Priority Condition Enumeration (PE) Section

Fall 2019

BOX_00 (PE1003)

BOX_05 (PE1004)

Programmer Instructions: In PE, CAPI will allow the interviewer to press CTRL-S to select a different RU member and complete the section (including not starting with the respondent/reference person) at any point during the section. CAPI should return to the first unanswered question when returning to an RU member’s section that has already been started but not completed.

PEIntroduction (PE1005)

BLAISE NAME: PEIntroduction

Question Text:

PRIORITY CONDITION ENUMERATION (PE) SECTION – ASKED FOR EACH RU MEMBER.

CTRL-S: SWITCH TO PE QUESTIONS FOR A DIFFERENT RU MEMBER.

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_10 (PE1006)

Programmer Instructions: This item is presented only for the first person that goes through the PE section. Skip PEIntroduction for all other RU members.

Display Instructions:

BOX_10 (PE1006)

LOOP_10 (PE1010)

PE10 (PE1015)

BLAISE NAME: PersGnrlHlth

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

{END-DT}

Question Text:

Please think about {your/{PERSON}'s} health between {START DATE} and {END DATE}.

In general, compared to other people of {your/his/her} age, would you say that {your/his/her} health is excellent, very good, good, fair, or poor?

Responses: EXCELLENT 1 PE20 (PE1020)

VERY GOOD 2 PE20 (PE1020)

GOOD 3 PE20 (PE1020)

FAIR 4 PE20 (PE1020)

POOR 5 PE20 (PE1020)

REFUSED RF PE20 (PE1020)

DON'T KNOW DK PE20 (PE1020)

Display Instructions:

PE20 (PE1020)

BLAISE NAME: PersMntlHlth

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

{END-DT}

Question Text:

In general, would you say that {your/{PERSON}'s} mental health is excellent, very good, good, fair, or poor?

Responses: EXCELLENT 1 BOX 20 (PE1025)

VERY GOOD 2 BOX 20 (PE1025)

GOOD 3 BOX 20 (PE1025)

FAIR 4 BOX 20 (PE1025)

POOR 5 BOX 20 (PE1025)

REFUSED RF BOX 20 (PE1025)

DON'T KNOW DK BOX 20 (PE1025)

Display Instructions:

BOX_20 (PE1025)

PE30A (PE1030)

BLAISE NAME: DxHypertension

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

a. hypertension, also called high blood pressure{, other than during pregnancy}?

HELP: F1

Responses: YES 1 PE30B (PE1035)

NO 2 PE30B (PE1035)

REFUSED RF PE30B (PE1035)

DON'T KNOW DK PE30B (PE1035)

Programmer Instructions: If coded ‘1’ (YES), add ‘HYPERTENSION-HI BLOOD PRESSURE’ to person’s-medical-conditions-roster.

Display Instructions: Display ‘,other than during pregnancy’ if person being asked about is female and is 15 years of age or older or in categories 4-9. Otherwise, use a null display.

PE30B (PE1035)

BLAISE NAME: DxCHD

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

b. coronary heart disease?

Responses: YES 1 PE30C (PE1040)

NO 2 PE30C (PE1040)

REFUSED RF PE30C (PE1040)

DON'T KNOW DK PE30C (PE1040)

Programmer Instructions: If coded ‘1’ (YES), add ‘CORONARY HEART DISEASE’ to person’s-medical-conditions-roster.

Display Instructions:

PE30C (PE1040)

BLAISE NAME: DxAngina

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

c. angina, also called angina pectoris?

Responses: YES 1 PE30D (PE1045)

NO 2 PE30D (PE1045)

REFUSED RF PE30D (PE1045)

DON'T KNOW DK PE30D (PE1045)

Programmer Instructions: If coded ‘1’ (YES), add ‘ANGINA’ to person’s-medical-conditions-roster.

Display Instructions:

PE30D (PE1045)

BLAISE NAME: DxHeartAttack

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

d. a heart attack, also called myocardial infarction or MI?

