NATiONAL CENTER Series 1 

For HEALTH STATISTICS Number 2 

VITAL and HEALTH STATISTICS 

PROGRAMS AND COLLECTION PROCEDURES 

HealthSurveyProcedure 

Concepts, Questionnaire Development, and 

Definitions in the Health Interview Survey 

Concepts of morbidity, 

of medical services 

development, fiscal 

tions of terms used in 

Washington, D.C. 

U ,S . DEPARTMENT OF 

HEALTH, EDUCATION , AND WELFARE 

Anthony J. Ce Iebrezze 

Secretary 

disability, and utilization 

and faci Iities; questionnaire 

years 1958-64; and definistatistical reprts. 

May 1964 

Public Health Service 

Luther L. Terry 

Surgeon General 

I 
I 

See inside of back cover 

for catalog card. 

Public H&dth %vice Publication No. 1000-Series l-No 2 
NATIONAL CENTER FOR HEALTH STATISTICS 

Forrest E. Linder, Ph. D., Director


Theodore D. Woolsey, Deputy Director


Oswald K. Sagen, Ph. D., Assistant Director


(for Professional Relations)


Walt R. Simmons, M.A., Statistical Advisor


Alice M. Waterhouse, M.D., Medical Advisor


James E. Kelly, D.D.S., Dental Advisor


Louis R. Stolcis, M.A., Executive Officer


OFFICE OF HEALTH STATISTICS ANALYSIS


Iwao M. Moriyama, Ph. D., Chief


DIVISION OF VITAL”STATISTICS


Robert D. Grove, Ph. D., Chief


DIVISION OF HEALTH INTERVIEW STATISTICS


Philip S. Lawrence, SC.D., Chief


DIVISION OF HEALTH RECORDS STATISTICS


Monrm G. Sirken, Ph. D., Chief


DIVISION OF HEALTH EXAMINATION STATISTICS


Arthur J. McDowell, Chief


DIVISION OF DATA PROCESSING


Sidney Binder, Chief


Public Health Service Publication No. 1000-Series l-No. 2

-------------------------------------------------------------

-----------------------------------------------------------

-------------------------------------------------------

---------------------------------------------------

-------------------------------------------

-----------------------------------------------

----------------------------------------

-------------------------------------------- ---

----------------------

---------------------------------

--------------------------------------

-----------------------------------

------

----------------------

-------------------------------

---------

------------------------------------------

-----------------------------------

------------------------------------------------

CONTENTS


1. Introduction


A. General


B. Background


C. Statistical Desi~-------------------------------------------------­

2. Concepts in the Survey


A. The Concept of Morbidity


The Unrefined Data -----------------------------------------------


~e Sifting Criteria


The Dia~ostic Information


B. The Concept of Disabili~-------------------------------------------

C. Concepts in Measuring Utilization of Medical Services and Facilities----

3. Questionnaire Development


A. The Basic Questionnaire for Fiscal Year1964-------------------------


The Basic Questionnaire and the Special Topics


The Interviewer and theRespondent


The Strucmre of tieInterview


Time References in theInterview


B. Questionnaire Development Fiscal Years 1958-64---------------------


General -------------------------T-------------------------------


Questions: Social, Economic, and Demographic Characteristics-­


Questions and Tables: Illness and Injury Recall


Questions and Tables: Hospitalization


One-Time and Rotating Health Topics on Basic Questionnaire


The Special Supplements


Questionnaire, Fiscal Year 1964


Vision Supplement


Page 

1 

1 

2 

2 

4 

4 

5 

6 

6 

7 

7 

9 

9 

9 

10 

12 

14 

16 

16 

17 

17 

18 

18 

18 

21 

27 
-------- -------- -------- -------- -------- ------

- - - - --- - - - -- -- - -- --- -- ------ -- - - -- ------ - -- ----- -- - --- - -- - ----

---------------------------------------

---------------------------------------------

------------------------------------------

-------- -------- -------- -------- -------- ----

-----------------------------------------------

---------------------

------------------------------------

------------------------------------------------

--------------------------------------------------

--------------------------

---------------------------------------------------

--------------------------------------------

-----------------------

----------------------------

----------------------------------------------

-----------------------------------------

CONTENTS–Continued 

Page 

Figure 1. Social, economic, and demographic characteristics questions, 

fiscal years, 1958-64---------------------------------------

2. Illness-recall questions, fiscal years 1958-64------------------

3. Table I, fiscal years l958-64---------------------------------

4. Table A, fiscal years l958-64---------------------------------

5. Hospitalization questions, fiscal years 1958-64------------------

6. Table II, fiscal years l958-64---------------------------------

7. Physician and dental visits, fiscal years 1958, 1959,and 1964-----

8.	 Personal and nursing care athome and special aids (supplement), 

fiscal year l959--------------------------------------------

9.	 Health insurance, fiscal year 1960 (one-half year) and fiscal 

year l963-------------------------------------------------

10. X-ray visits: questions and table X, fiscal year1961-------------

11.	 Routine physical examination for children andspecialists’services, 

fiscal year l964--------------------------------------------

12. Personal health expenditures(self-enumeration), fiscalyear1963--

13.	 Followback form (hearing ability), fiscal year 1963. (Page lof


4-page form.)


4.	 Definitions and Discussionof Terms Used inthe SWvey, Fiscal Years


1958-64


The Contentsof the List ofTerms


General Morbidity Terms


TermsRelating to Disability


Disability Days ---------


Long-Term Disability


TermsRelating to Persons Injured and Accidents-­


Terms Relating To Hospitalization


Medical Care Terms


Dental Care Terms


Terms Relating to Health Insurance Coverage


Kind of Coverage


Terms Relating to Special Aids ---------------------------------------


Terms Relating to Persons Receiving Personal Care at Home -----------


Terms Relating to X-rays


Terms Relating to Personal Health E~endi~res


Demographic, Social, and Economic Terms


HoVsehold Composition


Location of Residence Terms


Index to Terms Defined -----------------------------------------------------

28 

29 

30 

32 

33 

34 

36 

38 

38 

39 

39 

40 

41 

42 

42 

42 

45 

45 

46 

47 

49 

51 

53 

54 

54 

54 

55 

55 

56 

57 

57 

60 

63 
HEALTH SURVEY PROCEDURE


Concepts, Questionnaire Development, and Definitions 

in the Health Interview Survey 

1. INTRODUCTION 

A. GENERAL 

The National Center for Health Statistics 

employs a variety of techniques including vital 

records, surveys, and examinations of the health 

of the American people. One part of this program, 

the Health Jnterview Survey, is a continuous sampling and interviewing of the civilian, noninstitutional population in the United States. This survey 

1as been collecting health and related information 

about the American people since July 1957. 

The emphasis in the Health Interview Survey 

is upon the social dimensions of morbidity. This 

means that morbidity is measured along an axis 

for which the scale is in terms of the impact that 

the @orbidity has upon the lives of the people contern d. Such a scale, it should be pointed out, may 

diffe ! in a number of ways from the scale that 

medical science uses, which can be broadly described as a continuum of pathological change. 

Measurement along both of these scales is useful 

fOr different purposes. The National ‘Health 

Survey intends to supply statistics based upon both 

types of measurement, but techniques other than 

the household-interview survey must be used to 

obtain statistics on morbidity in terms of medical 

criteria. 

Mortality statistics and reports of new cases 

of n@ifiable diseases were the only health statistics available on a continuing, national basis prior 

to the start of the National Health Survey. The 

former, though well established, usefully complete 

and accurate, and of enormous value, deal with one 

extreme of the continuum from health to ill health. 

The notifiable disease reports are limited in scope 

and of varying accuracy, depending upon the particular disease, but provide valuable information 

for disease surveillance and trends. Hence, the 

passage of the National Health Survey Act in July 

1956 pointed the way toward filling an important 

need for general purpose health information for 

assessment of national health problems. 

The Health Interview Survey is carried out in 

cooperation with the U.S. Bureau of the Census. 

The resources of the Bureau of the Census and the 

experience of that agent y with other national sample surveys and with several State and city health 

surveys made this cooperative arrangement an 

obvious one. The content and general specifications for the survey are determined by the 

Public Health Service, which also is responsible 

for the final data tabulation and for the analysis 

and publication of the results. Many of the design 

features of the survey, the drawing of the sample 

units, the interviewing and supervision of interviewing, and the coding of the data, together with 

quality control procedures, are conducted for the 

Public Health Service by the Bureau of the Census. 

1 
B. BACKGROUND 

In the development of morbidity, disability, 

and medical care concepts, the Health Interview 

Survey has been able to build upon foundations 

laid many years ago. Some of the basic elements 

originated in the Hagerstown, Md., illness survey 

of the early 1920’s. The Public Health Service’s 

Office of Statistical Investigations (now the Division of Public Health Methods) was responsible 

for that survey. 

About 2 decades later a major Health Survey 

was launched to obtain comprehensive statistics 

on diseases, injuries, and impairments in the 

general population of the United States. Carried 

out in 1935-36, that survey was a major project 

in which 737,000 urban households were visited 

by interviewers to obtain data on morbidity and 

many other health characteristics. It remains a 

landmark in the field. 

In the years since 1936 there have been a 

number of community studies of morbidity, prominent among which are the names of Hagerstown 

and Baltimore, Md.; Pittsburgh, Pa.; Hunterdon 

County, N. J.; Kansas City, Me.; New York City; 

and California (both San Jose and a statewide 

study). These studies, and experience with supplements to the Current Population Survey of the 

Bureau of the Census, demonstrated that the interview method is capable of providing useful information about the amount and distribution of 

diseases and injuries together with related information such as the accompanying loss of time 

from work or other usual activities. 

III January 1949, the U.S. National Committee 

on Vital and Health Statistics was established. Two 

subcommittees were formed in December 1949 

and October 1950 to study the need for current 

morbidity statistics. As a result of their recommendations, a third subcommittee was established 

in ,February 1951 under the chairmanship of Dr. 

W. Thurber Fales of Johns Hopkins University, 

and instructed to draft a‘ ‘Plan for a national morbidity survey keeping in view the interests of 

lccal areas. ” After careful study, this subcOmmittee recommended that several steps be taken, 

and in particular: “That a continuing national 

morbidity survey be conducted . . . . Its purpose 

would be to obtain data on the prevalence and incidence of disease, injuries, and impairments, on 

the nature and duration of the resulting disability, 

and on the amount and type of medical care 

received. The data would be obtained from a 

probability sample of households.” 

Therefore, plans for the Health Interview 

Survey could be based upon much experience. 

Yet the process of development of the concepts 

and definitions is still underway, and apart of the 

continuing program is to conduct research that 

will lead to concepts that are more objective, 

more explicit, and more useful. 

C. STATISTICAL DESIGN 

The statistical design of the Health Interview 

Survey, a joint product of the National Center for 

Health Statistics and the Bureau of the Census, is 

the pattern for an elaborate and complex multipurpose survey. The theory and formulation of the 

design have developed over a period of some 

years. A basic design has persisted throughout 

the life of the Health Interview Survey, but among 

the modifications three groups have been sufficiently distinct that they have been designated by 

design dates: the designs of 1957,1959, and 1963. 

The basic characteristics are Jhose of a 

highly stratified multistage probability design. 

In the first stage, primary sampling units (PSU’S) 

are selected from a universe of 1,900 such units 

which are geographically defined and which collectively exhaust the territory of the 50 States 

and the District of Columbia. Each PSU consists 

of a standard metropolitan statistical area (SMSA) 

or one or two contiguous counties. In a series of 

successive sampling steps, there is selected a 

final sampling unit which consists typically of a 

cluster of 6-9 neighboring households, called a 

“segment.” Data are secured, mainly through 

personal interview, for each member of these 

sample households. The design makes each week’s 

interviewing a probability sample of the entire 

United States, and weekly samples are additive in 

the sense that they can be combined for 13, 52, 

104, or more weeks. 

National statistics are the consequence of an 

estimation process built around five leading 

2 
features, and carried out principally on an electric 

computer. (1) The data are cmied, edited for consistency, and converted to a clean computational 

form. (2) Adjustment is introduced for nonresponse—which averages about 5 percent-by 

assigning to nonrespondents the characteristics of 

respmdents in the same segment. (3) Data are inflated by reciprocals of the probability of selection. The overall design is generally “selfweighting,” but certain technical and operational 

circumstances produce some departures. (4) The 

inflated data are modified by a ratio estimating 

technique which now uses 1960 pop~lation data 

classified by geography, race, and population 

density as the control variables. (5) A final step 

introduces poststratification, with the controls 

being independent estimates of current population 

for each of 60 age-sex-color cells, prepared by 

the Bureau of the Census. 

The 1957 design is described inconsiderable 

detail in the National Health Survey publication

A-2.1 

The 1959 design included several minor 

changes, and three somewhat more substantial 

revisions. The number of sample primary sampling units was increased from 372 to 503 and the 

number of households each year from 36,000 to 

38,000. The average size of assignment for an 

. 

%.S. National Health ~,Cy. The Statistical Design of tbe 

Health Household-interview Survey. Health Statistics, Series A-2. 

Public Health Service Publication No. j84-A2. Public Health 

Service. Washingmn, DC., July 1958. 

interviewer was increased from 12 to 13.5 households for a work week. 

For 1963 several further changes are worth 

special note. Population data from the 1960 Census 

had become available, and were used to increase 

efficiency of design. Structure of segments and 

assignments was mmiified in three important 

respects: segment size was changed from an expected six households to an expected nine households; the nine households were alternate ones in 

a cluster of about 18 neighboring households, 

whereas earlier the six had been a compact cluster 

of six adjacent households; assignments in a given 

week consisted of paired neighboring segments in 

1963, while earlier an assignment attempted to 

pair unlike segments. In the new design heterogeneity is obtained by giving the same interviewer 

different types of segments in successive weekly 

assignments. One result accompanying these 

changes was an increase in the average size of 

assignment from 13.5 households to 16 households. 

The manner of selecting specific segments was 

changed for about two-thirds of the total sample, 

from area sampling to list sampling, using 1960 

Census registers as the list frame. Most of the 

remaining third of the sample continues as an area 

sample. Sampling of building permits provides 

for newly constructed places in some sectors. 

Finally, the evidence from better estimates of 

components of variance, plus the above changes, 

together with the benefits from joint designing with 

the Census-BLS Current Population Survey led to 

a reduction from 503 to 357 primary sampling 

units and an increase from 38,000 to 42,000 sample 

households. 

3 
2. CONCEPTS IN THE SURVEY 

A. THE CONCEPT OF MORBIDITY 

Before questions to be used in the interview 

are drafted there must be an understanding about 

what is to be considered morbidity for the purpose of the survey. For the Health Interview 

Survey the underlying concept of morbidity can be 

stated as follows: 

1.


2. 

3. 

Morbidity is basically a departure from a 

state of physical or mental well -being,’ resulting from disease or injury, of which the 

affected individual is aware. Awareness connotes a degree of measurable impact on the 

individual or his family in terms of the 

restrictions and disabilities caused by the 

morbidity. Morbidity includes not only active 

or progressive disease but also impairments, 

that is, chronic or permanent defects that are 

static in nature, resulting from disease, injury, 

or congenital malformation. The existence of 

morbidity in an individual caused by a particular disease, injury, or impairment is called a 

“morbidity condition, ” or simply a‘ ‘condition. ” 

During the course of this condition there may 

be one or more periods when the affected 

individual considers himself to be “sick” or 

“injured.” These periods are spoken of as 

episodes of illness. The period or periods of 

illness may coincide with the period during 

which the condition exists, or they may cover 

only a part of that period. A condition may involve no illness, in the usual sense ofthe word. 

Hence, illness is only one form of evidence of 

the existence of a morbidity condition. Other 

evidence might be a decrease in, or complete 

loss of ability to perform various functions, 

particularly those of the musculoskeletal system or the sense organs; or a change in the 

appearance of the body, such as a rash or lump, 

believed to be abnormal by the person affected. 

For the purposes of this survey the concept of 

a morbidity condition is usually further limited 

by specifying that it includes only conditions 

as a result of which the person has taken one 

or more of various actions. Such actions might 

be the restricting of usual activities, bed disability, work loss, the seeking of medical 

advice, or the taking of medicines. 

4. The start, or onset, of the condition is conceived to be the time when the person first 

becomes aware of it. If there is an illness 

associated with the condition, the start, or 

onset, is usually the time when the illness 

begins or the injury occurs. In many instances 

it may be the time when a physician tells the 

person that he has a condition of which he was 

previously unaware. 

5. In the statement of this concept there has been 

reference to the individual’s awareness of his 

condition and to the individual’s actions as a 

result of the condition. Obviously in the case 

of children the statement must be modified. 

It is not always the child’s awareness or the 

child’s action which establishes the existence 

of a morbidity condition. Instead, it is the 

awareness and action of the people responsible 

for the care of the child, usually the parents. 

A similar modification applies to adults who 

are not competent to care for themselves. 

The introduction of a criterion of action into 

the concept of a morbidity condition deserves 

further explanation. Exceptions will be made to 

this action requirement if it seems appropriate. 

However, the rule has justification from the standpoint of both logic and practical utility. If the condition is of so little importance to the individual 

that, although aware of it, he takes no action of 

any sort, in the majority of instances it is of little 

health significance. Furthermore, the experience 

of earlier surveys reveals that there is a considerable degree of response error in the reporting of illness which has involved no disability 

or medical consultation. These minor illnesses 

seem to be subject to a good deal more memory 

bias and reporting variability than those which 

have affected the life of the individual to the extent 

that specific forms of action have been taken. 

It must be recognized that something is lost 

in the process of transforming a concept of the 

sort that has been described into an operational 

4 
procedure for measuring morbidity. In an interview survey the need for objectivity and simplicity 

necessarily modifies the concept. Nevertheless, 

the concept serves as a guide in framing the 

questions and instructions for the interview and in 

planning the coding and tabulating specifications. 

To the extent that the original concept is modified 

in the process of constructing an operational 

procedure, the questions, the instructions, the 

tabulating specifications, and, in fact, the whole 

structure of the survey become the actual working 

definition of morbidity. 

The interview, then, is only the first phase of 

the process of transforming the underlying concept into an instrument of measurement. In 

choosing the wording for the questions that were 

to be used to elicit reports of conditions for the 

Health Interview Survey it was necessary to cover 

all the aspects of morbidity that the original concept required. If the respondent did not associate 

the condition with the wording of one of the 

questions, the conditions would not be reported. 

Furthermore, it was desirable to stimulate the 

recall of the respondent to minimize the losses 

due to memory failure. These requirements led to 

the use of a series of questions approaching morbidity from a variety of directions. These are the 

illness-rec~Il questions discussed under Questionnaire Development. 

It was recognized that these questions might 

lead to the reporting of something outside the 

original concept of morbidity. However, the 

descriptive information obtained about each condition could be used to set up coding or tabulating 

criteria that would serve to retain only the desired 

conditions. 

The Unrefined Data 

Certain questions serve as the source of the 

original data on morbidity conditions. They are 

identified by reference to question numbers on 

the NHS-HIS (fiscal year 1964) questionnaire illustrated on pages 21-26. These basic inquiries are 

questions 8-14, questions 15-16 on hospitalizations, and, particularly, column (h) in Table II. 

In order to determine how well these questions 

cover the concept of morbidity that has been defined, it is necessary to review briefly each 

question, or set of questions, and to describe the 

intended purpose of each. 

Acute conditions.-By referring to the ques ­

tiomaire it will be seen that questions 8-11 are 

intended to secure reports of illnesses and injuries that were experienced at any time in the 2 

calendar weeks prior to the interview. The key 

words here are “sick,” “accident or injury,” 

“accident or injury that still bothers you or affects 

you,” and “take any medicine or treatment for any 

condition. ” Almost all of the acute conditions reported come from these questions since most acute 

conditions manifest themselves in the form of 

illnesses or involve the taking of some form of 

medicine or treatment. Chronic conditions are 

also reported in answer to these questions if they 

happen to have caused an illness episode during 

this 2-week period or if they are of the type that 

cause the person to feel ill all the time. 

Chronic conditions,-Since many chronic diseases and impairments of public health importance 

are not thought of as illness by respondents, or 

result in illness only at intervals, separate questions are included for the specific purpose of obtaining reports of chronic conditions of which the 

respondent is aware. These are questions 12-14 on 

the questionnaire. 

Question 14 asks, “Do you have any other 

ailments, conditions, or problems with your 

health,” and question 12 and 13 deal with 28 types 

of chronic diseases and 11 types of physical impairments listed on cards A and B (page 26). The 

reading of check lists of the sort contained on 

these cards has been shown by experience to be 

an effective device for stimulating the memory of 

the respondent. As pointed out earlier, if such 

questions as these result in the reporting of conditions for which no action of any kind has been 

taken, other data on the questionnaire maybe used 

when desired, to screen out such conditions in the 

tabulations. 

Hospitalized illness .-The questions on hospitalization, 15 and 16. serve a dual purpose. The 

hospitalization is a part of the picture of medical 

care utilization, and the illness is a part of the 

picture of morbidity in the population. 

5 
The Sifting Criteria 

Eliciting response to the questions enumerated above is but the initial step for obtaining raw 

data to be refined in later stages. The descriptive 

information about each condition obtained in 

Tables I and II on the questionnaire (pages 24 and 

25) is used to separate the chronic conditions from 

the total and to establish further criteria which define the morbidity that is tabulated. The chronic 

conditions are those listed on cards A and B and 

also any other present at the time of the interview 

which had their onset 3 months or more before 

the week of interview. The acute conditions are all 

other conditions reported. 

The hospitalized illness, having been recorded separately on the questionnaire with only 

a minor amount of interrelation to the other 

illness data, is analyzed, by and large, as a 

separate body of data. However, those conditions 

which are not already recorded in Table I are 

entered there if they appear on cards A or B or 

had at least 1 day of hospitalization in the 2 

calendar weeks prior to the week of interview. 

The criteria applied at the coding or tabulating 

stage to retain the conditions which fit the stated 

concept of morbidity are not considered to be unalterable. In general they are designed to put into 

effect the principle that a morbidity condition, as 

obtained by interview, must have resulted in some 

sort of impact, or some action on the part of the 

individual concerned. Different criteria may be 

applied for different types of morbidity conditions 

and for different purposes. 

At the present time only those acute illness 

and injuries which have resulted in a day or more 

of restricted activity or in seeking the advice of 

a physician are coded and tabulated. 

All chronic conditions, including both diseases and impairments, which are recorded on the 

questionnaire are coded, but criteria similar to 

those for acute conditions are introduced in the 

course of data tabulation. The same set of criteria 

are not used in all tabulations, however, and 

for certain purposes these requirements are 

omitted. In the case of impairments, for example, 

it is felt that the reduced ability to function implied by the description of the impairment (e.g., 

defective vision, blindness, ankylosed joint, and 

paralysis), is by itself sufficient criterion of the 

effect upon the life of the individual. Hence, in 

tabulations of impairments all conditions reported 

are usually included. In dealing with hospitalized 

illness the only usual cutoff for tabulating purposes 

is the dividing line between hospitals and other 

types of institutions reported in questions 15 and 

16. The name and address of the institution is 

obtained in column (o) of Table II, and this is used 

to determine whether it is a hospital according to 

the definition adopted for the survey. (See definition of “Hospital episode” on page 49.) 

The Diagnostic Information 

The attainable objectives in determining the 

nature of the condition in a household interview 

are quite naturally limited by the method employed 

to collect the information. The interview includes 

questions such as: 

“What was the matter?” 

“What did the doctor say it was? Did he use any 

medical terms?” 

“What was the cause of your husband’s dizzy 

spelIs ?” 

“What kind of trouble was it?” 

The accuracy and completeness of the replies to 

such questions depend upon the respondent’s 

knowledge of the nature of the condition and upon 

his willingness to pass on this knowledge to the 

interviewer. 

The reliability of the statements on the nature 

of the condition is undoubtedly quite different for 

attended and unattended conditions. In ascertaining 

the nature of attended conditions the interviewer 

asks the respondent what he has been told by the 

physician. It should be emphasized that accomplishing this successfully is the most that one can 

hope to do in establishing a diagnosis for an 

attended condition by the household-interview 

technique, without making use of additional data 

sources. 

With regard to unattended conditions, there is 

no doubt that the respondent often attempts selfdiagnosis or uses the diagnosis of other family 

members. For some types of unattended conditions 

the diagnoses supplied by respondents are probably reasonably accurate. These include such conditions as injuries, the common cold, simple 

functional digestive disorders, corns, styes, and 
I 

I 

I 

the common communicable diseases of childhood 

when an unattended case follows an attended case 

in the family. Nevertheless, for most unattended 

cases the most that can be expected is to secure 

good symptomatic descriptions of the conditions. 

For these reasons the approach in the Health 

Interview Survey is usually to tabulate as diagnostic entities only those conditions for which the 

response is unambiguous. Others reported are 

grouped in relatively broad diagnostic categories. 

For example, diabetes and the common cold are 

tabulated as single entities, while “other acute 

upper respiratory conditions” contaifls several 

forms of acute respiratory illnesses. 

B. THE CONCEPT OF DISABILITY 

The term “disability” has several common 

usages. For example, a “disability” often means 

a condition that interferes with ability to work. 

Also, conditions are frequently classified as producing temporary partial, temporary total, permanent partial, or permanent total “disability.” 

In this sense the various degrees of “disability” 

have some legal, or official definition that is related to compensation. Then there is the term 

“disabling” which has been usedin illness surveys 

for many years to describe a condition which prevents the individual from carrying on his usual 

activities for one or more days. 

It has been observed that speaking of a 

“disabling condition,” as the term has been used 

in surveys, meant to some people no less than 

severe chronic disability, despite the fact that the 

range of conditions covered might include such 

minor disability as the case of the common cold 

that laid the person up for a day or two. 

Because the other usages had gained such 

wide acceptance in certain fields it was decided 

not to employ the term “disability” in this survey 

except in a very generaI’ sense where it is intended 

to cover the whole field of interference with 

activities caused by disease, injury, or impairment (in much the same way that the term ‘‘morbidity” is used for a generic rather than a specific 

concept) and also where other words used with it 

make clear the desired meaning, as in “bed disability.” For other specific indices of disability 

new terms that are more descriptive of the concepts of the survey have been and will be introduced. Furthermore, it was decided that the Health 

Interview Survey needed, not one, but several 

different specifically defined indices of disability 

to serve different purposes. These are presented 

under the general heading of “Terms Relating to 

Disability” on page 45. 

The disability terms used in this survey may 

be grouped into three categories: (1) terms 

describing the individual’s status during a specified day, or number of days, which are equally 

applicable to acute conditions or chronic conditions, to all members of the population, and to 

any day of the week, e.g., restricted-activity day 

and bed-disability day (2) terms describing the 

individual’s status during a specified day, or 

number of days, which apply to both acute and 

chronic conditions but only to certain members 

of the population on days when they would have 

been working at a job or business, or going to 

school, if it had not been for their condition,e .g., 

work-loss day and school-loss day; and (3) terms 

applying only to chronic conditions, or persons 

with one or more chronic conditions, which 

describe their usual status “at the present time, ” 

meaning in this case during recent months, e.g., 

“chronic activity limitation” and “chronic mobility limitation. ” 

Since these terms were devised for use in this 

survey and have special meanings, it is especially 

important that the user of statistics from the survey become familiar with the concepts which the 

terms represent. 

C. CONCEPTS IN MEASURING 

UTILIZATION OF MEDICAL SERVICES 

AND FACILITIES 

The personal interview can be used as a 

medium for determining how illnesses, injuries, 

and impairments affect people-the restrictions 

and disabilities they suffer and the medical care 

the y receive. This latter term may be broadly 

interpreted to encompass the concept of utilization 

of medical services and facilities. It might be so 

broadly defined as to include everything that people 

use to care for their well-being, including such 

items as health sanitation, personal hygiene, and 

7 
food intake. The Health Interview Survey has 

measured, or plans to measure, the utilization of 

medical services and facilities in terms of medical 

attention, dental care, hospitalization, use of Xray facilities, preventive care services, nursing 

care services, use of prosthetic appliances and 

devices, self treatment, and other similar components of medical care or services. 

Medical care concepts come into the interview in a number of places. There is, for example, 

the subject of medical consultation for a condition. 

For each condition listed in Table I inquiry is made 

as to whether the person has ever “talked to” a 

physician about this condition. If the answer is 

“Yes,” the condition is classified as “medically 

attended.” For chronic conditions there was a 

question in fiscal years 1958-61 about the interval 

of time since a physician was last consulted. 

The use of the concept of medical attendance 

necessitates the defining of the term “physician” 

and also the defining of what is meant by “talking 

to” or consulting a physician. The definitions are 

contained in the section on “Definitions and Discussion of Terms. ” It will be seen there that 

medical attendance is broadly defined. It does not 

imply continued attendance or consultation, nor 

does it require that the physician give the advice 

in person. The emphasis is upon the fact that the 

condition was brought to the attention of a 

physician; that the initial action necessary to set 

in motion the procedure of diagnosis and treatment was taken. Any definition more restrictive 

than this would involve the question of what con ­

stitutes adequate care—a question which is not a 

part of the subject matter of the survey. 

The same concept of medical attendance is 

applied in determining the interval since last 

medical consultation for a chronic condition. 

For the first 4 years of the survey, Table I 

contained the question: “Do you still take any 

medicine or treatment that the doctor prescribed 

(for your condition) or follow any advice he gave?” 

The answers provide additional information on the 

medical care of chronic conditions. An affirmative 

answer to either part of this question is taken to 

mean that the condition is “still under care. ” 

Again, the definition reveals that “under care” 

is interpreted broadly. Whether a person considers himself to be “still under care” or no 

longer under care is dependent upon his attitude. 

He may have received instructions to maintain a 

certain regimen, but if he has long since ceased 

to follow the instructions he may think of himself 

as finished with medical care for the condition. 

However, the attitude reflects his past behavior 

and, hence, suggests what his future behavior may 

be in regard to the instructions. It is, therefore, 

believed to be a useful additional means of characterizing the chronic condition. 

Two of the principal concepts in the area of 

medical care included in the interview are the 

physician visit and the classification of visits by 

type of service. These are closely paralleled by 

similar concepts in the area of dental care, and 

the two can be discussed together. 

There are two major points to which attention 

must be directed in the definitions, which will be 

found under the heading of “Medical Care Terms” 

and “Dental Care Terms” in the section, “Definitions and Discussion of Terms. ” One is the 

inclusion in the statistics of the visit at which the 

service is given, not by the physician or dentist 

himself, but by some other person such as a nurse 

or dental hygienist acting under the physician’s or 

dentist’s supervision. The other is the exclusion 

of the “visit” at which the service consisted of a 

sin@e procedure administered identically to a 

number of people who all came for the same purpose, as in a glaucoma screening program. 

