IHIS

Page 1 of 35

2010 NHIS Questionnaire - Sample Adult
Quality of Life

Question ID: QOL.100_00.000

Instrument Variable Name: VIS_SS QuestionText:

These next questions are new and we are testing them. Some may sound similar to questions you already answered.
Do you have difficulty seeing, even when wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto VIS_1]
(4) [goto HEAR_SS]

Question ID: QOL.110_00.000

Instrument Variable Name: VIS_1 QuestionText:

Do you wear glasses to see far away?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses SkipInstructions:

(1,2,R,D)[goto VIS_2]

Question ID: QOL.120_00.000

Instrument Variable Name: VIS_2 QuestionText:

Do you have difficulty clearly seeing someone's face across a room {fill: even when wearing these glasses}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses SkipInstructions:

(1-4,R,D)[goto VIS_3]

Question ID: QOL.130_00.000

Instrument Variable Name: VIS_3 QuestionText:

Do you wear glasses for reading or to see up close?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses SkipInstructions:

(1,2,R,D)[goto VIS_4]

Question ID: QOL.140_00.000

Instrument Variable Name: VIS_4 QuestionText:

Do you have difficulty clearly seeing the picture on a coin {fill: even when wearing these glasses}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty seeing, even when wearing glasses SkipInstructions:

(1-4,R,D)[goto HEAR_SS]

Question ID: QOL.150_00.000

Instrument Variable Name: HEAR_SS QuestionText:

Do you have difficulty hearing, even when using a hearing aid? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto HEAR_1]
(4)[goto MOB_SS]

Question ID: QOL.160_00.000

Instrument Variable Name: HEAR_1 QuestionText:

Do you use a hearing aid?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty hearing, even when using a hearing aid SkipInstructions:

(1)[goto HEAR_2]
(2,R,D)[goto HEAR_3]

Question ID: QOL.160_00.001

Instrument Variable Name: HEAR_2 QuestionText:

How often do you use your hearing aid(s)? Would you say all of the time, some of the time, rarely, or never?

1 All of the time
2 Some of the time
3 Rarely
4 Never
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use a hearing aid SkipInstructions:

(1-4,R,D)[goto HEAR_3]

Question ID: QOL.170_00.000

Instrument Variable Name: HEAR_3 QuestionText:

Do you have difficulty hearing what is said in a conversation with one other person in a quiet room {fill: even when wearing your hearing aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty hearing, even when using a hearing aid SkipInstructions:

(1-3,R,D)[goto HEAR_4]
(4)[goto MOB_SS]

Question ID: QOL.170_00.001

Instrument Variable Name: HEAR_4 QuestionText:

Do you have difficulty hearing what is said in a conversation with one other person in a noisier room {fill: even when wearing your hearing aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have no difficulty, some difficulty, a lot of difficulty, or refuse or don't know if they have difficulty hearing what is said in a conversation with one other person in a quiet room (even when wearing their hearing aid(s)) SkipInstructions:

(1-4,R,D)[goto MOB_SS]

Question ID: QOL.180_00.000

Instrument Variable Name: MOB_SS QuestionText:

Do you have any difficulty walking or climbing steps? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto MOB_1]

Question ID: QOL.190_00.000

Instrument Variable Name: MOB_1 QuestionText:

Do you have difficulty moving around inside your home? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto MOB_2]

Question ID: QOL.200_00.000

Instrument Variable Name: MOB_2 QuestionText:

Do you use any equipment or receive help with walking, climbing steps, or moving around?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1)[goto MOB_3A]
(2,R,D)[goto MOB_4]

Question ID: QOL.200_00.001

Instrument Variable Name: MOB_3A QuestionText:

Do you use any of the following...
Cane or walking stick?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around SkipInstructions:

(1,2,R,D)[goto MOB_3B]

Question ID: QOL.200_00.002

Instrument Variable Name: MOB_3B QuestionText:

*Read if necessary.
Do you use any of the following...
Walker?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around SkipInstructions:

(1,2,R,D)[goto MOB_3C]

Question ID: QOL.200_00.003

Instrument Variable Name: MOB_3C QuestionText:

*Read if necessary.
Do you use any of the following...
Crutches?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around SkipInstructions:

(1,2,R,D)[goto MOB_3D]

Question ID: QOL.200_00.004

Instrument Variable Name: MOB_3D QuestionText:

*Read if necessary.
Do you use any of the following...
Wheelchair?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around SkipInstructions:

(1,2,R,D)[goto MOB_3E]