Responses: YES 1 PE30E (PE1050)

NO 2 PE30E (PE1050)

REFUSED RF PE30E (PE1050)

DON'T KNOW DK PE30E (PE1050)

Programmer Instructions: If coded ‘1’ (YES), add ‘HEART ATTACK-MYOCARDIAL INFARC’ to person’s-medical-conditions-roster.

Display Instructions:

PE30E (PE1050)

BLAISE NAME: DxOthHeartCond

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

e. any other kind of heart condition or heart disease, other than coronary heart disease, angina, or heart attack?

HELP: F1

Responses: YES 1 PE30F (PE1055)

NO 2 PE30F (PE1055)

REFUSED RF PE30F (PE1055)

DON'T KNOW DK PE30F (PE1055)

Programmer Instructions: Note that condition record for OTHER HEART CONDITION is not created here, but at PE90.

Display Instructions:

PE30F (PE1055)

BLAISE NAME: DxStroke

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

f. a stroke, ministroke, or TIA? A TIA is short for Transient Ischemic Attack.

HELP:F1

Responses: YES 1 PE30G (PE1060)

NO 2 PE30G (PE1060)

REFUSED RF PE30G (PE1060)

DON'T KNOW DK PE30G (PE1060)

Programmer Instructions: If coded ‘1’ (YES), add ‘STROKE-TIA’ to person’s-medical-conditions-roster.

Display Instructions:

PE30G (PE1060)

BLAISE NAME: DxEmphysema

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

g. emphysema?

HELP: F1

Responses: YES 1 PE30H (PE1065)

NO 2 PE30H (PE1065)

REFUSED RF PE30H (PE1065)

DON'T KNOW DK PE30H (PE1065)

Programmer Instructions: If coded ‘1’ (YES), add ‘EMPHYSEMA’ to person’s-medical-conditions-roster.

Display Instructions:

PE30H (PE1065)

BLAISE NAME: DxHghCholest

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

h. high cholesterol?

Responses: YES 1 PE30I (PE1070)

NO 2 PE30I (PE1070)

REFUSED RF PE30I (PE1070)

DON'T KNOW DK PE30I (PE1070)

Programmer Instructions: If coded ‘1’ (YES), add ‘HIGH CHOLESTEROL’ to person’s-medical-conditions-roster.

Display Instructions:

PE30I (PE1070)

BLAISE NAME: DxCancer

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

i. cancer or a malignancy of any kind?

Responses: YES 1 PE30J (PE1075)

NO 2 PE30J (PE1075)

REFUSED RF PE30J (PE1075)

DON'T KNOW DK PE30J (PE1075)

Programmer Instructions: Note that condition record for CANCER is not created here but at PE140 and/or PE140OS.

Display Instructions:

PE30J (PE1075)

BLAISE NAME: DxArthritis

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

j. arthritis?

Responses: YES 1 PE30K (PE1080)

NO 2 PE30K (PE1080)

REFUSED RF PE30K (PE1080)

DON'T KNOW DK PE30K (PE1080)

Programmer Instructions: Note that condition record for arthritis is not created here but at PE170.

Display Instructions:

PE30K (PE1080)

BLAISE NAME: DxDiabetes

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

k. diabetes or sugar diabetes {, other than during pregnancy}?

HELP: F1

Responses: YES 1 PE30L (PE1085)

NO 2 PE30L (PE1085)

REFUSED RF PE30L (PE1085)

DON'T KNOW DK PE30L (PE1085)

Programmer Instructions: If coded ‘1’ (YES) add ‘DIABETES’ to person’s-medical-conditions-roster.

Display Instructions: Display ‘other than during pregnancy’ if person being asked about is female and is age 15 or older or in age categories 4-9. Otherwise use a null display.

PE30L (PE1085)

BLAISE NAME: DxAsthma

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

l. asthma ?

HELP: F1

Responses: YES 1 PE30M (PE1090)

NO 2 PE30M (PE1090)

REFUSED RF PE30M (PE1090)

DON'T KNOW DK PE30M (PE1090)

Programmer Instructions: If coded ‘1’ (YES) add 'ASTHMA' to person’s-medical-conditions-roster.