The first rule was adopted because it was 

believed to give a more useful measure of the 

total volume of care provided, and because the 

concept as defined corresponded more closely to 

what the layman thinks of as a visit to the physician 

or dentist. 

The second rule, on the other hand, was introduced because certain types of service, particularly in the field of mass preventive care, seemed 

remote from the personalized care that is implied by the terms “physician visit” and “dental 

visit, ” If a physician administered a test of hearing 

to every child in a school classroom it hardly 

seemed appropriate that every child be counted as 

having had one “physician visit.” Therefore it was 

decided that the counting of such services could 

be better handled as a separate inquiry into the 

volume and type of preventive care services. 

The average layman responding in an interview cannot give accurate detailed information 

about the nature of the service performed at each 

8 
I


visit, Consequently, visits have been classified in 

broad groups according to the type of service. 

The definitions and method of classifying the 

visits are presented in the section on “Definitions 

and Discussion of Terms.” Since some of these 

are quite special to the survey, itis essential that 

they should be studied before the data can be fully 

understood. 

The terms dealing with the classification of 

hospitalization are defined in the section, “Terms 

Relating to Hospitalization.” In general, this 

article deals with inpatient hospital episodes. 

The use of X-ray facilities has been measured 

in terms of visits to X-ray facilities, the part-of3. QUESTIONNAIRE 

A. THE BASIC QUESTIONNAIRE FOR 

FISCAL YEAR 1964 

The Basi~ Questionnaire 

and the Special Topics 

The interview consists of a core of basic 

questions which are asked each year, and certain 

other questions which are asked on specific topics 

at intervals of 3 to 5 years. The latter are termed 

rotating topics. In addition, the questionnaire for 

a given year usually contains one or more special 

health topics or supplements. This subdivision of 

the content of the interview permits the survey 

to respond to changing needs for data and to take 

up a greater variety of subjects, while at the same 

time maintaining a core of fundamental types of 

information. The latter provide time-trend statistics of basic indices of morbidity and related 

health topics. Data from the basic questionnaire 

can also be tabulated and presented in greater 

detail because the design of the sample permits 

accumulation of results over any length of time 

that seems desirable. Hence, larger samples 

are available for the basic data than for those 

contained in the supplements. 

body x-rayed, and the place of service. 

The extent of personal and nursing care received at home was the subject of inquiry in terms 

of the condition causing the requirement, the 

duration of the care, who performed the service, 

and whether it was constant or part time. The use 

of prosthetic appliances and other devices was 

concerned with the use of hearing aids, artificial 

limbs, braces, and wheel chairs. The condition 

causing the use of the appliance was determined, 

as well as the extent of use. The use of home 

remedies and other forms of self treatment will 

be the subject of a future inquiry. 

DEVELOPMENT 

The basic questionnaire is also subject to 

change, though it has been described as containing 

a core of fundamental types of information sucn 

as acute illness, injury, and disability. Amendments in this part, however, are made no more 

frequently than once a year. Some of these amendments are minor and have the clarification of 

concepts and other technical improvements without change in the underlying substance as their 

objective. Others involve expansion into new 

subject areas or the deletion of certain topics for 

a period, perhaps of several years, and the 

substitution of other topics. A regular schedule 

of rotation of these fundamental types of data may 

be developed after more is known about the rapidity 

of change in the indices. 

Thus, the questionnaire is not considered to 

be an inflexible dmument. The distinction between 

the basic portion and the supplements is one of 

degree, depending upon whether changes in content 

are made at frequent or at infrequent intervals, 

and this in turn depends upon the rapidity of 

change in the health measurement considered. 

The description of the content of the questionnaire contained in this report relates to the basic 

questionnaire as used in the current fiscal year 

1964, July 1963 through June 1964. However, the 

discussion of definitions in the last section of this 

publication covers the entire 7 years of data 

collection. 

9 
The Interviewer and the Respondent 

The various steps leading up to the interview 

itself, including the selection of the sample, the 

measures taken to insure complete coverage of 

the sample population, and the selection and 

training of field supervisors and interviewers, 

are described in the report, Statistical Design of 

the Health Household-Interview Suvvey?’ R is also 

indicated in this report that, wherever possible, 

the visit of the interviewer is preceded by a letter 

from the Director of the Bureau of the Census 

announcing that an interviewer maybe expected”to 

visit and setting forth the general purposes of the 

survey. The confidential treatment that will be accorded any information given is emphasized. 

The interviewer then calls at the household. 

If after repeated efforts no one can be found at 

home, if there is definite evidence that the household will be absent during the entire period assigned for completion of this interview, or if it 

is found that this dwelling unit should not be 

covered in the survey for any reason, the interviewer fills out certain items on the questionnaire 

describing the type of “noninterview.” These 

‘‘noninterview” questionnaires are turned in along 

with the rest of the assignment for record purposes. During the first several survey years the 

noninterview rate has been about 5 percent of 

which refusals are about 1 percent. 

Let it now be assumed that a suitable household respondent, as defined below, is present at 

the time the interviewer calls. The interviewer 

introduces herself; explains the purpose of her 

visit, and identifies herself as an employee of the 

Bureau of the Census. Without volunteering further 

explanation she begins the questioning. 

The questions about the composition of the 

household may be asked of any “responsible” 

adult member of the household who is 19 or more 

years of age (or married) and who is mentally 

competent to answer. The same person is considered an acceptable respondent for the facts 

concerning the age, sex, marital status, and other 

background characteristics of all persons related 

to him. In general, with a few rare exceptions, the 

following rules apply in this part of the interview: 

L Information about adults may be supplied 

by the person himself, the spouse, a 

parent, or an adult son or daughter 

residing in the household. 

2.	 Information about children is to be supplied by a parent unless some other adult 

is usually responsible for the care of the 

child. 

3.	 No person is asked to supply information 

about a person unrelated to himselfi hence, 

a servant or a lodger, for example, must 

be interviewed for himself unless there is 

a relative in the household who can answer 

for him. 

4. Single persons 17 or 18 years old may 

respond for themselves but must not 

respond for other family members. 

In the parts of the interview dealing with 

illness, medical and dental care, and hospitalization, the rules regarding the acceptability of 

respondents and one additional rule are applied. 

each adult at home at the time of the interview 

must be interviewed for himself. If a particular 

adult is not at home, then the rules for acceptability stated above are followed. 

If no acceptable respondent for a particular 

member of the household is at home at the time 

of the interview, the interviewer completes the 

questioning for all persons for whom there is an 

acceptable respondent and makes arrangements to 

call again to finish the interviewing for that 

household. 

The interviewer has been taught ~o be polite 

but persevering in adhering to the interview as it 

is printed on the questionnaire. She avoids unnecessary discussion and, if the respondent shows 

an inclination to wander from the subject, steers 

the interview back to the topic being covered. 

Answering the questions in the interview is 

entirely voluntary on the part of the respondent 

hence; tact and an understanding of the importance 

of the st!rvey are essential attributes of the 

interviewer. The low rate of refusals encountered 

indicates that cooperation of the respondents has 

been? on the whole, successfully obtained. 

Before leaving the household the interviewer 

must review the questionnaire to make sure that 

each item of information has been secured for 

every member of the household for whom it is 

required. Then, leaving a letter of appreciation 

printed under the seal of the Public Health Service 

and signed by the Surgeon General, she adds her 

own thanks and proceeds to her next assignment. 

10

A great deal of thought goes into the preparation of an interview that will flow along in a 

natural manner and put the respondent at ease. 

But this appearance of informality is deceptive 

since the interviewers are strictly enjoined toadhere to the form of the interview. The questions 

in the interview are planned with utmost care to 

carry a particular meaning arising out of the requirements for certain statistical information. 

One source of bias and variability in the results 

can be reduced substantially by asking questions 

in the exact manner in which they are shown on 

the questionnaire. This must be dcihe by every 

interviewer in every interview. It must not be 

assumed, however, that the best interviewer is an 

automaton. The best interviewer knows how to 

adjust to the unexpected situation and can distinguish between the essential and unessential elements in the interview. If she senses that the 

question has not been understood, or has been 

misunderstood, she may repeat the question or 

explain its meaning in terms provided by her 

manual. The interviewers’ manual serves as a 

continuing training guide, and as a ready reference 

manual for use during the interview as needed. 

In obtaining the answers to certain questions 

specified by the questionnaire, the interviewer 

performs a function that is simply one of reporting 

what she hears. This function does not include any 

element of interpretation. For this reason, lay 

interviewers are generally preferred to medically 

trained interviewers, despite the nature of some 

of the information that is being handled. A person 

with a medical education is trained to interpret 

what the patient says, and this interpretation is 

difficult to standardize for statistical purposes. 

The requirements of good interviewing will 

not be discussed further here. It must be stressed, 

however, that a major part of the SUCC:SSof the 

survey rests upqn the proper selection and explicitness of the questions; the adherence to the 

wording of these questions; and the conscientiousness, understanding, and skill of the interviewers. 

It should also be mentioned that prior to the 

adoption of a new version of the questionnaire, one 

or more stages of pretesting the questionnaire are 

undertaken in samples of households. Therefore, 

it has been predetermined that the questionnaire 

can be applied in household interviews. 

Despite the best efforts of the planners, the 

field supervisors, and the interviewers, useful 

information can be provided in the interview only 

if the respondents know the answers to the 

questions they are being asked. All evidence 

points to a high degree of cooperation on the part 

of the household respondents, but they may still 

give incomplete or inaccurate replies without 

being aware of it. 

One of the principal occasions of such 

errors is a respondent replying to questions concerning other members of his household. Such respondents may k spoken of as “proxy respondents. ” The difficulty is not with the answers 

given about children, for it is assumed that when 

the “proxy respondent” is a parent or other person 

responsible for the child’s care the errors will be 

fewer than if the child responded for himself. However, there is a good deal of evidence to indicate 

that, by and large, the information supplied by 

“proxy respondents” for other adults in the household is not as complete or accurate as that which 

those adults can supply for themselves. It is 

reasonable to suppose that the more distantly related the “proxy respondent” is to the person for 

whom he reports, the poorer will be the quality of 

the information. Thus, the rules, listed earlier, 

which the interviewer must follow in using “proxy 

respondents” put a premium on a close relationship. Attention has been drawn to the fact that the 

rules are more stringent for the health and medical care information than for the demographic 

particulars. This is not solely because the health 

and medical care data are the main object of the 

interview. These data are also more personal and 

less likely to be known to a husband, wife, sister, 

or brother. 

From the standpoint of reliability of responses it would be ideal in household interviews 

if every adult could be interviewed for himself. 

The cost of such a procedure is quite high, however, since more calls to the household are required. The rules adopted represent a compromise 

between the method that is least expensive, i:e., 

one respondent for a household, and the method 

that is most reliable, i.e., every adult responding 

for himself. 

Since “proxy respondents” are most likely to 

be wives and the adults for whom they report are 

11

most likely to be husbands, the statistics for 

working husbands are probably somewhat less 

reliable than those for their wives. While little 

is known about the extent of this difference for 

the Health Interview Survey, or the extent of 

biases that may be present because of the difference, it will be possible to learn something 

more about the problem from research that is now 

being conducted. If necessary, the rules for accepting “proxy respondents” will be made even 

more stringent. 

The Structure of the Interview 

The opening questions in the interview (questionnaire, page 22) are intended to provide a complete roster of the members of the household 

including any who may be temporarily absent, but 

excluding members on full-time active duty with 

the Armed Forces. Care is taken to exclude any 

person staying in the household who has a usual 

place of residence elsewhere. Any such person 

has an opportunity to come into the sample at 

his usual place of residence. The name of the head 

of the household is always entered in the first 

column of the questionnaire, and the structure of 

the household is revealed by ascertaining the 

relationship of each person to the household head. 

The names of the various members of the 

household are obtained as well as the relationships. The main purpose of getting the names 

is to permit the interviewer to refer to them 

in subsequent questions in a manner that will 

unmistakably identify them for the respondent. 

With this preparation the interviewer can 

proceed to secure the first portion of the personal 

particulars and social and economic characteristics of each person (questions 3-7 and 24-27. 

pages 22 and 23). Comments on the concepts and 

classification of these items will be found on 

page 17 of this report. 

After securing the descriptive information 

about the members of the household in questions 

3-7, the interviewer asks questions 8-14 known 

as the “illness-recall questions, ” (page 22). The 

object of these questions is to elicit reports 

of the occurrence of illnesses, injuries, chronic 

conditions, and impairments among members of 

the household. The plan of the illness-recall 

questions and the concept of illness which they 

. 

represent are discussed on pages 17 and 18. 

Illnesses, injuries, chronic conditions, and 

impairments, in short all evidences of morbidity, 

are called “morbidity conditions ,” or simply 

“conditions.” Each report of a condition brought 

forth by th& illness-recall questions is made the 

basis ~or an entry on a sin@e line of Table I on 

the questionnaire (pages 24 and 25). 

Immediately following the “illness-recall” 

questions are two questions designed to identify 

periods of hospitalization. The second of these, 

question 16, is addressed to stays in nursing 

homes, rest homes, or similar places. This is 

done to assure completeness in the reports of 

hospitalization, since the respondent cannot be 

expected to know whether a particular institution 

called a “nursing home” is actually classified as 

a hospital or not. The determination of whether 

the institution is actually a hospital or not is made 

after checking the name of the hospital against 

lists that are maintained. 

The next part of the interview consists of 

carrying the reported conditions through Table I, 

one at a time. The questions in Table I are designed to obtain the following types of information 

about each condition: 

1.	 Whether the condition has ever been attended by a physician. 

2.	 The most accurate description the respondent is capable of giving about the 

nature of the condition. 

3.	 Whether the condition caused restriction 

of activities for a day or more, and, if so, 

the number of days of disability measured 

in terms of restricted activity, confinement to bed, and loss of time from work 

or schml. 

4.	 Certain facts about the onset of the condition in order to determine if it is a case 

that should be included in the counts of the 

incidence of new cases and whether it is of 

sufficient duration to be considered 

chronic. 

5. whether the condition, if determined to be 

chronic according to survey criteria, is a 

new or an old chronic condition; and approximately how many days the chronic 

condition kept the person in bed in the 

past year or caused other restriction of 

activity. 

12 
6.	 The extent to which usual activity and mobility are limited for persons reported to 

have one or more chronic conditions. 

In the course of ‘completing Table I it may 

become evident that a condition is an injury. For 

each such condition the interviewer fills out Table 

A (page 24) to obtain the following data about the 

accident or event that caused the injury: 

1.	 If the condition reported is the aftereffect 

of an injury, the nature of the original 

injury, and the length of time since it 

recurred. 

2.	 Whether a motor vehicle was involved in 

any way and whether the vehicle was 

moving or nonmoving. 

3.	 Whether the accident happened at home or 

elsewhere. (By asking this, it is also 

possible to determine whether an old injury, or aftereffect of an injury, reported 

by a person who is now a civilian, originated while the person was in the armed 

services. ) 

4.	 Whether the person was at work at his job 

or business at the time the accident 

happened. 

If a person sustains more than one injury in 

the same accident, Table A is filled out only once, 

but if the person has had more than one accident, 

one Table A is completed for each accident. Hence, 

each completed Table A represents one accident 

or injury-causing event. 

Hospital episodes reported in response to 

questions 15 and 16 are entered in Section T and 

details of each hospitalization are entered in Table 

II. 

The information obtained about each period of 

hospitalization is as follows: 

1, The month, day, and year of admission. 

2. The length of stay in nights. 

3.	 How many of the nights were within the 

year prior to the week of the interview 

and/or within the 2-week period prior to 

the week of the interview. 

4.	 Whether the person was still in the hospital at the beginning of the week of the 

interview. 

5.	 The most accurate description the respondent is capable of giving about the 

nature of the condition which occasioned 

the stay in the hospital. 

6. The names of any operations performed. 

7.	 Whether completed hospitalizations during which an operation or delivery was 

performed “hadany portion of the surgeon’s 

(doctor’s) bill paid by any form of insurance. 

8. The name and address of the hospital. 

As in Table I, any injuries reported in Table 

II are carried to Table A to get the data on 

accidents. 

If the condition reported on Table II had one 

or more nights of hospitalization in the 2 weeks 

prior to the week of interview, or was an impairment, or chronic condition shown on card A (used 

for question 12), and does not already appear on 

Table I, it is carried back to Table I for entry 

there. 

The next section of the interview deals with 

dental care. This is the first of the four rotating 

health topics on the basic questionnaire for the 

fiscal year 1964. The others are medical care, 

routine physical examinations for children, and 

specialists’ services. The questions about dental 

care provide information about the number of 

times each person in the household has consulted 

a dentist, and the type of service provided during 

each visit. An additional question was asked to 

determine the interval since the last visit to a 

dentist. 

Similar information is then obtained about 

medical care. The questions provide information 

about the number of times each person in the 

household has consulted a physician, where this 

consultation took place, the type of service performed (in broad categories), and the interval 

since a physician was last consulted for any reason 

at all. 

Question 22 provides information about the 

number of children under age 17 who have had 

routine physical examinations during the past 

year. Question 23 provides information about the 

number of visits to certain medical specialists 

and practitioners. 

It should be noted that an important aspect of 

the sections of the interview covering medical 

care, dental care, vision, specialist services, and 

hospitalization is that these are independent of the 

section dealing with morbidity conditions. For example, there is no attempt to make sure that every 

report of a visit to a physician for diagnosis or 

13 
treatment corresponds to a condition in Table I. 

The only exception to this rule is that reports of 

hospitalized conditions in Table II which have not 

been previously entered in Table I are added to 

Table I if it can be definitely determined that they 

meet one of the criteria for inclusion in Table I. 

There are three reasons for this separation 

of the sections. First, it simplifies the work of the 

interviewer; second, it simplifies the analysis; and 

third, it makes it possible to omit one section of 

the interview from the survey with a minimum of 

effect upon the data from the other sections. 

Questions 24-27, concerning military service, education, labor force status, and income, are 

then asked. The interviewer then turns to page 1 

of the questionnaire to verify the address and to 

ask certain questions about the living quarters. 

The front page of the questionnaire serves 

two purposes. The first is to provide space for a 

record of interviewing and certain information 

about’ the dwelling unit. The second is to provide 

for a record of office operations. The numbered 

spaces to be filled in on the front page are referred 

to as “items” to distinguish them from the numbered “questions ‘‘ in the main part of the interview. Most of these items are used primarily for 

the administration and control of the survey. Only 

a few comments will be included here. 

Item 3, “Identity Code,” is the geographic 

location code which permits the analysis of the 

sample results by degree of urbanization of the 

residence of the household members. 

Items 10-16 are filled out after the main part 

of the interview is completed. Items 10 and 11 

provide the basis for a separation of rural population into “farm and ‘‘nonfarm. ” The interviewer 

asks the questions only if the “rural” box has been 

previously checked by the field office. 

Items 12-15 are included to make sure that 

no household that should be in the sample is 

skipped. 

Item 16 is asked in order to facilitate calling 

back for information that has ken missed in the 

interview and to help in the scheduling of reinterviews. 

Item B is a reminder to the interviewer to 

identify persons shown in Table I who have eye 

conditions. If there are such persons, Table B is 

completed for each person, and, if necessary, one 

copy of the Vision Supplement is also completed. 

The Vision Supplement contains questions on 

details of the onset, severity, and adjustment to 

the vision impairment. Section A is used for 

persons with substantial impairment of vision, 

and Section B is used for persons with severe 

visual impairment (see page 27). 

Time References in the Interview 

Nothing has been said up to this point about 

the period of time which respondents are asked to 

have in mind for the reporting of conditions, 

medical and dental visits, and hospitalizations. 

This is a feature of the interview which warrants 

special attention because of the bearing it has upon 

the completeness of reporting and the possibilities 

for analysis of the data. Previous experience in 

surveys of morbidity has demonstrated that the 

memory of respondents has definite limitations. 

Apparently, the longer the period of time prior 

to the interview for which recall is requested, 

the less complete the reporting will be and the 

more error will be encountered in the placing of 

events in time. As might be expected, there is 

a positive correlation between the significance or 

seriousness of the event and the length of time over 

which usefully accurate recall can be expected. 

Much remains to be learned about this subject, but 

the length of the recall periods was decided according to the knowledge available at the time of 

the planning of the Health Interview Survey. 

In the first place, the period of time covered 

by the questioning terminates, to be exact, at 

Sunday midnight before the calendar week in which 

the interview is conducted. Thus, the beginning of 

the calendar week of interviewing is considered 

to be “the present time. ” Experience after that 

time is disregarded. The interviewers are given 

assignments of interviewing which are scheduled 

to be completed in a calendar week. A good deal 

of the interviewing is completed on Monday, 

Tuesday, and Wednesday, but callbacks for 

households where no one was found home at the 

first call often cause completion of the assignment to be delayed until the later part of the week, 

and on rare occasions it will extend into the following week. When this happens the time reference 

point is shifted forward a week. 

Measuring backward in time from the beginning of the interview week there are three time 

14 
periods with which the interview is concerned. 

Great care, including the use of a calendar, is 

taken to make sure that the respondent is aware 

of the proper reference period. These time periods 

are the previous 2 weeks, the previous 3 months, 

and the previous year.2 

The fortnight prior to the week of interview 

is the period referred to in all questions having 

to do with current illnesses and injuries; current 

disability in terms of days of restricted activity, 

days confined to bed, and days lost from work or 

school; and number of physician and dent?l visits. 

While the use of the 2-week period assures 

reasonable accuracy in the completeness of reporting of current illnesses, injuries, and physician and dental visits,, the shortness of the period 

makes it impossible to derive certain useful types 

of distributions. For example, it would be useful 

to know the relative frequent y of illnesses causing 

less than 7 days of bed disability, 7-13 days, 14-

29 days, and so forth, but this cannot be done accurately with a short reference period. However, 

the total number of days of bed disability can be 

estimated from the total of all bed-days falling 

within the 2-week period, including those associated with conditions having their onset before the 

2-week period. Furthermore, an approximate 

average number of bed-days per case can be 

estimated by dividing the total number of days by 

the number of conditions having their onset within 

the 2-week period. 

Similar considerations apply to estimates of 

medical and dental visits. The distribution of 

persons according to the number of medical or 

dental visits they have had in the 2-week period 

is of limited value because of the shortness of the 

time period. But the total number of visits can be 

more accurately estimated and averages can be 

computed, for example, the average number of 

dental visits per person per year. 

The 3 months prior to the week of the interview 

are referred to in the interview in connection with 

the determination of whether a condition is to be 

considered acute or chronic. The application of 

this time reference is discussed under the defi2

For certnin special purposes the 2-week period is also subdivided intn “last week” snd the “week before. ” See column (k-3) 

of Table I on the questionnaire. 

nition of “Chronic condition” on page 42. There it 

will be noted that 3 months is taken as the dividing 

line between acute and chronic conditions. Those 

which are always assumed to be chronic because 

of their nature are exceptions to this rule. 

Also, this period of 3 months prior to the week 

of interview was used during July 1960 through 

June 1961 as the reference period for determining 

the number of X-ray visits made by the population. 

And, the period of a year prior to the week of 

interview is referred to in a number of places in 

the interview. First, it is referred to twice in the 

section dealing with smioeconomic characteristics of the household members. The usual activity 

status of each person during “the past 12 months” 

is obtained. (See definition of “usual activity 

status” on page 59. ) The amount of the family’s 

income in the prior year is also sought. 

Those conditions which are assumed a priori 

to be chronic are contained in two lists which are 

read to the respondent (page 26). If a member of 

the household is reported to have “had any of 

these conditions during the past 12 months, ” he 

is assumed to have it at the present time, and the 

condition is listed on the questionnaire. 

Other places in the interview where the period 

of a year is used are as follows: 

1.	 For each chronic condition report, the 

respondent is asked whether it was first 

noticed “during the past 12 months or before that time. ” 

2.	 The past 12 months is the period for which 

the respondent is asked to give the approximate number of days spent in bed on 

account of a chronic condition. 

3.	 The past 12 months is also the period for 

which hospiMization information is 

sought. 

4.	 The past 12 months is the period for which 

information about physical examination of 

children and use of specialists’ services 

is asked. 

The choice of a 1-year reference in various parts 

of the interview is made for one or more of three 

general reasons. The reasons are different for 

each item. 

First, those events which the survey enumerates that are major happenings in the life of an 

individual, such as admission to a hospital, tend 

to occur more rarely and, hence, the longer period 

15 
of time is needed to provide enough data for 

analysis. Fortunately, such events are alsolikely 

to be remembered accurately over a longer period 

of time. 

Second, the year is a natural unit for recalling major events since there is usually an 

annual cycle of dates (such as birthdays, holidays, 

and the beginning of school) which can W used by 

the respondent as a means of establishing the 

approximate date of episodes of hospitalization, 

the first illness from a chronic disease, and so 

forth. 

Finally, some chronic diseases are characterized by attacks of illness separated by fairly 

long periods when the person feels relatively well. 

If the period of time referred to in the interview 

is short, it is less likely to include one of the 

episodes. Since it is the attacks that are remembered best, the longer time period will sometimes elicit reports of additional chronic conditions which are still present but have caused 

no recent trouble. 

In choosing the time references for use in the 

interview it is also important to introduce only a 

minimum number of different ones. It can readily 

be seen that referring to five or six different time 

periods is likely to confuse the respondent and 

result in erroneous replies. Hence, the number 

has been kept to three; the 2-week period, the 3-

month period, and the year, each terminating at 

the beginning of the week of interview. 

B. QUESTIONNAIRE DEVELOPMENT 

FISCAL YEARS 1958-64 

General 

The complete questionnaire in use during the 

12 months from July 1963 through June 1964 is 

illustrated bn pages 21-26. This questionnaire is 

different from those used in each of the previous 

6 years of data collection. Certain items on each 

questionnaire are repeated. These topics are designed to reveal trends in incidence of acute illnesses and injuries, prevalence and impact of 

chronic conditions, disability incurred—both 

short-term, as disability days, and long-term as 

chronic limitations of activitfi information about 

injuries and their causative accident or occurrence; and, of course, the social, economic, and 

demographic characteristics of members of each 

household interviewed. 

Other health topics may be included in the 

questionnaire for half a year, 1, or 2 years and 

then removed. Some of these health topics are returned to the questionnaire after an absence of a 

number of years. The basic purpose of these noncontinuous topics is to increase the scope and 

“coverage of the health interview. The health interview must be limited to a reasonable period of 

time to assure cooperation of the respondent and 

minimize memory bias due to fatigue. If all of the 

items for which information has been requested 

are included in the same questionnaire, the length 

of “theinterview becomes prohibitive both in time 

expended and in the cost of interviewing. 

To overcome these objections certain basic 

items (mentioned above) are included on each 

questionnaire. The remainder of the questionnaire 

is reserved for the one-time and the rotating 

health topics. An example of the rotating health 

topics, is the obtaining of information on the number of physician and dental visits in fiscal years 

1958 and 1959 and the requesting of similar dafa 

on the fiscal 1964 questiomaire. Examples of onetime health topics are those relating to home 

nursing care and the use of special aids. 

Several devices are used in collecting information about noncontinuing health topics. One is 

the inclusion of the topic on the questionnaire and 

obtaining of the data during the course of” the 

household interview. An alternative is the device 

of leaving a supplementary form for self-enumeration and subsequent mailing to the collection 

point. A drawback to this method is the administrative cost of followup of nonrespondents. Another 

problem is the lack of control over the entries on 

the form, a conscientious household membership 

will complete the form correctly, while in another 

household the respondent may fill in the items 

carelessly in order to get the form out of the way. 

On the other hand, self-enumeration forms maybe 

useful in obtaining types of information which are 

better known to persons who may not be at home 

at the time of interview, e.g., working persons, 

than to housewife respondents. 

A method of collecting data which is currently 

being used is that of identifying persons with 

specific health problems and then using a supplementary form to obtain additional information 

16 
about these persons. One example of this type is 

the Vision Supplement incorporated with the fiscal 

year 1964 questionnaire (see page 27). Another 

example is the Hearing Ability questionnaire used 

during fiscal year 1963 which was mailed to 

persons who reported some hearing loss on the 

fiscal year, 1963 questionnaire. After completing 

the additional questions the respondent mailed the 

form to the central collection point. 

Figures 1-13 show developments in the 

questionnaire during the fiscal years 19S8 through 

1964. Changes in the front page of the questionnaire are omitted since this page is almost entirely devoted to sampling and administrative de-. 

tails. The Vision Supplement is briefly mentioned 

since it was discussed and illustrated on pages 14 

and 27. The figures show various parts of the contents of the questionnaire. The continuing topics 

are depicted by reproducing the original set of 

items in use during fiscal year 1958 and during the 

most recent survey year, fiscal 1964, with major 

deviations in interim years. The one-time and the 

rotating topics are also illustrated. 

The discussion of each figure will relate the 

topic to the interview, state its purpose, and 

mention the content in the intervening years. The 

reader is reminded that appendix III shown in the 

Series B and in the Series C reports. “Health 

Statistics from the U.S. National Health Survey, 

lists the contents of the questionnaire for each 

of the fiscal years 1958 through 1961. The Series 

10 publications of the National Center for Health 

Statistics show the contents of the questionnaire 

for fiscal year 1962 and later. 

Questions: Social, Economic, and 

Demographic Characteristics 

Figure 1 shows the content of the questions 

designed to obtain a variety of the characteristics 

of the members of each household in the sample. 

These characteristics are used in the estimating 

procedures which inflate the sample to the civilian, 

noninstitutional population of the United States, and 

also serve as variables to which the various health 

measurements can be related. For example, the 

age distribution, usual activity status, sex, marital status, family income group, etc., are all important variables which affect or are affected by 

the health of the people. Residence, as a variable, 

is obtained from the’ sample segment location 

shown on the front page of the questionnaire (see 

page 1 of the fiscal year 1964 questionnaire). 

The content of the demographic questions has 

remained quite stable for each questionnaire. 

However, there have been a few changes, as listed 

below: 

1.	 Place of birth was asked for fiscal years 

1958 and 1959 only. 

2.	 Current activity status was obtained as q 

separate question beginning in fiscal year 

1960 (see question 26, fiscal year 1964) 

rather than included in Table I where it 

would be answered only by persons who 

reported an illness or injury. 

