The Supplement on 

Aging to the 1984 

IUational Health 

Interview Survey 

Includes descriptions of the sample, 

questionnaire content, and survey 

operations, and presents strategies and 

procedures for analysis of the Supplement 

on Aging to the 1984 National Health 

Interview Survey. 

Programs and Collection Procedures 

Series 1, No. 21 

DHHS Publication No. (PHS) 87-1323 

U.S. Department of Health and Human 

Services 

Public Health Service 

National Center for Health Statistics 

Hyattsville, Md. 

October 1987 (reprinted 12/96) 
Copyright information 

All material in this report is in the public domain and may be 

reproduced or copied without permission; citation as to source, 

however, is appreciated. 

Suggested citation 

National Center for Health Statistics, J. E. Fitti and M. G. Kovar: The 

Supplement on Aging to the 1984 National Health Interview Survey. 

Vita/ and Health Statistics. Series 1, No. 21. DHHSPub. No. (PHS) 

87-1323. Public Health Service. Washington. U.S. Government 

Printing Office, Oct. 1987. 

Library of Congress Cataloging-in-Publication Data 

Fitti, Joseph E. 

The supplement on aging (SOA) to the 1984 National 

Health InteNiew Survey. 

(Vital & Health Statistics. Series 1, Programs and 

collection procedures ; no. 21) (DHHS pubkatiOn ; 

no. (PHS) 87-l 323) 

Author: Joseph E. Fitti and Mary Grace Kovar. 

“October 1986.” 

Bibliography: p. 

Supt. of Dots. no.: HE 20.6209:1/21 

1. Aged-Health and hygiene-United States. 2. AgedUnited States-United States-Social conditions. 

3. Aged-United States- Social conditions. 4. Health 

surveys-United States. 5. National Health Interview 

Survey (U.S.) I. Kovar, Mary Grace. National Center 

for Health Statistics (U.S.) Ill. Title. IV. Series: 

Vital and health statistics. Series 1, Programs and 

collection procedures ; no. 21. V. Series: DHHS 

publication ; no. (PHS) 87-l 323. [DNLM: 1. National 

Health Interview Survey (U.S.) 2. Aged-United States. 

3. Health Sewices for the Aged-United States. 

W2 A N14va no.211 

RA409.U44 no.21 312’.07’23 s 87-600066 

[ RA408.A3] (305.2’6’09731 

ISBN 0-8406-0369-X 
National Center for Health Statistics Cooperation of the U.S. Bureau of the Census 

Manning Feinleib, M.D., Dr.P.H., Director 

Robert A. Israel, Deputy Director 

Jacob J. Feldman, Ph.D., Associate Director for Analysis 

Under the legislation establishing the National Health Interview Survey, the Public 

Health Service is authorized to use, insofar as possible, the services or facilities of other 

Federal, State, or private agencies. 

In accordance with specifications established by the Division of Health Interview 

Statistics, the U.S. Bureau of the Census, under contractual agreement, - participated in 

and Epidemiology planning the survey and collecting the data. 

Gail F. Fisher, Ph.D., Associate Directorfor Planning 

and Extramural Programs 

Peter L. Hurley, Associate Directorfor VitaZ and Health 

Statistics Systems 

Stephen E. Nieberding, Associate Director for kanagement 

George A. Schnack, Associate Director for Data Processing 

and Services 

Monroe G. Sirken, Ph.D., Associate Director for Research 

and Methodology 

Sandra S. Smith, Information Oficer 

Vital and Health Statistics Systems 

Peter J. Hurley, Associate Director 

Mary Grace Kovar, Dr.P.H., Special Assistant for Data 

Policy and Analysis 

Gloria Kapantais, Assistant to the Directorfor Data Policy, 

Planning and Analysis 

Division of Health Interview Statistics 

Owen T. Thornberry, Jr., Ph.D., Director 

Gerry E. Hendershot, Ph.D., ChieJ Illness and Disability 

Statistics Branch 

Nelma B. Keen, ChieJ Computer Systems and Programming 

Branch 

Stewart C. Rice, Jr., ChieJ Survey Planning and 

Development Branch 

Robert A. Wright, ChieJ Utilization and Expenditure 

Statistics Branch 

For sale by the U.S. Government Printing Office 

Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328 

ISBN O-l 6-048931-8 
Contents 

Introduction ............................................................................................... 1 

Overview of the National Health Interview Survey ............................................................ 1 

Overview of the 1984 Supplement on Aging. ................................................................. 2 

Chapter 1. Sample description ............................................................................... 4 

National Health Interview Survey. .......................................................................... 4 

Supplement on Aging.. ................................................................................... 4 

Figure 

1. SOA sample selection tables A and B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Table 

A. Number of persons for whom interviews for the Supplement on Aging were obtained, by age and sex . . . . . . . . . . . . . . . . 

Chapter 2. Questionnaire planning and development. ............................................................ 

Planning and development of the SOA Questionnaire .......................................................... 

Pretests ................................................................................................. 

Description of the SOA Questionnaire. ...................................................................... 

Table 

B. Length of interview of the National Health Interview Survey (NHIS) and of the Supplement on Aging (SOA): Bradenton 

Pretest..............................................................................................~. 

Chapter3. Surveyoperations ................................................................................ 11 

Datacollection .......................................................................................... 11 

Interviewertraining ..................................................................................... 11 

Datacollection ........................................................................................ 11 

Quality control: Data collection ............................................................................ 12 

Quality control procedures. .............................................................................. 12 

Reinterviewing.......................................................; ................................. 13 

Quality controlf Data processing and editing. ................................................................. 13 

Table 

C. Response rates for the Supplement on Aging (SOA), by quarter .and type of response . . . . . . , . . . . . . . . . . . . . . . . . . . . . . 

Chapter4. AnalysisofSOAdata ............................................................................. 15 

Estimation .............................................................................................. 15 

Weights ............................................................................................... 15 

Pointestimates ......................................................................................... 15 

Examples of national estimates. .......................................................................... 17 

V~ances ............................................................................................... 17 

Curves of relative standard errors ......................................................................... 17 

Designeffects .......................................................................................... 18 

Calculatingvariances.. ................................................................................... 18 

Considerations of sample design ............................................................................ 19 

5 

5 

8 

12 

. . . 

III 
Strategies for analysis ..................................................................................... 

Relationship between the questionnaire and the data ......................................................... 

Preliminary analysis .................................................................................... 

Weightedanalysis ...................................................................................... 

Finalanalysis .......................................................................................... 

Figures 

2. Poststratification cells for SOA. .......................................................................... 

3. Stages for analysis of data from a survey with a complex sample design ......................................... 

Tables 

D. Number of persons in the National Health Interview Survey (NHIS) and Supplement on Aging (SOA) samples and Supplement on Aging response rates, by selected characteristics. .................................................. 

E. Sample numbers and population estimates for persons ages 55 years and over, by selected characteristics: National 

Health Interview Survey (NHIS) and Supplement on Aging (SOA), 1984. ...................................... 

Chapter 5. Differences between data files from the 1984 NHIS Basic Questionnaire and the Supplement on Aging. ....... 

Weights ................................................................................................. 

Respondents ............................................................................................. 

NHISbasicrespondentrule .............................................................................. 

SOA respondent rule ................................................................................... 

Conditions .............................................................................................. 

Condition lists ......................................................................................... 

Conditionsonconditionfile .............................................................................. 

Family relationship and number of persons. .................................................................. 

Family relationship ..................................................................................... 

Numberofpersonsinthefamily .......................................................................... 

Tables 

F. Number and percent of self-responses to the Supplement on Aging and number of proxy responses, by selected demographic andhealthcharacteristics ......................................................................... 

G. Number and percent of self-responses to the Supplement on Aging (SOA) and number of proxy responses, by type of response to the National Health Interview Survey (NHIS) Basic Questionnaire. ................................... 

Chapter6. Prospectivestudies ............................................................................... 

Followup through the National Death Index. ................................................................. 

Other aspects of the Longitudinal Study of Aging. ............................................................. 

Table 

H. Number and percent of persons in the Longitudinal Study of Aging (LSOA) 1986 initial followup reinterview sample, 

by age and race ........................................................................................ 

References ................................................................................................ 

Appendixes 

I. 1984 National Health Interview Survey Basic Questionnaire ................................................ 

II. 1984 Supplement on Aging Questionnaire ................................................................ 

III. Bradenton, Florida, Supplement on Aging Pretest Questionnaire ............................................. 

IV. Supplement on Aging Reinterview Questions. ............................................................. 

V. Definition of selected terms in the 1984 Supplement on Aging. .............................................. 

VI. Selected information about the design and estimation of the 1984 Supplement on Aging ......................... 

VII. ExamplesusingSAS .................................................................................. 

VIII. Consultants and staff of the 1984 SuDPlement on A&e. .................................................... 

19 

19 

19 

20 

20 

15 

19 

16 

16 

21 

21 

21 

21 

21 

21 

21 

21 

22 

22 

23 

22 

22 

24 

24 

24 

25 

26 

29 

51 

70 

102 

106 

108 

112 

114 
Symbols 

a w m Data not available 

. . . Category not applicable 

Quantity zero 

0.0 Quantity more than zero but less than 

0.05 

Z Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

* Figure does not meet standard of 

reliability or precision 

# Figure suppressed to comply with 

confidentiality requirements 
The Supplement on Aging 

to the 1984 National Health 

Interview Survey 

by Joseph E. Fitti, MSPH, Division of Health Interview 

Statistics, and Mary Grace Kovar, Dr.P.H., Vital and Health 

Statistics Systems 

Introduction 

Overview of the National Health 

interview Survey 

The National Health Survey Act of 1956 provided for a 

continuing survey to secure, on a voluntary basis, accurate and 

current statistics on the amount, distribution, and effects of 

illness and disability in the United States and the services rendered because of such conditions. Mandated by this legislation, 

the National Health Interview Survey (NHIS) is a principal 

source of information on the health of the civilian noninstitutionalized population of the United States. 

The purpose of the survey is to provide national data on 

the incidence of illness and accidental injuries, the prevalence 

of chronic conditions and impairments, the extent of disability, 

the utilization of health care services, and on other health related topics. A major strength of the survey is that these statistics can be obtained for the U.S. civilian noninstitutionalized 

population. Because NHIS data are obtained during household 

interviews from the people themselves, the statistics are a 

measure of health status and experiences and a reflection of the 

social and economic dimensions of health issues as reported by 

individuals, that is, the extent and impact of illness and disability and the resulting uses of health care services are reported by 

the people experiencing them. 

Interviews are conducted each week throughout the year 

in a probability sample of households. The interviewing is performed by a permanent staff of highly trained and supervised 

interviewers of the U.S. Bureau of the Census under detailed 

specifications provided by the Division of Health Interview 

Statistics, National Center for Health Statistics (NCHS). U.S. 

Bureau of the Census interviewers trained on the NHIS, some 

of whom have worked on this survey for over 10 years, generally 

work only on this survey and remain as its field staff for their 

full careers as Census interviewers. 

The questionnaire used in the interview is divided into two 

basic units, a basic questionnaire that is constant over long 

periods and special topic questions, or a supplement, that differ 

from year to year (appendixes I and II, respectively). 

The basic questionnaire contains items on 

l Basic demographic characteristics of household members, 

including age, sex, race, Hispanic origin, education, marital 

status, veteran status, employment or major activity status, 

and income. 

Disability days, including restricted activity and bed days, 

and work or school loss days occurring during the 2-week 

period prior to the interview. 

Doctor visits during the past year and during the 2 weeks 

prior to the interview. 

Acute and chronic conditions responsible for disability 

days and doctor visits. 

Long-term limitation of activity resulting from chronic disease or impairment and chronic conditions associated with 

disability. 

Short-stay hospitalization, including number of persons 

with hospital episodes during the past year and number of 

discharges from short-stay hospitals. 

Interval since the last doctor visit. 

Supplements are changed in response to current interest in 

special health topics. Suggestions and requests for special topic 

coverage are solicited and received from many sources. These 

include the Public Health Service and other agencies of the 

Department of Health and Human Services, other Federal 

agencies, university-based researchers, administrators of national organizations and programs in private and public health 

sectors, and other specialists in the field of interest. In addition, 

NCHS staff are aware of data needs and issues of public health 

importance for consideration as special topics to be included in 

the NHIS. 

Facsimilies of the first pretest questionnaire, reinterview 

questions, definitions of the SOA terms, information about survey design and estimation, examples for the Statistical Analysis 

System’s (SAS) processing of data, and the consultants and 

staff of the SOA appear in appendixes III-VIII. 

The sample design of the NHIS, which is discussed in 

more detail in the section Sample description, provides unique 

analytic opportunities. The sample is designed so that each 

week’s data collection constitutes a sample of the civilian noninstitutionalized population of the United States. The weekly 

samples can be aggregated to increase the sample size, or they 

can be used to study trends or seasonal variation. 

Data collected over the period of a year form the basis, for 

annual estimates of the health characteristics of the population. 

These annual estimates are the bases for most NHIS reports, 

such as “Current Estimates,” which is published annually in 

Vital and Health Statistics. 

Data collected over a longer period can also be aggregated 

1 
and appropriately weighted to form the basis for average annual 

estimates. These estimates are the basis for many analyses of 

low-frequency characteristics, such as the prevalence of some 

chronic conditions or special characteristics of contacts with 

physicians. 

Conversely, data from any quarter can be analyzed to study 

short-lived high-frequency phenomena, such as major flu epidemics, or to study seasonal variation. If the techniques are 

combined, seasonal variation over the course of many years 

can be studied. 

Throughout the NHIS data collection and data processing, 

extensive quality control procedures are followed to reduce 

nonsampling errors in the data produced from both the basic 

questionnaire and the special topic questions. (For details, see 

reference 1.) 

Data release occurs in many forms including publications, 

tabulations, and public-use data tapes. 

Data are published by the Center in Series 10 of Vita2 and 

Health Statistics, in Advance Data, and in Health United 

States. Information about how to order publications can be 

obtained by writing or calling the Scientific and Technical Information Branch of NCHS. Data are also released in Statistica 

Abstracts of the United States and many other Federal Government publications. The U.S. Government Printing Office 

sells the NCHS and other Federal agency publications. 

Public-use data tapes containing basic questionnaire data 

are released by NCHS through the National Technical Information Service (NTIS) in Springfield, Va.a The public-use 

tapes, which contain all the information on the basic NHIS 

questionnaire, are usually released to the research community 

within 2 years of the completion of the calendar year of the 

data collection. That is, all data collected on the basic questionnaire in 1984 are available to anyone who wishes to purchase 

the data tapes through NTIS. 

Public-use data tapes containing supplement topic data, 

including the 1984 SOA, are available directly from the Division of Health Interview Statistics, National Center for Health 

Statistics, by writing to 

Division of Health Interview Statistics 

National Center for Health Statistics 

Center Building, Room 2-44 

3700 East-West Highway 

Hyattsville, Maryland 20782. 

The release of the public-use tapes means that many analyses are published by people or organizations that are not connected with NCHS. Although the NCHS staff are interested in 

who uses the data and often work with independent analysts if 

asked, the responsibility for using the tapes correctly rests with 

the users. This monograph is designed to describe the design 

and implementation of the 1984 Supplement on Aging and to 

assist users of the data from it. 

a National Technical Informat 

5285 Port Royal Road 

Springfield, Virginia 22 16 1 

Tel: (703) 487-4650 

ion Service 

Overview of The 1984 Supplement 

on Aging 

Increasing interest in aging led to the entire 1984 supplement’s being devoted to a population group rather than to a 

single health topic. A precedent had been set for dedicating an 

NHIS supplement to a specific population group in 198 1 when 

a comprehensive supplement on children was conducted as part 

of the survey. In the Child Health Supplement, data were gathered on a national probability sample of 15,4 16 children 17 

years of age and under, and information was provided on a 

variety of specific issues related to that population. 

Concerns among a number of public health agencies and 

individuals about the increasing proportion of older people in 

the U.S. population led, as early as 1980, to recommendations 

that the NHIS address this special subgroup. Issues dealing 

with the health and functional status of older people and the 

need for alternatives to institutionalization as the mode for 

providing care were identified at this early point by professionals in the field of aging. 2-6 Information about these and 

related characteristics of the older population was needed. 

Statements of the need for this information were made by 

the Department of Health and Human Services in the 1980 

National Long-Term Care Data Plan of the Division of LongTerm Care Policy, Office of the Assistant Secretary for Planning and Evaluation;’ by the Office of Management and Budget 

in its 1980 report of the Interagency Statistical Committee on 

Long-Term Care of the Elderly;* and by the 198 1 White House 

Conference on Aging, Final Report, Vol. III, Recommendation 

No. 627 .gJo 

It was postulated that information about the health conditions that were most prevalent, about living arrangements, family 

and social support availability, retirement income and financial 

obligations, functional status and limitations, and attitudes and 

opinions about their own health and abilities would help in 

assessing the future needs of the elderly.’ lvl* 

In addition to responding to the topic recommendation of 

the National Health Interview Survey’s Technical Consultants 

Panel that these informational needs about the elderly could be 

addressed through the NHIS, a special supplement on aging in 

1984 was particularly timely because NCHS planned to conduct the National Nursing Home Survey (NNHS) in 1984. 

The SOA data on the noninstitutionalized population would 

complement the NNHS data on residents of nursing homes 

and would provide, for the first time, comprehensive data on 

almost the total elderly population. 

The development of a supplement to help provide some of 

this information from a national survey of elderly people themselves began in 1982 and resulted in the 1984 NHIS Supplement on Aging that is described in this report. The objectives of 

the 1984 SOA were: 

l To characterize the health and social status of people aged 

55 and over in the United States. 

l To provide information about how psychosocial and environmental factors interact with health factors to influence 

the aging individual in a changing society. 

l To provide a knowledge base for investigating issues of 

prevention and postponement of disability and dependency 

2 
and for framing research questions and hypotheses on the 

interplay between changing home environments and the 

aging individual. 

l To delineate issues and data for research on the enhancement of care, social support, and coping for those older 

people who do become disabled. 

l To provide information about factors that influence individuals’ ability to live independently in the household and 

the community as they grow older. 

l To form the basis for a prospective study, the Longitudinal 

Study of Aging (LSOA). (See chapter 7 of this report for 

description of the LSOA.) 

In 1984 the supplement to the NHIS was the Supplement 

on Aging. NCHS selected this as the supplemental topic; no 

outside funds were sought or received. However, special sup 

plement suggestions that had been received from outside agencies through the topic solicitation process were incorporated, 

and there was extensive consultation with staRof other agencies. 

Consequently, the needs of other organizations in the Federal 

Government were met as much as possible. 
Chapter 1 

Sample description 

National Health Interview Survey 

The National Health Interview Survey (NHIS) sample is 

designed to produce national estimates for the civilian noninstitutionalized population residing in the United States. The approach to doing so is first to divide the United States into geographically defined areas called primary sampling units (PSU’s), 

which collectively cover the 50 States and the District of Columbia. The PSU’s are classified into strata (combinations of 

PSU’s with similar characteristics), and, in 1984 and earlier 

years, one PSU was selected from each stratum. Within the 

selected PSU’s, small compact clusters of housing units are 

then selected. Details of the sample design, listing segments, 

and selecting housing units in the NHIS sampling procedure 

are provided in Series 1 of Vital and HeaZth Statistics. 1,13 

There is clustering within the PSU, within the segment, 

and within the household because all family members in the 

selected housing unit are in the sample. This clustering causes 

the procedures for analysis, especially the variance estimation, 

to differ from those in simple random sampling. 

An important aspect of the NHIS sample design is that it 

is a multistage probability design that permits a continuous 

sampling of the civilian noninstitutionalized population in the 

United States. It is designed in such a way that the sample 

scheduled for each week is an independent sample of the population; the weekly samples are additive over time. Thus, the 

design permits estimates for high-frequency measures (or for 

large population groups) to be produced from a short period of 

data collection and estimates for low-frequency measures (or 

for smaller population subgroups) to be obtained from a longer 

period of data collection. Because interviewing is done throughout the year with about 800 households in the sample each 

week, there is no seasonal bias in the annual estimates. 

The NHIS sample is updated or redesigned after each decennial census. The redesign that was implemented in 1973. 

was an update and modification of earlier sample designs rather 

than an entirely new design. This update formed the basis for 

the 1984 NHIS sample. Details of the design and the updated 

sample have been published. 1 J 3 

In 1984, 41,47 1 eligible households were in the NHIS 

sample. Interviews were conducted in 39,996 (96.4 percent) of 

these households, yielding data on 105,290 persons of all ages 

who resided in them at the time of the interview.14 

Supplement on Aging 

One of the objectives of the Supplement on Aging (SOA) 

was to provide finer statistical measures of functional limitations and the presence of chronic health conditions among older 

persons than is provided in the NHIS basic questionnaire. (See 

appendix I.) To produce a broader base for estimating these 

and other critical characteristics of this subpopulation, a sample 

design was developed that permitted collecting the maximum 

amount of information about older people, among whom the 

occurrence of these health “problems” is greatest, namely, 

people 65 years and over. 

Another objective of the SOA was to provide information. 

about older people that could be used as baseline data in measurements of change over time through a later prospective study. 

This longitudinal study was conceived as an assessment of 

change over time both among those older and most likely to 

have problems and also among those less likely to have problems in 1984 but who would move into the critical ages within 

10 years. With this objective of later contact to ascertain 

changes, the age level established for the SOA sample was 55 

years and over. This age level was also determined as appropriate for the SOA because of the need for information about 

age differentials in the ability of the elderly to work and about 

the impact on the work force of early retirement among those 

under 60 years of age; ages 55 years and over provided an 

appropriate age cutoff. 

Because there are a large number of people in the age group 

55-64 years in contrast to the older ages, selecting all of them 

would have yielded more precision than needed to make comparisons with the older group. Further, the SOA entailed a long 

interview and, because there were more likely to be multiple 

persons in households with younger age people, extremely long 

interviews would have resulted because each eligible person 

was interviewed for himself or herself. Because problems among 

younger people are less prevalent than among older ones and 

for the cost savings it provided, it was decided further that including all people in the younger ages in the sample was not 

necessary. 

Consequently, the design of the SOA sample was: 

l A systematic one-half sample of people in the 1984 NHIS 

households who were ages 55-64 years. 

l All people in the 1984 NHIS households who were ages 

65 years and over. 

The selection of sample persons was accomplished by using 

the listing form on the front of the SOA questionnaire (figure 

1). The procedure for selecting the one-half sample of people 

ages 55-64 years was simply listing by age, from oldest to 

youngest, persons 55-64 years and selecting those listed on 

every other line of the listing form. 

4 
I SUPPLEMENT ON AGING SAMPLE SELECTION I 

Use Table A or B as indicated on HIS- 1 Household Composition Page. Circle that letter and enter number below to indicate the order of interview (1 -1’. down RT 64 

from the top of the listing, 2 up from the bottom). Follow this order whenever two or rnore sample persons are at home at the same time. l-i 3-4 

18. Are there any nondeleted persons 65 years old I 5 

or older in the family? I I 0 Yes (list by age (oldest to youngest) in upper portion of appropriate table, 

I mark “SP” box on HIS- 1 for each, THEN 191 

I 2 q No 179) -i 

I 19. Are there any nondeleted persons 55 -- 64 years i 6 

old in the family? I 

1 c Yes (List by age (oldest to youngest) in lower portion of appropriate table, mark “SP” box on 

I HIS- 1 for each “X” person, and begin supplement using the appropriate “order of interview “) CY -I 

I ’ i 2 u No (Segin interview(s) using the appropriate “order of interview”) I 

AC!@ 

1 7-8 

Ill-12 -- 

[ 15-16 

119-20 --- 

123-24 --- 

127-28 ---- 

131-32 --- * 

E5-36 

--_ 

TABLE A _-_ 

Name 

TABLE B -- 

Person Sample 

Age Name Person Sample 

number person number person 

19-10 )( 139-40 141-42 x 

113-14 )( 145-46 x 

17-18 x 147-48 149-50 x 

121-22 )( 151-52 153-54 .- x 

l23,26 x [ 55-56 --_ --. (57-58 ---.---- 

129-30 159-60 161-62 x 

133-34 ---I x k3-64 -.-- 165-66 

[37-38 -- [67-68 169-70 x 

Figure 1. SOA sample selection tables A and 6 

The listing forms were printed on the cover of the SOA 

questionnaire (appendix II), and they provided for selection 

starting with the first line on one-half of the forms and with the 

second line on the other half. People ages 55-64 years were 

listed on the form even though they had been included in the 

NHIS basic household listing procedure. This relisting of 

NHIS basic information was necessary to produce the eligible 

persons listed in the order of oldest to youngest for the SOA 

selection and to permit the SOA record to include all the eligible 

household members. 

Interviewers were given questionnaires with the two selection versions alternated to ensure equal use of both versions. 

Additionally, interviewers were instructed to try to alternate 

between the two sample selection versions if the order of sup 

plies was disturbed or if no persons ages 55 years and over 

lived in the household. 

In addition, to tirther assure randomization in the selection 

procedure and to aid in overcoming position bias in. households 

with more than one selected sample person, the order in which 

the interviewer asked to interview a selected sample person 

was controlled to alternate between top-down and bottom-up 

sequences. 

A similar procedure of listing all people ages 65 years and 

over was followed. However, all of these listed people were 

selected for interview. 

In some households the sampling procedures resulted in 

more than one person being selected for the SOA interview. 

The sample design produced a statistically valid sample of 

Table A. Number of persons for whom interviews for the 

Supplement on Aging were obtained, by age and sex 

Age and sex 

Total.......................................... 

Age 

Number 

16,148 

55-64years............... . . . . . . . . . . . . . . . . . . . . 4,651 

65-74years.................................,.. 7,093 

75-04 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,578 

85 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 826 

Sex 

Male.......................................... 6,793 

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,355 

persons ages 55 years and over living in the NHIS households 

who were interviewed in 1984. It permitted adjustment for 

probability of selection and application of NHIS weighting 

procedures to yield national estimates as well as estimates for 

the four geographic regions defined by the U.S. Bureau of the 

Census and for some large metropolitan areas. 

The number of persons for whom SOA interviews were 

obtained is shown by age and sex in table A. 

Because the NHIS is based on a sample with approximately equal probability of selection, the SOA sample design 

produced, in effect, a distribution for people ages 65 years and 

over in the sample that is about the same as that in the civilian 

noninstitutionalized population. 
Chapter 2 

Questionnaire planning 

and development 

Planning and development of the SOA 

questionnaire 

Planning and development of the Supplement on Aging 

(SOA) questionnaire began in February 1982. The first step 

was to determine the topics to be included. 

Topic suggestions were received from a variety of sources, 

both inside and outside the National Center for Health Statistics (NCHS). Suggestions from outside NCHS came in response to the topic solicitation from the Division of Health 

Interview Statistics and from notifications to interested agencies 

and persons about plans to develop a supplement on aging. 

Suggestions from outside NCHS came from sources such as the 

National Institute on Aging, the Administration on Aging, the 

U.S. Senate Select Committee on Aging, the U.S. House of 

Representatives Special Committee on Aging, the Social Security Administration, voluntary and nonprofit organizations, 

and experts in the field of aging. 

Decisions about topics to include required consideration 

of two major factors: the feasibility of obtaining the data in the 

NHIS interview and the comparability with data to be collected 

in other Center surveys in which information was gathered on 

the elderly population. In the latter context, it was necessary 

for the SOA to include information about the noninstitutionalized population that would be similar to that gathered in the 

National Nursing Home Survey on the institutionalized older 

population, so that by combining the data from the two surveys 

estimates for the total older population would be possible. 

Another important consideration, which helped focus the 

content of the SOA, was the objective of providing information 

that would be useful in determining alternatives to institutionalization when the elderly become impaired. Though crosssectional in character, the SOA information about personal 

and community resources available to the elderly, about functional and health status, and about use of care services would 

be pertinent to this objective. 

However, to assess the relationship between these aspects 

of the lives of elderly people and any later need for institutionalization or other care would require additional data on change 

in status and use of resources to continue independent living. 

Consequently, it was necessary for the cross-sectional SOA to 

be conceived as also being the baseline data source for later 

longitudinal information to study the relationship between 

changes in functional status and living arrangements and the 

path from independent living through dysfunction and institutionalization to death. 

These concepts and objectives provided the guidelines and 

determined the SOA topic coverage. 

Activities to develop the concepts and to conduct the background research on existing surveys and questions dealing with 

the topics suggested for the SOA began in February 1982, 

following the review of topic suggestions. 

The evaluation of the suggestions and the development of 

the first version of the questionnaire involved literature reviews, 

reviews of previous or existing surveys, extensive consultation 

with both agencies and individuals knowledgeable in the suggested topic areas (appendix VIII), and participation in both 

privately and federally sponsored conferences and meetings on 

issues of the aging. 

An NCHS Work Group on Surveys of the Aging (appendix 

VIII), which addressed issues and developed recommendations 

for coordination among the National Nursing Home Survey, 

the National Mortality Followback Survey, and the NHIS 

Supplement on Aging, provided additional input in evaluating 

the topics to be included in the SOA and in guiding the development of the SOA questionnaire. 

The result of the research and investigation of 22 suggested 

topics was the recommendation, made in October 1982, to 

include the following seven areas: 

l Family structure, relationships, support and living arrangemerits?l7 

l Community and social supp~rt.~~@~~~~~~ 

l Occupation and retirement.20v21 

l Conditions and impairments.4v22-27 

l Structural characteristics of housing, activities of daily living (ADL’s), instrumental activities of daily living (IADL’s) 

and special aids.28p2g 

l Regular medical care and nursing home stay.4,28v2g 

l Health opinions and behavior, including the Center for 

Epidemiology Studies-Depression (CES-D) scale as a 

measurement of mental health status, alteration or disturbance of mood, indication of gross memory loss, and 

locus of control. 15p2g-32 

Because the information sought about each person would 

usually be reported most reliably by the sample persons themselves, the respondent rule established was self-response except 

in cases where sample persons were physically or mentally 

unable to respond. In these cases, an adult, preferably living in 

the household, would be accepted as proxy. 

A questionnaire covering the seven topics (appendix III) 

was designed; and it, along with the plan for the first pretest, 

6 
'l\,n. 

was submitted to the Office of Management and Budget 

(OMB) for clearance. The relationship with other surveys was 

one consideration in the design. Wherever reasonable, the items 

used in the questionnaire were drawn from questionnaires of 

other surveys that had already been tested or from surveys that 

had already been conducted. 

Questions from the following surveys were used in designing the first pretest document: 

l National Center for Health Statistics surveys 

The National Health Interview Survey, basic questionnaire and previous supplements. 

The 1976- 1980 Second National Health and Nutrition Examination Survey, OMB 68-RI 502. 

The 1977 National Nursing Home Survey-Resident 

Questionnaire, OMB 68-S75025. 

The 1979 National Survey of Personal Health Practices and Consequences, OMB 68-R1663. 

The 1983 NHANES Epidemiologic Followup Study, 

OMB 0925-0161. 

The 1982-84 National Hispanic Health and Nutrition 

Examination Survey, OMB 0937-0078. 

The 1985 National Nursing Home Survey, OMB 

0937-0114. 

l Other surveys 

- The 1972 Survey of Work Experience, National 

Longitudinal Survey, OMB 1205-0044, U.S. Bureau 

of the Census, Department of Commerce. 

- The 1974 Supplemental Income Survey, OMB 72- 

S73009, Social Security Administration, Department 

of Health, Education, and Welfare (DHEW). 

- The 1974 Survey of Low Income, Aged and Disabled, 

OMB 72-S74005, Social Security Administration, 

DHEW. 

- The 1975 Survey of Institutionalized Persons-Family 

Questionnaire, OMB 41 -S75070, DHEW. 

- The 1976 National Survey of the Aged, conducted by 

the University of Chicago.33 

- The 197 8 Annual Housing Survey, Longitudinal Survey of Housing Adjustments of Older People, OMB 

63-R1656, Department of Housing and Urban Development (DHUD). 

- The 1978 Survey of American Family Life, OMB 

68-S75078, National Institutes of Health, Department of Health and Human Services (DHHS). 

- The 1978 Survey of Disability and Work, OMB 72- 

S77007, Social Security Administration, DHHS. 

- The 1979 Retirement History Survey, OMB 72- 

S70411, Social Security Administration, DHHS. 

- The 1982 Long-term Care Survey, OMB 0990-0021, 

Health Care Financing Agency, DHHS. 

- The 1982 Survey of Work Experience-National 

Longitudinal Survey, OMB 1205-0044, U.S. Bureau 

of the Census, Department of Commerce. 

Pretests 

The National Health Interview Survey (NHIS) pretest 

samples are prepared by the U.S. Bureau of the Census especially for each pretest. Pretest samples are drawn from the 

NHIS sample, which is made large enough to allow such pretests.’ When possible, the pretest samples are drawn from 

communities that are easily accessible to Washington, D.C., 

and have census tracts with population characteristics that are 

most likely to provide enough respondents to test the questions 

and procedures designed for the specific survey. The SOA pretest samples were drawn from census tract listings in communities and from tracts within those communities with a high prevalence or proportion of residents ages 55 and over. 

Two pretests were conducted in the development of the 

Supplement on Aging. OMB approval of the survey was requested in two submissions, the first covering the first pretest 

only and the second covering the second pretest and the full 

1984 NHIS. This procedure was used because of the exploratory nature of the first pretest with a preliminary questionnaire 

that required the experience of actual interviewing to assess 

and determine modifications. 

Bradenton, Fla., was the site of the first pretest conducted 

June 6- 10, 1983. It was selected because it is a popular location 

for retirement, and it has a high proportion of residents who are 

55 years of age or over. 

Eighteen specially selected, experienced NHIS interviewers 

and 22 observers from the National Center for Health Statistics 

and the Bureau of the Census participated in this pretest. Pretest materials that were prepared included questionnaires (appendix III), interviewer manual, training guide, observation form 

and instructions, interviewer debriefing form and instructions, 

and administrative reports and forms. 

Classroom training, conducted by the U.S. Bureau of the 

Census’ Field Division trainer, was held on the first day, followed by 3 days of observed interviewing and a one-half day 

debriefing session. 

Advance letters were mailed to households in the selected 

pretest sample segments. Each household was then visited by 

an interviewer; interviews, however, were conducted only in 

households in which there was at least one person 55 years or 

over. The full NHIS basic questionnaire and the First Pretest 

Supplement on Aging questionnaire were administered in all 

interviewed households. 

The pretest respondents answered the questions according 

to the rule planned for the survey, that is, responding for themselves unless physically or mentally incapable of doing so. If 

more than one person 55 years or over lived in the household, 

all those of eligible ages were interviewed. 

Interviews in the Bradenton Pretest were obtained from 

256 sample persons in 18 1 households. Approximately 20 percent of the test households had more than one sample person. 

Forty-three percent of the interviews were conducted with 

male respondents and 57 percent with female respondents. 

Ninety-two percent of the interviews were with people 65 years 

or over. Noninterviews in the first pretest were negligible. 

Generally, respondents were very cooperative, mentally 

alert, and in relatively good health. 

The length of time for the interview (table B) was greater 

than anticipated and was the most serious problem revealed by 

the first pretest. From the interviewer debriefings, observer debriefings, and tabulations and reviews of the completed pretest 

7 
Table B. Length of interview of the National Health interview 

Survey (NHIS) and of the Supplement on Aging (SOA): Bradenton 

Pretest 

/tern 

Total NHIS basic 

interview interview 

SOA 

interview 

Number of SOA persons 

in household 

One...................... 

Two...................... 

First person. . . . . . . . . . . . . . 

Second person. . . . . . . . . . . 

Minutes per household 

81 .O 24.6 56.4 

123.0 28.5 94.5 

. . . . . * 52.2 

. . . . * . 42.3 

questionnaires, it was discovered that three interrelated problems dominated the first pretest and contributed to the long 

interviews-questionnaire length, perceived repetition of questions, and multiple sample persons per household. 

A principal reason for the long interviews was the seeming 

repetition of nearly similar questions in several topic areas 

such as in the Family Structure and Living Arrangements and 

Community and Social Support sections, and the Activities of 

Daily Living (ADL), the Instrumental Activities of Daily Living (IADL), and the Occupation/Retirement sections. Additionally, some environmental items were asked unnecessarily 

of all sample persons in a household with more than one eligible 

person and were repetitious. 

The Bradenton Pretest produced valuable information 

needed to make revisions in both content and procedures that 

would reduce the length of the SOA interview and still allow all 

persons in households with more than one eligible person to be 

interviewed. 

The major revisions to the first pretest document included: 

Changing detailed questions about living family members 

to ask about children and siblings only. 

Reducing the number of kinds of help received as support 

to ask about financial support only. 

Reducing the inquiry about awareness, knowledge of sponsorship, and long-term and short-term usage of community 

services to recent, short-term usage only. 

Reducing the number of questions about social activities in 

which the sample person participates. 

Eliminating the detailed information about the health condition, if any, for which retirement benefits are received. 

Eliminating obtaining the health condition that causes difficulty performing 10 job-related tasks and measuring existence of difficulty only. 

Deleting questions about use of specific prostheses and 

other physical function aids. 

Reducing the detailed items about use of medical care 

services to asking about doctor visits only. 

Deleting the CES-D scale. In Bradenton, it was discovered 

that the list of items worked well if there was only one 

person present. If another household member was present, 

there was too much interaction between them to obtain 

valid information. 

Eliminating items that repeated NHIS basic questionnaire 

items. 

The questionnaire was revised extensively on the basis of 

the Bradenton experience, and OMB clearance for the second 

pretest and the main study was granted. 

The second pretest, using the shortened SOA questionnaire, was conducted in Wilmington, Del., September 22-26, 

1983. 

Approximately the same number of interviewers and observers attended the Wilmington pretest. Training, interviewing, observation, and debriefing procedures were identical to 

the first pretest. Materials for training and observation were 

rewritten for the second pretest questionnaire and procedures. 

During the second pretest, a total of 234 NHIS basic 

questionnaires and SOA questionnaires were completed. These 

included the following numbers of the two questionnaires, obtained by the mode of interviewing indicated: 

Number Interview method 

161 Both NHIS basic and SOA questionnaires collected 

by observed personal interviewing. 

11 NHIS basic questionnaires collected by observed 

personal interviewing and SOA questionnaires collected by telephone interviewing. 

62 NHIS basic questionnaires only collected by observed personal interviewing obtained in households 

with no persons 55 years or older. 

Telephone interviewing was used for a small portion of the test 

to determine the feasibility of conducting callbacks by this interview mode. 

Though the pretest sample population in Wilmington was 

generally a more diverse and younger group, they were equally 

cooperative. 

The Wilmington pretest revealed that the interview was 

still long, averaging 40 minutes for the SOA. However, problems of redundancy of questions and multiple sample persons 

per household were resolved with the second pretest formatting 

and question revisions. 

Following the second pretest debriefings and questionnaire 

reviews, further modifications were made to the content of the 

questionnaire to reduce the length. The procedure for rotation 

of the order of interview for conducting the SOA in households 

with more than one sample person was developed to help reduce 

the apparent bias of fewer reported conditions and the preponderance of women respondents in the second interview in 

these households. 

The NCHS SOA Work Group (appendix VIII) reviewed 

the Wilmington pretest results and the suggestions for modifications. The work group, made up of members from all survey 

programs in the Center, assisted in making decisions about 

question rewording and deletions to achieve the desired 25- 

minute interview for the final version of the SOA. 

The major revisions in the coverage made as a result of the 

two pretests were: 

l The procedure to ask the items about family structure, 

relationship, and support only once in those households 

with both a husband and wife in the SOA sample. 
The reduction in the number of items about the structural 

characteristics of the residence. 

The simpler version of items about community and social 

support that eliminated specific awareness and knowledge 

questions and addressed only usage of community services. 

The refinement of information obtained about sources of 

retirement income and deletion of questions about the longlest held job. 

The reformatting of ADL’s and IADL’s to make it easier 

for the interviewer to administer and for the respondent to 

answer while still obtaining information about the main 

condition causing difficulty performing the activity. 

The reduction of the number of items about receipt of health 

care to eliminate duplication of basic NHIS questions 

about doctor visits and to allow interviewers to concentrate 

on information about recent nursing home stays. 

The deletion of the CES-D scale. 

Description of the SOA Questionnaire 

The final SOA Questionnaire, resulting from the two pretests and revisions based on these experiences, contains the 

following topic sections (appendix II): 

l Section N, Family Structure, Relationships, Support, and 

Living Arrangements. 

l Section 0, Community and Social Support. 

l Section P, Occupation and Retirement. 

l Section Q, Conditions and Impairments. 

l Section Rl, Activities of Daily Living (ADL’s). 

l Section R2, Instrumental Activities of Daily Living 

(IADL’s). 

l Section S, Nursing Home Stay, Help with Care, and 

Hospice. 

l Section T, Health Opinions. 

l Section U, Condition Pages. 

The final questionnaire contains questions that are comparable to questions on similar topics in other surveys. The 

following listing gives references to the SOA sections and items 

and to the comparable survey: 

SOA section and 

item number(s) 

N Family Structure, Relationships, Support, and 

Living Arrangements 

4a-d-Frequency of 

contact with children 

Comparable study 

1976 National Survey of the 

Aged33 

1985 National Nursing 

Home Survey 

197 l-75 National Health 

and Nutrition Examination 

Study (NHANES) 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

SOA section and 

item number(s)-Con. 

14a-h-Rental, mortgage, value of housing 

0 Community and Social 

support 

4a-f-Social interaction 

P Occupation and 

Retirement 

3a-b, 4,5-Income excluding disability income 

1 Oa-j, 11, 12-Ability 

to perform work tasks 

Q Conditions and 

Impairments 

la-f, 6a-c, 7a, b, 8- 

Visual impairment 

9a-c, lOa-c, llHearing impairment 

12a-m, 13a-e-Selected 

health conditions 

Comparable study-Con. 

1986 NHANES 

Epidemiologic Followup 

Study 

1978 Annual Housing Survey 

1985 National Nursing 

Home Survey 

Survey of Income Program 

Participants (SIPP) 

1976 National Survey of the 

Aged33 

1986 NHANES 

Epidemiologic Followup 

Study 

1982 Survey of Work 

Experience 

1971-75 NHANES 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

1985 National Nursing 

Home Survey 

1982 Survey of Work 

Experience 

1971-75 NHANES 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

1986 NHANES 

Epidemiologic Followup 

Study 

1977 NHIS, Vision 

Supplement 

1985 National Nursing 

Home Survey 

1971-75 NHANES 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

1986 NHANES 

Epidemiologic Followup 

Study 

1977 NHIS, Hearing 

Supplement 

1985 National Nursing 

Home Survey 

1984 NHIS condition lists 

1985 National Nursing 

Home Survey 

1971-75 NHANES 

9 
SOA section and 

item number(s)-Con. 

16a-e-ND1 matching 

Rl Activities of Daily Living 

( ADL’s) 

R2 Instrumental Activities of 

Daily Living (IADL’s) 

S Nursing Home Stays, 

Help with Care, and 

Hospice 

1 a-f-Nursing Home 

Stays 

Comparable study-Con. 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

1986 NHANES 

Epidemiologic Followup 

Study 

National Death Index User 

File Format34 

1985 National Nursing 

Home Survey 

1971-75 NHANES 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

1986 NHANES 

Epidemiologic Followup 

Study 

1971-75 NHANES 

1982-84 NHANES 

Epidemiologic Followup 

Study 

1986 NHANFS 

Epidemiologic Followup 

Study 

1985 National Nursing 

Home Survey 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

SOA section and 

item number(s)-Con. Comparable study-Con. 

2a-b-Care if Needed 

T Health Opinions 

4a-b, 5a-b, 7, 8, 9 

U Condition Pages 

1986 NHANES 

Epidemiologic Followup 

Study 

1985 National Nursing 

Home Survey 

1979 National Study of 

Personal Health Practices 

and Consequences 

1971-75 NHANES 

1982-84 NHANES 

Epidemiologic Initial 

Followup Study 

1986 NHANES 

Epidemiologic Followup 

Study 

1984 NHIS 

1971-75 NHANES 

1982-84 NHANES 

Epidemiologic lnitial 

Followup Study 

1986 NHANES 

Epidemiologic Followup 

Study 

To produce the final version of the SOA Questionnaire 

(appendix II)-one that could be administered in a 25-minute 

coherent, manageable interview that includes all eligible sample 

persons in a household and obtains information on a variety of 

topics pertinent to the objectives of the survey-required the 

efforts of one full-time and two part-time staff members of the 

Survey Planning and Development Branch, Division of Health 

Interview Statistics for 20 months. (See appendix VIII.) 

10 
Chapter 3 

Survey operations 

Data collection 

Interviewing for the 1984 Supplement on Aging (SOA) 

was conducted by the U.S. Bureau of the Census, Field Division, in the standard face-to-face interviewing procedure for 

conducting the National Health Interview Survey (NHIS). (See 

reference 1 for a description of the NHIS procedures.) The 

SOA was administered in the 1984 NHIS sample households 

after the NHIS basic questions were asked of the household 

respondent about all the household members. Because the rule 

for the SOA was self-response if possible, sometimes the original 

respondent continued with the SOA and sometimes the respondent for the SOA was another person who had not participated in the household interview. 

The interview period for the 1984 NHIS and SOA was 

January 9, 1984, through January 6, 1985, with interviewing 

conducted weekly throughout the year. Appendixes I and II 

contain the questionnaires used. 

Interviewer training 

who participated in the development of the supplement (ap 

pendix VIII). 

Training on the SOA for experienced interviewers consisted of 1% days of group classroom sessions in January. Additionally, portions of a 2-hour home study in March, a 3-hour 

home study in June, and the l-day July group training were 

devoted to the SOA. Trained supervisors also trained interviewers as needed during the year. NCHS staff attended both. 

the January and the July group training. 

In addition to the training for experienced NHIS interviewers, the initial training-that is, the basic training on NHIS 

for new interviewers-was modified to accommodate the complex SOA. Historically, the initial training for NHIS interviewers takes about a full week and includes only 1 M days for 

any supplement to be covered. This basic training package was 

modified, and additional time was given for training new interviewers on the SOA. The procedures and concepts included in 

the SOA were more complex than usual, and they required 

thorough knowledge of the NHIS conventions and concepts to 

administer. 

NHIS interviewer training is conducted by the U.S. Bureau 

of the Census, Field Division, and consists of two types: 

Data collection 

Initial training, which is the basic NHIS training for interviewers newly assigned to NHIS either from other 1J.S. 

Bureau of the Census surveys or as new employees. It is 

conducted periodically as the Bureau’s Field Division 

acquires new NHIS interviewers. 

Group training, which is training conducted in weeklong 

classroom training sessions on the current year’s special 

procedures and questions, including supplements. It is 

conducted for interviewers who have been working as 

NHIS interviewers for at least the past year. It is conducted 

at the beginning of the NHIS data collection year in January and again midway through the year. 

In addition to classroom training, NHIS interviewer training includes home study, self-instruction exercises, and observed practice interviewing. Detailed interviewer instruction 

manuals are prepared for both the NHIS basic questionnaire 

and for the supplements. 

For group training sessions covering a supplement or special 

topic questions, a training package is specially written by the 

U.S. Bureau of the Census. Specifications for the training and 

guidance for emphases in the classroom session and home study 

segments are provided by the staff of the Survey Planning and 

Development Branch, Division of Health Interview Statistics, 

A total of 16,697 sample persons in the 39,996 households 

responding to the 1984 NHIS were selected for the SOA interview. The SOA interviews were completed for 96.7 percent of 

the sample, or 16,148 persons. Self-response, which was the 

primary respondent rule, accounted for 89.8 percent and proxy 

response, for 6.9 percent; 3.3 percent did not respond to the 

SOA. Less than 1 percent were partial interviews. Thus, the 

effective response rate was 96.7 (the SOA response rate) X 

96.4 (the NHIS household interview response rate) = 93.2 

percent. 

Data in table C summarize these results by quarter and 

show the breakdown of personal visit and telephone callback 

interviews. 

Weekly monitoring of response rates for each of the census 

regional offices and the national total was conducted throughout 

the interviewing. The nonresponse rate at the outset of interviewing was 4.25 percent, and it increased to 5.88 percent for 

the first quarter. Reasons for nonresponse were analyzed from 

the interviewer memoranda that are required to explain noninterviews and from supervisors’ monitoring interviewers with 

high noninterview rates. The problems of the combined length 

of the basic questionnaire and the SOA and the initial opinion 

of the interviewers that the basic questionnaire was more im11 
Table C, Response rates for the Supplement on Aging (SOA), by quarter and type of response .Y 11, 

I984 Jan. - Apr. - July- Oct. - ;I i 

Item total Mar. June Sept. Dec. I! 

Number of persons selected for SOA .................................... 16,697 4,152 4,247 4,197 4,101 

Percent of sample persons 

Nonresponse ........................................................ 3.3 5.9 2.8 2.3 

Refused .......................................................... 2.7 4.7 2.5 2.2 

Absent1............................................. ............. 0.2 0.4 0.1 0.1 

Incapable1........................................................ 0.1 0.2 0.1 0.0 

Other ............................................................ 0.3 0.6 0.1 0.1 

TotalSOAresponse2 ................................................. 96.7 94.1 97.2 97.7 

Self-response ....................................................... 89.8 89.5 90.5 89.5 

Nocallback ....................................................... 83.5 83.2 83.8 83.3 

Personalcallback .................................................. 3.5 3.8 4.1 3.2 

Telephonecallback ................................................ 2.e 2.5 2.6 0.0 

Proxy response ...................................................... 6.9 4.7 6.7 8.2 

No callback ....................................................... 5.3 3.6 5.0 6.4 

Personalcallback .................................................. 0.9 0.7 1.2 0.9 

Telephonecallback ................................................ 0.7 0.4 0.5 0.9 

Number of persons responding to SOA .................................. 16,148 3,909 4,129 4,101 

‘Outcome dispositions of “Temporarily absent” and “Mentally or physically incapable” were assigned only if there was no proxy respondent available, 

2Because administrative data are used in this table, rates shown differ slightly from those in table D. 

2.3 

1.7 

0.2 

0.1 

0.3 

97.7 

89.5 

84.0 

2.4 

3.1 

7.8 

6.1 

0.8 

0.9 

4,009 

portant than the SOA (performance ratings were based on completed basic interviews only) were addressed. 

Special procedures were implemented to reduce nonresponse. Procedures were implemented during the first quarter 

of the interviewing, and review of the problems and general 

instruction on nonresponse reduction was conducted in the July 

training sessions. 

The procedure changes were: 

l Changing the callback rule to accept proxy response after 

the second personal visit or the first telephone callback. 

This reduced the antagonism of initially willing proxies 

who were told at the early callback they could not be interviewed and then were asked for an interview at a later 

callback. 

l Issuing a warning to interviewers not to take proxies simply 

to avoid refusals. 

l Instructing interviewers to suggest calling back to continue, 

particularly for conducting the SOA, in situations where 

respondent fatigue was apparent. 

l Stressing the importance of a smooth, inconspicuous transition from the NHIS basic interview to the SOA (they 

were separate questionnaires) and the technique of politely 

suggesting that a second SOA sample person might want 

to leave the room and return later as tools for keeping the 

refusal rate to a minimum. 

The impact of providing special procedures to reduce nonresponse was apparent in the second quarter (April-June). 

The results, shown by quarter in table C, indicate that there 

was some increase in proxy interviews after the first quarter, 

but callback interviewing did not increase as much or as consistently with the new procedures. Self-response remained at 

about the same level throughout the interviewing periods. 

An intense effort to reduce nonresponse was made by the 

U.S. Bureau of the Census field staff following the implementation of measures to address this problem. A lower nonresponse 

rate was achieved with implementation of the special proce12 

dures and was maintained for the balance of the year, producing 

the SOA’s final 3.29 percent noninterview rate. (For a discussion of issues in nonresponse applicable to the population of 

the SOA, see references 35 and 36.) 

Quality control: Data collection 

Quality control procedures are followed in data collection, 

data preparation and coding, and in data editing stages of the 

survey operations. Additionally, the quality of the data itself is 

assessed through reinterviewing. 

Quality control procedures 

The interviewer training program and the field quality control procedures are described in detail in other publications.l*14 

Only a brief summary of the field quality control measures that 

applied to the NHIS basic interview and the SOA is presented 

here. 

Observation of interviewers is an important procedure in 

the field. Each NHIS interviewer is observed in a group of 

households in his or her assignment by an interviewer supervisor 

or senior interviewer. An observation report is used to document 

the interviewer’s performance. There are three types of observations: 

l Initial observations are conducted on each interviewer 

newly assigned to NHIS for 2 days on his or her first interviewing assignment, for 1 day on the second assignment, 

and for part of a day on the first listing-of-addresses assignment. (An interviewing assignment is 1 week of sample, 

and it is to be completed within 2 weeks.) 

l Systematic observations are conducted by supervisors on 

all interviewers. One-half of the experienced interviewers 

are observed each quarter, with the halves being rotated 

throughout the four quarters. Systematic observation is 

made on newly assigned interviewers during the first quarter 

following their initial assignment. 
l SpeciaLneeds observations are made by supervisors when 

they determine through the field edit of completed questionnaires and other field monitoring that an interviewer 

might need more training. 

Another quality control activity that is conducted both in 

field and in data preparation stages of the survey is the performance of several types of edits. Field edits are the initial 

edits conducted on the survey data. The three field edits are as 

follows: 

Interviewers are responsible for performing an edit of all 

work, prior to submitting it to the census regional office, 

including checks for completeness, consistency, and legibility of entries. 

The regional office staff performs further edit checks of the 

questionnaires submitted by the interviewers. Specifications 

are prepared by the staff of the Survey Planning and Development Branch of DHIS and the Health Surveys Branch 

staff of the U.S. Bureau of the Census (appendix VIII) for 

these regional office edits that determine the percent of 

work edited and the specific questionnaire content to be 

edited. 

If edit results or observation reports indicate errors, such 

as omissions or inconsistencies, additional editing of the 

individual interviewer’s work is done by the census regional office staff. 

Specifications for conducting these field edits require that 

the work of experienced interviewers receive more editing at 

the beginning of the data collection year when new items (or 

supplements) are first administered. As the year progresses, 

the percent of experienced interviewer work receiving field edit 

is reduced. For interviewers newly working on NHIS, the first 

four assignments are always edited by the regional office staff. 

Reinterviewing 

Approximately 5 percent of all interviews are designated 

for reinterview. The reinterview serves as a check on interviewer 

performance and as a measure of the reliability and accuracy 

of the NHIS and SOA data. 

The content of the reinterview is determined by the DHIS 

Survey Planning and Development Branch staff and, in 1984, 

included questions from both the NHIS basic questionnaire 

and the SOA. (See appendix IV for the content of the SOA 

reinterview.) For each household designated for reinterview, 

the subset of questions is asked (by telephone) by the interviewing supervisor within 2 weeks of the original interview. 

Responses are entered on a form specially designed for reinterviewing. Interviewers are not informed which households are 

reinterview households. 

The reinterview sample is divided into two parts: an 80- 

percent subsample and a 20-percent subsample. In the larger 

subsample, the supervisor carries out reconciliation of the reinterview results with the original interview results. In the smaller 

subsample, no reconciliation of differences is made. In the analysis of the reinterview data, the degree of inconsistency is determined by computer on the processed reinterview questionnaires. 