Display Instructions:

PE30M (PE1090)

BLAISE NAME: DxADHDADD

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

Question Text:

{Now I’m going to ask you about certain medical conditions {you/{PERSON}} may have had. For these questions, please think about {your/his/her} health over {your/his/her} lifetime.} [{Have/Has} {you/{PERSON}} ever been told by a doctor or other health professional that {you/he/she} had…]

m. Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)?

Responses: YES 1 BOX_30 (PE1095)

NO 2 BOX_30 (PE1095)

REFUSED RF BOX_30 (PE1095)

DON'T KNOW DK BOX_30 (PE1095)

Programmer Instructions: If coded ‘1’ (YES), add the priority condition ‘ATTEN DEFICIT/HYPERACTIVITY’ to person’s-medical-conditions-roster.

Display Instructions:

BOX_30 (PE1095)

PE40 (PE1100)

BLAISE NAME: AgeDxHypertension

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the hypertension, also called high blood pressure, was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1 PE50 (PE1105)

REFUSED RF PE50 (PE1105)

DON'T KNOW DK PE50 (PE1105)

Programmer Instructions: Hard range check: 0 to person’s current age.

Display Instructions:

PE50 (PE1105)

BLAISE NAME: HghBld2x

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

Question Text:

{Were/Was} {you/{PERSON}} told on two or more different visits that {you/he/she} had hypertension, also called high blood pressure?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Display Instructions:

PE60 (PE1110)

BLAISE NAME: AgeDxCHD

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the coronary heart disease was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Hard range check: 0 to person’s current age.

Display Instructions:

PE70 (PE1115)

BLAISE NAME: AgeDxAngina

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the angina, also called angina pectoris, was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Hard range check: 0 to person’s current age.

Display Instructions:

PE80 (PE1120)

BLAISE NAME: AgeDxHeartAttack

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the heart attack, also called myocardial infarction or MI, was first diagnosed?

IF MORE THAN ONE HEART ATTACK, PROBE FOR AGE WHEN FIRST HEART ATTACK DIAGNOSED.

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Hard range check: 0 to person’s current age.

Display Instructions:

PE90 (PE1125)

BLAISE NAME: OthHeartCond

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with the other kind of heart condition or heart disease, other than coronary heart disease, angina, or heart attack./Now let’s talk about {your/{PERSON}’s} other kind of heart condition or heart disease, other than coronary heart disease, angina, or heart attack.} What did the doctor or other health professional call it?

Responses: HEART MURMUR 1 PE100 (PE1135)

HEART ARRHYTHMIA/IRREGULAR HEARTBEAT 2 PE100 (PE1135)

BLOCKED OR CLOGGED ARTERY 3 PE100 (PE1135)

CONGESTIVE HEART FAILURE 4 PE100 (PE1135)

ATRIAL FIBRILLATION 5 PE100 (PE1135)

MITRAL VALVE PROLAPSE 6 PE100 (PE1135)

ENLARGED HEART 7 PE100 (PE1135)

HEART VALVE PROBLEMS (E.G., LEAKY, BLOCKED, COLLAPSED) 8 PE100 (PE1135)

TACHYCARDIA/RAPID HEART RATE 9 PE100 (PE1135)

BRADYCARDIA/SLOW HEART RATE 10 PE100 (PE1135)

OTHER (SPECIFY) 91 PE90OS (PE1130)

REFUSED RF PE100 (PE1135)

DON'T KNOW DK PE100 (PE1135)

Programmer Instructions: If coded ‘1’ at PE90, add ‘HEART MURMUR’ to person’s-medical-conditions-roster.

If coded ‘2’ at PE90, add ‘ARRHYTHMIA/IRREGULAR HEARTBEAT’ to person’s-medical-conditions-roster.

If coded ‘3’ at PE90, add ‘BLOCKED OR CLOGGED ARTERY’ to person’s-medical-conditions-roster.