3.	 Beginning in fiscal year 1962, social and 

economic questions were moved to the end 

of the questionnaire in order to begin the 

health questions earlier in the interview. 

4.	 For fiscal years 1962 and 1963 information 

on the cxcupation and industry of members 

of the labor force was obtained. 

Questions and Tables: 

Illness and Iniury Recall 

The health probe questions shown in figure 2 

are designed to obtain a listing of the health 

problems of each member of the household during 

the various reference periods (see pages 14 and 

15). The probe questions have been slightly modified since the first year of data collection. The 

purpose of the changes has been to aid the interviewer in asking the questions and to clarify the 

wording for the respondent. The arrangement of 

the questions has been changed in some instances 

to fit in with the pattern of memory recall of the 

average respondent. 

Each response of an illness or injury obtained 

for household members from the illness-recall 

questions is entered on a line of Table I (fig. 3). 

If multiple injuries to a person were sustained in 

a single accident, they are entered on one line of 

the table; this is done to indicate that only one 

accident was responsible for the several injuries. 

In general, Table I has been arranged in five 

sections on each questionnaire, although the content of the table has differed from year to year. 

17 
Figure 3 shows the entire Table I content for 

fiscal years 1958 and 1964. Arrows indicate that 

a column has been present on each questionnaire, and inserted notes show additions and 

omissions.3 The five sections of the table show 

(1) the source of the response (question and person), (2) ,whether medically attended and information needed to obtain a diagnosis from the listing 

in the International Classification of Diseases, 7th 

Revision (ICD), (3) the disability days sustained 

in the 2-week-reference period, (4) the time of 

onset, and (5) the impact of chronic conditions 

on the person. 

Figure 4 (Table A) shows the additional information that was obtained about injuries. For all 

years except fiscal years 1960 and 1961, this table 

includes only data about the class and place of 

accident. In fiscal years 1960 and 1961 additional 

details were obtained as to how the accident occurred. Table A is used concurrently with Table I. 

If an injury is reported in column d-1 or causes 

an impairment or a symptom, the details of the 

accident are entered in Table A regardless of when 

the accident occurred, 

Questions and Tables: Hospitafi’zation 

The numl~er of hospitalizations during the 12 

months preceding the interview for each household member is obtained. by asking several questions (fig. 5). The details of each hospitalization 

as well as supplementary information are entered 

in Table II (fig. 6). The questions remained 

about the same for the first 3 fiscal years. An 

additional question, inserted in fiscal year 1961 and 

retained thereafter, reminds the interviewer to 

ask about hospitalizations for deliveries when a 

child under 1 year of age is listed as a household 

member. For fiscal year 1963 there was a change 

in the time reference for the hospitalization-recall 

questions. An extra period of recall was added to 

the 12 months preceding the week of interview by 

extending the period to the first of the month 

%Tote the trend to place more interviewer instmctions directly 

nn the questionnaire. These really represent little change, merely 

what is believed to be a better administration of the questionnaire. 

preceding the 12-month period, e.g., respondents 

interviewed during July 1963 were asked about 

hospitalizations occurring since June 1, 1962. 

Only hospitalizations which were within the 12 

months prior to interview (as determined by dates 

obtained in Table II) are used in the tabulations. 

However, special studies have indicated that more 

accurate reporting of hospitalizations within the 

12 months is obtained if the recall required of the 

respondent extends beyond the 12-month period. 

Table II includes the source of the response, 

the date of admission, length of stay, the cause 

of admission, operations performed, and the name 

of the hospital on each of the questionnaires. In 

fiscal years 1959 and 1960 supplementary data 

were obtained about the portion of the hospital bill 

which was paid by insurance. In fiscal year 1961 

questions about recuperation time following operation were included. In fiscal year 1964 supplementary questions about the portion of the surgeon’s bill for operations and dcctor’s bill for 

delivery have been included. 

One-Time and Rotating Health Topics 

on Basic Questionnaire 

Figures 7-11 show other health topics which 

have been added to the basic questionnaire for a 

period of 6 months to 2 >ears, and in some instances (fig. 7 and 9) have been reinserted in a 

later year. Figure 7 is devoted to information 

about physician and dental visits for each household member. Figure 8 is the form used to obtain 

information about personal and nursing care at 

home and the need for special appliances or aids. 

Figure 9 shows the questions about health insurance coverage, Figure 10 illustrates the collection of information on X-ray visits. Figure 11 

shows the questions about routine physical examinations for. children and the use of specialists’ 

and practitioners’ services. 

The Special Supplements 

. 

A portion of a booklet of forms used to obtain 

information about personal health expenditures 

is reproduced in figure 12. The booklet was left 

with the respondent with instructions that household memhers participate in completing the re -

18 
spective pages. One sheet was to be completed 

for each household member and the booklet mailed 

to the collecting points. Followup procedures were 

carried out for nonresponse and incomplete 

returns. 

Figure 13 is a facsimile of the first section 

of a 4-part questionnaire on hearing ability. This 

section provides information about the degree of 

hearing impairment. Other sections, not shown, 

include questions concerning history, problems 

of communication, and special training extent of 

use and satisfaction with hearing aids; and medical 

and audiometric services received. The other 

pages were used to obtain information about the 

medical history of the hearing loss and subsequent 

adjustment, e.g., use of hearing aid and training in 

lip reading. This form was not left with the household at the time of the interview, but was mailed at 

a later date to any household member reporting 

some hearing loss in Table I of the basic questionnaire, with the request that he complete the form 

and return it by mail. Again, there were followups by mail and personal visits to initial nonrespondents. 

The Vision Supplement, the first page of which 

is shown on page 27, is discussed under the fiscal 

year 1964 questionnaire items. The purpose is 

similar to that of the hearing ability form, but 

the form was completed by the interviewer, because of the problems that a person with vision 

loss might encounter in completing the forms. 

If the person was available at the time of the interview, he was questioned at that time, about his 

vision impairment. Arrangements were made for 

another visit by the interviewer, if he was not at 

home. 

19 
QUESTIONNAIRE 

The item bel.awshowtheexxct content andwordlng of the basic ~uestionnnire used inthenationwide hous~oldsuweyofthe U. S. Xizti,mcJ 

lIeakh Survey. Tha actual mmstionnaireis designed fmx household M a.nit and includes additional spaces forrcfvrt.s mrroret hanone mrsm, 

dition, accident, orhosnitdization. S“ch repetitive spaces are omitted in this ill”~tration. 

ONFIDEMTIAL .Thc N.tio..l Hc.lth S.rvcyis authorized by P.bli. L.w6520f thc84!h Congress (70 S.t 48% 42 U.S.C. 3051. All inlw­


ttio. which w.ld permit idmtific.tim of the individ..l will be held strictly c.nfidemi.1, will be used ..1 bypermr,s eng.ged in md for a~oET nvREA v No. 6;-620.s


e Pufpme.. fth. survey, ..d will not betisclos.d orrelcased t.other. formyother pwposcs(22FR I d 7). APPROVA’ ZXPmES,”LT,,. ,,6,


:.AII,H2.RIS.1 (FY-1964)
 ,. u.s ::::!: gp:”:,c::: ~1. c.


1. Q..*li...~i,*— AC,,”. u ,m.L,c,, N. . . . . . . . . . . . US. P“. L,C “EALTHSER”, C-E 

of NATIONAL HEALTH SURVEY 

F15cAL YEAR.. 1964 uesrio... ims 

(.) Add,es..rdescriptio. of[.c.tion: l.cl.dc .ity, z.nemd Sratc 

3“%’ 4“ %= 5“ :~p: 

Code 

& (b) %nm.t w., 

(b) M.tlms.ddrcss if not show. in 2(.) OR n=m. s .fl.wni. 2(*) 

If d!kaq;~ti~ire is for . . ‘-EXTRAS, unit i. . B ., NTA .. Em..,, ,.t,,, 

%’1 f km No. If in NTA Se&mcnt, .1s. mm 

E SEGMENT LIST 

(.) Nsme of speci.1 dwclli.~ PI... ~Cod. SHEET NO. ILINE NO. 

Ask ltmw 10..d 11 ONLY if ‘, R.r.l VVbm ismmkcd 

I I <. 12. Type of Iivi.&qu.ers (.h. eke.. 

I 

t...> 

I I 

1 0 Rural-+ [XI Nlotbcr (s,,pt.,t.m>z, a I!..siq nit o Other unit 

+i..l S.,apl. by which f.umd for FIRbT..it listed . . pmpertfi 

0. D. y.. own ., ,.., ,hl, pi...? ALL s.snw.m (.sk if km 2[.) .ddrcss identifies .SINGLE.UNIT stmctur.). 

13. A,, ,h,,. my o.cupl,d w ,...., IIV1.Q q..,,,,, BESIDES YOUR OWN-­ n 0.” o R,., D Rem f,., 

[A.k 11(.>) (A.k Ii(b)> (A.k.l 1(.)> ..l. th. bm.rm.t? . . . . OYcs--S— L— o No 

.JI . ..” ,h,, ,,om?. . . . . . — n y=, -..s _ L— —m No ,, 1. (m)COwno, R,n, f,.e>-D... ,hl, pi... h.,. 10o, m.,. me,..? --on any wh. r Iloc+ of,hl, b.ildlng?. , . . nYc, --S— L— a N. 

(b) CR=nt3- D.., th. pi... y.urmvh.v. 10., AM,. ..,.,? Wlllr. bl.x fo, ..ch ,..,,.,. N07,!.,.’U 

ALL . ..mmus(.sk if 1tem2(.) ide.tifi. s..tire flcm.r.r.mmmberedpmof flomim. 

MULTI- ff2WT ,tructur.1. o Ye. — ON. 14. A,, th.,. mny.cc.pl.d., vo.m, livlngqw!.,. BESIDES YOUR OWN-­

t- N km 2(.) identifies mite flo.t 

. . . . ,hi. ,,ow, (c) D.,lngth. p.st12m.n+hsdtd l(d) D.tlngth. po,,12mon,h. dld 

sal., .f crop,, I!v.,fock, md I sol..of .rw,, 11,.s,ock, ond [f km 2(.) identifies pm of floor, specify p.ti I

oYes--S_L _a No 

.th,, farm p,cd.,1. I,mth. oth., form prod..,, frm ,h. ..,. ,h. . . .f ,h,, {Iew? ,P!l, 7.,,. X ,o, . ..h . . . . .. ..N07 1,.,. d.,


pl.c. .me.n, t. $50., I P1. . ..m.”.tlo$z.o..


mm.? m,.? TA and NTA S, BCWUS(ask ., .!1 units EXCEPT APARTMENT HOU2ES).


I 15. l.,h.r. o~.th,, b,lldlng o.,hls~op,fly fwwepl. t.llv. in..l,h,e..upd~,~c.~?~? 

nYe,--S— L— a No o Y,. u N. o Y.. ,U N. (Fill T.bl. X [.,...!! w.rt.,. NOT ,I,t. d.l I elc~fmne No. 

16. Wh;, 1. ,h. ,.1.phm numb., b.,.? I= I Ii OR n No ,.l,phon. 

1 I 
------------------ ----------------------------------------------------- ----------------

----------------------------------------------------------------------- -----------------

------------------------------------------- ---------------------------- ------------

-- --

1.	 (o) Wh.tls!he n.m. of*hehead .f?hisho.sehold? (Ent.rncuneinfir.t column) 

(b) Whotar. the.omes of.11.therp.rs.ns wh. live h.ra? (Liscall pers.ns who live here) “’’”=’” o 

(.)lh.ve li.ted(R.ad.ames). l.ther. o.yone.l.. .t.yl.g her... w.u.ho. f,i..ds, relotfv.., .rr..mer.? myes[Li.t) ONO 

(d) H~elmlssed ..yonewho .s..lly llvesh.r. b.tisnow_Tempor. rilyi". hospital?, . . . . . . . . . . . . mYes(L1.t) ON. Aw.y.n business? . . . . . . . . . . . . . . . . . . . OY,. (L,.,) oN. 

O.. Vi.it Or V...n?.n? . . . . . . . . . . . . . . . . aYes(LJ.tj ON. -—---- — —--------

(e) Do any of the people in this household h... a home onywh.m .1s.? First n.me 

OY.S (ApP1yhe"..hofd m.mb.r.hJP r"l..; lf"ofahou..hold m.mi.r, d.1.fe) ON. (L . . ..o. tlonnllrn.lr.> 

If any md.lt m.les listed, ask: 

(f)	 A;eanyofthe p.,so.s i.thi. ho.s.h.ld nowo. f.ll-tim. activ. d.tywith th. Armed F.rc.softh. 

United Stotes? f_J Yes fD.lefe) m No 

2.	 How .r~y.. related loth. he.d of th. ho.+ehold? (Ent.rrel.cionship tohe.d, for example: wife, daughter, grands.., RelntiomKzp mothe~t”-law, .pan”cr, mom.,, <?ome,’s V/tie, CCC. ) He.d 

3, H.woldw.r. yo. o.yo.rlas! blrfbday? Age mu.der Iy..r 

4. Rae. (Check .neboxfor eschpers.n) O!ffhite ON..W. Ofl!her 

S. &x( Check o.eb.. foreachpers.n) o Male O Female 

If 17 y.=. old Or OVCr, ask:	 (If y?. lemr”that perso”s”.der 17am .c have bee” ~Und17yts. ONeve, m.rri.d 

6.	 Areyounowrn.rrl.d, widowed, div.,c.d, ..porat.d or..vhr.mtirri.d? mar,, ed (~ther ch?” amu[l.d.) check th. “Und. 17 y,,. ” o Married ~ Dive.,ccd box but gtv. martt.l s,,msm, .f.cmqe.) (Check one box for e..h person) o Widowed o scpwswd 

If 17ye.rs.ld orovec, ask: l=f Und. 17yrs. 

7. (a) Wha+w.r. yo. doing most .ffh. past 12nnnfhs - O Working 

(F.rm.les> n.arkl ,.. 6=1.9 .orrafhing +.? u Keeping house 

(Fcmf.m.lesk k.v.gbou,., ? wodd.g.r doti.gsom.thlna .ls.? u %nethi.g else 

If “Something else” checked, andper.m is 45 years cddoz over, ask — ------ —-------

(b) Ar. y.. retir.d? O Yes o No 

Deccrmi"e which .dults.re .th.me."d record this in formacio". B.gi.ning tith Q.estion 8yo. arecointerview fortimself.r oUnd. I!lym. 

H lhcrself, e.ch.d.ltper%"who isathome.(Ifpers." u"der19istheresp.ndc"t, cbeckthe `'Athome'' box.) u At home o Nor at home 

o No 8. W.r. y.usl.k .f..ytim. LAST WE EK OR THE WEEK BEFORE? (That is, Ae2-w.ck p.rl.d*teh *.dcd*ls p.si S.ndW night.) 

(.) ti.tw.sth. m.kr? 

(b) hYfhii190iS.? -. o Yes n No 

9. L..t w..k or At. vm.k b.f.r. did y.. take any nmdlcl.. or tmati.nt for any . ..ditle. (besides . . . vAlch y.. told m. about)? 

(a) For wfIat .mxflti. n.? 

(b) Any fhing .1s.? 

o Yes o No 10. L.a’t w..k ., *h. w..k b.f.r. did YOUha,. any accid,nts or 1.1.,1 ..? 1“ 

(o) w%.tw.r.thy? 

(b) Anything .1 s.? 

~ -----,

fg Yes u No 

1L Old you �v.r hove M (any ofhor) ac.ldent or Inlury that sNll both.rs ye. or off.ct. Y.V in any WOY? 

(.) 1. wh.t way d... it bofh.r YCU? (Record present effects) 

(b) A@hlng .I so? 

~ Yes u No 

12. H.’ .ny... in *h. fanny - y.., your --, .1.. . had any of Ih.se cc.ndltions OURING THE PAST 12 MONTHS? 

(Read Cwd A, co”ditio” by emdition; record i“ his .olunm any ccmditiom mentioned for the person) 

o r,. O No 

13. D..s onyon. 1. +h. family h.v. MY of th.’. condltlons? 

(Read Card B, condition by co.dicim; record i“ his column any conditiom rnentio”ed for the person) 

14. D. you h.ve o.y ether oilrnent., c.”ditlo”s, or probl.ms with your he.lth? I-J Yes ~ NCI 

(.) What is the condition? (Record condition itself if still present; ochccwise record present effects.) 

(b) Any other problems with your he.ltb? 

o Yes ~ m No 1s. (.) Hav. ~.. b... t. . hospld at 91Y tkn. d“.. , 0 y.., ‘ago? 

If ‘~Yes,’ ask: 

(b) How many Wm.s w... y.. in th. h..plt.l during that p.riod? No. of time. 

16. (.) Has myon. in ffw fmmily b.cn a Pliant 1“ o nursing h.m., rest hem., ., COY SImitar P!... .1... ,.y..,.,.? p_ F:____ k___qrIf *tYes. !) .sk, 

(b) Who We. *hIs? 

(.) tf.w m-y Win.. w.r. You In a ..r.lng hem. or r..+ hem. during that p.ri.d? No. of tim.s 

R o Responded for self-e.tir.Iy 

(For l% persons 19 yeus old or over, show who responded for (or w.. ptesent dtuing the asking of) Q. %16. If per.on. r=.po.d.d o Responded for s.lf-pazdy 

Q. 8-16) for self, show wbeth.c entirely or p.rdy. For perscas under 19 show who respo”dcd for them. 

cnl. —--wIIs r....ndem 

INTERVIEWER Ex.mim ages and r.1.cionsbips in Questions 2 and 3 for children one year old or under, then check lh. appropriate ‘co. i“ Question 17(a). 

I I I 

17.	 (a) O Bsby (babies) one year or I (b) Are bixth(.) for b.by (b.bi.s) and I (c) was born in lh. h.spiml? [ (d) When w.. b.,.? (E.,., mmth, d., �nd v.ar)

under I,sted. (GO ,. ~. 17b) , delivery for mother show” in Table 11> I 

co Q. 17(d)) o	 N. baby (If birrhd.!e (b.bits) o.. year or [ O Yes (0. to Q. 18) ,-J Y,, (Go t 

[ 

f,fo”~h 

is o“ m ~~~r 

—. 

dote show~~ Qs. 15 under f,s,ed. (Go ,. 0. 18) [ f=l No (Go ,. Q. 17(.)) = No (Go to Q. 18) and 16, fill o“. Ii”, of Table U for rmxh. c and 

I I I one line for child. ) 

INTERVIEWER After completing Table II for all persons, carry each condicion~- Col. (h) or COI. (i) back co Table I if it does not already appear there 

**IM ~r mom n,ghts in Column (f) 

~ 

22 
-----

--------

-- ------

---------------

------- ---------

-----------------

----------------

O Yes o No 18. LAST WEEK OR THE WEEK BEFORE did .“”0”. I. the frm+ly go to . dmntist? .——--. ._— 

N.. of times 11 “VCS,” ask: ---. .— ___ -. 

(1) (2) (3) 

(’=) who W.. this? ~ m u Fillings 

o	 0 n Extmccion. or 

(b) Anyone .! S.? O ~ m Straighte.i. 

For each person with ‘*Ye. ” checked, ask: a u O 

(Orthodontia“5

Tce.une.c for gums 

[c) How many times did you visit the de.?lst LAST WEEK OR THE WEEK BEFORE? D 

m 

n 

u 

O 

o 

Cleaning teeth 

Examination 

0 ~ O Demure work (d) what did y.” have d... (fh. lost time, th. tlm. before, et..)? 0 0 0 Other @DeCif,)7 

other s.rgety 

(.) Anything .1 s.? 

If *’No** t. Question 18, ask: a Under 6 mos. u 6-12 m.., 

19. ABOUT how I..g h., it ban sin.. y.. wont t. . damtist? No. of y,ars_ o Nc,., 

o !0. LAST WEEK OR THE WEEK BEFORE did any... III !he fanily t.jk to a INTERVIEWER: DO NOT COUNT d.actocs see. _-__. Yes ______ g-Yl ___ doctor org. to . d.cfor’. of fl.. or .11.1.? whife a. inp.tient in a hospiml _ No. of tkaes L.$t Week If “Y.s, ” ask: 

_No. of time. Week Before (.) Who WOSthl a? Place Purpose 

(b) Any... .1..? Horn. = At bonm 0/7 = Ohg. 01 trcat- - &las%- Purp.ase . 

For EACH person with “Y..” box checked, ask Questions 20(.) chr.u8h (f}	 off. . At office met 1 

Cl !.. = CSwp$ti.nt Nat. = P,e/p.ast natal 

(.) H.w m.ny Nm.s did y.. =.. or talk 10. doctor LAST WEEK?	 Hospital 2 

Clinic G... = :%% check-up (d) How m.”y tlm.s did y.” see or talk to o doctor the WEEK BEFORE LAST? ~. . COmpmy ~, I/v = Immu”.;v.cc. 3 

Ask for EACH visit t. a doctor i. last 2 weeks: industry Ey. = Eye Exam 4 T.1. = tier telephone (glasses) (.) Wh*r. dld You *.lk tc Ih. doctor (the l..t Ilm., *h. Nm. b. f.r., etc.)? oh = Other [SP.CNY> O*. =Ocher @F..c,fy) 5 

(f) Why dl d you got. (..11) the doctor (that Nm.)? 6 

O Umdet 6 m... u 6-12 m.. If “No “ to Q“escion 20, ask: 

1, ABOUT how long h.. it be.n’ sin.. y.. h.v. s..” w talked t. o do.?.r? No. of years_ 0 Never 

If any cblldr.n under 17 years in househ.fd, .sk: 

2.	 OURING THE FAST 12 MONTHS was-- (w. ---, --, .?.. ) token to a doctor for o 

ROUTINE physl.d .x.mtin.tlo., thot IS, not for a porticvl.r 111. . . . b.? for a gsn.rd .h.ck-.p? m 17 ye-. 0. over 

If “Yes, ” .“d “ore tha. “.. child .“der 17 years, asfc o Yes a No 

(0) WIIoVIOSthis?


(b) Any of th. .fh.r chlldr.n?


‘3. OURING THE PAST 12 MONTHS has ANYONE in th. family - that Is, Y.., your --, .tc., - r...eded any $ (Muk (X) SXci.fist) Times 

smvlcas from .ny of th. p.rs.ns IIst. d o. thls card? Pleas. .h..k “Y.s” or ‘“N. ” for e..h . . . II.t.d. Pedkmcricimn A 

H.”d respo.dem pe.cil ..d cud (NH2-HIS-1(.)) Obsteticiso or 

For each “Y.. ” box checked on the card, ask Gynecologist B 

(a) Who saw th. (specialist) ‘f (Mark (X) for each specialist in person’s column.) Ophth.lm.aiogist c 

(b) About how many Nm.. did you s*. . (specialist) during the past 12 months (mot .0.”N.9 0t01uyngo10gi8t D 

any “i’h. whll. yOIJw,,. in th. hospital)? ,P.ychi.trist E 

(c) Did any... .1s. s.. a (specirdist) during !h. past 12 mcmths? Destologist F 

[f “v..,” ask Otdvaptdist G 

(d) Who W09 this? Cbiimcc.n H 

(.) About how many tlm.s did y.. s.. a (speci.iist) during !h. P.S+ 12 monlh. (not c..ntti.n 

my “t, it. whll. yo” w.,. 1“ th. hospital)? Opt.metisc I 

Podisuisc or 

Check the *$Nme”” box for each person who did not . . . a .paclali.t. ChirOpc&st J 

u Nooe 

O Fem. or under 17 YCU. If mule and 17 years old or over, ask: o Yes a No !~	 (a) 01 d yO” �“.? S.,”. i“ th. Arm.d Forces of th. Unl?.d St.at.s? — ----— 

ff “Y.,,” ask: n w. O ~;~c-time 

(b) W., .“y of yew s.,.! c. during . war or w.. it p.oca+lm. only? 

[f ‘War. ” ask: own o Korean 

(.) O.rl..a vdtl.h war dl d you a.rv.? o Other 

If ‘*Pe.ce. time only,” ask 

(d) W.. WY of YOU, S*IVtC* b91W... Jun. 27, 1950 and J.”.my 31, 1955? m Ye. u No 

If 17 years old .X over, .S!C u Under 17 ye.ra 

Elm: 12345678 !S (a) h%at is th. hl~h.si g,od. ye” ow.. d.d I. scfwol? High: 1234 

(CtrCle hish.st grad. attended w check “No”e”) college: 12345+ 

o None (b)	 Old y.. f!nl.h !h. .- gr.d. (par)? 

fg Yes ~ No 

Ask for all persons 17 YCUS old or over: O Under 17 yeua 

‘6. (o) Old you work .+ a“y Nm. lost w..k or th. w.ek Mar.? o Yea n No 

If “N.,r! ..k BOTH 26fb) and 26fch . 

(b) Ev.n though you did not work 1.s+ w.ak or th. w.ek b-fete do y.. hovs a 10b or ku.1..ss? 0 Yes n No 

(4 W.r. you I..klng for nvrk or on layoff fmm a lob? n Yes o No 

!7. W7tlch of th. s. lnewn. oro. ps r.pr.’..ts your total cnmbin.d f.mlly income for th. past 12 months, thof i% your%, ywr - -’s, �IG? 

(Show C.rd H). I.cl.d. Incom. from .11 s..rc.s, such . . W.Q.S, saiorl.s, r.nts from pmp.rty, s.cid s..urity or r.tlmn.nt 

b.”. fit., h.lp from r.lmlv.s, .+.. 

Toc.1 No. of h.spit.lizacio”s 

iNTERVIEWED. Enter the total �umber of fmpii.iiz.ti.ns f.r each Person kom %esrio.s 15 mnd 16, or check tbe ‘*None” box. T Fill am line of Tabie 11 for each separate SC*Yin the hc.spir.l. or 0 No., 

23 
---------

-- ------

.. -----------

--

Told. I - ILLNESSES, IMPAIRMENTS, AffD N4dURlES 

!w.- D;d F.n .1[ ill . . . . . and ~e...t CAUSE KIND PART OF BODY 

i.. Yew effect. of ‘“oldssi.iur,t. N tk ..WY i. C.!. (d-1) i. F- . . . retry in Cd. (d-1) m Cd. Ask C.IY f.,: 

l., .“,, (a) N dmw talked to, ask: (d-Z) ths! includes & wud,,. tMpAtRME~5, ,,CURP ENT,, 

AT What did the doctor say it An IMPAIRMENT, Allergy, T.- IN URIES and PRESENT EFFECT 

0 2 ~,OLD,, lf4jfNfIEs ANY was? _did h. giv. it . A,th,n. ,Gm4itic@ ,, And 1.,, 

TIME mcdl..l nom.? . ~::th VXse. a.e- Ab ,ss.. I.fl,mm ,1.” 

Idk (b) N doc,w :* tilked to, . SYMPTOM ‘“Tmutble,” 

1. � ,ccmd cw,nnl mt,y .cd .,k w St,ok. - !#% g: (d-2) - (d-4) u rqu!md. d-cl,, Ask: gyr 

.!3..1 F- ;Il iajwics whkh happ.ncd Ic.mc frun Q.e.ti.n 11 or 13, .sk: Whet kind of . . . lsit? v%” ...? LAST WEEK OR THE WEEK .Fw .“ .Nezgy w ,uok, .,k, ~:+):’e Weak”,,, 

BEFORE, ..k: Wh.ty,t of fh. b.d~ is aff.cf.d? What .------- part .f th. body w.. h.rt? What WOS th. CaUS. of . . . ? ffOW does th. .II.,w (strek.) Shov dc,.il (w 

Anyfhi”~ .1..? 

(Also, fill Table A I- .11 (N ‘Gus.,, i. . . ir,iury, 

H-4 . (Sk.U, s.,lF.. I..,)

B.sk .(uwc,, m3dd!., ,mc,) 

lnjwi.s) .l,ofNITablc A) AraI . (Should,,, UPK,, c Ihw, 1..,,. 

wri,,, h,nd; onc @ Ltih) 

L., . NNP, “WM. km,, ICWC,, mile, 

low, me s bed) 

jb) (.) (6-1) (d-2) (d-l) I (d.4) 

Whnt kid .f I.iury MS it? eff.cl put E“ “ .,.. (Om w btih) 

lCfYe. I I x * 

ON. 

lgYe. . x 7 

oN. 

oYes x x 

8 

ON. 

OY.S z x 

9 ON. 

CIY.S x x 

to 

[ ON. 

——. 

T.bl. 11- HOSPITALIZATI 

b-- USE YClUS CALENDAR 

lion Y. . ..l4!hmro .“ W“* 1“ d!. Complcw from ..wie. in Cc.lumcz-l so.	 k.spit.l (wc.; WI.., .!..) d.,ln, :;!%:,. (c) sod (dh or, if not clear .sk ti-eI F., wh.tcnndltlen dldy-~t., ,h. h.s,l,.l-. 

Ih. pa.t y.ar — ,“ ,“*, W!esuolls.- d. y.. know th. .mdlc.l .ws.7 

1..,,,.,? - “.W ,mm” W.,. you W%.. did you ~t., h,.. ,INI Inth. lh. ho,,l!.1 :U&y .,*h,, .1 +h

-,+’ ,0s,1,,1 (If medical name not known, enter reswmdw,ds 

.+., d.,, 

.St!m.te.) 

.,! known, c.bt.,. ~e:t.c 

estim.c.) 

month,? th . wc.k 

b. f.r.? 

>!shl? I (Entry must show ‘8C..*.,,S ‘tKird,,~ and a+P..t 

of bcdy, ” i. s.med.t.il .s,equired m T.bIe l,) 

(b) (c) (d) (e) (II (*) (b) 

(g Y.’ 

Month F YzT— Ni’hrs 7iix7— Ni&ht. O No 

(the IO*I Nm.)? 

w.,. 1 de.+,iw..) 1“ ; .J.”i~~i Iosi 

(E.ter nwmh, d.y mndyeq N &.wn $y part w..k ., $undq 

.— 

x D.y 3#Y.., Ni’hcs %x7— Ni’h,.

—— 

Month D.y 

o Yes —_ 

Namh D.y E o No I

ToM. A - ACC4DENTS AND IUJURICS 

(b) w.,M-* III-I on. mowWIIICI. i.v.ks? . . . . . . . . . . . . . . . . . . . . . . . ...!... . . . . . . . . . . . . . . . . 0 Yes (Mom lb.. on.) o NO 

(.l W.mlt(*l*.r m.)wvl.s**. *lm*7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oy.. ON. . 

f. (d W-. ild !fI* =.Id-t hoppcn - * h~. w ,OMO MA., rl.c.? 

