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pdfQuestion ID: VFY.0040.00.1
Variable name: CURRES_C
Interview module: VFY(Child.VFY)
Universe: HHSTAT_C=1
Question Text:
Response:
Fills:
The next questions are about ^SCNAME. Enter the line number of the person to
whom you are speaking. If Sample Child respondent refuses to participate enter
CTRL-R.
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
RF:
^ALIASNAME[1]
^ALIASNAME[2]
^ALIASNAME[3]
^ALIASNAME[4]
^ALIASNAME[5]
^ALIASNAME[6]
^ALIASNAME[7]
^ALIASNAME[8]
^ALIASNAME[9]
^ALIASNAME[10]
^ALIASNAME[11]
^ALIASNAME[12]
^ALIASNAME[13]
^ALIASNAME[14]
^ALIASNAME[15]
^ALIASNAME[16]
^ALIASNAME[17]
^ALIASNAME[18]
^ALIASNAME[19]
^ALIASNAME[20]
^ALIASNAME[21]
^ALIASNAME[22]
^ALIASNAME[23]
^ALIASNAME[24]
^ALIASNAME[25]
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 1 of 223
Skip Instructions: if CBSTAT_A=1[goto BCK.THANKS_CB]
else if OUTCOME=215 [goto BCK.THANKS_INSUF]
else [goto BCK.THANKS_SUF]
If CURRES_C not in Roster.FAM.KNOWSC [goto KNOAVAIL_C]
Else
if
CURRES_C
ne
LNO_HHRESP
AND
CURRES_C
Roster.FAM.KNOWSC [goto AVAIL_C]
Else
if
CURRES_C
=
LNO_HHRESP
AND
CURRES_C
Roster.FAM.KNOWSC
AND
CURRES_C
not
Roster.bREL.bPerson[PX_C].PARENTS[goto RELTIV_C]
Else
if
CURRES_C
=
LNO_HHRESP
AND
CURRES_C
Roster.FAM.KNOWSC
AND
CURRES_C
Roster.bREL.bPerson[PX_C].PARENTS[goto VFYALL_C]
Question ID: VFY.0060.00.1
Variable name: KNOAVAIL_C
in
in
in
in
in
Interview module: VFY(Child.VFY)
Universe: (NOT(CURRES_C IN Roster.FAM.KNOWSC) OR
(CURRES_C IN Roster.FAM.KNOWSC AND
CURRES_C IN NOTKNOW_C AND KnowSC_Count > 1)
OR (NewResp_Flg = 1))
Question Text:
Response:
^KNOAVAIL_C_fill Enter the line number of available respondent from list or
press F9 to set up a callback if no one is available or refused. ^KNOAVAIL_C_fill_2
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
^ALIASNAME[1]
^ALIASNAME[2]
^ALIASNAME[3]
^ALIASNAME[4]
^ALIASNAME[5]
^ALIASNAME[6]
^ALIASNAME[7]
^ALIASNAME[8]
^ALIASNAME[9]
^ALIASNAME[10]
Page 2 of 223
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
RF:
Fills:
^ALIASNAME[11]
^ALIASNAME[12]
^ALIASNAME[13]
^ALIASNAME[14]
^ALIASNAME[15]
^ALIASNAME[16]
^ALIASNAME[17]
^ALIASNAME[18]
^ALIASNAME[19]
^ALIASNAME[20]
^ALIASNAME[21]
^ALIASNAME[22]
^ALIASNAME[23]
^ALIASNAME[24]
^ALIASNAME[25]
Refused
^KNOAVAIL_C_fill
If (KnowSC_Count = ActiveNotKnow_Count)
fill : "* If there are no other knowledgeable people to
select then press the end key."
ELSE
fill : "I have recorded that ^KNOWSC ^areis_c
knowledgeable
about
and
responsible
for
^SCNAME's health care. ^WHOIS currently available
and willing to answer these questions?"
^KNOAVAIL_C_fill_2
If (ActiveNotKnow_Count > 0)
fill : "* People listed in gray have said that they are
not knowledgeable about the SC. If you incorrectly
set someone as not knowledgeable then you may
select that person and continue the interview."
Skip Instructions: <01-25> [goto INTMODE_C]
if CBSTAT_A=1[goto BCK.THANKS_CB]
else if OUTCOME=215 [goto BCK.THANKS_INSUF]
else [goto BCK.THANKS_SUF]
[goto bCallback.ARRANGE_CALLBACK]
Page 3 of 223
Question ID: VFY.0080.00.1
Variable name: INTMODE_C
Interview module: VFY(Child.VFY)
Universe: HHSTAT_C=1 and KNOAVAIL_C in (1-25)
Question Text:
Response:
Fills:
How are you contacting ^KNOAVAIL_C?
1.
2.
Personal visit
Telephone
^KNOAVAIL_C
Display name of person whose line number was
selected at KNOAVAIL_C
Skip Instructions: <1> if HHRESPSC_FLG ne 1 [goto AVAIL_C]
else
if
HHRESPSC_FLG=1
and
LNO_SCRESP
Roster.bREL.bPerson[PX_C].PARENTS[goto RELTIV_C]
else [goto VFYALL_C]
<2> [goto TINTRO_C]
Question ID: VFY.0090.00.1
Variable name: TINTRO_C
not
in
Interview module: VFY(Child.VFY)
Universe: HHSTAT_C=1 and INTMODE_C=2
Question Text:
Response:
Hello, my name is ( say your name). I'm calling from the U.S. Census Bureau.
We are conducting the National Health Interview Survey on behalf of the
National Center for Health Statistics, part of the Centers for Disease Control
and Prevention (CDC). This is a nationwide survey about the health of both
adults and children. I have some information from ^HHRESP. ^HHSEX told me
that you would be a good person to talk to about the health of ^SCNAME.
Read if necessary: I believe I am calling you on a cell phone. Before we continue, I
have to ask: Are you currently driving a vehicle?
Even if the respondent is
using a hands-free device while driving, you must enter '1'.
DK:
RF:
Don't Know
Refused
Page 4 of 223
Fills:
^HHRESP
Display the name of the person selected at
Roster.HHC.HHRESPAVAIL
^SCNAME
Fill ALIAS of HHSTAT_C=1
^HHSEX
If GEN.SEX_FINAL[LNO_HHRESP]=1, fill: He
elseif GEN.SEX_FINAL[LNO_HHRESP]=2, fill: She
elseif GEN.SEX_FINAL[LNO_HHRESP] in (DK,RF),
fill: They
Skip Instructions: <1,RF,DK> [goto ATTN_C]
<2> [goto LETTER_C]
Question ID: VFY.0100.00.1
Variable name: ATTN_C
Interview module: VFY(Child.VFY)
Universe: TINTRO_C=1
Question Text:
For your safety, we will call you back at another time.
Enter 1 to continue.
Response:
Skip Instructions: <1> [goto bCallback.CB_POSSIBLE]
Question ID: VFY.0110.00.1
Variable name: LETTER_C
Interview module: VFY(Child.VFY)
Universe: TINTRO_C=2
Question Text:
Response:
If sample child respondent is a new respondent read question below, otherwise enter
1 Read if necessary: A letter describing the National Health Interview Survey was
sent to your home recently. Do you remember seeing the letter?
DK:
RF:
Don't Know
Refused
Page 5 of 223
Skip Instructions: <1,2,RF,DK> [goto S_INTRO_C]
Question ID: VFY.0120.00.1
Variable name: S_INTRO_C
Interview module: VFY(Child.VFY)
Universe: TINTRO_C=2
Question Text:
?[F1] If sample child respondent is a new respondent read question below,
otherwise enter 1 Read if necessary: There are a few things I need to cover before
we continue. I'd like you to know that taking part in this survey is voluntary. You may
choose not to answer any questions you don't wish to answer, or end the interview at
any time without penalty. We are required by Federal law to develop and follow strict
procedures to protect the confidentiality of your information and use your answers
only for statistical research. I can describe these laws if you wish. Except for the
National Center for Health Statistics and Census Bureau employees and specially
designated agents, no one can see your answers until all information that could
identify you and/or your family has been removed. Only after that will your data be
made available to researchers. For most children, the survey will take less than
^SCTIME minutes. I'd like to continue now unless you have any questions. If
respondent asks for more information about the privacy laws, press F1.
Response:
Fills:
^SCTIME
If ASTAT=1 and SAMEFAM_FLG=1, fill: 20
Else, fill: 30
Skip Instructions: <1> if HHRESPSC_FLG ne 1 [goto AVAIL_C]
else
if
HHRESPSC_FLG=1
and
LNO_SCRESP
Roster.bREL.bPerson[PX_C].PARENTS[goto RELTIV_C]
else [goto VFYALL_C]
Page 6 of 223
not
in
Question ID: VFY.0130.00.1
Variable name: AVAIL_C
Interview module: VFY(Child.VFY)
Universe: ((CURRES_C ne LNO_HHRESP AND CURRES_C in Roster.FAM.KNOWSC
AND KNOAVAIL_C = EMPTY) OR
(KNOAVAIL_C in (1-25) AND KNOAVAIL_C ne LNO_HHRESP AND
TINTRO_C not in (1,DK,RF)))
Question Text:
Response:
Fills:
I have recorded that you are knowledgeable about and responsible for
^SCNAME's health care. Is that correct?
1.
2.
RF:
Yes
No
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1>If (LNO_SCRESP not in Roster.bREL.bPerson[PX_C].PARENTS)
{respondent is not a parent} [goto RELTIV_C]
Else If Roster.tblName.bPerson[PX_C].ONOFFCAMPUS in (1,RF,DK)
{Sample Child is on campus} [goto VFYONCAMP_C]
Else [goto VFYALL_C]
<2> if KNOAVAIL_Count gt 0 [goto KNOAVAIL_C]
Else [goto NOMORE_C]
if CBSTAT_A=1[goto BCK.THANKS_CB]
else if OUTCOME=215 [goto BCK.THANKS_INSUF]
else [goto BCK.THANKS_SUF]
Question ID: VFY.0150.00.1
Variable name: RELTIV_C
Interview module: VFY(Child.VFY)
Universe: CURRES_C ne RF
AND
KNOAVAIL_Count gt 0 AND KNOAVAIL_C ne RF
AND
TINTRO_C not in (1,DK,RF)
AND
AVAIL_C ne RF AND AVAIL_C ne 2
AND
LNO_SCRESP not in Roster.bREL.bPerson[PX_C].PARENTS
Question Text:
What is your relationship to ^SCNAME?
Response:
Page 7 of 223
1.
2.
3.
4.
5.
6.
7.
8.
9.
DK:
RF:
Fills:
Parent (Biological, adoptive, or step)
Grandparent
Aunt/Uncle
Brother/Sister
Other relative
Legal guardian
Foster parent
Other non-relative
Spouse or partner
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <9> [goto ERR_RELTIV_C]
<4,5,8,RF,DK> [goto VFYRESP_C]
<1,2,3,6,7> if Roster.tblNAME.bPerson.[PX.C].ONOFFCAMPUS IN (1,RF,DK)
and HHRESPSC_FLG ne 1 [goto VFYONCAMP_C]
Else [goto VFYALL_C]
Check Name: ERR_RELTIV_C
Text:
{signal ERR_RELTIV_C} The spouse or partner of the Sample Child cannot answer
questions about him/her.
Hard / Soft Edit: Soft
Universe: RELTIV_C=9
Skip Instructions: If KNOAVAIL_Count gt 0 [goto KNOAVAIL_C]
else [goto NOMORE_C]
Page 8 of 223
Question ID: VFY.0180.00.1
Variable name: VFYRESP_C
Interview module: VFY(Child.VFY)
Universe: RELTIV_C IN (4,5,8,RF,DK)
Question Text:
Response:
Fills:
To confirm, are you RESPONSIBLE FOR ^SCNAME's health care?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <2,RF,DK>if KNOAVAIL_Count > 0 [goto KNOAVAIL_C]
else [goto NOMORE_C]
<1> if Roster.tblName.bPerson[PX_C].ONOFFCAMPUS in (1,RF,DK) [goto
VFYONCAMP_C]
Else [goto VFYALL_C]
Question ID: VFY.0190.00.1
Variable name: VFYONCAMP_C
Interview module: VFY(Child.VFY)
Universe: AVAIL_C=1
and
Roster.HHC.tblNAME.bPerson.ONOFFCAMPUS
(1,RF,DK) and HHRESPSC_FLG ne 1 and (RELTIV_C ne 9)
Question Text:
Response:
in
I want to confirm some information. Does ^SCNAME live in on-campus
housing or off-campus housing? Read if necessary: On-campus housing
includes residence halls and dorms where students live together. It also includes
buildings that are owned, leased, or managed by the school. Fraternities and
sororities are on-campus housing.
1.
2.
DK:
RF:
On campus
Off campus
Don't Know
Refused
Page 9 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,RF,DK> [goto VFYALL_C]
<2> [goto NOMORE_C]
Question ID: VFY.0200.00.1
Variable name: VFYALL_C
Interview module: VFY(Child.VFY)
Universe: KNOAVAIL_Count gt 0 AND KNOAVAIL_C ne RF AND TINTRO_C not in
(1,DK,RF) AND AVAIL_C ne RF AND VFYONCAMP_C ne 2 AND (RELTIV_C
ne 9)
Question Text:
Response:
Fills:
Please verify the following information about the sample child before proceeding: I
have recorded ^childvsex, ^AGE_C, ^NATORG_C, and ^RACE_C. Would you
like to make any changes to this ^additionalinfo_C? ^RACEVRBATvalue_C If
respondent "refuses" or says "don't know", enter "2" for "no."
1.
2.
Yes
No
^NATORG_C
If NATO_FINAL=1 fill: "^SCNAME is of Hispanic or
Latino Origin"
If NATO_FINAL=2 fill: "^SCNAME is not of Hispanic
or Latino Origin"
If NATO_FINAL=DK fill: "whether ^SCNAME is of
Hispanic or Latino Origin is not known"
If NATO_FINAL=RF fill: "information about whether
^SCNAME is of Hispanic or Latino Origin was not
provided"
^childvsex
If SEX_FINAL=1, fill: "^SCNAME is male"
If SEX_FINAL=2, fill: "^SCNAME is female"
If SEX_FINAL=DK, fill: "^SCNAME's sex is not
known"
If SEX_FINAL=RF,fill: "^SCNAME's sex was not
provided"
^AGE_C
If AGE_FINAL NE ('RF', 'DK'), fill: "^SCNAME is
^AGENO_C ^AGETP_C old"
If AGE_FINAL IN ('RF', 'DK'), fill: "^SCNAME is
under 18"
^RACE_C
If GEN.RACE_FINAL[PX_C].RACE_FINAL NE 'RF'
OR 'DK', fill: "^SCNAME is^RACEFILLAND_C."
IfGEN.RACE_FINAL[PX_C].RACE_FINAL='DK', fill:
^SCNAME's race is not known"
Page 10 of 223
IfGEN.RACE_FINAL[PX_C].RACE_FINAL='RF', fill:
^SCNAME's race was not provided"
^additionalinfo_C
See attachment for fill instructions
^RACEVRBATvalue_C
IF
GEN.HHRESPSC_FLG
ne
1
and
GEN.RACE_FINAL[PX_C].RACE_VRBAT_FINAL ne
(empty,RF,DK), fill "* If respondent wants information
on which other race ^SCNAME is listed as, say
^RACE_VRBAT."
Skip Instructions: <1> [goto VFYDEM_C]
<2> if GEN.SEX_FINAL[PX_C] IN (RF,DK) [goto SEXGUESS_C]
elseif NATO_FINAL=1 [goto HISPTYPE_C]
elseif RACE_FINAL=6 [goto PITYPE_C]
elseif RACE_FINAL=7 [goto ASIANTYPE_C]
elseif RACE_FINAL=8 [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0210.00.1
Variable name: VFYDEM_C
Interview module: VFY(Child.VFY)
Universe: VFYALL_C=1
Question Text:
Response:
Read if necessary: What should I change?
commas.
1.
2.
3.
4.
DK:
RF:
Enter all that apply, separate with
Sex
Age
Hispanic or Latino Origin
Race
Don't Know
Refused
Skip Instructions: If 1 NOT IN VFYDEM_C and GEN.SEX_FINAL[PX_C] IN (DK,RF) [goto
SEXGUESS_C]
elseif 1 IN VFYDEM_C [goto NEWSEX_C]
elseif 2 IN VFYDEM_C [goto NEWAGENO_C]
elseif 3 IN VFYDEM_C [goto NEWNATORG_C]
elseif 4 IN VFYDEM_C [goto NEWRACE_C]
If GEN.SEX_FINAL[PX_C] IN (DK,RF) [goto SEXGUESS_C]
elseif NATO_FINAL=1 [goto HISPTYPE_C]
elseif RACE_FINAL=6 [goto PITYPE_C]
elseif RACE_FINAL=7 [goto ASIANTYPE_C]
elseif RACE_FINAL=8 [goto RACEOTHER_C]
Page 11 of 223
else [goto BMONTH_C]
Question ID: VFY.0220.00.1
Variable name: NEWSEX_C
Interview module: VFY(Child.VFY)
Universe: 1 IN VFYDEM_C
Question Text:
Response:
Fills:
Is ^SCNAME male or female?
1.
2.
DK:
RF:
Male
Female
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: if
GEN.SEX_FINAL[PX_C]=RF,DK
and
NEWSEX_C=RF,DK
SEXGUESS_C]
elseif 2 IN VFYDEM_C [goto NEWAGENO_C]
elseif 3 IN VFYDEM_C [goto NEWNATORG_C]
elseif 4 IN VFYDEM_C [goto NEWRACE_C]
elseif NATO_FINAL=1 [goto HISPTYPE_C]
elseif RACE_FINAL=6 [goto PITYPE_C]
elseif RACE_FINAL=7 [goto ASIANTYPE_C]
elseif RACE_FINAL=8 [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0230.00.1
Variable name: SEXGUESS_C
[goto
Interview module: VFY(Child.VFY)
Universe: GEN.SEX_FINAL[PX_C] IN (DK,RF) and (VFYDEM_C NOT IN 1 or
(VFYDEM_C=1 and NEWSEX_C IN (RF,DK))) and (RELTIV_C ne 9)
Question Text:
Enter your best guess of ^SCNAME's sex
Response:
Page 12 of 223
1.
2.
Fills:
Male
Female
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2>
if 2 IN VFYDEM_C [goto NEWAGENO_C]
elseif 3 IN VFYDEM_C [goto NEWNATORG_C]
elseif 4 IN VFYDEM_C [goto NEWRACE_C]
elseif NATO_FINAL=1 [goto HISPTYPE_C]
elseif RACE_FINAL=6 [goto PITYPE_C]
elseif RACE_FINAL=7 [goto ASIANTYPE_C]
elseif RACE_FINAL=8 [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0240.01.1
Variable name: NEWAGENO_C
Interview module: VFY(Child.VFY)
Universe: 2 IN VFYDEM_C
Question Text:
Response:
Fills:
1 of 2 How old is ^SCNAME?
DK:
RF:
Enter number for age.
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: goto [NEWAGETP_C]
Page 13 of 223
Question ID: VFY.0240.02.1
Variable name: NEWAGETP_C
Interview module: VFY(Child.VFY)
Universe: NEWAGENO_C=001-120
Question Text:
Response:
2 of 2
1.
2.
3.
4.
Enter number for age time period.
Day(s)
Week(s)
Month(s)
Year(s)
Skip Instructions: <1,2,3,4> if 3 IN VFYDEM_C [goto NEWNATORG_C]
elseif 4 IN VFYDEM_C [goto NEWRACE_C]
elseif NATO_FINAL=1 [goto HISPTYPE_C]
elseif RACE_FINAL=6 [goto PITYPE_C]
elseif RACE_FINAL=7 [goto ASIANTYPE_C]
elseif RACE_FINAL=8 [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0260.00.1
Variable name: NEWNATORG_C
Interview module: VFY(Child.VFY)
Universe: 3 IN VFYDEM_C
Question Text:
Response:
Fills:
Is ^SCNAME Hispanic or Latino?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> if 4 IN VFYDEM_C [goto NEWRACE_C]
elseif NATO_FINAL=1 [goto HISPTYPE_C]
elseif RACE_FINAL=6 [goto PITYPE_C]
elseif RACE_FINAL=7 [goto ASIANTYPE_C]
elseif RACE_FINAL=8 [goto RACEOTHER_C]
else [goto BMONTH_C]
Page 14 of 223
Question ID: VFY.0270.00.1
Variable name: NEWRACE_C
Interview module: VFY(Child.VFY)
Universe: 4 IN VFYDEM_C
Question Text:
Response:
Fills:
What race or races is ^SCNAME? Please select 1 or more of these categories:
White, Black, African American, American Indian, Alaska Native, Native
Hawaiian, Pacific Islander, Asian, or some other race? Enter all that apply,
separate with commas.
1.
2.
3.
4.
5.
6.
7.
8.
DK:
RF:
White
Black/African American
American Indian
Alaska Native
Native Hawaiian
Pacific Islander
Asian
Some other race
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: if NATO_FINAL=1 [goto HISPTYPE_C]
elseif RACE_FINAL=6 [goto PITYPE_C]
elseif RACE_FINAL=7 [goto ASIANTYPE_C]
elseif RACE_FINAL=8 [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0280.00.1
Variable name: HISPTYPE_C
Interview module: VFY(Child.VFY)
Universe: GEN.NATO_FINAL[PX_C]=1 and (KNOAVAIL_Count gt 0 AND KNOAVAIL_C
ne RF AND TINTRO_C not in (1,DK,RF) AND AVAIL_C ne RF AND
VFYONCAMP_C ne 2 AND (RELTIV_C ne 9))
Question Text:
What is ^SCNAME's Hispanic or Latino ancestry or origin, such as Mexican,
Mexican American, ^CHICANOA, Central or South American, Puerto Rican,
Cuban, Dominican (Republic), or Other Hispanic, ^LATINOA, or Spanish -- and
if ^SCNAME has more than one, tell me all of them. Enter all that apply,
separate with commas.
Response:
Page 15 of 223
1.
2.
3.
4.
5.
6.
7.
DK:
RF:
Fills:
Mexican, Mexican American, or Chicano(a)
Central American
South American
Puerto Rican (Boricua)
Cuban
Dominican (Republic)
Other Hispanic, Latino(a), or Spanish (specify)
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^CHICANOA
If SEX_FINAL = 1 fill: "Chicano"
if SEX_FINAL = 2,DK,RF fill "Chicano or Chicana"
^LATINOA
If SEX_FINAL= 1 fill: "Latino"
if SEX_FINAL = 2,DK,RF fill "Latino or Latina"
Skip Instructions: <7> [goto HISPOTHER_C]
<1-6,RF,DK>
if GEN.RACE_FINAL[PX_C]=6 [goto PITYPE_C]
elseif GEN.RACE_FINAL[PX_C]=7 [goto ASIANTYPE_C]
elseif
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
or
(HHRESPSC_FLG ne 1 and RACE_SP[PX_C] in (ZZ,RF,DK))) [goto
RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0290.00.1
Variable name: HISPOTHER_C
Interview module: VFY(Child.VFY)
Universe: HISPTYPE_C=7
Question Text:
Response:
?[F1] What is ^SCNAME's Hispanic or Latino ancestry or origin? If ^SCNAME
has more than one, tell me all of them. Start typing and then select from list. If
Hispanic or Latino ancestry is not on the list, type "ZZ" and enter verbatim. If any of
the following are mentioned, backup to previous screen and correct the entry.
Mexican Mexican American Chicano/Chicana Central American (REFER TO HELP
SCREEN) South American (REFER TO HELP SCREEN) Puerto Rican (Boricua)
Cuban/Cuban American Dominican (Republic) If respondent provides more than
one other Hispanic or Latino ancestry or origin, select 'ZZ' from the lookup table. At
the next question, enter ALL the other Hispanic or Latino ancestries or origins in the
verbatim field.
DK:
RF:
Don't Know
Refused
Page 16 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto HISPVRBAT_C]
if GEN.RACE_FINAL[PX_C]=6 [goto PITYPE_C]
elseif GEN.RACE_FINAL[PX_C]=7 [goto ASIANTYPE_C]
elseif
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
(GEN.HHRESPSC_FLG ne 1 and Roster.HHC.RACE_SP[PX_C]
(ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0300.00.1
Variable name: HISPVRBAT_C
or
in
Interview module: VFY(Child.VFY)
Universe: HISPOTHER_C=ZZ
Question Text:
Response:
Fills:
Read if necessary: What is ^SCNAME's Hispanic or Latino ancestry or origin? If
^SCNAME has more than one, tell me all of them.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: if GEN.RACE_FINAL[PX_C]=6 [goto PITYPE_C]
elseif GEN.RACE_FINAL[PX_C]=7 [goto ASIANTYPE_C]
elseif
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
(GEN.HHRESPSC_FLG ne 1 and Roster.HHC.RACE_SP[PX_C]
(ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Page 17 of 223
or
in
Question ID: VFY.0310.00.1
Variable name: PITYPE_C
Interview module: VFY(Child.VFY)
Universe: GEN.RACE_FINAL[PX_C]=6 and (KNOAVAIL_Count gt 0 AND KNOAVAIL_C
ne RF AND TINTRO_C not in (1,DK,RF) AND AVAIL_C ne RF AND
VFYONCAMP_C ne 2 AND (RELTIV_C ne 9))
Question Text:
Response:
Fills:
I have recorded that ^SCNAME is Pacific Islander. What specific ethnic group
or groups is ^SCNAME-- such as Guamanian or Chamorro, Samoan, or other
Pacific Islander? If ^SCNAME is more than one, tell me all of them. Enter all
that apply, separate with comma
1.
2.
3.
DK:
RF:
Guamanian or Chamorro
Samoan
Other Pacific Islander
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <3> [goto PIOTHER_C]
<1,2,RF,DK> if GEN.RACE_FINAL[PX_C]=7 [goto ASIANTYPE_C]
elseif
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
(GEN.HHRESPSC_FLG ne 1 and Roster.HHC.RACE_SP[PX_C]
(ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0320.00.1
Variable name: PIOTHER_C
or
in
Interview module: VFY(Child.VFY)
Universe: PITYPE_C=3
Question Text:
Response:
Read if necessary: I have recorded that ^SCNAME is Pacific Islander. What specific
ethnic group or groups is ^SCNAME? If ^SCNAME is more than one, tell me all of
them. Start typing and then select from list. If Pacific Islander ethnic group is not on
the list, type "ZZ" and enter verbatim. If respondent provides more than one ethnic
group, select 'ZZ' from the lookup table. At the next question, enter ALL the ethnic
groups in the verbatim field.
DK:
RF:
Don't Know
Refused
Page 18 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto PIVRBAT_C]
if GEN.RACE_FINAL[PX_C]=7 [goto ASIANTYPE_C]
elseif
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
(GEN.HHRESPSC_FLG ne 1 and Roster.HHC.RACE_SP[PX_C]
(ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0330.00.1
Variable name: PIVRBAT_C
or
in
Interview module: VFY(Child.VFY)
Universe: PIOTHER_C=ZZ
Question Text:
Response:
Fills:
Read if necessary: I have recorded that ^SCNAME is Pacific Islander. What specific
ethnic group or groups is ^SCNAME? If ^SCNAME is more than one, tell me all of
them.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions:
if GEN.RACE_FINAL[PX_C]=7 [goto ASIANTYPE_C]
elseif
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
(GEN.HHRESPSC_FLG ne 1 and Roster.HHC.RACE_SP[PX_C]
(ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Page 19 of 223
or
in
Question ID: VFY.0340.00.1
Variable name: ASIANTYPE_C
Interview module: VFY(Child.VFY)
Universe: GEN.RACE_FINAL[PX_C]=7 and (KNOAVAIL_Count gt 0 AND KNOAVAIL_C
ne RF AND TINTRO_C not in (1,DK,RF) AND AVAIL_C ne RF AND
VFYONCAMP_C ne 2 AND (RELTIV_C ne 9))
Question Text:
Response:
Fills:
I have recorded that ^SCNAME is Asian. What specific ethnic group or groups
is ^SCNAME-- such as Asian Indian, Chinese, Filipino, Japanese, Korean,
Vietnamese, or Other Asian? If ^SCNAME is more than one, tell me all of them.
Enter all that apply, separate with commas.
1.
2.
3.
4.
5.
6.
7.
DK:
RF:
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <7> [goto ASIANOTHER_C]
<1-6,RF,DK>
elseif
GEN.RACE_FINAL[PX_C]=8
(GEN.HHRESPSC_FLG ne 1 and
(ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Page 20 of 223
and
(NEWRACE_C=8
Roster.HHC.RACE_SP[PX_C]
or
in
Question ID: VFY.0350.00.1
Variable name: ASIANOTHER_C
Interview module: VFY(Child.VFY)
Universe: ASIANTYPE_C=7
Question Text:
Response:
Fills:
What is ^SCNAME's specific Asian ethnic group or groups? If ^SCNAME has
more than one, tell me all of them. Start typing and then select from list. If Asian
ethnic group is not on the list, type "ZZ" and enter verbatim. If any of the following
are mentioned, backup to previous screen and correct the entry. (Asian) Indian
Chinese Filipino Japanese Korean Vietnamese If respondent provides more than
one ethnic group, select 'ZZ' from the lookup table. At the next question, enter ALL
the ethnic groups in the verbatim field.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto ASIANVRBAT_C]
if
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
or
(NEWRACE_C=EMPTY
and
GEN.HHRESPSC_FLG
ne
1
and
ROSTER.HHC.RACE_SP[PX_C] IN (ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0360.00.1
Variable name: ASIANVRBAT_C
Interview module: VFY(Child.VFY)
Universe: ASIANOTHER_C=ZZ
Question Text:
Response:
Read if necessary: What is ^SCNAME's specific Asian ethnic group or groups? If
^SCNAME has more than one, tell me all of them.
