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pdfAttachment 4d - Main Questionnaire Supplement Questions
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2018 Q1 NHIS Instrument Spec Report
Section name: Adult Conditions
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.085_00.010
Variable Name
AASAGE
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e)
IN ('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months and still have asthma
Question Text
How old were you when you were first told you had asthma?
Answer Codes
001-120,
Refused
Don't know
Question Type
Integer
Field Pane Description
Asthma age
Fill Instructions
Special Instructions
Skip Instructions
If AASAGE ge AGE, then [got ERR_AASAGE]
<001-120> [goto AASMYR] [goto AASAGE16]
Hard Edits
ERR_AASAGE
* Number of years is greater than age.
* Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 1 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.085_00.020
Variable Name
AASAGE16
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e)
IN ('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASAGE(e) IN
('997','999')
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, and refused or said don't know to question on age they
were first told they had asthma
Question Text
Were you less than 16 or 16 or older when you were first told you had asthma?
Answer Codes
1. Less than 16
2. 16 or older
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Told had asthma
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto AASMYR]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 2 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.010
Variable Name
AASMHSP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, have you stayed overnight in a hospital because of
asthma?
*If in hospital for asthma AND other reasons, enter '1'.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Past 12 months overnight in hospital for asthma
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AWZMSWK]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 3 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.030
Variable Name
AWZMSWK
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, HOW MANY DAYS were you UNABLE to [fill1:
work/get work done around the house] because of your asthma?
*Enter '0' for none.
*Enter '996' if respondent is unable to do this activity.
Answer Codes
Question Type
Allow 0-365,996,R,D
Integer
Field Pane Description
Fill Instructions
Days unable to work because of asthma
Fill1: IF DOINGLW2=1,2,4 fill "work"; else if DOINGLW2=3,5,R,D fill "get work done
around the house"
Special Instructions
Skip Instructions
<0-100,996,R,D> [go to AASMPMED]
<101-365> [go to ERR1_AWZMSWK]
<366-994> [go to ERR2_AWZMSWK]
Hard Edits
if AWZMSWK = 366-994 then display ERR2_AWZMSWK:
"366-994 days not allowed in this field.
*Please correct."
Soft Edits
if AWZMSWK >100 and ne 996 then display ERR1_AWZMSWK:
"AWZMSWK is an unusually large number;
*Please verify.
AssocHelp
Thursday, June 15, 2017
Page 4 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.060
Variable Name
AASMPMED
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Now I'm going to ask you about two different kinds of ASTHMA medicine. One
prevents symptoms over the long term. The other is for quick relief of symptoms
during an attack or episode. This quick relief medicine is breathed in through your
mouth using a canister inhaler or a disk inhaler.
DURING THE PAST 3 MONTHS, have you used the kind of PRESCRIPTION asthma
inhaler that gives QUICK relief from asthma symptoms during an attack? Include only
medications prescribed by a health care professional.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Quick relief inhaler
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto AASMTYP]
<2,R,D> [go to AASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 5 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.065
Variable Name
AASMTYP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and and
AASMPMED(e)='1'
Universe-text
Sample adults 18+ who have used a quick relief prescription asthma inhaler in the
past three months
Question Text
When you take your rescue prescription asthma medication, would you say that you
most often use an inhaler and/or disk, or do you most often use a nebulizer?
*Read if necessary: Both an inhaler or a disk inhaler are very portable canisters or
devices used to inhale medication in one or two breaths. A nebulizer is a machine
that turns liquid medication into a mist that you inhale into the lungs over a few minutes
Answer Codes
Question Type
1. Inhaler or disk
2. Nebulizer
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Prescription asthma medication
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to AASMCAN]
<2,R,D> [go to AASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 6 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.070
Variable Name
AASMCAN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and and
AASMTYP(e)='1'
Universe-text
Sample adults 18+ who have used a prescription asthma inhaler/disk most often in the
past three months
Question Text
DURING THE PAST 3 MONTHS, did you use more than three canisters or disks of
this type of quick relief inhaler?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
More than 3 canisters
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 7 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.090
Variable Name
AASMDTP2
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
The second kind of asthma medication is different from inhalers used for quick relief.
It is the preventive kind that is used to protect your lungs and keep you from having
attacks. It can be either a pill or an inhaler.
Are you NOW taking a preventive asthma medication every day or almost every day,
less often, or never?
Answer Codes
Question Type
1. Every day or almost every day
2. Less often
3. Never
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Preventive asthma medication usage
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [go to AASWMP]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 8 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.100
Variable Name
AASWMP
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
An asthma action plan is a printed form with specific instructions based on your
asthma that tells when to change the amount or type of medicine, when to call the
doctor for advice, and when to go to the emergency room.
Has a doctor or other health professional EVER given you an asthma action plan?
*Read if necessary: Include nurses and asthma educators.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Action plan
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AASCLASS]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 9 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.100_00.110
Variable Name
AASCLASS
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Have you ever taken a course or class on how to manage asthma yourself?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Course or class
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAS_REC]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 10 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.105_01.010
Variable Name
AAS_REC
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Has a doctor or other health professional EVER taught you
...how to recognize early signs or symptoms of an asthma episode?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Recognize early signs
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAS_RES]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 11 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.105_02.020
Variable Name
AAS_RES
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
*Read if necessary: Has a doctor or other health professional EVER taught you
...how to respond to episodes of asthma?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Respond to episodes
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAS_MON]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 12 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.105_03.030
Variable Name
AAS_MON
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
*Read if necessary: Has a doctor or other health professional EVER taught you
...how to monitor peak flow for daily therapy?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Monitor peak flow
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAPENVLN]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 13 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.010
Variable Name
AAPENVLN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Has a doctor or other health professional EVER advised you to change things in your
home, school, or work environment to improve your asthma?
Answer Codes
1. Yes
2. No
3. Was told no changes needed
Don't know
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Advised you
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [go to AAROUTIN]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 14 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.020
Variable Name
AAROUTIN
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, how many times did you see a doctor or other
health professional for a routine checkup for your asthma? Please do not include
emergency room visits, visits to urgent care centers, or other visits for acute care for
an asthma episode or attack.
*Enter '0' for none.
Answer Codes
Question Type
Allow 0-365,R,D
Integer
Field Pane Description
Number of times seeing doctor for asthma
Fill Instructions
Special Instructions
Skip Instructions
<0-50,R,D> [go to AASYMPT]
<51-365> [goto ERR_AAROUTIN]
Hard Edits
Soft Edits
ERR_AAROUTIN
[fill4: AAROUTIN] is an unusually large number.
* Please verify.
AssocHelp
Thursday, June 15, 2017
Page 15 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.030
Variable Name
AASYMPT
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months and saw a doctor/health professional about their asthma in the past year
Question Text
The next three questions are about the last time you saw a doctor or other health care
professional for routine care or for any reason.
At your last visit, did your doctor or other health professional ask HOW OFTEN
….you had asthma symptoms?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Asked frequency asthma symtoms
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AARESCUE];
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 16 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.040
Variable Name
AARESCUE
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months and who use a quick relief inhaler and saw a doctor/health professional about
their asthma in the past year
Question Text
At your last visit, did your doctor or other health professional ask HOW OFTEN
….you used a quick relief inhaler?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Frequency quick relief inhaler
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to AAACTLIM]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 17 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.050
Variable Name
AAACTLIM
Universe
HHSTAT4 = 'S' and (AGE GE '018' and AGE not IN ('997','999')) and
(AASSTILL(e)='1' or AASMYR(e)='1')
Universe-text
Sample adults 18+ who still have asthma or who had asthma episode/attack in past 12
months and saw a doctor/health professional about their asthma in the past year
Question Text
At your last visit, did your doctor or other health professional ask HOW OFTEN
…asthma symptoms limited your daily activities?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Limit daily activities
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if DOINGLW2=1,2,4 or WRKLYR2=1 and AASAGE LE 15 or AASAGE16=1
[goto AASSTAT];
else if if DOINGLW2=1,2,4 or WRKLYR2=1 and AASAGE GE 16 or
AASAGE16=2,R,D [goto AASEMP];
else [goto ULCEV]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 18 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.060
Variable Name
AASSTAT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e)
IN ('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and (AASAGE(e) LE '015' or
AASAGE16(e)='1')
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, and were less than 16 years of age when they were told
they had asthma
Question Text
Compared to when you were first told you had asthma, would you say your asthma
has been better, worse, or about the same as an adult?
Answer Codes
1. Better
2. Worse
3. About the same
Refused
Don't know
Question Type
Pick One - answer list pane
Field Pane Description
Asthma status
Fill Instructions
Special Instructions
Skip Instructions
<1,3,R,D> [goto AASWKREL]<2> [goto AASEMP]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 19 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.070
Variable Name
AASEMP
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e)
IN ('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and ((AASAGE(e) GE '016') or
(AASAGE16(e) IN (‘2’,'7','9')) or AASSTAT(e)='2')
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, and were 16 years of age or older or less than 16 years
of age and their asthma has gotten worse as an adult or age at time of diagnosis is
unknown
Question Text
Were you employed when [fill 1: you first developed symptoms of asthma/your asthma
got worse]?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Employed
r AASAGE16=1) then fill “your asthma got worse”
Special Instructions
Skip Instructions
<1.2.R,D> [goto AASWKREL]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 20 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.080
Variable Name
AASWKREL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e)
IN ('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1'
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, were 16 years of age or older or less than 16 years of
age and their asthma has gotten worse as an adult or age at time of diagnosis is
unknown
Question Text
Have you been told by a doctor or other health professional that your asthma [fill: was
probably caused by your work/was probably made worse by your work/was ever made
worse by any job you have ever had]?”
