Form 0920-0214 Redesigned Adult Questionnaire

Changes to 2020 National Health Interview Survey in light of Novel Coronavirus (2019-nCoV)

Att 2 AdultQuestionnaire Word 120819

Re-Designed Adult Questionnaire

OMB: 0920-0214

Document [docx]
Download: docx | pdf



Attachment 2 Adult Questionnaire


Form Approved

OMB. No. 0920-0214

Exp. Date 12/31/2020


Assurance of confidentiality – We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA, Title 5 of Public Law 107-347). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.


Notice – Public reporting burden of this collection of information is estimated to average 49 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333. ATTN: PRA (0920-0214).







Shape1



Universe:

(EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7) or EMPLSTWRK_A=1)

Question Text:

^JOBFOR whom ^dodid you work ^job? Enter the name of the company, business or employer. Read if necessary for those with more than one MAIN job or business: Where ^dodid you work for the most amount of time?

Response:

DK: Don't Know

RF: Refused

Fills:

^JOBFOR Intro to whom worked


^dodid If EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A=2,7, fill: "do"

If EMPLSTWRK_A=1, fill: "did"


^job if (EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7)) fill: "at your MAIN job or business"

else no fill

Skip Instructions:

<verbatim,RF,DK> [goto EMDKINDIND_A]

Shape2



Universe:

(EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7) or EMPLSTWRK_A=1)

Question Text:

What kind of business or industry ^iswas this? Read if necessary: For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank.

Response:

DK: Don't Know

RF: Refused

Fills:

^iswas If EMPLASTWK_A=1 OR EMPNOWRK_A=1 OR EMPRSNOWK_A IN (2,7) fill: "is"

If EMPLSTWRK_A=1, fill: "was"

Skip Instructions:

<verbatim,RF,DK> [goto EMDKINDWRK_A]

Shape3



Universe:

(EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7) or EMPLSTWRK_A=1)

Question Text:

What kind of work ^arewere you doing? Read if necessary: For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant.

Response:

DK: Don't Know

RF: Refused

Fills:

^hacer_A Spanish only


^arewere If EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7), fill: "are"

If EMPLSTWRK_A=1, fill: "were"

Skip Instructions:

<verbatim,RF,DK> [goto EMDIMPACT_A]

Shape4



Universe:

(EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7) or EMPLSTWRK_A=1)

Question Text:

What ^arewere your most important activities or duties on this job or business? Read if necessary: For example: patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records.

Response:

DK: Don't Know

RF: Refused


Fills:

^arewere If EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7), fill: "are"

If EMPLSTWRK_A=1, fill: "were"

Skip Instructions:

<verbatim,RF,DK> [goto EMDSPRVIS_A]

Shape7



Universe:

(EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7) or EMPLSTWRK_A=1)

Question Text:

^DoDid you supervise other employees as part of your job?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^DoDid If EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7), fill: "Do"

If EMPLSTWRK_A=1, fill: "Did"

Skip Instructions:

<1,2,RF,DK> [goto EMDWRKCAT_A]

Shape8



Universe:

(EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7) or EMPLSTWRK_A=1)

Question Text:

Which of these BEST describes your MAIN job or ^WRKCAT?

Response:

1. Employee of a PRIVATE company for wages



  1. A FEDERAL government employee

  2. A STATE government employee

  3. A LOCAL government employee

  4. Self-employed in OWN business, professional practice or farm

  5. Working WITHOUT PAY in a family-owned business or farm DK: Don't Know

RF: Refused

Fills:

^WRKCAT If EMPLASTWK_A=1 or EMPNOWRK_A=1 or

EMPRSNOWK_A IN (2,7), fill: "work situation"

If EMPLSTWRK_A=1, fill: "business in the past 12 months"

Skip Instructions:

<1-6,RF,DK> if (EMPLASTWK_A=1 or EMPNOWRK_A=1 or EMPRSNOWK_A IN (2,7)) [goto EMPPDSKLV_A]

else [goto EMPDYSMSS_A]




Question Text:

The next set of questions asks about injuries. The first question is about repetitive strain injuries. By this, we mean injuries caused by repeating the same movement over an extended period. Examples include carpal tunnel syndrome, tennis elbow, or tendonitis. During the past 3 months, did you have any injuries due to repetitive strain?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto REPLIMIT_A]

<2,RF,DK> [goto next section]

Shape11


Universe:

REPSTRAIN_A=1

Question Text:

Were any repetitive strain injuries serious enough to limit your usual activities for at least 24 hours?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto REPSAWDOC_A]

<2,RF,DK> [goto next section]



Universe:

REPSTRAIN_A=1 &amp; REPSLIMIT_A=1

Question Text:

For the next questions, please think only about the repetitive strain injuries that limited your usual activities for at least 24 hours after the injury occured.

During the past 3 months, did you talk to or see a doctor or other health professional about your repetitive strain injuries?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto REPSWORK_A]

Shape13


Universe:

HHSTAT_A=1 &amp; REPSTRAIN_A=1 &amp; REPSLIMIT_A=1

Question Text:

During the past 3 months, how many days of work did you miss because of your repetitive strain injuries? Enter 0 if respondent says they did not work in the past 3 Enter 90 if respondent says they missed every day of work in the past 3 months

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<0,RF> [goto REPSTOPCHG_A]

<1-90,DK> [goto REPFUTWORK_A]



Universe:

REPSTRAIN_A=1 &amp; REPLIMIT_A=1 &amp; REPWRKDAYS_A>=1 &amp; REPWRKDAYS_A<=90 or REPWRKDAYS_A=DK

Question Text:

Do you expect to miss any more days of work because of your repetitive strain injuries?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto REPSTPCHG_A]

Shape15


Universe:

REPSTRAIN_A=1 &amp; REPSLIMIT_A=1

Question Text:

During the past 3 months, did you stop working or change jobs because of your repetitive strain injuries? Enter no if respondent says they did not work in the past 3 months

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto REPREDUCE_A]



Universe:

REPSTRAIN_A=1 &amp; REPLIMIT_A=1

Question Text:

During the past 3 months, did you make a major change in your work activities, such as taking on fewer hours or lighter duties, because of your repetitive strain injuries? Enter no if respondent says they did not work in the past 3 months

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto REPWRKCAUS_A]

Shape17


Universe:

REPSTRAIN_A=1 &amp; REPSLIMIT_A=1

Question Text:

Did a doctor or other health professional ever tell you that any of your repetitive strain injuries were likely work-related?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto next section]

Shape19


Question Text:

The next set of questions asks about SUDDEN injuries. People can be injured accidentally, or on purpose. They may hurt themselves or others may cause them to be hurt. Enter '1' to continue.

Response:


Skip Instructions:

<1> [goto ANYINJURY_A]

Shape20


Question Text:

^NOTREPS the past 3 months, did you have an accident or an injury where any part of your body was hurt?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^NOTREPS prefix any injury

Skip Instructions:

<1> [goto INJLIMIT_A]

<2,RF,DK> [goto next section]

Shape21


Universe:

ANYINJURY_A=1

Question Text:

Did any of these injuries limit your usual activities for at least 24 hours after the injury occurred?