Quality control: Data processing and 

editing 

Specifications for clerical editing and coding of the SOA 

data by the data preparation staff of NCHS were prepared by 

the Survey Planning and Development Branch design group, 

Division of Health Interview Statistics (appendix VIII). 

Among the specifications for clerically editing and coding 

the SOA were: 

l Cross-checks of identification information about the SOA 

sample person and other household data with the basic 

NHIS information. 

l Codes and coding procedures for verbatim responses, such 

as codes for the equipment used in performing activities of 

daily living and for the relationships of contact persons 

with the sample persons. 

l Edits of condition data entered from the NHIS basic questionnaire to the SOA. 

l Edits of the sample recording and selection. 

l Preparation of noninterview records. 

Quality control of the coding of questionnaire information 

consists of recoding 10 percent of all questionnaires by two 

independent coders. Comparison of all three coding results are 

analyzed to determine if any coder exceeds the acceptable error 

level of no more than 5 percent of the coded items. Indication 

of coding errors requires the supervisor to conduct retraining or 

to review the code development with the questionnaire design 

staff to determine suitability of the codes. 

The quality of the machine keying is maintained by a lOOpercent independent key verification of all items in the questionnaires. After the data are on tape, a third type of edit, computer edits, is performed in the preparation of the final data 

tapes. 

The computer edit checks for inconsistencies and invalid 

responses, provides algorithms for imputation, and generates 

recodes. The specifications for these computer edits are provided by data analysts of the Illness and Disability Branch, 

Division of Health Interview Statistics, who attend the pretests 

and the interviewer training and who work in conjunction with 

the DHIS questionnaire design specialists to ascertain the intent 

and meaning of the questions (appendix VIII). 

The specifications for computer edits for the SOA included 

over 350 decision logic ta.bles designed to perform automated 

tasks for checking the quality of the SOA data, checking its 

consistency with the NHIS basic questionnaire information, 

and developing recodes useful in analytic processing of the final 

user files. 

tion 

0 

l 

The SOA data tapes contain the SOA interview informawith the following record structure: 

A file of person records containing, for each person for 

whom an interview was completed, all items in the NHIS 

basic questionnaire that are on the person file, weights, all 

items in the SOA questionnaire (except the items used to 

permit matching to the National Death Index), special 

recodes, and selected condition and utilization information. 

A file of condition re cords, w ith identifiers that permit 

linkage to the person records, containing all conditions 
mentioned in the SOA interview plus any condition for the 

individual that is related to a “limited activities” status 

from the basic NHIS questions. (Codes: Unable to perform 

major activity, Limited in amount or kind of major activity, 

Limitation in other activities, and Not limited, in position 

7 1 on the SOA public-use person data tape.) 

The detail of the content, coding, and structures of these 

two SOA data record types is contained in the public-use data 

tape documentation. 

Among the computer editing of the SOA data and the 

preparation of the final files, the following two specific edits are 

of note because they make the data easier to use: 

l The first of these is the addition to the SOA condition 

record, which contains reference to data on activities of 

daily living (ADL’s) and on individual activities of daily 

living (IADL’s), of special condition information that was 

reported for the SOA sample person with the ADL or IADL 

trouble. The special information is abbreviated data on the 

condition, or conditions, given in the interview as the source 

of trouble when performing the ADL or IADL. Included 

in the special ADL or IADL related condition information 

is the condition serial number, the International Classification of Diseases (ICD) code,37 an acute or chronic code, 

hospitalization information, how long the person had the 

condition, and the date of the last doctor visit for the condition. 

The second is the inclusion in the condition record file 

information obtained from the basic interview about the 

SOA sample person that indicates whether the sample 

person has any limitation of activity and what condition 

causes that limitation. 

14 
Chapter 4 

Analysis of SOA data 

Estimation 

Weights 

The National Health Interview Survey (NHIS) is designed 

to produce estimates for the civilian noninstitutionalized population residing in the United States. Therefore, the data must 

have weights to inflate the sample numbers to the national estimates. These weights are on all public-use data tapes. 

When creating the weights, the 52 weeks of data collection 

in a year are viewed as the consolidation of four quarters of 13 

weeks each. Each quarter is a national sample and the quarter 

is the fundamental unit for weighting. 

The basic weight for each quarter is the product of four 

factors 

l The inverse of the probability of selection at each stage of 

selection (PSU, segment, household). 

l A noninterview adjustment at the segment level. 

l A first-stage ratio adjustment. 

l A poststratification adjustment to 60 age-race-sex population totals that are provided by the U.S. Bureau of the 

Census for each quarter. 

(A more complete discussion can be found in reference 1.) 

The weights for the basic NHIS were not suficient for the 

SOA, however, for two reasons: 

l The sample for people ages 55-64 years was only a half 

sample. 

l There was, as described in chapter 3, an additional nonresponse on the SOA. 

Therefore, the NHIS weights for each quarter were multiplied by an additional factor to poststratify the SOA to the 

NHIS basic data using the 16 poststratification cells for people 

ages 55 years and over shown in figure 2. This was the equivalent of repeating the fourth factor for the SOA. The result is 

that the national estimates, when the weights on the SOA tape 

Age 

Black Other 

Male Female Male Female 

55-59 years .......... 

60-64 years .......... 

65-74 years .......... 

75 years and over. ..... 

Figure 2. Poststratification cells for the Supplement on Aging 

are used, are precisely the same for each of the specified agesex-race cells as they are when estimated from the NHIS basic 

data tape. As shown in table D, response rates were lower for 

people under 65 years of age than for people age 65 years and 

over, and they were lower in the first than in subsequentquarters. However, as shown in table E, the estimated population in 

each quarter and in each age, sex, and race group is the same 

when derived from either the basic NHIS or the SOA despite 

the difference in the number in the sample. 

The differences in the weights on the SOA tape are transparent to the user. The weights for persons ages 65 years and 

over are similar to those on the basic tape because only the 

additional nonresponse had to be taken into account. The 

weights for persons ages 55-64 years are approximately twice 

as large as those on the basic tape or for people ages 65 years 

and over because of the half sample in the SOA for people in 

that age group (appendix VI, table I). 

The user who links data from the NHIS basic data files to 

the SOA files should remember to use the weights on the SOA 

files instead of those on the basic data tapes. 

Point estimates 

National estimates for most data can be made by using the 

appropriate weight as a multiplier for each record. The basic 

unit for the weights is a quarter, and the files are constructed so 

that estimates can be made for any quarter. If only one quarter 

of data is used, the final basic weight will produce the national 

estimate of the population for that quarter by any characteristic, 

and the weights for events will produce the national estimates 

of the number of events that occurred during the quarter. If two 

quarters of data are used, the population estimates must be 

averaged, but the events are summed so that all events occurring 

during the 6 months are counted. If four quarters (the full year 

of the SOA) are used, the populations are averaged over the 

four quarters, and the events are summed to give a count of all 

events occurring during the year. The weights that average the 

populations and sum the events are on the data tapes. 

Analyses could be done using only the final basic weight 

for the quarter in tape location 20 l-209 and the 6.5 weight in 

tape location 228-236. (Because the data are based on a 2- 

week recall period and there are 13 weeks in a quarter, each 

event must be multiplied by 6.5 to estimate the number of such 

events in 13 weeks.) However, there are also weights that average the population if more than one quarter of data is used and 

there are weights formed by multiplying the frequency count of 

events by the weight that is appropriate for the recall period. 

15 
Table D. Number of persons in the National Health Interview Table E. Sample numbers and population estimates for persons 

Survey (NHIS) and Supplement on Aging (SOA) samples and ages 55 years and over, by selected characteristics: National Health 

Supplement on Aging response rates, by selected characteristics Interview Survey (NH IS) and Supplement on Aging (SOA), 1984 

Charecteristic NHIS SOA 

SOA 

response 

rate 

Characteristic NHIS SOA NHIS SOA 

Sample number 

Total’ ......................... 

55-64’ years. .................. 

65 YEARS AND OVER 

Total .......................... 

Age 

65-74 years. ................... 

75-84 years. ................... 

85 years and over ............... 

Quarter 

Jan.-Mar. ..................... 

Apr.-June. ..................... 

July-Sept. ..................... 

Oct.-Dec. ..................... 

Sex 

Male .......................... 

Female ........................ 

Race 

Other than black. ................ 

Black .......................... 

Family in household 

Alone ......................... 

Unrelated person only. ........... 

Spouse only. ................... 

Other relatives .................. 

Health status 

Excellent. ...................... 

Very good ...................... 

Good .......................... 

Fair ........................... 

Poor .......................... 

Unknown ...................... 

Limitation of activity 

Unable to perform major activity. ... 

Major activity, limited ............ 

Outside activity, limited. .......... 

No limitation .................... 

Hospital episodes 

0 ............................. 

1 ............................. 

2 or more ...................... 

Number in sample 

21,746 16,148 0.96 

9,852 4,651 0.94 

11,894 11,497 0.97 

7,344 7,093 0.96 

3,698 3,578 0.97 

852 826 0.97 

2,887 2,717 0.94 

3,095 3,002 0.97 

2,961 2,895 0.98 

2,951 2,883 0.98 

4,829 4,643 0.96 

7,065 6,854 0.97 

11,002 10,642 0.97 

892 855 0.96 

3,726 3,655 0.98 

137 134 0.98 

6,408 6,162 0.96 

1,623 1,546 0.95 

1,876 1,816 0.97 

2,400 2,335 0.97 

3,727 3,602 0.97 

2,497 2,419 0.97 

1,334 1,274 0.96 

60 51 0.85 

1,285 1,229 0.96 

1,659 1,619 0.98 

1,707 1,667 0.98 

7,243 6,982 0.96 

9,535 9,234 0.97 

1,659 1,593 0.96 

700 670 0.96 

‘Response rates assume that one-half of the NHIS people ages 55-64 years 

were selected for the Supplement on Aging. 

The estimates and tape locations of appropriate weights 

are 

Estimate Tape location 

1. Population by any characteristic 

One quarter of data 201-209 

6 months of data 210-218 

1 year of data 219-227 

Total. .................. 

Age 

55-64 years ............ 

65-74 years ............ 

75-84 years ............ 

85 years and over ........ 

Quarter 

Jan.-Mar. .............. 

Apr.-June .............. 

July-Sept. .............. 

Oct.-Dec. .............. 

Sex 

Male. .................. 

Female ................. 

Race 

Other than black ......... 

Black. .................. 

Family in household 

Alone .................. 

Unrelated person only. .... 

Spouse only. ............ 

Other relative. ........... 

Health status’ 

Excellent ............... 

Very good. .............. 

Good. .................. 

Fair. ................... 

Poor ................... 

Limitation of activity 

Unable to perform major 

activity ................ 

Major activity, limited ..... 

Outside activity, limited . . , 

No limitation ............ 

Hospital episodes 

0 ...................... 

1 ...................... 

2 ormore..;. ........... 

in units 

21,746 16,148 48,485 48,485 

9,852 4,651 22,053 22,052 

7,344 7,093 16,287 16,288 

3,698 3,578 8,252 8,249 

852 826 1,893 1,897 

5,365 3,909 12,07 1 12,07 1 

5,493 4,129 12,101 12,101 

5,522 4,101 12,136 12,136 

5,366 4,009 12,l 78 12,177 

9,405 6,793 21,073 21,072 

12,341 9,355 27,412 27,413 

20,042 14,93 1 44,234 44,255 

1,704 1,217 4,159 4,159 

5,066 4,289 11,312 11,414 

255 188 589 582 

13,860 9,712 30,887 30,997 

2,565 1,959 5,698 5,492 

4,035 2,826 9,010 8,954 

4,628 3,369 10,393 10,342 

6,760 5,030 15,05 1 15,068 

4,053 3,188 8,953 9,103 

2,161 1,665 4,835 4,820 

2,403 1,755 5,367 5,329 

2,789 2,169 6,168 6,260 

2,345 1,985 5,202 5,321 

14,209 10,239 31,749 31,576 

18,159 13,297 40,522 40,534 

2,572 2,018 5,706 5,651 

1 ,015 833 2,257 2,299 

Population estimate in thousands 

‘Responses of “don’t know” are not shown separately. 

NOTE: Sample numbers should not be used to compute response rates because 

of the half sample for ages 55-64 years. 

Estimate-Con. 

2. 12-month recall 

Hospital episodes 

Hospital days: 

Quarter 

Semiannual 

Annual 

Doctor visits: 

Quarter 

Semiannual 

Annual 

Tape location-Con. 

327-335 

300-308 

309-317 

318-326 

273-281 

282-290 

291-2’99 

16 
Estimate-Con. Tape location-Con. 

3. 2-week recall 

Restricted activity days 237-245 

Bed disability days 246-254 

Work-loss days 255-263 

The frequency of the 12-month and 2-week recaZ1 events 

has already been multiplied by the appropriate factor, and the 

weight given above is a variable-specific weight. This enables 

the user to obtain precisely the same estimates that appear in 

NHIS publications without making assumptions about what to 

do about persons for whom some part of the information is 

unknown. For example, these weights take care of cases where 

the week of the doctor visit is unknown and cases where it is 

known that the person had days in bed but the number of days 

is unknown. When using these weights, do not use the variable 

itself as a multiplier; if the variable is used, the variable component will be squared. It is suggested that users compare their 

estimates with the estimates published by NCHS to verify the 

use of the correct weights. 

Weights where the frequency has already been multiplied 

by the appropriate weight are those in tape locations 237-335, 

and they are labeled with the variable name. 

Alternatively, the user can create a new weight by multiplying the frequency of the variable by the appropriate weight. 

This is the only approach for variables such as the number of 

hospital discharges and their associated days or the number of 

acute conditions. These variable-specific weights are not on 

the SOA tapes because the staff of the Division of Health Interview Statistics uses the hospital or condition tapes to make 

estimates, and the weights are on those tapes for the basic NHIS. 

Because the recall period for hospital discharges and the 

associated days is 6 months, the semiannual weight in tape 

locations 210-2 18 should be used. Multiplying the number of 

discharges in tape locations 132- 133 by the weight will produce 

the annual estimated number of discharges. 

A 2-week recall is used for acute conditions. Therefore, 

the correct weight is the 6.5 weight. 

Tape locations for weights and frequency counts are 

Tape Coca tion 

Estimate Weight 

1. 12-month recall 

Hospital episodes 219-227 

Hospital days 219-227 

2. 6-month recall 

Hospital discharges 210-218 

Discharge days 210-218 

3. 2-week recall 

Restricted activity days 228-236 

Bed-disability days 228-236 

Work-loss days 228-236 

Acute conditions 228-236 

Doctor contacts 228-236 

Examples of national estimates 

To 

quarter, 

obtain 

select 

the 

the 

national estimate of the popu 

quarter using tape 

Frequency 

122-123 

124-126 

132-133 

134-136 

98-99 

100-101 

102-103 

118-119 

120-121 

location 5, 

.lation in any 

and multiply 

each record in the quarter by the weight in tape locations 201- 

209. 

To obtain the national estimate of the number of people in 

the year, multiply each record in the entire file by the weight in 

tape locations 2 19-227. 

These are the weights used for estimates for the number of 

people by any population characteristics, such as age, race, 

sex, people limited in activity, people with one or more limitations in activities of daily living, people with one or more children, people married or widowed, or people living in a retirement 

complex. 

To obtain the national estimate of the number of bed days 

in any quarter, select the quarter using tape location 5 and 

accumulate the weights in tape locations 246-254. Altematively, multiply each record by the 6.5 weight in tape locations 

228-236 and by the frequency of bed days in 2 weeks in tape 

locations 1 OO- 10 1. 

To obtain the national estimate of the number of bed days 

in the year, multiply each record in the entire file by the same 

weight, the one in tape locations 246-254. Alternatively, multiply by the 6.5 weight and the frequency. 

Using the weight in tape locations 237-245 will produce 

the number of restricted activity days for a quarter if only a 

quarter of data is used, for 6 months if 6 months is used, or for 

the year if all records are used. The alternative is the same as 

that given above for bed days except that the frequency count 

is in tape locations 98-99. In each case, national estimates are 

produced, but the user can examine seasonal variation in the 

items with a 2-week recall period. 

Examples using the SAS3* are given in appendix VII. 

Variances 

Because of the complex sample design of the NHIS, there 

is clustering in primary sampling units (PSU’s), in segments, 

and in households. The clustering, which is done to reduce costs 

and make such national surveys possible, usually results in 

variances that are larger than those that would have been obtained if the NHIS had been based on a simple random sample. 

This clustered design produces problems for many users 

who are accustomed to using programs, such as the SAS38 and 

Statistical Package for the Social Sciences (SPSS),39 that assume simple random sampling for all variance estimates used 

for confidence intervals or tests of significance. 

There are a number of alternative ways of dealing with 

incorporating the variances in design-based analysis. 

Cures of relative standard errors 

The Division of Health Interview Statistics uses curves of 

relative standard errors for all analyses in Series 10 pub1ications.l 

The curves for 1984 are in Vital and HeaZth Statistics, Current 

Estimates 1984. l4 

These curves in that report can be used without modification for data on persons ages 65 years and over. They must be 

adjusted for persons ages 55-64 years because of the half 

sample. The relative standard errors for data for people ages 

55-64 years can be adjusted reasonably well by multiplying by 

the square root of 2, that is, approximately 1.4. 
In using these curves, one must assume that covariances 

are zero. Such an assumption will result in an overestimate if 

the variables are positively correlated and an underestimate if 

they are negatively correlated. 

Design effects 

The analyst can use design effects to adjust the results 

from analyses that were based on the assumption of simple 

random sampling. The design effect is defined as the variance 

from the complex sample divided by the variance of a simple 

random sample of the same size. For standard errors the square 

root of the design effect is used. 

Some selected design effects for data on the SOA are given 

in appendix VI, table II. They are relatively small. Most are 

less than 1.5, which means that the standard error would be 

about 23 percent larger than if the SOA had been based on a 

simple random sample of the same size. That is, the complex 

sample design did not markedly increase the variance estimates 

that would have been obtained under simple random sampling. 

The relatively small design effects occur because, in general, 

older people do not tend to cluster. They tend to be distributed 

throughout communities rather than living in one particular 

area, and they tend to live alone or with only one other person. 

Moreover, they tend to have chronic conditions, and their disability is associated with chronic conditions. There is relatively 

less geographic or household clustering of chronic conditions 

than of acute conditions. Thus, there is little clustering in PSU’s, 

segments, or households. 

There may also be a social effect that counteracts potential 

household clustering. Two older people who are both disabled 

may not live together because of inability to care for one another. 

The user should not assume that design effects are always 

small. Some design effects are relatively large for the SOA 

variables. In the NHIS they are large for many of the characteristics of children. People with small children tend to live in 

recently constructed housing and, therefore, there is geographic 

clustering. They tend to have more than one child and, therefore, 

there is household clustering, especially if the analyst is using a 

large age group such as school-aged children. Also, acute conditions are more common among children and, given that many 

acute conditions (and the disability days associated with them) 

are communicable diseases, acute conditions will cluster more 

than the chronic conditions (and disability days associated 

with them) that are characteristic of older people. 

Calculating variances 

There are several approaches currently used to calculate 

variances for data from samples with complex sample designs. 

They are: 

l Taylor linearization. 

l Balanced half sample replication (BRR). 

l Jackknife procedures. 

l Bootstrap procedures. 

There is an extensive survey research literature on these 

approaches that should be investigated by the interested user.40v41 

(A good place to begin is with the Proceedings of the Survey 

Research Section of the American Statistical Association.) 

However, the general reader needs only to know that 

l They are asymptotically similar. 

l The first three have been used in publications from the 

National Center for Health Statistics. 

l There are only a few widely available software programs 

to use any of them. 

The general user who does not have access to someone to 

write variance programs is confined to one of the commercially 

available programs. There are, as far as the authors know, only 

three supported software packages. They are: 

l The packages available through the Research Triangle Institute (RTI). All run under SAS and use standard SAS 

statements. There are three programs, SESUDAAN, 

SURREGR, and RATIOEST.42-44 They are separate 

packages that perform different functions. All are based on 

Taylor series approximations. 

l The programs available through the University of Michigan. 

These run under OSIRIS and use OSIRIS statements.45 

They are all incorporated in the complete OSIRIS package. 

Some, such as PSALMS, are based on Taylor series approximations and some, such as REPERR, are based on 

half-sample replication. 

l The program, SUPERCARP, available through the University of Iowa. 46 This program also uses the Taylor series 

approximation. 

SUPERCARP, called PC CARP, is also available for 

microcomputers. 46 The others are not available for microcomputers. 

There are a number of other programs in use by specific 

research organizations or Federal agencies. Some of them have 

advantages that the commercially available programs may not 

have. For example, the BRR program of the National Center 

for Health Statistics takes poststratification into account. 

A recent study on ease of use4’ indicates that the programs 

from the Research Triangle Institute (RTI) take fewer input 

statements from the programmer, and they take less computer 

time than the OSIRIS or SUPERCARP programs or the BRR 

program developed at the NCHS. 

They also run under SAS, which many people have available; have generally good regression programs;43 and are statistically well designed. 

Therefore, the users should evaluate what is available, the 

environment in which they operate, and choose the program 

that is easiest to use under that environment. 

The examples in this report are based on the RTI programs 

in the SAS environment because I 

l They are available at the National Center for Health Statistics. This includes the availability of the program 

GENCAT that can be used for categorical data analysis. 

l They offer the possibility of downloading a variance-co 

variance matrix to a personal computer and using PC SAS48 

for final analysis. 
Considerations of sample design 

The NHIS sample design in use in 1984 consisted of 376 

primary sampling units (PSU’s),’ one in each stratum. All variance programs assume that there were two PSU’s in each stratum. It was necessary, therefore, to create pseudo-PSU’s and 

strata for the calculation of variances. The 298 pseudo-PSU’s 

are1 in tape locations 187-l 89 on the SOA public-use data 

tapes. The user should form pseudostrata by pairing adjacent 

pseudc+PSU’s. For example, PSU’s 1 and 2 form stratum 1, 

PSU’s 3 and 4 form stratum 2, and so forth. 

The SAS statements for forming the strata are in appendix VII. 

A serious problem for the analyst who wishes to estimate 

variances or covariances is that, because the NHIS is essen-• 

tially a self-weighting sample and because the population of the 

United States is not equally distributed among geographic areas, 

there are P.SU’s that have no sample persons in particular 

subdomains of interest. There are, for example, 61 pseudoPSU’s that have no one in the sample who is 85 years or over 

(appendix VI, table III). There are PSU’s that have no black 

males ages 65 years and over, and there are certainly PSU’s 

that have no one with the characteristic of interest for other 

analyses. 

One method of dealing with this problem is to collapse 

PSU’s and strata, that is, to combine them so that each PSU 

has at least one sample person with the characteristic of interest. 

If the analysis of interest is focused on only one population 

characteristic for which there is a problem, such as an analysis 

of data about people ages 85 and over, the analyst can investigate the distribution of the sample by pseudo-PSU’s and 

combine only those where it is necessary. This will preserve as 

much of the sample design as feasible. If the analysis uses 

several such characteristics, more combining may be needed. 

This should be done with great care to preserve the sample 

structure. 

There is, as far as the authors know, little published literature on the impact of extensive combining of strata, but some 

investigation at the NCHS suggests that the effect on the variances may be minimal. 

Strategies for analysis 

After the analyst feels comfortable with the structure of 

the data file and the way the questions have been translated 

into variables on the tape, the analysis of the SOA data can be 

approached in three stages. First. investigate the data without 

weights as if they were derived from a simple random sample. 

Second, incorporate the weights to make national estimates. 

And finally, incorporate both weights and the complex sample 

design. The three stages are shown in figure 3. 

Relationship between the questionnaire 

and the data 

The National Health Interview Survey (NHIS) is a complicated survey, and the variables on the public-use data tape 

