Symbol Key. Blue Box: Logic Logic related to skip patterns and question display parameters

Transcription

1 In-persn Questinnaire TABLE OF CONTENTS: Intrductin/ SP Identity Verificatin (V 11 questins) Overall health General (G 2 questins) SF-8 (SF 8 questins) Cnditins and treatments Diagnses (D 10 questins) Fllw-ups fr specific cnditins (AST 17 questins, DIA 13 questins, HBP 4 questins, CHL 5 questins, AMI 2 questins, CHF 4 questins, EMP 5 questins, KID 2 questins, CAN 2 questins, DEP 5 questins) Pain (P 3 questins) Mental Health Happiness (H 1 questin) Depressin (PHQ 9 questins) Access and Utilizatin (U 18 questins) Preventin and Screening General (S 5 questins) Wmen (SW 3 questins) Elderly (SE 5 questins, including ne just fr men) Health Behavirs Diet and Exercise (EX 6 questins) Smking (SMK 6 questins) Alchl (A 3 questins) Medicatin (M 7 questins) Csts (C 26 questins, mstly prbes) Medical Csts (20 questins) Dental Csts (2 questins) Other Csts (4 questins) Cvering Csts Includes insurance cverage (INS -13 questins) Demgraphics (DEM 16 questins) Anthrpmetry (NOT SHOWN) Bld Pressure/ Medicatin lkup (6 questins, BP PROTOCOL NOT SHOWN) Dried Bld Spts (NOT SHOWN) Cntact (CNT 3 questins) Reprt f Findings (NOT SHOWN) Remuneratin (NOT SHOWN) Pst-Interview (PI 3 questins) Symbl Key Lgic Optinal help screen Blue Bx: Lgic Lgic related t skip patterns and questin display parameters White bx with blue text: Optinal help screen fr interviewer This help screen appears if the interviewer mves the muse ver the wrd r wrds in the questin text that appear in blue. Grey Arrw: Nested Questins These arrws flag questins that are nested within ther questins and are designed nly t prbe further n the main questin in ther wrds, they are nt standalne items. In the CAPI instrument, they d nt lk any different than regular questins

2 INTERVIEWER: PLEASE COMPLETE THE FOLLOWING INFORMATION (NOT TO BE READ TO SP): interviewer1_raw. Interviewer ID: interview_lcatin_inp. Lcatin f interview: PORTLAND EAST CLINIC PORTLAND WEST CLINIC PORTLAND SOUTH CLINIC SP S HOME bm_x_scale. Scale ID#: bm_x_stadi. Stadimeter ID#: bm_x_mrn. OMRON Bld Pressure Device ID#: 1. INTRODUCTION Let me start by verifying sme basic infrmatin abut yu, t make sure we have it right in ur files. name_cnf_raw. First, yur name appears in ur recrds as {FULL NAME FROM PRELOAD}. Is that crrect? Yes, name basically crrect (minr crrectins can still be made n the next page) N, there are significant changes in SP s name (changes can be recrded n next page) N, WRONG PERSON à TERMINATE INTERVIEW [nt in deidentified dataset]. Culd yu verify the spelling f yur name fr me? Please begin with yur first name, fllwed by yur middle name, and then yur last name. First: Middle: Last: Suffix: new_name_raw: INTERVIEWER: CHECK HERE IF YOU HAD TO MAKE ANY CHANGES TO THE SP'S NAME gender_inp. ASK ONLY IF NOT OBVIOUS Q1. And yur gender is Male Female Transgender: Male t Female Transgender: Female t Male

3 new_gender_raw. INTERVIEWER: CHECK HERE IF YOU HAD TO CHANGE THE GENDER FROM ITS ORIGINAL VALUE ({PRELOADED VALUE}) Q2. db_raw. And what is yur date f birth? INTERVIEWER: DO NOT READ RESPONSE OPTIONS. {DOB FROM PRELOAD} A DIFFERENT DATE. (ENTER CORRECTION ON NEXT PAGE. ) DON T KNOW db_cnf_raw. In ur recrds, yur date f birth is listed as {DOB FROM PRELOAD}. Wuld yu mind just cnfirming if this is crrect? Crrect Incrrect. Enter crrectin n next page. DON T KNOW ASK IF: db_raw = DK r PNTA [*_crrected]. ENTER CORRECT DATE OF BIRTH db_mnth_crrected db_day_crrected db_year_crrected ASK IF: db_raw= A different date r db_cnf_raw= Incrrect. INTERVIEWER WARNING: YOU HAVE ENTERED A DATE OF BIRTH BEFORE 1946 OR AFTER PLEASE RECHECK THE DATE BEFORE PROCEEDING, AND CORRECT IF NECESSARY BY NAVIGATING BACK TO THE PREVIOUS SCREEN. ASK IF DATE CORRECTION HAS YEAR < 1946 OR > 1988 (THIS MAKES SP INELIGIBLE FOR THE STUDY, ALTHOUGH WE WILL KEEP GOING WITH THE INTERVIEW.) Q3. agecnf_raw. OK, thanks fr verifying that infrmatin. S yu are {CALCULATE AGE} years ld. Is that right? Yes. N, the crrect age is. [agecnfcrrected_raw] DON T KNOW ASK IF: db is cnfirmed as date listed r the crrect db is entered in ne f tw pssible places; db_raw r db_cnf_raw. db_raw =1 [,] r db_raw=0 [A DIFFERENT DATE] r db_cnf_raw = 1 [Crrect] r db_cnf_raw = 0 [incrrect]

4 ver50_bvius_raw. INTERVIEWER: IS IT COMPLETELY OBVIOUS WHETHER THE SP IS OVER OR UNDER 50, TO THE EXTENT THAT IT WOULD BE EMBARRASSING TO ASK? Obviusly UNDER 50 Obviusly OVER 50 Nt bvius; need t ask SP later n. ASK IF: db_cnf_raw = DK r PNTA ccsign_raw. Did {SP S NAME} sign the general cnsent frm fr the questinnaire and health measures? Yes N à TERMINATE INTERVIEW want_rf_raw. Des {SP S NAME} wish t receive the Reprt f Findings frm physical measurements in the mail? Yes N

5 2. GENERAL HEALTH [Thanks again fr verifying yur persnal infrmatin and fr agreeing t participate in ur study.] I'd like t start the interview with sme general questins abut yur health. Q4. health_last12_inp. Overall, hw wuld yu rate yur health during the past 12 mnths? Wuld yu say it has been [READ CHOICES] Excellent Very Gd Gd Fair Pr, OR Very pr? DON T KNOW Q5. health_change_inp. Cmpared with 12 mnths ag, wuld yu say that yur health is nw better, wrse, r abut the same? Better Wrse Abut the same DON T KNOW The next few questins ask fr yur views abut yur health during the past 4 weeks. If yu are unsure abut hw t answer a questin, please give the best answer yu can. INTERVIEWER: FOR THE NEXT 8 QUESTIONS ("THE SF-8 SCALE"), USE RESPONSE CARDS #1-8, ONE CARD PER QUESTION. INSTRUCT SP TO POINT TO THE CORRECT ANSWER ON EACH CARD. Q6. sf1_inp. Overall, hw wuld yu rate yur health during the past 4 weeks? [READ CHOICES OR POINT TO CARD #1] Excellent Very Gd Gd Fair Pr Very pr DON T KNOW

