The Changing Lives of Older Couples Study

Wave III Control Follow-up Survey

CODEBOOK

Facesheet

VAR #

7001 FS. Seq.#/CASE ID

7002 FS. Respondent # -- 1st 4 digits (CLOC ID#)

7003 FS. Respondent # -- last 2 digits, preprinted as 71

[V7004: BUILD 6-digit Respondent ID# (V7002+V7003)]

7005 FS. Result Code

01. Complete I'v

03. Complete Telephone I'v

05. Partial I'v

07. Partial Telephone I'v

7006 FS. Respondent "history": 2 digits

Code 1st 2-digit # precoded on Facesheet

7007 FS. Matched Control ID#--1st 4 digits

7008 FS. Matched Control ID#--last 2 digits, preprinted as 31

[V7009: BUILD 6-digit ID# (V7007+V7008)]

7010 FS. "History" of person to whom R is matched: 2 digits

Code last 2-digit # precoded on Facesheet

7011 FS1. INTERVIEWER's ID# (4 digits from label)

7012 FS2. Interview No.: (2 digits from box)

99. NA

7013 FS3. Date of Interview--MONTH

Code MONTH (01-12)

7014 FS3. Date of Interview--DAY

Code DAY (01-31)

7015 FS3. Date of Interview--YEAR

Code 4-digit YEAR (1992-1995)

7016 FS4. Length of Interview

Code # of MINS (001-240)

SECTION A: HOUSEHOLD LISTING

A1. First, I need to list all the people who live here. I don't need names, just the age, sex and relationship to you for each person. Let's start with you. How old are you?

Now I need the age, sex and relationship to you of any other adults and children who live here.

7101 A1. SUMMARY # Persons in HOUSEHOLD

┌──────────────┐

│0 in 7105-7131├─────01. One ┌──────────────┐

└──────────────┘ │Code # persons│

┌──────────────┐ │listed in grid│

│0 in 7108-7131├─────02. Two │(01-20). │

└──────────────┘ └──────────────┘

┌──────────────┐

│0 in 7111-7131├─────03. Three

└──────────────┘

┌──────────────┐

│0 in 7114-7131├─────04. Four

└──────────────┘

┌──────────────┐

│0 in 7117-7131├─────05. Five

└──────────────┘

┌──────────────┐

│0 in 7120-7131├─────06. Six

└──────────────┘

┌──────────────┐

│0 in 7123-7131├─────07. Seven

└──────────────┘

┌──────────────┐

│0 in 7126-7131├─────08. Eight

└──────────────┘

┌──────────────┐

│0 in 7129-7131├─────09. Nine

└──────────────┘

10. Ten

20. Twenty

99. NA

7102(#1) A1(a). MEMBERS OF THE HOUSEHOLD BY RELATIONSHIP TO RESPONDENT

7105(#2)

7108(#3) Partner/Spouse

7111(#4)

7114(#5) 01. RESPONDENT

7117(#6) 02. Spouse of R

7120(#7) 03. Partner of R

7123(#8)

7126(#9) Child

7129(#10)

10. Child(ren), NA sex (incl. foster child/stepchild)

11. Son (incl. adopted)

12. Daughter (incl. adopted)

13. Stepson (incl. partner's son)

14. Stepdaughter (incl. partner's daughter)

15. Son-in-law (incl. daughter's partner)

16. Daughter-in-law (incl. son's partner)

17. Foster son

18. Foster daughter

Parent/Grandparent

20. Parent, NA sex ("parents" code 21, 22)

21. Father (incl. adoptive father)

22. Mother (incl. adoptive mother)

23. Stepfather

24. Stepmother

25. Father-in-law (incl. partner's father); ("my in-laws" code 25 and 26)

26. Mother-in-law (incl. partner's mother)

27. Grandparent; great-grandparent, NA sex

28. Grandfather; great-grandfather

29. Grandmother; great-grandmother

Sibling/Sibling-in-law

31. Brother

32. Sister

33. Stepbrother

34. Stepsister

35. Brother-in-law

36. Sister-in-law

7102(#1) A1(a). Continued

7105(#2)

7108(#3) Other Relatives

7111(#4)

7114(#5) 40. Grandchild/great grandchild, NA sex

7117(#6) 41. Grandson; great grandson

7120(#7) 42. Granddaughter; great granddaughter

7123(#8) 43. Nephew

7126(#9) 44. Niece

7129(#10) 45. Uncle; great-uncle

46. Aunt; great-aunt

47. Cousin

48. Other "in-laws"

┌─────────┐

│Make Card├────────49. Other relative

└─────────┘

Unrelated Persons

62. Housemate/roommate

63. Household employee; live-in sitter; housekeeper

64. Friend

66. Person related to R's partner (exc. child or parent)

67. Roomer; boarder

┌─────────┐

│Make Card├────────97. Other unrelated person

└─────────┘

98. DK

99. NA

00. Inap, no further persons in HU

7103(#1) A1(b). SEX

7106(#2)

