Additional Healthcare Questions (AH) Section

BOX_00 (AH1000)

BOX_10 (AH1005)

BOX_20 (AH1010)

BOX_30 (AH1015)

AH10 (AH1025)

BLAISE NAME: MissWork

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{NUMBER OF DAYS IN HOSPITAL: {NUMBER OF DAYS}}

{NUMBER OF DAYS INSTITUTIONALIZED: {NUMBER OF DAYS}}

{The next questions ask about time/Now think about} when {you/{PERSON}} may have missed a half day or more from work {since {PERSON’S START DATE}/between {PERSON’S START DATE} and {PERSON’S END DATE}}. {In answering these questions, please include any time when this occurred because of {your/{PERSON}' s} physical illness or injury, or a mental or emotional problem such as stress or depression.}

{Including the time {you/{PERSON}} {were/was} in {the hospital} {and} {the long-term care facility}, how/How} many days did {you/{PERSON}} miss a half day or more from work {since {PERSON’S START DATE}/ between {PERSON’S START DATE} and {PERSON’S END DATE}}? Please do not include work around the house.

PROBE: Include any time when a half day or more was missed because of a physical illness or injury, or a mental or emotional problem.

HELP: F1

Responses: RECORD NUMBER OF DAYS 1 AH20 (AH1030)

NO DAYS MISSED FROM WORK 2 BOX_50 (AH1045)

DOES NOT WORK (OTHER THAN AROUND THE HOUSE) 3 BOX_50 (AH1045)

REFUSED RF BOX_50 (AH1045)

DON'T KNOW DK BOX_50 (AH1045)

Display Instructions: Display ‘NUMBER OF DAYS IN HOSPITAL: { }’ if person has at least one hospital stay that ended in current round (i.e., discharge date not coded ‘95’ (STILL IN HOSPITAL)). Otherwise, use a null display.

For ‘NUMBER OF DAYS’, display total number of days person was in hospital for all hospital stays that ended in current round (i.e., discharge date not coded ‘95’ (STILL IN HOSPITAL)). Otherwise, use a null display.

Display 'NUMBER OF DAYS INSTITUTIONALIZED: { }' if person has at least one institutional stay (IC event) that ended in current round (i.e., discharge date not coded '95' (STILL IN INSTITUTION)). Otherwise, use a null display.

For 'NUMBER OF DAYS', display total number of days person was in an institution for all institutional stays that ended in current round (i.e., discharge date not coded '95' (STILL IN INSTITUTION)). Otherwise, use a null display.

Display 'The next questions ask about time' if first time through the Additional Healthcare Questions (AH) Section in the current round. Otherwise, display 'Now think about'.

Display 'since {PERSON’S START DATE}' if not round 5. Display 'between {PERSON’S START DATE} and {PERSON’S END DATE}' if round 5.

Display 'In answering . . . or depression.' if first time through the AH section in the current round. Otherwise, use a null display.

Display 'Including the time {you/{person}} {were/was} in {the hospital} {and} {the long- term care facility}, how' if person has at least one hospital stay (HS) or one institutional stay (IC) event that ended in current round (i.e., discharge date not coded '95' (STILL IN HOSPITAL/ INSTITUTION)). Otherwise, display 'How'.

Display 'the hospital' if person has at least one hospital stay (HS) event that ended in the current round. Otherwise, use a null display.

Display 'the long-term care facility' if person has at least one institutional care (IC) event that ended in the current round. Otherwise, use a null display.

Display 'and' if person has both a hospital stay (HS) event and an institutional care (IC) event that both ended in the current round. Otherwise, use a null display.

AH20 (AH1030)

BLAISE NAME: NoWork

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{NUMBER OF DAYS IN HOSPITAL: {NUMBER OF DAYS}}

{NUMBER OF DAYS INSTITUTIONALIZED: {NUMBER OF DAYS}}

[{The next questions ask about time/Now think about} when {you/{PERSON}} may have missed a half day or more from work {since {PERSON’S START DATE}/between {PERSON’S START DATE} and {PERSON’S END DATE}}. {In answering these questions, please include any time when this occurred because of {your/{PERSON}' s} physical illness or injury, or a mental or emotional problem such as stress or depression.}

{Including the time {you/{PERSON}} {were/was} in {the hospital} {and} {the long -term care facility}, how/How} many days did {you/{PERSON}} miss a half day or more from work {since {PERSON’S START DATE}/ between {PERSON’S START DATE} and {PERSON’S END DATE}}? Please do not include work around the house.

PROBE: Include any time when a half day or more was missed because of a physical illness or injury, or a mental or emotional problem.]

ENTER NUMBER OF DAYS

HELP: F1

Responses: 1 BOX_40 (AH1035)

Programmer Instructions: Hard Checks:

1. RF/DK not allowed. If RF/DK coded here display the following message: “REFUSED AND DON’T KNOW DISALLOWED. IF NUMBER OF DAYS MISSED FROM WORK IS UNKNOWN, SELECT REFUSED OR DON’T KNOW AT PREVIOUS QUESTION (AH10-MissWork).”
   