DK:
RF:
Don't Know
Refused
Page 21 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions:
if
GEN.RACE_FINAL[PX_C]=8
and
(NEWRACE_C=8
or
(NEWRACE_C=EMPTY
and
GEN.HHRESPSC_FLG
ne
1
and
ROSTER.HHC.RACE_SP[PX_C] IN (ZZ,RF,DK))) [goto RACEOTHER_C]
else [goto BMONTH_C]
Question ID: VFY.0370.00.1
Variable name: RACEOTHER_C
Interview module: VFY(Child.VFY)
Universe: (KNOAVAIL_Count gt 0 AND KNOAVAIL_C ne RF AND TINTRO_C not in
(1,DK,RF) AND AVAIL_C ne RF AND VFYONCAMP_C ne 2 AND (RELTIV_C
ne 9))
and(NEWRACE_C=8 or (NEWRACE_C=EMPTY and GEN.HHRESPSC_FLG
ne 1 and ROSTER.HHC.RACE_SP[PX_C] IN (ZZ,RF,DK)))
Question Text:
Response:
Fills:
What other race or races is ^SCNAME? Start typing and then select from list. If
race is not on the list, type "ZZ" and enter verbatim.
If respondent provides more
than one other race, select 'ZZ' from the lookup table. At the next question, enter ALL
the other races in the verbatim field.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto RACEVRBAT_C]
[goto BMONTH_C]
Page 22 of 223
Question ID: VFY.0380.00.1
Variable name: RACEVRBAT_C
Interview module: VFY(Child.VFY)
Universe: RACEOTHER_C=ZZ
Question Text:
Response:
Fills:
Read if necessary: What other race or races is ^SCNAME?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto BMONTH_C]
Question ID: VFY.0410.01.1
Variable name: BMONTH_C
Interview module: VFY(Child.VFY)
Universe: (RELTIV_C IN (1,2,3,6,7) OR VFYRESP_C = 1 OR (PCNT18UP_C gt 1 and
(KNOAVAIL_C
IN
Roster.bREL.bPerson[PX_C].PARENTS))
and
DOB_COUNT_C LT 2 and (RELTIV_C ne 9)
Question Text:
Response:
1 of 3 What is ^SCNAME's date of birth? Please give month, day, and year for
the date of birth.
Enter month of birth.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
DK:
RF:
January
February
March
April
May
June
July
August
September
October
November
December
Don't Know
Refused
Page 23 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-12,RF,DK> [goto BDAY_C]
Question ID: VFY.0410.02.1
Variable name: BDAY_C
Interview module: VFY(Child.VFY)
Universe: (RELTIV_C = 1, 2, 3, 6, 7 OR VFYRESP_C = 1 OR (PCNT18UP_C gt 1 and
(AVAIL_C IN Roster.bREL.bPerson[PX_C].PARENTS)) and DOB_COUNT_C
LT 2 and (RELTIV_C ne 9)
Question Text:
Response:
2 of 3
DK:
RF:
Enter day of birth.
Don't Know
Refused
Skip Instructions: <1-31,RF,DK> Only allow valid days for month entered. if days not valid [goto
ERR_BDAY_C]
else [goto BYEAR_C]
Check Name: ERR_BDAY_C
Text:
{check ERR_BDAY_C}
^BDAY_C is not a valid day for ^BMONTH_C.
Hard / Soft Edit: Hard
Fills:
^BDAY_C
Fill value from Child.VFY.BDAY_C
^BMONTH_C
Fill value from Child.VFY.BMONTH_C
Universe: Invalid dates for the month entered
Page 24 of 223
Question ID: VFY.0410.03.1
Variable name: BYEAR_C
Interview module: VFY(Child.VFY)
Universe: (RELTIV_C = 1, 2, 3, 6, 7 OR VFYRESP_C = 1 OR (PCNT18UP_C gt 1 and
(AVAIL_C IN Roster.bREL.bPerson[PX_C].PARENTS)) and DOB_COUNT_C
LT 2 and (RELTIV_C ne 9)
Question Text:
Response:
3 of 3
DK:
RF:
Enter year of birth.
Don't Know
Refused
Skip Instructions: <1900-current year,RF,DK>
if (BYEAR_C gt current year) or (BYEAR_C=current year and BMONTH_C gt
current month) or (BYEAR_C=current year and BMONTH_C=current month
and BDAY_C gt current day) [goto ERR_BYEAR_C]
elseif BDAY_C=29 and BMONTH_C=2 and (BYEAR=2000 or BYEAR_C/4
remainder ne 0) [goto ERR_BDAYLEAP_C]
elseif AGETEMP_C
NOMORE_C]
in
(RF,DK)
AND
BYEAR_C
in
(RF,DK)
[goto
elseif ((BYEAR_C not IN (RF,DK) and AGETEMP_C not IN (RF,DK) and
AGETEMP_C ne AGE_CALC_C) AND (AGETEMP_C not IN (RF,DK) and
AGETEMP_C ne AGE_CALCMINUS1_C)) and DOB_COUNT_C ne 1 [goto
VFYDOB_C]
elseif (AGETEMP_C eq AGE_CALC_C or AGE_CALCMINUS1_C) or
DOB_COUNT_C=1
if AGE_FINAL ge 18 [goto NOMORE_C]
else [goto next section]
Page 25 of 223
Check Name: ERR_BDAYLEAP_C
Text:
{check ERR_BDAYLEAP_C}
^BDAY_C is not a valid day for ^BMONTH_C.
Hard / Soft Edit: Hard
Fills:
^BDAY_C
Fill value from Child.VFY.BDAY_C
^BMONTH_C
Fill value from Child.VFY.BMONTH_C
Universe: Invalid dates for the leap year
Check Name: ERR_BYEAR_C
Text:
{check ERR_BYEAR_C}
Future date invalid.
Hard / Soft Edit: Hard
Universe: (BYEAR_C>current
year)
or
(BYEAR_C=current
BMONTH_C>current
month)
or
(BYEAR_C=current
BMONTH_C=current month and BDAY_C>current day)
Question ID: VFY.0430.00.1
Variable name: VFYDOB_C
year
year
and
and
Interview module: VFY(Child.VFY)
Universe: ((BYEAR_C not IN (DK,RF) and AGETEMP_C not IN (DK,RF) and
AGETEMP_C ne AGE_CALC_C) AND (AGETEMP_C not IN (DK,RF) and
AGETEMP_C ne AGE_CALCMINUS1_C)) and DOB_COUNT_C ne 1 and
(RELTIV_C ne 9)
Question Text:
There is a difference between the age the computer calculated from
^SCNAME's date of birth of ^AGEDOB_C_fill and the age I had previously
recorded of ^TEMPAGE_C. I recorded ^SCNAME's ^dateofbirth_C
Response:
Page 26 of 223
1.
2.
DK:
RF:
Fills:
Yes
No
Don't Know
Refused
^AGEDOB_C_fill
Fill one age calculated from AGE_CALC_C as "(age)
year(s) old"
Fill two ages calculated from AGE_CALC_C and
AGE_CALCMINUS1_C as "(age) or (age) year(s)
old"
If AGE_CALC_C or AGE_CALCMINUS1_C is equal
to 0, then display as "less than 1"
^TEMPAGE_C
fill value of AGETEMP_C as "(age) year(s) old"
If AGETEMP_C is equal to 0, then display as "less
than 1"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^dateofbirth_C
If BDAY_C, BMONTH_C and BYEAR_C are all valid,
fill: "date of birth as ^BMONTH_C ^BDAY_C,
^BYEAR_C, is that correct?"
If only BMONTH_C and BYEAR_C are valid, fill:
"date of birth as ^BMONTH_C ^BYEAR_C, is that
correct?"
If only BDAY_C and BYEAR_C are valid, fill: "year of
birth as ^BYEAR_C, is that correct?"
If only BYEAR_C is valid, fill: "year of birth as
^BYEAR_C, is that correct?"
Skip Instructions: <1,RF,DK> if GEN.AGE_FINAL[PX_C] gt 18 [goto NOMORE_C]
else [goto next section]
<2> if DOB_COUNT_C le 1 [goto BMONTH_C]
elseif GEN.AGE_FINAL[PX_C] gt 18 [goto NOMORE_C]
else [goto next section]
Page 27 of 223
Question ID: VFY.0440.00.1
Variable name: NOMORE_C
Interview module: VFY(Child.VFY)
Universe: GEN.AGE_FINAL[PX_C] GT 17 or GEN.AGE_FINAL[PX_C] in (RF,DK) or
VFYONCAMP_C=2 OR (KNOAVAIL_Count = 0)
Question Text:
Response:
Fills:
^SCNAME no longer meets the requirements to be sample child for this family. End
this interview and begin the Sample Adult Interview. If there is no Sample Adult or the
Sample Adult interview has been completed, EXIT ^auxNoMore Not everyone in
our survey is asked all questions. I have all the information that I need from
you about ^SCNAME.
Enter '1' to continue.
1.
Enter 1 to Continue
^SCNAME
Fill ALIAS of HHSTAT_C=1
^auxNoMore
IF KNOAVAIL_Count = 0,fill "* If there is still a
knowledgeable respondent available, back up and
select that person."
Skip Instructions: If there is a callback set for Sample Adult [goto BCK.THANKS_CB]
else if GEN.OUTCOME IN 215 [goto BCK.THANKS_INSUF]
else [goto BCK.THANKS_SUF]
Question ID: HIS.0010.00.1
Question Text:
Response:
Variable name: PHSTAT_C
Interview module: HIS(Child.HIS)
Would you say ^SCNAME's health in general is excellent, very good, good, fair,
or poor?
1.
2.
3.
4.
5.
DK:
RF:
Excellent
Very Good
Good
Fair
Poor
Don't Know
Refused
Page 28 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-5,RF,DK> [goto next section]
Question ID: SWL.0010.00.3
Variable name: LSATIS_C
Interview module: SWL(Child.SWL)
Universe: 12>=AGE_FINAL>=17
Question Text:
Response:
Fills:
Using a scale of 0 to 10, where 0 means "very dissatisfied" and 10 means "very
satisfied", how do you think ^SCNAME feels about ^hisher_C life as a whole
these days?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <0-10,RF,DK> [goto next section]
Question ID: AST.0010.00.1
Question Text:
Response:
Variable name: ASTINTRO_C
Interview module: AST(Child.AST)
Now I am going to ask you about certain medical conditions.
continue.
1.
Enter 1 to Continue
Skip Instructions: <1> [goto ASEV_C]
Page 29 of 223
Enter '1' to
Question ID: AST.0020.00.1
Question Text:
Response:
Fills:
Variable name: ASEV_C
Interview module: AST(Child.AST)
Has a doctor or other health professional EVER told you that ^SCNAME had
asthma?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto ASTILL_C]
<2,RF,DK> [goto next section]
Question ID: AST.0030.00.1
Variable name: ASTILL_C
Interview module: AST(Child.AST)
Universe: ASEV_C=1
Question Text:
Response:
Fills:
Does ^SCNAME still have asthma?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto ASAT12M_C]
Page 30 of 223
Question ID: AST.0040.00.1
Variable name: ASAT12M_C
Interview module: AST(Child.AST)
Universe: ASEV_C=1
Question Text:
Response:
Fills:
During the past 12 months, has ^SCNAME had an episode of asthma or an
asthma attack?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto ASER12M_C]
Question ID: AST.0050.00.1
Variable name: ASER12M_C
Interview module: AST(Child.AST)
Universe: ASEV_C=1
Question Text:
Response:
Fills:
During the past 12 months, did ^SCNAME have to visit an emergency room or
urgent care center because of ^hisher_C asthma?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 31 of 223
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: DIB.0010.00.1
Question Text:
Response:
Fills:
Variable name: PREDIB_C
Interview module: DIB(Child.DIB)
Has a doctor or other health professional EVER told you that ^SCNAME had
prediabetes or borderline diabetes?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto DIBEV_C]
Question ID: DIB.0020.00.1
Question Text:
Response:
Fills:
Variable name: DIBEV_C
Interview module: DIB(Child.DIB)
^NOTPRED a doctor or other health professional EVER told you that ^SCNAME
had diabetes?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^NOTPRED
If PREDIB_C=1: "Not including prediabetes, has"
If PREDIB_C IN ('2','DK','RF'): "Has"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Page 32 of 223
Question ID: DLD.0010.00.1
Variable name: ADHDEV_C
Interview module: DLD(Child.DLD)
Universe: GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Has a doctor or other health professional ever told you that ^SCNAME had
Attention-Deficit/Hyperactivity Disorder or ADHD or Attention-Deficit Disorder
or ADD? Read if necessary: Health professionals can include school psychologists
and school nurses.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto ADHDNW_C]
<2,RF,DK> [goto IDEV_C]
Question ID: DLD.0020.00.1
Variable name: ADHDNW_C
Interview module: DLD(Child.DLD)
Universe: ADHDEV_C=1
and
GEN.AGE_FINAL[PX_C]
GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
ge
2
and
Does ^SCNAME currently have Attention-Deficit/Hyperactivity Disorder or
ADHD or Attention-Deficit Disorder or ADD?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 33 of 223
Skip Instructions: <1,2,RF,DK> [goto IDEV_C]
Question ID: DLD.0030.00.1
Question Text:
Response:
Fills:
Variable name: IDEV_C
Interview module: DLD(Child.DLD)
Has a doctor or other health professional ever told you that ^SCNAME had an
intellectual disability, also known as mental retardation? Read if necessary:
Health professionals can include school psychologists and school nurses.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto IDNW_C]
<2,RF,DK> [goto ASDEV_C] if GEN.AGE_FINAL[PX_C]
GEN.AGE_FINAL[PX_C] le 17, else [goto DDEV_C]
Question ID: DLD.0040.00.1
Variable name: IDNW_C
ge
2
and
Interview module: DLD(Child.DLD)
Universe: IDEV_C=1
Question Text:
Response:
Fills:
Does ^SCNAME currently have an intellectual disability, also known as mental
retardation?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 34 of 223
Skip Instructions: <1,2,RF,DK> if GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le
17 [goto ASDEV_C]
else [goto DDEV_C]
Question ID: DLD.0050.00.1
Variable name: ASDEV_C
Interview module: DLD(Child.DLD)
Universe: GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Has a doctor or other health professional ever told you that ^SCNAME had
Autism, Asperger's disorder, pervasive developmental disorder, or autism
spectrum disorder? Read if necessary: Health professionals can include school
psychologists and school nurses.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto ASDNW_C]
<2,RF,DK> [goto DDEV_C]
Question ID: DLD.0060.00.1
Variable name: ASDNW_C
Interview module: DLD(Child.DLD)
Universe: ASDEV_C=1 and GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C]
le 17
Question Text:
Response:
Does ^SCNAME currently have Autism, Asperger's disorder, pervasive
developmental disorder, or autism spectrum disorder?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 35 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto DDEV_C]
Question ID: DLD.0070.00.1
Question Text:
Response:
Fills:
Variable name: DDEV_C
Interview module: DLD(Child.DLD)
^NOTEVER a doctor or other health professional ever told you that ^SCNAME
had any other developmental delay? Read if necessary: Health professionals
can include school psychologists and school nurses. Read if necessary:
Developmental delays are significant delays in a child's development. Examples
include cognitive, motor, speech, social, emotional and behavioral delays.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^NOTEVER
If ADHDEV_C ne 1 AND IDEV_C ne 1 and
ASDEV_C ne 1 fill: "Has"
If ADHDEV_C=1 AND IDEV_C ne 1 and ASDEV_C
ne 1 fill: "Not including ADHD, has"
If ADHDEV_C ne 1 AND IDEV_C=1 and ASDEV_C
ne 1 fill: "Not including an intellectual disability, has"
If ADHDEV_C ne 1 AND IDEV_C ne 1 and
ASDEV_C=1 fill: "Not including autism spectrum
disorder, has"
If ADHDEV_C=1 AND IDEV_C=1 and ASDEV_C ne
fill: "Not including ADHD or an intellectual disability,
has"
If ADHDEV_C=1 AND IDEV_C ne 1 and
ASDEV_C=1 fill: "Not including ADHD or autism
spectrum disorder, has"
If ADHDEV_C ne 1 AND IDEV_C=1 and
ASDEV_C=1 fill: "Not including an intellectual
disability or autism spectrum disorder, has"
If ADHDEV_C=1 AND IDEV_C=1 and ASDEV_C=1
fill: "Not including ADHD, an intellectual disability or
autism spectrum disorder, has"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 36 of 223
Skip Instructions: <1> [goto DDNW_C]
<2,RF,DK> if GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le
17 [goto LDEV_C]
else [goto next section]
Question ID: DLD.0080.00.1
Variable name: DDNW_C
Interview module: DLD(Child.DLD)
Universe: DDEV_C=1
Question Text:
Response:
Fills:
Does ^SCNAME still have this other developmental delay?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> if GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le
17 [goto LDEV_C]
else [goto next section]
Question ID: DLD.0090.00.1
Variable name: LDEV_C
Interview module: DLD(Child.DLD)
Universe: GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Has a representative from a school or a health professional ever told you that
^SCNAME had a learning disability?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 37 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto LDNW_C]
<2,RF,DK> [goto next section]
Question ID: DLD.0100.00.1
Variable name: LDNW_C
Interview module: DLD(Child.DLD)
Universe: LDEV_C=1 and GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C]
le 17
Question Text:
Response:
Fills:
Does ^SCNAME currently have a learning disability?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: ALG.0010.00.2
Question Text:
Variable name: ALGINTRO_C
Interview module: ALG(Child.ALG)
The next set of questions are about different types of allergies.
Response:
Skip Instructions: <1> [goto CURRESP_C]
Page 38 of 223
Question ID: ALG.0020.00.2
Question Text:
Response:
Fills:
Variable name: CURRESP_C
Interview module: ALG(Child.ALG)
Does ^SCNAME get symptoms such as sneezing, runny nose, or itchy or
watery eyes due to hay fever, seasonal or year-round allergies? Read if
necessary: Hay fever, seasonal or year-round allergies may also be known as
environmental allergies, allergic rhinitis or allergic conjunctivitis.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto DXRESP_C]
<2,RF,DK> [goto CURFOOD_C]
Question ID: ALG.0030.00.2
Variable name: DXRESP_C
Interview module: ALG(Child.ALG)
Universe: CURRESP_C=1
Question Text:
Response:
Fills:
Have you ever been told by a doctor or other health professional that
^SCNAME had hay fever, seasonal or year-round allergies? Read if necessary:
Hay fever, seasonal or year-round allergies may also be known as environmental
allergies, allergic rhinitis or allergic conjunctivitis.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 39 of 223
Skip Instructions: <1,2,RF,DK> [goto CURFOOD_C]
Question ID: ALG.0040.00.2
Question Text:
Response:
Fills:
Variable name: CURFOOD_C
Interview module: ALG(Child.ALG)
The next question is about food allergies. People with food allergies have
reactions such as hives, vomiting, trouble breathing, or throat tightening that
occur within two hours of eating a specific food. Does ^SCNAME have an
allergy to one or more foods? Read if necessary: Food allergies are different
from food intolerances, such as lactose and gluten intolerance, and other digestive
disorders, including irritable bowel syndrome.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto DXFOOD_C]
<2,RF,DK> [goto CURSKIN_C]
Question ID: ALG.0050.00.2
Variable name: DXFOOD_C
Interview module: ALG(Child.ALG)
Universe: CURFOOD_C=1
Question Text:
Response:
Have you ever been told by a doctor or other health professional that
^SCNAME had an allergy to one or more foods?
Read if necessary: Food
allergies are different from food intolerances, such as lactose and gluten intolerance,
and other digestive disorders, including irritable bowel syndrome.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 40 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto CURSKIN_C]
Question ID: ALG.0060.00.2
Question Text:
Response:
Fills:
Variable name: CURSKIN_C
Interview module: ALG(Child.ALG)
The next question is about an allergic skin condition. Does ^SCNAME get an
itchy rash due to eczema or atopic dermatitis? Read if necessary: The rash can
be dry, scaly, bumpy, or crusty and lasts for several days or longer without treatment.
Eczema is different from hives which come and go in a few hours.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto DXSKIN_C]
<2,RF,DK> [goto next section]
Question ID: ALG.0070.00.2
Variable name: DXSKIN_C
Interview module: ALG(Child.ALG)
Universe: CURSKIN_C=1
Question Text:
Response:
Have you ever been told by a doctor or other health professional that
^SCNAME had eczema or atopic dermatitis?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 41 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: VIS.0010.00.1
Question Text:
Response:
Fills:
Variable name: VISINTRO_C
Interview module: VIS(Child.VIS)
I would like to ask you some questions about difficulties ^SCNAME may have.
Enter '1' to continue.
1.
Enter 1 to Continue
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto WEARGLSS_C]
Question ID: VIS.0020.00.1
Question Text:
Response:
Fills:
Variable name: WEARGLSS_C
Interview module: VIS(Child.VIS)
Does ^SCNAME wear glasses ^CONTACTS? Read if necessary: Persons who
wear glasses to read or to do other occasional tasks should answer yes to this
question.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^CONTACTS
If AGE=5-17 fill "or contact lenses"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto VISIONDF_C]
Page 42 of 223
Question ID: VIS.0030.00.1
Question Text:
Response:
Fills:
Variable name: VISIONDF_C
Interview module: VIS(Child.VIS)
^GLASSCONTACT ^SCNAME have difficulty seeing? Would you say ^SCNAME
has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this
at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^GLASSCONTACT
If WEARGLSS_C=1 fill "When wearing glasses
^CONTACTS does"
else if WEARGLSS_C ne 1 "Does"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: HEA.0010.00.1
Question Text:
Response:
Variable name: HEARAID_C
Does ^SCNAME use a hearing aid?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 43 of 223
Interview module: HEA(Child.HEA)
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto HEARINGDF_C]
Question ID: HEA.0020.00.1
Question Text:
Response:
Fills:
Variable name: HEARINGDF_C
Interview module: HEA(Child.HEA)
^USEHRAID_C ^SCNAME have difficulty hearing sounds like people's voices or
music? Would you say ^SCNAME has: no difficulty, some difficulty, a lot of
difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^USEHRAID_C
If HEARAID_C=1 fill "When using ^hisher_C hearing
aid(s) does " else fill "Does "
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto next section]
Page 44 of 223
Question ID: MOB.0010.00.1
Variable name: EQUIP_C
Interview module: MOB(Child.MOB)
Universe: GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Does ^SCNAME use any equipment or receive assistance for walking?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> if GEN.AGE_FINAL[PX_C]=2-4 [goto NOEQWLKDF_C]
else if GEN.AGE_FINAL[PX_C] ge 5 [goto NOEQWLK100_C]
<2,RF,DK> if GEN.AGE_FINAL[PX_C]=2-4 [goto WLKDF_C]
else if GEN.AGE_FINAL[PX_C] ge 5 [goto WLK100_C]
Question ID: MOB.0020.00.1
Variable name: NOEQWLKDF_C
Interview module: MOB(Child.MOB)
Universe: EQUIP_C=1 and GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Response:
Fills:
Without using ^hisher_C equipment or assistance, does ^SCNAME have
difficulty walking? Would you say ^SCNAME has: no difficulty, some difficulty,
a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Page 45 of 223
Skip Instructions: <1-4,RF,DK> [goto EQWLKDF_C]
Question ID: MOB.0030.00.1
Variable name: EQWLKDF_C
Interview module: MOB(Child.MOB)
Universe: EQUIP_C=1 and GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Response:
Fills:
When using ^hisher_C equipment or assistance, does ^SCNAME have difficulty
walking? Read if necessary: Would you say ^SCNAME has: no difficulty, some
difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1-4,RF,DK> [goto next section]
Page 46 of 223
Question ID: MOB.0040.00.1
Variable name: WLKDF_C
Interview module: MOB(Child.MOB)
Universe: EQUIP_C IN (2,RF,DK) and GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Response:
Fills:
Compared with children of the same age, does ^SCNAME have difficulty
walking? Would you say ^SCNAME has: no difficulty, some difficulty, a lot of
difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: MOB.0050.00.1
Variable name: NOEQWLK100_C
Interview module: MOB(Child.MOB)
Universe: EQUIP_C=1 and GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C]
le 17
Question Text:
Response:
WITHOUT USING ^hisher_C equipment or assistance, does ^SCNAME have
difficulty walking 100 yards on level ground? That would be about the length of
1 football field or 1 city block. Would you say ^SCNAME has: no difficulty,
some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
No difficulty
Page 47 of 223
2.
3.
4.
DK:
RF:
Fills:
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-3,RF,DK> [goto NOEQWLK13M_C]
<4> [goto EQWLK100_C]
Question ID: MOB.0060.00.1
Variable name: NOEQWLK13M_C
Interview module: MOB(Child.MOB)
Universe: NOEQWLK100_C IN (1,2,3,RF,DK) and GEN.AGE_FINAL[PX_C] ge 5 and
GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
WITHOUT USING ^hisher_C equipment or assistance, does ^SCNAME have
difficulty walking a third of a mile on level ground? That would be about the
length of 5 football fields or 5 city blocks. Read if necessary: Would you say
^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do
this at all?
1.
2.
3.
No difficulty
Some difficulty
A lot of difficulty
Page 48 of 223
4.
DK:
RF:
Fills:
Cannot do at all
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1-4,RF,DK> [goto EQWLK100_C]
Question ID: MOB.0070.00.1
Variable name: EQWLK100_C
Interview module: MOB(Child.MOB)
Universe: EQUIP_C=1 and GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C]
le 17
Question Text:
Response:
Fills:
WHEN USING ^hisher_C equipment or assistance, does ^SCNAME have
difficulty walking 100 yards on level ground? That would be about the length of
1 football field or 1 city block. Read if necessary: Would you say ^SCNAME has:
no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 49 of 223
Skip Instructions: <1-3,RF,DK> [goto EQWLK13M_C]
<4> [goto next section]
Question ID: MOB.0080.00.1
Variable name: EQWLK13M_C
Interview module: MOB(Child.MOB)
Universe: EQWLK100_C IN (1,2,3,RF,DK) and GEN.AGE_FINAL[PX_C] ge 5 and
GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
WHEN USING ^hisher_C equipment or assistance, does ^SCNAME have
difficulty walking a third of a mile on level ground? That would be about the
length of 5 football fields or 5 city blocks. Read if necessary: Would you say
^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do
this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto next section]
Page 50 of 223
Question ID: MOB.0090.00.1
Variable name: WLK100_C
Interview module: MOB(Child.MOB)
Universe: EQUIP_C=2,RF,DK
and
GEN.AGE_FINAL[PX_C]
GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
ge
5
and
Compared with children of the same age, does ^SCNAME have difficulty
walking 100 yards on level ground? That would be about the length of 1 football
field or 1 city block. Would you say ^SCNAME has: no difficulty, some
difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto WLK13M_C]
<4> [goto next section]
Question ID: MOB.0100.00.1
Variable name: WLK13M_C
Interview module: MOB(Child.MOB)
Universe: WLK100_C IN (1,2,3,RF,DK) and GEN.AGE_FINAL[PX_C] ge 5 and
GEN.AGE_FINAL[PX_C] le 17
Question Text:
Compared with children of the same age, does ^SCNAME have difficulty
walking a third of a mile on level ground? That would be about the length of 5
football fields or 5 city blocks. Read if necessary: Would you say ^SCNAME has:
no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Response:
Page 51 of 223
1.
2.
3.
4.
DK:
RF:
Fills:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: UPP.0010.00.1
Variable name: PICKUPDF_C
Interview module: UPP(Child.UPP)
Universe: GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Response:
Fills:
Compared with children of the same age, does ^SCNAME have difficulty
picking up small objects with ^hisher_C hands? Read if necessary: Would you
say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot
do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Page 52 of 223
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: UPP.0020.00.1
Variable name: SELFCAREDF_C
Interview module: UPP(Child.UPP)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Does ^SCNAME have difficulty with self care, such as eating or dressing?
Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot
of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: COM.0010.00.1
Variable name: UNDRSTYOU_C
Interview module: COM(Child.COM)
Universe: GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Does ^SCNAME have difficulty understanding you? Read if necesary: Would
you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C
cannot do this at all?
Response:
Page 53 of 223
1.
2.
3.
4.
DK:
RF:
Fills:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto UNDRSTCHD_C]
Question ID: COM.0020.00.1
Variable name: UNDRSTCHD_C
Interview module: COM(Child.COM)
Universe: GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Response:
Fills:
When ^SCNAME speaks, do you have difficulty understanding
^himherthem_C? Read if necessary: Would you say ^SCNAME has: no difficulty,
some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^himherthem_C
if GEN.SEX_FINAL[PX_C]=1 fill "him";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"them"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Page 54 of 223
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: COM.0030.00.1
Variable name: UNDRSTIHH_C
Interview module: COM(Child.COM)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
When ^SCNAME speaks, ^doesheshedothey_C have difficulty being
understood by people inside of this household?
Read if necessary: Would you
say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot
do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^doesheshedothey_C
If SEX=1 fill: "does he"
If SEX=2 fill: "does she"
If SEX IN ('RF','DK') fill: "do they"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto UNDRSTOHH_C]
Page 55 of 223
Question ID: COM.0040.00.0
Variable name: UNDRSTOHH_C
Interview module: COM(Child.COM)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
When ^SCNAME speaks, ^doesheshedothey_C have difficulty being
understood by people outside of this household? Read if necessary: Would
you say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C
cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^doesheshedothey_C
If SEX=1 fill: "does he"
If SEX=2 fill: "does she"
If SEX IN ('RF','DK') fill: "do they"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: COG.0010.00.1
Variable name: LEARNDF_C
Interview module: COG(Child.COG)
Universe: GEN.AGE_FINAL[PX_C] ge 2 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Compared with children of the same age, does ^SCNAME have difficulty
learning things? Read if necessary: Would you say ^SCNAME has: no difficulty,
some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
Response:
Page 56 of 223
1.
2.
3.
4.
