Health Status (HE) Section

BOX_00 (HE1000)

BOX_10 (HE1005)

BOX_20 (HE1010)

HE10 (HE1015)

BLAISE NAME: HelpPhone

Context Header: {STR-DT}

{END-DT}

Question Text:

Does anyone in this household receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping (because of an impairment or a physical or mental health problem)?

Responses: YES 1

NO 2 HE40 (HE1055)

REFUSED RF HE40 (HE1055)

DON'T KNOW DK HE40 (HE1055)

Programmer Instructions: If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVES HELP' at HE20 by CAPI then

- If person is < 13 or in age categories 1-3 go to LOOP_10.

- Otherwise, go to HE40.

If coded '1' (YES) and a multi-person RU, continue with HE20.

Display Instructions:

HE20 (HE1020)

BLAISE NAME: HelpPhoneRoster

Context Header: {STR-DT}

{END-DT}

Question Text:

Who is that?

PROBE: Does anyone else receive help or supervision doing these types of activities [such as using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping]?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5

Programmer Instructions: If any of the persons selected are < 13 or in age categories 1-3, continue with LOOP_10.

Otherwise, go to HE40.

Roster behavior:

1. Multiple select allowed.

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

Roster Definition: This item displays RU-members-roster (FULLNAME) for selection.

Roster Filter: None. Display all RU members.

Note: Placeholder for MHOP specifications. Throughout the HE section, deceased RU members in multi-person RUs where there is at least one RU member who is not deceased will display on rosters for selection. This was done for administration ease so FIs do not have to back up to re-code a gate question if a deceased person was mentioned. This is a change from the administration method in WVS. During post-processing, HE data for deceased persons will need to be cleared out (set to -1) at some point along the process so that the data patterns are consistent.

LOOP_10 (HE1025)

HE30 (HE1040)

BLAISE NAME: HelpPhoneBillsHlth

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

{END-DT}

Question Text:

{Do/Does} {you/{PERSON}} receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry or going shopping because of an impairment or a physical or mental health problem?

HELP: F1

Responses: YES 1 END_LP10 (HE1050)

NO 2 END_LP10 (HE1050)

REFUSED RF END_LP10 (HE1050)

DON'T KNOW DK END_LP10 (HE1050)

Display Instructions:

END_LP10 (HE1050)

HE40 (HE1055)

BLAISE NAME: HelpPersnlCare

Context Header: {STR-DT}

{END-DT}

Question Text:

Does anyone in this household receive help or supervision with personal care such as bathing, dressing, or getting around the house (because of an impairment or a physical or mental health problem)?

HELP: F1

Responses: YES 1

NO 2 HE70 (HE1100)

REFUSED RF HE70 (HE1100)

DON'T KNOW DK HE70 (HE1100)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person as 'RECEIVES HELP' at HE50 by CAPI then

- If person is < 13 or in age categories 1-3 go to LOOP_20.

- Otherwise, go to HE70.

If coded '1' (YES) and multi-person RU, continue with HE50.

Display Instructions:

HE50 (HE1060)

BLAISE NAME: HelpPersnlCareRoster

Context Header: {STR-DT}

{END-DT}

Question Text:

Who is that?

PROBE: Does anyone else receive help or supervision with personal care [such as bathing, dressing, or getting around the house]?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5

Programmer Instructions: If any of the person(s) selected are < 13 or in age categories 1-3, continue with LOOP_20.

Otherwise, go to HE70.

Roster Behavior:

1. Multiple select allowed.

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

Roster Definition:

This item displays RU-members-roster for selection.

Roster Filter:

None. Display all RU members.

LOOP_20 (HE1065)

HE60 (HE1080)

BLAISE NAME: HelpPersnlProb

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

{END-DT}

Question Text:

{Do/Does} {you/{PERSON}} receive help or supervision with personal care such as bathing, dressing or getting around the house because of an impairment or a physical or mental health problem?

