Questionnaire Public Report

04/09/2019 03:31:00 PM

Cohort:

National Longitudinal Survey of Youth 1979

Round:

NLSY79 Round 28

Instrument :

R28 Youth Main Field

  1. Health

 

 

Q11-1AAA

Section: Health

([total number of employers reported] >= 1)

COMMENT: Is there at least one employer listed?

If Answer = 1 Then Go To Q11-1B

Default Next:

Q11-4

Lead-In:

Q9-FILTER [1:1], Q9-2A [1:1], Q9-67A [1:1], Q9-72 [Default], Q9-SKID-15C [Default], MS1-LOOP-END_MS1 [Default]


 

Q11-1B

Section: Health

[is this job current?(1)]==1

COMMENT: STATUS (Merged,%datevar%,1 WAS R WORKING IN WEEK BEFORE INTERVIEW WEEK?

If Answer = 1 Then Go To Q11-4

Default Next:

Q11-3

Lead-In:

Q11-1AAA [1:1]


 

Q11-3

Section: Health

(INTERVIEWER: ENTERING HEALTH SECTION)

Would your health keep you from working on a job for pay now?

 

1   YES   ...(Go To Q11-5A)

 

0   NO

 

Default Next:

Q11-4

Lead-In:

Q11-1B [Default]


 

Q11-4

Section: Health

[Are you/Would you be] limited in the kind of work you [(could)] do on a job for pay because of your health?

 

1   YES

 

0   NO

 

Q11-5

Section: Health

[Are you/Would you be] limited in the amount of work you [(could)] do because of your health?

 

1   YES

 

0   NO

 

Default Next:

Q11-5A

Lead-In:

Q11-4 [Default]


 

Q11-5A

Section: Health

(([Would your health keep you from working now?]==1) || ([Limited in kind of work due to accident or injury?]==1) || ([Limited in amount of work due to accident or injury?]==1))

COMMENT: Check if R has reported a health limitation which affects work.

If Answer = 1 Then Go To Q11-7

Default Next:

PAIN_1

Lead-In:

Q11-3 [1:1], Q11-5 [Default]


 

Q11-7

Section: Health

Since what month and year have you had this limitation?

 

1   SELECT TO ENTER DATE   ...(Go To Q11-8)

 

0   IF VOLUNTEERED: 'ALL MY LIFE'

 

Default Next:

PAIN_1

Lead-In:

Q11-5A [1:1]


 

Q11-8

Section: Health

INTERVIEWER: ENTER DATE FROM WHICH R HAS HAD THIS LIMITATION.

 

 

Month

Year

Day

 

 

Default Next:

PAIN_1

Lead-In:

Q11-7 [1:1]


 

PAIN_1

Section: Health

In the past 30 days, have you suffered from chronic pain from an illness or medical condition?

 

1   YES   ...(Go To PAIN_2)

 

0   NO

 

Default Next:

Q11-CARE-CHECK

Lead-In:

Q11-5A [Default], Q11-7 [Default], Q11-8 [Default]


 

PAIN_2

Section: Health

How often do you experience pain? Do you experience it...? (READ LIST)

 

6   All the time

 

5   Daily

 

4   Several times a week

 

3   Approximately once a week

 

2   Several times a month

 

1   Approximately once a month

 

0   Less often than once a month

 

Default Next:

Q11-CARE-CHECK

Lead-In:

PAIN_1 [1:1]


 

Q11-CARE-CHECK

Section: Health

RECCOUNT([Final Household Roster])

COMMENT: copy all the people from the info sheet to the roster

If Answer = 0 Then Go To Q11-9

Default Next:

Q11-CARE-1

Lead-In:

PAIN_1 [Default], PAIN_2 [Default]


 

Q11-CARE-1

Section: Health

Is anyone in your household (besides you) disabled or chronically ill?

 

1   YES   ...(Go To Q11-CARE-2)

 

0   NO

 

Default Next:

Q11-CARE-4

Lead-In:

Q11-CARE-CHECK [Default]


 

Q11-CARE-2

Section: Health

Which household member is this?

(INTERVIEWER: PROBE IF THERE IS MORE THAN ONE HOUSEHOLD MEMBER: "Is there anyone else?")

Default Next:

Q11-CARE-3

Lead-In:

Q11-CARE-1 [1:1]


 

Q11-CARE-3

Section: Health

Do you regularly spend time helping or taking care of [this person/these people]?

 

1   YES   ...(Go To Q11-CARE-3B)

 

0   NO

 

Default Next:

Q11-CARE-4

Lead-In:

Q11-CARE-2 [Default]


 

Q11-CARE-3B

Section: Health

About how many hours per week do you spend doing this?

ENTER # OF HOURS 

 

Default Next:

Q11-CARE-4

Lead-In:

Q11-CARE-3 [1:1]


 

Q11-CARE-4

Section: Health

Do you regularly spend time helping or taking care of a relative or friend who does not live in your household?

 

1   YES   ...(Go To Q11-CARE-4B)

 

0   NO

 

Default Next:

Q11-9

Lead-In:

Q11-CARE-1 [Default], Q11-CARE-3 [Default], Q11-CARE-3B [Default]


 

Q11-CARE-4B

Section: Health

About how many hours per week do you spend doing this?

ENTER # OF HOURS 

 

Default Next:

Q11-9

Lead-In:

Q11-CARE-4 [1:1]


 

Q11-9

Section: Health

How much do you weigh?

(ENTER POUNDS)

 

 

Default Next:

Q11-10_A

Lead-In:

Q11-CARE-CHECK [0:0], Q11-CARE-4 [Default], Q11-CARE-4B [Default]


 

Q11-10_A

Section: Health

How tall are you?

(INTERVIEWER: IF R ANSWERS ONLY IN FEET OR ONLY IN INCHES, LEAVE OTHER FIELD BLANK.)

ENTER FEET: 

 

Q11-10_B

Section: Health

 

ENTER INCHES: 

 

Default Next:

Q11-GENHLTH_1A_1

Lead-In:

Q11-10_A [Default]


 

Q11-GENHLTH_1A_1

Section: Health

How often do you do vigorous activities for at least 10 minutes that cause heavy sweating or large increases in breathing or heart rate?

 

1   MORE THAN ONCE A WEEK

 

2   ONCE A WEEK

 

3   ONE TO THREE TIMES A MONTH

 

4   HARDLY EVER OR NEVER

 

7   EVERY DAY

 

9   UNABLE TO DO THIS ACTIVITY

 

Q11-GENHLTH_2A_1A

Section: Health

How often do you do light or moderate activities for at least 10 minutes that cause only light sweating or slight to moderate increase in breathing or heart rate?

 

1   MORE THAN ONCE A WEEK

 

2   ONCE A WEEK

 

3   ONE TO THREE TIMES A MONTH

 

4   HARDLY EVER OR NEVER

 

7   EVERY DAY

 

9   UNABLE TO DO THIS ACTIVITY

 

Default Next:

Q11-GENHLTH_3A_1A

Lead-In:

Q11-GENHLTH_1A_1 [Default]


 

Q11-GENHLTH_3A_1A

Section: Health

How often do you do physical activities specifically designed to strengthen your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)

 

1   MORE THAN ONCE A WEEK

 

2   ONCE A WEEK

 

3   ONE TO THREE TIMES A MONTH

 

4   HARDLY EVER OR NEVER

 

7   EVERY DAY

 

9   UNABLE TO DO THIS ACTIVITY

 

Q11-GENHLTH-PRV1

Section: Health

Do you have a health care provider that you can see when you are sick or need advice about your health?

 

1   YES   ...(Go To Q11-GENHLTH-PRV2)

 

0   NO

 

Default Next:

Q11-GENHLTH_4A

Lead-In:

Q11-GENHLTH_3A_1A [Default]


 

Q11-GENHLTH-PRV2

Section: Health

What kind of place do you go to most often for this care—is it a clinic, doctor's office, emergency room, or some other place?

 

1   CLINIC OR HEALTH CENTER

 

2   DOCTOR'S OFFICE OR HMO

 

3   HOSPITAL EMERGENCY ROOM

 

4   SOME OTHER PLACE

 

5   DON'T GO TO ONE PLACE MOST OFTEN

 

Default Next:

Q11-GENHLTH_4A

Lead-In:

Q11-GENHLTH-PRV1 [1:1]


 

Q11-GENHLTH_4A

Section: Health

About how long has it been since your last general physical exam or routine checkup by a medical doctor or other health professional? Do not include a visit about a specific problem.

Has it been...(
READ CATEGORIES AS NECESSARY)?

 

0   Never

 

1   A year ago or less

 

2   More than 1 year but not more than 2 years

 

3   More than 2 years but not more than 3 years

 

4   More than 3 years but not more than 5 years

 

5   Over 5 years ago

 

Default Next:

Q11-GENHLTH_4B

Lead-In:

Q11-GENHLTH-PRV1 [Default], Q11-GENHLTH-PRV2 [Default]


 

Q11-GENHLTH_4B

Section: Health

[RESPONDENT GENDER]

If Answer = 1 Then Go To Q11-GENHLTH_4C_M

Default Next:

Q11-GENHLTH_4C_F

Lead-In:

Q11-GENHLTH_4A [Default]


 

Q11-GENHLTH_4C_M

Section: Health

During the past 24 months, that is since [{refdate_24mo~X}], have you had any of the following medical tests or procedures?

 

- A flu shot?

 

- A blood test for cholesterol?

 

- A blood test for diabetes or blood sugar levels?

 

- An examination of your prostate to screen for cancer?

 

- A colonoscopy or other test to screen for colorectal cancer?

 

- Have you had your blood pressure measured?

 

 

1   YES

 

0   NO

 

Default Next:

Q11-GENHLTH_4D_M

Lead-In:

Q11-GENHLTH_4B [1:1]


 

Q11-GENHLTH_4D_M

Section: Health

Are you currently taking...

 

- ...aspirin regularly to lower the risk of a heart attack or other cardiovascular event?

 

- ...any medications to control your blood sugar level?

 

- ...any medications to control your blood pressure?

 

 

1   YES

 

0   NO

 

Default Next:

Q11-GENHLTH_4E_M

Lead-In:

Q11-GENHLTH_4C_M [Default]


 

Q11-GENHLTH_4E_M

Section: Health

During the past 24 months, that is since [{refdate_24mo~X}], have you seen or talked to either of the following types of doctors?

 

- A dentist for a routine check-up or exam?

 

- An optician or opthamologist for a routine eye exam?

 

 

1   YES

 

0   NO

 

Default Next:

Q11-GENHLTH_4F

Lead-In:

Q11-GENHLTH_4D_M [Default]


 

Q11-GENHLTH_4C_F

Section: Health

During the past 24 months, that is since [{refdate_24mo~X}], have you had any of the following medical tests or procedures?

 

- A flu shot?

 

- A blood test for cholesterol?

 

- A blood test for diabetes or blood sugar levels?

 

- A mammogram or x-ray of the breast to search for cancer?

 

- A PAP smear?

 

- A bone density test to screen for osteoporosis?

 

- A colonoscopy or other test to screen for colorectal cancer?

 

- Have you had your blood pressure measured?

 

 

1   YES

 

0   NO

 

Default Next:

Q11-GENHLTH_4D_F

Lead-In:

Q11-GENHLTH_4B [Default]


 

Q11-GENHLTH_4D_F

Section: Health

Are you currently taking..