DK:
RF:
Fills:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto REMEMBERDF_C]
Question ID: COG.0020.00.1
Variable name: REMEMBERDF_C
Interview module: COG(Child.COG)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Compared with children of the same age, does ^SCNAME have difficulty
remembering things? Read if necessary: Would you say ^SCNAME has: no
difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Page 57 of 223
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: ANX.0010.00.1
Question Text:
Response:
Fills:
Variable name: ANXFREQ_C
Interview module: ANX(Child.ANX)
How often does ^SCNAME seem very anxious, nervous, or worried? Would you
say: daily, weekly, monthly, a few times a year, or never?
1.
2.
3.
4.
5.
DK:
RF:
Daily
Weekly
Monthly
A few times a year
Never
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-5,RF,DK> [goto next section]
Question ID: DEP.0010.00.1
Question Text:
Response:
Fills:
Variable name: DEPFREQ_C
Interview module: DEP(Child.DEP)
How often does ^SCNAME seem very sad or depressed? Would you say: daily,
weekly, monthly, a few times a year, or never?
1.
2.
3.
4.
5.
DK:
RF:
Daily
Weekly
Monthly
A few times a year
Never
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 58 of 223
Skip Instructions: <1-5,RF,DK> [goto next section]
Question ID: BEH.0010.00.1
Variable name: BEHDFPLYG_C
Interview module: BEH(Child.BEH)
Universe: GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Response:
Fills:
Compared with children of the same age, does ^SCNAME have difficulty
playing? Would you say ^SCNAME has: no difficulty, some difficulty, a lot of
difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-4,RF,DK> [goto BEHKBHYG_C]
Question ID: BEH.0020.00.1
Variable name: BEHKBHYG_C
Interview module: BEH(Child.BEH)
Universe: GEN.AGE_FINAL[PX_C] IN (2,3,4)
Question Text:
Compared with children of the same age, how much does ^SCNAME kick, bite,
or hit other children or adults? Would you say: not at all, the same or less,
more, or a lot more?
Response:
Page 59 of 223
1.
2.
3.
4.
DK:
RF:
Fills:
Not at all
The same or less
More
A lot more
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: BEH.0030.00.1
Variable name: BEHDFCNTR_C
Interview module: BEH(Child.BEH)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Compared with children of the same age, does ^SCNAME have difficulty
controlling ^hisher_C behavior? Read if necessary: Would you say ^SCNAME
has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Page 60 of 223
Skip Instructions: <1-4,RF,DK> [goto BEHDFFCS_C]
Question ID: BEH.0040.00.1
Variable name: BEHDFFCS_C
Interview module: BEH(Child.BEH)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Does ^SCNAME have difficulty concentrating on an activity that ^heshe_C
enjoy^s doing? Read if necessary: Would you say ^SCNAME has: no difficulty,
some difficulty, a lot of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^s
if SEX_FINAL[PX_C]=1,2 fill "s"
else fill blank
Skip Instructions: <1-4,RF,DK> [goto BEHDFCHG_C]
Page 61 of 223
Question ID: BEH.0050.00.1
Variable name: BEHDFCHG_C
Interview module: BEH(Child.BEH)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Does ^SCNAME have difficulty accepting changes in ^hisher_C routine?
Read if necessary: Would you say ^SCNAME has: no difficulty, some difficulty, a lot
of difficulty, or ^heshe_C cannot do this at all?
1.
2.
3.
4.
DK:
RF:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto BEHDFMKFR_C]
Question ID: BEH.0060.00.1
Variable name: BEHDFMKFR_C
Interview module: BEH(Child.BEH)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Does ^SCNAME have difficulty making friends? Read if necessary: Would you
say ^SCNAME has: no difficulty, some difficulty, a lot of difficulty, or ^heshe_C cannot
do this at all?
Response:
Page 62 of 223
1.
2.
3.
4.
DK:
RF:
Fills:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: BSC.0010.00.1
Question Text:
Response:
Variable name: BSCINTRO_C
Interview module: BSC(Child.BSC)
The following statements are not to be read to the respondent. They are displayed
and included here for legal reasons. The Baby Pediatric Symptom Checklist is part
of the larger Survey of Well-being of Young Children, copyrighted by Tufts Medical
Center. For more information go to
https://www.floatinghospital.org/The-Survey-of-Wellbeing-of-Young-Children/Overvie
w.aspx Enter '1' to continue.
1.
Enter 1 to Continue
Skip Instructions: <1> [goto BSCNWPPL_C]
Question ID: BSC.0020.00.1
Question Text:
Variable name: BSCNWPPL_C
Interview module: BSC(Child.BSC)
These next questions are about ^SCNAME's behavior. Think about what you
would expect of other children the same age, and tell me how much each
statement applies to ^SCNAME. Does ^SCNAME have a hard time being with
new people? Would you say not at all, somewhat, or very much?
Response:
Page 63 of 223
1.
2.
3.
DK:
RF:
Fills:
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCNWPLCS_C]
Question ID: BSC.0030.00.1
Question Text:
Response:
Fills:
Variable name: BSCNWPLCS_C
Interview module: BSC(Child.BSC)
Does ^SCNAME have a hard time in new places? Would you say not at all,
somewhat, or very much?
1.
2.
3.
DK:
RF:
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCCHG_C]
Question ID: BSC.0040.00.1
Question Text:
Response:
Variable name: BSCCHG_C
Interview module: BSC(Child.BSC)
Does ^SCNAME have a hard time with change?
say not at all, somewhat, or very much?
1.
2.
Not at all
Somewhat
Page 64 of 223
Read if necessary: Would you
3.
DK:
RF:
Fills:
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCHLOPPL_C]
Question ID: BSC.0050.00.1
Question Text:
Response:
Fills:
Variable name: BSCHLOPPL_C
Interview module: BSC(Child.BSC)
Does ^SCNAME mind being held by other people?
you say not at all, somewhat, or very much?
1.
2.
3.
DK:
RF:
Read if necessary: Would
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCCRYALT_C]
Question ID: BSC.0060.00.1
Question Text:
Response:
Variable name: BSCCRYALT_C
Does ^SCNAME cry a lot?
somewhat, or very much?
1.
2.
3.
DK:
RF:
Interview module: BSC(Child.BSC)
Read if necessary: Would you say not at all,
Not at all
Somewhat
Very much
Don't Know
Refused
Page 65 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCCLMDWN_C]
Question ID: BSC.0070.00.1
Question Text:
Response:
Fills:
Variable name: BSCCLMDWN_C
Interview module: BSC(Child.BSC)
Does ^SCNAME have a hard time calming down?
you say not at all, somewhat, or very much?
1.
2.
3.
DK:
RF:
Read if necessary: Would
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCFUSSY_C]
Question ID: BSC.0080.00.1
Question Text:
Response:
Fills:
Variable name: BSCFUSSY_C
Is ^SCNAME fussy or irritable?
somewhat, or very much?
1.
2.
3.
DK:
RF:
Interview module: BSC(Child.BSC)
Read if necessary: Would you say not at all,
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 66 of 223
Skip Instructions: <1-3,RF,DK> [goto BSCSTHE_C]
Question ID: BSC.0090.00.1
Question Text:
Response:
Fills:
Variable name: BSCSTHE_C
Is it hard to comfort ^SCNAME?
somewhat, or very much?
1.
2.
3.
DK:
RF:
Interview module: BSC(Child.BSC)
Read if necessary: Would you say not at all,
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCSCHD_C]
Question ID: BSC.0100.00.1
Question Text:
Response:
Fills:
Variable name: BSCSCHD_C
Interview module: BSC(Child.BSC)
Is it hard to keep ^SCNAME on a schedule or routine?
Would you say not at all, somewhat, or very much?
1.
2.
3.
DK:
RF:
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCPTSLP_C]
Page 67 of 223
Read if necessary:
Question ID: BSC.0110.00.1
Question Text:
Response:
Fills:
Variable name: BSCPTSLP_C
Is it hard to put ^SCNAME to sleep?
somewhat, or very much?
1.
2.
3.
DK:
RF:
Interview module: BSC(Child.BSC)
Read if necessary: Would you say not at all,
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCSTYSLP_C]
Question ID: BSC.0120.00.1
Question Text:
Response:
Fills:
Variable name: BSCSTYSLP_C
Interview module: BSC(Child.BSC)
Does ^SCNAME have trouble staying asleep?
say not at all, somewhat, or very much?
1.
2.
3.
DK:
RF:
Read if necessary: Would you
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto BSCPRLKSL_C]
Page 68 of 223
Question ID: BSC.0130.00.1
Question Text:
Response:
Fills:
Variable name: BSCPRLKSL_C
Interview module: BSC(Child.BSC)
Is it hard for ^youmembersoffamily to get enough sleep because of ^SCNAME?
Read if necessary: Would you say not at all, somewhat, or very much?
1.
2.
3.
DK:
RF:
Not at all
Somewhat
Very much
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^youmembersoffamily
If PCNT='2' fill "you"
elsefill "members of your family"
Skip Instructions: <1-3,RF,DK> [goto next section]
Question ID: SCH.0010.00.1
Variable name: SCHDYSMSS_C
Interview module: SCH(Child.SCH)
Universe: GEN.AGE_FINAL[PX_C] ge 5 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
During the past 12 months, about how many days of school did ^SCNAME miss
because ^HeShe_C had an illness, injury, or disability? Enter '996' if child did
not go to school in the past 12 months.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^HeShe_C
If SEX_FINAL_C=1 fill "He"
else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C=blank: fill "They"
Page 69 of 223
Skip Instructions: <0-99,996,RF,DK> [goto SCHSPEDEV_C]
<100-365> [goto ERR1_SCHDYSMSS_C]
<366-995> [goto ERR2_SCHDYSMSS_C]
Check Name: ERR1_SCHDYSMSS_C
Text:
{signal ERR1_SCHDYSMSS_C} ^SCHDYSMSS_C is an unusually large number,
did ^SCNAME miss ^SCHDYSMSS_C days of school because of illness, injury,
or disability? Please verify.
Hard / Soft Edit: Soft
Fills:
^SCHDYSMSS_C
Fill value from SCHDYSMSS_C
^SCNAME
Fill ALIAS of HHSTAT_C=1
Universe: SCHDYSMSS_C=100-365
Check Name: ERR2_SCHDYSMSS_C
Text:
{check ERR2_SCHDYSMSS_C} "366-995" days not allowed in this field.
Hard / Soft Edit: Hard
Universe: SCHDYSMSS_C=366-995
Page 70 of 223
Question ID: SCH.0020.00.1
Question Text:
Response:
Fills:
Variable name: SCHSPEDEV_C
Interview module: SCH(Child.SCH)
Has ^SCNAME ever had a special education or early intervention plan, such as
an Individualized Education Plan, an IEP, or an Individualized Family Service
Plan, an IFSP?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto SCHSPED_C]
<2,RF,DK> [goto next section]
Question ID: SCH.0030.00.1
Variable name: SCHSPED_C
Interview module: SCH(Child.SCH)
Universe: SCHSPEDEV_C=1
Question Text:
Response:
Fills:
Does ^SCNAME currently have a special education or early intervention plan?
Read if necessary: Consider special education or early intervention plans received
during the past school year.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto SCHSPEDEM_C]
<2,RF,DK> [goto next section]
Page 71 of 223
Question ID: SCH.0040.00.1
Variable name: SCHSPEDEM_C
Interview module: SCH(Child.SCH)
Universe: SCHSPED_C=1
Question Text:
Response:
Fills:
Does ^SCNAME receive these services to help with ^hisher_C emotions,
concentration, behavior, or mental health?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: INS.0010.00.1
Question Text:
Response:
Variable name: HICOV_C
Interview module: INS(Child.INS)
?[F1] The next questions are about health insurance. Include health insurance
obtained through employment or purchased directly as well as government
programs like Medicare, Medicaid, and the Children's Health Insurance
Program that provide medical care or help pay medical bills. Is ^SCNAME
covered by any kind of health insurance or some other kind of health care
plan?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 72 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,R,D> [goto HIKIND_C]
<2> [goto MCAIDPRB_C]
Question ID: INS.0020.00.1
Variable name: HIKIND_C
Interview module: INS(Child.INS)
Universe: HICOV_C IN (1,RF,DK)
Question Text:
Response:
?[F1] What kinds of health insurance or health care coverage does ^SCNAME
have? Is it...Private health insurance, Medicare, Medicare supplement,
Medicaid, Children's Health Insurance Program or CHIP, military related health
care including TRICARE, CHAMPUS, VA health care and CHAMP-VA, Indian
Health Service, state-sponsored health plan, or an other government program?
Enter all that apply, separate with commas.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
DK:
RF:
Fills:
Private health insurance
Medicare (including Medicare Advantage)
Medicare supplement (Medigap)
Medicaid
Children's Health Insurance Program (CHIP)
Military related health care: TRICARE (CHAMPUS) / VA health care /
CHAMP-VA
Indian Health Service
State-sponsored health plan
Other government program
No coverage of any type
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: if > 1 answer selected and (<10> in HIKIND_C) [goto ERR1_HIKIND_C]
else if HIKIND_C=RF,DK or (<10> in HIKIND_C) [goto MCAIDPRB_C]
else [goto SINCOVDE_C]
Page 73 of 223
Check Name: ERR1_HIKIND_C
Text:
{check ERR1_HIKIND_C} Cannot mark "no coverage of any kind" and another type.
Please correct.
Hard / Soft Edit: Hard
Universe: if more than 1 answer selected at HIKIND_C and (<10> in HIKIND_C)
Question ID: INS.0030.00.1
Variable name: MCAIDPRB_C
Interview module: INS(Child.INS)
Universe: HIKIND_C IN (10,RF,DK)
Question Text:
Response:
Fills:
?[F1] There is a program called Medicaid that pays for health care for persons
in need. ^STATEMA Is ^SCNAME covered by Medicaid?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^STATEMA
if STMEDICAID ne empty, fill: "In ^STATENAME it is
alsocalled ^STMEDICAID."
else fill: blank
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto SINCOVDE_C]
Page 74 of 223
Question ID: INS.0040.00.1
Question Text:
Response:
Fills:
Variable name: SINCOVDE_C
Interview module: INS(Child.INS)
?[F1] ^INADDITIONIS ^SCNAME covered by a SEPARATE plan that only pays
for dental services?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^INADDITIONIS
If (HIKIND_C=1-9 or MCAIDPRB_C=1), fill "In
addition to ^HITYPECNOSS, is"
else fill "Is"
Skip Instructions: <1,2,RF,DK> [goto SINCOVVS_C]
Question ID: INS.0050.00.1
Question Text:
Response:
Fills:
Variable name: SINCOVVS_C
Interview module: INS(Child.INS)
?[F1] Is ^SCNAME covered by a SEPARATE plan that only pays for vision
services?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto SINCOVRX_C]
Page 75 of 223
Question ID: INS.0060.00.1
Question Text:
Response:
Fills:
Variable name: SINCOVRX_C
Interview module: INS(Child.INS)
?[F1] Is ^SCNAME covered by a SEPARATE plan that only pays for
prescriptions?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto HICHANGE_C]
Question ID: INS.0070.00.1
Question Text:
Response:
Fills:
Variable name: HICHANGE_C
Interview module: INS(Child.INS)
?[F1] I have recorded ^SCNAME is ^COVEREDC. Is this correct?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^COVEREDC
if HIKIND_C=10,R,D and MCAIDPRB_C=2,R,D and
SINCOVDE_C=2,R,Dand SINCOVVS_C=2,R,Dand
SINCOVRX_C=2,R,Dfill: "not covered by health
insurance"
else fill: "covered by ^HITYPEC"
Skip Instructions: <1,RF,DK>
if 2 in HIKIND_C [goto MCPART_C]
else if 4 in HIKIND_C or MCAIDPRB_C=1[goto MACHMN_C]
else if 1 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 3 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else if 7 in HIKIND_C [goto HINOTYR_C]
else if 10 in HIKIND_C and MCAIDPRB_C IN (2,RF,DK) [goto HILAST_C]
else [goto FINISH_C]
<2> [goto ERR1_HICHANGE_C]
Page 76 of 223
Check Name: ERR1_HICHANGE_C
Text:
{check ERR1_HICHANGE_C} Press Enter to go back to HIKIND_C and update
coverage.
Hard / Soft Edit: Hard
Universe: HICHANGE_C=2
Question ID: INS.0080.00.1
Variable name: MCPART_C
Interview module: INS(Child.INS)
Universe: 2 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] What type of Medicare coverage does ^SCNAME have? Is it Part A hospital insurance, Part B - medical insurance, or both?
1.
2.
3.
DK:
RF:
Part A- hospital only
Part B- medical only
Both Part A and Part B
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <2,3,RF,DK> [goto MCCHOICE_C] <1> [goto MCPARTD_C]
Question ID: INS.0090.00.1
Variable name: MCCHOICE_C
Interview module: INS(Child.INS)
Universe: 02 IN HIKIND_C AND MCPART_C IN (2,3,RF,DK)
Question Text:
?[F1] Is ^SCNAME enrolled in a Medicare Advantage plan?
Response:
Page 77 of 223
1.
2.
DK:
RF:
Fills:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto MCHMO_C]
Question ID: INS.0100.00.1
Variable name: MCHMO_C
Interview module: INS(Child.INS)
Universe: 02 IN HIKIND_C AND MCPART_C IN (2,3,RF,DK)
Question Text:
Response:
Fills:
?[F1] Is ^SCNAME under a Medicare managed care arrangement, such as an
HMO, that is, a Health Maintenance Organization?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto MCANAME_C]
<2,RF,DK> if MCCHOICE_C=1 [goto MCANAME_C]
else if MCCHOICE_C=2,RF,DK, [goto MCPARTD_C]
Question ID: INS.0110.00.1
Variable name: MCANAME_C
Interview module: INS(Child.INS)
Universe: MCCHOICE_C=1 or MCHMO_C=1
Question Text:
Response:
?[F1] What is the name of ^SCNAME's Medicare Advantage or Medicare HMO
plan?
DK:
RF:
Don't Know
Refused
Page 78 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto MCPARTD_C]
Question ID: INS.0120.00.1
Variable name: MCPARTD_C
Interview module: INS(Child.INS)
Universe: 2 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] Is ^SCNAME enrolled in Medicare Part D, also known as the Medicare
Prescription Drug Plan?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK>
if 4 in HIKIND_C or MCAIDPRB_C=1[goto MACHMN_C]
else if 1 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 3 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Page 79 of 223
Question ID: INS.0130.00.1
Variable name: MACHMN_C
Interview module: INS(Child.INS)
Universe: 4 IN HIKIND_C or MCAIDPRB_C=1
Question Text:
Response:
Fills:
?[F1] The next questions are about Medicaid coverage. What is the name of
^SCNAME's Medicaid health plan?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto MAXCHNG_C]
Question ID: INS.0140.00.1
Variable name: MAXCHNG_C
Interview module: INS(Child.INS)
Universe: 4 IN HIKIND_C or MCAIDPRB_C=1
Question Text:
Response:
Fills:
?[F1] Was ^SCNAME's Medicaid obtained through Healthcare.gov or the
^MARKETPLACE?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^MARKETPLACE
If no state specified below, fill "Health Insurance
Marketplace"
If state specified below fill:
If CA then fill "Health Insurance Marketplace, such
as Covered California"
If CO then fill "Health Insurance Marketplace, such
as Connect for Health Colorado"
If CT then fill "Health Insurance Marketplace, such
as Access Health CT"
If DC then fill "Health Insurance Marketplace, such
as DC Health Link"
If ID then fill "Health Insurance Marketplace, such as
Your Health Idaho"
If KY then fill "Health Insurance Marketplace, such
as Kentucky Health Benefit Exchange"
If MA then fill "Health Insurance Marketplace, such
Page 80 of 223
as Massachusetts Health Connector"
If MD then fill "Health Insurance Marketplace, such
as Maryland Health Connection"
If MN then fill "Health Insurance Marketplace, such
as MNsure"
If NM then fill "Health Insurance Marketplace, such
as BeWellNM"
If NV then fill "Health Insurance Marketplace, such
as Nevada Health Link"
If NY then fill "Health Insurance Marketplace, such
as New York State of Health"
If RI then fill "Health Insurance Marketplace, such as
HealthSource RI"
If VT then fill "Health Insurance Marketplace, such as
Vermont Health Connect"
If WA then fill "Health Insurance Marketplace, such
as Washington Health Plan Finder"
Skip Instructions: <1,2,RF,DK> [goto MAPREM_C]
Question ID: INS.0150.00.1
Variable name: MAPREM_C
Interview module: INS(Child.INS)
Universe: 4 IN HIKIND_C or MCAIDPRB_C=1
Question Text:
Response:
Fills:
?[F1] A health insurance premium is the amount ^SCNAME or a family member
pays each month for health care coverage. Does ^SCNAME or a family member
pay a premium for this Medicaid plan?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 81 of 223
Skip Instructions: <1,2,RF,DK> [goto MADEDUC_C]
Question ID: INS.0160.00.1
Variable name: MADEDUC_C
Interview module: INS(Child.INS)
Universe: 4 IN HIKIND_C or MCAIDPRB_C=1
Question Text:
Response:
Fills:
?[F1] A deductible is the amount you have to pay for health care before your
health insurance or health coverage plan will start paying your medical bills.
Does ^SCNAME's Medicaid plan have an annual deductible? Read if
necessary: A deductible is different from a copay (copayment).
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto MAHDHP_C]
<2,RF,DK>
if 1 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 3 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Page 82 of 223
Question ID: INS.0170.00.1
Variable name: MAHDHP_C
Interview module: INS(Child.INS)
Universe: MADEDUC_C=1
Question Text:
Response:
Fills:
?[F1] Is the annual deductible for medical care for this plan less than
^HDHPDED or ^HDHPDED or more? If there is a separate deductible for
prescription drugs, hospitalization, or out-of-network care, do not include those
deductible amounts here.
1.
2.
DK:
RF:
Less than ^HDHPDED
^HDHPDED or more
Don't Know
Refused
^HDHPDED
Fill: $1,400
Skip Instructions: <1,2,RF,DK>
if 1 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 3 in HIKIND_C [goto SET_INSPRI_FLAG]
else if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Question ID: INS.0260.00.1
Variable name: PLANNAME1_C
Interview module: INS(Child.INS)
Universe: INSPRI1_FLG1_C=1 and INSPRI1_FLG2_C=1 and INSPRI1_FLG3_C=1 and
GEN.INSPRI_FLG=1
and
GEN.SAMEFAM_FLG=1
and
Adult.INS.PLANNAME1_A=empty
Question Text:
Earlier I recorded that ^YOUSANAME ^WEREWAS covered by ^HIPNAM1_A. Is
^SCNAME covered by this same plan as ^YOUSANAME?
Response:
Page 83 of 223
1.
2.
DK:
RF:
Fills:
Yes
No
Don't Know
Refused
^YOUSANAME
If GEN.SARESPSC_FLG=1, fill "you"
else fill "^SANAME"
^HIPNAM1_A
Fill value from Adult.INS.HIPNAM1_A
^SCNAME
Fill ALIAS of HHSTAT_C=1
^WEREWAS
If SARESPSC_FLG=1, fill "were",
else "was"
Skip Instructions: <1> if Adult.INS.bPlan[1].POLHLD_A ne 1 [goto POLHLDA1_C],
if INSPRI2_FLG2_C=1 and INSPRI2_FLG3_C=1 and INSPRI2_FLG4_C=1
and INSPRI2_FLG5_C=1 [goto PLANNAME2_C] else [goto MORPLAN_C]
<2,RF,DK> if INSPRI2_FLG2_C=1 and INSPRI2_FLG3_C=1 and
INSPRI2_FLG4_C=1 and INSPRI2_FLG5_C=1 [goto PLANNAME2_C] else
[goto HIPNAM1_C]
Question ID: INS.0270.00.1
Variable name: POLHLDA1_C
Interview module: INS(Child.INS)
Universe: PLANNAME1_C=1 and Adult.INS.bPlan[1].POLHLD_A=2,RF,DK
Question Text:
Response:
?[F1] Health insurance plans are usually obtained in one person's name even if
other family members are covered by that plan. That person is called the
policyholder. Is ^SCNAME the policyholder for ^HIPNAM1_A?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 84 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^HIPNAM1_A
Fill value from Adult.INS.HIPNAM1_A
Skip Instructions: <1,2,RF,DK> if INSPRI2_FLG2_C=1 and INSPRI2_FLG3_C=1
INSPRI2_FLG4_C=1 and INSPRI2_FLG5_C=1 [goto PLANNAME2_C]
else [goto MORPLAN_C]
Question ID: INS.0280.00.1
Variable name: PLANNAME2_C
and
Interview module: INS(Child.INS)
Universe: INSPRI2_FLG2_C=1 and INSPRI2_FLG3_C=1 and INSPRI2_FLG4_C=1 and
INSPRI2_FLG5_C=1 and GEN.INSPRI_FLG=1 and GEN.SAMEFAM_FLG=1
and Adult.INS.PLANNAME2_A=empty
Question Text:
Response:
Fills:
Earlier I recorded that ^YOUSANAME ^WEREWAS covered by a second plan
^HIPNAM2_A. Is ^SCNAME covered by this same plan as ^YOUSANAME?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^YOUSANAME
If GEN.SARESPSC_FLG=1, fill "you"
else fill "^SANAME"
^HIPNAM2_A
Fill value from Adult.INS.HIPNAM2_A
^SCNAME
Fill ALIAS of HHSTAT_C=1
^WEREWAS
If SARESPSC_FLG=1, fill "were",
else "was"
Skip Instructions: <1> if Adult.INS.bPlan[2].POLHLD_A ne 1 [goto POLHLDA2_C],
else if PLANNAME1_C IN(2,RF,DK) [goto MORPLAN_C]
else if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
<2,RF,DK> if PLANNAME1_C IN (2,RF,DK,empty) [goto HIPNAM1_C]
else [goto MORPLAN_C]
Page 85 of 223
Question ID: INS.0290.00.1
Variable name: POLHLDA2_C
Interview module: INS(Child.INS)
Universe: PLANNAME2_C=1 and Adult.INS.bPlan[2].POLHLD_A=2,RF,DK
Question Text:
Response:
Fills:
?[F1] Read if necessary: Health insurance plans are usually obtained in one
person's name even if other family members are covered by that plan. That person is
called the policyholder. Is ^SCNAME the policyholder for ^HIPNAM2_A?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^HIPNAM2_A
Fill value from Adult.INS.HIPNAM2_A
Skip Instructions: <1,2,RF,DK> if PLANNAME1_C IN(2,RF,DK,empty) [goto MORPLAN_C]
else if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Question ID: INS.0300.00.1
Variable name: HIPNAM1_C
Interview module: INS(Child.INS)
Universe: (3 in HIKIND_C) or (1 in HIKIND_C and ((PLANNAME1_C
IN(2,RF,DK,empty)) and (PLANNAME2_C IN (2,RF,DK,empty)))
Question Text:
Response:
?[F1] It is important that we record the complete and accurate name of each
private health insurance plan. What is the COMPLETE name of ^SCNAME's
plan? Do NOT include plans that only provide extra cash while in the hospital
or plans that pay for only one type of service such as long term care, accidents,
or dental care. Read if necessary: Do you have a health plan card or something
with the plan name on it?
DK:
RF:
Don't Know
Refused
Page 86 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto MORPLAN_C]
Question ID: INS.0310.00.1
Variable name: MORPLAN_C
Interview module: INS(Child.INS)
Universe: HIPNAM1_C
ne
empty
or
((PLANNAME1_C=1
and
PLANNAME2_C=2,RF,DK,empty) or (PLANNAME1_C=2,RF,DK,empty and
PLANNAME2_C=1))
Question Text:
Response:
Fills:
?[F1] Is ^SCNAME covered by any other private health insurance plans?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto HIPNAM2_C]
<2,RF,DK>
if (PLANNAME1_C = 1 or PLANNAME2_C = 1) then
if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
else [goto bPlan[1].POLHLD_C]
Page 87 of 223
Question ID: INS.0320.00.1
Variable name: HIPNAM2_C
Interview module: INS(Child.INS)
Universe: MORPLAN_C=1
Question Text:
Response:
?[F1] What is the name of that private health insurance plan?
Read if
necessary: Do you have a health plan card or something with the plan name on it?
DK:
RF:
Don't Know
Refused
Skip Instructions: [goto bPlan[1].POLHLD_C]
Question ID: INS.0340.00.1
Question Text:
Response:
Fills:
Variable name: POLHLD_C
Interview module: INS(Child.INS.bPlan)
?[F1] I am going to ask you some questions about ^FIRSTPLANC. Health
insurance plans are usually obtained in one person's name even if other family
members are covered by that plan. That person is called the policyholder. Is
^SCNAME the policyholder for ^THISPLANC?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^FIRSTPLANC
If PlanNum = 1 then
if
HIPNAM1_C
IN
(RF,DK)
AND
HIPNAM2_C=empty fill: "this plan"
elseif HIPNAM1_C IN (RF,DK) fill: "this first plan"
else fill: "this ^HIPNAM1_C plan"
if PlanNum = 2 then
if HIPNAM2_C IN (RF,DK) fill: "this second plan"
else fill: "this ^HIPNAM2_C plan"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^THISPLANC
if PlanNum=1 then
if HIPNAM1_C IN('RF','DK') fill: "this plan"
Else fill: "^HIPNAM1_C"
if PlanNum=2 then
if HIPNAM2_C IN('RF','DK') fill: "this plan"
Else fill: "^HIPNAM2_C"
Page 88 of 223
Skip Instructions: <1,RF,DK> [goto PRPLCOV_C]
<2> [goto PLNWRK_C]
Question ID: INS.0350.00.1
Variable name: PRPLCOV_C
Interview module: INS(Child.INS.bPlan)
Universe: POLHLD_C=1,RF,DK
Question Text:
Response:
Fills:
Does this plan cover someone other than ^SCNAME?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto PLNWRK_C]
Question ID: INS.0360.00.1
Question Text:
Response:
Variable name: PLNWRK_C
Interview module: INS(Child.INS.bPlan)
?[F1] Which one of these categories best describes how this plan was
obtained? Was it obtained through an employer or union, purchased directly,
obtained through Healthcare.gov or the Affordable Care Act, also known as
Obamacare, obtained through a state or local government or community
program or obtained in some other way?