HELP: F1

Responses: YES 1 END_LP20 (HE1090)

NO 2 END_LP20 (HE1090)

REFUSED RF END_LP20 (HE1090)

DON'T KNOW DK END_LP20 (HE1090)

Display Instructions:

END_LP20 (HE1090)

HE70 (HE1100)

BLAISE NAME: HelpAids

Context Header: {STR-DT}

{END-DT}

Question Text:

Does anyone in this household use any aids such as a walker, grab bars in the bathtub or any other special equipment for personal care or everyday activities (because of an impairment or a physical or mental health problem)?

HELP: F1

Responses: YES 1

NO 2 HE90 (HE1110)

REFUSED RF HE90 (HE1110)

DON'T KNOW DK HE90 (HE1110)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person as 'USES AIDS' at HE80 by CAPI and go to HE90.

If coded '1' (YES) and a multi-person RU, continue with HE80.

Display Instructions:

HE80 (HE1105)

BLAISE NAME: HelpAidsRoster

Context Header: {STR-DT}

{END-DT}

Question Text:

Who is that?

PROBE: Does anyone else use any aids [such as a walker, grab bars in the bathtub or any other special equipment] for personal care or everyday activities?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 HE90 (HE1110)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 HE90 (HE1110)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 HE90 (HE1110)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 HE90 (HE1110)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 HE90 (HE1110)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster Definition:

This item displays RU-members-roster (FULLNAME) for selection.

Roster Filter:

None. Display all RU members.

HE90 (HE1110)

BLAISE NAME: HelpWalkClimb

Context Header: {STR-DT} {END-DT}

Question Text:

Does anyone in this household have difficulties walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time (because of an impairment or a physical or mental health problem)?

Responses: YES 1

NO 2 HE190 (HE1180)

REFUSED RF HE190 (HE1180)

DON'T KNOW DK HE190 (HE1180)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person as 'HAVING DIFFICULTY' at HE100 by CAPI then

- If person is >= 13 or in age categories 4-9 go to LOOP_30.

- Otherwise, go to HE190

If coded '1' (YES) and a multi-person RU, continue with HE100.

Display Instructions:

HE100 (HE1115)

BLAISE NAME: HelpWalkClimbRoster

Context Header: {STR-DT}

{END-DT}

Question Text:

Who is that?

PROBE: Does anyone else have difficulties [walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time]?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5

Programmer Instructions: If any of the person(s) selected are >= 13 or in age categories 4-9, continue with LOOP_30.

Otherwise, go to HE190.

Roster Behavior:

Multiple select allowed.

Display Instructions: Roster 2 – no add/edit/delete Roster Definition:

This item displays RU-members-roster for selection.

Roster Filter:

None. Display all RU members.

LOOP_30 (HE1120)

HE110 (HE1130)

BLAISE NAME: DfcltLift

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

{END-DT}

Question Text:

&HE-1.

{For these next questions, I would like you to think about the time when {you/{PERSON}} entered the institution and what {you/he/she} was able to do at that time.}

Please look at show card HE-1 and tell me how much difficulty {do/does} {you/{PERSON}} have lifting something as heavy as 10 pounds, such as a full bag of groceries? Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses: NO DIFFICULTY 1 HE120 (HE1135)

SOME DIFFICULTY 2 HE120 (HE1135)

A LOT OF DIFFICULTY 3 HE120 (HE1135)

COMPLETELY UNABLE TO DO IT 4 HE120 (HE1135)

REFUSED RF HE120 (HE1135)

DON'T KNOW DK HE120 (HE1135)

Display Instructions: Display ‘For these next questions, I would like you to think about the time when {you/{PERSON}} entered the institution and what {you/he/she} was able to do at that time.’ if person being asked about coded as being institutionalized at end date. If person being asked about is a current RU member living in the RU, use a null display.

HE120 (HE1135)

BLAISE NAME: DfcltStair

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

{END-DT}

Question Text:

&HE-1.

