Plan and Operation 

of the Hispanic 

Health and 

?Wkrition 

Examination 

Survey 

7l9m-84 

This report describes the plan and operation 

of the Hispanic Health and Nutrition 

Examination Survey (HHANES). The 

population for this study consisted of 

Mexican-Americans living in the five 

Southwestern States, Cuban-Americans 

living in Dade County, Florida, and Puerto 

Ricans living in portions of the States of New 

York, Connecticut, and New Jersey. Persons 

6 months-74 years of age were included in 

the study. 

Programs and Collection Procedures 

Series 1, No. 19 

DHHS Publication No. (PHS) 85-1321 

U.S. Department of Health and Human 

Services 

Public Health Service 

National Center for Health Statistics 

Hyattsville, Md. 

September 1985 
All material appearing in this report is in the public domain and may be 

reproduced or copied without permission; citation as to source, however, is 

appreciated. 

National Center for Health Statistics: Plan and operation of the Hispanic Health 

and Nutrition Examination Survey, 198284. Vital and HeaM Statistics. Series 

1, No. 19. DHHS Pub. No. (PHS) 85-1321. Public Health Service. Washington. 

U.S. Government Printing Cffice, Sept. 1985. 

Plan and operation of the Hispanic Health and Nutrition Examination Survey, 

1982-84. 

(Series 1, Programs and collection procedures; no. 19) (DHHS Publication; 

no. (PHS) 85-1321) 

Author: Kurt R. Maurer. 

Bibliography: p. 

1. Health surveys-United States. 2. Nutrition surveys-United States. 3. 

Heatth status indicate-United States. 4. Hispanic Americans-Health and 

hygiene-Statistics. 5. Hispanrc Americans-Nutrition-Statistics. 6. Public 

heaith-United States-Statistics. 7. United States-Statistics, Medical. I. 

National Center for Health Statistics (U.S.) II. Title. Ill. Series: Vital and health 

statistics. Series 1, Programs and collection procedures: no. 19. IV. Series: 

DHHS publication; no. (PHS) 85-l 321. [DNLM: 1. HeaRh Surveys-United 

States. 2. Hispanic Americans. 3. Nutrition Surveys-United States. W2 A 

N148va no.191 

RA409.U44 no. 19 362.1’0723 s 85-10648 

[RA407.3] [362.1’77’0896873] 

ISBN O-8406-031 5-O 

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 
National Center for Health Statistics

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

Robert A. Israel, Depuly Director

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

Epidemiology

Game J. Losee, Associate Director for Data Processing and

Setvices

Alvan O. Zarate, Ph. D., Assistant Director for International

Statistics

E. Earl Bryant, Associate Director for Interview and Examination

Statistics

Stephen E. Nieberding, Associate Director for Management

Gail F. Fisher, Ph. D., Associate Director for Program Planning,

Evaluation, and Coordination

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

Methodology

Peter L. Hurley, Associate Director for Vital and Health Care

Statistics

Alice Haywood, Information Of/leer

Interview and Examination Statistics Program

E. Earl Bryant, Associate Director

Mary Grace Kovm, Dr. P. H., Special Assistant for Data Policy and

Analysis

Division of Heatth Examination Statistics

Robert S. Murphy, Director

Catherine E. Woteki, Ph. D., Depu@ Director

Clifford L. Johnson, Chief Nutrition Statistics Branch

Suzanne G. Haynes, Ph. D., Chiej Medical Statistics Branch

Kurt R. Maurer, Chief Suwey Planning and Development Branch

ChieJ Programming Staff

Division of Data Processing

George A. Schnack, Director

Donald E. Boesch, Special Assistant to the Director

Gerald C. Sanders, Chiej Data Preparation Branch

William M. Spillane, Chief Programming and Systems

Development Branch

William H. Senter, Chief, Computer Center Branch

Dwision of Data Services

James C. Jacks, Ph. D., Director

Phillip R. Beattie, Deputy Director

David L. Larson, Chief, Health Examination Field Operations

Branch

Sandra Surber Smith, Chief, Scientific and Technical Information

Branch

John E. Mounts, Chief, Publications Branch

OfFice of Research and Methodology

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

James T. Massey, Ph. D., Chief Survey Design Sta~

Data Processing and Services Program

Game J. Losee, Associate Director

Martin A. Baum, Ph. D., Deputy Associate Director
Contents

Acknowledgments . . . . ..-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .-v

Lktofcontributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . - . . . . . vi

Introduction . . . . . . . . . . . . . . . . . . . -. . -- .- . -. - . . - . . . . . . . ------ . -. ---- I

Survey Planning and Development

Chapter l. Cross-cultural aspects . . . . . . . . . - - . - . . . . . - - . -- -- . - - . - . . . . - . . - . 4

Chapter 2. Health status assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . - . . . . 7

Chapter 3. Nutritionalstatus assessment. . . . . . . . . . . . - . . . - - . - . . - . - - . . - - . . . . . - 16

Chapter 4. Assessment ofenvironmental exposure toselected toxic chemicals . . . . - . . . . . . . . . . . . 21

Chapter 5. Sample design and estimation procedures - - - . . . . - - . . . . - - - - . - .“- . - - - . - 23

Chapter 6. Informed consent, safety and referral process . . . , - . . . . . . - . . . . . . . . . . - . . . 33

Chapter 7. Pilot testing .. ----- . . . . . . . . . . . . . . . . . . . . . ------- . . -..-...36

Survey Operation

Chapter 8. Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40.

Chapter 9. QuaIity control ---- ------------------- . . . . . . . . . . . . . . . . . . . 46

Chapter 10. Data Processing ----- . . . . . . . . . . . . . . . . . . . . . . . . - . . . - . -....-.52

Survey Analysis

Chapter ll. Approaches forthe analysis of data . . . . . . . . . . . . . . . . ..- ------------- 56

References . . . . . . . . . . . . ------------------ ------------------ -.-..-63

Appendmes

I. Persons and agencies involved in the planning and development of the HHANES . . . . . . . . . . . . . . . . 69

II. Summsry of data collection instruments and procedures . . . . . . . . . . . . - - . . . . . . . . . . . - 72

IH. Examination components by age groups -------------- ------------------ ----75

Iv. Description of food models, food coding manual, and nutrient data base . . - . . . . . . . . . . . . . . . 76

v. Blood and urine assessments by specimen types and age gTOUpS . . - - . . . . . . . . . . . . . . . . . . 77

VI. Laboratories for blood and urine assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

VII. Criteria for inclusion in the special’ hematological subsample . . . - . . . . . - . - . . . . . - . . . . . - . 79

VIII. Pesticide target compounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -..80

IX. Consent forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -....-81

x. Reports of findings . . . . . ..-. -------------------- . - . . - . - . . . -..-...83

XI. Examples ofanalytic approaches . . . . . . . . . . . . . . . . ..- ------------------- --87

XII. Datacollection forms for the HHANES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -..-..95

List of text figures

1. Translation equivalence rating model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2. HHANESMexican-origin universe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..24

3. HHANESPuerto Rican-origin universe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

4. Example ofa cluster map..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

5. Within-household sampling rates, by survey mea and age: Hispanic Health and Nutrition Examination

Sumey,1982-84 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -.-....--...-....30

Ill
6. Example of household composition table and sample person selection table used in the Hispanic Health and Nutrition

Survey, 1982-84, . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . - . - . ., . . . . ...31

7, Flowchart ofactivities at asurvey location . . . . . . . . . . ..-. . . . . . . . . . . . . . . . . . . . ..40

8. Floor planand functions of the mobile examination center . . . . . . . . . . . . . . . . . . . . . . - . - . . . 43

9. Summary oflaboratory data flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. -53

10. Strategies foranalysis of complex sample data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

List of text tables

A.

B.

c.

D.

IE.

F.

G.

IH.

J.

K.

Primary sampling units, by number and percent Hispanic population and target number of sample persons: Hispanic

Health and Nutrition Examination Survey, 1982-84 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expected coverage of the eligible Hispanic population within the Southwest primary sampling units (PSU’S): Hispanic Health and Nutrition Examination Survey, 1982–84 . . . . , . . . . , . . . . . . . . . . . . . . . . .

Expected coverage of the eligible Hispanic population within Dade County and the New York City area primary

sampling units (PSU’ s): Hispanic Health and Nutrition Examination Survey, 1982–84 . . . . . . . . . . . . . . .

Selected design effects from the first National Health and Nutrition Examination Survey . . . . . . . . . . . . .

Estimates of standard errors and design effects for whether children have received care within an interval adequate

for preventive care for specified subpopulations of children and youths under 18 years of age, National Health Interview Sumey,1975–76 annual average - t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of examined persons, estimated means, estimated standard errors of the mean, and design effects for the

number of decayed, missing, and filled (DMF) teeth from the first National Health and Nutrition Examination Survey:United States, 1971–74 . . . . . . . . . . . ..- . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of examined persons, proportion of persons with periodontal index (PI) greater than zer,o, estimated standard

errors of the proportions, and design effects, by race and whether current cigarette smoker from the fiit National

Health and Nutrition Examination Survey detailed sample: United States, 197 1–74 . . . . . . . . . . . . . . .

Summary of multiple regression models for the number of decayed, missing, and filled (DMF) teeth on age, race,

sex, and sweets for 6,349 examined persons ages 11–30 from the first National Health and Nutrition Examination

Survey :United States, 1971 -74.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypothesis tests for variation in the proportion of persons with periodontal index (PI) greater than zero, by race and.

smoking status from the first National Health and Nutrition Examination Survey detailed sample: United States,

1971–74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . - . -....-..4

Comparison of Q statistics for adequacy of medical cme, by selected variables, simple random sample (SRS), andl

complex sample designs, and of proportion and logit models from the National Health Interview Survey: United.

States, 1975–76 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27

28

28

57

58

58

59

59

59

60
Acknowledgments

The design and execution of a large study such as the were consulted during the planning of the survey. Even

Hispanic Health and Nutrition Examination Survey the best planned study is only as good as the staff that

(HHANES) could not have been accomplished without the collects, monitors, and prepares the data. More than 100

participation of a large number of people. In addition to people were involved in these aspects of the study. Lastly,

the many members of the staff at the National Center for without the support of the surveyed communities and the

Health Statistics who dedicated several years to the develop- participation of the sample persons, the study could not have

ment of HHANES, nearly 150 others, listed in appendix I, been successfully completed.
List of Contributors

Ronette Russell-Briefel, Dr.P.H,

Survey Planning and Development Branch

Division of Health Examination Statistics

National Center for Health Statistics

Connie M. Dresser

Nutrition Statistics Branch

Division of Health Examination Statistics

National Center for Health Statistics

Trena M. Ezzati

Survey Planning and Development Branch

Division of Health Examination Stati5tic5

National Center for Health Statistics

Jean S. Findlay

Health Examination Field Operations Branch

Division of Data Services

National Center for Health Statistics

Joe Fred Gonzalez

Survey Design Staff

Office of Research and Methodology

National Center for Health Statistics

Dale C. Hitchcock

Survey Planning and Development Branch

Division of Health Examination Statistics

National Center for Health Statistics

Mary Grace Kovar, Dr,P.H.

Office of Interview and Examination Statistics

National Center for Health Statistics

Josefina Lago

Westat, Inc.

Clifford L. Johnson

Nutrition Statistics Branch

Division of Health Examination Statistics

National Center for Health Statistics

David L. Larson

Health Examination Field Operations Branch

Division of Data Services

National Center for Health Statistics

Marie Leahy

Survey Planning and Development Branch

Division of Health Examination Statistics

National Center for Health Statistics

James T. Massey, Ph.D.

Office of Research and Methodology

National Center for Health Statistics

Kurt R. Maurer

Survey Planning and Development Branch

Division of Health Examination Statistics

National Center for Health Statistics

John E. Mounts

Publications Branch

Division of Data Services

National Center for Health Statistics

Claudia Scala Moy

Survey Planning and Development Branch

Division of Health Examination Statistics

National Center for Health Statistics

Sandra T. Rothwell

Programming and Systems Development Branch

Division of Data Processing

National Center for Health Statistics

Sandra S. Smith

Scientific and Technical Information Branch

Division of Data Services

National Center for Health Statistics

Fernando M. Trevifio, Ph.D.

Survey Planning and Development Branch

Division of Health Examination Statistics

National Center for Health Statistics

Joseph Waksberg

Westat, Inc.

Andrew A. White, Ph.D.

Survey Design Staff

Office of Research and Methodology

National Center for Health Statistics

vi
Plan and Operation of

the Hispanic Health

and Nutrition

Examination Survey

Introduction

by Kurt R. Maurer

The Hispanic Health

(HHANES) is one of the

and Nutition Examination Survey

many surveys that have been conducted by the National Center for Health Statistics (NCHS)

since the 1950’s. The NCHS health survey programs have

as their foundation the National Health Survey Act of 1956,

which has been updated periodically since its original passage

by the U.S. Congress. A portion of the 1956 act states

as follows:

The Congress hereby finds and declares-( l) that the latest

information on the number and relevant characteristics of persons

in the country suffering from heart disease, cancer, diabetes,

arthritis and rheumatism, and other diseases, injuries, and handicapping conditions is now seriously out of date; and (2) that

periodic inventories providing reasonably current information

on these matters are urgently needed for purposes such as

(.4) appraisal of the true state of health of our population

(including both adults and children), (B) adequate planning

of any programs to improve their health, (C) research in the

field of chronic diseases, and (D) measurement of the numbers

of persons in the working ages so disabled as to be unable

to perform gainful work. ]

Subsequent to the passage of the National Health Survey

Act, work began under the authority of the Surgeon General

of the U.S. Public Health Service to meet the requirements

of the act by establishing the National Health Survey. Three

approaches to collecting data by means of the National Health

Survey were proposed. The first was to be a continuing

nationwide National Health Interview Survey (NHIS), through

which data would lx collected directly from household respondents by interviewers. Whereas NHIS can provide information

on illnesses known to persons, as well as impairments, accidents, injuries, use of health services, and other health topics,

it cannot supply information on the prevalence of undiagnosed

and nonmanifest disease. In addition, the data are subject

to other response and interviewing biases. Hence, two supplementary data collection systems were planned: Periodic record

surveys of hospital discharges, physicians’ offices, and nursing

homes: md a continuing survey using health examination

procedures. Additional discussion on the origin and plans

of the National Health Survey has recently been published

marking the 25th anniversary of the 1956 act.2

Beginning in 1960, data from household interviews and

extensive physical examinations were collected through the

National Health Examination Survey. Since 1970, when a

nutrition component was added, the survey has been called

the National Health and Nutrition Examination Survey

(NHANES). Five surveys using health-examination procedures have been completed since 1960; the most recent,

NHANES 11, was completed in 1980. Numerous topics have

been addressed in these surveys. 3-s An ex~ination by a

physician has been done in each of the surveys, and an

examination by a dentist has sometimes also been included.

In addition to various physiological measurements, such as

blood pressure and electrocardiogram, a substantial number

of blood and urine laboratory tests have also been performed.

The results of these surveys have been published in nearly

200 reports,9 and computer microdata tapes have been released

to the public. 10

After the field work for NHANES II began in 1976,

the staff at NCHS began the process of evaluating the National

Health and Nutrition Examination Survey. In 1977, a contract

was signed with the National Academy of Public Administration (NAPA) to evaluate NHANES, with specific attention

to its utility in answering questions about nutrition-related

public health problems. An expert panel was assembled by

the Academy to address these issues. The panel recognized

a need for “.. information about the health and nutritional

status both of the entire population and, of many groups

within it. ” One recommendation made by the NAPA panel

was that rather than beginning another national HANES immediately after completion of NHANES II, NCHS should

conduct a study of the health and nutritional status of a

subpopulation group instead. Several groups were considered,

and the final recommendation was to conduct a study of

the Hispanic population in the United States. 1]

Throughout the history of the National Health Survey,

the mandate of the 1956 Congressional Act had been fulfilled

for the general U.S. population with the provision of data

on a wide range of health status measures. However, there

was a notable lack of comparable data for the Hispanic

population. Previous NHANES samples, although composed

of approximately 20,000 examined persons each, included

insufficient numbers of Hispanics to enable an adequate estimation of health characteristics separately for Mexican-Americans, Cuban-Americans, or Puerto Ricans, or even for the
groups combined. Thus, the goal of the Hispanic Health

and Nutrition Examination Survey (HHANES) was to produce,

for the three major Hispanic subgroups, estimates of health

and nutritional status that are comparable to estimates available

for the general population,

Following the recommendation to conduct HHANES,

a group was assembled by the NAPA panel to make recommendations regarding the plan and operation of HHANES

(a list of panel members is included iri appendix I). This

group met for four days in the spring of 1979 and discussed

some of the broad problems that needed to be addressed

by the survey design staff, These included questionnaires,

community and sample person cooperation, dietary intake

measurement, degree of acculturation, and staffing characteristics. Also, major substantive components of the survey were

suggested. The recommendations of the NAPA panel and

the advisory group were found to be invaluable by the staff

at NCHS and were used as a general basis for the design

of HHANES ,

The planning of the specific content of the HHANES

followed the guidelines used in the development of the earlier

NHANES efforts, namely:

1.

2.

3.

4.

5.

6.

7.

8.

Stating the purpose of the proposed information,

Specifying what data are needed to achieve the stated

purpose.

Ascertaining the best method or methods of obtaining

those data.

Determining whether a health examination survey is an

appropriate mechanism for collecting those data.

Demonstrating that the expected prevalence level is consonant with the ability of the survey to determine it

within reasonable confidence limits.

Determining whether the data collection process can be

adequately standardized.

Specifying the costs related to equipment, laboratory

work, personnel, and other aspects of data collection

and analysis.

Ranking the proposed topics according to priority.’2

An additional criterion was considered: The proposed

survey component should allow comparisons with the general

population, requiring such components to be very similar

to those included in NHANES I (197 1–73) or NHANES

II (1976-80). These nine criteria were meant to serve as

guidelines; exceptions were occasionally made for topics

thought to be particularly relevant to the study population

(such as detailed questions on health services utilization,

which might be more appropriate for a household intemiew

study), A few new topics were also included because recent

advances in technology enabled study of certain conditions

in a population setting. For example, gallbladder ultrasonography and impedance audiometry were included in HH,ANES,

although their inclusion in previous studies hail been

impractical.

This report is intended to be of use to persons with

various interests in HHANES. Those who plan to use published reports of survey results will find the information

on the design and operation of the studies helpful for proper

interpretation of the published results, Users of microdata

tapes from the study may require a greater technical understanding of the survey so that the selection of specific research

topics and analytic methods will be consonant with the research

methods employed in the study, In addition, researchers who

plan to conduct their own community studies maybe interested

in replicating some of the procedures used in HHANES.

To fulfill the needs of each of these groups, this report

presents the rationale for the study and documentation of

the survey content and methods. It also documents the data

preparation procedures and the measures that were taken

to assure the quality of the data collection. The main body

of the report is divided into three major sections: Survey

Planning and Development, Survey Operations, and Survey

Analysis. Additional information is contained in the appendixes, beginning with the names of many of the nearly 150

persons from outside NCHS who contributed to the design

and operation of this complex survey. They are listed in

appendix I. Appendixes II and III contain a summary of

the data collection methods used in HHANES and, for quick

reference, an outline of the examination components by age

group. Appendixes IV through XI are described in the relevant

chapters. Examples of the data collection forms usecl in the

survey are contained in appendix XII.

Although many of the concepts and topics covered by

the report could be included in more than one chapter, a

decision was made to limit detailed discussion of a particular

procedure or target condition to only one—sometimes arbitrarily chosen-chapter. For example, there is considerable overlap between the chapters on health status assessment and

nutritional status assessment, but to avoid repetition or fragmentation, the various issues are discussed in only one of

the chapters, with references to the detailed discussion included wherever pertinent.

2
Survey Planning

and Development
Chapter 1

Cross-cultural aspects

by Fernando M. Trevir70, Ph.D.

The major design features incorporated to increase the

cultural sensitivity, validity, and reliability of the Hispanic

Health and Nutrition Examination Survey (HHANES) are

discussed in this chapter. Several obstacles to the development

and implementation of HHANES were immediately encountered. First, the National Center for Health Statistics (NCHS)

had never conducted a survey on a specific ethnic population

before. Second, NCHS had few Hispanic or Spanish-speaking

staff members and few staff members who were familiar

with Hispanic cultures. Third, existing NCHS survey instruments had never been translated into Spanish; thus, there

were no Spanish-language questionnaires that could serve

as models for HHANES instrument development. No other

agency or institution had ever conducted a survey of such

magnitude across the three major Hispanic national origin

groups. Because such a cross-cultural effort had never been

attempted, there was little experience from which NCHS

could benefit.

To address these issues and to involve as many Hispanic

researchers as possible in the planning of the HHANES,

four task forces, consisting of experts in the areas of Hispanic

health and nutrition, were convened in the summer of 1980.

(See appendix I for a list of members of each of the task

forces.) The Health Services Task Force made recommendations regmding how best to assess Hispanics’ use of and

need for health services and their perceived barriers to care.

The Dietary Task Force made recommendations to NCHS

on how best to tailor the dietary component of the survey

to assess the Hispanic diets. The Translation Task Force

developed and monitored the extensive translation process

required in the development of the HHANES Spanish language

instruments. The Outreach Task Force developed a community

outreach plan to inform local communities and leaders of

data collection efforts in their communities in hopes of securing a maximum response rate in the survey. With the input

received from the task forces, NCHS staff members developed

an initial set of questionnaires and examination protocols.

Translation

Many researchers questioned whether a single set of

Spanish-1anguage insbwments could effectively be used with

Mexican-Americans, Puerto Ricans, and Cuban-Americans,

given their dialectical differences, For HHANES it was decided that the goal of the translation process would be to

produce a single Spanish-language version of the questionnaires that would be conceptually equivalent to the English

and equally understandable to persons in each Hispanic subgroup. In order to accomplish this task, all forms were to

be translated independently by translators from each c~fthe

three groups and differences in usage would later be reconciled. A description of the method devised by the Translation

Task Force follows.

Before beginning the translation process, all instruments

were first developed in English. The resulting questionnaires

were then subjected to a rigorous forward-back translation

methodology. (For a detailed discussion of translation issues

in cross-cultural research see reference 13.) All items to

be translated (more than a thousand sets of question and

answer categories) were sent for forwwd translation to three

independent translators—a Mexican-American, a Puerto

Rican, and a Cuban-American. Translators were instructed

to translate the instruments into idiomatic Spanish appropriate

for their group. The ensuing three Spanish translations were

sent to three other translators of the same Hispanic groups

who, without having seen the original English-language clocuments, were asked to translate the Spanish instruments back

into English.

NCHS staff members then compared the original EnglishIanguage source documents to the back-translated English-language questionnaires, evaluating the conceptual and structural

equivalence of each item. Conceptual equivalence was defined

as the absence of differences in meaning or content between

the two versions. Structural equivalence referred to equivalence in vocabulary, syntax, spelling, and punctuation. Conceptual and structural equivalence were viewed as being indeFigure 1. Translationequivalence rating model

Conceptual equivalence

+–

El Structural + ‘ 3

equivalence _ ~ g

Code 1 = Unil versione are equivalent in both dimensions:

No maJor structural differences; and

no essential differences in meamng or content.

Code 2= Unit versions are mostly equwalent:

Some structural differences; but

no essent]al differences in meamng or content.

Code 3 = Unit versions are mostly unequivalent:

No structural differences; but

differences m meaning or content.

Code 4 = Unit versions are not eqwalent in ether dimension:

Some structural differences; and

differences in meaning or content.

A
pendent measures (that is, the two versions could be conceptually equivalent without being structurally equivalent, and vice

versa). The equivakncc riiting model is depicted in figure 1.

Concurrently, the three Spmish translations were sent

to three independent reviewers: a Mexican-American, a Puerto

Rican, and a Cuban-American. The reviewers rated each

item of “their” language version for equivalence (using the

equivalence rating model) with the same item from the other

two Spanish versions. For example, the Puerto Rican reviewer

compared the translation done by the Puerto Rican translator

with those of the Cuban- and Mexican-American translators.

In addition to scoring the translations for conceptual and

structural equivalence, each reviewer was asked to specify

which translator had achieved the best translation for that

item.

The results of the English to English and Spanish to

Spanish comparisons were reviewed and reconciled by the

Translation Task Force. It was as yet uncertain whether

one Spanish translation could be conceptually equivalent for

the three major Hispanic groups. However, in the interest

of research comparability and operational simplicity, it was

decided to proceed with developing and testing a single

Spanish language set of instruments. The Task Force members

were therefore instructed to develop a single translation of

each item, after reviewing subgroup language differences.

There were two predominant problems that arose in the

development of a single Spanish translation. First, certain

words were understood by the members of each of the three

subgroups but had different meanings for them. For example,

the word “almuerzo” is understood by Puerto Ricans and

Cubans to mean “lunch.” Among Mexican-Americans, however, “almuerzo” commonly refers to “breakfast .“ To rectify

this type of conceptual unequivalence, it was decided to

use a descriptive phrase that would be conceptually equivalent

for the three subgroups, yet might not reflect their common

language usage or their preferred word choice. In this example,

in the questions referring to “lunch, ” the word CCalmuerzo”

was replaced with the phrase “la comida de mediodia,” which

literally means “the midday meal .“ The second type of problem

in achieving a single translation revolved around certain concepts or things for which the subgroups use different words.

For example, in the development of the questions on smoking,

the word “cigar” became problematic because each subgroup

has a different word for cigar. Puerto Ricans call a cigar

a “cigamo, ” whereas Cubans use the word “tabaco ,“ and

Mexican-Americans use ‘Lpuro.” This type of dilemma was

resolved using an alternate word structure within the question.

The item, “About how many cigars a day do you smoke?”

was translated as “Cuintos (puros/tabacos/cigarros) fuma por

dia mis o menos?” In such an alternate word situation,

interviewers were trained to use the word appropriate to

the subgroup of the respondent when phrasing the question.

The English and Spanish questionnaires were then tested

in the Bronx, New York; Miami, Florida; and El Paso,

Texas. (See chapter 7 for a description of the pilot testing

process. ) Translation problems were identified during the

pilot tests through interview observation, interviewer debriefing, and questionnaire edits. These translation problems were

resolved by a team of bilingual Hispanic researchers who

were familiar with the English questionnaires and were knowledgeable regarding the conceptual intent of each question.

The resulting HHANES instruments were subjected to a final

test (the ‘Ldress rehearsal”) in San Antonio, Texas. However,

the translations continued evolving as minor problems were

discovered during the first few months of data collection.

In both the household interview and the examination,

respondents were given the choice of pmticipating in either

English or Spanish. In a few instances, respondents started

the interview in one language but decided to switch to the

other language in the course of participating in the survey.

The vast majority of sample persons who stated they wanted

to be interviewed in one language participated throughout

the survey in that language.

Survey content

As discussed earlier, one goal of HHANES was to produce

estimates of health characteristics of Hispanics that could

be compared with similarly obtained data on the general

population. But in determining the exact content of the survey,

it was recognized that an approach of merely repeating the

NHANES II survey components in translation would not

adequately address many important issues of interest to Hispanic health researchers.

To identify some of the health issues of particular importance to Hispanics, and with the intent of making HHANES

as culturally sensitive as possible, a literature review was

conducted. Not surprisingly, the review yielded few investigations of Hispanic health and nutritional status. Results of

local area studies, for example, suggested that some portions

of the Mexican-American population may experience a greater

prevalence of adult onset diabetes14 and gallstones15 than

that of the general population. By including measures of

these conditions for a wider population of Hispanics, the

HHANES could produce normative data to compare with

data from the Mexican-American studies and the general

population.

In the past, the health examination surveys relied heavily

on the examination component and the biochemical and anthropometric measurements in their data collection. However,

because one focus of HHANES was health care needs assessment (in general and relative to particular diseases), more

emphasis had to be given to the interview portion of the

survey than was traditional. For reasons of data comparability,

questions from NHIS or other national surveys were used

whenever possible rather than developing new, noncomparable

questions. However, for several areas of inquiry, appropriate

existing questions were not available from any major survey.

In these instances, NCHS planners developed new questions

with the assistance of the Health Services and Dietary Task

Forces or other consultants in the appropriate field.

Several questionnaire components were developed in an

effort to measure special characteristics and needs of the

Hispanic population. Because studies have indicated

differential patterns of health services utilization among Hispanics, 16’17HHANES included a series of questions to meas5
ure various aspects of utilization, including information on

usual source of care, waiting time, travel time, satisfaction

with care received, and barriers encountered in receiving

care. Pilot testing revealed that the use of folk healers seemed

to be too sensitive a topic to be measured in any detail

in this survey. Hence, only one question was included dealing

with consultation with a curandero, sobador, herbalist, or

spiritualist.

Many researchers believed that some measure of accul- -

turation was essential for the analysis of health care utilization

and other data. Several acculturation scales were considered

for inclusion in HHANES. All of these scales were limited

by the fact that they had been specifically developed for

one of the subgroups and had been validated for only that

group. In the final analysis, the acculturation scale developed

by Cuellar, Harris, and Jasso 1Efor use in a Mexican-American

clinical population was selected because it was deemed to

bean effective and concise instrument. The scale was modified

at NCHS to make it applicable to all three Hispanic subgroups

included in the survey. When pilot testing revealed the need

to reduce the length of all survey components, the acculturation

section was shortened to include only those items that, as

reported by the authors, accounted for most of the variance

in acculturation score, The shortened acculturation section

included questions on the respondent’s language usage and

preference and on the ethnic identification and nativity of

the respondent and of his or her parents,

Operational aspects

For purposes-of sample selection, persons were separated

into eligible and ineligible categories defined by self-reported

ethnicity or “national origin.” Eligible families were those

in which at least one member was identified as being Mexican,

Mexican-American, Chicano, or “Hispano” in the Southwest;

Cuban or Cuban-American in Dade County, Florida; and

Puerto Rican or Boricuan in the New York City area, After

a family was designated as being “eligible” based on these

criteria, a differential age subsampling scheme was applied

in order to select certain family members to receive the

extended intemiew and examination. These persons are referred to as “sam~le persons.” (For more detail on the sampling

procedures, see chapter 5.) The sample design for HHANES

led to the selection of more sample persons per family than

in previous NHANES, often with entire families being

selected. (However, it should be noted that, because of the

definition of family eligibility, occasionally non-Hispanic family members were selected. ) The greater number of sample

persons per eligible family allows greater analysis of familial

aggregation of disease prevalence and assessments of

similarities in health behavior and service utilization at the

individual level within the family.

Eligible sample persons could only be selected if they

were living in their usual place of residence at the time

of the HHANES interview. In order to maximize the inclusion

of migrant farm workers in the sample, HHANES planners

purposely sequenced the stand locations so as to collect data

during the months from October to April at local survey

sites that serve as homebase to large numbers of migrant

agricultural workers. This time period corresponds to the

time when migrant workers are most likely to be at their

usual place of residence.

In an effort to encourage sample person participation

in the survey and to ensure the cross-cultural vali!dity of

the data, several procedures were incorporated into the operation of HHANES. All HHANES personnel expected to have

significant interactions with sample persons were bilingual

in English and Spanish and almost all were Hispanic. These

personnel included the household interviewers, dietary interviewers, examining physicians, and dentists, as well as the

interviewers and receptionists in the mobile examination centers. Efforts were made to fill other positions such as laboratory

technologists and radiologic technicians with bilingunl staff,

When this was not possible, :he non-Spanish-speaking staff

members were provided with basic instruction in conversational Spanish so that they could establish at least minimal

dialogue with monolingual, Spanish-speaking sample persons.

A central concern in the planning process for HHANES

was securing the participation of selected sample persons

who were undocumented workers because, in communities

in which they represented a large proportion of the population,

their health status and utilization patterns would affect the

entire population. No attempt was made to identify respondents

as being documented or undocumented because such an attempt would likely have an adverse effect on the public

perception of HHANES and would certainly frighten away

a substantial portion of the sample in some locations. Instead,

undocumented persons were merely included as they fell

into the sample. Given that almost all household interviewers

were of Hispanic origin, undocumented workers whlo were

asked to participate were often quite candid with the interviewer about their legal status and their fear of being apprehended. Interviewers reassured them that all information

would be collected solely for statistical purposes and that,

by law, HHANES staff were forbidden to disclose arry identifying information to any individual or agency (including

other Government agencies) without the sample person’s consent (Section 30t3(d) of the Public Health Service Act (42

USC 242 m).) Because questions regarding legal status were

not asked, there are no data on the response rate among

undocumented workers. However, anecdotal evidence indicated a favorable response rate among these persons.