1.
2.
3.
4.
5.
DK:
RF:
Through an employer, union, or professional association
Purchased directly
Through Healthcare.gov or the Affordable Care Act, also known as
Obamacare
Through a state or local government or community program
Other
Don't Know
Refused
Page 89 of 223
Skip Instructions: <1,3> [goto PLNPAY_C]
<2,4,RF,DK> [goto PLNEXCHG_C]
<5> [goto PLNWKSP_C]
Question ID: INS.0370.00.1
Variable name: PLNWKSP_C
Interview module: INS(Child.INS.bPlan)
Universe: PLNWRK_C=5
Question Text:
Response:
Read if necessary: How was this plan obtained?
DK:
RF:
Don't Know
Refused
Skip Instructions: [goto PLNEXCHG_C]
Question ID: INS.0380.00.1
Variable name: PLNEXCHG_C
Interview module: INS(Child.INS.bPlan)
Universe: PLNWRK_C IN (2,4,5,RF,DK)
Question Text:
Response:
Fills:
?[F1] Was the plan obtained through Healthcare.gov or the ^MARKETPLACE?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^MARKETPLACE
If no state specified below, fill "Health Insurance
Marketplace"
If state specified below fill:
If CA then fill "Health Insurance Marketplace, such
as Covered California"
If CO then fill "Health Insurance Marketplace, such
as Connect for Health Colorado"
If CT then fill "Health Insurance Marketplace, such
as Access Health CT"
If DC then fill "Health Insurance Marketplace, such
as DC Health Link"
If ID then fill "Health Insurance Marketplace, such as
Your Health Idaho"
If KY then fill "Health Insurance Marketplace, such
as Kentucky Health Benefit Exchange"
If MA then fill "Health Insurance Marketplace, such
as Massachusetts Health Connector"
If MD then fill "Health Insurance Marketplace, such
Page 90 of 223
as Maryland Health Connection"
If MN then fill "Health Insurance Marketplace, such
as MNsure"
If NM then fill "Health Insurance Marketplace, such
as BeWellNM"
If NV then fill "Health Insurance Marketplace, such
as Nevada Health Link"
If NY then fill "Health Insurance Marketplace, such
as New York State of Health"
If RI then fill "Health Insurance Marketplace, such as
HealthSource RI"
If VT then fill "Health Insurance Marketplace, such as
Vermont Health Connect"
If WA then fill "Health Insurance Marketplace, such
as Washington Health Plan Finder"
Skip Instructions: <1,2,RF,DK> [goto PLNPAY_C]
Question ID: INS.0390.00.1
Question Text:
Response:
Variable name: PLNPAY_C
Who pays for this health insurance plan?
commas.
1.
2.
3.
4.
5.
6.
DK:
RF:
Interview module: INS(Child.INS.bPlan)
Enter all that apply, separate with
^SCNAME or family (living in the household)
Employer or union
Someone outside the household
Medicare
Medicaid
Other government program
Don't Know
Refused
Skip Instructions: <1-6,RF,DK> if 1 IN PLNPAY_C [goto HICOSTN_C]
else [goto PRDEDUC_C]
Page 91 of 223
Question ID: INS.0400.01.1
Variable name: HICOSTN_C
Interview module: INS(Child.INS.bPlan)
Universe: 1 IN PLNPAY_C
Question Text:
Response:
Fills:
?[F1] How much does ^SCNAME's family currently spend for health insurance
premiums for ^FIRSTPLANC? Please include payroll deductions for premiums.
DK:
RF:
Don't Know
Refused
^FIRSTPLANC
If PlanNum = 1 then
if
HIPNAM1_C
IN
(RF,DK)
AND
HIPNAM2_C=empty fill: "this plan"
elseif HIPNAM1_C IN (RF,DK) fill: "this first plan"
else fill: "this ^HIPNAM1_C plan"
if PlanNum = 2 then
if HIPNAM2_C IN (RF,DK) fill: "this second plan"
else fill: "this ^HIPNAM2_C plan"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <20000-99995> [goto ERR1_HICOSTN_C]
<1-19999> [goto HICOSTT_C]
[goto PRDEDUC_C]
Check Name: ERR1_HICOSTN_C
Text:
{signal ERR1_HICOSTN_C} [^HICOSTN_C] is unusually high. Please verify. Make
corrections if necessary.
Hard / Soft Edit: Soft
Fills:
^HICOSTN_C
Fill value from Child.INS.HICOSTN_C
Universe: if HICOSTN_C GE 20000
Page 92 of 223
Question ID: INS.0400.02.1
Variable name: HICOSTT_C
Interview module: INS(Child.INS.bPlan)
Universe: HICOSTN_C IN (1-99995)
Question Text:
?[F1]
Response:
1.
2.
3.
4.
5.
6.
7.
8.
DK:
RF:
Enter time period for premium payments.
Once a week
Once every 2 weeks
Once a month
Twice a month
Every two months
Quarterly (every 3 months)
Once a year
Twice a year
Don't Know
Refused
Skip Instructions: <1-8,RF,DK> [goto PRDEDUC_C]
Question ID: INS.0410.00.1
Question Text:
Response:
Variable name: PRDEDUC_C
Interview module: INS(Child.INS.bPlan)
?[F1] A deductible is the amount you have to pay for health care before your
health insurance or health coverage plan will start paying your medical bills.
Does this health plan have an annual deductible? Read if necessary: A
deductible is different from a copay (copayment).
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Skip Instructions: <1> [goto PRHDHP_C]
<2,RF,DK> [goto INTROCOV_C]
Page 93 of 223
Question ID: INS.0420.00.1
Variable name: PRHDHP_C
Interview module: INS(Child.INS.bPlan)
Universe: PRDEDUC_C=1
Question Text:
Response:
Fills:
?[F1] Is the ^FAM_C annual deductible for medical care for this plan less than
^HDHPAMT_C, or ^HDHPAMT_C or more? If there is a separate deductible for
prescription drugs, hospitalization, or out-of-network care, do not include those
deductible amounts here.
1.
2.
DK:
RF:
Less than ^HDHPAMT_C
^HDHPAMT_C or more
Don't Know
Refused
^HDHPAMT_C
if
POLHLD_C=2
"^HDHPDED_family"
Else fill"^HDHPDED"
or
PRPLCOV_C=1,
^FAM_C
if POLHLD_C=2 or PRPLCOV_C=1, fill 'family'.
Else no fill.
fill
Skip Instructions: <1> [goto INTROCOV_C]
<2,RF,DK> [goto HSAHRA_C]
Question ID: INS.0430.00.1
Variable name: HSAHRA_C
Interview module: INS(Child.INS.bPlan)
Universe: PRHDHP_C=2,RF,DK
Question Text:
There are special accounts or funds that can be used to pay for medical
expenses, sometimes referred to as Health Savings Accounts or HSAs, Health
Reimbursement Accounts or HRAs, Personal Care accounts, Personal Medical
funds, or Choice funds. These are DIFFERENT from Flexible Spending
Accounts or FSAs. Is there one of these accounts or funds with this plan?
Response:
Page 94 of 223
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Skip Instructions: <1,2,RF,DK> [goto INTROCOV_C]
Question ID: INS.0435.00.1
Question Text:
Response:
Fills:
Variable name: INTROCOV_C
Interview module: INS(Child.INS.bPlan)
The next three questions are about services ^FIRSTPLANC may cover. Enter
'1' to continue.
1.
Enter 1 to Continue
^FIRSTPLANC
If PlanNum = 1 then
if
HIPNAM1_C
IN
(RF,DK)
AND
HIPNAM2_C=empty fill: "this plan"
elseif HIPNAM1_C IN (RF,DK) fill: "this first plan"
else fill: "this ^HIPNAM1_C plan"
if PlanNum = 2 then
if HIPNAM2_C IN (RF,DK) fill: "this second plan"
else fill: "this ^HIPNAM2_C plan"
Skip Instructions: <1> [goto PRRXCOV_C]
Question ID: INS.0440.00.1
Question Text:
Response:
Variable name: PRRXCOV_C
Interview module: INS(Child.INS.bPlan)
Does ^FIRSTPLANC pay for any of the costs for medications prescribed by a
doctor? Read if necessary: Even if ^SCNAME has not used this benefit, please
answer if this plan would cover at least some of the costs if ^SCNAME were
prescribed medications.
1.
Yes
Page 95 of 223
2.
DK:
RF:
Fills:
No
Don't Know
Refused
^FIRSTPLANC
If PlanNum = 1 then
if
HIPNAM1_C
IN
(RF,DK)
AND
HIPNAM2_C=empty fill: "this plan"
elseif HIPNAM1_C IN (RF,DK) fill: "this first plan"
else fill: "this ^HIPNAM1_C plan"
if PlanNum = 2 then
if HIPNAM2_C IN (RF,DK) fill: "this second plan"
else fill: "this ^HIPNAM2_C plan"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto PRDNCOV_C]
Question ID: INS.0450.00.1
Question Text:
Response:
Fills:
Variable name: PRDNCOV_C
Interview module: INS(Child.INS.bPlan)
Does ^FIRSTPLANC pay for any of the costs for dental care? Read if
necessary: Even if ^SCNAME has not used this benefit, please answer if this plan
would cover at least some of the costs if ^SCNAME did have dental care.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^FIRSTPLANC
If PlanNum = 1 then
if
HIPNAM1_C
IN
(RF,DK)
AND
HIPNAM2_C=empty fill: "this plan"
elseif HIPNAM1_C IN (RF,DK) fill: "this first plan"
else fill: "this ^HIPNAM1_C plan"
if PlanNum = 2 then
if HIPNAM2_C IN (RF,DK) fill: "this second plan"
else fill: "this ^HIPNAM2_C plan"
Page 96 of 223
Skip Instructions: <1,2,RF,DK> [goto PRVSCOV_C]
Question ID: INS.0460.00.1
Question Text:
Response:
Fills:
Variable name: PRVSCOV_C
Interview module: INS(Child.INS.bPlan)
Does ^FIRSTPLANC pay for any of the costs for routine vision care, such as
glasses and contact lenses? Read if necessary: Even if ^SCNAME has not used
this benefit, please answer if this plan would cover at least some of the costs if
^SCNAME did have vision care.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^FIRSTPLANC
If PlanNum = 1 then
if
HIPNAM1_C
IN
(RF,DK)
AND
HIPNAM2_C=empty fill: "this plan"
elseif HIPNAM1_C IN (RF,DK) fill: "this first plan"
else fill: "this ^HIPNAM1_C plan"
if PlanNum = 2 then
if HIPNAM2_C IN (RF,DK) fill: "this second plan"
else fill: "this ^HIPNAM2_C plan"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> If there is another plan [goto bPlan for next plan]
else if 5 in HIKIND_C [goto CHNAME_C]
else if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Page 97 of 223
Question ID: INS.0470.00.1
Variable name: CHNAME_C
Interview module: INS(Child.INS)
Universe: 05 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] Earlier I recorded that ^SCNAME is covered by the Children's Health
Insurance Program or CHIP. What is the name of the plan?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto CHXCHNG_C]
Question ID: INS.0480.00.1
Variable name: CHXCHNG_C
Interview module: INS(Child.INS)
Universe: 05 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] Was ^SCNAME's CHIP plan obtained through Healthcare.gov or the
^MARKETPLACE?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^MARKETPLACE
If no state specified below, fill "Health Insurance
Marketplace"
If state specified below fill:
If CA then fill "Health Insurance Marketplace, such
as Covered California"
If CO then fill "Health Insurance Marketplace, such
as Connect for Health Colorado"
If CT then fill "Health Insurance Marketplace, such
as Access Health CT"
If DC then fill "Health Insurance Marketplace, such
as DC Health Link"
If ID then fill "Health Insurance Marketplace, such as
Your Health Idaho"
If KY then fill "Health Insurance Marketplace, such
as Kentucky Health Benefit Exchange"
If MA then fill "Health Insurance Marketplace, such
Page 98 of 223
as Massachusetts Health Connector"
If MD then fill "Health Insurance Marketplace, such
as Maryland Health Connection"
If MN then fill "Health Insurance Marketplace, such
as MNsure"
If NM then fill "Health Insurance Marketplace, such
as BeWellNM"
If NV then fill "Health Insurance Marketplace, such
as Nevada Health Link"
If NY then fill "Health Insurance Marketplace, such
as New York State of Health"
If RI then fill "Health Insurance Marketplace, such as
HealthSource RI"
If VT then fill "Health Insurance Marketplace, such as
Vermont Health Connect"
If WA then fill "Health Insurance Marketplace, such
as Washington Health Plan Finder"
Skip Instructions: <1,2,RF,DK> [goto CHPREM_C]
Question ID: INS.0490.00.1
Variable name: CHPREM_C
Interview module: INS(Child.INS)
Universe: 05 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] A health insurance premium is the amount ^SCNAME or a family member
pays each month for health care coverage. Does ^SCNAME or a family member
pay a premium for this CHIP plan?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 99 of 223
Skip Instructions: <1,2,RF,DK> [goto CHDEDUC_C]
Question ID: INS.0500.00.1
Variable name: CHDEDUC_C
Interview module: INS(Child.INS)
Universe: 5 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] A deductible is the amount you have to pay for health care before your
health insurance or health coverage plan will start paying your medical bills.
Does ^SCNAME's CHIP plan have an annual deductible? Read if necessary: A
deductible is different from a copay (copayment).
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto CHHDHP_C]
<2,RF,DK> if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Question ID: INS.0510.00.1
Variable name: CHHDHP_C
Interview module: INS(Child.INS)
Universe: 5 IN HIKIND_C and CHDEDUC_C=1
Question Text:
?[F1] Is the annual deductible for medical care for this plan less than
^HDHPDED or ^HDHPDED or more? If there is a separate deductible for
prescription drugs, hospitalization, or out-of-network care, do not include those
deductible amounts here.
Response:
Page 100 of 223
1.
2.
DK:
RF:
Fills:
Less than ^HDHPDED
^HDHPDED or more
Don't Know
Refused
^HDHPDED
Fill: $1,400
Skip Instructions: <1,2,RF,DK> if 8 in HIKIND_C [goto OPNAME_C]
else if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Question ID: INS.0520.00.1
Variable name: OPNAME_C
Interview module: INS(Child.INS)
Universe: 8 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] Earlier I recorded that ^SCNAME is covered by a state-sponsored plan.
What is the name of the plan?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto OPXCHNG_C]
Question ID: INS.0530.00.1
Variable name: OPXCHNG_C
Interview module: INS(Child.INS)
Universe: 8 IN HIKIND_C
Question Text:
?[F1] Was ^SCNAME's state-sponsored plan obtained through Healthcare.gov
or the ^MARKETPLACE?
Response:
Page 101 of 223
1.
2.
DK:
RF:
Fills:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^MARKETPLACE
If no state specified below, fill "Health Insurance
Marketplace"
If state specified below fill:
If CA then fill "Health Insurance Marketplace, such
as Covered California"
If CO then fill "Health Insurance Marketplace, such
as Connect for Health Colorado"
If CT then fill "Health Insurance Marketplace, such
as Access Health CT"
If DC then fill "Health Insurance Marketplace, such
as DC Health Link"
If ID then fill "Health Insurance Marketplace, such as
Your Health Idaho"
If KY then fill "Health Insurance Marketplace, such
as Kentucky Health Benefit Exchange"
If MA then fill "Health Insurance Marketplace, such
as Massachusetts Health Connector"
If MD then fill "Health Insurance Marketplace, such
as Maryland Health Connection"
If MN then fill "Health Insurance Marketplace, such
as MNsure"
If NM then fill "Health Insurance Marketplace, such
as BeWellNM"
If NV then fill "Health Insurance Marketplace, such
as Nevada Health Link"
If NY then fill "Health Insurance Marketplace, such
as New York State of Health"
If RI then fill "Health Insurance Marketplace, such as
HealthSource RI"
If VT then fill "Health Insurance Marketplace, such as
Vermont Health Connect"
If WA then fill "Health Insurance Marketplace, such
as Washington Health Plan Finder"
Page 102 of 223
Skip Instructions: <1,2,RF,DK> [goto OPPREM_C]
Question ID: INS.0540.00.1
Variable name: OPPREM_C
Interview module: INS(Child.INS)
Universe: 8 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] A health insurance premium is the amount ^SCNAME or a family member
pays each month for health care coverage. Does ^SCNAME or a family member
pay a premium for this state-sponsored plan?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto OPDEDUC_C]
Question ID: INS.0550.00.1
Variable name: OPDEDUC_C
Interview module: INS(Child.INS)
Universe: 8 IN HIKIND_C
Question Text:
Response:
?[F1] A deductible is the amount you have to pay for health care before your
health insurance or health coverage plan will start paying your medical bills.
Does ^SCNAME's state-sponsored plan have an annual deductible? Read if
necessary: A deductible is different from a copay (copayment).
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 103 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1>[goto OPHDHP_C]
<2,RF,DK> if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Question ID: INS.0560.00.1
Variable name: OPHDHP_C
Interview module: INS(Child.INS)
Universe: 8 IN HIKIND_C and OPDEDUC_C=1
Question Text:
Response:
Fills:
?[F1] Is the annual deductible for medical care for this plan less than
^HDHPDED or ^HDHPDED or more? If there is a separate deductible for
prescription drugs, hospitalization, or out-of-network care, do not include those
deductible amounts here.
1.
2.
DK:
RF:
Less than ^HDHPDED
^HDHPDED or more
Don't Know
Refused
^HDHPDED
Fill: $1,400
Skip Instructions: <1,2,RF,DK> if 9 in HIKIND_C [goto OGNAME_C]
else if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Page 104 of 223
Question ID: INS.0570.00.1
Variable name: OGNAME_C
Interview module: INS(Child.INS)
Universe: 9 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] Earlier I recorded that ^SCNAME is covered by an other government
program. What is the name of the plan?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto OGXCHNG_C]
Question ID: INS.0580.00.1
Variable name: OGXCHNG_C
Interview module: INS(Child.INS)
Universe: 9 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] Was ^SCNAME's other government plan obtained through Healthcare.gov
or the ^MARKETPLACE?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^MARKETPLACE
If no state specified below, fill "Health Insurance
Marketplace"
If state specified below fill:
If CA then fill "Health Insurance Marketplace, such
as Covered California"
If CO then fill "Health Insurance Marketplace, such
as Connect for Health Colorado"
If CT then fill "Health Insurance Marketplace, such
as Access Health CT"
If DC then fill "Health Insurance Marketplace, such
as DC Health Link"
If ID then fill "Health Insurance Marketplace, such as
Your Health Idaho"
If KY then fill "Health Insurance Marketplace, such
as Kentucky Health Benefit Exchange"
If MA then fill "Health Insurance Marketplace, such
as Massachusetts Health Connector"
If MD then fill "Health Insurance Marketplace, such
Page 105 of 223
as Maryland Health Connection"
If MN then fill "Health Insurance Marketplace, such
as MNsure"
If NM then fill "Health Insurance Marketplace, such
as BeWellNM"
If NV then fill "Health Insurance Marketplace, such
as Nevada Health Link"
If NY then fill "Health Insurance Marketplace, such
as New York State of Health"
If RI then fill "Health Insurance Marketplace, such as
HealthSource RI"
If VT then fill "Health Insurance Marketplace, such as
Vermont Health Connect"
If WA then fill "Health Insurance Marketplace, such
as Washington Health Plan Finder"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto OGPREM_C]
Question ID: INS.0590.00.1
Variable name: OGPREM_C
Interview module: INS(Child.INS)
Universe: 9 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] A health insurance premium is the amount ^SCNAME or a family member
pays each month for health care coverage. Does ^SCNAME or a family member
pay a premium for this other government plan?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 106 of 223
Skip Instructions: <1,2,RF,DK> [goto OGDEDUC_C]
Question ID: INS.0600.00.1
Variable name: OGDEDUC_C
Interview module: INS(Child.INS)
Universe: 9 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] A deductible is the amount you have to pay for health care before your
health insurance or health coverage plan will start paying your medical bills.
Does ^SCNAME's other government plan have an annual deductible? Read if
necessary: A deductible is different from a copay (copayment).
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto OGHDHP_C]
<2,RF,DK> if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Question ID: INS.0610.00.1
Variable name: OGHDHP_C
Interview module: INS(Child.INS)
Universe: 9 IN HIKIND_C and OGDEDUC_C=1
Question Text:
Response:
?[F1] Is the annual deductible for medical care for this plan less than
^HDHPDED or ^HDHPDED or more? If there is a separate deductible for
prescription drugs, hospitalization, or out-of-network care, do not include those
deductible amounts here.
1.
2.
DK:
RF:
Less than ^HDHPDED
^HDHPDED or more
Don't Know
Refused
Page 107 of 223
Fills:
^HDHPDED
Fill: $1,400
Skip Instructions: <1,2,RF,DK> if 6 in HIKIND_C [goto MILSPC_C]
else [goto HINOTYR_C]
Question ID: INS.0620.00.1
Variable name: MILSPC_C
Interview module: INS(Child.INS)
Universe: 6 IN HIKIND_C
Question Text:
Response:
Fills:
?[F1] Earlier I recorded that ^SCNAME is covered by military related health
care. What types of military related health care ^areisSEX_C ^heshe_C covered
by?
Enter all that apply, separate with commas.
2.
3.
DK:
RF:
TRICARE (CHAMPUS)
CHAMP-VA (do not include CHAMPUS)
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^areisSEX_C
if GEN.SEX_FINAL[PX_C] in (1,2) fill: "is"
elseif GEN.SEX_FINAL[PX_C] in (DK,RF) fill: "are"
Skip Instructions: <2-3,RF,DK> [goto HINOTYR_C]
Page 108 of 223
Question ID: INS.0630.00.1
Variable name: HILAST_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and MCAIDPRB_C IN (2,RF,DK)
Question Text:
Response:
Fills:
How long has it been since ^SCNAME last had health care coverage that paid
for doctor's visits or hospital stays?
0.
1.
2.
3.
4.
5.
6.
DK:
RF:
Never
Within the past year (anytime less than 12 months ago)
Within the last 2 years (1 year but less than 2 years ago)
Within the last 3 years (2 years but less than 3 years ago)
Within the last 5 years (3 years but less than 5 years ago)
Within the last 10 years (5 years but less than 10 years ago)
10 years ago or more
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto HILASTMY_C]
<2,3> [goto HISTOPJOB_C]
<4,5,6,0,RF,DK> [goto RSNHICOST_C]
Check Name: ERR1_HILAST_C
Text:
{check ERR1_HILAST_C} Years since last health coverage exceedchild's age.
Please correct.
Hard / Soft Edit: Hard
Universe: (AGE_FINAL = 0 and HILAST_C in (2,3,4,5,6)) or
(AGE_FINAL = 1 and HILAST_C in (3,4,5,6)) or
(AGE_FINAL = 2 and HILAST_C in (4,5,6)) or
(AGE_FINAL in (3,4) and HILAST_C in (5,6)) or
(AGE_FINAL in (5,6,7,8,9) and HILAST_C in (6))
Page 109 of 223
Question ID: INS.0640.00.1
Variable name: HILASTMY_C
Interview module: INS(Child.INS)
Universe: HILAST_C=1
Question Text:
Response:
Fills:
In the past 12 months, how many months was ^SCNAME without coverage?
If less than 1 month, enter '1'.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-12,RF,DK> [goto HISTOPJOB_C]
Question ID: INS.0650.00.1
Variable name: HISTOPJOB_C
Interview module: INS(Child.INS)
Universe: HILAST_C IN (1,2,3)
Question Text:
Response:
Fills:
?[F1] Think about the last time that ^SCNAME did have health care coverage. I
am going to read a list of reasons why someone might no longer be enrolled in
coverage. Please tell me, yes or no, if this is a reason why ^SCNAME is no
longer enrolled in ^hisher_C last health care plan. The policyholder retired,
lost a job, or changed employer?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 110 of 223
Skip Instructions: <1,2,RF,DK> [goto HISTOPMISS_C]
Question ID: INS.0660.00.1
Variable name: HISTOPMISS_C
Interview module: INS(Child.INS)
Universe: HILAST_C IN (1,2,3)
Question Text:
Response:
Fills:
Read if necessary: Is ^SCNAME no longer enrolled in ^hisher_C last health care plan
because... A deadline was missed for signing up or paying for ^hisher_C
coverage?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> [goto HISTOPAGE_C]
Question ID: INS.0670.00.1
Variable name: HISTOPAGE_C
Interview module: INS(Child.INS)
Universe: HILAST_C IN (1,2,3)
Question Text:
Response:
Read if necessary: Is ^SCNAME no longer enrolled in ^hisher_C last health care plan
because... ^HeShe_C became ineligible because of ^hisher_C age or because
^heshe_C left school?
1.
Yes
Page 111 of 223
2.
DK:
RF:
Fills:
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^HeShe_C
If SEX_FINAL_C=1 fill "He"
else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C=blank: fill "They"
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Skip Instructions: <1,2,RF,DK> [goto HISTOPCOST_C]
Question ID: INS.0680.00.1
Variable name: HISTOPCOST_C
Interview module: INS(Child.INS)
Universe: HILAST_C IN (1,2,3)
Question Text:
Response:
Fills:
Read if necessary: Is ^SCNAME no longer enrolled in ^hisher_C last health care plan
because... The cost for the coverage increased?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 112 of 223
Skip Instructions: <1,2,RF,DK> [goto HISTOPELIG_C]
Question ID: INS.0690.00.1
Variable name: HISTOPELIG_C
Interview module: INS(Child.INS)
Universe: HILAST_C IN (1,2,3)
Question Text:
Response:
Fills:
?[F1] Read if necessary: Is ^SCNAME no longer enrolled in ^hisher_C last health
care plan because... ^HeShe_C had Medicaid, CHIP, or other public coverage,
but ^werewas_C no longer eligible?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^HeShe_C
If SEX_FINAL_C=1 fill "He"
else if SEX_FINAL_C=2 fill "She"
elseif SEX_FINAL_C=blank: fill "They"
^werewas_C
If SEX_FINAL_C=1,2 fill "was"
else if SEX_FINAL_C=DK, RF fill "were"
Skip Instructions: <1,2,RF,DK> [goto RSNHICOST_C]
Page 113 of 223
Question ID: INS.0700.00.1
Variable name: RSNHICOST_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and (MCAIDPRB_C IN (2,RF,DK))
Question Text:
Response:
Fills:
^INSREASONS_C Is ^SCNAME currently uninsured because coverage is not
affordable?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^INSREASONS_C
If HILAST_C=0,4,5,6,RF,DK, fill: "There are many
reasons why people do not have health insurance
coverage."
If HILAST_C=1,2,3, fill: "We just discussed reasons
you lost coverage, now I am going to ask you some
questions about why ^SCNAME hasn't obtained
coverage."
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto RSNHIWANT_C]
Question ID: INS.0710.00.1
Variable name: RSNHIWANT_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and (MCAIDPRB_C IN (2,RF,DK))
Question Text:
Response:
There are other reasons that people do not have health insurance coverage.
^PLUSCOSTC ^SCNAME currently uninsured because... ...your family does not
need or want coverage for ^SCNAME?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 114 of 223
Fills:
^PLUSCOSTC
if REASNHICOST_C = 1 then fill "In addition to cost,
is"
Else fill "Is"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto RSNHIELIG_C]
Question ID: INS.0720.00.1
Variable name: RSNHIELIG_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and (MCAIDPRB_C IN (2,RF,DK))
Question Text:
Response:
Fills:
Read if necessary: There are other reasons that people do not have health insurance
coverage. ^PLUSCOSTC ^SCNAME currently uninsured because... ...^heshe_C
^areisSEX_C not eligible for coverage?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^PLUSCOSTC
if REASNHICOST_C = 1 then fill "In addition to cost,
is"
Else fill "Is"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^areisSEX_C
if GEN.SEX_FINAL[PX_C] in (1,2) fill: "is"
elseif GEN.SEX_FINAL[PX_C] in (DK,RF) fill: "are"
Page 115 of 223
Skip Instructions: <1,2,RF,DK> [goto RSNHICONF_C]
Question ID: INS.0730.00.1
Variable name: RSNHICONF_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and (MCAIDPRB_C IN (2,RF,DK) )
Question Text:
Response:
Fills:
Read if necessary: There are other reasons that people do not have health insurance
coverage. ^PLUSCOSTC ^SCNAME currently uninsured because... ...the process
of signing up for coverage for ^SCNAME is too difficult or confusing?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^PLUSCOSTC
if REASNHICOST_C = 1 then fill "In addition to cost,
is"
Else fill "Is"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto RSNHIMEET_C]
Question ID: INS.0740.00.1
Variable name: RSNHIMEET_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and (MCAIDPRB_C IN (2,RF,DK))
Question Text:
Response:
Read if necessary: There are other reasons that people do not have health insurance
coverage. ^PLUSCOSTC ^SCNAME currently uninsured because... ...your family
cannot find a plan that meets ^SCNAME's needs?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 116 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^PLUSCOSTC
if REASNHICOST_C = 1 then fill "In addition to cost,
is"
Else fill "Is"
Skip Instructions: <1,2,RF,DK> [goto RSNHIWAIT_C]
Question ID: INS.0750.00.1
Variable name: RSNHIWAIT_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and (MCAIDPRB_C IN (2,RF,DK))
Question Text:
Response:
Fills:
Read if necessary: There are other reasons that people do not have health insurance
coverage. ^PLUSCOSTC ^SCNAME currently uninsured because... ...you applied
for coverage for ^SCNAME but it has not started yet?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^PLUSCOSTC
if REASNHICOST_C = 1 then fill "In addition to cost,
is"
Else fill "Is"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto RSNHIOTH_C]
Page 117 of 223
Question ID: INS.0760.00.1
Variable name: RSNHIOTH_C
Interview module: INS(Child.INS)
Universe: 10 IN HIKIND_C and (MCAIDPRB_C IN (2,RF,DK))
Question Text:
Response:
Fills:
Is there another reason that ^SCNAME currently does not have health
insurance coverage?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto RSNHIOTHSP_C]
<2,RF,DK> [goto FINISH_C]
Question ID: INS.0770.00.1
Variable name: RSNHIOTHSP_C
Interview module: INS(Child.INS)
Universe: RSNHIOTH_C=1
Question Text:
Response:
What is the other reason for not having coverage?