Question ID: QOL.200_00.005

Instrument Variable Name: MOB_3E QuestionText:

*Read if necessary.
Do you use any of the following...
Prosthesis?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around SkipInstructions:

(1,2,R,D)[goto MOB_3F]

Question ID: QOL.200_00.006

Instrument Variable Name: MOB_3F QuestionText:

*Read if necessary.
Do you use any of the following...
Someone's assistance?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around SkipInstructions:

(1,2,R,D)[goto MOB_3G]

Question ID: QOL.200_00.007

Instrument Variable Name: MOB_3G QuestionText:

*Read if necessary.
Do you use any of the following...
Other type of equipment or help?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for walking, climbing steps, or moving around SkipInstructions:

(1)[goto MOBSPEC]
(2,R,D)
if MOB_3D='1' [goto COM_SS]
elseif MOB_3D IN (2,R,D) [goto MOB_4]

Question ID: QOL.200_00.008

Instrument Variable Name: MOBSPEC QuestionText:

*Specify other type of equipment or help received for getting around.

Verbatim Verbatim response
97 Refused
99 Don't know

UniverseText: Sample adults 18+ who use an other type of equipment or help for walking, climbing steps, or moving around SkipInstructions:

(allow 50,R,D)
if MOB_3D='1' [goto COM_SS]
elseif MOB_3D IN (2,R,D) [goto MOB_4]

Question ID: QOL.210_00.000

Instrument Variable Name: MOB_4 QuestionText:

Do you have difficulty walking 100 yards on level ground, that would be about the length of one football field or one city block {fill: without the use of your aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do not use a wheelchair SkipInstructions:

(1-3,R,D)[goto MOB_5]
(4)[goto MOB_6]

Question ID: QOL.220_00.000

Instrument Variable Name: MOB_5 QuestionText:

Do you have difficulty walking a third of a mile on level ground, that would be the length of five football fields or five city blocks {fill: without the use of your aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do not use a wheelchair and have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty walking 100 yards on level ground (without the use of their aid) SkipInstructions:

(1-4,R,D)[goto MOB_6]

Question ID: QOL.230_00.000

Instrument Variable Name: MOB_6 QuestionText:

Do you have difficulty walking up or down 12 steps {fill: without the use of your aid(s)}? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who do not use a wheelchair SkipInstructions:

(1-4,R,D)
if MOB_2 IN '2,R,D' [goto COM_SS]
elseif MOB_2 = '1' [goto MOB_7]

Question ID: QOL.240_00.000

Instrument Variable Name: MOB_7 QuestionText:

Do you have difficulty walking 100 yards on level ground, that would be about the length of one (1) football field or one city block, when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for getting around but do not use a wheelchair SkipInstructions:

(1-3,R,D)[goto MOB_8]
(4)[goto MOB_9]

Question ID: QOL.250_00.000

Instrument Variable Name: MOB_8 QuestionText:

Do you have difficulty walking a third of a mile on level ground, that would be the length of five football fields or five city blocks, when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for getting around but do not use a wheelchair and who have no difficulty, some difficulty, a lot of difficulty, or refused or don't know if they have difficulty walking 100 yards on level ground, when using their aid SkipInstructions:

(1-4,R,D)[goto MOB_9]

Question ID: QOL.260_00.000

Instrument Variable Name: MOB_9 QuestionText:

Do you have difficulty walking up or down 12 steps, even when using your aid(s)? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who use equipment or receive help for getting around but do not use a wheelchair

Question ID: QOL.270_00.000

Instrument Variable Name: COM_SS QuestionText:

Using your usual language, do you have difficulty communicating, for example understanding or being understood?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto COM_1]

Question ID: QOL.280_00.000

Instrument Variable Name: COM_1 QuestionText:

Do people have difficulty understanding you when you speak? Would you say no difficulty, some difficulty, a lot of difficulty, or are they unable to understand you?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(if COM_SS IN (1,R,D) and COM_1 IN (1,R,D)) [goto COM_2];
elseif (COM_SS IN (2,3,4) or COM_1 IN (2,3,4)) [goto P_COM_1A]

Question ID: QOL.285_01.000

Instrument Variable Name: P_COM_1A QuestionText:

Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no to each.
...Because you sometimes talk too fast, feel shy or have trouble expressing yourself?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or cannot communicate, or have some difficulty, a lot of difficulty or cannot be understood when speaking SkipInstructions:

(1,2,R,D)[goto P_COM_1B]

Question ID: QOL.285_02.000

Instrument Variable Name: P_COM_1B QuestionText:

*Read if necessary.
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no
to each.
...Because of a physical problem with your mouth or tongue?