   
2. ‘0’ not allowed. If ‘0’ entered, display the following message: "IF NO DAYS MISSED FROM WORK, SELECT CODE 2 'NO DAYS MISSED FROM WORK' AT PREVIOUS QUESTION (AH10-MissWork).”
   
   
3. 1 through number of days in person’s reference period allowed. If number entered > number of days in person’s reference period, display the following message: “NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN {PERSON}’S REFERENCE PERIOD.”

Display Instructions: Display “{The next questions … around the house” and the PROBE in lighter grayed out text and in brackets. Display AH10 and AH20 on the same form pane.

See AH10 for other display instructions.

BOX_40 (AH1035)

AH30 (AH1040)

BLAISE NAME: MissWorkYr

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

NUMBER OF DAYS MISSED WORK: {NUMBER OF DAYS}

Of those days, how many were in {YEAR}?

ENTER NUMBER OF DAYS

Responses: 1 BOX_50 (AH1045)

REFUSED RF BOX_50 (AH1045)

DON'T KNOW DK BOX_50 (AH1045)

Programmer Instructions: Hard Check:

Days missed from work in {YEAR} entered at AH30 must be < or = total days missed from work entered at AH20. If AH30 > AH20, display the following message: “DAYS MISSED IN {YEAR} MUST BE LESS THAN OR EQUAL TO TOTAL NUMBER OF DAYS MISSED FROM WORK.”

Display Instructions: For 'NUMBER OF DAYS,' display the number entered at AH20.

(For specifications purposes only; CAPI handles automatically): 'YEAR' in question text is first calendar year of panel (FirstPanYear).

BOX_50 (AH1045)

AH40 (AH1050)

BLAISE NAME: MissWorkOth

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{Besides the {NUMBER OF MISSED WORK DAYS} days {you/{PERSON}} missed a half day or more from work because of {your/his/her} own illness or injury, did/Did} {you/{PERSON}} miss more than a half day from work {between {PERSON’S START DATE} and {PERSON’S END DATE}} because of someone else's illness, injury, or health care needs, for example, to take care of a sick child or a relative?

HELP: F1

Responses: YES 1 AH50 (AH1055)

NO/DO NOT WORK 2 BOX_70 (AH1070)

REFUSED RF BOX_70 (AH1070)

DON'T KNOW DK BOX_70 (AH1070)

Display Instructions: Display ‘Besides the ..., did’ if AH10 is coded ‘1’ (RECORD NUMBER OF DAYS). Otherwise, display ‘Did’.

For ‘NUMBER OF MISSED WORK DAYS’, display number recorded at AH20.

Display 'between {PERSON’S START DATE} and {PERSON’S END DATE}' if round 5. Otherwise, use a null display.

AH50 (AH1055)

BLAISE NAME: DaysOth

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

How many days did {you/{PERSON}} miss a half day or more from work because of someone else's illness, injury, or health care needs?

ENTER NUMBER OF DAYS

HELP: F1

Responses: 1 BOX_60 (AH1060)

REFUSED RF BOX_70 (AH1070)

DON'T KNOW DK BOX_70 (AH1070)

Programmer Instructions: Hard Checks:

1. ‘0’ not allowed. If ‘0’ entered, display the following message: “IF NO WORK DAYS MISSED, BACK UP AND CORRECT PREVIOUS ANSWER (AH40-MissWorkOth).”
   
   
2. 1 through number of days in person’s reference period allowed. If number entered at AH50 > number of days in person’s reference period, display the following message: “NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN {PERSON}’S REFERENCE PERIOD.”

Display Instructions:

BOX_60 (AH1060)

AH60 (AH1065)

BLAISE NAME: DaysOthYr

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

NUMBER OF DAYS MISSED WORK DUE TO SOMEONE ELSE'S HEALTH: {NUMBER OF DAYS}

Of those days, how many were in {YEAR}?

ENTER NUMBER OF DAYS

Responses: 1 BOX_70 (AH1070)

REFUSED RF BOX_70 (AH1070)

DON'T KNOW DK BOX_70 (AH1070)

Programmer Instructions: Hard Check:

Days in missed from work in {YEAR} entered at AH60 must be < or = days missed work due to someone else's health at AH50. If AH60 > AH50, display the following message: “DAYS MISSED IN {YEAR} MUST BE LESS THAN OR EQUAL TO TOTAL NUMBER OF DAYS MISSED FROM WORK DUE TO SOMEONE ELSE’S HEALTH.”

Display Instructions: For “NUMBER OF DAYS”, display the number entered at AH50.

(For specifications purposes only; CAPI handles automatically): 'YEAR' in question text is first calendar year of panel (FirstPanYear).