Looking at show card HE-1, how much difficulty {do/does} {you/{PERSON}} have walking up 10 steps without resting?

PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

IF RESPONDENT VOLUNTEERS THAT PERSON IS COMPLETELY UNABLE TO WALK, SELECT 'COMPLETELY UNABLE TO WALK.'

Responses: NO DIFFICULTY 1 HE130 (HE1140)

SOME DIFFICULTY 2 HE130 (HE1140)

A LOT OF DIFFICULTY 3 HE130 (HE1140)

COMPLETELY UNABLE TO DO IT 4 HE130 (HE1140)

COMPLETELY UNABLE TO WALK 5 HE170 (HE1160)

REFUSED RF HE130 (HE1140)

DON'T KNOW DK HE130 (HE1140)

Programmer Instructions: If coded '5' (COMPLETELY UNABLE TO WALK), automatically code HE130, HE140, HE150, and HE160 as '4' (COMPLETELY UNABLE TO DO IT) by CAPI.

Display Instructions:

HE130 (HE1140)

BLAISE NAME: DfcltWalkABlock

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

{END-DT}

Question Text:

&HE-1.

Looking at show card HE-1, how much difficulty {do/does} {you/{PERSON}} have walking about 3 city blocks or about a quarter of a mile?

PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses: NO DIFFICULTY 1 HE140 (HE1145)

SOME DIFFICULTY 2 HE140 (HE1145)

A LOT OF DIFFICULTY 3 HE140 (HE1145)

COMPLETELY UNABLE TO DO IT 4 HE150 (HE1150)

REFUSED RF HE140 (HE1145)

DON'T KNOW DK HE140 (HE1145)

Programmer Instructions: If coded '4' (COMPLETELY UNABLE TO DO IT), automatically code HE140 as '4' (COMPLETELY UNABLE TO DO IT) by CAPI.

Display Instructions:

HE140 (HE1145)

BLAISE NAME: DfcltWalkMile

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

{END-DT}

Question Text:

&HE-1.

Looking at show card HE-1, how much difficulty {do/does} {you/{PERSON}} have walking a mile?

PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses: NO DIFFICULTY 1 HE150 (HE1150)

SOME DIFFICULTY 2 HE150 (HE1150)

A LOT OF DIFFICULTY 3 HE150 (HE1150)

COMPLETELY UNABLE TO DO IT 4 HE150 (HE1150)

REFUSED RF HE150 (HE1150)

DON'T KNOW DK HE150 (HE1150)

Display Instructions:

HE150 (HE1150)

BLAISE NAME: DfcltStand20Min

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

{END-DT}

Question Text:

&HE-1.

Looking at show card HE-1, how much difficulty {do/does} {you/{PERSON}} have standing for about 20 minutes?

PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses: NO DIFFICULTY 1 HE160 (HE1155)

SOME DIFFICULTY 2 HE160 (HE1155)

A LOT OF DIFFICULTY 3 HE160 (HE1155)

COMPLETELY UNABLE TO DO IT 4 HE160 (HE1155)

REFUSED RF HE160 (HE1155)

DON'T KNOW DK HE160 (HE1155)

Display Instructions:

HE160 (HE1155)

BLAISE NAME: DfcltBendStoop

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

{END-DT}

Question Text:

&HE-1.

Looking at show card HE-1, how much difficulty {do/does} {you/{PERSON}} have bending down or stooping from a standing position to pick up an object from the floor or tie a shoe?

PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses: NO DIFFICULTY 1 HE170 (HE1160)

SOME DIFFICULTY 2 HE170 (HE1160)

A LOT OF DIFFICULTY 3 HE170 (HE1160)

COMPLETELY UNABLE TO DO IT 4 HE170 (HE1160)

REFUSED RF HE170 (HE1160)

DON'T KNOW DK HE170 (HE1160)

Display Instructions:

HE170 (HE1160)

BLAISE NAME: DfcltReachUp

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

{END-DT}

Question Text:

&HE-1.