1.0 At bom (bide IwJsc) 2. u At h.me (adi.c.mt p,.mi.e.) u %w othec PI,., 

II ‘Same c.,be, pl.ce,”, .,b 

(b) W* kl.d of PI... w., N? 

3.0 Sueet sad bithw.y (includes t..dw.y) 6.0 kbc+l fi..l.dc* .cbool ptemises) 

4.0 F- 7.0 PI..* of recreation sod wart., .m.~ u s.11001 

5. u Lad.stri.l plm.x fi.clud.s W.mise.) a o D+t.f$..elti th. .I... whom . .. Id..t h..p...d) 

i. W.rey.. o, w,k., y.., l.be, b.sl..s, wh~,e.lk,hqp ~,fl,fl 

1. n Yes 2.0 NO 3, OWhileir, Arcud Scmices 4.mff.der 17.rtime.f.cc8de.t 
--------------

-------------

---------

-------------

Ask Cd. (j) - (.) ONLY for completed ho.pit.k.tions (’”N.”’ i. cd. (8)) 

AND deli.cry w cs.er.ti.. shown in Cd. (h) .x Cd. (i) w.,. ..” .p.,.,lm. 

:oshy:uP-.rt N -N.” 1. Did (wIN) Dld (will) Wh., 1. ,h. .o,n. .f ,h. 8...,. 

!%{;’9 $Q”” , c.+. (j), ask ,h. 1...,. ,h. [“SW. . . . . COmper.yel plan? 

h..p!,d? . . . . *my {., . . . . q 

N ‘“Y.,, ), .,k, ;oy,:j#,..- D. y.” IL2 . . m.,. 1.. 374., 01 ““u. t. d.,.m”h.. *.*.,., 

paid f., by ~y,!,y OIth: SW. nw,. of th. . .. 1..”-... d...tib. 1. *e,.,. 

[.)	 What w.. th. am. any kind .1 SUrg.o.,s uu.. &l.-J 

of ,h* .p.,*lw? In..mc.? ::$bfp- /d%t:..) !dafil.r’s) 

[b) $::;$., .pw- 1. b. pold hill? 

ferby in..,. 

. . ...1 ony 

kl.d? 

(i) (i) (k) (1) (m) (.) 

, lTABLE II - HOSPITALIZATIONS 

Ask Lar .11 ho.pit.llz.ticms 

Whti i, ,h. nmn. md add”.. .f ,h. h.,pi,.l 

Y.. .-r. 1.? 

IC”t.rt”lf”. n.. .f.hO.Plt.1. .tr..t .rhl,b”., ~


M WIIJ.. ,, ,. . . . . . . . . .,,, . . . S,.,., ,, .,,,


“., ,..”., .“,., <Out,., “


.:


(.) 

o Y.* 0 No Ig :::.. 0 pc:y m ycfio o Ye. m Y.% ims”r...n N.., 

N.,1.,u”.cc (ch.ck~.s, 

(:M 0 Armed Force, )S41”,. ‘ oN. (o. ,. 0%(.. ,. OF:+.. ,* o No o F,,, “f. =-------, %-xx 

C.I. [k>) Cl. [.)) C.,. (n)J n Onhe, [Sp.elf, h 1oo”.,..> 1 

n Y.* o NO 0 Yes 07. lgYa <0. a Ye, (0. o Y,. a Y., hsu!.m. N.me 

,. c.,. t. co,. ,. c.,. Nori.mm.cc (ch.*m.J: 

O bed F.,.., “cdic,,e ~:=:, -------~ .-:iza;e 2 

OR!<.. ,. C+8’co.,. O%’;oo ,. 0 N. o Free ..,, I co,. (,,, c.,. (.,, c.,. <“,> 0 Orb., (sm.,,. l,, fo.l”s,..J 

N.-c n Ye, n u. o 3’<s (.. oYes <.s. or=. (.. ~ y.. o Yes k.,-.., 

,. co,. ,. co,. ,. . . . . N.ti.,tm..e (G.ckc.,d, 

Q N-cd f-c., M,&<,,c street -p; xG; 3 ON:(C. ,. 0({: (0. ,. 0 t:’foo ,. o No 

cr. (*)) c.,. (.>, ..s,. (.>> RR:%.,,,h,=m+ I 

m Y,, 0 NO o Y.. r.. n Y.’ (.3. o Y,, (0. ~ Y., O Yes i.swa.c. N.=. 

,. c.,. t. c.,. ,0 c.,. N., i..u!q.c. (ch.., a,.x _________ 

~~,(oo ,0 ~fig,oo,o ~~:;oo ,0 ~ NO gpd ,.,.,. MC&cm,= ~G::S7.:e---------- ”-- 4 

Cr. (k)> Cl. (.,, ..1. (.,, Clcx%.c,,rh,mm. t.., ‘u”” I 

cd. fnE,w TO RESPONDENT 

ynnp, E.,11.r I. th. l.lor,l.w p. 

t.ld m. .baut Y.., .y. mndl. 

m(s) N... Thl\ 1.. tn.,,., of 

with ,CY. sp.elal Intw.sf to th. Public 

cod,- H.olth S.rvlc. this y.., -d 

tion(s) ( ho.. x.m .ddltl~d W.S. r

~eportcd ,1... akou, l,.

P’1 

(*) (b) (e) (d) (e) (f) (s) 

o Ye, o Ye, ~ Y,, =Y,,wc .,.. (Cl. (w = Yes 

.’ ~.’, (S=. B W,.) 

0 N. O No 0 N. 0,.,, (SeC7. A Sum..) = ‘o 

0 No I

o N. (A,k Cd. (;)> (g HUAIY U.” ., ;... (wow 

25 
IQ 

0. Card A Card B Cord D 

NATIONAL HEALTH SURVEY NATIONAL HEALTH SURVEY NATIONAL HEALTH SURVEY 

Check List of Chronic Coriditions Ch*ck List of Selected Impairmmt< 

For: 

Has anyone in the family had any of these conditions during the past 12 months? Voes anyone in the family hwe my Workors and othm persons �xcept 

of these conditions Houscwiv*s ond Children 

L Asthma 16. Any other chronic stomach 1. Ileaf”ess or serious trouble hearing 1. Notable towork at all. 

2. Tuberculosis trouble v:ith one or both ears 

3. Cbmnic bronchitis 17. Kidney stones or cbmnic 2. .Serioustmuble seeiq with o“e.ar both 2. AbIem wotkbut limited in 

amount of work or kind eyes even when wearing glasses 4. Repeated attacks of sinus of work. trouble kidney troubIe 3. Cleft palate 5. Rheumatic fever 18. MentaI Illness 4. Any speech defect 3. Able toworkbut limited in 6. Hardening of the arteries 19. Arthritis or rheumatism s. Missing fingers, hand, or kind or amount of other 

7. High blood pressure m. Diab+tes arm-toes, foot, or leg activities. 

8. Heart trouble. 21. lhyroid troubIc or goiter 6. Palsy 4. Notlimited inanyoftbese 9. Wake 22. Any aIIergy 7. Paralysis of any kind ways. * 10. Trouble with varicose veins 23. Epilepsy & Repeated trouble witb back 

11. Hemorrhoids cmpiles 24. Chronic nervous trouble or spine 

12. Hay fever 25. Cancer 9. Club foot 

13. Tumor, cyst or growth 26. chronic skin trouble 0. Permanent stiffness or any 

14. Chronic gallbladder or liver trouble 27. ,Hernia or mpmce deformity of the foot, leg, 

15. Stomach ulcer 28. Prostate trouble fingers, armor back 

1.	 Any condition present since 

b;rth -

Card E Card F Card H 

NATIONAL HEALTH SURVEY NATIONAL HEALTH SURVEY NATIONAL HEALTH SURVEY NATIONAL HEALTH SURVEY 

For: Housewife FOC ‘or: Gildren undar6ysars old Family income during past 12 months 

Chil drcn from 6 though 

16 years old 

1. Not able to keep house at all. 1. Notable togo to school !. NotabIe mtakepamat all in Group .4. Under $S00 (Including loss) 

2. Able to keep house but limited at all. ordinary pIay with other Group ~. $500- $999 in amount or kind of children. 

housework. 2. Able togotoscbool but 

limited to certain types of 2. Able to play witb other Group C. $1,000-$1,999 

1. Able to keep house but limited schools or in school children but limited in Group D. $2,000-$2,999 

in kind or amount of attendance. amount or kind c.f play. 

other activities. GmuP E. $3,000-$3,999 

3. Able togo. tb school but :. Notlimited inanyoftbese Group F. $4,000-$4,999 i.	 Not limited in any of these limited in other activities. ways. 

ways. GtpupG. $5,000- S6,999 

4.	 Not fimitedin anyof these %up H. $7,000-$9,999 ways. 

;mup I. $10, QOO- 114,999 

irmpj. #15,000 andover 

— 
---- ---- ---- ---- ---- --- ---- --

bRM NHS-HIS.l(b) U.S. DEPARTMENT OF COMMERCE
 !.9.6s) BUREAU OF THE CENSUS Name of person Age


Psu Segment Serial No. Sample 

VISION SUPPLEMENT BNATIONAL. HEALTH SURVEY 

Column ntmrberofperson. . . . . . . . . . . . . . . . . . 

a Responded for self 

OR 

Colnmrr number of respondent . . . . . . . . . . . . . . . 

NT ERVIEWER Complete either Section A or B 

Complete Section A (buff Pages 2- 6), if: 

(a) Both “Yes” and “No ‘‘ in answer to Columns (c), (d), and (e) of Table B 

OR 

(b) “Grear deal” or *’Some” in answer to Column (j) of Table B. 

Complete Section B (blue Pages 7- 10), if:


“No” in answer to all of Columns (c), (d), and (e) of Table B.


RESPONDENT RULES FOR VISION SUPPLEMENT 

f theperson forwhom the VkionSupplement is to be completed is an eligible respondent according to the regular eligible responlent rules, he is to respond for bimself. If he is not at home orotberwise not available, make arrangements forareturrr canto 

nterview him. (Two additional calls to contact him maybe made.) 

f theperson isnot ineligible respondent, or is unable torespond forhimself because of disability or illness, completerhe inter­

,iew with any eligible respondent for him. 

ftheperson isan eligible 

nterview week, complete 

]se of the other respondent 

Footnotes and comments 

3ECORD OF. RETURN 

:ALLS TO COMPLETE 

N. IMPLEMENT 

Name of interviewer 

EXCEPTION TO RESPONDENT RULES FOR VISION SUPPLEMENT 

respondent for himself, butdefinitely isnotgoing to be available forinterview at anytime during 

the interview with any other eligible respondent for him. In such a case, explain the reason forrhe 

in a footnote. 

cOm- cOm1 pleted 2 pieced 

Date 

a None 

Time 

Code 

SONFIDENTIAL -This information iscoIlected forthe U.S. Public Healrh Seniceunder authority of Public Law6520fthe 84th 

Congress (7o Stat. W 42 U. S. C. 302. Allinformation which would penit identification .of the individual will beheld sttictly 

confidential, will be used only by persons engaged in and for the purposes of the survey, and will not be disclosed or released to 

others foranyothei pqoses(22FR 1687). 

USC OMM.DC t618S P-63 

27 
---------------------------------------------

--

----

---------------

---------------

----------------

----------------

----------------

FY 1958 FY 1964 

1. (.) -t 1. w- or *M ,1 *1, hnbld? {mt.r ,... 1. tl,.t CO,w., 1,”, ,“. [1> “ : Whet .,. ,h..-..1 .1)oh, P.,SW,.+. lr.. h.,.?(List all Peruan. who Ii., h.,.) (b) � .t .“ tk,-.fell.tbor Ersa. h lt”&.rM <L1.t .11 m,.- .,. . 1 hm.. h,,.d (Red mm,). 1. ,h”. .v.”. .1.. .,v1.s b.,. now . ..h .s f,l.ti,, ,.1.,1..,, ., ,“-”s? mull, 11,, hero, ad ,11 w,’00. .twlmt h.,, .bo k.”. . . u=..1 Mm, of


r..ld . . . . .I...r. r.. Li.$ lb,,. m,.m. 1. ,h. Br..c,ibti .rd.r.l T::li~i:-::so:::::::EF~~
 M ~- (ok) Iwmer —ll”bwml 0“. 01.. (u4— 

wmym.a~~ am, visit, - rirn$ .“. mad I.itial n Y.. (A..,r ,..,.,.,, . . . . . . . . . . ,“,.,: ,, ,.”,.,.,, If m;.du!t mml.. Iis,cd, ,,k, 

(*) 1s mm - El. #t911u b. * n a. O 1.. (Lint)— (f) A.. w.1 h U“,,.* s,.,..? P.M. 1. thl. h....h.!d . ..- M1.tr.. ... Iv. 4.w .lth h A,..d F..... .; th. o Y,, (..,.,.> ON. (0 b -J .1 w -1* ha” . k �lti”? 

(a) Istilmm .1”* 11”’ bmti m n m 01.. (l.lw— - .--.----------- (.) 0. e.y .f ih. P“,l. 1. this h.nmh.li h.... baa ..IjT.1,.r. .1s.? 

-..,.,.,.,.,., ;::..:.--: “.,.

o	 MO (1 . . . . 01 QW,,icam.lr., 01..m met . b.ti,d .*.,. ti,a., 2. H.!. . . . y.. r.lotG6 t. th. h.d .f ,h. h..,,.h.li? (Enter rel.ti... hip to hc.i, for CXMPI.: wife, d.uglmer, gr~d..., Re!.tica,hiP ~d 

molh..l..l . w, p....,, rnc.m,,, me,,. “,1., cl..) 

2.	 m - at, “1.= to * M .1 tb8 -w (*,., ,,1.tiam.hl. ,0 ,.ad, r., -1-~-~bi. 3, HO.I.Id . . . . p on p., l.” h,,id.y? & Ound.l F. ,,”,1.: hod. .,1.. d..at,,, ,, M,C,, mot,.r.,..l... W,,,.,, Id”,, ,Od..ro s 

.11.. ,,.. , mu 

4. Rcce (Ch<ck one &ax f- e,cb PNX.) n nit. Ig Nw n ah. 

3. h (m..k -. b- for �Mi mr’m) la lilt. 0 !(.s,. S .%x (Gck a. b, Iw <xh PC,90.) 0 Ml. o F.M@le : 

n Oth.r 1117 y,-, old ., ..,,, ask, (11y?” l,MI th., Pcr.ca, under 17.,. or h.,. been 0U0617 P o Never m.rri,d 

4. A,. y.M ..w ..,,fid, .ra.w.i, dt..r.ti, ..p.,s,.d w ..w.,wI. (.4? .“r,.d (~,, thp .MuJ1d) check ,h. WImd. 17 Yrs.”. o Matrlcd o Di.md 

& m, (c,.., m, b., *M ,C,h PO,snm) 0 ml. n n..!. [Check . . . box 1., �ch P.,...) box b., g,., -“,,J sts,.. ,.. fmam,., 0 Wid..d n spud 

M 17 ,ar. old or . ..., .,K. 0 Umd. 17 yt., 

u. 0 lu,r 7. (.) mm “m p. Al., . . . . d *. ,.,, 12 ““h, - a Wkia’ 

5. Mm �M “. m “ mar l“t M- I t mu I (Fot ..l.sk “,kl ~., W“, -*1”1 .1..? n Xqimg ha-. 

(F.., f.mml..> k-q Imu.c, ..rkl., “ &rn, .Aln, .1”? o S.ehii .1., 

M ‘,5M.IMw .1,.O, .he.kcd, and P=..- is 4S rc”. old m o.”, msti 

,.UM,,, 

I 

1=.1. . . I.r.am ..”, *V) (h] &. p“ r,,tt.o Ly Y.. 0?40 6.	 9W8 ““ Y9a b“? (“cord .,*,* ., mr.,m { 

7. A“ ,oa W, &d, ti60n#, ditww4, mmuatsd or ,mw �.rrlti 

,Cir.1. M,b,, t ,,U. co9@L*tM ., .h..k -m..., 

~ D ma. 

If ml.. -d i, ,..,. .14 ., . ..., “k: 0-. . . ‘m& ,4 ,“. If ..1, .nd 17 ye”. old w .,.,, ask: n F.m. 0, UC-la 17 Jar# 

9. 

If -Y... - “k 

(b) Am ,OU nom II tba Amd mm 

frm 

mot m,tim!re”rns? 

(1: -r,,,,, d.1.t, WI* m,... . ..s.1.,8.1,.) 0 r,, n “. / 

If ‘,Y.’,,” .,k: 

(b) w.. .r ,.”, S.,”1.. *,1”, a -,.,...1, p..<..,im. .“1,? 

If w.,,-

0“, 

..k, 

01. 

Own 

n 

o 

~;=k 

Km” 

(.1 DL.ln, 41A “., did y.. ..,,.? o Othcc 

(.) 1- =7 

- .* 

.1x- -ml- &rImz a -r or mu It w--tire “s.r, -h? c1 1., a ?O*c*- -.---------Aim-ml M ,, P...eti,”, .+,,, ,Sk: 

(d) W., o“, .1 y..,,.,,,.. b., . . . . J... 27, 1954 a,+ Jcw.q 31, 17S5?. n Ye. a N. 

m some? Oml,l”h Mwlcia D “- 1! 

(.) Did Yca em. -m, 1, * Armd FOrcas or tic LMtod Ctata? -13~”-------Qy--- IL (.) D,d YOU.v.r S. IV. 1.,11. Am.d ?.,..s .f ,h. U.,,.d S,ems? QK. ---—— G! !1 

tb. 

(d) W-inc bid “r dld If ‘T*.c.-t 1..- ml,, .*K 0“.1 o K.,*MI 1 If 17 y,”, old or .,.,, .,i: o We, 17 p.”

I.) w ru .1 m. ..mim betnm mm 27, MM =d JUI..I.J w 1#557 2S (.) ha, 1.,!,. MA.,, wed. ~.. -!.nd.d in school? 

HiIh: 1234 

(Circle hich,.r ‘,ad. .rt<nd,d ~ .I,c.k Wc+.” 9 cdl.’,, 12; 45+ 

w, (.) -’t “m m dnl,r 90.t of the ,Ut M mmth. (b] Old Y.. finl.h ,h. . . ,,cd. (,..,)? o N... 

(For ..1,. 0,., ,6X m*l.z, Imklw *, m*, or *l,K -m,’ .1-7 n Y.. ON. 

(M rtiw.n.r 10: WMUI. Iocumc for-h, k~lnckam-, . . .Mmz-thinr else? D ~,,9in,,Ou,. Ask f.f .11 per,.., 17 P“. old w o..,, 

E!.= 1234$678 

I {?0,child,,” 6 - 1,), wlas la AI or tit.= EIM.z .1s0? 26. (.) D,d y.. ..o,k m . . . ....1... w..k ., ,h. ..6 b.h,.? 

n under17 yeIf ‘~, thl., .ls.-. ch.ckti, mud o.r.c4 1’ 50 ,..,. old or o,.,. “k m Y.. n F3. 

!! ‘, FJ.,,o.,k BOTH 2c4b).ti 2&k 

~ (b) E,.. ,h.vsh y.. d,d . . . ~,k 1.,, w..k ., ,h. w..k We,. d. y.. ha,.. lob ., b+,l..,s? a Y.. o N. 

[.) W.r. y.. Io.khw 1., wm,k.,.,, IOYO1l;- . !.h? n — Y.* = N.

I ?7.	 tiring tie P“t 12 -W 1, *1c4 Z* didlb, titd l,w. of ywr fmll, f.11, “r~ ~. 27. H .h �f !h. s. [.co,”. ,,w,, ,.,,.’-, s x-r t.td co.b[..d foml!, 1..., ”.1., ,ht 9..112 m..i,’, lh.1 Is, wr”., yew..,,, .,.. ? Grov I 

th.t IL YOUI’ ‘, MU, --”., ,b.? ,S!!.. Card “, IBC1.6C l“-. frm ,11 19,.. c.d In. 1“.lud. ,“.... W* “ q“, Ul, rl”. mti flm pruperly, pmshn,, help I- rel.tiv.’. eta b.”.{,,.. h.!, frs. ,.lml,,.s, .,..

fmm .[1 la.,..., ,“.h . . ..,.s, ..[.,l .,, ,.”,. fm,n prc+.m, . ..!0! ,..”,ity ., ,.,1,.,7 .”, 

Figure 1. SIXial, economic, and demographic characteristics questions, fiscal years 1958-64. 

— — —— ——. 

11
-----------------------------------------------------------------------

-----------------------------------------------------------------------

-----------------------------------------------------------------------

FY 1958 

mareimtezmtd h xl b19& of illma, &f&r =IIOU or 80t .- n res 0 ffo 

12. lm’e208s lcbat4t S8el A2f ~ammu~ 

(8) -t was* Dm%el? (b) ~Smz elsez 

22. ~ ~~~ ~Iti-&are dSd yoa b,ve w accititi ~r ~.fi=, e~~er ,t O r.. n Ho 

(*) mat *III they? 

(b) SDYtbiu �lse? 

12. Last - or tie - before did mu feel w ill effects fra = wrller O Ye. n Ifo 

uxidat m S48227 

(8) -t mm tbzseeffects? 

(b) kytMnK else? 

1S. Last meb or tbe wek before did zw me my medfciae or treaamt for ~ Cl Yes 0 No camditica (besides. ..tiidt M told meabat)? 

(s) For *t caditimti 

(b) SWUM elme? 

13. dr m ~ n6 & 200 h- my ailmalti or Culditims Umthvecan- a Yes o No 

tinaed for a long tlmt? (If -w.-) ha 221M* u“ *. t btie= ~M ~1 U= t~~ 

(8) matare
I&?7z 

(b) kzthinc elm?


16. Sa6 anyme in fbe fdfy - yea, yOOr-- , etc. - fmd w of tbcse CaOdtucllzommam a Yes n No 

Pmf 22 2dwfsb3? 

(Read Card A. conditionby condition;remrd my conditions mer,tlomdin the COIW for the D,,, On) 

17. 00ea immma 18 tba f-ifs kave w of tbesc cmditicms? n Yes la No 

(fwad Card B. conditionby c.mditlor,;recordmy m“ditims
 .mtlomd in the columnfor the person)


FY 1964 

8. W.r. you sick .! my tlrm LAST WEEK OR THE WEEK BEFORE? (That 1s, lh. 2.w..k p.rl.d which md.d thl. P..* S.nday .t+t. ) n Yes @ U No 

(.) whol WOS th. maW.r? 

(b) Anyihl.g .1s.? 

~-~,~---------~-N:-- 9. Last w..k or th. w..k b.lw. dld y.. tak. any nwdicin. ., qr..~.nt {w my ..ndltlen (b.sld.s . . . #IIch p. told on. b..,)? 

(.) For wh.t condlilm.? 

(b) Anything .1s.? 

10. Last w..k o, th. vm.k b.fti. did you h.,. any accldoneso, I. IU,I.S? 

(.) WII.t w.r. thy? 

(b) Anything .Is.? 

11. Old y.. .VO, h... an (any A.,) accident or tn@ry tbrn still bc.thws p. or aff.ct. y.. 1. my vq? 

(.) 1. +.! wv d... M bothw Yw? (Record present effect.) 

(b) AnyWng .1s.? 

12. HCI, on,... in th. fc+nlly . p., y.., --, .m. . h.d my of th.s. .ondltlm. OURING THE FAST 12 MONTHS? 

(R..d Card A, condition by condition; r.ccud i. hi. column any conditions mentioned fm the person) 

13. 0..s my... III th. family h.,. my of th.s. condltlnns? 

(Read Cud B, condition by condition; record i. his column any conditions mentioned for the per...) 

14. D. y.. hm.. my .th.r oilmtmf., ..ndiqi.ns, or problms with your h..lth? 

(a) What Is the ..ndlti.n? (Record condition itself if stilt preaem; otb.wise record present effect..) 

(b) Any .th., p,.bl.m with y.., h.ol,h? 

‘O-~e~---------~-N~-­

‘u-~: ---------~-N:--

Ig Yes D N. 

o Yes 0 No 

O Ye. ON. 

W Figure 2. Illness-recall questions, fiscal years 1958-64. -4 
--

----------

-----

--

SOURCE DETERMINATION OF DIAGNOSIS DISABILITY DAYS IN TWO WEEKS 

FY 195[ 

N it?taytbing (Also, fill Table A) 

& . 

[ 1 

(0 Jbj 

— 

3 

(c) 

Y“ 

(d-1) 

I 

(d-a) 

x 

Inflo 

n 

(d-s) 

YM 

I 

(d-4) 

x 

I 

[d-s) 

x 

(k)) 

(.2) (f) 

Dws 

(c) 

‘IT Id ~atdid .kke doctor sw it If m Lmr..irment or .ymDtc.., �sk ~~a:t~imd of . . . tfmble mmltafirt.tof,the fc& kR%!- \ffw flow mmy If 6 yews old 

m was? did he mm w = L@- �ay of these or ova’, tsk 

~ mfdicas temm? mm - * an of (If eye ~ did dws, Ifws ~Mt =* If “ye=, 

trouble of . ...-= &d were you O= tie Sn)col. D8 

mc- (If doctor not t.lked to . ““”’ mu kind (If kind of trouble (If Lmrt of bc.iy cm b. YOnfa imbed -

-7!0. ,, in 001. (c) - record (If C.U* is .1rew2y ,:: :rle.rs .lrend, 

, 

e.t,red in CO1. determined 

(d-l) 

fro. entries mt &m the 2 *11 or m (d-1) clrcl, ‘X-S .ith- in .01S. thro”sh M wr mostof before 

~t resuonde,t, s d.sorlptic.n) entered in (d-1) .1,.1. .,=,, “kg out Uklits the question) [d-4), circle ‘X,> .itbout ytini:- P&; the dw? ~!#~	 %s”d? 

...kea j cd. ,. ? (If ill-effects cd e.rli.r .x,, .~tbout “ki.~ the wkins the question) m.rking : ffo. Pa accident 81S0 fill Table A) quest ion) 

(3&Yal 

for as ataJob you ‘m $E of la :$wy or fawi- ~m~,c , . mr- 10, For an accident or lnj.ry (If accident nes5 : .Cm OCCU..1M durlmc DSSL 2 fill Table A) 

or iaiurr, Ordkmrj Check one (W&. -1)’ a reeks, “ti	 m-aw 

Mt:tb No yea excsot ~at~oftie~~ for . ..? krt? tit kimd of imju” (Ca + 

else? 

1 ON FY ‘58:59 

ONLY 

REPLACED BY 

ONLY MINOR CHANGES CURRENT 

IN INTERVENING YEARS ACTIVITY 

QUESTIONS 

g \ 

SUBDIVIDED 

FY 1964 FY 60 et.seq 

I.ble 1- ILLNESSES, IMPAIRMENTS, AND INJURIES (Additional lines of Table Ion Pages 4.5) 

cd. Did Fcr .11 illnesses?@ ~esent CAUSE KIND PART OF BOOY 

No. 

cd 

P=-

Y.. 

w., 

AT 

effect. of ‘%ld,, ,n)ur,es 

(.) If doctw talked co, ask 

M“, did h doctor SOY it 

U the entry i. Co!. (d-1) is Fa any entry i. Cd. (d-1) or CCL 

(d-2) that includes the words: 

Ak I 

;M:&&NTS, ‘iCURRENT,, 

INJURIES and PRESENT EFFECTS 

son ANY _did he give it e An ftdPAIRMENT, Alle,g# Tumor OF “OLD” INJURIES 

Asthma ‘tC..ditiom), And for, . TIME medical nom.? m CY.: ,CDisease, S Ab cc,... I. flmlm+tio. yn C& down have days day, 

WEEK talk (b) If doctor not talked co, . SYMPTOM Growth ,*Trouble,, N.ur!lat. 

$ 1. c1 re..xd mi~in.1 entry .nd ..k Stroke” g;pdot g:%~t,, things y.. to did . . . did . . . BEFORE 

(d-2) - (d-4) ., required. . us.+ d.? cut k.ep ~o. keepy.. ~,m:;% 

doctor — --------- Ask 2::.ss I d.~. i!, bed .11 from ,--- 5 .be.t F- .11 injuries whfch fuppened 

came fcornQuestion 11 or 13, .S!C 

What kind of . . . iS it?	 H#p;,= #;;* $:;; 

.J 

%’ . . . ? LAST WEEK OR THE WEEK What WOS the cause of . . . ? ‘For an allergy or .xmk, .sk: Weakness BEFORE, ask: ~hq Eq ~f_t~e_b~dy &-.&@?- Wh.t part of th. kady wos hurt? How does the oll.rgy (stroke) Show dct.il ftx: What kind of iriiury was it? (If ‘“Cause”. is *n injury, effect you? Em., . . . (o., o, bath)

Anything �lse? .1s. fill T.ble A) !w:@f::,’a%%=i,f, (Al,?,. fill Table A Is .11 Am+- ( .oulder, UW.U, eltaw 10TI,,, i.jur, es) w,,!, fund; ~n{ot ,.,,>

(*) (c) (d-1) (d-2) (d-3) 

L.g . 

!OOG

ff,p, .0. WWU, ./dy) . e, 

) 10WC,,u,k!e, ml.

(.) (f) <f-l) ((-2) (6) (h) 

‘E(t) ““;7’ 

1 

gY.s x x x —Days —DWS — Day, 

[ aNo G u F“”. cg %.e u :.., 

Figure 3. Table I, fiscal years 1958-84. 
. 

+ 

ONSET IMPACT OF CHRONIC C9NJDITIONS 

I Table I - ILLR 5SES, IMPAIMSNTS Al ACCIDER 

Did YOM first rnti~-.. . To lnterDfmlfta T3EPmT3mmTss vleleF: mti-m.. . Itio= �t or -2-

Plene If -1.,, 

or before that tiw?. mmN6 mE 0, “2-

K)cg. PA5f23Ms+42sl & md 10 C.1. 

CbWk me Did . . . start orbefore tkmt read (r) 8sk: 

&T20g the Dut :=26 tk? 

staf=- PleUe 

my fly, :%J%L ~m on Tbmtell condition (If d.ri.c 9- mmt. look at this �c.ntlm month. either an. 12 *ontbs, -k Wh:ra:g ~ 5 (If durlw D“, :foy,: 5 (Ga fits - 2 weeks, ask): co.tlnue: 

malt *f& or ; 

YOUbwt. the 

.2. mieh Serk, l“t Other~ia= state. 3 

r.)) meek or the S30P g% ~- WOlts 

& be foz’e? F, *S fit- J.m 

wmrO- best. 

pri.te) (Show 

Card fi) USED IN 

FY ‘58-’61 

(-) (m (*) (.) 