Finally, a major public affairs effort was initiated and

continued throughout the survey to inform the various communities of the purpose and methods of HHANES and to

solicit their cooperation and support. These outreach efforts,

which were specifically tailored to each of the three major

Hispanic subgroups, included distribution of informational

materials in English and Spanish, briefings with community

representatives, extensive use of the media, and solicitation

of support from Hispanic organizations, schools, and churches.

Throughout the survey, interest and active support were generated, resulting in increased ease of operations and improved

survey response.

6
Chapter 2

Health status assessment

by Claudia Scala Moy, Fernando M. Trevifio, Ph. D., and

Kurt R. Maurer

The National Health Examination Surveys (NHES) and

the National Health and Nutrition Examination Surveys

(NHANES) conducted by the National Center for Health

Statistics (NCHS) have long served as an important part

of the nation’s health monitoring systems. Traditionally, these

surveys have been designed to establish the normative distributions for certain population parameters such as height, weight,

blood pressure, and blood nutient levels. In addition, these

surveys have been instrumental in ascertaining the prevalence

of certain chronic diseases as well as the prevalence of risk

factors for given conditions. In the latter capacity, examination

surveys help identify populations at high risk so that risk

modification programs may be targeted in a more et%cacious

manner. Data from the national examination surveys have

been used to investigate risk factors found in other studies.

The health examination surveys have also been useful in

identi~ing health care needs.

The Hispanic Health and Nutrition Examination Survey

(HHANES) was the first special population survey ever undertaken by NCHS. Given the language barrier faced by many

Hispanics, and given their lower income and educational

attainment relative to the general population, there were

reasons to suspect that the Hispanic population may not

have had adequate access to health care resources in this

country, 19’20In view of the potentially kuge reservoir of

previously undiagnosed health problems among Hispanics,

and because interview surveys carI only provide measures

of previously diagnosed or recognized conditions, the advantages of collecting data primarily through examinations rather

than solely by interview me obvious. The design for HHANES

placed an emphasis on identifying the unmet health care

needs of Mexican-Americans, Puerto Ricans, and CubanAmericans.

HHANES relied on five principal data collection

methodologies-physical examinations, diagnostic testing, anthropometxy, laborato~ analyses, and personal interviews.

(Samples of all of the data collection forms are contained

in appendix XI I.) Care was taken to incorporate questions

and procedures from other national surveys so that the information collected on Hispanics could be compared with that

collected for the general population through NHANES, the

National Health Interview Survey (NHIS), the National Survey

of Family Growth (NSFG), and other federally sponsored

surveys.

The laborato~ analyses, diagnostic tests, and medical

and dental examinations were designed to provide an objective

assessment of unmet health care needs relative to specific

target conditions. The HHANES household interview component was greatly enlarged over those used in the previous

national examination surveys to provide data on perceived

health care needs relative to the target condhions as well

as to provide data on general patterns of health care utilization,

health practices, barriers to the use of care, health insurance

coverage, and other such factors that may relate to the health

status of the Hispanic population. Questions concerning participation in governmental health and nutrition programs were

also included so that the health outcomes of these programs

may be better evaluated.

For each examined person, the physician recorded diagnostic impressions of any suspected conditions that were

believed to be life threatening, on a downward course, or

causing a functional limitation. For each suspected condition,

the basis of the physician’s clinical judgment (medical history,

physical examination, or both) was indicated, as were the

confidence with which this assessment was made, the severity

of the suspected condition, and whether or not the sample

person had consulted a physician regarding the condition

during the past year. The examining physician also rated

the level of health (excellent, very good, good, fair, or

poor) of each examined person. This rating was recorded

so that a physician’s assessment of an individual’s health

status could be compared with the person’s own perceived

health status and also with objective indicators of health

status .

There are limitations to the ability to assess health care

needs by means of HHANES because of several factors

inherent in the survey design. First, diagnostic impressions

and health care needs assessments are based on a limited

physical examination at a single point in time with no diagnostic followup for persons with abnormal findings. Second,

the physical examination, of necessity, focused on certain

selected chronic conditions; it was not designed to provide

a comprehensive determination of health status or total need

for care.

The remainder of this chapter consists of a discussion

of each major target condition or component, delineating

the precedent for the data collection, the developmental background, and the methodology employed to study the condition

in the Hispanic population. (Nutritional aspects of several

of the components are discussed in chapter 3,) For some

of the target conditions, sufilcient data were collected to

allow the differentiation of persons with positive findings

into at least three categories related to need for health care:

7
1. Persons with positive findings who were unaware of

the presence of their condition (previously undiagnosed

and/or asymptomatic).

‘2. Persons who were aware of their condition (diagnosed

and/or symptomatic) but were not being treated for it.

g Persons who were aware of the condition and were under

treatment for it.

For hypertension it may be possible to designate a fourth

category, consisting of persons whose condition is determined

to be “under control” based on previous diagnosis, treatment

history, and survey findings. Hence, persons in the first

two categories could be said to have an “unmet health care

need” relative to that condition, whereas persons in the latter

two categories have received care,

Although the exact prevalence of diabetes among persons

of Hispanic origin is unknown, it is generally believed to

be one of the major health problems of that population.

Several studies have indicated that diabetes is more prevalent

among persons of Mexican ancestry (that is, of American

Indkm and European admixture) than among the white population of the United States. 14 Data from NHANES 1121 and

NHIS22 indicate that the overall prevalence in the United

States of diagnosed diabetes is about 3 percent, with wide

variation by age and sex. The prevalence of previously undiagnosed diabetes estimated from NHANES II was equally high.2 ]

If, as has been shown by surveys such as NHIS,’7 some

Hispanic groups uti,lize preventive or routine health services

with less frequency than the general population, then they

may have a higher level of previously undiagnosed diabetes.

Thus, to establish the prevalence of diabetes and impaired

glucose tolerance for Hispanics, and to assess the need for

health care related to this condition, diabetes was selected

as a major component for HHANES. The National Institute

of Arthritis, Diabetes, Digestive and Kidney Diseases

(NIADDK) sponsored a 75-gram, 2-hour oral glucose tolerance test, which was conducted on a random half-sample

of examinees 20-74 years of age. As was done in NHANES

II, the test was administered in the morning following an

overnight fast of 10-16 hours. This procedure, endorsed

by the American Diabetes Association and the World Health

Organization, has been recommended to provide uniform

international criteria for the diagnosis of diabetes and impaired

glucose tolerance. 23

The results of the laboratory component for diabetes,

the physician’s diagnostic impressions and statement of health

care needs, and an extensive medical history interview enable

both the determination of the prevalence of the disease among

Hispanics and the evaluation of the level of unmet health

care needs pertaining to diabetes. Several factors associated

with diabetes, such as obesity and dietary intake (discussed

in chapter 3), were measured in HHANES. In addition,

several possible sequelae of diabetes were examined in the

survey, including kidney and cardiovascular diseases, retinal

changes, and limitation of activity. Amdysis of the results

of the oral glucose tolerance test in relation to HHANES

examination and interview data for risk factors, related conditions, and complications or outcomes, will contribute :significantly to the knowledge of the epidemiology of dia~betes

for the Hispanic population. The interview rmd examination

provide data that enable classification of diabetic individuals

into the three health care needs categories described earlier,

Responses to questions on previous diagnosis and bafiis of

the diagnosis, utilization of medical care for diabetes, and

prescribed treatments, including compliance with drug treatments (ascertained via the questions on medicine and vitamin

use), together with the physician’s impressions, allow the

determination of health care needs.

Hypertension

Hypertension affects millions of persons in the United

States, leading to high levels of morbidity and mortality.

In the past, there has been considerable research related

to the epidemiology of hypertension, focusing on risk factors

and comparing the prevalence among white and black population groups. Very little is known about hypertension among

Hispanics in this country. It has been hypothesized that Mexican-Americans in the Southwest, due to their relatively low

socioeconomic status and underutilization of the health care

system, may be a particularly high risk group for undiagnosed

hypertension. 24’25

A great deal of money and effort have been spent in

recent years to educate the public about the prevalence and

dangers of hypertension, which is both a disease in itself

and a risk factor for cardiovascular and kidney diseases.

Yet, because of the persistence of misinformation and inadequate health care, there is still thought to be a high

level of undiagnosed and untreated hypertension .26 This level

has been estimated for the general population of the United

States using data from NHANES II, and with an expanded

hypertension component in HHANES, the analytical potential

for the Hispanic population is enhanced.

As in NHANES, blood pressure was measured far all

examined persons 6 years of age or older. Measurements

were taken at two different times during the physician’s

examination according to a standardized protocol that required

5 minutes of relative immobility in a sitting position immediately before the blood pressure was taken .27 Because

of the survey objective of assessing health care neecls in

relation to diagnosed conditions, additional information was

ascertained through a detailed medical history interview. The

National Heart, Lung, and Blood Institute recommended modifications to NHANES II and NHIS questions so that hypertensive individuals may be classified into four control status

categories, which are an elaboration of the three levels described earlier

1. Previously undiagnosed.

2. Diagnosed, but not currently under treatment (including

persons not complying with prescribed treatment lregimens).

3. Diagnosed and currently under treatment, but not under

control.

4. Diagnosed, under treatment, and currently under control.
Differentiation of hypertensives into these categories was

made possible through questions on screening and diagnosis,

treatment modalities, compliance with treatment, and health

care visits for monitoring blood pressure. Other parts of

the medical history interview, the dietary interview, and the

examination and laboratory assessments provide information

on related conditions, risk factors, and sequelae of

hypertension.

Heart disease

Heart disease is acknowledged as the single most important health problem in the United States today. Its contribution

to mortality and morbidity in the U.S. population is well

documented. More deaths are due to heart disease than to

any other cause ,2s and it is the most frequent cause of limitation of activity.zg Moreover, diseases of the heart place a

heavy burden on the health care system, with about 11 million

outpatient visits each year attributable to these conditions .30

Considerable research on the epidemiology of coronruy heart

disease has led to an understanding of many of the factors

related to its development. Through examination procedures

and interviews, data were collected by means of NHANES

I and II to establish the prevalence of coronary heart disease

and some of its risk factors in the general population. Similar

data for Hispanics were collected in HHANES. For diagnostic

purposes, standard 12-lead and Frank lead electrocardiograms

were recorded for all persons 20-74 years of age. Posterior-anterior chest X-rays were taken for the same age group, and

lateral chest X-rays were taken for persons 45–74 years of

age for the diagnosis of lung pathology and left ventricular

hypertrophy, and for assessment of lung volume. (No chest

X-rays were taken for women who suspected that they were

pregnant.)

The medical history interview included a series of questions developed by Rose to screen for angina pectoris and

myocwdial infarction. This questionnaire has been used widely

in the past 20 years for estimating the prevalence of angina

pectoris and myocardial infarction in populations.3 1’32 The

questions were designed so that the degree of severity of

symptoms could be measured and compared with results

of the electrocardiogram and other tests, A subset of the

Rose questions was included in NHANES II and may be

useful for comparison with HHANES. Other survey components assessed coronary heart disease risk factors and other

related information. Levels of swum cholesterol, triglycerides,

and high density lipoproteins were measured. Determinations

of body weight, blood pressure, and resting heart rate were

also made. Dietary intale information, smoking history, and

reported use of birth control pills were collected as well.

Gallstones

Despite high incidence and prevalence in the United

States of persons with gallstones, very little work has been

done to determine the epidemiology of the disease. Data

from the 1975 NHIS showed the incidence of gallbladder

disease to be nearly 400,000 new cases per year.33 However,

considering the inability of an interview survey to identify

asymptomatic or undiagnosed “cases ,“ it is likely that the

actual magnitude of gallbladder disease in the United States

may be much higher. Estimates as high as 1 milIion new

cases of gallstones per ye&4 or prevalence of persons with

undiagnosed (“silent”) gallstones around 10 million35 have

been suggested. Whatever the actual number of persons with

gallstones in the totaJ U.S. population, an even higher prevalence is suspected among Mexican-American adults. 15 The

cost of gallstones and gallbladder disease is high, both in

terms of dollars spent directly for health care and in terms

of associated disability and resultant economic loss. Cholecystectomy is one of the most common operations in this country,36 costing an estimated $5 billion annually .35 Gallbladder

disease can lead to a considerable degree of disability. Data

from NFHS show that a large proportion of persons with

gallbladder conditions (20. 8 percent in 1975) reported eight

or more bed days resulting from that condition in the year

prior to interview .33

In its 1979 report to the U.S. Congress, the National

Commission on Digestive Diseases recommended collaboration between NIADDK and NCHS to collect data on the

prevalence of digestive diseases, specifically gallstones .37 As

a result, NIADDK supported and funded the inclusion of

a gallstones component in HHANES. Through examinations,

tests, and interviews, data were collected to meet the following

objectives:

. To estimate the prevalence of persons with undiagnosed

gallstones and of persons surgically treated for gallstones

according to age, sex, and other demographic factors.

● To investigate risk factors thought to be associated with

the occurrence of gallstones.

. To study the association of various symptoms with the

presence of gallstones.

The objective of estimating the prevalence of persons

with gallstones is best met through an examination survey

such as HHANES, because a large proportion of all gallstone

cases—perhaps 50 percent or more—are asymptomatic, or

are symptomatic but undiagnosed. To establish diagnoses,

HHANES included a real-time diagnostic ultrasound procedure

that took approximately 20 minutes to complete; was noninvasive, highly sensitive, and highly specific; and involved no

known risk to examinees.3B The examination was administered

to a random half-sample of examinees 2&74 years of age—the

same group designated for the oral glucose tolerance test.

Participants were required to fast for at least 6 hours before

the ultrasound examination.

Numerous other survey components will be helpful to

researchers examining the relationship between gallbladder

disease and related conditions and possible risk factors. Previous pregnancy or use of oral conmaceptives may be associated

with gallstones among women. The Dietary Questionnaire,

the anthropometric data, the extensive medical history interviews, the physician’s examination, and other tests and procedures provide information that can be used in studying these

associations among current gallstone cases as well as among

persons who have been surgically treated.
To study the association of reported symptomatology

with gallstones, a history of symptoms related to gallstones

was included. This history included questions on previous

diagnosis of gallstones, gallbladder X-rays, and surge~ for

gallstones or gallbladder disease. Further questions ascertained

occurrence, frequency, and descriptive information on various

symptoms, including nausea, vomiting, pain in the abdomen

or lower chest, and specific types of distress following eating.

These questions were designed to constitute a standardized

interview that could recreate the sarne type of information

nommlly obtained by a physician during a clinical medical

history.

lDental disease

Data from NHIS have shown that Hispanics in all age

groups tend to receive dental care less frequently than the

general population. 39 The absence of care or the delay in

seeking needed care poses a serious threat to the future

dental health of children; poor dental health status can lead

to poor nutritional status. So that the prevalence of dental

disease and related health care needs among Hispanics could

be assessed, a dental examination and interview were included

in HHANES.

In NHANES I, a comprehensive dental examination was

performed for the general population. The aim in HHANES

was to replicate, as much as possible, the same procedures

used in NHANES I and in the National Dental Caries Prevalence Survey conducted by the National Institute of Dental

Resemch (NIDR) on school-age children, The measures of

dental health and disease,40’41 to be developed in collaboration

with NIDR based on findings from HHANES are as follows:

A decayed, missing, filled (DMF) surface index so that

differences in disease experience can be studied among

different population groups.

A dental restorative treatment needs index, which can

be used to estimate the number and types of dental

services and personnel required to provide comprehensive

dental care for the Hispanic population.

A simplified oral hygiene index, which measures the

amount of debris and calculus on selected surfaces for

six predesignated teeth that are present.

A periodontal index, which permits comparison of the

prevalence of periodontal disease for Hispanics with the

general population.

For edentulous persons, a determination as to whether

a full denture is absent or present, and if present, whether

it is defective.

A clinical assessment by the examining dentist of “severe”

malocclusion, with notation of present or past orthodontic

treatment.

in the physical examination, no treatment was offered

to sample per~ons in need of care, but they were provided

with a report of significant findings.

The dental cme sections of the Adult and Child %rnple

Person Questionnaires complemented the dental examination

in measuring perceived dental health status, utilization of

services, and dental habits. Data from these interviews allow

classification into the health care needs categories and provide

a focus for public health information programs. Information

on the use of fluoride and data on nutritional practices from

the Dietary Questionnaire will provide additional insight into

risk factors and outcomes of dental disease.

Otitis media and hearing problems

Otitis media, or middle ear disease, is the most frequent

pediatric diagnosis made in the United States. Studies have

estimated overall prevalence to be in the 15- to 20-percent

range; more than two-thirds of preschool children experience

at least one bout of the disease at some time in their lives,

and a substantial number of those children have recurrent

attacks. Otitis media may involve acute symptoms, such

as earache, fever, temporzuy hearing loss, and effusion.

Chronic otitis media, characterized by effusion and limited

tympanic compliance, may often be asymptomatic and urldiagnosed,42 If the Hispanic population is a medically underserved

group, then there may be a higher prevalence rate for chm-onic

otitis media with resulting hearing loss among Hispanics

than has been observed among the general population. A

genetic role in predisposition to middle ear disease has been

suggested.43 HHANES data may show whether Hispanic children have prevalence rates of chronic otitis media different

from rates for other population groups when differences in

health services utilization are taken into account.

The HANES programs present a unique opportunity to

contribute to the knowledge of the prevalence and impact

of otitis media. Beginning with HHANES, screening for

possible middle ear disease was accomplished through a combination of physician’s examination findings and tympanctmetric data, Taken by itself, otoscopic examination of the eardrum

is very subjective and fraught with difficulties. It is not

unusual for the ear canal to be obstructed by wax so that

the eardrum is obscured, (HHANES physicians did not attempt

to remove wax,) Even if the tympanic membrane can be

seen, signs of disease may be very subtle and hence subject

to interobsewer variability.a Therefore, to enhance the physician’s diagnostic capabilities, the relatively new procedure

of impedance tympanome~ was included in HHANES. This

procedure involves placing in the external ear canal a small

hand-held probe through which a tone of fixed frequency

is directed. The mobility of the eardrum in response to the

tone is simultaneously recorded electronically while the pressure in the ear canal is varied, This simple, inexpensive,

rapid, sensitive, and objective technique is useful for detecting

middle ear effusion as well as for identifying noneffusive

middle ear disease ,42,45,4 Tympanome~ was performed on

all examinees in HHANES.

10
In addition to the tympanometry, hearing levels for persons 6-74 years of age were measured by puretone audiometry.

Although of limited value in detecting otitis media, the audiometry findings enable the study of associations between

hearing loss and history of middle ear disease and may

be useful in establishing functimd impairment. The relationship between the physician’s observations and results of the

tympanometry and audiometry will be examined in conjunction with information on past or current treatment by tympanostomy tubes or ear surgery, as reported in the interview.

The National Academy of Sciences has stated that the

presence of otitis media in an individual is an excellent

indicator of the lack of medical care utilization .47 Results

from the various HHANES examination components and tests,

as well as responses to questionnaire items on previous occurrence and treatment of infections and hearing problems, allow

classification of individuals according to health care needs.

Additional questionnaire data on visits for routine or sick

care will be useful for evaluating the importance of otitis

media as a health care needs issue.

Immunization

Beginning in 1977, the Department of Health and Human

Services (DHHS) began efforts to increase parental awareness

about the importance of immunization against childhood diseases. At that time it became apparent that little was known

about the level of protection among children in the U.S.

population. Data from the United States Immunization Surveys, sponsored by the Centers for Disease Control, and

from the 1978–79 National Hwdth Interview Survey were

collected solely by interview; the addition of serological testing

in HHANES provides important information to verify reported

immunization history.

With the objectives of estimating the level of protection

among Hispanic children and the number of immunized children, measuring the relationship between immunizations and

level of protection, and measuring access to preventive medical

care and continuity of ewe, the Bureau of Health Care Delive~

Assistance of the Health Resources and Services Administration sponsored an immunization history and serum assays.

The only immunization assessment included was for the DPT

shot (diphtheria, pertussis, tetanus) because DPT shots are

routinely given by primary care physicians on first encounters,

and it can generaIly be assumed that children who have

not begun a DPT series have not received any other routine

immunizations, Because the immunizations for diphtheria,

pertussis, and tetanus are all given together in one DPT

shot, serum antibody levels were measured for only one

disease. Tetanus was chosen for the following two reasons:

. Tetanus antitoxin antibodies are found only in individuals

who have received at least 1 or 2 shots (representing

at least 1 or 2 contacts with the medical care system).

Tetanus immunity is gained by immunization and rarely

by natural means because it is a rare disease that often

leads to death instead of increased antibody levels, and

immunity is not passed among persons. Diphtheria immunity, on the other hand, may be acquired naturally

because the disease is still common in some parts of

the world.

. Tetanus assay is technically feasible for HHANES. Unlike

assay methods for pertussis, those for tetanus are standardized and suitable for this survey; for example, the

serum may be frozen without any alteration of the

antibodies.

Because some people who have not received routine

DPT immunizations could still prove to be immune to tetanus,

questions on receiving tetanus shots without the diphtheria

and pertussis components and reasons for having the shots

administered were included.

Tuberculosis

Although the prevalence of tuberculosis (TB) in the United

States has been declining over the past few decades, recent

data show that the overall prevalence rate for Hispanics is

twice that for non-Hispanics .4s Of particular concern is the

contribution to the TB pool by foreign-born residents—specifically legal Hispanic immigrants who may have been infected

but showed no evidence of active disease on entry to the

United States, and illegal immigrants with TB infection or

active disease .49 The recent surge in Cuban immigration and

the constant stream of immigrants across the Mexican border,

in combination with such predisposing social conditions as

overcrowding and low income and education levels, indicate

that TB is likely to remain a serious public health problem

among some Hispanic groups.

As a result of local support and interest in the California

survey sites and in Dade County, Fla., HHANES included

a special study in those areas to estimate levels of exposure

to tubercle bacilli. The study included a skin test involving

the injection of 5 tuberculin units of purified protein derivative

(PPD). The PPD was injected by a nurse in the mobile

examination center at the time of the physical examination.

Test results were read and recorded by a nurse 48-72 hours

Iater, either in the respondent’s home or at the examination

center. Persons infected with TB react to the PPD. producing

induration and swelling around the injection site. Swelling

of 10 or more millimeters was considered a positive reaction

in HHANES. The TB skin test was done on all examinees

6 months through 74 years of age, beginning with the twelfth

Southwest location (Los Angeles) and continuing through

the Dade County phase of HHANES. Also, the household

interview included questions on history of having tuberculosis

and any exposure to persons with active disease. These data

will be useful for comparing TB exposure levels among

Hispanics with findings for the general population from

NHANES I. In addition, chest X-rays for all nonpregnant

examinees 20 years of age or over may allow estimation

of the level of radiographically apparent tuberculosis in the

Hispanic population. Although in this survey no data on

immigration status or length of residency in the United States

were collected, information on country of birth and level

of acculturation may be useful in analysis of the TB data.

11
vision

As part of the effort to measure the general level of

unmet health care needs among Hispanics, a vision component

was included in HHANES. Refractive errors constitute the

most common source of impaired visual acuity in the U.S.

population. The prevalence of those common, correctable

clisorders that are in excess among Hispanics compared with

the general U.S. population may be an indication of the

k~ck of access to the medical care system by this population

group. Inadequate correction, or no correction, of impaired

visual acuity that is correctable can be interpreted as “unmet

need. ”

The vision assessment consisted of three main components: A vision screening, a routine physical examination

of the eyes, and a questionnaire section on history of vision

problems and use of corrective lenses. The vision screening

included tests of near vision, binocularity of vision, and

distance vision. The tests were administered in the order

listed above to minimize the changes in lighting to which

the eyes had to adjust. The tests were given by the dentist,

who was trained in vision testing methods, to all sample

persons 6-19 years of age and to a random half-sample

of those 20-74 years of age. The tests were administered

in the dental examining room immediately following completion of the dental examination. The conditions of the vision

screening tests adhered largely to the procedures outlined

in the report of the National Academy of Sciences-National

Research Council Committee on Vision .50

The near vision test determined visual acuity at up to

four fixed distances from 30 to 60 centimeters (cm), A

test card consisting of Sloan letters or, for illiterate examinees,

Landolt Rings, was positioned at 40 cm from the eyes,

using a bar with a chin rest on one end and a metal frame

that held the card and could be moved to pre-marked distance

settings. This procedure provided a means for conducting

the near vision test at standard distances. Persons who were

unable to read the 20/20 line at 40 cm were also tested

at 60 cm, 50 cm, and 30 cm. Examinees who wore glasses

for near vision and remembered to bring them to the examination center were tested first without correction and then with

correction. Contact lens wearers were tested only with correction to avoid the problem of having to remove and reinsert

the lenses. For persons who forgot their glasses or contact

lenses, this information was recorded, but obviously only

uncorrected vision could be tested. The examiners were not

allways able to ascertain the reason that glasses were prescribed

(near or distance vision), so beginning in the Dade County

phase, examinees’ glasses were analyzed by a lensometer

to determine the correction.

Binocularity was assessed using the Random Dot E (RDE)

test, which is valuable for determining the presence of

amblyopia and for producing conservative estimates of

slereoacuity thresholds. The test, developed primarily for

use with young children, is simple, accurate, and quick,

and makes minimal demands on the subject.51 In HHANES,

examinees were given polarized glasses to be worn during

the test (the glasses were used over any corrective lenses);

they were then shown an RDE test card and a stereo blank

card and asked to identify the RDE card. The two cards

look identical to persons with impaired binocularity, whereas

those with normal vision can easily distinguish the outline

of an apparently recessed “E’ on the test card. The test

was conducted first at 50 cm and again at 100 cm. To

minimize the problem of guessing, the test was repeated

four times at each distance. A passing score depended on

choosing the correct card all four times.

Distance vision was tested using a chart with Sloan

Letters or Landolt Rings. The basic test distance was 4

meters. However, because of space limitations in the examination center, this distance was simulated by placing the chart

with reversed Sloan letters on an illuminated box on one

wall of the examination room and situating a mirror of high

optical quality on the opposite wall. The examinees then

read the reflection in the mirror. This procedure allowed

the determination of distance visual acuity as poor as 20/

200 +. To investigate the validity of this procedure, up to

four randomly selected sample persons each day were retested

using an actual 4-meter test distance in another part of the

examination center.

Distance vision was measured for each eye separately

and for both eyes together. Persons who wore glasses for

distance vision were tested with uncorrected vision for both

eyes first, followed by tests with correction for the left and

right eyes separately, and then both eyes. Contact lens wearers

were tested, with corrected vision only, first for each eye

separately and then for both eyes. Examinees who had no

corrective lenses, and those who forgot to bring them to

the examination center, had their uncorrected vision tested,

each eye separately, and then both eyes together. To control

bias resulting from memorization of the chart, the exa]miner

alternated the eye to be tested first-sample persons with

even numbers had the right eye tested first, and odd-numbered

sample persons began with the left eye.

Of course, visuzil acuity measurement as part of a screening test cannot by itself differentiate losses of acuity caused

by errors of refraction from those attributable to eye diseases

or injuries. Routine physical examination of the eye, performed by the physician (not an ophthalmologist) pemlitted

the identification of various eye conditions that may contribute

to impaired visual acuity. Ophthalmoscopic examination can

also provide a basis for assessing health care needs related

to eye conditions. For instance, the presence of florid cataracts

in the central visual axis, a condition usually corrected by

surgical removal of the lens, may indicate a lack of access

to surgical care. The eye examination also could idcnti~

diabetic and hypertensive retinopathy. Although many c~fthe

observable changes to the retina occur despite the treatment

of these diseases, lack of treatment and progression of these

diseases to more serious stages can be determined through

the ophthalmoscopic examination in conjunction with findings

from the physical examination, laboratory serum assays, and

medical interview. The routine physical inspection of the

eye also determined the prevalence of scleritis and other

visible inflammations of the eyeball. Pupil reactivity and

other necrologic and ophthalmologic conditions were noted

as well. Because neither an ophthalmologist nor more sophisticated equipment were employed for HHANES, other common

pathologic conditions of the eye, such as astigmatism, macular

12
degeneration, and noncentral cataracts, could not be identified.

The household medical history questionnaires contained sections on history of vision trouble and use of corrective lenses

for adults and children.

Kidney disease

Estimates of the prevalence of kidney disease and normative data relative to kidney disease do not exist for the

Hispanic population. The effect of serious renal disease on

the individual and the medical care system suggests a need

for data that are not available from any other source. Assessment of kidney disease is pzu-titularly suitable for HHANES

because of the hypothesized underutilization of health services

among Hispanics. which means that many cases of kidney

disease may be undiagnosed. Lack of treatment can lead

to severe kidney damage later in life.

The examination phase of the kidney assessment was

similar to the component used in NHANES II. It consisted

of a number of urine assessments to determine urine protein,

specific gravity, glucose, and ketones. Urine sediment was

examined microscopically for red cells, white cells, epithelial

cells, casts, and crystals. Other biochemical assessments related to kidney disease were serum creatinine and urea nitrogen. Several other sumey components are useful for interpreting these laboratory data. A brief history of kidney problems

and urinary infections was obtained during the household

interview. The relationship between kidney disease and

diabetes, hypertension, and cardiovascular disease can be

studied using data from both the interview and examination.

Liver disease

By means of NHANES II, information on the prevalence

of liver disease was collected for the general population.

The intent of the liver component of HHANES was not

merely to produce comparable prevalence estimates for the

Hispanic population. Rather, it was included so that the

association of liver disease with pesticide exposure and with

level of alcohol consumption could be investigated. In conjunction with its alcohol consumption interview component,

the National Institute on Alcohol Abuse and Alcoholism

(NIAAA) sponsored a standard battery of liver function tests

(including bilirubin, SGOT. and SGPT). Other survey data,

including liver disease history as reported in the household

interview, and physicians’ obsemations of the signs and

symptoms of liver disease, are of value in the analysis of

the laboratory assessments.

Alcohol consumption

Although for a number of years national and other largescale surveys have produced data related to drinking patterns

for the U.S. population, no such data for a representative

sample of Hispanics have been available until now. As part

of the Hispanic Initiative announced by the Department of

Health and Human Services in 1979, the Alcohol, Drug

Abuse, and Mental Health Administration (ADAMHA) was

requested to document the nature and extent of alcohol problems within this population group. With the support and

collaboration of NIAAA, an alcohol consumption component

was included in HHANES. NIAAA’s objectives addressed

by this survey component were:

. To characterize drinking patterns and practices for the

three major Hispanic subgroups.

. To compare data on drinking patterns and practices among

Hispanics with national survey data and with data on

other ethnic population subgroups.

. To relate the quantity, frequency, and variability of alcohol consumption with health parameters and health

conditions found in the survey.

The HHANES alcohol consumption component consisted

of a set of questions designed to measure the quantity, frequency, and variability of drinking. It was administered by

an interviewer to all examinees 12–74 years of age in the

examination center, which provided a private setting. These

questions were developed by NIAAA and NCHS staff, who

were advised by a group of outside experts knowledgeable

in the area of alcohol survey methodology. The questions

were designed to describe in detail the respondent’s pattern

of drinking over the 4 weeks preceding the interview and,

in a separate series, over the previous 12 months. Detail

on the types of beverages consumed, typical amounts, frequency of consumption of each, and maximum amounts consumed was obtained. Similar questions were asked of former

drinkers, referring to the period immediately preceding the

last drink. Although it is not possible to diagnose “alcoholism”

on an individual basis from these data, it is expected that

the data obtained will permit ranking of respondents according

to relative level of consumption as heavy, moderate, or light

drinkers, or as abstainers. The procedures in this component

replicate those from earlier NIAAA surveys, thus allowing

comparisons of patterns of alcohol use in Hispanic populations

with consumption patterns for other groups. A similar set

of questions was included in the 1983 NI-IIS, with the obvious

benefit of providing parallel data for the general population

during the same time period that HHANES was operationzd.