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_COM_1C]

Question ID: QOL.285_03.000

Instrument Variable Name: P_COM_1C QuestionText:

*Read if necessary.
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no
to each.
...Because you need to understand other languages or different ways of speaking?

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_COM_1D]

Question ID: QOL.285_04.000

Instrument Variable Name: P_COM_1D QuestionText:

*Read if necessary.
Which of the following, if any, are reasons for your difficulty communicating or being understood? Please say yes or no to each.
...Because you have trouble hearing?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or cannot communicate, or have some difficulty, a lot of difficulty or cannot be understood when speaking

Question ID: QOL.290_00.000

Instrument Variable Name: COM_2 QuestionText:

Do you use sign language?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1,2,R,D)[goto COG_SS]

Question ID: QOL.300_00.000

Instrument Variable Name: COG_SS QuestionText:

Do you have difficulty remembering or concentrating? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1)[goto UB_SS]
(2-4,R,D)[goto COG_1]

Question ID: QOL.310_00.000

Instrument Variable Name: COG_1 QuestionText:

Do you have difficulty remembering, concentrating, or both?

1 Difficulty remembering only
2 Difficulty concentrating only
3 Difficulty with both remembering and concentrating
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have some difficulty, a lot of difficulty, or are unable to remember or concentrate, or don't know or refused if they are able to remember or concentrate SkipInstructions:

(1,3,R,D)[goto COG_2]
(2)[goto COG_4]

Question ID: QOL.320_00.000

Instrument Variable Name: COG_2 QuestionText:

How often do you have difficulty remembering? Would you say sometimes, often or all of the time?

1 Sometimes
2 Often
3 All of the time
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,3,R,D)[goto COG_3]

Question ID: QOL.330_00.000

Instrument Variable Name: COG_3 QuestionText:

Do you have difficulty remembering a few things, a lot of things, or almost everything?

1 A few things
2 A lot of things
3 Almost everything
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,3,R,D)[goto P_COG_3A]

Question ID: QOL.335_01.000

Instrument Variable Name: P_COG_3A QuestionText:

Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I forget things because I am busy and have too much to remember.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,R,D)[goto P_COG_3B]

Question ID: QOL.335_02.000

Instrument Variable Name: P_COG_3B QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty is getting worse.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,R,D)[goto P_COG_3C]

Question ID: QOL.335_03.000

Instrument Variable Name: P_COG_3C QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty has put me or my family in danger.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,R,D)[goto P_COG_3D]

Question ID: QOL.335_04.000

Instrument Variable Name: P_COG_3D QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I only forget little or inconsequential things.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,R,D)[goto P_COG_3E]

Question ID: QOL.335_05.000

Instrument Variable Name: P_COG_3E QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...I must write down important things, such as my address or when to take medicine, so that I do not forget.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,R,D)[goto P_COG_3F]

Question ID: QOL.335_06.000

Instrument Variable Name: P_COG_3F QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My family members or friends are worried about my difficulty remembering.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,R,D)[goto P_COG_3G]

Question ID: QOL.335_07.000

Instrument Variable Name: P_COG_3G QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your difficulty remembering? Please say yes or no to each.
...My difficulty is normal for someone my age.

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty remembering SkipInstructions:

(1,2,R,D)
if COG_1=1 [goto UB_SS]
elseif COG_1 IN (3,R,D) [goto COG_4]

Question ID: QOL.340_00.000

Instrument Variable Name: COG_4 QuestionText:

How much difficulty do you have concentrating for ten minutes? Would you say a little, a lot, or somewhere in between?

1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have difficulty concentrating SkipInstructions:

(1,2,R,D)[goto UB_SS]
(3)[goto COG_5]

Question ID: QOL.350_00.000

Instrument Variable Name: COG_5 QuestionText:

Would you say this is closer to a little, closer to a lot, or exactly in the middle?