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Told asthma job related
fill 1: if (AASAGE >= 16 or AASAGE16=2,D,R) and AASEMP=1 then fill “was
probably caused by your work”
else if (AASAGE < 16 or AASAGE16=1) and AASSTAT=2 and AASEMP=1 then fill
“was probably made worse by your work”
else fill “was ever made worse by any job you have ever had”
Special Instructions
Skip Instructions
<1> [goto ULCEV]
<2,R,D> [goto AASDWKRL]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 21 of 22
Module
16
Section Name
Adult Conditions
Part
Question ID
ACN.107_00.090
Variable Name
AASDWKRL
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and (DOINGLW2(e)
IN ('1','2','4') or WRKLYR2(e)='1') and AASSTILL(e)='1' and AASWKREL(e) IN
(‘2’,’7’,’9’)
Universe-text
Sample adults 18+ who are currently employed or employed at some time in the past
12 months, still have asthma, were 16 years of age or older or less than 16 years of
age and their asthma has gotten worse as an adult or age at time of diagnosis is
unknown
Question Text
Did YOU ever discuss with a doctor or other health professional whether your asthma
[fill: was probably caused by your work/was probably made worse by your work/was
ever made worse by any job you have ever had]?”
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
Fill Instructions
Discussed asthma job related
fill 1: if (AASAGE >= 16 or AASAGE16=2,D,R) and AASEMP=1 then
fill “was probably caused by your work”
else if (AASAGE < 16 or AASAGE16=1) and AASSTAT=2 and AASEMP=1 then
fill “was probably made worse by your work”
else fill “was ever made worse by any job you have ever had”
Special Instructions
Skip Instructions
<1,2,D,R> [goto ULCEV]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 22 of 22
2018 Q1 NHIS Instrument Spec Report
Section name: Cancer Screening
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.130_00.000
Variable Name
PAPHAD1
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 HAD a Pap smear or Pap test?
*Read if necessary.
A Pap smear or Pap test is a routine test for women in which the doctor examines the
cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to
the lab.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had Pap
Fill Instructions
Special Instructions Display the text "A Pap smear or Pap test is a routine test for women in which the
doctor examines the cervix, takes a cell sample from the cervix with a small stick or
brush, and sends it to the lab." in BOLD GRAY text.
Skip Instructions
<1> [goto RPAP1_MT]
<2> [goto PAPNOT2]
[goto HYST]
Hard Edits
Soft Edits
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Thursday, June 15, 2017
Page 1 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.150_01.000
Variable Name
RPAP1_M1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1'
Universe-text
Female sample adults 18+ who have ever had a Pap test
Question Text
1 of 2
When did you have your MOST RECENT Pap test?
*Enter month of last Pap test.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Month
Fill Instructions
Special Instructions if RPAP1_M1 = store 'R' in RPAP1_Y1
if RPAP1_M1 = <96> store '9996' in RPAP1_Y1
Skip Instructions
<1-12,D> [goto RPAP1_Y1]
store "R' in RPAP1_Y1 [goto RPAP21]
<96> store "9996" in RPAP1_Y1 [goto RPAP1N1]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 2 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.150_02.000
Variable Name
RPAP1_Y1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and ('01' <= RPAP1_M1 <= '12' or RPAP1_M1='99')
Universe-text
Female sample adults age 18+ who answered month of last Pap test test or didn't
know month of last Pap test test
Question Text
2 of 2
*Enter year of last Pap test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RPAP1_Y1 gt current year or (RPAP1_Y1=current year and
RPAP1_M1 gt current month)
[goto ERR1_ RPAP1_Y1 (future date)]
elseif RPAP1_Y1 lt DOBY or (RPAP1_Y1=DOBY and RPAP1_M1 lt DOBM)
[goto ERR2_ RPAP1_Y1 (prior to birth date)]
elseif RPAP1_M1=D
[goto RPAP21]
elseif RPAP1_M1=1-12 [goto HPVPAP]
[goto RPAP21]
Hard Edits
ERR1_ RPAP1_Y1
* Future date invalid. Please correct.
ERR2_ RPAP1_Y1
* Date before birth. Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 3 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.160_01.000
Variable Name
RPAP1N1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and RPAP1_M1(e)='96'
Universe-text
Female sample adults 18+ who selected number and time period format for most
recent Pap test test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT Pap test?
*Enter number for time since last Pap test.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95,R,D
Refused
Don't Know
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RPAP1N1 = store 'R' in RPAP1T1
if RPAP1N1 = store 'D' in RPAP1T1
Skip Instructions
<1-95> [goto RPAP1T1]
store "R,D" in RPAP1T1 [goto RPAP21]
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Thursday, June 15, 2017
Page 4 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.160_02.000
Variable Name
RPAP1T1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and RPAP1_M1(e)='96' and ('01' <= RPAP1N1 <= '95')
Universe-text
Female sample adults 18+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent Pap test.
Answer Codes
Question Type
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Time period
Fill Instructions
Special Instructions If RPAP1N1 gt 5 and RPAP1T1=4, store '5' in RPAP21.
If RPAP1N1=4 and RPAP1T1=4, store '4' in RPAP21.
Skip Instructions
<1-3> [goto HPVPAP]
<4> (if RPAP1N1=4, set RPAP21=4 [goto HPVPAP];
elseif RPAP1N1 gt 5 and RPAP1N1 gt AGE, [goto ERR_RPAP1T1 (greater than
persons age)]
elseif RPAP1N1 gt 5 and RPAP1N1 le AGE, set RPAP21=5 and [goto HPVPAP]
elseif RPAP1N1=1,2,3,5, [goto RPAP21]
[goto RPAP21]
Hard Edits
ERR_RPAP1T1
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 5 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.165_00.000
Variable Name
RPAP21
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and (RPAP1_M1(e) IN ('97','98','99') or RPAP1_Y1(e) IN
('9997','9998','9999') or RPAP1N1(e) IN ('97','98','99') or RPAP1T1(e) IN ('7','8','9') or
(RPAP1T1(e) = '4' and RPAP1N1 IN ('1','2','3','5')))
Universe-text
Female sample adults 18+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last Pap test test
was over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A 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 but not more than 5 years ago
5. Over 5 years ago
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RPAP1N1 gt 5 and RPAP1T1=4, store '5' in RPAP21 and don't ask question.
If RPAP1N1=4 and RPAP1T1=4, store '4' in RPAP21 and don't ask question.
Based upon prior answers:
if RPAP1N1 = 1 and RPAP1T1 = '4', gray out answer codes 3,4,5
if RPAP1N1 = 2 and RPAP1T1 = '4', gray out answer codes 1,4,5
if RPAP1N1 = 3 and RPAP1T1 = '4', gray out answer codes 1,2,5
if RPAP1N1 = 5 and RPAP1T1 = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RPAP21;
else [goto HPVPAP]
Hard Edits
ERR_RPAP21
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 6 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.168_00.000
Variable Name
HPVPAP
Universe
HHSTAT4 = 'S' and (AGE LE '064' and AGE not IN ('997','999')) and PAPHAD1(e)='1'
Universe-text
Female sample adult who have ever had a Pap test
Question Text
An HPV test is sometimes given with the Pap test for cervical cancer screening. Did
you have an HPV test with your most recent Pap?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
HPV-Pap
Fill Instructions
Special Instructions
Skip Instructions
<1-2,R,D> if (RPAP21 = 1,2,3) or (RPAP1T1 = 1,2) or
(RPAP1_Y1 = (current year – 3) and RPAP1_M1 ge current month) or (RPAP1_Y1 gt
(current year – 3))
or (RPAP1T1 = 3 and RPAP1N1 le 36) [goto PAPABN3]; elseif (RPAP21 = 5) or
(RPAP1_Y1 = (current year – 5) and RPAP1_M1 lt current month) or
(RPAP1_Y1 lt (current year – 5)) or (RPAP1T1 = 3 and RPAP1N1 gt 60) [goto
PAPNOT2] elseif RPAP21 = R,D [goto HYST]
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Thursday, June 15, 2017
Page 7 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.180_00.000
Variable Name
PAPABN3
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPHAD1(e)='1' and ((RPAP21 IN (‘1’,’2’,’3’) or (RPAP1T1 IN (‘1’,’2’) or (RPAP1_Y1 =
(current year – 3) and RPAP1_M1 ge current month) or (RPAP1_Y1 gt (current year –
3) and RPAP1_Y1 not IN ('9996','9997','9999')) or (RPAP1T1 = '3' and RPAP1N1 le
'36') or (RPAP1T1 = '4' and RPAP1N1 IN ('1','2','3')))
Universe-text
Female sample adults 18+ who have had a Pap test in the past 3 years
Question Text
Have you had a [fill1: Pap/Pap or HPV] test in the LAST 3 YEARS where the results
were NOT normal?
Answer Codes
1. Yes, Pap test not normal
2. Yes, HPV test not normal
3. Yes, both were not normal
4. No
Refused
Don't Know
Question Type
Pick One - answer list pane
Field Pane Description
Fill Instructions
Abnormal Pap
Fill1: if HPVPAP=1 fill "Pap or HPV"; else fill "Pap"
Special Instructions
Skip Instructions
<1-4,R,D> [goto HYST]
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Thursday, June 15, 2017
Page 8 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.210_00.000
Variable Name
PAPNOT2
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
((PAPHAD1 = '2') or (RPAP21 IN ('5')) or (RPAP1_Y1 = (current year – 5) and
RPAP1_M1 lt current month) or (RPAP1_Y1 lt (current year – 5)) or (RPAP1T1 = '3'
and RPAP1N1 gt '60') or (RPAP1T1 = '4' and RPAP1N1 gt '5' ))
Universe-text
Female sample adults 18+ who have never had a Pap test, or who have not had a
Pap test in the last 5 years
Question Text
What is the most important reason you have [Fill1: NEVER had a Pap test/NEVER
had a Pap or HPV test/
NOT had a Pap test in the LAST 5 YEARS/
NOT had a Pap or HPV test in the LAST 5 YEARS]?