7109(#3) 1. Male

7112(#4) 2. Female

7115(#5)

7118(#6) 9. NA

7121(#7)

7124(#8) 0. Inap, no further persons listed

7127(#9)

7130(#10)

7104(#1) A1(c). AGE

7107(#2)

7110(#3) Code AGE (01-97)

7113(#4)

7116(#5) 01. One year or less

7119(#6)

7122(#7) 97. 97 years or more

7125(#8)

7128(#9) 98. DK

7131(#10) 99. NA

00. Inap, no further persons listed

SECTION B: PARENTING

VAR #

The next questions are about children.

7201 B1. Do you have any children who are not living here with you at the present time? Please include adopted children or

stepsons and stepdaughters not living here.

1. YES

┌─────────┐

│0 in 7202├─────────5. NO, NO CHILDREN ELSEWHERE

└─────────┤

└─────────9. NA

7202 B1a. How many do not live with you?

Code NUMBER (01-20)

98. DK

99. NA

00. Inap, 5 or 9 in 7201

7203 B2. Altogether, how many living children do you have? Again, please include any adopted children or stepsons and

stepdaughters you may have.

Code NUMBER (01-20), except:

98. DK

99. NA

┌──────────────┐

│0 in 7204-7225├─────00. NONE

└──────────────┘

7204 B2a. INTERVIEWER CHECKPOINT

1. R ONLY HAS ONE CHILD

┌─────────┐

│0 in 7205├─────────2. ALL OTHERS

└─────────┘

0. Inap, 00 in 7203

7205 B2b. Is this a son or daughter?

1. SON

2. DAUGHTER

9. NA

0. Inap, 00 in 7203; 2 in 7204

7206 B3. INTERVIEWER CHECKPOINT

┌──────────────┐

│0 in 7207-7208├─────1. R HAS NO CHILDREN LIVING ELSEWHERE

└──────────────┘

2. R HAS ONLY ONE CHILD LIVING ELSEWHERE

3. R HAS MORE THAN ONE CHILD LIVING ELSEWHERE

9. NA

0. Inap, 00 in 7203

7207 B4/B5. Think about your (son/daughter/children) who (does/do) not live with you. Does (he/she/how many of your children)

live within an hour's drive of here?

01. YES (to B4); One (to B5)

02-20.

96. NO (to B4); NONE (to B5)

98. DK

99. NA

00. Inap, 00 in 7203; 1 in 7206

7208 B4a/B5a. (RB, P. 1) In the past 12 months, how often did you have

contact with your (son/daughter/at least one of your children) who (doesn't/do not) live with you, either in person, by phone or by mail. Would you say more than once a week, about once a week, 1 to 3 times a month, less than

once a month or never?

1. MORE THAN ONCE A WEEK

2. ABOUT ONCE A WEEK

3. 1 TO 3 TIMES A MONTH

4. LESS THAN ONCE A MONTH

5. NEVER

8. DK

9. NA

0. Inap, 00 in 7203; 1 in 7206

[V7209-V7210: BUILD = 0]

7211 B6. INTERVIEWER CHECKPOINT

1. R HAS ONLY ONE CHILD

2. R HAS TWO OR MORE CHILDREN

0. Inap, 00 in 7203

7212 B7/B16. (RB, P. 2) How much do your children make you feel loved

and cared for? Would you say a great deal, quite a bit,

some, a little, or not at all?

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

0. Inap, 00 in 7203

7213 B8/B17. (RB, STILL ON P. 9) How much do you feel they make too

many demands on you? (Would you say a great deal, quite a

bit, some, a little, or not at all?)

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

0. Inap, 00 in 7203

7214 B9/B18. (RB, STILL ON P. 2) How much do you feel you make too

many demands on your children? (Would you say a great

deal, quite a bit, some, a little, or not at all?)

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

0. Inap, 00 in 7203

7215 B10/B19. (RB, STILL ON P. 2) How much are they willing to listen

when you need to talk about your worries or problems(--a

great deal, quite a bit, some, a little, or not at all)?

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

0. Inap, 00 in 7203

7216 B11/B20. (RB, STILL ON P. 2) How much are they critical of you or

what you do? (Would you say a great deal, quite a bit,

some, a little, or not at all?)

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

0. Inap, 00 in 7203

7217 B12/B21. (RB, P. 3) At this point in your life, how satisfied are

you with being a parent--are you completely, very,

somewhat, not very, or not at all satisfied?