Looking at show card HE-1, how much difficulty {do/does} {you/{PERSON}} have reaching up overhead, for example to remove something from a shelf?

PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses: NO DIFFICULTY 1 HE180 (HE1165)

SOME DIFFICULTY 2 HE180 (HE1165)

A LOT OF DIFFICULTY 3 HE180 (HE1165)

COMPLETELY UNABLE TO DO IT 4 HE180 (HE1165)

REFUSED RF HE180 (HE1165)

DON'T KNOW DK HE180 (HE1165)

Display Instructions:

HE180 (HE1165)

BLAISE NAME: DfcltGrasp

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

{END-DT}

Question Text:

&HE-1.

Looking at show card HE-1, how much difficulty {do/does} {you/{PERSON}} have using fingers to grasp or handle something such as picking up a glass from a table or using a pencil to write?

PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses: NO DIFFICULTY 1 END_LP30 (HE1175)

SOME DIFFICULTY 2 END_LP30 (HE1175)

A LOT OF DIFFICULTY 3 END_LP30 (HE1175)

COMPLETELY UNABLE TO DO IT 4 END_LP30 (HE1175)

REFUSED RF END_LP30 (HE1175)

DON'T KNOW DK END_LP30 (HE1175)

Display Instructions:

END_LP30 (HE1175)

HE190 (HE1180)

BLAISE NAME: LmtWork

Context Header: {STR-DT}

{END-DT}

Question Text:

Is anyone in this household limited in any way in the ability to work at a job, do housework, or go to school because of an impairment or a physical or mental health problem?

HELP: F1

Responses: YES 1

NO 2 HE230 (HE1215)

REFUSED RF HE230 (HE1215)

DON'T KNOW DK HE230 (HE1215)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person as 'LIMITED ABILITY' at HE200 by CAPI then

- If person is >= 5 or in age categories 3-9 go to LOOP_40.

- Otherwise, go to HE230

If coded '1' (YES) and a multi-person RU, continue with HE200.

Display Instructions:

HE200 (HE1185)

BLAISE NAME: LmtWorkRoster

Context Header: {STR-DT}

{END-DT}

Question Text:

Who is that?

PROBE: Is anyone else limited in the ability to work at a job, do housework, or go to school because of an impairment or a physical or mental health problem?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5

Programmer Instructions: If any of the persons selected are >= 5 or in age categories 3-9, continue with LOOP_40.

Otherwise, go to HE230.

Roster behavior:

1. Multiple select allowed.

Display Instructions: Roster 2 – no add/edit/delete.

Roster definition:

This item displays RU-members-roster for selection.

Roster filter:

None. Display all RU members.

LOOP_40 (HE1190)

HE210 (HE1200)

BLAISE NAME: LmtWhichActiv

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

{END-DT}

Question Text:

Which activities {are/is} {you/{PERSON}} limited in doing because of an impairment or a physical or mental health problem - working at a job, doing housework, or going to school?

ENTER ALL THAT APPLY.

Responses: WORKING AT A JOB 1 HE220 (HE1205)

DOING HOUSEWORK 2 HE220 (HE1205)

GOING TO SCHOOL 3 HE220 (HE1205)

REFUSED RF HE220 (HE1205)

DON'T KNOW DK HE220 (HE1205)

Display Instructions:

HE220 (HE1205)

BLAISE NAME: UnableWork

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

{END-DT}

Question Text:

{At the time {you/{PERSON}} entered the institution, was / {Are/Is}} {you/{PERSON}} completely unable to {work at a job}, {,/ and} {do housework} { and} { go to school}?

Responses: YES 1 END_LP40 (HE1210)

NO 2 END_LP40 (HE1210)

REFUSED RF END_LP40 (HE1210)

DON'T KNOW DK END_LP40 (HE1210)

Display Instructions: Display ‘At the time {you/{PERSON}} entered the institution, was’ if person being asked about coded as being institutionalized at end date. Display ‘{Are/Is}’ if person being asked about is a current RU member living in the RU.