Response:

1. Yes














Page 1 of 12

2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto NUMINJ_A]

<2,RF,DK> [goto next section]

Shape22



Universe:

INJLIMIT_A=1

Question Text:

For the next questions, please think only about the significant injuries that occurred during the past 3 months. By significant, I mean those injuries that limited your usual activities for at least 24 hours after the injury occurred.

^NOTREPS the past 3 months, how many times did these accidents or injury events occur? Enter 96 if number is 96 or greater

Response:

DK: Don't Know

RF: Refused

Fills:

^NOTREPS prefix any injury

Skip Instructions:

<1-9,RF,DK> [goto INJHOME_A]

<10-96> [goto ERR1_NUMINJ_A]

Shape23



Text:

{signal ERR1_NUMINJ_A} ^NUMINJ_A is an unusually large number. Please verify.

Hard / Soft Edit:

Soft

Fills:

^NUMINJ_A number of injuries

Universe:

NUMINJ_A>=10 &amp; NUMINJ_A<=96










Page 2 of 12


Shape24


Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did ^siginj_A occur while you were at your home? Read if necessary: Include the yards, garage, basement, and other places on the home property.

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1> if NUMINJ_A=1 [goto INJSPORTS_A]

elseif (NUMINJ_A>1 or NUMINJ_A in (RF,DK)) [goto INJWORK_A]

<2,RF,DK> [goto INJWORK_A]

Shape25



Universe:

INJLIMIT_A=1 &amp; ((NUMINJ_A<1 or NUMINJ_A in (RF,DK)) or (NUMINJ_A=1 &amp; INJHOME_A IN (2,RF,DK))

Question Text:

During the past 3 months, did ^siginj_A occur while you were working at a job or business? Enter no if respondent says they did not work in the past 3 months

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill


Skip Instructions:

<1,2,RF,DK> [goto INJSPORTS_A]

Shape26


Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did ^siginj_A occur while you were playing sports or exercising, including walking, biking, or running, playing baseball, basketball, football or doing any other physical activity? Read if necessary: Include recreational sports such as skating, skiing, tennis, golf, bowling, or fishing.

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto INJFALL_A]

Shape27


Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did ^siginj_C occur as a result of a fall or falling?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_C the significant injury/any significant injuries


Skip Instructions:

<1> if NUMINJ_A=1 [goto INJMOTOR_A]

elseif NUMINJ_A>1 or NUMINJ_A IN (RF,DK) & INJHOME_A=1 [goto INJFALLHOM_A]

elseif NUMINJ_A>1 or NUMINJ_A IN (RF,DK) & INJWORK_A=1 [goto INJFALLWRK_A]

else [goto INJMOTOR_A]

<2,RF,DK> [goto INJMOTOR_A]

Shape29


Universe:

(NUMINJ_A>1 OR NUMINJ_A in (RF,DK)) &amp; INJFALL_A=1 &amp; INJHOME_A=1

Question Text:

Did any fall occur while you were at your home?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> if INJWORK_A=1 [goto INJFALLWRK_A]

else [goto INJMOTOR_A]

Shape30


Universe:

INJLIMIT_A=1 &amp; INJFALL_A=1 &amp; INJWORK_A=1 &amp; (NUMINJ_A>1 or NUMINJ_A in (RF,DK))

Question Text:

Did any fall occur while you were working at a job or business?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused


Skip Instructions:

<1,2,RF,DK> [goto INJMOTOR_A]

Shape31


Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did ^siginj_A occur as a result of being in a motor vehicle crash or being hit by a motor vehicle while walking or biking? Read if necessary: Motor vehicles include cars, trucks, vans, buses, motorcyles, motorized scooters, motorized carts, tractors, ATVs, snowmobiles, dune buggies, and other motorized vehicles.

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1> [goto MVTYPE_A]

<2,RF,DK> [goto INJCHORES_A]

Shape32


Universe:

INJLIMIT_A='1' &amp; INJMOTOR_A='1'

Question Text:

Were you a driver, passenger, bicyclist, pedestrian, or doing something else when this occurred?

Response:

  1. Driver

  2. Passenger

  3. Bicyclist

  4. Pedestrian


5. Something else

DK: Don't Know

RF: Refused

Skip Instructions:

<1-5,RF,DK> [goto INJCHORES_A]

Shape33


Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did ^siginj_A occur while you were doing household activities, such as housework, cooking, home maintenance, or yardwork?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto INJSAWDOC_A]

Shape34


Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did you see or talk to a doctor or other health professional about ^siginj_A?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused



Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1> if EMERGE12M_A in (1-96,RF,DK) [goto INJER_A]

elseif EMERGE12M_A=0 & HOSPONGT_A in (1,RF,DK) [goto INJHOSP_A]

else [goto INJBONES_A]

<2,RF,DK> if [goto INJWRKDAYS_A]

Shape36


Universe:

INJLIMIT_A='1' &amp; INJSAWDOC_A='1' &amp; EMERGE12M_A IN (1-96,RF,DK)

Question Text:

During the past 3 months, did you go to an emergency room because of

^siginj_A?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> if HOSPONGT_A in (1,RF,DK) [goto INJHOSP_A]

else [goto INJBONES]

Shape37








Universe:

INJLIMIT_A=1 &amp; INJSAWDOC_A=1 &amp; HOSPONGT_A in (1,RF,DK)

Question Text:

During the past 3 months, were you hospitalized overnight because of

^siginj_A?




Response:


  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto INJBONES_A]

Shape38



Universe:

INJLIMIT_A=1 &amp; INJSAWDOC_A=1

Question Text:

During the past 3 months, did you have any broken bones as a result of

^siginj_A?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto INJSTITCH_A]

Shape39








Universe:

INJLIMIT_A=1 &amp; INJSAWDOC_A=1

Question Text:

During the past 3 months, did you get any stitches or staples because of

^siginj_A?




Response:



  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto INJWRKDAYS_A]

Shape41



Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, how many days of work did you miss because of

^siginj_A? Enter 0 if respondent says they did not work in the past 3 months Enter 90 if respondent says they missed every day of work in the past 3 months

Response:

DK:

RF:

Don't Know Refused


Fills:

^siginj_A


this injury or any injury fill

Skip Instructions:

<0,RF> [goto INJSTOPCHG_A]

<1-90,DK> [goto INJFUTWRK_A]

Shape42









Universe:

INJLIMIT_A &amp; INJWRKDAYS_A>=1 &amp; INJWRKDAYS_A<=90 or INJWRKDAYS_A=DK

Question Text:

Do you expect to miss any more days of work because of ^siginj_A that occurred during the past 3 months?