6 Q7. sf2_inp. During the past 4 weeks, hw much did physical health prblems limit yur usual physical activities, such as walking r climbing stairs? [READ CHOICES OR POINT TO CARD #2] Nt at all Very little Smewhat Quite a lt, r Yu culd nt d physical activities? DON T KNOW Q8. sf3_inp. During the past 4 weeks, hw much difficulty did yu have ding yur daily wrk, bth at hme and away frm hme, because f yur physical health? [READ CHOICES OR POINT TO CARD #3] Nne at all A little bit Sme Quite a lt, r Yu culd nt d daily wrk? DON T KNOW Q9. sf4_inp. Hw much bdily pain have yu had during the past 4 weeks? [READ CHOICES OR POINT TO CARD #4] Nne Very mild Mild Mderate Severe, r Very severe? DON T KNOW Q10. sf5_inp. During the past 4 weeks, hw much energy did yu have? [READ CHOICES OR POINT TO CARD #5] Very much Quite a lt Sme A little Nne? DON T KNOW

7 Q11. sf6_inp. During the past 4 weeks, hw much did yur physical health r emtinal prblems limit yur usual scial activities with family r friends? [READ CHOICES OR POINT TO CARD #6] Nt at all Very little Smewhat Quite a lt, r Yu culd nt d scial activities? DON T KNOW FOR EXAMPLE, FEELING ANXIOUS, DEPRESSED, OR IRRITABLE Q12. sf7_inp. During the past 4 weeks, hw much have yu been bthered by emtinal prblems, such as feeling anxius, depressed r irritable? [READ CHOICES OR POINT TO CARD #7] Nt at all Slightly Mderately Quite a lt, r Extremely? DON T KNOW Q13. sf8_inp. During the past 4 weeks, hw much did persnal r emtinal prblems keep yu frm ding yur usual wrk, schl, r ther daily activities? [READ CHOICES OR POINT TO CARD #8] Nt at all Very little Smewhat Quite a lt, r Yu culd nt d daily activities? DON T KNOW

8 3. CONDITIONS AND TREATMENTS Nw I d like t ask yu abut a few specific medical cnditins. I'll read a list f cnditins, and yu tell me if yu ve ever been diagnsed with any f them. When I say diagnsed, I mean that a dctr r health prfessinal has tld yu that yu have that cnditin. When we re dne with the list, I may g back and ask yu fr a little mre infrmatin abut each ne. [Ready?] Q14. ast_dx_inp. Has a dctr r ther health prfessinal ever tld yu that yu had asthma? DO NOT ACCEPT ASTHMA THAT IS SELF-DIAGNOSED OR DIAGNOSED BY A PERSON WHO IS NOT A DOCTOR OR OTHER HEALTH PROFESSIONAL. Yes N DON T KNOW Asthma is a cnditin that affects the airways that carry air in and ut f yur lungs. It causes symptms like wheezing (a whistling sund when yu breathe), cughing, chest tightness, and truble breathing. Q15. ast_inh_inp. When smene has a bad cugh r truble breathing, they may be given medicatin t inhale r breathe in, even thugh they have nt been diagnsed with asthma. Have yu used any kind f inhaled medicatin in the last 12 mnths? Yes N DON T KNOW ASK IF: ast_dx_inp is N, DK, r PNTA Q16. dia_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] diabetes {, ther than during pregnancy}? IF SP REPORTS PRE-DIABETES OR BORDERLINE DIABETES, ENTER NO. Insert wrd in brackets if gender = FEMALE Yes N DON T KNOW Diabetes is a disease in which the bdy des nt prperly prcess sugar, starch, and ther fds. Diabetes is diagnsed by a bld test that shws a very high level f sugar (glucse) in the bld stream. Q17. hbp_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] hypertensin r high bld pressure? IF SP REPORTS "HIGH NORMAL BLOOD PRESSURE", BORDERLINE HYPERTENSION", "PREHYPERTENSION", OR HYPERTENSION ONLY DURING PREGNANCY, ENTER NO. Yes N DON T KNOW Hypertensin, r high bld pressure, refers t repeatedly increased bld pressure with the first number 140 r higher and the secnd number 90 r higher.

9 Q18. chl_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] high chlesterl? Yes N DON T KNOW Chlesterl is a type f fat in the bldstream and is measured with a bld test, usually dne in the mrning befre yu ve eaten. A high level f chlesterl is a majr risk factr fr heart disease, which leads t heart attack. Q19. ami_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] a heart attack? Yes N DON T KNOW A heart attack (mycardial infarctin) happens when a bld clt suddenly cuts ff mst r all bld supply t the heart. Cmmn symptms include crushing lwer chest pain that may radiate t the jaw r arms. The chest pain may be accmpanied by nausea, sweating, and shrtness f breath. Q20. chf_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] cngestive heart failure? Yes N DON T KNOW Cngestive Heart Failure is a cnditin where the heart cannt pump enugh bld thrughut the bdy. Bld and fluid then "back up" int the lungs, which causes shrtness f breath. The heart failure causes a buildup f fluid in the feet, ankles, and legs. D nt cunt heart murmurs, drpped r skipped heart beats, chest pain r heart attacks. Q21. emp_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] emphysema r COPD? Yes N DON T KNOW Emphysema and COPD ("chrnic bstructive pulmnary disease") are lung diseases that make it hard t breathe. They can cause cughing that prduces large amunts f mucus (a slimy substance), wheezing (a whistling sund when yu breathe), shrtness f breath, chest tightness, and ther symptms. Mst peple wh have emphysema r COPD smke r used t smke. Lng- term expsure t ther lung irritants, such as air pllutin, chemical fumes, r dust, can als cntribute t COPD. Q22. kid_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] weak r failing kidneys? D nt include kidney stnes, bladder infectins, r incntinence. Yes N DON T KNOW Kidney failure can ccur either frm an acute situatin r frm chrnic prblems, such as prly cntrlled diabetes r high bld pressure. Peple whse kidneys are weak r beginning t fail may be able t keep themselves healthy thrugh diet and medicatin. Peple whse kidneys have failed cmpletely need t underg dialysis, a daily r weekly prcedure in which the bdy is cleansed f waste prducts using an external filter system.