Mo.— * Yr. — 

DW!3,. mB1,t 3 No Dr. n !hle 

UNbER CAkE I ,cT,&-+;/L,Ty 

LIMITATION LIMITATION 

+ 

OMITTED c1 FY ‘62:63 M I 

F

BED-DAYS USED IN 

IN 12 MOS. FY ‘60:61 

ONLY 

Iw.,. (hem Y- the work(ng \ / winds a o job

.~_ of the or 

T~l ..’ ILLNESSES, IMPAIRMEN1 AND INJURIES ste.ce- bu,ln., s

I I L!le”t up m that I Did you first ..aNc. . . . (did If Cd. (k-1) is T. ASOUT If 1 m select. time? 

I

it hc+wen) during the post checked ask: ‘nt”r- how many more da s Cd) 

3 nmn,hs w b.f.a,. ,h., days “ cd. [ 1) 

Nm.? Dld you N,.* CDN- during ad Cc.!. 

..!1.. 1?during ~fl~tWl~ the past (h) is


the pa&12 12 months blank o, (“) [v)


Ch.ck . . . Did N sta,t ~onth, O, bafwe ~k- 1) ha. . . . ~,hNe;$~d [happen) d.,ln ,s kept you ,8 Before D.,. the POS* 2 w.. t s *hot tlm,? check- I. bed ask: 

3 ing ., b.fo,, that ed, ., .11 or 

.Lm,h, 3 l!m.? ,h, most of How many 

(If during past condi- the day? of th. s. 

(GO ‘“’. 2 weeks, askh ~ion I day, w.,. 

‘0 + Whleh weak,	 ,, 0“ during

C.l< Card last w..k, or c.* is last w..k (k4)> the w.. k before? an, im- or th. 

P.,- week 

Inenr, before? o,herwise, 

.<-rn. 1 T T (k-4) 1“(,:] (1) (m) 7%s% D! —Days —OaYs

L__l!2L_Ll 

Figure 3. Table I, fiscal years 1958-64,-Con. 
FY 1958 

TABLE A (Accidents and Injuries) 

Liy~ 1. -U Part of tk. tody w Mrt? tit kisd ef Iml”ty mu it? W5M.’ ,1.,? � Ac::d~:,b&md d.rim, 

Table 1 

% mm dtd it wet? mm Year (km... my m. y..r if pvt.. t.I*W a kc,,,., h.,,,.,, P“t a ..,k, d.,,.. 

>. ~era did tie mcidmt bu.sm? 

� At hoi. <t,.Id. o, .“,,14. th. b“,,, � ,,,1.,. A,.*,“,,,,,*, � SW.th,r.lSC* I k 1- ~ -, kwe. h. or otSmr mos.mvebich 

imolvsd 1. lb. uxldat 1.x W? � r,. � ,. I 

5,	 ser. YM st VIA at scar Jab or bnst”,n *­

tbe MIdtmt k-cd? � ,.. •1 m U u*d*r M mar. .t timeof.
..ie.nt

Tcbl. A. (Acd&ma cnd h}url.s) 

L:,~No. 1. Wh.. dl~ ill. . ..14*. h.”..? 2. A, ,Iw ,[ma .1 II,. . ..14.... +.,,- .1 A. body W. hurt? Who!kl”d 4 tmufy w,, k? 

T.bl. 1 Amythlm,.1,.? 

Y..,: P,,Ks) O( b+ Si.d .1 injwy (s) 

(N 1%0 w 1%1 .1.. cm., ,be mm,h) 

cc,dc.,


mpp.ncd


-& El Mcak


,ck b.fme
 ,.,. ..,,


(.) W.*. s“, hvcb, b“. ., .th.t mot” vAt.1. 1“”1.A 1. th. cccld.o, i. ..y woy? I=IY.* 0 N. 10.,. s..,,.. a>


(b) w., m“. lfml M. mol., AM. 1.,.1”.4? n Y,, (mere ,h*m one) D N.


r.) w.. 1, (.s,h., .“.> m..,.. ., A. ,,-., i=f Y.. 0 N. (0. t. s.=tlc” n>


2.	El tittins i. - oat ~ (0. ,. 

1.W.,. y.. .utsli. th, ,.hk!,, vW., 1. “ .U .31,. . ,.,s.”w, “ w“. ,W ,ba 4,1,,,? 1.0	 L%,slde 3. n Pas.. q., $..,,.. .4 

(p,:;, s..tl.. . . ,, 

4. m D,i,e, ) 

kfi.n A . (34,3,, vthlct. Aald,nts) S,ct30mB . (Nw34dw %hkb Accldmw) — 

If ‘,0ut.ide80 i. q. 4, “k 

i. M N- did ,h, cdd,n, hcppm? 

1.0	 Accide.t bm.cm onto, “chick m.d per,m ,idi.’ 

. . bl.ycle, i. .m.ewar. m ..llm.d t.. 1., m bmse. 

d,.wa ,<hl<le 

2. � A..1de.t ~w... mu= v.hick md pet,.. wh. -.s w, !king, mol.’ , m m,ndl,’ 

3. n CRhU (S,..,ly 1,.” G1. . ...,.”, ,.N,”.,, 

(b) Wml klndis) d nm,w ,,hkl, w., ln,.l,,d? 

1. ig cm 2. � T-i 3. ig a“, 

4. n T,”ck S. D MMo,.@c 6. � OIb*r Cw.lt, 

If ,Yk,,i”’ i. w .x,,, ,,P. . ...’...’ m “ml..,,” 1, q. 4, �sk 

(s,..11, ..)..0 

3. � Motor Vebick c,- t. sudden slop 00 *oldny 

4.0 M.\~ -HC1. r- elf Id-*r 17. � Twis@, ,mmbll.’, cm. 

� AC...* 00 ,0s6. 

(b)	 WI,., klmd .1 mot., ‘d.l.t. .“.,. y.. I. l,”,lng I“) (s.,,1., 

out .0 d!.” If,. .C.lhlt 11-,H.4? 

1. lg c., 2. n T.xi 3.0 Bus 

4.0 Truck 5. � Momcycle 6.0 Otbet(Sm .11, 

A% FOR ALL ACCIDEllTS 

[.(.) W!,.,. dld ,fn . ..14s.. Iw,,on ..., 1,..m “ s- elm, ,1. -,. . . 

1.0 At hs. (i.,id. bws.) 2. Cl ACh-* Ml--t wcmi...) n Same OIL. ,1.., 

N “some C&r Act.)) .,kl 

(b) h, bhd .; ,1.: w., N? 

3.0 Stm.c ..d bl’hw., (in.ltsl.s romdv.y) 6.0 ~h..l (i.clodt. s.k.l pmml...) 

4. � F.,- 7. � Pkcc 8( ttcrratim .s6 .pcr., �zcrp+ .t .cb.d 

% � [06”,t,id Pk, (Includ., Pal,.,) 8. � Cibc, (S,..11” ,h, ,1,,. wh,m .,efd,a, h,,,,..d, 

). W“. yw “ .,wk “ m., I.b “ b..lm.. +- IA. . ..14... hoppwwd? 

1. � res 2. � NO 3. � while h Arm+d28,,1.,, 4. � U.d,r 17., d., 4 .ecid.ti 

32 Figure 4. Table A, fiscal years 1958-64. 
-----------------

-- --

FY 1964 

7..,. -

A --.. .F,-rn.ti-. AL!., ,Ll ,,, m,c. ..”,. s,”.,. ,. “,. ” ,,..., ,., -. 

Liiteb. 1. When M th. a.sctcht happen? 2. A+ the Mm, d the OCC$.J..9, what po,t of the body was hu,+? Whet klr,d .( tn@w was h? Anything .1s.7 

Table 1 Yew Pam(s) of body Kimf cd injury (imjucies) 

:;;=, � :~ 

1.s1 week Month
 ,, week


>.10,.


:00 t. 0, j] 

3,	 (a) Was . car,truck, bus or .th.r motor vehicle involved In the accident 1. any WW? . . . . . . . . . . . . . . . . . . . . . 0 Yes O No (OO to Q. 4) 

(b) W.* more then en. rooter v.hl.l. lnv~l,.d? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n Yes (More ,hw, cm) o No 

(c) vu. I* (.lth.r . ..) moving m th. elm.? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m Ye, O No 

& (.) M%.,. dld Ih. accid.m h,pp.n — m horn. o, same other PI...? 

1.0 At home (inside house) 2. D At home (.djacem premises) O Some other place 

N ‘tSame other place,,, ask: 

(h) Whet kind of Bloc. was [f? 

3. Cl Street =md highway (includes roadway) 6.0 School (includes school premises) 

4.0 F*US 7.0 place of cccreation .nd sports, except at school 

5.0 Industrial place (includes premises) 8.0 Ocher. CSP.aoff, U,. PI... -h.,. .C.dd.”t t,+p.n.d, 

i. W,,. y.” at work ., you, @ or bu.in.s, when-,he .ccidcn, happened? 

L n ~cs 2.0 NO 3. 0 While in Armed Services 4. = ffnd*r 17 at time of .ccidenc 

Intecvicvmr: Return to Table 1 and complete the rest of t~ts line. 

Figure 4. 

.26, (8) QNSINO ‘INS PAST 12 MINTSS.ha m.yone in 

Imwltal ovemleht or lancer? 

1f w es-:
 ~..

(b) wbw WIY times were You in the MsMtd?


26, (a) mtwin~ tie $mnt 12 ncmtha b- wme in 

hmc or sanitarium? 

.,,. .!... )0 .-” 

(b) Mm m.my ties were you in a mtrsinc he I 

15,	 (o) Hov. you b,.. In o h.spltol at -r Mm. .1... 

If V’e,,s ask: 

(b) How muw Nnms W,,. y., !“ the hc.spltol durtns that p.tfod? 

16.	 (.) Ha. C+IYM* In th. fmmily b..n n patlant In a “vrslng home, rest 

If ‘*Yes,B* ask 

(b) Who “.’ this?


(c) HOW mmny tlm.s war. YOU 1. a nursing horn. or . ..? hem- d.ring


Table A, fiscal years 1958-64.—Con. 

FY 1958 

HWSPITAL CARE 

the frmily beta a @ient in a n Yes (mble 11) D NO 

tie fmily bem 8 Pati-t it! II mmiw IL-M.** 

~----.-----------, 

or smitrmirn? I No. of tfrees J


F“Y 1964 

, 0 y.., .90? 0 Y.* 1 ON. ~ 

No. of times 

O Yes Ol+o 

home, or MY slmll.ar PI... since , a y.or 000? _______________ 

that p.rled? No. of times 

INTfIRVfEWEFU Examine *EC-S *“d mlatianships i. Questions 2 and 3 for children one year old or under, then check the appropriate b.. in Question 17(.s). I 1 I 

17.	 (a) ~ Bmby (babfCS) o“e Yem 0, (b) Are, birth(s) for baby (babies) cmd I (e) W.. born in !he hc..pi+al? i (d) When was born? (En,., mcmh. day .nd YO.,J 

under 1,.sted. (QO to Q. 17b) del,very for msbec shown i. Table U? j I bfo”t~ —. 

u	 No b.by (b.bies) .“. year or O Yes fC. to Q. 18> m Yes <GO t. Q. 17(d)> \ Of biztbdate is O! or %c dare show;: Q,. 15 

under lLsted. (0. to Q. 18) m No (Go 1. Q. 17(c)) / O No [GO t. Q. 18) and 16, fill one I,.. of Table N for nwtbcr and 

I I . . . line for chiId.) 

Figure 5. Hospitalization questions, fiscal years 1958-64. 

33 
--

--

FY 1958 

Table II - HOSPITALIZATION DURINf7 IT 12 MONTHS 

when dtd f&mJ~ :YS T. lntervl.l. r: 

J*: frln Ui.t w the .*ttei+ 

the fmspitti, H’= m of SW law of ma thin P?m 

RI. ~. pit,l?	 not Cvuntinc thesF--IJ-WS these--days still In tile Anythinc else? 

fie~w were in tha were durhd n (Month, Year] ,ett, jmst 12 xonths? the Pst 2 !&&%%! (ilecord each cnnditlcn in sw det.11 as c.lled for in ‘fable L 

perof” ;ee%e,e$u ~~~~, that r If caniitim 1s result of ..cldent m inj.ry. .1s. rlll Tale A )

) (.} (d) (e) (f) 

son ;:fi}$j%%

(=) (e) 

,s0. _ =All or O Xe* 

t — Jmr . - —~s — Lwn — ~a o No

I 

a J \ 

T.abl. II - HOSPITALIZATIOt- ~ Col. Qu=- USE YOUR CALEND )AR 

No. tion You raid +h.t you w.,. In !h. How rn.ny c’bnpl.te from enmi.s in C.lunms 

.]es~,{~d~ or, if ..t cle.r ask the For what .o.dlti.n did y.. enter the h..pit.l 

/ \ / 

of No. h.spNal (enc., *wI,., t..) during n::h:: :hy $“ 

: P=- !h. past y.m — do you know the m.dl.ml n.am.? 

How meny W.,. y.. - son Wh.n dld you ..,., ,h. h.spl,ol of Ih.s. stilt i. ,h. 

z

5 (th. 1.S1*IIw)?	 ;~;: 5% II .Ight. kplt.1 (If m++ name not koewn, cric:r tespondenr’s 

“m w,.,. i; ware last de$cr,puon.) 

: (Enter month, day mnd ye,c if known .. ;!y past w..k m Sunday

A exact date not known, obt.i” ~=ytpt $ th. w..k night? (Entry must show ‘“C . . ...” “’K rid,” and “Pact 

II escim. w.) months? baf.,.? of body” in smmc detail as requ, red m Table L) 

. SCinlarc) I T 

[a) (b) (c) 

0 Yes 

1 — . . . . . U No Month Day Yew Ni@ls Ni~hcs Nights 

‘SOURCE DATE OF ADMISSION LENGTH OF STAY CAUSE OF ADMISSION (DIAGNOSIS) 

) 

FY 1964 

Figure6. Table 11, fiscal years 1958-64. 

34 
I 

i 

FY 1958 

FY 1959 & 1960 

+ For completed h.aspimlizatiom ..IK 

w.. .ny .[ If “N.amto N ‘No. m Whet par! 

th. h.spital .01. (k), botb ..1s. 

bill fmld k., ask: (k) and (1) 

of the 

ho,piml Who ..,,8.. th. ..s+ of {his In.urme. -that %,, who 

by ..y kl.d Do you .,,,., .1 l.s”,. ”..? 0,, by any any .1 th. 

y{,::@;:* ‘“’s ‘h” ““m’”m? 

kind of hosplt.1 bill .; by 

plan thot to b. r-aid for insurance? 

poys for 

hospital 

..s1s? 

by hmrcm. 

0, any plan

et ibis kind? 

(k) (I) (m) (.) (.) 

~ Yes (Skip o Ye, (skip m Yes m Under !4 o Family member(s) [3 other fsp..m+ 

m .01.”) to ml.”) 

C%.P1. Z El Employer 

cl No n No O N“ (stop) I-J &0, more ;, l-hi.., clubs, etc. 

FY 1961 

—. . For completedhospit.liz.ciom (“No” in COI. (g)) of Pcmoms6 years old .nd 

c.vetwho.h.w . . opet.ti.n,. s.ttiq cd. fmcttx.,s. de fi.ery i. CoI.. (h).r(i): 

How many .Ighm w.,. Aft., ..14 th. hm. If ,%ill .n## in (k) 

How Ieng ha. it b... 

!ti’M4%3’f:- ‘;;;~$!!:l s!... p. I.11 th. 

ho.plml? 

o) _ (k) (1) 

No. of oI.qbts_	 No. C4 d.ys /22%:22 

D Still .mble ~.yb 7 Mo.tb.

Figure 6. Table II, fiscal years 1956-64.-Con. 35 
--

--------------

FY 1958 

MEDICAL CARE 

18. (q fMT mm fkf mffl m Bmtm did $myme in the fcmily- YOU your--, etc. - talk 0 Yes a No (8k1P o X*S O ffo (skip to a doctor or EO to . doctor, s office or clinic? dnyone eise? 

1f -,...! ----_-------L”-Q:2!)- -------------tow 

~b) l-~; �any t,.=. tiring the past z weeks’? No. of time’ so. cd t tms 

(c) MIere did you talk to the &ctar? ~ T.&4. I?.w.L * 

(d) sow sw times at (he, office, clinic, etc. )7 At he... . . .. . . . .. . . . Atha............... _ 

(Record total numb-r of times for each tme of Place)	 At office. . . . . . . . . . . . . _ At office . . . . . . . . . . . . . _ 

Hm$dtml .ll”l . . . . . . . . Hcwlml clinic . . . . . . . _ 

Ccapny m lrtd”stry. . . _ cc-m m indstry. . . 

Cwr tele~hme . . . . . . . . war f.el.vhcm... . . . . . _ 

Other (Sp.ci fy). . . . . . . Other .(s@..IfrJ..,.,., _ 

19. Rfmt did You have done? (1) (2) (3) 

If =0,. tb.n 0“. “lSit 0, Celer,h.a”e call: g ~ ~%&j:Mpe gg%fi%~% 

o 0 c1 lmln./wCc. o R !3 lMun.mCc. n n n meexu. (glasses) U Cl Cl me *xu, (s1u8es) “’did’””’””’ *’m ‘ie {!5:’} “sit ‘“r ‘e’”pbne -1’)’ a n u Other (sF+.i fYJ n n a Other m.olf”j 

I I 

80, If “No,, to Q. 18*, 8ak: — Mos. or __Yrs. —Mm or _Y,s . 

Now long has it hem sine. YW lut talked to a doctor? n Less than 1 m. n Navel’ = I.wS thmn 190. l=! H,”er 

U. f# ,fzfzS~,week or fbe week before did Msoae in the fmify EO to a dentist? Aw.me elas? o y.. n E tgy. ---.----..--?!:M- 3 Yes 

(b) wow mW tl.es &rlnc tie past z W*S? No. of ti”kes No. or tin. 

CL ~at did you have tie? (1) (2) (9) (1) (2) (3) 

If wore than one visit:	 n = n F1lli”&u 0 ~ O Fillings 

0 D 0 %truxicrn or other O 0 0 -trsctlms or other 

o 0 D 3%2LU1W D D 0 %%eninc 

“t ‘id ‘0” b’” ‘“em ‘i” Es”] “S”-’ 000 ‘rreatmnt for sw U 00 Treatumt for mm 

O = = Cleminf teeth 000 Clemnlnc teeth 

= D m other CSWC1 O) U 00 mfwr (*..4 iy)

I If 7t0,s to q. 21s, “k: —f@. or —rr.. —~. ~ —yr*. 

E3. WOW.long hss it bz%i since You mat to s dmtist? U bm thku 1 m. U Never D tam than 1 m. c1 M.”*, 

I 

)4. Is there myone in the Idly tio hsa lost �ll of fds teeth? n Y*8 n No n W o fro 

— = —— 

FY 1959 

B. (o) LAST WEEK OR THE WEEK BEFORE dld .“P”* in the family . y.”, your.-, o!c..mlk 0 Yew U No Ig Ye, O No t. e docto, m Q* 10 a docte,rs off!., a, ellnic? Amp.. .1,,? 

If *Y,*. — . -—_______ ____ _____ 

fb) How many elm.. durlq th. P.S1 2 wnks? No. of time. No. of tke. 

~ (c) whom dld YoU talk to tho doctor? ~ Ii!alSL IflcS 

(d) How amny llm.s m -- (hem., offlcq clinic, �.)? At home. . . . . . . ..— Ac home . . . . . . . . . (Record tot.1 mmba of times for each type of PI...) Atoffim . . . . . . . . At office . .. . . . . . . . Hospital clinic . . . . Hospit.1 clmuc . . . . 

w inal.try (“H.spit.l cfiiic. excludes .m.might SC.Y.) Ccqmy w i.d.stq Compm, Overtelephone . . . . over tdcpbor.e ....— other (Spcl f,, . . . . other (Sp..l f,) . . . . 

9. (o) L.st w..k .r the w..k b.f.r. did any... 1. th. fmlly S. to. d..tlst? Any... .I,.? 

If ~Ye*. a Yes U No Ig Ye. U No ——— —.. -— .-— - — ___________ (b) Raw many tlm.s durins th. past 2 w..ks? 

N.. of times N.. of times 

O. How many elm.. alm.gtiho, 1. th. PIIS*12 monthsdid p. go *. a dentls+?	 0 one o TLC.= m 0“= n tie= 

U T“. U FOUC- umre m Two o FOW a W. 

O None U None 

Figure 7. Physician and dental visits, fiscal years 1958, 1959, and 1964. 
--

-----------------

--

FY 1964 

0 Yes o No 18. LAST WEEK OR lHE WEEK BEFORE did .ny.n. 1. ,h. Idly ~ ,.. den,ls,? __________ 

No. of time. 

N “Yes,’: ask+ .-— -——-

(1) (2) (3) 

(a) Wh. ‘no, this? U O 0 Fillings 

O 0 0 Extractions or 

(b) Any... .1s.? other .urg.,y 

n n o ::,a~qc:::,: .3 For e..h p.ts.. with ‘*Y..*, checked, .S!G 0 0 D Tcecmeru (OC.yms 

o 0 m C1...in~teeth 

(.) H.w m..y Ilm*$ did v.. VISII th. d.ntl.t LAST WEEK OR THE WEEK BEFORE? 0 0 0 Ex.min.ci.. 

U O 0 Dentwe werk (d) what dld you hav. don. (th. 1.s1 thn., th. Nm. b.<.,., �C.)? 0 0 0 Other fSP..1fYj7 

(*) Anything .1 s.? 

[f ‘*No*, to Question 18, .sb ~ Under 6 m.s. D 6-12 rn.as 

19. ABOUT h.” long h., II b,,. .1”.. y.. WM? t. . du,,is,? 

o Y.* o No !0,€LAST WEEK OR THE WEEK BEFORE did -y... In th. fomlly folk t. . INTERVIEWER DO NOT COUNT doctors seen 

docto, e, go f. a docto,qs of f!.. or .11”1.? w~xle . . i.p.tie.t in . bospimf _ No. of time. hst Week 

If “’Yea,!’ *sla 

_ No. of cfmea Week Bef.te (o) Who was this? 

(b) Any... .fs.? .U.S--- Em?? --. 

For EACH PC,... with ‘#Yes*S box checked, .sk Q.ewi.a.s 20(c) through (f> 1 

(c) HOW m.ny Wm.. did You . . . .r t.lk t. . d..+or LAST WEEK? 2 

(d) How many ,[m.s dld you ,..., folk ,. a doctor th. WEEK BEFORE LAST? 3 

A.k for EACH visit t. a doctor in last 2 weeks: E=4 

(.) Wh.r. dld r.. tdk to th. doctor Oh. lost tlm., th. time b. f.r., t..)? 

m 

M Why dld you go+. (call) th. doctor (that 11111.)? [ I 

z Under 6 � .,. u 6-12 m., If “NO ‘, m Question ,?o, a,k 

1, ABOUT how long h., it b... .1... you h.v. . ...0. t.lk.d to a doctor? N.. of ~e.,._ o Nevec 

Figure 7. Physician snd dental visits, fiscal years 1958, 1959, and 1964.—Con. 

37 
--

--------------

---------------

--------------

FY 1959 

NURSING CARE AND SPECIAL AIDS 

23.	 1. +h.r. any... I. th. Imnl(y who r.qvlt.. .o..tm.t h.lp m ..r.l.g car.? 1. th.r. ..7...1. th. O Yes - Cmsl=m o No 

I.mlly wh. r.q.b.. h.lp ., . ..s1.0 ..,. ..17 PM of th. Nm., such . . h.lp in dr..si.g, ..tlng, o Yes - POrl-chm 

I*N.I ..+m!.’, �.? Co.dkio.: 

(D. . . . reccfd ‘Yes- for nom.1 c.,. 1- it+..,, ., children) I 

(.) F., whet <.nd!N.n?


(b) How long has h. r.q.lr.d this cor.? (Ye.rs; M months if less than 1 y..r)


(c) Wh. h*lPS wl]h thl. ..,.?


(Check .11 box.. th.t .pply. N ‘Other- specify in f.oc.otes) 

24.	 Do.s anyone fin th. fatally have o h.mlmg .Id? A. mNfiei.al mm o, [.# A b,... of my kind? 

A wh..l chat,? 

(e) For wh.t co.dNlc..? 

(b) Is I, us.d .11 *h. tirn., most .( th. flm., only . . ..sl.notly. o, n..,, us.d “w/? 

If ‘Occ. sion.lly. oc “N.vcc used am,. ask: 

(.) Why IS N th.t You n.v.r . . . N? 

_Yc.rs — Months 

0 Household members


IZ Other celariv.


O Trained (re&istered) muse


U Practical muse


0 Other (S,..11?) _


n Y., mNo 

7 TYP= Of Aid: 

Condition: 

0 All 0 O.c.sio..llr 

f=f Most a Never used 

Verbatim 

Figure 8. Personal and nursing care at home and speciakaids (supplement), fiscal year 1959, 

FY 1960 (ONE-HALF YEAR) 

18. (.) 1 h... ,.m. qu..tl.n, about h.olth l.s., . . . . . W. don’t wont m I.cl.de lnsur.nc. th.f P.Y, 

ONLY	 F., . ..ld.nts. E,., w. . .. Inl.,.,,.d 1. ON oth., kfnd, . . . Do Y.., p.,..., h... u Y., ~: No ~ DK 

l.s., . . . . that pq, .110, p.,t .1 th. bills wh.n YOU go ,. th. fm,p!,.al? Name(s) 

U “Y..,’* 

(b) Who! 1. ]h. ..m. of ih. p!.. (., plans)? Amy .ath.r p!...? 

(.) Wh. Is ..v.md by ihls PI.. (..ch PI..)?

(Check “Y.., ,, i. 18(,) f., c,ch p<,... c.vemf) 

(d) Do.. ih. PI.. (.lth.r ~lm) ~.y any part .f th. SU,g.On,, bill 1., 

a“ .pmti.n? ,-!,,~ I-J Y., ON. ._, 

19. (.) Ago!. .x.l.dl.g I........ that P.Y. ONLY for . ..id.nl.. d. w., Your. h... 1. . . . . . . . fg Ye, u NO U CK 

th.t	 PWS .110, PO.* .$ +h. bill +., doctors’ Vi’it. of hem. or at his effic.? Nanm(s) 

If “’Y..,** 

(b) Whet 1s th. mom. .1 *h. PI.. (or pfon,) ? Any .thm, plws? 

(c)	 Wh. 1. . . ..r.d bv this plon (..ch plan) 7 

[Check “Yes:’ in 19(.) for e.ch pm.. w+.A) 

Enter i. each P. CSO.’S column whether or not bc cesp.nded for W,ms.lf f.< question. 18 .md Ig Ci 

R: and if he did not, (1) show the column number of the person who responded for him M (2) the Col. 

.18, 19 fact that . Form NHS-3 [.) which coveted him l“.. left. n 

FY 1963 (FULL YEAR) 

[8, (e)	 I hove some q..,tlon. .bwt h,.lth l.,wanr... W. do.’t wont to Mud. I. SWC.IIC. th.t pays ONLY F., 

.a..ldonts, but w. . . . Into,. st.d I. .aI1 OFFI., kl.ds. 0. y.., Y.., --, tic., h... ln,urrmc. that POYS .1[ ., pa-t 

of th. bills wh.n you g. t. !h. ho,pltel? 

U ‘*Ye.,~’ ,ak 

(b) who 1. c.v.r.d by h.apft.t i...ro?..? (Ch..k the ‘ ‘Yes” box in M@) for each person covered) 

(c) WII.I 1. th. nom. .( th. Plm (.I Plms)? Any .thw plms? 

19. (o) Excf .dlng l.swo!m. if!.! POWONLY f.? .c.ld.n?s, d. y.., your -., ct.. h... ins.rrnc. the PU9S .11 et part of 

th. .urg.on’. bill f., . . .FW.N..? 

If ,, Yes,,, SSk 

(b) %. IS .w.r.d b“ 1. . . . . . . . for s.rg.e..’ btll.? (Check the “Ye.’S box in 19(.) for each person covered) 

(.) WIIG+t. *h. ..m. of *h. pfw (W PI...)? Any oth.r Plrns? 

~. (.) D. Y.., Y.., --,.% h... I...r-.. *h.t POV* ..Y P.,* .f d..~,.’ bill. f.t hem. ..11s ond .Hlcd visits? 

If “Yes,” ssk: 

(b) W. IS co..r.d by f.=.rmw f.r d..~r.’ bill.? (Ch..k :h. “y..” b.. in 2W for c~ch person covered) 

(.) Whaf 1. th. .ome of th. PICII (or pf.n.)? Any .th.r elms? 

(d) D... N (..ch PI..) PV f.r h.m. ..fls ..d .fft.. vI*Ns f=+ most kl.ds of sl.kn.ss? 

ff=p..d.d f., ,.lf 

No.__ .wP,s respond.., 

Form NlfS+ (.) Icft 

n Yes n No 

Nun. of pl.n(s) I

pYe, O No 

Name of PI..(s) 1 

n Yes G No

Name of plan(s) 

1 .-------_-_----

m Yes D No 1 

Figure 9. Health ineurance$ fiscal year 1960 (One.hau year) and fiscal year 1963. 
--

--

FY 1961 

X-RAY QUESTIONS 

21. (.) W. et. intw..t.d I. all kinds of X-my. - Dld you hm. your I..th X-rayed during the PO. I 

3 month.. - (th.t l., from through I.. I S.nd.y) ? 

N I’Yes,?’ 

(b) How many times? 

22. Du,lng ,ho past 3 m.mth, did y.. hav. . CHEST X-ray? 

23. (.) Dld y.. h... any (eth.r) kind .1 X-ray .1 .11 during th. post 3 months? 

If ,~Yes, ” 

(b) Wh.t part of th. body w.. X-r.y.d? 

24.	 (.) D.rl. th. past 3 months, did any... in th. lomlly h... any X-r.y. for the ?r..tnwnt of 

a .0” 3 hi.”? 

If *“Y,,,” 

(b) What port of th. body w., tr.mt.d? 

(c) W.. *hi. In.lud.d in th. X-r.y (s) you ,eld nm obo., befo,.? 

o Yes D NC! 

N.. “f mme, 

n Ycs-ch.st m No 

n Ye, ~ N. 