Response:



  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto INJSTOPCHG_A]

Shape44



Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did you stop working or change jobs because of

^siginj_A? Enter no if respondent says they did not work in the past 3 months

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto INJREDUCE_A]

Shape45









Universe:

INJLIMIT_A=1

Question Text:

During the past 3 months, did you make a major change in your work activities, such as taking on fewer hours or lighter duties, because of ^siginj_A? Enter no if respondent says they did not work in the past 3 months




Response:



  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^siginj_A this injury or any injury fill

Skip Instructions:

<1,2,RF,DK> [goto next section]


Shape47


Question Text:

1 of 2 The next questions are about physical activities such as exercise, sports, or physically active hobbies that you may do in your LEISURE time. We are interested in two types of physical activity --- moderate and

vigorous-intensity. Moderate-intensity activities cause moderate increases in breathing or heart rate whereas vigorous-intensity activities cause large increases in breathing or heart rate. How often do you do

MODERATE-INTENSITY LEISURE-TIME physical activities? If necessary, prompt with: How many times per day, per week, per month, or per year do you do these activities? Enter number for moderate leisure-time physical activities. Enter '0' for Never. Enter '996' if unable to do this type of activity.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-995> [goto MODTP_A]

<0,996,RF,DK> [goto VIGN_A]

Shape48



Universe:

MODN_A IN (1-995)

Question Text:

2 of 2 Enter time period for moderate leisure-time physical activities.

Response:

  1. Per day

  2. Per week

  3. Per month

  4. Per year

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4> if ((MODN_A gt 4 and MODTP_A=1) or (MODN_A gt 28 and MODTP_A=2) or (MODN_A gt 31 and MODTP_A=3) or (MODN_A gt 365 and MODTP_A=4)) [goto ERR1_MODN_A]

else [goto MODLN_A]

<RF,DK> [goto VIGN_A]

Shape49


Text:

{signal ERR1_MODTP_A} ^MODN_A times per ^MODTP_A is unusually high. Please verify.

Hard / Soft Edit:

Soft

Fills:

^MODN_A Fill value from MODN_A


^MODTP_A Fill value from MODTP_A

Universe:

if ((MODN_A gt 4 and MODTP_A=1) or (MODN_A gt 28 and MODTP_A=2) or (MODN_A gt 31 and MODTP_A=3) or (MODN_A gt 365 and MODTP_A=4))

Shape50



Universe:

MODTP_A IN (1-4)

Question Text:

1 of 2 About how long do you do these moderate leisure-time physical activities each time? Read if necessary: Moderate-intensity activities cause moderate increases in breathing or heart rate. Enter number for length of moderate leisure-time physical activities.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-995> [goto MODLTP_A]

<RF,DK> [goto VIGN_A]



Universe:

MODLN_A IN (1-995)

Question Text:

2 of 2 Enter time period for length of moderate leisure-time physical activities.

Response:

  1. Minutes

  2. Hours

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2> if ((MODLN_A gt 119 and MODLTP_A=1) or (MODLN_A gt 1 and MODLTP_A=2)) [goto ERR2_MODLTP_A]

else [goto VIGN_A]

<RF,DK> [goto VIGN_A]

Shape51


Text:

{signal ERR1_MODLTP_A} ^MODLN_A ^MODLTP_A is unusually high. Please verify.

Hard / Soft Edit:

Soft

Fills:

^MODLN_A


^MODLTP_A



Fill value from MODLN_A FIll value from MODLTP_A




Universe:

if (MODLN_A MODLTP_A=2)

gt

119

and

MODLTP_A=1)

or

(MODLN_A

gt

1

and



Question Text:

1 of 2 How often do you do VIGOROUS-INTENSITY LEISURE-TIME physical activities? Read if necessary: Vigorous-intensity activities cause large increases in breathing or heart rate. Read if necessary: How many times per day, per week, per month, or per year do you do these activities? Enter number for vigorous leisure-time physical activities. Enter '0' for Never. Enter '996' if unable to do this type of activity.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<0,996,RF,DK> [goto STRN_A]

<1-995> [goto VIGTP_A]

Shape53


Universe:

VIGN_A IN (1-995)

Question Text:

2 of 2 Enter time period for vigorous leisure-time physical activities.

Response:

  1. Per day

  2. Per week

  3. Per month

  4. Per year

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4> if (VIGN_A gt 4 and VIGTP_A=1) or (VIGN_A gt 28 and VIGTP_A=2) or (VIGN_A gt 31 and VIGTP_A=3) or (VIGN_A gt 365 and VIGTP_A=4) [goto ERR1_ VIGTP_A]

else [goto VIGLN_A]



Text:

{signal ERR1_VIGTP_A} ^VIGN_A times per ^VIGTP_A is unusually high. Please verify.

Hard / Soft Edit:

Soft

Fills:

^VIGN_A fill value from VIGN_A


^VIGTP_A fill value from VIGTP_A

Universe:

if (VIGN_A gt 4 and VIGTP_A=1) or (VIGN_A gt 28 and VIGTP_A=2) or (VIGN_A gt 31 and VIGTP_A=3) or (VIGN_A gt 365 and VIGTP_A=4)

Shape55


Universe:

VIGTP_A IN (1-4)

Question Text:

1 of 2 About how long do you do these vigorous leisure-time physical activities each time? Read if necessary: Vigorous-intensity activities cause large increases in breathing or heart rate. Enter number for length of vigorous

leisure-time physical activities.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-995>[goto VIGLTP_A]

<RF,DK>[goto STRN_A]



Universe:

VIGLN_A IN (1-995)

Question Text:

2 of 2 Enter time period for length of vigorous leisure-time physical activities.

Response:

  1. Minutes

  2. Hours

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2> if (VIGLN_A gt 119 and VIGLTP_A=1) VIGLTP_A=2) [goto ERR1_VIGLTP_A]

else [goto STRN_A]

<RF,DK> [goto STRN_A]

or

(VIGLN_A

gt

1

and

Shape57


Text:

{signal ERR1_VIGLTP_A} ^VIGLN_A ^VIGLNTP_A is unusually high. Please verify.

Hard / Soft Edit:

Soft

Fills:

^VIGLN_A Fill value from VIGLN_A


^VIGLNTP_A Fill value from VIGLNTP_A

Universe:

if (VIGLN_A gt 119 and VIGLTP_A=1) or (VIGLN_A gt 1 and VIGLTP_A=2)



Question Text:

1 of 2 Including activities that you mentioned earlier, how often do you do LEISURE-TIME physical activities specifically designed to STRENGTHEN your muscles such as sit-ups, push-ups, or lifting weights? Read if necessary: How many times per day, per week, per month, or per year do you do these activities? Enter number for strengthening activities. Enter '0' for Never. Enter '996' for Unable to do this type activity.

Response:

1-995. 1-995 times 996. Unable to do

DK: Don't Know

RF: Refused

Skip Instructions:

<1-995> [goto STRTP_A]

<0,996,RF,DK> [goto next section]

Shape59


Universe:

STRN_A IN (1-995)

Question Text:

2 of 2 Enter time period for strengthening activities.

Response:

  1. Per day

  2. Per week

  3. Per month

  4. Per year

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4> if (STRN_A gt 4 and STRTP_A=1) or (STRN_A gt 28 and STRTP_A=2) or (STRN_A gt 31 and STRTP_A=3) or (STRN_A gt 365 and STRTP_A=4) [goto ERR_STRTP_A]

else [goto next section]



Text:

{signal ERR1_STRTP_A} ^STRN_A times per ^STRTP_A is unusually high. Please verify.