1. COMPLETELY SATISFIED

2. VERY SATISFIED

3. SOMEWHAT SATISFIED

4. NOT VERY SATISFIED

5. NOT AT ALL SATISFIED

8. DK

9. NA

0. Inap, 00 in 7203

7218 B13/B22. Not using the booklet--How often do you feel bothered or

upset as a parent--almost always, often, sometimes,

rarely, or never?

1. ALMOST ALWAYS

2. OFTEN

3. SOMETIMES

4. RARELY

5. NEVER

8. DK

9. NA

0. Inap, 00 in 7203

7219 B14a/B23a. (RB, P. 4) How much do your children depend on you for

emotional support? Would you say a lot, some, a little or

not at all?

1. A LOT ┌───────────────┐

2. SOME │USE SAME COD │

3. A LITTLE │FOR V7220-7224 │

4. NOT AT ALL └───────────────┘

8. DK

9. NA

0. Inap, 00 in 7203

7220 B14b/B23b. How much do they depend on you for help or advice with

financial and legal matters?

7221 B14c/B23c. How much do they depend on you for help with errands,

babysitting or other chores?

7222 B14d/B23d. How much do you depend on your children for emotional

support?

7223 B14e/B23e. How much do you depend on them for help or advice with

financial and legal matters?

7224 B14f/B23f. How much do you depend on them for help with errands or

other chores?

7225 B15/B24. (RB, P. 5) At this point in your life, how often do you

and any of your children have unpleasant conflicts or disagreements? Would you say more than once a week, about once a week, 1 to 3 times a month, less than once a month,

or never?

1. MORE THAN ONCE A WEEK

2. ABOUT ONCE A WEEK

3. 1 TO 3 TIMES A MONTH

4. LESS THAN ONCE A MONTH

5. NEVER

8. DK

9. NA

0. Inap, 00 in 7203

7226 B25. How many grandchildren do you have, if any?

01. ONE

02-60.

98. DK

99. NA

┌─────────┐

│0 in 7227├─────────00. NONE

└─────────┘

7227 B25a/B25b. (RB,[STILL ON]P. 5) How often do you see your

(grandchild/grandchildren)? (Would you say more than once a week, about once a week, 1 to 3 times a month, less than

once a month, or never?)

1. MORE THAN ONCE A WEEK

2. ABOUT ONCE A WEEK

3. 1 TO 3 TIMES A MONTH

4. LESS THAN ONCE A MONTH

5. NEVER

8. DK

9. NA

0. Inap, 00 in 7226

SECTION C: SOCIAL SUPPORT

Now I would like to ask you some questions about your relationships with your relatives and friends. Please think of all your close family members, (including children,) as well as other friends and relatives.

7228 C1. Is there anyone in your life with whom you can really

share your very private feelings and concerns?

1. YES

┌─────────┐

│0 in 7229├─────────5. NO

└─────────┤

├─────────8. DK

└─────────9. NA

7229 C1a. How many such people are there?

Code NUMBER (01-95)

98. DK

99. NA

00. Inap, 5, 8-9 in 7228

[V7230-V7240: not used]

7241 C10. (RB, P. 6) On the whole, how much do your friends and relatives make you feel loved and cared for? Would you say a great deal, quite a bit, some, a little, or not at

all?

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

7242 C11. (RB, STILL ON P. 6) How much do you feel your friends and relatives make too many demands on you? (Would you say a

great deal, quite a bit, some, a little, or not at all?)

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

7243 C12. (RB, STILL ON P. 6) How much are your friends and relatives willing to listen when you need to talk about your worries or problems(--a great deal, quite a bit,

some, a little, or not at all)?

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

7244 C13. (RB, STILL ON P. 6) How much are they critical of you or what you do? (Would you say a great deal, quite a bit,

some, a little, or not at all?)

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

SECTION D: FEELINGS AND EMOTIONS

VAR #

D1-D2e. ARE OMITTED.

D3. (RB, P. 7) Now, I have a list of feelings and emotions that some people experience. Please think about the past month.

7301 D3. Have you felt afraid of what lies ahead for you? Would you say no, never; yes, but rarely; yes, sometimes; or

yes, often?

1. NO, NEVER ┌────────────────┐

2. YES, BUT RARELY │USE SAME CODE │

3. YES, SOMETIMES │FOR V7302-7305, │

4. YES, OFTEN │7307, 7313-7316 │

└────────────────┘

8. DK

9. NA

7302 D4. Have you felt extremely anxious and unsettled during the

past month?

7303 D5. During the past month, have you felt worried about how you

would manage your day-to-day affairs?