 

- ...aspirin regularly to lower the risk of a heart attack or other cardiovascular event?

 

- ...any medications to control your blood sugar level?

 

- ...any medications to control your blood pressure?

 

- ...any hormone replacement therapy or "HRT" medications?

 

- ...any prescription medication to treat or lower the risk of developing osteoporosis?

 

 

1   YES

 

0   NO

 

Default Next:

Q11-GENHLTH_M_CHECK

Lead-In:

Q11-GENHLTH_4C_F [Default]


 

Q11-GENHLTH_M_CHECK

Section: Health

[{PREV_MENOPAUSE}]== 1

COMMENT: R has reported date of menopause

If Answer = 1 Then Go To Q11-GENHLTH_4E_F

Default Next:

Q11_GENHLTH_M1

Lead-In:

Q11-GENHLTH_4D_F [Default]


 

Q11_GENHLTH_M1

Section: Health

Have you had a menstrual period in the past 12 months?

 

1   YES   ...(Go To Q11-GENHLTH_M1_CHECK)

 

0   NO

 

Default Next:

Q11-GENHLTH_M2

Lead-In:

Q11-GENHLTH_M_CHECK [Default]


 

Q11-GENHLTH_M1_CHECK

Section: Health

[Q11-GENHLTH_4D_F~4]== 1

COMMENT: R is currently taking hormone replacement therapy

If Answer = 1 Then Go To Q11-GENHLTH_M5

Default Next:

Q11-GENHLTH_4E_F

Lead-In:

Q11_GENHLTH_M1 [1:1]


 

Q11-GENHLTH_M2

Section: Health

How old were you when you had your last period?

 

1   ENTER AGE   ...(Go To Q11-GENHLTH_M2A)

 

2   NEVER HAD A PERIOD

 

Default Next:

Q11-GENHLTH_4E_F

Lead-In:

Q11_GENHLTH_M1 [Default]


 

Q11-GENHLTH_M2A

Section: Health

(How old were you when you had your last period?)

 

 

Default Next:

Q11-GENHLTH_M3

Lead-In:

Q11-GENHLTH_M2 [1:1]


 

Q11-GENHLTH_M3

Section: Health

What is the reason that your period stopped at that age?

 

1   Menopause   ...(Go To Q11-GENHLTH_4E_F)

 

2   Hysterectomy (that is, surgery to remove your uterus and/or ovaries)

 

3   Medical conditions or treatments such as estrogen blockers or chemotherapy   ...(Go To Q11-GENHLTH_4E_F)

 

4   OTHER (SPECIFY)   ...(Go To Q11-GENHLTH_4E_F)


If Answer >= -2 AND Answer <= -1 Then Go To Q11-GENHLTH_4E_F

Default Next:

Q11-GENHLTH_M4

Lead-In:

Q11-GENHLTH_M2A [Default]


 

Q11-GENHLTH_M4

Section: Health

Did your hysterectomy involve removal of both ovaries, one ovary, or just your uterus?

 

1   Both ovaries were removed

 

2   Only one ovary was removed

 

3   Only uterus was removed

 

Default Next:

Q11-GENHLTH_4E_F

Lead-In:

Q11-GENHLTH_M3 [Default]


 

Q11-GENHLTH_M5

Section: Health

Prior to taking hormone replacement therapy or "HRT" medications, had you had a menstrual period in the past 12 months?

 

1   YES   ...(Go To Q11-GENHLTH_4E_F)

 

0   NO

 

Default Next:

Q11-GENHLTH_M6

Lead-In:

Q11-GENHLTH_M1_CHECK [1:1]


 

Q11-GENHLTH_M6

Section: Health

How old were you when you had your last period prior to starting HRT?

 

1   ENTER AGE   ...(Go To Q11-GENHLTH_M6A)

 

2   NEVER HAD A PERIOD

 

Default Next:

Q11-GENHLTH_4E_F

Lead-In:

Q11-GENHLTH_M5 [Default]


 

Q11-GENHLTH_M6A

Section: Health

(How old were you when you had your last period prior to starting HRT?)

 

 

Default Next:

Q11-GENHLTH_4E_F

Lead-In:

Q11-GENHLTH_M6 [1:1]


 

Q11-GENHLTH_4E_F

Section: Health

During the past 24 months, that is since [{refdate_24mo~X}], have you seen or talked to any of the following types of doctors?

 

- An obstetrician, gynecologist or other doctor who specializes in women's health?

 

- A dentist for a routine check-up or exam?

 

- An optician or ophthalmologist for a routine eye exam?

 

 

1   YES

 

0   NO

 

Default Next:

Q11-GENHLTH_4F

Lead-In:

Q11-GENHLTH_M_CHECK [1:1], Q11-GENHLTH_M3 [-2:-1], Q11-GENHLTH_M3 [1:1], Q11-GENHLTH_M3 [3:4], Q11-GENHLTH_M5 [1:1], Q11-GENHLTH_M1_CHECK [Default], Q11-GENHLTH_M2 [Default], Q11-GENHLTH_M4 [Default], Q11-GENHLTH_M6 [Default], Q11-GENHLTH_M6A [Default]


 

Q11-GENHLTH_4F

Section: Health

Are you currently taking any medications to control or lower your cholesterol level?

 

1   YES

 

0   NO   ...(Go To PK_1)

 

Default Next:

Q11-GENHLTH_4G

Lead-In:

Q11-GENHLTH_4E_M [Default], Q11-GENHLTH_4E_F [Default]


 

Q11-GENHLTH_4G

Section: Health

Are any of those medications known as "statins"?

 

1   YES

 

0   NO

 

Default Next:

PK_1

Lead-In:

Q11-GENHLTH_4F [Default]


 

PK_1

Section: Health

Did you take any pain medication in the past 30 days, such as Aspirin, Ibuprofen or prescription pain medications?

 

1   YES

 

0   NO   ...(Go To Q11-GENHLTH_5A_1)

 

Default Next:

PK_2

Lead-In:

Q11-GENHLTH_4F [0:0], Q11-GENHLTH_4G [Default]


 

PK_2

Section: Health

Did you take a prescription medication or did you take one you can buy over-the-counter without a prescription?

 

1   PRESCRIPTION

 

2   OVER-THE-COUNTER   ...(Go To Q11-GENHLTH_5A_1)

 

3   BOTH

 

4   NOT SURE

 

Default Next:

PK_3

Lead-In:

PK_1 [Default]


 

PK_3

Section: Health

In the past 30 days, did you use prescribed painkillers in any way the doctor did not direct you to use them, such as for pain the doctor did not prescribe them for, in greater quantities or for longer than the doctor prescribed, or without a prescription?

 

1   YES

 

0   NO

 

Default Next:

Q11-GENHLTH_5A_1

Lead-In:

PK_2 [Default]


 

Q11-GENHLTH_5A_1

Section: Health

Do you have any of your own, natural teeth?

 

1   YES

 

0   NO   ...(Go To Q11-GENHLTH_6A)

 

Default Next:

Q11-GENHLTH_5A_2

Lead-In:

PK_1 [0:0], PK_2 [2:2], PK_3 [Default]


 

Q11-GENHLTH_5A_2

Section: Health

During a usual week, how many times do you....

...Brush your teeth?

# OF TIMES PER WEEK: 

 

Q11-GENHLTH_5A_3

Section: Health


...Use dental floss?

# OF TIMES PER WEEK: 

 

Default Next:

Q11-GENHLTH_6A

Lead-In:

Q11-GENHLTH_5A_2 [Default]


 

Q11-GENHLTH_6A

Section: Health

Are you now trying to lose weight, gain weight, stay about the same, or are you not trying to do anything about your weight?

 

1   Lose weight

 

2   Gain weight

 

3   Stay about the same

 

4   Not trying to do anything

 

Default Next:

Q11-GENHLTH_7A_CHECK

Lead-In:

Q11-GENHLTH_5A_1 [0:0], Q11-GENHLTH_5A_3 [Default]


 

Q11-GENHLTH_7A_CHECK

Section: Health

[{ROUND}]==28

If Answer = 1 Then Go To Q11-HLTHPLN-INTCHK

Default Next:

Q11-GENHLTH_7A

Lead-In:

Q11-GENHLTH_6A [Default]


 

Q11-GENHLTH_7A

Section: Health

When you buy a food item for the first time, how often would you say you read the nutritional information sometimes listed on the label - would you say always, often, sometimes, rarely or never?

 

0   Don't buy food

 

1   Always

 

2   Often

 

3   Sometimes

 

4   Rarely

 

5   Never

 

Q11-GENHLTH_7B

Section: Health

When you buy a food item for the first time, how often would you say you read the ingredient list on the package - (would you say always, often, sometimes, rarely or never)?

 

0   Don't buy food

 

1   Always

 

2   Often

 

3   Sometimes

 

4   Rarely

 

5   Never

 

Default Next:

Q11-GENHLTH_7C_1

Lead-In:

Q11-GENHLTH_7A [Default]


 

Q11-GENHLTH_7C_1

Section: Health

In the past seven days, how many times did you...

...Eat food from a fast food restaurant such as McDonalds, Kentucky Fried Chicken, Pizza Hut, or Taco Bell?

# TIMES: 

 

Q11-GENHLTH_7C_2

Section: Health

(INTERVIEWER: ENTER "PER DAY" OR "PER WEEK".)

 

1   Per day

 

2   Per week

 

Default Next:

Q11-GENHLTH_7D_1

Lead-In:

Q11-GENHLTH_7C_1 [Default]


 

Q11-GENHLTH_7D_1

Section: Health

(In the past seven days, how many times did you...)

...Eat a snack between meals?

# TIMES: 

 

Q11-GENHLTH_7D_2

Section: Health

(INTERVIEWER: ENTER "PER DAY" OR "PER WEEK".)

 

1   Per day

 

2   Per week

 

Default Next:

Q11-GENHLTH_7E_1

Lead-In:

Q11-GENHLTH_7D_1 [Default]


 

Q11-GENHLTH_7E_1

Section: Health

(In the past seven days, how many times did you...)

...Skip a meal?

# TIMES: 

 

Q11-GENHLTH_7E_2

Section: Health

(INTERVIEWER: ENTER "PER DAY" OR "PER WEEK".)

 

1   Per day

 

2   Per week

 

Default Next:

Q11-GENHLTH_7F_1

Lead-In:

Q11-GENHLTH_7E_1 [Default]


 

Q11-GENHLTH_7F_1

Section: Health

(In the past seven days, how many times did you...)

...Have a soft drink or soda that contained sugar? (Do not include diet soft drinks or sodas, or carbonated water.)

# TIMES: 

 

Q11-GENHLTH_7F_2

Section: Health

(INTERVIEWER: ENTER "PER DAY" OR "PER WEEK".)

 

1   Per day

 

2   Per week

 

Default Next:

Q11-HLTHPLN-INTCHK

Lead-In:

Q11-GENHLTH_7F_1 [Default]


 

Q11-HLTHPLN-INTCHK

Section: Health

[any spouse/partner to ask about insurance?]==1

If Answer = 1 Then Go To Q11-HLTHPLN-INTRO

Default Next:

Q11-79

Lead-In:

Q11-GENHLTH_7A_CHECK [1:1], Q11-GENHLTH_7F_2 [Default]


 

Q11-HLTHPLN-INTRO

Section: Health

The next questions are about health insurance. We would first like to find out about your own health insurance coverage. We will then ask about coverage of [{spintro}].