Hard / Soft Edit:

Soft

Fills:

^STRN_A Fill value from STRN_A


^STRTP_A Fill value from STRTP_A

Universe:

if (STRN_A gt 4 and STRTP_A=1) or (STRN_A gt 28 and STRTP_A=2) or (STRN_A gt 31 and STRTP_A=3) or (STRN_A gt 365 and STRTP_A=4)



Question Text:

The next questions are about walking for transportation. This is walking you might have done to travel to and from work, to do errands, or to go from place to place. I will ask you separately about walking for other reasons like relaxation, exercise, or walking the dog. In the past 7 days, did you walk for transportation? Read if necessary: Include walking to or from a bus, train, or rail stop. Read if necessary: Do not include walking for relaxation or exercise.

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto WLKTRANDAY_A]

<2,RF,DK> [goto WLKLEIS_A]

Shape62


Universe:

WLKTRAN_A=1

Question Text:

In the past 7 days, how many days did you walk for transportation?

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-7> [goto WLKTRANTPD_A]

<RF,DK> [goto WLKLEIS_A]



Universe:

WLKTRANDAY_A=1-7

Question Text:

On average, how many times per day did you walk for transportation?

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-94> [goto WLKTRANLGT_A]

<RF,DK> [goto WLKLEIS_A]

Shape64


Universe:

WLKTRANTPD_A=1-94

Question Text:

1 of 2 ^WALKTIMETP Enter number for length of walk for transportation.

Response:

DK: Don't Know

RF: Refused

Fills:

^WALKTIMETP If WLKTRANDAY_A=1 and WLKTRANTPD_A=1, fill:

"How long did that walk take?"

else fill "On average, how long did those walks take?"

Skip Instructions:

<1-995> [goto WLKTRANTP_A]

<RF,DK> [goto WLKLEIS_A]



Universe:

WLKTRANLGT_A=1-995

Question Text:

2 of 2 Enter time period for length of walking for transportation.

Response:

  1. Minutes

  2. Hours

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2> if ((WLKTRANLGT_A (WLKTRANLGT_A GT ERR1_WLKTRANLGT_A]

else [goto WLKLEIS_A]

<RF,DK> [goto WLKLEIS_A]

GT 1

119

and

and

WLKTRANTP_A=1) or WLKTRANTP_A=2))[goto

Shape66


Text:

{signal ERR1_WLKTRANLGT_A} Amount of time walkingis unusually high. Please verify.

Hard / Soft Edit:

Soft

Universe:

((WLKTRANLGT_A GT 119 and WLKTRANTP_A=1) or (WLKTRANLGT_A GT 1 and WLKTRANTP_A=2))

Shape67






Question Text:

Sometimes you may walk for fun, relaxation, exercise, or to walk the dog. In the past 7 days, did you walk for any of these reasons? Read if necessary: Do not include walking for transportation.




Response:


  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto WLKLEISDAY_A]

<2,RF,DK> [goto next section]

Shape69



Universe:

WLKLEIS_A=1

Question Text:

In the past 7 days, how many days did you walk for leisure or exercise? Read if necessary: Walked for fun, relaxation, exercise, or to walk the dog. Read if necessary: Do not include walking for transportation.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-7> [goto WLKLEISTPD_A]

<RF,DK> [goto next section]

Shape70



Universe:

WLKLEISDAY_A=1-7

Question Text:

On average, how many times per day did you walk for leisure or exercise?

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-94> [goto WLKLEISLGT_A]

<RF,DK> [goto next section]


Shape71


Universe:

WLKLEISTPD_A=1-94

Question Text:

1 of 2 ^WALKTIMELE Enter number for length of walk for fun, relaxation, or exercise.

Response:

DK: Don't Know

RF: Refused

Fills:

^WALKTIMELE If WLKLEISDAY_A=1 and WLKLEISTPD_A=1, fill:

"How long did that walk take?"

else, fill: "On average, how long did those walks take?"

Skip Instructions:

<1-995> [goto WLKLEISTP_A]

<RF,DK> [goto next section]

Shape72



Universe:

WLKLEISLGT_A=1-995

Question Text:

2 of 2 Enter time period for length of walking for fun, relaxation, or exercise.

Response:

  1. Minutes

  2. Hours

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2> if ((WLKLEISLGT_A GT 119 and WLKLEISTP_A=1) or (WLKLEISLGT_A GT 1 and WLKLEISTP_A=2)) [goto

ERR1_WLKLEISLGT_A], then [goto next section]

<RF,DK>[goto next section]

Shape73


Text:

{signal ERR1_WLKLEISLGT_A} Amount of time walkingis unusually high. Please verify.

Hard / Soft Edit:

Soft

Universe:

((WLKLEISLGT_A GT 119 and WLKLEISTP_A=1) or (WLKLEISLGT_A GT 1 and WLKLEISTP_A=2))



Universe:

HHSTAT_A='1'

Question Text:

In the past 3 months, how often did you feel very tired or exhausted? Would you say never, some days, most days, or every day?

Response:

  1. Never

  2. Some days

  3. Most days

  4. Every day

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto next section]

<2-4,RF,DK> [goto FGELNGTRD_A]

Shape74


Universe:

HHSTAT_A='1' and FGEFRQTRD_A IN ('2','3','4','RF','DK')

Question Text:

Thinking about the last time you felt very tired or exhausted, how long did it last? Would you say some of the day, most of the day, or all of the day?

Response:

  1. Some of the day

  2. Most of the day

  3. All of the day

DK: Don't Know

RF: Refused

Skip Instructions:

<1-3,RF,DK> [goto FGELEVTRD_A]



Universe:

HHSTAT_A='1' and FGEFRQTRD_A IN ('2','3','4','RF','DK')

Question Text:

Thinking about the last time you felt this way, how would you describe the level of tiredness? Would you say a little, a lot, or somewhere in between?

Response:

  1. A little

  2. A lot

  3. Somewhere in between a little and a lot DK: Don't Know

RF: Refused

Skip Instructions:

<1-3,RF,DK> [goto next section]

Shape77


Question Text:

On average, how many hours of sleep do you get in a 24-hour period? Enter hours in whole numbers, rounding 30 minutes (1/2 hour) or more UP to the next whole hour and dropping 29 or fewer minutes. Enter 1 if the respondent reports less than 1 hour of sleep.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-5> [goto ERR1_SLPHOURS_A]

<6-24,RF,DK> [goto SLPREST_A]

Shape78


Text:

{signal ERR1_SLPHOURS_A} Average number of hours of sleep is ^SLPHOURS. Please verify.

Hard / Soft Edit:

Soft

Fills:

^SLPHOURS number of hours slept

Universe:

SLPHOURS_A=1-5

Shape79


Question Text:

During the past 30 days, how often did you wake up feeling well-rested? Would you say never, some days, most days, or every day?

Response:

  1. Never

  2. Some days

  3. Most days















Page 1 of 3

4. Every day

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4,RF,DK> [goto SLPFLL_A]

Shape80



Question Text:

During the past 30 days, how often did you have trouble falling asleep? Would you say never, some days, most days, or every day?

Response:

  1. Never

  2. Some days

  3. Most days

  4. Every day

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4,RF,DK> [goto SLPSTY_A]

Shape81



Question Text:

Read if necessary: During the past 30 days... How often did you have trouble staying asleep? Read if necessary: Would you say never, some days, most days, or every day? Include waking up too early.