1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have somewhere in between a little and a lot of difficulty concentrating for ten minutes SkipInstructions:

(1,2,3,R,D)[goto UB_SS]

Question ID: QOL.360_00.000

Instrument Variable Name: UB_SS QuestionText:

Do you have difficulty with self care, such as washing all over or dressing? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto UB_1]

Question ID: QOL.370_00.000

Instrument Variable Name: UB_1 QuestionText:

Do you have difficulty raising a 2 liter bottle of water or soda from waist to eye level? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto UB_2]

Question ID: QOL.380_00.000

Instrument Variable Name: UB_2 QuestionText:

Do you have difficulty using your hands and fingers, such as picking up small objects, for example, a button or pencil, or opening or closing containers or bottles? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto LEARN_1]

Question ID: QOL.390_00.000

Instrument Variable Name: LEARN_1 QuestionText:

Do you have difficulty learning the rules for a new game? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto LEARN_2]

Question ID: QOL.400_00.000

Instrument Variable Name: LEARN_2 QuestionText:

Do you have difficulty understanding and following instructions for example, to use a cell phone or to get to a new place?
Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all/Unable to do
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto ANX_1]

Question ID: QOL.410_00.000

Instrument Variable Name: ANX_1 QuestionText:

How often do you feel worried, nervous or anxious? Would you say daily, weekly, monthly, a few times a year, or never?

1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-5,R,D)[goto ANX_2]

Question ID: QOL.420_00.000

Instrument Variable Name: ANX_2 QuestionText:

Do you take medication for these feelings?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1,2,R,D)
if (ANX_1 IN (4,5) and ANX_2=2) [goto DEP_1];
elseif (ANX_1 IN (1,2,3,R,D) or ANX_2 IN (1,R,D)) ([goto ANX_3]

Question ID: QOL.430_00.000

Instrument Variable Name: ANX_3 QuestionText:

Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings?
Would you say a little, a lot, or somewhere in between?

1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know

(1,2,R,D)[goto P_ANX_4A]
(3)[goto ANX_4]

Question ID: QOL.440_00.000

Instrument Variable Name: ANX_4 QuestionText:

Would you say this was closer to a little, closer to a lot, or exactly in the middle?

1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who feel worried, anxious, or nervous daily, weekly, or monthly or don't know or refused how often or who do take medication for these feelings or don't know or refused if they take medication for these feelings and the last time they felt worried, anxious, or nervous described the level of these feelings as somewhere in between a little and a lot SkipInstructions:

(1-3,R,D)[goto P_ANX_4A]

Question ID: QOL.445_01.000

Instrument Variable Name: P_ANX_4A QuestionText:

Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...My feelings are caused by the type and amount of work I do.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_ANX_4B]

Question ID: QOL.445_02.000

Instrument Variable Name: P_ANX_4B QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...Sometimes the feelings can be so intense that my chest hurts and I have trouble breathing.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_ANX_4C]

Question ID: QOL.445_03.000

Instrument Variable Name: P_ANX_4C QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...These are positive feelings that help me to accomplish goals and be productive.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_ANX_4D]

Question ID: QOL.445_04.000

Instrument Variable Name: P_ANX_4D QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...The feelings sometimes interfere with my life, and I wish that I did not have them.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_ANX_4E]

Question ID: QOL.445_05.000

Instrument Variable Name: P_ANX_4E QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...If I had more money or a better job, I would not have these feelings.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_ANX_4F]

Question ID: QOL.445_06.000

Instrument Variable Name: P_ANX_4F QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...Everybody has these feelings. They are part of life and are normal.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_ANX_4G]

Question ID: QOL.445_07.000

Instrument Variable Name: P_ANX_4G QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being worried, nervous, or anxious? Please say yes or no to each.
...I have been told by a medical professional that I have anxiety.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto DEP_1]

Question ID: QOL.450_00.000

Instrument Variable Name: DEP_1 QuestionText:

How often do you feel depressed? Would you say daily, weekly, monthly, a few times a year, or never?

1 Daily
2 Weekly
3 Monthly
4 A few times a year
5 Never
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-5,R,D)[goto DEP_2]

Question ID: QOL.460_00.000

Instrument Variable Name: DEP_2 QuestionText:

Do you take medication for depression?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1, 2, R, D) (if DEP_1 IN (4,5) and DEP_2=2) [goto PAIN_1]
elseif (DEP_1 IN (1,2,3,R,D) or (DEP_1 IN (4,5) and DEP_2 IN (1,R,D))) [goto DEP_3]

Question ID: QOL.470_00.000

Instrument Variable Name: DEP_3 QuestionText:

Thinking about the last time you felt depressed, how depressed did you feel? Would you say a little, a lot, or somewhere in between?

1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who feel depressed daily, weekly, monthly, or refused or don't know how often they feel depressed or who feel depressed a few times a year or never and do take medication or refused or don't know if they take medication for depression SkipInstructions:

(1,2,R,D)[goto P_DEP_4A]
(3)[goto DEP_4]

Question ID: QOL.480_00.000

Instrument Variable Name: DEP_4 QuestionText:

Would you say this was closer to a little, closer to a lot, or exactly in the middle?