Other measures of alcohol intake used for HHANES, as

in previous NHANES data collection efforts, included reports

in the 24-hour dietary recall and food frequency questions.

Data collected by the different methodologies used within

HHANES will be compared.

Analysis of data from such sources as NHANES 1, the

NCHS Hospital Discharge Survey, and mortality statistics

has implicated alcohol as an important risk factor for many

diseases.5z Although these data relate to the general U.S.

population, there is some evidence from small, communitybased surveys that the health of the Hispanic population

may be at even greater risk from the effects of alcohol

because of greater overall intake and larger proportions of

heavy drinkers. 53 Data collected by means of HHANES provide the opportunity to relate levels of alcohol consumption

to measures of health status for individuals in the Hispanic

population. These data may in turn be compared with similar

data for the general U.S. population collected in previous

national surveys. The basis for these analyses includes

biochemical assessments of liver function as well as reports

13
of health status, depressive symptomatology, and other diseases suspected to be related to alcohol intake, such as kidney

problems and heart disease. Also of interest in this survey

is the possible interaction of dietary intake and alcohol consumption for the three Hispanic subgroups, which may be

compared to that of the general U. S, population.

Drug abuse

The use of illicit drugs and the abuse of licit drugs

constitute a major threat to the health of certain portions

of the U.S. population. Studies have linked the use of psychotropic drugs with numerous diseases, including mental illness,

cardiovascular effects, and pulmonary conditions. The 1979

Surgeon General’s Report on Health Promotion and Disease

Prevention included drug use on its list of major risk factors

contributing to most of the premature morbidity and mortality

in the United States. Data from the 1977 National Survey

on Drug Abuse54 indicated that the prevalence of drug abuse

was increasing in the general population. For example, the

prevalence of marijuana use for adolescents ( 12–17 years

of age) was 16.1 percent, and among adults (18 years of

age and over) was 8.2 percent, These figures represent significant increases over the previous year. The National Survey

on Drug Abuse has been the major source of national estimates

of drug abuse prevalence in the untreated population. Although

Hispanics have been included as they came into the sample,

their numbers were insufficient to allow the generation of

prevalence estimates. However, other data sources, such as

ethnographic studies and clinical studies, have suggested that

the prevalence rate of drug use among Hispanics may be

different from that of the general population. For certain

substances, such as marijuana and inhalants, the prevalence

rates may be significantly higher among Hispanics than among

others. 55

To address this issue in a direct manner, as well as

to do its part in helping ADAMHA carry out the Hispanic

Initiative, the National Institute on Drug Abuse (NIDA) supported the inclusion of a drug abuse component in HHANES.

Specifically, NIDA wished to estimate the lifetime and current

prevalence of illicit marijuana, cocaine, inhalant, and sedative

use in the Hispanic population.

The HHANES drug component consisted solely of a

short series of questions geared to the assessment of duration

and frequency of use of marijuana, cocaine, and inhalants

and the lifetime prevalence of use of sedatives for “nonmedical

reasons.” These questions were included in the Adult Sample

Person Supplement, which was interviewer-administered in

a private room in the examination center. It was hoped

that the private setting and assurances of confidentiality would

encourage respondents to answer truthfully these sensitive

questions on illicit behavior. All examinees 12–74 years of

age were asked about sedative and marijuana use. Only persons

12-44 years of age were asked about inhalants and cocaine.

Depression

Psychiatric epidemiology has long been a subject of interest to researchers and to those who plan mental health services

and programs. However, a lack of reliable data on the incidence and prevalence of mental illness among Hispanics

and other population groups limits the ability to study etiological factors or to understand and address the needs of the

underserved population. In the past, numerous studlies designed to measure the level of psychiatric symptoms and

diagnoses have been undertaken on clinical and general population groups, using a variety of methodologies and producing

diverse results. Few attempts to assess prevalence of psychiatric disorder among Hispanics have been made, and most

of those concerned Mexican-Americans only. Those studies

that have been published produced conflicting results. Reviews

of admissions for psychiatric treatment show that MexicanAmericans are underrepresented in treatment facilities relative

to their representation within the community population, 56

However, results from community-based general population

surveys diverge, some indicating that the prevalence rate

of psychological problems among Mexican-Americans is

higher than for the general population and some leading

56 The hypothesis that M~xican- to the opposite conclusion.

American underrepresentation in treatment facilities reflects

barriers to mental health services and is not a relevant indicator

of need for care has been supported by researchers. 57S56

Nevertheless, regardless of the reason for their lower rates

of treatment for mental illness, the Hispanic population is

likely to have an increased prevalence, relative to the g,eneral

population, of demographic factors associated with mental

illness, such as low socioeconomic, educational and ennployment status, and cultural and language barriers.

To address the Hispanic Initiative goal of gathering information on the epidemiology of mental disorders among Hispanics, the National Institute of Mental Health (NIMH) developed a component for HHANES. The primary objective

of this component was to obtain prevalence rates of mental

illness among the three Hispanic subgroups so that comparisons could be made with rates obtained for the general population and to assess levels of need for care. This information

is important for planning mental health facilities and programs

for Hispanics. Additional objectives were to study aspects

of the association between physical and mental health and

to assess the extent to which epidemiological research results

obtained in the general population could be generalized,. Because sample persons were clustered within families, it is

also possible to study the family configuration of certain

psychiatric symptoms and diagnoses. This is important because of the growing interest in the effects of heredity on

the occurrence of mental disorders.

As a result of time constraints and other logistical considerations, the mental health component was limited to depression, which constitutes the most common psychiatric disorder

in the general population. NIMH sponsored the administration

of two survey instruments, the Center for Epidemiololgical

Studies Depression Scale (CES-D) and a portion of the Diagnostic Interview Schedule (DIS). They were administered

by an interviewer in a private room in the examination center

to all examinees 20-74 years of age. The CES-D is a short

(20-item) scale that measures current general depressive

symptomatology. 59’60 It has been used extensively both in

14
general population studies and in surveys of Hispanic

gTOUpS.6]@ Comparison of data for Hispanics from HHANES

with earlier data for the general population is possible because

the NHANES I Augmentation Survey also included the CESD, administered in a similar setting and context. A portion

of the DIS was included in HHANES to produce interval-level

measurement of depressive symptomatology as well as to

yield diagnoses of depression for this population. The DIS,

which was developed for the assessment of current and lifetime

prevalence of psychiatric disorders in the general population,

is a revision of earlier diagnostic questionnaires. Through

a highly structured interview that includes specified probes

to ascertain symptom severi~, interviewers with no clinical

training in psychiatry may obtain sufficient information for

diagnoses of certain disorders. Only rarely should the judgment

of an expert be required for the classification of “borderline”

cases. Several articles discussing the development and validity

of the DIS and of the Spanish version are available .63-65

The results of the HHANES data collection effort will be

compared with the results of other NIMH-sponsored applications of the DIS that were undertaken during the same period.66

Additional sections of HHANES should provide insight for

the analysis of the depression data. Level of alcohol consumption, illicit drug use, and degree of acculturation may relate

to the etiology of depression for this population. At the

very least, data horn this survey may indicate new directions

for future research.

15
Chapter 3

Nutritional status assessment

by Dale C. Hitchcock, Flonette Russell-Briefel, Dr. P.H.,

Clifford L. Johnson, and Connie M. Dresser

Central to the Natiomd Health and Nutrition Examination

Survey (NHANES) programs have been the assessment of

the nutritional status of the U.S. population and the measurement of changes in that status over time. Nutritional status

assessment is the comprehensive measurement and description

of factors or parameters that affect nutritional status at a

given time. Nutritional monitoring, then, is the measurement

of changes over time, requiring repetition of comparable

measurements at regular intervals. 1I,67 Traditionally, these

broadly specified goals have been accomplished through the

NHANES programs by using an approach that involves the

collection of data from a dietary interview, a medical history,

laborato~ tests, body measurements, and a physician’s

examination.

The Hispanic Health and Nutrition Examination Survey

(HHANES) was designed to provide baseline health and nutrition information comparable to that available from the earlier

surveys. Nutrition-related findings, including distributions of

nutrient intake, height, weight, and biochemical values, have

been published for the general U, S. population from the

earlier surveys ,68-70 Although these findings have usually

been reported for both white and black persons, the National

Center for Health Statistics (NCHS) has never been able

to report similar findings for the Hispanic population.

In addition to collecting data for the publication of normative distributions of population parameters, NCHS has increased efforts over the years to expand the type and use

of the data collected in NHANES to address research questions

regarding relationships between nutrition and the health conditions targeted in the surveys. Analyses of data from the

present study may generate new issues specific to the nutritional status of Mexican-Americans, Cuban-Americans, and

Puerto Ricans.

The objectives of this chapter are first to outline the

different data collection methodologies used in HHANES

and then to discuss how the data maybe analyzed in association

with the survey’s target conditions and other major nutrition

issues. These issues encompass associations between diet,

nutritional status, and health, as well as concerns in the

area of public health nutrition. Research topics that may

be investigated using HHANES data include diseases and

conditions such as anemia, obesity, cardiovascular disease,

hypertension, diabetes, digestive disorders, and dental caries.

Public health nutrition issues that may be addressed include

the adequacy of dietary intake, the need for food fortification,

the use of vitamin and mineral supplements, participation

in food programs, infant feeding practices, and the growth

of Hispanic children. Even though much of this analysis

of course focuses on the Hispanic population, many of the

topics and issues involved are not limited by ethnicity or

culture.

Methodology

Dietaryquestionnaire

In the two previous NHANES programs, the 24-lhour

recall and a 3-month food frequency questionnaire were utilized to collect data on dietary intake and food consumption

patterns. To maintain comparability with the earlier surveys,

the same dietary methods were used for HHANES. The

actual data collection instrument used (see appendix XII)

was developed with the assistance of the Dietary Task Force,

whose members were knowledgeable about the dietary practices of Mexican-Americans, Cuban-Americans, and Puerto

Ricans (see appendix I). The Dietary Questionnaire combined

an English and a Spanish version on the same form and

was administered by trained bilingual interviewers.

The 24-hour recall was included in HHANES to provide

information on the dietary intake of the target populations,

the contribution of selected foods and food groups to total

nutrient intake, the frequency of consumption of food items,

and the relationship of dietary intake to other dietary practices,

including vitamin and mineral usage, frequency of meals

and snacks, and typical sources of meals. As in previous

NHANES programs, the dietuy recall data were collected

with the aid of abstract food models. Following the dietary

interview, each food item reported was assigned a numerical

food code, which was in turn linked to a nutrient data base.

Further description of the food models, the food code manual

used by the interviewers, and the nutrient data bank used

for analysis of the data maybe found in appendix IV.

The food frequency section of the Dietary Questionnaire

was designed to indicate qualitative aspects and patterns of

typical foods or food-group consumption among Hispanics,

The food items used as examples to represent foods from

broader groups were selected with the help of the Dietary

Task Force. These examples were changed in some instances

as a result of pilot testing. The food frequency section also

estimated an individual’s typical food pattern, which may

be associated with measures of health status. In addition,

the Dietary Questionnaire contained questions on the uses

and types of special diets, the use of table salt, and ether

dietary practices.

16
Medical history data

The sample person questionnaires, administered to children and adults, included questions designed to collect nutrition-related information and history relevant to the target

conditions of the sumey. These questionnaires also contained

detailed sections focusing on the use of vitamin and mineral

dietary supplements and questions about participation in food

programs, such as school lunch and the Supplemental Food

Program for Women, Infants. and Children (WIC).

Laboratory determinations

Biochemical, hematological, and urinary assessments

were included to provide objective evidence of the health

and nutritional status of individuals with respect to anemias

and other blood cell disorders, vitamin deficiencies, toxic

levels of substances, and the risk or likelihood of disease.

Many of the assessments included in NHANES II were also

included in this survey to allow comparison of various blood

nutrient levels for Hispanics with those obtained for the

general U.S population, and to provide baseline estimates

of these values for the Hispanic population. Other tests,

although not performed in earlier surveys, have standardized

laboratory procedures and are likely to be repeated in future

national surveys, A complete list of laboratory determinations

included in the survey, and the laboratories at which they

were performed, may be found in appendixes V and VI.

Anthropometry

The major purposes of HHANES body measurements

were to assist in the determination of normal growth patterns

for Hispanic children, to develop normative distributions of

height and weight, and to estimate the prevalence of obesity

in the Hispanic population. Similar measures have been collected in the past for the general population. Height, weight,

skinfold, and other anthropometric measurements were collected by trained technicians using standardized equipment

and multiple measurements. Body frame size was assessed

by measuring bitrochanteric (hip) breadth and elbow breadth,

as in NHANES II, as well as biacromial (shoulders) breadth

and biiliac crest breadth, which were added for this survey.

Clinicalsigns

In NHANES I and H, many items indicating either clinical

or subclinical signs of malnub-ition were included as part

of the physician’s examination. In the review of unpublished

data from these surveys, an advisory group found that there

was a high degree of variability among physicians reporting

these clinical signs and that most of the signs were infrequently

reported, nonspecific in nature, and of uncertain diagnosis.

As a result of this review, only a few clinical signs relating

primarily to vitamin deficiencies were included in the

HHANES physician’s examination. These were limited to

observed conditions of the eye and skin such as xerophthalmia,

keratomalacia, follicular hyperkeratosis, petechiae, pellagrous

dermatitis, and ecchymoses.

Nutrition-related conditions

Although HHANES was not designed to test specific

hypotheses regarding the relationship of nutrition to chronic

conditions, the survey dots provide a unique set of nutritionand health-related population data that may be utilized to

investigate or to formulate general hypotheses on the associations between dietary intake, nutritional status, and health,

Many prevalent diseases or conditions, such as diabetes,

hypertension, and obesity, and their treai ment, are related

to nutritional practices and dietary inmke. Several of these

nutrition-related chronic diseases and conditions we discussed

in terms of the analytical opportunities that HHANES data

afford.

Iron status and anemia

It is generally agreed that the most common single nutritional deficiency in the majority of countries is iron deficiency, 71 which may be due to nutritional causes, blood

loss, impaired iron absorption, or other reasons. Dietary intake

inadequate to meet normal physiological needs is often cited

as the major source of iron deficiency. Hematological and

biochemical measurements related to iron status included in

both NHANES I and NHANES H have been used to assess

the iron status of the general population, 72.73 The Expert

Scientific Working Group, convened by the Federation of

American Societies for Experimental Biology as part of a

contract for the Food and Drug Administration [FDA), established to assess the iron nutritional status of the U.S. population based on NHANES 11 data. concluded that no single

biochemical indicator is diagnostic of iron de ficiency.73 The

combined use of several indicators of iron status provides

a much better measure of iron status.

As indicators of iron status, hemoglobin, hematocrit,

red and white cell counts, protoporphyrin, serum iron, total

iron binding capaci~ and serum ferritin were determined

in HHANES. Percent trrmsfen-in saturation, mean corpuscular

volume (MCV), mean corpuscular hemoglobin (MCH), and

mean corpuscular hemoglobin concentration (MCHC) were

also calculated. Additional tests (serum folate, red cell folate,

and differential leukocyte count) were performed on a special

subsample of the HHANES population. The criteria for inclusion in this subsample are outlined in appendix VII and

were based on high or low hematological values and the

selection of a control group.

This hematological and biochemical information may be

analyzed in conjunction with data on symptoms, signs, and

treatment of anemias collected during the physician’s examination, the dietary interview, the reproductive history questions,

and other related questionnaire sections. Using models defined

in previous analyses of NHANES H data,73 the iron status

of the Hispanic population may be compared with that of

the white and the black populations.

17
Overweight and obesity

Overweight (defined as excess body weight for height)

and obesity (defined as excess body fat oradipose tissue) 74’75

have been strongly associated with the development of certain

chronic diseases, including adult-onset diabetes and hypertension.76 Obesity has also been implicated as an independent

risk factor in the development of coronary heart disease. 77’78

In addition, gallbladder disease is more common in the

obese 15’79Estimation of the prevalence of overweight and

obesity in childhood is equally important because it has been

related to an increased likelihood of overweight and obesity

in adulthood. 76

Besides the increased physical health risks, overweight

and obesity affect psychological and emotional health .76 Data

an behavioral aspects of eating, such w food patterns, snacking, and whether breakfast is typically eaten, were collected

by means of HHANES. Responses to questions about changes

in appetite and weight were also gathered as part of the

Diagnostic Interview Schedule’s depression section. Information on the use and type of special diets, the use of prescription

and nonprescription diet pills, and food frequency data provide

additional information for investigating factors related to overweight and obesity.

Prevalence estimates of overweight and obesity in children

and adults from HHANES can provide important information

about the Hispanic population, which can be compared with

estimates for the white and black populations from previous

NHANES. In addition, associations between overweight and

obesity and nutrient intake, dietary practices, demographic

variables, and health characteristics may be studied. Data

cm self-perception of weight status were collected for sample

persons 6 years of age and older. For each sample person

under 12 years of age, infokation on the parent’s attitude

concerning the child’s weight was obtained. This attitudinal

data may provide insight into dietary habits and behavioral

aspects of overweight and obesity.

Coronary heart disease

The prevalence of coronary heart disease risk factors

among U. S, Hispanics is generally unknown. Coronmy heart

disease (CHD), the leading cause of death for adults in

the United States, is one of the target conditions included

in HHANES, as discussed in chapter 2. The major risk

factors for CHD-elevated serum cholesterol, hypertension,

cigarette smoking, and obesiq—were all measured in the

~uWeY.78,Bo-szEach of these risk factors is related to dieW_y

intake. For example, high blood pressure has been linked

with obesity and dietary vzwiables such as the consumption

of salt, sodium, potassium, and alcohol. 80,S2-S5 Cigmetie

smoking has also been associated with different dietary patterns. ‘6 In addition, diabetes, another target condition, is

related to increased risk of peripheral vascular disease .78

Hypertension

Hypertension, a major risk factor in the development

of stroke and heart disease ,80’82’83is another target condition

measured in HHANES. Relatively little information is available on the relationship of known risk factors to blood pressure

levels in Hispanics. HHANES nutrition data relevant to hypertension include caloric, calcium, sodium, and potassium intakes, alcohol consumption, salt use, and overweight and

obesity. 85The nutrition data, in combination with the medical

history, blood pressure, biochemical data (serum calcium,

potassium, and sodium), and clinical data, may be utilized

to study associations between diet $and the prevalence and

treatment of hypertension in Hispanics. Compliance with

suggested dietary treatment can be investigated using the

medical history information and the dietay recall and food

frequency data for known hypertensives.

Diabetes

Diabetes, particularly the adult-onset type, is one of

the target conditions believed to be more prevalent in Hispanics

than in the general population. 14’87 Diabetes and imp,aired

glucose tolerance are related to obesity and other health

and medicaI factors, such as parity and oral contraceptive

use ‘a HHANES will provide useful data that may allow

researchers to study the association between environmental

or nutritional factors and diabetes. For example, a pertinent

research question might be as follows: If Hispanics we a

group at high risk of developing diabetes, are there nutiition

habits or nutrients that are related to diabetes that are indtipendent of, or additive to, other factors such as obesity? Additionally, dietary habits and compliance with recommended :treatment could be investigated in individuals with known diabetes.

Digestive diseases

A diet that includes a variety of foods has been recommended as a means of consuming sufficient quantities of

essential nutrients, yet many persons experience difficulty

digesting certain food items. A series of questions about

problems with digestion, primarily for use in conjunction

with the gallbladder disease component of the survey, was

included in the Adult Sample Person Questionnaire, These

questions concern the occurrence of symptoms of digestive

problems apd the types of foods that may initiate digestive

distress.

A numbpr of digestive diseases, such as gallbladder disease and ulders, may be related to nutritional factors. In

addition, diet A,? treatment is commonly used to reduce dietary

symptoms. Increased prevalence of gallstones has been linked

to various nutritional factors, including increased food consumption, obesity, consumption of relatively small proportions

of vegetable protein, high consumption of unsaturated fats,

and low consumption of vegetables and fruit. ‘9790The study

of the association of dietary factors to digestive disease would

include the use of nutition data on dietary intake, food

habits, and the use of special diets in combination with

the disease history and medical findings.

Alcohol consumption

Data on alcohol consumption provide cultural as well

as health and nutritional information, The diets of m:rsons

consuming large quantities

liquor) may lack nutrients

.

of alcohol (beer, wine, or hard

that are obtainable from a diet

ie
composed of a variety of foods, the absence of which may

lead to a deficiency in those particular nutrients .91’92Alcohol

consumption can also decrease the ability to utilize nutrients;

thus, nutritional status may be altered. From a nutritional

standpoint, alcohol is also important because of the relative

amount of empty calories it supplies in the diet. Alcohol

can affect blood chemi$ries such as lipids (cholesterol,

triglycerides), lipoproteins (HDL-cholesterol), blood glucose,

and liver enzymes (for example, SGOT).91 ’92The contribution

of alcohol consumption to overall nutrient intake should be

considered in research relating dietary intake to such diseases

as cardiovascular disease, liver disease, and hypertension.

Dental health

Dental care services are utilized less frequently by Hispanics than by the general population .39 Dental health may

relate to availability of services, cost, education, and dietary

intake. Certain food items and food groups, particularly those

high in sugar, have been shown to be associated with the

development of dental caries .9a Data from HHANES may

be used to investigate other issues, including the relationship

between decayed, missing, and filled (DMF) surface index

and the calcium to phosphorus dietary intake ratio; dietary

patterns and nuh-itional adequacy of edentulous adults or

persons whose teeth are indicated for extraction; and associations between vitamin C intake and dental health.

Risk factors for cancer and osteoporosis

While HHANES was not designed to investigate the

causal nature or relationship of nutrition to cancer and osteoporosis, data on the prevalence of risk factors and dietary

intake patterns that may be related to these diseases were

collected. Various health and research agencies are interested

in population data on dietary intake and risk factors that

can be compared between particular groups.

Certain dietary patterns and nutrients have been associated

with a risk of developing certain types of cancer. It has

been suggested that the consumption of vitamins A and C,

carotene, fat, alcohol, and fiber, and blood levels of certain

nutrients (for example, blood retinol), may be related to

the risk of developing certain types of cancer.94’95 Data on

food patterns, nutrient intake, and serum retinol were collected

by means of HHANES and may provide data for comparison

to other population groups.

Although HHANES did not include a component designed

to diagnose osteoporosis—a condition that is currently of

great nutrition research interest primarily in women-data

on suspected risk factors, such as age at menopause, smoking,

body mass index, and calcium and protein intake were collected. Among the possible etiologies of primary osteoporosis,

current data point to two probable causes: Deficiency of

estrogen and deficiency of calcium intake. 96 HHANES is

the first large-scale study to describe the calcium intake

and dietary pattern of Hispanic women, and questions are

included about reproductive history and use of estrogens.

Public health nutrition issues

Dwtary adequacy

Data from the 24-hour dietzuy recall may be used to

estimate the total food and nutrient consumption within population groups. These estimates of average intake can be used

to describe the nutritional adequacy of the diets of Hispanic

groups and subgroups. This is often accomplished by comparison to a standard, such as the Recommended Dietary

Allowance, 97

The U.S. Dietary Guidelines contain recommendations

concerning consumption of fat, cholesterol, sodium, sugar,

alcohol, and fiber, as well as maintenance of ideal body

weight and consumption of a variety of foods. 98 The survey’s

dietary data may be used to monitor changes in the intake

of these nutients and changes in food patterns over time.

Analysis of survey data may indicate the need for further

education on nutrition to meet these dietary guidelines.

The many types of clinical data collected by means

of the survey provide objective evidence to be used in conjunction with the dietary data to assess the health and nutritional

status of individuals and groups with respect to anemias,

blood disorders, and vitamin and mineral deficiencies and

toxicities. For example, vitamin A status assessment was

continued for HHANES because of the FDA requirement

for further information on the prevalence of vitamin A deficienc y and toxici~ in the population, Vitamin A deficiency

has been suspected as a significant nutritional problem among

Hispanics, especially in children and people in the low income

group .99 In addition, vitamin A is of research interest both

because of epidemiologic evidence linking it to the prevention

of cancer and because of the potential for toxicity by self-treatment with vitamin A supplements. The FDA has identified

the need for additional information on the vitamin A status

of the population. Vitamin A data from past NHANES programs and from HHANES may be used to determine the

prevalence of deficiency and toxicity and to identify population

groups at risk in order to develop appropriate policy.

Food fortification

Monitoring changes in nutritional status and other factors

can lead to modifications in fortification policy for specific

nuhients.lw Before the FDA will alter current food fortification policy, four criteria must be met:

1.

2.

3.

4.

There must be adequate biochemical or other physiological evidence that a nutritional problem or deficiency

exists within a population group.

The level of intake of the nutrient in question must

be low within ihe trugeted group.

The proposed level of fortification must not be harmful

or lead to toxicity.

The food items proposed for fortification must be consumed in adequate amounts by the targeted population.’01

19
NHANES programs constitute the primary source of evidence of nutrient deficiencies or toxicities in the population,

and NHANES data supplemented with other data, such as

information obtained during the Department of Agriculture’s

food consumption surveys, may be used to review food fortification policy. 100The FDA has al]ocated substantial rmOtuzes

to study iron, zinc, and folate fortification issues using indicators available from NHANES 11.731102’103HHANES will

provide similar data for Mexican-American, Cuban-American,

and Puerto Rican population subgroups.

Viamin and mineral supplement use

Measurement of the use of vitamin and mineral supplements is important information for determining the level of

intake and for interpreting biochemical data for nutrition

assessment, As part of the sections on use of medicines

and vitamins contained in the sample person questionnaires,

each individual was asked about the use of vitamin and

mineral supplements during the previous two weeks. If the

answer was positive, the interviewer asked to see the relevant

containers, and then recorded the brand name, the quantity

of each vitamin or mineral taken, and the frequency of use.

This questionnaire was more detailed than that used in the

previous NHANES and may provide benchmark data for

subsequent NHANES programs.

The compmison of data on dietary intake and laboratory

measures of nutritional status for supplement users and nonusers may indicate whether those who take vitamin or mineral

supplements require them for nutritional adequacy. In addition,

data on the prevalence of supplement use in the Hispanic

population can be compared with estimates for the general

population. The use of certain supplements, such as vitamin

A, is also of concern because of the potential toxicity related

to chronic use.

Participation in food programs

One of the goals of the National Nutrition Monitoring

System 67 is to provide the kind of surveillance system that

would enable Congress and other groups to evaluate the

effectiveness and adequacy of various food programs. Although HHANES was not designed to permit detailed evaluation of the efficacy of federally funded food programs in

the U.S. Hispanic population, several issues may be addressed.

In addition to providing information about the proportion

of the Hispanic population participating in these pro,grams,

HHANES data may be used to draw comparisons between

food program participants and nonparticipants regarding many

of the nutrition-related measurements obtained in the survey;

for example, iron status in children or dietary adequacy in

older adults. These data may also suggest the need for education about the availability of food programs.

The questions concerning food program participaticm were

asked as part of the Family Questionnaire and the sample

person questionnaires. Information about participation in the

WIC program was collected for children under 12! years

of age; school-age persons were asked about participation

in school breakfast and school lunch programs; and all sample

persons over age 60 were asked about home delivery of

meals or group meals served through government prclgrams,

volunteer organizations, and churches.

Infant feeding practices and growth

Questions on infant feeding practices included in

HHANES were based on those used in NHANES II and

in the 1981 NHIS. These questions dealt with breastfeeding,

the use of infant formula, and the introduction of solid food.

This information will be useful for assessing infant feeding

practices, which bear on the nutritional status and growth

of children, These data for Hispanics may be compared with

data collected in NHANES 11 and NHIS for white and black

persons and may suggest important cultural differences concerning infant feeding practices.

Infant feeding practices have direct influence on thle nutritional status and growth of children. Body weight and height

(or length) are important indicators of the nutritional status

of infants and children and have been used in the previous

NHANES and NHES surveys to produce growth charts for

distribution to pediatricians and researchers around the

world. 1M Growth patterns for Mexican-American J ~~ubanAmerican, and Puerto Rican children will provide data that

may be compared with the standard growth charts produced

from the earlier surveys. Moreover, Tanner staging was performed during the physician’s examination to estimate the

maturational stage of youths 10-17 years of age. ’05

20
Chapter 4

Assessment of environmental

exposure to selected toxic

chemicals

by Trena M. Ezzati and Claudia Scala Moy

In the earlier National Health and Nutition Examination

Surveys, NHANES I and II, the National Center for Health

Statistics (NCHS) collected data from the general population

on elements in water and body burdens of lead, pesticides,

carbon monoxide, and cadmium. In the Hispanic Health and

Nutrition Examination Sumey (HHANES), the Environmental

Protection Agency (EPA) and the Centers for Disease Control

(CDC) sponsored an environmental health component designed to provide data on the Hispanic population’s exposure

to lead as well as exposure to, and body burden of, selected

pesticides.

Statistics relating exposure and body burden levels to

occupation, geographic region, employment status, age, sex,

ethnic group, socioeconomic status, place of residence, and

selected health and nutritional factors may be useful to environmental health researchers, regulators, and public health program planners. Data on type and extent of exposure to pesticides as reported in personal interviews, as well as actual

measures of concentration of selected residues in body fluids,

will enable the comparison of the exposure to environmental

pollutants within the Hispanic population to that in the general

U.S. population as determined in the earlier surveys. Additional components included in HHANES may provide information on health effects associated with exposure to these substances. A questionnaire section for women on reproductive

history, including information on children born with congenital

birth defects, is an example of such a component. Other

interview and examination sections

information for the study of health

exposure to these pollutants.

Pesticide exposure

will prov;de additional

effects associated with

As part of a cooperative agreement with NCHS, the

National Human Monitoring Program of EPA participated

in the assessment of the Hispanic population’s exposure to

selected pesticides by evaluating the amount and type of

exposure as reported by respondents and by measuring the

concentrations of specific residues and metabolizes in blood

and urine specimens collected from a subsarnple of study

participants. (Appendix VIII contains a list of the target

compounds in both serum and urine. ) The pesticide subsarnple

consisted of a half-sample of persons 12–19 years of age

and the group 20-74 years of age who had not been scheduled

for the glucose tolerance test. One blood and one urine

specimen from each subsarnple person were shipped to the

EPA Toxicant Analysis Center (TAC) for chemical analysis.

Field controls, consisting of field blanks and field-spiked

specimens, were supplied by TAC to the collection site to

monitor specimen degradation and contamination occurring

in the field.

So that the relationship between pesticide body burdens

and direct pesticide contact in the home or workplace can

be examined, questions on type and frequency of exposure

were included, with the major emphasis being on agricultural

contact with pesticides. Many of the chemicals included in

this study are known to accumulate in the body over time.

Therefore, a brief history of experience with farm work

or pesticide processing or application was obtained to aid

in the examination of the origins of pesticides in the body,

and to determine the relationship between length of exposure

and body burden. Questions on agricultural jobs performed

and crops worked with were included as an indirect measure

of the classes of pesticides used. Data on contact with pesticides through ingestion of water or food at risk of contamination and direct accidental contact with pesticides also were

collected. In addition to the occupational exposure, pesticide

exposure in the home or other environments was also measured. Questions were included on household and other use

of pesticides during the 12 months preceding the household

interview, and again for the 7 days prior to the examination.

Certain signs or symptoms suspected to be associated

with exposure to pesticides or industrial compounds were

assessed in the physical examination, These measures included

superficial examination of the eyeball (conjunctival injection),

observation of acute dermatologic conditions (for example,

contact dermatitis and chloracne), report of nausea, and acute

and subacute necrologic findings. Because HHANES is a

cross-sectional survey, there are limitations regarding the

ability to determine relationships between environmental pollutants, signs and symptoms of disease, and disease itself.

Furthermore, it may take several years before a health effect

is manifested as a result of acute or chronic exposure to

chemical environmental agents. Nevertheless, HHANES pesticide data may be important in determining the exposure

prevalence for the Hispanic population by geographic location

and occupation, and the survey will provide comparative

data for the statistics collected on body burdens of pesticides

for the national probability sample in NHANES II.