Response:

  1. Never

  2. Some days

  3. Most days

  4. Every day

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4,RF,DK> [goto SLPMED_A]


Shape82


Question Text:

Read if necessary: During the past 30 days... How often did you take any medication to help you fall asleep or stay asleep? Include both prescribed and over-the-counter medications. Read if necessary: Would you say never, some days, most days, or every day?

Response:

  1. Never

  2. Some days

  3. Most days

  4. Every day

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4,RF,DK> [goto next section]



Question Text:

These next questions are about drinking alcoholic beverages. Alcohol includes beer, wine, wine coolers, liquors such as vodka, whiskey or rum, mixed drinks or cocktails with alcohol, and any other type of alcoholic drink. In your ENTIRE LIFE, have you had at least 1 drink of any kind of alcohol, not counting small tastes or sips?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto DRK12MN_A]

<2,RF,DK> [goto next section]

Shape83


Universe:

DRKLIFE_A=1

Question Text:

1 of 2 During the past 12 months, how many days per week, per month or per year did you drink any type of alcoholic beverage? Read if necessary: Alcohol includes beer, wine, wine coolers, liquors such as vodka, whiskey or rum, mixed drinks or cocktails with alcohol, and any other type of alcoholic drink. Enter number for how often alcoholic beverages were consumed in the past 12 months. Then enter category of response (week, month, year). Enter '0' for Never.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<0> [goto DRK12ANYR_A]

<1-365> [goto DRK12MTP_A]

<DK> [goto DRKAVG12M_A]

<RF> [goto next section]



Universe:

DRK12MN_A IN (1-365)

Question Text:

2 of 2 Enter time period for how often alcoholic beverages were consumed in the past year.

Response:

  1. Per week

  2. Per month

  3. Per year

DK: Don't Know

RF: Refused

Skip Instructions:

<1-3,RF,DK> [goto DRKAVG12M_A]

Shape85


Universe:

DRK12MN_A IN (1-365,DK)

Question Text:

When counting number of drinks, one drink is equal to a 12-ounce beer, a

5-ounce glass of wine, or one shot or 1.5 ounces of liquor. A larger 40-ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks. During the past 12 months, on those days that you drank alcoholic beverages, on average, how many DRINKS did you have? Enter '0' if never drank in the past 12 months. Enter '1' if 1 or fewer drinks. Enter '95' if 95 or more drinks.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<0> [goto DRK12ANYR_A]

<1-3,RF,DK> [goto DRKBNG12M_A]

<4> if GEN.SEX_FINAL=2 [goto DRKANY30D_A]

elseif GEN.SEX_FINAL IN (1,RF,DK) [goto DRKBNG12M_A]

<5-95> [goto DRKANY30D_A]

<10-95> [goto ERR1_DRKAVG12M_A]

Shape87


Text:

{signal ERR1_DRKAVG12M_A} ^DRKAVG12M_A drinks is an usually high number. Please Do not probe.

Hard / Soft Edit:

Soft

Fills:

^DRKAVG12M_A Fill value from Adult.ALC.DRKAVG12M_A

Universe:

DRKAVG12M_A IN (10-95)

Shape88


Universe:

DRK12MN_A=0 or DRKAVG12M_A=0

Question Text:

In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage? Read if necessary: One drink is equivalent to a 12-ounce beer, a

5-ounce glass of wine, or a drink with one shot (1.5 ounces) of liquor. A 40-ounce beer would count as 3 drinks or a cocktail drink with 2 shots would count as 2 drinks.

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> if DRK12MN_A ne 0 and UTZ.LASTDR_A=1 [goto DRKADVISE_A]

else [goto next section]

Shape89


Universe:

(DRKAVG12M_A IN (1,2,3,RF,DK) or (DRKAVG12M_A=4 and GEN.SEX_FINAL IN (1,RF,DK)))

Question Text:

During the past 12 months, did you ever have ^BINGE drinks in a day?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Fills:

^BINGE If GEN.SEX_FINAL IN (1,RF,DK) fill: "5 or more"

If GEN.SEX_FINAL=2, fill: "4 or more"

Skip Instructions:

<1> [goto DRKANY30D_A]

<2,RF,DK> if (DRKAVG12M_A IN (RF,DK) and DRK12MN_A GE 1) [goto DRKANY30D_A]

elseif UTZ.LASTDR_A=1 and (DRK12MN_A GE 1 or DRKAVG12M_A GE 1)[goto DRKADVISE_A]

elseif (UTZ.LASTDR_A NE 1 or (DRKAVG12M_A IN (RF,DK) AND

DRK12MN_A=DK))[goto next section]

Shape90


Universe:

((DRKAVG12M_A=5-95 or (DRKAVG12M_A=4 and GEN.SEX_FINAL=2)) or DRKBNG12M_A=1 or (DRKBNG12M_A=2,RF,DK and DRKAVG12M_A=RF,DK and DRK12MN_A GE 1))

Question Text:

The next question will ask you about ONLY the past 30 days. During the past 30 days, did you have at least one drink of any type of alcoholic beverage?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused



<2> if UTZ.LASTDR_A=1[goto DRKADVISE_A]

else [goto next section]








Shape91


Universe:

DRKANY30D_A IN (1,RF,DK)

Question Text:

During the past 30 days, how many times did you have ^BINGE drinks on an occasion? Read if necessary: A drinking occasion is considered to be approximately two hours. Enter '0' if none. Enter '60' if 60 or more times.

Response:

DK:

RF:

Don't Know Refused


Fills:

^BINGE


If GEN.SEX_FINAL IN (1,RF,DK) fill: "5 or more" If GEN.SEX_FINAL=2, fill: "4 or more"

Skip Instructions:

<0-60,RF,DK> if UTZ.LASTDR_A=1 and (DRK12MN_A ge 1 or DRKAVG12M_A ge 1) [goto DRKADVISE_A]

else [goto next section]

Shape92


Universe:

UTZ.LASTDR_A=1 and (DRK12MN_A ge 1 or DRKAVG12M_A ge 1)

Question Text:

In the past 12 months, has a doctor, dentist, or other health professional ADVISED you to stop or cut down on your drinking?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused





Shape95


Universe:

SMKEV_A=1

Question Text:

How old were you when you FIRST started to smoke fairly regularly? Smoking regularly is respondent defined. If asked about what this means, say that "It is whatever you consider as first starting to smoke fairly regularly." Enter '6' if less than 6 years old. Enter '95' if 95 years old or older. Enter '96' if never smoked regularly.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<6-95,96,RF,DK> if SMKAGE_A gt GEN.AGE_FINAL and SMKAGE_A ne 96

[goto ERR1_SMKAGE_A] else [goto SMKNOW_A]

Shape96


Text:

{check ERR1_SMKAGE_A} Starting age exceeds current age. Please correct

Hard / Soft Edit:

Hard

Universe:

If GEN.AGE_FINAL[PX_A]=valid and SMKAGE_A gt GEN.AGE_FINAL[PX_A] and SMKAGE_A NE <96>

Shape97








Universe:

SMKNOW_A IN (1,2)

Question Text:

During the past 12 months, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO QUIT SMOKING?