Default Next:

Q11-79

Lead-In:

Q11-HLTHPLN-INTCHK [1:1]


 

Q11-79

Section: Health

Are you covered by any kind of health insurance or some other kind of health care plan? (Include health insurance obtained through employment or purchased directly as well as government programs like Medicaid that provide medical care or help pay medical bills.)

(PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, [Medicaid or a Medicaid alternative plan such as [name of state Medicaid Program]].

 

1   YES   ...(Go To Q11-80B)

 

0   NO

 

Default Next:

Q11-80F

Lead-In:

Q11-HLTHPLN-INTCHK [Default], Q11-HLTHPLN-INTRO [Default]


 

Q11-80B

Section: Health

(INTERVIEWER: IF R PROVIDES NAMES OF HMOs OR INSURANCE COMPANIES, PROBE FOR THE SOURCE OF FUNDING.)

What is the source of your
primary health insurance or hospitalization plan? Is it from a policy from your current or previous employer, [your husband/wife/partner] a policy bought directly from a medical insurance company, a government sponsored plan, is it Medicaid or an alternative Medicaid provider, is it from Medicare, or is it from some other source?

 

1   POLICY FROM R'S CURRENT EMPLOYER

 

2   POLICY FROM R'S PREVIOUS EMPLOYER

 

3   POLICY FROM SPOUSE'S OR PARTNER'S CURRENT EMPLOYER

 

4   POLICY FROM SPOUSE'S OR PARTNER'S PREVIOUS EMPLOYER

 

5   POLICY R OR R'S SPOUSE OR PARTNER BOUGHT DIRECTLY FROM A MEDICAL INSURANCE COMPANY

 

6   MEDICAID OR MEDICAID PROVIDER/MEDI-CAL/MEDICAL ASSIST/WELFARE/MEDICAL SERVICE

 

8   MEDICARE

 

9   MILITARY HEALTH CARE SUCH AS TRICARE, CHAMPUS or CHAMPVA

 

10   OTHER STATE-SPONSORED OR GOVERNMENT PLANS SUCH AS THE AFFORDABLE CARE PLAN (ACA), OBAMA CARE, TRUMP CARE OR THE AMERICAN HEALTH CARE ACT

 

7   OTHER (SPECIFY)

 

Default Next:

Q11-80B-CHECK

Lead-In:

Q11-79 [1:1]


 

Q11-80B-CHECK

Section: Health

[spouse in hh?]==1 || [partner in hh?]==1

COMMENT: Is there a spouse listed on the household roster

If Answer = 1 Then Go To Q11-80B_1

Default Next:

Q11-80F

Lead-In:

Q11-80B [Default]


 

Q11-80B_1

Section: Health

Is [Spouse/partner's name] covered by this plan?

 

1   YES

 

0   NO

 

Default Next:

Q11-80F

Lead-In:

Q11-80B-CHECK [1:1]


 

Q11-80F

Section: Health

Have you (or your employer) set up a health savings account, medical savings account, or health-related flexible savings account to help pay your health care expenses?

 

1   YES

 

0   NO

 

Default Next:

Q11-HLTHPLN-3CHK

Lead-In:

Q11-79 [Default], Q11-80B-CHECK [Default], Q11-80B_1 [Default]


 

Q11-HLTHPLN-3CHK

Section: Health

[r covered by health plan?]==0 || [r has no health care coverage?]==1

COMMENT: /* Respondent reports no health insurance coverage, or coverage not specified in response categories. */

If Answer = 1 Then Go To Q11-80G

Default Next:

Q11-HLTHPLN-5CHK

Lead-In:

Q11-80F [Default]


 

Q11-80G

Section: Health

There is a program called Medicaid that pays for health care for persons in need. In [RESPONDENT STATE] it is also called [Medicaid or a Medicaid alternative plan such as [name of state Medicaid Program]]. Are you covered by Medicaid?

(INTERVIEWER: GENERALLY, IF R OR EMPLOYER DO NOT HAVE TO PAY, THE INSURANCE IS MEDICAID OR A MEDICAID ALTERNATIVE. PLEASE SEE HELP SCREEN FOR LIST OF MEDICAID ALTERNATIVE PROVIDERS AND PLANS FOR [RESPONDENT STATE].)

 

1   YES   ...(Go To Q11-HLTHPLN-5CHK)

 

0   NO

 

Default Next:

Q11-81C_1

Lead-In:

Q11-HLTHPLN-3CHK [1:1]


 

Q11-81C_1

Section: Health

Not including single service plans, about how long has it been since you last had health care coverage?

 

0   6 months or less

 

1   More than 6 months, but less than 1 year

 

2   More than 1 year, but not more than 3 years

 

3   More than 3 years

 

4   Never

 

Default Next:

Q11-HLTHPLN-5CHK

Lead-In:

Q11-80G [Default]


 

Q11-HLTHPLN-5CHK

Section: Health

[r has no health care coverage?]==1

COMMENT: /* Respondent reports some type of health insurance */

If Answer = 1 Then Go To Q11-HLTHPLN-6CHK

Default Next:

Q11-81A

Lead-In:

Q11-80G [1:1], Q11-HLTHPLN-3CHK [Default], Q11-81C_1 [Default]


 

Q11-81A

Section: Health

In the past 12 months, have you ever been without coverage?

 

1   YES   ...(Go To Q11-81B_1)

 

0   NO   ...(Go To Q11-HLTHPLN-7CHK)

 

Default Next:

Q11-HLTHPLN-6CHK

Lead-In:

Q11-HLTHPLN-5CHK [Default]


 

Q11-81B_1

Section: Health

About how many months were you without coverage?

 

 

Default Next:

Q11-HLTHPLN-6CHK

Lead-In:

Q11-81A [1:1]


 

Q11-HLTHPLN-6CHK

Section: Health

[r covered by health plan?]==0 || [r has no health care coverage?]==1 || [been without coverage in past 12 months?]==1

COMMENT: Respondent reports no health insurance coverage or coverage not specified in response categories or some non-coverage in the last 12 months

If Answer = 0 Then Go To Q11-HLTHPLN-7CHK

Default Next:

Q11-81G

Lead-In:

Q11-HLTHPLN-5CHK [1:1], Q11-81A [Default], Q11-81B_1 [Default]


 

Q11-81G

Section: Health

Which of these are the reasons you (do/did) not have health insurance?

(INTERVIEWER: SELECT ALL THAT APPLY.)

 

1   Person in family with health insurance lost job or changed employers

 

2   Got divorced or separated/death of spouse or partner

 

3   Employer does not offer coverage/or not eligible for coverage

 

4   Cost is too high

 

5   Insurance company refused coverage

 

6   [FEMALE ONLY] Medicaid/Medical plan stopped after pregnancy

 

7   Lost Medicaid/Medical Plan because of new job or increase in income

 

8   Lost Medicaid (OTHER)

 

9   OTHER (SPECIFY)

 

Default Next:

Q11-HLTHPLN-7CHK

Lead-In:

Q11-HLTHPLN-6CHK [Default]


 

Q11-HLTHPLN-7CHK

Section: Health

[any spouse/partner to ask about insurance?]==1

COMMENT: Respondent reported a spouse

If Answer = 1 Then Go To Q11-HLTHPLN-7CHKA

Default Next:

COGNITION-C1

Lead-In:

Q11-81A [0:0], Q11-HLTHPLN-6CHK [0:0], Q11-81G [Default]


 

Q11-HLTHPLN-7CHKA

Section: Health

VAREXIST([Q11-80B_1])

If Answer = 1 Then Go To Q11-HLTHPLN-7CHKB

Default Next:

Q11-83

Lead-In:

Q11-HLTHPLN-7CHK [1:1]


 

Q11-HLTHPLN-7CHKB

Section: Health

[{SPOPAR_COVERED}]==1

COMMENT: Spouse/partner covered by R's primary health care

If Answer = 1 Then Go To COGNITION-C1

Default Next:

Q11-83

Lead-In:

Q11-HLTHPLN-7CHKA [1:1]


 

Q11-83

Section: Health

Is [Spouse/partner's name] covered by any kind of health insurance or some other kind of health care plan? (Include health insurance obtained through employment or purchased directly as well as government programs like Medicaid that provide medical care or help pay medical bills.)

(PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, [Medicaid or a Medicaid alternative plan such as [name of state Medicaid Program]].

 

1   YES   ...(Go To Q11-84B)

 

0   NO

 

Default Next:

COGNITION-C1

Lead-In:

Q11-HLTHPLN-7CHKA [Default], Q11-HLTHPLN-7CHKB [Default]


 

Q11-84B

Section: Health

(INTERVIEWER: IF R PROVIDES NAMES OF HMOs OR INSURANCE COMPANIES, PROBE FOR THE SOURCE OF FUNDING.)

What is the source of [Spouse/partner's name]'s
primary health insurance or hospitalization plan? Is it from a policy from your current or previous employer, [your husband/wife/partner] a policy bought directly from a medical insurance company, a government sponsored plan, is it Medicaid or an alternative Medicaid provider, or is it from some other source?

(PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, [Medicaid or a Medicaid alternative plan such as [name of state Medicaid Program]].

 

1   POLICY FROM R'S CURRENT EMPLOYER

 

2   POLICY FROM R'S PREVIOUS EMPLOYER

 

3   POLICY FROM SPOUSE'S OR PARTNER'S CURRENT EMPLOYER

 

4   POLICY FROM SPOUSE'S OR PARTNER'S PREVIOUS EMPLOYER

 

5   POLICY R OR R'S SPOUSE OR PARTNER BOUGHT DIRECTLY FROM A MEDICAL INSURANCE COMPANY

 

6   MEDICAID OR MEDICAID PROVIDER/MEDI-CAL/MEDICAL ASSIST/WELFARE/MEDICAL SERVICE

 

8   MEDICARE

 

9   MILITARY HEALTH CARE SUCH AS TRICARE, CHAMPUS or CHAMPVA

 

10   OTHER STATE-SPONSORED OR GOVERNMENT PLANS SUCH AS THE AFFORDABLE CARE PLAN (ACA), OBAMA CARE, TRUMP CARE OR THE AMERICAN HEALTH CARE ACT

 

7   OTHER (SPECIFY)

 

Default Next:

COGNITION-C1

Lead-In:

Q11-83 [1:1]


 

COGNITION-C1

Section: Health

Part of this study is concerned with people's memory, and ability to think about things. First, how would you rate your memory at the present time? Would you say it is excellent, very good, good, fair or poor?

 

1   EXCELLENT

 

2   VERY GOOD

 

3   GOOD

 

4   FAIR

 

5   POOR

 

Default Next:

COGNITION-C2

Lead-In:

Q11-HLTHPLN-7CHKB [1:1], Q11-HLTHPLN-7CHK [Default], Q11-83 [Default], Q11-84B [Default]


 

COGNITION-C2

Section: Health

Compared to (two years ago/[year before current year]), would you say your memory is better now, about the same, or worse now than it was then?