DK:
RF:
Don't Know
Refused
Skip Instructions: [goto FINISH_C]
Page 118 of 223
Question ID: INS.0780.00.1
Variable name: HINOTYR_C
Interview module: INS(Child.INS)
Universe: HIKIND_C IN (1-9) or MCAIDPRB_C=1
Question Text:
Response:
Fills:
In the past 12 months, was there any time when ^SCNAME did NOT have ANY
health insurance or coverage?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto HINOTMYR_C]
<2,RF,DK> [goto FINISH_C]
Question ID: INS.0790.00.1
Variable name: HINOTMYR_C
Interview module: INS(Child.INS)
Universe: HIKIND_C IN (1-9) or (MCAIDPRB_C=1) and HINOTYR_C=1
Question Text:
Response:
Fills:
In the past 12 months, about how many months was ^SCNAME without
coverage?
If less than 1 month, enter '1'.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-12,RF,DK> [goto FINISH_C]
Page 119 of 223
Question ID: INS.0800.00.1
Question Text:
Response:
Variable name: FINISH_C
Interview module: INS(Child.INS)
The Sample Child health insurance section is now complete.
1.
Enter '1' to continue.
Enter 1 to Continue
Skip Instructions: <1> [goto next section]
Question ID: PAY.0010.00.1
Variable name: PAYINTRO_C
Interview module: PAY(Child.PAY)
Universe: (SAMEFAM_FLG=1 and PAY_FLG_A=blank) or (SAMEFAM_FLG=1 and
PAY_FLG_A=2 and SARESPSC_FLG ne 1) or (SAMEFAM_FLG ne 1)
Question Text:
Response:
?[F1] Now I am going to ask you about your family's medical bills. Include bills
for doctors, dentists, hospitals, therapists, medication, equipment, and nursing
home or home care. Enter '1' to continue.
1.
Enter 1 to Continue
Skip Instructions: <1> [goto PAYBILL12M_C]
Question ID: PAY.0020.00.1
Variable name: PAYBLL12M_C
Interview module: PAY(Child.PAY)
Universe: (SAMEFAM_FLG=1 and PAY_FLG_A=blank) or (SAMEFAM_FLG=1 and
PAY_FLG_A=2 and SARESPSC_FLG ne 1) or (SAMEFAM_FLG ne 1)
Question Text:
Response:
?[F1] In the past 12 months did anyone in your family have problems paying or
were unable to pay any medical bills? Read if necessary: Include bills for
doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home
care.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 120 of 223
Skip Instructions: <1,RF,DK> [goto PAYNOBLLNW_C]
<2> [goto PAYWORRY_C]
Question ID: PAY.0030.00.1
Variable name: PAYNOBLLNW_C
Interview module: PAY(Child.PAY)
Universe: ((SAMEFAM_FLG=1 and PAY_FLG_A=blank) or (SAMEFAM_FLG=1 and
PAY_FLG_A=2 and SARESPSC_FLG ne 1)) or ((SAMEFAM_FLG ne 1) and
PAYBLL12M_C IN (1,RF,DK))
Question Text:
Response:
Does anyone in your family currently have any medical bills that you are unable
to pay at all?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Skip Instructions: <1,2,RF,DK> [goto PAYWORRY_C]
Question ID: PAY.0040.00.1
Question Text:
Response:
Fills:
Variable name: PAYWORRY_C
Interview module: PAY(Child.PAY)
If ^SCNAME gets sick or has an accident, how worried are you that your family
will be able to pay ^hisher_C medical bills? Are you very worried, somewhat
worried, or not at all worried?
1.
2.
3.
DK:
RF:
Very worried
Somewhat worried
Not at all worried
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 121 of 223
Skip Instructions: <1-3,RF,DK> [goto next section]
Question ID: CVD.0010.00.4
Question Text:
Response:
Variable name: CVDINTRO_C
Interview module: CVD(Child.CVD)
The next set of questions are about coronavirus or COVID-19.
continue.
1.
Enter '1' to
Enter 1 to Continue
Skip Instructions: <1> [goto CVDDIAG_C]
Question ID: CVD.0020.00.4
Question Text:
Response:
Fills:
Variable name: CVDDIAG_C
Interview module: CVD(Child.CVD)
Has a doctor or other health professional ever told you that ^SCNAME had or
likely had coronavirus or COVID-19?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto COVIDTEST_C]
Question ID: CVD.0030.00.4
Question Text:
Response:
Variable name: COVIDTEST_C
Interview module: CVD(Child.CVD)
Has ^SCNAME ever been tested for coronavirus or COVID-19?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 122 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto CVDRSLT_C]
<2,RF,DK> if CVDDIAG_C=1 [goto CVDSEV_C]
else [goto next section]
Question ID: CVD.0040.00.4
Variable name: CVDRSLT_C
Interview module: CVD(Child.CVD)
Universe: COVIDTEST_C=1
Question Text:
Response:
Fills:
Did the test find that ^SCNAME had coronavirus or COVID-19? If any test has
shown that ^SCNAME had COVID-19, enter '1' for yes.
If the respondent indicates
they are waiting for ^SCNAME's results, enter '3' for Did not receive results. If the
respondent indicates the test was inconclusive, enter 'CTRL-D' for Don't Know.
1.
2.
3.
DK:
RF:
Yes
No
Did not receive results
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto CVDSEV_C]
<2-3,RF,DK> if CVDDIAG_C=1 [goto CVDSEV_C]
else [goto next section]
Page 123 of 223
Question ID: CVD.0050.00.4
Variable name: CVDSEV_C
Interview module: CVD(Child.CVD)
Universe: CVDDIAG_C=1 or CVDRSLT_C=1
Question Text:
Response:
Fills:
How would you describe ^SCNAME's coronavirus symptoms when they were at
their worst? Would you say no symptoms, mild symptoms, moderate
symptoms, or severe symptoms?
1.
2.
3.
4.
DK:
RF:
No symptoms
Mild symptoms
Moderate symptoms
Severe symptoms
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-4,RF,DK> [goto next section]
Question ID: UTZ.0010.00.1
Question Text:
Response:
Fills:
Variable name: UTZINTRO_C
^UTZINTRO2_C
1.
Enter '1' to continue.
Enter 1 to Continue
^UTZINTRO2_C
utilization intro
Skip Instructions: <1> [goto LASTDR_C]
Page 124 of 223
Interview module: UTZ(Child.UTZ)
Question ID: UTZ.0020.00.1
Question Text:
Response:
Fills:
Variable name: LASTDR_C
Interview module: UTZ(Child.UTZ)
Not including dental care, about how long has it been since ^SCNAME last saw
a doctor or other health professional about ^hisher_C health? Read if
necessary: Include doctors seen while a patient in a hospital.
0.
1.
2.
3.
4.
5.
6.
DK:
RF:
Never
Within the past year (anytime less than 12 months ago)
Within the last 2 years (1 year but less than 2 years ago)
Within the last 3 years (2 years but less than 3 years ago)
Within the last 5 years (3 years but less than 5 years ago)
Within the last 10 years (5 years but less than 10 years ago)
10 years ago or more
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1-6> if 0<=AGE_FINAL<=11 [goto WELLNESS_C]
<1> if 12<=AGE_FINAL<=17 [goto TIMEALONE_C]
<2-5> if 12<=AGE_FINAL<=17 [goto WELLNESS_C]
<0,RF,DK> [goto USUALPL_C]
Check Name: ERR1_LASTDR_C
Text:
{check ERR1_LASTDR_C} Years since last saw a doctor exceedchild's age. Please
correct.
Hard / Soft Edit: Hard
Universe: (AGE_FINAL = 0 and LASTDR_C in (2,3,4,5,6)) or
(AGE_FINAL = 1 and LASTDR_C in (3,4,5,6)) or
(AGE_FINAL = 2 and LASTDR_C in (4,5,6)) or
(AGE_FINAL in (3,4) and LASTDR_C in (5,6)) or
(AGE_FINAL in (5,6,7,8,9) and LASTDR_C in (6))
Page 125 of 223
Question ID: UTZ.0035.00.4
Variable name: TIMEALONE_C
Interview module: UTZ(Child.UTZ)
Universe: LASTDR_C=1 & 12<=AGE_FINAL<=17
Question Text:
Response:
Fills:
At their last medical care visit, did ^SCNAME have a chance to speak with a
doctor or other health provider privately, without you or another caregiver in
the room?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto WELLNESS_C]
Question ID: UTZ.0030.00.1
Variable name: WELLNESS_C
Interview module: UTZ(Child.UTZ)
Universe: LASTDR_C in (1,2,3,4,5,6)
Question Text:
Response:
Was this a well ^babychild visit, physical, or general purpose check-up?
Read if necessary: This kind of visit typically includes: height and weight
measurements, vaccinations, and vision or hearing checks. The doctor or other
health professional may also discuss topics related to ^SCNAME's health such as
^hisher_C growth and development, diet and exercise, safety, and sleep patterns.
These visits are usually scheduled in advance and occur when ^hesheistheyare_C
not sick. Read if necessary: If a wellness exam was combined with a sick care visit,
include this visit. Read if necessary: An obstetrician/gynecologist (OB/GYN) may
perform this visit.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 126 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^babychild
If AGE LE 2 fill "baby";
else if AGE GE 3 or AGE IN ('DK','RF') fill "child"
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^hesheistheyare_C
If SEX_FINAL_C=1 fill: "he is"
If SEX_FINAL_C=2 fill: "she is"
If SEX_FINAL_C=blank fill: "they are"
Skip Instructions: <1> [goto USUALPL_C]
<2,RF,DK> [goto WELLVIS_C]
Question ID: UTZ.0040.00.1
Variable name: WELLVIS_C
Interview module: UTZ(Child.UTZ)
Universe: WELLNESS_C in (2,RF,DK)
Question Text:
Response:
About how long has it been since ^SCNAME last saw a doctor or other health
professional for a well ^babychild visit, physical, or general purpose check-up?
Read if necessary: This kind of visit typically includes: height and weight
measurements, vaccinations, and vision or hearing checks. The doctor or other
health professional may also discuss topics related to ^SCNAME's health such as
^hisher_C growth and development, diet and exercise, safety, and sleep patterns.
These visits are usually scheduled in advance and occur when ^hesheistheyare_C
not sick. Read if necessary: If a wellness exam was combined with a sick care visit,
include this visit. Read if necessary: An obstetrician/gynecologist (OB/GYN) may
perform this visit.
0.
1.
Never
Within the past year (anytime less than 12 months ago)
Page 127 of 223
2.
3.
4.
5.
6.
DK:
RF:
Fills:
Within the last 2 years (1 year but less than 2 years ago)
Within the last 3 years (2 years but less than 3 years ago)
Within the last 5 years (3 years but less than 5 years ago)
Within the last 10 years (5 years but less than 10 years ago)
10 years ago or more
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^babychild
If AGE LE 2 fill "baby";
else if AGE GE 3 or AGE IN ('DK','RF') fill "child"
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
^hesheistheyare_C
If SEX_FINAL_C=1 fill: "he is"
If SEX_FINAL_C=2 fill: "she is"
If SEX_FINAL_C=blank fill: "they are"
Skip Instructions: <0,RF,DK> [goto USUALPL_C]
<1,2,3,4,5,6> if 0<=AGE_FINAL<=11 [goto USUALPL_C]
<1,2,3,4,5,6> if 12<=AGE_FINAL<=17 [goto PTIMEALONE_C]
Check Name: ERR1_WELLVIS_C
Text:
{check ERR1_WELLVIS_C} Years since wellness visit exceedchild's age. Please
correct.
Hard / Soft Edit: Hard
Universe: (AGE_FINAL = 0 and WELLVIS_C in (2,3,4,5,6)) or
(AGE_FINAL = 1 and WELLVIS_C in (3,4,5,6)) or
(AGE_FINAL = 2 and WELLVIS_C in (4,5,6)) or
(AGE_FINAL in (3,4) and WELLVIS_C in (5,6)) or
(AGE_FINAL in (5,6,7,8,9) and WELLVIS_C in (6))
Page 128 of 223
Question ID: UTZ.0045.00.4
Variable name: PTIMEALONE_C
Interview module: UTZ(Child.UTZ)
Universe: WELVIS_C IN (1,2,3,4,5,6)) & 12<=AGE_FINAL<=17
Question Text:
Response:
Fills:
At their last well-child visit, physical, or general purpose check-up did
^SCNAME have a chance to speak with a doctor or other health provider
privately, without you or another caregiver in the room?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto USUALPL_C]
Question ID: UTZ.0050.00.1
Question Text:
Response:
Fills:
Variable name: USUALPL_C
Interview module: UTZ(Child.UTZ)
Is there a place that ^SCNAME USUALLY goes to if ^hesheistheyare_C sick
and needs health care?
1.
2.
3.
DK:
RF:
Yes
There is NO place
There is MORE THAN ONE place
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hesheistheyare_C
If SEX_FINAL_C=1 fill: "he is"
If SEX_FINAL_C=2 fill: "she is"
If SEX_FINAL_C=blank fill: "they are"
Page 129 of 223
Skip Instructions: <1,3,RF,DK> [goto USPLKIND_C]
<2>[goto URGENT12M_C]
Question ID: UTZ.0060.00.1
Variable name: USPLKIND_C
Interview module: UTZ(Child.UTZ)
Universe: USUALPL_C IN('1','3','RF','DK')
Question Text:
Response:
Fills:
What kind of place ^isitgomostoften - a doctor's office or health center; an
urgent care center, a clinic in a drug store or grocery store; a hospital
emergency room; or some other place? Read if necessary: A doctor's office or
health center is a place where ^heshe_C see^s the same doctor or the same group of
doctors every visit, where you usually need to make an appointment ahead of time,
and where ^hisher_C medical records are on file. Read if necessary: Urgent care
centers, and clinics in a drug store or grocery store are places where you do not need
to make an appointment ahead of time, and do not usually see the same health care
provider at each visit.
1.
2.
3.
4.
5.
DK:
RF:
A doctor's office or health center
Urgent care center or clinic in a drug store or grocery store
Hospital emergency room
Some other place
Does not go to one place most often
Don't Know
Refused
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
^isitgomostoften
If USUALPL_C=1, fill: "is it"
else fill: "^doesheshedothey go to most often"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^s
if SEX_FINAL[PX_C]=1,2 fill "s"
else fill blank
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 130 of 223
Skip Instructions: <1-5,RF,DK> if 0<=AGE_FINAL<=11 [goto URGENT12M_C]
<1-5,RF,DK> if 12<=AGE_FINAL<=17 [goto PERSONALDOC_C]
Question ID: UTZ.0065.00.4
Variable name: PERSONALDOC_C
Interview module: UTZ(Child.UTZ)
Universe: 12<=AGE_FINAL<=17
Question Text:
Response:
Fills:
Do you have one or more persons you think of as ^SCNAME's personal doctor
or nurse? Read if necessary: A personal doctor or nurse is a health professional
who knows ^SCNAME well and is familiar with ^hisher_C health history. This can be
a general doctor, a pediatrician, a specialist doctor, a nurse practitioner, or physician
assistant.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> [goto URGENT12M_C]
Question ID: UTZ.0070.00.1
Question Text:
Response:
Variable name: URGENT12M_C
Interview module: UTZ(Child.UTZ)
During the past 12 months, how many times has ^SCNAME gone to an urgent
care center or clinic in a drug store or grocery store about ^hisher_C health?
Enter '96' if number is 96 or greater. Read if necessary: Urgent care centers and
clinics in drug stores or grocery stores are places where you do not need to make an
appointment ahead of time, and do not usually see the same health care provider at
each visit. Read if necessary: This is different from a hospital emergency room.
DK:
RF:
Don't Know
Refused
Page 131 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <0-39,RF,DK> [goto EMERGE12M_C]
<40-96> [goto ERR1_URGENT12M_C]
Check Name: ERR1_URGENT12M_C
Text:
{signal ERR1_URGENT12M_C} ^URGENT12M_C is an unusually large number.
Did ^SCNAME visit an urgent care center or clinic in a drug store or grocery
store about ^hishertheir health ^URGENT12M_C times in the past 12 months?
Please verify.
Hard / Soft Edit: Soft
Fills:
^URGENT12M_C
fill value from URGENT12M_C
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hishertheir
If
GEN.SEX_FINAL=1
fill
"his";
else
if
GEN.SEX_FINAL=2
fill
"her";
else if GEN.SEX_FINAL IN (DK, RF) fill "their"
Universe: URGENT12M_C=40-96
Page 132 of 223
Question ID: UTZ.0080.00.1
Question Text:
Response:
Fills:
Variable name: EMERGE12M_C
Interview module: UTZ(Child.UTZ)
During the past 12 months, how many times has ^SCNAME gone to a hospital
emergency room about ^hisher_C health?
Read if necesary: This includes
emergency room visits that resulted in a hospital admission. Enter '96' if number is
96 or more.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <0-39,RF,DK> if AGE GE '001'[goto HOSPONGT_C]
else [goto MEDDL12M_C]
<40-96> [goto ERR1_EMERGE12M_C]
Check Name: ERR1_EMERGE12M_C
Text:
{signal ERR1_EMERGE12M_C} ^EMERGE12M_C is an unusually large number.
Did ^SCNAME visit a hospital emergency room about ^hishertheir health
^EMERGE12M_C times in the past 12 months? Please verify.
Hard / Soft Edit: Soft
Fills:
^EMERGE12M_C
Fill value from Child.UTZ.EMERGE12M_C
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hishertheir
If
GEN.SEX_FINAL=1
fill
"his";
else
if
GEN.SEX_FINAL=2
fill
"her";
else if GEN.SEX_FINAL IN (DK, RF) fill "their"
Universe: EMERGE12M_C=40-96
Page 133 of 223
Question ID: UTZ.0090.00.1
Variable name: HOSPONGT_C
Interview module: UTZ(Child.UTZ)
Universe: GEN.AGE_FINAL[PX_C] GE '001' and GEN.AGE_FINAL[PX_C] LE '017'
Question Text:
Response:
Fills:
During the past 12 months, has ^SCNAME been hospitalized overnight?
^PAST12MER_C
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^PAST12MER_C
If ((EMERGE12M_C GE '01' and EMERGE12M_C
LE '96') or EMERGE12M_C='RF','DK'): Fill: "Do not
include an overnight stay in the emergency room."
Skip Instructions: <1,2,RF,DK> [goto MEDDL12M_C]
Question ID: UTZ.0100.00.1
Question Text:
Response:
Fills:
Variable name: MEDDL12M_C
Interview module: UTZ(Child.UTZ)
During the past 12 months, has medical care BEEN DELAYED for ^SCNAME
because of the cost?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto MEDNG12M_C]
Page 134 of 223
Question ID: UTZ.0110.00.1
Question Text:
Response:
Fills:
Variable name: MEDNG12M_C
Interview module: UTZ(Child.UTZ)
During the past 12 months, was there any time when ^SCNAME needed medical
care, but DID NOT GET IT because of the cost?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: ACC.0010.00.4
Question Text:
Response:
Fills:
Variable name: DLYCARE_C
Interview module: ACC(Child.ACC)
Was there any time when ^SCNAME DELAYED getting medical care because of
the coronavirus pandemic?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto DNGCARE_C]
Page 135 of 223
Question ID: ACC.0020.00.4
Question Text:
Response:
Fills:
Variable name: DNGCARE_C
Interview module: ACC(Child.ACC)
Was there any time when ^SCNAME needed medical care for something other
than coronavirus, but DID NOT GET IT because of the coronavirus pandemic?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto VIRAPP12M_C]
Question ID: ACC.0030.00.4
Question Text:
Response:
Fills:
Variable name: VIRAPP12M_C
Interview module: ACC(Child.ACC)
In the past 12 months, has ^SCNAME had an appointment with a doctor, nurse,
or other health professional by video or by phone?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto VIRAPPCVD_C]
<2,RF,DK> [goto next section]
Page 136 of 223
Question ID: ACC.0040.00.4
Variable name: VIRAPPCVD_C
Interview module: ACC(Child.ACC)
Universe: VIRAPP12M_C=1
Question Text:
Response:
Fills:
Were any of ^SCNAME's appointments done by video or by phone because of
reasons related to the coronavirus pandemic?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: PMD.0010.00.1
Question Text:
Response:
Fills:
Variable name: RX12M_C
Interview module: PMD(Child.PMD)
At any time in the past 12 months, did ^SCNAME take prescription medication?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto RXDL12M_C]
<2,RF,DK> [goto RXDG12M_C]
Page 137 of 223
Question ID: PMD.0020.00.1
Variable name: RXDL12M_C
Interview module: PMD(Child.PMD)
Universe: RX12M_C=1
Question Text:
Response:
Fills:
During the past 12 months, did you DELAY filling a prescription for ^SCNAME
to save money?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto RXDG12M_C]
Question ID: PMD.0030.00.1
Question Text:
Response:
Fills:
Variable name: RXDG12M_C
Interview module: PMD(Child.PMD)
During the past 12 months, was there any time when ^SCNAME needed
prescription medication, but DID NOT GET IT because of the cost?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Page 138 of 223
Question ID: IMM.0010.00.1
Question Text:
Response:
Fills:
Variable name: SHTFLU12M_C
Interview module: IMM(Child.IMM)
There are two types of flu vaccinations. One is a shot and the other is a spray,
mist, or drop in the nose. During the past 12 months, has ^SCNAME had a flu
vaccination?
Read if necessary: A flu vaccination is usually given in the fall and
protects against influenza for the flu season.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto SHTFLUNUM_C]
<2,RF,DK> [goto next section]
Question ID: IMM.0020.00.1
Variable name: SHTFLUNUM_C
Interview module: IMM(Child.IMM)
Universe: SHTFLU12M_C=1
Question Text:
Response:
Fills:
During the past 12 months, how many flu vaccinations has ^SCNAME
received?
1.
2.
DK:
RF:
1 vaccination
2 or more vaccinations
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2> [goto FLUVAC1M_C]
[goto next section]
Page 139 of 223
Question ID: IMM.0030.01.1
Variable name: FLUVAC1M_C
Interview module: IMM(Child.IMM)
Universe: SHTFLUNUM_C IN (1,2)
Question Text:
Response:
Fills:
1 of 2 During what month and year did ^SCNAME receive ^hisher_C most
recent flu vaccine? Enter month of most recent flu vaccine.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
DK:
RF:
January
February
March
April
May
June
July
August
September
October
November
December
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1-12,DK> [goto FLUVAC1Y_C]
if SHTFLUNUM_C=2 [goto FLUVAC2M_C]
else if SHTFLUNUM_C=1 [goto next section]
Page 140 of 223
Question ID: IMM.0030.02.1
Variable name: FLUVAC1Y_C
Interview module: IMM(Child.IMM)
Universe: (FLUVAC1M_C=1-12 or FLUVAC1M_C=DK)
Question Text:
Response:
2 of 2
DK:
RF:
Enter year of most recent flu vaccine.
Don't Know
Refused
Skip Instructions: and SHTFLUNUM_C = 2
FLUVAC2M_C]
else [goto next section]
if FLUVAC1M_C and FLUVAC1Y_C = a future date
ERR1_FLUVAC1Y_C];
if FLUVAC1M_C and FLUVAC1Y_C = a date prior to birth
ERR2_FLUVAC1Y_C];
if FLUVAC1M_C and FLUVAC1Y_C = a date prior to 12 months ago
ERR3_FLUVAC1Y_C]
[goto
[goto
[goto
[goto
Check Name: ERR1_FLUVAC1Y_C
Text:
{check ERR1_FLUVAC1Y_C} Future date invalid
Hard / Soft Edit: Hard
Universe: (FLUVAC1Y_C gt current year) or (FLUVAC1Y_C=current year and
FLUVAC1M_C gt current month)
Check Name: ERR2_FLUVAC1Y_C
Text:
{check ERR2_FLUVAC1Y_C} Date prior to birth
Hard / Soft Edit: Hard
Universe: FLUVAC1M_C and FLUVAC1Y_C = date prior to birth date
Page 141 of 223
Check Name: ERR3_FLUVAC1Y_C
Text:
{check ERR3_FLUVAC1Y_C} Date before 12 months ago
Hard / Soft Edit: Hard
Universe: (FLUVAC1Y_C lt current year-1) or (FLUVAC1Y_C=current year-1 and
FLUVAC1M_C lt current month)
Question ID: IMM.0040.01.1
Variable name: FLUVAC2M_C
Interview module: IMM(Child.IMM)
Universe: SHTFLUNUM_C=2
Question Text:
Response:
Fills:
1 of 2 During what month and year did ^SCNAME receive the flu vaccine
before that one? Enter month of the flu vaccine.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
DK:
RF:
January
February
March
April
May
June
July
August
September
October
November
December
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-12,DK> [goto FLUVAC2Y_C]
[goto next section]
Page 142 of 223
Question ID: IMM.0040.02.1
Variable name: FLUVAC2Y_C
Interview module: IMM(Child.IMM)
Universe: (FLUVAC2M_C=1-12 or FLUVAC2M_C=DK)
Question Text:
Response:
2 of 2
DK:
RF:
Enter year of next most recent flu vaccine.
Don't Know
Refused
Skip Instructions: [goto next section]
If FLUVAC2M_C and FLUVAC2Y_C = a date in the future [goto
ERR1_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to birth [goto
ERR2_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to 12 months ago [goto
ERR3_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date more recent than answer given
in (FLUVAC1M_C and FLUVA1Y_C) [goto ERR4_FLUVAC2Y_C]
Check Name: ERR1_FLUVAC2Y_C
Text:
{check ERR1_FLUVAC2Y_C}
Future date invalid
Hard / Soft Edit: Hard
Universe: (FLUVAC2Y_C gt current year) or (FLUVAC2Y_C=current year and
FLUVAC2M_C gt current month)
Check Name: ERR2_FLUVAC2Y_C
Text:
{check ERR2_FLUVAC2Y_C}
Date prior to birth
Hard / Soft Edit: Hard
Universe: FLUVAC2M_C and FLUVAC2Y_C = a date prior to birth
Page 143 of 223
Check Name: ERR3_FLUVAC2Y_C
Text:
{check ERR3_FLUVAC2Y_C}
Date before 12 months ago
Hard / Soft Edit: Hard
Universe: (FLUVAC2Y_C lt current year-1) or (FLUVAC2Y_C=current year-1 and
FLUVAC2M_C lt current month)
Check Name: ERR4_FLUVAC2Y_C
Text:
{check ERR4_FLUVAC2Y_C} The date entered for the second most recent flu
vaccine is after the date of the most recent flu vaccine. Please verify.
Hard / Soft Edit: Soft
Universe: (FLUVAC2Y_C gt FLUVAC1Y_C) or (FLUVAC2Y_C=FLUVAC1Y_C and
FLUVAC2M_C gt FLUVAC1M_C)
Question ID: MHC.0010.00.2
Question Text:
Response:
Fills:
Variable name: MHRX_C
Interview module: MHC(Child.MHC)
During the past 12 months, did ^SCNAME take any prescription medication to
help with ^hisher_C emotions, concentration, behavior or mental health?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 144 of 223
Skip Instructions: <1,2,RF,DK> [goto MHTHRPY_C]
Question ID: MHC.0020.00.2
Question Text:
Response:
Fills:
Variable name: MHTHRPY_C
Interview module: MHC(Child.MHC)
During the past 12 months, did ^SCNAME receive counseling or therapy from a
mental health professional such as a psychiatrist, psychologist, psychiatric
nurse, or clinical social worker?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: SOS.0010.00.4
Variable name: SUPPORT_C
Interview module: SOS(Child.SOS)
Universe: GEN.AGE_FINAL[PX_C] ge 12 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
How often does ^SCNAME get the social and emotional support ^heshe_C
needs? Would you say always, usually, sometimes, rarely, or never?
1.
2.
3.
4.
5.
DK:
RF:
Always
Usually
Sometimes
Rarely
Never
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshe_C
If GEN.SEX_FINAL[PX_C]=1 fill "he"
else if GEN.SEX_FINAL[PX_C]=2 fill "she"
else if GEN.SEX_FINAL[PX_C] in (RF,DK): fill "they"
Page 145 of 223
Skip Instructions: <1-5,RF,DK> [goto COMSUPPORT_C]
Question ID: SOS.0020.00.4
Variable name: COMSUPPORT_C
Interview module: SOS(Child.SOS)
Universe: GEN.AGE_FINAL[PX_C] ge 12 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
Other than parents or adults in ^SCNAME's home, is there at least one adult in
^SCNAME's school, neighborhood, or community who makes a positive and
meaningful difference in ^hisher_C life?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: SLE.0010.00.2
Question Text:
Response:
Variable name: SLEINTRO_C
Interview module: SLE(Child.SLE)
The next set of questions are about events that may have happened during
^SCNAME's life. These things can happen in any family, but some people may
feel uncomfortable with these questions. You may skip any questions you do
not want to answer. Enter '1' to continue.
1.