Response:


  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> if UTZ.LASTDR_A=1 [goto SMKTLK_A]

else [goto ECIGEV_A]

Shape98



Universe:

SMKNOW_A=3

Question Text:

1 of 2 How long has it been since you quit smoking cigarettes? Enter number for time since quit smoking.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-365> [goto SMKQTTP_A]

<DK,RF> if SMKAGE_A ne 96 [goto FORNUMCIG_A]

else [goto FORVARCIG_A]

Shape99



Universe:

SMKQTN_A IN (1-365)

Question Text:

2 of 2 Enter time period for time since quit smoking.

Response:

  1. Day(s)

  2. Week(s)

  3. Month(s)

  4. Year(s)

DK: Don't Know

RF: Refused














Page 2 of 5


Skip Instructions:

<1-3,RF,DK> if SMKAGE_A ne 96 [goto FORNUMCIG_A]

else [goto FORVARCIG_A]

<4> if SMKERR1_CALC_A lt 15 [goto ERR1_ SMKQTTP_A]

elseif SMKERR2_CALC_A gt GEN.AGE_FINAL[PX_A] [goto ERR2_SMKQTTP_A]

elseif SMKAGE_A ne 96 [goto FORNUMCIG_A] else [goto FORVARCIG_A]

Shape101



Text:

{signal ERR1_SMKQTTP_A} Respondent quit smoking before age 15? Please verify.

Hard / Soft Edit:

Soft

Universe:

SMKERR1_CALC_A lt 15

Shape102



Text:

{check ERR2_SMKQTTP_A} Age started smoking (^SMKAGE_A years) + years since quitting (^SMKQTN_A) exceeds current age. Please correct.

Hard / Soft Edit:

Hard

Fills:

^SMKAGE_A Fill value from Adult.CIG.SMKAGE_A


^SMKQTN_A age when quit smoking

Universe:

If GEN.AGE_FINAL[PX_A]=valid and SMKERR2_CALC_A gt GEN.AGE_FINAL[PX_A]



Universe:

SMKNOW_A=3 and SMKAGE_A ne 96

Question Text:

When you last smoked FAIRLY REGULARLY, how many cigarettes did you usually smoke per day? Smoking regularly is respondent defined. If asked about what this means, say that "It is whatever you consider was the last time you were smoking fairly regularly." Enter '94' if 94 or more cigarettes. Enter '95' if varied.

Enter '96' if never smoked cigarettes regularly.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<95,96,DK> [goto FORVARCIG_A]

<1-94,RF> if UTZ.LASTDR_A=1 and ((SMKQTN_A le 365 and SMKQTTP_A=1) or (SMKQTN_A le 52 and SMKQTTP_A=2) or (SMKQTN_A

le 12 and SMKQTTP_A=3) or (SMKQTN_A le 1 and SMKQTTP_A=4)) [goto SMKTLK_A]

else [goto ECIGEV_A]

Shape103


Universe:

(FORNUMCIG_A IN (95,96,DK) or (SMKNOW_A=3 and SMKAGE_A=96))

Question Text:

What is the average number of cigarettes that you smoked daily during the longest period that you smoked? Read if necessary: 1 pack equals 20 cigarettes. Enter '95' if 95 or more.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-95,RF,DK> if UTZ.LASTDR_A=1 and ((SMKQTN_A LE 365 and SMKQTTP_A=1) or (SMKQTN_A le 52 and SMKQTTP_A=2) or (SMKQTN_A

le 12 and SMKQTTP_A=3) or (SMKQTN_A le 1 and SMKQTTP_A=4)) [goto SMKTLK_A]

else [goto ECIGEV_A]



Universe:

UTZ.LASTDR_A=1 and (SMKNOW_A IN (1,2) or ((SMKQTN_A le 365 and SMKQTTP_A=1) or (SMKQTN_A le 52 and SMKQTTP_A=2) or (SMKQTN_A le 12 and SMKQTTP_A=3) or (SMKQTN_A le 1 and SMKQTTP_A=4)))

Question Text:

In the past 12 months, has a doctor, dentist, or other health professional ADVISED you about ways to stop smoking or prescribed medication to help you quit?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto ECIGEV_A]

Shape106


Question Text:

During the past 12 months, has a doctor or other health professional ADVISED you to ...Increase the amount of physical activity or exercise you get?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto ADVEAT_A]

Shape107


Question Text:

During the past 12 months, has a doctor or other health professional ADVISED you to ...Reduce the amount of fat or calories in your diet?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto ADVWGTPRG_A]

Shape108


Question Text:

Read if necessary: During the past 12 months, has a doctor or other health professional ADVISED you to ...Participate in a weight loss program?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused


Skip Instructions:

<1,2,RF,DK> [goto NOWACTIVE_A]

Shape109


Question Text:

Are you NOW ...Increasing your physical activity or exercise?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto NOWEAT_A]

Shape110


Question Text:

Are you NOW ...Reducing the amount of fat or calories in your diet?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto NOWWGTPRG_A]

Shape111


Question Text:

Read if necessary: Are you NOW ...Participating in a weight loss program?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused


Skip Instructions:

<1,2,RF,DK> if DIB.DIBEV_A=1 [goto next section] elseif DIB.DIBEV_A IN (2,RF,DK) [goto DIBPRGM_A]

Shape113


Question Text:

Has your mother, father, brother, or sister EVER been told by a doctor or other health professional that they have diabetes? Read if necessary: Include only blood relatives. Do not include step-relatives or those unrelated by blood.

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto DIABLAST_A]

Shape114


Question Text:

When was the last time you had a blood test for high blood sugar or diabetes by a doctor, nurse, or other health professional?

Response:

  1. Never

  2. Within the past year (anytime less than 12 months ago)

  3. Within the last 2 years (1 year but less than 2 years ago)



  1. Within the last 3 years (2 years but less than 3 years ago)

  2. Within the last 5 years (3 years but less than 5 years ago)

  3. Within the last 10 years (5 years but less than 10 years ago)

  4. 10 years ago or more

DK: Don't Know

RF: Refused

Skip Instructions:

<0-6,RF,DK> [goto next section]






















Page 1 of 1



Universe:

(WLK.WLKTRAN_A=1 or WLK.WLKLEIS_A=1)

Question Text:

The next questions are about where you live. How often does the ^TLwalking you reported earlier take place near your home? Would you say almost always, most of the time, some of the time, or never?