 

1   BETTER

 

2   ABOUT THE SAME

 

3   WORSE

 

Default Next:

COGNITION-C3

Lead-In:

COGNITION-C1 [Default]


 

COGNITION-C3

Section: Health

Now I am going to name a category and you will name things that belong in that category. Let's practice with the category "fruit." Can you think of any fruits?

INTERVIEWER: IF RESPONDENT DOES NOT IMMEDIATELY START NAMING FRUITS, PROVIDE A COUPLE OF EXAMPLES SUCH AS APPLES OR PEARS.

WAIT FOR TWO CORRECT ITEMS AND THEN SELECT <NEXT> TO CONTINUE.

Default Next:

COGNITION-C4

Lead-In:

COGNITION-C2 [Default]


 

COGNITION-C4

Section: Health

In a moment I will give you another category. When I say begin, you will name all the things from this new category you can think of, as fast as you can. You will have one minute to do this. I will let you know when your time is up. The new category is animals.

Do you have any questions?

Ready?

Begin.

SELECT <NEXT> TO CONTINUE.

Default Next:

COGNITION-C5

Lead-In:

COGNITION-C3 [Default]


 

COGNITION-C5

Section: Health

INTERVIEWER: COUNT NUMBER OF ANIMALS RESPONDENT LISTS. ENTER NUMBER OF ANIMALS.

TIME FOR ONE MINUTE. IF PERSON STOPS BEFORE 1 MINUTE IS UP, SAY


"There's still more time, can you think of any more?"

IF PERSON ASKS WHETHER BIRDS, FISH, INSECTS, REPTILES, ETC. ARE ACCEPTABLE, SAY "Yes."

 

 

Default Next:

Q11-H60-2

Lead-In:

COGNITION-C4 [Default]


 

Q11-H60-2

Section: Health

[{birthdate~Y}] <= 1958

If Answer = 1 Then Go To Q11-H60DIENER

Default Next:

Q11-H50-CHECK

Lead-In:

COGNITION-C5 [Default]


 

Q11-H50-CHECK

Section: Health

([{hlth50_mod}]==0) && ([{birthdate~Y}] >= 1963)

COMMENT: R has not yet received age 50 health module and was born later than 1962

If Answer = 1 Then Go To Q11-H50CESD

Default Next:

CIG_CHK1

Lead-In:

Q11-H60-2 [Default]


 

Q11-H60DIENER

Section: Health

I will read you five statements that you may agree or disagree with. Please tell me whether you strongly agree, agree, slightly agree, neither agree nor disagree, slightly disagree, disagree, or strongly disagree with each one.

 

- In most ways my life is close to my ideal.

 

- The conditions of my life are excellent.

 

- I am satisfied with my life.

 

- So far I have gotten the important things I want in life.

 

- If I could live my life over, I would change almost nothing.

 

 

7   STRONGLY AGREE

 

6   AGREE

 

5   SLIGHTLY AGREE

 

4   NEITHER AGREE NOR DISAGREE

 

3   SLIGHTLY DISAGREE

 

2   DISAGREE

 

1   STRONGLY DISAGREE

 

Default Next:

Q11-H60CESD

Lead-In:

Q11-H60-2 [1:1]


 

Q11-H60CESD

Section: Health

Now I am going to read a list of the ways that you might have felt or behaved recently. After each statement, please tell me how often you felt this way during the past week.

During the past week.....

 

- I did not feel like eating; my appetite was poor.

 

- I felt that I could not shake off the blues, even with help from my family or friends.

 

- I had trouble keeping my mind on what I was doing.

 

- I felt depressed.

 

- I felt that everything I did was an effort.

 

- My sleep was restless.

 

- I felt lonely.

 

- I felt sad.

 

- I could not get "going".

 

 

0   None at all or less than 1 day

 

1   1-2 days

 

2   3-4 Days

 

3   5-7 Days

 

Default Next:

Q11-GAD-7

Lead-In:

Q11-H60DIENER [Default]


 

Q11-GAD-7

Section: Health

Over the last 2 weeks, how often have you been bothered by the following problems - not at all, on several days, on more than half the days, or nearly every day?

(INTERVIEWER: REPEAT CATEGORIES ONLY IF NECESSARY)

 

- Feeling nervous, anxious or on edge

 

- Not being able to stop or control worrying

 

- Worrying too much about different things

 

- Trouble relaxing

 

- Being so restless that it is hard to sit still

 

- Becoming easily annoyed or irritable

 

- Feeling afraid as if something awful might happen

 

 

0   NOT AT ALL

 

1   SEVERAL DAYS

 

2   MORE THAN HALF THE DAYS

 

3   NEARLY EVERY DAY

 

Default Next:

Q11-H60RESILIENCE

Lead-In:

Q11-H60CESD [Default]


 

Q11-H60RESILIENCE

Section: Health

After each statement, please tell me whether you strongly agree, slightly agree, neither agree nor disagree, slightly disagree, or strongly disagree with each one.

 

- I tend to bounce back quickly after hard times.

 

- I have a hard time making it through stressful events.

 

- It does not take me long to recover from a stressful event.

 

- It is hard for me to snap back when something bad happens.

 

 

5   STRONGLY AGREE

 

4   SLIGHTLY AGREE

 

3   NEITHER AGREE NOR DISAGREE

 

2   SLIGHTLY DISAGREE

 

1   STRONGLY DISAGREE

 

Default Next:

Q11-H60BPARCHK1

Lead-In:

Q11-GAD-7 [Default]


 

Q11-H60BPARCHK1

Section: Health

[Is bio father alive]

If Answer = 0 Then Go To Q11-H60BPARCHK2

Default Next:

Q11-H60BPAR-1

Lead-In:

Q11-H60RESILIENCE [Default]


 

Q11-H60BPAR-1

Section: Health

This next series of questions asks about your biological parents' health.

Is your biological father still alive?

 

1   YES   ...(Go To Q11-H60BPAR-4)

 

0   NO


If Answer >= -2 AND Answer <= -1 Then Go To Q11-H60BPAR-6

Default Next:

Q11-H60BPAR-2

Lead-In:

Q11-H60BPARCHK1 [Default]


 

Q11-H60BPAR-2

Section: Health

What caused your biological father's death?

 

1   HEART DISEASE

 

7   STROKE

 

3   CANCER

 

8   DEMENTIA (e.g., ALZHEIMER'S DISEASE)

 

11   LIVER DISEASE (e.g., CIRRHOSIS)

 

9   PNEUMONIA/FLU

 

5   LUNG DISEASE (e.g., COPD, EMPHYSEMA)

 

4   OLD AGE

 

2   ACCIDENT OR INJURY

 

10   SUICIDE

 

6   OTHER (SPECIFY)

 

Q11-H60BPAR-3

Section: Health

How old was he when he died?

ENTER AGE: 

 

Default Next:

Q11-H60BPAR-4

Lead-In:

Q11-H60BPAR-2 [Default]


 

Q11-H60BPAR-4

Section: Health

[Did/Does] your father have any major health problems?

 

1   YES   ...(Go To Q11-H60BPAR-5)

 

0   NO

 

Default Next:

Q11-H60BPARCHK2

Lead-In:

Q11-H60BPAR-1 [1:1], Q11-H60BPAR-3 [Default]


 

Q11-H60BPAR-5

Section: Health

What [{are/were_fath}] these problems?

Enter 

 

Default Next:

Q11-H60BPARCHK2

Lead-In:

Q11-H60BPAR-4 [1:1]


 

Q11-H60BPARCHK2

Section: Health

[biological mother alive]

If Answer = 0 Then Go To Q11-H60SF12-1

Default Next:

Q11-H60BPAR-6

Lead-In:

Q11-H60BPARCHK1 [0:0], Q11-H60BPAR-4 [Default], Q11-H60BPAR-5 [Default]


 

Q11-H60BPAR-6

Section: Health

Is your biological mother still alive?

 

1   YES   ...(Go To Q11-H60BPAR-9)

 

0   NO


If Answer >= -2 AND Answer <= -1 Then Go To Q11-H60SF12-1

Default Next:

Q11-H60BPAR-7

Lead-In:

Q11-H60BPAR-1 [-2:-1], Q11-H60BPARCHK2 [Default]


 

Q11-H60BPAR-7

Section: Health

What caused your biological mother's death?

 

1   HEART DISEASE

 

7   STROKE

 

3   CANCER

 

8   DEMENTIA (e.g., ALZHEIMER'S DISEASE)

 

11   LIVER DISEASE (e.g., CIRRHOSIS)

 

9   PNEUMONIA/FLU

 

5   LUNG DISEASE (e.g., COPD, EMPHYSEMA)

 

4   OLD AGE

 

2   ACCIDENT OR INJURY

 

10   SUICIDE

 

6   OTHER (SPECIFY)

 

Q11-H60BPAR-8

Section: Health

How old was she when she died?

ENTER AGE: 

 

Default Next:

Q11-H60BPAR-9

Lead-In:

Q11-H60BPAR-7 [Default]


 

Q11-H60BPAR-9

Section: Health

[Did/Does] your mother have any major health problems?

 

1   YES   ...(Go To Q11-H60BPAR-10)

 

0   NO

 

Default Next:

Q11-H60SF12-1

Lead-In:

Q11-H60BPAR-6 [1:1], Q11-H60BPAR-8 [Default]


 

Q11-H60BPAR-10

Section: Health

What [{are/were_moth}] these problems?

 

 

Default Next:

Q11-H60SF12-1

Lead-In:

Q11-H60BPAR-9 [1:1]


 

Q11-H60SF12-1

Section: Health

Next I will be asking you more specific questions about your health. This information will help keep track of how you feel and how well you are able to do your usual activities.

If you are unsure about how to answer, please give the best answer you can.

Default Next:

Q11-H60SF12-2

Lead-In:

Q11-H60BPARCHK2 [0:0], Q11-H60BPAR-6 [-2:-1], Q11-H60BPAR-9 [Default], Q11-H60BPAR-10 [Default]


 

Q11-H60SF12-2

Section: Health

In general, would you say your health is ....

 

1   Excellent

 

2   Very Good

 

3   Good

 

4   Fair

 

5   Poor

 

Default Next:

Q11-H60SF12-3

Lead-In:

Q11-H60SF12-1 [Default]


 

Q11-H60SF12-3

Section: Health

The following items are activities you might do during a typical day. Does your health limit you in these activities?

......Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf?

 

3   Yes, Limited a Lot

 

2   Yes, Limited a Little

 

1   No, Not Limited at All

 

Q11-H60SF12-3B

Section: Health

..... Climbing several flights of stairs?

 

3   Yes, Limited a Lot

 

2   Yes, Limited a Little

 

1   No, Not Limited at All

 

Default Next:

Q11-H60SF12-4

Lead-In:

Q11-H60SF12-3 [Default]


 

Q11-H60SF12-4

Section: Health

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

..... Accomplished less than you would like?

 

1   YES

 

0   NO

 

Q11-H60SF12-4B

Section: Health

.... Were limited in the kind of work or other activities?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60SF12-5

Lead-In:

Q11-H60SF12-4 [Default]


 

Q11-H60SF12-5

Section: Health

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?

.... Accomplished less than you would like?