10 Q23. cancer_dx_inp. [Has a dctr r health prfessinal ever tld yu that yu had] cancer r a malignancy f any kind? Yes N DON T KNOW A malignancy is a tumr r grwth that is cancerus. Q24. dep_dx_inp. [Has a dctr r ther health prfessinal ever tld yu that yu had] depressin r anxiety disrder? Yes N DON T KNOW Clinical depressin is characterized by an all- encmpassing lw md, lw self- esteem, and lss f interest r pleasure in nrmally enjyable activities. Anxiety disrder includes generalized lng- lasting anxiety, panic attacks, and phbias, ften accmpanied by physical symptms such as headache, sweating, nausea, ht flashes, muscle spasms, r fatigue. ASTHMA FOLLOW UP SECTION: Asked if diagnsed with asthma (ast_dx_inp=yes) r nt diagnsed with asthma but uses an inhaler (ast_dx_inp= N, DK, r PNTA and ast_inh_inp=yes) Q25. ast_when_inp. Nw I have a few questins abut yur asthma. When were yu first tld that yu had asthma? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW ASK IF: ast_dx_inp = Yes Q26. ast_mnth_inp, ast_year_inp. D yu remember what mnth and year it was? ASK IF: ast_when_inp= 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) Q27. ast_nw_inp. D yu still have asthma ASK IF: ast_when_inp = 2-3 r nw? >3 r DK r PNTA Yes N DON T KNOW

11 ASTHMA SYMPTOM SECTION: Ask remaining asthma questins if ast_nw_inp = Yes r DK OR IF ast_inh_inp = YES. Nte: INTRO READ BY INTERVIEWER DEPENDS ON WHETHER SP has been diagnsed with asthma (ast_dx_inp = Yes) r SP has nt been diagnsed with asthma but uses an inhaler (ast_dx_inp Yes and ast_inh_inp = Yes) The next few questins are abut yur asthma symptms, such as cughing, wheezing, chest tightness, r shrtness f breath. Fr each ne, please tell me hw ften yu've had it in the last 4 weeks either never, a few days, sme days, mst days, r every day. READ IF: ast_dx_inp = Yes Yu mentined that yu ve had t use an inhaled medicatin in the last 12 mnths, fr READ IF: ast_inh_inp = Yes prblems such as cughing, wheezing, chest pain, r shrtness f breath. I am ging t refer t these kinds f prblems as asthma symptms, because they are similar t what happens when a persn has asthma. These symptms d nt necessarily mean that yu have asthma nly a dctr r health prfessinal can tell fr sure. But it is pssible that yu may have undiagnsed asthma, s I wuld like t get a little mre infrmatin abut yur symptms. I ll read a list f asthma symptms. Fr each ne, please tell me hw ften yu've had it in the last 4 weeks either never, a few days, sme days, mst days, r every day. USE CARD #9. READ THE CHOICES ON THE FIRST QUESTION. AFTER THAT, READ THEM ONLY IF NECESSARY. Q28. lass1_inp. [S, in the last 4 weeks, hw ften have yu had each f these symptms?] Cugh? Never? A few days? Sme days? Mst days? Every day? DON T KNOW Q29. lass2_inp. [S, in the last 4 weeks, hw ften have yu had each f these symptms?] Wheezing? [READ ONLY IF NECESSARY] Never? [READ ONLY IF NECESSARY] A few days? [READ ONLY IF NECESSARY] Sme days? [READ ONLY IF NECESSARY] Mst days? [READ ONLY IF NECESSARY] Every day? DON T KNOW

12 Q30. lass3_inp. [S, in the last 4 weeks, hw ften have yu had each f these symptms?] Shrtness f breath? [READ ONLY IF NECESSARY] Never? [READ ONLY IF NECESSARY] A few days? [READ ONLY IF NECESSARY] Sme days? [READ ONLY IF NECESSARY] Mst days? [READ ONLY IF NECESSARY] Every day? DON T KNOW Q31. lass4_inp. [S, in the last 4 weeks, hw ften have yu had each f these symptms?] Chest pain? [READ ONLY IF NECESSARY] Never? [READ ONLY IF NECESSARY] A few days? [READ ONLY IF NECESSARY] Sme days? [READ ONLY IF NECESSARY] Mst days? [READ ONLY IF NECESSARY] Every day? DON T KNOW Q32. lass5_inp. [S, in the last 4 weeks, hw ften have yu had each f these symptms?] Asthma attack? [READ ONLY IF NECESSARY] Never? [READ ONLY IF NECESSARY] A few days? [READ ONLY IF NECESSARY] Sme days? [READ ONLY IF NECESSARY] Mst days? [READ ONLY IF NECESSARY] Every day? DON T KNOW An asthma attack is when yur asthma symptms get wrse. Breathing becmes difficult and yu may need t g t the dctr. Q.33 lass6_inp. In the last 4 weeks, hw many asthma attacks did yu have? Enter number f attacks XX Dn t knw ASK IF lass5_inp = a few days OR sme days OR mst days OR every day

13 Q34. lass7_inp. In the last 4 weeks, hw ften have yu been awakened at night because f yur asthma symptms [cughing, wheezing, chest pain, shrtness f breath]? USE CARD #9; READ CHOICES IF NECESSARY Never, A few days, Sme days, Mst days, r Every day? DON T KNOW Q35. lass8_inp. Overall, hw wuld yu rate the severity f yur asthma {symptms [cughing, wheezing, chest pain, shrtness f breath]}? Wuld yu say [READ CHOICES] Very mild, Mild, Mderate, Severe, r Very severe? DON T KNOW Insert the part in brackets if ast_dx_inp des nt equal YES Q36. ast_cntrller_inp. Lng-term cntrller medicatins are taken every day t help cntrl asthma symptms and t prevent asthma attacks. In the last 4 weeks, have yu taken a lng-term cntrller medicatin fr yur asthma symptms? Yes N DON T KNOW Examples f lng- term cntrller medicatins include: Singulair, Flvent, Advair, Pulmicrt, Symbicrt, Azmacrt and QVAR. Q37. ast_inhaler_inp. Quick-relief inhalers, smetimes called rescue inhalers, are taken nly when needed and are used t treat asthma symptms when they ccur. In the last 4 weeks, have yu used a quick-relief inhaler fr yur asthma symptms? Yes N DON T KNOW

14 S far, we have been talking abut yur asthma symptms in the last 4 weeks. Nw think back t the last 12 mnths. Q38. ast_dc_inp. In the last 12 mnths, have yu talked in persn t a dctr r ther health prfessinal abut yur asthma r asthma symptms [cughing, wheezing, chest pain, r shrtness f breath]? Yes N DON T KNOW Q39. ast_ed_inp. In the last 12 mnths, hw many times have yu had t g t an emergency rm because f asthma symptms [cughing, wheezing, chest pain, r shrtness f breath]? IF SP ASKS, INCLUDE VISITS TO A HOSPITAL URGENT CARE CLINIC. Enter number f times: XXX DON T KNOW Q40. ast_ed_prbe_inp. If yu were giving yur best guess, wuld yu say it was [READ CHOICES] Never, Once, OR Mre than nce? DON T KNOW LOGIC ASK IF: ast_ed_inp=dk Q41. ast_hsp_inp. In the last 12 mnths, did yu stay in a hspital vernight because f yur asthma symptms [cughing, wheezing, chest tightness, shrtness f breath]? Yes N DON T KNOW DIABETES SECTION: Ask if dia_dx_inp = YES Q42. dia_when_inp. Nw I have a few questins abut yur diabetes. When were yu first tld that yu had diabetes? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR

15 Mre than 3 years ag? DON T KNOW Q43. dia_mnth_inp, dia_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF: dia_when_inp = 1-2 r 2-3 in 2010; dia_when_inp= 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) Q44. dia_insulin_rx_inp. In the last 12 mnths, has a dctr r ther health prfessinal prescribed insulin fr yur diabetes? INCLUDE ANY EARLIER PRESCRIPTIONS THAT HAVE BEEN RENEWED IN THE LAST 12 MONTHS. Yes N DON T KNOW Q45. dia_insulin_use_inp. Are yu nw taking insulin? Yes N DON T KNOW ASK IF dia_insulin_rx_inp = Y r DK Q46. dia_pills_rx_inp. In the last 12 mnths, has a dctr r ther health prfessinal prescribed any diabetic pills. t lwer yur bld sugar? INCLUDE ANY EARLIER PRESCRIPTIONS THAT HAVE BEEN RENEWED IN THE LAST 12 MONTHS. Yes N DON T KNOW Als called ral agents r hypglycemic agents. Q47. dia_pills_use_inp. Are yu nw taking diabetic pills? Yes N DON T KNOW ASK IF dia_pills_rx_inp = Y r DK Q48. dia_check_rx_inp. In the last 12 mnths, has a dctr r ther health prfessinal advised yu t check yur bld sugar at hme?

16 Yes N DON T KNOW Q49. dia_check_d_inp. D yu nw check yur bld sugar at hme? Yu can include times when a family member r friend helps yu, but dn't include times when a dctr r ther health prfessinal des it. Yes N ASK IF dia_check_rx_inp= Y r DK DON T KNOW Q50. dia_supplies_needed_inp. Checking yur bld sugar requires supplies, like testing strips and a meter. In the last 12 mnths, have yu been able t get all the testing supplies yu needed t check yur bld sugar as ften as yu needed t? Yes N DON T KNOW ASK IF dia_check_rx_inp = Y r if dia_check_d_inp = Y Q51. dia_feet_inp. In the last 12 mnths, has a dctr r ther health prfessinal checked yur feet fr any sres r irritatins? Yes N DON T KNOW Q52. dia_eyes_inp. In the last 12 mnths, have yu had an eye exam in which yur pupils were dilated? This wuld have made yu sensitive t bright light fr a little while. Yes N DON T KNOW Q53. dia_diet_inp. D yu fllw a special diet t cntrl yur diabetes? Yes N DON T KNOW Q54. dia_nurse_inp. In the last 12 mnths have yu attended a diabetes training class r ne-n-ne training with a diabetes educatr, dietician, r nutritinist? Dn t include regular dctrs r ther health prfessinals.

17 Yes N DON T KNOW A diabetes educatr is a nurse wh teaches peple with diabetes abut the day-t-day aspects f diabetes self-care, such as, use f diabetes medicatins, checking and cntrlling bld sugar levels, and managing weight thrugh diet and exercise. High Bld Pressure Fllw Up QUESTIONS. Ask IF: hbp_dx_inp = yes Q55. hbp_when_inp. Nw I have a few questins abut yur high bld pressure. When were yu first tld that yu had high bld pressure r hypertensin? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW Q56. hbp_mnth_inp, hbp_year_inp. D yu remember what mnth and year it was? 1 LOGIC ASK IF: hbp_when_inp = 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) Q57. hbp_rx_inp. In the last 12 mnths, has a dctr r health prfessinal prescribed any medicatin fr yur high bld pressure? INCLUDE ANY EARLIER PRESCRIPTIONS THAT HAVE BEEN RENEWED IN THE LAST 12 MONTHS. Yes N DON T KNOW 1 This questin shuld have been psed if the respnse t hbp_when_inp was 1-2 years ag, r 2-3 years ag, and the interview was being cnducted in 2010, r if the respnse t hbp_when_inp was within the last year r 1-2 years ag, and the interview was being cnducted in In fact, due t a cding errr the questin was psed t all wh respnded 1-2 years ag r 2-3 years ag regardless f the year in which the interview was cnducted.

18 Q58. hbp_rx_use_inp. Are yu nw taking prescribed medicatin fr yur high bld pressure? Yes N DON T KNOW CHOLESTEROL FOLLOW UP QUESTIONS ASK IF: chl_dx_inp = yes ASK IF: hbp_rx_inp= YES r DK Q59. chl_when_inp. Nw I have a few questins abut yur high chlesterl. When were yu first tld that yu had high chlesterl? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW Q60. chl_mnth_inp, chl_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF: chl_when_inp= 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include DON T KNOW and ) Q61. chl_test_when1_inp. Hw lng has it been since yu last had yur chlesterl checked? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW ASK IF chl_when_inp des nt equal within the last year Q62. chl_rx_inp. In the last 12 mnths, has a dctr r health prfessinal prescribed any medicatin t lwer yur chlesterl? INCLUDE ANY EARLIER PRESCRIPTIONS THAT HAVE BEEN RENEWED IN THE LAST 12 MONTHS. Yes N DON T KNOW

19 Q63. chl_rx_use_inp. Are yu nw taking any prescribed medicatin t lwer yur chlesterl? ASK IF chl_rx_inp= YES r DK Yes N DON T KNOW AMI FOLLOW UP QUESTIONS ASK IF ami_dx_inp = YES Q64. ami_when_inp. Yu mentined a heart attack. When were yu first tld that yu had a heart attack? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW Q65. ami_mnth_inp, ami_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF: ami_when_inp = 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) CHF FOLLOW UP QUESTIONS Ask IF chf_dx_inp = Y Q66. chf_when_inp. Nw I have a few questins abut yur cngestive heart failure. When were yu first tld that yu had cngestive heart failure? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW

20 Q67. chf_mnth_inp, chf_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF: chf_when_inp= 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) Q68. chf_rx_inp. In the last 12 mnths, has a dctr r health prfessinal prescribed any medicatin fr yur cngestive heart failure? INCLUDE ANY EARLIER PRESCRIPTIONS THAT HAVE BEEN RENEWED IN THE LAST 12 MONTHS. Yes N Dn t knw Q69. chf_rx_use_inp. Are yu nw taking medicatin fr yur cngestive heart failure? Yes N DON T KNOW ASK IF chf_rx_inp = Y r DK EMPHYSEMA / COPD FOLLOW UP QUESTIONS ASK IF emp_dx_inp = Y Q70. emp_when_inp. Nw I have a few questins abut yur COPD. When were yu first tld that yu had emphysema r COPD? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW Q71. emp_mnth_inp, emp_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF: emp_when_inp = 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and )