If coded ‘4’ at PE90, add ‘CONGESTIVE HEART FAILURE’ to person’s-medical-conditions-roster.

If coded ‘5’ at PE90, add ‘ATRIAL FIBRILLATION’ to person’s-medical-conditions-roster.

If coded ‘6’ at PE90, add ‘MITRAL VALVE PROLAPSE’ to person’s-medical-conditions-roster.

If coded ‘7’ at PE90, add ‘ENLARGED HEART’ to person’s-medical-conditions-roster.

If coded ‘8’ at PE90, add ‘HEART VALVE PROBLEMS’ to person’s-medical-conditions-roster.

If coded ‘9’ at PE90, add ‘TACHYCARDIA/RAPID HEART RATE’ to person’s-medical-conditions-roster.

If coded '10' at PE90, add ‘BRADYCARDIA/SLOW HEART RATE’ to person’s-medical-conditions-roster.

If coded ‘RF’ at PE90, add ‘OTH HRT COND-REFUSED’ to person’s-medical- conditions-roster.

If coded ‘DK’ at PE90, add ‘OTH HRT COND-DON’T KNOW’ to person’s-medical-conditions-roster.

Display Instructions: Display “I have a few more… with the other kind of heart condition or heart disease, other than coronary heart disease, angina, or heart attack.” if first condition being followed-up on in the current round.

Otherwise, display “Now let’s talk … the other kind of heart condition or heart disease, other than coronary heart disease, angina, or heart attack.

PE90OS (PE1130)

BLAISE NAME: DxHeartCondOS

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

Question Text:

[What did the doctor or other health professional call it?]

Responses: 1 PE100 (PE1135)

REFUSED RF PE100 (PE1135)

DON'T KNOW DK PE100 (PE1135)

Programmer Instructions: If coded ‘91’ at PE90, add the priority condition ‘OTH HRT COND-{SPECIFY TEXT....}’ to person’s-medical-conditions-roster. Use first 17 characters of the other specify text entered at PE90OS as part of the condition name. Use "DON'T KNOW" and "REFUSED"

for "SPECIFY TEXT...." when coded "DK" or "RF" at PE90OS.

Display Instructions:

PE100 (PE1135)

BLAISE NAME: AgeDxOthHeartCond

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

Question Text:

How old {were/was} {you/{PERSON}} when the {CONDITION} was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Hard range check: 0 to person’s current age.

Refer to BOX_30 for routing instructions.

Display Instructions: For ‘CONDITION’ display the condition roster text entered at PE90 or PE90OS.

PE110 (PE1140)

BLAISE NAME: AgeDxStroke

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the stroke, ministroke, or TIA was first diagnosed?

IF MORE THAN ONE STROKE, PROBE FOR AGE WHEN FIRST STROKE DIAGNOSED.

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Hard range check: 0 to person’s current age.

Display Instructions:

PE120 (PE1145)

BLAISE NAME: AgeDxEmphysema

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the emphysema was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Hard range check: 0 to person’s current age.

Display Instructions:

PE130 (PE1150)

BLAISE NAME: AgeDxHghCholest

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the high cholesterol was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Hard range check: 0 to person’s current age.

Display Instructions:

PE140 (PE1155)

BLAISE NAME: CodeAllCancer

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

Question Text:

&PE-1.

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with cancer./Now let’s talk about {your/PERSON}’s} cancer.} Looking at show card PE-1, what kind of cancer was it?

ENTER ALL THAT APPLY.