Response:

  1. Almost always

  2. Most of the time

  3. Some of the time

  4. Never

DK: Don't Know

RF: Refused

Fills:

^TLwalking walking for transportation/leisure

Skip Instructions:

<1-4,RF,DK> [goto ROADSWLK_A]

Shape115



Question Text:

Where you live, are there roads, sidewalks, paths or trails where you can walk?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto SHOPSWLK_A]




















Page 1 of 5



Question Text:

Read if necessary: Where you live... Are there shops, stores, or markets that you can walk to?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto TRANSITWLK_A]

Shape117


Question Text:

Read if necessary: Where you live... Are there bus or transit stops that you can walk to?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto FUNWLK_A]

Shape118


Question Text:

Read if necessary: Where you live... Are there places like movies, libraries, or places of worship that you can walk to?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused



Shape120


Question Text:

Read if necessary: Where you live... Are there places that you can walk to that help you relax, clear your mind, and reduce stress?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto SIDEWLK_A]

Shape121


Question Text:

Where you live, do most streets have sidewalks?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto TRAFFICWLK_A]

Shape122


Question Text:

Read if necessary: Where you live... Does traffic make it unsafe for you to walk?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused



Shape125


Question Text:

Read if necessary: Where you live... Does crime make it unsafe for you to walk?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto ANIMALWLK_A]

Shape126


Question Text:

Read if necessary: Where you live... Do dogs or other animals make it unsafe for you to walk?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto WEATHERWLK_A]

Shape127


Question Text:

How often does the weather make you less likely to walk? Would you say almost always, most of the time, some of the time, or never? Read if necessary: We mean any kind of bad weather that makes you less likely to walk, such as hot, cold, rainy, snowy, and windy weather.

Response:

1. Almost always


  1. Most of the time

  2. Some of the time

  3. Never

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4,RF,DK> [goto PEOPLEWLK_A]

Shape130


Question Text:

How often are there people walking within sight of your home? Would you say every day, every 2 to 3 days, about once a week, or less than once a week?

Response:

  1. Every day

  2. Every 2 to 3 days

  3. About once a week

  4. Less than once a week

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4,RF,DK> [goto next section]




Question Text:

The next questions are about sun exposure. Enter '1' to continue.

Response:

1. Enter 1 to Continue

Skip Instructions:

<1> [goto SUNSKIN_A]

Shape131


Question Text:

After several months of not being in the sun, if you THEN went out into the sun without sunscreen or protective clothing for one hour, which of these would happen to your skin? Would you get a severe sunburn with blisters, have a moderate sunburn with peeling, burn mildly with some or no darkening or tanning, turn darker without sunburn, or would nothing happen to your skin? Read if necessary: Even if you did not go out in the sun, what would happen if you did? Use the most recent experience. If not, then think about the past. Read if necessary: By "sunburn" we mean even a small part of your skin turns red or hurts for 12 hours or more. Do not read the choice "do not go out in the sun." Select this choice if respondent volunteers.

Response:

  1. Get a severe sunburn with blisters

  2. Have a moderate sunburn with peeling

  3. Burn mildly with some or no darkening/tanning

  4. Turn darker without sunburn

  5. Nothing would happen to my skin

  6. Do not go out in the sun

  7. Other

DK: Don't Know

RF: Refused

Skip Instructions:

<1-7,RF,DK> [goto SUNSHADE_A]



Question Text:

When you go outside on a sunny day, for more than one hour, how often do you... ...Stay in the shade? Would you say always, most of the time, sometimes, rarely, or never stay in the shade? Do not read the choice "don't go outside on a sunny day for more than one hour." Select this choice if respondent volunteers.

Response:

  1. Always

  2. Most of the time

  3. Sometimes

  4. Rarely

  5. Never

  6. Don't go outside on a sunny day for more than one hour DK: Don't Know

RF: Refused

Skip Instructions:

<1-6,RF,DK> [goto SUNHAT_A]

Shape133


Question Text:

When you go outside on a sunny day, for more than one hour, how often do you... ...Wear a hat that shades your face, ears AND neck such as a hat with a wide brim all around? Would you say always, most of the time, sometimes, rarely, or never wear a hat? Do not read the choice "don't go outside on a sunny day for more than one hour." Select this choice if respondent volunteers.

Response:

  1. Always

  2. Most of the time

  3. Sometimes

  4. Rarely

  5. Never

  6. Don't go outside on a sunny day for more than one hour DK: Don't Know

RF: Refused

Skip Instructions:

<1-6,RF,DK> [goto SUNSHIRT_A]

Shape136


Question Text:

Read if necessary: When you go outside on a sunny day, for more than one hour, how often do you... ...Wear a long-sleeved shirt? Read if necessary: Would you say always, most of the time, sometimes, rarely, or never wear a long-sleeved shirt? Do not read the choice "don't go outside on a sunny day for more than one hour." Select this choice if respondent volunteers.

Response:

  1. Always

  2. Most of the time

  3. Sometimes

  4. Rarely

  5. Never

  6. Don't go outside on a sunny day for more than one hour DK: Don't Know

RF: Refused

Skip Instructions:

<1-6,RF,DK> [goto SUNSCREEN_A]

Shape137


Question Text:

Read if necessary: When you go outside on a sunny day, for more than one hour, how often do you... ...Use sunscreen? Read if necessary: Would you say always, most of the time, sometimes, rarely, or never use sunscreen? Do not read the choice "don't go outside on a sunny day for more than one hour." Select this choice if respondent volunteers.

Response:

  1. Always

  2. Most of the time

  3. Sometimes

  4. Rarely

  5. Never


6. Don't go outside on a sunny day for more than one hour DK: Don't Know

RF: Refused

Skip Instructions:

<1-6,RF,DK> [goto SUNTAN_A]

Shape138


Question Text:

When spending time outdoors, how often do you try to get some sun for the purpose of developing a tan? Read if necessary: Would you say always, most of the time, sometimes, rarely, or never? Do not read the choice "don't spend time outdoors." Select this choice if respondent volunteers.

Response:

  1. Always

  2. Most of the time

  3. Sometimes

  4. Rarely

  5. Never

  6. Don't spend time outdoors

DK: Don't Know

RF: Refused

Skip Instructions:

<1-6,RF,DK> [goto ANYSBURN_A]

Shape139


Question Text:

During the past 12 months, did you ever have a sunburn?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto NUMSBURNS_A]

<2,RF,DK> [goto SUNBED_A]













Page 4 of 7


Shape140


Universe:

ANYSBURN_A=1

Question Text:

During the past 12 months, how many times have you had a sunburn?

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<1-39,RF,DK> [goto SUNSWIM_A]

<40-365> [goto ERR1_NUMSBURNS_A], then [goto SUNSWIM_A]

Shape141



Text:

{signal ERR1_NUMSBURNS_A} ^NUMSBURNS is an unusually high number. Please confirm.

Hard / Soft Edit:

Soft

Fills:

^NUMSBURNS Fill value from Adult.SUN.NUMSBURNS_A

Universe:

NUMSBURNS_A=40-365

Shape142


Question Text:

During the past 12 months, how many times have you used an indoor tanning device such as a sunlamp, sunbed, or tanning booth? Do NOT include times you have gotten a spray tan.

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<0-99,RF,DK> [goto next section]

<100-365> [goto ERR1_SUNBED_A], then [goto next section]

Shape143



Text:

{signal ERR1_SUNBED_A} ^SUNBED is an unusually high number. Please confirm.