reflect that complexity. It is a good idea for the user to check 

the variables on the SOA tape against the questions on the 

Inclusion of 

Stage 

Type of 

arlalysis Sample weights 

~~~~ 

Complex 

sample design 

4 

2 

3 

Preliminary No No 

Weighted Yes No 

Final Yes Yes 

=igure 3. 

complex 

Stages for the 

sample design 

analysis of data from a survey with a 

questionnaire to learn how the questions were translated into 

data. 

There are many skip patterns on the questionnaire, that is, 

the answer to one question leads the interviewer to one of 

several choices for the next question. An answer of “No” or 

“Don’t Know” frequently results in subsequent questions on 

the topic being skipped. Because the questions were not asked, 

the entry on the tape is a blank. The blank means that the 

question was not asked because it was not relevant; it does not 

mean that the data are missing. 

For example, if the answer to the first question for each 

activity of daily living (ADL) about whether the person has 

any difficulty was “No, ” “Doesn’t do for another reason,” or 

“Don’t Know,” all of the rest of the questions about that ADL 

were skipped, and the interviewer started with the next ADL. 

The entries on the data tape for the subsequent questions relating to that ADL are blanks. 

There are many other such examples. Questions about 

children were asked only if there were children. Questions 

about retirement were asked only if the person had ever 

worked. The questions in the section on Health Opinions in 

SOA Section T were asked only of self-respondents. 

The number of the question that is the source of the data is 

on the public-use tape to make it easy to refer to the questionnaire for the specific question. However, if there was a question that determined whether the question of interest was asked, 

it is earlier on the questionnaire. Sometimes it is a checkbox 

that the interviewer marked on the basis of a much earlier 

question. It is advisable to search for such questions and checkboxes, especially if there appear to be many blank responses. 

Preliminary analysis 

Although the SOA was designed to make national estimates, much preliminary investigation can be done on the basis 

of the sample counts. The National Health Interview Survey is 

essentially a self-weighting survey;49 there was no oversampling 

in 1984, and there was no subsampling on the SOA except for 

the half sample of people ages 55-64 years. 

Preliminary, exploratory analysis at this stage has many 

advantages. There is a great deal of information on the SOA 

and. many variables and possible combinations of variables. 

Computer programs for simultaneously examining a number of 

variables under the assumption of simple random sampling are 

widely available. Using these programs, the user can examine 

a lot of information, rank the variables in importance according 

to some predetermined, usually relaxed criterion, and retain 

only those which may statistically differentiate in later analysis. 

19 
The preliminary analysis using sample counts also informs the 

user about the sample size in each cell; this information is essential for making decisions about the final analysis. 

At this stage, estimates of the number of events have little 

meaning. Because of the recall periods used for some of the 

NHIS questions, the user must be extremely careful in interpreting data unless a weight is used. For example, 2-week 

recall questions are used to make estimates of the number of 

events during a 13.week quarter. The number of, say, contacts 

with a doctor in the past 2 weeks must be multiplied by 6.5 to 

produce that quarterly estimate and then summed over the four 

quarters to produce the annual estimate. 

It can be seen from table I of appendix VI that, except at 

the extremes of the distribution, there is not much variation in 

the population weights among people ages 55-64 years or 

among people ages 65 years and over. Therefore, relationships 

among the variables relating to characteristics of persons can 

be investigated with a fair degree of certainty that those relationships will hold for the national estimates as long as there is 

a control for the half sample for ages 55-64 years. Because 

variance from a sample with a complex design are, on the 

average, larger than those for a simple random sample of the 

same size, relationships that are not significant at this stage are 

not likely to be significant when the complex design is taken 

into account. 

Weighted analysis 

Although most computer packages have an option for including weights, the user has to be careful to use the weight that 

is appropriate for each variable. The weights that are on the 

public-use data tapes were discussed in some detail previously 

in this section, and examples of their use are given in appendix 

VII. Using them is essential if the analyst wishes to make inferences about the population of the United States. 

Analysts using standard computer packages and weighted 

data need to remember that most programs assume that the 

weighted population estimate is the sample size when they calculate the test statistics. Therefore, when weights are used, the 

statistical levels are no longer valid. 

Final analysis 

The final analysis should incorporate both the weights and 

the complex sample design, The weights are needed to make 

the point estimates for the population of inference. The complex sample design should be incorporated so that the statistical inferences will be appropriate. 

More detailed discussion of these strategies for analyses 

can be found in Series 2, No. 92 and Series 1, No. 19 of Vital 

and HeaZth Statistics. 49*50 

20 
Chapter 5 

Differences between data files 

from the 1984 NH IS Basic 

Questionnaire and the 

Supplement on Aging 

Weights 

The weights on the Supplement on Aging (SOA) files differ from those on tapes from the basic NHIS as discussed in 

chapter 4. 

The SOA was poststratified to the National Health Interview Survey (NHIS) for the 16 cells (4 age X 2 sex X 2 race) 

used for poststratification of the NHIS. Therefore, population 

estimates for those 16 cells are the same except for rounding. 

The weights for persons ages 65 and over are slightly larger 

on the SOA files than on the files from the basic questionnaire. 

The weights for persons ages 55-64 are slightly more than 

twice as large. 

Respondents 

NH IS basic respondent rule 

The basic NHIS interview is conducted with an adult member of the household who is knowledgeable about the health of 

the household members. This individual is usually an adult 

female household member. 

In addition to this basic respondent rule, the NHIS procedure allows for participation in the NHIS basic interview by 

other household members present at the time of the interview. 

Generally, the NHIS basic interview is conducted with 

one individual as the household respondent. 

The basic NHIS interview also has a reference person 

designated among the household members. This individual is 

one of the household members who owns or rents the dwelling 

unit. The reference person is designated primarily as the basis 

for enumerating household membership; relationships for household members are given in relation to the reference person. 

In households where there was an SOA sample person, 

the basic NHIS information was collected from persons other 

than the SOA sample person in 17.1 percent of the interviews. 

SOA respondent rule 

For the SOA, self-response by the selected sample person 

was the respondent rule. The selected sample person was sought 

for interview by callback, if necessary. An attempt was made 

to interview the sample person alone; a suggestion was made 

that a second sample person might wish to leave and be interviewed after the first. Similarly, it was suggested that other 

household members might not wish to be present. However, 

the practical situation, particularly in SOA households with 

two or more eligible sample persons of older ages, was such 

that both sample persons were usually present during interviews. 

The SOA response rule allowed for proxy response in 

those instances where sample persons were mentally or physically unable to respond for themselves or when the sample 

person was absent during the period of data collection. Of the 

SOA interviews, 8.5 percent were conducted with a proxy respondent. There was a difference in the percent who responded 

for themselves after the first quarter for the reasons discussed 

in chapter 3, Data collection. SOA data users should note that 

younger people and people without limitations in ADL’s and 

IADL’s were likely to answer the questions for themselves 

(table F). 

A cross-classification of self-response and proxy response 

to the SOA by self-response and proxy response to the basic 

NHIS interview is shown in table G. 

Conditions 

Condition lists 

In the NHIS, six condition lists (one for each body system) 

are printed on the questionnaire. One list of the six is used for 

each household. Therefore, the effective sample used to estimate the prevalence of chronic conditions is only one-sixth of 

the 42,000 households. 

In contrast, only one list of chronic conditions was used in 

the SOA. 

The condition list used for the SOA was a compilation of 

conditions from the six condition lists in the NHIS basic 

questionnaire that are most prevalent among people ages 55 

year or over. The interviewer read the entire list aloud. The 

respondent had to answer whether or not the sample person 

had each condition on the list. This differed from the NHIS 

basic interview wherein only one of the six lists is administered 

in each household. 

This use of one list should result in more reliable estimates 

of prevalence for persons ages 55 years and over from the SOA 

than from the NHIS basic data. It also yields the ability to 

investigate multiple conditions. 

Conditions in the SOA, as in the NHIS basic questionnaire, were also derived from responses to questions in addition to those on the condition list, such as cause of trouble with 

the ADL’s and IADL’s. 

Conditions on the condition file 

Only conditions mentioned in response to questions on the 

SOA are on the SOA condition tape, with one exception. The 

exception is that conditions mentioned in response to limitation 

21 
Table F. Number and percent of self-responses to the Supplement Table G. Number and percent of self-responses to the Supplement 

on Aging and number of proxy responses, by selected demographic on Aging (SOA) and number of proxy responses, by type of response 

and health characteristics to the National Health Interview Survey (NHIS) basic questionnaire 

Type of response 

Characteristic Total 

Self- Proxy Selfresponse response response 

Total . . . . . . . . . . . . . . 16,148 14,783 1,365 

Percent 

91.5 

Quarter 

Jan.-Mar. . . . . . . . . . 3,909 3,631 278 92.9 

Apr.-June . . . . . . . . . 4,129 3,792 337 91 .a 

July-Sept. . . . . . . . . . 4,101 3,719 368 90.7 

Oct.-Dec. . . . . . . . . . 4,009 3,641 368 90.8 

Age 

55-64 years. . . . . . . . 4,651 4,284 367 92.1 

65-74 years. . . . . . . . 7,093 6,643 450 93.7 

75-84 years. . . . . . . . 3,578 3,250 328 90.8 

85 years and over . . . 826 606 220 73.4 

Sex 

Male . . . . . . . . . . . . . . 6,793 6,030 763 88.8 

Female . . . . . . . . . . . . 9,355 8,753 602 93.6 

Living arrangement 

Alone . . . . . . . . . . . . . 4,289 4,206 83 98.1 

With others . . . . . . . . 11,859 10,577 1,282 89.2 

Number of ADL’s’ 

with difficulty 

0 .*a a........ m.... 12,893 

1 ,. . . * * * *a. . . * ,, I. 1,317 

2 . . . *a * . * . ..s . . . . . 646 

3 . . . * . . . . .* * . . . . * . 403 

4ormore . . . . . . . . . . 799 

12,159 824 93.7 

1 ,187 130 90.1 

553 93 85.6 

343 60 85.1 

541 258 67.7 

Receives help with 

1 or more ADL’s’ 

0 . . . . . . . . . . . ..a.* 14,853 

1 . . . . . . . . n.,...... 526 

2 . . ..a. * . . . * . . . . . . 255 

3ormore . . . . . . . . . . 514 

13,901 952 93.6 

430 96 81.7 

178 77 69.8 

274 240 53.3 

Number of lADL’s2 

with difficulty 

0 ,...*..*..,.*,..* 12,360 

1 .*..* * e........., 2,113 

2 .* .* . . . * * ., ., , . . . 586 

3 . . . . . . . . *. . . . , .., 325 

4ormore.. . . . . . . . . 764 

11,622 738 94.0 

1,964 149 92.9 

522 64 89.1 

261 64 80.3 

414 350 54.2 

Receives help with 

1 or more IADL’s2 

0 . . * * . . . . . . . * * . . . . 

1 * . . . . . * . * . . . . . , , . 

2 * * . * . . * * . ..I.. , . . 

3ormore . . . . . . . . . . 

13,040 12,270 770 94.1 

1,689 1,557 132 92.2 

484 417 67 86.2 

935 539 396 57.6 

Number of interviews 

‘Activities of -daily living. 

2/nstrumentaI activities of daily living. 

of activity questions in the NHIS basic interview are also on 

the SOA condition file. As a result, almost all conditions on 

the SOA tape are chronic conditions. Acute conditions mentioned in response to NHIS basic questions about restriction of 

activity or physician visits within the previous 2 weeks are not 

Type of 

response to NHIS 

basic questionnaire Total 

Type of response to SOA 

Self- Proxy Selfresponse response response 

Total . . . . . . . . . . . . . . 

Self. . . . . . . . . . . . . . . 

Entirely . . . . . . . . . . 

Partly . . . . . . . . . . . 

Not recorded . . . . . 

Proxy. . . . . . . . . . . . . . 

Percent selfresponse. . . . . . . . . . 

Entirely . . . . . . . . . . 

Number of interviews Percent 

16,148 14,783 1,365 91.5 

13,301 12,953 349 97.4 

12,296 12,066 230 98.1 

1,005 887 118 88.3 

86 61 25 70.9 

2,761 1,769 992 64.1 

82.4 87.6 25.5 80.2 

76.1 81.6 16.8 74.7 

on the SOA condition Ele. The user who wishes touse them will 

have to match to the basic NHIS questionnaire condition file. 

A count of the number of acute conditions is on the SOA. 

person file in tape locations 118-l 19. There will generally not 

be records on the SOA condition file for these conditions. 

Family relationship and number of persons 

Family relationship 

There are two differences in the information about relationships in the SOA and the NHIS basic interview. These 

differences are: 

l The relationships of household members in the SOA are 

relationships to the SOA sample person. 

l The relationships in the SOA are relationships for all 

household members, not only family members of the SOA 

sample person. 

In the NHIS basic interview, family membership and relationships are determined in relation to the reference person. 

As indicated previously, this individual is an adult member of 

the household who owns or rents the dwelling unit. Membership and relationship designations are listed only among those 

persons related by blood, marriage, or adoption. Members of 

the household who are not related to the reference person (individuals for whom a separate basic NHIS questionnaire is 

used) constitute a separate family group from those in the 

initial questionnaire. Consequently, the relationships of these 

individuals are determined in relation to the reference person in 

the second (or subsequent) family group. 

In contrast, in the SOA the relationships of all household 

members are shown to the SOA sample person regardless of 

who owns or rents the dwelling unit (that is, the NHIS reference person). This relationship information in the SOA was 

obtained from the SOA respondent, who was usually the SOA 

sample person. All household members were listed and relationship to the SOA sample person indicated. 

Because the family composition is determined in the NHIS 

basic interview in a way that could exclude possible household 

members who are closely associated with or even responsible 

for the SOA sample person, the SOA interview relisted family 

22 
members, added unrelated household members to the list, and, 

consequently, showed relationships of all household members, 

both family and unrelated, to the SOA sample person. 

Number of persons in the family 

The number of persons in the family living in the household, the individual’s marital status, and several other such 

items that can be derived from either the basic NHIS questions 

or SOA questions do not agree perfectly. 

There are several reasons 

0 The NHIS is a survey of the civilian noninstitutionalized 

population. If a person listed as living in the household is 

found to be a member of the Armed Forces on active duty 

or currently in an institution such as a nursing home, that 

person is deleted from the NHIS basic household roster. 

On the basic NHIS, family size and family relationships 

are coded as if that person does not live in the household. 

On the SOA, where a much more extensive list of questions 

about relationships was asked, such a person was retained 

on the list of household members for relationship coding to 

the SOA sample persons; and relationships given are the 

respondents’ answers. The codes to indicate relationship 

on the SOA were the same codes used for coding relationships in the basic NHIS. 

l The respondents to the basic household interview and the 

SOA were not always the same person. A higher proportion of the respondents to the SOA were self-respondents. 

They could, and in some cases did, give different answers. 

l Despite editing and verification, there are interviewer and 

coder errors on the NHIS. Most are caught and resolved; 

a few probably remain. 

The differences in family size are small (only 2 percent of 

the person records differ, and almost all of those by only 1 

percent), but the analyst should know that they exist and decide 

which to use. The decision may depend on the analysis of 

interest. 

In general, it is believed that the SOA responses are more 

accurate. The SOA respondent may know about a marriage 

long ago that the basic NHIS household respondent did not 

know about. Conversely, an extremely old person answering 

the SOA could have been confused or misunderstood the question. This possibility was minimized by using proxy respondents. 

For consistency with other data from the NHIS, the NCHS 

staff uses family size and whether the person was living alone 

as they are reported on the basic NHIS questionnaire. In any 

analysis, data from the basic questionnaire should be used for 

control variables if the analyst wishes to make comparison with 

other NHIS data. 

23 
Chapter 6 

Prospective studies 

The Supplement on Aging (SOA) was designed as a baseline study for the Longitudinal Study of Aging (LSOA). Specific information was included in the questionnaire to enable 

follow-up of the sample persons (appendix II). This included 

l Questions asking for the name, address, and telephone 

number of a person who would know where the sample 

person would be in the future if the sample person was 

not available at the 1984 location. 

l Questions that provided information necessary to perform 

matches with the National Death Index. 

In addition, the sample persons were informed at the time of 

the 1984 interview of the intention to recontact them in the 

future. 

NCHS is conducting the LSOA in conjunction with the 

National Institute on Aging. The study includes, in addition to 

the information secured from matches with the National Death 

Index, reinterviews with those sample persons, or their proxies, 

who were living in 1986 and will include those alive in 1988. 

Followup through the National Death Index 

The National Death Index (NDI) is a central, computerized index of death record information compiled from magnetic 

tapes submitted under contractual arrangements to the National 

Center for Health Statistics (NCHS) by the State vital statistics offices. These tapes (beginning with deaths occurring in 

1979) contain a standard set of identifying data for each decedent. The data are used in searches of the ND1 to identify 

and locate death records filed in the United States. The ND1 

enables investigators conducting statistical studies to determine 

if persons in their studies may have died; if so, the Index provides the names of the States where the deaths occurred, the 

corresponding death certificate numbers, and the dates of death. 

The ND1 user can then make the necessary arrangements with 

the appropriate State offices to procure copies of death certificates or specific statistical information such as cause of death.34 

The NDI is designed primarily to facilitate prospective 

studies in medical and health research by reducing the time, 

expense, and effort involved in State file searches. In the past, 

investigators conducting such studies have often found it necessary to contact all or most State vital statistics offices, asking 

each to search its files to see if a death record had been filed for 

any individual in the entire study group, Studies of this type are 

frequently very large, including thousands of subjects, because 

the risk under investigation may be small on a per individual 

basis. Furthermore, State vital statistics offices cannot always 

promptly undertake large file searches because of staff limitations. The ND1 provides a convenient computerized source for 

such searches. 

Deaths included in the ND1 file begin with those occurring 

in 1979. The data base management system in which the data 

are stored is updated annually. All State data for a given calendar year are received, processed, and added to the national file 

approximately 12 to 18 months after the end of the calendar 

year. 

Through matching this file annually, the occurrence of 

deaths among the SOA sample people will be discovered. This 

information will provide an important update of the data available in the baseline study, enabling analyses of a number of 

variables from both the SOA and the NDI. For example, cause 

of death can be related to conditions and other health status 

information or to hospital stays or doctor visits indicated in the 

12 months prior to the 1984 SOA interview. 

The followup of the SOA sample through matching with 

the ND1 will be an important aspect of the longitudinal data on 

the older population. 

Other aspects of the Longitudinal Study of 

Aging 

The initial followup of the LSOA is designed to provide 

critically needed information on the paths from health through 

functional disability to institutionalization and death by monitoring changes in living arrangements and functional capacity 

on a continuing basis. These two factors, living arrangements 

and functional status, have been identified as the prime risks 

for institutionalization. If intervention programs are to be designed to reduce institutionalization, the progression from independent living to that status must be studied. 

The purpose of the Longitudinal Study of Aging is twofold 

To study changes in functional status and living arrangements with the hope of recognizing potential points, for 

intervention to prevent institutionalization and provide alternative forms of care to extremely elderly people. 

To study length of life and death rates by characteristics of 

the population that are not reported on death certificates, 

such as education, whether living alone or with others, frequency of contact with family or friends, and other characteristics for which data were collected on the SOA. 

24 
During the initial followup in 1986, LSOA information 

was collected on current living arrangements and functional 

status and any changes in living arrangements (including institutionalization) and functional status since the previous interview for those people still living in the community. Death will 

be verified through matching the NDI. 

The design of the LSOA consists of 

‘Advance mailing of letters explaining the study to sample 

persons ages 70 years and over at the time of the SOA. 

Telephone contact and interviewing in 1986 and in 1988 

among those ages 70 years and over who are still living 

and who have telephone numbers or contact persons. 

Mail contact with a self-administered questionnaire in 

1986 and 1988 among those ages 70 years and over who 

are still living and who do not have telephone numbers or 

contact persons. 

Matches of all SOA sample persons to the ND1 for years 

1984 through 1990. 

Matches of all SOA sample persons ages 65 years and 

over at the time of the SOA interview to medicare files to 

obtain information about hospital usage and cost data. 

The LSOA will provide comprehensive data on the SOA 

Table H. Number and percent of persons in the Longitudinal Study 

of Aging (LSOA) 1986 initial followup reinterview sample, by age 

and race 

Percent 

Age and race SOA’ LSOA in LSOA 

Number of 

sample persons 

Total......,.................. . . . . 7,541 5,151 68.3 

Age in 1984 

70-79 years. . . . . . . . . . . . . . . . . . . . . . . 5,446 3,061 56.3 

80 years and over . . . . . . . . . . . . . . . . . . 2,095 2,090 99.8 

Race 

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,891 4,535 65.8 

All other.. . . . . . . . . . . . . . . . . . . . . . . . . 650 616 94.8 

Black. -... . . . . . . . . . . . . . . . . . . . . . 563 560 99.5 

Other........................... 87 56 64.4 

’ Suppleme nt on Aging. 

sample, indicating changes over a 6-year period. 

The number of SOA sample persons ages 70 years and 

over in 1984 and the number and percent selected for the 

LSOA reinterview are shown in table H. 

25 
References 

‘National Center for Health Statistics, M. G. Kovar and G. S. Poe: 

The National Health Interview Survey Design, 1973-84, and Procedures, 1975-83. Vi’tal and Health Statistics. Series 1, No. 18. 

DHHS Pub. No. (PHS) 85-l 320. Public Health Service. Washington. U.S. Government Printing Office, Aug. 1985. 

2L Breslow: The challenge to health statistics in the eighties, Pub. 

Health Repts. 96( 3):23 l-237, May-June 198 1, 

3H. B. Brotman: Every Ninth American, An Analysis for the Chairman of the Select Committee on Aging, House of Representatives, 

97th Congress. Comm. Pub. No. 97-332. Washington. U.S. Government Printing Office, July 1982. 

4R . Kane and R Kane: Assessing the Elderly. Livingston Books, 198 1. 

5M . G. Kovar: Demographic trends and health care’ implicationsmorbidity and health care utilization. Proceedings of the Second Conference on the Epidemiology of Aging. U.S. Department of Health 

and Human Services, Public Health Service, National Institutes of 

Health. NIH Pub. No. 80-969, July 1980, pp. 317-328. 

6U . S. Department of Health and Human Services, The Federal Council on the Aging, Long-Term Care Committee: The Need for LongTerm Care, Information and Issues, A Chartbook of the Federal 

Council on the Aging, DHHS Pub. No. (OHDS) 8 l-20704. 

‘U . S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Division of Long Term 

Care Policy: DHHS Statistical Plan for Nationally Valid LongTerm Care Data, 1960. Unpublished internal departmental working 

document. 

8U S. Office of Management and Budget, Interagency Statistical Committee on Long Term Care of the Elderly: Data Coverage of the 

Functionally Limited Elderly, 1980. NTIS Pub. No. PB801212558. 

gU S. Senate Select Committee on Aging and National Retired Teachers’Association/American Association of Retired Persons: Survey of 

Delegates to the 1981 White House Conference on Aging: A Preliminary Report, Mar. 1982. 

l”U S Senate Select Committee on Aging: Report on the 1981 White 

House Conference on Aging, Vols. I, II, and III, Staff No. 245-1914, 

1982. 

“L G Branch and A. M. Jette: A prospective study of long-term care 

institutionalization among the aged. Am. J. Pub. Health. 72( 12): 1373- 

1379, Dec. 1982, 

12L G. Branch, S. Katz, K. Kniepmann, and J. A. Papsidero: A prospective study of functional status among community elders. Am. J. 

Pub. Health. 74( 3):266-268, Mar. 1984. 

13National Center for Health Statistics: The statistical design of the 

health household-interview survey by the staff of the U.S. National 

Health Survey and the Bureau of the Census. Health Statistics. DHEW 

Pub. No. (PHS) 582-A2 Public Health Service. Washington. U.S. 

Government Printing Office, July 1958. 

1 4National Center for Health Statistics, P. W. Reis: Current estimates 

from the National Health Interview Survey: United States, 1984. 

Vital and Health Statistics. Series 10, No. 156. DHHS Pub. No. 

(PHS) 86-1584. Public Health Service. Washington. U.S. Government Printing Office, July 1986. 

15L. F. Berkman and L. Breslow: Health and Ways of Living: The 

Alameda County Study). New York. Oxford University Press, 1983. ’ 

16W. E. Broadherd, B. H. Kaplan, S. A. James, E. H. Wagner, et al.: 

The epidemiologic evidence for a relationship between social support 

and health. Am. J. Epidemiol. 117(5):521-537, May 1983. 

17S. M. Thornton and V. Fraser: Understanding “Senility’‘-A Layperson’s Guide. University Without Walls Faculty, Loretto Heights 

College, Denver, Cola. Sept. 1978. 

l*B Sanders: Measuring community health levels. Amer. J. Pub. 

Health. 54(7):1063-1070, July 1984. 

lgR Wilkins MUrb, and 0. B. Adams: Health expectancy in Canada, 

late’ 1970’s: Demographic, regional, and social dimensions. Am. J. 

Pub, Health. 73(9):1073-1080, Sept. 1983. 

20R B. Pearl: Response Effects in Survey Measurement of Net 

Wealth. Contract No. 100-79-0197, HEW. Urbana, Ill. University of 

Illinois, May 1982. 

21Tax Equity and Fiscal Responsibilities Act of 1982, Section 1 (b) 

Part II, Changes in Benefits, Premiums, and Enrollment, 22. Hospice 

Care: Conference Report. 97th Congress, 2nd Session, House of 

Representatives, Report No. 97-760, Aug. 1982. 

22Alzheimer’s Disease and Related Disorders Association, Inc.: A D 

Plight Faces States and Feds. A, D. Newsletter. 6( 1): l-2, Spring 

1986. 

23R . L. Alvin, J. Milton, J. C. Gallager, and B. L. Riggs: The national 

cost of acute care for hip fractures associated with osteoporosis. Clinical Orthopedics. 150:172-176, July-Aug. 1980. 

24K. W. Haase and E. E. Bryant: Development of a scale designed to 

measure functional distance vision loss using an interview technique. 

Proceedings of the American Statistical Association. Social Statistics 

Section, 1973. 

25R . Heller and D. E. Krueger: Validity of a survey question as a 

measure of visual acuity impairment. Am. J. Pub. Health. 73( 1):93- 

95, Jan. 1983. 

26R . A . Owen, L. J. Melton, III, K. A. Johnson, et al.: Incidence of 

Colles’ fracture in a North American community. Am. J. Pub. Health. 

72(6):605-607, June 1982. 

27L . G . Raise: Osteoporosis. University of Connecticut Health Center, 

Farmington, COM. (Draft), 1983. 

26 
28S. Katz, L. G. Branch, M. H. Branson, et al.: Active life expectancy. N. Engl. J. Med. 309(20): 12 1 G- 1224, Nov. 17, 1983. 

29R. A. Whitfield: Health status and survival needs of the elderly. 

Am. J. Pub. Health. 72(8):789-790, Aug. 1982. 

30G. A. Kaplan and T. Camacho: Perceived health and mortality: A 

nine-year followup of the human population laboratory cohort. Am. 

J. Epidemiol. 117(3):292-304, 1983. 

31 J. M. Mosey and E. Shapiro: Self-related health: A predictor of 

mortality and morbidity among the elderly, Am. J. Pub. Health. 

72( 8):800-808, Aug. 1982. 

32D F Sullivan* A single index of mortality and morbidity. HS’MHA 

Health’ Reports. ‘86(4):347-354, Apr. 197 1. 

33E. Shanas: National Survey of the Aged. Prepared for the U.S. 

Department of Health and Human Services, Ofice on Human Development Services, Administration on Aging. DHHS Pub. No. 

(OHDS) 83-20425, Dec. 1982, 

34National Center for Health Statistics: User’s Manual, The National 

Death Index. DHHS Pub. No. (PHS) 8 l-l 148. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1981. 

3sU.S. Bureau of the Census: Response Rates for Elderly Respondents. 

SMIS Bibliography, No. 54. 

36U.S. Bureau of the Census: Nonresponse Bias and Characteristics 

of Non-respondents. SMIS Bibliography, No. 14. 

37World Health Organization: Manual of the International Statistical Classz@ation of Diseases, Injuries, and Causes of Death, Based 

on the Recommendations of the Ninth Revision Conference, 1975. 

Geneva. World Health Organization, 1977. 

38SAS User’s Guide: Statistics, Version 5. Cary, N.C. SAS Institute, 

Inc., 1985. 0 

39SPSS: StatisticaI Package for the Social Sciences. New York. 

McGraw-Hill Book Co., 1975. 

40K. F. Rust: Variance Estimation for Complex Estimators in Sample 

Surveys. Journal of Official Statistics, Vol. 1, No. 4, 1985. 

41 K. M. Wolter: Introduction to Variance Estimation. Springer-Verlag. New York, 1985. 

42B. V. Shah: SESUDAAN, Standard Errors Program for Computing 

of Standardized Rates from Sample Survey Data, Research Triangle 

Park, N.C., Research Triangle Institute, 1981. 

43M. Holt: SURREGR, Standard Errors of Regression Coeficients 

From Sample Survey Data, Research Triangle Park, N.C., Research 

Triangle Institute, May 1977 (revised Apr. 1982). 

44B. V, Shah: RATIOEST Standard Error Program for Computing 

Ratio Estimates for Survey Sample Data. Technical Report, Research 

Triangle Park, N.C., Research Triangle Institute, 1981. 

45Survey Research Center Computer Support Group: OSIRIS IV 

User’s Manual. Ann Arbor, Mich. Institute for Social Research, 

University of Michigan, 1979. 

46M A Hidiroglou W A Fuller, and R. D. Hickman: SUPERCAb, 6th ed. Ames, Iowa: Survey Section, Statistical Laboratory, 

Iowa State University, Oct. 1980. 

47S B Cohen, V. L. Burt, and G. K. Jones: Efficiencies in variance 

estimation for complex surveys. The American Statistician. 40(2): 

157-164, May 1986. 

48SAS for Personal Computers, Version 6. Cary, N.C. SAS Institute, 

Inc., 1985. 

49National Center for Health Statistics, J. Landis, J. Lepkowski, S. 

Eklund, and S. Stehouwer: A statistical methodology for analyzing 

data from a complex survey, the First National Health and Nutrition 

Examination Survey. VitaZ and Health Stutistics. Series 2, No. 92. 

DHHS Pub. No. 82-l 366. Public Health Service. Washington. U.S. 

Government Printing Office, Sept. 1982. 

5oNational Center for Health Statistics: Plan and operation of the 

Hispanic Health and Nutrition Examination Survey, 1982-84. VitaI 

and Health Statistics. Series 1, No. 19. DHHS Pub. No. 85-l 321. 

Public Health Service. Washington. U.S. Government Printing Ofice, 

Sept. 1985. 

27 
Appendixes 

Contents 

I . 1984 National Health Interview Survey Basic Questionnaire . . . . . . . . . . . . ..*................................. 29 

II. 1984 Supplement on Aging Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 

III. Bradenton, Florida, Supplement on Aging Pretest Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 

IV. Supplement on Aging Reinterview Questions. . . . . . . . . . . . . . . . . . . . . ..,...........................,.....*.... 102 

v. Definition of selected terms in the 1984 Supplement on Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 

VI. Selected information about the design and estimation of the 1984 Supplement on Aging. . . . . . . . . . . . . . . . . . . . . . . . . . 108 

VII. Examples using SAS .................................................................................. 112 

Examples of national estimates ....................................................................... 112 

Examples of national estimates with standard errors. ..................................................... 112 

VIII. Consultants and staff of the 1984 Supplement on Aging. .................................................... 114 

Consultants outside the National Center for Health Statistics .............................................. 114 

National Center for Health Statistics, Work Group on Surveys on the Aging. ................................ 115 

National Center for Health Statistics, Division of Health Interview Statistics, Staff for the 1984 Supplement on 

Aging. ........................................................................................... 115 

U.S. Bureau of the Census, Demographic Surveys Division, Staff for the 1984 Supplement on Aging ............ 116 

Tables 

I 

II. 

Annual weights in tape location 219-227 by age: 1984 NHIS Supplement on Aging ............................ 108 

Design effects for selected data on the 1984 NHIS Supplement on Aging. ..................................... 108 

III. Number of sample persons in the 1984 NHIS Supplement on Aging, by pseudoprimary sampling unit and age ...... 109 

28 
Appendix I 

1984 National Health Interview 

Survey Basic Questionnaire 

O.M.B. -. - NO. . 0937-0021 : Approval Expires March 31, 1985 

MCL - Information contained on this form which would permtt ldentlficatlar of any individual or 1. 2. R.O. number 3. Sample 

Iblishment has been collected with a guarantee that it will be held in strict confidence, will be used Book 

1 fog purposes stated for this study, and will not be disclosed or released to others without the consent 

-of 

he individual or the establishment In accordance with section 308(d) of the Public Health Service 

(42 USC 242m). books 

M HIS.1 (1984) 4. Segment type 5. Control number 

.OJl n Area PSU I 

1 Segment I 

U.S. DEPARTMENT OF COMMERCE 

, Serial 

BuREAUOF THE CENSUS Cl Permit I 

ACTING AS COLLECTING AGENT FOR THE 

I I 

U.S. PUBLIC HEALTH SERVICE 

C j Address I 

I : 

NATIONAL HEALTH INTERVIEW SURVEY Cl Cen-Sup I I 

rl Special Place I I 

I I 

0. What is your exact address? (Include House No.. Apt. No., or other identification. I 

1 LISTING 

14. Nonlnterview reason 

county and ZIP code) 

’ SHEET 

I 

TYPE A 

_-_.----- ___. -------- ._-- --------, 

01 0 Refusal - Describe in loolnotes Fill items 

------ -_______ __ _____._._ ------ 

I- 1-6a. 7, 

1 Sheet No. 

02 m No one at home - repeated calls 9 as 

I -.-- -- _.____ ____I_____________ ---_ ____-- ------ ------__---_----- 03 r] Temporarily absent - Footnore applicable, 

City 1 State ( County IZIP code i 04 1) Other (SpecilyJ 

2 

10, 13-15 

I I 

I I I 

I Line No. 

I 

b. is this your mailing address ? (Mark box or specify rf different. Include !- ; Same as 6a 

county and ZIP code.) TYPE 6 

05 r I Vacant - nonseasonal 

____________________-~-------------------------------------~--------- 06 C] Vacant - seasonal 

07 r;) Occupied entirely by 

-------- ___ _______ -_---- -____--- -_---.--- ---__------ ------ ---_- 

City 1 State 1 County ppcoo~; - - - 

persons with URE 

I I I 

08 r] Occupied entirely by Armed 

I I I 

Forces members Fill items 

I l-6a, 7, 8, 

c. Special place name I Sample unit number i Type code . 09 r-’ Unfit or fo be demolished 9 as 

I 

I I 

1 o r--l Under construction, not ready applicable. 

1 I 1 [I 1 Converted to temporary business 10. 12-15 

AREA SEGMENTS ONLY 

I 

or storage 

12 [- ] Unoccupied tent site or trailer 

. YEAR BUILT site 

CT; Ask I 3 [ -i Permit granted, construction 

nor started 

c]I Do not ask 

------------_------s-m-- ___--_-_-----_--_------~-~- __________ ------ --- 1 4 [ --; Other (Specify) 

When was this structure originally built? J 

C: Before 4-I-70 (Continue inlerview) 

[.J After 4-I-70 (Complete item Bc when required; end interview) 

TYPE C 

. COVERAGE QUESTIONS (5 cj Unused line of listing sheet 

r- Ask items that are marked 1 6 [-.I Demo1 i shed 

E; Do not ask 1 7 [I] House or trailer moved 

__----____________-_----------------- --------T-----------------N--Bmw 

I* ry Are there any occupied or vocont living quarters besides 1 8 [-J Outslde seg;lnt F/II /ferns 

l-6a, 8c 

your own in this building? 

f [7.’ Yes (F/i/ Table X) 

business 

] [T, No 

I g C.; Converted to permanent il marked. 

or storage 12-15, Send 

---- --------__----___-----------~~-~~-------~~- --( -_.- ------_-------- 

--- 2 0 [-:.I Merged Inter-Comm. 

1. [I’ Are there any occupied or vocan! living quarters besides I I T-Yes (Fill Table X) 

your own on this floor? -: 21 r-1 Condemned 

! LJ I? No 22c; Built after April I, 1970 

--------____--______----------~---------~--- --1--------------------- 

23 

:. [I ’ Is there any other building on this property for people 

Cl Other (Specify) 

to live in either occupied or vacant? 

1 r-1 Yes (Fill Table Xl 3 

; ;I; No 

: 15. Record of calls 

3. LAND USE I 

’ - URBAN (70) Month i Date 

Beginning Ending Completec 

1 time time Mark (X) 

2 ‘* RURAL 

- Reg. units and SP. PL. units coded 85-88 In 6c - Ask item 9b 1 a.m. a.m. 

I 

- SP PL. units nof coded 85-88 In 6c - Mark “No” in iiem 96 without asking I p.m. p.m. 

__..____________________ 1 ---- -----._--_____ - _____ -------- ____-_- --------_- 

>. During the post 12 months did soles of crops, livestock, and other a.m. a.m. 

farm products from this place omount to $1,000 or more? 

2 

I p.m. p.m. 

1 

(101 

I 

3 1 a.m. a.m. 

I p.m. p.m. 

I 

I 

CLASSIFICATION OF LIVING QUARTERS - Mark by observotion I 

4 a.m. a.m. 

p.m. p.m. 

. LOCATION of unit 1, 

I 

I 

Unit IS: 

I 

01 ;I, House, apartment, flat 

5 I a.m. a.m. 

i- ’ In a Special Place - Refer lo Table 0 in 02 r. HU in nontranslent hotel, motel, etc. 

- Part C ol manual; then complete IOd or e I _ _ p.m. p.m. 

1 

I 

r-‘ NOT In a Special Place /lob) 

03 [: * HU-permanent In transient hotel, motel, erc. 

t ---__------------------------m-e- 04 7. HU In rooming house 

I 6 

a.m. a.m. 

1. Access I 05 f-1 * Mobile home or trailer with no permanent I I p.m. p.m. 

r : Dlrecr (tOd) I room added 

i[ Through another unit (lk) 

I 16. List column numbers of persons requlrlng 

I Ob-- Mobtle home or trailer with one or cal I backs for “Supplement on Aging.” 

I - more permanent rooms added 

I 

-_______ -__-_---w--w----- -- ----- 

t 

07:; 8 HU not speclfled above - Describe 

[Ij None 

:. Complete kttchen facilities . in loofnoles 

___-----_-_-----_ -_------------se I 

c: For lhls unit only (I&f) 1 e. OTHER unit (Mark one) 

I 00 . -- Quarters not HU in rooming or boarding house Column 

I 

Not a separate HW; combine I 09 . - : Unit not permanent in transient hotel, number+ 

with unif through which 

I 

morel, etc. 

access IS galned. (Apply 17. Record of additional contacts 

merged unif procedures if 

, 10 -- Unoccupied tent sire or trailer sure 

I 

1 

add/f/ona/ livrng quarters 

space was Ilsfed separately.) f 

1 1 - - OTHER unit nor speclfled above - Descrrbe I 

fn foolnofes Month I 1 Date Beginning Ei\ding Completec 

time time Col. No. 

1 1 

I 

; P 

- 1 ; T 

a.m. a.m. 

GO TO HOUSEHOLD COMPOSlTlON PAGE 

p.m. p.m. 

1 P 

’ 2 I a.m. a.m. 

, What is the telephone number here? : Area code number 12. Was this Interview observed? 1 T p.m. p.m. 

I I 

1 I _ . No 

P 

None I Yes 2 . a.m. 

.._ 3 I 

, T ;::. p.m. 

. Interv,ewer’s name I Code 1 

I P I 

I 4 I a.m. a.m. 

I I T p.m. p.m. 1 

29 
A. HOUSEHOLD COMPOSITION PAGE 

lo. What ore the names of all persons living or stoying bore ? 

the persons who owns or rents this home. 

Start with the nomo of the person or one of 

Enter name rn REFERENCE PERSON column. 

b. What ore the names of all other persons living or staying here? Enter names in columns. 

c. I hove listed (read names). Hove I missed: 

- ony babies or small children?. . . , . . . . . , . . . . . . , . , . , , , . . . . . , . , , , . . . . . , . 

- ony lodgers, boarders, or persons you employ who live here? . . . . . . . . . . . . . . . . . 

- anyone who USUALLY lives here but is now away from home traveling or in o hospital?. . . . 

- anyone else staying here?. . . . . . . . . . . . . . . . . . . . . . . . . . , , . . , . , , , . , , , , , , 

d. Do oil of the persons you hove named usually live here? C, Yes 12) 

Probe rf necessary: 

C No (APPLY HOUSEHOLD MEMBERSHIP 

RULES. Delete nonhousehold members 

Does -- usually live somewhere else? 

by on “X” from I-C2 ond enter reason.) 

Ask for o/l persons beginning with column 2: 

2. Whot is -- relationship to (reference person)? 

3. What is -- dote of birth? (Enter dote ond age ond mwk sex.) 

I’ REFERENCE PERIODS 

2=WEEK PERIOD Al --m-m ----. -..- --. ..--- ----.__. --..._ ..-__ . . _ __ _ - -- - -. - . . . - .-- ._-.- _.------__ 

124ONTH DATE 

-- - ---.. -. - --- ---.--------------.---------- -------- -- -.-_-- ------- ------ - --.- 

13-MONTH HOSPITAL DATE 

A2 ASK CONDITION LIST-. Use Table -to determine Sample Person(s). Mork “9” box(es). 

A3 I Refer to ages of o/l related HH members. 

lo. Are any of the persons in this fomilv now on full-time active 

duty with the ormod forces? w 

IF- 1 Yes 

-----------we 

b. Who is this? * 

-----.--------------------.------.------------ -..________ 

Delete column number(s) by on “X” from I - C2. 

- - -... -. . --_ . . . . . -_-----_ ---. .-e-.--w. -----.--------------------------- -. 

C. Anyone else? 

----- -------- -em--- _ _. _- - - 

Ask for each person in armed forces: 

[I ? Yes (Reosk 4b and c) 

d. Where does -- usually live ond sleep, here or somewhere else? 

Mark box in person’s column. 

C! No 

---_-_- 

19 

---. 

If related persons I7 ond over ore listed in oddition to the respondent ond ore not present, soy: 

i. We would like to hove all adult fomily members who ore at home take port in the interview. 

Are (names of persons 17 and over) at home now? If “Yes,” ask: Could they join us? (Allow time) 

Reod to respondent(s): 

This survey is being conducted to collect informotion on the notion’s health. I will ask obout 

hospitolitotions, disability, visits to doctors, illness in the family, and other heolth rejotcd items. 

HOSPITAL PROBE 

io. Since ( IEmonth hosprtol dote) o year ogo, wos -- o potient in o hospitol OVERNIGHT? 

-.- - -- _-__ _ __ _.--. . _ __-.._._.--_-_ --- . . . . ---.----- _________- - _.._.--_- ----- -------.- 

b. How many different times did -- stay in any hospital overnight or longer since 

(Ilmonth hospital dote) o year ago? 

Ask for each child under one: 

‘0. Wos -- born in o hospital? 

-----..--------------^____ . . . . ----_-- _--_ .__--_ --- __.._.___ _____.__. _-_ 

A$ &-&o$e> -&d % id: 

b. Hove you included this hospitalization in the number you gave me for --? 

OOTNOTES 

1. First name 43 

1 \ 

Last name sex 

I ilJ M 

2 I;] F 

2. Relationship 

’ REFERENCE PERSON 

3. Date of birth 

Month Date Year 

A3 :I 1 All persons 65 and over (S) 

:I Other (4) _ 

. -_ --. _- . _ _-_ ----- -.-- -0---- 

--_ _ _ _.-- - -.-_ ..-- ---_ -we. -0----a 

7- 

4d. j 1’ Living at home 

1 ------------------------ 

:: Not llvlng at home 1 

60. I : 1 Ye5 

2 i-i No (Mark “HOSP.” box, 

- THEN NP) 

-_--- . - _____-_. -- ----.-___ __..____ 

b. 

Number of times 

(Make entry in 

“HOP.” box, 

THEN NP) 

_-_ _.-.._ ----. ..-_ .--. i .._. __- ---_ 

b. r; Yes (NP) 

c ;;x;Correct 6 and “HOSP.” 

30 
B. LIMITATION OF ACTIVITIES PAGE I 

Bl Refer to oge. Bl 117 18-69(f) 

2 j-1 Other (NP) 

/ t 

1. What was -- doing MOST OF THE PAST 12 MONTHS; working at a iob+or business, 1. I 17 Working (2) 

keeping house, going to school, or something else? 2 c: Keeping house (3) 

Priority if 2 or more octivlttes reported: (I) Spent the most time doing; (2) Considers the most important. 3 ry Going to school (5) 

4 fl Something else (5) 

2a. Does any impairment or health problem NOW keep -- from working at a iob or business? 20. 1 r 1 Yes (7) l-3 No 

-~~~--~~~~-~~~~~~~-~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~,~~~.~~~~~~~~~~~~~~~~~~~~~~~~ 

b. Is -- limited in the kind OR omount of work -- can do because of ony impairment or heolth problem? b. 2 i-y Yes (7) 3 !--; No (6) 

30. Does ony impairment or heolth problem NOW keep -- from doing any housework at all? 30. 4 i : ’ Yes (4) No 

------------^----------------------~--------------------------------------.---,------------------------- 

b. Is -- limited in the kind OR amount of housework -- con do because of any impairment or health problem? b. 5rlYes (4) 6 No (5) 

I 

40. What (other) condition causes this? 

Ask if injury or operation: When did [the (injury) occur?/--hove the operation?] 40. (Enter condition in C2, THEN 4b) 

Ask rf operotion over 3 months ago: For what condition did -- hove the operation? 

If pregnoncy/deIrvery or O-3 months injury or operation - 

1; . . Old age (Mark “Old age” box, 

Reosk question 3 where limrtotion reported, soyrng: Except for -- (condition), . . . ? THEN 4c) 

OR reosk 4b/c. 

-----------__----------------------------------------------------------------~------------------------ 

b. Besides (condttion) is there any other condition that causes this limitation? b. rl Yes (Reask 4a and b) 

p, No (4d) 

-------------------------------------------------------------------------~^--~--_-----------__________ 

c. Is this limitation caused by any (other) specific condition? c. r-1 Yes (Reask 4a and b) 

rT No 

----------------------------------- ~-~~~~~~~~-___~_~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~ 

Mark box if only one condo tion. d. f-7 Only I condition 

d. Which of these conditions would you soy is the MAIN cause of this limitation? 

Main cause 

I 

50. Does any impairment or health problem keep -- from working at a iob or business? So. 1 n Yes (7) (-iNo 

------^------------------------------------- ~~~~~~~~~~~~^__~~~~~____---------~---.~~~~~~~---~~~~~~~~~~-~~~~ 

b. Is -- limited in the kind OR amount of work -- could do becoure of any impairment or health problem? b. 2nYes (7) 31 jNo 

1 

B2 Refer to questtons 30 ond 3b. 

B2 1 r “Yes”in 3a or 3b (NP) 

2 n Other (6) 

. 

60. Is -- limited in ANY WAY in any activities because of on impoirment or health problem? 60. i fl Yes 2 r-- No fNP) 

--_--------------------------- ____________________----------------------------------------------o-----, 

b. In whot way is -- limited? Record limitation, not condition. b. 

Limitation 

, 

to. What (other) condition causes this? 

Ask if rnlury or operation: When did [the (in’ur 

F 

) occur?/--hove the operation?] 70. (Enter condition in C2, THEN 76) 

Ask if operation over 3 months ago: For w at condition did -- have the operation? 

/f pregnancy/delivery or O-3 months injury or operotion - 

1 I--’ Old age (Mark “Old age” box, 

Reosk question 2, 5, or 6 where limitation reported, soying: Except for -‘- (condition), . . .? THEN 7c) 

OR reosk 7b/c. 

____________________------------------------------------------------ ------,---..--------_____C__________ 

b. Besides (condition) is there ony other condition that causes this limitation? b. [ ‘.: Yes (Reash 7a and b) 

y, No f 7d) 

________________________________________-------------------------------------------------------------- 

C. Is this limitation caused by any (other) specific condition? C. !-! Yes (Reash 7a and b) 

cl No 0 ________________________----------------------------------------~----------------- ------------------------ 

Mork box if on/y one condition. d. r Only I condition 

d. Which of these conditions would you soy is the MAIN cause of this limitation? . 

Main cause 

31 
B. LIMITATION OF ACTIVITIES PAGE, Continued 

B3 Refer to age. 

8. What wos -- doing MOST OF THE PAST 12 MONTHS; 

going to school, or something else? 

working ot o job or business, keeping house, 

Priority if 2 or more activities reported: (I) Spent the most time doing; (2) Considers the most important. 

90. Because of ony impairment or health problem, does -- need the help of other persons with -- personal 

core needs, such OS eating, bathin%, dressing, or getting around this home? 

-------___---_----------- -----------------c------------------------------------- 

b. Because of ony impoirment or heolth problem, does -- need the help of other persons in handling -- routine 

needs, such OS everyday household chores, doing necessary business, shopping, or getting around for 

other purposes? 

100. I8 -- able to take port AT ALL in the usual kinds of ploy activities done by most children -- age? 

---_--------- ------ 

b. Is -- limited in the kind OR 

---aamount ----- 

of ploy 

------- m--m--- 

activities -0 con do 

---- 

Louse 

--c--------- ------ 

of any impairment or health 

---- 

problem? 

110. Does any impoirment or health problem NOW keep -- from ottending school? 

--------------------_______________^____--------------------------------- 

b. Does -- ottend o special school or special classes because of any impairment or health problem? 

--------------------____________________--------------------------------- 

c. Does -- need to ottend a special school or special classes because of any impairment or health problem? 

----- ----m-e .----_-- ------ 

limited in school attendance because 

---- - ----- 

of -- heolth? 

120. Is -- limited in ANY WAY in any activities because of on impoirment or health problem? 

-----a---- mm------ m---m- ------- 

b. !n what woy is -- limited? Record limitation, 

---------- 

not condition. 

130. What (other) condition causes this? 

Ask if injury or operation: When did [the (iniury) occur?/--have the operotion’J 