Responses: BLADDER 1

BLOOD 2

BONE 3

BRAIN 4

BREAST 5

CERVICAL 6

COLON 7

ESOPHAGUS 8

GALLBLADDER 9

KIDNEY/RENAL 10

LARYNX-WINDPIPE 11

LEUKEMIA 12

LIVER 13

LUNG 14

LYMPHOMA (NON-HODGKIN'S) 15

MOUTH/TONGUE/LIP 16

OVARIAN 17

PANCREAS 18

PROSTATE 19

RECTUM 20

SKIN MELANOMA 21

SKIN NON-MELANOMA 22

SKIN (UNKNOWN TYPE) 23

SOFT TISSUE MUSCLE OR FAT 24

STOMACH 25

TESTICULAR 26

THROAT OR PHARYNX 27

THYROID 28

UTERINE 29

OTHER 91

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If ‘OTHER’ (91) selected alone or in combination with any other response, continue with PE140OS.

Otherwise, go to LOOP_20.

For each type of cancer selected at PE140, Add the priority condition ‘Cancer-{Specify Type…}' to person’s-medical-conditions-roster, where ‘Specify Type’ is the name of the cancer type selected. Since the length of the CONDNAM is limited to 30 characters, abbreviate ‘SOFT TISSUE’ option to ‘CANCER-SOFT TISSUE MUSCL/FAT’. Use "DON'T KNOW" and "REFUSED" for ‘Specify Type’ when coded "DK" or "RF" at PE140.For each type of cancer selected, create a condition and condition-by-round record.

Display response options ‘6’ (CERVICAL), ‘17’ (OVARIAN) or ‘29’ (UTERINE), if the person is female. Otherwise, use a null display.

Display response options ‘19’ (PROSTATE) or ‘26’ (TESTICULAR), if the person is

Display Instructions: Display 3 columns for the answer list pane. For males, the columns with each display 9 response options. For females, the first two columns will each display 10 response options and the third column will display 8 options. The space between the columns should be minimized to prevent horizontal scrolling. The current UI spec says to display the categories in 13px, but the point size can be reduced (no lower than 9 px) to enable the choices to fit within the answer list pane in 3 columns without horizontal scrolling.

PE140OS (PE1160)

BLAISE NAME: CancerOS

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

Question Text:

SPECIFY: OTHER TYPE OF CANCER:

Responses: 1 LOOP_20 (PE1165)

REFUSED RF LOOP_20 (PE1165)

DON'T KNOW DK LOOP_20 (PE1165)

Programmer Instructions: Add the priority condition ‘Cancer - {other specify}’ to person’s-medical-conditions-roster and set associated PE flags.

Use first 23 characters of the other specify text entered at PE140OS as part of the condition name. Use "DON'T KNOW" and "REFUSED" for "SPECIFY TEXT...." when coded "DK" or "RF" at PE140OS.

Display Instructions:

LOOP_20 (PE1165)

PE150 (PE1170)

BLAISE NAME: AgeDxCancer

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

Question Text:

How old {were/was} {you/{PERSON}} when the {CONDITION} was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1 PE160 (PE1175)

REFUSED RF PE160 (PE1175)

DON'T KNOW DK PE160 (PE1175)

Programmer Instructions: Hard range check: 0 to person’s current age.

Display Instructions: For {PERSON'S MEDICAL CONDITION} in the header, display the type of cancer enumerated at PE140 or PE140OS that is currently being asked about.

PE160 (PE1175)

BLAISE NAME: Remission

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

Question Text:

Is {your/{PERSON}'s} {CONDITION} in remission, that is, the {CONDITION} is under control?

HELP: F1

Responses: YES 1 END_LP20 (PE1180)

NO 2 END_LP20 (PE1180)

REFUSED RF END_LP20 (PE1180)

DON'T KNOW DK END_LP20 (PE1180)

Display Instructions:

END_LP20 (PE1180)

PE170 (PE1185)

BLAISE NAME: ArthritisTp

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

Question Text:

{I have a few more questions to ask about each of {your/[PERSON}’s} conditions. Let’s start with arthritis./Now let’s talk about {your/{PERSON}’s} arthritis.} What type of arthritis was that?

PROBE: {Were/Was} {you/{PERSON} diagnosed with rheumatoid arthritis or osteoarthritis?

SELECT ‘NOT SPECIFIED’ IF RESPONDENT DOES NOT KNOW THE TYPE OF ARTHRITIS.