Lead exposure

Lead exposure is another

health concern. The common

major environmental public

sources of human exposure

21
to lead in the environment include gasoline, old paint, and

food. Other sources of lead exposure include dust, soil,

water, glazed ceramic vessels, and pewter containers.

Three systems within the human body appear to be especially sensitive to the effects of high levels of lead: The

blood forming systems, the nervous system, and the renal

system. Furthermore, the potential damage to health as a

result of lead exposure is greatest for infants and very young

children (5 years of age or less) for the following reasons:

o The health effects of lead occur at lower threshold levels

in children.

ID Children have a greater tendency than adults to ingest

items other than food (pica behavior) that contain lead;

for example, soil, paint chips, plaster, or newsprint.

o Children tend to absorb greater proportions of lead than

do adults at comparable levels of intake.

@ The high lead levels in children primarily affect the

central nervous system whereas in adults the effect is

primarily on the peripheral nervous system. ‘m

The importance of reducing human exposure to lead

has been clearly recognized by public heakh officials, Less

Iead is now used in food carIs than in the past, and public

concerns over lead-base paints have helped to eliminate their

use. EPA initially began limiting the amount of lead in

gasoline because it attacks catalytic converters. Subsequlmtly,

EPA began monitoring the amount of lead-containing gasoline

produced. A lead phasedown process was implemented in

1976, and by 1980, lead used in gasoline was reduced to

86,500 tons—less than one-third the amount used in 19’70.106

During this same time period, from 1976 to 1980, data

from NHANES II showed a decline in the blood lead levels

for the U.S. civilian noninstitutionalized population. 107

To provide comparable data for the Hispanic population,

blood lead determinations were performed for all HHANES

participants by the Center for Environmental Health at the

Centers for Disease Control, Quality control of the laboratory

analysis included independent duplicate assessments ‘within

the same analytic run.

These laboratory determinations, as well as the interview

data on place of residence (that is, whether urban or rural

and size of place) can be used to relate the distribution

of blood lead levels and the prevalence of abnormal levels

to the individual’s place of residence, Selected demographic,

socioeconomic, and other health and nutritional data will

provide data for statistical analysis.

22
Chapter 5

Sample design and estimation

procedures

by Joe Fred Gonzalez, Jr., Trena M. Ezzati, Andrew A. White,

Ph. D., James T. Massey, Ph. D., Josefina Lago, and Joseph

Waksberg

Introduction

The general structure of the HHANES sample design

was similar to that of the previous National Health and

Nutrition Examination Surveys. All of these studies have

used complex, multistage, stratified, clustered samples of

defined populations. The major difference between HHANES

and the previous surveys is that HHANES was a survey

of three special subgroups of the population in selected areas

of the United States rather than a national probability sample.

The four stages of selection were primary sampling units

or PSU’s (counties or small groups of contiguous counties),

segments (clusters of households), households, and eligible

persons. This chapter describes the broad design specifications, the definition and construction of the universes of

PSU’S, the stratification and selection methods that were

used at each stage of the design, and the basic framework

for constructing estimates for the survey.

Design specifications

The planning phase and survey objectives for HHANES

have been discussed in previous chapters. The survey specifications that directly affected the sample design were as

follows:

● HHANES should be a probability sample survey whose

target population consists of civilian noninstitutionalized

“e]igible” Hispmics; that is, Mexican-Americans in the

Southwest; Puerto Ricans in the New York City area

(defined as selected counties in New York, New Jersey,

and Connecticut); and Cuban-Americans in Dade County

(Miami), Fla.

I . The eligible Hispanics 6 months-19 years of age and

45–74 years of age should be oversampled to improve

the reliability of estimates of their health characteristics

and nutritional status.

. The total sample size selected for HHANES should result

in approximately 12,000 examined persons.

. An average of two to three sample persons should be

selected from each sample household.

. The number of sample persons selected at each survey

location within each PSU should be approximately equal.

. The data collection mechanism used for NHANES II

should be used for HHANES, with appropriate modifications (as a result of different or new health and laboratory

tests). At any time during the survey period, two of

the three medical examination centers should be operating

in different locations while the third is being serviced

or relocated.

. The total data collection period should be about 2%

years.

. The average length of an individual examination should

be between 2 and 3 hours, with variations depending

on the age of the examinee. The time required to examine

a preschooler should be less than 1 hour, and the time

for an adult should not exceed 2% to 3 hours.

● Based on experience from previous surveys, the PSU’S

should be composed of single counties, or small groups

of contiguous counties.

Definition of the universe and primary

sampling units

Ideally, the target population for HHANES should be

all households with at least one member of Hispanic origin.

However, the United States includes States and counties with

very small numbers or proportions of Hispanics. If sampled,

the costs of screening enough households to locate a reasonable

sample size in these areas would be quite high. Consequent] y,

HHANES was restricted to those counties in the three target

areas of the country that had a sufficient number or proportion

,

of’ Hispanics to render it economically feasible to screen

households and to operate an examination center over a 4-

to 7-week time period.

Using 1980 Census data, counties from the three target

survey areas were distributed into cells according to the

percent and number of Hispanics in the respective county. ’06

Counties were identified for inclusion in one of the three

sampling frames if they satisfied any one of the four following

criteria, based on a combination of the county’s total number

of Hispanics and the proportion of the total 1980 county

population that was of Hispanic (Mexican, Puerto Rican,

Cuban, and “other” Hispanic) origin:

1. The county Hispanic-origin population was greater than

or equal to 30,000.

2. The county Hispanic-origin population was greater than

or equal to 10,000 and less than 30,000, and it constituted

at least 5 percent of the total county population.

3. The county Hispanic-origin population was greater than

or equal to 5,000 and less than 10,000, and it constituted

at least 10 percent of the total county population.

23
4. The county Hispanic-origin population was less than districts (ED’s) as defined by the U.S. Bureau of the Census

5,000, and it constituted at least 15 percent of the total that did not contain a minimum number (between 50 and

county population. 100) of eligible Hispanics were excluded. A BG is a combinaAs a result of the above criteria, 229 counties were

identified and grouped into 210 PSU’s, each PSU defined

as a single county or a small group of contiguous counties

with a 1980 Hispanic population of at least 1,000. The

HHANES Mexican-origin universe for the Southwest consisted of 193 PSU’S (figure 2); the HHANES Puerto Rican-origin universe for the New York City area consisted of 16

PSU’S (figure 3); and the HHANES Cuban-origin universe

consisted of only 1 PSU, Dade County (Miami), Fla.

The HHANES Mexican-origin universe of first-stage units

(193 PSU’S) included abo&<4p&rcent of the 1980 Mexicanorigin population in the United States and about 97 percent

of the 1980 Mexican-origin population in the 5 southwestern

States. As a means of reducing screening costs (the screening

procedure will be described later), a small proportion-usually

less than 10 percent-f the Mexican-origin population in

low Hispanic density areas within each sample PSU was

not covered. That is, those block groups (BG’s) or enumeration

tion of numbered census blocks, a subdivision of census

tracts, or a block numbering mea as defined in areas for

which there are block statistics. In areas where censufi blocks

were not established, ED’ s—geographic areas containing approximately 300 housing units—were used. The count of

eligible Hispanics within a given BG or ED was defined

as the number of Mexican-origin persons plus a certain (PSUspecific) proportion of persons of “other Spanish” origin

who were assumed to be of Mexican origin. (This is discussed

in more detail in a later section of this chapter.) Hence,

with the exclusion of the noncovered counties and the out-ofscope BG’s and ED’s, the net coverage rate of the 1980

Mexican-origin population in the five southwestern States

was approximately 87 percent (.97x .90).

The HHANES Cuban-origin universe, which ccmsisted

of only-one PSU, Dade County (Miami), Fla., included

about 57 p$rcent of the 1980 Cuban-origin population of

the United’States and about 96 percent of the Cuban-origin

Primary ssmpling units

Figure 2. HHANES Mexicsn-ongin universe

24
-%T Philadelphia

ocean

@ Burlington

0/ %%

% 9

I : n - \@@&k. )

Nonuniverse

0

PSU universe n

Sample PSU’S m

\ /. Y Primary sampling units

F@yre 3. HHANES Puerto Rin-origin universe

population of Dade County itself after the exclusion of low

Hispanic density BG’s. ”

The HHANES Puerto Rican-origin universe of first-stage

units (16 PSU’S) included about 59 percent of the 1980 Puerto

Rican-origin population in the United States and about 90

percent of the Puerto Rican-ongin population in the defined

universe for the New York City area after the exclusion

of BG’s and ED’s with low Hispanic density.

Even though HHANES was not designed as a national

Hispanic survey, and no national estimates for Hispanics

can be made, the three HHANES universes included approximately 76 percent of the 1980 Hispanic-origin population

in the United States.

“Because the official date of the 1980 Census was April 1, 1980, the

Cubans who came to the United Stotes in the period immediately following

April 1 were not included in the 1980 Census count. It is generally believed

that at tlw time of the survey most of them were in Dade County. As

a result, the proportion of the Cuban-origin population in Dade County

covered by the survey was prcrbubly gretter Lhan96 percent.

Because three separate universes were created, direct

statistical inferences may be made for the Mexican-ori:il~

population residing in the defined universe for the five southwestern States, for the Puerto Rican-origin population residing

in the defined universe for the New York City area, and

for the Cuban-origin population residing in Dade County

(Miami), Fla.

Stratification of primary sampling units

Stratification of units prior to sample selection is a technique that is widely used in scientific sampling. The goal

of stratification is to reduce the variance of the survey estimates

by forming strata that are composed of homogeneous units.

For a multistage design, this can be accomplished in part

by partitioning the universe of PSU’S into optimally

homogeneous strata. Based on sampling theory, 109 PSU’S

should be stratified according to the survey variables of interest; however, estimates of survey variables are generally

25
unknown prior to the conduct of a particular survey. In

addition, it is impossible to select a small subset of survey

variables for stratification of a multipurpose survey designed

to yield estimates of a large number of variables. Therefore,

stratification is usually based on the sociodemographic characteristics that are believed to be correlated with the survey

variables. The following discussion of stratification in

HHANES is extracted from a paper by Gonzales and White,

presented at the 1982 annual meeting of the American Statistical Association. 110

The 1980 Census information for the Mexican-origin

population in the southwestern PSU’S was unavailable prior

to stratification; therefore, information based on Hispanics

of all origins was used for the stratification process. The

characteristics of the PSU’s in the five southwestern States

that were used as stratification variables were:

1.

2.

3.

4.

5.

Number of Hispanics.

Percent Hispanic.

Ratio of the 1980 to the 1970 Hispanic population.

Median income.

Percent urban.

For the New York City area component of HHANES,

the corresponding stratification variables were in terms of

the number of Puerto Ricans. Stratification was not required

for the Miami-area component of HHANES because only

one PSU, Dade County, was sampled.

A critical sample design requirement for HHANES was

that each stratum in the Southwest be of approximately equal

Hispanic population size, and that each New York City-area

stratum consist of approximately equal Puerto Rican population size. This was a requirement because equal-size strata

generally minimize sampling variances, at the same time

permitting roughly the same number of sample interviews

and examinations at each survey location. This requirement

was satisfied by forming equal size strata (clusters), and

then applying the same sampling fraction to each stratum.

The Statistical Analysis System (SAS) routine PROC

CLUSTER, which is described in the SAS User’s Guide, 1]1

was used to stratify the HHANES PSU’s in the Southwest

and the New York City area. The SAS PROC CLUSTER

routine employs a hierarchical algorithm] 12to identify clusters

of elements having similar attributes. There are various types

of distance criteria to measure the closeness (similarity) between elements or clusters of elements. This SAS procedure

used complete linkage as the distance criterion. Each PSU,

which had five stratification characteristics, was treated as

a multivariate element—that is, as a vector observation. Complete linkage measured the similarity between two clusters,

that is, the largest pairwise distance between a vector observation in one cluster and a vector observation in the other

cluster. One major drawback of the algorithm is its inability

to impose constraints on the cluster sizes, Nevertheless, iterative application of the SAS procedure controlled the clustering

process to yield strata of approximately equal size. The cluster

analysis was performed separately for the Southwest and

the New York City area universes.

As mentioned earlier, PSU’S were characterized as vector

observations in 5-dimensional vector space because there were

five stratification variables. As a consequence of the form

of distance measure used—Euclidean (linear)- the variables

or elements of the vector observations with the largest absolute

magnitude dominate the distance measure (for example, population totals versus percents or ratios). To resolve this inequitable contribution from each stratification variable to the distance

measure, equalization was achieved by ranking on th,e same

scale. This method also ensured that equal importance was

assigned to each variable by transforming the vecltors of

observed PSU values to vectors of rank val.ugs.

Operational, cost, and time considerations, as well as

desired precision of survey estimates, dictated that HHANES

be conducted at 14 different locations (counties) in the Southwest, seven counties in the New York City area, and one

in Florida (Dade County). Because one PSU per stratum

was to be drawn, it was necessary to form 14 strata in

the Southwest and seven strata in the New York City mea.

Because of their sizable Hispanic populations, the clounties

of Los Angeles, Calif. and Bexrw (San Antonio), Tex,, were

identified as self-representing (certainty) PSU’s; that is, they

were selected with probability equal to 1. In the New York

City area, the counties of the Bronx, Kings, and New York,

with their large numbers of Puerto Ricans, were identified

as certainty PSU’s.

After removing the certainty PSU’S from the universe,

each noncertainty stratum was successively identified and

withdrawn from the universe without replacement. Then a

new stratum cutoff size was computed by dividing the remaining Hispanic population in the universe by the number of

strata yet to be formed. In practice, it was impossible to

achieve exactly the same size for each stratum; therefore,

a tolerance level of plus or minus 10 percent from the cutoff

value was allowed for the noncertainty strata. Prior to invoking

the SAS clustering algorithm on each successive run, the

SAS PROC RANK routine was used to re-rank the raw

variables of the remaining PSU’S in the universe. The above

procedures were repeated until all of the PSU’S were stratified.

Part of the SAS PROC CLUSTER output included a

cluster map, This map was vital for the formation of the

strata (clusters) because it graphically illustrated the hierarchical path followed in producing the desired clusters. Figure

4 demonstrates a fictitious example of a cluster map. Each

full column of asterisks on the map represents a PSU. Down

the far left side of the map, the number of clusters appears

for each hierarchical level of clustering. The uppermost row

Fgure 4. Example of a cluster map

PSUHispanicpopu/ation

Number of clusters N, N= N= N4 N5 N= N, Ns Ng N,a

10

9

8

7

6

5

4

3

2

1

******* ***

******* **** *

** **** * * * **** *

* ******* * * * *** * *

* ******* **** * **** *

* *** *** * **** ******* *

**********   ** ***** *

*** ***   ** ** **********

**************** **********

*** *************************

NOTE: N, (i= 1,..,,1 O) denoles lhe Hlspanlc population efthe Iti PSU.

26
on the map shows the initial hierarchical level of clustering,

in which each PSU’S vector of ranks is treated as a single

cluster. The lowest row on the map represents one cluster

of all the PSU’s remaining in the universe. As the cluster

map is read downward and across, one can see how adjacent

columns (PSU’s) collapsed hierarchically to form clusters.

Candidate clusters were screened and the cluster that

amalgamated the earliest (that is, had smallest distance measures or was “closest” together) and achieved plus or minus

10 percent of the current stratum cutoff size was selected.

If all of the constrained clusters had populations that were

too large, the subcluster that formed first within the size

constraint was selected as a stratum.

Selection of primary sampling units

As previously mentioned. for the Miami area, Dade

County was the only PSU selected; and for the New York

City area, one PSU per stratum was selected with probability

proportional to size (PPS). The Southwest and the New York

City area universes of PSU’S were stratified according to

the five demographic characteristics discussed earlier.

Moreover, it was deemed desirable to maximize the probability

that the proportion of sample PSU’S in each of the five

southwestern States would correspond to the proportion of

the eligible population in each State. Therefore, during PSU

selection for the Southwest, a slightly modified version of

a procedure introduced by Goodman and Kishl 13 and sum- –

marized in Kishl’4 was employed to obtain a balanced sample

with respect to State while retaining a b-ue probability sample

design. A detailed description of this controlled selection

process and its application to health examination surveys

is given in other NCHS reports. s’115

The goal of controlled selection was to introduce controls

beyond stratification into the sampling process. As applied

in past health examination surveys, the first step involved

defining a set of admissible patterns to ensure that sampling

according to any pattern would result in the desired distribution

of PSU’S across the conmol classes. A pattern was ascertained admissible when, for each control class within the

pattern, the number of PSU’S was within 1 of the number

expected if a sample of the same number of PSU’s were

to be drawn strictly at random from the universe with probabilities proportional to PSU size. The total set of patterns

was formed such that the probability of selecting any given

PSU in the universe was proportional to its population. Each

pattern within the set was usually assigned a probability

of selection based on the accumulated size of the sample

PSU’S within the pattern. The sum of the probabilities of

selection over all patterns was held equal to 1. A pattern

was then picked at random.

For the southwestern States, having State as the single

control variable during selection allowed the procedure to

Table A. Primary aampting units, by number and percent H~nic population and farget number of sample persons: Hispanic Heaith and Nutrition Examination

Sunfey, 1902-S4

Primary Target

samplmg unil Total 1980 1980 Hispanic number of

within Suwey Hispanic Percent population sample

survey area /OCdf!O~ population’ Hisparri? in sfratuti persons

Soulhwesl area

Allprimary samplmg units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Los Angeles, Calif? . . .Los Angeles, CalIf. . . . . . . . . . . . . . 2.065.727

Bexar, Tex? . . . . . . . . . . . . . . .. San Antonio. Tex. . . . . . . . . . . . . . . . . . 460,911

Harris, Tex. . . . . . . . . . . . . . . . .. Houston .Tex. . . . . . . . . . . . . . . . . 369,075

El Paso, Tex. . . . . . . . . . . . . . .. El Paso. Tex. . . . . . . . . . . . . . . . 297,001

San Diego, Calif. . . . . . . . . . . . .. San Dqo.Callf. . . . . . . . . . . . . . . . 275,176

Cameron, Tex. . . . . . . . . . . . . .. Harlinge~. Tex. . . . . . . . 161,632

Santa Clara, Calif. . . . . . . . . . . .. San Jose. Callf. . . . . 226,611

Pima, Ariz. ., , ., . . . . . . . . . .. Tucson. Ar[z. . . . . . . . . . . . . . . . . . 111,418

Contra Cosla, CalIf. . . . . . . . . .. Concord CalIf. . . . . . . . . . . . . . . . . . 55,977

Glasscock-Midland, Tex. . . . . .. Midland. Tex. . . . . . . . . . . . . . . . . . . 12,699

Alameda, Calif. , . . . . . . . . . . . .. Oakland Calif. . . . . . . . . . . . . . . . . . . . 129,962

Weld, Colo. . . . . . . . . . . . . . . . .. Greeley. Colo. . . . . . . . . . . . . . . . 21,017

Quay, N.Mex. . . . . . . . . . . . . . .. TucuMexrl. N.Mex. . . . . . . . . . . . . . . . 3,753

Bee, Tex. ,., . . . . . . . . . . . . . .. Beev!lle. Tex. . . . . . . . . . . . . . . . . . . . 11,914

New York CIfy area

Allprimary samplingumt . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bronx, N.Y? . . . . . . . . . . . . . . .. Bronx NY . . . . . . . . . . . . . . . . . . . . 320,096

Kings, N.Y? . . . . . . . . . . . . . . . .. Brooklyn. N.Y. . . . . . . . . . . . 279,646

New York, N.Y? . . . . . . . . . . . .. Manhattan. N.Y. . . . . . 166,326

Fairfield, Corm. . . . . . . . . . . . . .. Brldgeporf. Corm. . . . . . . . . . . . . . 29,527

Hudson, N.J. . . . . . . . . . .Norfh Bergen, N,J. . . . . . . . . . . . . 55,820

Nessau, N.Y. . . . . . . . . . . ,. Carle PIace, N.Y. . . . . . . . . . . . . . . . 13,904

Queens, N.Y. . . . . . . . . . . . . . .. Queens. N.Y. . . . . . . . . . . . . . . . . . . 63,425

Miami area

Dade County, Fla. . . . . . ., ... Mlaml, Fld. . . . . . . . . . . . . . . . . . 407,253

. . . . . . . .

27.6

46.6

15.3

61.9

14.8

77’.1

17.5

21.0

8.5

15.1

11,6

17,0

35,5

45.8

., . . .

2.065,727

460,911

479,616

493,459

561,507

532,890

425,610

514,450

457.644

545,012

469,476

544,237

454,839

450.653

. . . . . . . . .

27.4

12.5

11.6

3.7

10.0

1.1

4.4

. . . . . . . .

320,096

279,646

166,326

101,796

101,332

106,617

101,206

10,000

2,435

543

565

562

662

628

502

606

539

643

577

641

536

541

3,913

1,062

928

552

336

336

361

336

25.1 407,253 2.266

‘ Forthe NewYork city area this solumn representsIh!>Lolal 1980 Puerto Rcan populahon and for the Mlaml area Ihe lolal 1980 Cuban population

2Forthe New York CIly area this column represents Ihe percent Puerlo Rcan populabon and forihe M!ami area the percent Cuban populatmn

3Forlhe New York City area Ibis column represents Ih,, lolal 1900 Puerto Wan populahon in the stratum and for the Miami area Lhe19s0 Cuban population m mestratum,

4Because of their large Hispanic populahons, these counties ware identified as self-represenbng, or cerlainiy (pro babhiy equal to 1), PSU’S.

27
be modified to some extent for simplicity. The goal was

to preserve the representation of the five southwestern States,

and at the same time to select the final sample of 14 PSU’s

(selecting one PSU per stratum) with probability proportional

to their Hispanic population. Thus, for the Southwest, 100

equally probable patterns were defined so that each pattern

detailed for each stratum which State (of those represented

in the stratum) should contribute the single PSU to represent

that stratum in a potential sample based on that pattern.

These patterns were defined so that the number of patterns

that would include any given PSU in a final sample was

proportional to its Hispanic population.

The actual procedure used differed from the usual practice

in Goodman snd Kish’s controlled selection 113 in that some

of the 100 patterns were duplicates. As applied previously,

patterns were not usually assigned equal probabilities, and

indeed the duplicate patterns could have been collapsed and

assigned proportionally higher selection probabilities.

Nevertheless, by allowing duplicates, pattern construction

was made somewhat more straightforwmd, and the same

goal was accomplished. One of the 100 admissible patterns

was then selected by simple random sampling. The State

representation having thus been set for each stratum, the

final PSU’S were selected using PPS sampling from among

the PSU’s dictated by the selected pattern for each stratum.

Table A shows the sample PSU’S selected for the three

phases of HHANES and the target number of sample persons

for each PSU.

Selection of segments and households

The within-PSU sampling procedures were designed to

achieve the target number of sample persons, as shown in

table A, and to yield an approximate self-weighting samPle

of households such that every household would have about

the same probability of selection. Within the PSU’s selected

at the first stage of sampling, the in-scope population ccmsisted

of all households and residents of group quarters (noninstitutional) containing one or more eligible Hispanics. Certain

types of living quarters-institutions, Indian reservations, and

military installations-were considered out of scope for the

suNey .

Further, block groups (BG’s) and enumeration districts

(ED’s) with low eligible Hispanic density were excluded

from each of the three universes to reduce the costs of

the household screening procedures, The overall goal was

to attain a minimum of 90-percent coverage of the eligible

Hispanic population within each sample PSU, althoulgh this

TableB. Expected coverage of the eligibleHispanicpopulationwithinthe Southwest primary samplingunfts(PSU’S} HispanicHealth and NutritionExamination

Survey, 198244

Percent ‘tither Minimum number of Expected P(ercent

Spanish r’irrcluded eligible Hispanics percent

Southwest PSU!S

BG5 orEds in

as eligible perBG or ED’ coverage PSU ,excluded

Los Angeles, Calil, . 50 100 93.9 41

Bexar, Tax . . . . . . . . . . . . . . . . . . 75 100 97.6 33

Harris, Tax. . . . . . . . . . . . . . 40 100 .99.1 65

EIPaso, Tax, . . . . . . . . . . . . . . . . 60 100 99.2 9

San Diego, Calif. . . . . . . . . . . . . . . 70 90 90.0 46

Cameron, Tex. . . . . . . . . . . . . 75 100 98.7 20

SantaClara,Calif. 60 100 90,1 55

Pima, Ariz. . . . . . . . . . . . . . . . . . 75 100 90.5 47

Contra Costa, Calif. 75 50 85.7 52

Glaascock-Midland, Tex. . . 75 50 90.0 50

Alameda, Calif. . . . . . . . . . . . . . 75 50 88.8 46

Weld, Colo. . . . . . . . . . . . . . 100 90 89.8 51

Quay, N.Mex. . . . . . . . . . . . . . . . . 100 100 97.7 40

Bee, Tex. . . . . . . . . . . . . . . . . . . 100 100 99.0 18

‘BG = blockgroup; ED= enumerationdistrict,

NOTE. Forthe purpose of estimatingthe expectedcoveragefor HHANES in lhe Southwest,%digibleHmpanics”were classified as all Mexican-Americansand a propmtfonof “otherSpanish” assumedto

be“Hispanos: asestimatedIrom1970Censusdata asshown m thefirst column,

TableC. Expected coverage of the eligibleHispanicpopulationwithinthe Dede County and New York City area pnmaty samplingunite (PSU’S):HispanicHeafth

and Nutrition ExaminationSuwey, 1982-84

Minimum number of Expected Percent

Miami and eligible Hispanics percent BG’s orEds in

New York City area PSIJk perBGorED’ coverage PSU excluded

Dade, Fla. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Cuban-Americans 96.2 49

Bronx, N.Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Puerto Ricans 96.4 34

Kings, N.Y, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Puerfo Ricans 93.3 54

New York, N,Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Puerto Ricans 91.9 61

Queens, N.Y. . . . . . . . . . . . . . . . . . . . . . . . . . 25 Puerto Ricans 90.0 50

Nassau, N.Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Puerto Ricans

Fairfield, Corm,

90.0 6

. . . . . . . . . . . . . . . . . . . . . . . . 35 Puerto Ricans 90,0 80

Hudson, N.J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 Puerto Ricans 90.2 56

‘ BG= block groups; ED= enumaratmn dkstnci.
goal had to be slightly relaxed in a few PSU’S. The minimum

number of eligible Hispanics per BG or ED varied between

50 and 100 persons in the Southwest (table B), and between

6 and 100 persons in the New York City area (table C).

In the Miami area, there was a minimum of about 100

eligible Hispanics per BG or ED (table C).

After eliminating BG’s and ED’s that were out of scope,

the remaining BG’s and ED’s were sorted by two stratification

variables: An economic index and Hispanic density. The

economic index was based on contract rent in areas where

rental housing dominated and on home value in areas of

predominantly owned homes. More specifically, within each

survey site, BG’s and ED’s were sorted in the following

way:

. Primary Sort. Percent of population in BG or ED that

was eligible Hispanic. Three groups-less than 30 percent, 30-59.9 percent, and 60 percent or more.

● Secondary Sort. Owner versus renter, classification based

on which one was more than 50 percent of the occupied

housing in the BG or ED.

. Final Sort. Alternating ascending and descending order

of median value of home in owner areas and median

rent in rental areas.

This sequencing sort automatically had the effect of stratification when a systematic sample of segments was selected.

The Secondmy Sampling Units (SSU’S) were “segments.”

In urban blocked areas, a segment was defined as a block

or group of neighboring blocks (generally contiguous). In

Quay, N. Mex., which was a nonblocked PSU, the selection

of segments was a two-step process. ED’s were selected

first, and then segments were manually mapped and selected

from the sampled ED’s. The frame used for the sampling

of blocks and ED’s was the STF- 1B tape from the 1980

Census. In order to determine a probability of selection for

each segment within a PSU, H measure of size (MOS) was

established for each segment based on these 1980 Census

data. The MOS was calculated by multiplying the estimated

number of eligible Hispanics in a segment by the age-specific

household sampling rates. The MOS established for each

segment in the Southwest and in the New York City area

corresponded to the number of sample persons expected from

the segment. It included only eligible Hispanics and was

approximately equal to the sum of three-fourths of the estimated number of persons 6 months–19 years of age, plus

one-half of those 2044 years of age, plus all of those

45–74 years of age living in the segment. In the Miami

area (Dade County), the MOS for each segment was approximately equal to the sum of till of those 6 months–19 years

of age, plus two-thirds of those 2044 years of age. plus

all of those 45–74 years of age living in the segment.

The age-specific rates that were used to compute the

MOS of segments were also used to select sample persons

within sampled households (to be described in detail later).

The age-specific sampling r~tes were established to ensure

sufficient sample sizes in the desired estimation cells. These

sampling rates were therefore used to compute the MOS

of segments because they retlected the number of expected

sample persons somewhat better than total population or total

households, and thus provided greater control of segment

size.

One of the sampling goals for HHANES was to design

the within-PSU sampling procedures to yield a desired six

sample households (approximate] y 18 sample persons) per

segment. In order to achieve this goal it was necessary to

inflate the target of 18 sample persons to a minimum of

27 sample persons per segment. Therefore, a minimum MOS

of 27 was established. This minimum MOS included a sufficient number of households to achieve the target sample

size and a reserve to allow for important changes in the

age distributions or in the total population of the area since

1980. An MOS was calculated for each block and ED.

If the block MOS was less than 27, the block was combined

with as many of the subsequent blocks from the sorted list

as necessary to reach the minimum of 27. However, the

combinations were kept within a BG. If the combination

of blocks reached the end of the BG without reaching 27,

the combination was added to the immediately preceding

block or blocks. The individual blocks, combinations of

blocks, or area segments within ED’s were the actual sampling

units (segments).

In selecting the sample of segments, a skip interval

was determined by dividing the total PSU measure of size

by the number of segments required to yield the target number

of sample persons for the PSU. Using a random start between

O and the skip interval, a systematic sample of segments

was selected with probability proportional to size (PPS).

That is, the probability of selection depended on the MOS

for each segment. After selecting the sample segments, households were listed within each segment. The sample was

designed so that every household would have approximately

the same probability of selection: therefore, a systematic

sample of households was selected based upon the segment

MOS. For example, if the segment MOS was 54, then a

systematic sample of .5 (27 divided by 54) of the households

within the segment was selected.

A modified Perkin’s Stop Rule. 1‘6 a sequential sampling

procedure, was employed in order to achieve, as closely

as possible, the target number of sample persons in each

PSU. The maximum sample of households within each segment consisted of a basic sample of households plus several

groups of reserve households. Each group of reserve households was a random subsample of households sampled within

the segments selected in the PSU’S. As the household sampling

was being accomplished within a PSU, progress in connection

with achievement of the target sample size was closely monitored. If it appeared that enumeration of sample persons

within households was less than that predicted based on

the MOS, reserve households were added to the basic sample

in groups until the target sample was achieved. In certain

PSU’S, it was necessary to remove some households from

the sample because of greater numbers of sample persons

than anticipated. The households to be removed were randomly

designated to reduce any potential biases resulting from the

procedure.

29
Selection of sample persons

After the sample” households had been identified, the

composition of the household was determined by interviewers

using the Household Screener Questionnaire (appendix XII).

The main purpose of the screening interview was to identify

eligible Hispanic families and to select sample persons from

these families to be interviewed and examined. Beginning

with a household reference person, who was the person or

one of the persons who owned or rented the dwelling unit,

the names of all household members were listed on the

questionnaire, ordered by family. (For this survey, a “family”

consisted of all household members who were related by

blood, marriage, or adoption.) To ensure that the sample

person selection procedure could be applied in a standardized

manner, household members were listed in a prescribed order.

Family 1 included the reference person and his or her spouse,

followed by the remaining members of the reference person’s

family, listed according to age, from oldest to youngest.

All other household members who were unrelated to the

reference person were considered to be part of separate

families. Within these secondmy families, a similar order

for listing members was followed; that is, family head, spouse,

and other members in order of age.