Part(s) of bod~ 

Ig 1’,. ~ No 

Part(s) of body: 

............................. n Y., ~ No 

o	 Yes r~N. 

Part(s) of be+: 

..-----....................... Yes 

rlONS 22-25 

m ,%e.me. t]> i. .01. (0 ask: j 

25. (.) Did ..y.n. 

H ~,y.,,” 

(b) What pmt 

(.) W.* tht. 

P.,{ of bcdy 

i. th. f.mlly have . 11.or..c.P. during th. P.Zt 3 m~fh.? 

of th. be+ w., this $.,? 

included In the X-my(,) y.. mld m. about fmf.r.? 

. ——. sX -FILL I IE 

——— LINE FOR E, H PART OF BODY ENTRY FROM WI —— 

“ 

If ..Y children under 

!2. DURING TH E PAST 

ROUTfNE physic.1 

[f W%,,*8 and m:,, 

(.) ~. was this? 

(b) AJIy of the other 

!3,	 DUR04G THE PAST 

.. WIC.S from .“y of 

(.) 

17 y..rs in 

12 MONTHS 

.xomtn.ti.n, 

,h,. . . . Mid 

chtldm”? 

12 MONTH3 

the persons 

Hew many where did m, 

dlff.r.nt ho.. the # .r.y(sfi 

wm. s did ~ot How mm X-rays how. YOU,. . . w.,. O, t i a (h... X-r. WI d.,. F.lt.1, d.ct.,ts Ing II . past 

3 month,? ON!.., et.. ) ? 

(d) (d 

HO.*:,*] _ 

Dr. office — 

Ocbe< 

!j:;.y 

!?%+::~~)~~ 

,he,e,,. x-ray(,) F.. 6.* c.ndi?i.an w.,. y.. b.1.g tr..t.d 

were far 1,..,. IInlonf? I

(o 18) (h) 

DCbcck-.plex.mi..tio. 

0 Treatment 

m Beth 

CONT’D BELOW 

Ask for e.ch p.m.. with 2 m more lines i. Table X: 

(A,k after .11 X-t.YS have bee. recorded through ..1s. (.)-(h) of T*ble X 10C .P.IS..) 

W.,. my .1 ,h.s. ,.. X.,.ys y.. told m. abut mk.n m th. mm. t!me?


w $,Y., ,,


Which X&. WM. the,.? (i)


No y,+ Enrer information below f.r X-ray. uken at same time:
 stop)


Part(.) of WY: N.. ; Pm(s) of bcd~ No. 

, 

1 I 

Figure IO. X-ray visits: questions and table X, fiscal year 1961. 

household, ask: 

wax (were --, . -, .1.. ) token to . 

th.1 IS, not for . p.rNcul.c lll”ess 

u.d.r 1, Y.W% ,sW 

has ANYONE I. the f.mlly - that 

II sled.. this card? Please check 

(NHS-HIS-l(a)) 

the c-J, ask: 

FY 1964 

do. !m for o 

b.t for . gener.1 checkwp? n 17 yesr, or 0,., 

~ Yes fg No 

Is, y.., yaw --, .1.., - received any t (Muk (X3 Specialist) ?ime. 

“Y.s” or “No” fer each . . . Ilsted. Pedistricim A 

Obstecricisa or 

G~...6i6t.t B 

H.nd r.sp.ndmt pencil and card 

Fe, e.cb !(Yc,]> box checked . . 

(.) Who saw the (sP.ci.list) ? (Mark (X) for each specialist in person,s column.) Ophtbafmologist c 

(b) About how m..y l!m.. did You s.. . cswi.li,d d.rl.s *h. P..+ 12 m..ths (..t . . ..*8.9 0tAcyn6010gi.S D 

any ,1.1!s while you w.,. [. the h.aspllo l)? P,rcr”tri.t E 

(.) Did onyone .1s. s.. . (s,.ci.list) durl.g the post 12 month,? Dencamlo&i.t F 

If “T,.,” mk: Orrbopcdist G 

(d) Who w., this? ‘Cbiropmctor H 

(.1 About h.w mony times did y.. s.. o (specialist) during the post 12 months (not 

any vI. N, while you w.,. t. the h.spit.l)? 

counting optometrist I 

POdi*uist 0. 

Check the C,Nme>$ box f.r each m.,.” who did no, s.. . .p.clal{st. Cbir+ist J 

o None 

Figure 11. Routine physical examination for cti.ldren and specialists’ services, fiscal year 1964. 

39 

1 
FY 1963


COSTS FOR MEDICAL AND DENTAL CARE DURING THE PAST 12 MONTHS 

FROM: TO: 

PLEASE ANSWER THE QUESTIONS I.N EACH SECTION BELOW FOR: 

Name of person 

IF EXACT AMOUNTS ARE NOT KNOWN, PLEASE ENTER YOUR BEST ESTIMATE. 

DOCTORS’ BILLS 

1. How much did all of jhe doctors’ (including surgeons’) bills for this person come to during the past 12 months? 

Be surs to count all doctors’ bills for: m No doctors’ 

bills 

Operations Check-ups Pregnancy care Laboratory fees Immunizations or shots 

Treatments Deliveries x-rays Eye examinations Any other doctors’ services 3 

HOSPITAL BILLS 

2. (a) Wtrs this person in a hospital (nursing home, rest home, sanitarium, etc.) overnight ar [anger during the post 

12 months? 

m Yesy m No (Go to Q..etion 3) 

(b) How much did all of the hospital bills come ta for this persGn for the past 12 months? 

Be sum to coant all hospital bills far: 

Room and Operating and Anesthesia X-rays A“y other 

board delivery raom Special treatments Tests hospital services $ 

MEDICI!4E COSTS 

3. About how much was spent for medicine for this person during the past 12 months? 

Be sura to taunt costs for all kinds of msdicine whether ~ No COStS 

or not prescribed by a doctor, such as: for medicine 

Tonics Prescript ions Ointments Any other 

Pills Salves Vitamins medicine 

$ 

DENTISTS’ BILLS 

4. How much did oil of the dentists’ bills far this person come to far the past 12 months? 

Be surs to count all dental bills for: ~ No dentists’ 

bills 

Fillings Cleanings Bridgework Straightening A“y other 

Extracticms X-rays Dental plates of teeth dental services 

$ 

SPECIAL MEDICAL EXPENSES 

5. How much did the bills come to for this person during the past 12 months for: 

n None I_J None m Nane 

Eye glasses? 

m=a~~m’m ‘:’%prac’”rs’ l“ 

n None ~ None Special braces ~ None 

or trusses, 

Hearing Aids? $ Corrective 

shoes? $ 

wheel chairs or 

artificial limbs? .$ 

OTHER MEDICAL EXPENSES 

6.	 Enter any other medical expenses incurred during the past 12 months which are not included a Non. above, showing the kind and amount of expenditure (far example, emergency ar outpatient 

treotment in o hospital or clinic). (If no other msdical expense$, check the ‘[None8* box.) 

Kind $ 

. 

FOR OFFICE PSU No, Segment No. Serial No. Column No. 

USE ONLY 

Figure 12. Personal health expenditures (self-enumeration), fiscal year 1963.. 

40 
FY 1963 —.— .—. — 

NATIONAL HEALTH SURVEY ~mKm 

(Hearing Ability) 

SERI a. COL 

qame of person for whom this form should be filled our 

GENERAL INSTRUCTIONS 

F’lease answer aIl of the question sin this form thatapply to you. hfost of the question scan be answered 

by checking one of the boxes, like this: ~. In some of the questions, more tbn” cme box may be 

checkcd for your answer. In a few questions, anumber (such asage)is asked for. Ina few others, a 

.vritten description or explanation is required. 

If the person for whom the information isrequesteti is a child, aparenc or guardian should answer the 

questions forhim or her. 

SECTION A 

(Please donotomit maypart ofouestionsl ond2 eventhou hone ormoreof tlzestatements mV not “ 

appenrto be directly related to your present ability to hear. f 

1. WITHOUT using a hearing aid, what can you hear? Yes No (P,eaSe check ,Jj.g ..ye.ql*o,llNo,. boxaftereach .qLqt.s,..s”t.) 

I can hear loud noises. 

4-1--

Mostof the time I can tell one kind ofnoisc from another. 

If I hear a sound, most of rhc time I can tell if it is.aperson’s voice or trot. 

I can hear andunderstand a few words aperso” s+,sif I can see his face and lips. 

I I 

I can hear and understand a few words a person says without seeing his face and Iips. 

Icanbear ondun.4erstand most of teethings a person says if Icsn seehisfacesnd lips. 

I can hear and understand most of rhechingss person says without seeing his face snd lips. I I Most of thetime I can hetrrtrnd understand a discussion between several people without 

seeing their faces and lips. 

Ican hear and understmrda telephonec onversation on anordi”ary telephmte (that isa 

telephone without an amplifier). 

2. Please describe how well you can hear, without using ahearingaid, by checking oneof the statements 

helorv foretrch ear. For example, a person whoisdeaf inhis Ieftear and basgood bearing in his right 

ear would cbeck tbe following: In left ear-box(d); hr right esr-box (e). 

I 

I 

In Ieft ear 1 in right � ar t 

(m) ~iiyhearing is good I 

1 (e) m!.fyhearing is good 

(b) ~Ihavea litdetro.blebearhg I (f) mIbavea little trouble hearing 

(c) mIhavea lotoftrouble hearing ~ (~ l_JIh=e alotof trouble hearing 

I (d) mI.m deaf I (h) ~Iamdeaf 

f youhave checked tbatyour heating is goodin bothers (a) and (e) checked, skip the questions on Pages 2 

md 3 and turn to Secrion D on Page 4. 

fyouhsve anytroubIe hesringatafl, please goon attdsnswer thequestions that follow cm %ges 2 and 3. -

Figure 13. Followback form (hearing ability), fiscal year 1963. (page 1 of 4-page form) 

41 
4. DEFINITIONS AND DISCUSSION OF 

TERMS USED IN THE SURVEY FISCAL YEARS 1958-64 

THE CONTENTS tions (fig. 2. page 29). In the coding and tabulating 

OF THE LIST OF TERMS process: condit~ons are selected or classified according to a number of different criteria, such as, In this section will be found a classified listing whether they were medically attended; whether 

of terms used in reports on the Health Interview they resulted in disability; whether they were acute 

Survey. These terms are alphabetically arranged or chronic; or according to the type of disease, for easy reference in the Index to Terms Defined injury, impairment, or symptom reported. For 

on page 63. the purposes of each published report or set of 

The selection of terms to be included in the tables, only those conditions recorded on the ques­ following list was a matter of judgmenq no formal tionnaire which satisfy certain stated criteria are 

rules were followed. However, certain types of included. 

terms have in general been excluded: Conditions, except impairments, are coded by 1. Terms used in connection with the special type according to the International Classification 

supplements to the basic questionnaire. of Diseases with certain modifications adopted to 

These are defined as necessary in reports make the code more suitable for a householddealing with supplemental data. interview-type survey. Impairments are coded ac2.	 Terms relating to the methodology of the cording to a special supplementary classification. 

survey, such as ‘‘noninterview, ” “accept- (See definition of “Impairment.” See also definiable respondent, ” and so forth. Although tions of “Chronic condition,” “Acute condition,”

these terms are occasionally used in re- “Injury condition,” and “Hospitalized condition.”) 

ports on results of the survey, it was not Chronic condition.— A condition is considered 

considered necessary to provide formal to be chronic if (1) it is described by the respond- definitions except in reports devoted to ent in terms of one of the chronic diseases on the 

.! 

. 

methodological matters. 

3. Terms denoting rates, ratios, or other indices where the meaning of such terms is 

believed to be self-evident from the 

context. 

4.	 Terms in general usage are excluded unless some special point regarding their 

usage needed explanation. 

Definitions of additional terms and minor revisions of these definitions may appear in statistical reports. Furthermore, as the basic questionnaire is changed new terms will be introduced. 

Hence, this list should be consideredprovisional. 

General Morbidity Terms 

Condition. —A morbidity condition, or simply 

a condition, is any entry on the questionnaire which 

describes a departure from a state of physical or 

mental well-being. It results from a positive response to one of a series of’ ‘illness-recall” ques -

“Check List of Chronic Conditions” or in terms of 

one of the types of impairments on the’ ‘Check List 

of Impairments” (page 26) or (2) the condition is 

described by the respondent as having been first 

noticed more than 3 months before the week of the 

interview. 

Persons with chronic conditions .—fie estimated number of persons with chronic conditions 

is based on the number of persons who at the time 

of the interview were reported to have one or more 

chronic conditions. (See definition of “Chronic 

condition.”) 

Acute condition.— An acute condition is defined as a condition which has Iasted less than 3 

months and which has involved either medical 

attention or restricted activity. When estimating 

incidence, acute conditions are restricted to those 

which had their onset during the 2 weeks prior 

~o the interview week and which involved either 

medical attention or restricted activity during 

42 
that 2-week period. However, certain conditions 

which are always classified as chronic, regardless of onset have been excluded. Conditions always classified as chronic are shown in the 

Check Lists of Chronic Conditions and Impairments (page 26). 

Injury condition .—An injury condition, or 

simply an injury, is a condition of the type that is 

classified to the nature of injury code numbers 

(N800-N999) in the International Classification of 

Diseases. In addition to fractures, lacerations, 

contusions, burns, and so forth, which are commonly thought of as injuries, this group of codes 

includes the effects of exposure, such as sunburn, 

adverse reactions to immunizations and other 

medical procedures, and poisonings. Unless 

otherwise specified, the term injury is used to 

cover all of these. 

Since a person may sustain more than one injury in a single accident, e.g., a broken leg and 

laceration of the scalp, the number of injury conditions may exceed the number of persons injured. 

See definition of “Person injured.” 

Statistics of current or acute injury conditions 

include only injuries which involved at least 1 full 

day of restricted activity or medical attendance. 

Chronic effect of injurY.—A chronic condition resulting from an injury may be either an 

impairment, such as paralysis, or some other 

type of late effect of the injury, such as arthritis. 

Disability from such conditions is included with 

that resulting directly from the injuries, unless 

otherwise specified. 

With a few exceptions, injuries that are still 

giving trouble are classified according to the 

chronic effect of the injury if the injury occurred 

3 months or more before the interview week, but 

to the injury itself if the injury occurred less than 

3 months before. 

Impairment. —Impairments are chronic or 

permanent defects, resulting from disease, injury, 

or congenital malformation. They represent decrease or loss of ability to perform various functions, particularly those of the musculoskeletal 

system and the sense organs. All impairments are 

classified by means of a special supplementary 

code for impairments. Hence, code numbers for 

impairments in the International Classification of 

Diseases are not used. In the Supplementary Code 

impairments are grouped according to the type of 

functional impairment and etiology. The impairment classification is shown in Health Statistics 

frotn the National Health Survey, Series B, 

No. 35. 

Hospitalized condition .—A hospitalized condition is a condition responsible for a hospital episode. (See definition of “Hospital episode.”) If 

there is more than one hospitalized condition for 

any one episode, only that one believed to be 

chiefly responsible for the stay in the hospital is 

tabulated. If a person enters a hospital for diagnostic tests, or for an operation, the condition that 

made the tests or operation necessary is considered to be the hospitalized condition. 

Normal delivery in a hospital is included as a 

hospitalized condition but care of the well, newborn infant is not. 

Onset of condition.—A morbidity condition, 

whether acute or chronic, is considered to have 

had its onset when it was first noticed. This could 

be the time the person first felt “sick, ” or became 

injured, or it could be the time the person or his 

family was first told by a physician that he had a 

disease of which he had been previously unaware. 

For a chronic condition, episodic in nature, the onset is always considered to be the original onset 

rather than the start of the most recent episode. 

Incidence of conditions .—The incidence of 

conditions, whether acute or chronic, is the estimated number of conditions having their onset in a 

specified time period. The incidence may at times 

be limited to various subclasses of conditions, 

such as “incidence of conditions involving bed 

disability.” 

As previously mentioned, minor acute conditions involving neither restricted activity nor 

medical attention are excluded from the statistics. 

Also the incidence data for acute conditions is 

limited to the conditions which had their onset 

during the 2 weeks prior to the interview week. 

(See definition of “acute condition’ ‘.) 

For convenience in making comparisons, incidence rates per 100 or per 1,000 population are 

usually expressed on an annual basis, regardless 

of the time period to which the statistics relate. 

Thus, there may be weekly incidence rates on an 

annual basis, obtained by multiplying the weekly 

rate by 52, and quarterly rates on an annual basis, 

43 
dbtained by multiplying the quarterly rates by 4, 

and so forth. 

Prevalence of conditions .—In general, preva. 

lence of conditions is the estimated number of conditions of a specified type existing at a specified 

time or the average number existing during a specified interval of time. In the Health Interview Survey two different types of prevalence estimates 

are used: 

1.	 the number of cases involving restricted 

activity, bed disability, and so forth, on an 

average day (see definition of “Average 

number of persons with restricted activity each day’ ‘); and 

2. (for the prevalence of chronic conditions 

only), the number of chronic cases reported to be present or assumed to be 

present at the time of the interview; those 

assumed to be present at the time of the interview are cases described by the respondent in terms of one of the chronic 

diseases on the “Check List of Chronic 

Conditions” (page 26) andreportedtohave 

been present at some time during the 12-

month period prior to the interview. 

Estimates of the prevalence of chronic conditions may be restricted to cases that satisfy 

certain additional stated criteria, such as cases 

involving a day or more in bed in the past year, 

cases still under medical care, or those with specified degrees of limitation. (See definitions of 

chronic activity limitation and chronic mobility 

limitation. ) 

Activity-restricting condition.—An activityrestricting condition is any condition which has 

caused at least 1 day of restricted activity during 

the 2 calendar weeks before the interview week. 

(See definition of “Restricted-activity day.”) The 

incidence of acute activity-restricting conditions 

is estimated from the number of such conditions 

reported as having started in the 2-week period. 

However, a condition beginning in the 2-week 

period but not resulting in restricted activity until after the end of that period is not included. 

Bed-disabling condition.-A condition involving at least 1 day of bed disability during the 2 

calendar weeks before the interview week is called 

a bed-disabling condition. (See definition of’ ‘Beddisability day.”) The incidence of acute bed-disabling conditions is defined in a manner analogous to the incidence of acute activity-restricting 

conditions. 

Medically attended condition. --A condition 

about” which a physician was consulted is called a 

medically attended condition. Consulting a physician includes consultation in person or by telephone for treatment or advice. Advice from the 

physician transmitted to the patient through the 

nurse is counted as medical consultation as well 

as visits to physicians in clinics or hospitals. If 

at one visit the physician is consulted about more 

than one condition for each of several patients, 

each condition is counted as medically attended. 

A parent’s consulting of a physician about a 

child’s condition is counted as medical consultation about that condition even if the child was 

not seen by the physician at that time. 

For the purpose of this definition,’ ‘physician” 

includes doctors of medicine and osteopathic physicians. The term “doctor” is used in the interview, rather than “physician,” because of the need 

to keep to popular usage. However, the concept toward which all instructions are directed is that 

which is described here. 

A condition is counted as medically attended 

if a physician was consulted about it at its onset 

or at any time thereafter. However, the first 

medical attention for a condition that was present 

in the 2 weeks before the interview may not occur 

until after the end of the 2-week period. In fact, 

it may not occur until after the interview. Such 

cases are necessarily treated as though there had 

been no medical attention. 

Interval since last medical consultation for a 

condition.—l%e interval since the last medical 

consultation for a condition is obtained only for 

chronic conditions. It refers to the number of 

months or years prior to the week of interview 

since a physician was last consulted about the 

chronic condition. 

For the purposes of this definition “physician” 

is defined as in “Medically attended condition. ” 

Under care. —This information is obtained 

only for chronic conditions. A chronic condition 

which is “under care” is one for which the person 

is “under instruction” from a physician. By 

t‘under instruction” is meant one or more of the 

following: (1) taking certain medicine or treatment 

prescribed by a physician, (2) observing a certain 

44 
systematic course of alet or activity, (3) visiting 

the physician regularly forchecking on the condition, and (4) under instruction from the physician to return if some particular thing happens. 

For the purposes of this definition “physician” 

is defined as in “Medically attended condition.” 

Terms Relating to Disability 

Disability .-Disability is a general term used 

to describe any temporary or long-term reduction of a person’s activity as a result of illness 

or injury. 

Disability days areclassified as follows: days 

of restricted activity, days of bed disability, hospital days, and days lost from work or schooL All 

hospital days are, by definition, days of bed disability; all days of bed disabilit y are, by definition, 

days of restricted activity. The converse form of 

these statements is, of course, not true. Days lost 

from work and days lost from school are special 

terms which apply to the currently employed and 

the school-age populations only, but these, too, 

are days of restricted activity. See definitions of 

“work-loss day” and “school-loss day.” Hence, 

“restricted activity” is the most inclusive term 

used to describe the disability reported in the 

interview. 

Disability of persons with chronic conditions 

is also described by the extent to which their major 

activity or their mobility is limited. (See definitions of “Chronic activity limitation” and’ ‘Chronic 

mobility limitation.”) Persons with “Chronic activity limitation” are considered to be persons 

with long-term disability. 

Disability Days 

Restricted-activity daY.—A day of restricted 

activity is a day when a person cuts down on his 

usual activities for the whole of that day on account of an illness or an injury. The term “usual 

activities” for any day means the things that the 

person would ordinarily do on that day. For children under school age, “usual activities” depend 

upon whatever is the usual pattern for the child’s 

day. In turn, this will be affected by the age of the 

child, the weather conditions, and so forth. For 

retired or elderly persons, “usual activities” 

might consist of almost no activity, but cutting 

down on even a small amount for as much as a 

day would constitute restricted activity. On 

Sundays or holidays “usual activities” are taken to 

be the things the person usually does on such 

days—going to church, playing golf, visiting 

friends or relatives, or staying at home and 

listening to the radio, reading, watching television, and so forth. The type of reduction of 

usual activity varies with the age and occupation 

of the individual as well as with the day of the 

week or season of the year. 

Restricted activity covers the range from 

substantial reduction to complete inactivity for the 

entire day. A day spent in bed or a day home from 

work or school because of illness or injury is, of 

course, a restricted-activity day. 

Bed-disability daY.—A day of bed disability 

is one on which a person stays in bed for all or 

most of the day because of a specific illness or 

injury. All or most of the day is defined as more 

than half the daylight hours. All hospital days for 

inpatients are considered to be days of bed disability even if the patient was not actually in bed 

at the hospital. 

Work-loss day .—A day is counted as lost from 

work if the person would have been going to work 

at a job or business that day but instead lost tht! 

entire work day because of an illness or an injury. 

If the person’s regular work day is less than a 

whole day and the entire work day was lost, it 

would be counted as a whole workday lost. Work10SS days are determined only for currently employed persons 17 years of age and over. 

School-loss daY.—A day is counted as lost 

from school if the child would have been going to 

school that day but instead lost the entire school 

day because of an illness or an injury. If the 

child’s regular school day lasts only a part of a 

day and that part was lost from school, this whole 

day would be counted as lost. School-loss days 

are determined only for children 6-16 years of age. 

Condition-day: of restricted activity, bed disability. etc.—Condition-days of restricted activity, bed disability, and so forth are days of fie 

various forms of disability associated with anyone 

condition. Since any particular day of disability 

may be associated with more than one condition, 

the sum of days for conditions may add to more 

than the total number of person-days. 

45 
Person-days of restricted activity, bed disability, etc .—Person-days of restricted activity, 

bed disability, and so forth are days of the various 

forms of disability experienced by any one person. 

‘l%e sum of days for all persons in a group represents an unduplicated ,count of all days of disability for the group, i.e., a person with 2 condition-days of disability on a given day is included 

only once in the person-day count. 

Average number of persons with restricted 

activity each day .-The average number of persons with restricted activity is computed by dividing the “person-days of restricted activity” 

during a period by the number of calendar days in 

the period. Average number with bed disability is 

similarly defined. 

Long-Term Disability 

Chronic activitv limitation<- persons with 

chronic conditions are classified into four categories according to the extent to which their 

activities are limited at present as a result of 

these conditions. Since the usual activities of preschool children, school-age children, housewives, 

and workers and other persons differ, a different 

set of criteria is used for each group. There is a 

general similarity between them, however, as 

will be seen in the descriptions of the four categories below. In some of the reports of the Health 

Interview Survey, various combinations of the 

categories have been made to serve different 

purposes. 

1. Persons unable to carry on major activity 

for their group (major activity refers to


ability to work, keep house, or go to


school).


Preschool children: inability to take part


in ordinary play with 

other children. 

School-age children: inability to go to 

school. 

Housewives: inability to do any 

housework. 

Workers and all 

other persons: inability to work at 

a job or business. 

2. Persons limited in the amount or kind of 

major activity performed (major activity 

refers to ability to work, keep house, or 

go to school). 

Preschool children: 

School-age children: 

Housewives: 

Workers and all 

other persons: 

limited in the amount 

or kind of play with 

other children, e.g., 

need special rest 

periods, cannot play 

strenuous games, 

cannot play for long 

periods at a time. 

limited to certain 

types of schools or 

in school attendance, 

e.g., need special 

schools or special 

teaching, cannot go 

to school full time 

or for long periods 

at a time. 

limited in amount or 

kind of housework, 

e.g., cannot lift children, wash or iron, 

or do housework for 

long periods at a 

time. 

limited in amount or 

kind of work, e.g., 

need special working aids or special 

rest periods at work, 

cannot work full 

time or for loqg periods at a time, 

camot do strenuous 

work. 

3. Persons not limited in major activity but 

otherwise limited (major activity refers


to ability to work, keep house, or go to


school)


Preschool children: not classified in this


category. 

School-age children:	 not limited in going 

to school but limited 

in participation in 

athletics or other 

extracurricular activities. 

Housewives: not limited in housework but limited 

46 
4. 

in other activities, 

such as church, 

clubs, hobbies, civic 

projects, or shopping. 

Workers and all 

other persons:	 not limited in regular work activities 

but limited in other 

activitie~, such as 

church, clubs, hobbies, civic projects, 

sports. or games. 

Persons not limited in act]vlties 

Includes persons with chronic conditions 

whose activities are not limited in any of 

the ways described above. 

Chronic mobility limitation. —Persons with 

chronic activity limitation of some degree as a 

result of one or more chronic conditions are classified according to the extent to which their mobility is limited at present. There are four categories as follows: 

1. Confined to the house—confined to the 

house all the time except in emergencies. 

2. Cannot get around alone—able to go outside but needs the help of another person in 

getting around outside. 

3. Has trouble getting around alone—able to 

go outside alone but has trouble getting around 

freely. 

4. Not limited in mobility—not limited in any 

of the ways described above. 

Terms Relating to Persons Iniured 

and Accidents 

Person injured. —A person injured is one who 

has sustained one or more injuries in an accident 

or in some type of nonaccidental violence. (See 

definition of “Injury condition.”) Each time a 

person is involved in an accident or in nonac ­

cidental violence causing injury that results in 

at least 1 full day of restricted activity or medical 

attention, he is included in the statistics as a 

separate “person injured. ” Hence, one person may 

be included more than once. 

The number of persons injured is not equivalent to the number of “accidents” for several 

reasons: (1) the term “accident” as commonly 

used may not involve injury at all; (2) more than 

one injured person may be involved in a single 

accident so that the number of accidents resulting in injury would be less than the number of 

persons injured in accidents; and (3) the term 

‘‘accidenr” ordinarily implies an accidental origin, whereas “persons injured” as used in the 

National Health Survey includes persons whose 

injury resulted from certain nonaccidental violence. 

The number of persons injured in a specified 

time interval is always equal to or less than the 

incidence of injury conditions, since one person 

may incur more than one injury in a single 

accident. 

Class of accident. —Injuries, injured persons, 

and resulting days of disability may be grouped 

according to class of accident. This is a broad 

classification of the types of event which result 

in persons being injured. Most of these events 

are accidents in the usual sense of the word. 

But other kinds of mishap, such as overexposure 

to the sun or adverse reactions to medical procedures, and also nonaccidental violence. 

such as attempted suicide are included. The 

classes of accidents are: (1) motor-vehicle accidents, (2) accidents occurring while at work, 

(3) home accidents, and (4) other accidents. These 

categories are not mutually exclusive. For example, a person may be injured in a motorvehicle accident which occurred while the person 

was at home or at work. 

Motor-vehicle accident.—The class of accident is “motor vehicle” if a motor vehicle was 

involved in any way. Thus, it is not restricted to 

moving motor vehicles or to persons riding in 

motor vehicles. A motor vehicle is any mechanically or electrically powered device, not operated 

on rails, upon which or by which any person or 

property may be transported or drawn upon a land 

lighway. Any object, such as a trailer, coaster, 

sled, or wagon, being towed by a motor vehicle is 

considered a part of the motor vehicle. Devices 

used solely for moving persons or materials within the confines of a building and its premises are 

not counted as motor vehicles. 

Moving motor vehicle.—The accident is classified as “moving motor vehicle” if at least one 

of the motor vehicles involved in the accident was 

moving at the time of the accident. The vehicle 

was moving if the wheels were in motion at the 

time of the accident. 

47 
Nonmoving motor vehicle.—The accident is 

classified as “nonmoving motor vehicle” if the 

motor vehicle was not moving at the time of the 

accident. However, a vehicle falling off a jack or 

rack would be considered as nonmoving. 

Occupant of moving motor vehicle .—Allpersons involved in’ ‘moving motor vehicle accidents” 

are classified as occupants or nonoccupants. A 

person is considered an occupant, if his body was 

inside, or if he was getting in or out of a motor 

vehicle at the time of the accident. Also included 

as occupants at the time of the accident are persons who were thrown or fell from the inside of a 

motor vehicle; had their arms, legs, or head protruding from the motor vehicle; or were riding in 

the “bed” of a truck or on an open motor vehicle 

such as a motorcycle. In all of al.mve cases the 

person might be considered an occupant of a non,­

moving motor vehicle which is involved in an accident with a moving motor vehicle. All persons 

involved in moving motor vehicle accidents who 

were not occupants are classified as nonoccupants. 

Accident while at work.—The class of accident is “while at work” if the injured person 

was 17 years of age or over and was at work at 

a job or a business at the time the accident 

happened. 

Home accident.—The class of accident is 

“home” if” the injury occurred either inside the 

house or outside the house. “Outside the house” 

refers to the yard, buildings, and sidewalks on the 

property. “Home” includes not only the person’s 

own home but also any other home in which the 

injury might have occurred. 