HELP: F1

Responses: RHEUMATOID ARTHRITIS 1 PE180 (PE1190)

OSTEOARTHRITIS 2 PE180 (PE1190)

NOT SPECIFIED 3 PE180 (PE1190)

REFUSED RF PE180 (PE1190)

Programmer Instructions: If coded ‘1’ (RHEUMATOID ARTHRITIS), add the priority condition ‘RHEUMATOID ARTHRITIS’ to person’s-medical-conditions-roster.

If coded ‘2’ (OSTEOARTHRITIS), add the priority condition ‘OSTEOARTHRITIS’ to person’s-medical-conditions-roster.

If coded ‘3’ (NOT SPECIFIED) or ‘RF’ (REFUSED), add the priority condition ‘ARTHRITIS (NOT SPECIFIED)’ to person’s-medical- conditions-roster.

Code ‘DK’ (DON'T KNOW) disallowed.

Display Instructions: Display “I have a few more… with arthritis.” if first condition being followed-up on in the current round.

Otherwise, display “Now let’s talk … arthritis.

PE180 (PE1190)

BLAISE NAME: AgeDxArthritis

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

Question Text:

How old {were/was} {you/{PERSON}} when the {rheumatoid arthritis/osteoarthritis/arthritis} was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Hard range check: 0 to person’s current age.

Refer to BOX_30 for routing instructions.

Display Instructions: Display ‘rheumatoid arthritis’ if PE170 is coded ‘1’ (RHEUMATOID ARTHRITIS). Display ‘osteoarthritis’ if PE170 is coded ‘2’ (OSTEOARTHRITIS). Display ‘arthritis’ if PE170 is coded ‘3’

(NOT SPECIFIED) or ‘RF’ (REFUSED).

PE190 (PE1195)

BLAISE NAME: AgeDxDiabetes

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the diabetes or sugar diabetes was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Hard range check: 0 to person’s current age.

Refer to BOX_30 for routing instructions.

Display Instructions:

BOX_40 (PE1200)

PE200 (PE1205)

BLAISE NAME: AgeDxAsthma

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} How old {were/was} {you/{PERSON}} when the asthma was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Hard range check: 0 to person’s current age.

If Round 1 or 3, continue with PE210.

Otherwise (i.e., if Round 2 or 4), refer to Box_30 for routing instructions.

Display Instructions:

PE210 (PE1210)

BLAISE NAME: AsthmaStill

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.} {During an earlier interview, it was mentioned that {you/{PERSON}} {have/has} asthma.} {Do/Does} {you/{PERSON}} still have asthma?

HELP: F1

Responses: YES 1 PE220 (PE1215)

NO 2 PE220 (PE1215)

REFUSED RF PE220 (PE1215)

DON'T KNOW DK PE220 (PE1215)

Display Instructions: Display either “{I have a few more questions to ask about each…/Now let’s talk about…}” only when PE200 has not been asked.

Display ‘During an earlier interview, it…’ if asthma was added during a previous round (preload.xxx).

Otherwise (asthma added for person in current round), use a null display.

PE220 (PE1215)

BLAISE NAME: AsthmaAttack

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

Question Text:

During the past 12 months, {have/has} {you/{PERSON}} had an episode of asthma or an asthma attack?

HELP: F1

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If PE220 is coded ‘2’ (NO) and if asthma created this round (PE30L coded ‘1’ (YES) this round), continue with PE230.

If PE220 is coded ‘2’ (NO) and if asthma created in any prior round (preload.xxx) and PE230 (AsthmaLAttack)=EMPTY in a prior round (preload.xxx), continue with PE230.

Otherwise, go to PE240

Display Instructions:

PE230 (PE1220)

BLAISE NAME: AsthmaLAttack

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

Question Text:

When did {you/{PERSON}} last have an episode of asthma or an asthma attack?