 

1   YES

 

0   NO

 

Q11-H60SF12-5B

Section: Health

.... Didn't do work or other activities as carefully as usual?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60SF12-6

Lead-In:

Q11-H60SF12-5 [Default]


 

Q11-H60SF12-6

Section: Health

During the past 4 weeks, how much did pain interfere with your normal work (including both work outside of the home and housework)?

 

1   Not at all

 

2   A little bit

 

3   Moderately

 

4   Quite a bit

 

5   Extremely

 

Default Next:

Q11-H60SF12-7

Lead-In:

Q11-H60SF12-5B [Default]


 

Q11-H60SF12-7

Section: Health

Thinking only of the past 4 weeks, please give the one answer that comes closest to the way you have been feeling. How often during the past 4 weeks....

.... have you felt calm and peaceful?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H60SF12-7B

Lead-In:

Q11-H60SF12-6 [Default]


 

Q11-H60SF12-7B

Section: Health

.... Did you have a lot of energy?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H60SF12-7C

Lead-In:

Q11-H60SF12-7 [Default]


 

Q11-H60SF12-7C

Section: Health

.... Have you felt down-hearted and blue?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H60SF12-8

Lead-In:

Q11-H60SF12-7B [Default]


 

Q11-H60SF12-8

Section: Health

During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H60CHRC_CHK1

Lead-In:

Q11-H60SF12-7C [Default]


 

Q11-H60CHRC_CHK1

Section: Health

[blood pressure problems reported during 40+ Health Module]==1 || [{h50_bp_ht}]==1

COMMENT: R has previously reported high pressure

If Answer = 1 Then Go To Q11-H60CHRC-1B

Default Next:

Q11-H60CHRC-1

Lead-In:

Q11-H60SF12-8 [Default]


 

Q11-H60CHRC-1

Section: Health

Has a doctor ever told you that you have high blood pressure or hypertension?

 

1   YES   ...(Go To Q11-H60CHRC-1A)

 

0   NO

 

Default Next:

Q11-H60CHRC_CHK2

Lead-In:

Q11-H60CHRC_CHK1 [Default]


 

Q11-H60CHRC-1A

Section: Health

In what month and year was that first diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC_CHK2

Lead-In:

Q11-H60CHRC-1 [1:1]


 

Q11-H60CHRC-1B

Section: Health

Do you have high blood pressure or hypertension at the present time?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC_CHK2

Lead-In:

Q11-H60CHRC_CHK1 [1:1]


 

Q11-H60CHRC_CHK2

Section: Health

[r report diabetes/high blood sugar in 40+ Health Module]==1 || [{h50_diabetes_hbs}]==1

COMMENT: R has previously reported diabetes

If Answer = 1 Then Go To Q11-H60CHRC-2B

Default Next:

Q11-H60CHRC-2

Lead-In:

Q11-H60CHRC-1 [Default], Q11-H60CHRC-1A [Default], Q11-H60CHRC-1B [Default]


 

Q11-H60CHRC-2

Section: Health

Has a doctor ever told you that you have diabetes or high blood sugar?

 

1   YES   ...(Go To Q11-H60CHRC-2A)

 

0   NO

 

Default Next:

Q11-H60CHRC-2B

Lead-In:

Q11-H60CHRC_CHK2 [Default]


 

Q11-H60CHRC-2A

Section: Health

In what month and year was that first diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-2B

Lead-In:

Q11-H60CHRC-2 [1:1]


 

Q11-H60CHRC-2B

Section: Health

[{h60_skincancer_text1}] a doctor ever told you that you had skin cancer?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC-3

Lead-In:

Q11-H60CHRC_CHK2 [1:1], Q11-H60CHRC-2 [Default], Q11-H60CHRC-2A [Default]


 

Q11-H60CHRC-3

Section: Health

[{h60_cancer_text1}] a doctor ever told you that you have cancer or malignant tumor of any kind except skin cancer?

 

1   YES   ...(Go To Q11-H60CHRC-3A)

 

0   NO

 

Default Next:

Q11-H60CHRC_CHK4

Lead-In:

Q11-H60CHRC-2B [Default]


 

Q11-H60CHRC-3A

Section: Health

How many such cancers have you [{h60_cancer_text2}]?

ENTER # CANCERS: 

If Answer >= -2 AND Answer <= 0 Then Go To Q11-H60CHRC_CHK4

Default Next:

Q11-H60-CHRC-3AB

Lead-In:

Q11-H60CHRC-3 [1:1]


 

Q11-H60-CHRC-3AB

Section: Health

REPEAT

Default Next:

Q11-H60CHRC-3B

Lead-In:

Q11-H60CHRC-3A [Default]


 

Q11-H60CHRC-3B

Section: Health

In what month and year was [{Q11-H60-text_sub}] cancer diagnosed?

ENTER MONTH AND YEAR: 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-3C

Lead-In:

Q11-H60-CHRC-3AB [Default]


 

Q11-H60CHRC-3C

Section: Health

In which organ or part of your body did this cancer occur?

 

 

Default Next:

Q11-H60CHRC-3D

Lead-In:

Q11-H60CHRC-3B [Default]


 

Q11-H60CHRC-3D

Section: Health

Do you currently have any such cancer?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC-3DB-LOOP-END

Lead-In:

Q11-H60CHRC-3C [Default]


 

Q11-H60CHRC-3DB-LOOP-END

Section: Health

UNTIL ([{Q11-H60-LOOP3}]==[Number of cancers R reported] || [Number of cancers R reported]==0)

Default Next:

Q11-H60CHRC_CHK4

Lead-In:

Q11-H60CHRC-3D [Default]


 

Q11-H60CHRC_CHK4

Section: Health

[r report non-asthma/chronic lung problems in 40+ Health Module]==1 || [{h50_nonasthma_chroniclung}]==1

COMMENT: R has previously reported chronic lung condition

If Answer = 1 Then Go To Q11-H60CHRC-5

Default Next:

Q11-H60CHRC-4

Lead-In:

Q11-H60CHRC-3A [-2:0], Q11-H60CHRC-3 [Default], Q11-H60CHRC-3DB-LOOP-END [Default]


 

Q11-H60CHRC-4

Section: Health

Not including asthma, has a doctor ever told you that you have chronic lung disease such as chronic bronchitis or emphysema?

 

1   YES   ...(Go To Q11-H60CHRC-4B)

 

0   NO

 

Default Next:

Q11-H60CHRC-5

Lead-In:

Q11-H60CHRC_CHK4 [Default]


 

Q11-H60CHRC-4B

Section: Health

In what month and year was your chronic lung disease diagnosed?

ENTER MONTH AND YEAR: 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-5

Lead-In:

Q11-H60CHRC-4 [1:1]


 

Q11-H60CHRC-5

Section: Health

[{h60_heart_text1}] a doctor ever told you that you had a heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems?

 

1   YES   ...(Go To Q11-H60CHRC-5A)

 

0   NO

 

Default Next:

Q11-H60CHRC-7

Lead-In:

Q11-H60CHRC_CHK4 [1:1], Q11-H60CHRC-4 [Default], Q11-H60CHRC-4B [Default]


 

Q11-H60CHRC-5A

Section: Health

[{h60_heart_text2}] you have a heart attack or myocardial infarction?

 

1   YES   ...(Go To Q11-H60CHRC-5B)

 

0   NO

 

Default Next:

Q11-H60CHRC-5C

Lead-In:

Q11-H60CHRC-5 [1:1]


 

Q11-H60CHRC-5B

Section: Health

In what month and year did you have your [{h60_heart_text3}] heart attack or myocardial infarction?

ENTER MONTH AND YEAR: 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-5C

Lead-In:

Q11-H60CHRC-5A [1:1]


 

Q11-H60CHRC-5C

Section: Health

Do you currently have any angina or chest pains due to your heart?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC-6

Lead-In:

Q11-H60CHRC-5A [Default], Q11-H60CHRC-5B [Default]


 

Q11-H60CHRC-6

Section: Health

Has a doctor ever told you that you have congestive heart failure?

 

1   YES   ...(Go To Q11-H60CHRC-6A)

 

0   NO

 

Default Next:

Q11-H60CHRC-7

Lead-In:

Q11-H60CHRC-5C [Default]


 

Q11-H60CHRC-6A

Section: Health

In what month and year was your congestive heart failure?

ENTER MONTH AND YEAR: 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-7

Lead-In:

Q11-H60CHRC-6 [1:1]


 

Q11-H60CHRC-7

Section: Health

[{h60_stroke_text1}] a doctor ever told you that you had a stroke?

 

1   YES   ...(Go To Q11-H60CHRC-7A)

 

0   NO

 

Default Next:

Q11-H60CHRC-7B

Lead-In:

Q11-H60CHRC-5 [Default], Q11-H60CHRC-6 [Default], Q11-H60CHRC-6A [Default]


 

Q11-H60CHRC-7A

Section: Health

In what month and year did you last have a stroke?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-7B

Lead-In:

Q11-H60CHRC-7 [1:1]


 

Q11-H60CHRC-7B

Section: Health

[{h60_depression_text1}] a doctor ever diagnosed you as suffering from depression?

 

1   YES   ...(Go To Q11-H60CHRC-7C)

 

0   NO

 

Default Next:

Q11-H60CHRC-7E

Lead-In:

Q11-H60CHRC-7 [Default], Q11-H60CHRC-7A [Default]


 

Q11-H60CHRC-7C

Section: Health

In what month and year was your depression diagnosed?

 

 

Month

Year

Day

 

 

Q11-H60CHRC-7D

Section: Health

During the last 12 months, have you suffered from depression?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC-7E

Lead-In:

Q11-H60CHRC-7C [Default]


 

Q11-H60CHRC-7E

Section: Health

Has a doctor ever diagnosed you as suffering from anxiety?

 

1   YES   ...(Go To Q11-H60CHRC-7F)

 

0   NO

 

Default Next:

Q11-H60CHRC_CHK6

Lead-In:

Q11-H60CHRC-7B [Default], Q11-H60CHRC-7D [Default]


 

Q11-H60CHRC-7F

Section: Health

In what year and month was your anxiety diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-7G

Lead-In:

Q11-H60CHRC-7E [1:1]


 

Q11-H60CHRC-7G

Section: Health

During the last 12 months, have you suffered from anxiety?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC_CHK6

Lead-In:

Q11-H60CHRC-7F [Default]


 

Q11-H60CHRC_CHK6

Section: Health

[r report psychiatric problems during 40+ Health Module]==1 || [{h50_psychiatric}]==1

COMMENT: R has previously reported psychiatric problem

If Answer = 1 Then Go To Q11-H60CHRC_CHK7

Default Next:

Q11-H60CHRC-8

Lead-In:

Q11-H60CHRC-7E [Default], Q11-H60CHRC-7G [Default]


 

Q11-H60CHRC-8

Section: Health

Has a doctor ever told you that you had emotional, nervous, or psychiatric problems other than depression or anxiety?

 

1   YES   ...(Go To Q11-H60CHRC-8A)

 

0   NO

 

Default Next:

Q11-H60CHRC_CHK7

Lead-In:

Q11-H60CHRC_CHK6 [Default]


 

Q11-H60CHRC-8A

Section: Health

In what month and year were your emotional, nervous or psychiatric problems diagnosed?

