text
Was this only during the first year after you were diagnosed with diabetes?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Stopped in 1st year
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if SEX=1 or (SEX=2 and PREGEVER=2,R,D) [goto DIBPRGM];
else (SEX=2 and PREGEVER=1) [goto DIBGDM]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 19 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.195_00.010
Variable Name
DIBGDM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (SEX=2 and
PREGEVER(e)='1')
Universe-text
Female Sample adults 18+ who have ever been pregnant
Question Text
[Fill1: Were you FIRST told by a doctor or other health professional that you had
diabetes, sugar diabetes, or gestational diabetes during pregnancy?/
Were you EVER told by a doctor or other health professional that you had diabetes,
sugar diabetes, or gestational diabetes during pregnancy?]
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Gestational diabetes
If DIBEV1=1 fill: Were you FIRST told by a doctor or other health professional that you
had diabetes, sugar diabetes, or gestational diabetes during pregnancy?;
else fill:
Were you EVER told by a doctor or other health professional that you had diabetes,
sugar diabetes, or gestational diabetes during pregnancy?
Special Instructions
Skip Instructions
<1,2,R,D> [goto DIBBABY]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 20 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.197_00.010
Variable Name
DIBBABY
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (SEX=2 and
PREGEVER(e)='1')
Universe-text
Female Sample adults 18+ who have ever been pregnant
Question Text
Have you EVER had a baby that weighed 9 pounds (4 kg) or more at birth?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Baby 9+ lbs
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if DIBEV1=1 [goto AHAYFYR];
else if DIBEV=2,R,D [goto DIBPRGM]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 21 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.198_00.010
Variable Name
DIBPRGM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e) not in '1'
Universe-text
Sample adults 18+ who have not been diagnosed with diabetes
Question Text
These next questions are about a year-long program that can help people prevent Type
2 diabetes. This program has weekly sessions during the first 6 months and monthly
sessions over the last 6 months. People in the program receive support from a lifestyle
coach on achieving and maintaining a healthy lifestyle.
Have you EVER participated in this type of year-long program to prevent Type 2
diabetes?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Prevent diabetes program
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto DIBREFER]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 22 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.198_00.020
Variable Name
DIBREFER
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and DIBEV1(e) not in '1'
Universe-text
Sample adults 18+ who have not been diagnosed with diabetes
Question Text
Has a doctor or other health care professional ever referred you to such a program to
prevent Type 2 diabetes?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Refered to program
Fill Instructions
Special Instructions
Skip Instructions
<1> if DIBPRGM=1 [goto AHAYFYR];
else if DIBPRGM=2,R,D [goto DIBBEGIN]
<2,R,D> [goto DIBBEGIN]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 23 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.198_00.030
Variable Name
DIBBEGIN
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DIBPRGM(e) ne
'1' and DIBREFER(e) ne '1')
Universe-text
Sample adults 18+ who have not participated in a diabetes prevention program and
were not referred to one
Question Text
How interested are you in beginning such a year-long program to prevent Type 2
diabetes? Would you say…
*Read categories below.
Answer Codes
1. Very interested
2. Somewhat interested
3. Not interested
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Begin program
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto AHAYFYR]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 24 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.010
Variable Name
VIM_DREV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Have you EVER been told by a doctor or other health professional that you had
...Diabetic retinopathy?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Ever had diabetic retinopathy
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to VIMLS_DR]
[2,R,D> [goto VIM_CAEV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 25 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.020
Variable Name
VIMLS_DR
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VIM_DREV(e)='1'
Universe-text
Sample adults 18+ told they have diabetic retinopathy
Question Text
Have you lost any vision because of diabetic retinopathy?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Loss vision - retinopathy
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto VIM_CAEV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 26 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.030
Variable Name
VIM_CAEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary.
Have you EVER been told by a doctor or other health professional that you had
...Cataracts
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Have cataracts
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to VIMLS_CA]
[2,R,D> [goto VIM_GLEV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 27 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.040
Variable Name
VIMLS_CA
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VIM_CAEV(e)='1'
Universe-text
Sample adults 18+ told they have cataracts
Question Text
Have you lost any vision because of cataracts?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Vision loss cataracts
Fill Instructions
Special Instructions
Skip Instructions
[1,2,R,D> [goto VIMCSURG]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 28 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.045
Variable Name
VIMCSURG
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VIM_CAEV(e)='1'
Universe-text
Sample adults 18+ ever had cataracts
Question Text
Have you ever had cataract surgery?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Cataract surgery
Fill Instructions
Special Instructions
Skip Instructions
<1, 2,R,D> [go to VIM_GLEV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 29 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.050
Variable Name
VIM_GLEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary.