7304 D6. Has life seemed empty?

7305 D7. During the past month, did you feel amazed at your

strength?

[V7306: Not used]

7307 D9. During the past month, did you feel proud of how well you

were managing?

[V7308-V7312: Not used]

7313 D15. In the past month, have you felt anger toward God?

7314 D16. Have you felt empty inside, like an important part of you

is missing?

7315 D17. In the past month, have you felt that life has lost its

meaning?

7316 D18. Have you had any regrets about anything that happened

between you and your (husband/wife)?

[V7317-V7329: Not used]

7330 D30. Many people experience stressful situations in their

7331 lifetime. What is the most stressful thing that has ever

happened to you?

01. Relationship with spouse/partner; marriage problems; divorce/separation

02. Worries about children; relationship with child; include caring for new baby

03. Problem pregnancy; distress surrounding a pregnancy (exc. 30-34); pressure from loved ones to have/not have the baby

04. Relationship with parents; worries/concerns about parents

Mental Health/Drug/Alcohol Problems or Suicide of R's:

20. Self/Respondent

21. Spouse/partner/ex-spouse

22. Child

23. Parent

24. Other relative/friend/person close to R

Other Health Problems of R's (incl. accidental injuries):

30. Self/Respondent

31. Spouse/partner/ex-spouse

32. Child

33. Parent

34. Other relative/friend/person close to R

48. Death of relative/friend; threat of death--R or other person

49. Death or loss of pet

80. Financial problems; debts; unable to pay bills; reduced income

81. Work/job related problems (exc. 83)--no mention of financial implications; unemployment/job loss; start own business

82. School related problems

83. Moving, including the related problems of separation from family or dealing with a new job or being in an unfamiliar place

7330 D30. Continued

7331

91. Gulf War: mention that R or loved one actually sent to Saudi Arabia area due to the war; actually in danger/ combat zone

92. Gulf War: worry that R/spouse/loved one will go to war/will be killed or injured; war general worry

95. (To be assigned by Supervisor only) Miscellaneous less severe or trivial problems

┌─────────┐

│Make Card├────────97. Other

└─────────┘

98. DK

99. NA

00. Inap, no further mention

SECTION E: DREAMS AND NIGHTMARES

VAR #

[V7601-V7643: Not used]

7644 E32. (RB, P. 8) Now I have two sets of questions focusing on dreams and nightmares which many people have after their spouse's death. First, I will ask you about dreams. During the past 12 months, approximately how many times, if any, did you have dreams about your (husband/wife)

(-- once or twice, 3 or 4 times, about once a month,

2-3 times a month, once a week or more, or none?)

1. 1-2

2. 3-4 TIMES

3. ONCE A MO.

4. 2-3 TIMES/MO.

5. ONCE A WEEK OR MORE

┌─────────┐

│0 in 7645├─────────6. NONE

└─────────┘

8. DK

9. NA

7645 E32a. How do these dreams make you feel -- very sad or upset,

somewhat sad or upset, somewhat happy, or very happy?

1. VERY SAD OR UPSET

2. SOMEWHAT SAD/UPSET

3. SOMEWHAT HAPPY

4. VERY HAPPY

8. DK

9. NA

0. Inap, 6 in 7644

[V7646: Not used]

7647 E34. (RB, STILL ON P. 8) The next questions are about nightmares. During the past 12 months, approximately how many times, if any, did you have nightmares about your (husband/wife) (-- once or twice, 3 or 4 times, about once a month, 2-3 times a month, once a week or more,

or none?)

1. 1-2

2. 3-4 TIMES

3. ONCE A MO.

4. 2-3 TIMES/MO.

5. ONCE A WEEK OR MORE

6. NONE

8. DK

9. NA

[V7648: Not used]

SECTION H: SELF DESCRIPTION

VAR #

H1. (RB, STILL ON P. 23) Please tell me how true the following statements are as they apply to you now.

7901 H1. On the whole I am satisfied with myself. (Is this very true, somewhat, a little, or not true at all as it applies

to you?)

1. VERY TRUE ┌───────────────┐

2. SOMEWHAT TRUE │USE SAME CODE │

3. A LITTLE TRUE │FOR V7902-7905 │

4. NOT TRUE AT ALL └───────────────┘

8. DK

9. NA

7902 H2. At times I think I am no good at all.

7903 H3. I wish I could have more respect for myself.

7904 H4. All in all, I am inclined to feel that I am a failure.

7905 H5. I feel I am a person of worth, at least equal with others.

[V7906-7908: BUILD = 0]

H10. (SAB, P. 1) Please look at page 1 of the large blue booklet where you will find a number of statements. After each statement, put an "X" in the answer category that indicates how strongly you agree or disagree with the statement as it applies to you. The best answer is usually the one that comes to your mind first, so try not to spend too much time on any one statement. Continue until you see a STOP sign at the bottom of page 4. (If you prefer, I can read the statements to you.)