Display ‘work at a job’ if HE210 is coded ‘1’ (WORKING AT A JOB), either alone or in combination with other codes or if HE210 is coded ‘RF’ (REFUSED) or ‘DK’ (DON'T KNOW). If HE210 is not coded ‘1’ (WORKING AT A JOB), ‘RF’ (REFUSED), or ‘DK’ (DON'T KNOW), use a null display.

Display ‘,’ if HE210 is coded ‘1’ (WORKING AT A JOB), ‘2’ (DOING HOUSEWORK), and ‘3’ (GOING TO SCHOOL) or if HE210 is coded either ‘RF’ (REFUSED) or ‘DK’ (DON'T KNOW). Display ‘ and’ if HE210 is coded ‘1’ (WORKING AT A JOB) and either ‘2’ (DOING HOUSEWORK) or ‘3’ (GOING TO SCHOOL) . Otherwise, use a null display.

Display ‘do housework’ if HE210 is coded ‘2’ (DOING HOUSEWORK), either alone or in combination with other codes or if HE210 is coded ‘RF’ (REFUSED) or ‘DK’ (DON'T KNOW). If HE210 is not coded ‘2’ (DOING HOUSEWORK), ‘RF’ (REFUSED), or ‘DK’ (DON'T KNOW), use a null display.

Display ‘and’ if only codes ‘2’ (DOING HOUSEWORK) and ‘3’ (GOING TO SCHOOL) are selected at HE210 or if codes ‘1’ (WORKING AT A JOB), ‘2’ (DOING HOUSEWORK), and ‘3’ (GOING TO SCHOOL) are all selected at HE210 or if coded either ‘RF’ (REFUSED) or ‘DK’ (DON'T KNOW) at HE210. Otherwise, use a null display.

Display ‘go to school’ if HE210 is coded ‘3’ (GOING TO SCHOOL), either alone or in combination with other codes or if HE210 is coded ‘RF’ (REFUSED) or ‘DK’ (DON'T KNOW). If HE210 is not coded ‘3’ (GOING TO SCHOOL), ‘RF’ (REFUSED), or ‘DK’ (DON'T KNOW), use a null display.

END_LP40 (HE1210)

HE230 (HE1215)

BLAISE NAME: LmtSocial

Context Header: {STR-DT}

{END-DT}

Question Text:

(Besides the limitations we just talked about,) is anyone in this household limited in participating in social, recreational or family activities because of an impairment or a physical or mental health problem?

HELP: F1

Responses: YES 1

NO 2 BOX_30 (HE1225)

REFUSED RF BOX_30 (HE1225)

DON'T KNOW DK BOX_30 (HE1225)

Programmer Instructions: If coded '1' (YES) and a single person RU, automatically code person as 'LIMITED IN PARTICIPATION' at HE240 by CAPI and go to BOX_30.

If coded '1' (YES) and a multi-person RU, continue with HE240.

Display Instructions:

HE240 (HE1220)

BLAISE NAME: LmtSocialRoster

Context Header: {STR-DT}

{END-DT}

Question Text:

Who is that?

PROBE: Is anyone else limited in participating in social, recreational, or family activities because of an impairment or a physical or mental health problem?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 BOX_30 (HE1225)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 BOX_30 (HE1225)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 BOX_30 (HE1225)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 BOX_30 (HE1225)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 BOX_30 (HE1225)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

Display Instructions: Roster 2 – no add/edit/delete.

Roster definition:

This item displays RU-members-roster for selection. Display RU member's first, middle, and last names (FULLNAME).

Roster filter:

None. Display all RU members.

BOX_30 (HE1225)

HE250A (HE1230)

BLAISE NAME: DfcltMmry

Context Header: {STR-DT}

{END-DT}

Question Text:

Do any of the adults in this household...

a. Experience confusion or memory loss such that it interferes with daily activities?

