ADULT DENTAL QUESTION PROPOSED FOR 2013-14 For how many months of the past 12 months did you have any kind of dental insurance that pays for some or all of your routine dental care? MONTHS POTENTIAL TEEN AND CHILD ORAL HEALTH QUESTIONS FOR 2013-14 CHIS 2007 TEEN AND CHILD ORAL HEALTH QUESTIONS The highlighted questions are the only questions that have been fielded since 2007. These questions are about your/child s dental health. (IF CHILD IS >1 YEAR AND < 2 YEARS, ASK: Does (CHILD) have any teeth yet?) QT07_M1 TF14 QT07_M2 About how long has it been since you last visited a dentist or dental clinic? Include dental hygienists and all types of dental specialists. HAVE NEVER VISITED... 0 [GO TO QT07_M3] LESS THAN 6 MONTHS AGO... 1 6 MONTHS UP TO 1 YEAR AGO... 2 1 YEAR UP TO 2 YEARS AGO... 3 2 YEARS UP TO 5 YEARS AGO... 4 MORE THAN 5 YEARS AGO... 5 [GO TO QT07_M3] [GO TO QT07_M3] Was it for a routine checkup or cleaning, or was it for a specific problem? TF15 ROUTINE CHECKUP OR CLEANING... 1 SPECIFIC PROBLEM... 2 BOTH... 3 Main Reason Have Not Visited Dentist PROGRAM NOTE QT07_M3: IF M1=1 (< 6 MONTHS AGO) OR 2 (6 MONTHS 1 YEAR AGO), GO TO QT07_M4; ELSE IF M1 = 0 (NEVER VISITED) OR 3 (1-2 YEARS AGO) OR 4 (2-5 YEARS AGO) OR 5 (MORE THAN 5 YEARS AGO), CONTINUE WITH QT07_M3 AND IF QT07_M1 =0 say. ( in the past year ) Main Reason Have Not Visited Dentist-NEW 2007 QT07_M3 What is the main reason you haven t visited a dentist {in the past year}? TM1 COST, COULD NOT AFFORD... 1 NO INSURANCE... 2 DID NOT HAVE A DENTIST, NONE AVAILABLE... 3 FEAR, PAIN, NERVOUSNESS... 4 NO TRANSPORTATION, TOO FAR AWAY... 5 NO PROBLEMS WITH TEETH... 6 OTHER, SPECIFY:... 7 PROGRAM NOTE QT07_M4:
IF QT07_M1 = 0 (NEVER VISITED A DENTIST), GO TO QT07_M6; ELSE CONTINUE WITH QT07_M4 QT07_M4 Is there a particular dentist or place you usually go to for your dental care? TF25 NO... 2 MORE THAN ONE PLACE... 3 s to Dentist, Past 12 Months-NEW 2007 PROGRAM NOTE QT07_M5: IF QT07_M1 = 0 (NEVER VISITED A DENTIST) OR 3 (1-2 (1-2 YEARS AGO OR 4 (2-5 YEARS AGO) OR 5 (MORE THAN % YEARS AGO), GO TO QT07_M6; ELSE CONTINUE WITH QT07_M5 QT07_M5 TF25 During the past 12 months, about how many visits did you make to a dentist? VISITS REFUSED... -7 DON T KNOW... -8 QT07_M6 TF26 QT07_M7 TF28 QT07_M8 TF29 Teeth QT07_M9 TM3 During the past 12 months, was there any time when you needed dental care but you could not afford it? NO... 2 During the past 12 months, did you miss any time from school because of a dental problem? Do not count time missed for cleaning or a check-up. NO... 2 [GO TO M9] [GO TO M9] [GO TO M9] How many days of school did you miss because of dental problems? DAYS LESS THAN ONE DAY 94 REFUSED... -7 DON T KNOW... -8 of Teeth-NEW 2007 ASKED OF TEENS ONLY: How would you describe the condition of your teeth: excellent, very good, good, fair, or poor? EXCELLENT 1
VERY GOOD 2 GOOD 3 FAIR 4 POOR. 5 HAS NO NATURAL TEETH.... 6 DON T KNOW.. -7 REFUSED..-8 CHIS 2003 CHILD ORAL HEALTH QUESTIONS ONE CYCLE ONLY CC3 During the past 2 years, did a dentist or hygienist ever recommend that your CHILD get dental treatment other than a check-up, but he/she didn t get it? NO... 2 [SKIP TO CC5] REFUSED...-7 [SKIP TO CC5] DON T KNOW...-8 [SKIP TO CC5] CC4 What is the main reason (CHILD) did not get the treatment? FEAR, APPREHENSION, NERVOUSNESS, PAIN, DISLIKE GOING 1 NO REASON TO GO (NO PROBLEMS, NO TEETH)...2 COULD NOT AFFORD IT/TOO EXPENSIVE...3 NO INSURANCE...4 OTHER...91 REFUSED...-7 DON'T KNOW/NOT SURE/DON T REMEMBER...