┌───────────────────────────────────────────────────────────────┐

│NOTE: ITEMS H11 - H54 are reproduced by special permission of │

│the publisher, Psychological Assessment Resources, Inc., │

│16102 North Florida Avenue, Lutz, Florida, 33549, from the NEO │

│Personality Inventory, by Paul Costa, and Robert McCrae, │

│without permission of PAR, Inc. │

└───────────────────────────────────────────────────────────────┘

7909 H11. I have a very active imagination. Do you strongly agree,

agree, feel neutral, disagree or strongly disagree?

1. STRONGLY AGREE ┌───────────────┐

2. AGREE │USE SAME CODE │

3. NEUTRAL │FOR V7910-7952 │

4. DISAGREE └───────────────┘

5. STRONGLY DISAGREE

8. DK

9. NA

7910 H12. I keep my belongings neat and clean.

7911 H13. I'm an even-tempered person.

7912 H14. I am dominant, forceful, and assertive.

7913 H15. I'm pretty good about pacing myself so as to get things

done on time.

7914 H16. I don't get much pleasure from chatting with people.

7915 H17. I like to have a lot of people around me.

7916 H18. I am sometimes completely absorbed in music I am listening

to.

7917 H19. I have a clear set of goals and work toward them in an

orderly fashion.

7918 H20. I rarely experience strong emotions.

7919 H21. I work hard to accomplish my goals.

7920 H22. I am easily frightened.

7921 H23. I tend to blame myself when anything goes wrong.

7922 H24. I waste a lot of time before settling down to work.

7923 H25. I often worry about things that might go wrong.

7924 H26. Sometimes I'm not as dependable or reliable as I should

be.

7925 H27. Poetry has little or no effect on me.

7926 H28. It takes a lot to get me mad.

7927 H29. I experience a wide range of emotions or feelings.

7928 H30. I have strong emotional attachments to my friends.

7929 H31. I never seem to be able to get organized.

7930 H32. I prefer jobs that let me work alone without being

bothered by other people.

7931 H33. I strive for excellence in everything I do.

7932 H34. I am seldom sad or depressed.

7933 H35. I'm pretty set in my ways.

7934 H36. I have trouble resisting my cravings.

7935 H37. I have sometimes done things just for "kicks" or

"thrills".

7936 H38. I enjoy solving problems or puzzles.

7937 H39. It would not bother me if I had to punish a child or pet.

7938 H40. Once I find the right way to do something, I stick to it.

7939 H41. At times I have been so ashamed I just wanted to hide.

7940 H42. Some people think I'm selfish and egotistical.

7941 H43. I tend to be cynical and skeptical of others' intentions.

7942 H44. I often feel inferior to others.

7943 H45. I would rather cooperate with others than compete with

them.

7944 H46. I believe that most people will take advantage of you if

you let them.

7945 H47. Some people think of me as cold and calculating.

7946 H48. I am a cheerful, high-spirited person.

7947 H49. I consider myself broad-minded and tolerant of other

people's lifestyles.

7948 H50. I'm hard-headed and tough-minded in my attitudes.

7949 H51. I generally try to be thoughtful and considerate.

7950 H52. When everything seems to be going wrong, I can still make

good decisions.

7951 H53. I am a very active person.

7952 H54. I have a wide range of intellectual interests.

SECTION J: HEALTH AND LIMITATION OF ACTIVITIES

VAR #

8001 J1. The next questions are about your health. In general, how satisfied are you with your health‑‑completely, very,

somewhat, not very, or not at all satisfied?

1. COMPLETELY SATISFIED

2. VERY SATISFIED

3. SOMEWHAT SATISFIED

4. NOT VERY SATISFIED

5. NOT AT ALL SATISFIED

8. DK

9. NA

J2. We'd like to know if you have experienced any of the following health problems during the last 6 months.

8002 J2a. Have you had arthritis or rheumatism?

1. YES ┌──────────────┐

5. NO │USE SAME CODE │

│FOR V8003-8009│

8. DK └──────────────┘

9. NA

8003 J2b. During the last 6 months, have you had a lung disease?

8004 J2c. Have you had hypertension, sometimes called high blood

pressure, or have you taken medication for it?

8005 J2d. Have you had a heart attack or other heart trouble during

the last 6 months?

8006 J2e. Have you had diabetes or high blood sugar, or have you

taken medication for it?