For each individual household member, relationship to

the reference person (or family head, in the case of secondary

families within the household) was ascertained, and national

origin or ancestry was obtained using a preceded list of

categories. (See Household Screener Questionnaire and

Flashcard S 1 in appendix XII,) Eligibility for the survey

was determined by family unit. A family was considered

eligible if at least one family member’s reported national

origin or anceshy met the criteria for eligibility appropriate

to the survey location. These criteria were as follows:

Suf-veylocation Nattonal origin or ancestry

Southwestern PSU’S . . . . . Mexican or Mexicano,

Mexican-American

Chicano, Hispano, Spanish-American or

Spanish (when no other country of

origin was mentioned)

New York, New Jersey,

and Connecticut PSU’S . . . Puerto Rcan and Borlcuan

Dade County, Fla., PSU . Cuban and Cuban-American

In cases of multiple origins reported for an individual,

the person was considered eligible if any one of the reported

origins met these criteria.

If a family was eligible for the survey, all members

of that family were eligible to be selected for the extended

intemiew and examination. To ensure sufficient sample size

in desired estimation cells, sample persons were selected

according to the sampling rates shown in figure 5. Each

family member’s age was obtained, and the interviewer classified each household member between the ages of 6 months

and 74 years into one of three age categories: 6 months–19

:years, 20-44 years, and 45–74 years. The particular sampling

patterns to be used for selection of sample persons within

the three age groups were indicated on each Household

Screener Questionnaire before it was assigned to an

interviewer.

F~ure 5. Wtihin-household sampling rates, by survey area and ago:

Hmpenie Heafth and Nutrition Examination Suwey, 1982-S4

Swveyarea and age Sampling rate

Southwesl end New York City area

6montha-19 yeara . . . . . . . . . . . . . . . . . . . . . . . . 21/4

2044 yeare . . . . . . . . . . . . . . . . . . . . . . . . 1/2

4574 years . . . . . . . . . . . . . . . . . . . . . 1

Miami (Dade County)

6monthe-19 years . . . . . . . . . . . . . . . . . . . . 1

2044years . . . . . . . . . . . . . . . . . . . . . . . . . . . W3

45-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

The hypothetical example in figure 6 illustrates how

the sampling rates were applied in the Southwest. The information in figure 6 shows that there are two families in one

household. In Family 1, two of the members are re]ported

as being of non-Mexican descent; however, because at least

one of the members is of Mexican descent, all of the members

are eligible for the Southwestern phase of the survey. Family

2 in this household is not eligible. Amada and Rosa Perez

are both classified as being of “Other Latin American” descent

(catego~ 9 on card S 1), with “Nicaraguan” specified. Therefore, Family 2 is not considered eligible, and no sample

persons would be selected from that family.

. Patterns “B ,“ “F,” and “K’ are specified on the sample

person selection table for this household, For the elligible

family of four, there are three adults (ages 47, 50, and

33) and one child (age 18). The number of persons ir) each

of the three age groups is 1, 1, and 2, respectively. The

sample person selection table indicates that pattern B is to

be followed for the age category “6 months-19 years,” requiring that the second, third, fourth, sixth (and so on) person

listed in that age group be selected as a sample pferson.

This means that Luis may not be selected as a sample person

because he is the first person in that age group, and pattern

B starts with the second person. Therefore, there is no sample

person for that age group. In the sample person selection

table for the age category 20-44 years, pattern F is ciircled.

Pattern F requires that the first, second, fifth (and so on)

person in the category 20-44 years of age be selected. Because

Margaret is the first and only person in that age category,

she is selected as a sample person. In the third ancl final

category, persons 45–74 years, there is only one sampling

pattern, and that is pattern K. The instruction for pattern

K is to include all persons between the ages of 45 and

74 years. In the example, there are two persons within this

age group, Mary and Juan, both of whom are sample persons.

30
Fqure 6.

20. NAME

FIRST, MIDDLE, LAST

@

Mary ~IMMe=

(A@l

lvloqard ckbow

L uis Jiwncz

2a. NAME

FIRST, MIDDLE, LAST

@

2b. IF NOT

COMPLETED

ASK: What is

--’s mlatiOnship to (~F.

PERSON)?

@

REF

PERSON

Ilusbad

son

2b. IF NOT

COMPLETED

ASK: What is

--J s rnlation.

Ship to

(HEAD)?

@

@ FAMILY #l

2c. HAND CARD S1. Plow give me the number of the group or

groups that repmzemm —’s national origin or armutry.

a. ELIGIBLE FAMILY?

2DN0 [NEXT FAMILY OR Q.3)

Z& What is —’s I Zf. ! 29. MARK ONE

i ,,

data of birth? AGE:

61

U= M~s-.

CHT.

MO DAY YR 19 20-44 45-74

YRS. YRS. YRS,

126 @@@ @ @ @ @

1 1 1 1 , I

2h. SAMPLE PERSON %.

FI

(NUMBER ALL SP’S

SEQUENTIALLY

wITHIN FAMILYI

z. NCHS #

135

0

2c. HAND CARD S1. Please give me the number of the group or

i

groupt that repro.senti —’s national origin or ancestw.

2d.

6

LIGIBLE FAMILY?

127 1 ❑ Yes (2e) 2J3NO[NEXTFAMII

2e. What is —’s Zf. 2g. MARK ONE

data of birth? AGE: ~

;::, MOS,-

MO DAY YR

19 20-14 45.74

YRS, YRS. YRS.

‘“ o @ @ o @ @ @

SAMPLE PERSON SELECTION TABLE

a

t

WITHIN FAMILY)

2i. NCHS #

1,5

0

PERSONS

6 momhs – 19 years

A

lst, 2nd, 3rd, 5th, 61h, 7thr 9th, 101h, 1Ith

@

2nd, 3rd 4th, 6th, 7th, Eth, 10th, llth, 12th

c

lSI, 3,d, 41h, 5th, 7th, Bth, 9rh. 1 lth, 12th

o

lst, 2nd, 41h, 51h, 6th, Bth, 91h, loth, 12th

E

All

PERSONS PERSONS

20 years -44 years 45 years -74 years

lSI, 2nd, 5th, 6th, 9th, All

10[h

G

3rd, 41h, 7th, Bth, 1 lth.

12th

H

lSI, 2nd, 4th, 5th, 7th,

Bth, 10th, 1 Ilh

I

2nd, 3rd, 5th, 6th, 6th,

9th, llth, 12th

J

l$t, 3rd, 4th, 6th, 7th,

9th, 10rh, 12th

Example of hounehold com~sitian table and sample person selecfbn ti used in the Hmpanic He#lh and Nutrition Exmtimstion Survey, 196%64

31
Estimation procedures 2, Adjustment for nonresponse within homogeneous

,

HHANES was designed so that estimates could be prosociodemographic cells to reduce the potential bias atduced for the three separate target populations. The estimates

tibutable to nonresponse, under the assumption that withwere derived through a multistage estimation procedure that in cells the characteristics of the respondents are similar

was designed to yield statistics that come close to minimizing to those of the nonrespondents.

the mean square errors of desired estimates. The procedure

3. Adjustment for noncoverage within the PSU to reduce

consisted of four basic components:

the potential bias due to the exclusion of BG’s and

ED’s with few Hispanic residents.

1. Inflation of sample person observations by the product 4, Poststratified ratio adjustment by age and sex to make

of the reciprocals of the probabilities of selection at the final sample estimates of the population correspond

each stage of the design (PSU, segment, household and to Bureau of the Census estimates of the civilian noninsample person). stitutionalized target population.

32
Chapter 6

Informed consent, safety, and

referral process

by Dale C. Hitcheock

Early in the development of the Hispanic Health and

Nutrition Examination Survey (HHANES), the planners decided that the National Center for Health Statistics (NCHS)

had an obligation to the sample persons to maximize the

benefits of their participation. The need to fulfill this obligation

stemmed in part from the public’s growing sophistication,

which has resulted in people wanting to know what personal

benefits, if any, may be gained from participation in such

surveys. The survey planners’ obligation stemmed also from

their growing awareness of the Hispanic population’s low

level of utilization of health care services, for whatever the

reasons might be. As an example of the latter point, the

examination phase of the survey was seen to be the first

extensive physical examination that many participants in the

survey had ever received. In addition, the various Hispanic

adviso~ ~oups involved in the planning of the survey warned

the planners that more had to be done in this survey in

terms of benefits to the sample persons than in previous

surveys if HHANES was to gain the widespread community

support necessary for its success. Changing Federal regulations

regarding informed consent procedures and human subject

safety requirements also necessitated changes in many procedures that had been employed in earlier NHANES surveys,

This chapter discusses those procedural changes implemented in HHANES for the purpose of improving the

benefit to the sample people, m the overall context of confidentiality, human subject safety. informed consent, and reporting

of findings.

Confidentiality

As in all NCHS surveys. stimple persons for HHANES

were guaranteed that their participation would be kept confidential. In accordance with Section 308(d) of the Public

Health Service Act, NCHS assured each respondent that the

confidentiality of all responses to this survey would be maintained and that any information from questionnaires or other

records that identified individuals would not be disclosed

without securing prior written consent from the respondent.

A discussion of the confidentiality regulations applying to

NCHS programs is available. 1I7 Cefiain of these regu] atiOIIS

are important to users of data collected by means of HHANES,

particularly to those researchers wishing to use the public

use data tapes generated from the survey. Obviously the

names and addresses of sample persons are not included

on these data tapes; nor are certain other identifying variables.

Furthermore, to reduce the risk of disclosing the identification

of individuals, it is NCHS policy to withhold from data

tapes information that identifies a survey location (primary

sampling unit) populated by fewer than 100,000 persons.

For users of HHANES data, this means that although NCHS

will be able to provide aggregate statistics for highly populated

counties such as Bexar County, Tex., similar information

for less populated counties such as Bee County, Tex., cannot

be provided.

Human subject safety and informed consent

Human subjects in research are also protected by the

National Research Act, Public Law 93–348. Related requirements are listed in the Code of Federal Regulations, Title

45, Part 46. The purpose of the regulations is to safeguard

both the rights and the welfare of subjects involved in human

research. To assure compliance with these regulations, it

was the responsibility of the sponsoring agency, NCHS, to

convene an institutional review board (IRB). For HHANES,

the IRB had two major responsibilities: (1) to assure that

legally effective informed consent would be obtained from

each sample person; and (2) to determine if there were any

risks involved in participation in the survey, and if so, to

certify that any risks to the subjects would be outweighed

by the benefits. Balanced impartiality was a major consideration in the selection of members for the IRB. The members

included experts in areas such as the delive~ of health cme

and included both men and women, Hispanics and nonHispanics.

Four examination components were identified for presentation to the IRB to be considered for human subject safety

concerns. Presentations were made by NCHS staff and consultants to the IRB concerning the equipment and procedures

used in the electrocardiogram, X-ray, tuberculin test, and

ultrasound portions of the medical examination. In addition,

questionnaires thought to cover potentially sensitive areas,

such as reproductive history, alcohol consumption, mental

health, and use of drugs, were reviewed. Although the members of the IRE were satisfied that the risk to a sample

person participating in the survey appemed minimal, the

consensus was that the proposed method of obtaining informed

consent could be improved. Thus, the IRB initially voted

to withhold certification

operational procedures.

until NCHS revised the necessary

33
Consequently, certain modifications were made to the

informative materials developed to communicate the nature

of the survey to the sample people, and new procedures

were developed to obtain informed consent. The approved

procedures used in HHANES were as follows. Each household

falling into the screening sample was sent a letter briefly

describing the survey and explaining that an interviewer would

call on that family shortly. After administering the household

questionnaires for an eligible family, the interviewer discussed

the examination phase of the survey with each sample person

and gave the family a brochure. This brochure was developed

to convey the contents of the examination, the voluntary

nature of participation in every phase of the survey, the

purpose of the study, and the confidentiality with which

any information collected would be treated. After the sample

person had a chance to review the brochure and ask any

questions, the interviewer presented him or her with the

Consent to Examination and Request to Furnish Results form.

Sample persons were asked to read and sign this form as

an indication of their willingness to participate in the study.

All sample persons 12 years of age or older were asked

to sign the consent form. For children under 18 years old,

the signature of the parent or guardian was also obtained.

The consent forms used in HHANES are shown in

appendix IX.

The consent form, which was available in both English

and Spanish, discussed the research nature of the program,

the content of the examination, and the length of time a

sample person might expect to be in the examination center.

The form also pointed out that slight discomfort might be

experienced during certain procedures. The interviewer was

instructed to allow ample time for the sample persons, their

guardians, or representatives to read the material contained

in the consent form. An effort was made to have the form

signed in the home, but sample persons could, at their option,

either bring the signed form with them when they came

to the examination center, or have additional questions answered at the examination center before they signed. Upon

completing the form, which also was used to secure permission

to forward the results of the examination to the sample person’s

own physician or clinic, sample persons were given a copy.

A signed consent form was required before the examination

was given to any person.

Members of the IRB also felt that the survey placed

a considerable time burden on the sample persons, and that

NCHS should strive to see that participants were compensated

for their time to the extent possible, particularly because

the survey was designed as a research vehicle and could

not offer treatment to the participants. In previous NHANES

surveys, each sample person received remuneration in appreci-

. ation for participating in the examination; each person’s travel

expenses to the Mobile Examination Center were covered;

child care arrangements were made; and results of the examination were forwarded to each sample person’s physician or

clinic. With these considerations as a foundation, NCHS

staff developed new procedures designed primarily to ensure

that the benefits that sample persons would obtain from their

participation in the examination would, to the extent possible,

have the maximum benefit to their personal health.

Report of findings

The new system required a thorough effort by NCHS

outreach coordinators to provide opportunities for those sample

persons who did not have a usual source of healtlh care

to choose a clinic or doctor’s office to which reports of

findings from their examination could be sent to ensure appropriate interpretations. The NCHS outreach coordinators contacted county health officials and other community sources

in each area to obtain a list of clinics that were expected

to be both acceptable and accessible to sample persons with

no usual source of care; payment information was also inlcluded

on this list. The same approach was used for soumes of

dental care.

Basically, there were three circumstances in which communication between NCHS and a sample person’s source

of health care were made, based on the severity of the

findings. This discussion refers to each of these circumstances

as “levels .“ Level I was used to identify those situations

in which a medical emergency was discovered by a member

of the HHANES examination team and verified by tlm staff

physician, who further determined that the medical findings

required immediate attention by a health care provider. An

emergency medical kit was kept in each examination center

so that emergency treatment could be given when abscdutely

necessary. However, the prefemed manner of handling the

medical emergencies was to contact local rescue squads,

ambulance services, and hospital emergency rooms, the telephone numbers of which were kept posted in the examination

center. A Level I contact with a health care provider on

behalf of a sample person was rare.

A more frequent occurrence was a Level II contact.

This occurred when the examination staff determined that

there were major medical findings that could be expected

to cause adverse effects within 30 days, and the findings

had not been previously diagnosed, attended, manifested,

or communicated to the examinee by his or her health care

provider. When such a condition was identified upon review

of the examination and questionnaire information, the staff

physician explained his or her concern to the person and

urged that an appointment with a medical care provicler be

made in the next 2 or 3 weeks. The physician checked

to see that the sample person had indicated a heakhl care

provider on the consent form and then sent a letter to that

provider indicating the findings from the examination and

stating that the sample person had been advised to contact

that doctor or clinic. The same procedure was used by the

staff dentists. Positive ultrasonography results indicating

gallstones required the physician to mail a special letter explaining why the test was done, indicating the fimiings,

and reminding the provider that surge~ for the re]moval

of asymptomatic gallstones may not be necessary.

Level III contacts provided routine findings from the

survey to the sample person’s source of health care. As

in previous NHES and NHANES programs, a report of findings was mailed to each sample person’s health cme provider

upon the compilation of the data needed for this report.

Where in the past only one letter was used to communicate

findings, two letters were used in HHANES. (Examples of

34
the letters are in appendix X.) The first report contained

the findings from the examination that were readily available

and dependent only upon the staff and equipment in the

examination center. These included findings from the physician’s examination; some Iaboratoty results, such as hematocrit, hemoglobin, cell counts and urinalysis; and copies of

the chest X-rays and ECG tracings for sample persons receiving those tests. The report was designed to be similar to

the laboratory report of findings obtained by physicians in

private practice, with an explanation that the findings came

from a screening examination and that no attempt was made

by the staff physician to integrate the findings into a diagnosis.

Routine reports of dental findings were also mailed directly

from the examination center to each sample person’s source

of dental care.

A second report of findings was sent after NCHS received

the results of urine and blood analyses performed under

contract by outside laboratories. Efforts were made in all

laboratory contracts and interagency agreements to ensure

that findings would be reported more quickly than had been

possible in earlier NHANES programs. Abnormally high or

low laboratory values were communicated as soon as possible

by telephone to NCHS so that special communications could

be made to the health care provider involved.

35
Chapter 7

Pilot testing

by Kurt H. Maurer and Dale C. Hitchcock

After the plans for the survey had been developed,

thoughts and efforts turned to assessing the adequacy and

feasibility of these plans. As in the previous examination

surveys, “a detailed pilot tests were planned; however, because

of the cross-cultural nature of the Hispanic Health and

Nutrition Examination Survey (HHANES), it was necessary

to expand the pilot test format. In addition to the usual

need to test and to refine questionnaire design and

construction, examination procedures, sample design, and

sample person selection procedures, emphasis had to be

directed to testing the translation of the documents, the

proposed outieach methodology, and the cultural acceptability

of the various components and the survey as a whole.

To achieve these basic objectives, three communities,

each predominantly composed of one of the target groups,

were selected for pilot testing, The primary objective of

the first two tests, held in the Bronx, N. Y. (September

28 through October 27, 1981, with 185 sample persons),

and Miami, Fla. (November 16 through December 11, 1981,

with 240 sample persons) was to evaluate the adequacy of

the questionnaires in both English and Spanish. Were the

concepts to be measured adequately conveyed to the sample

person? Were the response categories appropriate? Were the

terms well chosen with regard to the educational level of

the population to be surveyed? Did the respondents have

the information required to answer the questions, and would

they be willing to give the interviewer the requested

information? Which questions might be better asked in the

Mobile Examination Center as they were too sensitive to

ask in the household? It was necessa~ also to evaluate

the Spanish translation to determine whether it was

conceptually equivalent to the English and whether the single

translation would be equally understandable to persons in

each of the three groups to be included in the study; that

is, Mexican-Americans, Cuban-Americans, and Puerto

Ricans.

The third pilot test was held in El Paso, Texas, between

January 4 and March 19, 1982, and included 462 sample

persons, In addition to testing the questionnaires and

translations, a physical examination was incorporated. This

El Paso pilot study was the first attempt to test the procedures

of the main survey under the then current plans.

In addition to questionnaire construction (and translation)

and examination protocols, many other survey features needed

to be developed and tested before the survey went into the

“field.” Sample design and sample person selection procedures

were among these, Response rates are of perennial concern

when typically about 25 percent of those selected for the

survey do not participate in the examination. To keep response

rates as high as possible, the survey design staff knew that

trust and understanding must be engendered in the cwerall

Hispanic community, in the local communities, and, most

importantly, among those individuals selected for participation

in the study. To encourage this trust and understanding,

outreach procedures were developed, and staff was hired

to implement these procedures. (See chapter 8 for a description

of the outreach efforts. ) These activities, part of a public

affairs initiative, were also tested in each of the pilot studies.

Three methods were available for reviewing the pilot

tests: Observation, forms review, and debriefings. It was

known that traditional observation of interviews would be

difficult because many of the NCHS staff members were

not bilingual or bicultural. Hence, it was decided that allowing

staff members to observe interviews would be unwise because

of the effect that they might have on the rapport between

the bilingual and bicultural interviewers and the sample

persons, However, the few bilingual NCHS staff members,

along with several of the contractors’ supervisory staff, were

involved in observing as many interviews as was practical.

With this somewhat limited opportunity for observation of

interviews, added emphasis was given to interviewer

debriefing and forms review for the identification of sample

selection and questionnaire design problems. In the El Paso

pilot test, where attention turned primarily to evaluating the

examination procedures, sample persons were observed (with

discretion) undergoing the examination. Many of the survey

design staff also underwent the examination. The number

of persons being examined daily was kept low in the beginning

to allow the operations staff to become more experienced

with the new protocols and to allow adequate time to resolve

equipment problems and deficiencies in the protocols. As

a result, debrieflmg of the staff was a constant, intensive

process throughout the pilot test. The survey design staff

reviewed many of the examination forms for evidence of

recording errors, inconsistencies, and lack of adherence to

procedures. Weekly staff meetings were held to give the

operations staff opportunities to air their concerns and

problems. The design staff then could review these problems

and discuss potential solutions with the operations staff.

After the three pilot studies were completed, a period

of 2 months was allocated to complete re-evaluation of the

survey procedures and materials. With such ambitious plans

for pilot testing, the need for systematic approaches to the

36
analysis of the testing results became apparent. The results

of each pilot test, including observations, forms review, and

debriefing, were compiled in rather extensive internal

evaluation reports. These reports served as a means of

communicating among the many people working on the survey

as well as those in policymaking positions at NCHS. Because

the evaluation reports included results, problems, and proposed

solutions, they also served as a means of focusing the attention

of the staff and those in policymaking positions to bring

about better solutions.

Following the review of the pilot test results and

subsequent revisions, the procedures and materials were

subjected to a final test. This last test, referred to as the

“dress rehearsal,” was mounted in San Antonio, Texas (July

9-August 7, 1982, including 384 sample persons). By that

time, the survey was thought to be ready and final preparations

had been made. The intent of the dress rehearsal was not

so much to evaluate the procedures that had already been

extensively tested; rather, it was an opportunity to refine

these procedures and to attain more experience and proficiency

in administering the survey before initiating actual data

collection. In addition, in the San Antonio dress rehearsal,

the quality control and data processing systems that had

been developed were tested. Following the completion of

the dress rehearsal, a few minor changes were made, and

the survey was finally ready. However, some minor

moMications were made in the survey data collection forms

and procedures as late as the eighth location to be surveyed.

37
Survey Operation
Chapter 8

Data collection

by David L. Larson, Jean S. Findlay, John E. Mounts, and

Sandra S. Smith

Introduction

The provision of standardized data is a major goal in

the planning and operation of a health survey such as the

Hispanic Health and Nutrition Examination Survey

(HHANES). The objective of standardization of data collection

is the production of data of uniform quality throughout the

entire survey period, from person to person and location

to location. This requires standardization of the setting and

equipment as well as of the individual procedures. In

HHANES, as in the previous National Health and Nutrition

Examination Surveys, a standardized setting was provided

by the use of mobile examination centers housed in trailers

that traveled from site to site. Detailed protocols were developed for each data collection technique; frequent extensive

training and retraining and a wide variety of quality control

measures (discussed in chapter 9) were instituted to ensure

the standardization of the survey procedures and equipment,

For the first time in a HANES, NCHS contracted with

a private company (Westat, Inc. ) to provide members of

the field team and to assume responsibility for several aspects

of the data collection, including many of the day-to-day

functions of the field offices and examination centers, At

the same time, NCHS field staff, including supervisors and

technical personnel, as well as the headquarters staff, actively

participated in the data collection and monitoring of the

contractor’s work.

This chapter contains a description of the operation of

HHANES, focusing primarily on the logistics of running

this complex survey. The operation at each survey location

involved a number of different activities, which are outlined

in figure 7. Preliminary activities included selection of a

primary sampling unit or PSU (see chapter 5 for a description

of the sample design and selection), scheduling of the survey

at the selected location, establishing community contacts to

publicize the survey, and selection and preparation of the

specific sites for the setup of the examination center and

the field office, where all survey operations were coordinated

and documented. The data collection phase at each survey

location consisted of two main components: the household

interview (which encompassed identification of the sample

and the administration of several questionnaires) and the

examination.

Primary

sampling

unit selected

and scheduled

Public affairs Addresses Site

(community level) selected selection

Household Field

screening office setup

Sample Examination

persons center

selected setup

Household Testing and

interview calibration

of equipment

v

Examination

data collection 4

Reports of

findings

Fgure 7. Flow chart 01 activities ats survey location

40
Sequencing and scheduling of survey

locations

The HHANES was conducted over a 2V2 year period,

from July 1982 until December 1984. During that time,

data were collected in 31 survey locations. The locations

were sequenced depending on several logistic considerations:

Avoiding the North in the winter months and the South

in the summer, surveying migrant workers when residing

in their wintertime homes, and increasing operating and cost

efficiency. The planners decided to survey the Mexican-American population first because it was the largest of the three

Hispanic groups being studied. Previous experience showed

that it would take about 18 months to survey the 10,000

sample persons representing this population. The plan for

the Southwest was to start in Texas, move west through

Colorado, New Mexico, and Arizona, and complete the region

by moving through California from south to north. Following

the close of the Southwest phase in December 1983 the

survey moved to Dade County, Fla., for 14 weeks. Data

collection then progressed to the New York City area, beginning in May 1984 and ending in December 1984.

In the Southwest each survey location had a target sample

size of between 536 and 662 sample persons. There were

17 locations: six in Texas, one in Colorado, one in Arizona,

one in New Mexico, and eight in California, all combining

to form the Mexican-American part of the survey. For

maximum operating and cost efficiency, the locations were

paired so that travel time between the paired locations operating concurrently was reduced to a minimum, The pairs then

were placed in such a pattern that travel time between the

sets of pairs was as short as possible. Because operationally

the optimum number of sample persons per location was

approximately 500, the Dade County, Fla., PSU was split

arbitrarily into four sites of 566 sample persons each, all

operating from the same field office, so movement of the

examination centers was not necessary. For the Puerto Rican

part of the survey, the seven PSU’S were divided into nine

sites, seven in New York, one in New Jersey, and one

in Connecticut.

To assign estimated dates for the various activities related

to the operation of a survey location, it was necessary to

consider the time required to move trailers and personnel

between the locations; to do household screening and interviewing; to setup the examination center, including calibration

and testing of all equipment and procedures; to conduct examinations; and to allow for staff vacation time. Estimates for

these times were developed using NCHS past experience,

the contractor’s experience, and the projected ratio for each

location of eligible households to households screened.

Public affairs

AS mentioned in chapter ], an Outreach Task Force

was formed to evaluate the special conditions that would

surround and influence a survey of Hispanics. Recognizing

that major cultural and language barriers existed in the Hispanic communities, the task force articulated some concepts

and approaches for the development of an outreach plan

intended to promote participation in HHANES. To interpret

and carry out the guidelines provided by the Outreach Task

Force, a HHANES Public Affairs Task Force was established.

The Public Affairs Task Force designed, developed, implemented, and coordinated a public affairs initiative, which

was an integral part of the survey operations. The objectives

of the public affairs effort were to inform national and local

audiences about the survey, to help overcome cultural barriers,

to elicit community support and cooperation, and thereby

to increase survey response by those selected to participate

in the survey. This public affairs initiative was designed

to encompass national, regional, and local approaches, and

to use both community and media contacts. At the national

and regional levels the objective was to inform target audiences

(national and local Hispanic groups, health and other professional organizations, data users, decision makers, and the

general public) of the purpose, usefulness, and projected

outcome of the survey. At the local level the objectives

focused on increasing community acceptance of the survey

as well as on increasing participation.

The HHANES opened in San Antonio, Tex., in July

1982 with a major briefing for the media, government officials,

and representatives from major national Hispanic and health

organizations. Other major national briefings and presentations

were given at various points during the survey to announce

general entry into another area of the country, These events,

which usually involved the news media and Hispanic health,

political, educational, religious, civic, business, and grass

roots community organizations, were geared toward providing

validity to and recognition of the presence of the survey

in the region; toward informing the general public of the

survey’s purpose, location, and schedule in an area; and

toward soliciting general support from regional, State, and

local officials, Hispanic organizations, and the public. In

addition to the initial briefing in San Antonio, regional briefings were held in Los Angeles and San Jose, Calif,; in

Miami, Fla.; and in New York City.

I%or to beginning survey operations in each new location,

advance visits were made to the survey areas to inform

officials and Hispanic leaders of the schedule, to solicit their

support, to develop a list of key contacts and organizations,

and to determine the area’s unique characteristics and any

specific problems or needs. Such visits were also made to

inform leaders and the general public about the purpose,

scope, procedures, and eventual outcome of the survey.

In addition to the briefings and community contacts,

a wide range of promotional materials was developed to

explain both to the target Hispanic audiences and to the

general public the purposes and operation of the survey.

This effort also was designed to generate acceptance of the

survey in general and cooperation with interviewers and medical staff in the examination trailers at each site. Many of

these promotional materials, produced in both English and

Spanish, were designed for use throughout the survey in

all locations. Other special materials were developed to fit

the requirements of each community. For example, Fernando

Valenzuela, pitcher for the Los Angeles Dodgers baseball

41
team, was featured in a television public service announcement

(PSA) and posters used in the Southwest. Luis Oquendo

and Velia Martinez, members of the cast of the Public Broadcasting Service series, “Qu6 Pasa, USA?”, and Miami television host Rolando Bamal, were used in radio PSA’s in the

Miami area, and Oquendo and Martinez also were used in

posters. Actress Rita Moreno was featured in radio PSA’S,

posters, and a letter of endorsement used in the New York

City area. Special fliers, news releases, and other printed

materials were generated for local use in each location. A

question and answer sheet covering commonly asked questions

about the survey was prepared for staff use.

Household interviewing

Data collection in HHANES began with a household

interview. Before the opening of the examination center in

a survey location, and continuing during its operation, the

sample persons were identified, detailed questionnaires were

administered, and appointments were made for the examination. The sample person selection and the assignment of

particular questionnaires and examination components for each

sample person depended on the age at the time of the screening

interview. The elapsed time between the interview and the

examination appointment was quite variable, with a number

of sample persons having a birthday during that period. Because the examination was administered according to the

age at interview, it is important for users of the data to

be aware of the lag time; the date of interview, date of

examination, and date of birth are all available for each

examined person.

Interviewing staff

Hired by Westat and its subcontractor, Development Associates, the household interviewing staff consisted of about

25 bilingual persons, most of whom were also bicultural

and of the background appropriate to the area being surveyed.

Within a data collection phase, the corps of interviewers

remained fairly constant. In the Southwest, for example,

it seemed more efficient to have the interviewers travel from

location to location rather than to attempt to hire and train

a new group of interviewers every few months. Not only

did this save time and money, but because the interviewers

naturally became increasingly proficient as time went on,

they were more effective at convincing sample persons of

the importance of the health examination. In addition to

the main household interviewers, special screening interviewers were hired in some areas that had a small proportion

of Hispanics relative to the out-of-scope population. These

interviewers were not necessarily bilingual because much

of their time had to be spent identifying and “screening

out” non-Hispanic residents of the survey area. When an

eligible household was found, one of the regular interviewers

was sent back to complete the household interview.

Before the opening of each of the three major HHANES

phases, and occasionally at other times when new interviewers

were hired, Westat conducted week-long interviewer training

sessions. These sessions, which were often observed and

monitored by NCHS design staff, consisted of lectures, films

illustrating listing procedures and interviewing techniques,

mock interviews, written exercises, and practice interviews

with materials prepared in advance by the trainers. In the

first few days following training, new interviewers were often

observed conducting household interviews, and their work

was checked closely. Retraining was provided at any time

throughout the survey that it became necessary.

The household interview

In the household interview, several questionnaires were

administered in order to screen the household for eligibility

and to obtain the necessary demographic and health information from selected sample persons. The questionnaires used

in the household were as follows:

●

●

●

●

The Household Screener Questionnaire, administered

once at each selected address, for determining household

composition and eligibility and for selecting sample

persons.

The Family Questionnaire, administered once for each

family containing sample persons, which included sections on family relationships, basic demographic information, Medicare and health insurance coverage, participation in income assistance programs, and housing

characteristics.

The Child Sample Person Questionnaire, for sample

persons 6 months through 11 years of age, which included

sections on a number of health status issues, health care

utilization, infant feeding practices, participation in meal

programs, school attendance, and language use.

The Adult Sample Person Questionnaire, for sample

persons 12–74 ‘years of age, which included sections

on health status measures, health services utilization,

meal program participation, and acculturation level.