HELP: F1

Responses: WITHIN PAST 2 YEARS 1 PE240 (PE1221)

WITHIN PAST 3 YEARS 2 PE240 (PE1221)

WITHIN PAST 5 YEARS 3 PE240 (PE1221)

MORE THAN 5 YEARS 4 PE240 (PE1221)

NEVER 5 PE240 (PE1221)

REFUSED RF PE240 (PE1221)

DON'T KNOW DK PE240 (PE1221)

Display Instructions:

PE240 (PE1221)

BLAISE NAME: LungPM

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

Question Text:

{Even though {you/{PERSON}} {{don’t/doesn’t} currently have asthma}/{haven’t/hasn’t} had an asthma attack in the past year}, we have a few questions about {your/his/her} use of asthma medications in the past.} There are two different kinds of asthma medicine. One is for quick relief. The other does not give quick relief but protects {your/his/her} lungs and prevents symptoms over the long term.

{Have/Has} {you/{PERSON}} ever taken the preventive kind of asthma medicine used every day to protect {your/his/her} lungs and keep {you/him/her} from having attacks? Include both oral medicine and inhalers. This is different from inhalers used for quick relief.

Responses: YES 1 PE250 (PE1222)

NO 2 PE260 (PE1223)

REFUSED RF PE260 (PE1223)

DON'T KNOW DK PE260 (PE1223)

Display Instructions: If [PE210 is coded ‘2’ (NO) and PE220 is coded '1' (YES)] or PE220 is coded '2' (NO), 'RF' (REFUSED) or 'DK' (DON'T KNOW), display "Even though ... use of asthma medications in the past."

Otherwise, use a null display.

If PE210 is coded ‘2’ (NO) and PE220 is coded '1' (YES) , display “{don’t/doesn’t} currently have asthma". Otherwise (i.e., PE220 is coded '2' (NO), 'RF' (REFUSED) or 'DK' (DON'T KNOW), display "{haven’t/hasn’t} had an asthma attack in the past year".

PE250 (PE1222)

BLAISE NAME: TakePMDaily

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

Question Text:

{Are/Is} {you/{PERSON}} now taking this medication (that protects the lungs) daily or almost daily?

Responses: YES 1 PE260 (PE1223)

NO 2 PE260 (PE1223)

REFUSED RF PE260 (PE1223)

DON'T KNOW DK PE260 (PE1223)

Display Instructions:

PE260 (PE1223)

BLAISE NAME: Inhaler

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

Question Text:

During the past 3 months, {have/has} {you/{PERSON}} used the kind of prescription inhaler that you breathe in through your mouth that gives quick relief from asthma symptoms?

Responses: YES 1 PE270 (PE1224)

NO 2 PE280 (PE1225)

REFUSED RF PE280 (PE1225)

DON'T KNOW DK PE280 (PE1225)

Display Instructions:

PE270 (PE1224)

BLAISE NAME: InhalerGT3Can

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

Question Text:

During the past 3 months, did {you/{PERSON}} use more than three canisters of this type of inhaler?

Responses: YES 1 PE280 (PE1225)

NO 2 PE280 (PE1225)

REFUSED RF PE280 (PE1225)

DON'T KNOW DK PE280 (PE1225)

Display Instructions:

PE280 (PE1225)

BLAISE NAME: PeakFlow

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

Question Text:

A peak flow meter measures how hard you can blow air out of your lungs. {Do/Does} {you/{PERSON}} currently have a peak flow meter at home?

Responses: YES 1 PE290 (PE1226)

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), refer to BOX_30 for routing

Display Instructions:

PE290 (PE1226)

BLAISE NAME: HaveFlowMeter

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

Question Text:

Did {you/{PERSON}} ever use the peak flow meter?

Responses: YES 1 PE300 (PE1227)

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), refer to BOX_30 for routing instructions.

Display Instructions:

PE300 (PE1227)

BLAISE NAME: LUseFlowMeter

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

Question Text:

&PE-2.

Looking at show card PE-2, when did {you/{PERSON}} last use the peak flow meter? Was it within the last seven days, more than seven days ago but within the last thirty days, or more than thirty days ago?

