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BOX_00A
THE AP SECTION IS ASKED IN ROUNDS 3 AND 5 ONLY.
IF IT IS ROUND 1, 2, OR 4, CONTINUE TO THE NEXT
SECTION.
BOX_00
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME.
BOX_01
IF PERSON IS LESS THAN 1 YEAR OF AGE (OR AGE
CATEGORY 1), GO TO BOX_02
OTHERWISE, CONTINUE WITH AP12
AP12
{PERSON'S FIRST MIDDLE AND LAST NAME}
The next few questions ask about the amounts and types of preventive
care {you/{PERSON}} may receive.
On average, how often {do/does} {you/he/she} 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.
IF PERSON BEING ASKED ABOUT IS 18 YEARS OF AGE OR
OLDER (OR IN AGE CATEGORIES 4-9), CONTINUE WITH
AP15
IF PERSON BEING ASKED ABOUT IS 16 OR 17 YEARS OF
AGE, GO TO AP32
OTHERWISE (THAT IS, PERSON BEING ASKED ABOUT IS
LESS THAN 16 YEARS OF AGE OR IN AGE CATEGORIES
1-3), GO TO BOX_02
AP15
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since {you/{PERSON}} had
{your/his/her}
blood pressure checked by a doctor, nurse or other
health professional?
WITHIN PAST YEAR ....................... 1 {AP16}
WITHIN PAST 2 YEARS .................... 2 {AP16}
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]
AP16
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since {you/{PERSON}} had
{your/his/her}
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 {you/{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
{you/{PERSON}} to...
YES NO
AP17A_01
...Eat fewer high fat or high
cholesterol foods? 1 2 ( ) AP17A_02
REFUSED (-7) AND DON’T KNOW (-8) ALLOWED.
AP17A_02
...Exercise more? 1 2 ( ) {AP18}
REFUSED (-7) AND DON’T KNOW (-8) ALLOWED.
AP18
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how long has it been since {you/{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} {you/{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} {you/{PERSON}} have a health problem or
condition that makes
taking aspirin unsafe for {you/him/her}?
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} {you/{PERSON}} lost all of
{your/his/her} upper and lower
natural (permanent) teeth?
YES .................................... 1
{BOX_01A}
NO ..................................... 2
{BOX_01A}
REF ................................... -7
{BOX_01A}
DK .................................... -8
{BOX_01A}
BOX_01A
IF PERSON BEING ASKED ABOUT IS MALE AND IS 40
YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 6-9),
CONTINUE WITH AP19
IF PERSON BEING ASKED ABOUT IS MALE AND IS LESS
THAN 40 YEARS OF AGE (OR IN AGE CATEGORIES 4-5),
GO TO AP28
OTHERWISE (I.E., PERSON BEING ASKED ABOUT IS
FEMALE), GO TO AP20A
AP19
{PERSON'S FIRST MIDDLE AND LAST NAME}
When did {you/{PERSON}} have {your/his} 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} {you/{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 {you/{PERSON}} have {your/her} 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 {you/{PERSON}} have {your/her} 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]
IF PERSON BEING ASKED ABOUT IS 30 YEARS OF AGE OR
OLDER (OR IN AGE CATEGORIES 5-9), CONTINUE WITH
AP22
OTHERWISE, GO TO AP28
AP22
{PERSON'S FIRST MIDDLE AND LAST NAME}
When did {you/{PERSON}} have {your/her} 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]
IF PERSON BEING ASKED ABOUT IS 40 YEARS OF AGE OR
OLDER (OR IN AGE CATEGORIES 6-9), CONTINUE WITH
AP24
OTHERWISE, GO TO AP28
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 {you/{PERSON}} do {your/his/her} 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 {you/{PERSON}} had
{your/his/her} 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]
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 {you/{PERSON}} have {your/his/her} 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 {you/{PERSON}} had
{your/his/her} 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 {you/{PERSON}} have {your/his/her} 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 {you/{PERSON}} did
{your/his/her} 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} {you/{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} {you/{PERSON}} without shoes?
PROBE FOR INCHES IF NOT REPORTED.
AP29_01
FEET:
[Enter Feet] ........................... {AP29_02}
REF ................................... -7 {AP30}
DK .................................... -8 {AP30}
SOFT CHECK:
SOFT RANGE CHECK: 2 TO 6
AP29_02
INCHES:
[Enter Inches] ......................... {AP30}
REF ................................... –7 {AP30}
DK .................................... –8 {AP30}
HARD CHECK:
HARD RANGE CHECK: 0 TO 11
AP30
{PERSON'S FIRST MIDDLE AND LAST NAME}
About how much {do/does} {you/{PERSON}} weigh without
shoes?
ENTER CURRENT WEIGHT TO THE NEAREST POUND.
[Enter Pounds] ......................... {AP32}
REF ................................... -7 {AP32}
DK .................................... -8 {AP31}
SOFT CHECK:
SOFT RANGE CHECK: 50 TO 500
HARD CHECK:
HARD RANGE CHECK: 30 TO 999
AP31
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AP-1.
Looking at this card, what is your best guess of
{your/{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]
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’.
BOX_02
GO TO NEXT QUESTIONNAIRE SECTION.
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