(Samples of the actual questionnaires are contained in

appendix XII. )

An important concept in the household interview phase

was that of “eligible respondent ,“ which varied dependhg

on the specific questionnaire being administered. Household

composition, ethnicity, and age of household members could

be reported by any knowledgeable household member who

was at least 18 years old or who had been married. Since

a household might contain more than one family, an eligible

respondent for the Family Questionnaire was a member of

that family who was at least 18 years old and who lived

in the household. (If there was no family member 18 years

old or older, the head of the family or any member who

had ever been married was acceptable as the respondent.)

For the sample person questionnaires, in which detailed

personal information was obtained for each sample person,

the respondent rules varied according to age. Persons at

least 18 years old had to respond for themselves, unless

they were physically or mentally unable to be interviewed.

For sample persons 12–1 7 years of age, either self- or proxyresponse was acceptable. For sample persons under the age

of 12, proxy respondents were required, except for a few

questions addressed directly to children 6-11 years of age.

An acceptable proxy respondent was a family member at

least 18 years of age, preferably a parent or guardian of

the sample person.

42

..——-
@ Recepfiorr aree-The coordinator, who directed the flow of examinees through

the center, verified the names and addresses of sample persons, took their

temperatures, and provided them with exam gowns and specimen cups for

urinalysis.

@ Dietary interview roorns-oieticians determined general patferns of food

consumption and asked for a 24-hour recall of foods consumed using food

models to establish quantities.

@ /nrerviewroorn-An interviewer administered a medical questionnaire covering

the following subjects: alcohol consumption, drug abuse, depression, smoking,

pesticide exposure, and reproductive history. Information on the use of

medicines and vitamins in the past 24 hours was also obtained.

@ Dental and eye exam room-A dentist performed a dental examination and

administered a vision test.

@ Laboratory-A technician divided the blood and urine specimens for analysis. A

portion of each sample was tested in the laboratory for certain hematological

properties. The remainder was further subdivided, labeled, processed, and

prepared for shipment to various analytic laboratories.

@ X-ray andu/trasoundroom-Technicians took posterior-anterior and left lateral

chest X-rays and performed an ultraeonography of the gallbladder.

@ Venipuncture roorrr-A nurse took blood samples for biochemical testing and

provided sample pereons with Glucola for the glucose tolerance test to

measure the prevalence of diabetea.

@ Pfrysica/ exam room-A physician performed a medical examination, focusing

on the cardiovascular, gaatrointestinal, neurological, and musculoskeletal

systems, and recorded impressions of overall health, nutritional and weight

status, and health care needs.

@ Audiometry and impedance roorrr-A technician performed an audio test to

determine hearing levels and a fympanic impedance test to measure the

elasticif y of the eardrum.

@ E/ectrocardiWram roo*A techniciantookan electrocardiogram using the

standard 12 leads and Frank leada as perl of the determination of prevalence of

heart problems.

@ &dYmeasuremenfs roo*A technician took a variety of body measurements,

including height, weight, skinfolds, upper arm girth, elbow breadth, and hip width

to assess growth, development, and olmsity in sample persons,

Fgure 8. Floor plan and functions of the mobffe examination center

In the initial contact with a selected household, the

interviewer determined “eligibility, ” that is, whether any

household members were of the Hispanic background

appropriate to the survey location (Mexican-American in the

Southwest, ~uban-American in Dade County, or Puerto Rican

in the New York City area). If, after three attempts, the

interviewer was unable to talk with a household member,

information on household composition and ethnic origin of

the household members was obtained from at least two

neighbors so that the eligibility of the nonrespondent household

could be determined.

If one or more eligible families lived in the household,

a preselected sampling pattern was followed to choose specific

family members to patiicipate in the extended interview and

examination. The interviewer then explained the survey and

administered the sample person questionnaires and the Family

Questionnaire. Then, the interviewer called the field office

to make an appointment for each sample person to have

the examination. At that time, a six-digit sample number

was assigned according to the sample person’s age and whether

or not the sample person was in the fasting or nonfasting

sample. An examination appointment was then scheduled

at the sample person’s convenience; the major restriction

on appointment scheduling was that persons in the fasting

half-sample, who were designated to receive the glucose

tolerance test and gallbladder ultrasound examination, had

to be scheduled in the morning since the glucose tolerance

test required an overnight fast of 10 to 16 hours. (Persons

43

—.
in the fasting group who were unable to make a morning

appointment were given the ultrasound examination in the

afternoon or evening if they had fasted at least 6 hours,

but the glucose tolerance test was only given in the morning.)

Before leaving the household, the interviewer informed the

sample persons that each would be given $20.00 as a token

of appreciation after receiving the examination, as well as

either taxi fare or mileage costs of driving to and from

the examination center. Then the interviewer obtained from

the sample persons written consent to be examined and to

allow NCHS to release the examination findings to a physician

or clinic of their choosing (specified on the consent form).

After the interviewer completed all aspects of the

household interview, the field office was responsible for

continuing contact with the sample persons. One week before

the scheduled examination, a reminder letter was sent.

Included in this letter were any special instructions, such

as a reminder to bring glasses for the eye examination,

and, for those in the fasting group, a reminder not to eat

the morning of the examination. Two days before the

scheduled examination, a person from the field office

contacted the sample person by telephone or, if the household

had no telephone, by personal visit as an additional reminder.

If an appointment was cancelled or the sample person failed

to appear for the scheduled appointment, the contractor staff

made further efforts to persuade the person to come. An

immediate attempt to contact the person was made in order

to emphasize the importance of the individual’s participation,

and followup contacts were continued until another

appointment was made, or it became abundantly clear that

the sample person wished never to hear about the survey

again.

The examination

The examination center

As mentioned earlier, examinations were conducted in

mobile examination centers. These facilities consisted of sets

of three trailers arranged side by side with connecting passageways. As in the previous NHANES, there were three complete

examination centers, two operating simultaneously and the

third in transit. The use of the examination centers provided

a standardized setting for all the examination components

in all of the survey areas. Figure 8 contains a diagram

and description of the floor plan and functions of the examination center. The layout and flow of the examination centers

were similar to those in NHANES H, although the facilities

had to be renovated to accommodate the examination components new for HHANES.

The design of the examination center and the

characteristics of the equipment used for data collection in

HHANES were determined according to several criteria:

. Could off-the-shelf equipment be operated reliably in

the mobile examination centers without extensive

modification?

. Could the equipment be calibrated?

● Could the staff be taught to operate the equipment so

that the results were accurate and reproducible?

. Could the equipment fit into the available space?

. Could the equipment produce data that would be accepted

by the scientific community?

. Could the equipment be maintained?

Occasionally equipment had to be designed and crafted

especially for HHANES. This was done only if the test

was essential to the survey, and the mobile examination

center environment would not permit the standard method

to be used or the equipment normally used in a clinical

setting was unable to provide reliable statistical data for

survey purposes.

Logistics

The movement of the field personnel, equipment, and

supplies from location to location or from headquarters to

field was a task quite often taken for granted, but one that

required a great deal of effort. As mentioned earlier, the

schedule for each survey location was developed taking into

consideration the time required to set up the trailers and

ship the supplies. The trailer travel time was absorbed in

the schedule because, with three trailer systems and only

two examination teams, one set of trailers was always available

to “leap-frog” to a future location while examinations were

still being conducted at another site. To complicate the moving

schedules, twice a year the two examination teams were

mixed up to try to prevent them from developing what is

known as “drift in technique,” a phenomenon that often

happens during long surveys such as HHANES.

The supplies had to be sent to each location before

examination center setup. The supply system was based on

accurate inventories produced at the close of each survey

location and sent to the headquarters. Many of the supplies

were shipped directly from the individual suppliers to each

site, but the rest were sent from headquarters stock. The

decision as to what would be stored by headquarters was

based on the availability and shelf life of the item and on

any shipping hazards. The Centers for Disease Control shipped

supplies that needed special clearances or that were related

to the laboratory quality control program. All shipping arrangements were made well in advance of the time the trailers

and staff arrived at the new location.

Before examinations started at a survey location, the

field office and examination center had to be set up. The

office setup process started with advance arrangements, including securing contracts for the office space, furniture, and

telephones. The examination center was set up in two steps.

The first step, usually requiring 1 day unless there were

complications, included the parking and leveling of the trailers,

the deployment of the passageways to form the examination

center, and the connection of the electrical and plumbing

systems. The second step consisted of unpacking and setting

up the equipment and instruments, calibrating them, unpacking

the supplies, and testing the equipment and procedures during

a practice examination session.

Examination staff

Selecting, hiring, training, and keeping personnel for

any project is difficult; staffing for HHANES was especially

44
difficult because of the requirement that many staff be bilingual, the constraints of holding medical examinations in trailers, and the requirement that staff be on continuous travel

status.

Because examinations were always being conducted in

two examination centers simultaneously, there were two complete examination teams, each of which included both government and contractor employees. The positions of medical

doctor, dentist, dietary interviewer, and interviewer were

filled by the contractor since they necessitated a great deal

of communication with sample persons and, therefore, required fluency in both Spanish and English. Members of

the NCHS examination staff included health and laboratory

technicians, nurses, examination coordinators, and dietary

coordinators. After the staff members were hired, they were

trained by expert consultants in each of the data collection

areas. These training sessions were held before the pretests,

before the dress rehearsal, and after the survey started. During

the survey, each consultant visited the examination sites in

the field at least four times a year to monitor the data

quality and to retrain if necessary.

Examination center operation

At the examination center the staff was prepared to

examine 20 sample persons per day, 5 days a week, ordinarily

Tuesday through Saturday. There were two examination sessions per day, held during the morning, afternoon, or evening

for the convenience of the sample persons. Occasionally

it was necessary to hold Sunday sessions. The examination

required about 2 to 3 Y2 hours, depending on the ages and

the number of persons being examined at a session.

At the examination center, a coordinator directed

examinees through the various examination procedures according to a flow system. The purposes of the flow system

were to keep to a minimum the time examinees were in

the examination center and to use examination staff efficiently.

Because the time required for the various exam components

varied and because all examinees did not receive the same

components, the flow system had to be flexible and dependent

on which examiner was available and which examinee had

been waiting the longest. Another consideration was the possible interaction between examination components. Since the

glucose challenge (Glucola) could have an effect on the

urinalysis, electrocardiogram (ECG), and gallbladder ultrasound results, a urine specimen was collected and the

ECG and ultrasound procedures were done before the glucose

tolerance test was begun. Descriptions of the various tests

and examination procedures are contained in other chapters

of this report.

Under certain circumstances (described in chapter 6),

major medical findings expected to lead to complications

within 1 month of the examination were immediately forwarded to the physician specified by the affected sample

person. In general, though, results of the various examination

components were sent to each examinee’s physician about

4 weeks after the close of a survey location.

45
Chapter 9

Quality control

by Jean S. Findlay and Trena M. Ezzati

Introduction

Two sources of error may enter into survey data collection

activities. The first type is sampling error, the error that

occurs because data were collected from only a sample of

the total population of interest. The other source is nonsampling error, the error that arises at various stages of the

data collection from such sources as measurement and recording errors in the examination and errors in the interview

attributable to interviewer mistakes, recall problems, poor

questionnaire design, or problems with the translations. This

chapter describes the various HHANES data collection procedures with respect to their potential sources of error and

the steps taken to reduce that error. The procedures for

measuring non sampling error are also described so that data

users may have a basic overview of its effect on the survey

results.

Quality control of the sampling

procedures and process

Sampling error arises at all stages of sampling, from

selection of the primary sampling units (PSU’s) to identification of individual sample persons. Errors in the sampling

process can result in noncoverage or incorrect coverage of

persons and places. The ability to use survey data to describe

the universe population (that is, Mexican-Americans in

selected areas of the Southwest, Cuban-Americans in Miami,

and Puerto Ricans in the New York City area) depends

on controlling or adjusting for errors in the sample design

or selection process,

Primary sampling unit selection

Although there were rules by which the primary sampling

units (PSU’s) were defined and stratified (see chapter 5 for

a description of the sample design), some of the procedures

were subjective; however, because these decisions were made

before sample selection, there was no bias in the selection

process. The stratification was reviewed to detect any grossly

incorrect procedure, and, to ensure that no PSU was included

in more than one stratum or omitted entirely, the stratum

populations were totaled and compared with the total published

counts for the States. There was no formal quality control

procedure in relation to the selection of the sample PSU’S.

However, various verification checks were made to ensure

that the procedures were performed correctly.

Household listing

The quality of the household listing process was checked

in three ways. First, household interviewers checked for structures completely missed as well as for missing dwelling

units within buildings that had had at least one dwelling

unit already listed. The interviewers did these checks on

a subsample of the addresses. Any new dwelling units found

were added to the sample in such a way that the probabilities

of selection of the dwelling units were known. Second, a

supervisor replicated each lister’s work just after training

was completed and compared the two listings. If the lister’s

work was acceptable, more work was assigned. Third, the

supervisor accompanied each lister at least once during the

field listing period at each survey location to observe and

provide instruction if necessary.

Sample selection

Selection of the survey sample was accomplished in

two steps. The first was to screen listed households to identify

the eligible households, those containing at least one member

who belonged to the Hispanic group eligible in the area

being studied. The second step was to draw a sample of

the members of those families containing at least one eligible

Hispanic. This final stage of sample selection, which was

done by applying predetermined probabilities based on age

to each family member, resulted in the selection of persons

to receive the extended interview and examination. (A discussion of within-household sample selection is contained in

chapter 5.) The screening and sample selection procedures

were verified at several points. In the field, two supervisors

independently verified that ail households and families had

been correctly categorized as eligible or ineligible and also

ensured that the within-household sampling pattern had been

applied correctly. Any errors found were corrected before

the survey location closed so all identified sample persons

had the chance to be examined. After the close of a location,

the Household Screener Questionnaires from households with

sample persons were checked during data processing a third

time for correct sampling procedure. Likewise, the questionnaires from non sampled households were checked for errors.

Adjustments to the sample were made as required.

46
QuaIii control of nonsampling error

Response rates and efforts to reduce

nonresponse

One type of error occurring in perhaps all surveys, especially those in which participation is voluntary, is that due

to nonresponse. If there is a large proportion of nonrespondents

whose characteristics differ from the respondents with respect

to the measurements being made, the ability to generalize

from survey data may be compromised just as if persons

were erroneously left out of the sample. The potential effect

of any nonresponse bias is greater when response rates are

low. Therefore, a major effort was made in HHANES, as

in all previous NCHS health examination surveys, to reduce

the magnitude of nonresponse.

Even though the full effect of nonresponse bias never

can be really known, rough estimates of bias can be made

for an interview and examination survey such as HHANES

by comparing household interview data from sample persons

who were examined with interview data from those who

were not examined. Because the interview response rate is

substantially higher than the examination response rate, nonresponse bias with respect to selected health characteristics

may be estimated from the large amount of medical histo~

data available on nonexamined sample persons.

The following is an illustration of how bias due to nonresponse can be evaluated, using estimated data from the Southwest phase of HHANES. Of the total sample, 100 percent

of the households were successfully screened and classified

as eligible or ineligible based on ethnic origin. For approximately 90 percent of the sample persons selected from the

eligible households, information on demographic characteristics, including educational level, occupation, and income,

was collected. Approximately 85 percent of the sample persons

completed the Sample Person Questionnaire containing the

medical history information. Finally, about 75 percent of

the sample persons in the Southwest received the examination.

Since the examination is the most important analytic component of any HANES, a survey “respondent” was one who

completed the examination as well as all interview components. A “nonrespondent ,“ then, was a sample person who

was not examined, regardless of whether or not any interview

data had been obtained. The 25 percent of the sample persons

who did not complete the examination can be divided into

three groups:

1. Those for whom medical and demographic interview

data were collected.

2. Those for whom demographic information only is available.

3. Those about whom nothing is known.

A comparison of the interview data from these first

two groups and the examined group may provide some understanding of the extent of bias due to nonresponse to the

examination. The group for whom no data are available

accounts for roughly 10 percent of the original sample and

remains a potential source of unmeasurable error. It is possible

that these persons differ substantially from those who were

located and agreed to participate. The issues of nonresponse

bias ] 18-]20 and factors related to participation 120-]25 in health

examination surveys are discussed in several reports.

Before the start of data collection at a survey location,

efforts were made to inform the selected community of the

purpose and methods of HHANES in order to gain general

acceptance of the survey and to increase response (this public

affairs program is discussed in Chapter 8). However, because

a considerable loss of respondents occurs between the interview and examination phases of data collection, most efforts

at increasing response to HHANES were directed at making

the examination experience more appealing. Some methods

used in HHANES included adapting the schedule of examining

sessions to suit the needs of each particular locality; scheduling

examination appointments at the convenience of the sample

persons; scheduling whole families together for the examination; using bilingual, mostly Hispanic interviewers and exam

staff members; printing the questionnaires in both Spanish

and English; locating the examination centers in convenient

and socially acceptable places; providing free transportation

to and from the examination center; providing for baby sitting;

obtaining permission from the schools for student examinees

to miss classes; sending the examination results to the

examinee’s personal health care provider; and giving each

examined person $20 as a token of appreciation. Also, an

extensive follow-up system was used to help sway sample

persons who refused the examination or broke their

appointments.

Two adaptations to the traditional HANES sample design

were made primarily to improve response rates. The number

of sample persons selected per family was increased over

what it had been in past surveys, and the geographic size

of the PSU’s was again reduced (as it was in NHANES

II) so the travel distance between the segments and the examination center was as short as possible.

QuaIii control of household interviews

Assuring the quality of the household interview data

was a long, thorough process. First, the efforts of many

people combined to develop and pretest the questionnaires

in both Spanish and English and to ensure that the two

versions were equivalent. Precise definitions of questionnaire

terms were written and incorporated into detailed instruction

manuals. Then, to administer the household interview, the

HHANES contractor recruited and hired interviewers who

were not only fluent in both Spanish and English but who

were for the most part of the specific Hispanic cultural heritage

eligible for selection in the area where the survey was being

conducted at the time. Before the interviewers went into

the field, they went through an intensive training program

specific to the survey and its questionnaires. Later retraining

sessions were conducted as necessary.

Verification of completed questionnaires with respondents

is a procedure often used in interview surveys to be sure

the questionnaires have not been falsified. For HHANES,

however, a verification procedure for completed questionnaires was not used because all interviewed sample persons

either were given the examination or were contacted again

after the initial interview as a followup to a broken examination

appointment or a refusal. The expectation was that during

47
the examination or the followup contacts, any falsification

of the questionnaires would be discovered. Therefore, since

the only cases that seemed subject to falsification were those

classified as either vacant or not dwelling units, 10 percent

of those cases were verified to assure the validity of the

sample. If anyone discovered that an interviewer had falsified

questionnaires, the interviewer was immediately removed from

the job, and all work done by this person was verified

or redone to the extent necessary to assure the validity of

the data.

One of the most direct methods of monitoring used in

all NCHS health examination surveys is observation of the

interviews by NCHS and contractor staff. In HHANES, however, the amount of interview observation was somewhat

limited by the scarcity of bilingual staff. Still, observation

of the household interviews helped identify a number of

problems that would have otherwise remained undetected.

Field edits were a very important part of quality control.

Interviewer supervisors edited completely the first 25 questionnaires done by each interviewer. If these were satisfactory,

then key item edits were substituted for complete edits until

the supervisor was convinced that the interviewer’s work

was of consistent, high quality. But, if the complete edits

indicated the interviewer’s work did not meet standards, the

supervisor worked with the interviewer to help improve the

quality of that person’s work. Then if the complete edits

showed the work had improved sufficiently, only key item

edits were done for a period of time. However, if unable

to meet the standards of quality required, the interviewer

was released.

Also, throughout the survey NCHS field staff edited

all questionnaires completely and informed the interviewer

supervisors of any error patterns existing so interviewers

could be corrected. Whenever possible NCHS field personnel

sent each questionnaire containing errors to the mobile examination center on the day of the sample person’s examination

so the correct information could be retrieved directly from

the examinee. Members of the NCHS and contractor’s headquarters staff also made frequent field visits to edit forms.

These processes led to the discovery of problems, either

interviewer errors or questionnaire deficiencies, that needed

attention.

QuaIii control of the examination

Quality control of the health examination had the two

goals of reducing systematic and random measurement error

for each examination component and of quantifying what

error remained wherever possible. Among the quality control

measures that applied to the examination taken as a whole

were the standardized environment provided by the three

identical sets of mobile examination centers, detailed written

instructions available for all procedures, specialized training

of examiners before they collected data, periodic retraining

of examiners to reduce the “drift” in technique inherent in

long surveys, formal transmittal procedures to account for

and to send the data from the field to the processing center,

documentation of any unusual occurrences that may have

affected the data, review of all examination forms before

examinees left the examination center, and a practice examination session conducted on nonstudy persons the day before

regular examinations began at each location to be sure all

the equipment and staff were functioning properly.

Other elements of the field quality control program applied

individually to the various components of the examination.

For example, the technicians calibrated the equipment and

instruments used for ultrasonography, electrocardiography

(ECG), audiometry, tympanometry, X-rays, body measurements, and the laboratory procedures. These calibrations were

done at various intervals depending on the instrument, some

as often as before each examination, others once per survey

location, weekly, daily, or twice daily. The survey also

employed a biomedical engineer whose responsibility it was

to ensure that the equipment always functioned at the high-performance levels required.

For the two examination components that were actually

interviews, the Dietary Questionnaire and the Adult Sample

Person Supplement, the dietary coordinator at each location

edited a sample of each interviewer’s work and discussed

the results of the edits with the interviewer, pointing out

any problems revealed.

As with the household interview component of HHANES,

observation of the data collection was an important quality

control measure. Various staff persons from both NCHS

and the contractor periodically visited the field to observe

specific components of the examination. For many of the

examination components, expert consultants visited the field

at least four times a year to observe the procedures under

their respective jurisdictions. Following a visit, the consultant’s findings were discussed with the appropriate examiner,

who was retrained in the proper technique if necessary. The

examinations for which this quality control procedure was

used were the physician’s and dental examinations, the vision

test, audiometry, tympanometry, body measurements, ultrasonography, and the laboratory procedures. A variation

on this was to tape record interviews that could not be

easily observed, such as the dietary interview. For these

the consultant listened to the tapes to verify that the interviews

were being conducted properly and retrained the interviewers

if necessary. For all these examination components the consultants’ written reports documented the quality of the data

gathered at the times of the observations.

Certain examination components, such as ECG, tympanometry, X-rays, and ultrasonography, yielded hard documents. The films and tracings produced by these components

had to meet a number of standards of quality to be acceptable.

If they did not meet the standards according to the technicians’

self-evaluation, the technicians repeated them. The supervisory and chief technicians regularly evaluated the films and

tracings and retrained the technicians when necessary. Furthermore, the ECG’s were recorded not only on paper as tracings

but also on tapes that were analyzed by computer. Any

abnormal ECG’s detected by the computer were read by

experts to ensure that the computer diagnoses were correct

or to adjust them if necessary.

For two examination components, assistants recorded the

findings on the examination form in order to free the hands

of the examiner to do the procedure. This process was used

48
to reduce the chance of recording error for body measurements

and the dental examination. Because the recorder for body

measurements was one of the health technicians, the

examiner’s measurement technique was checked as the measurements were recorded.

Another quality control measure used for audiometry

and body measurements was the comparison over time of

the mean or median measurements taken by the health technicians at each location. If any abnormal variability appeared,

the supervisory technician and the appropriate consultant

checked the measurement techniques and corrected the technicians when warranted.

Replicate data

Even though marry methods were used to keep measurement error to a minimum, some degree of measurement

error may be left in the data. Therefore, another objective

of the quality control program was to determine the extent

of this error. To do this, the survey collected replicate data,

either by rereading hard documents produced by the procedures, such as X-rays, ECG’S, and photographs of height

measurements, or by repeating procedures exactly as they

had been done originally. The scope and frequency of collection of replicate data varied greatly. For example, on the

one hand, the technicians replicated readings for hematocrit

and hemoglobin as often as on every examinee. On the

other hand, complete replicate examinations (except for Xrays) were performed on a small sample of examinees who

volunteered to participate a second time. The purposes of

the different sets of replicate data varied as well. Many

replicates were done to enable supervisors or consultants

to monitor the quality of the data regularly, so problems

could be detected and corrective measures taken before quality

was adversely affected. Other replicates were collected for

use at the end of the survey to describe the measurement

error contained in certain sets of data.

The group of examinees who would receive a second

complete examination consisted of volunteers rather than a

statistical subsample of examinees because the nonresponse

problems associated with a statistical subsample would have

been enormous. The possible bias resulting’ from the use

of a nonstatistical sample was not of prime importance because

the main interest was not with the values of the measurements

themselves but rather with the errors in the measurements.

In addition to quantifying measurement errors, the complete

replicates would allow the assessment of real intraindividual

variation over a 2- to 3-week period. This real variation

can be of great concern also, especially for such data collection

techniques as the body measurements.

During the first few weeks at a survey location most

sample persons were asked after their examinations if they

were willing to return 2 to 3 weeks later for a second full

examination. Generally, about 12 volunteers at each survey

location were scheduled for re-examination. Whenever possible, the components of the replicate examination were done

by an examiner other than the one who did the original.

Operationally, there were problems getting the desired number

of complete replicate examinations, often because few

examinees volunteered, even fewer showed up, or the examination slots were needed for original examinations.

Although the full-scale replicate examinations were the

single most ambitious undertaking of replicate data gathering

in HHANES, other replicate measurements were periodically

performed for the purposes of monitoring and evaluating

inter- and intra-examiner variability. For example, replicate

data were gathered by consultants or supervisors designated

as “standards” who went to the field periodically and replicated

such examination components as the dental examination, vision test, blood pressure, and body measurements. These

replicates were mainly used as a basis for monitoring the

measurement process and retraining the examiners in the

proper techniques if necessary. Additionally, for body measurements and ultrasonography, intertechnician replicates were

regularly collected, providing at the end of the survey a

large pool of replicate data from which to describe the measurement error in these two examination components.

Sometimes, instead of replicating a procedure, an expert

reread the hard document produced by the procedure. This

was done for ultrasonography, tympanometry, X-rays, and

body measurements. For instance, to evaluate the readability

of the ultrasound films and to evaluate the technicians’ determinations of normal or abnormal gallbladder, a sample of

films was sent to the Johns Hopkins University to be independently evaluated by two expert radiologists. The sample consisted of all films of abnormal gallbladders and of about

10 percent of the films of normal gallbladders. Any disagreements between the evaluations of the two experts were reconciled by a third radiologist from the National Institutes of

Health. After comparing the diagnoses of the experts with

those of the technicians, analysts produced measures of agreement. Also, for much of HHANES, the technicians recorded

each ultrasound examination on videotape. Then experts

evaluated these tapes for correct procedures and diagnoses.

Two procedures were used for the quality control of

the tympanometry. All abnormal tracings were reread by

an expert from the National Institutes of Health, and corrections to the data were made when indicated. In addition,

in order to assess the quality of the tympanograms and the

extent of measurement error, a sample of 10 percent of

all of the tracings was reread so that the expert’s independent

evaluation of the findings could be compared with the technicians’ determination of normal or abnormal impedance.

As mentioned earlier, a recorder entered the body measurement values as the technician took the measurements.

As a safeguard against recording emor in the essential measurements of standing height and weight, extra quality control

devices were implemented. For body weight, the scale automatically printed the weight in kilograms on the body measurement recording form. For height, the technician took an

instant photograph of the height scale setting for each standing

height measurement and read the measurement to be recorded

from the photograph, not directly from the scale. The camera

was perpendicular to the height scale so that the picture

taken of the measurement was devoid of any parallax that

might have occurred if technicians of different heights had

read the measurements directly from the scale. Then later,

49
all the height photographs and weight printouts were compared

with the hand-recorded entries on the forms. The data were

corrected when recording errors were found.

For the X-ray examination component, two experts independently interpreted all the posterior-anterior and lateral chest

X-rays. They later discussed their findings and resolved any

differences between interpretations. Both the individual and

combined findings were available to analysts of the X-ray

data.

Quality control of laboratory processing

Various laboratory assessments were made in the mobile

examination center laboratory the same day the blood and

urine specimens were obtained; numerous other tests were

performed under contract by outside laboratories. Different

systems were developed to monitor the quality of both levels

of analysis.

Mobile examination center laboratory

A significant amount of instrument quality control took

place in the analysis of examinees’ blood samples; for example, control specimens were used to check the Coulter Cell

Counter daily, As discussed earlier, the various instruments

were also checked and calibrated at the beginning of each

survey location, and preventive maintenance was performed

as scheduled with results recorded in an instrument log book.

The laboratory technicians did all hematocrit and hemoglobin

determinations in duplicate. In order to assure quality in

hematology, each technician participated in the Centers for

Disease Control Proficiency Testing Program at least 4 times

a year.

The Clini-Tek instrument used for urinalysis automatically

read the reagent strips. Therefore, variability in lighting,

visual acuity and color matching, and technician timing and

technique, was virtually eliminated. In addition, the machine

automatically recalibrated itself, thus removing the need for

calibration by the laboratory technicians. Instrument performance checks were produced daily and proficiency testing

was done 4 times a year.

Contract laboratories

At the practice examination session for each location,

the technicians split the blood drawn from examinees and

sent pairs of tubes to the various laboratories performing

HHANES laboratory analyses. Each split duplicate was sent

to the laboratory in the same shipment with the original

but with a different identifying number.

In addition to the blind-split duplicates, the various laboratories participating in HHANES routinely performed their

own replicate and quality control determinations. Whenever

differences larger than predetermined tolerances occurred,

the analyses were repeated. Generally two types of quality

control systems were used by the chemical laboratories:

“bench” quality control pools inserted by the analyst in each

analytical run to monitor the day-to-day analysis, and “blind”

quality control samples placed in vials, labeled, and processed

so as to be indistinguishable from regular HHANES samples.

Quality control of the data processing

Another major survey operation, that of data processing,

included the data input, editing, and imputation procedures.

Processing of the data was an integral part of the HHANES

operation. Quality control of the data processing began from

the time the data collection forms were received at the NCHS

data processing center in Research Triangle Park (RTP),

North Carolina, and continued through the data editing process. Although a thorough discussion of this process is presented in chapter 10, a brief description of the HHANES

data processing program and the associated quality control

measures is presented below.

In HHANES, as in previous DHES surveys, some data,

such as ECG’s, were recorded directly on magnetic tape

for immediate computer use. Other data, such as X-rays,

ultrasonograms, tympanograms, height photos, and weight

printouts, were recorded in the form of hard documents.

But the majority of HHANES data were collected by interviewers and examiners checking boxes and making written entries

with numbers or words in appropriate spaces on standard

forms, thus requiring computer processing of the data

collected.

The objectives of the HHANES data processing program

were to detect and correct field collection errors, control

the processing operation, and provide data, ready for analysis,

in a timely fashion. Although clerical edits to detect missing

and inconsistent data were performed in the field, the actual

processing of data began after the data collection forms arrived

at RTP. There the processing started with an accounting

of all the interview and examination forms for each survey

participant. One quality control measure was implemented

to make it easier to catch errors in the recording of the

basic five-digit number assigned to each sample person. During the final stage of sample selection, a single computer-generated check digit was added to the sample number. Then,

during data processing, if a computer edit found that the

check digit disagreed with the sample number on a particular

record, the record was rejected and either the sample number

or the check digit cocrected. After all identification numbers

and basic demographic variables were verified, the majority

of the interview and examination data collection forms were

then subjected to clerical edits of some nature to determine

whether or not the forms had been properly completed and

to correct as many errors as possible. Following the completion

of the clerical editing, the records were keyed with 100-percent

verification. Computer edits were then performed for each

field on each form, and a computer printout was produced

for all records containing inconsistencies. The corrected records were edited again, and this process continued until

there were no edit failures. Frequency counts for the various

data sets were produced and the results sent to DHES for

review. Finally a structure check was completed for each

sampled household to determine inconsistencies between

forms. After RTP made the data tapes available to DHES

for processing, internal quality control tabulations were generated and evaluated. One facet of this internal quality control

was the comparison of means, medians, and percentiles for

50
various examination data with those from previous HANES might indicate internal laboratory drift, or problems with

programs or with other data published in the literature. In the laboratory quality control or methodology.

addition, the laboratory data were monitored for trends which

51
Chapter 10

Data processing

by Sandra T. Rothwell and Marie Leahy

The data processing portion of the Hispanic Health and

Nutrition Examination Survey (HHANES) operation was a

large and critical element. Through this system, field-collected

data in the form of questionnaires, examination forms,

laboratory reports, X-rays, and electrocardiogram recordings

were translated into machine-readable electronic information

suitable for analysis. This chapter presents an overview of

several aspects of the data processing of these various types

of data, including the flow of data from the field to NCHS,

preliminary editing and coding, quality control of coding

and keyboarding, and substantive review and re-editing of

the data.