1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know

(1-3,R,D)[goto P_DEP_4A]

Question ID: QOL.485_01.000

Instrument Variable Name: P_DEP_4A QuestionText:

Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...My feelings are caused by the death of a loved one.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_DEP_4B]

Question ID: QOL.485_02.000

Instrument Variable Name: P_DEP_4B QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...Sometimes the feelings can be so intense that I cannot get out of bed.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_DEP_4C]

Question ID: QOL.485_03.000

Instrument Variable Name: P_DEP_4C QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...The feelings sometimes interfere with my life, and I wish I did not have them.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_DEP_4D]

Question ID: QOL.485_04.000

Instrument Variable Name: P_DEP_4D QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...If I had more money or a better job, I would not have these feelings.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_DEP_4E]

Question ID: QOL.485_05.000

Instrument Variable Name: P_DEP_4E QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...Everybody has these feelings. They are part of life and are normal.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_DEP_4F]

Question ID: QOL.485_06.000

Instrument Variable Name: P_DEP_4F QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your feelings of being depressed? Please say yes or no to each.
...I have been told by a medical professional that I have depression.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto PAIN_1]

Question ID: QOL.490_00.000

Instrument Variable Name: PAIN_1 QuestionText:

Do you have frequent pain?

1 Yes
2 No
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1,2,R,D)[goto PAIN_2]

Question ID: QOL.500_00.000

Instrument Variable Name: PAIN_2 QuestionText:

In the past 3 months, how often did you have pain? Would you say never, some days, most days, or every day?

1 Never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)
(if PAIN_1=2 and PAIN_2=1) [goto TIRED_1];
elseif (PAIN_1 IN (1,R,D) or PAIN_2 IN (2,3,4,R,D)) [goto PAIN_3]

Question ID: QOL.510_00.000

Instrument Variable Name: PAIN_3 QuestionText:

Thinking about the last time you had pain, how long did the pain last? Would you say some of the day, most of the day, or all of the day?

1 Some of the day
2 Most of the day
3 All of the day
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who have frequent pain or refused or don't know whether they have frequent pain or have had pain some days, most days, every day, or refused or don't know how often they have had pain in the past 3 months SkipInstructions:

(1-3,R,D)[goto PAIN_4]

Question ID: QOL.520_00.000

Instrument Variable Name: PAIN_4 QuestionText:

Thinking about the last time you had pain, how much pain did you have? Would you say a little, a lot, or somewhere in between?

1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know

(1,2,R,D)[goto P_PAIN5A]
(3)[goto PAIN_5]

Question ID: QOL.530_00.000

Instrument Variable Name: PAIN_5 QuestionText:

Would you say the amount of pain was closer to a little, closer to a lot, or exactly in the middle?

1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who the last time they had pain it was somewhere between a little and a lot SkipInstructions:

(1-3,R,D)[goto P_PAIN5A]

Question ID: QOL.535_01.000

Instrument Variable Name: P_PAIN5A QuestionText:

Which of the following statements, if any, describe your pain? Please say yes or no to each.
...It is constantly present.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_PAIN5B]

Question ID: QOL.535_02.000

Instrument Variable Name: P_PAIN5B QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Sometimes I'm in a lot of pain and sometimes it's not so bad.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_PAIN5C]

Question ID: QOL.535_03.000

Instrument Variable Name: P_PAIN5C QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Sometimes it is unbearable and excruciating.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_PAIN5D]

Question ID: QOL.535_04.000

Instrument Variable Name: P_PAIN5D QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...When I get my mind on other things, I am not aware of the pain.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_PAIN5E]

Question ID: QOL.535_05.000

Instrument Variable Name: P_PAIN5E QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...Medication can take my pain away completely.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_PAIN5F]

Question ID: QOL.535_06.000

Instrument Variable Name: P_PAIN5F QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...My pain is because of work.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto P_PAIN5G]

Question ID: QOL.535_07.000

Instrument Variable Name: P_PAIN5G QuestionText:

*Read if necessary.
Which of the following statements, if any, describe your pain? Please say yes or no to each.
...My pain is because of exercise.

