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 |
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
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: |
|
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: |
|
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: |
|
Lead-In: |
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: |
|
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: |
|
Lead-In: |
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-CARE-4 [1:1] |
Q11-9 |
Section:
Health |
How much do you weigh?
(ENTER POUNDS)
|
|
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11_GENHLTH_M1 [Default] |
Q11-GENHLTH_M2A |
Section:
Health |
(How old were you when you had your last
period?)
|
|
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-HLTHPLN-5CHK [Default] |
Q11-81B_1 |
Section:
Health |
About how many months were you without coverage?
|
|
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
COGNITION-C4 [Default] |
Q11-H60-2 |
Section:
Health |
[{birthdate~Y}] <=
1958
If Answer = 1 Then Go To Q11-H60DIENER
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-GAD-7 [Default] |
Q11-H60BPARCHK1 |
Section:
Health |
[Is bio father alive]
If Answer =
0 Then Go To Q11-H60BPARCHK2
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H60BPAR-6 [1:1],
Q11-H60BPAR-8 [Default] |
Q11-H60BPAR-10 |
Section:
Health |
What [{are/were_moth}]
these problems?
|
|
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H60CHRC-3 [1:1] |
Q11-H60-CHRC-3AB |
Section: Health |
REPEAT
Default Next: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H60CHRC-3B [Default] |
Q11-H60CHRC-3D |
Section:
Health |
Do you currently have any such cancer?
|
1 YES |
|
0 NO |
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H50BPAR-1 [1:1],
Q11-H50BPAR-3 [Default] |
Q11-H50BPAR-5 |
Section:
Health |
What [{are/were_fath}]
these problems?
|
|
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H50BPAR-6 [1:1],
Q11-H50BPAR-8 [Default] |
Q11-H50BPAR-10 |
Section:
Health |
What [{are/were_moth}]
these problems?
|
|
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H50CHRC-3 [1:1] |
Q11-H50CHRC-3AB |
Section:
Health |
REPEAT
Default Next: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H50CHRC-3B [Default] |
Q11-H50CHRC-3D |
Section:
Health |
Do you currently have any such cancer?
|
1 YES |
|
0 NO |
Default Next: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
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: |
|
Lead-In: |
Q11-H50SLP-5 [Default] |
Q11-H50OPEN-1A |
Section:
Health |
(INTERVIEWER: RECORD
VERBATIM RESPONSE.)
|
|
Default Next: |
|
Lead-In: |
Q11-H50OPEN-1 [1:1] |