8007 J2f. Have you had a stroke during the last 6 months?

8008 J2g. Have you had any broken or fractured bones?

8010 J3. Have you had cancer or a malignant tumor of any kind, or

have you been treated for it in the past 6 months?

1. YES

┌──────────────┐

│0 in 8011-8013├───5. NO

└──────────────┤

├───8. DK

└───9. NA

8011 J3a. What kind of cancer or malignant tumor did you have? (In

8012 what part of your body did it start?)

8013

01. "Abdomen"--NFS 33. Melanoma

02. Adrenal gland 95. Metastasized; "all over"

03. "Arm"--NFS 34. Mouth; oral

04. "Back"--NFS 08. Myeloma (multiple)

05. Bladder 35. "Neck"--NFS

06. "Blood"--NFS 36. Nose; nasal

07. Bone; cartilage 37. Ovary

08. Bone marrow 38. Pancreas; ampulla of

09. Brain; astrocytoma Vater

10. Breast 39. "Pelvis"--NFS

11. Bronchia; bronchus 40. Penis

12. Bowel 41. Prostate

12. Rectum

13. Cervix 33. Skin--melanoma; black

12. Colon mole

14. Ear 42. Skin--basal cell

15. Endometrium 43. Skin (other or NA which)

16. Esophagus incl. any body part with

17. "Extremities"--NFS skin cancer

18. Eye 44. Spine

19. "Face"--NFS 45. Spleen

20. "Female organs"--NFS 46. Stomach

21. Gallbladder

22. Gastrointestinal 47. Testicles

48. Throat

23. "Head"--NFS 49. Thyroid; goiter on neck

24. Hip 50. Tongue

25. Hodgkins 51. Trachea

26. Jaw 52. Urethra/ureter

27. Kidney; renal 15. Uterus/womb

28. Larynx; vocal cords 53. Vagina

29. "Leg"--NFS 54. Vulva; labia

06. Leukemia ┌─────────┐

30. Lip │Make Card├─97. Other

31. Liver └─────────┘

11. Lung; "chest"--NFS 98. DK

32. Lymph nodes/glands; 99. NA

"glands behind the

ear"; "nodes"; 00. Inap, 5, 8-9 in 8010;

lymphoma (exc. 25) no further mentions

8014 J4. In the past 6 months, have you had any major health

problems that I haven't asked you about?

1. YES

┌──────────────┐

│0 in 8015-8017├───5. NO

└──────────────┤

├───8. DK

└───9. NA

8015 J4a. What are they?

8016

8017 Use HEALTH CONDITION MASTER CODE

000. Inap, 5, 8-9 in 8014; no further mention

8018 J5. INTERVIEWER CHECKPOINT

┌──────────────┐

│0 in 8201-8255├───1. R ANSWERS "NO" TO ALL QUESTIONS IN J2a-h,J3 AND J4

└──────────────┘

2. ALL OTHERS

SECTION J: HEALTH AND LIMITATION OF ACTIVITIES

VAR #

MARK THE BOX NEXT TO ALL PREPRINTED CONDITIONS IN THE GRID TO WHICH R ANSWERED "YES" IN J2a-h,J3 AND J4. IF MORE THAN 5, ASK J6-9a ONLY FOR FIRST 5 CONDITIONS.

8201 J5. SUMMARY

Code # of columns filled in for J2a-h, J3a and J4a, including supplement pages, if any (01-14).

┌──────────────┐

│0 in 8211-8255├───01. One

└──────────────┘

┌──────────────┐

│0 in 8220-8255├───02. Two

└──────────────┘

┌──────────────┐

│0 in 8229-8255├───03. Three

└──────────────┘

┌──────────────┐

│0 in 8238-8255├───04. Four

└──────────────┘

┌──────────────┐

│0 in 8247-8255├───05. Five

└──────────────┘

06. Six

14. Fourteen

99. NA (see Supervisor before using)

00. Inap, 1 in 8018

┌────────────────────────────────────────────────────────────┐

│NOTE: The name of a "SPECIFY" condition must be matched to │

│its order of mention at J4a (p.43). E.g., if "gout" was the│

│3rd condition coded at J4a, and it appears as a "SPECIFY" on│

│a supplement page, the code for condition type is 13. │

└────────────────────────────────────────────────────────────┘

8202(#1) CONDITION TYPE (from top of column)

8211(#2)

8220(#3) 01. (J2a) ARTHRITIS/RHEUMATISM

8229(#4) 02. (J2b) LUNG DISEASE

8238(#5) 03. (J2c) HYPERTENSION/HIGH BLOOD PRESSURE

8247(#6) 04. (J2d) HEART TROUBLE

05. (J2e) DIABETES/HIGH BLOOD SUGAR

06. (J2f) STROKE

07. (J2g) BROKEN OR FRACTURED BONES

08. (J2h) LOSS OF URINE BEYOND CONTROL

09. (J3a) CANCER

11. (J4a) SPECIFY--1st mention at J4a, p.43

12. (J4b) SPECIFY--2nd mention at J4a, p.43

13. (J4c) SPECIFY--3rd mention at J4a, p.43

00. Inap, 1 in 8018; no further conditions

8203(#1) J6. Were you hospitalized during the last 6 months for

8212(#2) (CONDITION)?

