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Preventive Care (AP) Section
BOX_00A
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THE AP SECTION IS ASKED IN ROUNDS 3 AND 5 ONLY. IF
IT IS ROUND 1, 2, OR 4, CONTINUE TO THE NEXT
SECTION.
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BOX_00
======
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CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME.
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AP01
====
OMITTED.
AP02
====
OMITTED.
AP03
====
OMITTED.
AP04
====
OMITTED.
AP04A
=====
OMITTED.
AP05
====
OMITTED.
AP06
====
OMITTED.
AP07
====
OMITTED.
AP08
====
OMITTED.
AP09
====
OMITTED.
AP10
====
OMITTED.
AP11
====
OMITTED.
AP11A
=====
OMITTED.
AP11B
=====
OMITTED.
AP11C
=====
OMITTED.
BOX_01
======
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IF PERSON IS LESS THAN 1 YEAR OF AGE (OR AGE
CATEGORY 1), GO TO BOX_02
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OTHERWISE, CONTINUE WITH AP12
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AP12
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
The next few questions ask about the amounts and types
of
preventive care (PERSON) may receive.
On average, how often (do/does) (PERSON) receive a
dental
check-up?
TWICE A YEAR OR MORE ................... 1
ONCE A YEAR ............................ 2
LESS THAN ONCE A YEAR .................. 3
NEVER GO TO DENTIST .................... 4
REF ................................... -7
DK .................................... -8
[Code One]
HELP AVAILABLE FOR DEFINITION OF DENTAL CHECK-UP.
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IF PERSON BEING ASKED ABOUT IS 18 YEARS OF AGE OR
OLDER (OR IN AGE CATEGORIES 4-9), CONTINUE WITH
AP15
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IF PERSON BEING ASKED ABOUT IS 16 OR 17 YEARS OF
AGE, GO TO AP32
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OTHERWISE (THAT IS, PERSON BEING ASKED ABOUT IS
LESS THAN 16 YEARS OF AGE OR IN AGE CATEGORIES
1-3), GO TO BOX_02
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AP13
====
OMITTED.
AP14
====
OMITTED.
AP15
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had
(PERSON)’s blood
pressure checked by a doctor, nurse or other health
professional?
WITHIN PAST YEAR ....................... 1 {AP15OV}
WITHIN PAST 2 YEARS .................... 2 {AP15OV}
WITHIN PAST 3 YEARS .................... 3 {AP16}
WITHIN PAST 5 YEARS .................... 4 {AP16}
MORE THAN 5 YEARS ...................... 5 {AP16}
NEVER .................................. 6 {AP16}
REF ................................... -7 {AP16}
DK .................................... -8 {AP16}
HELP AVAILABLE FOR DEFINITION OF BLOOD PRESSURE CHECK.
[Code One]
AP15OV
======
IF NOT ALREADY GIVEN, ASK: About how long ago in
months
has it been?
IF LESS THAN ONE MONTH AGO, ENTER 0.
NUMBER:
[Enter Small Number] ................... {AP16}
REF ................................... -7 {AP16}
DK .................................... -8 {AP16}
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HARD CHECK:
0 – 24
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AP16
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had
(PERSON)’s blood
cholesterol checked by a doctor or other health
professional?
WITHIN PAST YEAR ....................... 1 {AP17}
WITHIN PAST 2 YEARS .................... 2 {AP17}
WITHIN PAST 3 YEARS .................... 3 {AP17}
WITHIN PAST 5 YEARS .................... 4 {AP17}
MORE THAN 5 YEARS ...................... 5 {AP17}
NEVER .................................. 6 {AP17}
REF ................................... -7 {AP17}
DK .................................... -8 {AP17}
HELP AVAILABLE FOR DEFINITION OF BLOOD CHOLESTEROL
CHECK.
[Code One]
AP17
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had a
routine
check-up by a doctor or other health professional?
IF NECESSARY, SAY: A routine check-up is a visit with
a doctor
or other health professional for assessing overall
health,
usually not prompted by a specific illness or
complaint. It
usually includes a blood pressure check, and may
include taking
a blood sample for analysis and questions about health
behaviors
such as smoking.