-8 CC12 Do you currently have any kind of insurance that pays for any of (your child s) routine dental care, including dental insurance, prepaid dental plans such as HMOs, or government plans such as Medi- Cal or Healthy Families? NO... 2 REFUSED... -7 DON T KNOW... -8 CC13 Who pays for the cost of this dental insurance, not counting any co-pays or deductibles you may have? SELF OR FAMILY...1 RESPONDENT'S CURRENT OR FORMER EMPLOYER OR UNION 2 SPOUSE'S CURRENT OR FORMER EMPLOYER OR UNION 3 SOMEONE OUTSIDE HOUSEHOLD...4 MEDICARE...5 MEDI-CAL (MEDICAID)...6 HEALTHY FAMILIES PROGRAM...7 OTHER GOVERNMENT DENTAL PROGRAM (E.G., HEALTHY KIDS IN SANTA CLARA AND SF COUNTIES, HEALTHY SMILES IN ALAMEDA COUNTY).8 OTHER...91 REFUSED...-7 DON'T KNOW...-8
PROGRAMMING NOTE: CC14 ASK CC14 ONLY AS CONFIRMATORY QUESTION FOR THOSE WHO SAID THEIR CHILD HAD NO DENTAL INSURANCE BUT SAID THEY HAD MEDI-CAL FOR HEALTH INSURANCE] ELSE SKIP TO PROGRAMMING NOTE CC15 CC14 Is it correct that your child is covered by Medi-Cal? Does your child's Medi-Cal coverage include coverage for dental care? NO... 2 [SKIP TO CC16] REFUSED...-7 [SKIP TO CC16] DON T KNOW...-8 [SKIP TO CC16] PROGRAMMING NOTE: CC15 ASK CC15 ONLY AS CONFIRMATORY QUESTION FOR THOSE WHO SAID THEY/THEIR CHILD HAD NO DENTAL INSURANCE BUT SAID THEY HAD HEALTHY FAMILIES FOR HEALTH INSURANCE ELSE SKIP TO CC16 CC15 Is it correct, then, that you are/your child is/are you/is your child) covered by the Healthy Families Program? Does (your/your child's) Healthy Families coverage include coverage for dental care? NO... 2 REFUSED...-7 DON T KNOW...-8 CC2 CHIS 2001 CHILD ORAL HEALTH HEALTH QUESTIONS ONE CYCLE ONLY {These questions are about {CHILD NAME /AGE/SEX} s dental health.} Does {CHILD NAME /AGE/SEX} use toothpaste when brushing {his/her/his or her} teeth? [SKIP TO CC4] DOES NOT BRUSH TEETH... 3 [SKIP TO CC4] [SKIP TO CC4] DON T KNOW... -8 [SKIP TO CC4] CC3 Does the toothpaste contain fluoride? DON T KNOW... -8 CC4 CC7B Does {CHILD NAME /AGE/SEX} now take prescription vitamins with fluoride or other kind of fluoride tablets, drops or mouthwash either at home or at school or day care? REFUSED...-7 DON T KNOW...-8 Do you use any free community or public dental programs for {CHILD NAME /AGE/SEX}'s dental care?
PROGRAMMING NOTE CC8: IF CAGE => 6, SKIP TO CC10; ELSE CONTINUE WITH CC8 DON'T KNOW... -8 CC8 When {CHILD NAME /AGE/SEX} goes to sleep or takes a nap, does {he/she/he or she} sleep with something in {his/her/his or her} mouth, like a thumb, bottle or pacifier? [SKIP TO CC10] REFUSED...-7 [SKIP TO CC10] DON T KNOW...-8 [SKIP TO CC10] CC9A What does {he/she/he or she} sleep with? CC9A NURSING AT MOTHER'S BREAST... 1 [SKIP TO CC10] BOTTLE... 2 PACIFIER... 3 [SKIP TO CC10] THUMB/FINGER... 4 [SKIP TO CC10] OTHER... 91 [SKIP TO CC10] REFUSED... 6 [SKIP TO CC10] DON'T KNOW... 7 [SKIP TO CC10] CC9B What is in the bottle? (for example, milk, water, juice) MILK... 1 JUICE OR OTHER SUGARY DRINK... 2 [SKIP TO PN CC10] WATER... 3 [SKIP TO PN CC10] OTHER... 91 [SKIP TO PN CC10] [SKIP TO PN CC10] DON'T KNOW... -8 [SKIP TO PN CC10] CC9C Is it usually plain milk, chocolate milk, or milk with sugar added? PLAIN MILK... 1 CHOCOLATE MILK/MILK WITH SUGAR ADDED... 2 OTHER... 91 DON'T KNOW... -8 CHIS 2009 FREQUENCIES MOST RECENT DENTAL VISIT Teens Ages 12-17 Children ages 3-11 % % 6 months ago or less 75.6 74.6 More than 6 months ago up to 1 year ago 14.3 15.5 More than one year ago up to 2 years ago 5.6 3.3 More than 2 years ago up to 5 years ago 2.7 0.7 More than 5 years ago 0.6 0.2* Never been to dentist 1.2* 5.7 *unstable estimate