Other —The class of accident is “other” if 

the ‘ence of injury cannot be classified in 

one or more of the first three class-of-accident 

categories, This category therefore includes persons injimed in public places (e.g., tripping and 

falling in a store or on a public sidewalk), and 

also nonaccidental injuries such as homicidal and 

suicidal attempts. The survey does not cover the 

military population, but current disability of 

various types resulting from prior injury occurring while the person was in the Armed Forces 

is covered and is included in this class. The class 

also includes mishaps for which the class of accident could not be ascertained. 

Place of accident. —Persons injured are classified according to the type of place where the injury occurred. The places of accidents are: (1) 

home, (2) street or highway, (3) farm, (4) industrial place, (5) school, (6) place of recreation, 

and (7) other. 

Home,—The place of accident is considered 

as “home” if the injury occurred either inside or 

outside the home but within the property boundaries of the home. “Home” includes not only the 

person’s own home but also any other home (vacant or occupied) in which he may have been when 

he was injuried. “Home” includes afiy structure 

that has the primary function of a dwelling unit and 

includes the structure and premises of such places 

as apartment houses and house trailers. 

Inside the house.-” Inside the house” includes 

any room, attic, cellar, porch, or steps leading to 

an entrance. of the house. However, inside the garage is not considered as inside the house. 

Outside the house.— “Outside the house” includes the yard, driveway, garage, patio, gardens, 

or walks. On a farm, only the premises adjacent 

to the house are considered as part of the home. 

Injuries due to accidents occurring on cultivated 

land, in barns, or other similar farm buildings 

would not be considered home injuries. 

Street or highwa y. —’’Street or highway” 

means the entire area between property lines of 

which any part is open for the use of the public 

as a matter of right or custom. It includes the 

roadway, shoulder, curb, or public sidewalk; excluded are private driveways, lanes, or sidewalks. 

Farm.— “Farm” as a place of accident refers 

to accidents occurring in farm buildings or on 

cultivated land, but does not include accidents occurring in the farm home or premises. A ranch 

is considered a farm. 

Industrial place.—” Industrial place” is the 

term applied to accidents occurring in an industrial place or premises. Included are such 

places as factories, railway yards, warehouses, 

workshops, logging camps, shipping piers, oil 

fields, shipyards, sand and gravel pits, canneries, and auto repair garages. Construction projects, such as houses, buildings, bridges, and new 

roads, are included in this category. Buildings 

undergoing remodeling, with the exception of 

private homes, are classified as industrial places 

or premises. 

School.— “school” as a place of accident includes all accidents occurring in school buildings 

or on the preinises. This classification includes 

48 
elementary schools, high schools, colleges, and 

trade and business schools. 

Place of recreation. —’’Placeof recreation” 

is used to describe accidents occurring in places 

organized for sports and recreation other than 

recreational areas located at a place already defined as “home, ‘‘ “industrial place,” or ‘‘~chool.” 

Bowling alley, amusement park, football stadium, 

and dance hall are examples of “place of recreation. 1t In !iplaceof accident!’ classification Ofinjuries, the place is significant rather than the activity in which the person was engaged at the time 

of accident. Hence, an injury sustained by a person at a dance hall while he was at work is classified as a “place of recreation” injury. Likewise, 

an injury occurring while a person was engaged 

in a sport in an industrial place is classified as 

an “industrial place” injury. 

Other. —Accidents which cannot be classified 

in any of the above groups or for which the place 

is unknown are classified as “other.” Included in 

the classification are such places as restaurants, 

churches, business and professional offices, and 

open or wooded country. 

Type of accident.—” Type of accident” is recorded for all accidents involving injury in order 

to classify injuries according to the circumstances 

relating to the accident. Accidents are grouped by 

type according to the following concepts: 

(A)	 Accidents in which specific factors are 

involved, but may or may not have caused 

the injury. Included in this group are 

moving motor vehicle, uncontrolled fire, 

explosion, firearms, and nonmotor vehicle such as train or bicycle. The 

definition of moving motor vehicle in 

this instance is identical to that for 

“moving motor vehicle” as a class of 

accident. An accident in which a nonmoving motor vehicle is involved may 

be shown as a separate category, or this 

group of accidents may be distributed 

among the types listed below which describe the circumstances relating to 

the accident. 

(B)	 Accidents in which injury is caused directly by an agent, such as machinery 

in operation, a knife, scissors, nail, 

animal or insect, foreign body in eye or 

other orifice, or a poisonous substance 

swallowed by the person involved. 

(c) Accidents described in terms of the 

events leading to the occurrence of the 

injury, such as falling, bumping into a 

person or object, being struck by a 

moving object, handling or stepping on 

sharp or rough objects, being caught in, 

pinched or crushed, coming in contact 

with hot object or flame, lifting, twisting, 

or stumbling. 

(D) Accidents resulting in injury that cannot 

be classified in groups (A), (B), or (C) 

are classified as “other.” Accidents of 

unknown type are also included in this 

group. 

A complete listing of the types of accidents is 

shown on the National Health Survey Questionnaire 

NHS-4 (all fig. 4, FY 1960-61). In order to 

prevent the describing of any injury as the resuIt 

of more than one type of accident, an injury that 

may be assigned to two or more types is classified in the first type designated that adequately 

describes the circumstances of the accident. 

Terms Relating to Hospitalization 

Hospital episode. —A hospital episode is any 

continuous period of stay of 1 or more nights in a 

hospital as an inpatient, except the period of stay 

of a well,, newborn infant. 

Hospital .—A hospital is defined as any institution meeting one of the following criteria: (1) 

named in the listing of hospitals in the current 

Guide Issue of Hospitals, the Journal of the 

American Hospital Association; (2) named in 

the listing of hospitals in the Directories of the 

American Osteopathic Hospital Association; or 

(3) named in the annual inventory of hospitals and 

related facilities submitted by the States to the 

Division of Hospital and Medical Facilities of the 

Public Health Service in conjunction with the Hill 

Burton program. 

Hospital ownership. —-Hospital ownership is 

a classification of hospitals according to the type 

of organization that controls and operates the 

hospital. The category to which an individual 

hospital is assigned and the definition of these 

categories follows the usage of the American 

Hospital Association. 

Type of hospital service. —Type of hospital 

service is a classification of hospitals according 

to the predominant type of cases for which they 

provide care. The category to which an individual 

49 
hospital is assigned and the definition of these 

categories follows the usage of the American 

Hospital Association. 

Short-stay hospital .—A short- stay hospital is 

one for which the type of service is general; maternity, eye, ear, nose, and throat; children’s; 

osteopathic hospital; or hospital department of 

institution. 

Hospital admission. —A hospital admission is 

a hospital episode that began during a specified 

period of time. (See definition of “Hospital episode.”) A hospital admission is recorded whenever a present member of the household is reported to have been admitted to a hospital in the 

12-month period prior to the interview week. 

Hospital discharge. —A hospital discharge is 

a hospital episode that ended during a specified 

period of time covered by the survey. (See definition of “Hospital episode.”) 

A hospital discharge is recorded whenever a 

present member of the household is reported to 

have been discharged from a hospital in the 12-

month period prior to the interview week. For 

certain reports of the National Health ‘Survey, 

estimates were based on discharges which occurred during the 6-month period prior to the 

interview. 

Hospital day.—A hospital day is a day on which 

a person is confined to a hospital. The day is 

counted as a hospital day only if the patient stays 

overnight. Thus, a patient who enters the hospital 

on Monday afternoon and leaves Wednesday noon 

is considered to have had 2 hospital days. 

Estimates of the total number of hospital 

days are derived by summing the days for all 

hospital episodes of a particular type. (See definition of “Hospital episode.”) For example, the 

number of hospital days may be summed for all 

hospital discharges. (See definition of “Hospital 

discharge.”) 

Hospital days per year. —These are the total 

number of days for all hospital episodes in the 

12-month period prior to the interview week. For 

the purposes of this estimate episodes overlapping 

the beginning or end of the 12-month period are 

subdivided so that only those days falling within 

the period are included. 

Number still in hospital.—lle number still 

in hospital is the number of persons in hospitals 

at the beginning of the interview week. 

Length of hospital sta y.—The length of hospital stay is the duration in days, exclusive of the 

day of discharge, of a hospital discharge, (See definition of “Hospital discharge.”) 

Average length of hospital stay .—The average 

length of hospital stay per discharged patient is 

computed by dividing the total number of hospital 

days for a specified group by the total number of 

discharges for the same group. 

Surgical operation. —A surgical operation includes any cutting or piercing of the skin or other 

tissue, stitching of cuts or wounds, setting of 

fractures and dislocations, the introduction of 

tubes for drainage, “tapping,” and terms ending 

in “scopy” (e.g., cystoscopy). Deliveries are 

counted as operations. Injections and transfusions, 

however, are not included, nor are routine circumcisions. 

Only operations performed in hospitals upon 

inpatients are included. 

Operations are classified by type according to 

a condensed version of “Classification Codes for 

Surgical Operations and Procedures,” published 

by the Bureau of Medical Services, Public Health 

Service, Department of Health, Education, and 

Welfare. 

Length of postoperative hospital stay.—l%e 

length of postoperative hospital stay is the duration in days from the date of the operation, including the day of the operation, to the date of discharge from the hospital, exclusive of the day of 

discharge, of a hospital discharge. (See definition 

of “Hospital discharge.”) 

Convalescence after surgery ..-Convalescence after surgery is the duration of convalescent days of a hospital discharge from the 

date of the patient’s operation, including the day 

of the operation, to the dtite the patient returned 

to his usual full-time activity. The total number 

of convalescent days is recorded for each completed hospitalization if an operation was performed, if a fracture or dislocation was set, or 

if the hospital stay included a delivery. 

Hospital bill.— A hospital bill is defined as 

the bill submitted by the hospital to the patient 

for the care and =rvices received during the 

period of hospitalization. Bills submitted to the 

patient by doctors, surgeons, anesthetists, or 

other individuals for services rendered during 

the period of hospitalization are not considered 

as part of the hospital bill. 

The hospital bill will normally include the 

cost of the room, meals, regular nursing service, 

laboratory tests, X-rays, medicines, injections, 

use of the operating room, and other services that 

50 
may be provided for the patient. When the charges 

for special nurses, anesthetists, ambulance service, etc., are included by the hospital on the bill 

submitted to the patient, these are also considered as part of the hospital bill for purposes 

of the Survey. 

Proportion of bill paid bv insurance.—The 

proportion of the bill paid (also referred to as 

fraction of bill paid) by insurance was determined 

by the respondent’s own estimate of the part of 

the total hospital bill that was paid for or was 

expected to be paid for by insurance. The response categories used are: (a) no part of the 

bill paid by insurance; (b) less than one-halt 

(c) one-half up to, but not including, three-fourths; 

(d) three-fourths or more. 

Hospital insurance. —Hospital insurance is 

any insurance plan designed to pay all or part of 

the hospital bill (see definition of “Hospital bill”) 

of the insured individual. The insurance can be 

either a group or an individual policy with the 

premiums paid by the individual, his employer, a 

third party such as a union, fraternal organization 

or family member, or a combination of these. 

Benefits received under the plan can be in the 

form of payment to the individual or to the hospital. However, the plan must be a formal one with 

defined membership and benefits rather than an 

informal one. For example, an employer simply 

paying the hospital bill for an employee would not 

constitute a health insurance plan. ‘‘Workmen’s 

compensation,” or employee’s liability insurance, 

when designed to pay all or part of the hospital 

bill of the employee, are considered hospital insurance. The important ingredient in this definition is that the person receiving the benefit 

has been specifically named either as an individual or as part of a specified group. 

The insurance does not have to cover costs 

of hospitalization for all diseases and injuries, 

as long as it covers the particular condition for 

which the person was hospitalized. 

The use of funds from other kinds of insurance benefits to pay hospital bills, such as 

Social Security benefits or disability insurance, 

would not be counted as hospital insurance. Free 

hospital care is not considered hospital insurance. 

Examples of free care are public assistance or 

public welfare care, veteran’s care given free of 

charge, care given to dependents of military 

personnel (Medicare Plan), care given to children under the Crippled Children’s progrsm, and 

care of patients admitted free for research purposes. Also excluded as hospital insurance in this 

study is liability insurance that pays for hospital 

care, if it is carried by someone other than the 

person hospitalized, his family, his employer, or 

his union or fraternal organization. An example 

of this type of exclusion is a person hospitalized 

as a result of an automobile accident in which some 

person other than the one hospitalized carried 

liability insurance that paid for the hospital care 

of the injured person. 

Medical Care Terms 

Physician visit. —A physician visit is defined 

as consultation with a physician, in person or by 

telephone, for examination, diagnosis, treatment, 

or advice. The visit is considered to be a physician 

visit if the service is provided directly by the physician or by a nurse or other person acting under 

a physician’s supervision. For the purpose of this 

definition “physician” includes doctors of medicine and osteopathic physicians. The term 

“doctor” is used in the interview, rather than 

“physician,” because of the need to keep to popular usage. However, the concept toward which all 

instructions are directed is that which is ~escribed here. 

Physician visits for services provided on a 

mass basis are not included in the tabulations. A 

service received on amass basis is defined as any 

service involving only a single test (e.g., test for 

diabetes) or a single procedure (e.g., smallpox 

vaccination) when this single service was administered identically to all persons who were at the 

place for this purpose. Hence, persons passing 

through a tuberculosis chest X-ray trailer, by this 

definition, are not included as physician visits. 

However, a special chest X-ray given in a physician’s office or an outpatient clinic is considered 

to be a physician visit. 

Physician visits to hospital inpatients are not 

included. 

If a physician is called to the house to see 

more than one person, the call is considered to be 

a separate physician visit for each person about 

whom the physician was consulted. 

A physician visit is associated with the person 

about whom the advice was sought, even if that person did not actually see or consult the physician. 

51

For example, if a mother consults a physician 

about one of her children, the physician visit is 

ascribed to the child. 

Place of visit .—The place of visit is a classification of tlie types of places at which a physician 

visit took place. (See definition of’ ‘Physician visit.”) The definitions of the various categories are 

as follows: 

1.	 Home is defined as any place in which 

the person was staying at the time of the 

physician’s visit. It may be his own home, 

the home of a friend, a hotel, or any other place the person may be staying (except as an overnight patient in a hospital). 

2.	 Office is defined as the office of a physician in private practice only. This may 

be an office in the physician’s home, an 

individual office in an office building, or 

a suite of offices occupied by several physicians. For purposes of this survey, physicians connected with prepayment group 

practice plans are considered to be in 

private practice. 

3.	 Hospital clinic is defined as an outpatient 

clinic in any hospital. 

4. Company or industry health unit refers to 

treatment received from a physician or 

.	 under a physician’s supervision at a 

place of business (e.g., factory, store, 

office building). This includes emergency 

or first-aid rooms located in such places 

if treatment was received there from a 

physician or trained nurse. 

5.	 Telephone contact refers to advice given 

in a telephone call directly by the physician or transmitted through the nurse. 

6.	 Other refers to advice or treatment received from a physician or under a physician’s general supervision at a school, 

at an insurance office, at a health department clinic, or any other place at 

which a physician consultation might take 

place. 

Type of medical servicq.—A medical service 

is a service received when a physician is consulted. For the purposes of this survey, medical 

services have been categorized into several broad 

types. A single physician visit (see definition of 

“Physician visit”) may result in the recording of 

more than one type of medical service (though a 

particular type is not recorded more than once for 

any one physician visit). Tables showing physician 

visits classified by type of medical service therefore may add to more than the total number of 

visits. The definitions of the types of medical 

service are as follows: 

1.	 Diagnosis and treatment include (a) examinations and tests in order to diagnose 

an illness regardless of whether the examinations and tests resulted in a diagnosis, and (b) treatment or advice given 

by the physician or under the physician’s 

supervision. The category includes diagnosis alone, treatment alone, and both 

combined. X-rays either for diagnostic 

purposes or for treatment are included 

in this class. 

2.	 Prenatal and posmatal care include consultations concerning the care of the 

mother during pregnancy and in the postpartum period. It excludes consultations 

for illnesses not related to pregnancy or 

delivery. 

3.	 General checkup includes checkups for 

general purposes and also those for specific purpose, such as employment or 

insurance. If a diagnosis or diagnoses 

are made in the course of a general checkup, the physician visit is classified to 

“Diagnosis and treatment” as well as to 

“General checkup.” If the consultation is 

for checking up on a specific condition, 

as, for example, when a person goes at 

regular intervals for a check on a tuberCU1OUSor heart condition, this is classified as “Diagnosis and treatment” and 

not as “General checkup.” 

4.	 Immunization/vaccination includes this 

preventive service when provided by a 

physician or under a physician’s supervision. A physician service which is for 

the sole purpose of receiving immunization against a particular disease given 

at the same time and place that many 

other persons are receiving the identical 

immunization is excluded because” of the 

rule for exclusion of such services in the 

definition of a physician visit. 

52 
5.	 Eye examination refers only to the examination of the eyes by a doctor of medicine or an osteopathic physician for the 

purpose of establishing a need for glasses 

or a change in the type of glasses. Other 

diagnosis or treatment of eye conditions 

is classified under “Diagnosis and treatmerit. ” 

6.	 Other includes specific preventive-care 

services (such as vitamin injections) 

not embraced by the above type-of-service categories. Also included are all 

visits where an unknown type of service 

was reported. 

Interval since last physician visit.—The interval since the last physician visit is the length 

of time prior to the week of interview since a physician was last consulted in person or by telephone 

for treatment or advice of any type whatsoever. 

(See definition of “Physician visit.”) 

The interval M recorded as under 6 months, 

6-12 months, the last complete year, or never. 

Routine physical examination.—A routine 

physical examination is defined as an examination 

into the general health of a child under 17 years 

old. A routine physical examination would include 

such things as checking weight and height, hearing 

and seeing ability, heart, lungs, etc., depending on 

the age of the child. 

Visits of children to the doctor for “shots” or 

vaccination only are not counted as routine physical examinations. 

Visits of children to the doctor for a particular illness condition, for example, a child going 

at regular intervals for a check on a tuberculous 

or allergic condition, are not classified as routine physical examinations. 

‘Services of certain medical specialists or 

practitioners .—A service from a medical specialist or practitioner is the service received when 

the medical specialist or practitioner is consulted. 

The service is recorded each time a member of 

the household is reported to have consulted a 

medical specialist or practitioner during the 

12-month period prior to the interview week. 

If two or more different specialists of the same 

type are seen, a record is made of the combined total of the number of times each is seen. 

For the purpose of the survey, the doctor 

who is a medical specialist must limit his 

practice to the speciality involved. Doctors who 

do not qualify to use the specialist name but 

limit their practice to the specialty involved, if 

so indicated by the respondent, are counted as 

specialists. 

Dental Care Terms 

Dental visits .—Each visit to a dentist’s 

office for treatment or advice is considered to 

be a dental visit. The visit may involve services 

provided directly by the dentist or by a technician 

or a dental hygienist acting under a dentist’s 

supervision. Services provided while a person 

was a patient in a hospital for overnight or longer 

are not considered to be dental visits. 

Type of dental service.—A dental service is 

a service received when a dentist or dental hygienist is visited. For purposes of this survey, dental services have been categorized into a number 

of broad types. If a single dental visit involves 

more than one type of dental service, each type of 

service is recorded. If a particular type of service is rendered more than once during a single 

visit, the type of service is nevertheless recorded 

only once. For example, if during a single dental 

visit, 1 tooth is extracted and 3 teeth are filled, 

the types of services rendered during that visit 

are recorded as “Extractions” and “Fillings,” 

each category being recorded only once. The categories of types of dental services are defined 

as follows: 

1.	 Fillings include temporary fillings, permanent fillings, inlays, crowns, and similar procedures. 

2.	 Extractions (or other surgery) include any 

dental surgery and related activity such as 

removal of stitches. 

3.	 Cleaning teeth includes all forms of dental prophylaxis. 

4.	 Examination includes checkup, consultation, and X-rays. 

5.	 Denture work includes taking impressions for false teeth, plate fitting or repair, and bridgework. 

6.	 Straightening includes orthodontic treatment and brace work and also fitting or 

repair of braces. 

53 
7. Gum treatment includes all periodontal 

work, except prophylaxis. 

8. Other includes all types of dental service not listed above. 

Interval since last dental visit.—The interval 

since the last dental visit is the length of time 

prior to the week of interview since a dentist or 

dental hygienist was last visited for treatment or 

advice of any type whatsoever. 

Edentulous persons.— Persons who have lost 

all of their permanent teeth or who have a congenital absence of permanent teeth are classed as 

edentulous persons. An edentulous person may 

have dentures but does not have any natural teeth. 

Terms Relating to Health Insurance 

Coverage 

Health insurance is any plan specifically designed to pay all or part of the medical or hospital expenses of each insured individual in the 

household. The insurance can be either a group 

or an individual policy’ with the premiums paid 

by the individual, his employer, a third party, or 

a combination of these. Benefits received under 

the plan can be in the form of payment to the 

individual or to the hospital or doctor. However, 

the plan must be a formal one with defined membership and benefits rather than an informal one. 

For example, an employer simply paying the hospital bill for an employee would not constitute a 

health insurance plan. 

For the National Health Survey, health insurance excludes the following kinds of plans: (1) 

plans limited to the “dread diseases,” such as 

cancer and polio; (2) free care such as public assistance or public welfare, care given free of 

charge to veterans, care given to dependents of 

military personnel (Medicare), care given under 

the Crippled Children or similar programs, and 

care of persons admitted for research purposes; 

(3) insurance which pays bills only for accidents, 

such as liability insurance held by a car or property owner, insurance that covers children for 

accidents at school or camp, a+ insurance for a 

worker that covers him only for accidents on the 

job; and (4) insurance which pays only for loss of 

income. 

Kind of Coverage 

For the National Health Survey, the three 

forms of health insurance are as follows: 

Hospital. —Insurance which pays all or part 

of the hospital bill for the hospitalized person. By 

hospital bill is meant only the bill submitted by 

the hospital itself, not the doctor’s or surgeon’s 

bill or the bill for special nurses. Such a bill always includes the cost of room and meals and 

may also include the costs of other services such 

as operating room, laboratory tests, and X-rays. 

(See definitions of “Hospital bill” and “Hospital 

Insurance,” as listed under the “Terms Relating 

to Hospitalization”.) 

Surgical. -Insurance which pays in whole or 

part the bill of the doctor or surgeon for an 

operation whether performed in a hospital or in 

the doctor’s office. Insurance which pays the costs 

of visits to a doctor’s office for postoperative 

care is included as surgical insurance. 

Doctor visit. —Insurance which pays the doctor’s bill for nonsurgical care whether or not it 

pays for surgical care. Policies must cover home 

and office calls, special diagnostic examinations, 

or other nonsurgical medical services. Insurance 

which covers only for surgery, or only for inhospital visits by the doctor is not included in 

most types of home and office services. 

Classification of type of insuring organization .—Interview responses are divided into two 

categories, Blue Plan and other. 

Blue Plan .—Any plan which the respondent 

said was Blue Cross, Blue Shield, or which appeared in the Blue Cross Guide published by the 

Blue Cross Commission was coded as a Blue Plan. 

—* Other —All names of plans which were not ineluded above were coded as other..For the most 

part these were private insurance companies but 

this category also includes independent prepayment plans such as the Health Insurance Plan of 

Greater New York and the Kaiser Foundation 

Health Plan. 

Terms Relating to Special, Aids 

Special aid .—A special aid is a device used 

to compensate for defects resulting from disease, 

injury, impairment, or congenital malformation. 

54 
Aids included are hearing aids, wheel chairs, 

braces, and artificial limbs. Information isrecorded about special aids even though the persons 

possessing them do not use them. 

1.	 Hearing aid is defined as any kind of mechanical or electrical device used to improve hearing. 

2.	 Wheel chair is any device stated by the 

respondent to be a wheel chair, but excluding wheeled’ ‘walkers” and nonwheeled 

devices for support. 

3.	 Brace is defined as any kind of supportive 

device for the arms, hands, legs, feet, 

back, neck, or head, exclusive of temporary casts, slings, bandages, trusses, 

belts, or crutches. Dental braces are 

also excluded. 

4. Artificial limb is a device used to replace 

a missing leg, arm, hand, or foot. It does 

not have to have moving parts, but a device employed only for lengthening a leg 

where the whole leg and foot is present is 

not included. 

Use of special aid.—lhe frequencyof use of a 

special aid was recorded as reported by the respondent in terms of “all of the time, ” “most of 

the time,” “occasionally, “ or “never used now. ” 

When necessary, it was explained that these terms 

referred to the times when a person possessing 

such a device would ordinarily be expected to use 

it, such as during the waking hours and under the 

circumstances that would normally require it. 

Terms Relating to Persons Receiving 

Personal Care at Home 

Personal care at home is family help or 

nursing care provided part time or full time in 

the person’s own home either by members of the 

household, other relatives, friends, persons hired 

for the service, or by charitable or public agencies. Usual care required by infants is not included as nursing care. 

Constant care means the person could not be 

left alone, in that someone must always be in attendance or within call. 

Part-time care means that the person could 

not get along without help during certain times or 

with certain activities, such as dressing, eating, or 

getting into a chair. 

Duration of care is the number of months or 

years that the person has required continuing 

nursing care whether on a constant or part-time 

basis. 

Person providing care.—A “household member” providing help or nursing care is a person 

who is a member of the interviewed household. 

“Other relative” is a related person living outside of the household. “Trained nurse” is a private registered nurse, public health nurse, or 

visiting nurse. If a trained nurse who is a 

member of the household provides the care it is 

recorded as “trained nurse” rather than household member. “Practical nurse” includes persons 

called a nurse by the respondent but not stated to 

be a “trained nurse. ” 

“Other” includes friends and also persons 

employed only to sit with the person requiring care. 

Length of time under care.— For a person 

currently under care the length of time was recorded as the the total time that he had required 

full or part-time care on a continuous basis. If 

there were periods during which no care was required, only the last uninterrupted period was to 

be counted. 

Terms Relatihg to X-rays 

X-ray visit .—An X-ray visjt is defined as a 

visit by a person to a physician’s office, dentist’s 

office, hospital, mobile X-ray unit, Public Health 

Department, etc., during the course of which Xray equipment is used for diagnosis or treatment. 

X-ray includes X-ray film photography and X-ray 

emission for treatment and fluoroscope, but excludes the use of radioisotopes. Only one visit is 

counted each time the person is x-rayed, regardless of the number of X-ray films exposed 

or the number of ports used. However, statistics are collected for each of the separate areas 

of the body toward which X-rays have been emitted 

(see below). 

An X-ray visit is counted each time the person visits a facility for X-rays during the reference period. Hence, one person may be included 

in the statistics more than once. However, if 

several areas of the body are x-rayed during 

a single visit, only one X-ray visit is recorded. 

The term X-ray visit is used synonymously with 

“person-” event in other National Health Survey 

statistics, e.g., person-day. 

55 
Statistics are prepared separately for dental 

X-ray visits and medical X-ray visits, i.e., other 

than dental. A dental X=ray visit is defined as an 

X-ray usually taken in a dentist’s office for 

the primary purpose of studying the condition 

or formation of the teeth. If an X-ray of the 

teeth or jaw is taken in a hospital or clinic 

primarily for dental purposes, it is counted 

as a dental X-rav. 

Place of X~ra ye—The place of X-ray is a 

classification of the types of places at which an 

X-ray visit (other than dental) took place. Place 

of X-ray is not recorded for dental X-ray visits. 

‘Ihe definitions of the three categories are as 

follows: 

1.	 Hospital is defined as the place at which 

X-rays were received while an inpatient 

in the hospital and also X-rays received 

as an outpatient at a hospital clinic. 

2.	 Doctor’s office is defined as the office of 

any doctor who has his own X-ray equipment, or the office of a radiologist. 

“Doctor’s office t1 also includes clinics 

run by a group of doctors if the clinic 

provides X-ray services. 

3. O-r is defined as places other thanhospitals or doctors’ offices at which X-ray 

services are provided. For example, such 

places include schools, mobile units, Public Health Departments, etc. 

Type of service. —X-ray service is classified as diagnosis or treatment. Diagnosis is defined as X-rays for checkup or examination using 

X-ray or fluoroscopic procedures to determine 

the presence, absence, or state of a disease or 

condition. X-rays for treatment are X-rays used 

in treating a condition which has already been 

diagnosed. 

Body areas,—For each X-ray other than dental, the areas of the body to which the X-rays are 

directed is classified in one of six categories, as 

follows: 

1.	 Head and neck is defined as that portion of 

the body, exclusive of skin covering only, 

above the trunk. 

2.	 C- is defined as that portion of the 

trunk above the diaphragm including the 

shoulder. 

3.	 Upper abdomen is defined as that portion 

of the body between the diaphragm and the 

transverse colon. 

4.	 Lower abdomen is defined as the remainder of the trunk including the hip. 

5.	 Extremities are defined as the hands and 

arms exclusive of the shoulders, and the 

feet and legs exclusive of the hip. 

6.	 Skin is defined as the outer covering of the 

=y. X-rays of the skin only are excluded from categories 1-5. 

Terms Relating to Personal Health 

Expenditures 

Expenditures for medical and dental care.— 

‘Ihese are the total expenditures for medical and 

dental care for a person during a specified 12-

month period. The National Health Survey collects 

the data for each member of a household in the 

Survey sample for the specified 12-month period. 

The total expenditures are defined as all bills 

paid (or to be paid) for medical and dental care by 

the person himself, his family or friends, and any 

part paid by health insurance. This is included 

whether it is paid directly to the hospital or 

doctor, or paid to the person himself, or to his 

family. If a respondent does not know the exact 

amount paid by insurance, he is requested to estimate it and include it in the total bill. 

For the National Health Survey, expenditures 

for medical and dental care exclude amounts paid 

(or to be paid) by: workmen’s compensation, 

nonprofit -organizations, military services including Medicare, Veterans Administration, and 

by Federal, State, city, or county governments. 

If a baby is born in the household during the 

specified 12-month period, the hospital and doctor bills relating to the baby’s birth are included 

in medical expenditures for the mother. However, 

all other medical expenditures relating to the 

baby’s health are counted in the medical expenditures for the baby. 

‘l%ere are six categories of personal health 

expenditures for medical and dental care as 

follows: 

1.	 Doctors’ bills. —lloctors’ bills are defined as the total bills paid (or to be 

paid) for medical care to doctors, including surgeons, for a person during the 

specified 12-month period. Such bills include costs of operations, treatments, 

checkups, deliveries, pregnancy care, 

X-rays, laboratcm-y fees, eye exanina­

> 

56 
tions, immunizations or shots, and any 

other doctors’ services provided for the 

patient. 