21 Q72. emp_xg_tld_inp. Because f yur emphysema r COPD, have yu ever been tld t use supplemental xygen? Yes N DON T KNOW Q73. emp_xg_use_inp. Are yu nw using supplemental xygen? Yes N DON T KNOW ASK IF: emp_xg_tld_inp = Y Q74. emp_xg_needed_inp. In the last 12 mnths, have yu been able t get all the supplies yu needed fr yur supplemental xygen? Yes N DON T KNOW ASK IF: emp_xg_tld_inp = Y KIDNEY FOLLOW UP QUESTIONS ASK IF: kid_dx_inp = Yes Q75. kid_when_inp. Yu mentined being diagnsed with weak r failing kidneys. When were yu first tld that yur kidneys were weak r failing? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW Q76. kid_mnth_inp, kid_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF kid_when_inp= 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) CANCER FOLLOW UP QUESTIONS ASK IF: cancer_dx_inp = Y Q77. cancer_when_inp. Yu mentined being diagnsed with cancer. When were yu first tld that yu had cancer? Was it

22 [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW Q78. cancer_mnth_inp, cancer_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF: cancer_when_inp = 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) DEPRESSION FOLLOW UP QUESTIONS ASK IF dep_dx_inp = 1 (yes) Q79. dep_when_inp. Yu mentined being diagnsed with depressin r anxiety. When were yu first tld that yu had depressin r anxiety? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW Q80. dep_mnth_inp, dep_year_inp. D yu remember what mnth and year it was? LOGIC ASK IF: dep_when_inp = 1-2 r 2-3 in 2010; = 0-1 r 1-2 in 2009 Mnth: *chse mnth* Year: *chse year* (Chices fr bth mnth and year include dn t knw and ) Q81. dep_therapy_inp. In the last 12 mnths, did yu have a sessin f psychlgical cunseling r therapy that lasted 30 minutes r lnger with any type f prfessinal? Yes N DON T KNOW

23 Q82. dep_rx_inp. In the last 12 mnths, has a dctr r health prfessinal prescribed any medicatin fr yur depressin r anxiety? INCLUDE ANY EARLIER PRESCRIPTIONS THAT HAVE BEEN RENEWED IN THE LAST 12 MONTHS. Yes N DON T KNOW Q83. dep_rx_use_inp. Are yu nw taking prescribed medicatin fr depressin r anxiety? Yes N DON T KNOW ASK IF dep_rx_inp = Y r DK PAIN One ther cnditin peple smetimes struggle with is chrnic pain. Q84. pain_where_inp. Yu mentined earlier that yu've had sme amunt f pain in the last 4 weeks. In which f the fllwing places did yu have pain mre than nce a week? Yu can say "yes" t mre than ne. [READ CHOICES] Back r neck? [pain_back_inp] ASK IF sf4_inp very mild Jints? [pain_jints_inp] Head? [pain_head_inp] Other? xxx [pain_ther_inp; Text descriptin saved as variable pain_therdetails_inp] N specific place [pain_general_inp] Each answer chice is an indicatr variable DON T KNOW [pain_dk_inp] denting the selectin r selectins chsen [pain_pnta_inp] Q85. pain_interference_inp. During the last 4 weeks, hw much did pain interfere with yur nrmal wrk (including bth wrk utside the hme and husewrk)? Wuld yu say... [READ OPTIONS] Nt at all, A little, Mderately, Quite a bit, OR Extremely? DON T KNOW ASK IF sf4_inp very mild Yu mentined earlier that yu have nt had any bdily pain in the last 4 weeks, but I wanted t find ut if that was because yu were using pain medicatins. READ IF SF4 = n pain

24 Q86. pain_meds_inp. Are yu taking any kind f medicatin ever day r mst days t help yu cntrl r manage chrnic pain? Yes N DON T KNOW ALWAYS ASK f everyne interviewed, even if there is n reprt f pain. 4. HAPPINESS AND MENTAL HEALTH We ve talked a lt abut yur physical health. Nw I have sme questins n hw yu are ding mre generally -- thinking nt just f yur health, but f yur life as a whle. Q87. happy_inp. Taken all tgether, hw wuld yu say things are these days wuld yu say that yu are very happy, pretty happy, r nt t happy? Very happy Pretty happy Nt t happy DON T KNOW The next few questins ask hw ften yu ve been bthered by certain kinds f prblems in the last tw weeks. After I read each item n the list, please tell me hw ften yu've experienced it in the last tw weeks either nt at all, several days, mre than half the days, r nearly every day. USE CARD #10. READ THE CHOICES ON THE FIRST QUESTION. AFTER THAT, READ THEM ONLY IF NECESSARY. Q88. phq1_inp. Over the last tw weeks, hw ften have yu been bthered by having little interest r pleasure in ding things? Wuld yu say it was [READ CHOICES AND POINT TO CARD #10] Nt at all, Several days, Mre than half the days, r Nearly every day? DON T KNOW Q89. phq2_inp. [Over the last tw weeks, hw ften have yu been bthered by] feeling dwn, depressed, r hpeless? [READ CHOICES OR USE CARD #10] Nt at all Several days Mre than half the days Nearly every day DON T KNOW

25 Q90. phq3_inp. [Over the last tw weeks, hw ften have yu been bthered by] truble falling r staying asleep, r sleeping t much? [READ CHOICES OR USE CARD #10] Nt at all Several days Mre than half the days Nearly every day DON T KNOW Q91. phq4_inp. [ Over the last tw weeks, hw ften have yu been bthered by] feeling tired r having little energy? [READ CHOICES OR USE CARD #10] Nt at all Several days Mre than half the days Nearly every day DON T KNOW Q92. phq5_inp. [Over the last tw weeks, hw ften have yu been bthered by] pr appetite r vereating? [READ CHOICES OR USE CARD #10] Nt at all Several days Mre than half the days Nearly every day DON T KNOW Q93. phq6_inp. [Over the last tw weeks, hw ften have yu been bthered by] feeling bad abut yurself, r that yu re a failure, r have let yurself r yur family dwn? [READ CHOICES OR USE CARD #10] Nt at all Several days Mre than half the days Nearly every day DON T KNOW

26 Q94. phq7_inp. [Over the last tw weeks, hw ften have yu been bthered by] truble cncentrating n things, such as reading the newspaper r watching TV? [READ CHOICES OR USE CARD #10] Nt at all Several days Mre than half the days Nearly every day DON T KNOW Q95. phq8_inp. [Over the last tw weeks, hw ften have yu been bthered by] mving r speaking s slwly that ther peple culd have nticed? Or the ppsite - being s fidgety r restless that yu have been mving arund a lt mre than usual? [READ CHOICES OR USE CARD #10] Nt at all Several days Mre than half the days Nearly every day DON T KNOW Q96. dep_impair_inp. We've mentined sme prblems that have been bthering yu in the last tw weeks, such as {FIRST PHQ8 QUESTION >0} and {LAST PHQ8 QUESTION >0}. Hw difficult have these prblems made it fr yu t d yur wrk, take care f things at hme, r get alng with peple? Wuld yu say it s been [READ CHOICES] Nt difficult at all, Smewhat difficult, Very difficult, r Extremely difficult? DON T KNOW LOGIC ASK IF: At least ne f PHQ1 t PHQ8 is several days, mre than half the days, r nearly every day.