Ask if operotion over 3 months ago: For what condition did -- have the operation? 

If pregnancy/delivery or O-3 months injury or operotion - 

Reosk question where limirotion reported, soying: Except for -- (condition) 3 , . . . . 

OR reosk 13b/c. ---_---------------------------------------------------------------------- 

b. Besides (condition) is there ony other condition that causes this limitation? 

------------------------------------------------------------------------- 

c. Is this limitation caused by any (other) specific condition? 

Mork box if only one condition. 

d. Which of these conditions would you say is the MAIN cause of this limitoiion? 

FOOTNOTES 

83 0.d Under 5 (IO) 2 18-69 INP, 

I ‘1, s-17 (71) 3 70 and 

over 181 

8. 1 ;1 i Working 

2 :I; Keeping house 

3 I-’ .- Going to school 

4 il Something else 

1 12 Yes (73) il_j No 

--_----------------------- 2 : -1 Yes (13) 3 C : No (121 

110. ._ 

I 

I I j Yes (13) _-- ClNo 1 ___----__-------

----- b. 2 1-1 Yes (13) C No 

--- -- _---------__-_--------. 

C. 3 :I! Yes (13) Cl No 

_-- -__-__-__---___--------. 

d. 

1 

4 [ij Yes (73) s c No 

120. 

1 ~~ ~~ 

1:~JYes 2 L; No (NPI 

_-- -__---_-_----__--------. 

b. 

Limitation 

130. (Enter condition in C2, THEN f3b) 

1 !---’ Old a e (Mark “Old age” box, 

THE& 13~) 

----------------------~~~~~ 

b. ,ij Yes (Reask 13a and b) 

r- No (13d) 

-----__--_------~~~~----~-~ 

C. J Yes (Reask 13a and b) 

:] No 

--_-___-_____-------------- 

d. [-A Only I condition 

Mam cause 

32 
B. LIMITATION OF ACTIVITIES PAGE, Continued 

B4 Refer to olc. 

* 

B5 Refer to “Old ore: and “LA” boxes. Murk fmt oporoprmte box. 

b. 

help of other porrons with -- 

this Itom.? 

porrono I 

hip of other persons in handling -- routine 

rbppina, or Wing around for otkr pWpOSOS? 

ISa. What (othar) edition tous 

Ask if rnjury of operution: 

At& if opermron over 3 months 040: For -- hovo ho oporotion? 

If ptcponcy~dclwcry or O-3 months injury or operation - 

Reork ouettion 14 where limitation rmned. saying: Emopt for -- (condition). . . .? 

OR reas& ISbic. --me --------------------------------------------------------------------- 

b. Bosider Icondiuon) is thwo any otkr cmdition that COY~OS &is limitation? 

c. 

--c-------------------------------------- 

Is this linitotiom cousod by l ny (&or) ,pocific condition? 

--c--w ------------------------- 

Mark box if only one condition. 

d. Which of those conditions wooId pu soy ir tk cause of this limitation? 

“I 

BS = “old l #c” bon marked (14) 

c hwy In *‘LA” bon (14) 

2 oww WPl 

140. 1 

t 

c‘ Yes f rsi 2 No 

m-w --_--------------------. 

b. 2 ~Yu s r‘: No (UP) 

150. (Enrw CQdltidn in C2, THEU 7Sb) 

1 @ Old age (U8rk “Old 8@’ box, 

THEN 75~) 

k I c YU tamk 7k md W 

Q NofTSd) 

c Yu (Ramk 7sI o/d b) 

c No 

:OOTNOTES 

33 
I 0. RESTRICTED ACTIVITY PAGE PERSON 1 I 

I ~~~ Hond calendar. 

I tth l noxt quostionr refer to the 2 weeks outlined in red on that colcndor, 

beginning Monday, fel and ending this post Sundoy fdsel.) I 

I I Refer to age. 

01 

1 - Under 5 f4) S-17 (31 I8 and over i/J 

10. DURING THOSE 2 WEEKS, did -- work at ony time at a iob or business, 

not counting work around the house. 3 (inciude,unpoid work in the family 

[form/business] .) 

I r Yes fMork “Wo” box, THEN 2) 2 No 

b. 

---------^---------------..--~-- 

Even though -- did not work during those 2 

have a iob or business? 

-e--m -w----m.---.----_ 

weeks, did -- 

11‘ Yes fMork l ‘Wb” box, THEN 2) 2 !-. i No (41 

~ 20. During those 2 weeks, did -- miss ony time 

or business becouso of illness or injury? 

j <Yes oo 0 No (4) 

from a iob 

b. Outing that 2.week period, how many days did -- miss more 

I than half of the day from -- job or business beca.tse of 

iiinoss or injury? 

001. ; None (4) 

b. During that 2-weok poriod, how many days did -- miss more 

than hoif of tho day from school because of illness or injury? 

I oo :l; None 

40. During those 2 wooks, did -- stay in bed because of illness or injury? . 

L-j Yes oo I: 1 No (6) 

--------------------_________^__________ ---w--s - - 

b. During that 20wook period, how many days did -- stay in bed more 

than half of tho day because of iiinoss or injury? 

02 Refer to 26 and 3b. 

No days in 2b or 3b (6) 

_. I or more days In 2b or 3b (5) 

5. On how many of the fnumber rn 2b or 3bJ days missed from 

[work/schooiJ did -- stay in bed moython holf of the day 

because of illness or injury? 

00 None 

No. of days 

Refer lo 2b. 3b. ond 4b. 

missed from work 

6a. (Not counting the day(s) missed from school 1 1, 

(and) in bed 

Was there any (OTHER) time during those 2 weeks that -- cut down 

on the things -- usually does because of illness or injury? 

Yes 00 No (03) 

missed from work 

b. (Agoin, not counting the day(s) missed from school 

(and) in bed 1 ) , 

During that period, how many (OTHER) days did -- cut down for 

more than half of the day because of illness or injury? 

00 None I No. of cut-down days 

Refer to 2-6. 

03 I__ No days in 2-6 (Mark “No” in RD. THEN Nf’) 

-’ 1 or more days in 2-6 (Mark “Yes” I~I RD. THEN 7) 

Refer to 2b, 3b, 4b, and 6b. 

7a. What (other) condition caused -- to [ $i’$\iied] dw$~~hose 2 

(Enter condttton In CZ, THEN 7b) 

_.^ -- --e--m--------- --------e-s ---_- ._.- ----------__~ 

b. Did any other condition cause -- to [ ~;‘~~;~ed ] ;:;;ti;hat 

t Yes (Reosk 70 and b) 2 No 

FOOTNOTES 

I oo C ! None (6) I 

1 I I 

FORM WIS.1 ‘19941 lll.Q.(13l 

34 
E. 2-WEEK DOCTOR VISITS PROBE PAGE r / 

. I 

Rcod to respondent(s): 

These next questions ore about health care received during the 2 weeks outlined in red on that calendar. 

El Refer to age. 

f--) Under 14 Ilb) 

c I4 and ovel /la) 

(Besides the time(s) you just told me about) During those 2 weeks, did anyone in the family receive health 

care at home or go to a doctor’s office, clinic, hospital or some other place? Include care from a nurse or 

anyone working with or for a medical doctor. Do not count times while an overnight patient in a hospital. 

r:Yes i- ’ No (30) 

--------------------------------------------------------------------------- 

Who received this care? Mark “DR Visrt” box in person’s column. 

---------------------------------------------~---------------------------- 

c. Anyone else? 

____-_---__-__---_____-_____---_--------------~~_--_--------______-“____-- 

: Yes (Reosk 2b and c) ! No 

Ask for each person with “DR Visit” in 2b: 

d. How many times did -- receive this care during that period? 

--------------------- 

T’ OR Vtsit 

30. (Besides the time(s) you already told me about) During those 2 weeks, did anyone in the family get any 

medical advice, prescriptions or test results over the PHONE from a doctor, nurse, or anyone working with 

or for a medical doctor? 

______-_____________----------------------------------------------~~------ 

c ’ Yes L No tE2) ------^-----^^----__--- 

b. Who was the phone call about ? Mark “Phone call” box rn person’s column. r. Phone call 

------------_-------------------------------------------~----------------- 

c. Were there any calls about anyone else? 

_____ - -__-_ -^_------------------------ _-_______ r::~~~!R:_“:~‘_“_o_n_d, ---- ?? --_- -^--------------------- 

Ask for each person with “Phone call” in 3b: 

d. How many telephone calls were made about --? 1 

I E2 I Add numbers In I, Zd, and 3d for each person. Record total number of visits and co/Is in “2-WK. DV” box in item Cl. I 

FOOTNOTES 

35 
F. 2.WEEK DOCTOR VISITS PAGE t OR VISIT I 

Refer to Cl, “2.WK. DV” box. 1 PERSON NUMBER 

Fl Refer to age. 

Fl C; Under 14 (lb) 

E I4 and over (la) 

la. On what (other)date(s)du ring those 2 weeks did -- see or talk to a medical doctor nurse or doctor’s assistant? 

------- ---.------ --- -------------_ - -------- -----2 __._! ________________ 10. 

b. On what (other) dote(s) d uring those 2 weeks did anyone see or talk to a medical doctor, nurse, and - - 

or doctor’s orristant about --? b. Month Date 0000 n Week before 

__________________ -_-__--_.--__-_-__------- -----_ -.--_ _--- - ..--. --- -- --. -..- --___-----_ 4-----------L------. 

Ask after last OR visit column for this person: 

c, Were there any other visits or calls for-- during that period?Mke necessary correction to 2-WK.DV box In Cl. 

2. Where did -- 

place, or was this a telephone call? 

If doctor’s office: Was this office in a hospital? 

If hospital: Was it the outpatient clinic or the emergency room? 

If clinic: Was it a hospital outpatient clinic, a company clinic, a public health clinic, or some 

other kind of clinic? 

If lab: Was this lab in a hospital? 

What was done during this visit? (Footnote) 

Ask 3b if under 14. 

30. Did -- --e-m. actually talk to a medical doctor? 

---- ------e---w---- -----__ _-__- ---_.- --__----__--.-e__._. -__. --_--.--_-- - 

b. Did anyone actually talk to a medical doctor about --? 

------------------------------ ---___- -_-- - -____. ._.____ -. -_. - - - _ .- - __ . 

1 Cj Yes (31) 2 (-1 No (3~) 

8 F; OK if M.D. (3~) 

9 L- OK who was 

seen (311 

- ._ - _- _. _ --_-._-------------------. 

C, What type of medical person or assistant was talked to? 

9s (J OK 

w-e-- _-----------------_- -_--. _________ -------_.----- _-_----_-- 

d. Does the (entry in 3c) work with or for ONE doctor or MORE than one doctor? 

------ ----- ----____________c---- __-_____- ------ ..-. . - 

l . For this &isit/calowhat kind of doctor was the (entry in 3c) working with or for 

practitioner or a specialist? _--___---___------__-----------~----- _____- -_.__ ._-_ _..-- --.- -_.. - 

3 C None (4) 

2 ‘,: ’ Specialist (39) 9 C; OK (4. 

f, Is that doctor a general practitioner or a specialist? 1. 

--------.-a ----a-----__- -_--_- --- 

g. What kind of specialist? 

- -.------ _.-----. . -_ .__-__ -__ - _ - . . -. . -- -_. ----- .--------w---e__-- ____. 

Kmd of specialist 

Ask 46 if under 14. 

40. For what condition did -- see or talk to the [&ctor/(ontry in 3cl on (date in 

_-_-----a--- _--_-~--____----_____-__----__L--.- 

b. For what condition did anyone see or talk to the poctor/(entry in 3cd 

Mark first appropriate box, 

---_------------------------ 

Was 

----_----------- 

a condition found as a result of the ~est(s)/examinationl) ? ---a-------------- -____---------------- -L 

;: Wos this [test/exominatiod because of a specific condition 

---_- 

-- had? 

- -a-------- --- 

During the past iweeks 

___------- ----------------‘- 

l * wos -- sick because of -- pregnancy? 

--_-_--------------------- -__-------_ ___. ---- 

,/)? Mark first appropriate box. 

_ . - . - _ . _ 

about -. 

_ ---.-- 

. . -- - 

- on 

--- 

- - 

(doie-in -I )? 

_. -. 

40. 

and 

b. 

- _. 

- - _- _ _. _ - 

c. 

---.-- --- 

d. 

- .- - - _. - -- 

0. 

- -.-- - 

1 I] Condition (Item C2, THEN 4s) 

2cj Pregnancy (48) 

3 Cl Test(s) or examination (4~) 

0 lz: Ocher @pecify) 

J 

(49) 

. --_._--__-_----.--._.-.-.-___--___-. 

i; ; Yes (4h) 1:; No 

_----------------___------. 

-(- I Yes (4h) 

. T’- ;yes 

- -=‘. 

- . . - - - - - - Lp~~;~ - - - - -. 

-e-v --d-----------e---- _-. 

1. What was the matter? 

1. 

Condition 

f/fern c2, 

THEN 4g) 

-----. --- - _____ __--__----__ ----__---- -- -._-.___- -- _ .- -. ._- - 

g. During th~r&isit~ol~war the uoctor/lentry in 3cfl talked to about-c&y (other) condition? 

. _. _. . - _ - . . _. - - __ - ---..-- ---.--..-- _--___- 

9. *:I Yes 1.1 No (5) 

c___________--------_________c_______ - -_._-.- _.----- --. . ----- ----. -- .-.-..-.-- - -.--- ---.---. -Fe----,- __-. 

h. What was the condition? h. if- Pregnancy (4e) 

(Item C2, 

Condition THEN 40) 

Murk box if “Telephone” in 2. SO. 0 [zj Telephone in 2 (Nexf OR visit) 

Sa. Did -- have any kind of surgery or operation during this visit, including bone settings 1 (1:: Yes 

ond stitches? 2 . 2 No (Next OR visit) 

---e-m-- _______--_----------_____________c_ -----S.-w--.--- --_.. --- 

b. Whot was the nome of the surgery or operation. 3 If name of operation not known, 

describe what was done. 

----- --______-____ --------- -_--..--. --- ------- ---- --_____.-_____ 

C. Was there any other surgery or operation during this visit? 

- --------.--_- -.___ __._ - __________ 

(1) (2) 

- --.-. -----_ -_ ---- _______________ 

;I, Yes iReask 56 and c) 

=L’ No 

36 
G. HEALTH INDICATOR PAGE 

lo. During the 2-week period outlined in red on that c 

from on occident or other 

olendor, 

cause that you hove not yet told 

has anyone 

me about? 

in the family hod on injury 

’ Yes 

. _ 

[I ’ No I2) 

-------- - _- _..---_ -_ _ _ -- - _ -_ ___ _ -._ _.. ^-- - _- ._.._ - 

lb. 

. - . . 

C. 

- .- 

-_ _ 

e. 

- --.-. - .-------_------ 

Iz: lnlury 

__. - - - -.- - - _. - 

b. Who was this? Mark “ln~ury” box in person’s column. 

Enter rnjuryfles) rn person’s column. 

Injury 

-_--.- ---- --- _.-- _--_--_ 

d. Did anyone hove ony other injuries during that period? 

Yes (Reosk lb, c, and d) 

Ask for each Injury rn Ic: 

a. As a result of the (rn ur rn lc) did [--/anyone] see or tolk to a medical doctor or assistant 

(obout -- ) or did -- + cut own on -- usual activities for more than half of o day? 

i - ; Yes (Enter rnjury rn C2, THEN 

le for nexf injury) 

j I No (le for newt rnlury) 

1. During the post 12 months , (thot is, since (12-month date) a year ago} ABOUT how many days did illness 

or injury keep -- in bed more than half of the -(Include doy days while an overnight patient in a hospital.) 

2. 000 c ; None 

No. of days 

000 CA None (3b) 

000 c ’ Only when overnlght 

patient in hospital 

)a. During the past 12 months, ABOUT how many times did [-- /anyone]see or talk to a medico1 doctor 

or assistant (about --)? (Do not count doctors seen while on overnight patient in a hospital.) 

(Include the (qumber in 2-WK DV box) visit(s) you already told me about.) 

30. 

--- 

b. 

No. of visits J 

.----. - -..--_ _.--__. - __ 

b. About how long has it been since [--/anyone] lost saw or talked 

(about --)? Include doctors seen while a patient in o hospital. 

to a medical or assistant t /I; IntervIew week (Reask 3b) 

2 E ! Less than I yr. (Reask 3a) 

3 ‘L’ I yr.. less than 2 yrs. 

4 C, 2 yrs., less than 5 yrs. 

5 Cj 5 yrs. or more 

0 (-” Never 

I. Would YOU say -- health 

g-4 fair, or poor? 

in I is excellent, very good, 1 [-’ Excellent 4 ,. Fair 

2 I-:v ery good 5: Poor 

. . . 

3 iI; Good 

Mark box I f under 18. 

About how tall is -- 

50. 

b. 

I-:_’ Under I8 (NP) 

ia. without shoes? 

Feet Inches 

-.. - .- -- - --. 

b. 

_._. . __ .- -_. - --- - 

how much does -- weigh without 

Pounds ~~ 

FOOTNOTES 

37 
H. CONDITION LISTS 1 AND 2 

love mentioned them before. 

lo. Does onyone in the family {read names} NOW hove - 

If “Yes,” ask Ibandc. - 

20. Does onyone in the family {reod names} NOW hove - 

If “Yes,” ask 2b and c. 

b. Who is this? 

C. Does anyone else NOW hove - 

Enter condition and letter in oppropriote person’s column. 

A-L ore conditions affecting 

b. Who is thi s? 

c. Does onyone else NOW hove - 

Enter condition and letter in ODDroDriote DefSOn’S column. 

A. PERMANENT stiffness or any deformity of the foot, leg, 

fingers, arm, or bock? (Permanent stiffness - joints will 

not move ot oil.) 

. _ - . _ - . - . _ - I 

__-_.--- _____ __- -.._- _--.- -_ -. 

8. Paralysis of any kind? I 

M-AA are impairments. 

Id. hq,UyRlNC THE PAST 12 MONTHS, did anyone in the family 

- If “Yes,” ask le and f. 

e* Who was this? 

f. DURING THE PAST 12 MONTHS, did onyone else hove - 

- 

- 

. - 

. - 

- - 

_ - 

- 

A. Deofnes 

ears? 

- --.. _ - 

,s in one or both 

Enter condition and letter in oppropriote person’s column. P. A missing breast, 

C-L are conditions affecting the bone and muscle. kidney, or lung? __-___-__ __-.--_- -,- - 

M-W ore conditions effecting the skin. 9. Palsy or cerebral palsy? 

(ser’o-brol) 

C. Arthritis of any kind or 

rheumo ti sm? 

I 

_ _ _ _ __ -_ _ _ -. - - -. -. - - -.- 

Reosk Id __ __-_ -_ -.-_ --.- - -_- -I-- 

R. Porolysis of ony kind? 1 

M. A tumor, cyst, or growth 

of the skin? 

__. 

I ._- ___- ----- -_ - t-- 

_._-_-_ -- --.-- -- ---- i- . 

S. Curvoture of the spine? 

---_ ----.--- ..-_ _--- - 

neck, bock, or spine? I 

-.- 

T. REPEATED trouble with 

_ - _ _ - -. _ _ - - -. _ - - __ -.- _. _ I - 

D. Blindness in one or both 

eyes? 

_. -_.-.----_ -_.- -.-- 

E. Cotorocts? 

_. .__- .--_--_- ---- 

D. Gout? 

_ __ __ __.-_---- -- 

N. Skin cancer? 

__ ----- _--_._ -__-_._ i- -. 

0. Eczema or psoriasis? 

(ek’ so-ma) or . 

F. Glaucoma? 

___. __-__---_--_ ._ 

G. Color blindness? 

. _. ------ --- -- --. - 

Il. A detached retino 

other condition of 

retina? 

-- _..-_------_ 

or any 

the 

----- 

E. Lumbago? U. An TROUBLE with 

folren arches or flatfeet? 

_-_---__----.-------- - 

V. A clubfoot? 

_------_ --__- - -- ----- 

W. A trick knee? 

_ -_-------_ - - . . . . - - 

i, ‘PERMANENT stiffness 

or any deformity of the 

foot, leg, or bock? 

(Permanent stiffness - 

joints will not move 

at all.) 

--___ - - --.._---_ -. 

Y. PERMANENT stiffness 

(so-rye-uhesis) 

_.__. -_-__--_. --. _ ^ - 

P. TROUBLE with dry or 

itching skin? I I 

F. Sciotico? 

G. A bone cyst or bone 

spur? 

___-_ 

__-_ -_ - _ _ _. _. _ _ - - - -. - - t-’ 

9. TROUBLE with acne? 

___ _._._ 

I ------_ -- - --i- - I. Any other trouble seeing 

with one or both eyes EVEC 

when wearing glosses? H. Any other disease of the 

bone or cortiloge? 

_______ -_--_-_---_ -- 

R. A skin ulcer?% 

_____ ---.--_.- ___- -. _- 

I 

- 

J. A cleft palate or harelip! 

S. Any kind of skin allergy? _-. - .--_ --_ - ____. I I. A slipped or ruptured ’ 

disc? ._-- -_--. __--- __.._--.. .-- 

T. Dermatitis or any other 

skin trouble? 

_ __ -------_-------- - _,.-_ 

U. TROUBLE with ingrown 

toenails or f ingernoil s? 

-- -----__--__--- .-. _.. - 

V. TROUBLE with bunions, 

corns, or colluses? 

_ _____ -_--_-_ ---- -..- 

W. Any disease of the hair 

or scalp? 

K. Stammering or stuttering? 0 ____. -___-_--- - -._- - I-- 

1. REPEATED trouble with 

neck, bock, or spine? 

or ony deformity of the 

fingers ), bond, or arm? L. Any other speech 

. _._. . -- . _ -_. 

defect? 

-._. - _ _ _ _ . . -. - - 

Z. Mental retordotion? 

_--. . . . --- .- 

& Any condition caused by 

on accident or injury 

which hoppened more than 

3 months ogo? If “Yes,” 

ask: what is the condition? 

4. Loss of torte or. 

which hos losted 

months or more? 

_ _ -. ----_ ---. 

smell 

3 

M. A missing finger, hand, 

or arm; toe, foot, 

or lea? 

A 

38 
H. CONDITION LISTS 3 AND 4 

Read to respondent(s) and OS& list specified in AZ: 

Now I am going to rood o list of medical conditions. Tell mo if onyono in the family has had ony of theso conditions, even if 

hove mentioned thorn beforo. 

30. DURING THE PAST 12 MONTHS, did onyone in the 

family {read names} hove - 

If “Yes,” ask 3b and c. 

b. Who was this? 

c. DURING THE PAST 12 MONTHS, did anyone else hove - 

Enter condition and letter in appropriate person’s column. 

Make no entry in item C2 for cold; flu; red, sore, or strep 

throot; or “virus” even if reported in this list. 

Conditions affecting the digestive system. 

40. DURING THE PAST 12 MONTHS, did anyone in the fomily 

{read names} have - 

If “Yes,” ask 4b and c. 

b. Who was this? 

co DURING THE PAST 12 MONTHS, did anyone else have - 

Enter condition and letter in appropriote person’s column. 

A-6 ore conditions affecting the glondulor system 

C is a blood condition 

D-I ore conditions affecting the nervous system 

1-Y ore conditions affecting the genito-urinary system 

4 

- 

Reask 30 

A. Gall stones? 

_ _- --._ - -_.-. _ _ -- ---- 

N. Enteritis? 

-c 

? 

. 

-. - 

-- 

-- 

_- 

-- 

A. A goiter or other thyroid 

I I 

Reask 40 

trouble? N. Any other kidney trouble B. Any other gallbladder 0. Diverticulitis? 

(Dye-veretic-yoo-lye’tis) ___-__ ------------_ t--j ----- -- --------- --. 

B. Diabetes? 

I I 

0, Bladder trouble? 

C. Cirrhosis of the liver? P. Colitis? ___ -------- .----- -+--d-- ----- ----------_-. 

C. Anemia of any kind? I I P, Any diseose of the 

genitol organs? 

------ ------ ------ -- - ----- -------- t I -----. D. Fatty liver? 9. A spastic colon? 

_ _ -..--- -------. --.---- 

E. Hepatitis? 

-. __.- - _._-----_--__ 

F. Yellow jaundice? 

D. Epilepsy? 

E. REPEATED seizures, 

convulsions, or blackouts? 

Q. A missing breast? 

R. Breast cancer? 

R. FREQUENT 

constipation? 

---_-------------- -- ---------------- I 1 - -- 

S, Any other bowel trouble? 

F. Multiple sclerosis? 

G. Migraine? 

S. * Cancer of the prostate? 

T. *Any other prostate T. Any other intestinal 

G. Any other liver trouble? trouble? 

_.-._ ----.--_.-------- - 

4. An ulcer? 

____-------------- -- ------___-------_-_ 11 U. ** Trouble with 

H. FREQUENT headaches? men8 trua tion? U. Cancer of the stomach, 

intestines, colon or 

I. Neuralgia or neuritis? I I V. ** A hysterectomy? If “Yes,*’ ask: 

I. A hernia or rupture? 

I- 

---. - ----- --_ -- -.--- - 

J. Nephritis? I I For what condition did 

-a hove o hysterectomy? 

1. Any disease of the 

esophagus? 

V. During the post 12 

months, did anyone (else 

in the family h&e any 

other condition of the 

digestive system? 

I we **A tumor, cyst, or 

K. Kidney stones? 

L REPEATED kidney 

t 

growth of the uterus 

------___-------_ _- or ovories? 

-----___---~~--__- 

’ infections? X. ** Any other disease of 

the uterus or ovaries’ - -__- ---------.---I--- --------s--------‘-- 

Y. 

M. A missing kidney? 

** Any other female 

trouble? 

L Gastritis? 

---------------we-- If “Yes,” ask: Who 

was this? - What was 

-. FREQUENT indigestion? 

I the condition? Enter 

in item C2, THEN 

reask V. ‘Ask only if males in family. 

“*Ask only if females in family. 

A. Any other stomach 

trouble? I J 

39; 
H. CONDITION LISTS 5 AND 6 

Read to respondent(s) and ask list specified in AZ. 

Now I om going to read a list of medical conditions. Tell me if anyone in the family hos had any of these conditions, even if 

you hove mentioned them before. 

I I 5a. Hos onyone in the family {reod names} EVER had - 

/f “Yes,” ask 5b and c. 

I.1 

60. DURING THE PAST 12 MONTHS, did anyone in the family 

{read names} have - 

If “Yes, *’ ask 6b and c. 

Who was this? b. Who was this? 

C. Hos anyone else EVER had - 

Enter condition and letter in appropriote person’s column. 

Conditions affecting the heort and circulatory system. 

I I 1 

A. Rheumatic fever? 

._-__------------ -1 I G. 

-- --- 

A stroke or a 

cerebrovascular accident? I 

6. Rheumatic heart disease? I I (ser’o-bro VQS ku-lar) 1 

._-_--------------- +--t-------------------j 

c. Hardening of the arteries 

or arteriosclerosis? I H. A hemorrhage of the 

brain? 

__-_--------------- j--+-------------- ---- 1 

D. Congenital heart disease. 

1 I 

I. Angina pectoris? 

.___-_------------- --- (pek’to-ris) I 

E. Coronary heort di scare? 

__----------------- 

J. A myocordial 

infarction? 

F. Hypertension, sometimes --------..--------- 

called high blood 

I t 

K. 

pressure? 

Any other heart 

attack? 1 

Sd. DURING THE PAST 12 MONTHS, did anyone in the 

family have - 

If “Yes,” ask Se and f. 

l . Who was this? 

1. DURING THE PAST 12 MONTHS, did anyone else have - 

Enter condition and letter in oppropriote person’s column. 

Conditions affecting the heart and circulatory system. 

L. Damoged heort valves? 

.___d__ ---- --------+--- 

M. Tochycardio or rapid 

heart? 

__-------s-w _------ --- 

N. A heart murmur? 

_- _______---------- 1 --- 1 

0. Any other heart trouble? 1 

Q. Any blood clots? 

_-----_-------- 

R, Varicose veins? 

--------------- 

S. Hemorrhoids or 

piles? 

----_----__-___ 

T. Phlebitis or 

thrombophlebitis? 

__--------------w-s +--c-----------------..-+--~. 1 

P. An aneurysm? 

(an yoo=ritm) 

U. Any other condition 

affecting blood 

circulation? 

b. 

C. DURING THE PAST 12 MONTHS, did anyone else have - 

Enter condition ond letter in oppropriote person’s column. 

Make no entry in item C2 for cold; flu; red, sore, 

throot; or “virus” even if reported in this list. 

or strep 

Conditions affecting the respiratory system. 

Reask 60. 

A. Bronchitis? K. A missing lung? 

_--_-------__-----~--~-----------~------- 

B. Asthma? L. Lung cancer? 

_____-------------~--~------~-~--~------- 

C. Hay fever? M. Emphysema? 

________----------~--~--------~---------- 

D. Sinus trouble? N. Pleurisy? 

__________-_____--~____________________-- 

E. A nosal polyp? 0. Tuberculosis? 

_- -__- --_----------,----_--- -_------------ 

F. A deflected or deviated P. Any other work. 

nasal septum? related respiratory 

condition, such as 

-------------------.--- 

dust on the lungs, 

G. *Tonsillitis or enlorge- silicosis, asbestosis, 

ment of the tonsils or or pneu-mo-co-ni -o-si s? 

adenoids? 

H. * Laryngitis? 

Q. During the past 12 monthr 

did anyone (else) in the _----------------- t---l family.have.any other 

I. A tumor or growth of 

the throat, larynx, or 

trachea? 

I 1 

respiratory, lung, or 

pulmonary condition? 

If “Yes,” ask: Who wos 

___--------------_ -- this?-What was the 

J. A tumor or growth of 

’ I 

condition? Enter in item 

the bronchial tube I C2, THEN reosk Q. 

or lung? I I 

“If reported in this list only, ask: 

- 

-- 

.-- 

-- 

-- 

-- 

_-- 

- 

I. How many times did -- have (condition) in the post 12 months? 

If 2 or more times, enter condition in item C2. 

If only l time, ask: 

2. How long did it lost ? If I month or longer, enter in item C2. 

If less than I month, do not record. 

If tonsils or odenoids were removed during post I2 months, 

enter the condition causing removal in item C2. 
I J. HOSPITAL PAGE HOSPITAL STAY 1 I 

1. Refer to C I, “HOSP.” box. 

1. PERSON NUMBER 

2. You said earlier that -- was a potient in the hospital Month Date Year 

ago. On what date did -- enter the hospital ([the last 

Record each entry dote in o separate Hospital Stay column. 2. 

1 lo3. Hew many nights was -0 in the hospitol? 3. 0000 @ None (Next HS) 

Nights 

4. For what condition did -- enter the hospitol? 4. 1 0 Normal delivery 

l For delivery osk: l For newborn ask: oFor initial “No condition” ask: 2 c] Normal at birth (5) 

Was this o normal delivery ? Wos the boby normal ot birth? Why did -- enter the hospital? 3 0 No condition 

> 

/f “No,” osk: If “No.” ask: l For tests, ask: 0 Condition 

What wos the matter? Whot wos the motter? Whot were the results of the tests? 2 

If no results, ask: 

Why were the torts performed? 

Jl 0 At least one ni 

38 

ht in l-week 

Jl 

reference per8 (Enter ConUition 

Refer to questions 2, 3, and Z-week reference period. 

in C2, THEN 5) 

n No nights in l-week reference period (5) 

So. Did -- have ony kind of surgery or operation during this stay in the hospitol, 

including bone settings and stitches? SO. i 0 Yes 2 n No (6) 

-------------------i-----------.------------------------------------..---------------------------------- 

b, What wos the namo of the surgery or operotion? 

If nome of operation not known, describe what wos done. be (1) 

(2) 

(3) 

_---_---_-----------_______L____________---------------------------..---------------------------------- 

C. Was there any other surgery or opemtion during this stay? 

C* 0 Yes (Rersk 56 and c) ci No 

6. What is the name and oddresr of this hospital? 

Name 

6. 

Number and street 

City or County State 

41 
CONDITION 1 

1. Name of condition 

1 PERSON NO.- 

Mark “2.wk. ref. 

in c2 us source. 

pd.” box without asking if “LIP” or “HS” 

2. When did [--/anyone] last see or talk to a 

about -- (condition)? 

0 q Interview week (Reask 2) so 

1 C; 2-wk. ref. pd. - 63 

2 0 Over 2 weeks, less than 6 mos. ‘Li 

--- 

3 0 6 mos., less than I yr. 

4 E I yr.. less than 2 yrs. 

doctor or assistant 

2 yrs., less than 5 yrs. 

5 yrs. or more 

Or. seen. OK when 

-- ---__-_ _---------- 

OK 11 Dr. seen 1 

Dr. never seen I 

(36) 

30. (Eorlior you told me about -- (sonditioo)) Did the doctor or assistant 

call the (gondition) by a more technical or specific name? 

1 EYes 2 0 No 8 u OK 

------------____-------------------------------- 

Ask 3b if “Yes” in 30, otherwise transcribe condition nome from 

item I without asking: 

b. What did he or she call it? 

%=I fv 

1 0 Color Blindness (NC) 2 0 Cancer Pel 

3 0 Normal pregnancy. 

normal delivery, 

vasectomy 

> 

(5) 

4 n Old age (NC) 

8 m Other (3~) 

__________------------~~~------------ z---------.. 

c. What was the cause of -- (condition in 3b)? (Specify) 

3 

Mark box if occident or injury. o [<: Accident/injury (5) 

d. Did the [condition in 3b) result from an accident or injury? 

1 z Yes (5) 2 CJNo 

---------------------------------- 

A;k%,~%-~o$-b$n name in 3b includes ony of the following words: 

Ailment 

Bod 

Concor 

Condition Disorder 

Disoose 

l . What kind of (condition in 3b) is it? 

Specify 

------- ____________ _--_______________ 

Askif-oiiy-ifbi;rgy or stroke in 36-e: 

f. Mow does the [allergy/stroke] NOW affect --? (Specify) 

3 

For Stroke, fill remainder of this condition page for t;e first present 

effect. Enter in item C2 ond complete a separate condition page for 

each odditionol present effect. 

Ask 3g if 

following 

there is on impoirm,Fnt 

entries in 3b-f: 1 

Abscess 

Ache (except head or ear) 

Blooding (oxcopc mons+to!) 

Blood clot 

Boil 

Cancer 

Cromps (except menstrual) 

Cyst \ 

(refer to Cord Cq2) or any, of the 

Domoge 

Growth 

Homorrhogo 

Info&on 

lnflommotion 

Neuralgia 

Neuritis 

Pain 

g. What port of the body is affected? 

Palsy 

Paralysis 

Rupture 

Soro(ners) 

Stiff(noss) 

Tumor 

U leer 

Voricoso veins 

Wook(noss) 

Shoti the folloning detail: 

Hood. ................................ skull, SCQ~P, foe . 

Bock/spino,‘vertebroo .................... .uppor, middle, Iuwor 

Side. ..................................... loft or right 

Eor ........................ innor or outer; loft, eight, or both 

Eye. ................................. left, right, or both 

Arm.. ...... shouldor, upper, elbow, lowor or wrist; loft, right, or both Hond '. .............. l nriro hand or fingers only; left, right, or both 

Leg. ........... hip, upper, knee, lowor, or onklo; left, right, or both 

Foot ............ entire foot, arch, or toos only; loft, right, or both 

-- _-----------. 

E;ceptfo; ii&r &&,&-in~e%i oig&i, >sk % if-there ore any of the 

following entries in 3b-f: 

Infection Sore Soreness 

h. What part of the (part of body in 3b-g) is affected by the [infection/ 

sore/soreness] - the skin, muscle, bone, or some other part? 

Specify 

Ask if there ore any of the following entries in 3b-f: 

Tumor Cyst Growth 

4. Is this [tumor/cyst/grawtU malignant or benign? 

- . 1 L-1 Malignant 2 [.. 1 Benign 9 ;z OK 

a. When was 

r 

-- (condition in 36/3f) 

first noticid? 1 1 CJ 2-wk. ref. pd. 

2 ci Over 2 weeks (0 3 months 

5 I - ----.----_ 

---- -- --_ I 3 L\ Over 3 months to I year 

b. When did -- L (nome of injury in J 4 C 1 Over I year to 5 years 

&)? 5 CJ Over 5 years 

Ask probes as necessary: 

(War it on or since (first dote of 2-week ref. period) 

or was it before that date?) 

(Was it less than 3 months or more than 3 months ago?) 

(Was it less than 1 year or more thon 1 year ogb?) 

(Was it less than 5 years or more than 5 years ago?) 

42 
Reter lo FiD and C2. 

Kl r* I ,,y,,*. ln 

E ; Other (K2) 

“RD” box AND more than I condition’m C2 (6) 

60. During the 2 weeks outlined in red on thot calendar, did -- (condrtion) 

cause -- to cut down on the things -- usually does? 

i-; Yes C ; No (K2.I 

-----we-.-. .--- ---..- -------- ----. ---..--.- --- 

b. During thot period, how many days did -- cut down for more than holf 

of the day? 

00 c.: None (K2) - Days 

7. During those 2 weeks, how many days did -- stay in bed for more than 

half of the day because of this condition? 

00 0 None Day 5 

Ask if “Wo/Wb” box morked in Cl : 

8. During those 2 weeks, how many days did -- miss more than half of 

the day from -- iob or business because of this condition? 

00 c None -Days 

Ask if age S-17: 

9. During those 2 weeks, how many days did -- miss more than half of the 

day from school because of this condition? 

00 L-1 None -Days 

K2 c Condrtron has “CL LTR” In C2 as source (10) 

c, Condrtron does not have “CL LTR” in C2 as source (K4) 

10. About how many doys since (12-month dote) o year ago, has this 

condition kept -- in bed more than half of the day? (Include doys 

while on overnight potient in a hospital.) 

000 [ r1 None Days 

11. Was -- ever hospitalired for -- (condition in 32)? -. 

1 [i i Yes z(:.No 

K3 L ; Missing extremity or organ (K4) 

c j Other (12) 

120. Does -- still have this condition? 

I C; Yes (K4) rl; No 

--__--...- _--. -- ____-- ----- -----.- _______ _ 

b. ‘i;thTs &&tion;ompletely cured or is it under control? 

2 C; Cured 

3 CJ Under control (K4) 

8 C i Other fSpa~ity)~ 

fK4) 

c, i-&&-t -h& -liig-di i --I- 

- - . _ _ 

have thi; ;anditien-be&r; St-was-cured? 

_ _ 

L Less than 1 month OR 

( 

L Months 

Number C 1 Years 

---------------------- - --- ____- ----- ____ .___ __ 

d. Was this condition present at any time during the past 12 months? 

1 C, Yes 2L!No 

c 

0 [ ) Not an acctdent/rn)ury (NC) 

K4 I E First accldent/rnfury for thus person (14) 

8 [II Other (13) 

13. Is this (condiiion rn 34 the result of the same accident you alreody 

told me about? 

L_. Yes (Record condi lion page number where 

ac&denf questions tirst completed.) + - (NC) 

-- No Page No. 

l-. 

14. Where did the occident hoppen? 

1 L, At home (instde house) 2 Ii: 

3 I- ; 

At home (adjacent premises) 

Street and htghway (Includes roadway and public sidewalk) 

4 ;z Farm 

s I- * Industrial place (Includes premises) L.. 

6 cl: School (Includes premises) 

7 L- Place of recreation and sports, except at school 

8 iI Other (Specily) 

At 

Nork box if under 18. 

150. Was -- 

L1_: Under 18 (16) 

under 18 when the accident happened? 

1 :--, Yes (161 [l; No 

-. -----. -- ---_.---- -.-- -------- --- --_--------_ -- 

b. Was -- in the Armed Forces when the accident happened? 

2 C) Yes (16) I;; No 

--...- .- .-- --..___ -_.--- _ -_.--- _--- --- -_----- -- 

c. Was -- at work at -- iob or business when the accident happened? 

3zYes b u No 

160. Was o car, truck, bus, or other motor vehicle involved in the accident 

in any way? 

I !i : Yes 2 [.I ; No (17) 

. _ _ . - _____ --__-. _--__.-- ._.- ----_-------- 

b.Was more than one vehicle involved? 

-- 

1 ci Yes 2C;No 

-. - ----._-- _. _ --_--_-__ - _---- -- ---- -.- 

c. Was [it/either one] moving at the time? 

---------_ 

1; '- Yes 

.___ 2 i.1‘: No 

170. At the time of the accident what part of the body was hurt? 

What kind of injury was it? 

Anything else? 

Port(s) of body + Kind of injury i 

I - - _. _. . _ - --.-- 

Ask if box 3. 4, or S-io;ked in Q.5: 

I ----. ------- __----__ --_ 

b. What part of the body is affected now? 

How is -- (port of body) affected? 

Is -- affected in ony other way? 

Port(s) of body ’ Present offacts ** 

* Enter’part of body in same detail as for 3s. 

‘* If multiple present effects, enter in C2 each’one that is not the 

same as 3b or C2 and complete a separate condition page for it. 

43 
L. DEMOGRAPHIC BACKGROUND PAGE 

Ll CT, Under 5 f/VP) 

Ll Refer to oge. 

1;; 5-I 7 12) 

I_ , I8 and over (1) 

lo. Did -- EVER serve on active duty in the Armed Forces of the United States? 10. ’ I:.: yes -(Mark “AF” box, THEN It 

2 re ; No (2) 

_ . - . - . . . . 

b. When did -- serve? 

_ . . . . .__ . -. -..-. .__._. -.-----_- _-_. -__ 

Vietnam Era (Aug. ‘64 to April ‘75) . . . . . . . . VN 

Mork box in descending order of priority. 

Thus, if person served in Lietnom ond in Korea, 

mark VN. 

I 

b. 1 i-:VN 5 [:j PVN 

Korean War (June ‘50 to Jan. ‘55) . . . . . . . . . KW 2;i.KW 8 Cl 0s 

World War II (Sept. ‘40 to July ‘47). . . . . , . . WWII 3 [’ WWII 

horId War I (April ’ I7 to Nov. ’ 18) . . . . . . . . WWI 

o!--]DK 

Post Vietnam (May ‘75 to present) . . . . . . . . PVN 

4 t; : WWI 

Other Service (all other periods) . . . . . . . . . . OS 

- _ . . . - _- _ ._. ___ _ ._ __ . --.-. - .-- ..-.- ---. _ ._--- - --------.-- 

c. Was -- EVER an active member of o National Guard or military reserve unit? 

C :- Ye= 2:. ‘NO(~) 7[-jDK(2) 

.- __ _-.- _.. _ _ . . __ _ _..__-__. _-- ____. __ __ _.__. - --.._. ---- 

d. Was ALL of -- active duty service related to National Guard or military reserve training? 

d ’ I_ “-‘Yes 3i-jNo s[-jDK 

la. What is the highest grade or year of regular school -- has ever attended? 20. 00 !.. Never attended or 

kindergarten (NP) 

Elem: 12345678 

High: 9 IO II I2 

College: l 2 3 4 5 6 t 

b. Did--- ~. .----- . . _ - _ . . - - --.-_ _ . _ ._ _ _. -. . _ . - -. - -_. . . - - ----_- _ -. _. ______---------------- 

tnish the (number in 20) [grade/year]? -- b. I C’Yes 2CjNo 

Hand Cord R. Ask first olternative for first person; ask second olternotive for other persons. 

3a. 

6: 

hat is the number of the group or groups which represents -- race? 

hat is -- race? 1 30. I 2 3 4 

2 

fircle all that apply 

- Aleut, Eskimo, or American Indian 4 - White 

2 - Asian or Pacific Islander 5 - Another group not I isted - Specify 

3 - Black Specily 

_____.. .--. - .----. -------- - -- -. -.-.. . .----.---. -- - -- ..--- __. _ __ -____,,.__ . __________ ________ 

Ask rf multiple entries: b. I 2 3 4 

b. Which of those groups; that is, (entries in 30) would you say BEST represents -- race? 3 

- 

Specity 

-_- . _ _. - . . . - . __ _ . _ -..-----_----. _ _ _ - _.._.. . -___ _ - --. ----- -. -. .._.__ _ __ _. ___.________ _____ 

c. Mark observed race of respondent(s) only. 

C. ‘rIlw 2[1] 6 31-j 0 

Hond Card 0. 

4a. Are any of thoie groups -- national origin or ancestry? (Where did -- ancestors come from?) 40. l L-i Yes 2 C ] No (NPI 

_ _--------- ______.__. -__-~-_------ ------ ----- --.--. - -.... ----------.---- ----. .- -___ _. _ _ ._____ _ ______ ___ 

b. Please give me the number of the group. 

Circle all that apply 

I - Puerto Rican 5 - Chicano 

2 - Cuban 6 - Other Latin American 

b. 1 2 3 4 5 6 7 

3 - Mexican/Mexican0 7 - Other Spanish 

4 - Mexican American 

44 
L. DEMOGRAPHIC BACKGROUND PAGE, Continued 

L2 Refer to “Age” and “Wa/Wb” boxes In C/. 

Sa. Earlier you said that -- has a iob or business but did not work last week or the week before. 

Was -- looking for work or on layoff from a job during those 2 weeks? 

---------------_--__------------------------------------~---------------- 

b. Earlier you said that -- didn’t have o job or business last week or the week before. 

Was -- looking for work or on layoff from a iob during those 2 weeks? 

-----__-_-___-..__-_------~--------------------~---------------- ----.-- ----- 

C. Which, looking for work or on layoff from a iob? 

66. Earlier you said that -- worked last week or the week before. Ask bb. 

--------- 

b. For whom did 

_ -_--_ 

-- work? 

-------- 

Enter name 

-------- 

of company, 

----. - 

business, 

- - - _ - - .- _. -

organization, 

-- 

Of 

_.__ -----_ __--- ------- 

other employer. 

_---m-m- ------- 

c. For whom did -- work 

of company, business, 

-------------. ----------- - - --- ____ -------- ---..- 

at -- last full-time iob or business lasting 2 consecutive weeks or more 

organization, or other employer or mark “NEV” or “AF” box rn person’s 

d. 

__-------------- 

What kind of business or 

State Labor Department, 

_ _. -

? Enter 

column 

_ -. - 

name 

------ 

industry 

farm. 

------- -- 

is this? For 

-----_ 

example 

--_ -._- 

, TV and 

---------.----- 

radio manufacturing, 

- __ _ - - _- - 

retail shoe 

_ -- 

store, 

_ -.__- 

-_------------- 

l * What kind of work was 

If “AF” in bb/c. mark 

--is-------.----- _-.. ---__-_-___------ ---- -___--___-._-_-__---__ 

-- doing? For example, electrical engineer, stock clerk, typist, farmer. 

“AF” box rn persor’z column without asking. 

e---w- ____-__ - ---.---- ---.~--_---_------_-- 

1. What were -- most important activities or duties at that iob? 

files, sells cars, operates printing press, finishes concrete. 

-------------- 

For example, types, 

------_--- 

keeps account 

.--------- 

books, 

------------__-- ---- - ________________________________________-.- - __ _ _ - __ .- .- - - - 

Complete from entries in 6b-f. If not clear, ask: 

ga Was -- 

An employee of o PRIVATE compony, business or Self-employed in OWN business, professionol 

individuol for woges, rolory, or commission? . . . . . . . P practice, or form? 

A FEDERAL government employee? . . . . . . . . . . . . . F Ask: Is the business incorporated? 

A STATE government employee? , . . . . . . . . . . . . . . S Yes............................1 

A LOCAL government employee? . . . . . . . . . . . . . . . L No.....................,........SE 

Working WITHOUT PAY in fomily business 

or form? . . . . .,....................... WP 

- NEVER WORKED or never worked ot a full-time 

job losting 2 weeks or more.. , . . . . , . . . . . . . . . NEV 

L2 

so. 

--- 

b. 

-.-- 

C. 

--- 

6b. 

and 

C. 

--^ 

d. 

. . -- 

0. 

- _ ._ 

f. 

- - -. 

9. 

0 1’ Under I8 (NP) 

( .; - * Wa box marked (6a) 

2r * Wb box marked (5a) 

3:-: Neither box marked (5b) 

1 (r; Yes (5c) 

.-_-_-_--- _----- ------ ---- 

------. 

Industry 

------.- 

Dccupafton 

--.----._---_ 

----__ 

’ NEV(6g) 

; AF(6e) 

----_._ 

AF (NP) 

--_-_------------_-_~~- 

Durles 

._- ---------_-.--_-_ .__-- 

Class of worker 

1’ p 

I - 2. F 

3 s 

5 _ I 

6 - SE - 

7 - WP 

-- 

-- 

. - 

4 L 8 NEV - 

=OOTNOTES 

45 
L. DEMOGRAPHIC BACKGROUND PAGE. Continued I I 

Mark box if under I 4. If “Morri td” refer to household composition ond mark accordingly. 

7. I9 -- now married, widowed, divorced, separated, or has -- never been married? 

7. 0 cl Under I4 

1 0 Married - spouse tn HH 

z 0 Married - spouse not in HH 

3 0 Widowed 

4 0 Divorced 

s fi Separated 

6 0 Never married 

80. Was the total combined FAMILY income during the past 12 months - that is, yours, (read names. including 

Armed Forces members living at home) more or less than $20,000? Include money from iobs, social security, 

retirement income, unemployment payments, public assistance, and so forth. Also include income from 

interest, dividends, net income from business, farm, or rent, and any other money income received. 

80. 1 u S20,OOO or more (Hend 

Card 1) 

z 0 Less than S20.000 Wand 

Cerd J) 

Read if necessary: Income is important in anolyring the health information we collect. For example, this 

information helps us to learn whether persons in one income group use certain types of medical care services 

or have certain conditions more or less often than those in another group. 

.----- .---- - ---- ----------- ------. --.-------.--_ __- ________________________ ----.. -^-_~--__--_----__- _.___ 

Read porentheticol phrase if Armed forces member living at home or if necessary. b. oaf-]A loL;K 20 s u 

b. Of those income 

during the post 1 s 

roups, which letter best represents the total combined FAMILY income 

months (that is, yours, (read names. including Armed Forces members 

01 f--J8 t 1 1-J L 21 gv 

living ot home))? Include wages, salaries, and the other items we just talked about. 

02 q c 12 i-J M 22 u w 

03 0 D 

Income is important in anolyting the health information we collect. For example, this 

13:‘.N 23 q x 

Read if necessary: 

information helps us to learn whether persons in one income group use certain types of medical care services 

04 q E 14[]0 24 u Y 

or have certain conditions more or less often than those in another group. 

OS (--J F 1sm P 25 u z 

06 0 G 16 UQ 26uzz 

07 f-J H 1‘1 l-j R 

08 0 I 18 LIJ S 

09 u J 1s a T 

Ru. o 0 Under 17 

1 q Present for all qupstions 

a. Mark jrrst oppropriote box. 2 q Present f or some buestions 

R 

3 q Not present 

-__------- ---- ----------.- -.----- .-- . ----- -------- -------- -------- ------- ___,___ ------_--_- _________ 

b. Enter person number of respondent. b. 

Person number(s) of respondent(s) 

‘OOTNOTES 

46 
WI. HEALTH INSURANCE PAGE 

Read to respondent(s): 

Modicaro is a Sociai Sacurity hoaith inruranco program for dirabied parsons and for persons 66 years old 

and over. Poop10 covorod by Modkan have a card that looks iiko this. 

Show card. 

b. Is-- now covorod? 

2a. Is -- now covorod by tha part of Social Security Medicare which pays for hospital bills? 

Mark _____ box in person’s column. -___----------- 

b. is-- now covered by that part of Medicare which pays for doctor’s bills? This is the Medicare plan for 

which - - or some l gancy must pay a certain amount each month. Mark box in person‘s column. 20No 

Ask for each person with “DK” in 28 and/orb: I 0 Hospital 

3. May I pkaso soo the Social Security Modican card(r) for - - (and - -1 to determine the type of coverago? 3. 2 0 Medical 

Transcribe the information from the card or merk the “Card N.A. l ’ box. 3 0 Card N.A. 

Wo l ra intorotod in l H kind, of haaith inruranco plans oxcopt those which pav only for accidents. 

4a. (Not counting Modicaro) Is anyone in tha family now covered by a health insurance 

plan which pays any part of a hospital, doctor’s or surgeon’s bill? Cl Yes 0 NO fw 0 0~ fM11 

----------------------------------------- 

b. %hai ii tha name of the plan? Record in Table H. 1. 

_______-_- ------ ----- --- - 

-------- L__ --------------------____________________--------------- --- 

c. Is anyono in tha family now covorod by any other horith insurance plan 

which pays any part of a hospital, doctor’s or xurgeon’r bill? 0 Yes fReesk 4b and c) 0 No (5) 

TABLE HA 

Se. Was thir jnemel plon obtW through 

6a. ~~daP,, pay any pert of horpital 

under thir I 0 Covered (NPj 

en l mployw 0I union? 1 cl Yes 2 q No 9nDK 2 c] Not covered (NP) 

1 0 Yes 2 0 No 161 9 q OK (6) 

------------------ 

b. ----------- - - .- - - -. - -- && th-Ia plon vy any pert of doctor’s 01 

b. la it now cowied uh on empfoyu or union? rurgeon’r bills for opudonr? 

1 0 Yes 20No 9nDK 1 Cl Yes 2 q No 9nDK 

PLAN 2 h Doe8 thk 

? 

an per l ny pert of hoap#tel 7. I8 -- covued 7. 

5a. Was thlr jname) plan -inod thm@ y l xpenrea under this I 0 Covered (NPI 

an employer or union? 10 Yes 2 q No 90DK Insme) plan? 2 0 Not covered fNP1 

1 cl Yes 2 0 No 161 9 0 OK (61 -------------------- 

__--------_----- ---- b. Do08 this pkn pay any pert of dootor’r or 

b. la it now cerried throu@h en employer or union? 8~rgoon’o billa for operetionr? 

1 Cl Yes 20No 9nDK i 0 Yes 2 q No 90DK r 

Sm. Doer this an pay any part of hospital 7. Is -- coverod 7. 

Sm. Wan thir lnamel plen obtained &ou#h oxpen ? under this 1 0 Covered INPI 

an l mployZunion? 1 Cl Yes 2 q No 90DK (name) plan? 2 0 Not covered (NPI 

1 Cl Yes 2 0 No 16) 9 0 OK (6) --__--_------------- 

__------ ------------ b. Doea this plen pey l ny pert of dootor’r or 

b. Is it now cadad through WI l mp4oy.r or union? l urgeom’a billr for oporationr? 

1 Cl Yes 20No s0DK 1 cl Yes 20No 9nDK 4 

Ml 1 0 Covered fNP) 

M 1 Review 1 and 7 for each person and determine if “Covered” by either Medicare and/or insurance, or “Not covered. ” 2 0 Not covered under 65 (NP) 

3 0 Not covered 65 and over (NPI 

Ask for each person “Not covered” in M 1. If “Not covered 65 and over, “ include “or Medicare. ” 

8a.{Many poop10 do not carry health imuranco for varkur narons.} Hand Card M. .8a. 

Which of thora statomonts doscriks why - - la not covorad by any health inruranco (or Modican)? 

1 2 3 4 5 6 7 03 

Any other mason? Circle all reasons given. ___-_--------------- -------------------___________--__-_____ Specify 

Mark box if only one reason. If “Not covered 65 and over, “ in MI, include “or Medicare. “ 60 Cl Only one reason 

b. What is the MAIN nason - - is not covorod by any hoaith insurance (or Medicare)? b. 1 2 3 4 5 6 7 8L( 

t 

FORM HIS-1 11984) (8-9.S3l 

Specify 

47 
I 

Ask on/y if persons under 20 in family: 

9s. Doss anyono in thir family now rocoivo assistance through ths “Aid to Pamilks 

with Depondont Childrod’ Program, somotlmos cdkd “AFDC” or “ADC”? 

Cl Yes 0 No (10) q DK 

____________________----------------------------------------------------------------- 

b. Door-- now recolvs AFDC or ADC? 

9b. 1 GYes 

2 NO 

90DK 

10s. Does l nyons in this family now ncolvo the “Suppkmontd Security 

Income” or “881” goldeokrod chsck? 

El Yes q No (11) ci DK 

---_------__-___________________________~~~~~~-~~~--------------.~------------------~-- 

b. Doss-- now rocolvs this chock? 

lob. i q lYes 

2 q No 

90DK 

I 18. Thors is s natio~l program calkd Modkdd which pays for health can 

for psrson~ in nod. (In this Stats lt is also calkd /name)). 

During the put 12 months, has l nyons in this family rocolvsd hodth 

care which has bson or will bs pald for by Modkdd 401 (name))? 

Cl Yes 0 No /I21 0 DK 

-----------------------------~~~~--------_----------------------~~~~~~---------------- 

b. Has - - rscoivsd this con In the put 12 motMs? llb. 1 q lYes 

2 q No 

9uDK 

I2a. Does l nyons in the family now have l Modkaid (or InameB csrd whkh 

looks like this? Show Medic&d card(s). 

Cl Yes 0 No (13) 0 DK 

-----------------------------------~--~~~~~~~~~~~~~~~~~~~~~~~~~---------------------- 

b. Does-- now have this card? 

lib. 1 GYes 

2 ONo 

9uDK 

--------------------------~-------------------------------------.--------------------- 

Ask for each person with “Yes” in 12b: 

c. M~yIp~w~--(8nd--)c~rdb)? 

Mark appropriate boxfed in person’s column. 

c. 0 Medicaid card seen 

1 Cl Current Id 

2 0 Expired 

3 0 No card seen 

8 q Other card seen 

y’ 

Specify 

1% Is anyone in the family now covorod by any other publk 

ss~lstmcs program that pays for ho&h care? 

0 Yes 0 ;o$ext 0 DK 

--------------------.-_----_----__________-____________-_-----~_-.__-_------------------ 

b. Is-- now covsmd? 

13b. 1 q Yes 

2 GNo 

9 q .DK 

FORM HIS.1 I1 SMI (S-Q-83) 

48 
I M. HEALTH INSURANCE PAGE, Continued I 

14s. Does anyons in the family now rocsivs military ntirsmsnt psymsnts 

from any branch of ths Armod Forces or a psnslon from ths Votsrsns 

Administrstion? Do not inciuds VA disability compsnsstion. 

Cl Yes 0 No (15) 0 DK 

----_-----_-----------~- -____ --------------_~_---.---------_.---.------ -.--.---- -- ._ .-_- 

b. Door-- now rscsivs military ntiromont or a VA pension? 14b. i 0 Yes 

2 0 No 

9 0 DK 

----------------------------_--------------_-----------------~----------.---.--. - 

Ask for each person with “Yes” in 14b: 

c. Which doss - - rscsivs - ths Armod Forcss rstirsmsnt, ths VA psnsion or both? I fl Armed Forces C. 

Mark box in person’s column. 

20VA 

3 0 Both 

- - .- 

I Sm. Is anyons in ths family now covsrod by CHAMP-VA, which is msdicsi 

insurancs for depsndsnts or survivors of dissbisd vstsrsns? 

Cl Yes q No (16) 0 DK 

---------------------------------------- _____ ------ _________ -----------.----. . -. - -. - 

b. Is - - now covsred by CHAMP-VA? 16b. 1 Cl Yes 

2 0 No 

9 0 DK 

16s. Is snyons in ths family now covsred by any othsr program that provides 

hosith care for military depsndsnts or survivors of military parsons? 

Cl Yes q No (M2) q DK 

------------------------------------------_-_-------__-____I-----------~ --- - --. - - --- - -.- 

b. Is-- now covorod? 16b. 1 q Yes 

2 0 No 

9 c] DK 

M2 Refer to “Af” box above person‘s column. M2 I 0 AF box marked f 171 

2 0 Other INPI 

17s. Do.8 - - hsvs a disability rolsted to - - ssnics in ths Armsd Forcss of ths Unltsd Ststss? 178. 1 Cl Yes 

2 0 No lNPl 

------- ----_------------------------ -_______ -- -____________ ---.-- _-- ----.-.----- - - - - 

b. Doss - - now rocsivs compsnsstion for this dissbiiity from ths Vstsrans Administration? b. 1 Cl Yes 

2 0 No 

FOOTNOTES 

FORM HIS. 1 I1 984 (8-943) 

49 
-w-w - ---, ------.I--- 

18s. During ths p8st 12 months, th8t is sincs 

related HH members 18 or over) b88n i8id h----k 

IP-month date 8 yssr 8go, h8vo {reed names of 

rom8 o oriosts job? 

Cl Yes 0 No fM4) 0 DK lM41 

b. ~ho~&this~%- - - - 

--------------------------------------------------------.-------------------- 

18b. 

Mark “Laid off/lost job” box in person’s column. 

I 0 Laid off/lost job 

------------------------------------------------------------------.-------------------- 

c. Anyono l ls8? 

0 Yes (Reask 186 end c) 0 No 

------------------------------------------------.--~-------------------- 

Aik;idT i andf Fo,,h,erson with “Laid off/lost job” in 18b. 

d. How m8ny tlmos h8s - - b88n kid off or lost 8 job during the p8st 12 months? d. p Times 

----------------------------- ----- ------------- __________ ---- -___-.___- ---_---- _______ -- 

o. In wh8t month ~8s - - I8id off or did - - loss a job ([the 1881 tims/ths 8. 

tfmo kfors thd? El Time 1 

I Time 2 

El Time 3 

------------------_-------------------------------.--~-------------------- 