Have you EVER been told by a doctor or other health professional that you had
...Glaucoma?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Have glaucoma
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to VIMLS_GL]
[2,R,D> [goto VIM_MDEV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 30 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.060
Variable Name
VIMLS_GL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VIM_GLEV(e)='1'
Universe-text
Sample adults 18+ told they have glaucoma
Question Text
Have you lost any vision because of glaucoma?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Lost vision glaucoma
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto VIM_MDEV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 31 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.070
Variable Name
VIM_MDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
* Read if necessary.
Have you EVER been told by a doctor or other health professional that you had
...Macular Degeneration
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Macular degeneration
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to VIMLS_MD];
<2,R,D> and ABLIND=2,R,D,’ ’ [goto VIMGLASS]
else if <2,R,D> and ABLIND=1 [goto AVISREH]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 32 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.080
Variable Name
VIMLS_MD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VIM_MDEV(e)='1'
Universe-text
Sample adults 18+ told they have macular degeneration
Question Text
Have you lost any vision because of macular degeneration?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Vision loss macular degeneration
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D>and ABLIND=2,R,D,’ ’ [goto VIMGLASS];
else <1,2,R,D> and ABLIND=1 [goto AVISREH]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 33 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.100
Variable Name
VIMGLASS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ABLIND(e)
IN('2','7','9,')
Universe-text
Sample adults 18+ who are not blind
Question Text
Do you currently wear eyeglasses or contact lenses?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Wear eyeglasses
Fill Instructions
Special Instructions
Skip Instructions
<1,> [go to VIMREAD];
<2,R,D> and AVISION=1 [go to AVISREH];
else <2,R,D> and AVISION=2,R,D [goto AVDF_NWS]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 34 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.110
Variable Name
VIMREAD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VIMGLASS(e)='1'
Universe-text
Sample adults 18+ wear glasses or contacts
Question Text
Do you wear eyeglasses or contact lenses to read books or newspapers, write, or do
other things that require you to see well up close, such as cooking, sewing or fixing
things?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Glasses to read books
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to VIMDRIVE]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 35 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.120
Variable Name
VIMDRIVE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and VIMGLASS(e)='1'
Universe-text
Sample adults 18+ wear glasses or contacts
Question Text
Do you wear eyeglasses or contact lenses to drive, read road and street signs, watch
TV, or see things in the distance?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Glasses to drive
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> and
If AVISION=1 [go to AVISREH];
Else if AVISION=2,R,D [goto AVDF_NWS]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 36 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.130
Variable Name
AVISREH
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AVISION(e)='1'
Universe-text
Sample adults 18+ who have trouble seeing
Question Text
Do you use any vision rehabilitation services, such as job training, counseling, or
training in daily
living skills and mobility?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Vision rehab
Fill Instructions
Special Instructions
Skip Instructions
<1 2,R,D> [goto AVISDEV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 37 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.440_00.140
Variable Name
AVISDEV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AVISION(e)='1'
Universe-text
Sample adults 18+ who have trouble seeing
Question Text
Do you use any adaptive devices such as telescopic or other prescriptive lenses,
magnifiers, large print or talking materials, CCTV, white cane, or guide dog?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Use adaptive devices
Fill Instructions
Special Instructions
Skip Instructions
<1 2,R,D> and if ABLIND = 2,R,D then [goto AVDF_NWS];
else <1,2,R,D> and ABLIND=1 [goto AVISEXAM]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 38 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.441_00.010
Variable Name
AVDF_NWS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ABLIND(e)
IN('2','7','9,')
Universe-text
Sample adults 18+ who are not blind
Question Text
[Fill1: Even when wearing glasses or contact lenses, because / Fill 2: Because ] of your
eyesight, how difficult is it for you
...To read ordinary print in newspapers
*Read categories below.
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all because of eyesight
6. Do not do this activity for other reasons
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Read newsprint
Fill1: when VIMGLASS=1
Fill2: when VIMGLASS=2,R,D
Special Instructions
Skip Instructions
<0-4,6,R,D> [goto AVDF_CLS]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 39 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.441_00.020
Variable Name
AVDF_CLS
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ABLIND(e)
IN('2','7','9,')
Universe-text
Sample adults 18+ who are not blind
Question Text
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because / Fill 2: Because ] of
your eyesight, how difficult is it for you
...To do work or hobbies that require you to see well up close such as cooking, sewing,
fixing things around the house or using hand tools
*Read categories below.