Hard / Soft Edit:

Soft

Fills:

^SUNBED Fill value from Adult.SUN.SUNBED_A

Universe:

SUNBED_A=100-365

Shape144


Question Text:

The following questions are about CT scans. During this test, you lie down on your back and are moved through an open, donut-shaped x-ray machine. Have you EVER HAD a CT scan?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto CTSCANCHST_A]

<2,RF,DK> [goto next section]

Shape145



Universe:

CTSCANEV_A=1

Question Text:

Were any of the CT scans of your chest area?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,DK> [goto CTLNGCAN_A]

<2,RF> [goto next section]

Shape146









Universe:

CTSCANCHST_A IN (1,DK)

Question Text:

The next question is only about CT scans to check or screen for lung cancer, sometimes called low-dose CT scans. Were any of the CT scans of your chest area done mainly to check or screen for lung cancer?




Response:


  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1> [goto CTLNGWHEN_A]

<2,RF,DK> [goto next section]

Shape147



Universe:

CTLNGCAN_A=1

Question Text:

When did you have your MOST RECENT CT scan of your chest area done mainly to check or screen for lung cancer?

Response:

  1. Within the past year (anytime less than 12 months ago)

  2. Within the past 2 years (1 year but less than 2 years ago)

  3. Within the past 3 years (2 years but less than 3 years ago)

  4. Within the past 5 years (3 years but less than 5 years ago)

  5. Within the past 10 years (5 years but less than 10 year ago)

  6. 10 years ago or more

DK: Don't Know

RF: Refused

Skip Instructions:

<1-6,RF,DK> [goto next section]




Universe:

ASTILL_A=1 OR ASAT12M_A=1

Question Text:

During the past 12 months, have you stayed overnight in a hospital because of your asthma?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto ASDAYS12M_A]

Shape148


Universe:

ASTILL_A=1 OR ASAT12M_A=1

Question Text:

During the past 12 months, how many days were you UNABLE to work or get work done around the house because of your asthma?

Response:

DK: Don't Know

RF: Refused

Skip Instructions:

<0-99,RF,DK> [goto ASINHALE3M_A]

<100-365> [goto ERR_ASDAYS12M_A], then [goto ASINHALE3M]

Shape149


Text:

{signal ERR_ASDAYS12M_A} ^ASDAYS12M_A days is unusually high. Please verify. Make corrections if necessary.

Hard / Soft Edit:

Soft

Fills:

^ASDAYS12M_A Fill value from Adult.AST.ASDAYS12M_A

Universe:

ASDAYS12M_A=100-365



Universe:

ASTILL_A=1 OR ASAT12M_A=1

Question Text:

During the past 3 months, have you used the kind of PRESCRIPTION asthma inhaler that gives QUICK relief from asthma symptoms during an attack? Read if necessary: Include only medication prescribed by a health care professional.

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto ASPREVR_A]

Shape151


Universe:

ASTILL_A=1 OR ASAT12M_A=1

Question Text:

Are you NOW taking a preventive asthma medication every day, most days, some days, or never?

Response:

  1. Every day

  2. Most days

  3. Some days

  4. Never

DK: Don't Know

RF: Refused

Skip Instructions:

<1-4,RF,DK> [goto ASJOB_A]



Universe:

ASTILL_A=1 OR ASAT12M_A=1

Question Text:

Have you ever been TOLD BY a doctor or other health professional that your asthma was caused by, or your symptoms were made worse by, any job you ever had?

Response:

  1. Yes

  2. No

DK: Don't Know

RF: Refused

Skip Instructions:

<1,2,RF,DK> [goto next section]

Shape154

Question Text: You said that you have difficulty with ^DIFF. Did ^THISDIFF begin before age 22?


Response: 1. Yes

2. No

DK: Don't Know

RF: Refused

Fills: ^THISDIFF If only one chosen from: MOB.DIFF_A IN (3,4)

COM.COMDIFF_A IN (3,4)

COG.COGMEMDFF_A IN (3,4)

UPP.UPPSLFCR_A IN (3,4)

SOC.SOCERRNDS_A IN (3,4), fill "this difficulty"


If more than one of the five conditions chosen from above, fill "any of these difficulties"


^DIFF (If MOB.DIFF_A IN (3,4)

if (MOB.WLK100_A IN (3,4) or MOB.WLK13M_A IN (3,4) or MOB.NOEQWLK100_A IN (3,4) or

MOB.NOEQWLK13M_A IN (3,4)), then fill "walking" if (MOB.STEPS_AIN (3,4) or MOB.NOEQSTEPS_A

IN (3,4)), then fill "climbing steps"

if none of MOB.WLK100_A, MOB.WLK13M_A, MOB.NOEQWLK100_A, MOB.NOEQWLK13M_A, MOB.STEPS_A, or MOB.NOEQSTEPS_A = 3 or 4,

but MOB.DIFF_A = 3 or 4, then fill "walking or climbing steps"


If COM.COMDIFF_A IN (3,4), then fill "communicating"


If COG.COGMEMDFF_A IN (3,4),

If COG.COGTYPEDFF_A IN (1,3), then fill

"remembering"

If COG.COGTYPEDFF_A IN (2,3), then fill

"concentrating"

If COG.COGTYPEDFF_A IN (DK,RF), then fill

"remembering or concentrating"


If UPP.UPPSLFCR_A = 3 or 4, then fill "self-care"


If SOC.SOCERRNDS_A = 3 or 4, then fill "doing errands alone"


Page 1 of 2

the fills with commas and place an "and" before the last item.

If two of the above are true, separate them with "and"

Skip Instructions:

<1,2,RF,DK> [goto next section]


If more than two of the above are true, then separate




















































Page 2 of 2

2020 National Health Interview Survey (NHIS) Questionnaire PAI: Chronic Pain




Question ID: PAI.0060.00.3

Variable: PAIOTCMEDS_A Interview Module: Adult Content Type: Emerging Content


Question Text:


Over the past three months, did you use any of the following to manage your pain?

...Over-the-counter medications such as aspirin, Tylenol, Advil, or Aleve?


Response:

  1. Yes

  2. No

7 Refused

9 Don't Know Universe:

Sample Adults 18+ who had pain at least some days in the past 3 months and PAINMNG_FLG=1 Skip Instructions:

<1,2,RF,DK> [goto PAIPRSMEDS_A]

Variable: PAIPRSMEDS_A Interview Module: Adult Content Type: Emerging Content


Question Text:


* Read if necessary: Over the past three months, did you use any of the following to manage your pain?

…A pain reliever [fill: other than an opioid/ ] prescribed by a doctor, dentist, or other health professional? Fills:

If OPD.OPD3M_A=1, then fill “other than an opioid”; otherwise, leave blank Response:

  1. Yes

  2. No

7 Refused

9 Don't Know Universe:

Sample Adults 18+ who had pain at least some days in the past 3 months and PAINMNG_FLG=1 Skip Instructions:

<1,2,RF,DK> [goto PAIPHYSTPY_A]

Variable: PAIEXRCISE_A Interview Module: Adult Content Type: Emerging Content


Question Text:


* Read if necessary: Over the past three months, did you use any of the following to manage your pain?

... Other forms of exercise, such as walking, swimming, bike riding, stretching, or strength training? Response:

  1. Yes

  2. No

7 Refused

9 Don't Know Universe:

Sample Adults 18+ who have pain at least some days and PAINMNG_FLG=1 Skip Instructions:

<1,2,RF,DK> [goto PAIMASSAGE_A]

Page 2 of 4


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File Created2021-01-13
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