Responses: YES 1 HE250B (HE1235)

NO 2 HE250B (HE1235)

REFUSED RF HE250B (HE1235)

DON'T KNOW DK HE250B (HE1235)

Display Instructions:

HE250B (HE1235)

BLAISE NAME: DfcltDecision

Question Text:

[Do any of the adults in this household...]

b. Have problems making decisions to the point that it interferes with daily activities?

Responses: YES 1 HE250C (HE1240)

NO 2 HE250C (HE1240)

REFUSED RF HE250C (HE1240)

DON'T KNOW DK HE250C (HE1240)

Display Instructions:

HE250C (HE1240)

BLAISE NAME: DfcltSup

Question Text:

[Do any of the adults in this household...]

c. Require supervision for their own safety?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If HE250A, HE250B, or HE250C is coded '1' (YES) and a single-person RU, automatically code as 'EXPERIENCES CONFUSION' at HE260 by CAPI and go to BOX_40.

If HE250A, HE250B, and HE250C are all coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), go to BOX_40.

Otherwise, continue with HE260.

Display Instructions:

HE260 (HE1245)

BLAISE NAME: DfcltMDSRoster

Context Header: {STR-DT}

{END-DT}

Question Text:

Who is that?

PROBE: Does anyone else {experience confusion or memory loss such that it interferes with daily activities} {{or } have problems making decisions to the point that it interferes with daily activities} {{or } require supervision for their own safety}?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 BOX_40 (HE1495)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster definition:

This item displays RU-members-roster for selection.

Roster filter:

None. Display all RU members..

Display 'experience confusion or memory loss such that it interferes with daily activities' if HE250A coded '1' (YES).

Display '{or} have problems making decisions to the point that it interferes with daily activities' if HE250B coded '1' (YES). Display the 'or' only if HE250A is also coded ‘1’ (YES).

Display '{or} require supervision for their own safety' if HE250C is coded '1' (YES). Display 'or' only if HE250A and/or HE250B are also coded ‘1’ (YES).

HE270 (HE1250)

BLAISE NAME: DfcltHear

Question Text:

With this next set of questions we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities.

{Please answer the next few questions for family members age 1 or older.}

Is anyone in this household deaf or does anyone have serious difficulty hearing?

Responses: YES 1

NO 2 HE290 (HE1280)

REFUSED RF HE290 (HE1280)

DON'T KNOW DK HE290 (HE1280)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person at HE280 by CAPI and go to HE290.

If coded '1' (YES) and a multi-person RU, continue with HE280.

Display Instructions:Display the sentence ‘Please answer...age 1 or older.’ if any RU members are < 1 year of age or in age category 1. Otherwise, use a null display.

HE280 (HE1255)

BLAISE NAME: DfcltHearRoster

Question Text:

Who is that?

PROBE: Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 HE290 (HE1280)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 HE290 (HE1280)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 HE290 (HE1280)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 HE290 (HE1280)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 HE290 (HE1280)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster definition:

This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection

Roster filter:

Display only RU members who meet the following conditions:

person is > or = 1 year of age or in age categories 2-9

HE290 (HE1280)

BLAISE NAME: DfcltSee

Question Text:

Is anyone in this household blind or does anyone have serious difficulty seeing, even when wearing glasses?

Responses: YES 1

NO 2 HE310 (HE1310)

REFUSED RF HE310 (HE1310)

DON'T KNOW DK HE310 (HE1310)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person at HE300 by CAPI and go to HE310.

If coded '1' (YES) and a multi-person RU, continue with HE300.

Display Instructions:

HE300 (HE1285)

BLAISE NAME: DfcltSeeRoster

Question Text:

Who is that?

PROBE : Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 HE310 (HE1310)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 HE310 (HE1310)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 HE310 HE1310)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 HE310 (HE1310)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 HE310 (HE1310)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster definition:

This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection.