*Put response into correct category below.
Answer Codes
Question Type
1. No reason/never thought about it
2. Didn't need it/didn't know I needed this type of test
3. Doctor didn't order it/didn't say I needed it
4. Haven't had any problems
5. Put it off/didn't get around to it
6. Too expensive/no insurance/cost
7. Too painful, unpleasant, or embarrassing
8. Had hysterectomy
9. Don't have doctor
10. Had HPV vaccine
11. Other
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Why no Pap
[fill 1] if PAPHAD1 = '2' fill 'NEVER had a Pap test';
else if PAPHAD1=1 and HPVPAP=1 fill "NOT had a Pap or HPV test in the LAST 5
YEARS";
else if PAPHAD1=1 and HPVPAP is ne '1', fill "NOT had a Pap test in the LAST 5
YEARS"
Special Instructions if PAPNOT2 = <8> store '1' in HYST and do not ask HYST question
Skip Instructions
<1-7,9-11,R,D> [goto HYST]
<8> if AGE GE 30 [goto MAMHAD1] else [goto next section]
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Thursday, June 15, 2017
Page 9 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.220_00.000
Variable Name
HYST
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
PAPNOT2(e) ne '08'
Universe-text
Female sample adults 18+ who have not already indicated they have had a
hysterectomy
Question Text
Have you had a hysterectomy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had hysterectomy
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> if AGE GE 30 [goto MAMHAD1] else [goto next section]
Hard Edits
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AssocHelp
Thursday, June 15, 2017
Page 10 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.230_00.000
Variable Name
MAMHAD
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2'
Universe-text
Female sample adults age 30+
Question Text
Have you EVER HAD a mammogram?
*Read if necessary.
A mammogram is an x-ray taken only of the breast by a machine that presses against
the breast.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had mammogram
Fill Instructions
Special Instructions Display the text " A mammogram is an x-ray taken only of the breast by a machine
that presses against the breast." in BOLD GRAY text.
Skip Instructions
<1> [goto RMAM1_MT]
<2> [goto MAMNOT1]
if AGE GE 40 [goto COLHAD];
else [goto next section]
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Thursday, June 15, 2017
Page 11 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.260_01.000
Variable Name
RMAM1_MT
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
1 of 2
When did you have your MOST RECENT mammogram?
*Enter month of last mammogram.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if RMAM1_MT = store 'R' in RMAM1_YR
if RMAM1_MT = <96> store '9996' in RMAM1_YR
Skip Instructions
<1-12,D> [goto RMAM1_YR]
store "R' in RMAM1_YR [goto RMAM2]
<96> store "9996" in RMAM1_YR [goto RMAM1N]
Hard Edits
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Thursday, June 15, 2017
Page 12 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.260_02.000
Variable Name
RMAM1_YR
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and ('01' <= RMAM1_MT <= '12' or RMAM1_MT='99')
Universe-text
Female sample adults age 30+ who answered month of last mammogram or didn't
know month of last mammogram
Question Text
2 of 2
*Enter year of last mammogram.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RMAM1_YR gt current year or (RMAM1_YR=current year and
RMAM1_MT gt current month)
[goto ERR1_ RMAM1_YR (future date]
elseif RMAM1_YR lt DOBY or (RMAM1_YR=DOBY and RMAM1_MT lt DOBM)
[goto ERR2_ RMAM1_YR (prior to birth date)]
elseif RMAM1_MT=D
[goto RMAM2]
elseif RMAM1_MT=1-12
[goto MAMREAS]
goto RMAM2
Hard Edits
ERR1_ RMAM1_YR
* Future date invalid. Please correct.
ERR2_ RMAM1_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 13 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.270_01.000
Variable Name
RMAM1N
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and RMAM1_MT(e)='96'
Universe-text
Female sample adults 30+ who selected number and time period format for most
recent mammogram from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT mammogram?
*Enter number for time since last mammogram.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RMAM1N = store 'R' in RMAM1T
if RMAM1N = store 'D' in RMAM1T
Skip Instructions
<1-95> [goto RMAM1T]
store "R,D" in RMAM1T [goto RMAM2]
Hard Edits
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Thursday, June 15, 2017
Page 14 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.270_02.000
Variable Name
RMAM1T
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and RMAM1_MT(e)='96' and ('01' <= RMAM1N <= '95')
Universe-text
Female sample adults 30+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent mammogram.
Answer Codes
Question Type
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions if RMAM1N gt 5 and RMAM1T=4, store '5' in RMAM2.
if RMAM1N=4 and RMAM1T=4, store '4' in RMAM2.
Skip Instructions
<1-3> goto MAMREAS
<4> if RMAM1N=4
set RMAM2=4
goto MAMREAS
elseif RMAM1N gt 5 and RMAM1N gt AGE
goto ERR_RMAM1T (greater than persons age)
elseif RMAM1N gt 5 and RMAM1N le AGE
set RMAM2=5
goto MAMREAS
elseif RMAM1N=1,2,3,5
goto RMAM2
goto RMAM2
Hard Edits
ERR_RMAM1T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 15 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.275_00.000
Variable Name
RMAM2
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and (RMAM1_MT(e) IN ('97','98','99') or RMAM1_YR(e) IN
('9997','9998','9999') or RMAM1N(e) IN ('97','98','99') or RMAM1T(e) IN ('7','8','9') or
(RMAM1T(e) = '4' and RMAM1N IN ('1','2','3','5')))
Universe-text
Female sample adults 30+ who failed to give a complete date in either the month or
year format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last mammogram
was over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RMAM1N gt 5 and RMAM1T=4, store '5' in RMAM2 and don't ask question.
If RMAM1N=4 and RMAM1T=4, store '4' in RMAM2 and don't ask question.
Based upon prior answers:
if RMAM1N = 1 and RMAM1T = '4', gray out answer codes 3,4,5
if RMAM1N = 2 and RMAM1T = '4', gray out answer codes 1,4,5
if RMAM1N = 3 and RMAM1T = '4', gray out answer codes 1,2,5
if RMAM1N = 5 and RMAM1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RMAM2]
else [goto MAMREAS]
Hard Edits
ERR_RMAM2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 16 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.310_00.000
Variable Name
MAMREAS
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
What was the MAIN reason you had this mammogram -- was it part of a routine exam,
because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Reason for mammogram
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto MAMABN1]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 17 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.320_00.000
Variable Name
MAMABN1
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram
Question Text
After your MOST RECENT mammogram, were you advised to have more tests?
*Read if necessary: More tests may include another mammogram, a sonogram, an
MRI, a biopsy, or something else to check for problems in your breast.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
More tests
Fill Instructions
Special Instructions Display the text "More tests may include another mammogram, a sonogram, an MRI, a
biopsy, or something else to check for problems in your breast." in BOLD GRAY text.
Skip Instructions
<1> [goto MFOLLOW1]
<2,R,D> if (RMAM21 = 3,4,5) or (RMAM1_Y1 = (current year – 2) and RMAM1_M1 lt
current month) or
(RMAM1_Y1 lt (current year – 2)) or (RMAM1T1 = 3 and RMAM1N1 gt 24) [goto
MAMNOT1]; else if
AGE GE 40 [goto COLHAD];else [goto next section]
Hard Edits
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Thursday, June 15, 2017
Page 18 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.325_00.000
Variable Name
MFOLLOW1
Universe
HHSTAT4='S' and (AGE GE '030' and AGE not IN ('997','999')) and SEX='2' and
MAMHAD(e)='1' and MAMABN1(e)='1'
Universe-text
Female sample adults 30+ who have ever had a mammogram and was recommended
to have more tests
Question Text
Which tests did you actually have?
*Enter all that apply, separate with commas.
Answer Codes
Question Type
0. None
1. Ultrasound
2. Breast MRI
3. Additional mammogram(s)
4. Biopsy
5. Other
Refused
Don’t know
Enter all that apply
Field Pane Description
Which test(s)
Fill Instructions
Special Instructions Do not allow '0' with other answer categories.
Skip Instructions
<0-5,R,D> if (RMAM21 = 3,4,5) or (RMAM1_Y1 = (current year – 2) and RMAM1_M1
lt current month) or
(RMAM1_Y1 lt (current year – 2)) or (RMAM1T1 = 3 and RMAM1N1 gt 24) [goto
MAMNOT1]; else if
AGE GE 40 [goto COLHAD];else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 19 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.330_00.000
Variable Name
MAMNOT1
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and SEX='2' and
((MAMHAD = '2')
or (RMAM21 IN (''3','4','5')) or (RMAM1_Y1 = (current year – 2) and RMAM1_M1 lt
current month) or (RMAM1_Y1 lt (current year – 2))
or (RMAM1T1 = '3' and RMAM1N1 gt '24') or (RMAM1T1 = '4' and RMAM1N1 gt '2'
Universe-text
Female sample adults 30+ who have never had a mammogram or not had a
mammogram in the past 2 years
Question Text
What is the most important reason why you have [fill1: NEVER had a
mammogram/NOT had a mammogram in the PAST 2 YEARS]?
*Put response into correct category below.
Answer Codes
Question Type
1. No reason/never thought about it
2. Didn't need it/didn't know I needed this type of test
3. Doctor didn't order it/didn't say I needed it
4. Haven't had any problems
5. Put it off/Didn't get around to it
6. Too expensive/no insurance/cost
7. Too painful, unpleasant or embarrassing
8. I'm too young
9. Don't have doctor
10. Other
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Fill Instructions
Why no mammogram
[fill 1] if MAMHAD = '2' fill 'NEVER had a mammogram';
else fill 'NOT had a mammogram in the PAST 2 YEARS'
Special Instructions
Skip Instructions
<1-10,R,D> if AGE GE 40 [goto COLHAD]; else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 20 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.430_00.000
Variable Name
PSAHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999') and SEX='1')
Universe-text
Male sample adults 40+
Question Text
Have you EVER HAD a PSA test?