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto TIRED_1]

Question ID: QOL.540_00.000

Instrument Variable Name: TIRED_1 QuestionText:

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

1 Never
2 Some days
3 Most days
4 Every day
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1)[goto QOL_1]
(2-4,R,D)[goto TIRED_2]

Question ID: QOL.550_00.000

Instrument Variable Name: TIRED_2 QuestionText:

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

1 Some of the day
2 Most of the day
3 All of the day
7 Refused
9 Don't know

(1-3,R,D)[goto TIRED_3]

Question ID: QOL.560_00.000

Instrument Variable Name: TIRED_3 QuestionText:

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

1 A little
2 A lot
3 Somewhere in between a little and a lot
7 Refused
9 Don't know

(1,2,R,D)[goto PTIRED4A]
(3)[goto TIRED_4]

Question ID: QOL.570_00.000

Instrument Variable Name: TIRED_4 QuestionText:

Would you say it was closer to a little, closer to a lot, or exactly in the middle?

1 Closer to a little
2 Closer to a lot
3 Exactly in the middle
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months and the last time they felt this way the level of tiredness was somewhere between a little and a lot SkipInstructions:

(1-3,R,D)[goto PTIRED4A]

Question ID: QOL.575_01.000

Instrument Variable Name: PTIRED4A QuestionText:

Is your tiredness the result of any of the following? Please say yes or no to each.
...Too much work or exercise?

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto PTIRED4B]

Question ID: QOL.575_02.000

Instrument Variable Name: PTIRED4B QuestionText:

*Read if necessary.
Is your tiredness the result of any of the following? Please say yes or no to each.
...Not getting enough sleep?

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto PTIRED4C]

Question ID: QOL.575_03.000

Instrument Variable Name: PTIRED4C QuestionText:

*Read if necessary.
Is your tiredness the result of any of the following? Please say yes or no to each.
...A physical or health-related problem?

1 Yes
2 No
7 Refused
9 Don't know

(1,2,R,D)[goto PTIRED4D]

Question ID: QOL.575_04.000

Instrument Variable Name: PTIRED4D QuestionText:

*Read if necessary.
Is your tiredness the result of any of the following? Please say yes or no to each.
...Something else?

1 Yes
2 No
7 Refused
9 Don't know

(1) [goto PTIRED4E]
(2,R,D) [goto QOL_1]

Question ID: QOL.575_05.000

Instrument Variable Name: PTIRED4E QuestionText:

*Specify other reason for tiredness.

97 Refused
99 Don't know
Verbatim Verbatim response

UniverseText: Sample adults 18+ who felt very tired or exhausted some days, most days, every day, or refused or don't know how often they felt very tired or exhausted in the past 3 months and whose tiredness is the result of something else SkipInstructions:

(allow 50,R,D) [goto QOL_1]

Question ID: QOL.580_00.000

Instrument Variable Name: QOL_1 QuestionText:

Are you limited in your ability to carry out daily activities? Would you say not at all, a little, a lot, or completely limited?

1 Not at all
2 A little
3 A lot
4 Completely
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-4,R,D)[goto QOL_2B]

Question ID: QOL.590_00.002

Instrument Variable Name: QOL_2B QuestionText:

For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Working outside the home to earn an income?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto QOL_2C]

Question ID: QOL.590_00.003

Instrument Variable Name: QOL_2C QuestionText:

*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Going to school or achieving your education goals?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto QOL_2D]

Question ID: QOL.590_00.004

Instrument Variable Name: QOL_2D QuestionText:

*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in leisure or social activities?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto QOL_2E]

Question ID: QOL.590_00.005

Instrument Variable Name: QOL_2E QuestionText:

*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Getting out with friends or family?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto QOL_2F]

Question ID: QOL.590_00.006

Instrument Variable Name: QOL_2F QuestionText:

*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Doing household chores such as cooking and cleaning?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto QOL_2G]

Question ID: QOL.590_00.007

Instrument Variable Name: QOL_2G QuestionText:

*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Using transportation to get to places you want to go?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto QOL_2H]

Question ID: QOL.590_00.008

Instrument Variable Name: QOL_2H QuestionText:

*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in religious activities?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto QOL_2I]

Question ID: QOL.590_00.009

Instrument Variable Name: QOL_2I QuestionText:

*Read if necessary.
For each of the following activities, please tell me if you do the activity, don't do the activity, or are unable to do the activity.
Participating in community gatherings?

1 Do the activity
2 Don't do the activity
3 Unable to do the activity
7 Refused
9 Don't know

UniverseText: Sample adults 18+ who were not asked the family disability questions (FDB) and were randomly selected to receive the Quality of Life (QOL) section SkipInstructions:

(1-3,R,D)[goto next section]

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