Roster filter:

Display only RU members who meet the following conditions:

person is > or = 1 year of age or in age categories 2-9

HE310 (HE1310)

BLAISE NAME: DfcltMind

Question Text:

{Please answer the next few questions for family members age 5 or older.}

Because of a physical, mental, or emotional condition, does anyone in this household have serious difficulty concentrating, remembering, or making decisions?

Responses: YES 1

NO 2 HE330 (HE1320)

REFUSED RF HE330 (HE1320)

DON'T KNOW DK HE330 (HE1320)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person at HE320 by CAPI and go to HE330.

If coded '1' (YES) and a multi-person RU, continue with HE320.

Display Instructions: Display the sentence ‘Please answer … age 5 or older.’ if any RU members are < 5 years of age or in age categories 1 or 2. Otherwise, use a null display.

HE320 (HE1315)

BLAISE NAME: DfcltMindRoster

Question Text:

Who is that?

PROBE : Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 HE330 (HE1320)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 HE330 (HE1320)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 HE330 (HE1320)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 HE330 (HE1320)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 HE330 (HE1320)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster definition:

This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection.

Roster filter:

Display only RU members who meet the following conditions:

person is > or = 5 years of age or in age categories 3-9

HE330 (HE1320)

BLAISE NAME: DfcltWalk

Question Text:

Does anyone in this household have serious difficulty walking or climbing stairs?

Responses: YES 1

NO 2 HE350 (HE1330)

REFUSED RF HE350 (HE1330)

DON'T KNOW DK HE350 (HE1330)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person at HE340 by CAPI and go to HE350.

If coded '1' (YES) and a multi-person RU, continue with HE340.

Display Instructions:

HE340 (HE1325)

BLAISE NAME: DfcltWalkRoster

Question Text:

Who is that?

PROBE: Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 HE350 (HE1330)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 HE350 (HE1330)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 HE350 (HE1330)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 (HE350 HE1330)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 HE350 (HE1330)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster definition:

This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection.

Roster filter:

Display only RU members who meet the following conditions:

person is > or = 5 years of age or in age categories 3-9

HE350 (HE1330)

BLAISE NAME: DfcltDress

Question Text:

Does anyone in this household have difficulty dressing or bathing?

Responses: YES 1

NO 2 HE370 (HE1345)

REFUSED RF HE370 (HE1345)

DON'T KNOW DK HE370 (HE1345)

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person at HE360 by CAPI and go to HE370.

If coded '1' (YES) and a multi-person RU, continue with HE360.

Display Instructions:

HE360 (HE1335)

BLAISE NAME: DfcltDressRoster

Question Text:

Who is that?

PROBE : Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 HE370 (HE1345)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 HE370 (HE1345)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 HE370 (HE1345)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 HE370 (HE1345)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 HE370 (HE1345)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster definition:

This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection.

Roster filter:

Display only RU members who meet the following conditions:

person is > or = 5 years of age or in age categories 3-9

HE370 (HE1345)

BLAISE NAME: DfcltErrand

Question Text:

{Please answer the next few questions for family members age 15 or older.}

Because of a physical, mental, or emotional condition, does anyone in this household have difficulty doing errands alone such as visiting a doctor's office or shopping?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If coded '1' (YES) and a single-person RU, automatically code person at HE380 by CAPI and go to BOX_40.

If coded '1' (YES) and a multi-person RU, continue with HE380.

Display Instructions:Display the sentence ‘Please answer...age 15 or older.’ if any RU members are < 15 years of age or in age categories 1 - 3. Otherwise, use a null display.

HE380 (HE1350)

BLAISE NAME: DfcltErrandRoster

Question Text:

Who is that?

PROBE : Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 BOX_40 (HE1495)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 BOX_40 (HE1495)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

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

Roster definition:

This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection.

Roster filter:

Display only RU members who meet the following conditions:

person is > or = 15 years of age or in age categories 4-9

BOX_40 (HE1495)

Return to Top