2.	 Hospital bills. —Hospital bills are the total 

expenditures paid (or to be paid) for 

hospitalizations of a person during the 

specified 12-month period. Only ~ospitalizations for overnight or longer in a 

hospital (nursing home, rest home, sanitarium, etc.) are counted. Hospital bills 

include costs of room and board, operating and delivery room, anesthesia, special treatments, X-rays, tests, and any 

other services provided and billed for by 

the hospital. 

3.	 Medicine costs .—Medicine costs are total 

expenditures paid (or to be paid) for 

medicine for a person during the specified 12-’fnonth period. The total expenditures for medicine include the costs of all 

kinds of medicine whether or not prescribed by a doctor, such as tonics, pills, 

prescriptions, salves, ointments, vitamins, and any other medicine. But health 

foods, soaps, cosmetics, and similar 

preparations are excluded. 

4.	 Dentists’ bills .—Dentists’ bills are defined as the total bills paid (or to be paid) 

for dental care for a person during the 

specified 12-month period. Dentists’ bills 

include cost of fillings, extractions, cleanings, X-rays, bridgework, dental plates, 

straightening of teeth, and any other dental 

services. 

S.	 Special medical expenses .—Special medical expenses paid (or to be paid) for a 

person during the specified 12-month 

period include costs of the following: 

eye glasses, hearing aids, special nursing, 

physical therapy, speech therapy, corrective shoes, chiropractors’ fees, and 

special braces or trusses, wheel chairs, 

or artificial limbs. 

6.	 Other medical expenses .-All medical expenses for a person during the specified 

12-month period not included above are 

classified as other. For example, emergency or outpatient treatment in a hospital 

or clinic would be classified as other. 

Demographic, Social, and Economic Terms 

~—The age recorded for each person is 

the age at last birthday. Age is recorded in 

single years and ‘grouped in a variety of distributions depending upon the purpose of the table. 

Race. —Race is recorded as ‘White,” 

“Negro,” or “Other. “ “Other” includes American 

Indian, Chinese, Japanese, and so forth. Mexican 

persons are included with “White” unless definitely known to be Indian or another nonwhite 

race. 

Birthplace.-The place of birth is the State 

of birth of persons born in the United States, or 

the country or the territory of birth of those born 

outside the United States. The place of birth is 

the place where the person’s parents were living 

at the time of his birth, not the location of the 

hospital or other address at which the birth may 

actually have taken place. The place of birth is 

recorded in terms of the present boundaries 

rather than the boundaries as they were defined 

at the time of birth. For example, a person born 

in Serbia would be recorded as having been born 

in “Yugoslavia.” 

Household Composition 

3?WY” —This term refers to a group of two 

or more persons related by blood, marriage, or 

adoption who are living together in the same 

household. Although the usual household contains 

only the primary family, a household can contain 

secondary families as well as individuals unrelated to the family. A lodger and his family who 

are not related to the head of the household, or a 

resident employee and his wife are considered a 

secondary family and not a part of the primary 

family. However, if the son of the head of the 

household and the son’s wife and children are 

members of the household, this subfamily is 

treated as part of the primary family. “fhe definitions of primary and secondary families are 

the same as those used in the 1960 Census. 

Head of family is usually the person regaraed 

as the “head” by the members of the group. 

Married women are never classified as heads 

if their husbands are living with them at the 

time of the survey except when the husband is 

a member of the Armed Forces. Only one 

57 
person in each family can be designated as the 

head. Therefore, the number of heads of 

families is equal to the number of families. 

Other family members are all persons who 

are related to the head of the family by blood, 

marriage, or adoption. 

Individuals are persons (other than inmates of 

institutions) who are not living with any relatives. An unrelated individual can be (a) a 

household head living alone or with nonrelafives, (b) a lodger or resident employee with 

no relatives in the household, (c)a staff member of an institution who has no relatives 

living with him, or (d) a resident of a dormitory, lodging house, or other shared-residence facility who has no relative living with 

him. The definitions of primary and secondary 

individuals are the same as those used in 

the 1960 Census. 

Marital status .-Marital status is recorded 

only for persons 17 years of age or older. ‘l’he 

marital status categories are as follows: 

—— Under 17 includes all persons aged 0-16 regardless of. their marital status. 

Married includes all married persons not 

separated from their spouse because of 

marital discord. Persons with common-law 

marriages are considered to be married. 

Never married includes persons who were 

never married and persons whose only marriage was annulled. 

Other includes persons who are widowed, divorced, legally separated, and persons separated because of marital discord. 

Living arrangements .—Living arrangement 

defines the individual’s relationship to other 

persons within the same household. The definition of living arrangements consists of categories as follows: 

Living alone - refers to persons living in a


one-member household.


Living with nonrelatives - denotes persons


living in a household with another person or


persons, none of whom are related to him by


blood, marriage, or adoption.


Living with relatives—married - describes


married persons who are living in a house-


hold with another person or persons, of whom


one or more are related to him by blood,


marriage, or adoption.


Living with relatives—other - refers to 

persons who are widowed, divorced, separated, or never married living in a household with another person or persons, of whom 

one or more are related to him by blood, 

marriage, or adoption. 

This classification is constructed from combined data on household composition, family relationship, and marital status. Thus it is possible 

to separate those living alone, or with nonrelativies, or with relatives. Those living with rela~ives can be further classified by whether they 

are married and living with a spouse. 

Education .—Each person age 17 or older is 

classified by education in terms of the highest 

grade of school completed. Only grades completed 

in regular schools, where persons are given a 

formal education, are included. A “regular” school 

is one which advances a person toward an elementary or high school diploma, or a college, 

university, or professional school degree. Thus, 

education in vocational, trade, or business schools 

outside the regular school system is not counted in 

determining the highest grade of school completed. 

Each member of a family is classified according to the education of the head of the family 

of which he is a member. Within the household all 

persons related to each other by blood, marriage, 

or adoption constitute a family. Unrelated individuals are classified according to their own 

education. 

Income of family or of unrelated individuals.— 

Each member of a family is classified according 

to the total income of the family of which he is a 

member. Within the household all persons related 

to each other by blood, marriage, or adoption constitute a family. Unrelated individuals are classified according to their own income. “ 

The income recorded isthe total of all income 

received by members of the family in the 12-

month period prior to the week of interview. Income from all sources is included, e.g., wages, 

salaries, rents from property, pensions, help from 

relatives, and so forth. 

Veteran status.— In order to establish veteran 

status, information is secured concerning service 

in the Armed Forces. The information is obtained 

only for males 17 years of age and over. The categories of service in the Armed Forces include the 

58 
following: no military service, peacetime service 

only, World War I service, World War II service, 

Korean conflict service, and military service, 

period unknown. 

Service in the Armed Forces means active 

duty for any period of time in the U.S. Army,Navy 

Air Force, Marine Corps, or Coast Guard. Peacetime service in the Merchant Marine, in a National Guard unit, or in active reserve training is 

not considered to be service in the Armed Forces. 

If a man has served in more than one war, he 

is classified according to the latest war in which 

he served. 

When males 17 years of age and over are 

grouped into two classes,veterans andnonveterans 

men with peacetime service only are included,with 

those having no military service as nonveterans, 

Usual. activity status .—All persons in the 

population are classified according to their usual 

activity status during the 12-month period prior 

to the week of interview. The “usual” activity 

status, in case more than one is reported, is the 

one at which the person spent the most time during..— the 12-month period. Children under 6 years of 

age are classified as “preschool.” AH persons 

aged 6-16 years are classified as “school age. ” 

The categories of usual activity status used 

for persons aged 17 years and over are: usually 

working, usually keeping house, retired, and other. 

For several reasons these categories are not comparable with somewhat similarly named categories in official Federal labor force statistics. 

First, the responses concerning usual activity 

status are accepted without detailed questioning, 

since the objective of the question is not to estimate the numbers of persons in labor force categories but to identify crudely certain population 

groups which may have differing health problems. 

Second, the figures represent the usual activity 

status over the period of an entire year, whereas 

official labor force statistics relate to a much 

shorter period, usually 1 week. Third, the minimum age for usually working persons is age 17 

in the National Health Survey and the official 

labor force categories include all persons age 14 

or older. Finally in the definitions of specific 

categories which follow, certain marginal groups 

are classified differently to simplify procedures. 

Usually working includes persons 17 

years of age or older who are paid employees; self employed in their own business, 

profession, or in farming; or unpaid employees in a family business or farm. Work 

around the house, or volunteer or unpaid 

work, such as for a church, etc., is not 

counted as working. 

Usually keeping house includes female 

persons 17 years of age or older whose 

major activity is described as “keeping 

house” and who cannot be classified as 

“working.” 

Retired includes persons 45 years old 

or over who consider themselves to be retired. In case of doubt, a person 45 years of 

age or older is counted as retired if he, or 

she, has either voluntarily or involuntarily 

stopped working, is not looking for work, and 

is not described as “keeping house.” A retired person may or may not be unable to 

work. 

- in this report includes males 17 

years of age or older not classified as 

“working” or “retired” and females 17 years 

of age or older not classified as “working,” 

“keeping house ,“ or “retired.” Persons aged 

17 years and over who are going to school 

are included in this group. 

The labor force.— This includes all persons 

17 years of age and older who worked at or had 

a job or business or were looking for work during 

the 2-week period prior to week of interview. The 

labor force consists of persons currently employed and those unemployed as defined below. 

Currently employed describes persons 

17 years of age or over who reported that 

at anytime during the 2-week period covered 

by the interview they either worked at, or 

had a job or business. Current employment 

includes paid work as an employee of someone else, self-employment in business, farming, or professional practice, and unpaid 

work in a family business or farm. Persons 

who were temporarily absent from their job 

or business because of a temporary illness, 

vacation, strike, or bad weather are considered as currently employed if they expected to work as soon as the particular 

event causing their absence no longer existed. 

Free-lance workers are considered as currently employed if they had a definite arrangement with one or more employers to work for 

pay according to a weekly or monthly schedule 

59 
either full time or part time. Excluded from the 

currently employed are such persons who have 

no definite employment schedule but work only 

when their services are needed. 

Persons excluded from the currently employed population are (1) persons receiving revenue from an enterprise in whose operation they 

do not participate, (2) persons doing housework 

or charity work for which they receive no pay, 

and (3) seasonal workers during the portion of 

the year they were not working. 

Old definition.— In National Health Survey reports dealing with employment data 

issued prior to the report, Series 10, Number 

7, persons who did not work during the 2-

week period prior to week of interview, or 

who had a job or business though on layoff 

or looking for work were included in the currently employed population. 

New definition.— In Series 10-7 and subsequently, persons who did not work during 

the 2-week period prior to week of interview, 

or who had a job or business though on layoff or looking for work were excluded from 

the currently employed population, and considered as unemployed. 

The number of currently emplqyed persons 

estimated by the National Health Survey (NHS) 

wifi differ from the estimates prepared by the 

current Population Survey (CPS), U.S. Bureau 

of the Census, for several reasons. In addition 

to sampling variability they include three primary conceptual differences, namely: (1) NHS 

estimates are for persons 17 years of age or 

over; CPS estimates are for persons 14 years 

of age or over. (2) NHS uses a 2-week-reference 

period, while CPS uses a l-week-reference period. (3) NHS is a continuing survey with separate 

samples taken weekly, while CPS is a monthly 

sample taken for the survey week which includes 

the 12th of the month. 

Unemployed describes persons 17 years and 

over who did not work, had no job or business, 

but were looking for work; or persons with a 

job but on layoff or looking for work during 

the 2-week period prior to the interview. 

Occupation. —A person’s occupation may be 

defined as his principal job or business. For the 

purposes of this survey, the principal job or 

business of a respondent is defined in one of the 

following ways. If the person worked during the 

2-week-reference period of the interview, or had 

a job or business, the question concerning his 

occupation (or what kind of work he was doing) 

applies to his job during that period. If the respondent held more than one job, the question is 

directed to the one at which he spent the most 

time. But, it refers to the one he considers most 

important when equal time is spent at each job. A 

person who has not begun work at a new job, is 

looking for work, or on layoff from work is 

questioned about his last full-time civilian job. 

A full-time job is defined as one at which the 

person spent 35 or more hours per week and which 

lasted 2 consecutive weeks or more. Aperson who 

has a job to which he has not yet reported, and 

has never had a previous job or business, is 

classified as a “new worker. ” 

Industr y.—The industry in which a person 

was reportedly working was classified by the 

major activity of the establishment in which he 

worked. 

The only exceptions to the above are those 

few establishments classified according to the 

major activity of the parent organization and 

they are as follows: laboratories, warehouses, 

repair shops, and storage. 

Quarter .—The quarters used by the National 

Health Survey are actually 13-week periods 

rather than 3 calendar months. Since each 13-

week period begins on a Monday and ends on a 

Sunday, the actual dates of the beginning and; 

end of each 13-week period may overlap into 

another calendar quarter. Therefore, the time 

periods in the table headings are the approximate 

rather than the precise periods during which the 

interviewing was conducted. 

Work days in each quarter.—The quarters 

used by the National Health Survey are actually 13-week periods rather than 3 calendar 

months. In order to compute the number of persons 

absent from work each day, the assumption is 

made that there are 245 work days in the year 

or 61.25 work days in each quarter. 

Location of Residence Terms 

Urban and rural residence for fiscal years 

1958-62 .—The definition of urban and rural areas 

60 
-----

. 

Iused in the National Health Survey during fiscal 

years 1958-62 was the same asthatused in the 

1950 Census. 

Urban and rural residence for fiscal years 

1963 et seq .—The definition of urban-rural areas 

now used in the National Health Survey is the 

same as that used in the 1960 Census. According 

to this definition, the urban population comprises 

all persons living in (a) places of 2,500 inhabitants 

or more incorporated as cities, boroughs, villages, and towns (except towns in New England, 

New York, and Wisconsin); (b) the densely settled 

urban fringe, whether incorporated or unincorporated, of urbanized areas (see below); (c) towns in 

New England and townships in New Jersey and 

Pennsylvania which contain no incorporated municipalities as subdivisions and have either 25,000 

inhabitants or m:re, or a population of 2,500 to 

25,000 and a density of 1,500 persons or more 

per square mile; (d) counties in States other than 

the New England States, New Jersey, and Pennsylvania that have no incorporated municipalities 

within their boundaries and have a density of 

1,500 persons of more per square mile; and (e) 

unincorporated places of 2,500 inhabitants or more 

not included in any urban fringe. The remaining 

population is classified as rural. 

Size of place. —The urban population is classified as living in urbanized areas or in urban 

places outside urbanized areas. An urbanized 

area, according to the 1960 Census definition, 

contains at least one city which had 50,000 inhabitants or more in 1960 as well as the surrounding closely settled incorporated places and 

unincorporated areas. 

The remaining urban population is classified 

as living in urban places outside urbanized areas. 

These urban places may be grouped according to 

size. 

Farm and nonfarm residence for fiscal years 

1958.62.—The rural population may be subdivided 

into the rural-farm population, which comprises 

all rural residents living on farms, and the ruralnonfarm population, which comprises the remaining rural population. 

“ In determination of whether the members of a 

household resided tm a farm or a ranch (fiscal 

years 1958-62), the statement of the household 

respondent that the house was on a farm or ranch 

was accepted, with the following exception. Ahouse 

occupied by persons who. paid cash Kent for house 

of a tenant farmer who rented farm land as well 

as house and yard; (2) the quarters of a hired 

hand who received living quarters on a farm as 

part of his compensation; or (3) separate living 

quarters inside a structure which was classified 

as on a farm. In all these cases fie living quarters 

were counted as on a farm. Furthermore, all persons in institutions, summer camps, motels, and 

tourist camps which were located in farm ?reas 

were classified as nonfarm. The remaining rural 

population not classified as “rural farm” was 

classified as “rural nonfarm. ” 

Farm and nonfarm residence for fiscal years 

1963 et seq .—The rural population may he subdivided into the rural-farm population, which comprises all rural residents living on farms, and the 

rural-nonfarm population, which comprises the 

remaining rural population. The farm population 

includes persons living in rural territory on 

places of 10 or more acres from which sales of 

farm products amounted to $50 or more during 

the previous 12 months or on places of less than 

10 acres from which sales of farm products 

amounted to $250 or more during the preceding 

12 months. Other persons living in rural territory 

were classified as nonfarm. Persons were also 

classified as nonfarm if their household paid rent 

for the house but their rent did not include any 

land used for farming. 

Standard metropolitan statistical areas.—The 

definitions and titles of standard metropolitan statistical areas (SMSA) are established by the U.S. 

Bureau of the Budget with the advice of the Federal 

Committee on standard metropolitan statistical 

areas. A number of the largest SMSA’S are included in the National Health Survey places 

of residence for which data may be provided. 

Region.— For the purpose of classifying the 

population by geographic area, the States are 

grouped into four major regions. These regions, 

which correspond to those used by the Bureau of 

the Census, are as follows: 

Region States Included 

Northeast	 Maine, New Hampshire, Vermont, 

Massachusetts, Rhode Island, 

Connecticut, New York, 

New Jersey, Pennsylvania 

61 
North Central- Michigan, Ohio, Indiana, Illinois, Georgia, Florida, Kentucky, Texas, 

Wisconsin, Minnesota, Iowa, Tennessee, Alabama, Mississippi, 

Missouri, North Dakota, Arkansas, Louisiana, Oklahoma 

South Dakota, Nebraska, Kansas West --------- Montana,, Idaho, Wyoming, 

South -------- Delaware, Maryland, District of Colorado, New Mexico, Arizona, 

Columbia, Virginia, West Virginia, Utah, Nevada, Alaska, Washington, 

North Carolina, South Carolina, Oregon, California, Hawaii 

000


62 
INDEX TO TERMS DEFINED 

Accidents, 47-49 Cannot get around alone, 47 

class of, 47-48 Care 

farm, 48 constant, 55 

home, 48 duration of, 55 

motor-vehicle, 47 length of time under, 55 

“other,” 48 part-time, 55 

place of, 48-49 person providing, 55 

place of recreation, 49 personal, 55 

school, 48 prenatal and postnatal, 52 

type of, 49 still under, 44 

work, 48 Checkup, general, as type of medical 

Activities, persons not limited in, 47 service, 52 

Activity Chest, as site for X-ray, 56 

chronic limitation of, 46-47 Chronic 

major activity limitation, 46-47 

persons limited in amount or kind condition, 42 

of, 46 conditions, persons with$ 42 

persons not limited in but otherwise effect of injury, 43 

limited, 46 mobility limitation, 47 

persons unable to carry on, 46 Cleaning teeth, 

restricted, average number of persons as type of dental service, 53 

with, 46 Company or industry health unit, as place of 

restricted, day of, 45 physician visit, 52 

restricting condition, 44 Condition, 42 

usual, status, 59 activity-restricting, 44 

Acute condition, 42 acute, 42 

Admission, hospital, 50 

Age, 57 

bed-disabling, 44 

chronic, 42 

hospitalized, 43 

injury, 43 

medically attended, 44 

onset of, 43 

Bed-disability persons with chronic, 42 

condition-days of, 45 Condition-days of restricted-activity, bedday, 45 disability, etc., 45 

person days of, 46 Conditions 

Bed-disabling condition, 44 incidence of, 43 

Birthplace, 57 prevalence of, 44 

Blue Plan, Confined to the house, 47 

as type of insurance coverage, 54 Convalescence after surgery, 50 

Body areas. as site for X-ray, 56 Currently employed, 59 

63 
Day


bed-disability, 45


hospital, 50


restricted-activity, 45


school-loss, 45


work-loss, 45


Days piir year, hospital, 50


Dental service, types of, 53


Dental visits, 53


interval since last, 54


Dentists’ bill, 57


Denture work, 

as type of dental service, 53


Diagnosis, as type of medical service, 52


Disability, 45


long-term, 46


Discharge, hospital, 50


Doctor visit, 54


Doctors’ bill, 56


Doctor’s office,


as place of X-ray, 56


Duration of care, 55


Edentulous persons, 54


Education, 58


Effect of injury, chronic, 43


Episode, hospital, 49


Examination,


eye, 53


routine physical, 53


Expenditures for medical and dental


care, 56


Expenses


other medical, 57


special medical, 57


Extractions, as type of dental


servicej 53


Extremities, as site for X-ray, 56


Eye examination, 53


Family, 57


head of, 57


income, 58


other members, 58


Farm,


as place of accident, 48


Farm and nonfarm residence, 61


Fillings, as type of dental service, 53


General checkup, as type of medical


service, 52


Geographic regions, and States


included, 61


Gum treatment, as type of medical


service, 54


Has trouble getting around alone, 47


Head and neck, as site for X-ray, 56


Health unit, company or industry,


as place of physician visit, 52


Home


accident, 48


physician visit, 52


Hospital


admission, 50


bill, 50, 57


clinic, as place of physician visit, 52


day, 50


days per year, 50


definition, 49


discharge, 50


episode, 49


insurance, 51


length of stay, 50


length of postoperative stay, 50


number still in, 50


ownership, 49


place of X-ray, 56


short-stay, 50


type of service, 49


Hospitalized condition, 43


Immunization, as type of medical 

service, 52


Impairment, 43


Incidence of conditions, 43


Income, family, 58


Industrial place, accident, 48


Industry or company health unit, as place of


physician visit, 52


Industry, as place of employment, 60


Injured person, 47


Injury


chronic effect of, 43


condition, 43


64

Insurance


hospital, 51


proportion of bill paid, 51


type of coverage, 54


Insuring organization, classification of


type of, 54


Interval since last


dental visit, 54


medical consultation for a condition, 44


physician visit! 51


Keeping house, as usual activity, 59


Labor force, 59


Length of hospital stay, 50


Average length of hospital stay, 50


Length of time “waler care, 55


Length of postoperative hospital


stay, 50


Limitation


of activity, 46-47


of mobility, 46-47


Living alone, 58


Living arrangements; 58


Living with nonrelatives, 58


Living with relatives —married, 58


Living with relatives—other, 58


Major activity: see chronic activity limitation


Marital status, 58


Medical consultation, interval since last


for a. particular condition, 44


Medical service, type of, 52


Medically attended condition, 44


Medicine costs, 57


Motor-vehicle


accident, 47


moving, 47


nonmoving, 48


Not limited in


activities, 47


major activity, 46


mobility, 47


Number still in hospital, 50


Occupant of moving motor vehicle, 48


Occupation, 60


Office


of physician, definition, 52


place of visit, 52


Onset of condition, 43


Operation, surgical, 50


“Other,” as


class of accident, 49


family members, 58


insurance coverage, 54


marital status, 58


place of physician visit, 52


place of X-ray, 56


preventive care services, 53


type of


dental service, 54


medical service, 53


usual activity, 59


usual activity statue, 59


Person-days of restricted-activity, bed-


disability, etc., 46


Personal care at home, 55


constant care, 55


part-time care, 55


Persons


edentulous, 54


injured, 47


limited in amount or kind of activity, 46


not limited in activities, 47


not limited in major activity, 46


unable to carry on major activity, 46


with chronic conditions, 42


with restricted-activity, average


number of each day, 46


persons providing care, 55


Place, size of, 61


Physician visit,


interval since last, 53


place of, 52


Prenatal and postnatal care, as type


of medical service, 52


Prevalence of conditions, 44


Quarter, 60


65

Race, 57


Region, geographic, 61


Residence,


farm and nonfarm, 61


urban and rural, 61


terms relating to location of, 60-61


Restricted-activity


average number of persons with, 

by, 46


condition-days of, 45


day, 45


person days of, 46


Retired, as usual activity, 59


Routine physical examination, 53


School attendance, as usual activity, 59


School-loss &y, 45


Service,


type of dental, 53


type of hospital, 49-51


type of medical, 52


of certain medical specialists or 

practitioners, 53


Short-stay hospital, .50


Size of place, 61


Skin, as site for X-ray, 56


Special aid, 54


Standard metropolitan statistical areas, 61


Still under care, 44


Street or highway,


as place of accident, 48


Surgery, convalescence after, 50


Surgical, insurance coverage, 54


Surgical operation, 50


Teeth


cleaning of, as type of dental


service, 53


66


Teeth-Con. 

extraction of, as type of dental 

service, 53


filling of, as lype of dental 

service, 53


straightening of, as type of dental 

service, 53


Telephone contact, 52


Treatment as type of


hospital service, 49-51


medical service, 52


Unemployed, 60


Usual activity status, 59


Urban and rural residence, 60


Use of special aid, 55


Usually working, going to school, or


keeping house: see Activity, major 

categories of 

Vaccination, as type of medical service, 52


Veteran status, 58


Visit, dental, 53


Visit, physician, 51


Work


while at, class of accident, 48


Work days in each quarter, 60


Working, as usual activity, 59


Work-1oss day, 45


X-ray, as type of medical service, 52


place of, 56


visit, 55


* U. S. GOVERNMENT PRINT2NG OFFICE :1973 515-212/46 
.. 

ouT~mE OF REPORT SERIW fo~ VITAL AND HEALTH STATKTi4X ‘k 

Public ECWM Service Publication Nb. 1~00 .$$’ 

*RIM 1-4. @l NERAL SENI~; Prwgrantdepcrifitiona, metbodologicrd reeearoh, end ensf yticd studhs of vital -d hewltb statistics, . ~


Earlier repate ~f this kind tisve &ex?ed in “Vital Stetietice-Special Reports’ sad in “ESCM41 Stetiatic.s horn tbe”X4e#akal ‘kS&lI SOWW;RSeriS4


A snd D, PIE! Publication Ng. 584..,


Ssries 1:	 P~s .-d oolleotion prnt@ered.-Reporta which describe the gemerml~tia of the Nct@ooI COO*Ffos Eeeltb Mti”etioe eed ‘‘ 

M offices and divi r+ions, dqta oolleqion metbds ueedi definiti ms, and other mmtsrist necessaey fof aader~~% of tbc k~~­

cd obewcbxistioc of publi shad dBta. 

w	 D** ev~uatioe @ ,methods -sch. -Studies of new Bhtieticat metb&blW itmltrdieg: ~~m~~ tws~ of news- ~+ .: 

cd., stridies of vitsk’etatjsti’bs OO1leCtiOri mwtbods, new snslytiosl tonhniqnes; objective evshksths of r@isb41ity of ,ed~,dxte, , ,, 

oontribhtions to statMcsI theory. ,. ..,.,.. ” 

series 3: Anslyticel Studiee~~This ser& corhp&s re&t.s presenting arkl$iwel or hapretive stedkc bwecd omvital SDIIhh~tb eteth+ 

Series 4:	 ~urnenta and oommittse repxts .- Final reports of majnr commi~ss ooncptned with vitef cod h@tt at4stioe eod docurnep$w’ 

suCh qs reeotrwededed model vitsf registration laws and revised birfb ertd deqth .fxw$ificatee. 

~ER fES 10-1’4. DilTA FROM TEE NATIONAL HEAJ.J’THSURVIM 

Esrlier reporbt of tbe’kirid spp?dng ih Series 10 h4ve been’issrred ss “Health Statistics km the Natiocs4 &h ~,” Series B @ G & 

Publication No: 584. ,. 

Series 10: StAietics on illoeee, aocidatd injeriec, disability, use of hoepitel, medical, dental, md .othes cervices, @ c4bimhe~walkted . 

topics. bssed on dst+ orAleoted in the costiewipg Nationsl Health hterview.survwy. 

Series 11: Data from the IKslth Examination Srrwey be@ @ the direct examinetio% tWin& end tnseeurereqitof I@ti~ WOpl-, ~f *6’ ~, 

population of Ur?Utritfd Staten, including tbu medically defieed prevekmce of speoifkc diseuree, sad disWw4ioe0 ut the PoPeti* .’ .. tion with respeot to various phyeictt end pbyeiological measur&en4S; . ,“ ., 

Series 19: DatE from the ‘H@th Jteoords Survey reletiqg to ~e health chsr6cternstics of p6rsone in institutions, ad ra baepitd, m~cef 

nursing; snd personal cere reoeiveif, bssed 00 nstirnal samples of astsblishrnenta providiqg W?ae eerviaes and aetpphe of the 

residents of petiente, or of reoords of the esteblishrninrt.a. ,.. , 

SERIES 20+!8. DATA ,FROMTHE$ATKINAL VITAL STATf~CS SYSTEM 

Eerfier reportc of ti’ie kind have ~en issued in “Vifsl &@iatics-SpeCial Reports.” 

Series 20: 

Series 21: 

—	 %ies $49. 

Series 9% 

WrioUs rcpnrts on mnrtdity, tabulations by aaq,se of death, age, eto., time aeriea of IS*S, dete for &gs@c 81+ “’**, ‘ 

cities, ek-otbsr fheq as inchlded its mtusl a m~thly repofi. ,,’ 

Dste on ndslity ouch as birb by age of motheq birth order, gengrspbic ersw, StAtss, cities, time eeriie of’ ‘k,” @.-@ooWila” 

tipns of data not included in the reguler &nuat v~ymes oc tnnntbly ‘kcqrortw. -“ 

Data & matings sod divorce by vssioas demographic factore, geogrr+hic cress, &c.-other “Ab thet ine$wdwd.in ,~B& O?*;&Y’ 

reports. 

DSta from the pmgrem of sample surveys relat@ to vitrd recnrds. The subjects beirig c@ere4 in tbcme e~ey,e erS v4rie$ jnal~ 

in~ topics such as mortality by socioecrinomic cIasses, hospit+etion in the lest yew of life, %rsY”OxPObUIe dti% ~~cY~ 

etc. 

Cotalog Card 

U.S. National Center /or Health Stafisfics 

Health survey procedure. Concepts, questionnaire development, snd definitions in 

the Heelth Interview Survey. Concepts of morbidity, disability, and utilization of medical services and facilities; questbnn airs development, fiscal years, 1958-1964, and 

definitions of terms used in statistical reportc. Washington, U.S. Department of Heelth, 

Education, and Welfare, Public Health Service, 1964. 

66P. diagrs. 27cm. (Its Vital cnd Health Statistics, Sniea 1, no. 2) 

U.S. Public Health Service. Publication no. 1000, Ssries 1, no. 2. 

1. Heclrh $UIVeyS - tddrodolOgy . 1. Tlth. 

IL Title: Healrh Interview SIK?SY. (Series. Series: U.S. Public HecSrb Service. Publicw 

tion rm. 1000, Series 4 m. 2) 

Cataloged by Deponent of Health, Education, and Welfue Library.