Enter 1 to Continue
Page 146 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto VIOLENEV_C]
Question ID: SLE.0020.00.2
Question Text:
Response:
Fills:
Variable name: VIOLENEV_C
Interview module: SLE(Child.SLE)
Has ^SCNAME ever been the victim of violence or witnessed violence in
^hisher_C neighborhood?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> [goto JAILEV_C]
Question ID: SLE.0030.00.2
Question Text:
Response:
Variable name: JAILEV1_C
Interview module: SLE(Child.SLE)
Has ^SCNAME ever been separated from a parent or guardian because the
parent or guardian went to jail, prison, or a detention center?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 147 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto MENTDEPEV_C]
Question ID: SLE.0040.00.2
Question Text:
Response:
Fills:
Variable name: MENTDEPEV_C
Interview module: SLE(Child.SLE)
Did ^SCNAME ever live with anyone who was mentally ill or severely
depressed?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto ALCDRUGEV_C]
Question ID: SLE.0050.00.2
Question Text:
Response:
Fills:
Variable name: ALCDRUGEV_C
Interview module: SLE(Child.SLE)
Did ^SCNAME ever live with anyone who had a problem with alcohol or drugs?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto PUTDOWN_C]
Page 148 of 223
Question ID: SLE.0060.00.3
Question Text:
Response:
Fills:
Variable name: PUTDOWN_C
Interview module: SLE(Child.SLE)
Has ^SCNAME ever lived with a parent or adult who frequently swore at
^himher_C, insulted ^himher_C, or put ^himher_C down?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^himher_C
him, her, they
Skip Instructions: <1,2,RF,DK> [goto BNEEDS_C]
Question ID: SLE.0070.00.3
Question Text:
Response:
Fills:
Variable name: BNEEDS_C
Interview module: SLE(Child.SLE)
Has there ever been a time when ^SCNAME's basic needs were NOT met, such
as having enough to eat, being able to go to a doctor when ^heshewas sick, or
having a safe place to stay?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^heshewas
heshewas
Skip Instructions: <1,2,RF,DK> [goto UNFAIRRE_C]
Page 149 of 223
Question ID: SLE.0080.00.4
Question Text:
Response:
Fills:
Variable name: UNFAIRRE_C
Interview module: SLE(Child.SLE)
Has ^SCNAME ever been treated or judged unfairly because of ^hisher_C race
or ethnic group?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> if 12>=AGE_FINAL>=17 [goto UNFAIRSO_C]
else [goto next section]
Question ID: SLE.0090.00.4
Variable name: UNFAIRSO_C
Interview module: SLE(Child.SLE)
Universe: '012'>=AGE_FINAL>='017'
Question Text:
Response:
Fills:
Has ^SCNAME ever been treated or judged unfairly because of ^hisher_C
sexual orientation or gender identity?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 150 of 223
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: BLY.0010.00.4
Question Text:
Response:
Fills:
Variable name: BULLYVIC_C
Interview module: BLY(Child.BLY)
During the past 12 months, how often was ^SCNAME bullied, picked on, or
excluded by other children?
0.
1.
2.
3.
4.
DK:
RF:
Never in the past 12 months
1-2 times in the past 12 months
1-2 times per month
1-2 times per week
Almost every day
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <0-4,RF,DK> [goto CYBERVIC_C]
Question ID: BLY.0020.00.4
Question Text:
Response:
Fills:
Variable name: CYBERVIC_C
Interview module: BLY(Child.BLY)
During the past 12 months, has ^SCNAME been electronically bullied? Read
if necessary: Count being bullied through texting, Instagram, Facebook, or other
social media
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 151 of 223
Skip Instructions: <1,2,RF,DK> [goto BULLYPERP_C]
Question ID: BLY.0030.00.4
Question Text:
Response:
Fills:
Variable name: BULLYPERP_C
Interview module: BLY(Child.BLY)
During the past 12 months, how often did ^SCNAME bully others, pick on them,
or exclude them?
0.
1.
2.
3.
4.
DK:
RF:
Never in the past 12 months
1-2 times in the past 12 months
1-2 times per month
1-2 times per week
Almost every day
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <0-4,RF,DK> [goto next section]
Question ID: INJ.0010.00.2
Question Text:
Variable name: INJINTRO_C
Interview module: INJ(Child.INJ)
The next set of questions asks about all types of 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_C]
Page 152 of 223
Question ID: INJ.0020.00.2
Question Text:
Response:
Fills:
Variable name: ANYINJURY_C
Interview module: INJ(Child.INJ)
During the past 3 months, did ^SCNAME have an accident or an injury where
any part of ^hisher_C body was hurt?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1> [goto INJLIMIT_C]
<2,RF,DK> [goto next section]
Question ID: INJ.0030.00.2
Variable name: INJLIMIT_C
Interview module: INJ(Child.INJ)
Universe: ANYINJURY_C=1
Question Text:
Response:
Fills:
Did any of these injuries limit ^SCNAME's usual activities for at least 24 hours
after the injury occurred?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 153 of 223
Skip Instructions: <1> [goto NUMINJ_C]
<2,RF,DK> [goto next section]
Question ID: INJ.0040.00.2
Variable name: NUMINJ_C
Interview module: INJ(Child.INJ)
Universe: INJLIMIT_C=1
Question Text:
Response:
Fills:
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 ^SCNAME's usual activities for at least 24 hours after the injury
occured. During the past 3 months, how many times did ^SCNAME have a
significant injury? Enter '96' if number is 96 or greater.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-9,RF,DK> [goto INJHOME_C]
<10-96> [goto ERR1_NUMINJ_C]
Check Name: ERR1_NUMINJ_C
Text:
{signal ERR1_NUMINJ_C}
verify.
^NUMINJ_C is an unusually large number. Please
Hard / Soft Edit: Soft
Fills:
^NUMINJ_C
Number of injuries
Universe: NUMINJ_C=10-96
Page 154 of 223
Question ID: INJ.0050.00.2
Variable name: INJHOME_C
Interview module: INJ(Child.INJ)
Universe: INJLIMIT_C=1
Question Text:
Response:
Fills:
During the past 3 months, did ^siginj_C occur while ^SCNAME was at
^hisher_C home?
Read if necessary: Include the yards, garage, basement, and
other places on the home property.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^siginj_C
the significant injury/any significant injuries
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1> if NUMINJ_C=1 and GEN.AGE_FINAL le 2 [goto INJFALL_C]
elseif NUMINJ_C=1 and GEN.AGE_FINAL ge 3 [goto INJSPORTS_C]
elseif (NUMINJ_C gt 1 OR NUMINJ_C IN (RF,DK)) [goto INJSCHOOL_C]
<2,RF,DK> [goto INJSCHOOL_C]
Question ID: INJ.0060.00.2
Variable name: INJSCHOOL_C
Interview module: INJ(Child.INJ)
Universe: ((NUMINJ_C gt 1 or NUMINJ_C IN (DK,RF)) or (NUMINJ_C=1 and
INJHOME_C IN (2,RF,DK))
Question Text:
During the past 3 months, did ^siginj_C occur while ^SCNAME was at
^DAYCARESCHOOL? Read if necessary: Include classrooms, playgrounds,
sports fields, swimming pools, parking lots and other places on school or daycare
property.
Response:
Page 155 of 223
1.
2.
DK:
RF:
Fills:
Yes
No
Don't Know
Refused
^siginj_C
the significant injury/any significant injuries
^SCNAME
Fill ALIAS of HHSTAT_C=1
^DAYCARESCHOOL
If
GEN.AGE_FINAL[PX_C]
ge
0
and
GEN.AGE_FINAL[PX_C] le 2, fill: "daycare"
If
GEN.AGE_FINAL[PX_C]
ge
3
and
GEN.AGE_FINAL[PX_C] le 5, fill: "school or
daycare"
ifGEN.AGE_FINAL[PX_C]
ge
6
and
GEN.AGE_FINAL[PX_C] le 17, fill: "school"
Skip Instructions: <1,2,RF,DK> if GEN.AGE_FINAL lt 3 [goto INJFALL_C]
elseif GEN.AGE_FINAL ge 3 [goto INJSPORTS_C]
Question ID: INJ.0070.00.2
Variable name: INJSPORTS_C
Interview module: INJ(Child.INJ)
Universe: INJLIMIT_C=1 and GEN.AGE_FINAL ge 3 and GEN.AGE_FINAL le 17
Question Text:
Response:
Fills:
During the past 3 months, did ^siginj_C occur while ^SCNAME was 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.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^siginj_C
the significant injury/any significant injuries
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 156 of 223
Skip Instructions: <1,2,RF,DK> [goto INJFALL_C]
Question ID: INJ.0080.00.2
Variable name: INJFALL_C
Interview module: INJ(Child.INJ)
Universe: INJLIMIT_C=1
Question Text:
Response:
Fills:
During the past 3 months, did ^siginj_C occur as a result of a fall or falling?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <1> if NUMINJ_C=1 [goto INJMOTOR_C]
elseif NUMINJ_C gt 1 or NUMINJ_C IN (RF,DK) and INJHOME_C=1 [goto
INJFALLHOM_C]
elseif NUMINJ_C gt 1 or NUMINJ_C IN (RF,DK) and INJSCHOOL_C=1 [goto
INJFALLSCH_C]
else [goto INJMOTOR_C]
<2,RF,DK> [goto INJMOTOR_C]
Question ID: INJ.0090.00.2
Variable name: INJFALLHOM_C
Interview module: INJ(Child.INJ)
Universe: (NUMINJ_C gt 1 OR NUMINJ_C IN (RF,DK)) and INJFALL_C=1 and
INJHOME_C=1
Question Text:
Response:
Did any fall occur while ^SCNAME was at ^hisher_C home?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 157 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> if INJSCHOOL_C=1 [goto INJFALLSCH_C]
else [goto INJMOTOR_C]
Question ID: INJ.0100.00.2
Variable name: INJFALLSCH_C
Interview module: INJ(Child.INJ)
Universe: (NUMINJ_C gt 1 OR NUMINJ_C IN (RF,DK)) and INJFALL_C=1 and
INJSCHOOL_C=1
Question Text:
Response:
Fills:
Did any fall occur while ^SCNAME was at ^DAYCARESCHOOL?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^DAYCARESCHOOL
If
GEN.AGE_FINAL[PX_C]
ge
0
and
GEN.AGE_FINAL[PX_C] le 2, fill: "daycare"
If
GEN.AGE_FINAL[PX_C]
ge
3
and
GEN.AGE_FINAL[PX_C] le 5, fill: "school or
daycare"
ifGEN.AGE_FINAL[PX_C]
ge
6
and
GEN.AGE_FINAL[PX_C] le 17, fill: "school"
Skip Instructions: <1,2,RF,DK> [goto INJMOTOR_C]
Page 158 of 223
Question ID: INJ.0110.00.2
Variable name: INJMOTOR_C
Interview module: INJ(Child.INJ)
Universe: INJLIMIT_C=1
Question Text:
Response:
Fills:
During the past 3 months, did ^siginj_C 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, motorcycles, motorized
scooters, motorized wheelchairs, motorized carts, tractors, ATVs, snowmobiles, dune
buggies, and other motorized vehicles.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <1> [goto INJMVTYPE_C]
<2,RF,DK> [goto INJSAWDOC_C]
Question ID: INJ.0120.00.2
Variable name: INJMVTYPE_C
Interview module: INJ(Child.INJ)
Universe: INJMOTOR_C=1
Question Text:
Response:
Was ^SCNAME a ^DRIVER passenger, bicyclist, pedestrian, or doing
something else when this occurred? Enter all that apply, separate with commas.
1.
2.
3.
4.
5.
DK:
RF:
^INJDRIVER
Passenger
Bicyclist
Pedestrian
Something else
Don't Know
Refused
Page 159 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^DRIVER
Whether child was driver
Skip Instructions: If
GEN.AGE_FINAL[PX_C]
lt
ERR1_INJMVTYPE_C]
<1-5,RF,DK> [goto INJSAWDOC_C]
6
and
INJMVTYPE_C=1
[goto
Check Name: ERR1_INJMVTYPE_C
Text:
{check ERR1_INJMVTYPE_C} Verify. "Driver" is unavailable for children under 6
years old.
Hard / Soft Edit: Hard
Universe: GEN.AGE_FINAL[PX_C] lt 6 and INJMVTYPE_C=1
Question ID: INJ.0130.00.2
Variable name: INJSAWDOC_C
Interview module: INJ(Child.INJ)
Universe: INJLIMIT_C=1
Question Text:
Response:
Fills:
During the past 3 months, did ^SCNAME see a doctor or other health
professional about ^siginj_C?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^siginj_C
the significant injury/any significant injuries
Page 160 of 223
Skip Instructions: <1> if UTZ.EMERGE12M_C IN (1-96,RF,DK) [goto INJER_C]
elseif UTZ.EMERGE12M_C=0 and UTZ.HOSPONGT_C IN (1,RF,DK) [goto
INJHOSP_C]
else [goto INJBONES_C]
<2,RF,DK> [goto INJSCHDAYS_C]
Question ID: INJ.0140.00.2
Variable name: INJER_C
Interview module: INJ(Child.INJ)
Universe: INJSAWDOC_C=1 and UTZ.EMERGE12M_C IN (1-96,RF,DK)
Question Text:
Response:
Fills:
During the past 3 months, did ^SCNAME go to an emergency room because of
^siginj_C?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <1,2,RF,DK> if UTZ.HOSPONGT_C IN (1,RF,DK) [goto INJHOSP_C]
else [goto INJBONES_C]
Question ID: INJ.0150.00.2
Variable name: INJHOSP_C
Interview module: INJ(Child.INJ)
Universe: INJSAWDOC_C=1 and UTZ.HOSPONGT_C IN (1,RF,DK)
Question Text:
Response:
During the past 3 months, was ^SCNAME hospitalized overnight for ^siginj_C?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 161 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <1,2,RF,DK> [goto INJBONES_C]
Question ID: INJ.0160.00.2
Variable name: INJBONES_C
Interview module: INJ(Child.INJ)
Universe: INJSAWDOC_C=1
Question Text:
Response:
Fills:
During the past 3 months, did ^SCNAME have any broken bones as a result of
^siginj_C?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <1,2,RF,DK> [goto INJSTITCH_C]
Question ID: INJ.0170.00.2
Variable name: INJSTITCH_C
Interview module: INJ(Child.INJ)
Universe: INJSAWDOC_C=1
Question Text:
Response:
During the past 3 months, did ^SCNAME get any stitches or staples because of
^siginj_C?
1.
Yes
Page 162 of 223
2.
DK:
RF:
Fills:
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <1,2,RF,DK> [goto INJSCHDAYS_C]
Question ID: INJ.0180.00.2
Variable name: INJSCHDAYS_C
Interview module: INJ(Child.INJ)
Universe: INJLIMIT_C=1
Question Text:
Response:
Fills:
During the past 3 months, how many days of ^DAYCARESCHOOL did
^SCNAME miss because of ^siginj_C? Enter '90' if ^SCNAME missed every day
of daycare or school in the past 3 months
DK:
RF:
Don't Know
Refused
^DAYCARESCHOOL
If
GEN.AGE_FINAL[PX_C]
ge
0
and
GEN.AGE_FINAL[PX_C] le 2, fill: "daycare"
If
GEN.AGE_FINAL[PX_C]
ge
3
and
GEN.AGE_FINAL[PX_C] le 5, fill: "school or
daycare"
ifGEN.AGE_FINAL[PX_C]
ge
6
and
GEN.AGE_FINAL[PX_C] le 17, fill: "school"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <0,RF> [goto next section]
<1-90, DK> [goto INJFUTSCH_C]
Page 163 of 223
Question ID: INJ.0190.00.2
Variable name: INJFUTSCH_C
Interview module: INJ(Child.INJ)
Universe: INJSCHDAYS_C IN (1-90, DK)
Question Text:
Response:
Fills:
Do you expect ^SCNAME to miss any more days of ^DAYCARESCHOOL
because of ^siginj_C that occurred during the past 3 months?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^DAYCARESCHOOL
If
GEN.AGE_FINAL[PX_C]
ge
0
and
GEN.AGE_FINAL[PX_C] le 2, fill: "daycare"
If
GEN.AGE_FINAL[PX_C]
ge
3
and
GEN.AGE_FINAL[PX_C] le 5, fill: "school or
daycare"
ifGEN.AGE_FINAL[PX_C]
ge
6
and
GEN.AGE_FINAL[PX_C] le 17, fill: "school"
^siginj_C
the significant injury/any significant injuries
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: TBI.0010.00.4
Question Text:
Response:
Variable name: TBIINTRO_C
Interview module: TBI(Child.TBI)
The next questions are about head injuries that may have occurred anytime in
^SCNAME's life. Please think about all head injuries, for example, from playing
sports, car accidents, falls, or being hit by something or someone.
1.
Enter 1 to Continue
Page 164 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto TBILOSTCON_C]
Question ID: TBI.0020.00.4
Question Text:
Response:
Fills:
Variable name: TBILOSTCON_C
Interview module: TBI(Child.TBI)
As a result of a blow or jolt to the head, has ^SCNAME ever been knocked out
or lost consciousness?
Read if necessary: Please think about all head injuries,
for example, from playing sports, car accidents, falls, or being hit by something or
someone.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto TBICHKCONC_C]
<2,RF,DK> [goto TBIDAZED_C]
Question ID: TBI.0030.00.4
Variable name: TBIDAZED_C
Interview module: TBI(Child.TBI)
Universe: TBILOSTCON_C IN (2,RF,DK)
Question Text:
Response:
As a result of a blow or jolt to the head, has ^SCNAME ever been dazed or had
a gap in ^hisher_C memory?
Read if necessary: Please think about all head
injuries, for example, from playing sports, car accidents, falls, or being hit by
something or someone.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 165 of 223
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1,2,RF,DK> [goto TBIHEADSYM_C]
Question ID: TBI.0040.00.4
Variable name: TBIHEADSYM_C
Interview module: TBI(Child.TBI)
Universe: TBILOSTCON_C IN (2,RF,DK)
Question Text:
Response:
Fills:
As a result of a blow or jolt to the head, has ^SCNAME had headaches,
vomiting, blurred vision, or changes in mood or behavior?
Read if necessary:
Please think about all head injuries, for example, from playing sports, car accidents,
falls, or being hit by something or someone.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto TBICHKCONC_C]
Page 166 of 223
Question ID: TBI.0050.00.4
Question Text:
Response:
Fills:
Variable name: TBICHKCONC_C
Interview module: TBI(Child.TBI)
Has ^SCNAME ever been checked for a concussion or brain injury by a doctor,
nurse, athletic trainer, or other health professional?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,DK> [goto TBIDRCONC_C]
<2,RF> [goto next section]
Question ID: TBI.0060.00.4
Variable name: TBIDRCONC_C
Interview module: TBI(Child.TBI)
Universe: TBICHKCONC_C IN (1,DK)
Question Text:
Response:
Fills:
Did a doctor, nurse, athletic trainer, or other health professional ever say that
^SCNAME had a concussion or brain injury?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Page 167 of 223
Question ID: PAR.0010.00.1
Variable name: PARINTRO_C
Interview module: PAR(Child.PAR)
Universe: GEN.PARENTS_FINAL[PX_C].NONFOST_CNT_FINAL GE 1
Question Text:
Response:
Fills:
Now I'm going to ask questions about ^SCNAME's parents living here.
'1' to continue.
1.
Enter
Enter 1 to Continue
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto tblPARREL]
Question ID: PAR.0030.00.1
Question Text:
Response:
Fills:
Variable name: RELCHPAR_C
Interview module: PAR(Child.PAR.tblPARREL.bParent)
^AreyouIspar ^SCNAME's biological, adoptive, or step ^fathermother?
1.
2.
3.
4.
DK:
RF:
Biological
Adoptive
Step
Other
Don't Know
Refused
^AreyouIspar
If PX=LNO_SCRESP, fill: "Are you"
else fill: "Is ALIAS[PX]"
^fathermother
If GEN.SEX_FINAL[PX]='1', fill: "father"
If GEN.SEX_FINAL[PX]='2', fill: "mother"
If GEN.SEX_FINAL[PX]='('DK','RF')', fill: "parent"
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 168 of 223
Skip Instructions: <1-4,RF,DK>
if
last
parent
in
GEN.PARENTS_FINAL[PX_C].NONFOST_FINAL [goto MARINTRO_C if any
parent in GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL has MAR_FLG_A
ne 1]
else [goto tblPARBORN.bParent.PARBORN_C
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
Adult.NAT.NATUSBORN_A=empty]
for
first
parent in
where
else [goto next section]
else
[goto
RELCHPAR_C
for
next
GEN.PARENTS_FINAL[PX_C].NONFOST_FINAL]
parent
listed
at
**Note: update skip instructions to tblPARBORN**
Question ID: PAR.0040.00.1
Variable name: MARINTRO_C
Interview module: PAR(Child.PAR)
Universe: At least one parent listed in GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
has GEN.MAR_FLG_A IN (3,empty) or (GEN.MAR_FLG_A=2 and PX=PX_A
and SARESPSC_FLG ne 1)
Question Text:
Response:
The next set of questions are about marriage and cohabitation.
continue.
1.
Enter '1' to
Enter 1 to Continue
Skip Instructions: For the first parent in GEN.PARENTS_FINAL[PX_C].PARENTS _FINAL with
GEN.MAR_FLG_A ne 1,
If GEN.MAR_FLG_A=blank or (GEN.MAR_FLG_A=2 and PX=PX_A and
SARESPSC_FLG ne 1) [goto tblMAR.bParent.MARITAL_C]
Elseif GEN.MAR_FLG_A=3 [goto tblMAR.bPARENT.EVRMARRIED_C]
Page 169 of 223
Question ID: PAR.0090.00.1
Variable name: MARITAL_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: (GEN.MAR_FLG_A[PX] = EMPTY or (GEN.MAR_FLG_A[PX] = 2 and PX =
GEN.PX_A
and
GEN.SARESPSC_FLG
ne
1))
and
auxMARSTATSetByPreviousPerson[PX] ne 2
Question Text:
Response:
Fills:
^AreyouIspar married, living with a partner together as an unmarried couple, or
neither?
1.
2.
3.
DK:
RF:
Married
Living with a partner as an unmarried couple
Neither
Don't Know
Refused
^AreyouIspar
If PX=LNO_SCRESP, fill: "Are you"
else fill: "Is ALIAS[PX]"
Skip Instructions: <1> [goto SPOUSLIV_C]
<2> if GEN.PCNT16PLUSNOSC=1 [got ERR1_MARITAL_C] else [goto
PARTNERWHO_C]
<3,RF,DK> [goto EVRMARRIED_C]
Check Name: ERR1_MARITAL_C
Text:
{signal ERR1_MARITAL_C} Respondent is the only person 16 or older on the
household roster. There is no one else eligible to select.
Hard / Soft Edit: Soft
Universe: MARITAL_C=2 and GEN.PCNT16PLUSNOSC=1
Skip Instructions: Correct: [goto MARITAL_C]
Suppress: [goto EVRMARRIED_C]
Page 170 of 223
Question ID: PAR.0100.00.1
Variable name: SPOUSLIV_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: MARITAL_C=1
Question Text:
Response:
Fills:
Does ^yourPARspouse currently live in the household?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^yourPARspouse
if PX=LNO_SCRESP, fill: "your spouse"
else fill: "ALIAS[PX]'s spouse"
Skip Instructions: <1> if GEN.PCNT16PLUSNOSC=1 [goto ERR1_SPOUSLIV_C] else [goto
SPOUSWHO_C]
<2> [goto SPOUSEP_C]
loop through table for remaining parents else [goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]]
Check Name: ERR1_SPOUSLIV_C
Text:
{signal ERR1_SPOUSLIV_C} Respondent is the only person 16 or older on the
household roster. There is no one else eligible to select.
Hard / Soft Edit: Soft
Universe: MARITAL_C=1 and SPOULIV_C=1 and GEN.PCNT16PLUSNOSC=1
Skip Instructions: Correct: [goto SPOUSLIV_C]
Suppress: loop through table for remaining parent else [goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]]
Page 171 of 223
Question ID: PAR.0110.00.1
Variable name: SPOUSEP_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: SPOUSLIV_C=2
Question Text:
Response:
Fills:
Does ^yourPAR spouse not live here because ^youPAR and ^yourPAR spouse
are legally separated?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^yourPAR
If PX=LNO_SCRESP, fill: "your"
else fill ALIAS[PX] + " 's "
^youPAR
If PX=LNO_SCRESP, fill: "you"
else fill "ALIAS[PX]"
Skip Instructions: <1,2,RF,DK>
loop through table for remaining parents else [goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]
Question ID: PAR.0120.00.1
Variable name: SPOUSWHO_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: SPOUSLIV_C=1
Question Text:
Response:
Which person is ^yourPAR spouse? Enter line number of spouse. Deleted
persons cannot be selected. Enter '0' if respondent wishes to select a deleted
person.
00.
01.
02.
Not on roster
^ALIASNAME[1]
^ALIASNAME[2]
Page 172 of 223
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
DK:
RF:
Fills:
^ALIASNAME[3]
^ALIASNAME[4]
^ALIASNAME[5]
^ALIASNAME[6]
^ALIASNAME[7]
^ALIASNAME[8]
^ALIASNAME[9]
^ALIASNAME[10]
^ALIASNAME[11]
^ALIASNAME[12]
^ALIASNAME[13]
^ALIASNAME[14]
^ALIASNAME[15]
^ALIASNAME[16]
^ALIASNAME[17]
^ALIASNAME[18]
^ALIASNAME[19]
^ALIASNAME[20]
^ALIASNAME[21]
^ALIASNAME[22]
^ALIASNAME[23]
^ALIASNAME[24]
^ALIASNAME[25]
Don't Know
Refused
^yourPAR
If PX=LNO_SCRESP, fill: "your"
else fill ALIAS[PX] + " 's "
Skip Instructions: <1-25> if MARITAL_C=3 "Neither" for person selected at SPOUSWHO_C
[goto ERR1_SPOUSWHO_C]
{person selected at SPOUSWHO_C has conflicting answer of "Neither"
married or living with a partner at MARITAL_C}
elseif SPOUSLIV_C=2 "Outside household" for person selected at
SPOUSWHO_C [goto ERR2_SPOUSWHO_C]
{person selected at SPOUSWHO_C has conflicting answer of married with a
spouse living outside the household at SPOUSLIV_C}
elseif person selected at SPOUSWHO_C ((was already selected previously at
SPOUSWHO_C or PARTNERWHO_C) or (already chose a spouse/partner))
[goto ERR3_SPOUSWHO_C]
{person selected at SPOUSWHO_C is already indicated as married to
someone else/a partner of someone else}
else if GEN.SEX_FINAL[SPOUSWHO_C] IN('1','2') and GEN.SEX_FINAL[PX]
IN ('1','2') [goto SPOUSSEX_C]
Page 173 of 223
else loop through table for remaining parents
else [goto tblPARBORN.bParent.PARBORN_C
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
Adult.NAT.NATUSBORN_A=empty]
else [goto next section]
<0,RF,DK> loop through table for remaining parents
else [goto tblPARBORN.bParent.PARBORN_C
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
Adult.NAT.NATUSBORN_A=empty]
else [goto next section]
for
first
parent in
where
for
first
parent in
where
Check Name: ERR1_SPOUSWHO_C
Text:
{signal ERR1_SPOUSWHO_C} Person selected also has answer of "Neither"
married or living together as an unmarried couple. Please correct.
Hard / Soft Edit: Soft
Universe: if MARITAL_C=3 "Neither" for person selected at SPOUSWHO_C
Skip Instructions: [goto MARITAL_C]
[goto SPOUSWHO_C]
Check Name: ERR2_SPOUSWHO_C
Text:
{signal ERR2_SPOUSWHO_C} Person selected was indicated to have a spouse
living outside the household. Please correct.
Hard / Soft Edit: Soft
Universe: SPOUSLIV_C=2 "Outside household" for person selected at SPOUSWHO_C
Skip Instructions: [goto SPOUSLIV_C]
[goto SPOUSWHO_C]
Page 174 of 223
Check Name: ERR3_SPOUSWHO_C
Text:
{signal ERR3_SPOUSWHO_C} Person selected is already indicated as
^marriedpartner someone else. Please correct.
Hard / Soft Edit: Soft
Fills:
^marriedpartner
if person selected was previously selected at
SPOUSWHO or person selected has MARITAL_C=1
fill
"married
to"
elseif person selected was previously selected at
PARTERWHO
or person
selected
has
MARITAL_C=2 fill "a
partner of"
Universe: person selected at SPOUSWHO_C ((was already selected previously at
SPOUSWHO_C or PARTNERWHO_C) or (already chose a spouse/partner))
Question ID: PAR.0130.00.1
Variable name: SPOUSSEX_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: SPOUSEWHO_C=1-25 and GEN.SEX_FINAL[SPOUSWHO_C] IN (1,2) and
GEN.SEX_FINAL[PX] IN (1,2)
Question Text:
Response:
Fills:
I have previously recorded that ^ParentX ^sex_ParentX and that
^fillSPOUSWHO_C ^sex_SPOUSWHO_C. Is that correct?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^fillSPOUSWHO_C
If SPOUSWHO_C=LNO_SCRESP, fill: "you are"
else fill "ALIAS[SPOUSWHO_C] is"
^sex_SPOUSWHO_C
If SEX[SPOUSWHO_C]=1 fill: "male"
If SEX[SPOUSWHO_C]=2 fill: "female"
^ParentX
If PX=LNO_SCRESP, fill: "you are"
else fill: "ALIAS[PX] is"
^sex_ParentX
If SEX[PX]=1, fill: "male"
If SEX[PX]=2, fill: "female"
Page 175 of 223
Skip Instructions: <1,RF,DK> loop through table for remaining parents else [goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]
<2> [goto FIXSPOUSSEX_C]
Question ID: PAR.0140.00.1
Variable name: FIXSPOUSSEX_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: SPOUSSEX_C=2
Question Text:
Response:
Which was not correct?
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Enter all that apply, separate with commas.
^ALIASNAME[1]
^ALIASNAME[2]
^ALIASNAME[3]
^ALIASNAME[4]
^ALIASNAME[5]
^ALIASNAME[6]
^ALIASNAME[7]
^ALIASNAME[8]
^ALIASNAME[9]
^ALIASNAME[10]
^ALIASNAME[11]
^ALIASNAME[12]
^ALIASNAME[13]
^ALIASNAME[14]
^ALIASNAME[15]
^ALIASNAME[16]
^ALIASNAME[17]
^ALIASNAME[18]
^ALIASNAME[19]
^ALIASNAME[20]
^ALIASNAME[21]
^ALIASNAME[22]
^ALIASNAME[23]
Page 176 of 223
24.