f. f& ~ik%‘i~ &4-i [thaVthos.l job layoff(s) or job ioss(os), did- - recoivs 

ummpioymont insur8ncs knofits? 

I Cl Yes 

2 q No 

1 ga. Bocauss of Jnemes of persons in 186) job I8yoffW or job ioss(ss), did 8nyon8 in 

th8 f8mily IOU 8ny hulth insur8nco covsmgs th8t had boon car&d through 

m8vtho*.1 jobb)? 

q Yes q NO (~4) q IDK (~4) 

-------------------- .---- ------------------- -____._- --__----_-.--.------- ---- --_------- 

b. &ho &.a this? 

Mark “Lost coverage” box in person‘s column. 

19b. 1 El Lost coverage 

-----------------------~~~---------------~-----~~~~~~~-----~-~~---.-------------------- 

c. Anyons olu? 

0 Yes (Reesk 196 and cl 0 No 

M 3 Refer to 196 end mark appropriate box. M3 i q Lost coverage (20) 

2 0 Did not lose coverage WY 

20s. For ANYTIME during [th8t/thoa81 job i8yoff(s) or job loss(os), ~8s - - without 8ny 

typ8 of ho&h iruur8nco cover8g8? {Do not includs ho&h cars programs, such as 

208. 1 0 Yes 

Modicsid, AFDC, or military bon&it progr8ms, 8s h88lth insur8nc8 covsr8gs.) 2 u No ffVf1 

-------_-------------------------------~~-----------~-------------.--------------------- 

b. For how long was - - without some typ8 of h88ith lnsur8nco covor8go? b. oo 0 Less than 1 month 

(How m8ny months is th8t7) 

Months 

210. For ANYTIME during [thmt/thoaol job layoff(s) or job loss(os~, was - - covwod by 218. I UYes 

8ny h88lth c8n progr8m, such as M8dic8id, AFDC, or a military bsnofit program? 2 0 No fNP) 

. ______________------------------------------------------------.---.--------------------- 

b. Forhowiongwos-- covarsd by some hsaith cars program? b. oo 0 Less then 1 month 

(How many months is thai?) 

Months 

M4 

M4 

Refer to sgds) and mark appropriate box. 

I 0 No person 55’ in family fHHpg.1 

8 0 Other (Supplement on Aging) 

1 flOB4I 18.9.83) 

50 
Appendix I I 

1984 Supplement on Aging 

Questionnaire 

U S. DEPARTMENT OF COMMERCE 

BUREAU OF THE CENSUS 

ACTING AS COLLECTING &GENT FOR THE 

U.S. PUBLIC HEALTH SERVICE 

NATIONAL HEALTH INTERVIEW 

SURVEY 

SUPPLEMENT BOOKLET 

B. Final status of supplement 

o 0 No SP selected 

Interview 

I-EL 

I 0 Complete interview (all appropriate pages completed) 

2 0 Partial interview (some but not all appropriate 

pages completed) (Explain in noted 

Noninterview 

3 0 Refused (Explain in noted 

4 0 SP temporarily absent, no proxy available 

5 0 SP mentally or physically incapable, no proxy available 

8 0 Other ExPlain in notes) 

OMB No. 0937902 1: Approval Expires March 31, 1985 

NOTICE: Information contained on this form which would permit identification of any individual or establishment 

has been collected with a guarantee that it will be held in strict confidence, will be used only for purposes stated for 

this study, and will not be disclosed or released to others without the consent of the individual or the establishment 

in accordance with section 308(d) of the Public Health Service Act (42 USC 242mI. 

1 5T 80 2. R.O. Number 1 3-4 3. Sample I s-7 

0ook - of -books t I I 

4. Control number [ 8-10 ) Segment Ill-141 Serial 

PSU I I 

I I 

5. Person 1 17-1816. Sex 1 19 1 7. Person name 

number 

, 140-541 

I I 0 Male I 

%;ple 120-39: First Ekkfle 

I 

1 88 f 

I I I I 2 0 Female I I I 

9. Date supplement 57-80 10. Interviewer identification I61 -62 

completed Name 1 Code 

I 

I 

I 

I 

NOTES 

ONTACT PERSON INFORMATION 

0 Contact information for this family unit already obtained, transcribe when editing. fill item 7 5 below, THEN go to HIS- I Household Page or next SOA. 

Read to SOA respondent at end of interview - The National Center for Health Statistics may wish to contact you again to obtain additional health related 

information. Please give me the name, address, and telephone number of a close relative or friend who would know where you could be reached in 

case we have trouble reaching you. (Please give me the name of someone who is not currently living in the household.) P/ease print items I 1, 72, 14. RT 62 

11. Contact Person name 1 RT 61 I 3-4 I S-24 ’ 

Last t First 

I 

I 

I 

125-39’ 

: Middle 

I initial 

1 40 13. i”a,cod,e/tei,eprne,nurrjrber,- , ‘, , , , :I11 1 

I 

I I 0 None 2 0 Refused 9 0 DK 1 1s 

1 Pa. Address (Number and street) 4. Relationship to Sample Person 

b. City 166-65; State 186-871 zip I 

I 1 Code 

I I 

I I 

TRANSCRIPTION FROM HIS-1 3-4 

16. Area code/telephone number from HIS-l, item 11 123-32. 17b. Mailing address from HIS-I, item 6b I 0 Same as 6a on HIS-l S 

Number and street 6-30 

I 0 None 2 0 Refused 33 

17~ Exact address from HIS- 1, item 6a (Please print items 7 7a -cj 34-68 City 31 -so: State 161-52’ zip (63-61 

Number and street/description I : Code 

I I 

City I I Bg-78, State 

I 

I 

I I 

I I 

1 79-801 zip 181-89 

. c. Special Place name (Fill if applicable1 [62-97 

I Code 

I 

SUPPLEMENT ON AGING SAMPLE SELECTION I 

1 Use Table A or B as indicated on HIS-1 Household Composition Page. Circle that letter and enter number below to indicate the order of interview (1 = down 

from the top of the listing, 2 = up from the bottom). Follow this order whenever two or more samole oersons are at home at the same time. 

18. Are there any nondeleted persons 65 vears old I 

or older in tne family, 

i 1 0 Yes (List by age (oldest to youngest) in upper portion of appropriate table. 

mark “SP” box on HIS- 1 for each, THEN 7 91 

i 2 ENo (791 

19. Are there any nondeleted persons 65-64 years 

old in the family? 

TABLE A 

Age Name 

1 7-8 

111-12 

115-16 

119-20 

123-24 

;27-28 

!31-32 

:35-36i 

1 I 0 Yes (list by age (oldest to youngest) in lower portion of appropriate tab/e, mark “SP” box on L 6 

I 

HIS- I for each “X” person, and begin supplement using the appropriate “order of interview”) 

I 2 0 No (Begin interview(s) using the appropriate “order of interview”) 

TABLE B ~ 

Person Sample Person Sample 

number person Age Name number person 

19-10 )( 139-40 141-42 x 

113-14 j( 143-44 146-46 x 

117-18 x 147-48 149-80 x 

121-22 )( Ill-52 (63-54 )( 

126-28, x 155-56 157-56 

129-30 (69-60 161-62 x 

1 

I 133-34 x 163-84 165-66 

I I 137-38 167-68 169-70, x 

51 
I SUPPLEMENT ON AGIN’G 3-4 

--I 

I Section N. FAMILY STRUCTURE, RELATIONSHIPS, SUPPORT, AND LIVING ARRANGEMENTS I \ 

I 1 5 

8. initial status of sample person 1 I 0 Available INI b) Nl- 1 2 q Callback required (Next SPI 

8-9 

b. Supplement beginning time 10 

Read to respondent - We are interested in obtaining further information about the health of people 55 years of age and older in 

the United States. I will also ask you some questions about your family and social activities. I 

Ask of verify for each HH member 

{name on HIS- 7) related to you? 

Enter “Sample Person” on appropriate line. 

Enter “Unrelated” for persons not related to the sample person. 

En tef “Deleted” for any deleted persons, except AF members 

living at home and babies born during interview wee&. 

Enter ages from HIS- 1. 

05 

(41-42 143-44 145-48 

06 

[47-48 149-50 [Sl-52 

07 

183-54 p5s-58 167-58 

08 

[ 59-80 181-82 [ 83-84 

09 

185-88 [87-88 * [es- 70 

I I 

I 71 

N2 

I 0 Sample person is now married (A/3) 

Refer to marital status (page 46 or 4 71 on HIS- I 

i 

I 2 0 Sample person is now widowed, divorced, separated (2bl 

’ 3 0 Sample person has never been married (61 -i 

I I 

I I 

N3 Spouse of Sample Person previously interviewed on SOA 1 I 0 Yes (61 

I 2 q No (2) 

1 72 

I I 

2a. How long have you been married (to (name of spousell? I oo q Less than one year 

> 

173-74 

I (3) I 

I -Number of years 

- - ---.-------------------------------------------------;------- I 

b. Earlier [you told me/l was told] that you are now 

I 

I 

[widowed/divorced/separated]. How long have 

oo 0 Less than one year 75-78 

I 

you been [widowed/divorced/separated]? I 

i -Number of years 

I 

3a. Including step and adopted children, how many LIVING 

children do you have? 

I 

, oo 0 None (6) 177-78 

I 

I 

-Number 

How many of your children 

many are daughters? 

. - -_ - - - - - -. - __ - 2 - - - - _ 

b. are sons and how 

I -Number of sons 

I 

I -Number of daughters 

I I 

i El Total number of children 

Compare with 3a, reconcile differences 

N4 Refer to relationship foster in I 

I I 1 85 

I 0 Any of SP’s children live in household (61 

1 s 0 Other f4) 

I 

FOOTNOTES 

* 

FORMHIS 1 SB 1984 ,3 13841 

52 
Section N. FAMILY STRUCTURE, RELATIONSHIPS, SUPPORT, AND LIVING ARRANGEMENTS, Continued I 

4a. How quickly can I&y one of your children/your son/your 

daughter] get here? f I 0 Minutes 

’ 88-88 

--I 

I 

I 2 0 Hours 

I _~ Number 

I 

3 0 Days 

I - _. __ - - . - __ - - .- - - - - -. - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - _______ ----- -------- _ ._ ,- - - . I 

I 

b. How often do you see [any one of your children/your 1 ooo 0 Less than once a year/never 

188-91 

son/your daughter]? 

I I 0 Day 

I 2 0 Week 

I 

I Times per 3 0 Month 

I 1 4 0 Year 

I _----.-------------------------__- 

r---- 

____ -___-_----------- _____ --__- --- 

c. How often do you talk on the telephone with [any one of I ooo 0 Less than once a year/never [92-94 

your children/your son/your daughter]? I 

I 

1 

I 0 Day 

I 20 Week 

I 

I 3 0 Month 

I Times per 

4 0 Year 

---- ---------_----------- _____ -___ I--------------------- ----- ------------ 

d. How often do you get mail from [any one of your I ooo 0 Less than once a year/never 195-97 

children/ your son/your daughter]? I 

I I 0 Day 

I 2c3 Week 

I 

I Times per 3 0 Month 

I 4 0 Year 

I 

5. [Do your children/Does your son/Does your daughter] I 

I 

1 98 

routinely give you money to help with your living I 10 Yes 

expenses or pay your bills? ’ 20No 

I 

1 

6a. including step and adopted brothers, how many LIVING 

brothers do you have? 

’ 000 None 

I 

199-100 

I 

I 

I Number of brothers 

I ---‘- _____________ -__---.----__~ ---. 

b. Including step and adopted sisters, how many LIVING I 

sisters do you have? 

, 000 None 

I 

Number of sisters 

7. How long have you been living here, in this [house/apartment]? i oo 0 Less than 1 year 

103-104 

I 

I Ij I 

I 

I Number of years 

I ‘1 

Other family member previously in rervie wed on SOA 

I 

I 

1 105 

I 

1 Cl Yes (121 

I 2 E No (8) 

Mark if known I 108 

8 l is this [house/apartment] in a RETIREMENT 1 i 0 Yes 

[community/building or complex]? I 20 No (70) 

I -I 

9. Whether you use them or not, are the following services i 107 

available in THIS retirement [community/building or complex]? I i Cl Yes ‘-1 I 

a. Group meals for residents? I 20No 

-t 

b. Housekeeping or maid service? I 

, i 0 Yes 

I 20No 

-_--------.--._-----__---- _____ -___ L-- ___________ -___---------- . . . 

I 

c. Medical services? I i Cl Yes 

’ 2c1 No 

-_-. -__ --__--------_-----__------- r - - _ - - _ - - _ _ _ _ - - _ - - - - - - __ - - . - - -. - - - 

d. Telephone call service to check on your well-being? i Cl Yes 

20 No 

-----_------_-_---_______________ L- - -- ----__-- - --- -- - - - - -. - - -- -- - - - - - - -- 

I 

0. Recreational services? 1 1 Cl Yes 

I 

I 20No 

1 Oa. Is it NECESSARY to go up or down a step to get into this 

[house/apartment] from the outside? 

’ loNo 1 

I . Yes - If not mentioned, ask: Is it one or more than one? 

I d 

I 2 0 1 steD 

3 0 More than 1 step 

- - - .- - - - - - - _- - - -.----- ------_-------- b - - _ _ _ _ _ - _ _ _ - _ - _ _ - - - -. - - - .- -- - - - -- - -- - 

b. Counting basements and stepdown living areas as I 

separate levels, does this [house/apartment] have more 1 10 Yes 

than one floor or level? ; 20 No f77b) 

I 

I I I 

FORM HIS 1 ISBI I 19841 13 13 841 

53 
1 Section N. FAIWLY STRUCTURE, RELATIONSHIPS. SUPPORT, AND LIVING ARRANGEMENTS, Continued I 3-4 1 

I 

I 

11 a. Does this [house/apartment] have a bathroom, bedroom, 

and kitchen ALL on the SAME floor or level? 

! lOYes 

5 

I 

, 22 No -I _ - _ , ._ _ _ - - - _ _ _ - - - - - __ - - - - - - - - - ._ 

b. Does this [house/apartment] have a walk-in shower, that 

is, where you don’t step over the side of the tub to get into , lOYes 

the shower? 1 20No , 

-i - 

i 

12a. Because of a health or physical problem, do YOU NEED 

a bathroom, bedroom, and kitchen all on the same floor 

! lOYes 

or level? ; 23No 

- -. - -. -. - __..___ ---+-- -- _____..__ --- --.--- .- - .- --- 

b. Because of a health or physical problem, do YOU NEED 

a walk-in shower? I lOYes 

1 20No 

I I 

I I i 0 Sample person lives alone ( 7 4) 

’ 

N6 

2 0 Sample person lives with spouse only 

Mark first appropriate box I 3 0 Sample person lives only with persons 

I 

> 

fN71 

under 18 years old (and spouse) 

8 0 All other f l3a) 

13a. Do you and jread names of all other household members) live 

together NOW because YOU need to share living expenses? 

I lOYes 

I 20No 

-- - ---- -------------.----------~-- 

b. Do you and [read names of all other household memml live together 

NOW because of a health or physical problem YOU have? 

) i Cl Yes 

’ 20No 

L N7 I I 1 12 

Spouse of SP previous/y interviewed on SOA 1 Cl Yes (Section 0) 

I 20 No 1141 

I 14a. Is this [house/apartment1 now - 

(1) Owned or being bought by you (OR someone in the household)? . .i I 0 Yes (146) 0 No 

(2) Rented for money? . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : i 0 Yes (14h) 0 No 

(3) Occupied without payment of money rent? . . . . . . . . . . . . . . . . . : 1 Cl Yes (Section 01 

I 

I 

b. Who owns or is buying it? i i Cl Sample person 16 

2 Cl Spouse (14cl 

Anyone else? I 17 

i 3 0 Child 18 

Follow skip instructions for lowest numbered box marked. I 4 0 Grandchild 19 

i s 0 Other relative (Section 0) 20 

I 6 0 Nonrelative I 21 

------------------_-----------~-- ~-------------------------------- 

c. Is this place fully paid for or is there a mortgage being paid? i I 0 Fully paid for (74fl 

-22 - 

1 

; 

2 0 Mortgage being paid 

gfl DK (74f) 

---------_--------_-----------~-- ~------.---------,-------~~~~----- 

d. Do you know about how much principal is still owed on the I 

I iiJYes L-ii -* 

mortgage? ’ 20 No/DK (14fI 

---------------- -------------------------------------------------- 

e. How much principal is still owed? I 24--29 

I 

I $ 

I Amount 

---------------------------------~------------------------- ------- 

f. Do you know the present value of this place, that is, about how i 10 Yes 

-30 - 

much it would bring if you sold it on today’s market? I 2 0 No/DK (Section 01 I ------------------------------------------------------------------~--- 

g. What is the present value? 

I 

I 

131-3” 

; $- (Section 0) 

I Amount 

------------.----_-_--- ____ - _______ 

h. Who is paying rent for it? I i Cl Sample person 

Anyone else? I 2 Cl Spouse 

I 3 0 Child 

I 4 0 Grandchild 

i 5 G Other relative 

I 6 0 Nonrelative 

FOOTNOTES 

FOAM HIS 1 ISBI I1 994) 13.13-941 

54 
I Section 0. COMMUNITV AND SOCIAL SUPPORT 

I I 01 Refer to age 

I i El Sample person is 55- 59 (3) 

I 2 3 Sample person is 60 or older (1 I I 

NOTE - Ask 2 immediately after receiving a “Yes” in 1. 

Read to respondent - The next questions are about 

community services. 

2. How often did you use it - frequently, 

sometimes, or rarely? 

I 

1. In the past 12 months, did YOU - 

I 

i Cl Yes 1 44’ I 0 Frequently 1 45 

20No 

> 

2 0 Sometimes 

> 

Reask 1 and resume list 

a. Use a senior center? I 

I g 0 D K (Next sefvice) 3 0 Rarely 

I 

b. Use special transportation for the I i Cl Yes 1 48 

I 

I 0 Frequently 1 47 

elderly? 

I 

20No Reask 1 and resume list 

g 0 D K 

1 

2 Cl Sometimes 

(Next service) 

I 3 0 Rarely ) 

I 

c. Have meals delivered to your home I i 0 Yes 1 48 I 0 Frequently 1 49 

by an agency or organization like 20No 2 0 Sometimes Reask 7 and resume list 

Meals on Wheels? I 

I g 0 D K (Next service) 3 Cl Rarely f > 

d. Eat meals in a senior center or in I 

I i 0 Yes 1 50 I 0 Frequently [ 51 

some place with a special meal pro- I 20No 2 Cl Sometimes Reask 1 and resume list 

gram for the elderly? I 

I 

g 0 DK 

> 

(Next sefvicej 3 Cl Rarely 

I > 

e. Use a homemaker service for the I I i7 Yes 1 52 1 53 

elderly that provides services like I 

I 0 Frequently 

dNo 

cleaning and cooking in the home? I 

) 

2 Cl Sometimes 

> 

Reask 7 and resume list 

I 

I 

g 0 D K fk?xt sefvicej 3 0 Rarely 

~ f. Use a service which makes routine I 

I i 0 Yes 1 54 I 0 Frequently 1 55 

telephone cslls to check on the 

health of elderly people? I 20No 2 Cl Sometimes Reask 1 and resume lisr 

I g 0 D K 

) 

fhh?xt servicej 3 0 Rarely 

I > 

g. Use a visiting nurse service? I I 57 

I 

i Cl Yes [ 58 I 0 Frequently 

I 20No 

> 

2 Cl Sometimes Reask 1 and resume lisr 

I g 0 D K (Next service) 

I a 

3 0 Rarely 

> 

h. Use a health aide who comes into I 

I i 0 Yes L 58 I 0 Frequently 1 59 

the home? 1 2flNo 2 0 Sometimes Reask 7 and resume /;?I 

I g 0 D K 

1 

(Next service) 

I 3 0 Rarely 

I I > 

i. Use adult day care or day care for the I I i 0 Yes 1 80 I 0 Frequently 1 81 

elderly? I 20No 2 0 Sometimes 

I I 90DK > f3’ 3 0 Rarely 

I 

3a. In the past 12 months, did you do any volunteer work for any 1 lOYes 

organized group? . ; 20No 

’ 90DK 

; .- .- 

> 

(4) 

___ _----_. _--.------._--_----___- _____ -__ --_-__------ _---.- -_.- ----- -- 

b. How often did you do volunteer work - frequently, sometimes, or rarely? I I 0 Frequently 

I 2 0 Sometimes 

1 3 0 Rarely 

Hand Calendar 

Read to respondent - The next questions refer to the 2 weeks (outlined in red on that calendar), beginning Monday fdatel 

and ending this past Sunday (date). 

14. During those 2 weeks did you - 

I a. Get together socially with friends or neighbors? I 

I 1 !JYes 2nNo 

I 

. _ _ - - . ._ I -. - - -- - - _ - - ._ - _. _. -- - - _ .- - -. - - - _ . - _ ._- _ 

b. Talk with friends or neighbors on the telephone? I - ----.-- I 

, i OYes 2flNo 

_ - - __ - - . . _ - - - - - - - - - - ._ - . . - - - - 

c. Get together with ANY relatives (not including household members)? 

. . _. 

I i OYes 

- . 

2 !--; No 

_ .- _ -. . . - ._ _ ._ -. __ - _ . . _ . _ __- _ - - _. ._ _ _ - , . _ _ _. ._ _ _ 

d. Talk with ANY relatives on the telephone (not including I -7 

household members)? i i T-3 Yes 2;JNo 

. I 

- .-- - - - . .^_ - . _. - .- . -. - . -. -_ . _ 

e. Go to church or temple for services or other activities? I 

: i Z Yes 2r1No 

I 

. . . . -- ___. -- -- - 

f. Go to a show or movie, sports event, club meeting, classes or 

other group event? I i ilYes 27 No 

02 1 : 

Respondent 

Self (51 

1 70 

- - 

2 . , Proxy fSecrion PI 

--- 

1‘ About enough 

2 : 1 Too much 

. . . 

3 * Would like to do more 

i-71 

55 
Rf 67 

Section P. OCCUPATION AND RETIREMENT 3-4 

\ I 

Pl Refer to Wa/Wb boxes for SP in C 7 on the 1 tn WaorWbmarked (Idl 1 s 

I 

HIS- 7, Household Composition Page , 8 u Other (la) 

1 \ 1 

I a. Have you EVER worked at a job or business? 1 lOYes 1 6 

j 20Nof2) 

b. Have you worked at 

were 45 years old? 

_ _. - 

a job 

_. _ - - .- - _ - - - - 

business, at any time 

--_ 

since 

_ .---. 

YOU 

r .- 

- - __ - - -_ 

’ lOYes 

I 20No 

’ 9CrjDK > 

f- - 

- __ _. - - _ 

I iCJYes 

’ 2 0 No (21 

__ _ . _ . _ - - .- 

._ ___ _ _____ _ .--- ___._ -_ -_ - .._ 

c. Did you work at all at a job or business in the past 12 

months, that is, since f 7 2 month date) a year ago? 

-_-_---- -__-_------_ - - _. - - _ 

d. Since (7 2 month date) a year ago, in how many weeks did you 

work, e-part time, not counting work around the 

I I 52 0All year - 52 weeks 

I 

house? Include paid vacations and paid sick leave. I 

I 

I Weeks 

_ _ ._______ -_.---__---------- __.. - & _ - - - - - -. - _ _ _ _ _ __ _ __ _- .- _ _ _ _ _ _ - - - - & - -- - - - - 

e. In the weeks that you worked, how many hours a week did I 11-12 

you USUALLY work at ALL jobs? I 

I 

I Hours 

I / 

2a. At this time, do you consider yourself completely retired, 

partly retired, or not retired at all? 

I 0 Completely retired 

2 0 Partly retired 

3 n Not retired at all 

4 n Never worked (31 

1 

I 1 14 

P2 Refer to SP’s work status in 7a and 7b 1 I 0 “No” in 1 a or 1 b 131 

I 8 n All other (2bl 

2b. Have you retired more than once? I lOYes 1s 

’ 20No 

_ _ __ __ . _ - - _ _. - _ ._ __ - _- _ .- __ L _ . ._ - _ __ _ _ _ - - _ - - - . . - - _ _ - - - - - - - -. - - - - -. - - - 

C. How long has it been since you retired (the last time)? I 

, oo 0 Less than 1 year Y 

‘16-17 

Number of years 

_ _ ____ -_- -----. _ - ._.__ L ____ _ ___ _- _.-- - _- --- --- _------ --- 

d. (The last time you retired) Did you retire mainly because of a 

health or physical problem you had? 

t I n Yes (3) 

_ _. _ 

I 2nNo - _ - _ .-__ _ 

e. (That time) Did you retire mainly because you thought your 

work would cause a health problem? 

’ 1ClYes 

I 2C1No 

Hand card SOA 7 or read sources for a telephone interview I 

3a. (Even though you do not consider yourself retired) Are 

you NOW receiving RETIREMENT income from any of 

these sources? Do NOT include any disability income. 

b. Which ones? Mark a// sources given ) Note - Ask 4 and 5 for each source marked in 3b 

Any other source? 

I i- : Social Security 1 21 oo 0 Less than 1 year 

Number of years 

lOOwn 

2 q Someone else 

3 0 Both 

LA!! 

I 

2 I-. Railroad retirement 1 2s oo c3 Less than 1 year 126-27 iClOwn 1 28 

2 q Someone else 

~-- Number of years 3 q Both 

oo r? Less than 1 year 130-31 tOOwn 

2 I7 Someone else 

Number of years 3 fl Both 

oo 5 Less than 1 year 134-3s 1 inOwn 

2 Cl Someone else 

3 n Both -_____ Number of years 

~________ .--- 

00: 1 Less than 1 year 138-39 i!JOwn 

.2 El Someone else 

3 r-j Both 

-____-- Number of years ---A--- -- 

FOOTNOTES 

1 32 

1 36 

L-!E- 

- .- _- _____--~- 

3 , A private employer or ----piunion pension 

4 A government employee pension 1- 

(Federal, State, or local) 

- . - - - ---- -. -. -- 

5 Military retirement / 37 

I 41 Specify - 

A/ 

Some other source - 

56 
Section P. OCCUPATION AND RETIREMENT, Continued I 

6. Are you now rocolblng disability payments from any source? I 

I [ 44 

; 1clYes 

1 2 0 No (91 

I 

1 

7. Are you rocolving diubility payments because of a disability 

YOU have or bocauso you are a dependent or survivor of 

l omoono l l80? 

! 1 46 

I i q Own 

’ I 2 Cl Someone else (9) 

’ 3 0 Both 

I 

8. How long have you been receiving disability payments? 

If more than one, record the longest one. 

I 

i 000 Less than 1 year 

140-47 

I 

I 

~ Number of years 

8. Hwo you EVER rocoived rny disability payments from 

Soclrl Socurlty? 

I 

I 

I I OYes 

I 20No 

’ s0DK 

1 48 

1 Nota - Ask IOa -j before asking 11 and 12. 

Read to respondent - 

PIoar toll mo if you have 

following l ctivitio8 - 

difficulty you do the 

10. By your841 and not using aids, do you I L-T!!!- 

have any difficulty - I 1OYes 

I 

a. Walking for a quartor of a mile { that is I 2 q No 

l bout2or3blocks)? I s 0 NA/DK 

b. Walking up 10 atops without rerting? ’ 

I I q Yes LEI 

I 2 q No 

I 9 0 NAlDK I 

c. Standing or bolng on your foot for 

about 2 hour8? 

I 

I Lx.- 

I 1 q Yes 

i 2 q No 

I 

I s 0 NA/DK 

d. Slttlng for about 2 hour.? i 

I 2 q No 

I s 0 NA/DK 

&ask 10 I ) locIYes 

I 

0. Stooping, crouching, or kneeling? t 2 ONo 

I 

I s 0 NA/DK 

f. Roaching up over your head? i 

I i q lYes LA!!- 

I 

I 

I 2 flNo 

I 9 0 NA/DK 

I 

g. Roaching out 1 a8 if to shake l omoono’s 

hand) ? 

i 1 

1OYes 

I 

i 2 q No 

I 9 0 NAlDK I 

h. Using your fingor8 to grarp or handle? 1 

[ 77 

1 

i q lYes 

I 2 q No 

I s 0 NA/DK 

Reask 10 I I 1 81 

I i q Yes 

1. Ming or carrying 8omothing as heavy 

a8 26 pound8 truth aa two full bags of 

; 

2 0 No (7 7) grocorlor 1 ? , 

I s 0 NA/DK 

j. Ufting or carrying romothing a8 heavy i I 

a8 10 poUnd8? 

, 

1 OYes 

I 2 LJNo 

I s 0 NA/DK I 

MM HIS-1 Is1ll19841 13-13.841 

1 Note - Ask 7 1 and I2 for each “Yes” in 7 Oa-j. 

I 

I 1. How much difficulty do you 

have (activity in 1 Oj, romo, a 

lot, or are you unable to do it? 

[ 80 

1 0 Some 

2 0 A lot 

3 c] Unable 

i Cl Some 

2 0 A lot 

3 0 Unable 

1 Cl Some 

2 0 A lot 

3 0 Unable 

i Cl Some 

2 0 A lot 

1 82 

3 0 Unable 

1 Cl 

1 88 

Some 

2 0 A lot 

3 0 Unable 

i El Some 

,P!L 

2 0 A lot 

3 0 Unable 

1 Cl Some 

2 0 A lot 

3 c] Unable 

78 

i Cl 

1 

Some 

2 0 A lot 

3 0 Unable 

I Cl Some 

2 0 A lot 

3 0 Unable 

1 82 

1 88 

1 Cl Some 

2 0 A lot 

3 0 Unable 

12. For how long have you [had 

some difficulty/had a lot of 

difficulty/been unable to1 

Number of years 

000 Less than 1 year 

Number of years 

Number of years 1 

Number of years 1 

000 Less than 1 year 

,- Number of years 

178-78 

000 Less than 1 year 

- Number of years 

000 

178-80 

Less than 1 year 

,- Number of years 

183-84 . 

000 Less than 1 year 

Number of years 

000 Less than 1 year 

- Number of years 

57 
I Section P. OCCUPATION AND RETIREMENT, Continued I 

f I 

P3 Refer to Wa/Wb boxes for SP in C 1 on the I I d Wa or Wb box marked’(Section QI 1 88 

HIS- 1 +/ousehold Composition Page I 8 0 Other fP4) 

r-l- P4 Mark first appropriate box 

I 

I iOSPis75+ 

I 2 Cl Proxy 

(Section Q) 

I 

I 3 0 Self response (131 

13a. 

/ 

Do you think the& are some kinds of work 

you could do now if jobs wore available? 

---------- -_-_---_-------_---_--- 

b. Do you WANT to work at a job or business? 

I 

I 1 Cl Yes 

I 20No 

I (Section Q) 

I 9 0 DK/maybe 

I 

I 1 Cl Yes 

’ 20No 

I 

58 
---_ I IT66 I 

r Section Q. CONDITIONS AND IMPAIRMENTS I 3-4 1 

Read to respondent - Now tell me if you have any of these eye conditions, even if you have mentioned them before. 

’ ii i Yes 

c. Color blindness? 

I 

I 1 I3 Yes 

d. A detached retina or any othar 

Circle appropriate condition 

condition of the retina? 

e. Blindness in one or both eyes? 

If “Yes, ” ask: Which - one or both? 

1. Any other trouble 

wearing glasses? 

with one or EVEN 

I( 

I 

I iClYes 

I 

I Yes 

I I 00 One 

I ln Both (QII 

I 

1 iLlYes 

’ 5 i---- 

2L No 9i DK 

i 6 L---- 

2!-L;No 9i ;DK 

7 

2 1 ..-I N o 91 JDK 

1 8 

2i7 No 9nDK 

[ 9 

20 No 9uDK 

1 10 

20 No 9nDK 

I I 

I I 0 All “No” or “DK” in 1 a-f 121 

11 

Ql 

l 

Refer to answers in I a - f I 80 Other 

I 

- Enter “Yes” responses in EYE LTR box on 

I Condition Summary Chart, THEN Q2 -i 

Q2 Blindness in BOTH eyes reported in le 

I 1 12 

I 

I 

i Cl Yes /4a THEN 91 

I 2 0 No (21 

I 

2a. Do you use eyeglasses? Include eyeglasses that just magnify. i 10 Yes 

[ 13 

b. Were these eyeglasses prescribed ior you? 

I 

I 2 0 No (3) 

1 

- - ] 

10 Yes 

I. 

I 20 No 

I 

3. Do you use contact lenses? I 

I lOYes 

15 

’ 2uNo I 

4a. Have you ever had an operation for cataracts? 

I 

I 

, iU Yes 16 

b. Do you have a lena implant? 

. - 

I 

I 2 0 No (51 

: 

i lOYes 

I 2n No 

I 

6. Do you use a magnifying glass to read or to do other close work? i 10 Yes 

18 

; 20No -i 

Read to respondent - The next few que8tion8 are about how well you can see (wearing your [glasses/(or) contact lenses] if 

that’s how you see best). I 

6a. Can you see well anough to recognize the features of people i 10 Yes 1 19 

if they are within two or three feet? I 

I 20 No 

_ _ _ - - . - - - . . - . - 

b. Can you see well eno&hid watch T.V. 8 to 12 feet away? 

---+------ _ 

’ lOYes 

1 20 

I 

I 20No 

_-___- _______.__. - _-._ _I _--- - ^__.__ - _._. _ -. 

c. Can you see well enough to read newspaper print? I 2-l 

I ICI Yes 

’ 20No I 

1 

7a. Can you see well enough to step off a cure or down a Mop? I iCl Yes 

1 22 

I 

I’ 20 No 

I 

---_----.---_------_------_----___----__--.-----. - -_ 

b. &an you see &II&&h’& r&&e a friend walking on the I 

other side of the street? 

I 

, iCJYes 

I. 20 No I 

8. Which statement best describes your vision (wearing [glassed I I 0 No trouble 

(or) contact Ienresl) - no trouble seeing, a little trouble, or a I 

lot of trouble? I 20 Little trouble 

I 30 Lot of trouble 

59 
Section Q. CONDITIONS AND IMPAIRMENTS, Continued 

I 

Read to respondent - There next quertionr are about hearing. I 

I 

9. Do you NOW have - I 

I 

a. Tinnitus or ringing in the ears? Circle appropriate condition. 

- - _. - -- - - - -- _ _.. - - _ -- ._ - - -. - 

b. Deafness in one or both earr? 

If “Yes, ” ask: Which - one or both? 

I lOYes I 

I 

i Yes 

I 0 Cl One I 

I I 0 Both ((23) 

2s 

211No s0DK 

26 

20No sflDK 

3 - .- ._ - _ - - _ . - - _ - _ - - _ - 

c. Any other trouble hearing with one or both ears? I 

I 

i t Cl Yes 20No 90DK 

27 ‘-I 

I I I I I 0 All “No” or “DK” in 9a-c (101 l-e 

Q3 Refer to answers in 9a-c I a 0 Other - Enter “Yes” responses in EAR L TR box 

I on Condition Summary Chart, THEN 10 I 

1 Oa. Do you use a hearing aid? i i 0 Yes 

; 20No 

- - - - - - - - - - - __ _ - - ._ 

b. (With your hearing aid) Can you hear R6OSr of the things- - 

I 

I 

people 8ay? I 1 0 Yes (II! 

I 2 0 No 

I --~~---------~----__- _- -_ - _- -_ - _ _ 

c. (With your hearing aid) Can you hear ONLV A FEW WORDS I 

people say or LOUD noises? 1 i 0 Yes I l 20No 

11. Which statement best describe8 your hearing (with your 

I 32 

hearing aid) 

I I 0 No trouble 

- no trouble hearing, a little trouble, or a lot of 1 

trouble? 

2 0 Little trouble 

i 3 0 Lot of trouble -I 

Read to respondent - Please tell me if you have EVER had any of the following conditions, even if you have mentioned them before. 

12. Have you EVER had - 

I 

I 

a. Osteopororis, sometimes called fragile or soft bones? I 

(0s tee 0 po ro’ sis) I lOYes 

I 

------------------ --------------~- _. _ 

b. A broken hip? I 

I I OYes I 

----------------------- ----_.--.-- 

c . Hardening of the arteries or arteriosclerosis? 

i--- -.- 

I 

Circle appropriate condition I i OYes 

[ 33 

20No s0DK 

._ _ - - - 

20No s0DK 

1-32’ 

_ . .-__- --- 

1. 3s 

20No s0DK 

d. 

- -- 

Hypertension, 

------ - - 

sometimes caiiid-high blood .- - - - - - - - - - 7 pressure? 

1 . - - - . _ _ _ 

I 

I I OYes 20No sflDK 

-.-. __ --.- - -.-- _-----------_-- ________ *-- ______-__ -__--_ ._---- -- - 

e. Rheumatic fever? I 

1 I OYes 20No sODK 

_-_----------------------------------- l ____ - ____ -__-__._---- ---- _.-_- . 

f. Rheumatic heart disease? i 

I 

I lOYes 20No s0DK 

I 

~---~--------------------------~~~~-~------~-~--~--------- L _. _ - - - - . - - - - 

g. Coronary heart disease? I 39 

' 1OYes 20No 

L 

s0DK 

I -I 

--- ------_----------------~-~~-~ I _-__-_-__-_--_-------N-w-.- _ _ - -- - - 

h. Angina pectorir? I 

I 

(pek’ to ris) I i OYes 20No soDK 

I ----------------------------------t-------------------------- __---- 

i. A myocardiai infarction? I 

I I OYes 20No 90DK 

~-~-__--_-_----__________________ 1------_-___-___--_______________ 

j. Any other heart attack? I 

f i OYes 20No 90DK 

I 

-----. - ------------_--_ ----------w---t _______ - -_-.- --- __-__-------em 

it. A stroke or a cerebrovamcular accident? I - - -- - lL!c 

I 

(ser’ a-bro vas ku lar) I lOYes 20No s0DK 

Circle appropriate condition I 

I 

--- _.-- ---_-_-_-- ________ - -----_--_ 1-------------------------------- --- 

i 44 

I. Aitheimer’s diaeare? I 

(al’ 27 mers) 

I I IJYes 20No s0DK 

I I/ 

---------------_-_--------------- ______________------- 

7 

--------mmm. Cancer of any kind? I 

I 

I i 0 Yes 20No s0DK 

Q4 Refer to answers in 12a-m 

FORM HIS lIS8lI1984i (3.13 941 

I 

’ I 

I 

1 40 

I 0 All “No” or “DK” in 12a-m (13) I I a 0 Other - Enter “Yes” responses in EVER LTR box on Condition 

I Summary Chart, THEN 13 1 
Section Q. CONDITIONS AND IMPAIRMENTS, Continued 

I 

L During the PAST 12 MONTHS, did you have - I 

1 47 

a. Arthritis of any kind or rheumatism? 

I 

I i 0 Yes 2 0 No 9 0 OK 

Circle appropriate condition I 

__-______---------------------- 

b. iiibet.s? 

~-------------------- _ _ _ - -__ - - - - .- 

I 1 

I 1 Cl Yes 2 a No s0DK 

I c _----------------________________ 1- ---.- ---- --_-_ -----: ________----- -7 - - - . An aneurysm? 4g 

(an’ yoo rirm) I i Cl Yes 2 0 No 90DK 

I 

--------------------------------- -I __-------___-_--A---- -------- --- 

d. Any blood clots? I ---7 so 

I ' 1OYes 2 0 No 9 0 OK 

I 

-----_------~------------------ 

iLicosib veins? 

~------ _____-___ --- --------- ------ -- - 

0. I l-!!L 

I i 0 Yes 2 0 No sflDK 

Q5 Refer to answers in t3a - e 

I 

I 

I I 0 All “No” or “OK” in 13a-e (74) 1 62 

’ I 8 0 Other - Enter “Yes” responses in 7 2-MO LTR 

I box on Condition Summary Chart, THEN 14 

1 

14 Ia. During the past 12 months, that is, since ( 12-month date) 

a year ago, have you fallen? 

I i Cl Yes 1 63 

; 2 0 No f74dj 

---------------------~~~~+~~-~----~~~~~~- 

b. &i6w~nhi~t~rn~s? 

----.------ _ - -_ - - - - - -- 

l Lz!!- 

, i Cl One 

2 0 More than one 

__----_____----------------------- I ______________ ------_-----.-------.- --- 

C. [Did you fall/Were any of these falls] because you felt dizzy? I 

I 1 Cl Yes 1746) -lJFL 

’ 20No I -----.---------.--- __.____ --- _______ 

d. Do you sometimes have trouble with dizziness? 

+-.---------------------- ___---- --- 

! i OYes 

1 -se- 

-_ --- ----------------.----- 

l . D& d&iness preventyou in any way from doing things you 

-I _.--- ---------------.--.---- ----- -..----- 

I 

otherwise could do? I i q Yes 1 

I 2 0 No 

1 6;. Do you have trouble biting or chewing any kinds of food, 

such as firni meat or apples? 

If asked - includes wearing false teeth/dentures. 

I 1 58 

I 1 Cl Yes 

1 20No 

I 

Read to respondent - In order to determine how health practices and conditions are related to how long people live, we would like 

to refer to statistical records maintained by the National Center for Health Statistics. 

1Z 

I 

ja. I have your date of birth as fbirthdate from item 3 on HIS- 7 Household’ I 

1 s-11 

- 

Composition page). Is that correct? I Date of birth 

I 

I Month Date Year 

I 

I 

I L ---___-_-- --.----_----------- ______ -._---_-__-_-- 

b. In what State or country wore you born? 

- - - - -. - - -. 

’ g&OK I 

112113 

I 

White in the full name of the State or mark the appropriate box if the 1 - State 

sample person was not born in the United States. I 

1 

1 01 Cl Puerto Rico 050 Cuba 

I 

I 020 Virgin Islands 060 Mexico 

I 

I 030 Guam 96 0 All other countries 

I I 040 Canada 

_ _ - _ _ - _ __ - - - - ._ - _ - - - - _ _ _ - ------- - --j- ---.. ---_-- -__- ------ --- -.. 

c. To verify the spelling, what is your full name, including i Last ‘114-G 

middle initial? I 

I I First 134-48 

t 

I Middle initial 1 49 

_. - - _ - - - - - __ - _ 

iienYy fo;males; ask for females. 

- _ ._ - - - -. - - - - - - -. - -I- ___------ _ ___-___--_ . _ . 

I - 160-89 

d. What was your father’s LAST name? 

I 

I 

Verify spelling. 00 NOT write “Same. “ I Father’s LAST name I \ _ - - - - - -. - - _ - - - - - - - - - - - - - _. - _ - - - - .- - - . . -. _ _ - . . - . .- 

Read to respondent -We also need your Social Security Number. ) -170-78 

This information is voluntary and collected ggwggg99 0 OK I 

1 

e. What is your 

under the authority of the Public Health Service Act. There will be no effect on your 

; 

benefits and no information will be given to i 

any other government or nongovernment 1 m] - r] - I-TI-T-1 

agency. .I 

, Social Security Number 

Read if necessarv - The Public Health Service Act is title 42, I 

United States Code, section 

Social Security Number? 

242k. - 

I 

I Mark if number obtained from------+ I n Memory 

2 cj Records I 

1 

FORM HIS 1 ISBIt 13 13 841 

61 
Section Rl. ACTIVITIES OF DAILY LIVING (ADL’S) I 3-4 

Read to respondent - The next questions are qbout how well you are able 

by yourself and without using special equipment. 

to do certain activities - 

1. Bocwm of a ho&h or phyrlc8l 

probkm, do you have ANY 

dlffkuhy - 

Ask if “Doesn’t do”: 

IO thk bocwmo of a HEALTH or 

PHVSICAL problem? 

If “Yes, “mark box 1; if “No, ” 

mark box 3 

Ask 2 - 5 for each A DL marked 

‘*Ytw” in 1, 

2. By yourdf and without using 

apocld oqulpmont, how much 

dlffkutty do you have IA DLL 

some, l lot, or an you unable 

todolt? 

-3. Do you rocoivo help from 

another p8r8on in fA DLj? 

4a. Who giver thir help? 

Anyw l b.t 

--------- 

/&k?hi SOP box without 

asking if ON1 Y help is from 

spouse/children/parents. 

b. 18 thir help p8id for? 

Ask if necessary: 

Whkh hOlpW8Wo 

6*. DO YOU U80 8ny 8p0~i8l 

mont or 8id8 in iA Df I? 

b. Wk8t rpocl8l oqulpmont or 

dd8 d0 YOU U8.? 

Anything l l80? 

6m. 

Ask 6 if any A DL marked “Yes” in I. 

What lothor) condition ~8~808 

the trouble in (read ADUs) I? 

Ask if iniurv or ooeration: 

When did itho iin’ur 1 occur? / 

you have the oporet + on?] 

Enter injury if over 3 months agofl 

Ask or reask 6b, if 0- 3 

injury or operation. 

Ask if operation over 3 months 

880: For wh8t condition did 

you h8vo the operation? Enter 

condition. 

b. Boddor (condition), i8 thon any 

other condition which ~8~8.8 

thir trouble in (read ADLfslJ? 

c. I8 thi8 trouble in (read ADLIsll 

C8U80d bv 8nv lOthOr) 808CiffC 

conditiori? - 

d. Which of thO80 conditionr, 

that 18 (read conditions in 6a) 

would you 88V i8 th. m 

~8~80 of the trouble in fADL)? 

FOOTNOTES 

” ’ 

B8thing or 8howering? 

10 Yes 

2 0 No 

3 0 Doesn’t do for other reason ‘)I “!~~!resn’t(~ for other reri ‘i :?esn’I f o r other r e r 

I 

10 Some 10 Some 1 Cl Some 

2 0 A lot 2 0 A lot 2 0 A lot 

3 0 Unable 3 0 Unable 3 0 Unable 

1 Cl Yes 

2 0 No (51 

[ 7 1 24 1 41 

1 Cl Yes I Cl Yes 

2 0 No (51 2 0 No (51 

4a. Source of help i 4b. Paid 4b. Paid 4s. Source of help I 4b. Paid 

------p-l1 I 

4a. Source of help I 

112-1s ’ 

c , 

125-281 48-48 

r 

129-32 142-451 

, 

[ 

HH member ; 0 Cl S/C/P (51 HH member 1 0 0 S/C/P (51 HH member i 0 cl S/C/P (51 

1 Cl Relative . . . . i 1 0 Yes 2 0 No I 0 Relative . . . . I I 0 Yes 2 0 No I 0 Relative . . . . i I 0 Yes 2 0 No 

2 0 Nonrelative . 1 I OYes 20No 2 0 Nonrelative . I I 0 Yes 2 0 No 2 0 Nonrelative . I I 0 Yes 20 No 

Non-HH member I 

I I 

i 

Non-HH member I Non-HH member I 

3 0 Relative . . . . I 0 Yes 2 0 No 3 0 Relative . . . . ! I 0 Yes 2 0 No 3 0 Relative . . . . i I 0 Yes 20 No 

4 0 Nonrelative . I I 0 Yes 2 0 No 4 0 Nonrelative . I I c] Yes 2 0 No 4 0 Nonrelative . I I 0 Yes 2 0 No 

10 Yes 1 0 Yes 10 Yes I 

2 0 No (2 for next ADL 2 0 No (2 for next ADL 2 0 No (2 for next ADL 

with “Yes“ in 71 with “Yes” in II with “Yes” in 1) 

0 Old age 16~) 

0 Yes (Reask 6a and bl 

0 No (6dl 

0 Yes fReask 6s and b) 

0 No 

(1) 1 21 

I 0 O-3 month Inj/Op ONLY 

2 0 Old age 1 $ 

Ask 6d for next AD1 with “Yes“ in I 

30 

Condition - En:er in AD1 box on 

Condition Summary Chart, THEN ask. 

6d for next AD1 with “Yes” in 1. 

I 

(2) [ 38 

I 0 O-3 month InjlOp ONLY 

2 0 Old age ) 3 

Ask 6d for next ADL with “Yes” in 1 

30 

Condition - Enter in ADL box on 

Condition Summary Chart, THEN ask 

6d for next ADL with ‘Yes” in I. 

(3) 1 

I 0 0- 3 month Inj/Op ONLY 

2 0 Old age 

> 3 

Ask 6d for next ADL with “Yes“ in I 

30 

Condition - Enter in AD1 box on 

Condition Summary Chart, THEN ask 

6d for next A DL with “Yes” in I. 

3AM HIS.1 1s81l1984113 13 841 

62 
Section Rl. ACTIVITIES OF DAILY LIVING (ADL’S), Continued ’ 3-4 

Reesk 1 (4) 1 56 (61 1 73 461 ’ a0 (71 1 6 

Qotting In and out of hod or chain? Walking? Getting Outride? UIilBjj th. tOiht, inCh@d~ mm 

to the tokt? 

10 Yes 10 Yes 1 0 Yes 10 Yes 

2C1No 2 ONo 20No 20No 

3 0 Doesn’t do for other reason 3 0 Doesn’t do for other reason 3 0 Doesn’t do for other reason 3 0 Doesn’t do for other re8son 

1 67 1 74 1 91 1 6 

10 Some 10 Some 10 Some I 0 Some 

2 0 A lot 2 0 A lot 2 0 A lot 2 0 A lot 

3 0 Unable 3 0 Unable 3 0 Unable 3 0 Unable 

’ 50 [ 7s 1 92 ’ 7 

10 Yes i 0 Yes 10 Yes I 0 Yes 

2 0 No (5) 2 0 No (5) 2 0 No (51 2 0 No 15) 

M. Source of help ! 4b. Paid a. Source of help ! 4b. Paid 48. Source of help I 4b. Paid 48. Source of help 1 4b. Peid 

~19-621 

1 

[63-88 ’ 76-791 180-83 

IH member I 0 0 S/C/P 151 HH member 

-1 

p3-‘61 I87-loo 

I 0 0 S/C/P (5) 

I 

’ a-11 I p2-16 

HH member I 0 0 S/C/P (51 

I 

HH member I 0 0 S/C/P (51 

1 0 Relative . . . . i 1 0 Yes 2 0 No I 0 

2 0 Nonrelative . I loYes 20No 2 0 

Relative . . . . i 1 0 Yes 2 0 No 1 0 Relative . . . . i 1 0 Yes 2 0 No 

Nonrelative . I I 0 Yes 2 0 No 

I 0 Relative . . . . i I 0 Yes 2 0 No 

2 0 Nonrelative . I I 0 Yes 2 0 N,o 2 0 Nonrelative . I t 0 ~88 2 0 No 

I I I 

Ion-HH member I 

..I toYes 20No 

Non-HH member ’ 

..I lOYes 20No 

Non-HH member I Non-HH member j 

3 0 fbletive . . 3 0 Relative . . 3 0 Relative . . . . i I 0 Yes 2 0 No 3 0 Relative . . . . i I 0 Yes 20 No 

4 0 Nonrelative .I lOYes 20No 4 0 Nonrelative . f I OYes 20No 4 0 Nonrelative , i I OYes 20 No 4 0 Nonrelative . i I 0 Yes 2 0 No 

I 1 I 1 

10 Yes ’ 67 10 Yes ’ 04 10 Yes ’ 101 10 Yes ’ 16 

2 0 No (2 for next AD1 2 0 No (2 for next ADL 2 0 No (2 for next ADL 2 0 No (61 

with “Yes” in 1 I with “Yes” in I/ with “Yes” in 1) 

Special equipment or aids Special equipment or aids Special equipment or aids Special equipment or aids 

68-W 85-88 102-103 pi 

70-71 87-88 104-106 piiz 

(4) ’ 72 (61 ’ 89 

I 0 O-3 month Inj/Op ONLY I 0 O-3 month Inj/Op ONLY 

2 0 Old age 

> $ 2 0 Old age 3 > 

Ask 6d for next ADL with “Yes” in 1 Ask 6d for next AD1 with “Yes” in I 

‘6) ’ 106 17) ’ 21 

I 0 O-3 month Inj/Op ONLY I 0 0-3 month 

2 0 Old age > J 

Inj/Op ONLY 

1 

(Next pege) 

2 0 Old age 

Ask 6d for next AD1 with “Yes” in 1 

30 

Condition - Enter in A DL box on 

Condition Summery Chart, THEN esk 

6d for next ADL with “Yes“ in 1. 

FOOTNOTES 

30 

Condition - Enter in A DL box on 

Condition Summery Chart, THEN ask 

6d for next ADL with “Yes” in 1. 

30 

Condition - Enter in A 01 box on 

Condition Summery Chart, THEN esk 

6d for next ADL with “Yes” in I. 

30 

Condition - Enter in AD1 box on 

Condition Summery Chert, THEN 

next pege. 

63 
Section Rl. ACTIVITIES OF DAILY LIVING (ADL’SI, Continued 

I 

78. Do you have difficulty controlling your bowels? I 

, iUYes 

I 20 No17c) I 

-----------------ed--------------e 

b. How frequently do you have this difficulty - daily, several 

‘--------------------------- 

times a week, once a week, or lass than once a week? ! 

10 Daily 

20 Several times a week i 30 Once a week 

1 40 Less than once a week I 

1 s0DK 

-----------------------~--------- 

c. Do you have a colostomy or a device to help control 

~-------------------------~~--~ 

bowel movament*? 

1 lOYes 

, 20 No (81 ---------------------------------t-------------------------------- 

d. Do you need help from another person in taking care of I 

this device? 1 tOYes 

’ 20No 

8a. Do you have difficulty controlling urination? 

I 

, lOYes 

zu No f&l 

----_--_--_--_----------.----~ 

b. Hiwfiequently do you have this difficulty 

L---------------------~~~~- 

- daily, several I 

times a week, once a week, or less than once a week? I 10 Daily 

i 20 Several times a week 

1 30 Once a week 

I 

, 40 Less than once a week 

’ s0DK 

--------_--------_-----------~--~ L--------------_----------------- 

c. Do you have a urinary catheter or a device to help I 

control urination? i lOYes I 

20 No 137) 

----------------------- ----------.-- ;----------------------------~ 

d. Do you need help from another person in taking care of 

this device? 1 lOYes 

I 20No 

I 

Rl Mark first appropriate box 

I 

Mar& if known 

I av 

, I 0 Respondent is a proxy 

1 20 Sample person has only been 

seen in a bed or chair 

> 

(91 

I I 3n Telephone interview 

i so All other (Next page) -I 

# 

I 1 31 

I 

9. Because of a health or physical problem, do you usually - 10 Yes 170) 

a. Stay in bed all or most of the time? 20 No 

---------------------------A----.- I-----~-~~-~~-~~-~~-~~-~~------- 

b. Stay in a chair all or most of the time? I 

! 10 Yes (10) 

I 

I 

I 20 No Wext page) I 

I 100. ~ What (other) conditioncauses you to stay in [bed/a chair]? I 0 Old age (10~) I 

Ask if injury or operation: L 

I 

When did [the (injury) occur? / you have the operation?] 

Enter injury if over 3 months ago. 

Ask or reask 1 Ob, if 0- 3 months injury or operation. 

Ask if operation over 3 months ago: 

For what condition did you have the operation? I 

r 

Enter condition. I 

I 

___--_----- ----------_-----L----.--t-----.-- ______ -__-__---------- 

b. Besides (conditionI, is there any other condition which 

causes this? 

I 

I 

I 

; 

0 Yes ff?eask 10a and b) 

UNo f7Od) 

I 

I I 

--------- -----------------_---~-~~~~~~~~~~~~~~~~~-~~-~~--------------- I I 

c. Is this caused by any (other) specific condition? I 

1 0 Yes (Reask 1 Oa and bj 

; ONo 

Ask if multiple conditions, including old age, are listed in 7 Oa. 

Otherwise, mark appropriate box or transcribe the only listed 

condition. 

I I 0 0 - 3 month Inj/Op ONLY (Next page) 

I 20 Old age 

--- 33 

d. Which of these conditions, that is (read conditions in 1 Oal would -I 

you say is the MAIN cause of your zying in [bed/a chair] all 

1 

, 30 

or most of the tima? I 

I Condition - Enter “9” in AD1 box on Condition Summary Chart, THEN 

t 

FORM HIS. 1 691 I1 9941 13 13-841 

next page. 
Section R2. INCIDENTAL ACTIVITIES OF DAILY LIVING (UDL’S) / 

b Reed to respondent - Now I will ask about some other activities. Tell me about doing them by yourself. 

. 

11. Becauu of a ha&h or phyakal Problem, do you (1) 1 34 (2) 1 46 

have ANV dlffkulty - Proparing your own moalr? Shopping for panonol ltomr, (such 

88 tollot ltomr or modlclnor)? 

Ask if “Doesn’t do”: 1 cl Yes 1 Cl Yes 

Is this bwawe of l HEALTH or PHVSICAL problem? 

If “Yes, ” mar& box 1; if “No, ” mark box 3. 20No 20No 

3 0 Doesn’t do for other reason 3 0 Doesn’t do for other reason 

Ask 12- 14 foreechIADl. marked “Yes”in 11. 1 38 1 47 

12. By your&f, bow much dlffloulty do you have (IADLI, 10 Some 10 Some 

aomo,alot,oranyouun&lotodolt? 2 0 A lot 2 0 A lot 

3 0 Unable 3 0 Unable 

12. Do you receiw help from another ponon In fZAOL)? 1 36 1 40 

1 Cl Yes 10 Yes 

2 0 No (12 fornextZADL with 2 0 No (12 for next IADL with 

“Yes” in 1 1) “Yes” in 1 1) 

148. Who gives this help? 

I 1 

Source of help Paid Source of help Paid 

Anyona &a? 148. 

( 

14b. 148. 

f 

I I 14b. 

137-40 1 I41 -44 j4@-52 1 163-66 

HH member I 0 cl S/C/P HH member I 0 cl S/C/P 

--------- 

~a~~~h~s/c/pb~x~,~h~u~eskin~if”O~~~ her; i Go; spouse/children/ 

parents. THEN 12 for next IADL with “Yes” in 11. 

b. Is thk Mp paid for? 

Ask if necessary: Which holpora an paid? 

Ask 15ifanyfAOLmarked “Yes”in II. 

1 Sm. What (-1 c<lon CWHI the trouble in freed ZADLM)? 

Ask if injury or operation: 

.I 0 Relative . . . . i I 0 Yes 2 0 No I c Relative . . . .I I 0 Yes 2 0 No 

2 0 Nonrelative . I I 0 Yes 2 0 No 2 0 Nonrelative . I I 0 Yes 2 0 No 

I I 

Non-HH member I Non-HH member \ 

3 0 Relative . . . .I I 0 Yes 2 0 No 3 Cl Relative . . ..I lOYes 20No 

4 0 Nonrelative . i I 0 Yes 2 0 No 4 0 Nonrelative . 1 I 0 Yes 2 0 No 

I I 

0 Old age (15~) 

When did [the (injury) occur? / you have the oPoration?I 

Enter injury if over 3 months ago. 

Ask or reask 15b, if 0- 3 months injury or operation. 

Ask if operation over 3 months ago: 

For what condition dld you have the oporatlon? 

Enter condition. 

b. Bosldos (condition& lo thon any other conditlonOwhich 

eausos &o 8roubl6 In freed IADLfsll? 0 Yes (Reask 15a and b) 

0 No f15dl 

o. Is the trouble In head IADLfsj~ cauaod by any (other) 

speolflc eonditllG~ @ Yes (peas& 15a and b) 

0 No 

If multiple conditions, including old age, are listed in I5a, ask 15d 

for eachlAO with a “Yes” in 11. Otherwise, mark appropriate 

box or transcribe the on/y listed condition. 

d. Which of thou oondltlonr, that is freed conditions in 15aj 

would you say is the MAIN CIUSO of the trouble in 

IXAW? 

FOOTNOTES 

(1) [ 46 (21 1 67 

I 0 D-3 month Injl Op ONLY 

> 

I 0 0- 3 month Injl Op ONLY 

2 0 Old age 3 2 0 Old age 1 i 

. Ask 15d for nextDW1 with “Yes“ in I 1 Ask 15d for next IAD1 with “Yes” in 11 

30 30 

Condition - Enter in fA 01 box on Condition Condition - Enter infiDL box on Condition 

Summary Chart, THEN ask 15d for next IDOL Summary Chart, THEN ask 15d for next ZADl 

with “Yes” in II. with “Yes” in I I. 

65 
Section R2. INCIDENTAL ACTIVITIES OF DAILY LIVING (IADL’S), Continued 

(31 1 68 

(41 

1 70 (6) 1 82 (6) 1 84 

Managing your money, (such as koop- Reask 11 Doing heavy housework, (like rcrub- Doing light housework, (like doing track of l xponsos or paying billd? Wing the telophono? bing floors, or washing windows)? ing dishes, straightening up, or 

light cleaning)? 

10 Yes 1 Cl Yes 1 Cl Yes i Cl Yes 

z0No 20No 20No 20No 

3 0 Doesn’t do for other reason 3 fl Doesn’t do for other reason 3 0 Doesn’t do for other reason 3 0 Doesn’t do for other reason 

1 68 1 71 1 83 1 86 

1 Cl Some 1 Cl Some 1 Cl Some 1 Cl Some 

2 0 A lot 2 0 A lot 2 c] A lot 2 0 A lot 

3 0 Unable 3 0 Unable 3 0 Unable 3 0 Unable 

[ 80 1 72 1 84 1 88 

10 Yes 10 Yes I Cl Yes 1 0 Yes 

2 0 No (12 for nextIADL with 2 0 No f I2 for nextIADL with 2 0 No 172 for nextlAD with 

“Yes” in 1 7J “Yes” in 1 1) “Yes” in 1 II 

2 fl No (151 

I I I I 

Source of help I Paid Source of help I Paid Source of help I Paid Source of help I Paid 

I I I 148. I 

I 14b. 14s. I 14b. 14a. I 14b. 14a. I 14b. 

181-841 [ 85-88 173-781 [ 77-80 186-881 189-92 197-100 ’ ~101-104 

, I 1 I 

HH member I 0 Cl S/C/P HH member I 0 Cl S/C/P HH member I 0 0 S/C/P HH member I 0 0 S/C/P 

I 0 Relative . . . .I I 0 Yes 2 0 No I 0 Relative . . . .I I 0 Yes 2 0 No I 0 Relative . . . .I I 0 Yes 2 u No I 0 Relative . . . . f I 0 Yes 2 [7 No 

2 0 Nonrelative . 1 I 0 Yes 2 c] No 2 a Nonrelative . li0Yes 20No 2 0 Nonrelative . I I 0 Yes 2 0 No 2 0 Nonrelative . I I m Yes 2 0 No 

I I I I 

Non-HH member i Non-HH member i Non-HH member I Non-HH member I 

3 0 Relative . . . .I I 0 Yes 2 0 No 3 0 Relative . . . . IrnYes 20No 3 u Relative . . .I I 0 Yes 2 0 No 3 E Relative . . 1 I 3 Yes 2 5 No 

4 0 Nonrelative . I I 0 Yes 2 fl No 4 0 Nonrelative .)1[3Yes 2@No 

I 

4 0 Nonrelative . , I 0 Yes 2 0 No 4 c! Nonrelative . ; I 2 Yes 2c1 No 

I 1 I I 

(3) 1 68 (41 [ 81 0 1 93 (6) I 105 -- 

I 0 0- 3 month Inj/ Op ONLY 

> 

I 0 0- 3 month Inj/ Op ONLY 

> 

I 0 0- 3 month Inj/ Op ONLY 

> 

t 0 O-3 month 

2 0 Old age 

J 

2 0 Old age 

3 

2 0 Old age 

3 

W OP ONLY Next page 

Ask 15d for next3ADL with “Yes” in I 7 Ask 15d for nextlAD with “Yes” in 1 1 Ask 75d for next IA01 with “Yes” in 11 

2 E Old age > 

3c 3cl 30 -- 3 z ~--~- 

Condition - Enter in IAOL box on Condition Condition - Enter m IADL box on Condition Condition - Enter in IA 01 box on Condition Condition -- Enter inlAD box on Conditron 

Summary Chart, THEN ask 15d for next IADL Summary Chart, THEN ask 15d for next IA 01 Summary Chart, THEN ask 15d for next IADL Summary Chart, THEN nexf page 

with “Yes” in I 1. with “Yes” in Il. with “Yes” in I 7. 

FOOTNOTES 
.T 72 

I Section S. NURSING HOME STAY, HELP WITH CARE, AND HOSPICE , a-4 , 

18. Have you over boon a nddant or pathnt in l nuning homa? I 

I 1 q Yes 

I 2 q No 

I sODK fS21 

I 

--------------______------------- L ___-----____-------------------- --- 

b. How many DIFFERENT TIMES have you baan a nsidont or I 6-7 

pdont in a nunlng horn.? I - Number of times 

----------------___-------------- 

c. Wham ww you .dmitt.d (the FIRST tlmo)? 

~--------~.----------------~~~---- *ziiI 

I - 19- Y 

d. wk 

--- -- -------- ----- ~-------------------------------- 

WW. YW di.ch.rg.d Wt. ii-G time)? 

; 1...,,1 

-----------------------~~~~~~~--~ ;-------- -_----- -- ---- ------- ---- 

l . How long won you in the nuning home (the LAST tlma)? 

I oo 0 Less than 1 month 

$1 Refer to Id 

I 

I 

I Number of months 

I 

I I 0 Date discharged is since the 12-month reference date f IfI I ” 

I o 0 All other fS2) 

1 f. How many wook8 in the part 12 months, that i8,8ince I oo 0 Less than 1 week la-20 

(12 month dete) 8 year ago, were you in 8 nuning home? I 

I 

I Number of weeks -I 

$2 Refer t0 8ge 

la. An you now on a waiting list to go into a nursing home? 

I I 0 Sample 55- 64 121 

1 21 

person is 

I 2 0 Sample person is 65 or older (Ig) 

I 

I 1 22 

1 1cJYes 

I 

I 2 ONo 

I 9nDK 

2a. Is there a friend, relative, or neighbor who would take I 

Yes 

care of you for a few DAYS, if necessary? (Include the I - Who is this person? 

poop10 you live with.) 2 ONo 

HI-l member Non-HH member 

Mark one box only. I 

I 3 Cl Relative OR 5 Cl Relative 

I 4 0 Nonrelative 6 0 Nonrelative I 

b. i&hi; ~f>&i,%I&@~& ~e&~bor~h;&;dt;k~ - - - - - - : - - 

can of you for a few WEEKS, if nacesrary? (Include 

--Y;~ 

_______---------_------------ 

I 

_ Who is this panon? 

the people you live with.) I 20No 

I 

I HH member \ Non-HH member 

Mark one box on/y 

f 

3 El Relative OR 5 0 Relative 

I 4 0 Nonrelative 6 0 Nonrelative 

Skip to Section T if 8 proxy 