8221(#3)

8230(#4) 1. YES

8239(#5) 5. NO

8248(#6)

8. DK

9. NA

0. Inap, 1 in 8018; no further conditions

8204(#1) J7. Did (CONDITION) start in the last 12 months or was it

8213(#2) going on before that?

8222(#3) ┌─────────┐

8231(#4) │0 in J8 ├───1. STARTED IN LAST 6 MONTHS

8240(#5) │for this │

8249(#6) │condition│

└─────────┘

┌─────────┐

│0 in next├───2. GOING ON BEFORE

│2 vars │

└─────────┼───8. DK

└───9. NA

0. Inap, 1 in 8018; no further conditions

8205(#1) J7a. In what month did it start? (RECORD YEAR, ALSO.)--MONTH

8214(#2)

8223(#3) Code MONTH (01-12)

8232(#4)

8241(#5) 98. DK

8250(#6) 99. NA

00. Inap, 1 in 8018; 2, 8-9 in J7 for this condition;

no further conditions

8206(#1) J7a. In what month did it start? (RECORD YEAR, ALSO.)--YEAR

8215(#2)

8224(#3) Code YEAR (1987-1995)

8233(#4)

8242(#5) 9998. DK

8251(#6) 9999. NA

0000. Inap, 1 in 8018; 2, 8-9 in J7 for this condition;

no further conditions

8207(#1) J8. In the past 12 months, has your (CONDITION) become better,

8216(#2) stayed about the same, or become worse?

8225(#3)

8234(#4) 1. BETTER

8243(#5) 2. SAME

8252(#6) 3. WORSE

8. DK

9. NA

0. Inap, 1 in 8018; 1 in J7 for this condition;

no further conditions

[BUILD = 0 for the following vars: 8208-8210

8217-8219

8226-8228

8235-8237

8244-8246

8253-8255]

SECTION J: HEALTH AND LIMITATION OF ACTIVITIES

VAR #

8301 J10. Are you currently in bed or in a chair for most or all of

the day because of your health?

1. YES

5. NO

9. NA

8302 J11. Do you currently have any difficulty bathing by yourself?

1. YES

┌─────────┐

│0 in 8303├────────5. NO

└─────────┤

└────────9. NA

8303 J11a. How much difficulty do you have bathing by yourself--a

little, some, a lot, or can't you do this on your own?

1. A LITTLE

2. SOME

┌──────────────┐

│0 in 8304-8311├───3. A LOT

└──────────────┴───4. CANNOT DO

8. DK

9. NA

0. Inap, 5 or 9 in 8302

8304 J12. INTERVIEWER CHECKPOINT

┌──────────────┐

│0 in 8305-8311├───1. R ANSWERED "YES" (BOX WITH DOUBLE LINE) TO J10

└──────────────┘

2. ALL OTHERS

0. Inap, 3-4 in 8303

8305 J13. Do you currently have any difficulty climbing a few

flights of stairs because of your health?

1. YES

3. VOLUNTEERED: AGE IS ONLY LIMITATION

┌─────────┐

│0 in 8306├────────5. NO

└─────────┤

├────────8. DK

└────────9. NA

0. Inap, 3-4 in 8303; 1 in 8304

8306 J13a. How much difficulty do you have--a little, some, a lot, or

can't you do this at all?

1. A LITTLE

2. SOME

3. A LOT

4. CANNOT DO

8. DK

9. NA

0. Inap, 3-4 in 8303; 1 in 8304; 5, 8-9 in 8305

8307 J14. Do you currently have any difficulty walking several

blocks because of your health?

1. YES

3. VOLUNTEERED: AGE IS ONLY LIMITATION

┌─────────┐

│0 in 8308├────────5. NO

└─────────┤

├────────8. DK

└────────9. NA

0. Inap, 3-4 in 8303; 1 in 8304

8308 J14a. How much difficulty do you have--a little, some, a lot, or

can't you do this at all?