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all because of eyesight
6. Do not do this activity for other reasons
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
See up close
Fill1: when VIMGLASS=1
Fill2: when VIMGLASS=2,R,D
Special Instructions
Skip Instructions
<0-4,6,R,D> [goto AVDF_NIT]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 40 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.441_00.030
Variable Name
AVDF_NIT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ABLIND(e)
IN('2','7','9,')
Universe-text
Sample adults 18+ who are not blind
Question Text
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because / Fill 2: Because ] of
your eyesight, how difficult is it for you
...To go down steps, stairs, or curbs in dim light or at night
*Read categories below.
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all because of eyesight
6. Do not do this activity for other reasons
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Go down steps
Fill1: when VIMGLASS=1
Fill2: when VIMGLASS=2,R,D
Special Instructions
Skip Instructions
<0-4,6,R,D> [goto AVDF_DRV]
Hard Edits
Soft Edits
AssocHelp
Tuesday, September 22, 2015
Page 41 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.441_00.040
Variable Name
AVDF_DRV
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ABLIND(e)
IN('2','7','9,')
Universe-text
Sample adults 18+ who are not blind
Question Text
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because / Fill 2: Because ] of
your eyesight, how difficult is it for you
...To drive during daytime in familiar places
*Read categories below.
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all because of eyesight
6. Do not do this activity for other reasons
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Drive
Fill1: when VIMGLASS=1
Fill2: when VIMGLASS=2,R,D
Special Instructions
Skip Instructions
<0-4,6,R,D> [goto AVDF_PER]
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Tuesday, September 22, 2015
Page 42 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.441_00.050
Variable Name
AVDF_PER
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ABLIND(e)
IN('2','7','9,')
Universe-text
Sample adults 18+ who are not blind
Question Text
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because / Fill 2: Because ] of
your eyesight, how difficult is it for you
...To notice objects off to the side while you are walking along
*Read categories below.
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all because of eyesight
6. Do not do this activity for other reasons
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Notice objects while walking
Fill1: when VIMGLASS=1
Fill2: when VIMGLASS=2,R,D
Special Instructions
Skip Instructions
<0-4,6,R,D> [goto AVDF_CRD]
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Tuesday, September 22, 2015
Page 43 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.441_00.060
Variable Name
AVDF_CRD
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ABLIND(e)
IN('2','7','9,')
Universe-text
Sample adults 18+ who are not blind
Question Text
*Read if necessary:
[Fill1: Even when wearing glasses or contacts lenses, because / Fill 2: Because ] of
your eyesight, how difficult is it for you
...To find something on a crowded shelf
*Read categories below.
Answer Codes
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all because of eyesight
6. Do not do this activity for other reasons
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Crowded shelf
Fill1: when VIMGLASS=1
Fill2: when VIMGLASS=2,R,D
Special Instructions
Skip Instructions
<0-4,6,R,D> [goto AVISEXAM]
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Tuesday, September 22, 2015
Page 44 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.442_00.010
Variable Name
AVISEXAM
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
When was the last time you had an eye exam in which the pupils were dilated? This
would have made you temporarily sensitive to bright light.
Answer Codes
1. Less than one month
2. 1-12 months
3. 13-24 months
4. More than 2 years
5. Never
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Dilated pupils
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto AVISACT]
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Tuesday, September 22, 2015
Page 45 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.442_00.020
Variable Name
AVISACT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
Outside of work, do you participate in sports, hobbies, or other activities that can cause
eye injury?
This includes activities such as baseball, basketball, mowing the lawn, wood working,
or working with chemicals.
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Hobbies that cause eye injuries
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AVISPROT]
<2,R,D> [goto LUPPRT]
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Tuesday, September 22, 2015
Page 46 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.442_00.030
Variable Name
AVISPROT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and AVISACT(e)='1'
Universe-text
Sample adults 18+ and do participate in activities that can cause eye injury
Question Text
When doing these activities, on average, do you wear eye
protection always, most of the time, some of the time, or none of the time?
Answer Codes
1. Always
2. Most of the time
3. Some of the time
4. None of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Eye protection
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto LUPPRT]
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Tuesday, September 22, 2015
Page 47 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.460_00.010
Variable Name
CHPAIN6M
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999'))
Universe-text
Sample adults 18+
Question Text
In the past six months, how often did you have pain? Would you say...
*Read answer categories below.
Answer Codes
1. Never
2. Some days
3. Most days
4. Every day
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Chronic pain
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto PAINLMT] <2,R,D> [goto next section]
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Tuesday, September 22, 2015
Page 48 of 49
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.460_00.020
Variable Name
PAINLMT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and CHPAIN6M(e)
IN('2','3','4')
Universe-text
Sample adults 18+ who had chronic pain in the past 6 months
Question Text
Over the past six months, how often did pain limit your life or work activities? Would
you say...