WITHIN PAST YEAR ....................... 1 {AP17A}
WITHIN PAST 2 YEARS .................... 2 {AP17A}
WITHIN PAST 3 YEARS .................... 3 {AP17A}
WITHIN PAST 5 YEARS .................... 4 {AP17A}
MORE THAN 5 YEARS ...................... 5 {AP17A}
NEVER .................................. 6 {AP17A}
REF ................................... -7 {AP17A}
DK .................................... -8 {AP17A}
[Code One]
AP17A
=====
{PERSON’S FIRST MIDDLE AND LAST NAME}
Has a doctor or other health professional ever
advised
(PERSON) to...
YES NO
AP17A_01
========
...Eat fewer high fat or high
cholesterol foods? 1 2 ( ) AP17A_02
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REFUSED (-7) AND DON’T KNOW (-8) ALLOWED.
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AP17A_02
========
...Exercise more? 1 2 ( ) {AP18}
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REFUSED (-7) AND DON’T KNOW (-8) ALLOWED.
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AP18
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since (PERSON) had a flu
vaccination
(shot or nasal spray)?
WITHIN PAST YEAR ....................... 1 {AP18A}
WITHIN PAST 2 YEARS .................... 2 {AP18A}
WITHIN PAST 3 YEARS .................... 3 {AP18A}
WITHIN PAST 5 YEARS .................... 4 {AP18A}
MORE THAN 5 YEARS ...................... 5 {AP18A}
NEVER .................................. 6 {AP18A}
REF ................................... -7 {AP18A}
DK .................................... -8 {AP18A}
[Code One]
HELP AVAILABLE FOR DEFINITION OF FLU VACCINATION.
AP18A
=====
{PERSON'S FIRST MIDDLE AND LAST NAME}
(Do/Does) (PERSON) take aspirin every day or every
other
day?
YES .................................... 1 {AP18B}
NO ..................................... 2 {AP18AA}
REF ................................... -7 {AP18B}
DK .................................... -8 {AP18B}
AP18AA
======
{PERSON'S FIRST MIDDLE AND LAST NAME}
(Do/Does) (PERSON) have a health problem or
condition that
makes taking aspirin unsafe for (PERSON)?
YES .................................... 1
{AP18AAA}
NO ..................................... 2 {AP18B}
REF ................................... -7 {AP18B}
DK .................................... -8 {AP18B}
AP18AAA
=======
{PERSON'S FIRST MIDDLE AND LAST NAME}
Is that problem stomach related or something else?
STOMACH RELATED ........................ 1 {AP18B}
SOMETHING ELSE ......................... 2 {AP18B}
REF ................................... -7 {AP18B}
DK .................................... -8 {AP18B}
[Code One]
AP18B
=====
{PERSON'S FIRST MIDDLE AND LAST NAME}
(Have/Has) (PERSON) lost all of (PERSON)’s upper
and lower
natural (permanent) teeth?
YES .................................... 1
{BOX_01A}
NO ..................................... 2
{BOX_01A}
REF ................................... -7
{BOX_01A}
DK .................................... -8
{BOX_01A}
BOX_01A
=======
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IF PERSON BEING ASKED ABOUT IS MALE AND IS 40
YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 6-9),
CONTINUE WITH AP19
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IF PERSON BEING ASKED ABOUT IS MALE AND IS LESS
THAN 40 YEARS OF AGE (OR IN AGE CATEGORIES 4-5),
GO TO AP28
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OTHERWISE (I.E., PERSON BEING ASKED ABOUT IS
FEMALE), GO TO AP20A
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AP19
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
When did (PERSON) have (PERSON)’s most recent
"PSA" test?
IF NECESSARY, SAY: A "P-S-A" is a blood test to detect
prostate cancer. It is also called a prostate specific
antigen test.
WITHIN PAST YEAR ....................... 1 {AP24}
WITHIN PAST 2 YEARS .................... 2 {AP24}
WITHIN PAST 3 YEARS .................... 3 {AP24}
WITHIN PAST 5 YEARS .................... 4 {AP24}
MORE THAN 5 YEARS ...................... 5 {AP24}
NEVER .................................. 6 {AP24}
REF ................................... -7 {AP24}
DK .................................... -8 {AP24}
[Code One]
AP20A
=====
{PERSON'S FIRST MIDDLE AND LAST NAME}
(Have/Has) (PERSON) had a hysterectomy?
YES .................................... 1 {AP20}
NO ..................................... 2 {AP20}
REF ................................... -7 {AP20}
DK .................................... -8 {AP20}
HELP AVAILABLE FOR DEFINITION OF HYSTERECTOMY.