3a. Are you familiar with the term “HOSPICE,” that is, a service 

for the terminally ill? 

I 

i I q Yes 

I 2 0 No/DK (Section 77 

I 

I --------_-------____------------- ;-------------------~~-----------r3c-~ 

b. I8 thorn 8 horpice or an in-home hospice 8orvic~ in the I 

ims;pM;7n area/county] that you could use if you 

I I q Yes 

I 20No I 

I 9 QDK 1 

67 
Tl Respondent 

Section T. HEALTH OPINIONS 

I I i Cl Self response (1) 

I 2 0 Proxy (TZ) 

1 

I I 

1 Read to respondent - Now I’d like to ask your personal opinions 

about health related matters. 

I 

I 0 Excellent 4 0 Fair 

[ 28 

1. How good a job do you feel you are doing in TAKING CARE of your i 2 0 Very good 5 Cl Poor 

health? Would you say excellent, very good, good, fair, or poor? I 

3 q Good 

2. Compared with 1 year ago, would you say that your health is I 

now better, worse, or about the same as it was then? , I 0 Better 

1 29 

I 2 0 Worse 

’ 3OSame I 

3. During the PAST YEAR, has your overall health caused you a 1 1 30 

tya;;Tdeal of worry, some worrYI hardly any worry, or no worry , 

I c] A great deal of worry 3 q Hardly any worry 

, 2 Cl Some worry 4 0 No worry at all 

I 

Oa. Compared to other people your age, would you say you are I 

physically more active, less active, or about as active? I I 0 More active 1 31 

i 2 C Less active 

3 0 About as active (5) 

-----------------_--------------- L-----------------,-------,-----. 

b. Is that [a lot more or a Jlttle more active/a lot less or a little I 

less active]? I 

L-x 

i 0 Lot more 3 IJ Lot less 

I 2 Cl Little more 4 Cl Little less 

I 

I 

68. Compared to your own level of physical activity 1 year ago, I 1 33 

would you say you are now more active, less active, or about I I 0 More active 

the same as you were then? 

I 

I 

2 Cl Less active 

1 3 0 About the same (6) 

-----s--------s L ----_--_-_--_------------------- 

b.. Is ihitja%t ior: or 6 iR&-~o~e~&lve/a lot less or a little I 

less active]? I 

I 

1 Cl Lot more 

r -ii - 

3 0 Lot less 

2 Cl Little more 4 Cl Little less 

I 

6. How much control do you think YOU have over your future I 

health? Would you say you have a great deal of control, 1 

I 

I 0 A great deal of control 3 0 Very little control 

1 35 

some, very little, or none at all? I 2 0 Some control 4 Cl None at all 

I 

7. Do you feel that you get as much exercise as you need, or 

I 

I I 0 As much as needed 

1 36 

less than you need? I 

, 2 0 Less than needed 

8. Do you follow a REGULAR routine of physical exercise? I 

, 1 IJYes 

1 37 

i 

9. How often do you walk a mile or more at a time, without resting? .I 

(Note: One mile equals 8- 12 blocks.) I 

, 

Probe if necessary: About how many days a week is that? I 

I Oa. People find that they sometimes have more trouble I 1 

remembering things as they get older. In the PAST YEAR, I 

about how often did you have trouble remembering things - I 

frequently, sometimes, rarely, or never? 1 

I 

20No 

1 0 Every day 

2 q 4-6daysaweek 

3 q Z-3daysaweek 

I 0 Frequently 

2 0 Sometimes 

3 Cl Rarely 

o 0 Never f 11) 

4 0 1 day a week 

5 0 Less than 1 day a week 

o 0 Never 

1 38 

1 39 

--------------------------------- L ------------__------------------ 

r si- - 

b. Compared with a year ago, does this now happen more 

often, less often, or about the same? 

I I 0 More often WV I 

1 2 Cl Less often 

I 3 0 About the same 

11 a. People find that they sometimes get confused as they get i 1 a Frequently 1 41 

older. In the PAST YEAR, about how often did you get 

confused - frequently, sometlmes, rarely, or never? 

I 2 El Sometimes 

’ I 3 Cl Rarely 

I o 0 Never fT21 

----------_--__-_---------------- L ----------__--------------------- 

b. Compared with a year ago, does this now happen more 

I 

I I 0 More often 

often, less often, or about the same? I 

, 2 Cl Less often 

T2 Type of interview 

a. Proxy Reason 

T3 ---------------_--------------- L ____________________---------------- 

I 

I. oo 0 Non-HH member 

b. Enter person number of proxy respondent, or mark box. I Go to Condition Summary Chart 

I 

I Proxy Person No. 

3 0 About the same 

I 1 43 

I i Cl Self-personal Go to Condition Summary Chart 1 2 0 Self-telephone 

I 3 Cl Proxy personal 1 4 0 Proxy telephone tT3) 

I I 

I I I 0 Sample person temporarily absent [ 44 

I 

I 

2 0 Sample person mentally/physically incapable of responding (Explain) 

I s 0 Other Explain) 

I J J 

68 
r Section U. SUPPLEMENT CONDITION PAGES 1 

CONDITION A Except for eyes, ears, of internal organs, ask 3h if there are any of 

the following entries in 36 - f: 

Infection SOT0 Sorsnosr 

Is affected by 

In, muscle, 

, What part of the (part of body in 3bthe [infection/sore/soreness] - the When bone, or some other part? (Specify?! dld you last see or talk to a doctor or assistant about 1 

your (condition)? 

o 0 Interview week (Ressk 2) 5 0 2 yrs., less than 5 yrs. 

1 0 2-wk. ref. Dd. 6 0 5 vrs. . or more -- 

2 c] Over 2 weeks, less than 6 mos. 7 0 Dr. 

0 

seen, DK when -------- 

3 6 mos., less than 1 yr. 

-6~l%K~f kr. seen 

4 0 1 yr., less than 2 yrs. 9 0 Dr. never seen (36) 

> 

Ask if there are any of the following entries in 3b - f: 

Tumor Cyst Growth 

I. Is this [tumor/cyst/growth] malignant or benign? 

I 0 Malignant c 2 0 Benign snDK 

L-25 

DM the doctor or asslstant call the Icondition) by a more 

toohnloal or l Reclflc name? - 

1clYes 20No snDK 

---------------------------------- 

Ask Sb if “Yes” in 38, otherwise transcribe condition 

name from item 1 without asking: 

la-12 

What dld ho or she call It? (Specify) 

II 

i. a. When was your fcondit’o r I 

in 3b/3fl first noticed? 

7 1 q 2-weekref. pd. I 

2 0 Over 2 weeks to 3 months 

3 0 Over 3 months to 1 year 1 b. When did you (name 4 Cl Over 1 year to 5 years 

of injury in 3b)? 5 Cl Over 5 years 

Ask probes as necessary: 

I 0 Color Blindne.ss f/UC) 

2 Cl Csncer (38) 

3 Cl Vasectomy (51 

6 0 Other f3c) 

(Was It on or since (first date of Z-week ref. period) or 

was It before that date?) 

(Was it less than 3 months or more than 3 months ago?) 

(Was it less than 1 year or more than 1 year ago?) 

(Was it less than 6 years or more than 6 years ago?) 

Ul’ I q Missing extremity or organ in 3b/3f fU21 1 17 

W3) a 0 Other f 721 

2a.Do you still have this condition? 

1 Cl Yes fU2) ONo 

----_------------------------- -1 

b.ls this condition completely cured or is It under control? 

What was‘the cause of your (condition in 36/? ISpecifyk -- 

---------------------------------- 

Mark box if accident or injury o 0 Accident/injury (5) 1 

Old the (condition in 36) result from an accident or Injury? 

1 Cl Yes (51 20No ------------------------ 

Ask ielfthe condition name in 3b includes any of the following words: 

20 Cured 

30 Under control fU21 

6 0 Other (Specifyi 

Months 

Years 

----------- -- 

this condition before It 

--------------- 

c .About how long did you have 

was cured? 

10 

Number 20 

0000 Less than 1 month OR 

-------- 

d.Wis this condition 

past 12 months? 

--- ---- 

at any i&e during 

____---- 

the -I- 12- 

How does the [allorgyhtrokel NOW affect you? (Specifyi 

lOYes 20No 

u2 

(K4) 

l 0 Not an accident/injury fNCI 

2 0 First accident/injury for this person f 17bl 

6 0 Other f17bl 

1 

Ask if box 3, 4, or 5 marked in item 5 

7b.What part of the body is affected now? 

How Is your (part of body) affected? Same act. as Cond. - 

Are you affected In any other way? Abs8o88 Cwou 

AOM b-w Cramps (oxwpt 

hOSdOV8Od monrtrual) 

B b-m Cyst 

rmCrStVUOl) Damago 

uoodd8t Growth 

Bow Homorrha#o 

Infection 

Inflamm~tlon 

Nouralgl~ 

Nouritir 

P8in 

P&v 

Pu8lyrlr 

Rupture 

Soro(no~r) 

StIff(nosr) 

Tumor 

Ulcer 

Vuicow volna 

Woak(noaaJ 

, Whet vrt of the body is affected? (SpecifylJ 

Part(s) of body l Present effects ’ + 

1 24 

l Enter part of body in same detail as for 3g. I 

l l If multiple present effects, enter in Condition Summary Chart each one that is not the same as 3b 

above or is not already in the Condition Summary Chart. (If in C2 in HIS-l, enter condition number 

and transcribe when editing; if not, fill additional supplement page(s) during interview.1 

1 

a. /ndicate status of this 1 q Transcribed from HIS-1 

condition page. L 2 aobtained in SOA Interview 

Show the following detail: 

Hod .............................................. alcull, l wlp, f8co 

Dodd-. ............................... uppr,mld&,lowor 

~....................................................kfturiO M 

tw .................................... Innor or outor; loft, right, or both 

lye ............................................... loft,right,or both 

Arm ................ rhouldu, uppu, &bow, Iowu or w&t; I&t, right, or both 

Hd ......................... ontira hand or fingers only; loft, right, or both 

Log ...................... hip, uppu, knw, lowu, or wkk; loft, right, or both 

PO88 ....................... wtlm foot, arch, or tooa only; loft, right, or both 

t 

, 

____------- ------ 1------------ 

u3 I b. When editing, transcribe source data for this condition 

from the appropriate line in the Condition Summary Chart. 

EYE LTR;EAR Ll$EVER LTRll2 MO. LTR; ADL NUMBERS ; IADL NUMBERS ! CP 

26 I 27 I 28 I 28 130- 371 ‘30-43 I 44-46 

I I I I I I 

I I I I I I 

I I I I I I 

69 
Appendix I I I 

Bradenton, Florida, 

Supplement on Aging 

Pretest Questionnaire 

OMB No. 0937-OH2 Approval Exoires Seotember 30. 1983 

pd~lS-l (SAM (1983) 

U.S. DEPARTMENT OF COMMERCE 

RUREAU OF THE CENSUS 

ACTING AS COLLECTING AGENT FOR THE 

U S. PUBLIC HEALTH SERVICE 

. . 

NOTICE: Information contained on this form which would bermit identification of any Indlvldual or 

establishment has been collected with a guarantee that it will be held in strict confidence, wtll be used 

only for purposes stated for this study, and will not be disclosed or released to others wlthout the 

consent of the individual or the establishment in accordance with section 308(d) of the Public Health 

Service Act (42 USC 242m). 

1. I 2 .R.O. Number 1 3. Sample L _ 

Book ,-, of ~-, book 

SUPPLEMENT ON AGING 

NATIONAL HEALTH INTERVIEW SURVEY 

8. Interviewer identification I 

Name I Code 

I 

I 

I 

I 

7. Type of interview 

I 

i 0 Self-personal 3 Cl Proxy-personal 

2 Cl Self-telephone ) 

(9) 

4 fl Proxy-telephone 

8. Proxy information - Fill for all proxy interviews 

a. Name/relationship to sample person 

4. Control number [ I I I 

PSU I Segment I Serial 

I I 

I I I 

5. Sample Person I I I 

Neme I Age I Person No. 

I I 

I 

I 

I 

~ 9. Length of interview 

Time began Time ended Number of minutes 

a.m. a m. 

p.m. P m. 

, 10. Reason for supplement noninterview - Mark box, describe I 

situation below 

I 0 Refused 

2 0 Sample person temporarily absent and no proxy available 

, 

3 0 Sample person incapable and no proxy available 

4 0 Other (Specify) - 

Describe situation - 

-- 

- - -- - -. - - 

--.--.------ 

b. RdaSOn for proxy interview 

----- 

SUPPLEMENT ON AGING SAMPLE SELECTION 

I 

1 0 Sample selection completed on previous booklet I I 

I 

I 

1. Are there any nondeleted persons 65 years old or older in I I 0 Yes (Mark “SP” box on HIS- I for each, THEN 12) 

the family? I 

I 

I 

2 0 No 

I 

2. Are there any nondeleted persons 55-64 years old in I 

I -- 

the family? 

I 

I 0 Yes (131 

I 

I 

2 0 No18egin supplement interview(s) if any family 

I 

members 65 or older, otherwise end interview.) 

3. List by age (youngest to oldest) each nondeleted family member 

55 - 64 years of age. Then mark the “SP” box on the HIS- 1 for Age Name Person Sample 

number 

each listed person with an “X” in the sample person column 

person 

. - 

and begin supplement interview(s). 

X 

----. 

X 

.-- -- 

,---e-o 

X 

- 

X 

X / 

i 

X 

70 
r 

_-- -_ . 1 

I Section M. FAMILY STRUCTURE, RELATIONSHIPS, SUPPORT, AND LIVING ARRANGEMENTS I 

Read to respondent - We are interested In obtaining further information about the health of people 55 years of age and older in the 

United States. I will ask you some (addltional) questions about your family, social activities, any health problems 

you may have and how you deal with them. First I’d like to ask about your family. 

Ask or verify for each H/-f member 

1. How is jname on HIS- 1) related to you? 

Enter “Sample Person” on appropriate line. 

Enter “Unreleted” for persons not related to the semple person. 

Enter “Deleted” for any deleted persons, except Af members 

living et home and babies born during interview week. 

f n ter 8ges from HIS- 1. 

I 

1 Person No. 

I I 

Age on 

on HIS- 1 HIS- 1 

I 

Relationship to Sample Person 

i I 1 

t 

I 2 

i 

I 3 

I 

I 

I 4 

I 

I 5 

I 

I 

I 6 

I 

I 7 

t 

I 

I a 

t 

I 

I 9 

i I 1cJ I I 

I I i 

Ml I 

I 0 Sample person is now married (2~11 

Refer to marital status (page 461 on HIS- 1 

I 

2 0 Sample person is now widowed, divorced, separated f2b) 

I 3 q Sample person has never been married (4) -I 

2s. Earlier [you told me/l was told] that you are now married. 

How long have you been married (to heme of spouse) I? I 0 Less than one year 

> 

(3) 

Number of years 

b. Earlier [you told me/l was told) that you are now 

(widowed/divorced/separated). How long have you 

been [widowed/divorced/separated) ? . 

1 0 Less than one year 

- Number of years 

Mark box if S. P. has children 18 f in HH. 

3s. Do you have any living children 18 years old or older? 

Include stepchildren and adopted children. 

_ .-__- -___--__ --- 

I 0 Sample person has children 18 I in HH 

2 Cl Yes 

3 0 No 14) 

b. How kany of-your children 18 ye&sold or older are sons - 

-----+----------- - __ _ _ _ . . _ - _ _ . - - . . 

I 

and how many are daughters? (Include stepchildren and 

adopted children.) 

Number of sons 18 I 

Number of daughters 18 t 

I Total number of children 18 t 

‘Verify total with respondent 

_ 

I - .-_ - -_. . .-_. - - - - ._ --- .- --- --- ---- --------------- .-----. -- - - - - - -. - - - -- - - _- 

Skip to 3e if nd sons 18 1, otherwise mark box or ask 

c. [How many of your sons are/Is your son] now married? 

I 

0 All sons 18 t live in HH (3eI 

- Number of married sons 

. - - -. we 

d. iHow many of your sons/Does your soni lk close enough to 

---- T -------__---- - . . - - -- . . _ . .- 

get here within one hour, by the usual way? (Include (names I 

I 

of sons 18, living in HH) as well as sons not living here.) I 

I - Number of close sons 

I - -- - - -.. - - .- - - - 

&to 4 if nb daughters is t ; &h&wise mark box or &i - - - - - 

--_.-__-------_-.-.- ---_- . -. --- - .- - - ---_- - .._ I 

0 All daughters 18 + live in HH (4) 

e. [How many of your daughters are/Is your daughter] now f 

married? I Number of married daughters 

_- -_ - _ -. __--.-v---e 

f. iHow-many of your daughters/Does you; daughter] live 

close enough to get here within one hour, by the usual way? 

;~----------.---- -----.-. _- - _ -. -. _ _ - 

I 

I’ 

(Include (names of daughters 18 + living in the I-/HI as well as 

daughters not living here.) Number of close daughters 

L-i 

_ - 

I. 

71 
Section M. FAMILY STRUCTURE, RELATIONSHIPS, SUPPORT AND LIVING ARRANGEMENTS, Continued 

Mark box if S.P. has brotherfsl in HH 

4a. Do you have any living brothers, including step brothers? 

I 0 Sample person has brother(s) in HH 

20Yes 

I--- 

i 

L 

3 0 No 14d) 

-..--- - --- .- ..---- ------------- --.--------------.- -.-_ - - 

b. How many living brothers do &ha~~;k&ther? 

_._ _- .- ._ .- ----.- _ 

I I 

(Include step brothers.) I 

I 

I 

I -Number of brothers 

C . M&k box ii ai/ brothers jive in HH -. - - - 

----------.-----.-+- ---- -.- ------ _.---. . . 

I I 

[How many/Does he] live close enough to get hers I 0 All brothers live in HH 

within one hour, by the usual way? (Include (names of I 

brothers living in HH) as well as brothers not Ii-.) I 

I -Number of close brothers 

- - . . 

Mark box iiS. P. has sister(s) in HH -- - - - - 

--------------- +---.----- - ---_- _ - .- -_ - . - _. .-- ._ -..-..- 

I I 

d. Do you have any living sisters, including step sisters? I I 0 Sample person has sister(s) in HH 

I 2OYes 

I 3 0 No (M2) 

I -6----- --_- - _--. -.--- - 

e. How mani living-sister; do you ha& a&et&i - - - - - - - - - - - 1 

. - 

(Include step sisters.) I 

-Number of sisters 

-- _-- 

f . Mark box if all &t&s jive in l-/H - - - - - - - 

-----m---------a- +------- - .--_- _--- ___- _ __ . ._ . - - - . -- - _ _ 

I 

[Now many/Does she] live close enough to @et here I 0 All sisters live in HH 

within one-hour, by the usual way? (Irklud&(names of 

sisters living in HH) as well aa s/sters not IivinCj‘hw -Number of close sisters 

M21 Refer to age 

1 0 Sample person is 75 or older fM3) 

2 0 All other (51 

Mark box if S. P. has mother in HH 

Sa. Is your mother still living? 

I 0 Sample person’s mother in HH f5c) 

2OYes 

3 0 No (Scl 

I -- _. -. .-- ----.- ----------------.------------- - -__- - - - _ 

b. Doei your--moth& li~ekke enough to get here within 

_ - _ - - - - - 

I 

one hour, by the usual way? I 10 Yes 

L - 

I 

i 20No 

I 

- _- - - - - I. 

Mari box if S. P. has father in HI-f- ~. 

-------------w--w --_--. c* ---- ----- -- -__ .-._ - _ __ _ . ---- - -- 

I 

I 1 0 Sample person’s father in HH (M3) 

c. Is your father still living? I 2 0 Yes 

I 

I 3 0 No lM3) 

---.----------e-e--- ---------------_.___ - - . . . . _ ,. - - -..- 

d. Db&~&r’;~ther~~& close en&&h Roget here within 

lI 

one hour, by the usual way? I 10 Yes 

I 

I 20No 

I 

I 

M3 

I 

I 

Refer to 3- 5 I i 0 Any relatives in 3- 5 (M4; I 

I I 2 0 No relatives in 3 - 5 (Next page) 

M41 Refer to relationship roster in 1 and 3 - 5 

I 0 All relatives in 3 - 5 are HH members (Next Page) 

2 0 Other (6) 

I 

6s. (NOT including anyone living here) About how often do you 

see any of the relatives you just told me about? 

i 

I 

I 

I 

I 

I 

I 

I 

I 

I 

I 0 Every day 

202-6timesaweek 

3 0 Once a week 

4 0 2 or 3 times a month 

5 0 Once a month 

6 0 Less than once a month 

7 0 Never 

s0DK 

1 

_ - . - _-. - --.._--.----_---- 

b. (NOT i&uding~any&e’living her;)- About how often do 

t -------- -------------- .- -_ L --.__- .-. 

I L-l 

you talk on the telephone with any of the relativea you I 10 Every day 

just told me about? I 

I 202-6timesaweek 

I 3 0 Once a week 

4 0 2 or 3 times a month 

5 0 Once a month 

a 0 Less than once a month 

7 0 Never 

s0DK 

FOOTNOTES 

72 
Section M. FAMILY STRUCTURE, RELATIQNSHIPS, SUPPORT AND LIVING ARRANGEMENTS, Continued 

Note - Ask 8 immediate/y after receiving 8 “yes” in 7. 

Repeat question 7 when 

resuming the list. 

Read to respondent - I’m going to read a list of things that people sometimes get help with. 

. 

7. Do you usually receive - 8. Who usua/ly gives this help, a (spouse), relative, friend, 

neighbor or some other person? Anyone else? 

8. Help with fixing things around 

the house, such as home repairs 

or yard work? 

b. Help with housekeeping or 

housework, such as mending, 

sewing, or laundry? 

c. Help with cooking or preparing 

your meals? 

d. Help when you are ill? 

IB. Help taking your medication? 

--- -. . 

I. Help with your personal care, 

such as washing hair or clipping 

toe nails? 

--- 

8. REGULAR financial assistance 

or financial contributions? 

h.oney GIFTS? 

I. Other gifts, such as clothing or 

food? 

-- 

1. Regular vaccrtions, excursions 

or holiday trips provided by 

someone else? 

k. Transportation, that is, does 

anyone regularly drive you to 

the doctor, grocery, or send 

a taxi? 

l. Help with managing money? 

m . Help in any other way? 

I - 

1DYes * 10 Spouse 

20No 

) 

(Next activity) 2 0 Relative (Specify) 

3 0 Doesn’t apply 3 0 Friend/neighbor 

4 0 Other (Specify) 

i 0 Yes I i 0 Spouse -T--- 

20No 1 (Next activity) 2 0 Relative (Specify) 

3 0 Doesn’t apply 3 0 Friend/neighbor 

4 0 Other (Specify) --- 

I -: . I i 0 Yes 10 Spouse 

20No 

3 0 Doesn’t apply 1 

fNext 

activity) 

2 0 Relative (Specify) 

3 0 Friend/neighbor 

4 0 Other (Specify) 

i 0 Yes I 

-- em 

. 10 Spouse 1 

2nNo 

3 0 Doesn’t apply 1 

fNext 

activify) 

2 0 Relative (Specify) 

3 0 Friend/neighbor 

4 0 Other (Specify) 

i 0 Yes 

20No 

3 0 Doesn’t apply ) 

fNex t 

activity) 

2 0 Relative (Specify) -- 

3 0 Friend/neighbor 

4 0 Other (Specify) -,--------.-- 

I I 10 Yes i 0 

20 No 

3 0 Doesn’t apply > 

Spouse 

(Next 

activity) 

2 0 Relative (Specify) 

3 0 Friend/neighbor 

4 0 Other (Specify) 

I 

- - -----_- ------ 

i 0 Yes 10 Spouse L --- 

20 No 1 (Next 

activity) 

2 0 Relative (Specify) - --- 

3 0 Doesn’t apply 3 fl Friend/neighbor 

4 0 Other (Specify) -_-_--- -- -- --- 

10 Yes 

I - 

i 0 Spouse 

_______~._ --- _-- .--- .- L ------.-- _ 

20No 1 (Next 

activity) 

2 0 Relative (Specify) - .-- 

3 0 Doesn’t apply 3 0 Friend/neighbor 

4 0 Other (Specify) __-- 

--__- ---_ - ---_. 

i 0 Yes 1 

10 spouse 

T 

20No 

3 0 Doesn’t apply 1 (Next mtivity~ 

2 0 Relative (Specify) 

3 0 Friend/neighbor 

4 0 Other ISpecify) --- 

.--I.-- -- 

10 Yes I s i 0 Spouse II-- _--- 

20No 

3 0 Doesn’t apply ) 

(Next 

activity) 

2 0 Relative (Specify) I__-. 

3 0 Friend/neighbor 

4 0 Other (Specify) --- -_._--_ 

.---.---. --. ---_ 

i 0 Yes I 1 i 0 Spouse I -_-..-. - - 

20No 

1 

(Next 0ctivify) 2 0 Relative (Specify) --L-,--..-- .__ 

3 0 Doesn’t apply 3 0 Friend/neighbor 

4 0 Other (Specify) ______ -- 

-. -._- -__-__ 

i 0 Yes I i 0 Spouse L- --.-- 

20No 1 (Next 

activity) 

2 0 Relative (Specify) - ---- 

3 0 Doesn’t apply 3 0 Friend/neighbor 

4 0 Other (Specify) ___-_ -_---- _____._.__ 

------- ----_ -----..-I. 

i 0 Yes\ I 

What ways? 

Anything else? 

ISpecify) -- .- 

-.- --- 

------- 

20No 

73 
Section M. FAMILY STRUCTURE, RELATIONSHIPS, SUPPORT AND LlVlNG ARRANGEMENTS, Continued 

) Read to respondent - Now I’m going to ask some questions about i t 

your living arrangements. I 1 0 Days 

I 2 0 Weeks 

9. How long have you been living here, in this [house/apartment)? 1 Number 3 0 Months 

I 4 cl Years 

; 1 0 Ssmple person lives alone I 

M5 

I 

Mark first appropriate box I 

2 0 Sample person lives ONLY with spouse II 1) 

and/or any children under 18 years old 

I 

I 3 0 All other iM6) 

Refer to 9 

1 

I I 0 Sample person has lived here less than 5 years /IOa) 

I 1 2 0 Sample person has lived here 5 years or more f IOe) 

1 I 

I Oa. Did you move in with other HOUSEHOLD members who were 

already living here? 

1 1 Cl Yes I 

I 

I 2 0 No /lOcJ 

---. ..- - .----.--_ -- 

b. Did you-move in because-of health, finances, or for-- 

-w_----- t ---------------c--m--- -_ _- -- .- . . - . _.- ._-..._ -. . 

some other reason? I Health 

I i 0 Sample person 

Any other reason? I 2 0 Other person 

If unclear ask - Whose (health/finances] - yours or I Finances 

someone else’s? I 3 0 Sample person 

I 4 0 Other person 

t s 0 Other (Specify) 

-.--- a-----e-v- $----.----.A----- --____ ._ _.__ -- _ _ - 

c. Did any other H&k HOLD members m-ok in-with you 

. . . .- _. - . - . . 

after you were already living hare? I i OYes 

2 ONo /We) 

-._-- ____. -__-___---- -___-_ 

d. Did the-other ho&hoi6 members move in because of 

; ------ ----------- -..- .- - _ . . . . . ._ - - - . . -. - .- _ -. _ - 

f 

Health L-2 

health, finances, or for some other reason? 

Any other reason? I i 0 Sample person 

I 2 0 Other person 

If unclear as& - Whose [health/finances] - yours or I Finances 

someone else’s? I 3 0 Sample person 

f 4 0 Other person 

I 

‘s 0 Other (Specify) 

em..- .- - .--..-. --..--.--.----------.----.----- -.--- -- . ..-. . 

e. What Is the MAIN reason you are NO-W living together? Is It for 

health, finances, or some other reason? 

.I Health 

I 

f 

10 Sample person 

If unclear ask - Whose [health/finances) - yours or 

2 0 Other person 

someone else’s? t Finances 

I 3 0 Sample person 

.- - . .- - . . - - . 

- . 

4 0 Other person 

i 5 0 Other (Specify) 

) Read to respondent - Many things influence a person’s choice 

I 

I 

of a place to live. I’m going to read you a list of reasons that 

people have said are important in deciding whether or not to 

live in a particular home. 

11 a. Which of these statements are reasons why you are NOW living 

in THIS [house/apartment] - 

1 

1 

(1) It is close to needed services . . . . , . . . . . . , . . . . . . . . . . . . . . I i 0 Yes 20No 

(2) It has features I need for health reasons . . . . . . . . . . . . . . . . .I 10 Yes 20No 

(3) It has features ANOTHER household member I 

needsforhealthreasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t i 0 Yes 20No 

(4) It is close to friends or relatives , . . . . . . . . . . . . . . . . . . . . . . . i i 0 Yes 20No 

(5) It is the only place I can afford . . . . . . . . . . . . .’ . . . . . . . . . . .I i 0 Yes 2flNo 

(6) Some other reason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I I 0 Yes (SpecifyJ 

d 

20No 

I 

--.-- ---_.--.- -_-. -----__ - - ---- _ - - - ----.- - 

Mark box if only one “Yes” in I la 

---__---- _---- -----a-$---------w-------v-- ---- 

I 

o 0 Only one “Yes” in 11 a I 

I 

b. If you had to choose, which of those reasons would you 

say is the MAIN reason you are NOW living in THIS 

[house/apartment]? Circle main reason. 

1 1 2 3 4 5 6 (Specify) 

I 

I 

d 

I 

I 

FOOTNOTES 

I 

74 
I Section M. FAMILY STRUCTURE, RELATlONSHIPS, SUPPORT AND LIVING ARRANGEMENTS, Continued I 

12a. Is this [houso/apartmentl now - 

(1)Ownodorbel na bought by you (or somoono I 

In the household)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .! 1 0 Yes f12b) 20No 

i 

(2) Rented for cash? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I 1 0 Yes (1.2f) 2 0 No I 

I (3) Occupied without payment of cash rontf . . . . . . . . . . . . . . . . I i 0 Yes (Section Nl 

b. who o&k&-buyl& iti 4. _--.------------------.--- --Me--------------- - - -- - . . . - - 

t 

I 0 Sample person and/or spouse 

I 

2 0 Sample person and/or spouse 

with other HH members 

I 3 0 Others in HH /Specify) 

-- -.-------a ---em -.---------v-d-------- 

0. iGhl8 place fully paid for or is thorn 8 

4 ------------ - - -- .- - - - - . - ._ 

I 

I 

I 0 Fully paid for fI2ej I’ . 

mortgage being paid? 

I 

2 0 Mortgage being paid 

I 3 0 DKfl2eI 

-_.--._ -----m-w ----.------------------------ I --w-w-------------- -_ . - .- .-_ - - -. - .- -- - - -. . - - . .- _ - 

d. How much prlnclpal Is still owed on the mortga#o? I 

I I 8 

I Amount 

I 

I 

oODK 

-- .-------mm-----.-------------.--m-w ---.-----+------ ----- - - - -- - _. __ - _ . 

i 

I 

I 

I 

Hand csfd SM 12 

e. What Is the present value of this place, that Is, I 

1 0 Under $20,000 

about how much would it 2 0 $20,000 - 34,999 

on today’s market? 

bring If you sold it 

I I 4 3 0 35,000 - 49,999 

t 

0 50,000 74,999 Section NI 

5 0 75,000 - 99,999 

I 

I 

6 0 100,000 and over 

TOOK I 

Who Is - - paying ._. - - - rent - -- -- for - - It?- 

-- - - - 

f. - ------.-------------- + ___--__ ---- .---.-..- - _- . . -. . 

I I 1 0 Sample person and/or spouse I 

I 2 0 Sample person and/or spouse 

with other HH members 

I I 3 0 Others in HH (Specify) --- 

75 
r 

IdOt8 - Ask 2- 5 hf7?8di8t8/~ 

8ft8r f8C8iVhQ 8 “yes” 

in 1. Then resume 

r88dinQ iiS t. 

a. A 8anior canter? 

b. Tran8portatlon for the 

elderly? 

G. Meala on whaala or 

meala brought Into 

the home? 

d. Group meal8 or meal8 

outride the home? 

e. Advice about nutrition? 

f. Homamaker 8arvIce to 

help with hou8ahold 

chore8 like cleaning, 

8hopplng, and cookhq? 

g. Routine telephone 

call rarvlca to check 

on your health or 

wall-balng? 

h. Vi8ltln# nur8a rarvlce? 

I. A health alda who 

come8 Into the home? 

j. Adult day care or day 

care for the elderly? 

k. Gerlatrlc Day 

Rehabilitation Center, 

that 18, a place for 

phyrfcal therapy? 

I. Legal 8ervicer for 

the elderly? 

m . A ho8pica for the tarminally 

ill or an in-home horplce 

8ervice? 

Section N. COMMUNlTY AND SOCIAL SUPPORT 

1 f?88d to respondent - Tha next que8tlon8 are about community 8srvice8 for older people. 

. Which of the following rarvlca8 2. Have you ever u8ed it? 3. When did you lart ~80 (service)? 

are avallabla In thlr area? 

1 cl Yes I * 1 OYes I I 

20No 

lh/8Xt 88rViC8) 

2 0 No (5) 

aODK 3 0 DK (N8Xt S8WiC8) Number 

10 Y8S I - 1 OYes I I 0 Days ago I 

20No ) 

3ODK /N8X t S8f ViC8) 

2 0 No (5) 0 Weeks ago 

3 0 DK (N8Xt S8rViC8) 

{ 2 

3 

Number 

n Months ago 

4 0 Years ago (5) 

- 

1 Cl Yes I I 

_ 

1 q Yes 0 Days ago I 

20No /h/8X t S8WiC8) 2 0 No (5) a Weeks ago 

aODK 3 0 DK (N8Xt service) 

Number 

fl Months ago 

0 Years ago (5) 

10 Y8S I a i q Yes 1 L / 

20No (/i/8X t 88Wk8) 2 0 No (5) 

3ODK 3 0 DK (N8Xt S8WiC8) Number 

1 n Y8S I q Yes L-----P 

20No iN8X t S8rViC8) 2 0 No (5) 

sODK i 0 DK (N8Xt S8WiC8) 

/ 

lo Y8S I - 1 OYes I I 

20No ) 2 0 No (5) 

sODK /N8X t S8WiC8) 3 0 DK (N8Xt S8WiC8) Number 

1 2 

q Days ago I 

0 Weeks ago 

3 0 Months ago 

4 0 Years ago (51 

i 0 Yes 1 1 i q Yes 1 [7 Days ago 1 

20No 

(h/8Xt S8WiC8) 

2 0 No (5) 0 Weeks ago 

sODK 3 c] DK (N8Xt S8fViC8) Number 

0 Months ago 

0 Years ago (5) 

1 Cl Yes I i OYes I 1 Cl Days ago I 

20No 2 0 No (5) 0 Weeks ago 

3ODK 

) 

(h/8X t S8WiC8) 3 0 DK (hf8Xt servicel 

Number 

1 2 

3 fl Months ago 

4 0 Years ago (5) 

loves I 

- i OYes I fl Days ago I 

20No 

(b/8X t S8WiC8) 

2 0 No (5) 0 Weeks ago 

3ODK 3 0 DK (h/8Xt service) 0 

Number 

Months ago 

0 Years 8go (5) 

10 Yes 1 1 OYes 

20No 

3ODK ) (6) 

2 0 No (5) 

3 0 DK (61 

FORMHIS-l(SA)X(lB1)3)(3.10-83) 

76 
Section N. COMMUNlTY AND SOCIAL SUPPORT, Continued 

8. How often do you ~80 It - 

every day, at leaat once a week, 

at leaat once a month, or lo88 

than once a month? 

Hand cerd SN5 

6. Who I8 the rponaor of the program - the local haalth department, 

romo other State or local government agency, a rellglour group, or 

aoma other organlzatlon? 

Anyone alao? 

B. I 0 Every day I ’ t 0 LOCal health department 4 0 Some other organization (Specify) 1 

2 0 At least once a week 

3 0 At least once a month 2 

0 J 

Other State/local government agen!y 

4 0 Less than once a month 3 0 Religious group so DK 

5. 

I 0 Every day 

L 

10 Local health department 4 0 Some other organization (Specify) I 

2 0 At least once a week 4 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group so DK 

c. I 0 Every day I I 0 Local health department 4 0 Some other organization (Specify) I 

2 0 At least once a week 4 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group 50 DK 

d. I 0 Every day I 

2 0 At least once a week 

I 0 Local health department 40 Some other organization (Specify) 1 

d 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group so DK 

a. I 0 Every day I ’ 10 Local health department 4 0 Some other organization (Specify) I 

2 0 At least once a week 2 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group so DK 

f. 10 Every day I I 0 Local health department 4 d Some other organization ISpecify) 1 

2 0 At least once a week J 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group 50 DK 

90 I 0 Every day 1 ’ 

2 0 At least once a week 

10 Local health department 4 0 Some other organization (Specify) I 

d 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group 50 DK 

h. 10 Every day I ’ 10 Local 4 0 Some other organization (Specify) I 

2 0 

health department 

At least once a week d 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group 60 DK 

I. I 0 Every dgy I 4 

10 Local health department 4 0 Some othe; organization (Specify) I 

2 0 At least once a week J 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group 60 DK 

J* I 0 Every day I i c) Locel health department 4 0 Some other organization (Specify) I 

2 0 At least once 8 week +/ 

3 0 At least once a month 2 0 Other State/lo&al government agency 

4 0 Less than once a month 3 0 Religious group 50 DK 

k. i 0 Every day I I 0 Local health department 4 0 Some other organization (Specify) I 

2 0 At least once a week 

d 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group sODK 

I. I 0 Every day I I 0 Local health department 4 0 Some other organization (Specify) I 

2 0 At least once a week r/ 

3 0 At least once a month 2 0 Other State/local government agency 

4 0 Less than once a month 3 0 Religious group so DK 

t 0 Local health department 4 0 Some other organization (Specify) I 

J 

2 0 Other State/local government agency 

3 0 Religious group 50 DK 

MIM MS-1ISAlX 119831 I3-10-031 

77 
I Section N. COMMUNITY AND SOCIAL SUPPORT, Continued 

Reed to respondent - We are lntererted In learning how often people participate in certain actlvitle8. 

I 

6. In the aat week, (that would be from lart (day) through I 

today, P did you - 

I 

I 

a. Get together with neighbor8 at each other’8 reridence or 

I 

I 

outride the home? 10 Yes 20No 

b. ialk with bn; idghb&r on ;he t&phon61- - 

---_--e-e--- ;----------- ----.-- ---- --. -- - - - - _ - _____. __ _ _ 

I 10 Y8S 20 No 

- ._-.. _--- _..- -----a ---- - - -- -- _--.._ __------------ -------------.----._-- -..-_- t . . -- 

c. Get together with frlend8, OTHER THAN NEIGHBORS, at 

each other’8 re8idenco or outdde the home? 

I I 

I 

10 Yes 20 No 

- .- - - - - --__----_-_._-- ..-_ - .----- -___--__---__-__ -----------------_------_----------_-_- -._______ .___. _. 

d. Talk with frlend8, OTHER THAN NEIGHBORS, on the telephone? t. 

I 

lb Yes 20No 

----.-- - - -..- _ . . . - _-.- -_____-.____________ - ____-__ ------- -_--___l-_____._.._ - 

e. & together with ANY relative8 at each other’8 recridence or 

-__ . . __..._._._______ _. 

out8ide the home? 1 

I 

10 Yes 20No 

- --.- ------ -.-- --------- ---- -- ---_--_-_--------------- . ..- --.---_- _-_____ 

f. iilk with A&‘%&% on the telephone? T _- - 

I 10 Yes 20 No 

-.- ------- - - - --- - - - - - -... -------------_---- 

g. Watch’televi8lon with another per8on? 

;-------------------- - ..--. --- __ .- - - - _ ________.___ _ 

I 10 Yes 20No 1. 

-----D--.-e- ------------------w----m 

h. ob ii-church or temple f&r 8ervicer? 

&---------------~. - ---.. -.- ----.- --.- -__-- ._ --- - .- 

I iDYes 20No 

I.. GO i0 dl&~cK& ikpk fG&h& SCtL%ierF - 

--a--.-------- t ---------C------.--C-m- - -- -- - - - -- _.__ - .--_- - - - . 

I 

iDYes 20 No 

- --.-.-------.--.-- --------------------- --_--_ --------_----_-----.-- -.---. - .-_-_ _. -.-_.---- - __- 

j. Go to the grocery rtore? T 

I 

10 Y8S 20No 

-_-.. -.-------se--- -- - - -----..--- -_ ------ --.__-. - ____--- 

k.& to a rhow or movie, 8portr event, club meeting, cla88er or 

other group event? 

T 

------ ---- ---_---.-------- -- ------ -- -_-- ------. .---- 

I 

10 Yes 20 No 

-------- -- ----.------------_----_--_. 

I. r xer&Z& &&ipate in rport8t 

c ------.-------- ------- --- ---.-..-. ---. _. -. .---.- - - . --- 

I lOYes 20 No 

m. %ke an overnight trip away from home? 

- .- -__----_ - ---- -.-. -.--- --_--__--------_--- I _-------__---__-- ._--. - - _-_-. -_.- - - - __--__ - -.- . - ..-- -. 

I iDYes 20No 

78. At the pre8ent time, do you do any volunteer work 8uch a8 

helping in charity work, working in a 8hop for a nonprofit f iDYes 

organization, working in a hO8pit8l or nur8ing home without : 

20No (81 

pay, or doing community work without pay? 

---_----_ --_--..--- ----.--em- __---_-------- 

b. About how often do you do any volunteer work - every day, 

;------------------ ---_ __- -.__ -___ _ ._ 

at lea8t once a week, at lea8t once a month or Ie88 than once 

I 0 Every day 

a month? 

I 

1 

2 0 At least once a week 

3 0 At least once a month 

4 0 Less than once a month (8) 

c. 

_ -_ _ ._ _ - ._ _ . . _ _ -. . _ - - - . . ---.-.---mm------ 

Ab&h h&f many hour8 [per day/each week/each month] 

do you do volunteer work? 

I 

_-----e-e .- - - -_ 

_---- ----- _. _ - - - 

1 

I 8. At the present time do you ever participate in any i 

ORGANIZED renior citizen actlvitie8? 

I 

iDYes 

20No 

I Nl I f?espondent 

I i 0 Self (9) 

I I 2 0 Proxy (Section 01 

Regarding your prerent 8ocial activitie8, do you feel that 

you are doing about enough, too much, or would you like to 

be doing more? 

; 

I 

I 0 About enough 

20 Too much 

I 30 Would like to do more I 

78 
r I 

I Section 0. OCCUPATION AND RETDREMENT I 

)Read to respondent 

-~ r 

- Now I would like to a8k you some que8tionr about your work I 

background. Thi8 include8 work for pay or profit, unpaid work in 

a family farm or buainorr, or military 8ervice. 

I 

I 1 0 Yes I 

1 a. Have you EVER worked at a job or bU8ine88 full or part time? 2 0 No (3) 

------ ----.-- -- __ - - - --. _--__---_-.---~--------~-------~~~~ 

b. 6id you work at all at a job or bU8inO88 in the pa81 12 month8, that 18, 

I _- ------.- -- _.-.- -_----_---- -- 

8ince ( 12 month date) a year ago? I 1 0 Yes 

I I 2 0 No (21 

--_--------__--------- _---~--~-------------------.~---~~~~ 

r 

e__--_ - - -- _-._ . _._e -e-- -- . . 

c. Since (12 month detel a year ago, in how many week8 did you work, either full 

or part time, not counting work around the hou8e? include paid vacation8 and I 62 0 All year - 52 weeks 

paid 8ick leave? t 

Weeks 

. ..-.__---_-.-----.-.-.----~---~------ ----------- -.- ---_------ L -------- -- -- --.- -.--- --.--. - - - - 

d. In the week8 that you worked, how many hour8 a week did you USUALLY work 

at ALL job8? I 

I 

I - Hours 

I 

Pa. Now, think about ALL of your work experience, including work for pay or profit, i 

un 

di cp 

aid work in a family farm or bU8inO88, or military service. What KIND of work 

you do for the LONGEST period of time? (What wa8 your occupation?) I 

for exemple, electrical engineer, stock clerk. I Occupation ‘._ _ _ _ - - _ _ - - . - - .- . -_ -- - ---.-----------------__--_----___-___ 1. - - - -._- - -- - - - . . - - . __ -. - -- - - - . . .- . ^ - 

b. What were your mart important activities or dutie8 a8 a foccupetion)? I 

1 

For example, typed, kept account books, filed, sold cars, operated 8 I 

printing press, finished concrete. f Activities/Duties 

_-.___--_-- ----a------es ------------__---___-------------- 

c. Altogether, for how many year8 did you work a8 a foccupstion) ? 

I-___ -_---.~-_-~_--~_-__.-- .---. 

I o 0 Less than one month L-ii 

I I 0 Months 

1 - 

-_ - --._- - _---.- ----- --- 

L _ Number { 2 0 Years 

-------.---------------------- ________ _ ---___ - - __ . . - - _---. --._ -.. .- . _ . - - . _ . - 

d. For WHOM did you work a8 a (occupation) the LONGEST? I 

I 

Enter n8me of company, business, organization, of other employer. 

I If military service, enter “Armed Forces, ” THEN skip to 3. I Name of longest employer 

___-- __--a---- - _--.- __ a.-. -------a-------------- -___-_-__--___ m_-___ --_ - - - . 

0. tii;at kind of bU8ine88 or indu8try 18 thi8? I 

“.--. - ._.___ --- -- . -__ - _-- 

I 

I For exemple, TV and radio manufacturing, retail shoe store, state I 

i&or depertment, etc. 1 

I Industry I -_______---------------------------------------------- ------------------ 

~ 1. Wereyou- l- -v------ -- 

An employee of a PRIVATE company, bU8ine88 or individual I 

for wage8 or commi88ion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I 

~ A FEDERAL government employee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I 

1OP 

A STATE goveinment employee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I 

20F 

30s 

A LOCAL government employee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I 4OL 

Self-employed in OWN bu8ine88, profe8rionai practice, or f8rm? 

Ask: 18 thi8 bU8ine88 incorporated? I 

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I I 

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~ 

501 

60 SE 

Working without pay in family bu8ine88 or farm? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I 7OWP 

-1---- 

I 38. At thi8 time, do you conrider your8elf completely retired, partly retired ’ I 

or not retired at all? f 

I 0 Completely retired 

. 2 0 Partlv retired -I I 

I 

3 0 Not retired at all 

4 0 Never worked 1 

(41 

- -- - - -- . . ----.------------w-----------------w-- 

b. A&&i 6& i&e 660 did you retire? 

;_________.-_ - ---_ -__. _..----- . . ..- 

f 

o 0 Less than one month ago 

I 

I 0 Months ago 

I - Number 2 0 Years ago 

I ------ 

&ndcard So3 -------- 

-------------------------~-~-~~~--~-- L -------------.---- 

Reed categories if telephone interview 

c. Why did you retire? 

. 

Any other rea8on? 

I I 0 Because of your health 

I 

f 

2 0 Because of 8 fsmily member’s health 

3 0 Forced to retire because of age 

I (compulsory retirement) 

I 4 0 Company moved away 

I 5 0 Job was eliminated 

I 6 0 Wanted to retire 

I 7 0 Other (Specify) 

t 

-----------------------w--m-------- 

/Kirk bcix-iibhl,, GeTeeson in 3c. 

----_------ I---------. -. -.- - _ -. .- .- - .- - .- - - - .- 

I 0 0 Only one reason 

d. if you had to ChOo8e, which of tho8e rearonr would you ray wa8 the MAIN 

rea8on you retired? Circle main reason. 

I 123456 

I 

7 (Specify?/ 

I 

I 

FORMHISltSA)X 119d3113.10931 

79 
Section 0. OCCUPATION AND RETIREMENT, Continued 

NOTE - Ask 4a-j before asking 5 - 8 NOTE - Ask 5 - 8, as appropriate, for each “Yes *’ in 4a-j 

0. During the past 12 months, did S. How long have you 6. Dld you receive It 7. Is the (source in 41 8. What was the main 

you receive any payment8 or been receiving because you qualified 

-- 

receiveCiI%kaure condition or health 

benefits from- (source in 4)) for the payment, or of a disability YOU problem for which 

because you are a may have? you received benef itr 

dependent or survivor or payments from 

of romeone else? (source in 4)? 

m. A private union or 1 I I 1 I 

employer pendon? 

; 10 Ye9 1 Cl Own i 0 Yes 

; 20No 2 0 Someone else 2 q No (Next source) 

I Number 

(Next source) 

I 3 0 Both 

I 

b. A (Federal, state, or 

local} government 

1 [ I I I 

employee pen8ion? 1 i 0 Yes lOOwn i 0 Yes 

120No 2 0 Someone else 2 0 No (Next source) 

I Number 

fNex t source) 

t 

3 0 Both 

c. Military Retirement? f I I I 

I i q Yes 10 Own I 13 Yes 

120No 2 0 Someone else 2 0 No (Next source) I 

I Number 

fiVex t source) 

3 0 Both 

f d. Railroad Retirement? , [ I I I 

( i 0 Yes I 0 Days 

1 , 

10 Own 1 0 Yes 

) 2mNo 2 0 Weeks 2 0 Someone else 2 r] No /Next source) 

I Number 3 0 Months (Next source1 

I 4 Cl Years 3 0 Both 

8. Social Security? I ’ I 1 I I If i 0 Yes 10 Own i 0 Yes 

120No 2 Cl Someone else 2 0 No (Next source) 

I Number 

(Next source) 

3 0 Both 

I 

f. Workman’8 I 

I 

I * I 

compen8ationt 

r 

i 0 Yes I 0 Days I 0 Own 181 

20No 2 0 Weeks 

r 

t , 

2 0 Someone else 

Number 3 0 Months (Next source) ..’ 

I 4 0 Years 3 0 Both (81 

0. Supplemental Security f 1 I I 

Income, known a8 SSI 

{from Federal, state, or 

) 

I 1 I 

I i Cl Yes 10 Own 1 0 Yes 

local government)? 12130 2 0 Someone else 2 0 No (Next source) 

I (Next source) 

I 

Number 3 0 Both 

h. The Veterans I 

I I I I 

Adminirtration? 

1 i 0 Yes 10 Own 1 0 Yes 

Use when asking 5 and 7: ; 2 0 No 2 0 Someone else 2 0 No (Next source) 

Payment or benefit I INext source) 

from the VA? 

I 

Number 3 0 Both 

. State public welfare 1 1 I I I 

or aari8tance? 

i i 0 Yes 10 Own 1 0 Yes 

;20No 2 0 Someone else 2 0 No (Next source) 

I Number 

UVext source) 

3 0 Both 

I 

I 

. During the past 12 

1 

I I 

month*, did you receive 

any payment8 or 1 i 0 Yes I 0 Own (8) 

benefita from any 2 .O Someone else 

(other) source because 

; 20No 

-- (Next pegel 

of a DISABILITY to you 1 Number 

or someone elre? 

3 0 Both (8) 

If “Yes, ** ask: What was j 

the source? 

Specify all types, fill 5 - 8 1 

for first one mentioned. $ t 

I 

I 

1 

I 

I 

I 1 

80 
Section 0. OCCUPATION AND RETIREMENT, Continued 

1 Read to respondent - The next questions deal with your ability to do certain things that some people have difficulty with when they 

work at a job or business, or do chores around the house. 

Hand Card so8 

Please tell me how much difficulty, If any, you have doing EACH activity, by yourself, and not using any aids. 

8. Do you have no difficulty, some (11 (2) (3) (4) 

dlff lculty, much dlff lculty or are you Walk for a quarter of a 

unrblo at all to - mile, 

I 

Walk up and down Stand for long sit for long periods, 

which is about 2 one flight of stairs 

or 3 c ty blocks, 

without resting i 

without resting? 

periods, (about 2 

hours)? 

{about 2 hours)? 

I 0 No difficulty I 0 No difficulty 1 0 No difficulty 1 0 No difficulty 

2 0 Some 2 0 Some 2 0 Some 2 0 Some 

3 0 Much 3 0 Much 3 0 Much 3 0 Much 

4 0 Unable . 4 0 Unable . 4 0 Unable . 4 0 Unable 

Ask 10s -8 for each activity marked 

“much” or “unable” in 9. 

IOa. For how long have you [had much 

difficulty /been unable to] (activity)? ~~~~~s-~~~~~~~~~~~~s’~~~~~ 

b. What (other) condition .causer you to 

[have much difficulty/be unable to] 1 0 Old age(lOd) I 0 Old agefIOd) 1 0 Old age (IOd) 1 0 OldageflOdI 

(activity) 1 

Ask if injury or operation: When did 1. 1. 1. 1. 

[the liniuryJ occur?/you have the 

operatlonl? Enter injury if ovef 3 

months ago. 

2. 2. 2. 2. 

Ask or read 1 Oc, if 0- 3 months 

injury of operation. 3. 3. 3. 3. 

Ask if operation over 3 months ago: 

For what condition did you have the 4. 4. 4. 4. 

oporatlon? Enter condition. 

5. 5. 5. 5. 

c. Besides (condition) is there any other 

condltlon which causes this? 

I I I I 

1 0 Yes ;F;;f 1 Ob I 0 Yes fReas& 10b I 0 Yes IReask IOb 

and c) and cl 

1 0 Yes ;T;$ TOb 

2 0 No (Toe) 2 0 No (Toe) 2 0 No (Toe) 2 0 No (Toe) 

d. 18 this caused by any (other) specific I I 

t 

I 

condition? 1 0 Yes LF;;f 10b I c] Yes f30~$ IOb 1 0 Yes (Reask 10b 

and c) 

I 0 Yes Ip,“d”,“f 1 Ob 

20No 20No 20No 2 0 No 

Ask if mu/tip/e conditions, including o/d 

age, are listed in 1 Ob. Otherwise, mar& i 0 O-3 Inj/ 

I 

1 i 0 O-3 Inj/ i 0 O-3 Inj/ I 

appropriate box or transcribe the only Op. ONLY Op. ONLY Op. ONLY Op. ONLY 

listed condition. 2 0 Old age 7 2 0 Old age ,’ 7 l O o-3inj’>’ 2 0 Old age 7 2 c] Old age 

> 7 

e. Which of these conditions, that is (read 

conditions) would you say Is the MAIN 

10 for next activity 10 for next activity TO for next activity TO for next activity 

with “much”/“unable” with “much”/“unab/e” with “much”/“uneb/e” with “much”/“unable” 

cause of the trouble? 

FOOTNOTES 

-- 

Condition - Enter on Condition - Enter on Condition - Enter on Condition - Enter on 

Condition Summary Condition Summary Condition Summary Condition Summary 

Chart, THEN as& 10 for Chart, THEN ask 10 for Chart, THEN ask IO for Chart, THEN ask 10 for 

next activity with next activity with next activity with next activity with 

“much”l”unable. ” “much”/“unab/e. ‘* “much”/“unable. ” “much”/“unab/e. ” 

81 
Section 0. OCCUPATION AND RETIREMENT, Continued 

(6) (6, (7) (8) (81 (101 

Reask 9 Reach up (as If to get Reach out (as If to Use finger8 to grasp Reask 9 Lift or carry 

Stoop, crouch, or something from a shake someone’s or handle? 

kneel? Shelf}? hand}? 

Lift or carry something as heavy 

something as heavy 

as 25 ibr., (such a8 

as 10 ibr., (such as a 

10 lb. sack of 

two fuii bags of potatoes}? 

groceries}? 

I 0 No difficulty t 0 No difficulty t 0 No difficulty 1 0 No difficulty I 0 No difficulty (IO) I 0 No difficulty 

2 0 Some 2 0 Some 2 0 Some 2 0 Some 2 0 Some 2 0 Some 

3 0 Much 3 0 Much 30 Much 3 0 Much 3 0 Much 3 0 Much 

4 0 Unable 4 0 Unable I 4 0 Unable 4 0 Unable 4 0 Unable 4 0 Unable 

-f/ki~;: Number Eq33$ ~+)~~kiGic{~~~s ~{~~icjLz{~~~ 

I 0 Old age /IOdI I 0 Old age t IOd) I 0 Old age I IOd) I 0 Old age (IOdl I 0 Old age UOd) 1 0 Old age (IOdl 

1. 1. 1. 1. 1. 1. 

2. 2. 2. 2. 2. 2. 

3; ’ 3. 3. 3. 3. 3. 

4. 4. 4. 4. 4. 4. 

5. 5. 5. 5. 5. 5. 

I I I I I I 

1 0 Yes (Reask IOb I 0 Yes (Reask 1Ob 10 Yes (Reask 1 Ob 1 0 Yes Meask IOb 1 0 Yes fReesit 10b I 0 Yes V?eask 10b 

and cl and c) and c) and c) and c) and cl 

2 0 No (Toe1 2 0 No (Toe) 2 0 No (Toe) 2 0 No (Toe) 2 c No (TOeI 2 0 No (TOeI 

I I I 1 I I 

I 0 Yes ff?eask 10b I 0 Yes (Read 10b 10 Yes U?eask 10b 1 0 Yes (Reask IOb I 0 Yes Meask IOb I 0 Yes (Read 1 Ob 

and c) and cl and cl., and cj and c) and c) 

20No 20No 20No 20No 20No 20No 

l O o-3’ni’>’ 

I 

* iOO-3lnjl iOO-3Injl ’ 

I 

> 

’ 

Old age > 7 

- l q 0-31ni’ . l O 

* iOO-3Inj/ ’ 

2 0 Op.ld age ONLY 7 2 0 Op.ld age ONLY 7 2 0 Op. ONLY 2 0 Oldp. age ONLY IL 7 2 0 ““‘““>’ Oldp. age ONLY 7 2 0 Oldp. age ONLY > ;‘g;; 

10 for next activity 10 for next activity TO for next activity TO for next activity 10 for next activity 

with “much”l”unsble” with “much”/“unabk?” with “much”/“unab/e” with “much”/“unable” with “much”l”unab/e” 

Condition - Enter on Condition - Enter on Condition - Enter on Condition - Enter on Condition - Enter on Condition - Enter on 

Condition Summary Condition Summary Condition Summary Condition Summary Condition Summary Condition Summary 

Chart, THEN ask 10 for Chart, THEN ask 10 for Chart, THEN ask 10 for Chart, THEN ask 10 for Chart, THEN ask 10 for Chart, THEN next page. 

next activity with next activity with next activity with next activity with next activity with 

“much”/“unable. ” “much”/“uneble. ” “much”/“unab/e, ‘* “much”/“unable.” “much’*/“unable. *’ 

FOOTNOTES 

FORM HIS- ItSAIX I1 BS3~l3.lO~S3~ 

82 
r Section 0. OCCUPATION AND RETIREMENT, Continued 

Reed to respondent - We would like to know how health practlcea and condftlona are related to how long eopie live. The following 

Information will only be ueed to check against the vital l tatietlco record8 maintalne B by the National Center 

for Health Statlatice of the U.S. Public Health Servlco. The rerulto will only be used for statistical purposes 

and no Individual will be Identified. 

I Middle 

I 

I 

__--- --.-_--.--- ---_-__-----------__-~~~~~~~~--~~--- 

b. it&; your date of birth aa (birthdate from item 3 on HIS- I Household, 

_-_------------ ----_.- - .--. --. . . - _ 

Composition page). la that correct7 I], L-- 

t Verify/transfer from HIS- 1 

--.------ --.-- --.- ---.------------------------------------ A ---------- ----------- ----.^. -mm.- 

c. In what State were you born? I I 

Write in the full name of the State of mark the appropriate box 

if the sample person was not born in the United States. 

State 

1 i Cl Puerto Rico 

1 2 0 Virgin Islands 

I 3 0 Guam 

4 0 Canada 

I 5 0 Cuba 

f 6 0 Mexico 

l 7 0 All other 

-------- -.---- ---_-------________-____________________ 

d. What la your father’s last name? 

4 ____ ----- -------- -----_-----_*. -.--_- 

Verify spelling. DO NOT write “Same. ” I 

I 

Father’s last name 

I 

______ ---------me.- -_- _ -----------___----------- ---------- A ----------.------.--.---.---we-, --- 

Reed to respondent - We would like to have your Social Security Number. This will have i I 

no effect in any way on your benefltr. It will not be given to anyone 

in any other government or nongovernment agency. This informsI 

tlon is voluntary and Is collected under the authority of the Public 

Health Service Act and Title 42, United Statea Code, rectlon 242k. 1 tm-m-i 

I Social Security Number 

e. What la your Social Security Number? 1 10DK 

:OOTNOTES 

FOAM HIS. 1 MIX I1 9931 D- 10-93) 

83 
r Section P. CONDITIONS AND IMPAlRMENTS 

r Reed to respondent - Now I am going to read a list of eye Condition%. Tell mo if you have any of there conditions, 

even if you have mentloned them before. I 

1. 

(1. 

b. 

c. 

d. 

8. 

1. 

h. 

I. 

Do you NOW have - I 

I 

giindneaa in one or both eyes? I i Cl Yes 

I __ _ _ _ ____ _ --_-_ - ._- -- - -- -----------m---------w ---------- 

Cstsracta? r 

I 

I I 0 Yes 

_ ._--. _ _--___--- - ---_--------------w----m-- L _--------_ 

Glaucoma? I 

I I 0 Yes 

- -_-.. - - ---- _. -..- --.-- ------------------------aColor blindness? t ---------- 

Is 

- - -- - - ._ - - -. 

A detached retina?-- - 

:: 

I 0 Yes 

--------------------------a ---v-w ---- 

I 

I 

I i 0 Yes 

_ _. - _ .._ _ _ _ _- __ .- . . -. -_ 

&i other condition of the retinef--------- 

_----------- 

t 

---------- 

I 

i 0 Yes 

--- -- - - -- - . - . . -- - - -_ -- - ------.-- ------------- 

Trouble with close vision EVEN when weafi&g glasses? 

I------ 

I 

I 

I i 0 Yes 

_ _____ _ _ - _- -. - -. - ._ . -. . ..-._ - --_----_---- -------- ---a------ 

Trouble with distance vision EVEN when wearing glasses? t 

I 

i 0 Yes 

_ _-- --.--. - - . --- -- - -... -- -- ----- --.---.-------------- I_--------- 

Any other trouble seeing with one or both eyes EVEN when I 

wearing gia88e8? I 

I I 0 Yes 

20 No 

----- - - 

20No 

----- - - 

20No 

------- 

20No 

-------- 

20No 

--_----- 

20No 

-- ------ 

20No 

--m--m20No 

------- 

20No 

I l 0 All “No” in 1 a-i (2) I 

PI Refer to answers in la-i I 

I 2 0 Other - Enter “Yes” responses in Condition 

I Summery Chart, THEN 2 

I 

2a. Do you use preSCriptiOn eyeglaSSeS, including bifOCai%? I loves I I 

I 2 0 No (3) 