 

 

Month

Year

Day

 

 

Q11-H60CHRC-8B

Section: Health

During the last 12 months, have you had any emotional, nervous, or psychiatric problems?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC_CHK7

Lead-In:

Q11-H60CHRC-8A [Default]


 

Q11-H60CHRC_CHK7

Section: Health

[r report arthritis during 40+ Health Module]==1 || [{h50_arthritis}]==1

COMMENT: R has previously reported arthritis

If Answer = 1 Then Go To Q11-H60CHRC-9B

Default Next:

Q11-H60CHRC-9

Lead-In:

Q11-H60CHRC_CHK6 [1:1], Q11-H60CHRC-8 [Default], Q11-H60CHRC-8B [Default]


 

Q11-H60CHRC-9

Section: Health

Have you ever had, or has a doctor ever told you that you have, arthritis or rheumatism?

 

1   YES   ...(Go To Q11-H60CHRC-9A)

 

0   NO

 

Default Next:

Q11-H60CHRC-9B

Lead-In:

Q11-H60CHRC_CHK7 [Default]


 

Q11-H60CHRC-9A

Section: Health

In what month and year was your arthritis or rheumatism diagnosed?

 

1   ENTER MONTH AND YEAR   ...(Go To Q11-H60CHRC-9AB)

 

0   NEVER DIAGNOSED

 

Default Next:

Q11-H60CHRC-9B

Lead-In:

Q11-H60CHRC-9 [1:1]


 

Q11-H60CHRC-9AB

Section: Health

(In what month and year was your arthritis or rheumatism diagnosed?)

 

 

Month

Year

 

 

Default Next:

Q11-H60CHRC-9B

Lead-In:

Q11-H60CHRC-9A [1:1]


 

Q11-H60CHRC-9B

Section: Health

Do you sometimes have pain, stiffness, or swelling in your joints?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC-9C

Lead-In:

Q11-H60CHRC_CHK7 [1:1], Q11-H60CHRC-9 [Default], Q11-H60CHRC-9A [Default], Q11-H60CHRC-9AB [Default]


 

Q11-H60CHRC-9C

Section: Health

[{h60_osteoporosis_text1}] a doctor ever told you that you had osteoporosis?

 

1   YES   ...(Go To Q11-H60CHRC-9D)

 

0   NO

 

Default Next:

Q11-H60CHRC-10

Lead-In:

Q11-H60CHRC-9B [Default]


 

Q11-H60CHRC-9D

Section: Health

In what month and year was your osteoporosis diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-10

Lead-In:

Q11-H60CHRC-9C [1:1]


 

Q11-H60CHRC-10

Section: Health

Has a doctor ever told you that you have Alzheimer's Disease?

 

1   YES   ...(Go To Q11-H60CHRC-10A)

 

0   NO

 

Default Next:

Q11-H60CHRC-11

Lead-In:

Q11-H60CHRC-9C [Default], Q11-H60CHRC-9D [Default]


 

Q11-H60CHRC-10A

Section: Health

In what month and year was your Alzheimer's diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H60CHRC-10B

Lead-In:

Q11-H60CHRC-10 [1:1]


 

Q11-H60CHRC-10B

Section: Health

Are you currently taking medication for your Alzheimer's?

 

1   YES

 

0   NO

 

Default Next:

Q11-H60CHRC-11

Lead-In:

Q11-H60CHRC-10A [Default]


 

Q11-H60CHRC-11

Section: Health

Has a doctor ever told you that you have dementia, senility or any other serious memory impairment?

 

1   YES   ...(Go To Q11-H60CHRC-11A)

 

0   NO

 

Default Next:

Q11-H60FL-1

Lead-In:

Q11-H60CHRC-10 [Default], Q11-H60CHRC-10B [Default]


 

Q11-H60CHRC-11A

Section: Health

In what month and year was your dementia, senility, or memory impairment diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H60FL-1

Lead-In:

Q11-H60CHRC-11 [1:1]


 

Q11-H60FL-1

Section: Health

Do you currently use any special equipment to aid you in your usual activities? By this we mean things such as hearing aids, wheelchairs, scooters, canes, protheses, or special telephones. Please do not include eyeglasses or false teeth.

 

1   YES

 

0   NO

 

Default Next:

Q11-H60FL-2A

Lead-In:

Q11-H60CHRC-11 [Default], Q11-H60CHRC-11A [Default]


 

Q11-H60FL-2A

Section: Health

We are interested in how much difficulty people have with various activities because of a health or physical problem. Do you have any difficulty with...

Running about a mile?

 

1   YES

 

0   NO   ...(Go To Q11-H60FL-2E)

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2B

Lead-In:

Q11-H60FL-1 [Default]


 

Q11-H60FL-2B

Section: Health

Do you have any difficulty with..

walking several blocks?

 

1   YES

 

0   NO   ...(Go To Q11-H60FL-2E)

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2C

Lead-In:

Q11-H60FL-2A [Default]


 

Q11-H60FL-2C

Section: Health

Do you have any difficulty with..

Walking one block?

 

1   YES

 

0   NO   ...(Go To Q11-H60FL-2E)

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2D

Lead-In:

Q11-H60FL-2B [Default]


 

Q11-H60FL-2D

Section: Health

Do you have any difficulty with...

Walking across a room?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2E

Lead-In:

Q11-H60FL-2C [Default]


 

Q11-H60FL-2E

Section: Health

Do you have any difficulty with..

Sitting for about 2 hours?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Q11-H60FL-2F

Section: Health

Do you have any difficulty with..

Getting up from a chair after sitting for long periods?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2G

Lead-In:

Q11-H60FL-2E [Default]


 

Q11-H60FL-2G

Section: Health

Do you have any difficulty with..

Climbing several flights of stairs without resting?

 

1   YES

 

0   NO   ...(Go To Q11-H60FL-2I)

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2H

Lead-In:

Q11-H60FL-2F [Default]


 

Q11-H60FL-2H

Section: Health

Do you have any difficulty with..

Climbing one flight of stairs without resting?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2I

Lead-In:

Q11-H60FL-2G [Default]


 

Q11-H60FL-2I

Section: Health

Do you have any difficulty with..

Lifting or carrying weights
over 10 pounds, like a heavy bag of groceries?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60-2J

Lead-In:

Q11-H60FL-2G [0:0], Q11-H60FL-2H [Default]


 

Q11-H60-2J

Section: Health

Do you have any difficulty with..

Stooping, kneeling, or crouching?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2K

Lead-In:

Q11-H60FL-2I [Default]


 

Q11-H60FL-2K

Section: Health

Do you have any difficulty with..

Picking up a dime from a table?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2L

Lead-In:

Q11-H60-2J [Default]


 

Q11-H60FL-2L

Section: Health

Do you have any difficulty with..

Reaching or extending your arms above shoulder level?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60FL-2M

Lead-In:

Q11-H60FL-2K [Default]


 

Q11-H60FL-2M

Section: Health

Do you have any difficulty with..

Pulling or pushing large objects like a living room chair?

 

1   YES

 

0   NO

 

6   CAN'T DO

 

7   DON'T DO

 

Default Next:

Q11-H60SLP-1

Lead-In:

Q11-H60FL-2L [Default]


 

Q11-H60SLP-1

Section: Health

How much sleep do you usually get at night (or in your main sleep period) on weekdays or workdays?

ENTER # HOURS: 

 

Q11-H60SLP-1B

Section: Health

 

ENTER # MINUTES: 

 

Default Next:

Q11-H60SLP-2

Lead-In:

Q11-H60SLP-1 [Default]


 

Q11-H60SLP-2

Section: Health

How much sleep do you usually get at night (or in your main sleep period) on weekends or your nonworkdays?

ENTER # HOURS: 

 

Q11-H60SLP-2B

Section: Health

 

ENTER # MINUTES: 

 

Default Next:

Q11-H60SLP-3

Lead-In:

Q11-H60SLP-2 [Default]


 

Q11-H60SLP-3

Section: Health

How long does it usually take you to fall asleep at bedtime?

ENTER # HOURS: 

 

Q11-H60SLP-3B

Section: Health

 

ENTER # MINUTES: 

 

Default Next:

Q11-H60SLP-4

Lead-In:

Q11-H60SLP-3 [Default]


 

Q11-H60SLP-4

Section: Health

During a usual week, how many times do you nap for 5 minutes or more?

ENTER # TIMES: 

 

Default Next:

Q11-H60SLP-5

Lead-In:

Q11-H60SLP-3B [Default]


 

Q11-H60SLP-5

Section: Health

How often do you…

 

- … have trouble falling asleep?

 

- … wake up during the night and have trouble going back to sleep?

 

- … wake up too early in the morning and be unable to get back to sleep?

 

- … feel unrested during the day, no matter how many hours of sleep you had?

 

 

1   Almost always (4+ times per week)

 

2   Often (2-3 times per week)

 

3   Sometimes (2-4 times per month)

 

4   Rarely or never (once a month or less)

 

Default Next:

Q11-H60-SLP-6

Lead-In:

Q11-H60SLP-4 [Default]


 

Q11-H60-SLP-6

Section: Health

Have you ever been told by a doctor or other health professional that you have a sleep disorder?

 

1   YES   ...(Go To Q11-H60SLP-6A)

 

0   NO

 

Default Next:

Q11-H60OPEN-1

Lead-In:

Q11-H60SLP-5 [Default]


 

Q11-H60SLP-6A

Section: Health

What was the sleep disorder?

(INTERVIEWER: PLEASE SELECT ALL THAT APPLY.)

 

1   SLEEP APNEA

 

2   INSOMNIA

 

3   RESTLESS LEGS SYNDROME

 

4   OTHER

 

Default Next:

Q11-H60SLP-6B

Lead-In:

Q11-H60-SLP-6 [1:1]


 

Q11-H60SLP-6B

Section: Health

In the past year, have you had any treatments for your sleeping or snoring problem?

 

1   YES   ...(Go To Q11-H60SLP-6C)

 

0   NO

 

Default Next:

Q11-H60OPEN-1

Lead-In:

Q11-H60SLP-6A [Default]


 

Q11-H60SLP-6C

Section: Health

What treatments have you had?

(INTERVIEWER: PLEASE SELECT ALL THAT APPLY.)

 

1   OXYGEN

 

2   POSITIVE AIR PRESSURE DEVICE SUCH AS CPAP OR BIPAP

 

3   SURGERY OF THE NOSE OR THROAT

 

4   A DEVICE TO HELP POSITION YOUR JAW

 

5   NERVE STIMULATION OF THE TONGUE

 

6   ADHESIVE STRIPS WITH OR WITHOUT MEDICATION

 

7   ANY OTHER TREATMENTS?

 

Default Next:

Q11-H60OPEN-1

Lead-In:

Q11-H60SLP-6B [1:1]


 

Q11-H60OPEN-1

Section: Health

Is there anything else you want to tell us about your health?

 

1   YES   ...(Go To Q11-H60OPEN-1A)

 

0   NO

 

Default Next:

CIG_CHK1

Lead-In:

Q11-H60-SLP-6 [Default], Q11-H60SLP-6B [Default], Q11-H60SLP-6C [Default]


 

Q11-H60OPEN-1A

Section: Health

(INTERVIEWER: RECORD VERBATIM RESPONSE.)

 

 

Default Next:

CIG_CHK1

Lead-In:

Q11-H60OPEN-1 [1:1]


 

Q11-H50CESD

Section: Health

Now I am going to read a list of the ways that you might have felt or behaved recently. After each statement, please tell me how often you felt this way during the past week.