25.
^ALIASNAME[24]
^ALIASNAME[25]
Skip Instructions: <1-25> loop through table for remaining parents else [goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]
Question ID: PAR.0150.00.1
Variable name: PARTNERWHO_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: MARITAL_C=2 and GEN.PCNT16PLUSNOSC ge 2
Question Text:
Response:
Which person is ^yourPAR partner? Enter line number of partner. Deleted
persons cannot be selected. Enter '0' if respondent wishes to select a deleted
person.
00.
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Not on roster
^ALIASNAME[1]
^ALIASNAME[2]
^ALIASNAME[3]
^ALIASNAME[4]
^ALIASNAME[5]
^ALIASNAME[6]
^ALIASNAME[7]
^ALIASNAME[8]
^ALIASNAME[9]
^ALIASNAME[10]
^ALIASNAME[11]
^ALIASNAME[12]
^ALIASNAME[13]
^ALIASNAME[14]
^ALIASNAME[15]
^ALIASNAME[16]
^ALIASNAME[17]
^ALIASNAME[18]
Page 177 of 223
19.
20.
21.
22.
23.
24.
25.
DK:
RF:
Fills:
^ALIASNAME[19]
^ALIASNAME[20]
^ALIASNAME[21]
^ALIASNAME[22]
^ALIASNAME[23]
^ALIASNAME[24]
^ALIASNAME[25]
Don't Know
Refused
^pareja_C
Spanish fill
^yourPAR
If PX=LNO_SCRESP, fill: "your"
else fill ALIAS[PX] + " 's "
Skip Instructions: <1-25> if MARITAL_C=3 "Neither" for person selected at PARTNERWHO_C
[goto ERR1_PARTNERWHO_C]
{person selected at PARTNERWHO_C has conflicting answer of "Neither"
married or living with a partner at MARITAL_C}
elseif SPOUSLIV_C=2 "Outside household" for person selected at
PARTNERWHO_C [goto ERR2_PARTNERWHO_C]
{person selected at PARTNERWHO_C has conflicting answer of married with
a spouse living outside the household at SPOUSLIV_C}
elseif person selected at PARTNERWHO_C ((was already selected previously
at SPOUSWHO_C or PARTNERWHO_C) or (already chose a
spouse/partner)) [goto ERR3_PARTNERWHO_C]
{person selected at PARTNERWHO_C is already indicated as married to
someone else/a partner of someone else}
elseif
GEN.SEX_FINAL[PX]
IN
('1','2')
GEN.SEX_FINAL[PARTNERWHO_C] IN ('1','2')[goto PARTNERSEX_C]
else [goto EVRMARRIED_C]
<0,RF,DK> [goto EVRMARRIED_C]
Page 178 of 223
and
Check Name: ERR1_PARTNERWHO_C
Text:
{signal ERR1_PARTNERWHO_C} Person selected also has answer of "Neither"
married or living together as an unmarried couple. Please correct.
Hard / Soft Edit: Soft
Universe: if MARITAL_C=3 "Neither" for person selected at PARTNERWHO_C
Skip Instructions: [goto MARITAL_C]
[goto PARTNERWHO_C]
Check Name: ERR2_PARTNERWHO_C
Text:
{signal ERR2_PARTNERWHO_C} Person selected was indicated to have a
spouse living outside the household. Please correct.
Hard / Soft Edit: Soft
Universe: SPOUSLIV_C=2
"Outside
PARTNERWHO_C
household"
for
person
selected
at
Skip Instructions: [goto SPOUSLIV_C]
[goto PARTNERWHO_C]
Check Name: ERR3_PARTNERWHO_C
Text:
{signal ERR3_PARTNERWHO_C} Person selected is already indicated as
^marriedpartner someone else. Please correct.
Hard / Soft Edit: Soft
Fills:
^marriedpartner
if person selected was previously selected at
SPOUSWHO or person selected has MARITAL_C=1
fill
"married
to"
elseif person selected was previously selected at
PARTERWHO
or person
selected
has
MARITAL_C=2 fill "a
partner of"
Page 179 of 223
Universe: person selected at PARTNERWHO_C ((was already selected previously at
SPOUSWHO_C or PARTNERWHO_C) or (already chose a spouse/partner))
Question ID: PAR.0160.00.1
Variable name: PARTNERSEX_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: PARTNERWHO_C=1-25
and
GEN.SEX_FINAL[PX]
GEN.SEX_FINAL[PARTNERWHO_C] IN (1,2)
Question Text:
Response:
Fills:
IN
(1,2)
and
I have previously recorded that ^ParentX ^sex_ParentX and that
^fillPARTNERWHO_C ^sex_PARTNERWHO_C. Is that correct?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^ParentX
If PX=LNO_SCRESP, fill: "you are"
else fill: "ALIAS[PX] is"
^sex_ParentX
If SEX[PX]=1, fill: "male"
If SEX[PX]=2, fill: "female"
^fillPARTNERWHO_C
If PARTNERWHO_C=LNO_SCRESP, fill: "you are"
else fill "ALIAS[PARTNERWHO_C] is"
^sex_PARTNERWHO_C If GEN.SEX_FINAL[PARTNERWHO_C]=1 fill: "male"
If
GEN.SEX_FINAL[PARTNERWHO_C]=2
fill:
"female"
Skip Instructions: <1,RF,DK> [goto EVRMARRIED_C]
<2> [goto FIXPARTSEX_C]
Page 180 of 223
Question ID: PAR.0170.00.1
Variable name: FIXPARTSEX_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: PARTNERSEX_C=2
Question Text:
Response:
Which was not correct? Enter all that apply, separate with commas.
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
^ALIASNAME[1]
^ALIASNAME[2]
^ALIASNAME[3]
^ALIASNAME[4]
^ALIASNAME[5]
^ALIASNAME[6]
^ALIASNAME[7]
^ALIASNAME[8]
^ALIASNAME[9]
^ALIASNAME[10]
^ALIASNAME[11]
^ALIASNAME[12]
^ALIASNAME[13]
^ALIASNAME[14]
^ALIASNAME[15]
^ALIASNAME[16]
^ALIASNAME[17]
^ALIASNAME[18]
^ALIASNAME[19]
^ALIASNAME[20]
^ALIASNAME[21]
^ALIASNAME[22]
^ALIASNAME[23]
^ALIASNAME[24]
^ALIASNAME[25]
Skip Instructions: <1-25> [goto EVRMARRIED_C]
Page 181 of 223
Question ID: PAR.0180.00.1
Variable name: EVRMARRIED_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: MARITAL_C IN (2,3,RF,DK) or GEN.MAR_FLG_A[PX]
auxMARSTATSetByPreviousPerson[PX] = 2
Question Text:
Response:
Fills:
=
3
or
^HaveyouHasPAR ever been married?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^HaveyouHasPAR
If PX=LNO_SCRESP, fill: "Have you"
else, fill: "Has ALIAS[PX]"
Skip Instructions: <1>
if
(MARITAL_C=2
or
GEN.PAR_FLG_C[PX]=3
or
GEN.MAR_FLG_A[PX]=3) [goto LEGALSTAT_A]
elseif MARITAL_C=3 [goto WIDIVSEP_A]
else
loop
through
table
for
remaining
parents
else
[goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]
<2,RF,DK>
loop through table for remaining parents else [goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]
Question ID: PAR.0190.00.1
Variable name: LEGALSTAT_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: EVRMARRIED_C=1 and (MARITAL_C=2 or GEN.PAR_FLG_C[PX]=3 or
GEN.MAR_FLG_A[PX]=3)
Question Text:
What is ^yourPAR current legal marital status?
Response:
Page 182 of 223
1.
2.
3.
4.
DK:
RF:
Fills:
Married
Widowed
Divorced
Separated
Don't Know
Refused
^estadocivil_C
Spanish Fill
^yourPAR
If PX=LNO_SCRESP, fill: "your"
else fill ALIAS[PX] + " 's "
Skip Instructions: <1-4,RF,DK>
loop through table for remaining parents else [goto
tblPARBORN.bParent.PARBORN_C
for
first
parent
in
GEN.PARENTS_FINAL[PX_C].PARENTS_FINAL
where
Adult.NAT.NATUSBORN_A=empty] else [goto next section]
Question ID: PAR.0200.00.1
Variable name: WIDIVSEP_C
Interview module: PAR(Child.PAR.tblMAR.bParent)
Universe: EVRMARRIED_C=1 and MARITAL_C=3
Question Text:
Response:
Fills:
^AreyouIspar widowed, divorced, or separated?
1.
2.
3.
DK:
RF:
Widowed
Divorced
Separated
Don't Know
Refused
^AreyouIspar
If PX=LNO_SCRESP, fill: "Are you"
else fill: "Is ALIAS[PX]"
Skip Instructions: <1-3,RF,DK>
loop through table for remaining parents else [goto
FINISH_MAR_C]
Page 183 of 223
Question ID: PAR.0210.00.1
Question Text:
Response:
Variable name: FINISH_MAR_C
Interview module: PAR(Child.PAR)
The Sample Child MAR section is now complete.
1.
Enter 1 to Continue
Skip Instructions: <1> [goto tblPARBORN.bParent.PARBORN_C
GEN.PARENTS_FINAL[PX_C].PARENTS
Adult.NAT.NATUSBORN_A=empty]
else [goto next section]
Question ID: PAR.0230.00.1
Question Text:
Response:
Fills:
Enter '1' to continue.
Variable name: PARBORN_C
for
first
parent in
where
Interview module: PAR(Child.PAR.tblPARBORN.bPerso
^WereyouWaspar born in the United States or a U.S. territory?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^WereyouWaspar
If PX=LNO_SCRESP, fill: "Were you"
else fill: "Was ALIAS[PX]"
Skip Instructions: <1,2,RF,DK> loop through table for remaining parents else [goto next section]
Question ID: PAR.0240.00.1
Variable name: LOCK_PARENTS_VFY_FINAL
Interview module: PAR(Child.PAR)
Question Text:
Response:
1.
Enter 1 to Continue
Skip Instructions: <1> [goto next section]
Page 184 of 223
Question ID: NAT.0010.00.1
Question Text:
Response:
Fills:
Variable name: NATUSBORN_C
Interview module: NAT(Child.NAT)
Was ^SCNAME born in the United States or a U.S. territory?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto NATSTBORN_C]
<2> [goto NATUSYR_C]
[goto next section]
Question ID: NAT.0020.00.1
Variable name: NATSTBORN_C
Interview module: NAT(Child.NAT)
Universe: NATUSBORN_C=1
Question Text:
Response:
Fills:
In what state or U.S. territory was ^SCNAME born?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto CITIZEN_C]
else [goto next section]
Page 185 of 223
Question ID: NAT.0040.00.1
Variable name: NATUSYR_C
Interview module: NAT(Child.NAT)
Universe: NATUSBORN_C=2
Question Text:
Response:
Fills:
In what year did ^SCNAME come to the United States to stay?
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <2000-Current Year,RF,DK>
if NATUSYR_C gt current year [goto ERR1_NATUSYR_C]
if NATUSYR_C lt VFY.DEMBIRYR_C [goto ERR2_NATUSYR_C]
else [goto CITIZEN_C]
Check Name: ERR1_NATUSYR_C
Text:
{check ERR1_NATUSYR_C}
Future year invalid. Please correct.
Hard / Soft Edit: Hard
Universe: NATUSYR_C is a future year
Check Name: ERR2_NATUSYR_C
Text:
{check ERR2_NATUSYR_C}
Year is prior to date of birth. Please correct.
Hard / Soft Edit: Hard
Universe: NATUSYR_C = a year prior to child's birth year
Page 186 of 223
Question ID: NAT.0050.00.1
Variable name: CITIZEN_C
Interview module: NAT(Child.NAT)
Universe: NATUSBORN_C=2 or NATSTBORN_C=American Samoa
Question Text:
Response:
Fills:
Is ^SCNAME a citizen of the United States?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1> [goto NATCTZN_C]
<2,RF,DK> [goto next section]
Question ID: NAT.0060.00.1
Variable name: NATCTZN_C
Interview module: NAT(Child.NAT)
Universe: CITIZEN_C=1
Question Text:
Response:
Fills:
Was ^SCNAME born abroad to an American parent, born abroad and adopted
by an American parent, or did ^SCNAME become a U.S. citizen by
naturalization?
1.
2.
3.
DK:
RF:
Born abroad to American parent
Born abroad and adopted by an American parent
Became U.S. citizen by naturalization
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-3,RF,DK> [goto next section]
Page 187 of 223
Question ID: FEM.0010.00.1
Question Text:
Response:
Fills:
Variable name: FEMINTRO_C
Interview module: FEM(Child.FEM)
Now I have a few questions about ^youandothfam.
1.
Enter '1' to continue.
Enter 1 to Continue
^youandothfam
IF LNO_SCRESP <> PX_A OR
( LNO_SCRESP = PX_A AND ( (SARESPSC_FLG
<> 1 AND EMP_FLG_A=2) OR (EMP_FLG_A =
EMPTY) ) )THEN
fill: "you"
ENDIF
IF PCNT18UP_C >= 2 THEN
IF fill = EMPTY THEN
fill: "other members of your family"
ELSEIF (PCNT18UP_C = 2 AND (
(SAMEFAM_FLG <> 1) OR ( (SAMEFAM_FLG = 1)
AND
(
(SARESPSC_FLG
<>
1
AND
EMP_FLG_A=2) OR (EMP_FLG_A = EMPTY) ) ) ) )
OR (PCNT18UP_C > 2)THEN
fill: "you and other members of your family"
ENDIF
ENDIF
Skip Instructions: [goto tblFEM_C]
Question ID: FEM.0030.00.1
Question Text:
Response:
Variable name: FEMWORK_C
Interview module: FEM(Child.FEM.tblFEM_C.bPerson)
^DoesDoyouALIASNAME work for pay at a job or business?
If the respondent
says ^heshetheywork, but not for pay, at a family-owned job or business, enter '1' for
yes.
1.
Yes
Page 188 of 223
2.
DK:
RF:
Fills:
No
Don't Know
Refused
^DoesDoyouALIASNAMEIf PX=LNO_SCRESP, fill: "Do you" (that is if the
subject of the question is the sample child
respondent, fill: "Do you")
else fill: "Does ^ALIASNAME"
^heshetheywork
elseif GEN.SEX_FINAL=1 fill "he works"
elseif GEN.SEX_FINAL=2 fill "she works"
elseif GEN.SEX_FINAL=DK,RF fill "they work"
Skip Instructions: <1> [goto FEMWKFT_C]
<2,RF,DK> if there is another adult in the family [goto FEMWORK_C] for the
next adult 18+
else [goto next section]
Question ID: FEM.0040.00.1
Variable name: FEMWKFT_C
Interview module: FEM(Child.FEM.tblFEM_C.bPerson)
Universe: FEMWORK_C=1
Question Text:
Response:
Fills:
^DoesDoyouALIASNAME usually work 35 hours or more per week in total at
^hisheryour job or jobs?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^DoesDoyouALIASNAMEIf PX=LNO_SCRESP, fill: "Do you" (that is if the
subject of the question is the sample child
respondent, fill: "Do you")
else fill: "Does ^ALIASNAME"
^hisheryour
If PX=LNO_SCRESP, fill: "your"
(that is, if the subject of the question is the sample
child respondent, fill: "your")
else if SEX_FINAL[PX] = 1, fill "his"
else if SEX_FINAL[PX] = 2, fill "her"
else if SEX_FINAL[PX] in (DK,RF), fill "their"
Page 189 of 223
Skip Instructions: <1,2,RF,DK> if another adult in the family [goto FEMWORK_C] for the next
adult 18+
else [goto next section]
Question ID: INC.0010.00.1
Question Text:
Response:
Fills:
Variable name: INCINTRO_C
Interview module: INC(Child.INC)
The next questions are about your total family income in ^LASTYEAR BEFORE
TAXES. Based on questions asked earlier, we have that ^SCNAME's family
consists of ^INCINTRO_C_fill. Read if necessary: Income is important in
analyzing the health information we collect. For example, with this information, we
can learn whether persons in one income group use certain types of medical services
more or less often than those in another group. Please be assured that, like all other
information you have provided, these answers will remain confidential. Enter '1' to
continue.
1.
Enter 1 to Continue
^LASTYEAR
Fill year prior to current year
^SCNAME
Fill ALIAS of HHSTAT_C=1
^INCINTRO_C_fill
For all people with FAMC_REL_FLG =1 OR
(SAME_REL_FLG=1
for
SC
and
tblRelate_SA.bPerson.RELATE in (1-13,DK,RF)) OR
(FAMA_REL_FLG=1 and 1st person in SC's family
has tblRelate_SA.bPerson.RELATE in (1-13,DK,RF),
fill with their names.
Description: Person was identified as being in the
SC's family at WHOPAR/WHOFOST OR (Sample
Child is related to the Sample Adult and person on
roster was placed in Sample Adult's family based on
answer provided at RELATE), include their name as
part of the list of SC's family.
Include sample child on the list.
If
Household
Respondent
(Roster.HHC.HHRESPAVAIL) is on list of names, fill
"you" for name and place name at the beginning of
the list.
Include the word "and" before the last name on the
list.
Page 190 of 223
Skip Instructions: <1> [goto INCWRKO_C]
Question ID: INC.0020.00.1
Question Text:
Response:
Fills:
Variable name: INCWRKO_C
Interview module: INC(Child.INC)
In ^LASTYEAR, did ^YOUFAM18YRS_C receive income from wages, salaries,
commissions, bonuses, tips, or self-employment? Read if necessary: For the
purpose of this survey, ^SCNAME's family includes ^FAMVERSC_fill
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^YOUFAM18YRS_C
If GEN.PCNT18UP_C=1 fill "you"
else if GEN.PCNT18UP_C GT 1 fill "you or any
family members 18 or older"
^SCNAME
Fill ALIAS of HHSTAT_C=1
^FAMVERSC_fill
Loop through all persons on roster and add to list of
names if FAMILYC_flg = 1
Do not include Sample Child on list.
If
Household
Respondent
(Roster.HHC.HHRESPAVAIL) is on list of names, fill
"you" for name and place name at the beginning of
the list.
If only one person on the list of names and person
ne Roster.HHC.HHRESPAVAIL, follow list with "is".
If more than one person on the list or only one
person on list and person is Household Respondent
(Roster.HHC.HHRESPAVAIL), follow list with "are".
^LASTYEAR
Fill year prior to current year
Page 191 of 223
Skip Instructions: <1,2,RF,DK> [goto INCINTER_C]
Question ID: INC.0030.00.1
Question Text:
Response:
Fills:
Variable name: INCINTER_C
Interview module: INC(Child.INC)
In ^LASTYEAR, did ANY FAMILY MEMBERS receive income from
interest-bearing accounts or investments, dividends from stocks or mutual
funds, net rental income, royalty income, or income from estates and trusts?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^LASTYEAR
Fill year prior to current year
Skip Instructions: <1,2,RF,DK> [goto INCSSRR_C]
Question ID: INC.0031.00.1
Variable name: INCSSRR_C
Interview module: INC(Child.INC)
Universe: INCWRKO_C IN (1,2,DK) or INCINTER_C in (1,2,DK)
Question Text:
Response:
Fills:
Read if necessary: In ^LASTYEAR, did ^YOUFAMHERE_C receive... Income from
Social Security or Railroad Retirement?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^LASTYEAR
Fill year prior to current year
^YOUFAMHERE_C
If GEN.PCNT_C=2 fill "you"
else if GEN.PCNT_C GT2 fill "you or any family
members"
Page 192 of 223
Skip Instructions: <1,2,RF,DK> [goto INCSSISSDI_C]
Question ID: INC.0040.00.1
Variable name: INCSSISSDI_C
Interview module: INC(Child.INC)
Universe: INCWRKO_C IN (1,2,DK) or INCINTER_C in (1,2,DK)
Question Text:
Response:
Fills:
Read if necessary: In ^LASTYEAR, did ANY FAMILY MEMBERS receive...
Supplemental Security Income, SSI, or Social Security Disability Income, SSDI,
which are different from Social Security?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^LASTYEAR
Fill year prior to current year
Skip Instructions: <1> [goto SSISSDIBTH_C]
<2,RF,DK> [goto INCWELF_C]
Question ID: INC.0050.00.1
Variable name: SSISSDIBTH_C
Interview module: INC(Child.INC)
Universe: INCSSISSDI_C=1
Question Text:
Response:
Was this Supplemental Security Income, SSI, Social Security Disability Income,
SSDI, or both?
1.
2.
3.
DK:
RF:
SSI
SSDI
Both SSI and SSDI
Don't Know
Refused
Page 193 of 223
Skip Instructions: <1-3,RF,DK> [goto SSISSDIDSB_C]
Question ID: INC.0060.00.1
Variable name: SSISSDIDSB_C
Interview module: INC(Child.INC)
Universe: INCSSISSDI_C=1
Question Text:
Response:
Was this received as a disability benefit?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Skip Instructions: <1> [goto SSISSDIP_C]
<2,RF,DK> [goto INCWELF_C]
Question ID: INC.0070.00.1
Variable name: SSISSDIP_C
Interview module: INC(Child.INC)
Universe: INCSSISSDI_C=1 and SSISSDIDSB_C=1
Question Text:
Response:
In ^LASTYEAR, who received this disability benefit? Read if necessary: Do
NOT include a benefit received on behalf of someone else. Enter all that apply,
separate with commas.
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
^ALIASNAME[1]
^ALIASNAME[2]
^ALIASNAME[3]
^ALIASNAME[4]
^ALIASNAME[5]
^ALIASNAME[6]
^ALIASNAME[7]
^ALIASNAME[8]
^ALIASNAME[9]
^ALIASNAME[10]
Page 194 of 223
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
DK:
RF:
Fills:
^ALIASNAME[11]
^ALIASNAME[12]
^ALIASNAME[13]
^ALIASNAME[14]
^ALIASNAME[15]
^ALIASNAME[16]
^ALIASNAME[17]
^ALIASNAME[18]
^ALIASNAME[19]
^ALIASNAME[20]
^ALIASNAME[21]
^ALIASNAME[22]
^ALIASNAME[23]
^ALIASNAME[24]
^ALIASNAME[25]
Don't Know
Refused
^LASTYEAR
Fill year prior to current year
Skip Instructions: <1-25,RF,DK> [goto INCWELF_C]
Question ID: INC.0090.00.1
Variable name: INCWELF_C
Interview module: INC(Child.INC)
Universe: INCWRKO_C IN (1,2,DK) or INCINTER_C in (1,2,DK)
Question Text:
Response:
Fills:
In ^LASTYEAR, did ^YOUFAMHERE_C receive... Any public assistance or
welfare payments from the state or local welfare office?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^LASTYEAR
Fill year prior to current year
^YOUFAMHERE_C
If GEN.PCNT_C=2 fill "you"
else if GEN.PCNT_C GT2 fill "you or any family
members"
Page 195 of 223
Skip Instructions: <1,2,RF,DK> [goto INCRETIRE_C]
Question ID: INC.0100.00.1
Variable name: INCRETIRE_C
Interview module: INC(Child.INC)
Universe: INCWRKO_C IN (1,2,DK) or INCINTER_C in (1,2,DK)
Question Text:
Response:
Fills:
Read if necessary: In ^LASTYEAR, did ^YOUFAMHERE_C receive... Income from
retirement, survivor, or disability pensions?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^LASTYEAR
Fill year prior to current year
^YOUFAMHERE_C
If GEN.PCNT_C=2 fill "you"
else if GEN.PCNT_C GT2 fill "you or any family
members"
Skip Instructions: <1,2,RF,DK> [goto INCOTHR_C]
Question ID: INC.0110.00.1
Variable name: INCOTHR_C
Interview module: INC(Child.INC)
Universe: INCWRKO_C IN (1,2,DK) or INCINTER_C in (1,2,DK)
Question Text:
Response:
Read if necessary: In ^LASTYEAR, did ^YOUFAMHERE_C receive... Any other
sources of income such as VA payments from the Veterans Benefits
Administration, unemployment compensation, child support, or alimony?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 196 of 223
Fills:
^LASTYEAR
Fill year prior to current year
^YOUFAMHERE_C
If GEN.PCNT_C=2 fill "you"
else if GEN.PCNT_C GT2 fill "you or any family
members"
Skip Instructions: <1,2,RF,DK> [goto INCTOTAL_C]
Question ID: INC.0120.00.1
Variable name: INCTOTAL_C
Interview module: INC(Child.INC)
Universe: INCWRKO_C IN (1,2,DK) or INCINTER_C in (1,2,DK)
Question Text:
Response:
When answering this next question, please remember to include your income
PLUS the income of all family members living in this household. What is your
best estimate of the total income of all family members from all sources, before
taxes, in the last calendar year? Enter '999995' if the reported income is
$999,995 or greater.
DK:
RF:
Don't Know
Refused
Skip Instructions: <0-999> [goto ERR1_INCTOTAL_C]
<250001-999995> [goto ERR2_INCTOTAL_C]
<1000-250000> [goto next section]
[goto INC250PCT_C]
Check Name: ERR1_INCTOTAL_C
Text:
{signal ERR1_INCTOTAL_C} Do not read to the respondent.
unusually low. Make corrections if necessary.
Hard / Soft Edit: Soft
Fills:
^INCTOTAL_C
Fill value from INCTOTAL_C
Universe: INCTOTAL_C=0-999
Page 197 of 223
^INCTOTAL_C is
Check Name: ERR2_INCTOTAL_C
Text:
{signal ERR2_INCTOTAL_C} Do not read to the respondent.
unusually high. Make corrections if necessary.
^INCTOTAL_C is
Hard / Soft Edit: Soft
Fills:
^INCTOTAL_C
Fill value from INCTOTAL_C
Universe: INCTOTAL_C=250001-999995
Question ID: INC.0140.01.1
Variable name: INC250PCT_C
Interview module: INC(Child.INC)
Universe: INCTOTAL_C IN (DK,RF)
Question Text:
Response:
Fills:
Was your total family income from all sources less than ^250POVERTY_C or
^250POVERTY_C or more?
1.
2.
DK:
RF:
Less than ^250POVERTY_C
^250POVERTY_C or more
Don't Know
Refused
^250POVERTY_C
Fill value stored in Child.INC.INC250PCT_C
Skip Instructions: <1> [goto INC138PCT_C]
<2> if GEN.PCNT_C=2 [goto INC75K_C];
else if GEN.PCNT_C=4 OR GEN.PCNT_C ge 7 [goto INC400PCT_C];
else if GEN.PCNT_C IN (3,5,6) [goto INC100K_C]
[goto next section]
Page 198 of 223
Question ID: INC.0150.01.1
Variable name: INC138PCT_C
Interview module: INC(Child.INC)
Universe: INC250PCT_C=1
Question Text:
Response:
Fills:
Was your total family income from all sources less than ^138POVERTY_C or
^138POVERTY_C or more?
1.
2.
DK:
RF:
Less than ^138POVERTY_C
^138POVERTY_C or more
Don't Know
Refused
^138POVERTY_C
Fill value stored in Child.INC.INC138PCT_C
Skip Instructions: <1> [goto INC100PCT_C]
<2> [goto INC200PCT_C]
[goto next section]
Question ID: INC.0160.01.1
Variable name: INC100PCT_C
Interview module: INC(Child.INC)
Universe: INC138PCT_C=1
Question Text:
Response:
Fills:
Was your total family income from all sources less than ^100POVERTY_C or
^100POVERTY_C or more?
1.
2.
DK:
RF:
Less than ^100POVERTY_C
^100POVERTY_C or more
Don't Know
Refused
^100POVERTY_C
Fill value stored in Child.INC.INC100PCT_C
Skip Instructions: <1,2,RF,DK> [goto next section]
Page 199 of 223
Question ID: INC.0170.01.1
Variable name: INC200PCT_C
Interview module: INC(Child.INC)
Universe: INC138PCT_C=2
Question Text:
Response:
Fills:
Was your total family income from all sources less than ^200POVERTY_C or
^200POVERTY_C or more?
1.
2.
DK:
RF:
Less than ^200POVERTY_C
^200POVERTY_C or more
Don't Know
Refused
^200POVERTY_C
Fill value stored in Child.INC.INC200PCT_C
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: INC.0180.00.1
Variable name: INC75K_C
Interview module: INC(Child.INC)
Universe: INC250PCT_C=2 and GEN.PCNT_C=2
Question Text:
Response:
Was your total family income from all sources less than $75,000 or $75,000 or
more?
1.
2.
DK:
RF:
Less than $75,000
$75,000 or more
Don't Know
Refused
Skip Instructions: <1> [goto INC400PCT_C]
<2> [goto INC100K_C]
[goto next section]
Page 200 of 223
Question ID: INC.0190.00.1
Variable name: INC100K_C
Interview module: INC(Child.INC)
Universe: INC75K_C=2 or (INC250PCT_C=2 and GEN.PCNT_C IN (3,5,6))
Question Text:
Response:
Was your total family income from all sources less than $100,000 or $100,000 or
more?
1.
2.
DK:
RF:
Less than $100,000
$100,000 or more
Don't Know
Refused
Skip Instructions: <1> if GEN.PCNT_C IN (2,5,6) [goto next section]
else if GEN.PCNT_C=3 [goto INC400PCT_C]
<2> if GEN.PCNT_C IN (2,3) [goto INC150K_C]
else if GEN.PCNT_C IN (5,6) [goto INC400PCT_C]
[goto next section]
Question ID: INC.0200.01.1
Variable name: INC400PCT_C
Interview module: INC(Child.INC)
Universe: (INC75K_C=1 or (INC100K_C=1 and GEN.PCNT_C=3) or (INC100K_C=2 and
GEN.PCNT_C IN (5,6)) or (INC250PCT_C=2 and (GEN.PCNT_C=4 or
GEN.PCNT_C ge 7)))
Question Text:
Response:
Fills:
Was your total family income from all sources less than ^400POVERTY_C or
^400POVERTY_C or more?