1. A LITTLE

2. SOME

3. A LOT

4. CANNOT DO

8. DK

9. NA

0. Inap, 3-4 in 8303; 1 in 8304; 5, 8-9 in 8307

8309 J15. INTERVIEWER CHECKPOINT

┌──────────────┐

│0 in 8310-8311├───1. R ANSWERED "A LOT" OR "CANNOT DO" (BOXES WITH DOUBLE

└──────────────┘ LINES) TO EITHER J13a OR J14a

2. ALL OTHERS

0. Inap, 3-4 in 8303; 1 in 8304

8310 J16. Would you currently have any difficulty doing heavy work around the house such as shoveling snow or washing walls,

because of your health?

1. YES

3. VOLUNTEERED: AGE IS ONLY LIMITATION

┌─────────┐

│0 in 8311├────────5. NO

└─────────┤

├────────8. DK

└────────9. NA

0. Inap, 3-4 in 8303; 1 in 8304 or 8309

8311 J16a. How much difficulty would you have--a little, some, a lot,

or couldn't you do this at all?

1. A LITTLE

2. SOME

3. A LOT

4. COULD NOT DO

8. DK

9. NA

0. Inap, 3-4 in 8303; 1 in 8304 or 8309; 5, 8-9 in 8310

8312 J17. How would you rate your health at the present time? Would

you say it is excellent, very good, good, fair, or poor?

1. EXCELLENT

2. VERY GOOD

3. GOOD

4. FAIR

5. POOR

8. DK

9. NA

8313 J18. How much are your daily activities limited in any way by your health or health-related problems--a great deal,

quite a bit, some, a little, or not at all?

1. A GREAT DEAL

2. QUITE A BIT

3. SOME

4. A LITTLE

5. NOT AT ALL

8. DK

9. NA

8314 J19. Have you taken any non-prescription medications in the

last 30 days to help you sleep?

1. YES

┌─────────┐

│0 in 8315├────────5. NO

└─────────┤

├────────8. DK

└────────9. NA

8315 J19a. On how many days out of the past 30 did you take non-

prescription medication to help you sleep?

Code DAYS (01-30)

98. DK

99. NA

00. Inap, 5, 8-9 in 8314

8316 J20. (RB, P. 11) The next questions are about prescription-type medications taken with or without a doctor's prescription. Here is a list of medications people sometimes take to help them sleep or stay calm during the day. Are you taking any of these medications now? [LISTED IN RB: AMYTAL, AMOBARBITAL, BARBITURATE, BUTICAP, BUTISOL, CHLORAL HYDRATE, DALMANE, DORIDEN, HALCION, MEBARAL, METHAQUALONE, NEMBUTAL, NOLUDAR, PENTOBARBITAL, PHENOBARBITAL, PLACIDYL, QUAALUDE, RESTORIL, SECOBARBITAL,

SECONAL, SOPOR, TUINAL]

┌─────────┐

│0 in 8318├────────1. YES

└─────────┘

┌─────────┐

│0 in 8317├────────5. NO

└─────────┤

├────────8. DK

└────────9. NA

8317 J20a. (RB, STILL ON P. 11) On how many days out of the past 30

did you take any of these medications at least once?

Code DAYS (01-30)

98. DK

99. NA

00. Inap, 5, 8-9 in 8316

8318 J20b. (RB, STILL ON P. 11) Have you taken any of these

medications at any time in the past 4 years?

1. YES

5. NO

8. DK

9. NA

0. Inap, 1 in 8316

8319 J21. (RB, STILL ON P. 11) Did you ever take any of these

medications earlier than four years ago?

1. YES

5. NO

8. DK

9. NA

8320 J22. (RB, P. 12) Here is a list of medications people sometimes take to help them relax their muscles or calm down. They are sometimes called "nerve pills." Are you taking any of these medications now? [LISTED IN RB: ATARAX, ATIVAN, BUSPAR, CENTRAX, DEPROL, DIAZEPAM, DURAX, EQUANIL, LIBRIUM, LIMBITROL, MENRIUM, MEPROBAMATE, MILTOWN, PAXIPAM, SERAX, SK-LYGEN, TRANXENE, VALIUM,

VISTARIL, XANAX]

┌─────────┐

│0 in 8322├────────1. YES

└─────────┘

┌─────────┐

│0 in 8321├────────5. NO

└─────────┤

├────────8. DK

└────────9. NA

8321 J22a. (RB, STILL ON P. 12) On how many days out of the past 30

did you take any of these medications at least once?

Code DAYS (01-30)

98. DK

99. NA

00. Inap, 5, 8-9 in 8320

8322 J22b. (RB, STILL ON P. 12) Have you taken any of these

medications at any time in the past four years?

1. YES

5. NO

8. DK

9. NA

0. Inap, 1 in 8320

8323 J23. (RB, STILL ON P. 12) Did you ever take any of these

medications earlier than four years ago?

1. YES

5. NO

8. DK

9. NA