27 5. ACCESS AND UTILIZATION OF MEDICAL CARE Nw I'd like t ask yu abut the medical care that yu have been getting in the last few years. When I say "medical care", I am talking abut any type f care that yu get frm a dctr r ther health prfessinal, such as a nurse, a therapist, a physical therapist, r anyne else wh specializes in physical r mental health. Medical care culd be anything frm an emergency rm visit t a rutine screening r check-up. I am nt including dental care r rutine visin services, like glasses r cntact lenses. I am als nt including visits t the pharmacy, if all yu are ding is buying medicatin. [Des that make sense?] Q97. usual_place_inp. First, is there ne place yu usually g t get medical care? IF SP SAYS NO, ASK IF THERE IS NO PLACE OR MORE THAN ONE PLACE. Yes N place Mre than ne place DON T KNOW Q98. usual_place_where_inp. What kind f place d yu g t mst ften: is it a dctr s ffice, a hspital emergency rm, r sme ther place? SELECT THE APPROPRIATE CATEGORY BASED ON SP S DESCRIPTION. PROBE IF NECESSARY, USING THE OPTIONS BELOW. Dctr s ffice Hspital emergency rm r urgent care clinic Sme ther place: (ENTER NAME OR BRIEF DESCRIPTION: stred as variable usual_place_wherether_inp) DON T KNOW ASK IF: usual_place_inp is YES OR >1 OR DK Q99. usual_dc_inp. What type f dctr s ffice is it? Is it [READ CHOICES] A private dctr's ffice r clinic that usually requires an appintment? A free r lw-cst cmmunity health clinic? A walk-in clinic in a cmmercial center, like a Walmart? Or sme ther kind f place? (ENTER NAME OR BRIEF DESCRIPTION: ) [Name and descriptin stred as variable usual_dc_therdetails_inp] DON T KNOW Q100. usual_er_inp. Which emergency rm d yu g t mst ften? ENTER NAME OR LOCATION OF ER: DON T KNOW ASK IF: usual_place_w here_inp= dctr s ffice ASK IF: usual_plac e_where_inp = Hspital ER

28 Physical Care Q101. needed_care_phys_inp. In the last 12 mnths, was there a time when yu needed medical care fr a physical illness, injury, r cnditin? [I ll ask abut care and treatment fr mental health cnditins next.] Remember, dn't include dental care r rutine visin services. Yes N DON T KNOW ASK IF WE DON T ALREADY KNOW FROM PREVIOUS ANSWERS THAT SP RECEIVED MEDICAL CARE FOR PHYSICAL CONDITIONS IN THE LAST 12 MONTHS (CALCULATED VARIABLE) (knwn_phys_care=0) Q102. gt_care_phys_inp. [In the last 12 mnths, when yu needed medical care fr a physical illness, injury, r cnditin,] did yu always get all the care that yu needed? [Remember, dn't include dental care r rutine visin services.] INTERVIEWER: IF SP SAYS "NO", CLARIFY WHETHER HE/SHE GOT AT LEAST SOME CARE WHEN HE/SHE NEEDED IT, OR WHETHER HE/SHE GOT NO CARE AT ALL. Yes: gt all the care that was needed Gt sme but nt all the care that was needed Gt n care at all fr any physical cnditins in the last 12 mnths DON T KNOW ASK IF needed_care_phys_inp = YES OR IF WE ALREADY KNOW FROM PREVIOUS ANSWERS THAT SP RECEIVED MEDICAL CARE FOR PHYSICAL CONDITIONS IN THE LAST 12 MONTHS (CALCULATED VARIABLE) needed_care_phys_inp=yes OR knwn_phys_care=1 Q103. missed_care_phys_ins_inp. Think back t the last time yu didn t get all the care yu needed fr a physical injury r cnditin. Did yu have health insurance at that time? Yes N DON T KNOW ASK IF gt_care_phys_inp = SOME OR NONE Mental Care Q104. needed_care_ment_inp. In the last 12 mnths, have yu needed treatment r cunseling fr a mental health cnditin r persnal prblem? [Remember, everything yu tell me in this interview is cnfidential.] Yes N DON T KNOW ASK IF WE DON T ALREADY KNOW FROM PREVIOUS ANSWERS THAT SP RECEIVED MEDICAL CARE FOR DEPRESSION IN THE LAST 12 MONTHS (CALCULATED VARIABLE) (knwn_ment_care = 0) The mst cmmn mental health cnditins in the US are depressin and anxiety. Other cmmn cnditins include panic attacks, phbias, bsessive- cmpulsive disrder (OCD), biplar disrder, and pst- traumatic stress disrder (PTSD). There are als many ther cnditins that I have nt listed. Alchl and substance abuse are ften cunted as mental health cnditins, but please d nt include them here - - I will ask abut them next.

29 Q105. gt_care_ment_inp. In the last 12 mnths, when yu needed treatment r cunseling fr a mental health cnditin r persnal prblem, did yu always get all the treatment that yu needed? INTERVIEWER: IF SP SAYS "NO", CLARIFY WHETHER HE/SHE GOT AT LEAST SOME TREATMENT WHEN HE/SHE NEEDED IT, OR WHETHER HE/SHE GOT NO TREATMENT AT ALL. Yes: gt all the treatment that was needed Gt sme but nt all the treatment that was needed Gt n treatment at all fr any mental health issues in the last 12 mnths DON T KNOW Q106. missed_care_ment_ins_inp. Think back t the last time yu didn t get all the treatment yu needed fr a mental health cnditin r persnal prblem. Did yu have any kind f health insurance at that time? Yes N DON T KNOW Substance Abuse Care Q107. needed_care_subst_inp. In the last 12 mnths, have yu needed treatment r cunseling fr alchl r drug abuse? [Remember, everything yu tell me in this interview is cnfidential.] Yes N DON T KNOW Q108. gt_care_subst_inp. In the last 12 mnths, when yu needed treatment r cunseling fr alchl r drug abuse, did yu always get all the treatment that yu needed? INTERVIEWER: IF SP SAYS "NO", CLARIFY WHETHER HE/SHE GOT AT LEAST SOME TREATMENT WHEN HE/SHE NEEDED IT, OR WHETHER HE/SHE GOT NO TREATMENT AT ALL. Yes: gt all the treatment that was needed Gt sme but nt all the treatment that was needed Gt n treatment at all fr alchl r drug abuse in the last 12 mnths DON T KNOW Q109. missed_care_subst_ins_inp. Think back t the last time yu didn t get all the treatment that yu needed fr an alchl r drug abuse prblem. Did yu have any kind f health insurance at that time? Yes N DON T KNOW ASK IF needed_care_ment_inp = YES OR IF WE ALREADY KNOW FROM PREVIOUS ANSWERS THAT SP RECEIVED MEDICAL CARE FOR DEPRESSION IN THE LAST 12 MONTHS (CALCULATED VARIABLE) needed_care_ment_inp = YES OR knwn_ment_care = 1 ASK IF gt_care_ment_inp= SOME OR NONE ASK IF need_care_subst_inp = YES ASK IF gt_care_subst_inp = SOME OR NONE