*Read if necessary. A PSA test is a blood test to detect prostate cancer. It is also
called a prostate-specific antigen test.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had PSA test
Fill Instructions
Special Instructions Display the text "A PSA test is a blood test to detect prostate cancer. It is also called
a prostate-specific antigen test. " in BOLD GRAY text.
Skip Instructions
<1> [goto RPSA1_MT]
<2,R,D> [goto PSAADV]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 21 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_00.000
Variable Name
RPSA1_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
1 of 2
When did you have your MOST RECENT PSA test?
* Enter month of last PSA test.
* Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if RPSA1_MT = store 'R' in RPSA1_YR
if RPSA1_MT = <96> store '9996' in RPSA1_YR
Skip Instructions
<1-12,D> [goto RPSA1_YR]
store "R' in RPSA1_YR [goto RPSA2]
<96> store "9996" in RPSA1_YR [goto RPSA1N]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 22 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_01.000
Variable Name
RPSA1_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and ('01' <= RPSA1_MT <= '12' or RSPA1_MT='99')
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
2 of 2
* Enter year of last PSA test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RPSA1_YR gt current year or (RPSA1_YR=current year and
RPSA1_MT gt current month)
goto ERR1_ RPSA1_YR (future date)
elseif RPSA1_YR lt DOBY or (RPSA1_YR=DOBY and RPSA1_MT lt DOBM)
goto ERR2_ RPSA1_YR (prior to birth date)
elseif RPSA1_MT=D
goto RPSA2
elseif RPSA1_MT=1-12
goto PSAREAS
goto RPSA2
Hard Edits
ERR1_ RPSA1_YR
* Future date invalid. Please correct.
ERR2_ RPSA1_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 23 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_02.000
Variable Name
RPSA1N
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and RPSA1_MT(e)='96'
Universe-text
Male sample adults 40+ who have selected number and time period format for most
recent PSA test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT PSA test?
* Enter number for time since last PSA test.
* Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RPSA1N = store 'R' in RPSA1T
if RPSA1N = store 'D' in RPSA1T
Skip Instructions
<1-95> [goto RPSA1T]
store "R,D" in RPSA1T [goto RPSA2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 24 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_03.000
Variable Name
RPSA1T
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and RPSA1_MT(e)='96' and ('01' <= RPSA1N <= '95')
Universe-text
Male sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
* Enter time period for time since most recent PSA test.
Answer Codes
Question Type
1. Day(s) ago
2. Week(s) ago
3. Month(s) ago
4. Year(s) ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If RPSA1N gt 5 and RPSA1T=4, store '5' in RPSA2.
If RPSA1N=4 and RPSA1T=4, store '4' in RPSA2.
Skip Instructions
<1-3> goto PSAREAS
<4> if RPSA1N=4
set RPSA2=4
goto PSAREAS
elseif RPSA1N gt 5 and RPSA1N gt AGE
goto ERR_RPSA1T (greater than persons age)
elseif RPSA1N gt 5 and RPSA1N le AGE
set RPSA2=5
goto PSAREAS
elseif RPSA1N=1,2,3,5
goto RPSA2
goto RPSA2
Hard Edits
ERR_RPSA1T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 25 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.440_04.000
Variable Name
RPSA2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1' and (RPSA1_MT(e) IN ('97','98','99') or RPSA1_YR(e) IN
('9997','9998','9999') or RPSA1N(e) IN ('97','98','99') or RPSA1T(e) IN ('7','8','9') or
(RPSA1T(e) = '4' and RPSA1N IN ('1','2','3','5')))
Universe-text
Male sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last PSA test was
over 5 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. Over 5 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-5 in BOLD BLACK text.
If RPSA1N gt 5 and RPSA1T=4, store '5' in RPSA2 and don't ask question.
If RPSA1N=4 and RPSA1T=4, store '4' in RPSA2 and don't ask question.
Based upon prior answers:
if RPSA1N = 1 and RPSA1T = '4', gray out answer codes 3,4,5
if RPSA1N = 2 and RPSA1T = '4', gray out answer codes 1,4,5
if RPSA1N = 3 and RPSA1T = '4', gray out answer codes 1,2,5
if RPSA1N = 5 and RPSA1T = '4', gray out answer codes 1,2,3
Skip Instructions
<1-5,R,D> if answer code is grayed out [goto ERR_RPSA2]
else [goto PSAREAS]
Hard Edits
ERR_RPSA2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 26 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.441_00.000
Variable Name
PSAREAS
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
What was the MAIN reason you had this PSA test - was it part of a routine exam,
because of a problem, or some other reason?
Answer Codes
1. Part of a routine exam
2. Because of a problem
3. Other reason
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Reason for PSA test
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto PSASUGG]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 27 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.445_00.000
Variable Name
PSASUGG
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
Who first suggested the PSA test: you, your doctor, or someone else?
Answer Codes
1. Self
2. Doctor
3. Someone else
Refused
Don't know
Question Type
Pick One - answer pane list
Field Pane Description
Suggested PSA
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto PSADISC]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 28 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.450_00.000
Variable Name
PSADISC
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1' and
PSAHAD(e)='1'
Universe-text
Male sample adults 40+ who have had a PSA test
Question Text
Did the doctor discuss the advantages and disadvantages of this test with you before
doing it?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Discuss test
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto PSAADV]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 29 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.455_00.000
Variable Name
PSAADV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 40+
Question Text
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the
advantages of [fill 2: it/the PSA test]?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
PSA advantages
[fill 1] If PSAHAD=1 fill "Before you had the PSA test did" else fill "Did"
[fill 2] if PSAHAD=1 fill "it" else fill "the PSA test"
Special Instructions
Skip Instructions
<1,2,R,D> [goto PSADISAV]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 30 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.460_00.000
Variable Name
PSADISAV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SEX='1'
Universe-text
Male sample adults 40+
Question Text
[fill 1: Before you had the PSA test did/Did] a doctor EVER talk with you about the
disadvantages of [fill 2: it/the PSA test]?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Fill Instructions
PSA disadvantages
[fill 1] If PSAHAD=1 fill "Before you had the PSA test did" else fill "Did"
[fill 2] if PSAHAD=1 fill "it" else fill "the PSA test"
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLHAD]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 31 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.540_00.000
Variable Name
COLHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
There are several different kinds of tests to check for colon cancer. Colonoscopy
(colon-OS-copy) and sigmoidoscopy (sigmoid-OS-copy) are exams in which a doctor
inserts a tube into the rectum to look for polyps or cancer. For a colonoscopy, the
doctor checks the entire colon, and you are given medication through a needle in your
arm to make you sleepy, and told to have someone drive you home. For a
Sigmoidoscopy, the doctor checks only part of the colon and you are fully awake.
Have you EVER HAD a colonoscopy?
*Read if necessary:
A polyp is a small growth that develops on the inside of the colon or rectum.
Before these tests, you are asked to take a medication that causes diarrhea.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had colonoscopy
Fill Instructions
Special Instructions Display the text "A polyp is a small growth that develops on the inside of the colon or
rectum." in BOLD GRAY text.
Display the text "Before these tests, you are asked to take a medication that causes
diarrhea." in BOLD GRAY text.
Skip Instructions
<1> [goto COL_MT]
<2,R,D> [goto SIGHAD]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 32 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.560_01.000
Variable Name
COL_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
Universe-text
Sample adults 40+ who have ever had a colonoscopy
Question Text
1 of 2
When did you have your MOST RECENT colonoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if COL_MT = store 'R' in COL_YR
if COL_MT = <96> store '9996' in COL_YR
Skip Instructions
<1-12,D> [goto COL_YR]
store "R" in COL_YR [goto COL2]
<96> store "9996" in COL_YR [goto COLN]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 33 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.560_02.000
Variable Name
COL_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and ('01' <= COL_MT <= '12' or COL_MT='99')
Universe-text
Sample adults age 40+ who answered month of last colonoscopy or didn't know month
of last colonoscopy
Question Text
2 of 2
*Enter year of last colonoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if COL_YR gt current year or (COL_YR=current year and COL_MT gt
current month)
goto ERR1_ COL_YR (future date)
elseif COL_YR lt DOBY or (COL_YR=DOBY and COL_MT lt DOBM)
goto ERR2_ COL_YR (prior to birth date)
elseif COL_MT=D
goto COL2
elseif COL_MT=1-12
goto COLPAY
goto COL2
Hard Edits
ERR1_ COL_YR
* Future date invalid. Please correct.
ERR2_ COL_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 34 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.570_01.000
Variable Name
COLN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and COL_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent
colonoscopy from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT colonoscopy?
*Enter number for time since last colonoscopy.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if COLN = store 'R' in COLT
If COLN = store 'D' in COLT
Skip Instructions
<1-95> [goto COLT]
store "R,D" in COLT [goto COL2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 35 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.570_02.000
Variable Name
COLT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and COL_MT(e)='96' and ('01' <= COLN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent colonoscopy.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If COLN gt 10 and COLT=4, store '6' in COL2.
If COLN=6,7,8,9 and COLT=4, store '5' in COL2.
If COLN=4 and COLT=4, store '4' in COL2.
Skip Instructions
<1-3> goto COLPAY
<4> if COLN=4
set COL2=4
goto COLPAY
elseif COLN=6,7,8,9
set COL2=5
goto COLPAY
elseif COLN gt 10 and COLN gt AGE
goto ERR_COLT (greater than persons age)
elseif COLN gt 10 and COLN le AGE
set COL2=6
goto COLPAY
elseif COLN=1,2,3,5,10
goto COL2
goto COL2
Hard Edits
ERR_COLT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Thursday, June 15, 2017
Page 36 of 73
AssocHelp
Thursday, June 15, 2017
Page 37 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.575_00.000
Variable Name
COL2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
and (COL_MT(e) IN ('97','98','99') or COL_YR(e) IN ('9997','9998','9999') or COLN(e)
IN ('97','98','99') or COLT(e) IN ('7','8','9') or (COLT(e)='4' and COLN IN
('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last colonoscopy
was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If COLN gt 10 and COLT=4, store '6' in COL2 and don't ask question.