BOX_70 (AH1070)

AH70 (AH1075)

BLAISE NAME: CondInj

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Now I'm going to read you a list of some of the health conditions that were reported for {you/{PERSON}} between {PERSON’S START DATE} and {PERSON’S END DATE}.

READ CONDITIONS BELOW.

{Medical Condition}1

{Medical Condition}2

{Medical Condition}3

{Medical Condition}4

{Medical Condition}N

{Was this health condition/Were any of these health conditions} due to an accident or injury?

HELP: F1

Responses: YES 1

NO 2 BOX_100 (AH1110)

REFUSED RF BOX_100 (AH1110)

DON'T KNOW DK BOX_100 (AH1110)

Programmer Instructions: Roster behavior:

1. Select, add, delete, and edit disallowed.

If coded ‘1’ (YES) and only 1 condition eligible for display at AH70, auto-code that condition at AH80 and go to BOX_80. If coded ‘1’ (YES) and more than 1 condition eligible for display at AH70, continue with AH80.

Display Instructions: Roster 1- Report

Roster Definition:

This item displays the person's-conditions-roster.

Roster filter:

Display only the conditions for person that meet the following conditions:

Condition was ‘created’ during the current round (RndCreated=current round).

Condition is not a priority condition, that is, condition was not created in the PE section.

Display 'was this health condition' if only one condition eligible for display at AH70. Otherwise, display 'were any of these health conditions'.

AH80 (AH1080)

BLAISE NAME: Injury

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Which of {your/{PERSON}'s} health conditions were due to an accident or injury?

PROBE: Any other health conditions due to an accident or injury?

ENTER ALL THAT APPLY

HELP: F1

Responses: {MEDICAL CONDITION} 1 1 BOX_80 (AH1085)

{MEDICAL CONDITION} 2 2 BOX_80 (AH1085)

{MEDICAL CONDITION} 3 3 BOX_80 (AH1085)

{MEDICAL CONDITION} 4 4 BOX_80 (AH1085)

{MEDICAL CONDITION}N 5 BOX_80 (AH1085)

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.
   
   
2. Select, add, delete, and edit disallowed.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition:

Display the person-medical-conditions-roster for selection.

Roster Filter:

Display conditions that meet the following:

Condition was ‘created’ during the current round (RndCreated=current round).

Condition is not a priority condition, that is, condition was not created in the PE section.

BOX_80 (AH1085)

BOX_90 (AH1090)

LOOP_10 (AH1095)

AH90 (AH1100)

BLAISE NAME: InjWork

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {CONDITION} {PERS STR-DT} {PERS END-DT}

Question Text:

{You indicated that {you/{PERSON}} {are/is} not working now. Did the {CONDITION} happen while {you/{PERSON}} {were/was} at work on any previous job?/Did the {CONDITION} happen while {you/{PERSON}} {were/was} at work?}

Responses: YES 1 END_LP10 (AH1105)

NO 2 END_LP10 (AH1105)

DOES NOT WORK 3 END_LP10 (AH1105)

REFUSED RF END_LP10 (AH1105)

DON'T KNOW DK END_LP10 (AH1105)

Display Instructions: Display "You indicated that {you/{PERSON}}...previous job?" if AH10 is coded '3' (DOES NOT WORK (OTHER THAN AROUND THE HOUSE)). Otherwise, display “Did the {CONDITION} happen while {you/{PERSON}} {were/was} at work?”

For “{CONDITION}”, display the name of the medical condition being looped on.

END_LP10 (AH1105)

BOX_100 (AH1110)

BOX_110 (AH1115)

AH100 (AH1120)

BLAISE NAME: AllTeeth

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

The next few questions ask you to consider {your/{PERSON’s}} health.

{Have/Has} {you/{PERSON}} lost all of {your/his/her} upper and lower natural (permanent) teeth?

Responses: YES 1 AH110 (AH1125)

NO 2 AH110 (AH1125)

REFUSED RF AH110 (AH1125)

DON'T KNOW DK AH110 (AH1125)

Display Instructions:

AH110 (AH1125)

BLAISE NAME: Exer5Days

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{Do/Does} {you/{PERSON}} now spend half an hour or more in moderate or vigorous physical activity at least five times a week?

HELP: F1

Responses: YES 1 AH120 (AH1130)

NO 2 AH120 (AH1130)

REFUSED RF AH120 (AH1130)

DON'T KNOW DK AH120 (AH1130)

Display Instructions:

AH120 (AH1130)

BLAISE NAME: OFtSmoke

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{Do/Does} {you/{PERSON}} now smoke cigarettes every day, some days or not at all?

Responses: EVERY DAY 1 BOX_120 (AH1135)

SOME DAYS 2 BOX_120 (AH1135)

NOT AT ALL 3 BOX_120 (AH1135)

REFUSED RF BOX_120 (AH1135)

DON'T KNOW DK BOX_120 (AH1135)

Display Instructions:

BOX_120 (AH1135)

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