During the past week.....

 

- I did not feel like eating; my appetite was poor.

 

- I felt that I could not shake off the blues, even with help from my family or friends.

 

- I had trouble keeping my mind on what I was doing.

 

- I felt depressed.

 

- I felt that everything I did was an effort.

 

- My sleep was restless.

 

- I felt lonely.

 

- I felt sad.

 

- I could not get "going".

 

 

0   None at all or less than 1 day

 

1   1-2 days

 

2   3-4 Days

 

3   5-7 Days

 

Default Next:

Q11-H50BPARCHK1

Lead-In:

Q11-H50-CHECK [1:1]


 

Q11-H50BPARCHK1

Section: Health

[Is bio father alive]

If Answer = 0 Then Go To Q11-H50BPARCHK2

Default Next:

Q11-H50BPAR-1

Lead-In:

Q11-H50CESD [Default]


 

Q11-H50BPAR-1

Section: Health

This next series of questions asks about your biological parent's health.

Is your biological father still alive?

 

1   YES   ...(Go To Q11-H50BPAR-4)

 

0   NO


If Answer >= -2 AND Answer <= -1 Then Go To Q11-H50BPAR-6

Default Next:

Q11-H50BPAR-2

Lead-In:

Q11-H50BPARCHK1 [Default]


 

Q11-H50BPAR-2

Section: Health

What caused your biological father's death?

 

1   Heart Attack/Stroke

 

2   Accident

 

3   Cancer

 

4   Old Age

 

5   Emphysema

 

6   Other (specify)

 

Q11-H50BPAR-3

Section: Health

How old was he when he died?

ENTER AGE: 

 

Default Next:

Q11-H50BPAR-4

Lead-In:

Q11-H50BPAR-2 [Default]


 

Q11-H50BPAR-4

Section: Health

[Did/Does] your father have any major health problems?

 

1   YES   ...(Go To Q11-H50BPAR-5)

 

0   NO

 

Default Next:

Q11-H50BPARCHK2

Lead-In:

Q11-H50BPAR-1 [1:1], Q11-H50BPAR-3 [Default]


 

Q11-H50BPAR-5

Section: Health

What [{are/were_fath}] these problems?

 

 

Default Next:

Q11-H50BPARCHK2

Lead-In:

Q11-H50BPAR-4 [1:1]


 

Q11-H50BPARCHK2

Section: Health

[biological mother alive]

If Answer = 0 Then Go To Q11-H50SF12-1

Default Next:

Q11-H50BPAR-6

Lead-In:

Q11-H50BPARCHK1 [0:0], Q11-H50BPAR-4 [Default], Q11-H50BPAR-5 [Default]


 

Q11-H50BPAR-6

Section: Health

Is your biological mother still alive?

 

1   YES   ...(Go To Q11-H50BPAR-9)

 

0   NO


If Answer >= -2 AND Answer <= -1 Then Go To Q11-H50SF12-1

Default Next:

Q11-H50BPAR-7

Lead-In:

Q11-H50BPAR-1 [-2:-1], Q11-H50BPARCHK2 [Default]


 

Q11-H50BPAR-7

Section: Health

What caused your biological mother's death?

 

1   Heart Attack/Stroke

 

2   Accident

 

3   Cancer

 

4   Old Age

 

5   Emphysema

 

6   Other (specify)

 

Q11-H50BPAR-8

Section: Health

How old was she when she died?

ENTER AGE: 

 

Default Next:

Q11-H50BPAR-9

Lead-In:

Q11-H50BPAR-7 [Default]


 

Q11-H50BPAR-9

Section: Health

[Did/Does] your mother have any major health problems?

 

1   YES   ...(Go To Q11-H50BPAR-10)

 

0   NO

 

Default Next:

Q11-H50SF12-1

Lead-In:

Q11-H50BPAR-6 [1:1], Q11-H50BPAR-8 [Default]


 

Q11-H50BPAR-10

Section: Health

What [{are/were_moth}] these problems?

 

 

Default Next:

Q11-H50SF12-1

Lead-In:

Q11-H50BPAR-9 [1:1]


 

Q11-H50SF12-1

Section: Health

Next I will be asking you more specific questions about your health. This information will help keep track of how you feel and how well you are able to do your usual activities.

If you are unsure about how to answer, please give the best answer you can.

Default Next:

Q11-H50SF12-2

Lead-In:

Q11-H50BPARCHK2 [0:0], Q11-H50BPAR-6 [-2:-1], Q11-H50BPAR-9 [Default], Q11-H50BPAR-10 [Default]


 

Q11-H50SF12-2

Section: Health

In general, would you say your health is ....

 

1   EXCELLENT

 

2   VERY GOOD

 

3   GOOD

 

4   FAIR

 

5   POOR

 

Default Next:

Q11-H50SF12-3

Lead-In:

Q11-H50SF12-1 [Default]


 

Q11-H50SF12-3

Section: Health

The following items are activities you might do during a typical day. Does your health limit you in these activities?

......Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf?

 

3   Yes, Limited a Lot

 

2   Yes, Limited a Little

 

1   No, Not Limited at All

 

Q11-H50SF12-3B

Section: Health

..... Climbing several flights of stairs?

 

3   Yes, Limited a Lot

 

2   Yes, Limited a Little

 

1   No, Not Limited at All

 

Default Next:

Q11-H50SF12-4

Lead-In:

Q11-H50SF12-3 [Default]


 

Q11-H50SF12-4

Section: Health

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

..... Accomplished less than you would like?

 

1   YES

 

0   NO

 

Q11-H50SF12-4B

Section: Health

.... Were limited in the kind of work or other activities?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50SF12-5

Lead-In:

Q11-H50SF12-4 [Default]


 

Q11-H50SF12-5

Section: Health

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?

.... Accomplished less than you would like?

 

1   YES

 

0   NO

 

Q11-H50SF12-5B

Section: Health

.... Didn't do work or other activities as carefully as usual?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50SF12-6

Lead-In:

Q11-H50SF12-5 [Default]


 

Q11-H50SF12-6

Section: Health

During the past 4 weeks, how much did pain interfere with your normal work (including both work outside of the home and housework)?

 

1   Not at all

 

2   A little bit

 

3   Moderately

 

4   Quite a bit

 

5   Extremely

 

Default Next:

Q11-H50SF12-7

Lead-In:

Q11-H50SF12-5B [Default]


 

Q11-H50SF12-7

Section: Health

Thinking only of the past 4 weeks, please give the one answer that comes closest to the way you have been feeling. How often during the past 4 weeks....

.... have you felt calm and peaceful?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H50SF12-7B

Lead-In:

Q11-H50SF12-6 [Default]


 

Q11-H50SF12-7B

Section: Health

.... Did you have a lot of energy?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H50SF12-7C

Lead-In:

Q11-H50SF12-7 [Default]


 

Q11-H50SF12-7C

Section: Health

.... Have you felt down-hearted and blue?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H50SF12-8

Lead-In:

Q11-H50SF12-7B [Default]


 

Q11-H50SF12-8

Section: Health

During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

 

1   All the time

 

2   Most of the time

 

3   A good bit of the time

 

4   Some of the time

 

5   A little of the time

 

6   None of the time

 

Default Next:

Q11-H50CHRC_CHK1

Lead-In:

Q11-H50SF12-7C [Default]


 

Q11-H50CHRC_CHK1

Section: Health

[blood pressure problems reported during 40+ Health Module]==1

COMMENT: Did this respondent go through the extended health questions in round 18, round 19, round 20 or round 21? If yes, skip out

If Answer = 1 Then Go To Q11-H50CHRC-1B

Default Next:

Q11-H50CHRC-1

Lead-In:

Q11-H50SF12-8 [Default]


 

Q11-H50CHRC-1

Section: Health

Has a doctor ever told you that you have high blood pressure or hypertension?

 

1   YES   ...(Go To Q11-H50CHRC-1A)

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK2

Lead-In:

Q11-H50CHRC_CHK1 [Default]


 

Q11-H50CHRC-1A

Section: Health

In what month and year was that first diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H50CHRC_CHK2

Lead-In:

Q11-H50CHRC-1 [1:1]


 

Q11-H50CHRC-1B

Section: Health

Do you have high blood pressure or hypertension at the present time?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK2

Lead-In:

Q11-H50CHRC_CHK1 [1:1]


 

Q11-H50CHRC_CHK2

Section: Health

[r report diabetes/high blood sugar in 40+ Health Module]==1

COMMENT: Did this respondent go through the extended health questions in round 18, round 19, round 20 or round 21? If yes, skip out

If Answer = 1 Then Go To Q11-H50CHRC-2B

Default Next:

Q11-H50CHRC-2

Lead-In:

Q11-H50CHRC-1 [Default], Q11-H50CHRC-1A [Default], Q11-H50CHRC-1B [Default]


 

Q11-H50CHRC-2

Section: Health

Has a doctor ever told you that you have diabetes or high blood sugar?

 

1   YES   ...(Go To Q11-H50CHRC-2A)

 

0   NO

 

Default Next:

Q11-H50CHRC-3

Lead-In:

Q11-H50CHRC_CHK2 [Default]


 

Q11-H50CHRC-2A

Section: Health

In what month and year was that first diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H50CHRC-3

Lead-In:

Q11-H50CHRC-2 [1:1]


 

Q11-H50CHRC-2B

Section: Health

Has a doctor ever told you that you had skin cancer?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC-3

Lead-In:

Q11-H50CHRC_CHK2 [1:1]


 

Q11-H50CHRC-3

Section: Health

[Has/Since (date of 40+ Health Module) has] a doctor ever told you that you have cancer or malignant tumor of any kind except skin cancer?

 

1   YES   ...(Go To Q11-H50CHRC-3A)

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK3

Lead-In:

Q11-H50CHRC-2 [Default], Q11-H50CHRC-2A [Default], Q11-H50CHRC-2B [Default]


 

Q11-H50CHRC-3A

Section: Health

How many such cancers have you [Had/had since (date of 40+ Health Module)]?

ENTER # CANCERS: 

If Answer = 0 Then Go To Q11-H50CHRC_CHK3

Default Next:

Q11-H50CHRC-3AB

Lead-In:

Q11-H50CHRC-3 [1:1]


 

Q11-H50CHRC-3AB

Section: Health

REPEAT

Default Next:

Q11-H50CHRC-3B

Lead-In:

Q11-H50CHRC-3A [Default]


 

Q11-H50CHRC-3B

Section: Health

In what month and year was [most recent/next most recent] cancer diagnosed?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H50CHRC-3C

Lead-In:

Q11-H50CHRC-3AB [Default]


 

Q11-H50CHRC-3C

Section: Health

In which organ or part of your body did this cancer occur?