If COLN=6,7,8,9 and COLT=4, store '5' in COL2 and don't ask question.
If COLN=4 and COLT=4, store '4' in COL2 and don't ask question.
Based upon prior answers:
if COLN = 1 and COLT = '4', gray out answer codes 3,4,5,6
if COLN = 2 and COLT = '4', gray out answer codes 1,4,5,6
if COLN = 3 and COLT = '4', gray out answer codes 1,2,5,6
if COLN = 5 and COLT = '4', gray out answer codes 1,2,3,6
if COLN = 10 and COLT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_COL2]
else [goto COLPAY]
Hard Edits
ERR_COL2
*That is not a valid response.
*Please correct.
Thursday, June 15, 2017
Page 38 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.590_00.010
Variable Name
COLPAY
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLHAD(e)='1'
Universe-text
Sample adults 40+ who who have ever had a colonoscopy
Question Text
How much did you pay out of pocket for your most recent colonoscopy -- was it
NONE, PART, or ALL of the cost?
Answer Codes
1. None of the cost
2. Part of the cost
3. All of the cost
Refused
Don't Know
Question Type
Pick one-answer list pane
Field Pane Description
How much paid
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [goto SIGHAD]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 39 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.591_00.000
Variable Name
SIGHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Recall that a sigmoidoscopy is similar to a colonoscopy but the doctor checks only
part of the colon and you are fully awake. Have you EVER HAD a sigmoidoscopy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had sigmoidoscopy
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto SIG_MT]
<2,R,D> [goto CTHEARD]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 40 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.592_01.000
Variable Name
SIG_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
Universe-text
Sample adults 40+ who have ever had a sigmoidoscopy
Question Text
1 of 2
When did you have your MOST RECENT sigmoidoscopy?
*Enter month of last exam.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if SIG_MT = store 'R' in SIG_YR
if SIG_MT = <96> store '9996' in SIG_YR
Skip Instructions
<1-12,D> [goto SIG_YR]
store "R' in SIG_YR [goto SIG2]
<96> store "9996" in SIG_YR [goto SIGN]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 41 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.593_02.000
Variable Name
SIG_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
and ('01' <= SIG_MT <= '12' or SIG_MT='99')
Universe-text
Sample adults age 40+ who answered month of last sigmoidoscopy or didn't know
month of last sigmoidoscopy
Question Text
2 of 2
*Enter year of last sigmoidoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if SIG_YR gt current year or (SIG_YR=current year and SIG_MT gt
current month)
goto ERR1_ SIG_YR (future date)
elseif SIG_YR lt DOBY or (SIG_YR=DOBY and SIG_MT lt DOBM)
goto ERR2_ SIG_YR (prior to birth date)
elseif SIG_MT=D
goto SIG2
elseif SIG_MT=1-12
goto CTHEARD
goto SIG2
Hard Edits
ERR1_ SIG_YR
* Future date invalid. Please correct.
ERR2_ SIG_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 42 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.594_01.000
Variable Name
SIGN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
and SIG_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent
sigmoidoscopy from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT sigmoidoscopy?
*Enter number for time since last sigmoidoscopy.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if SIGN = store 'R' in SIGT
If SIGN = store 'D' in SIGT
Skip Instructions
<1-95> [goto SIGT]
store "R,D" in SIGT [goto SIG2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 43 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.595_02.000
Variable Name
SIGT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
and SIG_MT(e)='96' and ('01' <= SIGN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent sigmoidoscopy.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If SIGN gt 10 and SIGT=4, store '6' in SIG2.
If SIGN=6,7,8,9 and SIGT=4, store '5' in SIG2.
If SIGN=4 and SIGT=4, store '4' in SIG2.
Skip Instructions
<1-3> goto CTHEARD
<4> if SIGN=4
set SIG2=4
goto CTHEARD
elseif SIGN=6,7,8,9
set SIG2=5
goto CTHEARD
elseif SIGN gt 10 and SIGN gt AGE
goto ERR_SIGT (greater than persons age)
elseif SIGN gt 10 and SIGN le AGE
set SIG2=6
goto CTHEARD
elseif SIGN=1,2,3,5,10
goto SIG2
goto SIG2
Hard Edits
ERR_SIGT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Thursday, June 15, 2017
Page 44 of 73
AssocHelp
Thursday, June 15, 2017
Page 45 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.596_00.000
Variable Name
SIG2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and SIGHAD(e)='1'
and (SIG_MT(e) IN ('97','98','99') or SIG_YR(e) IN ('9997','9998','9999') or SIGN(e) IN
('97','98','99') or SIGT(e) IN ('7','8','9') or (SIGT(e)='4' and SIGN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last
sigmoidoscopy was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If SIGN gt 10 and SIGT=4, store '6' in SIG2 and don't ask question.
If SIGN=6,7,8,9 and SIGT=4, store '5' in SIG2 and don't ask question.
If SIGN=4 and SIGT=4, store '4' in SIG2 and don't ask question.
Based upon prior answers:
if SIGN = 1 and SIGT = '4', gray out answer codes 3,4,5,6
if SIGN = 2 and SIGT = '4', gray out answer codes 1,4,5,6
if SIGN = 3 and SIGT = '4', gray out answer codes 1,2,5,6
if SIGN = 5 and SIGT = '4', gray out answer codes 1,2,3,6
if SIGN = 10 and SIGT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out {goto ERR_SIG2]
else [goto CTHEARD]
Hard Edits
ERR_SIG2
*That is not a valid response.
*Please correct.
Thursday, June 15, 2017
Page 46 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.611_00.000
Variable Name
CTHEARD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
CT colonography, sometimes called virtual colonoscopy, is a new type of test that
looks for cancer in the colon. Unlike regular colonoscopies, you do not need
medication to make you sleepy during the test. In this new test, your colon is filled with
air and you are moved through a donut-shaped X-ray machine as you lie on your back
and then your stomach.
Before today, HAD YOU EVER HEARD of CT colonography or virtual colonoscopy?
*Read if necessary:
This is not the same as a colonoscopy or a sigmoidoscopy.
Unlike CT tests for other purposes, you DO take laxatives to clean out your colon for
this test.
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Heard of CT Colonography
Fill Instructions
Special Instructions Display the text "This is not the same as a colonoscopy or a sigmoidoscopy. " in
BOLD GRAY text.
Display the text " Unlike CT tests for other purposes, you DO take laxatives to clean
out your colon for this test." in BOLD GRAY text.
Skip Instructions
<1> [goto CTHADEV]
<2,R,D> [goto COLTOLD]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 47 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.612_00.000
Variable Name
CTHADEV
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHEARD(e)='1'
Universe-text
Sample adults 40+ who have ever heard of a CT colonography or a virtual
colonoscopy
Question Text
Have you EVER HAD a CT colonography or virtual colonoscopy?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had CT Colonography
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CT_MT]
<2,R,D> [goto COLTOLD]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 48 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.613_01.000
Variable Name
CT_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
Universe-text
Sample adults 40+ who have ever had a CT colonography or virtual colonoscopy
Question Text
1 of 2
When did you have your MOST RECENT CT colonography or virtual colonoscopy?
*Enter month of last CT colonography or virtual colonoscopy.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if CT_MT = store 'R' in CT_YR
if CT_MT = <96> store '9996' in CT_YR
Skip Instructions
<1-12,D> [goto CT_YR]
store "R' in CT_YR [goto CT2]
<96> store "9996" in CT_YR [goto CTN]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 49 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.614_02.000
Variable Name
CT_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and ('01' <= CT_MT <= '12' or CT_MT='99')
Universe-text
Sample adults age 40+ who answered month of last CT colonography or virtual
colonoscopy or didn't know month of last CT colonography or virtual colonoscopy
Question Text
2 of 2
*Enter year of last CT colonography or virtual colonoscopy.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if CT_YR gt current year or (CT_YR=current year and CT_MT gt current
month)
goto ERR1_ CT_YR (future date)
elseif CT_YR lt DOBY or (CT_YR=DOBY and CT_MT lt DOBM)
goto ERR2_ CT_YR (prior to birth date)
elseif CT_MT=D
goto CT2
elseif CT_MT=1-12
goto COLTOLD
goto CT2
Hard Edits
ERR1_ CT_YR
* Future date invalid. Please correct.
ERR2_ CT_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 50 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.615_01.000
Variable Name
CTN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and CT_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent CT
colonography or virtual colonoscopy from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT CT colonography or
virtual colonoscopy?
*Enter number for time since last CT colonography or virtual colonoscopy.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if CTN = store 'R' in CTT
If CTN = store 'D' in CTT
Skip Instructions
<1-95> [goto CTT]
store "R,D" in CTT [goto CT2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 51 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.616_02.000
Variable Name
CTT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and CT_MT(e)='96' and ('01' <= CTN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent CT colonography or virtual colonoscopy.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If CTN gt 10 and CTT=4, store '6' in CT2.
If CTN=6,7,8,9 and CTT=4, store '5' in CT2.
If CTN=4 and CTT=4, store '4' in CT2.