Flow of data

As described in previous chapters of this report, a number

of different types of data were collected by means of

HHANES. The four basic data collection categories, each

of which involved a distinct system for collecting and

preparing the data, were questionnaires and examination

forms, X-rays, electrocardiogram recordings, and blood and

urine specimens for biochemical analysis. A brief description

of the flow of each data type, from collection through editing

and transmittal of data to NCHS for processing, follows.

Questionnaires and examination forma

Questionnaires that were administered in the household

were collected and logged-in at the field office each day,

where they were edited for omissions and other errors. The

Sample Person Questionnaires (containing the medical history

information) for those who scheduled examination

appointments were sent to the examination center; thus, any

missing information could be collected, and the physician

could refer to the medical history information during the

examination. Following the examination, these questionnaires

were returned to the field office, where they were combined

with the other household questionnaires and prepared for

transmittal to the NCHS data processing center. The Dietary

Questionnaire and the Adult Sample Person Supplement,

which were administered in the examination center, were

edited in the field office and then boxed for shipment with

the other questionnaires. Examination forms remained in the

examination center until they were edited and prepared for

shipment. Transmittal of all of the questionnaires and

examination forms occurred in stages throughout each survey

location, but, in general, all materials pertaining to an

individual sample person were transmitted at the same time.

X-raya

During the examination, two chest X-rays were produced

for diagnosis of various cardiovascular, lung, and chest

conditions and for measurement of heart size. Two sets of

copies of the X-rays were made, one of which was included

in the routine reports of findings sent to each sample person’s

physician. The second set was analyzed under contract by

two radiologists who interpreted the X-rays independently,

compared their findings and resolved any differences in

interpretation. The results then were keyed to tape and sent

to NCHS for further processing.

Electrocardiogram recordings

In the examination center, electrocardiographic signals

were digitized and recorded on cassette tape. The cassette

tapes then were copied to 9-track tape and sent to Dalhousie

University in Nova Scotia for measurement and interpretation

of the recordings. The electrocardiogram findings were keyed

to tape and sent to NCHS. A separate list of persons with

abnormal findings also was sent to ensure the inclusion of

the information in the physician’s report of findings.

Laboratory data

Blood and urine specimens were collected and subjected

to an extensive battery of analyses, some of which were

performed by laboratory technicians in the examination center;

others were analyzed under contract by various laboratories.

The diagram in figure 9 is a simplified flow diagram of

the laboratory data production process, showing the various

paths followed for different types of specimens or analyses.

Detailed information on tests performed, descriptions of

applicable subgroups, and a list of responsible contract laboratories are included in appendixes V-VII.
Specimens collected in

mobile examination

center (MEC)

Blood Urine

+

I

+ +

Assessments done Spacimens Specimens Assessments

in MEC lab: prepared for

● hematocrit

prepared for done in MEC lab:

shipment to shipment to

● hemoglobin

● Dip-N-Multistix

laboratories laboratory ● microscopic

● red & white counts for analysis for analysis sediments

+ + + +

Results sent to Biochemistry and Chemistry profile Lipida Pesticides

Centers for hematology New Mexico Johns Hopkins

Disease Control Centers for

Envi?onmenta/

State University University Protection

Disease Control Agency

T v

Special Data sent to Data sent to

hematological Central Patient Battelle Corp.

subsample Registry in

analysis

for processing

North Carolina

for processing

v v * v

Data keyad Routine reports Data keyed Data keyed Data keyed Data keyed

➤ to tape, sent of findings to tape, sent to tapa, sent to tape, sent to tape, sent

to NCHS to physicians to NCHS to NCHS to NCHS to NCHS

4

Statistical

quality control

analysis

Ffgure 9. Summary of fafmratorydata fkow

Preparation of preliminary data tapes Clerical edting and keyboarding

Most of the data processing performed by NCHS involved After all accounting was completed for a survey location,

the preparation of interview and examination data. Unlike

the other types of data previously discussed, which were

sent to NCHS in the form of data tapes, the questionnaires

and examination forms contained handwritten entries that

required several preliminary steps before the final data tapes

could be produced.

Forms accounting

The first step in the system was to account for all the

forms received from the field offices. Included in this initial

step was the validation of critical data fields—age, sex,

and identification number. Reports on interview and

examination status and response rates were generated based

on this process of forms accounting.

each questionnaire and examination form was read by a

clerical editor. This system provided a means of detecting

before data entry any instances in which the data on the

forms appeared to be inconsistent. It was preferable to correct

these situations early in the cycle rather than to keyboard

obviously incorrect information that inevitably would be

rejected. In addition, the clerical editor looked for the types

of items that cannot be checked easily with a computer.

For instance, the editor would read comments written in

the margins of the collection form or review the comments

in residual categories. Such otherwise unusable information

frequently enabled manual backcoding into the specified

preceded categories; in other instances, it facilitated

interpretation of unclear entries, The clerical editors also

5’3
checked for skip pattern errors, read most of the check items

on the forms, looked at a few consistency problems (although

most of these were left to the computer edits), and completed

the industry and occupation coding according to U.S. Bureau

of the Census coding specifications.

All of the clerical editing was performed twice, both

to verify the editing and to check the validity of the industry

and occupation codes. A record was kept of all clerical

editing errors and decisions for purposes of continued

monitoring and training of the clerical staff.

Keying and verification occurred after clerical edits were

completed, For HHANES, cluster type key-to-disk data entry

equipment was used because it was capable of handling

large data entry jobs, could be programmed to perform some

tests of validity and consistency, allowed data entry operators

to change jobs with ease, and was equipped with

communications for the submission of jobs. In addition to

being programmed to detect range and validity errors on

individual fields, the data entry formats also controlled most

of the skip patterns so that in many cases it was virtually

impossible to enter data that should have been skipped. These

functions provided an additional level of verification of entries

and clerical editing.

All data were keyed twice. This 100-percent verification

not only ensured the best possible quality in the data

conversion, but also obviated the need for another subsystem

for sample quality control.

Review and re-editing of data

The final step in production of data tapes ready for

release to the public included re-editing and statistical quality

control analysis. Substantive editing of the interview and

examination data was accomplished in several stages. Edit

programs for each data set were designed to check for proper

format, range, and basic internal consistency. After these

edits had been run, preliminary tabulations were reviewed

by statisticians, analysts, and subject matter experts for editing

accuracy, completeness, and adherence to interview and

examination protocol. This review, as well as a statistical

analysis of the data to compare means, medians, and

distributions of some of the laboratory and examination

findings with data from earlier HANES and other sources,

revealed occasional deficiencies in the edit specifications or

programs and problems in the data collection. Reviewers’

recommendations in some cases resulted in changes in data

collection or laboratory analysis procedures.

As a result of this review stage, numerous additional

within- or across-form consistency edits were incorporated.

All data were again read by the revised edit programs, with

records containing inconsistent entries rejected and verified

by comparing keyed values with the entries on the original

data collection forms. The cycle of editing, rejecting,

reviewing, and correcting errors was repeated until it was

determined that no additional corrections could be made.

In many cases, apparently inconsistent or unlikely values

were left unchanged on the data tapes if they had been

coded and keyed correctly and could not be reconciled with

other available data. Depending on the particular data

collection document or the specific health topic involved,

missing values were sometimes imputed. All imputed values

have been flagged on the data tapes so that researchers can

distinguish between reported data and imputed data. This

entire process of editing and imputing resulted in data tapes

that were essentially “clean” and ready for analysis.

54
Survey Analysis

—
Chapter 11

Approaches for the analysis of

data

by Mary Grace Kovar, Dr.P.H.

Introduction to the problem

The sample design and estimation procedures that were

described in chapter 5 mean that special procedures should

be used to analyze data from the Hispanic Health and Nutrition

Examination Survey (HHANES). The theory and a designbased analytic approach to data from surveys such as HHANES

were presented in a monograph designed to aid users of

data from the first National Health and Nutrition Examination

Survey (NHANES I). t26 The purpose of this chapter is not

to repeat the theory given in that monograph but to provide

users of HHANES data with some examples of what happens

under different approaches and to provide some guidance

to help them make their own decisions.

This is a design-based approach; that is, the sample

design is taken into account in the analysis. There are other,

model-based, approaches. The reader who is interested in

investigating them might start with the Hansen, Madow,

and Tepping paper, the comments on that paper and the

references given by those commenting. 127The design-based

approach is suggested here, not because it is the best or

only approach for all possible analyses, but because it is

a pragmatic approach that appears to yield reasonable results.

There are two aspects of the HHANES design that must

be taken into account in analysis. One is the sample weights;

the other is the complex sample design. Weights are needed

to estimate means, medians, and other descriptive statistics.

Weights and the strata and primary sampling units (PSU’S)

from the sample design are needed to estimate variances

and test for statistical significance.

Each person in the sample represents a large number

of people in the U.S. population. If each sample person

represented the same number of people in the population,

that is, if they had equal probabilities of selection, the data

could be used without weights to study relationships. Because

they do not, the sample weights, which incorporate the selection probabilities, a nonresponse adjustment, and poststratification, must be used to produce the correct population estimates. The weights are on HHANES data tapes and instructions for using them are in the tape documentation. Most

widely available software packages have an option for incorporating weights in the analysis. The information needed

for computing the variances is also on the data tapes. The

need for incorporating the sample design is not as readily

apparent as the need for incorporating weights. Furthermore,

the instructions are not as straightforward, and very few

of the widely available software packages have this as an

option.

Most of the methods of statistical analysis taught in

classes and most of the software currently available for data

analysis depend on the assumption of simple random sampling.

In surveys with complex sample designs, the assumption

of simple random sampling is seldom appropriate. It usually

leads to estimating smaller variances than those estimated

taking the complex sample design into account. The smaller

variances lead to finding more differences statistically significant than would be found using the complex sample design.

The design effect, defined as the ratio of the variance

of a statistic from a complex sample to the variance of

the same statistic from a simple random sample of the same

size, that is,

Variance Compk sample

Design effect =

Variance si~ple random ,samp[e

is often used to show the impact of the complex sample

design on variances. If the design effect is near 1, the complex

sample design has little effect on the variances and one

could consider assuming simple random sampling for the

analysis.

However, design effects in NHANES I and II were

rarely near 1 and their size was inconsistent. Table D shows

selected design effects for NHANES 1. One might expect

that in smaller population groups the people would be more

homogeneous and the design effect would be reduced. That

was often the case for age groups in which the variable

under consideration was correlated with age, but even in

that instance the design effect was not negligible. For population groups defined by other measures, such as drinking

and smoking categories, the design effects were highly inconsistent, and were sometimes less than one.

Note also that equal sample sizes do not necessarily

mean that the design effects are equal. There were 195

current smokers who did not drink and 165 who were heavy

drinkers. Yet the design effect for the first group was 0.723

and for the second group it was 1.742 for the same response

variable (mean periodontal index).

In the NHANES, there was usually only one person

selected from each household. However, in HHANES there

is clustering within households with an expected average

56
Tde D. Sebcted design effeote from the first Netiinal Hestth snd Nutritiin

Exsmrnetbn survey

Variab/e Sample size Design effect

Decayed, missing, and filled teeth

l-74 years of age, . . . . . . . . . . . . . . .

l–17years of age, . . . . . . . . . . . . .

18-24 years of age . . . . . . . . . . . . . . .

Systolic blood pressure

6-74 years of age . . . . . . . . . . . . . . . . .

35-44 years of age . . . . . . . . . . . . . . .

55-64 years of age,.........,.,,..

Calories

l–74years of age . . . . . . . . . . . . . . . .

2$34years of age . . . . . . . . . . . . . . . .

65-74 years of age . . . . . . . . . . . . . . . .

Mean periodontal index (Pi)

Does not drink-never smoked

Does not drink-current smoker

Mcderate drinker-never smoked

Moderate drinker+ urrent smoker

Heavy drinker+urrent smoker

Whitwurrent smoker . . . . . . . . . .

Black+urrent smoker . . . . . . . . . .

20,749

7,104

2,297

17,656

2,317

1,255

20,749

2,694

3,466

417

195

176

463

165

85i

230

4.646

2.108

3.267

5.963

2.696

1.476

7.431

2.117

3.283

1.823

0.723

2.190

1.932

1.742

2.756

1.488

NOTE: Design effect = Variance m~p~. ~,,Iti~

Variants s,- ,.& *.M

SOURCE: National Center for Health Statistics, J.R. Landis, J.M. Lepkowaki, S A. Eklund, and

S.A. Stehouwer: A statistwal methodology for analyzing data from a complex survay. the first

National Health snd Nutrition Examination Survey, Vi(a/ and Hea/th sf~tj~fj~ serle~ 2, No 92

DHHS Pub. No, (PHS) S2–13E6 Public Health Service Washington. U.S. Government Printing

Office, Sept. 19S2.

of three persons per family and there is great interest in

measures, such as use of medical care, where family members

may tend to behave like one another. For example, children

in the same family may be much more like one another

in receiving immunizations than they are like children in

a neighboring family. We might expect the design effects

to be larger in that case.

Because there was no family clustering in NHANES,

there are no data from that survey to estimate its impact

on the design effects. However, all family members are

included in the National Health Interview Survey (NHIS);

data from that survey can be used to show the possible

impact of family clustering.

The overall design effect for whether children had received medical care within an interval deemed adequate for

preventive care was 2.76 (table E). Family clustering obviously had an impact on the design effects, The smallest

value was in families of fewer than four people. The largest

was in families of six or more people. If simple random

sampling is assumed, the standard error in families with

six or more people was 8 percent higher than in families

with three or fewer people. It was 88 percent higher when

the complex sample design is incorporated.’28

It is interesting to note that there is relatively little variation in the design effects when the children were classified

by a geographic variable compared with the variation when

they were classified by a family characteristic. Also, as in

NHANES, equal sample sizes did not result in equal design

effects.

Some examples from NHANES I and NHIS will illustrate

the importance of incorporating the weights and the sample

design in analyses. The examples from NHANES I illustrate

three possible strategies (shown in figure 10 below): Using

the sample counts and assuming simple random sampling

(option 1), incorporating the weights and assuming simple

random sampling (option 2), and incorporating both the

weights and the complex sample design (option 3). In the

NHIS example only options 2 and 3 are illustrated because

NHIS is essentially a self-weighting sample; the probabilities

of selection are equal in the basic design. Incorporating the

weights makes very little change in the estimates.

Fgure 10. Strategies for snatyeis of wmplex sample data

Inclusion of

Option Sample weights Complex sample design

1 No No

2 Yes No

3 Yes Yes

Data in table F illustrate the effect of the three strategies

on means. The sampling probabilities in NHANES I were

based on age. Therefore, incorporating the weights should

have relatively little effect on the estimated means when

the people are classified by age. As can be seen, the means

under option 1 do not differ greatly from the means under

option 2. Nor do the standard errors of the means differ

very much. Since both options 2 and 3 are based on weighted

data, the means are precisely the same. However, the standard

errors under option 3, which incorporates the complex sample

design, are very much larger than the standard errors under

option 2, which assumes simple random sampling.

Data in table G illustrate the effect of the three strategies

on proportions when adults are classified by race and smoking

status. Sampling probabilities were not based on these variables, and incorporating the weights should have more effect

on the estimated proportions within subcategories than when

age was the control variable. As can be seen by comparing

the proportions under option 1 with those under option 2,

it does. The estimated proportions under option 2 and 3

are precisely the same and are not shown for option 3.

Only the standard errors are shown to illustrate the effect

of incorporating the complex sample design.

Data in tables H, J, and K illustrate the effects of the

three strategies on test statistics. Table H illustrates a multiple

regression model. (Some of the basic data were shown in

table F.) Incorporation of the weights changes both the regression coefficients and the t-statistics somewhat. Incorporation

of the complex sample design results in larger standard errors

of the coefficients and, consequently, smaller t-statistics. The

effect on race was especially pronounced; the t-statistic was

7.42 under option 2 but 3.50 under option 3. In contrast,

the t-statistic for sweets, which was 7.17 under option 2,

was 6,43 under option 3.

Table J illustrates hypothesis tests for the data in table

G, The Q statistic for the effect of race was so large that,

even though incorporating the weights and the complex sample

design in the analysis reduced it, it remained significant

57
Table E. Estiitas of atanderd errore and design effects for whether children hava received care within an interval adequate for preventive care for specified

aubpopuletions of children and youths under 18 yaars of age, National Health Interview Survey, 1975-76 annual average

Number of Proportion

Standard Error

children in w)thadequate Simple Comp/ex Design

Variable thousands intetval random sample sample effect

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 73,234 0.8566 0.001295 0.002152 2,76

MDMA’

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.001933

0.006855

2.04

2.69

56,563

11.249

0.8829

0.7315

0.001352

0.004178

PHONE2

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.001331

0.004746

0.001946

0.008343

2.14

3.09

65,061

7,852

0.8671

0.7705

0.9090

0.8963

0.6596

0.7864

0.002543

0.002101

0.002656

0.002744

0.002693

0.002687

0.003170

0.005067

1.12

1.64

1.42

3.41

12,769

21,063

17,061

22,301

EDHEAD4

0-11 . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

130r more . . . . . . . . . . . . . .

0.002563

0.002105

0.001875

0.004240

0.002960

0.002383

2.74

1.98

1.62

24,771

25,888

21,874

0.7953

0.8678

0.9161

Residence’

SMSA . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Non-SMSA . . . . . . . . . . . . . . . . . . . . . . .

0.002415

0.004562

2.75

2.81

53,324

19,910

0.8701

0.8204

0.001456

0.002720

Outpatient department in the

county of residence

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.8718

0.8242

0.001498

0.002486

0.002514

0.004182

2.82

2.83

49,782

23,452

1Mother has had contact for medical care within year.

~elephone in the household.

3Family size (number of persons)

4Education of the family head (completed years).

5Reaidenc@m standard metropolitan statistical area (SMSA) or outside SMSA.

NOTE: Design effect = Variance Cowex,*W~

Variance .Sj.~ ,.m SeV@

SOURCE: M.G. Kovac A methodobgical study of factors associated with whether children receive adequate medical care hstitute of Statistics Wneo Series. No. 1428. Chapel Hill, N.C. Department of

Siostatistics, University of North Carolina, 1982

Table F. Number of examined pereon$ estimated mean% estimated standard errors of the mean, and design affecta for the number of decayed, missing,

and fflled (DW) teeth from the ffrat Natiid Hea4th and Nubftion Examination Survey United States, 1971-74

Option 1 @ion2 Option 3

Number of Mean Standard Mean Standard Mean Standard Design

Age examinedperwrs DMF error of mean DMF error of mean DMF error of mean effect

l–74years . . . . . . . . . . . . . . . 20,749 14.935 0.0793 14.723 0.0748 14.723 0.1613 4.848

l–17years . . . . . . . . . . . . . . . 7,104 3.338 0.0457 3.965 0.0464 3.965 0.0703 2.108

18-24 years . . . . . . . . . . . . . . 2,297 12.050 0.1339 11.924 0.1305 11,924 0.2367 3.287

25-34 years . . . . . . . . . . . . . . 2,694 16.872 0.1434 16.918 0.1397 16.918 0.2618 3.512

35-44 years . . . . . . . . . . . . . . 2,327 21.271 0.1595 21.436 0.1523 21.436 0.2481 2.654

45-54 years . . . . . . . . . . . . . . 1,599 22.515 0.1993 22.826 0.1893 22.826 0.2320 1.503

55-64 years . . . . . . . . 1,282 25.234 0.2280 25.744 0.2140 25.744 0.2790 1.700

65-74 years . . . . . . . . . . . . . . 3,466 27.608 0.1202 27.727 0.1151 27.727 0.1536 1.780

SOURCE:National Center for Health Statistics, J.R. Landis, J.M. Lepkowski, S.A Eklund, and S.A. Stehouwer: A statistical methodology for analyzing data from a complex survey, the first National Health

and Nutrition Examination Survey. Vifa/aKfHeafth StatMks. Serias 2, No. 92, DHHS Pub. No. (PHS) S2–1 366. Public Health Service. Washington, U.S Government Printing Office, Sept. 1982.

at the 0.05 level. However, the effect of smoking and the the standard errors were larger when the complex sample

interaction term, which were significant at the 0.05 level design was incorporated and the test statistics were smaller.

under the simple random sampling assumption, were no longer In some cases, the conclusions would not be affected, but

significant when the complex sample design was incorporated. in others they would be.

In general, using the weights changed the estimates; A final example from the National Health Interview Surusing the complex sample design changed the standard errors vey data that were given in table E confirms this observation

and therefore changed the test statistics. In both examples, (table K). Whether a proportion or a logit was used for

58

-—- -. —
Table Q. Number of examined pamonq proportii of persons with periodontal index (Pi) grester then zero, esthneted etenderd errors of the proportions,

and design affactq by race and whether current cigarette smoker from the first National Health snd Nutritiin Easmination Survey detailed sample: United

Steteq 1971-74

Unweighed Weighted

Option 1 Option 2 Option 3

Population estimate

Current Mmrberof Propotiion PI Standard

Race

ot examinadpersons Propoflion PI Standard Standard Design

cigarette smoker examinedpersons greater than zero error (inthousands) greater than zero error error effect

White Yes . . . . . . . . . . . 851 0.588 0.0169 1,076 0.574 0.0151 0.0250

White

2.756

No . . . . . . . . 1,574 0.476 0.0126 1,727

Black

0.449 0.0120 0.0225 3.534

Yes . . . . . . . . . . . 230 0.748 0.0286 17~ 0.697 0.0351

Black

0.0427 1,468

No . . . . . . . 264 0.758 0.0264 163 0.705 0.0357 0.0547 2.341

SOURCE:Netiinal Center for Health Statistics, J,R. Landis, J.M. Lepkowski, S.A Eklund, and S.A. Stehouwer: A stetisbcal methodology for analyzing data fmm a complex suwsy, the first National Health

and Nutrition Exarninatiin Survey, Wa/mdHes#h Statistics. Series 2, No. 92. DHHS Pub. No. (PHS) 82–1 366. Public Health Service Washington. U.S. Government Printing Office, Sept. 1982,

Tabfe H. Summsry of mulfipk regression models for the number of decayed, missing, snd filted (DMF) teeth on age, race, sex, and sweets for 6,349 examined

persona ages 11-30 from the first National Health and Nutritiin Examination Survey United States, 1971-74

Regression Standard error

Variable coefficient of coefficient t-statistic Design effect

Unweighed simple random sample design (option 1)

Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.685 0.0130 52.42

Race ..,....,..........,.,..,,.. 0.875 0.0699 9.73

Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . – 0.491 0.0752 – 6.52

Sweets . . . . . . . . . . . . . . . . . . . . . . . . . 0.057 0.0070 8.21

Weighted simple random sample design (option 2)

Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.705 0.0125 56.29

Race ..,...............,..,.,., ,.. 0.795 0.1072 7.42

Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . – 0.465 0.0696 – 6.65

sweets . . . . . . . . . . . . . . . . . . . . . . . . . . . 0049 0.0068 7.17 .,.

Weighted complex sample design (option 3)

Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.705 0.0209 33.67

Race . . . . . . . . . . . . . . . . . . . . . . . . . .

2.789

0.795 0.2277 3.50

sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.494

– 0.465 0.0926 5.01

Sweets . . . . . . . . . . . . . . . . . . . . . . . . . .,

1.769

0.049 0.0077 6.43 1.254

NOTE:.,, = category not applicable,

20URCE: National Centsr for Health Statistics, J.R. Lsndia, J.M. Lepkowski, S.A. Eklund, and S.A. Stehouwer A statmtlcal methodology for analyzing data from a complex survey, the first National Health

andNutrtionExaminationSurvey,Vits/sndHea/fhStatistics.Series2, No 92. DHHS Pub. No. (PHS) 82-1366 Public Health service Washington. U.S. Government Printing Office, Sept. 1982

Table J. Hypothas$ie teats for variation in the proportbn of persons with periodontal index (Pi) greater than zero, by race and stitng statue from the first

National Health and Nutrition Examination Survey detekd sample: Unitad States, 1971-74

Chi-square test criteria and significance levels

Unweightedsimple Weighted simple Weightad

Source of Oagrees

random sample design random sample design complex design

Design

van”ation of freedom Q p-va/ue 0 p-va/ue Q p-va/ue effect

Race . . . . . . . . . . . . . . . . . . . . . . . . . 1 96.59 0.00 50.20 0.00 26.02 <0.01

Smoking . . . . . . . . . . . . . . . . . . . . . . . . ,. 1

1.932

5.04 0.02 4.70 0.03 2,27 0.13 2.103

Racex smoking . . . . . . . . . . . . . . . . . 1 7.22 0.01 6.11 0.01 2,92 0.09 2.103

SOURCE: National Center for Health Statistics, J.R. Landis, J.M. Lepkowski, S A Eklund, and S.A. Stehouwer: A statistical methodology for analyzing data from a complex survey, the first National Health

snd Nulrifiin Examination Survey. Vita/ arrd Hea/fh .5Yatistics.Series 2, No. 92 DHHS Pub No. (PHS) 82–1 366. Public Health Service Washington. U S. Government Printing Office, Sept. 1982

59

.
Table K. Comparison of Q statistics for adequacy of medii care, by selected varidea, ehnple-random sample (SRS~ and complex sample desgns, and of

proportion and Iogif models from the National Health Interview Survey United Sfatea, 1975-76

Sourceof

Proportion model

Degrees

Logit model

variation of freedom SRS Complex SRS Complex

Error . . . . . . . . . . . . . . . . . .

Variable

MAMA’ . . . . . . . . . . . . . . . . . . . . . . . .

PHONE . . . . . . . . . . . . . . . . . . . . . . .

FAMSIZE3 . . . . . . . . . . . . . . . . . . . . . . .

MDMAxPHONE . . . . . . . . . . . . . . . . .

MDMAxFAMSIZE . . . . . . . . . . . . . . . . . .

PHONEXFAMSIZE . . . . . . . . . . . . . . . . .

Q-statistic

4 3.63 3.78 1.51 0.79

1 428,45 276.37 674.41 498.61

1 181.40 87.67 235.64 122.10

3 340.93 187.66 401.57 232.79

1 16.87 12.17 0.78 0.99

3 6.10 3.96 25.31 18.53

3 36.11 17.62 i 3.07 9.34

‘Mother has had contact for medical care within year

~elephone in the househoU.

‘Family size (number of persons).

SOURCE M.G Kovar: A meifmxloloaical studv of factors associated withwhether Chfldren r-ive adwate me~~l care l~sfifufeOf StafjStJCS~imeo Series. NO 1428 cha~l Hill. NC. DeDaflment of

Biostatistics, University of North Camiina, 1982

the analysis, the Q statistics were smaller when the complex

sample design was incorporated.

Strategies

The data analyst with the public use data tape can use

any of the three options. However, option 1 can lead to

incorrect estimates and variances, while option 2 should lead

to correct estimates but inappropriate variances. Option 3

should lead to both correct estimates and appropriate variances,

but option 3 requires more statistical expertise and more

computer time than the other options.

An approach that is sometimes used for data from surveys

with complex sample designs is to compute an overall design

effect and then use it as a multiplier. That is, the analysis

is done assuming simple random sampling; then each variance

is multiplied by a constant design effect. A standard error

is multiplied by the square root of the design effect. The

problem with this approach is that, as was shown earlier

in this chapter, there is seldom an overall design effect

that applies to all dependent variables or to all control variables. However, the use of an overall design effect is better

than assuming simple random sampling.

Another strategy that is sometimes used is to compute

variances for a set of selected statistics. The set is chosen

so that (a) the entire range of sample sizes from the smallest

to the largest subgroup is included; and (b) “like” statistics,

that is, those with similar distributions, are included in the

same set. A regression line is then fitted to the estimated

variances and the values read from the regression line are

used in analysis. This is the approach that is used for the

National Health Interview Survey. The curves from the regression equation are included in all Vital and Health Statistics

Series 10 publications, and the user reads the values from

the published curves. This approach has occasionally been

used for the presentation of NHANES data. It is a useful

approach for presentation when a large number of statistics

are being presented and when showing all of the standard

errors would vastly increase the size or number of tables.

However, it is based on the size of the population subgroup,

and clustering and interclass correlations vary widely among

subgroups of the same size.

As a practical matter, the best strategy seems to be

to explore hypotheses and eliminate inconsequential variables

under option 2. To avoid eliminating variables that might

be significant in the final analysis, the p-value should be

higher than the value that will be used for the final inferences.

Setting the p-value higher, say 0.10 or 0.15 rather than 0.05,

will protect the analyst from incorrectly eliminating a variable

if the design effect is less than 1, or if further analysis

will reveal new relationships.

Relationships found to be statistically or substantively

important under options 1 or 2 can then be investigated

under option 3. The sample weights and the estimated variance-covariance matrix for the estimates can be incorporated

in all final models and used for inferential conclusions.

A variant of option 3 is the only approach available

to users of the published data. It is impossible to publish

the full variance-covariance matrix because of the space it

would take. Only variances, standard errors, or relative standard errors are presented in NCHS publications. Users of

the published data can only use these variances and assume

that the covariances are zero.

There will be some loss of precision because the

covariances are seldom zero; the subpopulations being compared are not usually from independent samples. However,

the variances alone will work very well for many purposes.

The effect of using only the estimated variances and

assuming that the covariances are zero has been investigated

in some studies. 129,130The data are too extensive to show

here, but the covariance terms were rarely zero, and they

were negative in about one-third of the elements in all of

the variance-covariance matrixes calculated. Such deviations

from the assumption of zero covariances will obviously affect

the results to some extent. Therefore, the full matrix should

be used if at all possible.

60

—
Implementation for outliers that will distort relationships. If there are any,

The analyst is always limited to the variables that are

available on the data set, can be constructed from those

on the data set, or can be linked from another data set.

Within those limitations, a decision about which variables

are important needs to be made. The selection should be

made on substantive and theoretical grounds, with the decision

based on research and the literature. There is a risk, however,

in limiting oneself to the variables that have been used in

the past. The previous research may also have been based

on limited data that did not include all of the important

variables. In addition, knowledge and conditions may have

changed since the original research was done. This may

be especially important for social and policy research.

Therefore, it is desirable to have a method of examining

all of the available variables, ranking them in importance

according to some criterion, and selecting the most important.

In a large data set, a rational method of selecting variables

is crucial. Computational methods for simultaneously examining ail of the information while incorporating the complex

sample design are not available.

All of the widely available software packages have programs that can be used for screening. The analysis in the

Series 2 report referred to earlier] 26 used OSIRIS IV]31 for

the examples. Two examples using SAS132 are in

appendix XI.

Regression techniques are often used to screen variables.

They are particularly useful for continuous variables. Stepwise regression programs are widely available. The “all possible regression” programs are extremely useful, because many

variables can be screened simultaneously with very little

computer time.

The analyst using regression for screening should remember that most regression programs are fitting linear regres.

sions, and in exploratory data analysis there may not be

any reason to assume that the relationships are linear. The

continuous variable of interest can be transformed, of course,

and it may be necessary to make a transformation before

using a regression technique, It may also be useful to include

interaction terms, at least for the variables that appear to

be important. Finally, in using regression for screening, it

is advisable to make separate cross-tabulations to be certain

that the numbers in the cells are really sufficient for analysis.

Procedures for screening categorical variables have not

been used as frequently as regression techniques and are

not as widely available or known. Higgens and Koch] 33

proposed a procedure for categorical variables that is analogous

to step-wise regression and can be used to obtain a reasonable

subset. The only commercially available software to implement this approach is PARCAT. ]34 However, the procedure

can be approximated by successive subdivisions of frequency

tables.