 

 

Default Next:

Q11-H50CHRC-3D

Lead-In:

Q11-H50CHRC-3B [Default]


 

Q11-H50CHRC-3D

Section: Health

Do you currently have any such cancer?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC-3DB

Lead-In:

Q11-H50CHRC-3C [Default]


 

Q11-H50CHRC-3DB

Section: Health

UNTIL ([Q11-loop3 counter]==[Number of cancers R reported] || [Number of cancers R reported]==0)

Default Next:

Q11-H50CHRC_CHK3

Lead-In:

Q11-H50CHRC-3D [Default]


 

Q11-H50CHRC_CHK3

Section: Health

[asthma reptd in previous int]==1

COMMENT: Did this respondent go through the extended health questions in round 18, round 19, round 20 or round 21? If yes, skip out

If Answer = 1 Then Go To Q11-H50CHRC_CHK4

Default Next:

Q11-H50CHRC-3E

Lead-In:

Q11-H50CHRC-3A [0:0], Q11-H50CHRC-3 [Default], Q11-H50CHRC-3DB [Default]


 

Q11-H50CHRC-3E

Section: Health

Do you currently suffer from asthma?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK4

Lead-In:

Q11-H50CHRC_CHK3 [Default]


 

Q11-H50CHRC_CHK4

Section: Health

[r report non-asthma/chronic lung problems in 40+ Health Module]==1

COMMENT: Did this respondent go through the extended health questions in round 18, round 19, round 20 or round 21? If yes, skip out

If Answer = 1 Then Go To Q11-H50CHRC-5

Default Next:

Q11-H50CHRC-4

Lead-In:

Q11-H50CHRC_CHK3 [1:1], Q11-H50CHRC-3E [Default]


 

Q11-H50CHRC-4

Section: Health

Not including asthma, has a doctor ever told you that you have chronic lung disease such as chronic bronchitis or emphysema?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC-5

Lead-In:

Q11-H50CHRC_CHK4 [Default]


 

Q11-H50CHRC-5

Section: Health

[Has/Since (date of 40+ Health Module) has] a doctor ever told you that you had a heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems?

 

1   YES   ...(Go To Q11-H50CHRC-5A)

 

0   NO

 

Default Next:

Q11-H50CHRC-6

Lead-In:

Q11-H50CHRC_CHK4 [1:1], Q11-H50CHRC-4 [Default]


 

Q11-H50CHRC-5A

Section: Health

[Did/Since (date of 40+ Health Module) did] you have a heart attack or myocardial infarction?

 

1   YES   ...(Go To Q11-H50CHRC-5B)

 

0   NO

 

Default Next:

Q11-H50CHRC-5C

Lead-In:

Q11-H50CHRC-5 [1:1]


 

Q11-H50CHRC-5B

Section: Health

In what month and year did you have your [last] heart attack or myocardial infarction?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H50CHRC-5C

Lead-In:

Q11-H50CHRC-5A [1:1]


 

Q11-H50CHRC-5C

Section: Health

Do you currently have any angina or chest pains due to your heart?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC-6

Lead-In:

Q11-H50CHRC-5A [Default], Q11-H50CHRC-5B [Default]


 

Q11-H50CHRC-6

Section: Health

Has a doctor ever told you that you have congestive heart failure?

 

1   YES   ...(Go To Q11-H50CHRC-6A)

 

0   NO

 

Default Next:

Q11-H50CHRC-7

Lead-In:

Q11-H50CHRC-5 [Default], Q11-H50CHRC-5C [Default]


 

Q11-H50CHRC-6A

Section: Health

In what month and year was your congestive heart failure?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H50CHRC-7

Lead-In:

Q11-H50CHRC-6 [1:1]


 

Q11-H50CHRC-7

Section: Health

[Has/Since (date of 40+ Health Module) has] a doctor ever told you that you had a stroke?

 

1   YES   ...(Go To Q11-H50CHRC-7A)

 

0   NO

 

Default Next:

Q11-H50CHRC-7B

Lead-In:

Q11-H50CHRC-6 [Default], Q11-H50CHRC-6A [Default]


 

Q11-H50CHRC-7A

Section: Health

In what month and year did you last have a stroke?

 

 

Month

Year

Day

 

 

Default Next:

Q11-H50CHRC-7B

Lead-In:

Q11-H50CHRC-7 [1:1]


 

Q11-H50CHRC-7B

Section: Health

Has a doctor ever diagnosed you as suffering from depression?

 

1   YES   ...(Go To Q11-H50CHRC-7C)

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK6

Lead-In:

Q11-H50CHRC-7 [Default], Q11-H50CHRC-7A [Default]


 

Q11-H50CHRC-7C

Section: Health

In what month and year was your depression diagnosed?

 

 

Month

Year

Day

 

 

Q11-H50CHRC-7D

Section: Health

During the last 12 months, have you suffered from depression?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK6

Lead-In:

Q11-H50CHRC-7C [Default]


 

Q11-H50CHRC_CHK6

Section: Health

[r report psychiatric problems during 40+ Health Module]==1

COMMENT: Did this respondent go through the extended health questions in round 18, round 19, round 20 or round 21? If yes, skip out

If Answer = 1 Then Go To Q11-H50CHRC_CHK7

Default Next:

Q11-H50CHRC-8

Lead-In:

Q11-H50CHRC-7B [Default], Q11-H50CHRC-7D [Default]


 

Q11-H50CHRC-8

Section: Health

Has a doctor ever told you that you had emotional, nervous, or psychiatric problems other than depression?

 

1   YES   ...(Go To Q11-H50CHRC-8A)

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK7

Lead-In:

Q11-H50CHRC_CHK6 [Default]


 

Q11-H50CHRC-8A

Section: Health

In what month and year were your emotional, nervous or psychiatric problems diagnosed?

 

 

Month

Year

Day

 

 

Q11-H50CHRC-8B

Section: Health

During the last 12 months, have you had any emotional, nervous, or psychiatric problems?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC_CHK7

Lead-In:

Q11-H50CHRC-8A [Default]


 

Q11-H50CHRC_CHK7

Section: Health

[r report arthritis during 40+ Health Module]==1

COMMENT: Did this respondent go through the extended health questions in round 18, round 19, round 20 or round 21? If yes, skip out

If Answer = 1 Then Go To Q11-H50CHRC-9B

Default Next:

Q11-H50CHRC-9

Lead-In:

Q11-H50CHRC_CHK6 [1:1], Q11-H50CHRC-8 [Default], Q11-H50CHRC-8B [Default]


 

Q11-H50CHRC-9

Section: Health

Have you ever had, or has a doctor ever told you that you have, arthritis or rheumatism?

 

1   YES   ...(Go To Q11-H50CHRC-9A)

 

0   NO

 

Default Next:

Q11-H50CHRC-9B

Lead-In:

Q11-H50CHRC_CHK7 [Default]


 

Q11-H50CHRC-9A

Section: Health

In what month and year was your arthritis or rheumatism diagnosed?

 

1   ENTER MONTH AND YEAR   ...(Go To Q11-H50CHRC-9AB)

 

0   NEVER DIAGNOSED

 

Default Next:

Q11-H50CHRC-9B

Lead-In:

Q11-H50CHRC-9 [1:1]


 

Q11-H50CHRC-9AB

Section: Health

(In what month and year was your arthritis or rheumatism diagnosed?)

 

 

Month

Year

 

 

Default Next:

Q11-H50CHRC-9B

Lead-In:

Q11-H50CHRC-9A [1:1]


 

Q11-H50CHRC-9B

Section: Health

Do you sometimes have pain, stiffness, or swelling in your joints?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50CHRC-9C

Lead-In:

Q11-H50CHRC_CHK7 [1:1], Q11-H50CHRC-9 [Default], Q11-H50CHRC-9A [Default], Q11-H50CHRC-9AB [Default]


 

Q11-H50CHRC-9C

Section: Health

Has a doctor ever told you that you had osteoporosis?

 

1   YES

 

0   NO

 

Default Next:

Q11-H50FL-1

Lead-In:

Q11-H50CHRC-9B [Default]


 

Q11-H50FL-1

Section: Health

Do you currently use any special equipment to aid you in your usual activities? By this we mean things such as hearing aids, wheelchairs, scooters, canes, protheses, or special telephones. Please do not include eyeglasses or false teeth.

 

1   YES

 

0   NO

 

Default Next:

Q11-H50FL-2

Lead-In:

Q11-H50CHRC-9C [Default]


 

Q11-H50FL-2

Section: Health

We are interested in how much difficulty people have with various activities because of a health or physical problem. How difficult is it for you to…

 

- ... Run a mile?

 

- … Walk several blocks?

 

- … Walk one block?

 

- ... Sit for about 2 hours?

 

- ... Get up from a chair after sitting for long periods?

 

- ... Climb several flights of stairs without resting?

 

- ... Climb one flight of stairs without resting?

 

- ... Lift or carry weights OVER 10 pounds, like a heavy bag of groceries?

 

- ... Stoop, kneel, or crouch?

 

- ... Pick up a dime from a table?

 

- ... Reach or extend your arms above shoulder level?

 

- ... Pull or push large objects like a living room chair?

 

 

1   Not at all difficult for you

 

2   A little difficult

 

3   Somewhat difficult

 

4   Very difficult/can't do

 

5   Don't do

 

Default Next:

Q11-H50SLP-1

Lead-In:

Q11-H50FL-1 [Default]


 

Q11-H50SLP-1

Section: Health

How much sleep do you usually get at night (or in your main sleep period) on weekdays or workdays?

ENTER # HOURS: 

 

Q11-H50SLP-1B

Section: Health

 

ENTER # MINUTES: 

 

Default Next:

Q11-H50SLP-2

Lead-In:

Q11-H50SLP-1 [Default]


 

Q11-H50SLP-2

Section: Health

How much sleep do you usually get at night (or in your main sleep period) on weekends or your nonworkdays?

ENTER # HOURS: 

 

Q11-H50SLP-2B

Section: Health

 

ENTER # MINUTES: 

 

Default Next:

Q11-H50SLP-3

Lead-In:

Q11-H50SLP-2 [Default]


 

Q11-H50SLP-3

Section: Health

How long does it usually take you to fall asleep at bedtime?

ENTER # HOURS: 

 

Q11-H50SLP-3B

Section: Health

 

ENTER # MINUTES: 

 

Default Next:

Q11-H50SLP-4

Lead-In:

Q11-H50SLP-3 [Default]


 

Q11-H50SLP-4

Section: Health

During a usual week, how many times do you nap for 5 minutes or more?

ENTER # TIMES: 

 

Default Next:

Q11-H50SLP-5

Lead-In:

Q11-H50SLP-3B [Default]


 

Q11-H50SLP-5

Section: Health

How often do you…

 

- … have trouble falling asleep?

 

- … wake up during the night and have trouble going back to sleep?

 

- … wake up too early in the morning and be unable to get back to sleep?

 

- … feel unrested during the day, no matter how many hours of sleep you had?

 

 

1   Almost always (4+ times per week)

 

2   Often (2-3 times per week)

 

3   Sometimes (2-4 times per month)

 

4   Rarely or never (once a month or less)

 

Default Next:

Q11-H50OPEN-1

Lead-In:

Q11-H50SLP-4 [Default]


 

Q11-H50OPEN-1

Section: Health

Is there anything else you want to tell us about your health?

 

1   YES   ...(Go To Q11-H50OPEN-1A)

 

0   NO

 

Default Next:

CIG_CHK1

Lead-In:

Q11-H50SLP-5 [Default]


 

Q11-H50OPEN-1A

Section: Health

(INTERVIEWER: RECORD VERBATIM RESPONSE.)

 

 

Default Next:

CIG_CHK1

Lead-In:

Q11-H50OPEN-1 [1:1]