1.
2.
DK:
RF:
Less than ^400POVERTY_C
^400POVERTY_C or more
Don't Know
Refused
^400POVERTY_C
Fill value stored in Child.INC.INC400PCT_C
Page 201 of 223
Skip Instructions: <1> if GEN.PCNT_C ge 8 [goto INC150K_C]
else [goto next section]
<2> if GEN.PCNT_C IN (2,3) or GEN.PCNT_C ge 7[goto next section]
else if GEN.PCNT_C IN (4,5,6) [goto INC150K_C]
[goto next section]
Question ID: INC.0210.00.1
Variable name: INC150K_C
Interview module: INC(Child.INC)
Universe: (INC100K_C=2 and GEN.PCNT_C IN (2,3)) or (INC400PCT_C=2 and
GEN.PCNT_C IN (4,5)) or (INC400PCT_C=1 and GEN.PCNT_C ge 8)
Question Text:
Response:
Was your total family income from all sources less than $150,000 or $150,000 or
more?
1.
2.
DK:
RF:
Less than $150,000
$150,000 or more
Don't Know
Refused
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: FOO.0010.00.1
Variable name: FSNAP12M_C
Interview module: FOO(Child.FOO)
Universe: ((GEN.SAMEFAM_FLG=1
and
GEN.FOO_FLG_A=blank)
(GEN.SAMEFAM_FLG
ne
1)
or
(GEN.SAMEFAM_FLG=1
GEN.FOO_FLG_A=2 and GEN.SARESPSC_FLG NE 1))
Question Text:
Response:
or
and
At any time in the last 12 months did any family members living here receive
^FSSNAPNM? Read if necessary: This program puts money on a SNAP EBT card
that you can only use to buy food.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 202 of 223
Fills:
^FSSNAPNM
If AL then fill "Food Assistance Program or food
stamp benefits"
If AK then fill "Food Stamp Program (FSP) or food
stamp benefits"
If AZ then fill "Nutrition Assistance or food stamp
benefits"
If AR then fill "SNAP or food stamp benefits"
If CA then fill "CalFresh or food stamp benefits"
If CO then fill "SNAP or food stamp benefits"
If CT then fill "SNAP or food stamp benefits"
If DE then fill "Food Supplement Program or food
stamp benefits"
If DC then fill "SNAP or food stamp benefits"
If FL then fill "Food Assistance Program or food
stamp benefits"
If GA then fill "Food Stamp Program (FSP) or food
stamp benefits"
If HI then fill "SNAP or food stamp benefits"
If ID then fill "Food Stamp Program (FSP) or food
stamp benefits"
If IL then fill "SNAP or food stamp benefits"
If IN then fill "SNAP or food stamp benefits"
If IA then fill "Food Assistance Program or food
stamp benefits"
If KS then fill "Food Assistance Program or food
stamp benefits"
If KY then fill "SNAP or food stamp benefits"
If LA then fill "SNAP or food stamp benefits"
If ME then fill "Food Supplement Program or food
stamp benefits"
If MD then fill "Food Supplement Program or food
stamp benefits"
If MA then fill "SNAP or food stamp benefits"
If MI then fill "Food Assistance Program (FSP) or
food stamp benefits"
If MN then fill "SNAP or food stamp benefits"
If MS then fill "SNAP or food stamp benefits"
If MO then fill "Food Stamp Program (FSP) or food
stamp benefits"
If MT then fill "SNAP or food stamp benefits"
If NE then fill "SNAP or food stamp benefits"
If NV then fill "SNAP or food stamp benefits"
If NH then fill "SNAP or food stamp benefits"
If NJ then fill "NJ SNAP or food stamp benefits"
If NM then fill "SNAP or food stamp benefits"
If NY then fill "SNAP or food stamp benefits"
If NC then fill "Food and Nutrition Services or food
Page 203 of 223
stamp benefits"
If ND then fill "SNAP or food stamp benefits"
If OH then fill "Food Assistance Program or food
stamp benefits"
If OK then fill "SNAP or food stamp benefits"
If OR then fill "SNAP or food stamp benefits"
If PA then fill "SNAP or food stamp benefits"
If RI then fill "SNAP or food stamp benefits"
If SC then fill "SNAP or food stamp benefits"
If SD then fill "SNAP or food stamp benefits"
If TN then fill "SNAP or food stamp benefits"
If TX then fill "SNAP or food stamp benefits"
If UT then fill "SNAP or food stamp benefits"
If VT then fill "3SquaresVT or food stamp benefits"
If VA then fill "SNAP or food stamp benefits"
If WA then fill "Basic Food or food stamp benefits"
If WV then fill "SNAP or food stamp benefits"
If WI then fill "FoodShare Wisconsin or food stamp
benefits"
If WY then fill "SNAP or food stamp benefits"
Skip Instructions: <1> [goto FSNAP30D_C]
<2,RF,DK> if PCNTF1255_C GE 1 or PCNTC05_C GE 1, [goto FWIC12M_C]
else if PCNTC517_C GE 1 [goto FLUNCH12M_C]
else [goto FINISH_FOO_C]
Question ID: FOO.0020.00.3
Variable name: FSNAP30D_C
Interview module: FOO(Child.FOO)
Universe: FSNAP12M_C=1
Question Text:
Did any family members living here receive ^FSSNAPNM in the LAST 30 days?
Read if necessary: This program puts money on a SNAP EBT card that you can only
use to buy food.
Response:
Page 204 of 223
1.
2.
DK:
RF:
Fills:
Yes
No
Don't Know
Refused
^FSSNAPNM
If AL then fill "Food Assistance Program or food
stamp benefits"
If AK then fill "Food Stamp Program (FSP) or food
stamp benefits"
If AZ then fill "Nutrition Assistance or food stamp
benefits"
If AR then fill "SNAP or food stamp benefits"
If CA then fill "CalFresh or food stamp benefits"
If CO then fill "SNAP or food stamp benefits"
If CT then fill "SNAP or food stamp benefits"
If DE then fill "Food Supplement Program or food
stamp benefits"
If DC then fill "SNAP or food stamp benefits"
If FL then fill "Food Assistance Program or food
stamp benefits"
If GA then fill "Food Stamp Program (FSP) or food
stamp benefits"
If HI then fill "SNAP or food stamp benefits"
If ID then fill "Food Stamp Program (FSP) or food
stamp benefits"
If IL then fill "SNAP or food stamp benefits"
If IN then fill "SNAP or food stamp benefits"
If IA then fill "Food Assistance Program or food
stamp benefits"
If KS then fill "Food Assistance Program or food
stamp benefits"
If KY then fill "SNAP or food stamp benefits"
If LA then fill "SNAP or food stamp benefits"
If ME then fill "Food Supplement Program or food
stamp benefits"
If MD then fill "Food Supplement Program or food
stamp benefits"
If MA then fill "SNAP or food stamp benefits"
If MI then fill "Food Assistance Program (FSP) or
food stamp benefits"
If MN then fill "SNAP or food stamp benefits"
If MS then fill "SNAP or food stamp benefits"
If MO then fill "Food Stamp Program (FSP) or food
stamp benefits"
If MT then fill "SNAP or food stamp benefits"
If NE then fill "SNAP or food stamp benefits"
If NV then fill "SNAP or food stamp benefits"
If NH then fill "SNAP or food stamp benefits"
Page 205 of 223
If NJ then fill "NJ SNAP or food stamp benefits"
If NM then fill "SNAP or food stamp benefits"
If NY then fill "SNAP or food stamp benefits"
If NC then fill "Food and Nutrition Services or food
stamp benefits"
If ND then fill "SNAP or food stamp benefits"
If OH then fill "Food Assistance Program or food
stamp benefits"
If OK then fill "SNAP or food stamp benefits"
If OR then fill "SNAP or food stamp benefits"
If PA then fill "SNAP or food stamp benefits"
If RI then fill "SNAP or food stamp benefits"
If SC then fill "SNAP or food stamp benefits"
If SD then fill "SNAP or food stamp benefits"
If TN then fill "SNAP or food stamp benefits"
If TX then fill "SNAP or food stamp benefits"
If UT then fill "SNAP or food stamp benefits"
If VT then fill "3SquaresVT or food stamp benefits"
If VA then fill "SNAP or food stamp benefits"
If WA then fill "Basic Food or food stamp benefits"
If WV then fill "SNAP or food stamp benefits"
If WI then fill "FoodShare Wisconsin or food stamp
benefits"
If WY then fill "SNAP or food stamp benefits"
Skip Instructions: <1,2,RF,DK> if PCNTF1255_C GE 1 or PCNTC05_C GE 1, [goto
FWIC12M_C]
else if PCNTC517_C GE 1 [goto FLUNCH12M_C]
else [goto FINISH_FOO_C]
Page 206 of 223
Question ID: FOO.0030.00.1
Variable name: FWIC12M_C
Interview module: FOO(Child.FOO)
Universe: (PCNTF1255_C ge 1 or PCNTC05_C ge 1) AND
((GEN.SAMEFAM_FLG=1 and GEN.FOO_FLG_A=blank) or
(GEN.SAMEFAM_FLG ne 1) or
(GEN.SAMEFAM_FLG=1
and
GEN.FOO_FLG_A=2
GEN.SARESPSC_FLG ne 1) or
(GEN.SAMFAM_FLG=1
and
GEN.FOO_FLG_A=1
Adult.FOO.FWIC12M_A = EMPTY))
Question Text:
Response:
and
and
At any time in the last 12 months did any family members living here receive
benefits from the WIC program, that is, the Women, Infants, and Children
program?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Skip Instructions: <1,2,RF,DK> If PCNTC517_C GE 1 [goto FLUNCH12M_C]
else [goto FINISH_FOO_C]
Question ID: FOO.0040.00.1
Variable name: FLUNCH12M_C
Interview module: FOO(Child.FOO)
Universe: PCNTC517_C
ge
1
AND
((GEN.SAMEFAM_FLG=1
GEN.FOO_FLG_A=blank) or
(GEN.SAMEFAM_FLG
ne
1)
or
(GEN.SAMEFAM_FLG=1
GEN.FOO_FLG_A=2
and
GEN.SARESPSC_FLG
NE
1)
(GEN.SAMFAM_FLG=1
and
GEN.FOO_FLG_A=1
Adult.FOO.FLUNCH12M_A = EMPTY))
Question Text:
and
and
or
and
At any time in the last 12 months, did ^SCCHILDFAM_C receive free or
reduced-cost breakfasts or lunches at school? Read if necessary: The National
School Lunch Program and the School Breakfast Program provide cash assistance to
states to operate breakfast and lunch programs in schools and residential childcare
institutions. The programs provide low-cost or free breakfasts and lunches to
low-income children in kindergarten through 12th grade.
Response:
Page 207 of 223
1.
2.
DK:
RF:
Fills:
Yes
No
Don't Know
Refused
^SCCHILDFAM_C
if PCNTC517_C=1, fill "^SCNAME",
elseif PCNTC517_Cgt 1, fill "any child in your
family",
Skip Instructions: <1,2,RF,DK> [goto FINISH_FOO_C]
Question ID: FOO.0050.00.1
Variable name: FINISH_FOO_C
Interview module: FOO(Child.FOO)
Universe: FOO_FINISH_C = EMPTY AND
((GEN.SAMEFAM_FLG=1 and GEN.FOO_FLG_A=blank) or
(GEN.SAMEFAM_FLG ne 1) or
(GEN.SAMEFAM_FLG=1
and
GEN.FOO_FLG_A=2
and
GEN.SARESPSC_FLG NE 1) or
(GEN.SAMFAM_FLG=1
and
GEN.FOO_FLG_A=1
and
Adult.FOO.FWIC12M_A = EMPTY and (PCNTF1255_C ge 1 or PCNTC05_C
ge 1)) or
(GEN.SAMFAM_FLG=1
and
GEN.FOO_FLG_A=1
and
Adult.FOO.FLUNCH12M_A = EMPTY and PCNTC517_C ge 1))
Question Text:
Response:
The Sample Child food related programs section is now complete.
continue.
1.
Enter 1 to Continue
Skip Instructions: <1> [goto next section]
Page 208 of 223
Enter '1' to
Question ID: FDS.0010.00.3
Question Text:
Response:
Variable name: FDSINTRO_C
Interview module: FDS(Child.FDS)
These next questions are about whether you were always able to afford the
food you needed in the last 30 days. I'm going to read you several statements
that people have made about their food situation. For these statements, please
tell me whether the statement was often true, sometimes true, or never true for
your family in the last 30 days. Enter '1' to continue.
1.
Enter 1 to Continue
Skip Instructions: <1> [goto FDSRUNOUT_C]
Question ID: FDS.0020.00.3
Question Text:
Response:
Variable name: FDSRUNOUT_C
Interview module: FDS(Child.FDS)
The first statement is "We worried whether our food would run out before we
got money to buy more." Was that often true, sometimes true, or never true for
your family in the last 30 days?
1.
2.
3.
DK:
RF:
Often true
Sometimes true
Never true
Don't Know
Refused
Skip Instructions: <1-3,RF,DK> [goto FDSLAST_C]
Question ID: FDS.0030.00.3
Question Text:
Response:
Variable name: FDSLAST_C
Interview module: FDS(Child.FDS)
"The food that we bought just didn't last, and we didn't have money to get
more." Was that often true, sometimes true, or never true for your family in the
last 30 days?
1.
2.
Often true
Sometimes true
Page 209 of 223
3.
DK:
RF:
Never true
Don't Know
Refused
Skip Instructions: <1-3,RF,DK> [goto FDSBALANCE_C]
Question ID: FDS.0040.00.3
Question Text:
Response:
Variable name: FDSBALANCE_C
Interview module: FDS(Child.FDS)
"We couldn't afford to eat balanced meals." Was that often true, sometimes
true, or never true for your family in the last 30 days?
1.
2.
3.
DK:
RF:
Often true
Sometimes true
Never true
Don't Know
Refused
Skip Instructions: <1-2> [goto FDSSKIP_C]
<3,RF,DK> if FDSRUNOUT_C IN (1,2) OR FDSLAST_C IN (1,2) [goto
FDSSKIP_C];
else [goto next section]
Question ID: FDS.0050.00.3
Variable name: FDSSKIP_C
Interview module: FDS(Child.FDS)
Universe: FDSRUNOUT_C IN (1,2) or FDSLAST_C IN (1,2) or FDSBALANCE_C IN
(1,2)
Question Text:
Response:
In the last 30 days, did ^youorother_C ever cut the size of your meals or skip
meals because there wasn't enough money for food?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Page 210 of 223
Fills:
^youorother_C
If PCNT18UP_C=1 fill "you"
else fill: "you or other adults in your family"
^dejar_C
Spanish Only
Skip Instructions: <1> [goto FDSSKIPDYS_C]
<2,RF,DK> [goto FDSLESS_C]
Question ID: FDS.0060.00.3
Variable name: FDSSKIPDYS_C
Interview module: FDS(Child.FDS)
Universe: FDSSKIP_C = 1
Question Text:
Response:
In the last 30 days, how many days did this happen?
DK:
RF:
Don't Know
Refused
Skip Instructions: <1-30,RF,DK> [goto FDSLESS_C]
Question ID: FDS.0070.00.3
Variable name: FDSLESS_C
Interview module: FDS(Child.FDS)
Universe: (FDSRUNOUT_C IN (1,2) or FDSLAST_C IN (1,2) or FDSBALANCE_C IN
(1,2))
Question Text:
Response:
Fills:
In the last 30 days, did ^youorother_C ever eat less than you felt you should
because there wasn't enough money for food?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^youorother_C
If PCNT18UP_C=1 fill "you"
else fill: "you or other adults in your family"
^COMER_C
Spanish Only
^pensar_C
Spanish Only
Page 211 of 223
Skip Instructions: <1,2,RF,DK> [goto FDSHUNGRY_C]
Question ID: FDS.0080.00.3
Variable name: FDSHUNGRY_C
Interview module: FDS(Child.FDS)
Universe: (FDSRUNOUT_C IN (1,2) or FDSLAST_C IN (1,2) or FDSBALANCE_C IN
(1,2))
Question Text:
Response:
Fills:
In the last 30 days, were ^youorother_C ever hungry but didn't eat because
there wasn't enough money for food?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^youorother_C
If PCNT18UP_C=1 fill "you"
else fill: "you or other adults in your family"
^estar_C
Spanish Only
^COMER_C
Spanish Only
Skip Instructions: <1,2,RF,DK> [goto FDSWEIGHT_C]
Question ID: FDS.0090.00.3
Variable name: FDSWEIGHT_C
Interview module: FDS(Child.FDS)
Universe: (FDSRUNOUT_C IN (1,2) or FDSLAST_C IN (1,2) or FDSBALANCE_C IN
(1,2))
Question Text:
Response:
In the last 30 days, did ^youorother_C lose weight because there wasn't
enough money for food?
1.
Yes
Page 212 of 223
2.
DK:
RF:
Fills:
No
Don't Know
Refused
^perder_C
Spanish Only
^youorother_C
If PCNT18UP_C=1 fill "you"
else fill: "you or other adults in your family"
Skip Instructions: <1> [goto FDSNOTEAT_C]
<2,RF,DK> if FDSSKIP_C=1 or FDSLESS_C=1 or FDSHUNGRY_C=1 [goto
FDSNOTEAT_C]; else [goto next section]
Question ID: FDS.0100.00.3
Variable name: FDSNOTEAT_C
Universe: FDSSKIP_C=1
OR
FDSWEIGHT_C=1
Question Text:
Response:
Fills:
FDSLESS_C=1
Interview module: FDS(Child.FDS)
OR
FDSHUNGRY_C=1
OR
In the last 30 days, did ^youorother_C ever not eat for a whole day because
there wasn't enough money for food?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^pasar_C
Spanish Only
^youorother_C
If PCNT18UP_C=1 fill "you"
else fill: "you or other adults in your family"
Skip Instructions: <1> [goto FDSNEDAYS_C]
<2,RF,DK> [goto next section]
Page 213 of 223
Question ID: FDS.0110.00.3
Variable name: FDSNEDAYS_C
Interview module: FDS(Child.FDS)
Universe: FDSNOTEAT_C=1
Question Text:
Response:
In the last 30 days, how many days did this happen?
DK:
RF:
Don't Know
Refused
Skip Instructions: <1-30,RF,DK> [goto next section]
Question ID: HOU.0010.00.1
Variable name: HOUYRSLIV_C
Interview module: HOU(Child.HOU)
Universe: GEN.AGE_FINAL[PX_C] ge 1 and GEN.AGE_FINAL[PX_C] le 17
Question Text:
Response:
Fills:
About how long has ^SCNAME lived in this house/apartment?
1.
2.
3.
4.
DK:
RF:
Less than 1 year
1 to 3 years
4 to 10 years
11 years or more
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1-4,RF,DK> if ((SAMEFAM_FLG=1 and HOU_FLG_A=blank) or
(SAMEFAM_FLG ne 1) or (SAMEFAM_FLG=1 and HOU_FLG_A=2 and
SARESPSC_FLG ne 1)) [goto HOUTENURE_C]
else [goto next section]
If
GEN.AGE_FINAL[PX_C]
ERR1_HOUYRSLIV_C]
lt
Page 214 of 223
11
and
HOUYRSLIV_C=4
[goto
Check Name: ERR1_HOUYRSLIV_C
Text:
{check ERR1_HOUYRSLIV_C} Years in house/apartment exceedchild's age. Please
correct.
Hard / Soft Edit: Hard
Universe: (AGE_FINAL GE 1 AND AGE_FINAL LE 3, and HOUYRSLIV_C in (3,4)) or
(AGE_FINAL LE 10, and HOUYRSLIV_C=4)
Question ID: HOU.0020.00.1
Variable name: HOUTENURE_C
Interview module: HOU(Child.HOU)
Universe: (((SAMEFAM_FLG=1 and HOU_FLG_A=blank) or (SAMEFAM_FLG ne 1) or
(SAMEFAM_FLG=1 and HOU_FLG_A=2 and SARESPSC_FLG ne 1)) )
Question Text:
Response:
Fills:
Is this house/apartment owned or rented by you ^SOMEFAM_C?
a mortgage, record as owned.
1.
2.
3.
DK:
RF:
If house has
Owned or being bought
Rented
Other arrangement
Don't Know
Refused
^SOMEFAM_C
If PCNT_C=2 fill: blank
If PCNT_C gt2 fill: "or someone in your family"
Skip Instructions: <1,3,RF,DK> [goto next section]
<2> [got HOUGVASST_C]
Page 215 of 223
Question ID: HOU.0030.00.1
Variable name: HOUGVASST_C
Interview module: HOU(Child.HOU)
Universe: HOUTENURE_C=2 and (((SAMEFAM_FLG=1 and HOU_FLG_A=blank) or
(SAMEFAM_FLG ne 1) or (SAMEFAM_FLG=1 and HOU_FLG_A=2 and
SARESPSC_FLG ne 1)))
Question Text:
Response:
Is anyone in your family paying lower rent because the Federal, State, or local
government is paying part of the cost? Read if necessary: Federal, State, or
Local government housing programs for persons with low income may take many
forms. Government housing assistance could come from monetary assistance to help
pay rent, a program called "Section 8," direct payments to landlords, vouchers, or
other types of assistance from a local housing authority. Living in public housing is
considered housing assistance from the government.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: REC.0010.00.1
Question Text:
Response:
Fills:
Variable name: LNKFNAME_C
Interview module: REC(Child.REC)
Ask or verify: What is ^SCNAME's full name?
DK:
RF:
Enter first name.
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: [goto LNKMNAME_C]
Page 216 of 223
Question ID: REC.0020.00.1
Question Text:
Response:
Variable name: LNKMNAME_C
Enter middle name.
DK:
RF:
Interview module: REC(Child.REC)
Press "Enter" to skip to last name if child has no middle name.
Don't Know
Refused
Skip Instructions: [goto LNKLNAME_C]
Question ID: REC.0030.00.1
Question Text:
Response:
Variable name: LNKLNAME_C
Interview module: REC(Child.REC)
Enter last name.
DK:
RF:
Don't Know
Refused
Skip Instructions: [goto next section]
Question ID: TEL.0010.00.1
Variable name: TELCURWRK_C
Interview module: TEL(Child.TEL)
Universe: (SAMEFAM_FLG=1 and TELCURWRK_A=empty) or (SAMEFAM_FLG=1 and
TELCURWRK_A IN (DK,RF) and SARESPSC_FLG ne 1) or (SAMEFAM_FLG
ne 1)
Question Text:
Response:
Fills:
Is there at least one telephone INSIDE ^SCNAME's home that is currently
working and is not a cell phone?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Page 217 of 223
Skip Instructions: <1,2,RF,DK> [goto PHONELIVE_C]
Question ID: TEL.0020.00.1
Variable name: PHONELIVE_C
Interview module: TEL(Child.TEL)
Universe: TELCEL_A ne 1 and ((SAMEFAM_FLG=1 and PHONELIVE_A=blank) or
(SAMEFAM_FLG=1 and PHONELIVE_A IN (DK,RF) and SARESPSC_FLG
ne 1) or (SAMEFAM_FLG ne 1))
Question Text:
Response:
Fills:
Does ^SCNAME live with anyone who has a working cell phone?
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Question ID: LNK.0010.00.1
Question Text:
Variable name: LNKINTRO_C
Interview module: LNK(Child.LNK)
?[F1] We would like the last four digits of ^SCNAME's Social Security Number.
This information will help us link ^hisher_C survey data with other
health-related records of other government agencies, and allow us to conduct
additional research without taking up your time with more questions. The
National Center for Health Statistics (NCHS) uses this information for research
purposes only. Providing this information is voluntary. There will be no effect
on ^SCNAME's benefits if you do not provide this information. Federal laws
authorize us to ask for this information. Like all other answers you have
provided, this information will remain confidential.
Read if necessary: The
specific federal laws protecting ^SCNAME's privacy and the confidentiality of
^hisher_C data are the Public Health Service Act (Title 42, U.S.C., Section 242m(d)),
the Confidential Information Protection and Statistical Efficiency Act of 2018 (Title lll,
Public Law No. 115-435), and the Privacy Act of 1974 (5 U.S.C. § 552a). Read if
necessary: NCHS collects health-related data from other government agencies,
including records from Medicare and Medicaid Services, Social Security, housing,
and death certificates. If you agree, NCHS will attempt to link records such as these
with ^SCNAME's survey data to give a fuller picture of the kinds of things that affect
health. NCHS does this linkage. ^SCNAME's name and ^hisher_C information are
not given to these agencies. Read if necessary: If asked: ^SCNAME's data will not
be linked to records from the IRS (Internal Revenue Service) or ICE (Immigration and
Customs Enforcement). Enter '1' to continue.
Response:
Page 218 of 223
1.
Fills:
Enter 1 to Continue
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Skip Instructions: <1> [goto SSN4_C]
Question ID: LNK.0020.00.1
Question Text:
Response:
Fills:
Variable name: SSN4_C
Interview module: LNK(Child.LNK)
?[F1] What are the last four digits of ^SCNAME's Social Security Number?
Read if necessary: Providing this information is voluntary. There will be no effect on
^SCNAME's benefits if you do not provide this information. Federal laws authorize us
to ask for this information. Like all other information you have provided, these
answers will remain confidential. Read if asked about specific laws: The specific
federal laws protecting ^SCNAME's privacy and the confidentiality of ^hisher_C data
are the Public Health Service Act, which is Title 42, U.S.C., Section 242m(d); the
Confidential Information Protection and Statistical Efficiency Act of 2018, which is
Title lll, Public Law No. 115-435; and the Privacy Act of 1974, which is 5 U.S.C. §
552a. Enter 'N' if no Social Security Number.
DK:
RF:
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
^hisher_C
if GEN.SEX_FINAL[PX_C]=1 fill "his";
else if GEN.SEX_FINAL[PX_C]=2 fill "her";
else if GEN.SEX_FINAL[PX_C] in (blank,DK,RF): fill
"their"
Page 219 of 223
Skip Instructions: if SSN4_C=Adult.LNK.SSN4_A [goto ERR1_SSN4_C]
elseif SSN4_C=000-999 [goto ERR2_SSN4_C]
elseif SSN4_C NOT IN (N,DK,RF,000-999,0001-9999) [goto ERR3_SSN4_C]
<0001-9999> [goto THANKS_C]
[goto RLINK_C]
Check Name: ERR1_SSN4_C
Text:
{signal ERR1_SSN4_C} The last four digits of ^SCNAME's Social Security Number
are the same as the last four digits of ^SANAME's Social Security Number. Please
verify.
Hard / Soft Edit: Soft
Fills:
^SCNAME
Fill ALIAS of HHSTAT_C=1
^SANAME
Sample Adult's name
Universe: Adult.LNK.SSN4_A=SSN4_C
Check Name: ERR2_SSN4_C
Text:
{check ERR2_SSN4_C} You must enter all four of the last four digits of the Social
Security Number. Please correct.
Hard / Soft Edit: Hard
Universe: SSN4_C=000-999
Page 220 of 223
Check Name: ERR3_SSN4_C
Text:
{check ERR3_SSN4_C} The last 4 digits of a SSN may be between 0001-9999.
For a respondent who does not want to provide the SSN, enter 'Ctrl D' or 'Ctrl R' for
'Don't Know' or 'Refused.' If a respondent does not have a SSN, enter 'N'.
Please correct.
Hard / Soft Edit: Hard
Universe: SSN4_C NOT IN ('N','RF','DK','000-999','0001-9999')
Question ID: LNK.0030.00.1
Variable name: RLINK_C
Interview module: LNK(Child.LNK)
Universe: SSN4_C IN (N,RF,DK)
Question Text:
Response:
Fills:
?[F1] May we try to link ^SCNAME's survey data without a Social Security
Number? Read if necessary: Any data obtained are protected by strict federal
laws, including the Public Health Service Act, which is Title 42, U.S.C., Section
242m(d); the Confidential Information Protection and Statistical Efficiency Act of
2018, which is Title lll, Public Law No. 115-435; and the Privacy Act of 1974, which is
5 U.S.C. § 552a.
1.
2.
DK:
RF:
Yes
No
Don't Know
Refused
^SCNAME
Fill ALIAS of HHSTAT_C=1
Skip Instructions: <1,2,RF,DK> [goto next section]
Page 221 of 223
Question ID: THX.0010.00.1
Question Text:
Response:
Variable name: THANKS_C
Interview module: THX(Child.THX)
Thank respondent for answering these questions. If there is a Sample Adult interview
to complete, ask for appropriate person to respond to these questions. Enter '1' to
continue.
1.
Enter 1 to Continue
Skip Instructions: <1> [goto SCRESP_FNAME]
Question ID: THX.0020.01.1
Question Text:
Response:
Variable name: SCRESP_FNAME
Interview module: THX(Child.THX)
Ask or verify: In case I or someone from my office needs to get in touch with
you, we need your full name. What is your full name? Enter first name.
DK:
RF:
Don't Know
Refused
Skip Instructions: [goto SCRESP_LNAME]
Question ID: THX.0020.02.1
Question Text:
Response:
Variable name: SCRESP_LNAME
Enter last name.
DK:
RF:
Don't Know
Refused
Skip Instructions: [goto next section]
Page 222 of 223
Interview module: THX(Child.THX)
Check Name: Child parallel tab finished
Text:
You have finished the Child parallel tab. Press "Enter" or click OK to go back to the
main interview path. Then press the "END" key to jump to the next unanswered
question.
Hard / Soft Edit: Soft
Skip Instructions: Closing the box takes the user to the CASESTATUS screen
Page 223 of 223
| File Type | application/pdf |
| File Modified | 2020-09-24 |
| File Created | 2020-09-23 |