Skip Instructions
<1-3> goto COLTOLD
<4> if CTN=4
set CT2=4
goto COLTOLD
elseif CTN=6,7,8,9
set CT2=5
goto COLTOLD
elseif CTN gt 10 and CTN gt AGE
goto ERR_CTT (greater than persons age)
elseif CTN gt 10 and CTN le AGE
set CT2=6
goto COLTOLD
elseif CTN=1,2,3,5,10
goto CT2
goto CT2
Hard Edits
ERR_CTT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Thursday, June 15, 2017
Page 52 of 73
AssocHelp
Thursday, June 15, 2017
Page 53 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.617_00.000
Variable Name
CT2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and CTHADEV(e)='1'
and (CT_MT(e) IN ('97','98','99') or CT_YR(e) IN ('9997','9998','9999') or CTN(e) IN
('97','98','99') or CTT(e) IN ('7','8','9') or (CTT(e) = '4' and CTN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last CT
colonography or virtual colonoscopy was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If CTN gt 10 and CTT=4, store '6' in CT2 and don't ask question.
If CTN=6,7,8,9 and CTT=4, store '5' in CT2 and don't ask question.
If CTN=4 and CTT=4, store '4' in CT2 and don't ask question.
Based upon prior answers:
if CTN = 1 and CTT = '4', gray out answer codes 3,4,5,6
if CTN = 2 and CTT = '4', gray out answer codes 1,4,5,6
if CTN = 3 and CTT = '4', gray out answer codes 1,2,5,6
if CTN = 5 and CTT = '4', gray out answer codes 1,2,3,6
if CTN = 10 and CTT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_CT2]
else [goto COLTOLD]
Hard Edits
ERR_CT2
*That is not a valid response.
*Please correct.
Thursday, June 15, 2017
Page 54 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.619_00.000
Variable Name
COLTOLD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
The following questions are about another type of test to check for colon cancer - the
blood stool or occult blood test, or fecal immunochemical or FIT test, tests to
determine whether you have blood in your stool or bowel movement. These tests can
be done at home using a kit. You use a stick or brush to obtain a small amount of
stool at home and send it back to the doctor or lab.
Has your doctor or other health professional EVER told you about these tests for
blood in the stool to check for colon cancer?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Told about blood stool tests
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto COLTOLD]
<2,R,D] [goto HFOBHAD1]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 55 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.620_00.000
Variable Name
HFOBHAD1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Have you EVER HAD a blood stool or FIT test, using a HOME test kit?
*Read if necessary: Do not include tests done at the doctor's office.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't Know
Yes/No
Field Pane Description
Ever had home test
Fill Instructions
Special Instructions Display the text "Do not include tests done at the doctor's office." In BOLD GRAY text.
Skip Instructions
<1> goto RHFO2_MT
<2,R,D> [goto COLGDHAD]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 56 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.640_01.000
Variable Name
RHFO2_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and HFOBHAD1='1'
Universe-text
Sample adults 40+ who have ever had a home blood stool or FIT test
Question Text
1 of 2
When did you have your MOST RECENT blood stool or FIT test using a kit at home?
*Enter month of last home blood stool or FIT test.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if RHFO2_MT = store 'R' in RHFO2_YR
if RHFO2_MT = <96> store '9996' in RHFO2_YR
Skip Instructions
<1-12,D> goto RHFO2_YR
store "R" in RHFO2_YR and goto RHFO2
<96> store "9996" in RHFO2_YR and goto RHFO2N
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 57 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.640_02.000
Variable Name
RHFO2_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
HFOBHAD1(e)='1' and ('01' <= RHFO2_MT <= '12' or RHFO2_MT='99')
Universe-text
Sample adults age 40+ who answered month of last home blood stool or FIT test or
didn't know month of last test
Question Text
2 of 2
*Enter year of last home blood stool or FIT test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if RHFO2_YR gt current year or (RHFO2_YR=current year and
RHRO1_MT gt current month)
goto ERR1_RHFO2_YR (future date)
elseif RHFO2_YR lt DOBY or (RHFO2_YR=DOBY and RHFO2_MT lt
DOBM)
goto ERR2_RHFO2_YR (prior to birth date)
elseif RHFO2_MT=D
goto RHFO2
elseif RHFO2_MT=1-12
goto COLGDHAD
goto RHFO2
Hard Edits
ERR1_ RHFO2_YR
* Future date invalid. Please correct.
ERR2_ RHFO2_YR
* Date before birth. Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 58 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.650_01.000
Variable Name
RHFO2N
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
HFOBHAD1(e)='1' and RHFO2_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent home
blood stool or FIT test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT blood stool or FIT test
using a kit at home?
*Enter number for time since last home blood stool or FIT test.
*Enter '95' for 95 or more.
Answer Codes
Question Type
Allow 1-95, R, D
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if RHFO2N = store 'R' in RHFO2T
If RHFO2N = store 'D' in RHFO2T
Skip Instructions
<1-95> [goto RHFO2T]
store "R,D" in RHFO2T [goto RHFO2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 59 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.650_02.000
Variable Name
RHFO2T
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
HFOBHAD1(e)='1' and RHFO2_MT(e)='96' and ('01' <= RHFO2N <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most recent home blood stool or FIT test.
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If RHFO2N gt 10 and RHFO2T=4, store '6' in RHFO2.
If RHFO2N=6,7,8,9 and RHFO2T=4, store '5' in RHFO2.
If RHFO2N=4 and RHFO2T=4, store '4' in RHFO2.
Skip Instructions
<1-3> [goto COLGDHAD]
<4> if RHFO2N=4
set RHFO2=4
goto COLGDHAD
elseif RHFO2N=6,7,8,9
set RHFO2=5
goto COLGDHAD
elseif RHFO2N gt 10 and RHFO2N gt AGE
goto ERR_RHFO2T (greater than persons age)
elseif RHFO2N gt 10 and RHFO2N le AGE
set RHFO2=6
[goto COLGDHAD]
elseif RHFO2N=1,2,3,5,10
goto RHFO2
goto RHFO2
Hard Edits
ERR_RHFO2T
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
Thursday, June 15, 2017
Page 60 of 73
AssocHelp
Thursday, June 15, 2017
Page 61 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.655_00.000
Variable Name
RHFO2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
HFOBHAD1(e)='1' and (RHFO2_MT(e) IN ('97','98','99') or RHFO2_YR(e) IN
('9997','9998','9999') or RHFO2N(e) IN ('97','98','99') or RHFO2T(e) IN ('7','8','9') or
(RHFO2T(e) = '4' and RHFO2N IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last home blood
stool or FIT test was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If RHFO2N gt 10 and RHFO2T=4, store '6' in RHFO2 and don't ask question.
If RHFO2N=6,7,8,9 and RHFO2T=4, store '5' in RHFO2 and don't ask question.
If RHFO2N=4 and RHFO2T=4, store '4' in RHFO2 and don't ask question.
Based upon prior answers:
if RHFO2N = 1 and RHFO2T = '4', gray out answer codes 3,4,5,6
if RHFO2N = 2 and RHFO2T = '4', gray out answer codes 1,4,5,6
if RHFO2N = 3 and RHFO2T = '4', gray out answer codes 1,2,5,6
if RHFO2N = 5 and RHFO2T = '4', gray out answer codes 1,2,3,6
if RHFO2N = 10 and RHFO2T = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_RHFO2]
else [goto COLGDHAD]
Hard Edits
ERR_RHFO2
*That is not a valid response.
*Please correct.
Thursday, June 15, 2017
Page 62 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.660_00.000
Variable Name
COLGDHAD
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999'))
Universe-text
Sample adults 40+
Question Text
Cologuard is a new type of stool test to check for colon cancer. Unlike other stool
tests, Cologuard looks for changes in DNA in addition to checking for blood in your
stool. The Cologuard test is shipped to your home in a box that includes a container
for your stool sample.
Have you ever had a Cologuard test?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Ever had Cologuard test
Fill Instructions
Special Instructions
Skip Instructions
<1> if HFOBHAD1=1 [goto COLGDPRT]; else [goto COLGD_MT]
<2,R,D]if COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt
current month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current
year – 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60
or CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2
and RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D [goto
COLPROB1]; else [goto next section]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 63 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.662_00.000
Variable Name
COLGDPRT
Universe
HHSTAT4='S' and (AGE GE '018' and AGE not IN ('997','999')) and ((HFOBHAD1 =
'1') and (COLGDHAD(e)=-'1')
Universe-text
Sample adults 40+ who have ever had a home blood stool or FIT test and a
Cologuard test
Question Text
Was the blood stool or FIT test your reported earlier conducted as part of a Cologuard
test?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Earlier test part of Cologuard
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [goto COLGD_MT]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 64 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.665_01.000
Variable Name
COLGD_MT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLGDHAD='1'
Universe-text
Sample adults 40+ who have ever had a Cologuard test
Question Text
1 of 2
When did you have your MOST RECENT Cologuard test?
*Enter month of last Cologuard test.
*Enter '96' to go to number and time period format.
Answer Codes
Question Type
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
96. Time period format
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Month
Fill Instructions
Special Instructions if COLGD_MT = store 'R' in COLGD_YR
if COLGD_MT = <96> store '9996' in COLGD_YR
Skip Instructions
<1-12,D> goto COLGD_YR
store "R" in COLGD_YR and goto COLGD2
<96> store "9996" in COLGD_YR and goto COLGDN
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 65 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.665_02.000
Variable Name
COLGD_YR
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
COLGDHAD(e)='1' and ('01' <= COLGD_MT <= '12' or COLGD_MT='99')
Universe-text
Sample adults age 40+ who answered month of last Cologuard test or didn't know
month of last test
Question Text
2 of 2
*Enter year of last Cologuard test.
Answer Codes
Question Type
Integer
Field Pane Description
Year
Fill Instructions
Special Instructions Allow 4 character numeric field – must enter 4 numbers
Skip Instructions
if COLGD_YR gt current year or (COLGD_YR =current year and
COLGD_MT gt current month)
[goto ERR1_ COLGD_YR (future date)] elseif COLGD_YR lt DOBY or (COLGD_YR
=DOBY and COLGD_MT lt DOBM)
[goto ERR2_ COLGD_YR (prior to birth date)] elseif COLGD_MT =D [goto COLGD2]
elseif COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt current
month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current
year – 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60
or CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2
and RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D and
COLGD_MT lt current month
or COLGD_YR lt (current year -1)[goto COLPROB1]; else [goto next section]
[goto COLGD2]
Hard Edits
ERR1_ COLDG_YR
* Future date invalid. Please correct.