Responses: WITHIN LAST 7 DAYS 1

MORE THAN 7, BUT WITHIN LAST 30 DAYS 2

MORE THAN 30 DAYS AGO 3

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Refer to BOX_30 for routing instructions.

Display Instructions:

PE310 (PE1228)

BLAISE NAME: AgeDxADHDADD

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

Question Text:

{I have a few more questions to ask about each of {your/{PERSON}’s} conditions. Let’s start with {CONDITION}./Now let’s talk about {your/{PERSON}’s} {CONDITION}.}How old {were/was} {you/{PERSON}} when the Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD) was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1 BOX_50 (PE1230)

REFUSED RF BOX_50 (PE1230)

DON'T KNOW DK BOX_50 (PE1230)

Programmer Instructions: Hard range check: 0 to person’s current age.

Display Instructions:

BOX_50 (PE1230)

BOX_60 (PE1296)

PE320 (PE1298)

BLAISE NAME: DxJointPain

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

Question Text:

For these next two questions, please think about the last 12 months, that is between {MONTH YEAR-1} and today.

{Have/Has} {you/{PERSON}} had pain, aching, stiffness or swelling around a joint in the past 12 months?

Responses: YES 1 PE330 (PE1299)

NO 2 PE330 (PE1299)

REFUSED RF PE330 (PE1299)

DON'T KNOW DK PE330 (PE1299)

Programmer Instructions: If PE320 is coded '1' (yes) and one of the following is true:

- Round 1

- Round 3 and the priority condition ‘JOINT PAIN’ is not on person’s-medical- conditions-roster

Add the priority condition ‘JOINT PAIN’ to the person's-medical-conditions-roster.

If PE320 is coded '1' (yes) in Round 3 and the priority condition ‘JOINT PAIN’ reported in a previous round in the PE section (preload.xxx), the priority condition ‘JOINT PAIN’ should be flagged as 'selected' this round (with round status).

Display Instructions: For “MONTH YEAR-1” display the month of the current interview and the current interview year minus 1.

PE330 (PE1299)

BLAISE NAME: DxChronBronch

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

Question Text:

{For this next question, please think about the last 12 months, that is between {MONTH YEAR-1} and today.} {Have/Has} {you/{PERSON}} been told by a doctor or other health professional that {you/he/she} had chronic bronchitis? Do not include isolated instances of acute bronchitis.

HELP: F1

Responses: YES 1

NO 2 END_LP10 (PE1305)

REFUSED RF END_LP10 (PE1305)

DON'T KNOW DK END_LP10 (PE1305)

Programmer Instructions: If coded '1' (yes) and:

- The priority condition 'CHRONIC BRONCHITIS' not reported in a previous round in the PE section (preload.xxx), add the priority condition 'CHRONIC BRONCHITIS' to person's-medical-conditions roster.

If coded '1' (yes) and:

- Round 3 and

- The priority condition 'CHRONIC BRONCHITIS' reported in a previous round in the PE section (preload.xxx), the priority condition 'CHRONIC BRONCHITIS' should be flagged as 'selected' this round (with the round status).

If:

- coded ‘1’ (yes) and

- Round 1 or [not Round 1 and PE340 not asked in a previous round (preload.xxx)]

continue with PE340.

Otherwise, go to END_LP10.

Display Instructions: Display ‘{For the next question, please think about the last 12 months….}’ only if PE320 was not asked, otherwise, use a null display.

For “MONTH YEAR-1” display the month of the current interview and the current interview year minus 1.

PE340 (PE1300)

BLAISE NAME: AgeDxChronBronch

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

Question Text:

How old {were/was} {you/{PERSON}} when the chronic bronchitis was first diagnosed?

IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.

ENTER AGE.

Responses: 1 END_LP10 (PE1305)

REFUSED RF END_LP10 (PE1305)

DON'T KNOW DK END_LP10 (PE1305)

Programmer Instructions: Hard range check: 0 to person’s current age.

Display Instructions:

END_LP10 (PE1305)

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