AP20
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
When did (PERSON) have (PERSON)’s most recent
Pap test?
IF NECESSARY, SAY: A Pap smear or Pap test is a
routine
test for women in which the doctor examines the
cervix,
takes a cell sample from the cervix with a small stick
or
brush, and sends it to the lab.
WITHIN PAST YEAR ....................... 1 {AP21}
WITHIN PAST 2 YEARS .................... 2 {AP21}
WITHIN PAST 3 YEARS .................... 3 {AP21}
WITHIN PAST 5 YEARS .................... 4 {AP21}
MORE THAN 5 YEARS ...................... 5 {AP21}
NEVER .................................. 6 {AP21}
REF ................................... -7 {AP21}
DK .................................... -8 {AP21}
[Code One]
AP21
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
When did (PERSON) have (PERSON)’s most recent
breast exam?
IF NECESSARY, SAY: A breast exam is when the breasts
are felt
by a doctor or other health professional to check for
lumps.
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 3 YEARS .................... 3
WITHIN PAST 5 YEARS .................... 4
MORE THAN 5 YEARS ...................... 5
NEVER .................................. 6
REF ................................... -7
DK .................................... -8
[Code One]
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IF PERSON BEING ASKED ABOUT IS 30 YEARS OF AGE OR
OLDER (OR IN AGE CATEGORIES 5-9), CONTINUE WITH
AP22
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OTHERWISE, GO TO AP28
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AP22
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
When did (PERSON) have (PERSON)’s most recent
mammogram?
IF NECESSARY SAY: A mammogram is an x-ray taken only
of the
breast by a machine that presses against the breast.
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 3 YEARS .................... 3
WITHIN PAST 5 YEARS .................... 4
MORE THAN 5 YEARS ...................... 5
NEVER .................................. 6
REF ................................... -7
DK .................................... -8
[Code One]
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IF PERSON BEING ASKED ABOUT IS 40 YEARS OF AGE OR
OLDER (OR IN AGE CATEGORIES 6-9), CONTINUE WITH
AP24
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OTHERWISE, GO TO AP28
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AP23
====
OMITTED.
AP24
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
A blood stool test is a test that you do at home
using a special
kit or cards provided by a doctor or other health
professional
to determine whether the stool contains blood.
When did (PERSON) do (PERSON)'s most recent
blood stool test using a
home kit?
WITHIN PAST YEAR ....................... 1 {AP24A}
WITHIN PAST 2 YEARS .................... 2 {AP24A}
WITHIN PAST 3 YEARS .................... 3 {AP24A}
WITHIN PAST 5 YEARS .................... 4 {AP24A}
WITHIN PAST 10 YEARS ................... 5 {AP24A}
MORE THAN 10 YEARS ..................... 6 {AP24A}
NEVER .................................. 7 {AP26}
REF ................................... -7 {AP26}
DK .................................... -8 {AP26}
[Code One]
AP24A
=====
{PERSON'S FIRST MIDDLE AND LAST NAME}
What was the main reason (PERSON) had (PERSON)’s
most recent
blood stool test using a home kit? Was it...
Part of a routine exam, ....................... 1
{AP26}
Because of a problem, or ...................... 2
{AP26}
Some other reason? ............................ 3
{AP26}
REF .......................................... -7
{AP26}
DK ........................................... -8
{AP26}
[Code One]
AP25
====
OMITTED.
AP26
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
A sigmoidoscopy and a colonoscopy are both tests
that examine
the bowel by inserting a tube in the rectum. The
difference is
that during a sigmoidoscopy, you are awake and can
drive yourself
home after the test; however, during a colonoscopy,
you may feel
sleepy and you need someone to drive you home.
When did (PERSON) have (PERSON)'s most recent
colonoscopy?
WITHIN PAST YEAR ....................... 1 {AP26A}
WITHIN PAST 2 YEARS .................... 2 {AP26A}
WITHIN PAST 3 YEARS .................... 3 {AP26A}
WITHIN PAST 5 YEARS .................... 4 {AP26A}
WITHIN PAST 10 YEARS ....................5 {AP26A}
MORE THAN 10 YEARS ..................... 6 {AP26A}
NEVER .................................. 7 {AP27}
REF ................................... -7 {AP27}
DK .................................... -8 {AP27}
[Code One]
AP26A
=====
{PERSON'S FIRST MIDDLE AND LAST NAME}
What was the main reason (PERSON) had (PERSON)’s
most recent
colonoscopy? Was it...