ERR2_ COLDG_YR
* Date before birth. Please correct.
Thursday, June 15, 2017
Page 66 of 73
Soft Edits
AssocHelp
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.670_01.000
Variable Name
COLGDN
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
COLGDHAD(e)='1' and COLGD_MT(e)='96'
Universe-text
Sample adults 40+ who selected number and time period format for most recent home
blood stool or FIT test from the initial month screen
Question Text
1 of 2
*Read if necessary: When did you have your MOST RECENT Cologuard test?
*Enter number for time since last Cologuard test.
*Enter '95' for 95 or more.
Answer Codes
Allow 1-95, R, D
Question Type
Integer
Field Pane Description
Number
Fill Instructions
Special Instructions if COLGDN = store 'R' in COLGDT
If COLGDN = store 'D' in COLGDT
Skip Instructions
<1-95> [goto COLGDT]
store "R,D" in COLGDT [goto COLGD2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 67 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.670_02.000
Variable Name
COLGDT
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
COLGDHAD(e)='1' and COLDG_MT(e)='96' and ('01' <= COLGDN <= '95')
Universe-text
Sample adults 40+ who answered 1-95 for number part of this 2 part question
Question Text
2 of 2
*Enter time period for time since most Cologuard test
Answer Codes
Question Type
1. Days ago
2. Weeks ago
3. Months ago
4. Years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time period
Fill Instructions
Special Instructions If COLGDN gt 10 and COLGDT =4, store '6' in COLGD2
If COLGDN =6,7,8,9 and COLGDT =4, store '5' in COLGD2
If COLGDN =4 and COLGDT =4, store '4' in COLGD2
Skip Instructions
<1-3> if COLGD_YR gt current year or (COLGD_YR =current year and COLGD_MT gt
current month)
[goto ERR1_ COLGD_YR (future date)] elseif COLGD_YR lt DOBY or (COLGD_YR
=DOBY and COLGD_MT lt DOBM)
[goto ERR2_ COLGD_YR (prior to birth date)] elseif COLGD_MT =D [goto COLGD2]
elseif COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt current
month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current
year – 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60
or CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2
and RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D and
COLGDHAD=2 or COLGD_MT lt current month
or COLGD_YR lt (current year -1) or COLDGDT=3 and COLDGDN gt 12 [goto
COLPROB1]; else [goto next section] [goto COLGD2]
<4> if COLGDN =4
Thursday, June 15, 2017
Page 68 of 73
set COLGD2=4
goto COLPROB1
elseif COLGDN =6,7,8,9
set COLGD2=5
goto COLPROB1
elseif COLGDN gt 10 and COLGDN gt AGE
goto ERR_ COLGDT (greater than persons age)
elseif COLGDN gt 10 and COLGDN le AGE
set COLGD2=6
goto COLPROB1
elseif COLGDN =1,2,3,5,10
goto COLGD2
goto COLGD2
Hard Edits
ERR_COLGDT
* Time since last exam cannot be greater than age.
* Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 69 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.675_00.000
Variable Name
COLGD2
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and
COLGDHAD(e)='1' and (COLGD_MT(e) IN ('97','98','99') or COLDG_YR(e) IN
('9997','9998','9999') or COLDG(e) IN ('97','98','99') or COLDG(e) IN ('7','8','9') or
(COLGDT(e) = '4' and COLGDN IN ('1','2','3','5','10')))
Universe-text
Sample adults 40+ who failed to give a complete date in either the month or year
format or failed to give a complete date in the number and time period format, or
entered years ago in the time period format (excluding those whose last home blood
stool or FIT test was 6-9 or over 10 years ago)
Question Text
Was it:
*Read answer categories.
Answer Codes
Question Type
1. A year ago or less
2. More than 1 year but not more than 2 years
3. More than 2 years but not more than 3 years
4. More than 3 years but not more than 5 years
5. More than 5 years but not more than 10 years
6. Over 10 years ago
Refused
Don't know
Pick One - answer pane list
Field Pane Description
Time categories
Fill Instructions
Special Instructions Display answer categories 1-6 in BOLD BLACK text.
If COLGDN gt 10 and COLGDT=4, store '6' in COLGD2 and don't ask question.
If COLGDN=6,7,8,9 and COLGDT=4, store '5' in COLGD2 and don't ask question.
If COLGDN=4 and COLGDT=4, store '4' in COLGD2 and don't ask question.
Based upon prior answers:
if COLGDN = 1 and COLGDT = '4', gray out answer codes 3,4,5,6
if COLGDN = 2 and COLGDT = '4', gray out answer codes 1,4,5,6
if COLGDN = 3 and COLGDT = '4', gray out answer codes 1,2,5,6
if COLGDN = 5 and COLGDT = '4', gray out answer codes 1,2,3,6
if COLGDN = 10 and COLGDT = '4', gray out answer codes 1,2,3,4
Skip Instructions
<1-6,R,D> if answer code is grayed out [goto ERR_ COLGD2]
else f COLGD_YR gt current year or (COLGD_YR =current year and COLGD_MT
gt current month)
[goto ERR1_ COLGD_YR (future date)] elseif COLGD_YR lt DOBY or (COLGD_YR
=DOBY and COLGD_MT lt DOBM)
[goto ERR2_ COLGD_YR (prior to birth date)] elseif COLGD_MT =D [goto COLGD2]
elseif COLHAD=2 or COL2=6 or COL_YR=(current year – 10) and COL_MT lt current
Thursday, June 15, 2017
Page 70 of 73
month
or COL_YR lt (current year – 10) or COLT=4 and COLN ge 11 and COL2=R,D and
SIGHAD=2 or SIG2=5,6 or SIG_YR=(current year – 5) and SIG_MT lt current month
or SIG_YR lt (current year – 5) or SIGT=3 and SIGN gt 60 or SIGT=4 and SIGN ge 6
and SIG2=R,D and CTHEARD=2 or CTHADEV=2 or CT2=5,6 or CT_YR=(current
year – 5)
and CT_MT lt current month or CT_YR lt (current year – 5) or CTT=3 and CTN gt 60
or CTT=4 and CTN ge 6
and CT2=R,D and HFOBHAD=2 or RHFO2 =2,3,4,5,6 or RHFO2_YR=(current year –
1)
and RHFO2_MT lt current month or RHFO2_YR lt (current year – 1) or RHFO2T=2
and RHFO2N gt 52 or RHFO2T=3
and RHFO2N gt 12 or RHFO2T=4 and RHFO2N ge 2 and RHFO2=R,D and
COLGDHAD=2 or COLGD =2,3,4,5,6 or COLGD_YR=(current year – 1)
and COLGD_MT lt current month or COLGD_YR lt (current year – 1) or COLGDT=2
and COLGDN gt 52 or COLGDT=3
and COLGDN gt 12 or COLGDT=4 and COLGDN ge 2 and COLGD2=R,D [goto
COLPROB1] else [goto next section]
Hard Edits
ERR_COLGD2
*That is not a valid response.
*Please correct.
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 71 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.750_00.000
Variable Name
COLPROB1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999') and
((COLHAD = ‘2’) or (COL2 = ‘6’) or (COL_YR = (current year – 10) and COL_MT lt
current month) or (COL_YR lt (current year – 10)) or (COLT = '4' and COLN ge '11'
and COL2 IN ('7','9'))) and
((SIGHAD = ‘2’) or (SIG2 IN (‘5’,’6’)) or (SIG_YR = (current year – 5) and SIG_MT lt
current month) or (SIG_YR lt (current year – 5)) or (SIGT = ‘3’ and SIGN gt ‘60’) or
(SIGT = '4' and SIGN ge '6' and SIG2 IN ('7','9'))) and
((CTHEARD = 2) or (CTHADEV = 2) or (CT2 IN (‘5’,’6’)) or (CT_YR = (current year –
5) and CT_MT lt current month) or (CT_YR lt (current year – 5)) or (CTT = ‘3’ and
CTN gt ‘60’) or (CTT = '4' and CTN ge '6' and CT2 IN ('7','9'))) and
((HFOBHAD = ‘2’) or (RHFO2 IN (‘2’,’3’,’4’,’5’,’6’)) or (RHFO2_YR = (current year – 1)
and RHFO2_MT lt current month) or (RHFO2_YR lt (current year – 1)) or (RHFO2T =
‘2’ and RHFO2N gt ‘52’) or (RHFO2T = ‘3’ and RHFO2N gt ‘12’) or (RHFO2T = '4' and
RHFO2N ge '2' and RHFO2 IN ('7','9')))
Universe-text
Sample adults 40+ who have NOT had a colonoscopy in the past 10 years,
sigmoidoscopy in the past 5 years, CT colonography in the past 5 years, or home
blood stool/FIT test in the last year
Question Text
In the PAST 12 MONTHS, did a doctor or other health professional RECOMMEND
that you be tested to look for problems in your colon or rectum?
Answer Codes
1. Yes
2. No
Refused
Don't Know
Question Type
Yes/No
Field Pane Description
Recommend colorectal test
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto COLKIND1]
<2,R,D> [goto next section]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 72 of 73
Module
30
Section Name
Cancer Screening
Part
Question ID
NAF.770_00.000
Variable Name
COLKIND1
Universe
HHSTAT4='S' and (AGE GE '040' and AGE not IN ('997','999')) and COLPROB1(e)='1'
Universe-text
Sample adults 40+ who have had particular tests recommended to look for problems
in the colon and who have NOT had a colonoscopy in the past 10 years,
sigmoidoscopy in the past 5 years, CT colonography in the past 5 years, or home
blood stool/FIT test in the last year and who had another type of test recommended
Question Text
Which tests to check for colon cancer did the doctor or other health professional
recommend to you? Possible tests include stool blood or fecal occult blood or FIT test;
sigmoidoscopy; colonoscopy; CT colonography or virtual colonoscopy; or other.