30 Any Care Q110. care_any_inp. Have yu been t a dctr r received any medical care at all in the last 12 mnths? [Remember, I am nt including dental r visin services.] ASK IF SP HAS NOT ALREADY TOLD US IN PREVIOUS QUESTIONS THAT HE/SHE HAS BEEN TO THE DOCTOR IN THE LAST 12 MONTHS TO RECEIVED CARE FOR PHYSICAL, MENTAL, AND/OR SUBSTANCE ABUSE ISSUES. (CALCULATED VARIABLE). ask_care_any=1 Yes N DON T KNOW (SP unsure f the timing f mst recent medical care.) Prbe will fllw. INTERVIEWER UNCERTAIN: Des the fllwing cunt as medical care? [Interview cmments saved as care_anytype_inp. N further questins psed in this sectin if interviewer expressed cncerns.] INTERVIEWER: MARK "DON'T KNOW" ONLY IF THE SP IS UNSURE ABOUT THE TIMING OF HIS/HER MOST RECENT DOCTOR'S VISIT OR MEDICAL CARE. IF, AFTER PROBING, YOU ARE UNSURE WHETHER THE SP'S EXPERIENCE COUNTS AS MEDICAL CARE AT ALL, CHOOSE THE "INTERVIEWER UNCERTAIN" OPTION AND ENTER THE DESCRIPTION IN THE TEXT FIELD PROVIDED. (FOR THE LOGIC OF THE QUESTIONS THAT FOLLOW, THIS WILL BE EQUIVALENT TO ANSWERING "NO".) OK. I made a nte f it, but since I'm nt sure whether it cunts as medical care fr the purpses f this study, let's agree nt t include it in all the questins that fllw. READ IF: care_any_inp = INTERVIEWER UNCERTAIN Q111. care_any_prbe_inp. Think back t the last time yu gt any medical care. Was it definitely within the last 2 years? Yes N DON T KNOW OK. In that case, let's assume it was mre than 12 mnths ag and let's nt cunt it. ASK IF: care_any_inp =DK (SP unsure f timing) READ IF: care_any_prbe_inp = N r DK r PNTA Q112. care_any_cunt_inp. In that case, since yu're unsure, we can cunt it as medical care received in the last 12 mnths. Is that OK with yu? OK N: On further reflectin, SP realizes it was mre than 12 mnths ag. ASK IF: care_any_prbe_inp =YES Q113. care_when_inp. When was the last time yu received any medical care? Was it [READ CHOICES] Within the last 2 years Between 2 and 3 years ag, r Mre than 3 years ag? DON T KNOW ASK IF, BASED ON ALL QUESTIONS SO FAR, SP HAS NOT RECEIVED CARE IN THE LAST 12 MONTHS (care_last_year = 0 ) AND care_any_prbe_inp is neither DK nr PNTA

31 Satisfactin Q114. satisfactin_inp. Overall, hw wuld yu rate the quality f all the medical care yu have received in the last 12 mnths? Wuld yu say it was [READ CHOICES] Excellent, Very gd, Gd, Fair, OR Pr? DON T KNOW ASK IF, BASED ON ALL QUESTIONS SO FAR, SP HAS RECEIVED CARE IN THE LAST 12 MONTHS (care_last_year=1) ASK SECTION 6 (Screenings, Check- ups and Exams) ONLY IF SP HAS RECEIVED CARE IN THE LAST 12 MONTHS (care_last_year =1) AND AT LEAST ONE OF THE FOLLOWING IS TRUE: *dia_dx_inp (diabetes) nt equal YES *chl_dx_inpl (chlesterl) nt equal YES * SP is female * SP may be ver 50 (If nne f the abve are true, there is nthing t ask in this sectin, s we skip the whle sectin)

32 6. SCREENINGS, CHECK-UPS AND EXAMS Nw I have a few questins abut varius types f health screenings, checkups, r exams yu may have received in the last few years. Age check Q115. ver50_ask_raw, T ask these questins prperly, I need t knw just a little bit mre abut yur age. Wuld yu mind telling me if yu are under 50 r ver 50? Under r lder ASK IF ver50_bvius_raw=- 98 [Nt bvius, need t ask SP later n. ] Yu mentined earlier that yu ve NEVER been diagnsed with high chlesterl. READ IF: chl_dx_inp=no Chlesterl Screening Q116. chl_test_ever_inp. Have yu ever had yur chlesterl checked? Yes N DON T KNOW ASK IF chl_dx_inp nt equal YES Q117. chl_test_when_inp. Abut hw lng has it been since yu last had yur chlesterl checked? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW ASK IF: chl_test_ever_inp=yes Diabetes Screening Yu mentined earlier that yu ve NEVER been diagnsed with diabetes. READ IF: dia_dx_inp=no Q118. dia_test_ever_inp. Have yu ever had a bld test fr high bld sugar r diabetes {, ther than during pregnancy}? Yes N DON T KNOW ASK IF: dia_dx_inp nt = yes Insert wrds in brackets if gender = FEMALE

33 Q119. dia_test_when_inp. Abut hw lng has it been since yu last had a bld sugar test fr diabetes? Was it [READ CHOICES AND/OR USE TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW ASK IF: dia_test_ever_inp = yes Wmen s Health Screening ASK THE FOLLOWING 3 QUESTIONS ONLY IF FEMALE. Gender=female Q120. pap_inp. In the last 12 mnths, have yu had a Pap test r Pap smear? Yes N N/A: Hysterectmy DON T KNOW Q121. mam_inp. In the last 12 mnths, have yu had a Mammgram? Yes N DON T KNOW A Pap test r Pap smear is a test fr cancer f the cervix. ASK IF AGE 40 (OR UNKNOWN) Ask_40 =1) A mammgram is an x- ray f each breast t lk fr breast cancer. Q122. pregnant_inp. D yu have reasn t believe that yu are pregnant? 2 Yes N DON T KNOW ASK IF AGE IN RANGE [19, 49] OR IF SP IS OBVIOUSLY UNDER 50 OR SP TOLD US THEY RE OVER 50 Age<50 AND age>18 OR ver50_bvius_raw = 0 [bviusly under 50] r ver50_ask_raw is any f (0 [under 50] r - 99 [PNTA] Over 50 Screening ASK THE NEXT 5 QUESTIONS IF SP IS OVER 50 (frm DOB r because interviewer can tell, r because SP TOLD US THEY WERE OVER 50). ask_50=1 (CALCULATED VARIABLE) Q123. fbt_ever_inp. In the last 12 mnths, has a dctr asked yu t d a Bld stl test? Yes A bld stl test is a test that yu usually d at hme, using a special kit that a dctr gives yu. It checks whether the stl 2 This questin shuld have been psed t all wmen f ages cntains Instead bld, the it which was psed can be t a all sign wmen f clrectal ages cancer. wh received medical care in the last year.