*Read answer categories below.
Answer Codes
1. Never
2. Some days
3. Most days
4. Every day
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Pain limitations
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [goto the next section]
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Tuesday, September 22, 2015
Page 49 of 49
2016 Q1 NHIS Instrument Spec Report
Section name: Child Conditions, Limitations, Health Status
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.010
Variable Name
CVISTST
Universe
HHSTAT4='C' and (AGE LE '005' and AGE NE ' ') and CBLIND(e) NE '1'
Universe-text
Sample children <6 who is not blind
Question Text
?[F1]
Has [fill: SC name] EVER had [fill: his/her] vision tested by a doctor or other health
professional?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Vision tested
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CVISLT]
<2,R,D> [go to IHSPEQ]
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H_CVISTST
Tuesday, September 22, 2015
Page 1 of 8
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.010_H
Variable Name
H_CVISTST
Universe
Universe-text
Question Text
A vision test typically includes checking for visual activity by looking at an eye chart,
measuring eye muscle control and eye coordination, and checking the inside and
outside of the eye.
Health professionals include optometrists, ophthalmologists, physicians, nurses, and
physician assistants.
Answer Codes
Question Type
Help Screen
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
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Tuesday, September 22, 2015
Page 2 of 8
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.020
Variable Name
CVISLT
Universe
HHSTAT4='C' and (AGE LE '005' and AGE NE ' ') and CVISTST(e)='1'
Universe-text
Sample children <6 ever had vision tested
Question Text
When was [fill: his/her] vision last tested?
Answer Codes
1. In the last 12 months
2. In the last 13-24 months
3. Over 24 months
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Last time vision tested
Fill Instructions
Special Instructions Do not display answer categories with age ranges greater than respondent's age. For
example,
if the Sample Child is 1, do not display category 3.
Skip Instructions
<1-3,R,D> [go to IHSPEQ]
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Tuesday, September 22, 2015
Page 3 of 8
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.025
Variable Name
CVISGLAS
Universe
HHSTAT4='C' and ('006' <= AGE <= '017') and CBLIND(e) NE '1'
Universe-text
Sample children <18 who is not blind
Question Text
Does [fill: SC name] wear eyeglasses or contact lenses?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Wear eyeglasses
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CVISDIST]
<2,R,D> [go to CVISACT]
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Tuesday, September 22, 2015
Page 4 of 8
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.030
Variable Name
CVISDIST
Universe
HHSTAT4='C' and ('006' <= AGE <= '017') and CVISGLAS(e)='1'
Universe-text
Sample children <18 wear glasses or contact lenses
Question Text
Does [fill: SC name] wear eyeglasses or contact lenses to read road and street signs,
see the blackboard, play sports, watch TV, or see things in the distance?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
See road signs
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CVISREAD]
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Tuesday, September 22, 2015
Page 5 of 8
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.035
Variable Name
CVISREAD
Universe
HHSTAT4='C' and ('006' <= AGE <= '017') and CVISGLAS(e)='1'
Universe-text
Sample children <18 wear glasses or contact lenses
Question Text
Does [fill: SC name] wear eyeglasses or contact lenses to read books, write, play handheld games, or do other things that require [fill: her/him] to see well up close?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Read books
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [AGE GE 6 go to CVISACT;
else go to IHSPEQ]
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Tuesday, September 22, 2015
Page 6 of 8
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.040
Variable Name
CVISACT
Universe
HHSTAT4='C' and ('006' <= AGE <= '017')
Universe-text
Sample children 6-17
Question Text
Does [fill: SC name] participate in sports, hobbies, or other activities that can cause eye
injury? This includes activities such as baseball, basketball, soccer and mowing the
lawn.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Participate in sports
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to CVISPROT] <2,R,D> [go to IHSPEQ]
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Tuesday, September 22, 2015
Page 7 of 8
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
Question ID
CHS.270_00.050
Variable Name
CVISPROT
Universe
HHSTAT4='C' and ('006' <= AGE <= '017') and CVISACT(e)='1'
Universe-text
Sample children 6-17 participate in sports that cause eye injuries
Question Text
When doing these activities, on average, does [fill: he/she] wear eye protection always,
most of the time, some of the time, or none of the time?
Answer Codes
1.Always
2.Most of the time
3.Some of the time
4.None of the time
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Wear eye protection
Fill Instructions
Special Instructions
Skip Instructions
<1-4,R,D> [go to IHSPEQ]
Hard Edits
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AssocHelp
Tuesday, September 22, 2015
Page 8 of 8
| File Type | application/pdf |
| File Modified | 2015-09-24 |
| File Created | 2015-09-22 |