*Enter all that apply, separate with commas.
Answer Codes
Question Type
1. Stool blood test/fecal occult blood/FIT test
2. Sigmoidoscopy
3. Colonoscopy
4. CT colonography/virtual colonoscopy
5. Other
Refused
Don't know
Enter all that apply
Field Pane Description
Which test(s)
Fill Instructions
Special Instructions
Skip Instructions
<1-5,R,D> [goto next section]
Hard Edits
Soft Edits
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Thursday, June 15, 2017
Page 73 of 73
2018 Q1 NHIS Instrument Spec Report
Section name: Child Conditions, Limitations, Health Status
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.010
Variable Name
CASMHSP
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, has [fill: S.C. name] stayed overnight in a hospital
because of asthma?
*If in hospital for asthma AND other reasons, enter '1'.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CWZMSWK]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 1 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.030
Variable Name
CWZMSWK
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, HOW MANY DAYS of [fill1: daycare or
preschool/fill2: school/fill3: school or work] did [fill: S.C. name] miss because of [fill:
his/her] asthma?
*Enter '0' for none.
*Enter 995 if child home schooled.
*Enter 996 if child did not go to [fill1: daycare or preschool/fill2: school/fill3: school or
work].
Answer Codes
Question Type
Allow 0-365, 995,996,R,D
Integer
Field Pane Description
Fill Instructions
Days missed school
Fill1: Children ages 0-4 fill1 "daycare or preschool"
Fill2: Children ages 5-13 fill2 "school"
Fill3: Children ages 14-17 fill3 "school or work"
Special Instructions
Skip Instructions
<0-100,995,996,R,D> [go to CASMPMED]
<101-365> [go to ERR1_CWZMSWK]
<366-994> [go to ERR2_CWZMSWK]
Hard Edits
if CWZMSWK = 366-994 then display ERR2_CWZMSWK:
"366-994 days not allowed in this field.
* Please correct."
Soft Edits
if CWZMSWK >100 and ne 996 then display ERR1_CWZMSWK:
"CWZMSWK is an unusually large number; Did [fill: S.C. name] miss CWZMSWK
days of [fill1/fill2/fill3] due to asthma?"
1 correct proceed to CASMPMED;
2 incorrect, change answer
AssocHelp
Thursday, June 15, 2017
Page 2 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.060
Variable Name
CASMPMED
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Now I'm going to ask you about two different kinds of ASTHMA medicine. One
prevents symptoms over the long term. The other is for quick relief of symptoms
during an attack or episode. This quick relief medicine is breathed in through your
mouth using a canister inhaler or a disk inhaler.
DURING THE PAST 3 MONTHS, has [fill: S.C. name] used the kind of
PRESCRIPTION asthma inhaler that gives QUICK relief from asthma symptoms
during an attack? Include only medications prescribed by a health care professional.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Quick relief inhaler
Fill Instructions
Special Instructions
Skip Instructions
<1> [goto CASMTYP]
<2,R,D> [go to CASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 3 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.065
Variable Name
CASMTYP
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and CASMPMED(e)='1'
Universe-text
Sample child <18 who have used a quick relief prescription asthma inhaler in the past
three months
Question Text
When [fill: S.C. name] takes [his/her]rescue prescription asthma medication, would
you say that [he/she] most often uses an inhaler and/or disk, or does [he/she] most
often use a nebulizer?
*Read if necessary: Both an inhaler or a disk inhaler are very portable canisters or
devices used to inhale medication in one or two breaths. A nebulizer is a machine
that turns liquid medication into a mist that you inhale into the lungs over a few
minutes.
Answer Codes
Question Type
1. Inhaler or disk
2. Nebulizer
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1> [go to CASMCAN]
<2,R,D> [go to CASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 4 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.070
Variable Name
CASMCAN
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and CASMTYP(e)='1'
Universe-text
Sample child <18 who have used a prescription asthma inhaler/disk most often in the
past three months
Question Text
DURING THE PAST 3 MONTHS, did [fill: S.C. name] use more than three canisters or
disks of this type of quick relief inhaler?
Answer Codes
1. Yes
2. No
Refused
Don't know
Question Type
Yes/No
Field Pane Description
More than 3 canisters
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CASMDTP2]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 5 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.090
Variable Name
CASMDTP2
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
The second kind of asthma medication is different from inhalers used for quick relief.
It is the preventive kind that is used to protect your lungs and keep you from having
attacks. It can be either a pill or an inhaler.
Is [fill: S.C. name] NOW taking a preventive asthma medication every day or almost
every day, less often, or never?
Answer Codes
Question Type
1. Every day or almost every day
2. Less often
3. Never
Refused
Don't know
Pick One - answer list pane
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [go to CASWMP]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 6 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.100
Variable Name
CASWMP
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
An asthma action plan is a printed form with specific instructions based on [fill: S.C.
name]'s asthma that tells when to change the amount or type of medicine, when to call
the doctor for advice, and when to go to the emergency room.
Has a doctor or other health professional EVER given [fill: S.C. name] an asthma
action plan?
*Read if necessary: Include nurses and asthma educators.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Action plan
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CASCLASS]
Hard Edits
Soft Edits
AssocHelp
Thursday, June 15, 2017
Page 7 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.110
Variable Name
CASCLASS
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Has [fill: S.C. name] ever taken a course or class on how to manage [fill: his/her]
asthma?
*Include adult(s) who took a course for the child's asthma.
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Course or class
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CAS_REC]
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Thursday, June 15, 2017
Page 8 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.116
Variable Name
CAS_REC
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Has a doctor or other health professional EVER taught [fill: S.C. name] or [fill: his/her]
parent or guardian
...how to recognize early signs or symptoms of an asthma episode?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Recognize early signs
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CAS_RES]
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Thursday, June 15, 2017
Page 9 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.117
Variable Name
CAS_RES
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
*Read if necessary: Has a doctor or other health professional EVER taught [fill: S.C.
name] or [fill: his/her] parent or guardian
...how to respond to episodes of asthma?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Respond to episodes
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CAS_MON]
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Thursday, June 15, 2017
Page 10 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.118
Variable Name
CAS_MON
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
*Read if necessary: Has a doctor or other health professional EVER taught [fill: S.C.
name] or [fill: his/her] parent or guardian
...how to monitor peak flow for daily therapy?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Monitor peak flow
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CAPENVLN]
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Thursday, June 15, 2017
Page 11 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.130
Variable Name
CAPENVLN
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
Has a doctor or other health professional EVER advised you to change things in [fill:
S.C. name]'s home, school, or work environment to improve [fill: his/her] asthma?
Answer Codes
1. Yes
2. No
3. Was told no changes needed
Don't know
Refused
Question Type
Pick One - answer list pane
Field Pane Description
Advised you
Fill Instructions
Special Instructions
Skip Instructions
<1-3,R,D> [go to CAROUTIN]
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Thursday, June 15, 2017
Page 12 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.135
Variable Name
CAROUTIN
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months
Question Text
DURING THE PAST 12 MONTHS, how many times did [fill: S.C. name] see a doctor
or other health professional for a routine checkup for [fill: his/her] asthma? Please do
not include emergency room visits, visits to urgent care centers, or other visits for
acute care for an asthma episode or attack.
*Enter '0' for none.
Answer Codes
Question Type
Allow 0-365,R,D
Integer
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<0-50,R,D> [go to CASYMPT]
<51-365> [goto ERR_CAROUTIN]
Hard Edits
Soft Edits
ERR_CAROUTIN
[fill4: CAROUTIN] is an unusually large number.
* Please verify.
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Thursday, June 15, 2017
Page 13 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.140
Variable Name
CASYMPT
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months and saw a doctor/health professional about S.C.'s asthma in the past year
Question Text
The next three questions are about the last time [S.C. name] saw a doctor or other
health care professional for routine care or for any reason.
At his/her last visit, did [fill: S.C. name]'s doctor or other health professional ask HOW
OFTEN
….[fill: he/she] had asthma symptoms?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CARESCUE]
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Thursday, June 15, 2017
Page 14 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.145
Variable Name
CARESCUE
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months and use a quick relief inhaler and saw a doctor/health professional about
S.C.'s asthma in the past year
Question Text
At his/her last visit, did [fill: S.C. name]’s doctor or other health professional ask HOW
OFTEN
...[fill: he/she] used a quick relief inhaler
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [go to CAACTLIM]
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Thursday, June 15, 2017
Page 15 of 16
Module
11
Section Name
Child Conditions, Limitations, Health Status
Part
A
Question ID
CHS.100_00.150
Variable Name
CAACTLIM
Universe
HHSTAT4='C' and (AGE LE '017' and AGE NE ' ') and (CASSTILL(e)='1' or
CASHYR(e)='1')
Universe-text
Sample child <18 who still have asthma or who had asthma episode/attack in past 12
months and saw a doctor/health professional about S.C.'s asthma in the past year
Question Text
At his/her last visit, did [fill: S.C. name]’s doctor or other health professional ask HOW
OFTEN
…asthma symptoms limited [fill: his/her] daily activities?
Answer Codes
Question Type
1. Yes
2. No
Refused
Don't know
Yes/No
Field Pane Description
Fill Instructions
Special Instructions
Skip Instructions
<1,2,R,D> [if AGE LE 2 go to CCONDT1_1; else go to CCONDT_1]
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Thursday, June 15, 2017
Page 16 of 16
| File Type | application/pdf |
| File Modified | 2017-11-01 |
| File Created | 2017-06-15 |