34 N DON T KNOW Q124. cl_ever_inp. In the last 12 mnths, have yu had a sigmidscpy r a clnscpy? Yes N DON T KNOW Bth sigmidscpy and clnscpy are exams in which a tube is inserted in the rectum t view the cln fr signs f cancer r ther health prblems. Q125. psa_inp. In the last 12 mnths, have yu had a bld test t check fr prstate cancer? Yes N DON T KNOW ASK IF MALE gender=male Q126. tld_flu_inp. In the last 12 mnths, has a dctr r ther health prvider recmmended that yu have a flu sht? Yes N DON T KNOW Q127. did_flu_inp. Have yu had a flu sht in the last 12 mnths? Yes N DON T KNOW

35 7. HEALTH BEHAVIORS My next few questins are abut things peple d in their daily lives that can affect their health. Let's start with diet and exercise. Exercise Q128. exercise_inp. Cmpared with mst men/wmen/peple yur age, wuld yu say yu are mre physically active, less physically active, r abut the same? Mre active Less active Abut the same DON T KNOW Q129. tld_exercise_inp. In the last 12 mnths, have yu been tld by a dctr r health prfessinal t increase yur physical activity r exercise? Yes N DON T KNOW ASK IF SP RECEIVED MEDICAL CARE IN LAST 12 MONTHS. (calculated variable) care_last_year=1 Q130. nw_exercise_inp. Are yu currently trying t increase yur physical activity r exercise? Yes N DON T KNOW Q131. verweight_inp. D yu cnsider yurself nw t be verweight, underweight, r abut the right weight? Overweight Underweight Abut the right weight DON T KNOW Q132. tld_weight_inp. In the last 12 mnths, have yu been tld by a dctr r health prfessinal t lse weight? Yes N DON T KNOW ASK IF SP RECEIVED MEDICAL CARE IN LAST 12 MONTHS. (calculated variable) care_last_year=1

36 Q133. nw_weight_inp. Are yu currently trying t lse weight? Yes N DON T KNOW ASK IF verweight_inp = OVERWEIGHT OR DK OR IF tld_weight_inp = YES Smking Q134. smk_100_inp. The next few questins are abut smking. Let me start by asking: Have yu smked at least 100 cigarettes in yur entire life? NOTE: 1 PACK = 20 CIGARETTES Yes N DON T KNOW [Great. In that case, I dn t need t ask yu any mre questins abut smking.] READ IF smk_100_inp = N Q135. smk_nw_inp. D yu nw smke cigarettes every day, sme days, r nt at all? Every day Sme days Nt at all DON T KNOW ASK IF smk_100_inp= YES r DON T KNOW Q136. smk_quit_when_inp. Hw lng ag did yu quit smking? Was it. [READ CHOICES OR REFER TO TIME FRAME CARD] Within the last year, Between 1 and 2 years ag, Between 2 and 3 years ag, OR Mre than 3 years ag? DON T KNOW ASK IF smk_nw_inp= nt at all

37 Current Smkers: Ask the fllwing 3 questins f current smkers ASK IF smk_nw_inp = every day OR sme days OR dn t knw Q137. smk_avg_inp. During the last 4 weeks, n the days that yu smked, abut hw many cigarettes did yu smke per day? [Yur best estimate is fine.] IF SP REPORTS LESS THAN ONE CIGARETTE PER DAY (BUT MORE THAN 0), ENTER 1. IF SP REPORTS THE NUMBER OF PACKS SMOKED, USE THIS TABLE. Enter number f cigarettes: XXX DON T KNOW 0.5 packs = 10 cigarettes 1 pack = 20 cigarettes 1.5 packs = 30 cigarettes 2 packs = 40 cigarettes 2.5 packs = 50 cigarettes 3 packs = 60 cigarettes 3.5 packs = 70 cigarettes 4 packs = 80 cigarettes 4.5 packs = 90 cigarettes 5 packs = 100 cigarettes Q138. smk_quit_tld_inp. In the last 12 mnths, has a dctr r ther health prfessinal advised yu t quit smking? Yes N DON T KNOW ASK IF SP RECEIVED MEDICAL CARE IN LAST 12 MONTHS. (calculated variable) care_last_year=1 Q139. smk_quit_did_inp. Have yu tried t quit smking in the last 12 mnths? Yes N DON T KNOW Alchl The next few questins are abut drinking alchl. This includes beer, wine, wine clers, liqur (such as whiskey r gin), r any ther type f alchlic beverage. [Remember, yur answers t all the questins n this survey are cnfidential and will never be reprted with yur name t anyne.] Q140. alc_freq_inp 3. In the last 4 weeks, n hw many days did yu drink any type f alchlic beverage? Never Enter number f days XX days [select unit: per week/ ttal in the last 4 weeks] DON T KNOW 3 alc_freq_inp merges all respnses. Its units are Number f days SP drank alchl in the last 4 weeks. The apprpriate cnversin was made if the SP gave the number f days per week instead f the ttal number f days in the last 4 weeks. The number f days is als stred as alc_freq_number_inp and the units variable is stred as alc_freq_unit_inp. This prvides n additinal infrmatin t that given by alc_freq_inp and is stred nly fr cmpleteness f data.

38 Q141. alc_avg_inp. On the days when yu did drink alchl, I'd like t knw hw many drinks yu usually had. ASK IF alc_freq_inp never This can be a little tricky t cunt, since drinks cme in different sizes. When I say ne "drink", I m thinking f a 12 unce can f beer, a 5 unce glass f wine, r a 1 ½ unce sht f liqur. If yu ften have drinks in ther sizes, tell me abut them and we can figure ut hw much they shuld cunt fr. S, in the last 4 weeks, n the days when yu did drink alchl, hw many drinks did yu usually have per day? Enter number f drinks XX DON T KNOW INTERVIEWER: USE THIS CONVERSION TABLE FOR OTHER DRINKS AND DRINK SIZES. Regular bttle f beer = 1 drink; 40 z can/bttle f beer (a frty ) = 3 drinks; Regular bttle f wine = 5 drinks; Wine cler (nrmal size) = 1 drink; Mixed drink (nrmal size) = 1 drink Q142. binge_freq_inp 4. In the last 4 weeks, n hw many days did yu have {4 FOR WOMEN, 5 FOR MEN} r mre drinks in ne day? [Once again, when I say ne "drink", I m thinking f a 12 unce can f beer, a 5 unce glass f wine, r a 1 ½ unce sht f liqur.] ASK IF alc_freq_inp never Never Enter number f days XX days [select unit: per week/ttal in the last 4 weeks] 5 DON T KNOW INTERVIEWER: USE THIS CONVERSION TABLE FOR OTHER DRINKS AND DRINK SIZES. Regular bttle f beer = 1 drink; 40 z bttle f beer (a frty ) = 3 drinks Regular bttle f wine = 5 drinks Wine cler (nrmal size) = 1 drink Mixed drink (nrmal size) = 1 drink 4 binge_freq_inp merges all respnses. Its units are Number f days SP binge drank in the last 4 weeks. The apprpriate cnversin was made if the SP gave the number f days per week instead f the ttal number f days in the last 4 weeks. The number f days is als stred as binge_freq_number_inp and the units variable is stred as binge_freq_unit_inp. This prvides n additinal infrmatin t that given by binge_freq_inp and is stred nly fr cmpleteness f data. 5 NOTE: Due t a cding errr binge_freq_unit_inp was nt stred fr a number f surveys.