I _ _..- I ._--- _-_- _ - . . - _ - -.- -- -___---__-___---_---- _---_-_---~---__--_---_.--_..----------.--.. ---- 

b. Did you get or replace your eyeglasses in the past 12 I 

months, that is, since 112 month date) a year ago? I i 0 Yes 

I 2 0 No f3) I 

-- __----- 

c. hirthir because oi a new or chan~~dpr&&i$~o~~ 

-_---_---’ 

r 

_- ---- --__--- -_---__- --_. ..-. -_-----__-_-____ - . 

I 

i 0 Yes 

I 20No 

3a. Do you use contact lenses? i 10 Yes 

I 

I 2 0 No (41 

-- ____. - -__._--- -._ ______-__ -__--_--_---------- 

b. i&l you get or replace your contact lenses In the past 

c _-------s--w- -e--_------v-- 

I 

12 months, that la, since (12 month date) a year ago? I 10 Yes 

2 0 No (4) 

-_--_-_--_- _-.--__-- ______--__--___---_--- 1 _----------------------------------- 

c. Was this because of a new or changed prescription? I 

I i 0 Yes 

I 20No 

4a. Do you have intraocular lenses? I i 0 Yes 

I 2 0 No (5) 

- - _- - - --__--a_------------ --------------v-------m----- 

b. Didy& &t y&r &&ocular iei&& In the part 12 months, I- ______ - _.__-- 

I 

that is, since f I2 month date) a year ago? 

i 0 Yes 

20No 

Do you use a magnifying glass to read or to do other 

close work? 10 Yes 

aONo 

84 
Section P. CONDITIONS AND IMPAIRMENTS, Continued 

r Reed to respondent - The next few questtons are about how wall you can 8.0 (using your (glaaaes/(or) contacts1 

when you have to). 

I 

6a. Can you see well enough to see ordinary newsprlnt? I 

I 1 q Yes 20No 

I 

b. 

--- ----- --.------ -.--- - ---.---------- -------+------------------ ---- - ---.--- 

Can you see well enough to recognize the featuroa of people 

you know If they are two or three feet away? t 1 OYes 20No I 

--.-- ------.-*-----.--- --.-----------s--w------- L ________-_____-_ ------ --__ * ^.._ -- -.--_-- -_*-- 

c. Can you see moving objecta, much aa cara moving 

or people walking? I 

I 1 q Yes 20No 

I ------~-~-__--------------------------__---------____-________---------- -_-.--- -_-_-.. -.. 

d. Can you see well enough to step off a curb or down a step? I 

I 

I loves 20No 

_---- ---*---.--- -----s----m---------- 

e. C&-you see well enough to recognize a friend walking 

I------------------- ___.*._*______*-- ---*-_. 

on the other rids of the street? 

I 

I 1 0 Yes 20No 

I 

I P2 I i 

Refer to answers in 68 - e I I 0 All “No” in 6a-e (7s) 

I 2 0 Other (76) 

I 

7a. Can you see well enough to tell If a light Is on? 

I 

I 

I 1OYes I 

20No 

______---s-m --.------.----------_-___ 

b. Whi& stitement best describe8 your vision, (wearing 

L ___________________________ __________ 

I 

[glaraea/(or) contact lenses1 when you have to), - good, a 

little trouble seeing, a lot of trouble l eelng, or blind? 

I 0 Good 

2 0 Little trouble 

3 0 Lot of trouble 

4 0 Blind 

t 

Read to respondent - These next questions are about hearing. I 

I 

I 

I 8. Do you NOW have - i 0 Yes - Enter on Condition Summary Chart, THEN 9 

1 a. Deafness In one or both ears? I 

I 20No I 

-_-_--- --- 

&&lo hearing? 

------ -------- --------. ----- --_----_-------- --.----- ---.*._ ------.---- 

b. Auy-o&ei I 

I i Cl Yes - Enter on Condition Summary Chart, THEN 9 

I 20No 

I 

1 @a. Do you use a hearing aid? i OYes 

I 

I 2 0 No f9dl 

__._----- _.--. --- - - - - -- -.-------_-_------- ----- 

b. D&&u get or replace your hearing aid in the past 12 

l-------------- ---- ----.- ---- --.- -----------. 

I 

months, that Is, since (I2 month date) a year ago? I 

i q Yes 

I 2 0 No (9dl 

__._-.- --- -.--- ---------__-------- L -------- ------ -- _-__-* -------_--- __------ . . ---. . 

c. W&th~s&ka~so of a new or changed prescription? I 

I i OYes 

I 20No 

I ---- ------ _ -- *- - -- *-. - -. - - - - - -. - -___--_----___------------------------~ ___--__----------_--- 

d. (With your hearing aid) Can you hear well enough to hear I 

MOST of the things a person says without seeing his or I i 0 Yes f9f) 

her face? I 

20No 

I 

_--- -_--_- ---*---- -I-------_-------- 

e. (%thyour-h~arlng aid) Can you hear ONLY A FEW WORDS 

l------------------- ----_-- ** - .- - --v.--- 

I - - -- -- - Lli 

a person says or only LOUD noises? I i 0 Yes 

I 20No 

I , --**--- --. .- .- - - --- - ---- -------- -----L------------------- ---..-- - - - I- --- -- --- -_ 

f. Whkh st%skent best describes your hearing (when wearing I 

a hearing aid) - good, a little trouble hearing, a lot of trouble I I 0 Good 

hearing, or deaf? I 2 0 Little trouble 

I I 3 0 Lot of trouble 

I 4 0 Deaf 

I 

85 
Section P. CONDlTlOflS AND IMPAHUIENTS, Continued 

Note - Ask 11 immediately after receiving a 

“Yes * * in IO, then reask IO when resuming /is t. 

a. Arthritis of any kind or rheumatism? 

b. Oatoopofoalr, 8ometime8 called brittle 

or #Oft bonoa? 

(08 tee 0 po ro’sis) 

Read to respondent - I’m going to read a list of OTHER medical conditions. 

Please tell me If you have EVER had any of theme conditions, even If you have 

mentioned them before. 

10. Have you EVER had - 11; Are you NOW prevented In any way 

from doing any actlvitler because of 

(condition)? 

i 0 Yes 1 I 

20No 

3 o DK 

1 

i 0 Yes 

Next condition 2 ONo 1 

Reask 10 and resume list 

i 0 Yes I I 

20No 

1 

I 0 Yes 

Next condition 2 0 No 

a0DK ) 

Reask 10 and resume list 

c. A broken hip? 

d. Dlabotoa? 

e. An aneurysm? 

b’yoo ritm) 

f. Any blood clots? 

g. Varicose veins? 

h. Hypertonalon, aometlmer called 

hlqfh blood pressure? 

10 Yes 1 I 

1 

i 0 Yes 

20No Next condition 2 q No 

a0DK ) 

Reask 10 and resume list 

i 0 Yes I 1 

20No 

30DK 1 

1 Cl Yes 

Next condition 2 q No ) 

Reask IO and resume list 

10 Yes 1 1 

20No 

s0DK ) 

i 0 Yes 

Next condition 2 ONo 1 

Reask 10 and resume list 

10 Yes 1 I 

1 

i 0 Yes 

20No 2 ONo ) 

Read 10 and resume list 

30DK Next condition 

I I 

10 Yes 

20No 

) 

1 0 Yes Reask IO and fesume /is t 

s0DK Next condition 20No 1 

10 Yes 1 I 

20No 

s0DK 1 

1 0 Yes 

Next condition 2 ONo 1 

Ressk IO 8nd resume list 

I. Rheumatic fever? 

j. Rheumatic heart disease? 

k. Coronary heart disease? 

I. Anglnm pectorla? 

(pek’to ris) 

m . A myocardlal lnf arction? 

t’t. Any other heart attack? 

0. Cancer of any kind? 

P3 Refer to answers in 108 - 0 

i 0 Yes I I 

20No Reask 10 and resume list 

30DK 1 

i 0 Yes 

Next condition 2 q No ) 

i 0 Yes 1 1 

20No 

30DK 1 

i 0 Yes 

Next condition 2 q No 1 

a88Sk 10 and resume /is t 

i 0 Yes I 1 

20No 

1 

I CJ Yes Reask 10 and resume list 

s0DK /Vex t condition 2 q No ) 

10 Yes 1 I 

) 

1 U Yes 

20No 2 q No Reask 10 and fesume list 

.30 OK Next condition 1 

i 0 Yes I I 

1 

I Cl Yes 

20No Reask 10 and fesume list 

30DK Next condition 2 UNo 1 

10 Yes 1 I 

1 

i Cl Yes 

20No 

snDK Next condition 2 ONo > 

Reask 10 and resume list 

i 0 Yes I L 

i 0 Yes 

20No 

s0DK P3 ) , 

2 ONo 

I 0 All “No” or “OK” in 1Oa-o (121 

1 

I 0 Other - Enter “Yes” responses in Condition 

I Summary Chart, THEN 12 

I 

86 
I Section P. CONDITIONS AND IMPAIRMENTS, Continued 

128. Do you l ometimea foot dizzy? I 3OYes 1 

I 20No (12cl 

--.---------.---------________________C___- ---------------------- 

b. Are you proventod in any way from doing any l ctivitier T - .--.- -_-- - -------a--- - _- -- - a 

becrure of diuinea8? 

I 1OYes 

I 20No 

------------------------------a-e 

c. ik%jo~ 6iien in the pa8t month? 

~---------------------------------------------. 

f 

1 Cl Yes 

I 2 0 No (13) 

-me------------- --.-.-.----.----__.--_-__----- 

d. Did you fait becauao you felt dizzy or for rome other rearon? T 

-------------------------.--- ---- --------- 

I 0 Felt dizzy -I__: 

I 2 0 Other reason 

13a. Do you now have ail, mart, only a few, or 

none of your own teeth? I 0 All (Section Q) 

2 0 Most --I 

I I 3 0 Only a few 

I 4 

I 

0 None 

I 5 0 DK (Section Q) 

__----------------.----------------------- -I- ------------------------------------- ----__--.--. 

b. Do you now have faire teeth? I 10 Yes 

I 2 0 No (Section Cl) 

I --_--_--____---____----- _----___----__---------__--------------------- 

c. 60 youhs~s~-u~~~r-pia~~, a lower plate, or something ok? T 10 upper 

I 

I 2 Cl Lower 

I 3 0 Both 

I 4 0 Other (Specify) 

__.-.._-- -------m--w mm.----.- + ----------------- -------------------------------- 

d. Did you 

that ir, 8 7 nce ( 12 month date) a year agO? 

et or replace your faire teeth in the part 12 monthr, ; 1 Cl Yes 

I 

20 No 

I 30 DK 

87 
Section Q. HOUSING STRUCTURAL CHARACTERISTICS, ADC’S AND SPECIAL AIDS 

1 Read to respondent - Now f wiii ark you 8ome quertionr about houring. it 18 ea8ier for peopie to get around in rome home8 

than in other8 becsu8o of certain featurer. 

1 a. Do you HAVE to climb ANY steps to get into thi8 

[hou8e/spartment] from the aut8ide? 

-- ..- - -. -. ..- _ 

I I I I 0 No 

I Yes - If not mentioned ask: How many? 

I 

I 2 0 1 step 

b. Doe8 thir [hou8e/apartmentj have more than 1 floor or level? 

I 

3 0 More than 1 step 

--.- -- -.-- -.-.-_-------- ----- ---__--__- ---- - ------ _ .._.-. --..- --. .----- - _-_ - - - 

Count ba8ementr and step down living area8 aa separate laveis. I 

I . - .- 

I i 0 Yes 

I 20No 

Note - Ask 2% -8 before asking 3a - 8. I 2. Doe8 thi8 [hou8a/apartment] now have - 

a. A walk-in 8hower? 

b. 

__ -. -_ _ - - - -. .._ 

Your bedroom 

8ame floor? 

and b bath on the- - - 

---_ 

..-. .--_ _.- 

c. A b&h’& haif bath ON THE FLOOR where 

you 8pend mo8t of your time? 

----- _-__ _ .__ _ -- - ---- ----- 

d. Ab%droom ON THE FLOOR where you 

rpend mo8t of your time? 

- ----.---- _ --.__ _.- . . ._.- -- -----_- 

e. A kitchen on the 8ame floor a8 

your bedroom? 

10 Yes I 

i 0 Yes 

20No 20No 

----------------m--s---- 

i 0 Yes 

20No 

----- --------------- ---- 

10 Yes 

20No 

-------------__-----.----- 

i 0 Yes 

20No 

-- - -- -. - . . . _ - - - .- - - - _- - . . - . 

i 0 Yes I 

2flNo 

- - - - . . . - -. - - _- - . - 

10 Yes -I 

20No 

.___-..-- _-- - _ --._-- -- - . . - - . . - - 

10 Yes l-z20No 

----- --------- --------.--_ 

KlYes 

20No 

_---- .-_---- --_-- -_- -- ----.- . . . 

i 0 Yes - ---Ll20No 

h Read to respondent - Some people receive or need help to do 

I 

I 

certain daily activities. I 

I 

I 

I4a. Becaucle of a health or physical problem, do you RECEIVE help 1 i 0 Yes 

from another person when you go up or down 8tep8? I 20No 

Ask if “doesn’t do”: Is this because of a HEALTH or 

I 

PHYSICAL problem? -I 

3 0 Doesn’t do because of a health/physical problem (5) 

4 0 Doesn’t do for other reason (51 

--._---.-__----_-__.--~-_-.~-~-~_~-~_-__~~~ 

b. DO y&k ED help going up or down 8tep87 

km-- -_-___-__-_ --_-- .--. -_------ --------.--- _ ---- 

f 

Liz 

i 0 Yes 

I 

I 20No 

I 

FOOTNOTES 

3. Beceu8e of a health or phyrtcai problem, 

do you NEED - 

I 

88 
I Section Q. HOUSING STRUCTURAL CHARACTERISTICS, ADL’S AND SPECIAL AIDS, Continued 

Sa. Becau8o of a health or phyalcal problem, do you RECEIVE help from 

another person to bathe, l howor, or take a 8ponge bath? 

Ask if “doesn’t do”: I8 thlr becaure of a HEALTH or PHYSICAL problem? 

-------.-_ -- --- ----------------------~~----~~---~-~.~~--~ 

b. Do you NEED help from another person to bathe, 8howor, or take a 8ponge bath? 

- ._-. --- -- .--.---------------------.---------------- 

c. f)6 i& RkkD thir help mo8t of the time, 8ome of the tlmo or once In a while? 

--e----.--e -e--w- ---------------------------------m 

d. i&&e-of a health or phy8ical problem do you USE any 8peclal equipment 

to do thl8? 

1 OYes 

20No 

I 

3 0 Doesn’t do because of 

health/physical problem f5el 

4 0 Doesn’t do for other reason (61 

_.________ --------^ -. - ._ --.._ - .-. 

1 OYes 

2 0 No f5d) 

--.---- ----. -_--- -m------e----m--- - .-- 

1 0 Most of the time L-- 

2 0 Some of the time 

3 0 Once in a while 

____- - - - _ . --.---W.-e_. -_- - -. .- - --.- - 

i 0 Yes f5e) 

20No 

; I 0 Yes in 5b f5e) 

I 

I 2 0 Other (6) --I 

I So. What (other) condition cau8e8 you to need (help/(and) rpeclal equipment) 

to bathe, Ihower, or take a rponge bath? 

I 1 0 Old age f5gl 

I I 

Ask if injury or operation: When did [the (injury) occur/you have the operation]?’ 

Enter injury if over 3 months ago. 

Ask or ressk 5f if O-3 months injury or operation. 

Ask if operation over 3 months ago: For what condition dld you have the operation? 

Enter condition. 

1. 

2. 

4. 

--.-_------ ---- ------------------------ -..---- -- -- -------_.- - -__---_.._ I -_ - ------ - - -.-. - -- 

f. Be8lde8 fcondition), ir there any other condition that cau8.8 thir? I I 0 Yes (Reask 5e and f1 L-lI 2 0 No f5h) 

- - -. - - - - - - -- - -_ - _. -. - - - -------------------------------------~-- 

g. 18 thl8 cau8ed by any (other) rpecific condition? I 

________ __._ .- ---- --.-- --. . - .-- . 

I 0 Yes (Reask 5e end f) 

I 

I 20No 4 

---_-__.-_-_--- _--------- ------ ---------------------~~~-~~~ I .---. - .-- --- . . . --__. __ -._ - ._ ..-._. . . . - . 

Ask if multiple conditions, including o/d age, are listed in 5e. Otherwise, 

mark appropriate box or transcribe the only listed condition. I 0 0- 3 months injury/operation ONLY --Ill 

2 0 Old age > 

f61 

h. Which of there conditionr, that ir (read conditions), would you 8ay ir the 

MAIN condition that cau8e8 you to need [help/(and) rpecial equipment) to 

bathe, shower, or take a 8ponge bath? Enter on Condition I Summary Chart, 

I .Condition THEN 6. 

L 1 

6a. Becaure of a health or phy8ical problem, do you RECEIVE help froni 1 

another per8on to dr988? I 

1 OYes I 

, 20No 

Ask if “doesn’t do”: I8 thi8 bscau8o of a HEALTH or PHYSICAL problem? ; 3 0 Doesn’t do because of 

I 

I 

health/physical problem f6fl 

4 0 Doesn’t do for other reason f 7) 

.__. --.--.-------- --___-___L - --_--____________ b ..--. ___-_ -------- --.--.- --.-- -. 

b. & y&-U&ally dre88 in rtreei clother? I i OYes 

I 20No 

- -- .- - -_ -- -- .-. _- - - -- - - - - - - -------.-------------------------.----.- 

c. PO you NEED help from another per8on to dre88? 1 

____.._______ _-..-__-- .-- --- -. - 

I 

I ElYes 

2 0 No f6el 

-__. --.__---__~.-------- -----em- - --_----_-- - __..- --_---- _...- --_- --.-. 

d. &you NEED thlr help mart of the time, 8ome of &&&~~~&~ik-..&ils? I 

‘--- 

I 0 Most of the time I 

I 2 0 Some of the time 

.- .- L_ - 

_ -._ - 

_ - - 

I 

I 3 0 Once in a while 

---.- .-_------------ ---------- -___ ----- -___---_-- i--------... . . - 

e. kcbu~e‘bf a health or phy8ical problem do you USE any clpecial equipment I 

- __ -. - -- - -. - - - - - _- . . -- - - 

1 n Yes f6fI I-L 

to do thi8? I 

, 2GNo 

I Q2 I Refer to 6c 

I 

I 

I 0 Yes in 6c f6fI 

2 0 Other f 7)’ -i 

6f. What (other) condition cau8o8 you to need [help/(and) rpeclal equlpment] 

t0 dre88? 

I 

I 

1 n Old age f6hI 

I 

Ask if injury 01 operation: When did (the (injury) occur/you have the operation]? I 1 . -* 

Enter injury if over 3 months ego. I 

I 

2. 

Ask or reesk 6g if 0- 3 months injury or operation. 3. 

Ask if operation over 3 months ago: For what condition did you have the operation? i 

4. 

Enter condition. I 1 

- __. -- - - -- -_ .- - - - .- - - ^ .- - - _- - -. - - - - - - -_. -_ __---_-------------- .___ -_ _. _ . -- . - - - -- -- - 

g. Beride fcondition], ir there any other condition that cau8e8 thlr? I t n Yes Wteask 6f and g) 

I 2 0 No f6i) 

_a__a-------------------a--- 

h. i;-&i; &u&d by bii io;h~r)‘8p~=~fic-=~nditlon? I 

---_. . . . . . _._._. --- . . 

I I 0 Yes (Reask 6f and g) 

I 20No I 

Ask if multiple conditions, including o/d age, are listed in 6f. Otherwise, 

mark appropriate box or transcribe the only listed condition. 

. . I. Which of the8e conditionr, that 18 f& con- ), would you may I8 the MAIN 

condition that cau8e8 you to need [help/(and) rpecisl eC(uipment] to dre88? 

I 2 0 Old age 

t Enter on Condition 

1 

FORM HIS- 1 IS&X (1983I (3-10-831 

Condition 

Summary Chart, 

THEN 7. 

89 
Section Q. HOUSING STRUCTURAL CHARACTERISTICS, ADL’S AN’0 SPECIAL AIDS, Continued 

78. Because of a health or physical problem, do you RECEIVE help from 

another parron to aat? 

Ask if “doesn’t do”: Is this because of a HEALTH or PHYSICAL problam? 

I 

I 1 Cl Yes /7&I) I 

I 2 0 No (7~) 

I 

a 0 Doesn’t do because of 

I health/physical problem f 7f) 

--- __----.-__----- 

b. %&-y&3 fad totally by another person? 

i4 0 Doesn’t do for other reason (81 

------------------------------- ---em- --------- - ----a---- ..--- 

I i 0 Yes (78) 

20No 

- -. _- -. - -.. - - - - _ - - -- _- .- _- -. - -- - 

c . Do you-NEED help from another-parson to eat? 

------------------------ ;---- ---.-.--“.- ----...- - - -- ---__ 

I 

i 0 Yes -L-- 

2 0 No 178) 

-- --- ._-. -.-_ ----.- _--- -- ___._.__--.- _-__----- ____- - ---__--_______ 

d. Do you NEED this help most of the time, some of the time or 

+----- -...... - .-- - - -- . . __ - I. . 

once in a while? I 

10 Most of the time 

I 

20 Some of the time 

30 Once in a while 

---.---e------m----.---------- -__-- - --__--- 

a. ~&%&~o~ a k%itik+yrical problem do you USE any rpecial aquipmant 

--_- --_---__c---.------- -____ --- 

to do thir? 

!- 

I i 0 Yes /7f) 

I Q3 I Refer to 7c I i 0 Yes in 7c f7f) 

I 2 0 Other 181 -i 

I 0 Old aae (7h) 7f. What (other) condition causea you to need (help/(and) special equipment] to art? 

i 

1 

Ask if injury or operation: When did [the (injury) occur/you have the operation]? 

Enter injury if over 3 months ego. I 

1. 

Ask or reask 7g if O-3 months injury or operation. I 2. 

Ask if operation over 3 months ago: For what condition did you hava the operation? I 

Enter condition. I 

3. 

I 4. 

I 

I 5. 

----m----------s ------I--------------------------- ------- 

Q. Baaidor (condition), is there any other condition that causes this? 

r _ _ _ __ I _. _ _ _ _ -. - . _ .- _.- . . ._ - - - - - - -. .- . 

I I 0 Yes (Read 7f and g) 

2 0 No f 7i) 

------a------ - ------.-------------------------- --_-----_- -. _.. . - - - 

h. is-&is Gaured by any (other) rpeciflc condition? 

1 . . .- - _- -- -- -. -- . - - -. .- 

I 1 0 Yes (Reesk 7f and g) 

I 20No 

- .--.- -- - - - - --- - - -- ---------------------------------- 

Aikif>u/tiple conditions, including o/d age, are listed in 7f. Otherwise, I- 

---- --- ---- - ----- _------.-_-.-- _--- 

mark appropriate box or transcribe the on/y listed condition. I t 0 O-3 months injury/operation ONL 

I 2 0 Old age 9’ 18) 

I. Which of these conditions, that is (read condition&, would you say Is tha MAIN 

condition that causes you to need [help/(andI l pecial equipment] to oat? t Enter on Condition 

t 

Summary Chart, 

Condition THEN 8. I r 

88. Bacaura of a health or physical problem, do you RECEIVE help from 

another person to use the toilet, including getting to the toilet? I i 0 Yes 1 

I 20No 

Ask if “doesn’t do”: Is this because of a HEALTH or PHYSICAL problem? I s 0 Doesn’t do because of 

I health/physical problem f8ej I 

I 4 0 Doesn’t do for other reason (9) 

-- -.--- ---- -- ----- - ---- --- ------.----e-------------e--------------- ---------s--e _.- .- -. - - - - - - - -. .- - - - - 

b. Do you NEED help from another person to use the toilet, Including I 

getting to the toilet? I 1 Cl Yes 

LL __.__ - -. -__- -- -. - 

2 0 No (8dl 

.-- .- _--- - -.--- - .--.--. - - -- - - -- ---------.------------w--------B -- -. ,.-- ------ - 

c. Do you NEED this help most of the time, some of the time or 10 Most of the time 

once in a while? I 

I 20 Some of the time 

I 30 Once in a while 

------ --___-_--_-_---_--_-__------- ------------.---.------e-e..------ -- _ _ --_- - ----------.- .- 

d. Because of a health or physical problem do you USE any special equipment 

to do this? 

I I 0 Yes (88) 

I 

, 20No I 

Q4 Refer to 8b I 10 Yes in 8b (8e) I 

I 2 0 Other (9) 

80. What (other) condition causes you to need [help/(and) special equlpmant) to uaa the 

toilet, including getting to the toilet? 1 I 0 Old age (8gj 

* 

I Ask if injury or operstion: When did [the (injury) occur/you have the operation]? ; 1. I I 

I Enter injury if over 3 months ago. i 2. I 

Ask or reask 8f if O-3 months injury or operation. I 

Ask if operation over 3 months ago: For what condition did you have tha operation? 1 3. 

Enter condition. I 4. 

1. 

8s 

t 5. 

_----- _--------.-- -_--- .---- ------ _-----_------a---------------C--------.--- 

B&kes &&km), is there any other condition that cause8 this? I 10 Yes (Reask 8e and fl 

2 0 No /8hl 

- -. -_ - _ -_-.-- ___.--.- _ ___e -- ---___-____ ---w-w--- 

is this caus&f by any (other; apecifiiz condition? 

t --m--m-.--. -- . - -. . ----- 

I I I 0 Yes lReask 8e and f) 

i 20No I 

- _- -- - - - - - - --- ---- --- _.--.--__--- ___- --- -__- - -----_--_--- -- l- ---- ---.-._---.--- -._- ------ _ - ._ 1 _ - I 

I Ask if multiple conditions, including o/d age, are listed in 8e. Otherwise, i 

mark appropriate box or transcribe the on/y listed condition. I 

I 0 O-3 months injury/operation ONLY 

2 0 Old age 

1-i 

,b 

I 

I h. Which of these conditions, that is (read conditions), would you sa ia the MAIN 

condition that causes you to need [help/(and) special equipment J to use the 

toilet, including getting to the toilet? Condition 

Enter on Condition ’ 

Summary Chart, 

THEN 9. 

I I I 

FORM HIS 1lSNX 11993) (3 10-83) I 

90 
I Section Q. HOUSING STRUCTURAL CHARACTERISTICS, ADL’S AND SPECIAL AIDS, Continugd I 

98. Bacaura of a health or physical problem, do you RECEIVE help from 1 

I 

i q Yes Lanother person to get about the [houre/apartmant], that la, going 

from one room to another on the same floor or iavai? 

t 

20No 

Ask if “doesn’t do”: is thir because of a HEALTH or PHYSiCAl. problem? 

3 0 Doesn’t do because of 

1 health/physical problem (9e) 

I 4 0 Doesn’t do for other reason f10) ,., 

- - _- .- __ _ _ __ -- -. - - - - - - -----~~~-----~-~~-------~~~-~~~--(----------------------------- - 

b. Do you NEED help from another peison to get about the [house/apartment], 

I 1 q Yes L- 

(that is, going from one room to another on the same floor or iavai)? 2 0 No (94 

-__ -- - -- ----- ~~~----~--------~-~~~-,, ----- ------- 

6 youNEEb this help most of the time, some of the time or once in a while? 

&----------- ---- - -.------.---- - 

c. 

I 

1 0 Most of the time LI 2 0 Some of the time 

I 3 0 Once in a while 

____________ 1 - - _-.---.--------I---------------------------- -- --- ----.-. - ---- .----- -------- - 

d. B&cause of a health or phyaicai problem do you USE any special equipment I 1 Cl Yes (943) 

to do this? I 

I 20No 

Cl5 I Refer to 9b 

i 10 Yes in 9b f9e) 

I 

I 2 0 Other (10) -I 

90. What (other) condition causaa you to need [heip/(and) special equipment] 7 ~~ ~~ 

to get about the [house/apartment], (that is, going from one room to another on 

I I 0 Old age f9g) 

the same floor or level)? I a 

Ask if injury or operation: When did [the (injury) occur/you have the operation]? 

Enter injury if over 3 months ago. ; 2. I 

Ask or reask Of if O-3 months injury or operation. I 3. I 

Ask if operation over 3 months ago: For what condition did you have the operation? I 4. 

Enter. condition. I 

I 5. 

I ---- ------------------------------ ----_- -- -----__-- ..- ---._----------.__-.--. 

f. Besidis &ndition), is there-any other condition that causes this? 1 

I 10 Yes f&ask 9e and fl 

I 2 0 No (9h) 

----.--- .._-_- -.- -----..--.----.-----.-----------------------.---- --.- -.-_ _- - ._-- --__--_----- -.-- 

g. is this caused by any (other) specific condition? I- - -I 0 Yes (Reask 9e and f) 

I 

I 20No 

-_-_- __ -.-- ---- ------- ----- ------_---.-~~---_---___ 

A&if-&u&@/e conditions, including old age, are listed in 9e. Otherwise, 

t _--- --__ - .-- -- ------------- .- --. -. ..-- 

mark appropriate box or transcribe the on/y listed condition. I 

1 0 0 - 3 months injury/operation ONLY 

I 

2 0 Old age 1’ 

(10) 

h. Which of these conditions, that is (read conditions), would you say is the MAiN 

condition that causes you to need [heip/(snd) special equipment] to get about 

the [house/apartment], (that is, going from one room to another on the same 

1 Enter on Condition 

floor or level)? f Summary Chart, 

I Condition 7-t-WV 10. 

108. Because of a health or physical problem, do you RECEIVE 

help from another person to get in and out of bed or chairs? I i q Yes 

I 20No 

Ask if “doesn’t do”: is this because of a HEALTH or PHYSICAL problem? I 3 0 Doesn’t do because of 

I health/physical problem (IOe) 

I 4 0 Doesn’t do for other reason (I I) 

---.- -- --- ---- .--.---- - -----------------.--_- --_-_- - __--______ 

b. Do you NE ED help from another person to get in and out of bed or chairs 1 i q Yes 

I 2 q No (1Od) :I 

:---.--.-- .- - ---.--.--.-i,-,---- --- - - - - 

w--w-.--.---- -- -----.---------------m--m----------------- 1 --- - . ..- --_-.- __._ - ------ --- ----. 

c. Do you NEED this help most of the time, some of the time or once in a while? I I I 0 Most of the time 

; 2 0 Some of the time 

I 

I 3 0 Once in a while 

----- - - - -.- - ---.-.----------------------------------.------_ __. _- ---- -_- _-__- --.-- - - - - 

d. B&&e of a health or physical problem do you USE any l peciai equipment I 

to do this? I 1 q Yes (10e) 

I 20No 

I Q6 I Refer to IOb 

I 

I 

I OYes in lob (IOe) I 

2 0Other (I 1) 1 

I 

1 Oe. What (other) condition causes you to need [heip/(and) special equipment] 

to get in and out of bed or chairs ? 

i 

I 

I q Old age VOg) 

I I 

Ask if injury or operation: When did [the (injury) occur/you have the operation]? i 1. 

I 

Enter injury if over 3 months ago. I 2. 

Ask or reask I Of if 0- 3 months injury or operation. I 3. 

Ask if operation over 3 months ago: For what condition did you have the operation? 1 4. 

Enter condition. I 5. 

I ------ ----.----------------------w---m ----~----~-~--------------.----- 

f. B&idis (condition), is there any other condition that causes this? I I 0 Yes (Reask 1Oe and f) 

___I ___-_.----_ ------- --- .-------- - 

20No ItOh) 

---_-_ - --------_-------------_-w--w--------------- 

g. is%% kaured by any (other) specific condition? 

I I 0 Yes (Reask 1Oe and f) 

I 20No 

---_----_..--.-- -------------------------m----e--------- 

Ask if multiple conditions, including o/d age, are listed in 1Oe. Otherwise, 

+ ---_- -----.-------- -.---- _ - __ _ .- - 

l 

I 

I 0 0- 3 months injury/operation ONLY 

mark appropriate box or transcribe the only listed condition. 

I 

2 0 Old age lT 

-- -- 

(11) 

h. Which of these conditionr, that is (read conditions), would you say is the 

MAIN condition that causes you to need [heip/(and) special equipment] to 

get in and out of bed or chairs? 

Condition 

Enter on Condition 

Summary Chart, 

7-HEN 11. 

91 
Section Q. HOUSING STRUCTURAL CHARACTERISTICS, ADt’S ARiD SPECIAL; AIDS, Continued 

11 a. Bocauae of a health or physical problem, da you ~ECEWE hoip from I 

another perclon to prepare your own moaim? I 

10 Yes 1 

. 20No 

Ask if “doesn’t do”: Im thir bocau~ of 8 HEALTH or PHYSICAL probiom? ; 3 0 Doesn’t do because of 

I health/physical problem I I Id) 

I 

4 0 Doesn’t do for other reason I121 

-m-.-_--e_---- ---.----me ------------------a------------ --------------------- 

b. 6 you NEED help from another pormon to proparo your own moair? 7 

I 10 Yes 

-----*_** *.--,- -*s-.-d -----------------------------*-------- 

c. Do you NEED thia help mo8t of the time, 8omo of the time or onto in 8 white? 

:. 

2 0 No (12) 

I I 10 Most of the time 

i 

I 20 Some of the time 

I 30 Once in a while I 

I 

-----*.-----*------ -------------------------m---e----- 1 ------_---__-_f---------__--------* 

d. What (other) condition cau808 you to noad hoip preparing your own meata? I I 0 Oldage(llf) I 

I Ask ii injury or operation: When did [the (injury) occur/you have the oporationl? I 

I I 

I Enter injury if over 3 months ago. i 1. I 

Ask or ressk 11 e if 0- 3 months injury or operation. I 

Ask if operation over 3 months ago: For what condition did you have tha operation? f 

Enter condition. I 

I 

* n 

3. 

4. 

I 5. 

- ------.-.---.-a-----.--L-- -l 

l . @&aid%~ 6&dition), i, then any other condition ti;iic~~~~t~~~------------- I 

_______._ -----.--..--*----------.. 

I 

I 0 Yes (has& 11 d and e) 

20 No (llg) 

-----------_- *_ *- -------------------------------------- 

f. lo thia caurod by any (other) l pocifio eondition? 

; _______ --.._----_-----------~* 

I 

I 1 0 Yes (Reask 1 Id and e) 

I 20No 

------------*- *-*_- -- --L.-------------------------------- 1 ---- ------ -.- ---- -- - - ---- --- - .-- - - 

Ask if multiple conditions, including old age, are listed in I Id. Otherwise, 

mark appropriate box or trenscribe the on/y listed condition. I 

t 

I 0 0- 3 months injury/operation ONLY 

g. Which of theme conditions, that la (reed conditions), would you ray la the MAIN 

I 

2 0 Old age )’ 

I f 2, 

condition that cauaaa you to naod hoip to preparo your own moata? I 

1 

Enter on Condition 

Summary Chart, 

I Condition THEN 12. 

12a. Because of e health or phydcai problem, do you RECEIVE help from 

another person to ahop for p@rronai items, much as toiiot itema or 

medicines? 

Ask if “doesn’t do”: 1s thir becauu bf a HEALTH or PHYSICAL problem? 

I 10 Yes 1 

I 20 No 

I sn Doesn’t do because of 

I 

health/physical problem ( 124) 

I 4 0 Doesn’t do for other reason ( 13) 

I 

I - --em.- -_-- -* -- *_ me* *.-.-------------------------------- 

b. B6 Y&J NEED help from another pet&on to ahop for poraonai itamq, -l --m--s - ---- * - -- .-- - -- --.---- - *. 

(such aa toilet item8 ok medicine~)t 

I 

I 

i 0 Yes 

2 0 No (13) 

I 

----me.--.-- -.*.* - -we .b.--YB..-c--~---------~-------- -_---- -- 1 ------- ----- - - - .- ----. -*_- - ----I .* -- - 

e. Do you NEED thi8 help mart of the time, roma of the time or onto in a white’7 I 

I 10 Most of the time 4 

I 

I 

20 Some of the time 

30 Once in a while I 

I 

-----..---- .-- - --A-------&------------~-~-~~--~~~ 

d. ~hbti&&~condition cauaoa you to need hoip to ahop for porronai itema, (such am 

I __-___ _._- ___*_- ---*_---.--*-_*-*.--.---- 

toilet item8 br medicines)7 

f I 0 Old age (12f) 

I I 

Ask if injury or operation: . When did (the (iduty) occur/you hrvo the operation]? I 

1. 

Enter injury if over 3 months ago. t 

Ask or reask I2e if O-3 months injury or operation. I 2. 

Ask if operetion over 3 months sgo: kor what cIMditi&t did you have the operation7 I 

Enter condition. I 3. 

I 

I 

I 

4. 

I I 

I i 5. 1 I --------------.-------------*r.-----------,,----,------L 

a. &kidaa (condition), i8 there any other condition that cau8am thir7 

__-_____ - -_*- --.- _----------.-- ----- - 

I I 0 Yes (Reask 12d and el 

I 2 0 No f12g) 

-_---__---_--___I---_c-------------------------------- t -----_---- ---- - -- - - ---_*----- * --.- 

f. Ia thir caugod by any (other) l peciflc condition? 

I t 0 Yes (Reask 12d and e) 

I 20 No . :1 

_____________-------------------------------------- 

Ai& if multiple conditions, including old 8 

I ___-___-_-__-_-_-----------.- - - _.. . 

B 

8, are listed in 12d. Otherwise, 

mark eppropriete box or transcribe the on y listed condition. I 

I 

1 0 O-3 months injury/operation ONLY 

2 0 Old age 

I 

>I 

13) 

g. Which of those conditiona, that is {read conditions), would you say is the MAIN 

condition that cause8 you to need help from another penon to ahop for peraonai 

items, (ruch as toilet items or med!ciner)7 t 

I 

I Condition . ‘1 

Enter on Condition 

Suu-nn;r3y Chart, 

92 
I Soction 0. HOUSING STRUCTURAL CHARACTERISTICS, ADL’S AND SPECIAL AIDS, Continued 

13a. Bocauro of a health or phydcal probkm, do you RECEIVE heIp from 

another p8r8on to do light hou8owork, Ilko doing dM88, l traight8ning 

up, or light ckaning? 

i 1 O.Yes 

I 

I 

20No 

3 0 Doesn’t do because of 

Ask if ‘doesn’t do”: I8 thi8 bocau80 of a HEALTH or PHYSICAL problem? I 

I 

health/physical problem I1 3dl 

4 0 Doesn’t do for other reason / 14) 

--.------------------ ----------------------------------~--------------------------- 

b. Do you NEED h&p from another penon to do light houuwork, (like doing 

dbho8,8traightoning up, or Ilght ci8aning)? I lOYes 

I 2 0 No (14) 

----L-----.--------------------------------------------- 

c. Do you NEED thi8 help mo8t of the time, 8omo of the time or onto in a while? 

+-------------_----------.-- .- - . 

I I 10 Most of the time ‘--l 

i 

I 20 Some of the time 

30 Once in a while 

----------------------- -.--- -------------------------- 

d. chat (other) condition cau8e8 you to ne8d help to do light hou88work, (Iiko doing 

-I ---------------- ---- -- -----_ ---- - 

di8ho8,8traightoning up, or light &loaning)? 

) 10 Old age113f) 

Ask if ihjury or operation: Wh8n dld (010 (injury) occur/you have the operation]? I 

hter injUry if OV813 fFlOnthS 8gO. 1 

1. 

Ask or rebsk t3e if O-3 months injury of operetion. 

I 2. 

Ask if operation over 3 months ego: For what condition did you have the op8rationl I 

, 

Enter condition. I 3. 

I 

___------------------------------------------------ 

l . 8oddo8 fcorxfition), 18 thorn any other condition that cau8e8 thi8? I 

I 

10 Yes lhask 13d and e) 

I 20 No f13gi 

f. ii&ti%iG8-&i ar.,rrathb~s~~M~Eo-----------------------~ 

I 

‘: , 0 ves ,Re8sk ,3d 8na 8, 

I 20No 

-----.-----------------------w-m-- --_______- - ---- - ---- - I -----------.-_ -- -.---.-. --- ----- ---- ---. 

Ask if multiple conditions, including o/d age, 8m listed in 13d. Otherwise, 

merk eppropriete box or transcribe the on/y listed condition. I 

I I a 0-3 months injury/operation ONLY 

I 

2 0 Old age 1 

(14) 

g. Which of thorn condition8, that 18 freed conditions), would you 8ay I8 the MAIN 

condition that cau8.8 you to need help to do light hou8ework, (like doing di8hO8,. I 

8lraIght8ning up, or light cleaning)? I 

I 

I Condition . : 

Enter on Condition 

%uwrr Chart, 

I 14a. Bocau80 of a hoaIth or phyrica! problem, do you RECEIVE help from 

l noth8r person to do heavy hou8owork Ilko vacuuming, 8crubblng 

flOOV8, of wa8hing window8? 

i 

1 

10 Yes 

20No 

3 0 Doesn’t do because of I Ask if “doe&t do”: 18 thi8 bocau80 of a HEALTH or PHYSICAL problem? ; health/physic& problem ( I4dl 

I 4 0 Doesn’t do.for other reason f 15) I 

I -------------- ----------------;-------------------------.-------- 

b. & you NEED help from’%&@&&n to do heavy houeowork (like 

1 

vacuumh, 8crubbing floor-8, or wa8hing windowr)? 

I 

I 

tOYes 

? 0 No (15) 

------w--- -.------.------------------------------- -------------------------- 

c. Do you N&ED thb help mo8t of the time, 8om8 of the time or onto in a whlli? I 

I 10 Most of the time 

f 20 Some of the time 

I 30 Once in a while 

I 

,,.----------,-L -----_---------------------------------------------- 

I 

___-_ -.- --.--.-------- -.- - 

d. What (other) condition cau8.8 you to need help to do heavy hw8ework 

(Ilk. vaeu(tming, 8crubbing f(oor8, or wa8hbg window8)? I 

10 Oldage(14fI 

1 

I Ask if injury or operstion: When did [tho (injury) occur/you have the operation]? ; 1. 

Enter ifljury if over 3 months ago. I 

Ask or ressk 148 if 0 - 3 months injury or operetior 1. 

Ask if operation over 3 months ago: For what condition dld yw. have the op8ratlenl ; 

Enter condition. I 

I 

3 

. 

I I 4. 

I 5. 

- - ----.---.---.-- --------e--w.- --.------ _-.a- --- 

l .68tdoL (condition), 18 thorn any other condition that CauIa8 thi8? 

--------- -------meI. 

.--- -- -.- -- -. - _--- 

I 10 Yes (Read 14d and el 

t 20 No (14gi 

---.a-----------.------ _-_--_-------------- --- _------- -- 1 ---- ------- ---- ---- -.--------- f. 18 thi8 CaU8.d by any (other) 8pOCifiC Condition? 

I 1.0 Yes tae8sk 14d and e) 

I 20No 

-l --------i--------------------------------------------- -m-w---------- ---v-m--- ____ -- - - - _. . . 

Ask if multiple conditions, including old 

“B 

e, 8re listed in 14d. Otherwise, I 

m8rk sppropriste box of trenscribe the on y listed condition. I I 13 0- 3 months injury/operation ONLY (, 5, 

g. Which of thou condition8, that i8 (reed conditions), would you 8ay 18 the MAIN I 

2 0 Old age 1’ 

condition that cau8o8 you to naed help to do heavy hwuwork (Itko vacuuming, 

8crubbh8g fkon, or warhing windowr)? 

-I Enter on Condition 

I Summary Chart, 

I Condition THEN 15. 

foaMMlS~laA~x t18.3~~3-10~13~ 

93 
I Section Q. HOUSING STRUCTURAL CHARACTERMWS, ADL’S AIUD SPECIAL A8DS, Continued 

1 Sa. Bocauao of a health or phyaicai problem, do you RECEIVE help 

from another person to dial the toiophono or to roceivo call8 on 

the 101ophono’) 

Ask if “doesn’t do”: 18 thir becau80 of a HEALTH or PHYSICAL problem? 

*I 1 Cl Yes I I 20No 

I 3 0 Doesn’t do because of 

I health/physical problem (15d) 

I 4 0 Doesn’t do for other reason 116) I 

I ------.--------- ----------------------------------- b. blk you NEED help from another per8on to dial the t8iophona or to receive 

i--------------------------- 

caiir on the toiephone? I 1 Cl Yes 

I 20 Nof16) 

--------.__--------------------------------------------- ----------___----------~------- 

c. Do you NEED thi8 hoip mo8t of the time, 8omo of the time or onto in 8 while? II 10 Most of the time 

I 20 Some of the time 

I 30 Once in a while “i 

I 

---.-----------------------.----------------------C-.------_ L __--_ -__-- --_ -- _- _-_-_- -_-- - .----_- 

d. What (other) condition cau808 you to need help to dial the taiephono or to receive 

Ca118 on the teiophone? 

) I 0 Old age (15f) 

I I 

Ask if injury 0) operation: When did [the (injury] occur/you have the operation)? 

Enter injury if over 3 months ago. 

Ask or reask 158 if 0- 3 months injury or operation. 

I 1. 

I 

I 2. I 

Ask if operation over 3 months ago: For what condition did you have the operation? i 3. 

Enter condition. I I 

I 4. I 

5. I 

e-o- -.-.-- -.._ --w-w- --____ ---_-----_--- --____ ------ 

l . @%&&8?Goidition\, i8 there any other condition that ~a~808 thir? I- 

-_-_-- --_-_ -_--.__-.--_----------- 

I 

1 0 Yes (Ressk l5d and e) 

20 NolMg) 

---------------__-------------------------_-_-__________ 

f. i8 thi8 Cau8ad by any (other) 8pacific condition? 

;_________ -_ ____-._ ---- -----.--.---. 

I I 0 Yes (Reask 15d and 8) 

I 20No 

--v-----------v----- -..- -------------------_--------------- -_--- --__ - ----. --- ----- ------- ---- 

Ask if multiple conditions, including old age, are listed in 15d. Otherwisq, Imark appropriate box or transcribe the only listed condition. I 

I I 0 0 - 3 months injury/operation ONLY 

g. Which of these conditionr, that I8 (read conditions), would you 80~ I8 the MAIN I 

2 0 Old age Ii 

(f 6, 

condition that cau8e8 you to need help to dial the telephone or to receive call8 

on the t&phone? f 

; 

Enter on Condition 

Summary Cnart, 

I Condition THEN 16. 

1 I 

16a. Bocau8e of a health or phy8icai problem, do you RECEIVE help from 

another parson to get out8ide? 1 10 Yes I 

f 

20No 

Ask if “doesn’t do”: I8 thb beeawe of a HEALTH or PHYSICAL probiam? I 

3 0 Doesn’t do because of 

health/physical problem (16d) 

I 4 0 Doesn’t do for other reason (07) 

---.-.-- -- ---------------------a---------- 

b. bi you NEED help from another per8on to get outddo? 

------------- ; -----.- - ---.-- ---‘------‘T---- 

l 

I 

I 0 Yes 

20 No (Q7) 

-~-----------_--~__-_______--------------------------- ------.--- _----- _-----_-_------ 

c. Do you NEED thi8 hoip mo8t of the time, rome of the time or onto in a whiio? k 

I 10 Most of the time 

I 20 Some of the time 

30 Once in a while 

---- --------.-----..--------------------------------------- L -_-_--__. -_-_----------- ---.- ------- 

d. What (other1 condition cau8e8 you to nnd help to get outride? 

I I 0 Old age f16f) 

Ask if injury or operation: When did [the (injury) occur/you have the operation]? t 

Enter injury if over 3 months ago. I 1. 

Ask or reesk l6e if 0- 3 months injury or operation. I 2. 

Ask if operation over 3 months ego: For what condition did you have the operation? I 

I 

Enter condition. I 3. 

1 I I 

I 

I 5. 

--------------- ------------------------------------- ---------------------- 

0. ik8id.8 (condition), i8 there any other condition that cau8e8 thi8? I1 

10 Yes (Reask 16d and e) 

2 0 No 116gl 

------^-.-_---------------------------------------- 

f . ii ti&~ked by any (other) 8pecific condition? 

;_______ -_ ---.-- _.-. -.---------- 

I 10 Yes (Reesk 16d and el 

L 

20No 

--------c----------------------------------------- e-e---------- 

%kiTmu/tiple conditions, including o/d age, aie listed in 16d. Otherwise, 

_-_-_------ -- ----. 

m8rk appropriate box or transcribe the only listed condition. I 

1 

I 0 O-3 months injury/operation 

2 0 Old age 

g. Which 61 the8e conditionr, that I8 (read conditions), would you my 18 the MAIN 

WditiOn that cau8e8 you to need hoIp to get oufiide? 

FORM INS-1tSAtx tlW3) 0-1O-S31 

Condition 

Enter on Condition 

sgnma~y7 Chart, 

. I 

94 
I Section Q. HOUSING STRUCTURAL CHARACTERISTICS, ADL’S AND SPECIAL AIDS, Continued 

Q7 Mark first appropriate box 

Mark if known 

17. Because of a health or physical problem, do you usually - 

i 

I 

I 

I 

I 

I 

I 

I 

I 

I 

I 

1 0 Respondent is a proxy 

2 13 Sample person is or appears to (17) 

be confined to a bed or chair 

3 0 All other (081 

1’ A 

I 

i 0 Yes 1061 

a. Stay in bed ail or most of the time? I 20No 

- - -. - ..--.-.----.---------------------------- 

b. St;, k-a-chair ail or rnoi( 6f the time? 

l- --.-- - _. ----- -------- ---. -- 

I 

I i 0 Yes L-L 

I 2 0 No 

I Q8 I 

I 

I 

Refer to age I 1 0 Sample person is 55 

- 

69 (20) I 2 0 Sample person is 70 or older f 181 --I 

18a. Do you have @ifficuity in controlling your bowels? i OYes 

t 2 0 No fl8d 

__-_.._^_-.- - _--...- ---__---_-~_-~--~------ -_.__-_------~ 

b. 6; irequentiy do you have this difficulty - daily, several times a week, 

l-----..-- ..- ---- --._- .-_- -__-- . . . 

once a w8ek, or iess than once a week? I 1 q Daily 

I 2 0 Several times a week 

I 

I 3 n Once a week 

I 4 q Less than once a week 

I sODK 

------ -.-- --- -. -- ..-- --_-.-.----------- --- .-.- -- -__- --.---.----- ;----.- . - - .--- --.--- _ - -.. 

c. Does this difficulty restrict your activity, that is, limit your getting around? I I 1 OYes 

2 U No 

----- - .- _ -. - - - ----------------.--- __.- - __--------- 

d. & 36-u have a col&tbmy or 0th;; device to help control bowel movements? 

:- - - - - -..-- _ - - _ -_ -.- -- .- _ _ __ - 

I i Cl Yes 

I 2 n No (19) 

--__- _---- _.----_----_- -.- --___--- --- 

0. 60 &-n&d hsip fro& inotiei &son in taking care of this device? 

;-- .-.- -. . . _ . . __-. . 

I i 0 Yes 

I 

I 2 0 No (19) 

i-e -- - -. -. - - 

f. How frequ&y 60 you RiC%lVE this ha&L 

- --.-.._ -_ ---- -----._ _ 

&&tikyk need help, 

J _ _ __ __ - _ . _ _ . ._ _ 

I 

most of the time, some of the time, or once In a while? 1 [3 Everytime help is needed 

2 n Most of the time 

3 0 Some of the time 

4 0 Once in a while 

5 CJ Not at all 

1 

.-_ . . 

I -_ 

-. - - 

1 Ba. Do you have difficulty in controlling your urination? i q Yes 

I 

I 2 0 No f19d) 

__-- ^__- _ - - - -- -- ---- -.- _____--------- _--.-.- ----- 

b. How frequently do you have this difficulty - daily, several times a week, 

---- r - -- 

. . _.__ - .-.__-. -_---. . . 

I 

once a week, or less than once a week? 1 fl Daily 

2 0 Several times a week 

I 

I 3 0 Once a week’ 

I 4 0 Less than once a week 

I 5aDK 

---.-- . -- - - - -.- --- - -- --.------..- - - - .- - -. .- - - .- _ - - .- _- - ; __ . - - ._ - _ _ _ ._ _ _ _ _ __ _ _ _ __ _ . - 

c. Does this difficulty re&t.ioi;.activity, that is, limit your getting around? I 

I i El Yes 

20No 

---. ..----- . -.----- --- - --------.- ___.._ __-- -----_- - 

d. Do you have a urinary &that& or other d&&e to help control urination? 

:-- --.-- ---_-- _-..-_ - -.-. ---. .- 

I 

I t Cl Yes 

I 2 0 No (20) 

__-.----- - -- - - -_- - - --.-- __.-- -- _______ -- _____.______. -- 

e . Do you need help from another person in taking care of this device? 

; _. -- -- - - - - . .- _ - _ . - - - -_ - _. .- 

I i 0 Yes 

I 

2 0 No (201 

_ ._. _- - - ._ -. - - -_ -_ .- -. - - -- - - - .- - - - -------------- -- ____________ I - - _ _ _ ._ _. _ - ._ _ - - . - - - 

f. fi& ~r(s(rus&&io you RECEIVE this help - everytime you need help, I 

most of the time, some of the time, or once in a while? I 1 0 Everytime help is needed 

I 

I 

2 u Most oi the time 

3 0 Some of the time 

I 

I 4 0 Once in a while 

I 5 fl Not at all 

FOOTNOTES 

FORM HIS- 1 ISAlA I1 9831l3.10.83) 

95 
Section Q. HOUSING STRUCTURAL CHARACTERISTICS, ADL’r, AND SPECIAL AIDS, Continued 

20. Do you NOW UIO (any of the following spaclal aidr) - 

I 

I 

If known, mark without asking I 

I 

I 1 OYes 

I 

a. An artificial arm? 20No 

----- -- _---___---------------------.------. --- ..--. ; - _.._.. . 

b. Ah kifi~i~ik~1 -- 

. . . . 

1 1 OYes I 

I 

I 2nNo 

c. A ~;aO;-of~nG-~ind)‘ . . -- - - - - - - - - - - ---.--.--.---.-----------------__--.. - t-‘--- - . -- 

I 1 0 Yes (Specify) I 

If “Yes, l * ask: On what part of the body 18 the brace worn? I J 

I 

I Part of body 

I 

I 20No 

._ . -. .- - - -.-----s-e--. -----------_------.------------------------ -_------ -1 --._-_. _ . - . . . . .- 

d. Crutches? I i IElVes L-L 

I 

20No i 

-.- - ___--- -_.. .- - - .- _- -- - -_ - - - _- - -. -_ -_ - - - - - _. - .- .- _ ._ _ -. - -- ._ - 

0. A can0 or walking stick? - . - _ - - I‘ ---- I Cl Yes I 

I 20No 

. . _.-__ - _-.-.__ - -____.___ -._-. ---- _____ - . . . _^ _ . 1 .-_ 

f. &thope&~corrective shoes? - I I I i q Yes 

I 20No 

I _ -.. -. . .._ --_----_---- -..- --- _--- _ .-_.. -.-. 

g. A wheel chair? 1” .- 

1 q Yes 

; 

I 

I 2flNo 

--.-.--e-v-- w---m_ - .--'--m--w- -.-- ------------ --..-- -__----__--__ _-.-... _.-_, . 

h. A u&&or? 

1 - __ _- - -. 

I 

I i 0 Yes L-L 

I 20No 

I i* A gu,d;.dogl ._ - - - _. _ - - -. - - - .- .- -- --- --- --.----- --- - -------_.. -.-.-._ .- __ _ 

i- - 

_ .- . -. 

i 0 Yes I 

I 

I 2 0 No 

j. Any biher kind of aid for getting aro;nd?’ --- --- - - - - 

- - .- - - - - - - - - ._ __ __ .. . . . . _ _ I ._.. . 

I i 0 Yes (Specify) I 

If “Yes” specify, then ask: Anything alre? 

I 

i 

t 

I 

I 

I 

I 

20No 

FOOTNOTES 
I I 

Section R. REWJLAR MEDICAL CARE AND NURSlfk HOME STAY 

) Read to respondent - These next questions rotor to whore you 8.1 roguiar medical cam 

1 a. Is thero a particular clinic, health centor, doctor’s offico or some 

I 

other piaco outside this home where you usuaiiy go if you aro sick I 10 Ye8 (Ic) I 

or need advice about your heaith? I 20No 

--------------------------------------------- 

b. Do you usuaiiy receive modicai care at horn.? 

I------------------------------------ 

I 1 Cl Yes 12) r-‘-‘ 

1 2 0 No 13) 

------.--------------------------------------------------------------.----.---------------. 

c. What kind of place is it - a clinic, a health center, a doctor’s I 

offico or some other place? I 

t 0 Doctor’s office/group practice/doctor’s clinic 

If clinic: is this a hospital outpatient clinic, a company or 

school clinic, or some other kind of clinic? 

If hospital: Is this an outpatient clinic or an emergency room? 

I 2 0 Company or school clinic 

I 

3 0 Hospital outpatient clinic 

I 

I 

4 0 Hospital emergency room 

5 0 Health center (Specify) 

. 1 , s 0 Other (Specify) 

2a. Do you [go to (source in IcMroceive medical care at home] I 

1 

on a regular basis or only when you are sick? I 10 Only when sick f3) 

I 2 0 Regularly 

t 3 0 Both 

----------------------------------------------- -.I ------------------------------------- 

b. About how often do ydu usually [go to fsource in Icl/rocoive 

medical care at home] ? I 10 Daily 4 0 About every 6 months 

I 

I 

2 9 Weekly 5 0 Once a year 

I 3 0 Monthly s 0 Less than once a year 

I 

3. About how long has it been since a doctor or modicai parson - I o 0 Less than one month ago 

I 

1 

a. Gave you a diabetes test? I- { 

I 0 Months ago 3 0 Never 

Number 2 0 Years ago 40DK 

-------------------.- ------------------------- 

b. Lest checked your blood pressure? 

;------------------------------------ 

! o 0 Less than one month ago 

-LIE 

I 

I---- 

t 

{ 

I 0 Months ago 3 0 Never 

Number 2 0 Years ago 40DK 

----------------------- -----------------L---------------------------------------- 

c. Gave you a genarai physical check-up? I o 0 Less than one month ago 

-Lx 

I 

I 

{ 

I 0 Months ago 3 0 Never 

I Number 2 0 Years ago 4aDK 

1 

4a. Since ( 13 month hospital date) a year ago, were you a resident in a I I 

nursing home overnight7 I i q Yes 2 0 No (51 

-----------------------------,,----------------------------------------~------------- 

b. How many different times did you stay in a nursing home overnight 1 

or longer since I1 3 month hospital date) 1 

, 

I Number of times 

Note - Ask 4c-e, as indicated for each 

stay, starting with the most recent. STAY 1 STAY 2 STAY 3 

bc. When ware you discharged 1 I 1 

([the last time/the time 

bet ore that])? - la- - la- - laMonth Year Month Year Month Year 

--_w-----------__------------v---------- --------_-_-_____--- ---_.----------------- 

d. How long were you in the nursing 

home (that time)? 

{ 

I 0 Nights 

{ 

1 0 Nights 

2 0 Months - Number Number 2 0 Months Number { 

t 0 Nights 

2 0 Months 

---- ---------- ---.--- ---d- ---------------- %--------------------.---------------- -..--- 

l . What is the name and address Name _. 

of this nursing home? .: :’ j 2’. ,: 1.. 

.._ . . . __ :_. : : 

._. . . . . _C,,” .,. . . ..‘.. 

.: 

Number and street : : _‘. ,i ,_. 

. ‘. _, ‘. .: 

City (or county) S&e __’ , ‘_ 

:. 

Skip to 5b if any entries in 4c - 8. 

I 

i OYes I - 

5a. Have you over been a resident in a nursing home? I 

I 

20No 

30DK 

I 

~----------~~-~~-~~~~---~~~~~~~~~~~~~~~~~~~~~~~~~~~~ __- ---- --------t- --- _..-.- __------- -. --. 

b. Are you now on a waiting list to go into a nursing home? 

I 1 OYes 

I 

20No 

I 

30DK 

97 
Respondent 

Section 6. HEALTH OPINIONS AND BEHAVIOR 

I 

I 

I 

1 Cl Self response (1) 

I 2 El Proxy (91 

t 

Reed to respondent - The next group of queationa arka your paraonal 1 

opinlona about he&h related mattera. 1 Cl Excellent 

I 2c3 Good 

1 .How good a job do you feel you are doing In TAKING CARE of I 3 0 Fair 

your hoaith? Would you xay exceiient, good, fair, or poor? I 4n Poor 

I s 0 Other (Specify) 

2. Compared with two yearm ago, would you may that your health la 

I 

I 

now better, worse, or about the aame aa it was then? I i Cl Better 

I 

2 Cl Worse 

I 

3 Cl Same 

I 4 q Other (Specify) 

3 .Over the PAST YEAR, has your health caused you a areat deal of 

worry, some worry, hardly any worry, or no worry at ail? 

1 

I 

I 0 A great deal of worry 

2 0 Some worry 

t 

3 0 Hardly any worry 

I 4 0 No worry at all 

I I s 0 Other (Specify) 

4. How would you rate your current level of phyaicai activity? 

Would you say you are very active, active, moderately active, or 

rarely active? 

i Cl Very active 

2 0 Active 

3 0 Moderately active 

4 0 Rarely active (inactive) 

s 0 Other (Specify) 

lI 

6. Compared to your level of physical activity two yearm ago, would 

you aay you are now more active, leaa active, or about the same? I 0 More active 

2 0 Less active 

I 

i 3 0 About the same 

I 4 0 Other (Specify) 

6. Do you feel that you get as much exercl8e aa you need, or loxa 

than you need? I 0 As much as I need 

2 0 Less than I need 

3 c] Other (Specify) 

7. How much control do you think you have over your health? 

Would you ray you have a great doai of control, l oma, very iittio, 1 I 0 A great deal of control L 

or non0 at ail? 

, 

2 Cl Some control 

f 3 0 Very little control 

I 

4 0 None at all 

I 5 0 Other (Specify) 

L 

1 

s2 Interview I i Cl Personal interview (8) 

I 

I 2 0 Telephone interview (91 

I I 

FOOTNOTES 

98 
Section S. HEALTH OPINIONS AND BEHAVIOR, Continued 

I 

Hand card SS8 

Read to respondent - i am going to read a list of ways you may sometimes fool. Pieaso toil me how often you have felt this way DURtNG 

THE PAST WEEK: rarely or none of the time; some or a little of the time; occasionally or a moderate amount of 

time; or most or ail of the time. 

I 

8. During the past week, (that would be from last (day) 

through today,} how often - 

Rarely or Someora 

none of the little of 

time (less the time 

than 1 day) (1-2 days) 

Occasionally or 

a moderate 

amount of time 

(3 - 4 days) 

Most or 

all of 

the time 

(5-7 days) 

I 

a. Were you bothered by things that usually don’t bother you? 10 20 30 40 

I 

b. Did you not feel like eating; your appetite was poor? lfl 20 3cI SD 

I 

c. Did you feel that you could not shako off the biuos oven with I 

help from your family or friends? 10 20 30 40 

Read 8 I t 

d. Did you feel that you were just as good as other people? 10 20 30 40 

l . Did you have trouble keeping your mind on what you I 

wore doing? 10 20 30 40 