Part of a routine exam, ................ 1 {AP27}
Because of a problem, or ............... 2 {AP27}
Some other reason? ..................... 3 {AP27}
REF ................................... -7 {AP27}
DK .................................... -8 {AP27}
[Code One]
AP27
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
When did (PERSON) have (PERSON)’s most recent
sigmoidoscopy?
WITHIN PAST YEAR ....................... 1 {AP27A}
WITHIN PAST 2 YEARS .................... 2 {AP27A}
WITHIN PAST 3 YEARS .................... 3 {AP27A}
WITHIN PAST 5 YEARS .................... 4 {AP27A}
WITHIN PAST 10 YEARS ................... 5 {AP27A}
MORE THAN 10 YEARS ..................... 6 {AP27A}
NEVER .................................. 7 {AP28}
REF ................................... -7 {AP28}
DK .................................... -8 {AP28}
[Code One]
AP27A
=====
{PERSON'S FIRST MIDDLE AND LAST NAME}
What was the main reason (PERSON) did (PERSON)’s
most recent
sigmoidoscopy? Was it...
Part of a routine exam, ................ 1 {AP28}
Because of a problem, or ............... 2 {AP28}
Some other reason? ..................... 3 {AP28}
REF ................................... -7 {AP28}
DK .................................... -8 {AP28}
[Code One]
AP28
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
(Do/Does) (PERSON) now spend half an hour or more
in moderate
or vigorous physical activity at least five times a
week?
YES .................................... 1 {AP29}
NO ..................................... 2 {AP29}
REF ................................... -7 {AP29}
DK .................................... -8 {AP29}
HELP AVAILABLE FOR DEFINITION OF MODERATE OR VIGOROUS
PHYSICAL ACTIVITY.
AP29
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how tall (are/is) (PERSON) without shoes?
PROBE FOR INCHES IF NOT REPORTED.
AP29_01
=======
FEET:
[Enter Feet] ........................... {AP29_02}
REF ................................... -7 {AP30}
DK .................................... -8 {AP30}
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SOFT CHECK:
SOFT RANGE CHECK: 2 TO 6
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AP29_02
=======
INCHES:
[Enter Inches] ......................... {AP30}
REF ................................... –7 {AP30}
DK .................................... –8 {AP30}
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HARD CHECK:
HARD RANGE CHECK: 0 TO 11
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AP30
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how much (do/does) (PERSON) weigh without shoes?
ENTER CURRENT WEIGHT TO THE NEAREST POUND.
[Enter Pounds] ......................... {AP32}
REF ................................... -7 {AP32}
DK .................................... -8 {AP31}
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SOFT CHECK:
SOFT RANGE CHECK: 50 TO 500
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AP31
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AP-1.
Looking at this card, what is your best guess of
(PERSON)'s
weight?
99 POUNDS OR LESS ..................... 1 {AP32}
100 - 149 POUNDS ...................... 2 {AP32}
150 - 199 POUNDS ...................... 3 {AP32}
200 - 249 POUNDS ...................... 4 {AP32}
250 - 299 POUNDS ...................... 5 {AP32}
300 POUNDS OR MORE .................... 6 {AP32}
REF ................................... -7 {AP32}
DK .................................... -8 {AP32}
[Code One]
AP32
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
Would {you say you wear/(PERSON) say (he/she)
wears}
a seat belt when driving or riding in a car...
Always, ................................ 1 {BOX_02}
Nearly Always, ......................... 2 {BOX_02}
Sometimes, ............................. 3 {BOX_02}
Seldom, or ............................. 4 {BOX_02}
Never? ................................. 5 {BOX_02}
IF VOLUNTEERED: NEVER DRIVES OR RIDES
IN A CAR/ALWAYS USES PUBLIC
TRANSPORTATION OR WALKS ........... 6 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
[Code One]
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DISPLAY ‘you say you wear’ IF PERSON BEING ASKED
ABOUT IS THE RESPONDENT [PERSON IS SELECTED AT
RE06 WHEN RE02 IS CODED ‘1’ (RU MEMBER)].
OTHERWISE, DISPLAY ‘(PERSON) say (he/she) wears’.
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BOX_02
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GO TO NEXT QUESTIONNAIRE SECTION.
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