1 

f. Did you feel depressed? I 10 20 30 40 

Reask 8 I 

g. Did you fed that everything you did was an effort? 10 20 30 40 

I I 

h. Did you feel hopeful about the future? 10 20 30 40 

i. Did you think your life had been a failure? I 10 20 30 40 

I 

j . Did you feel fearful? 10 20 30 40 

I 

Read 8 I 

k. Was your sleep restless? 10 20 30 40 

I. Were you happy? I 10 20 30 rcl 

1 

m .Did you talk less than usual? 10 20 30 40 

I 

n. Did you fool lonely? I 10 20 30 40 

I 

Reask 8 I 

o. Were people unfriendly? I 10 20 30 40 

p. Did you enjoy life? 10 20 30 40 ’ 

q. Did you have crying speiis? 10 20 30 40 

I 

r. Did you feel sad? [ 10 20 30 40 

I 

s. Did you feel that people disliked you? I 10 20 30 40 

I 

1 

t . Could you not get “going”? 10 20 30 40 I 

8. Now I’m going to read you a list of thing8 people have told uo they 

have 8ometimer done. In the past week, that would be from iart 

1 

(day) through today, - I 10 Yes 

a. Did you forget any important thing8 like taking medicina I 20No I 

or paying bills? I 3ODK 

_- _- - - -- - - -. - -.-----_------ --------a7-------- +m-----------------------------------w4-------, 

I 

t 

i El Yes 

20No 

b. Did you have difficulty remambering date8? 

-._---- .-------.-e--s.- -I 3ODK --------___-----__N__ __---____--________________ 

I 

I 10 Yes 

c. Did you have difficulty remembering the time, like the time i 2ONo 

for an appointment? I sODK 

_ _. - -- - - - _ -- _____-----------_----------------------------------- 

.I 

------ --- -------e--e - - 

10 Yes 

d. Did you lose your way or have difficulty flnding your f 20No 

way back? I 3ODK I I 

10. Are you now taking any pre8cription medicine for your nerve8, f loves I 

like medicine to calm you down or to help depre88ionl 

f 

20No 

I 3ODK 

, 

11. (Besides the medicine) Are you now receiving treatment or 

I 

coun8eiing for a mental or emotional problem? I 

i 0 Yes I 

t 

20No Go to Condition Summary Chart 

sODK I 1 4 

FORM HIS l(SAIX (lBB3L 13 10 831 

99 
r 1 

I I 

Section T. SUPPLEMENT CONDITION PAGES 

CONDITION A Ask 3g if there is an impairment (refer to cerd cP2) or any of the 

folio wing en tries in 3b - f: 

I. Name of condition 1 Abscorr Cvrt P&y 

Damogo Pxrxlyslr 

2. When did you last see 01 talk to a doctor 01 assistant about 1 

Apdys 

Orowth Rupture 

your (condition) 1 Blooding bxcopt 

menstrual) 

Homorrhago Borotnosr) 

o 0 Interview week (Reask 2) s 0 2 yrs., less than 5 yrs. Blood clot 

fnfection Btlff boss) 

Boll 

Inflxmmotlon Tumor 

I 0 2-wk. ref. pd. 6 Cl 5 yrs. or more 

Cancmr 

Nourxlgla Ulcer 

2 0 Over 2 weeks, less than 6 mos. 7 0 Dr. seen, OK when Nourltls Vmlcoro volnr 

-------------- Cramps bxcopt 

3 0 6 mos., less than 1 yr. a 0 OK if Dr. seen monstruxl) Poln Womt(nosr) 

4 0 1 yr., less than 2 yrs. 9 0 Dr. never seen 

(36) 

3a. Did the doctor 01 assistant call the (condition) by a more 

tochnlcal ot specific name? 

- g. What part of the body Is affected? Specify), 

A’ 

iLlYes 20No 9 UDK 

Show the following detail: 

--------------------------,------------------ 

Ask 3b if “Yes” in 3a, otherwise transcribe condition Hoad .,.......,,........................... skull, scalp, face 

name from item I without asking: Back/rplno/vertobrao . . . . . . . . . . . . . . . . . . . . . . .uppor, mlddlo, lowor 

b. What did he 01 she call it? (Specify) 

d 

Bldx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . loft or right 

E8r ..,......................... Innor or outer; left, right, or both 

Ev. . . . . ..a..*............................. loft, right, or both 

- Arm . . . . . . . . . shouldor, upper, elbow, lower or wrist; left, right, or both 

I 0 Color Blindness WC) 3 Cl Vasectomy 15) 

1 #fend................, entlro hand or fingers only; loft, right, or both 

2 Cl Cancer (3e) 8 0 Other (3~) 

Lag . . . . . . . . . . . . . . hip, upper, boo, lowor, or xnklo; left, rlght, or both 

Foot . . . . . . . . . . . . . . . . entlro foot, arch, or tomr only; loft, right, or both 

-.--.----.-------m-m- -.---.- _____________________ - .-_ -. - -- - .- - - - -.. - -- - -- - -- - _ . . __. _- - 

c. What was the cause of your (condition in 3b) ? (Specify) 

d 

Except Or iiy%S, iGri,~~i%&iii organs, ask 3h if there are any of the 

following entries in 3b - f: 

Infoctlon Sore Soronoss 

-v-v ----------------C---____L_________ 

Merk box if accident or injury. o 0 Accident/injury 

h. What part of the @art of body in 3b-g) is affected by the 

. [infection/sore/soteness] - the skin;muscle, bone, or some 

d. Did the (condition in 3b) result from an accident or Injury? other part? (Specify) 

A/ 

i Cl Yes 20No 

---_ -- ---._ -----------_---------.-------- 

&-3%i’fthe condition name in 3b includes any of the following words: l Ask if there are my of the following entries in 36-f: 1 

Tumor Cvrt Growth 

Allmont Cantor Dlroaso Problom 

Anomla Condltlon Dlsordor Rupture 4. lo thla [tumor/cyst/growth] malignant 01 benign? 

Asthma Cyst Growth Trouble 

Attack Dofoct M0arl.r Tumor 1 Cl Malignant 2 il Benign 9n OK 

Bad Ulcer 

e. What kind of (condition in 3bl Is it? (Specify), 

K’ 

___-__~----__-._-~-- ------- ----- -__-_-----_----_c 

Ask 3f only if allergy or stroke in 3b-e: 

f. How doea the [allergy/stroke] NOW affect you? (Specifi), 

Y 

Ask probes as necessary: 

(Wao it on 01 since (first date of 2-week ref. period) or was it 

before that date?) 

(Was it learn than 3 months or mole than 3 months ago?) 

(Was it less than 1 year 01 more than 1 year ago?) 

(Warn it less than 5 years 01 more than 6 years ago?) 

FOOTNOTES 

100 
Section U. CONDlTlON SUMMARY CHART 

) iNSTRUCTiONS - If no entries in Summary Chart, 

complete cover page and any additional supplement 

booklets required. 

All conditions in Summary Chart must be accounted for. 

Compare to C2 in HIS-1 for sample person. 

1. If a condition page is already filled, enter the condition 

number in the diagonal space on the Summary Chart. 

2. If a condition page is notfilled, complete a lettered 

supplement condition page and enter the letter in the 

diagonal space. 

3. If the condition wording on the HIS-1 and the 

Summary Chart are similar but not identical, probe: is the (su&ement condition) the same condition 

as the (HIS- 1 condition) I was told about earlier? 

If any doubt, fill a supplement condition page. 

--w--e--- ---------- - - - _- - - JOB TASKS (01 7 --.- 

LYE CL LTR IPI I EAR LTA IPI 7 OTHER 7r~Fi-iPT - r -- -Aws-di - - 

I I I 

I I I I 

I I 1 I 

_--_--__- 

-s!i-Tr4s’s-Gi - 1- -EYE CL l.TR (PI 

------------ --_--_ 

r EAR LlR (PJ 1 

- - - .._ _. - 

OTHER CL LTR (PI T - - ADL’S (0, 

I I 

I f I I I I 1 1 

.__----- --- _------- -.. -. -.-- -.__ 

JOB TASKS (01 l--EYE CL LTR IPI r fiR iTf%l -I- OTHER CL LTR IPI T - - iDi% (01 -- - 

f I 

I 1 

I I I I I I 

----_---- __---._-__-----__- 

JO8 TASKS (01 7 

-- ---- - .-__ 

EYE CL LTR (P) l EAR LTR (PI -i OTHER CL LTR (P) r - -Ait’S--td, - - 

I 

I t 1 I 

--------- 

-i - - - - - 

--- 

EYE CL itfi-{PI 

--- ---__I--_- 

JOB TASKS (01 r ~KLTR (PI 7 

------- 

OTHER CL LTR IPI r - -ADC’S (QI 

I I 

I I I 

I 

I 

I I I I 

FOOTNOTES 

_ _-- - _ _- 

- -JEB-TxSi% 

- - -. 

7 - - - - - - 

----_ ._-. _-.--_-__--- 

IO) EYE CL LTc(i? - - I EAR CTR (PI l OTHER CL LTR (PI 

r - -~~i’s‘Ia~ - .- 

I I I 

I I I I 

I I I I 

IRMHIS 1ISAIX II9831 I3 10 831 

101 
Appendix IV 

Supplement on Aging 

Reinterview Questions 

I N. SUPPLEMENT ON AGING 

0 No eligible sample person (end interview) 

Sample Parson Name 

Sample Porron Number 

I I N 1 

o 0 Noninterview (Specify. THEN end interview) 

I 0 Available (Check item ~7) 

2 0 Callba c k required (arrange collbock) 

I CHECK 

ITEM N7 

I l--J If m&cd skip to section Q introduction above item I2 on page 22 

2 0 If marked go to 140 I 

140. Is this (house/apartment) (house/apartment) now - i 

f 

(1) Owned or being bought by you (or somwne in the household)? household)? . . . . . . . . . . I 1 0 Yes (I&) 

I 

Cl No 

(2) Rented for money? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 0 Yes (14/I)llh) cl No 

I 

(3) Occupied Occupied without without paym8nt paym8nt of money r8nt? . . . . . . . . . . . . . . . . . . . . . . . 1 1 0 f-J Yeses (Section (Section Q)) 

. 

-----------------------L--------------------------------------------------------------- 

b. Who owns or is buyina it? 

; 

f 1 0 S8mple person 

I 

2 f-J spouse ) U4c) 

16 

17 

Anyon 4 se? 

, 

I 

10 Child 

> 

10 

I 4 0 Grandchi Id 19 

Fe/low skip instructions for lowest numbered box marked. 1 S 0 Other relative 

(Sect/on 0) 20 

. , 

I 

6 0 Nonrelative 21 

A 

----------------------------------------------------- 

C. Is this place fully paid for or is there a mortwge being paid? r 

----------------------~-------------------- 

I 

1 0 Fully paid for (141) 

I 

2 0 Mortgage being paid 

I 

3 0 OK (t4t) 

------------------------------------------------------------------------------------------------- 

d. Do you know obout how much principal is still owed on the I 

mortgog88 I 

loYes 

k 

2 I-1 No (f4f) 

---------------------------------------~------------- ------------------e------------------------ 

e. How much principal is still owed? I 

I s 

Amount 

----------------------------------------------------- L -------------------I----------------------- 

f. Do you know the present value of this place, that is, obout how I 

much it would bring if you sold it on todoy’r market? I 

1 IYes 

2 11_1 No (Section 0) I 

-----------------------------------------------------l ----c-III---------------------------------- 

g. What is the present value? r 

I 

I 

S (Section 0) 

I Amount 

----------------------------------------------------- ------------------------------------------------ 

h. Who is poring rent fur it? LI 1 0 Sample person 37 

2 0 Spouse 36 

Anyone l l se? ! 3 q Child 39 

I 4 Grandchild 40 1 

1 S 0 Other relative 41 

I 

I 

0 

6 0 Nonrelative I42 

1 

1 

4 . 

FORM HIS-R-1 OOOIJ (1.1~•4J 

102 
Q. CONDITIONS AND IMPAIRMENTS lrrr 

b Read to respondent - Please tell me if you have EVER had any of these other conditions, even if you how mentioned them before. - 

I 

12. Hove you EVER hod - I 

I . 

0. Osteoporosis, sometimes called fragile or soft bones? 

I 

I 

I 

1 nYes 2 ONo 9 L7 DK 

(0s tee 0 po ro’ sis) 

------------------------------------------- --M-w- A ------------------ -~---------------------------- --- 

b. A broken hip? I l- 34 

I 

J 

1 IYes t(-JNo 9nDK 

---------------------------------------~--------- ------------------ ------------------------------ --- 

co Hordcning of the arteries or orteriorclworis? t I- 3s 

Circle oppmpriote condition I 

I 1 IYes 2f-JNo 9 ( OK 

I 

------------------------------------------------- 1 ---------------------------- -------------------- B-B 

d. Hypertension, sometimes colled high blood pressure? I l- 36 

; 1 OYes 20 No 9 0 OK 

------------- -------------------------- -----m-w-- -: ,,,,,,,-,,-------------------------------------- W-B 

e. Rheumatic fever? I 

7 

37 

I 

I 

1 0 Yes 2010 9 11 OK 

___________--------_---------------------------------------------- 

I 

-------------------------------- M-w 

f. Rheumatic heart direasa? I 7 

3a 

1 1 0 Yes 2nNo 9 0 OK 

-- ------------------------------ ------c--w------- -i ------------------------------------------------ --- 

g* Coronory heart diraose? I 7 

39 

I 1 0 Yes 2 Cl No 9 0 OK 

--------------------------------------------- ---- 1---------------------“‘----“---””’---------- --- 

h. Angino pectorir? I l- 40 

(pek’ to ris) I 

-1 

1 OYes 2f-J No ,uDK 

--c------------ ---------------c------------------ -------c---------------------------------------- m-m 

i. A myocardial Infarction? I 41 

I lf 1 0 Yes 2lNo ,nDK 

__________________------------------------------- 

i. Any other heort ottock? 

: 

------------------------------------------------ 

--- 

1 l- 42 

I 1 0 Yes 2f-JNo 9 0 OK 

_-_--__-_-__------------------------------------- 

k. A stroke or a cerebrovorcular occident? 

i -------------------c---------------------------- --- 

I 

I 7 

‘43 

(ser’ a-bro vas ku lar) I 

Circle oppropriote condition 

I 

I 

1rJYYcs 2nNo 9nDK 

------------------------------------------------- 

------------------------------------------------.--- 

I. Altheimer’s disuse? 

-I 

I 

I 

44 

(al’ zi mers) I 

I 1 0 Yes 2lNo 9 0 OK 

_------------------------------------------------ -4 ------------------------------------------------ w-w 

m. Cancer of ony kind? I 4s 

I lI I 1 DYeJs 2uNo 9 0 OK 

=OOTNOTES 

FORM HIS-R-1 (1954) (1.15-54) 

103 
ktion Rl, ACTIVITIES OF DAtLY LIVING (ADL’S) I 

) Read to respondent - The next questions are about how well you are able to do certain activities - 

by yourself and without using special equipment. 

(2) --IF 

Dr8sring? 

1. B8cous8 of a h8olth or ph sic01 

problem, do you hov8 A ml 

difficulty - 

Ask if “Doesn’t do”: 

Is this b8cous8 of o HEALTH or 

PHYSICAL probl8m? 

If “Yes,” mark box I; if “No,* 

mork box 3 

ci) 

Bothing or show8ring? 

I (3) 

ILL 

Eoting? 

10 Yes 1 OY+S 

2 0 No 2 0 No 

3 0 hard t do for othct ra8son s 0 Doesn’t do for other reason 

1 nyes 

2 0 No 

3 0 Doesn’t 00 for other reason 

1 23 Ask 2-S for each ADL marked 

“Yes” in 1. 

2. By yours8lf ond without using 

sp8ciol 8quipm8nt, how much 

difficulty do you hov8 (A&), 

som8, o lot, or Or8 you unobl8 

to do it? 

1 6 I .a 

1~Somc 1nSOlM 

2 0 A lot 2 0 A lot 

3 0 Unable s 0 Unable 

1 0 Some 

2 0 A lot 

3 0 Unable 

3. Do you r8c8iv8 help from 

onoth8r p8rson in (a)? 

1 DYes 

2 0 No (5) 

40, Who giv8s this h8lp? 

Anyon 81883 

----------------------- 

Mark the S/C/P box without 

osking if ONLY help is from 

spouse/chiIdren/porents. 

b. Is this hdp paid for? 

Ask if necessary: 

Which h8lp8rs or8 paid? 

50. Do you us8 ony sp8ciol equip 

m8nt or oids in (A&&)? 

Source of help Paid 

HH member I 0 0 S/C/P (5) 

1 0 Relative . . . ! lf=JYes z(-JNo 

t m Nonrelative 4 

Hen-HH munber I lnyes 21No 

3 (-‘J Relative . . 

1 

. , t 0 Yes 2 0 No 

4 0 Nonrelative . 1 1 IYes 2 0 Nd 

Source of help 1 Paid 

HH membm l I 0 (J S/C/P (5) 

1 0 ReI8tive . ..I 1~Yes 20No 

2 0 Nonrelative .I loYes toNo 

Non-HH rnanber t 

3 0 Rektive . . . I iDYes 2nNo 

4 0 Nonrelative .I I 1_1 Yes 2 0 No 

Source of help i Paid 1 

~42-69 ‘f 

HH mmber f 0 0 SK/P (5) 

1 0 Relativ8 . ..f loYe+ 2ONo 

2 c) Nonrelative . ! 1 0 Y8s 2 c] NO 

Non-HH member I 

3 0 Relative . . . 1 r DYes tONo 

4 0 Nonrelative . , ’1uY8S 2mNo 

f 

1018s 

3 0 No (2 tar rll with *‘YES” In 1) 

I 

1 IYes 

2 0 No (2 lor aI/ with “YES” In 1) 

b. Whot sp8ciol 8quipm8nt or 

oids do you US8? 

Anything 81 s8? 

Special equipment or aids Special equipment or aids Speciil equipment or aids 

Is142 

1 19-20 rs344 

=OOTNOTES 

104 
Section RI, ACTIVITIES OF DAILY LIVING (ADL’S), Continued IRt 

1 3-4 

Reosk I (4) ILL 

Wol king? 

(5) I (6) I 

Getting in and out of bed or chairs? Getting outside? Using the toilet, including getting 

to the toil 8t? 

1 CI]Yes 

2 ( No 

3 [ Doesn’t d o for other reason 

1 IYes 1 QYts 

2 0 No 2 f-J No 

3 n Doesn’t do for other reason 3 [ Doesn’t do for other reason 

10 Yes 

21 

cl 

No 

Doesn’t do for other reason 

1 74 I I 

1 0 Some 

2 0 A lot 

3 0 Unable 

1 q Some 

2DA lot 

3 0 Unable 

1 0 Some 

2 0 A lot 

3 0 Unable 

1 0 Some 

2nA lot 

3 0 Unable 

1 IYes 

2 0 No (5) 

\ 1 OYts 1 

2 0 No (5) 

1 fJYts \ 

2 0 No (5) 

1 OYts 1 

2 11 No (5) 

I 

Source of help ! Paid Source of helo Source of help i Paid Source of help Paid 

HH member ) 0 /-J S/C/P (5) 

t 0 Relative . . . f I 0 Yes 2 0 No 

2 0 Nonrelative . 1 I q Yes 2 0 No 

Non-HH mtmber I 

3 0 Relative . . . I 10 Yes 2 0 No 

4 0 Nonrelative . I Yes 2 No 

I 

10 0 

Paid 

HH mtmbtr ; 0 13 srcrp (5) 

1 0 Relative . . . 1 1 OYts 20 No 

2 ( Nonrelative . I 

I 

1 0 Yts 2 0 NO 

Non-HH mtmbtr I 

3 0 Relative . . . 1 10 Yes 2 0 No 

4 @ Nonrelative I 

. 1 1 0 Yes 2 0 Ne 

1 W-62 ; 163-66 

C(H member ; 0 0 SK/P (5) 

1 0 Relative . . . 1 10 Yes 2 0 No 

2 0 Nonrelative . f 1 0 Yes 2 0 No 

tion-HH mtmbcr I 

3 0 Relative . . . 1 1 f-J Yes 2 f-J No 

4 0 Nonrelative . I 1 DYts 2 0 No 

I 

193-S” ; 197.1oa 

HH member ; 0 0 SK/P (5) 

1 0 Relative . . . I ,I 0 Yes 2 1-1 No 

2 0 Nonrelative . I I 0 Yes 2 0 No 

Non-HH member t 

3 ( Relative . . . . 1 

4 0 Nonrelative . I 

tuYes 20No 

10 Yes 2 11 No 

I 

I 

10 Yes 

2 0 No (2 for e/l with “YES” sin 1) 

1 IYes I 

2 0 No (2 tor a// with “YES” rn 1) 

10 Yes I 

2 0 No (2 for e/I with “YES” in 1) 

10 Yes 

2 0 No (END IffTERVIEW) 

Special equipment or aids Special equipmtnt or aids Special”equipment or aids Special equipment or aids 

I6S-8b [be-69 

170-71 167-66 

FOOTNOTES 

‘ORM HIS-R-1 I1 9a41 (l-1$-$4) 

105 
Appendix V 

Definition of selected terms 

in the 1984 Supplement 

on Aging 

(Taken from the SOA 

Interviewer’s Manual) 

Community services 

Meals on Wheels-A service that delivers hot meals to 

the persons in their homes. 

Special meal program- Meals provided by a program or 

group on a regular or daily basis at a location outside the participants’ homes. 

Homemaker service-A program that provides help in the 

home with cleaning, cooking, and, sometimes, shopping. 

Visiting nurse service-A registered nurse employed by a 

. 

social service agency to provide medical care to persons in 

their homes. 

Health aide-An individual, not a registered nurse or doctor 

(as defined by NHIS), employed in the health profession to 

provide medical or health assistance to people in their homes. 

Adult day care or day care for the elderly-A place, operated by public or private funds, that provides day care for 

older persons on a nonresident basis. 

Retirement terms 

Retired (Completely, partially, or not at all)-These terms 

are respondent defined. 

Retirement income-This term is respondent defined. 

Dependent or survivor-Persons who receive payment as 

a result of their relationship to someone who is or was eligible 

for payments from some program. _ 

Pension-Income paid following termination of work to a 

person who was employed by the particular business, company, 

or organization providing the benefits. Pensions may also be 

paid to the survivors of deceased employees. 

Military retirement and Veterans Administration ( VA ) 

pensions- Income paid by the Federal Government to persons 

who retire from the military after 20 or more years of service as 

military retirement. Payments may be made to survivors. VA 

pensions differ from military retirement in that they are based 

on need, number of dependents, and nonservice connected disabilities or age. A VA pension received because of a disability 

should be reported in question 6. A VA pension received for 

other reasons should be reported as “some other source” in 3b. 

Interviewers probed for the distinction, if necessary. 

Own work experience- Those persons who receive retirement income because they themselves have worked a certain 

number of years or otherwise are themselves eligible for the 

benefit. 

Social Security-Includes such programs as retirement 

insurance and survivor’s insurance that provides payments either 

because the person is eligible or is a dependent or survivor of 

someone who was eligible because of work experience. 

Disability (in disability income)--This term is respondent 

defined. 

Condition related terms 

Ever-Present at any time in the person’s life through the 

Sunday night prior to the day of interview. Onset during the 

interview week is not included. 

Now-Present at any time during the past 2 weeks through 

the Sunday night prior to the day of interview. 

Past 12 nzonths-The period beginning with the 1Zmonth 

date specified for this interview and ending the Sunday night 

prior to the day of interview. 

ADL’s and IADL’s 

SpeciaZ equement-Aids or devices used to assist the 

person in a particular activity, such as canes, walkers, artificial 

limbs, and special plates. It also includes modifications to the 

home environment, such as lowered or raised commodes, lowered or raised kitchen equipment, and ramps. 

Getting outside-Moving from inside the unit to outside, 

including to a patio, porch, or to a building hallway. It does not 

imply any real movement or exertion once the person has reached 

the outside. 

Bed-Anything used for lying down or sleeping including 

sofa, cot, or mattress. 

Paid help-A voluntary reimbursement. It also includes. 

cases where no cash is received but the helper gets pay-in-kind 

or room and board for the help. 

Other terms 

Adopted children- Children for whom the sample person 

has been voluntarily or legally declared as the mother, father, 

or legal guardian. 

Stepchildren- Children of the sample person’s spouse by 

a former marriage. 

Stepbrother or stepsister- The son or daughter of the 

sample person’s stepfather or stepmother. 

106 
Retirement community, building, or complex-A house 

or an apartment is considered to be a retirement community, 

building, or complex if there is a formal arrangement or rules 

setting aside a group of units for this use or purpose. A person 

is not residing in a retirement community, building, or complex 

only because the majority of people in the city, neighborhood, 

building, or complex are retired. 

’ Medical services-Services provided on the premises by 

trained medical professionals, including doctors, nurses, or 

medical technicians. 

Mortgage-A long-term loan with the property as security. 

A mortgage can be financed through a bank, a savings and 

loan, a mortgage loan company, or a private person. A “land 

contract, ” “contract to purchase,” or “deed of trust” in which 

the buyer does not receive title until all or part of the price is 

paid is considered a mortgage. 

Mortgage principal-The current principal still owed on 

the mortgage; the outstanding balance on the loan amount, excluding interest, at the time of the interview. 

Volunteer work-Providing a service willingly and without 

pay for an organization or group. This includes activities such 

as collecting for the March of Dimes, overseeing playground 

activities, or working as a hospital volunteer or at church. It 

does not include such events as going to the store voluntarily 

for a neighbor or baby sitting if this activity is not through an 

organized group. 

Aid-Equipment or devices used to assist the person in a 

particular activity, such as a cane or walker, artificial limb, etc. 

Also include as aids special shoes, chairs, structural modifications to the home such as railings on stairs or walls, and other 

things normally needed for performing the activity only if they 

are of special construction, design, etc. or were installed specifically to assist the person in accomplishing the activity. 

Eyeglasses- Includes prescription eyeglasses as well as 

eyeglasses purchased at drug stores, variety stores, and so forth 

that did not require a prescription. 

Prescription eyeglasses- Eyeglasses that were obtained 

for the sample person under the direction or recommendation 

of an eye specialist, such as an ophthalmologist, an optometrist, 

or an optician. It does not include eyeglasses prescribed for 

someone else. 

Lens implant-Artificial lenses that are surgically and 

permanently placed inside the eye. This is sometimes referred 

to as an intraocular lens. 

Hearing aid-A compact amplifier worn to aid one’s hearing. This does not include devices not worn by the person, such 

as telephone amplifiers. 

Dizzy or dizziness- These terms are respondent defined. 

Dlflculty controlling bowels and/or urination-Di ficulty 

controlling bowels includes accidentally soiling one’s self as 

well as chronic inability to empty the bowels, excluding ocl 

casional constipation. Difficulty controlling urination includes 

accidentally wetting one’s self, including occasional slight 

“leaking.” 

Colostomy or urinary catheter or other device-Surgical 

openings and/or devices used to aid bowel movement or urination when the person has lost natural control of these functions 

through illness, disability, surgery, or other causes. This does 

not include enemas or suppositories as devices. 

Help in taking care of this device-Personal assistance or 

supervision is required and/or received in operating, maintaining, or cleaning the device, in emptying the bag, and so forth. 

In bed or chair all or most of the time-More than half of 

the hours the person usually is awake. 

Nursing home- A place that provides nursing and/or personal care services in addition to room and board. Nursing care 

may include such services as providing injections, catheterization, bowel and/or bladder retraining, and blood pressure, pulse, 

and respiratory checks. Personal care services include help in 

performing daily activities such as eating, bathing, dressing, or 

walking. It does not include stays in convalescent homes, sanatoria, mental institutions, or similar places. 

Times stayed in a nursing home-This refers to separate 

stays in a nursing home, not to the number of nights in a nursing 

home. If the person was moved (transferred) from one nursing 

home to another, include each as a separate stay, even if the 

stay was not overnight. 

Physical activity-This term is respondent defined. 

Exercise-Physical activity that the person consciously 

performs for the sake of his/her well being. The exercise does 

not have to be part of a formal program or prescribed activity. 

Exercise includes any kind of exercise such as walking, physical 

fitness programs, or sports. 

Regular routine- Physical exercise performed on a recurring basis at fairly even intervals, consisting of some set type of 

physical activity. Examples are golfmg every Thursday, walking 

around the block twice a day, or any other activity performed 

routinely for exercise. 

107 
Appendix VI 

Selected information about 

the design and estimation of 

the 1984 NH IS Supplement 

on Aging 

Table I. Annual weights in tape tocation 219-227 by age: 1984 NHIS Supplement on Aging 

Age in years at last birthday 

65 and over 

Item 55-64 Total 65- 74 75-84 85 and over 

Mean .......................................................... 

Median.. ...................................................... 

Percentile: 

10th ........................................................ 

25th ........................................................ 

75th ........................................................ 

90th ........................................................ 

Range: 

High.. ...................................................... 

Low......................................................: .. 

4,741 2,299 2,296 2,305 2,296 

4,485 2,174 2,174 2,168 2,171 

4,162 2,015 2,025 2,117 2,015 

4,300 2,067 2,067 2,078 2,094 

4,711 2,257 2,236 2,278 2,278 

5,627 2,785 2,754 2,810 2,714 

19,279 9,105 8,827 9,105 8,876 

1,280 398 398 1,470 1,495 

Table I I. Design effects for selected data on the 1984 NHIS Supplement on Aging 

Item 

55-64 

years 

65 years and over 

Total Male Female 

Numberofpersons ............................................................. 

Percent of persons: 

Ages80yearsandover ....................................................... 

Living alone ................................................................ 

Percent of persons with: 

Somecollege ............................................................... 

1 or more children.. ......................................................... 

1 ormoreADL’s’ ............................................................ 

1 or more IADL’s2. ........................................................... 

1 or more bed days in past 12 months. .......................................... 

1 or more hospital episodes in past 12 months ................................... 

1 or more community services used in past 12 months ............................. 

Average number of: 

Beddays(l2months) ........................................................ 

Bed days(2-week recall) ...................................................... 

Doctor contacts (2-week recall) ................................................. 

Acute conditions (20week recall) ............................................... 

. . . I . * . . . 

1.5678 1 .oooo 1.3212 

1.4742 1.9996 1.692 1 1.7340 

1.4334 1.5988 1.4564 1.3142 

1 .oooo 1.9640 1.4791 1.4346 

1 .oooo 1.6118 1 .1952 1.3740 

1.0797 1.7226 1 .oooo 1.6698 

1.1180 1.4663 1.2124 1.0755 

1 .oooo 1 .oooo 1 .1794 1 .oooo 

1.2551 2.0837 1.5796 1.4146 

1 .oooo 1.4072 1.2873 1.1623 

1.0941 1.1110 1 .oooo 1 .1260 

1 JO82 1.0900 1 .oooo 1 .OOOO 

1.3088 1 .oooo 1 .oooo 1 .ooOO 

‘Activities of daily living, 

21nstrumental activities of daily living. 

NOTE: Design effects are the ratios of variances. For standard errors, take the square root. 

I 

108 
Table III: Number of sample persons in the 1984 Supplement on Aging, by pseudoprimary sampling unit (PSU) and age 

Total ........ 

1 

2:':::::::::: 

3 ........... 

4 ........... 

5 ........... 

6 ........... 

7 ........... 

8 ........... 

9 

Id:::::::::: 

11.. ........ 

12 .......... 

13 .......... 

14 .......... 

15 .......... 

16 .......... 

17 .......... 

18 .......... 

19 .......... 

20 .......... 

21 .......... 

22 .......... 

23 .......... 

24 .......... 

25 .......... 

26 .......... 

27 .......... 

28 .......... 

29 .......... 

30 .......... 

31 .......... 

32 .......... 

33 .......... 

34 .......... 

35 .......... 

36 .......... 

37 .......... 

38 .......... 

39 .......... 

40 .......... 

41 .......... 

42 .......... 

43 .......... 

44 .......... 

45 .......... 

46 .......... 

47 .......... 

48 .......... 

49 .......... 

50 '.......... 

51 .......... 

$2 .......... 

53 .......... 

54 .......... 

55 .......... 

56 .......... 

b7..: ....... 

58 .......... 

59 .......... 

60 .......... 

61 .......... 

62 .......... 

63 .......... 

64 .......... 

65 .......... 

66 .......... 

67 .......... 

68 .......... 

69 .......... 

16,148 4,651 7,093 3,578 826 

22 7 8 5 2 

20 5 8 5 2 

32 14 9 9 0 

13 4 4 3 2 

35 11 14 9 1 

47 11 23 9 4 

34 9 15 10 0 

38 10 18 8 2 

47 12 23 10 2 

32 8 14 8 2 

21 5 8 6 2 

94 11 44 35 4 

32 6 13 11 2 

33 12 14 6 1 

27 8 15 4 0 

40 7 17 14 2 

23 8 11 4 0 

26 7 13 6 0 

40 9 18 11 2 

37 12 13 9 3 

78 23 37 15 3 

87 26 34 22 5 

133 45 62 21 5 

158 40 75 30 13 

132 35 61 27 9 

128 46 52 25 .5 

154 57 62 24 11 

184 62 77 37 8 

181 53 76 43 9 

226 70 104 43 9 

187 77 72 33 5 

170 49 71 41 9 

77 26 32 18 1 

72 13 33 22 4 

111 34 43 26 8 

112 33 54 18 7 

104 26 51 23 4 

114 34 47 26 7 

173 51 87 25 10 

210 63 96 42 9 

157 56 70 27 4 

168 38 91 34 5 

27 6 9 12 0 

24 8 10 6 0 

16 6 6 2 2 

28 6 15 4 3 

41 9 22 7 3 

32 3 16 11 2 

29 7 10 10 2 

28 5 15 7 1 

25 9 10 6 0 

23 7 8 6 2 

26 9 11 3 3 

22 4 11 7 0 

23 4 11 8 0 

31 9 12 8 2 

24 5 7 9 3 

32 7 15 7 3 

30 9 12 6 3 

16 7 3 1 5 

25 12 7 4 2 

32 10 19 3 0 

36 13 14 7 2 

32 6 13 10 3 

36 15 14 6 1 

27 10 11 4 2 

19 3 4 8 4 

18 5 6 7 0 

21 11 6 4 0 

PSU 

Age in years at last birthday 

All 

ages 55-64 65-74 75-84 85 and over 

70 .......... 

71 .......... 

72 .......... 

73 .......... 

74 .......... 

75 .......... 

76 .......... 

77 .......... 

78 .......... 

79.. ........ 

80 .......... 

81 .......... 

82 .......... 

83 .......... 

84 .......... 

85 .......... 

86 .......... 

87 .......... 

88 .......... 

89.. ........ 

90 .......... 

91 .......... 

92 .......... 

93 .......... 

94 .......... 

95 .......... 

9s .......... 

97.. ........ 

98 .......... 

99 .......... 

100 ......... 

101.. ....... 

102 ......... 

103 ......... 

104 ......... 

105 ......... 

106 ......... 

107 ......... 

108 ......... 

109 ......... 

110 ......... 

ill......... 

112 ......... 

113 ......... 

114 ......... 

115 ......... 

116 ......... 

117 ......... 

118 ......... 

119 ......... 

120 ......... 

121 ......... 

122 ......... 

123 ......... 

124 ......... 

125 ......... 

126 ......... 

127 ......... 

128 ......... 

129 ......... 

130 ......... 

131......... 

132 ......... 

133 ......... 

134 ......... 

135 ......... 

136 ......... 

137 ......... 

138 ......... 

139 ......... 

140 ......... 

32 10 13 8 1 

37 10 14 9 4 

29 11 12 4 2 

39 11 16 8 4 

31 8 12 10 1 

23 3 9 8 3 

19 4 6 8 1 

18 7 5 5 1 

28 7 11 7 3 

23 5 11 6 1 

26 11 8 6 1 

20 3 6 8 3 

21 11 7 2 1 

24 7 9 6 2 

36 8 15 8 5 

39 12 18 7 2 

25 5 10 7 3 

25 6 13 5 1 

15 4 7 4 0 

23 8 10 5 0 

26 6 15 5 0 

22 7 9 6 0 

26 9 10 6 1 

23 2 13 8 0 

17 5 7 5 0 

9 5 2 1 1 

30 10 3 11 6 

28 11 9 5 3 

45 13 17 13 2 

30 10 13 5 2 

15 6 3 6 0 

36 11 9 10 6 

34 13 12 7 2 

23 8 10 5 0 

26 9 5 9 3 

20 4 10 4 2 

52 5 18 22 7 

26 1 16 6 3 

14 7 3 4 0 

23 5 13 4 1 

24 11 8 5 0 

47 13 22 12 0 

23 7 10 5 1 

30 7 16 7 0 

26 7 10 7 2 

121 38 56 21 6 

109 21 52 26 10 

128 36 58 23 11 

120 47 42 28 3 

103 28 56 13 6 

90 28 41 19 2 

125 36 53 29 7 

100 26 47 21 6 

112 29 49 28 6 

109 34 46 23 6 

135 47 53 27 8 

126 52 50 22 2 

99 24 39 29 7 

92 26 50 14 2 

141 38 80 18 5 

160 51 71 30 8 

119 40 46 25 8 

91 27 38 22 4 

71 24 32 12 3 

62 21 28 9 4 

23 7 7 8 1 

27 13 8 6 0 

38 12 20 5 1 

21 6 10 5 0 

26 6 12 5 3 

25 8 10 5 2 

109 
Table Ill: Number of sample persons in the 1984 Supplement on Aging, by pseudoprimary sampling unit (PSU) and age-con. 

PSlJ 

AI/ 

ages 

Age in years at last birthday 

55-64 650 74 75-84 85 and ovel PSU 

141 ......... 

142 ......... 

143 ......... 

144 ......... 

145 ......... 

146 ......... 

147 ......... 

148 ......... 

149 ......... 

150 ......... 

151 ......... 

152 ......... 

153 ......... 

154 ......... 

155 ......... 

156 ......... 

157 ......... 

158 ......... 

159 ......... 

160 ......... 

161 ......... 

162 ......... 

163 ......... 

164 ......... 

165 ......... 

166 ......... 

167 ......... 

168 ......... 

169 ......... 

170 .......... 

171......... 

172 ......... 

173 ......... 

174 ......... 

175 ......... 

176 ......... 

177 ......... 

178 ......... 

179 ......... 

180 ......... 

181 ......... 

182 ......... 

183 ......... 

184 ......... 

185 ......... 

186 ......... 

187 ......... 

188 ......... 

189 ......... 

190 ......... 

191 ......... 

192 ......... 

193 ......... 

194 ......... 

195 ......... 

196 ......... 

197 ......... 

198 ......... 

199 ......... 

200 ......... 

201 ......... 

202 ......... 

203 ......... 

204 ......... 

205 ......... 

206 ......... 

207 ......... 

208 ......... 

209 ......... 

210 ......... 

211 ......... 

110 

24 10 10 4 0 

39 8 20 10 1 

31 13 11 4 3 

52 12 26 12 2 

25 5 10 6 4 

27 4 18 4 1 

42 7 21 11 3 

28 7 10 9 2 

35 11 19 5 0 

27 6 13 7 1 

34 10 16 7 1 

36 8 19 9 0 

55 10 36 9 0 

35 10 20 5 0 

16 7 6 3 0 

24 7 12 4 1 

22 7 9 4 2 

30 12 10 5 3 

31 8 17 6 0 

51 10 24 8 9 

27 10 9 7 1 

30 10 15 4 1 

13 8 5 0 0 

28 7 9 10 2 

51 18 23 8 2 

25 6 15 3 1 

31 6 15 8 2 

21 3 8 10 0 

22 3 12 6 1 

33 4 16 12 1 

28 7 14 6 1 

25 9 10 4 2 

24 10 8 3 3 

20 7 9 4 0 

25 4 8 13 0 

6 3 0 3 0 

25 9 6 6 4 

19 5 7 7 0 

23 9 12 1 1 

22 8 6 6 2 

21 6 8 6 1 

18 3 8 7 0 

16 6 6 4 0 

26 8 13 3 2 

38 14 18 5 1 

28 8 15 3 2 

39 9 26 3 1 

14 2 10 2 0 

38 10 24 3 1 

30 8 16 6 0 

18 7 9 2 0 

19 6 9 4 0 

86 16 46 18 6 

28 8 14 6 0 

16 3 5 6 2 

32 8 8 13 3 

11 3 6 2 0 

23 9 9 4 1 

20 2 6 8 4 

62 11 28 18 5 

26 7 8 10 1 

31 5 18 4 4 

33 9 11 10 3 

23 6 10 5 2 

29 12 8 8 1 

42 11 11 18 2 

28 6 17 4 1 

26 8 8 9 1 

27 7 16 3 1 

34 11 13 9 1 

21 6 11 4 0 

All 

ages 

Age in years at last birthday 

55-64 65-74 75-84 85 and over 

212 ......... 

213 ......... 

214 ......... 

215 ......... 

216 ......... 

217 ......... 

218 ......... 

219 ......... 

220 ......... 

221 ......... 

222 ......... 

223 ......... 

224 ......... 

225 ......... 

226 ......... 

227 ......... 

228 ......... 

229. ........ 

230 ......... 

231 ......... 

232 ......... 

233 ......... 

234 ......... 

235 ......... 

236 ......... 

237 ......... 

238 ......... 

239. ........ 

240 ......... 

241 ......... 

242 ......... 

243 ......... 

244 ......... 

245 ......... 

246 ......... 

247 ......... 

248 ......... 

249 ......... 

250: ........ 

251 ......... 

252 ......... 

253 ......... 

254 ......... 

255 ......... 

256 ......... 

257 ......... 

258 ......... 

259. ........ 

260 ......... 

261 ......... 

262 ......... 

263.--.-o 

264 ......... 

265 ......... 

266 ......... 

267 ......... 

268 ......... 

269. ........ 

270 ......... 

271 .......... 

272 ......... 

273 ......... 

274 ......... 

275 ......... 

276 ......... 

277 ......... 

278 ......... 

279. ........ 

280 ......... 

281 ......... 

282 ......... 

35 9 13 11 2 

22 7 8 6 1 

21 3 7 10 1 

37 7 22 7 1 

25 6 9 7 3 

21 4 14 3 0 

23 7 13 2 1 

33 8 14 10 1 

20 9 7 3 1 

43 10 18 15 0 

40 10 20 9 1 

20 6 10 3 1 

48 14 18 14 2 

24 8 12 3 1 

37 18 9 9 1 

35 11 17 4 3 

35 7 20 5 3 

32 6 17 7 2 

18 4 8 6 0 

32 6 16 9 1 

25 2 14 8 1 

22 6 12 2 2 

29 11 8 8 2 

36 8 15 10 3 

60 9 34 17 0 

126 38 41 43 4 

129 43 60 22 4 

94 28 44 17 5 

107 24 53 26 4 

110 43 43 15 9 

119 47 91 26 5 

69 21 32 13 3 

73 21 30 19 3 

107 29 48 28 2 

112 38 45 24 5 

84 32 35 14 3 

109 30 51 21 7 

105 29 52 22 2 

115 38 50 25 2 

119 40 47 24 8 

126 36 56 26 8 

254 67 107 67 13 

279 64 119 84 12 

61 13 30 14 4 

59 15 32 11 1 

41 13 13 15 0 

62 14 35 10 3 

36 9 17 10 0 

71 16 43 9 3 

45 11 22 11 1 

32 10 9 11 2 

38 12 19 6 1 

40 10 16 14 0 

39 8 18 6 7 

31 2 19 8 2 

25 5 16 3 1 

19 6 10 2 1 

28 8 11 9 0 

52 13 22 14 3 

29 7 15 6 1 

15 8 6 1 0 

28 10 10 5 3l 

32 9 16 7 0 

12 2 6 3 1 

27 9 10 7 1 

35 13 16 4 2 

14 5 5 4 0 

23 6 9 5 3 

5 0 5 0 0 

31 10 12 8 1 

24 10 7 6 1 
Table Ill: Number of sample persons in the 1984 Supplement on Aging, by pseudoprimary sampling unit (PSU) and age-Con. 

PSU 

AN 

sges 

Age in years at last birthday 

55-64 65-74 75-84 85 and over 

283......... 157 40 69 31 17 

284......... 158 52 66 34 6 

285......... 143 40 58 37 8 

286'......... 136 31 62 32 11 

287......... 99 28 44 22 5 

288......... 81 23 37 17 4 

289 . . . . . l . . . 150 44 54 42 10 

290 . . . . . . . . . 122 43 54 20 5 

PSU 

All 

ages 

Age in years at last birthday 

55-64 65-74 75-84 85 and over 

291...* . . . . . 112 30 49 24 9 

292 . . . . . . . . * 119 24 67 24 4 

293 I , . . . . . . . 186 49 82 44 11 

294 . . . . l . . . . 141 45 63 30 3 

295 . . . . * . . . . 106 36 42 24 4 

296 . . . . . . . . . 81 21 39 15 6 

297 . . l . . . . . . 109 32 46 26 5 

298.. . . . . . . . 106 36 39 24 7 

111 
Appendix VI I 

Examples using SAS 

These examples are all based on the assumption that the 

following scheme has been used to convert the public-use person 

file for the Supplement on Aging to a SAS file named NEW.SOA 

P# = variable from the Basic NHIS persons’ file with 

# indicates the first field of the tape location. 

xWGT = a weight with x indicating the kind of weight. 

PSU = pseudo primary sampling unit. 

S# = variable from the SOA with # indicating the 

first field of the tape location. 

The input statement would have the format: 

INPUT ; 

INFILE 

P25 25 P27 27-28 

PSU 187-189 

QWGT 201-209 SWGT 210-218 

AWGT 2 19-227 

BDWGT 246-254 

s404404s409409-410...; 

IF statements or other recoding statements: 

( 1) to change the unknowns and nonresponse (usually, 

but not always, coded as “9” on NHIS tapes) to a 

SAS format for unknowns, and 

(2) to create recodes. 

*The user should be careful not to confuse data not recorded 

because of a skip pattern with data not recorded because the 

person did not answer the question. 

*Recodes are optional; however, the following one is needed to 

estimate variances: 

STRATUM = PSU/2 + 0.5 ; 

STRATUM = INT(STRATUM) ; 

LENGTH 3 ; 

*sets 3 as the default to save space; 

LENGTH QWGT SWGT AWGT BWGT 8 ; 

*the weights need more space; 

LABEL and other statements as desired ; 

Examples of national estimates 

TABLES 

S404 * Pill / NOROW NOCOL NOPERCENT: 

WEIGHT AWGT ; 

TITLE1 ‘The number of people age 55 and over’ ; 

TITLE2 ‘according to the number of bed days’ ; 

TITLE3 ‘in the preceding year’ ; 

DATA ; 

SET NEW.SOA ; 

NEWWGT = P132 * SWGT ; 

PROC FREQ ; 

TABLES 

S404”Plll; 

WEIGHT NEWWGT ; 

TITLE1 ‘The number of people age 55 and over’ ; 

TITLE2 ‘according to the number of bed days’ ; 

TITLE3 ‘in the preceding year’ ; 

Tables can be made much more sophisticated by changing 

the options, recoding variables, or using PROC TABULATE. 

Note that in PROC TABULATE if any records have missing 

values for one variable in the table, those records will be deleted 

from the entire table. 

Users producing tables under such procedures will have to 

rely on the NHIS variance curves or on average design effects 

to make adjustments for the sample design if they wish to show 

confidence intervals or to test hypotheses. 

DO NOT rely on the test statistics that can be produced 

from such tables when weighted. Test statistics that are pro 

duced by options are incorrect because (a) they are based on 

assumptions 

of selection, 

of simple random sampling 

and (b) the programs assu 

equal probability 

,rne that the weighted 

sample is the true sample. 

Examples of national estimates with 

standard errors 

By using SESUDAAN, 42 which runs under SAS but is 

not available from the SAS Institute, analysts can obtain estimated standard errors for each point estimate. The program also 

produces design effects if requested as they are in the sample. 

Data must be sorted by stratum and PSU for the program to 

work properly. 

DATA ; 

DATA SET NEW.SOA ; ; 

SET NEW.SOA ; 

PROC FREQ ; 

112 

NOTE: A list of references follows the text. 
PROC SORT ; 

BY STRATUM PSU; 

PROC SESUDAAN ALLFOILS DEFT 

PSULVL = 2 STRLVL = 1; 

I&PORT P25 P43 P64 S404 ; 

LEVELS2347; 

ANALYSIS P71 ; 

FOILS 4 ; 

NEST STRATUM PSU; 

WEIGHT AWGT ; 

TABLES P25 P43 P64 S404 

P25 * P64 

SETPRINT CWIDTH = 16 MEANDEC = 6 

PVALDEC = 6 DEFTDEC = 4 ; 

TITLE1 ‘Sampling errors for estimated percent of people 

in each’ ; 

TITLE2 ‘limitation of activity group’ ; 

TITLE3 ’ 1984 SOA people age 55 and over’ ; 

/I 

113 
Appendix VI I I 

Consultants and staff of the 

1984 Supplement on Aging 

Consultants outside the National Center 

for Health Statistics 

Ronald Abeles, Ph.D. 

National Institute on Aging 

National Institutes of Health 

Building 32, Room 5CO5 

9000 Rockville Pike 

Bethesda, Md. 20892 

Jacob Brody, M.D. 

Dean, School of Public Health 

University of Illinois at Chicago 

Box 6998 

Chicago, Ill. 60680 

Herman Brotman 

3 108 Holmes Run Road 

Falls Church, Va. 22046 

Robert N. Butler, M.D. 

Chairman, Department of Geriatrics and Adult Development 

Mount Sinai School of Medicine 

The Mount Sinai Medical Center 

One Gustave Levy Place 

New York, N.Y. 10029 

John Busa 

Director, Planning, Evaluation, and Analysis 

Administration on Aging 

330 Independence Avenue, S. W. 

North Building, Room 4747 

Washington, D.C. 20201 

Joan Comoni-Huntley, Ph.D. 

National Institute on Aging 

National Institutes of Health 

Federal Building, Room 6 12 

7550 Wisconsin Avenue 

Bethesda, Md. 20892 

Karen Davis, Ph.D. 

Johns Hopkins University 

10537 Farnham Drive 

Bethesda, Md. 20814 

Paul Densen, Ph.D. 

Harvard Center for Community Health 

643 Huntington Avenue 

Boston, Mass. 02115 

Donald G. Fowles 

National Institute on Aging 

National Institutes of Health 

Building 32, Room SC 11 

9000 Rockville Pike 

Bethesda, Md. 20892 

Sidney Katz, M.D. 

Associate Dean of Medicine 

Brown University, Box G 

Providence, R.I. 029 12 

Barbara A. McCann 

Hospice Project Director 

Joint Commission on Accreditation of Hospitals 

875 North Michigan Avenue 

Chicago, Ill. 606 11 

Marsha Ory, Ph.D. 

National Institute on Aging 

National Institutes of Health 

Building 32, Room 5CO5 

9000 Rockville Pike 

Bethesda, Md. 20892 

Alan Pardini 

Department of Social and Behavioral Sciences 

School of Nursing N63 1Y 

University of California 

San Francisco, Calif. 94143 

Jon Pynoos, Ph.D. 

Director, Institute for Policy and Program Development 

University of Southern California 

Andrus Gerontology Center 

University Park MC-O 19 1 

Los Angeles, Calif. 90089 

Dorothy P. Rice 

Regents Lecturer 

Department of Social and Behavioral Sciences 

School of Nursing N63 1Y 

University of California 

San Francisco, Calif. 94143 

Matilda White Riley, Ph.D. 

Associate Director for Behavioral Sciences Research 

National Institute on Aging 

National Institutes of Health 

Building 32, Room 5CO5 

9000 Rockville Pike 

Bethesda, Md. 20892 

114 
Eva J. Salber, M.D. 

(Formerly-Duke University) 

1308 Arboretum Drive 

Chapel Hill, NC. 27514 

Ethel Shanus, Ph.D. 

222 Main Street, Apt. 301 

Evanston, Ill. 60202 

Ann R. Somers, D.Sc. 

UMDNJ/Rutgers Medical School 

31 Scott Lane 

Princeton, N.J. 08540 

Staff of the U.S. House of Representatives Special Committee 

on Aging 

Staff of the U.S. Senate Select Committee on Aging 

Julie Troccio 

American Health Care Association 

1200 Fifteenth Street, N.W. 

Washington, D.C. 20005 

Ann Wilder Zimmer, Ph.D. 

Special Assistant to the Associate Director for Biomedical 

Research and Clinical Medicine 

National Institute on Aging 

National Institutes of Health 

Building 32, Room 5Cll 

9000 Rockville Pike 

Bethesda, Md. 20892 

The National Center for Health Statistics 

Work Group on Surveys on the Aging 

Chair 

Mary Grace Kovar, Dr.P.H. 

Special Assistant for Health Data Policy and Analysis 

Vital and Health Statistics Sys.tems 

Work Group Members 

E. Earl Bryant 

Formerly Associate Director 

Office of Interview and Examination Statistics Program 

Clinton E. Bumham 

Formerly Chief, Survey Planning and Development Branch 

Division of Health Interview Statistics 

Thomas Drury, Ph.D. 

Chief, Health Status Measurement Branch 

Division of Epidemiology and Health Promotion 

Jacob J. Feldman, Ph.D. 

Associate Director 

Office of Epidemiology and Analysis Program 

Robert R. Fuchsberg 

Formerly Director 

Division of Health Interview Statistics 

Peter L. Hurley 

Associate Director 

Vital and Health Statistics Systems 

Jennifer Madans, Ph.D. 

Deputy Director 

Office of Epidemiology and Analysis Program 

Stewart C. Rice 

Chief, Survey Planning and Development Branch 

Division of Health Interview Statistics 

Isadore Seeman 

Formerly staff member 

Vital and Health Care Statistics Program 

National Mortality Follow-back Survey 

Monroe Sirkin, Ph.D. 

Associate Director 

Office of Research and Methodology 

Owen Thomberry, Ph.D. 

Director 

Division of Health Interview Statistics 

Joan Van Nostrand 

Acting Director 

Division of Health Care Statistics 

Ronald W. Wilson 

Director 

Division of Epidemiology and Health Promotion 

National Center for Health Statistics 

Division of Health Interview Statistics 

Staff for the 1984 Supplement on Aging 

Survey Planning and Development Branch staff responsible 

for the development and design of the 1984 Supplement on 

Aging questionnaire and data collection procedures were 

Joseph E. Fitti, Group Leader 

Amy Coyle 

Marie L. Monsees 

Illness and Disability Statistics Branch staff responsible 

for preparing the specifications for computer edits of the keyed 

data files were 

Susan Jack, Group Leader 

Gerry Hendershot, Ph.D. 

Charlotte Schoenbom 

Robyn Stone, Dr.P.H. (National Center for Health 

Services Research) 

Computer Systems and Programming Branch staff responsible for programming the computer edits and for preparing and 

documenting the data tapes were 

Patricia Sartwell, Group Leader 

Nancy Gagne 

George Gerhold 

Sue Hsiung 

Vance Hudgins 

Teresa Washington 

115 
U.S. Bureau of the Census 

Demographic Survey Division 

Staff for the 1984 Supplement on Aging 

Health Surveys Branch staff responsible for coordinating 

activities performed by the U.S. Bureau of the Census were 

Robert Mangold, Chief 

Gemma Fumo 

Catherine Hester 

116 
Vital and Health Statistics 

series descriptions 

SERIES 1. 

SERIES 2. 

SERIES 3. 

SERIES 4. 

SERIES 5. 

SERIES 10. 

SERIES 11. 

SERIES 12. 

SERIES-1 3. 

Programs and Collection Procedures-Reports describing 

the general programs of the National Center for Health 

Statistics and its offices and divisions and the data collection methods used. They also include definitions and 

other material necessary for understanding the data. 

Data Evaluation and Methods Research-Studies of new 

statistical methodology including experimental tests of 

new survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to 

statistical theory. Studies also include comparison of 

U.S. methodology with those of other countries. 

Analytical and Epidemiological Studies- Reports presenting analytical or interpretive studies based on vital 

and health statistics, carrying the analysis further than 

the expository types of reports in the other series. 

Documents and Committee Reports-Final reports of 

major committees concerned with vital and health statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

Comparative International Vital and Health Statistics 

Reports-Analytical and descriptive reports comparing 

U.S. vital and health statistics with those of other countries. 

Data From the National Health Interview Survey-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other 

health-related topics, all based on data collected in the 

continuing national household interview survey. 

Data From the National Health Examination Survey and 

the National Health and Nutrition Examination SurveyData from direct examination, testing, and measurement 

of national samples of th.e civilian noninstitutionalized 

population provide the basis for (1) estimates of the 

medically defined prevalence of specific diseases in the 

United States and the distributions of the population 

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships 

among the various measurements without reference to 

an explicit finite universe of persons. 

Data From the Institutionalized Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 13. 

Data on Health Resources Utilization-Statistics on the 

utilization of health manpower and facilities providing 

long-term care, ambulatory care, hospital care, and family 

planning services. 

SERIES 14. 

SERIES 15. 

SERIES 20. 

SERIES 21. 

SERIES 22. 

SERIES 23. 

Data on Health Resources: Manpower and FacilitiesStatistics on the numbers, geographic distribution, and 

characteristics of health resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

Data From Special Surveys-Statistics on health and 

health-related topics collected in special surveys that 

are not a part of the continuing data systems of the 

National Center for Health Statistics. 

Data on Mortality-Various statistics on mortality other 

than as included in regular annual or monthly reports. 

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; 

and statistics on characteristics of deaths not available 

from the vital records based on sample surveys of those 

records. 

Data on Natality, Marriage, and Divorce-Various statistics on natality, marriage, and divorce other than as 

included in regular annual or monthly reports. Special 

analyses by demographic variables; geographic and time 

series analyses; studies of fertility; and statistics on 

characteristics of births not available from the vital 

records based on sample surveys of those records. 

Data From the National Mortality and Natality SurveysDiscontinued in 1975. Reports from these sample sun/eys 

based on vital records are included in Series 20 and 21, 

respectively. 

Data From the National Survey of Family GrowthStatistics on fertility, family formation and dissolution, 

family planning, and related maternal and infant health 

topics derived from a periodic survey of a nationwide 

probability sample of women 15-44 years of age. 

For answers to questions about this report or for a list of titles of 

reports published in these series, contact: 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Public Health Service 

Hyattsville, Md. 20782 

301-436-8500 
U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Public Health Service 

National Center for Health Statistics 

3700 East-West Highway 

Hyattsville, Maryland 20782 

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300 

DHHS Publication No. (PHS) 87-l 323, Series 1, No. 21 

7-0098 (12/96)