Following are some final caveats about screening. First,

set the p-value high enough that borderline variables are

not excluded. Second, if there is prior knowledge that one

variable is highly associated with the response variable, screen

within each category of that variable, Third, check in advance

make decisions about how to treat them.

Implementation of option 3 requires the ability to weight

the data to the population estimates and to incorporate the

sample design in estimating the variances. The information

needed to do both is on HHANES public use data tapes.

To produce population estimates, use the weight that

is appropriate for the variable under investigation. There

is a weight for the interviewed sample, the examined sample,

and for each subsample. In SAS, the weight is incorporated

by a WEIGHT statement (PROC FREQ) or a FREQ statement

(PROC UNIVARIATE and PROC TABULATE). Incorporating the weights will produce the correct population estimates;

it will not produce the correct variance estimates or test

statistics.

To produce variance estimates it is necessary to assume

that the sample was selected with more than one primary

sampling unit (PSU) in each stratum. The HHANES sample

was selected with one PSU in each stratum (see chapter

5). The PSU’s have been paired to produce pseudostrata,

each with two PSU’S, numbered 1 and 2, on the public

use data tapes. These pseudostrata are used to compute the

variances,

Obtaining a consistent variance-covariance matrix from

a survey with a complex sample design is not always simple.

The development of computer programs to produce estimates

of the variance-covariance matrixes from surveys with such

designs has been slow and are still not in wide use. There

are three approaches that have been developed of which

only two, the balanced half-sample replication and the Taylor

series approximation, currently have software packages that

are commercially available for analytic use. The BRR program

of the National Center for Health Statistics’35 and the OSIRIS

package of the University of Michigan 131depend on a balanced

half-sample replication method. The SURREGR program of

the Research Triangle Institute] 36 and the SUPER CARp

program of the Iowa State University’37 depend on a Taylor

series approximation. If the sample size is sufficiently large

and there are sample persons in each PSU, they all give

approximately the same estimates of the variances and

covariances. 138–140

It should be noted that, if the sample size is small

or if the sample size in many strata or primary sampling

units is zero, the variance programs will not give the same

estimates. The estimates produced by the different programs

may vary by a factor of two or more. ]41 Before beginning

the analysis, the analyst should examine the distribution of

the sample by PSU’s and, if necessary, create different pairings

of the PSU’S. For example, if many pairs have observations

in only one of the PSU’S, PSU’S could be combined with

one another so that all PSU’S have at least one observation

(the number of PSU’S and strata will be smaller). The method

of pairing apparently had little influence on the variance

estimates for NHANES 1.142 Whether or not this holds true

for other surveys has not been examined.

Incorporation of the complex sample design into regression analyses requires only a regression program that takes

61
the sample design into account.

SURREGR is a regression program that runs under SAS,

which computes regression statistics and their sampling errors

for data from clustered sample designs using a Taylor series

approximation. 136 It was used for analyses of the lead data

from NHANES II. 143 The control file for that analysis is

given as example 1 in appendix XI.

Categorical data analysis requires an appropriate program

that permits the incorporation of the variance-covariance matrix from the complex sample into the analysis. At present,

the only approach to categorical data analysis that does so

is the Grizzle-Starmer-Koch linearized model. *4 There are

theoretical considerations (and the practical consideration of

having sample persons in most, if not all, of the P~U’s),

but given a consistent estimate of the variance-covariance

matrix, the approach is practical and reasonable. Fortunately,

a computer program to implement this weighted least squares

approach, GENCAT, is available. 145

The vector of proportions, together with their variances

and covariances, can be computed within SAS using SURREGR. Any other computing algorithm designed to compute

a vector and a consistent estimate of its covariance structure

could be used instead. The vector of sample proportions

and its covariance matrix is then entered directly into the

weighted least squares program,

Using this approach, the goodness of fit of models can

be evaluated using the Wald statistic

Q = (F’-Xb)’ V-l (F’-Xb)

When the model fits and and the data are derived from

a simple random sample, Q asymptotically follows the chisquare distribution. Even when the covariance matrix is estimated from a sample with a complex design, the same result

should hold for large samples. (See, for example, Shuster

and Downing. 146)

The weighted least squares estimator for the

vector, B, can be obtained from the survey data as

B = (x’v-’x)-‘x’ V-IF

When the fit of the model is adequate by

parameter

the Wald

statistic criteria, it is possible to examine the individual parameters to reduce the model. This test statistic is also asymptotically distributed as a chi-square random variable when the

null hypothesis is true. The predicted values will adequately

describe the statistically important sources of variation in

the data and will have smaller sampling errors than the

observed estimates. The smaller sampling errors result from

using the entire sample to estimate the variances for the

predicted functions, and the errors for the observed values

are estimated from the sample in each subclass.

The control file for the last column of table K is given

as example 2 in appendix XI. That control file includes

the transformation of the variable of interest, a proportion,

to a logit. This transformation is especially useful if the

147A discussion of the analysis proportion is near O or near 1.

is in Kovar. 12s

The control files for the NHANES I analyses in the

tables using OSIRIS IV & PSALMS are in Series 2 No.

gz126

62
References

1Public Health Service: Origin and program of the U.S. National

Health Survey. PHS Pub. No. 584-A 1. Washington. U.S. GovernmentPrinting Office, May 1958,

2Twenty.fifth anniversq of the National Health SurveY-a sPecial

section. Public Health Rep. 96(3): 195–237, May-June 1981.

?.Nationa] Center for Hea]th Statistics: Plan and initial program

of the Health Examination Survey, Vital and Health .Watistics.

Series 1, No. 4. PHS Pub. No. 1000. Public Health Service,

Washington. U.S. Government Printing Office, July 1965,

4National Center for Health Statistics: Plan, operation, and response

results of a program of children’s examinations. Vital and Health

Statistics. Series 1, No. 5. PHS Pub. No. 1000. Public Health

Service. Washington. U.S. Government Printing Office, Oct. 1967.

5National Center for Health Statistics: Plan and operation of a

health examination survey of U.S. youths 12–17 years of age.

Vital and Health Statistics. Series 1, No. 8. PHS Pub. No. 1000.

Public Health Service. Washington. U.S. Government Prhting Office, Sept. 1969.

6National Center for Health Statistics, H. W. Miller: plan and

operation of the Health and Nutrition Examination Survey, United

States, 197 1–73, Vital and Health Statistics. Series 1, Nos. 10a

and 10b. DHEW Pub. No. HSM 73–13 10. Health Services and

Mental Health Administration, Washington, U.S. Government Printing Office, Feb. 1973.

‘National Center for Health Statistics, A. Engel, R. S. Murphy,

K. Maurer, and E. Collins: Plan and operation of the HANES

I Augmentation Survey of Adults 25–74 Years, United States,

1974-75. Vital and Health Statistics. Series 1, No. 14. DHEW

Pub, No, (PHS)78–I 314. Public Health Service. Washington. U, S.

Government I%nting Office, June 1978.

‘National Center for Health Statistics, A. McDowell, A. Engel,

J. T. Massey, and K. Maurer: Plan and operation of the Second

National Health and Nutrition Examination Survey, 1976-80. Vital

and Health Statistics. Series 1, No. 15. DHHS Pub, No. (PHS)

8 1–13 17. Public Health Service. Washington, U.S. Government

Printing Office, July 1981,

gNational Center for Hea]th Statistics: Current listing and topical

index to the Vital and Health Statistics Series, 1962–78. DHEW

Pub. No, (PHS)79– 1301. Public Health Service. Washington. U,S,

Government Printing Office, Apr. 1979.

‘ONational Center for Health Statistics: Catalog of public use data

tapes from the National Center for Health Statistics. DHHS Pub.

No. (PHS)8 1–1213. I%blic Health Service. Hyattsville, Md.,

NOV. 1980.

ItNational Center for Health Statistics: Improving the Health and

Nutrition Examination Survey. An evaluation by a panel of the

National Academy of Public Administration, Hyattsville, Md.,

June 1981.

12A J McDowel]: Health examination surveys-in theory and apPlication, in P. Armitage, ed., National Health Survey Systems in

the European Economic Community. Proceedings of the Conference

on National Health Survey Systems in the European Economic

Community, Ott, 6-8, 1975. Commission of the European Communities. Luxembourg, 1977.

t3R Bfislin, w. J, Lonner, and R. M, Thomdike: Cross-cultural

Research Methods. New York. John Wiley and Sons, 1973,

pp. 32–54.

1AM p Stem S. p. Gaskill, C. R. Allen, et al.: Cardiovasctdar

risk factors in Mexican Americans in Laredo, Texas. 1. Prevalence

of overweight and diabetes and distributions of serum lipids. Am.

J. Epidemiol. 113(5):546555, 1981.

15,4 K Diehl, M. p. stem, V. S. Ostrower, and P. C. Friedman:

.

Prevalence of clinical gallbladder disease in Mexican-American,

Anglo, and Black women. South. Med. J. 73(4):438-441, 1980.

16 National Center for Health Services Research: Hispanic health

services research. Research Proceedings Series. DHHS Pub. No.

(PHS)80-3288. Public Health Service. Hyattsville, Md., Sept. 1980.

17Nationa1 Center for Health Statistics, F. M. Trevino and A, J,

Moss: Health insurance coverage and physician visits among Hispanic

and non-Hispanic people. Health, United States, 1983, DHHS Pub.

No. (PHS)8+1 232. Public Health Service, Washington. U.S. Government Printing Office, Dec. 1983, PD. 45-48.

IS1 Cuellm L, c, H~s, and R. Jasso: An acculturation scale

for Mexican American normal and clinical populations. Hispanic

J. Behav. Sci. 2(3):199–217, 1980.

‘~. Andersen, S. Z. Lewis, A. L. Giachello, et al.: Access to

medical care among the Hispanic population of the southwestern

United States. J. Health Sot. Behav. 22(1):78–89, 1981.

20A,. P Chesney, J. A. Chavira, R. P. Hall, and H, E. Gary

Jr.: Barriers to medical care of Mexican-Americans: The role of

social class, acculturation, and social isolation. Med. Care. 20(9):

883–891 , 1982,

z]Nationa] Center for Health Statistics, W. C. Hadden and M.

I. Hams: The prevalence of diagnosed diabetes, undiagnosed diabetes, and impaired glucose tolerance in the U. S., 1976-80. Vital

and Health Statistics. Series 11. Public Health Service, DHHS,

Hyattsville, Md. To be published.

zzNational Center for Hea]th Statistics, M. I. Harris: Unpublished

data from the 1976 National Health Interview Survey.

23Nationa1 Diabetes Data Group: Classification and diagnosis of

diabetes mellitus and other categories of glucose intolerance. Diabetes. 28(1 2): 1039-1057, 1979,

Z4R M Salcido. Needed: Hypertension research for Mexican-Americans. Public Health Rep. 94(4):372–375, 1979.

ZSM p Stem S, p, Gaskill, C. R. Alien Jr., et al.: Cardiovascular . .

risk factors in Mexican Americans in Laredo, Texas. 11. Prevalence

and control of hypertension, Am. J. Epidemiol. 113(5):556562,

1981.

63

.—
ZbNational Center for Health Statistics: Prevention pt’Ofk, f’.M.

Golden, R. W. Wilson, and J. Kavet. Health, United States, 1983.

DHHS Pub. No. (PHS)8&l 232. Public Health Service. Washington.

U.S. Government FWnting Office, Dec. 1983. pp. 246247.

zTAmerican Heart Association: Recommendations for human blood

pressure determination by sphygmomanometers, 1980.

zaNational Center for Health Statistics, M. Rowland, R. Fulwood,

and J. C, Kleinman: Changes in heart disease risk factors. Health,

United States, 1983. DHHS Pub. No. (PHS)841 232. Public Health

Service. Washington. U.S. Government Printing Office, Dec. 1983.

pp. 13–17.

zgNationa] Center for Health Statistics, C. S. Wilder: Limitation

of activity due to chronic conditions, United States, 1974. Vital

and Health Statistics. Series 10, No. 111. DHEW Pub. No.

(HRA)77-I 537, Health Resources Administration. Washington. U.S.

Government Printing Office, June 1977.

sONational Center for Health Statistics, R. 0. Gagnon, J ‘. ‘eLozier, and T. McLemore: The National Ambulatory Medical Care

Survey, United States, 1979 summary. Vital and Health Statistics.

Series 13, No. 66. DHHS Pub. No. (PHS) 82–1 727. Public Health

Service. Washington. U.S. Government Printing Office, Sept. 1982.

SIG A Rose: The diagnosis of ischaemic heart pain and intermittent

claudication in field surveys. Bull WHO. 27:645–658, 1962.

mG A Rose: Chest pain questionnaire. Milbank Mem. Fund Q

40(2):32-39, 1965.

33National Center for Health Statistics, T, F. Drury and L. J.

Howie: Prevalence of selected chronic digestive conditions, United

States, 1975. Vital and Health Statistics. Series 10, No. 123. DHEW

Pub. No. (PHS) 79-1558. Public Health Service. Washington. U.S.

Government Printing Office, July 1979.

34L. J. Schoenfield and J, M. Lachin: Chenodiol (chenodeoxycholic

acid) for dissolution of gallstones: The National Cooperative

Gallstone Study. A controlled trial of efficacy and safety, Ann.

Intern. Med. 95(3):257–282, 1981.

35W. A. Gracie and D. T, Ransohoff The silent gallstone: requiescat

in pace, in J. P. Delaney and R. L. Varco, eds., Controversies

in Surgery 11. Philadelphia. W .B. Saunders, 1983.

36Na~iona] center for Health Statistics, A. L. Ranofsky: Surgical

operations in short-stay hospitals, United States, 1975. Vital and

Health Statistics. Series 13, No. 34. DHEW Pub. No. (PHS)

78–1 785. Public Health Service. Washington. U.S. Government

Printing Office, Apr. 1978.

sTNational Commission on Digestive Diseases: Digestive diseases:

Neglected problems+xciting opportunities. Vol. 1, Report to the

Congress of the United States of the National Commission on Digestive Diseases. DHEW Pub. No. (NIH)79–1 878. National Institutes

of Health. Washington, U.S. Government Printing Office,

Jan. 31, 1979.

38p L Cooperberg and f+. J. Burhenne: Real-time ukrasonographyt

.

diagnostic technique of choice in calculous gallbladder disease.

N. Engl. J. Med. 302(23): 1277–1 279, 1980.

~gNational Center for Health Statistics, F. M. Treviiio and A. J.

Moss: Health indicators for Hispanic, black, and white Americans.

Vital and Health Statistics, Series 10, No. 148. DHHS Pub. No.

(PHS)841 576. Public Health Service. Washington, U.S. GovernmentPrinting Office, Sept. 1984.

~ational Institute for Dental Research: Dental treatment needs

of United States children, 1979–1980. The National Dental Caries

Prevalence Survey. NIH Pub. No. 83–2246. National Institutes

of Health. Washington. Dec. 1982.

4INational [nstitute for Dental Research: The prevalence of dental

caries in United States children. 1979–1 980. The National Dental

Caries Prevalence Survey. NIH Pub. No. 82–2245. National Institutes of Health. Washington. Dec. 1981.

42C, D, Bluestone: Otitis media in children: To treat or not to

treat? N. Engl. J. Med.. 306(23): 1399–1404, 1982.

43R. D. Feigin: Otitis media: Closing the information gap (editorial).

N. Eng/. ./. Med. 306(23):1417–1418, 1982.

‘J. L. Paradise: Testing for otitis media: Diagnosis ex machirra

(editorial). N. Engl. J. Med. 296(8):445+8, 1977.

‘$5J L paradise: Editorial retrospective: Tympanometry (editorial).

N. Engl. J. Med. 307(17): 1074-1076, 1982.

‘P, A. Shurin, S. 1. Pelton, and J. Finkelstein: Tympanometry

in the diagnosis of middle ear effusion. N. Engl. J. Med. 296(8):

412417, 1977.

‘t7D M Kessner and C, E. Kalk. A Strategy for Evaluating Health

.

Services. Institute of Medicine. National Academy of Sciences.

Washington. 1973. pp. 48-62.

48Department of Health and Human Services: Tuberculosis among

Hispanics in the United States, 1980. Morbidity and Mortalify Weekly

Report. Vol. 31, No. 18. Public Health Service, Washington.

May 14, 1982.

49L. B. Reichman, C. P. Felton, J. F, Hammarsten, et al.: Tuberculosis in the foreign born. Am. Rev. Respir, Dis. 116(3):561–564,

1977,

5oNAS-NRC Committee on Vision, Working Group 39: Recommended standard procedures for the clinical measurement and specification of visual acuity. Adv. Ophthalmol. 41: 103–148, 1980.

5‘R. D. Reinecke and K. Simons: A new stereoscopic test for

amblyopia screening, Am. J. Ophthalmol. 78(4):7 14-721, 1974.

SZJ J Ma]in and N. E, Munch: Implicated Alcohol and Disease

Entities— Alcohol as a Risk Factor in the Nation’s Health. Contract

No. ADM 28 I–79%0012. Rockville, Md. Laboratory of Epidemiology and Population Studies. National Institute on Alcohol Abuse

and Alcoholism. 1980.

53R. Caetano: Drinking patterns and alcohol problems among Hispanics in the U. S.: A review. Drug Alcohol Depend. 12(1):37-59,

1983.

54H. A. Abelson, P. Fishbume, and I. H. Cisin: The National

Survey on Drug Abuse, 1977. Stock No. 01 7–24-00702-2.

Washington. U.S. Government Printing Office, 1977.

55R, Perez, A, M. Padilla, A. Ramirez, et al.: Correlates and

changes over time in drug and alcohol use within a Barrio population.

Am. J. CommuniU Psychol, 8(6):62 1+36, 1980.

56R. E. Roberts: Prevalence of psychological distress among Mexican

Americans, J. Health Sot. Behav. 21 (2): 13+145, 1980.

57F, M, Trevirio, J. G. Bruhn, and H. Bunce: Utilization of community mental health services in a Texas-Mexico border city. Soc. Sci.

Med. 13A(3):331–334, 1979.

5SS w Vernon and R, E. Roberts: Prevalence of treated and

.

untreated psychiatric disorders in three ethnic groups. Soc. Sci.

Med. 16(17):1575–1582, 1982.

59L S Radloffi The CES-D Scale: A self-report depression scale

for research in the general population. Appl. Psychol. Measur.

1:385-401, 1977.

‘M. M. Weissman, D. Sholomskas, M. Pottenger, et al.: Assessing

depressive symptoms in five psychiatric populations: A validation

study. Am. J. Epidemiol. 106(3):203–214, 1977.

61R E Robefis: Reliability of the CES-D Scale in different ethnic

contexts. Psychiatry Res. 2(2): 125–1 34, 1980.

64

.-
151R E Robe~s and S. W. Vernon: The Center for Epidemiologic . .

Studies Depression Scale: its use in a community sample. Am.

J. Psychiatry. 140(1):4146, 1983.

63L N . Robins, J, E. Helzer, J. Croughan, and K. S. Ratcliff

The National Institute of Mental Health Diagnostic Interview

Schedule. Its history, characteristics and validity. Arch. Gen. Psychiatry. 38(4):381–389, 1981.

‘M. A. Bumam, M. Kamo, R, L. Hough, et al,: The Spanish

Diagnostic Interview Schedule, Reliability and comparison with

clinical diagnoses. Arch. Gen. Psychiatry. 40(11):11 89–1 196, 1983.

65M, K~o, A. Burnam, J. I. Escobar, et al.: Development of

the Spanish-language version of the National Institute of Mental

Health Diagnostic Interview Schedule. Arch. Gen. Psychiatry.

40(11):1183-1188, 1983.

‘W. W. Eaton, D. A. Regier, B. Z. Locke, and C. A. Taube:

The NIMH Epidemiologic Catchment Area Program, in: J, K. Wing,

P, Bebbington, and L. N. Robins, eds., What is a Case? The

Problem of Definition in Psychiatric Community Surveys, London.

Grant McIntyre Ltd., London. 1981.

6TG L Ostenso: National Nutrition Monitoring $WfXt_K A historical

pe~pective. J. Ant. Diet. Assoc. 84(10):1 181–1 185, 1984.

@Nationa] Center for Health Statistics, M. D. Carroll, S. Abraham,

and C. M. Dresser Dietary intake source data, United States,

1976-80. Vital and Health Statistics. Series 11, No, 231. DHHS

Pub. No. (PHS)83-I681. Public Health Service. Washington. U.S.

Government Printing Office, Mar. 1983.

@National Center for Health Statistics, S. Abraham, C. L. Johnson,

and M. F. Najjar: Weight and height of adults 18–74 years of

age, United States, 1971–74. Vital and Health Statistics. Series

11, No. 211. DHEW Pub. No. (PHS)79–1 659. Public Health Service,

Washington. U.S. Government I%nting Office, May 1977.

7%Jational Center for Health Statistics, R, Fulwood, C, L. Johnson,

J. D. Bryner, et al.: Hematological and nutritional biochemistry

reference data for persons 6 months-74 years of age, United States,

1976-80. Vital and Healih Statistics. Series 11, No. 232. DHHS

Pub. No. (PHS)83–I 682. Public Health Service, Washington. U.S.

Government Printing Office, Dec. 1982.

TIJ f) cook and c, A, Finch: Assessing iron status Of a population.

Am”.J; C1in. Nutr. 32:21 15–21 19.1979.

72Nationa1 Center for Health Statistics, J. D. Singer’, p. Granahant

N. N. Goodrich, et al.: Diet and iron status, a study of relationships,

United States, 197 1–74. Vital and Health Statistics. Series 11,

No. 229. DHHS Pub. No. (PHS)83–1 679. Public Health Service.

Washington. U.S. Government Printing Office. Dec. 1982.

73Life Sciences Research Office, S, M. Pilch and F. R. Senti,

eds,: Assessment of the Iron Nutritional Status of the U.S. Population

Based on Data Collected in the Second National Health and Nutrition

Examination Survey, 1976–1980. Contract No, (FDA) 233–83–2384.

Federation of American Societies for Experimental Biology.

Bethesda, Md., Aug. 1984.

74National Center for Health Statistics, S. Abraham, M. D. Carroll,

M. F. Najjar, and R, Fulwood: Obese and overweight adults in

the United States. Vital and Health Statistics. Series 11, No, 230.

DHHS Pub. No. 83–1 680. Public Health Service. Washington.

U.S. Government Printing Office, Feb. 1983.

75G A Bray: Definition and measurement Of obesity, in N. M.

.,

Kaplan and J. Stamler, eds., Prevention of Coronary Heart Disease.

Philadelphia, W .B. Saunders Co., 1983.

76,4 A Rimm and p. L, white: Obesity: Its risks and hazards.

in 6. A. Bray, ed., Obesity in America. NIH Pub, No, 79–359.

National Institutes of Health. Washington. U.S. Government Printing

Office, Nov. 1979.

77R J G~son, M, Feinleib, W, P. CasteHi, and p. M. McN~ar~

. .

Cigarette smoking as a confounder of the relationship between

relative weight and long-term mortality. The Framingharn Heart

Study. JAA4A. 249(16):2199-2203, 1983.

78w B Kannel: An ove~iew of the risk factors fOr cardiovascular

disease; in N. M. Kaplan and J. Statnler, eds.: Prevention of

Coronary Heart Disease. Philadelphia. W .B. Saunders Co., 1983.

79(3 D Fnedm~, w. B . Kannel, and T. R. Dawber: The epidemiol-

.

ogy of gallbladder disease: Observations in the Framingham study.

J. Chronic Dis. 19:273–292, 1966.

80J Stamlec Lifestyles, major risk factors, proof and public policy.

Ci;cuiation. 58(1):3-19, 1978.

sIA B Keys: Overweight, obesity, coronary heart disease, and

mo;ality, Nutr. Today. July-Aug: 16-22, 1980.

8ZL H Kuller Epidemiologyof coronary heart disease, in E.

G. ‘Perkins and W. J. Visek, eds., Dietary Facts and Health.

Champaign, Illinois, American Oil Chemists Society, 1983.

p. 46&495.

sqHYPe~ension Detection and Follow-up program Cooperative

Group: Five-year findings of the Hypertension Detection and Followup Program. 1. Reduction in mortality of persons with high blood

pressure, including mild hypertension. JAMA. 242(23):2562-2571,

1979.

84Hypertension Detection and Follow-up Program Cooperative

Group: Five-year findings of the Hypertension Detection and Followup Program. II. Mortality by race-sex and age. JAMA. 242(23):

2572–2577, 1979.

ssThe Joint Nation~ Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1984 report of the Joint National

Committee on Detection, Evaluation, and Treatment of High Blood

Pressure. Arch. Intern, Med. 144:1045-1057, 1984.

‘J T. Wack and J. Rodin: Smoking and its effects on body

weight and the systems of caloric regulation. Am. J. Clin. Nutr.

35(2):366380, 1982.

87c, L, Hanis, R, E. Ferrell, S. A. Barton, et al.: Diabetes among

Mexican Americans in Starr County, Texas. Am. J. Epidemiol.

118(5):659-672, 1983.

S8R, Russe]l-Briefel, T. Ezzati, and J. Perlman: The effect of oral

contraceptives on glucose tolerance (abstract). Federation Proceedings, 43(3):666, 1984.

WR K Scragg, A. J, McMichael, and P. A. Baghurst: Diet)

.

alcohol, and relative weight in gallstone disease. A case control

study. Br. Med. J. [Clin. Res. ] 288(6424):1 113–1 119, 1984.

‘D. A. Smith and M. 1. Gee: A dietary survey to determine

the relationship between diet and cholelithiasis. Am. J. Clin. Nutr.

32(7) :151> 1526, 1979.

$’Ic Gmtineau: Nutritional implications of alcohol, in present KnowL

edge in Nutrition. Fifth Edition. Washington. Nutrition Foundation,

Inc. 1984.

9ZC s Lieber: Alcohol, malnutrition and liver disease. J. Fla.

Med. ASSOC.66(4):463465, 1979.

93National Center for Health Statistics, B. A. Burt, S. A. Eklund,

J. R. Landis, et al.: Diet and dental health, a study of relationships,

United States, 197 1–74, Vital and Health Statistics. Series 11,

No. 225. DHHS Pub. No. (PHS)82–1675. Public Health Service.

Washington. U.S. Government Printing Office, Jan. 1982.

‘National Research Council Committee on Diet, Nutrition, and

Cancec Diet, Nutrition and Cancer. Washington. National Academy

Press, 1982.

65
95T Hirayama: Diet and cancer. Nutrition and Cancer, 1(3):67–81,

1979.

gGNationa] Institutes of Health: Osteoporosis. NIH Consensus Development Conference Statement. 5(1 ), April 1984.

97The National Resemch Council: Recommended Dietary Allowance.

Ninth edition. National Academy of Sciences. Washington, 1980.

98DeP~ment of Ag~cu]ture: Nutrition and your health. DietaQ

guidelines for Americans. Home and Garden Bulletin No. 232.

Department of Agriculture and U.S. Department of Health and

Human Services. Washington. Feb. 1980.

99Centers for Disease Control: Ten-State Nutrition Survey,

1968–1970, Vol. V, Dietary. DHEW Pub. No. (HSM) 72–8 133.

Health Services and Mental Health Administration. Atlanta, 1972.

1WA, L, Forbes and M. G, Stephenson: National Nutrition Monitoring

System: Implications for public health policy at FDA, J. Am. Diet.

ASSOC. 84(10):1 189–1193. 1984.

101Food and Drug Administration: Nutritional quality of foods; addition of nutrients. Federal Register. 45(18):63 14-6324. Jan. 25,

1980.

‘02Lifs Sciences Research Office, F. R. Senti and S. M. Pilch,

eds.: Assessment of the Folate Nutritional Status of the U.S. Population Based on Data Collected in the Second National Health and

Nutrition Examination Survey, 1976–1980. Contract no. (FDA)

233–83–2384. Federation of American Societies for Experimental

Biology. Bethesda, Md. Oct. 1984,

lo~Life Sciences Research Office, S. M. Pilch and F. R. Senti,

eds.: Assessment of the Zinc Nutritional Status of the U.S. Population

Based on Data Collected in the Second National Health and Nutrition

Examination Survey, 1976–1980. Contract no. (FDA) 233–83–2384.

Federation of American Societies for Experimental Biology.

Bethesda, Md. June 1984.

lWNational Center for Health Statistics, P. V. V. Hamill, T. A,

Drizd, C. L. Johnson, et al.: NCHS growth curves for children,

birth- 18 years, United States. Vital and Health Statistics. Series

11, No. 165. DHEW Pub. No, (PHS)78–1650, Public Health Service.

Washington. U.S. Government Printing Office, Nov. 1977.

’05J. M. Tanne~ Growth at Adolescence. Second edition. Oxford,

Blackwell Scientific Publication, 1962,

‘WA. W. Hansen: Lead in our environment. The Professional Nutritionist. Spring, 1983.

107National Center for Health Statistics, J. L. Annest and K. Mahaffey: Blood lead levels for persons 6 months–74 years of age,

United States, 1976-80. Vital and Health Statistics. Series 1I,

No. 233, DHHS Pub. No. (PHS) 8+1683. Public Health Service.

Washington. U.S. Government Printing Office, Aug. 1984.

10$3JT Massey and T, M, Ezzati: HHANES universe and estimated

coverage. Unpublished memorandum. National Center for Health

Statistics, Aug. 7, 1981.

‘%V. G. Cochran: Sampling Techniques. New York. John Wiley

and Sons, Inc., 1977.

‘‘OJ. F. Gonzalez and A, A. White: Stratifying primary sampling

units with the SAS cluster procedure, Proceedings of the Social

Statistics Section, American Statistical Association, Aug. 1982.

11ISAS Institute, Inc.: SAS Users’ Guide, 1979 edition. Raleigh,

N.C.

‘‘2S. C. Johnson: Hierarchical clustering schemes. Psychometrics,

XXXII:241–254, 1967.

1‘3R. Goodman and L. Kish: Controlled selection—a technique

in probability sampling. ./. Am. Statis. A. 45:35 @372, 1950.

1!4L Kish: Sumey samp~ing, New York. John Wiley and Sons,

Inc.: 1965.

I‘sNational Center for Health Statistics, E. E. Bryant, J. T. Baird,

and H. W. Mille~ Sample design and estimation procedures for

a national health examination survey of children, Vital and Health

Statistics. Series 2, No. 43. DHEW Pub. No. (HSM)72–1OO5.

Health Services and Mental Health Administration. Washington.

U.S. Government Prhting Office, Aug. 1971.

‘‘%J.S. Bureau of the Census: Technical Note No. 3. Washington.

1970,

11TNati~na] Center for Hea]th Statistics: Staff Manua~ on Confidentiality. DHEW Pub. No. (PHS)8&l 244. Public Health Service.

Hyattsville, Md., Apr. 1980.

II8Nat10nal Center for Health Statistics: The HANES Study Final

Report. Institute for Survey Research. Contract no. HSM–I l&73–

376. Philadelphia, Temple University, Apr. 1975.

‘‘9Nationa1 Center for Health Statistics: A Comparison and Analysis

of Examined and Unexamined Persons on Medical History Characteristics for the First Round of the Health and Nutrition Examination

Study. Contract no. HSM–I 10-73-371. Rockville, Md., Westat

Inc., Jan. 24, 1974.

lzoNational Center for Health Statistics, H. W. Miller and p. Williams: Factors related to response in a health examination survey,

United States, 1960-62. Vital and Health Statistics. Series 2,

No. 36. PHS Pub. No. 1000. Public Health Service. Washington.

U.S. Government Printing Office, Aug. 1969.

‘2’U .S. National Health Survey: Attitudes towards cooperation in

a health examination survey. Health Statistics. Series D, No. 6.

PHS Pub, No. 584. Public Health Service. Washington. U.S. Government Printing Office, July 1961.

‘22National Center for Health Statistics: Cooperation in health examination surveys. Vital and Health Statistics. Series 2, No. 9. PHS

Pub. No. 1000. Public Health Service. Washington. U.S. Government Printing Office, July 1965.

‘23Nationa1 Center for Health Statistics, W. L. Schaible: Quality

control in a national health examination survey. Vita/ and Health

Statistics. Series 2, No. 44. DHEW Pub. No. (HSM) 72–1023.

Health Services and Mental Health Administration. Washington.

U.S. Government Printing Office, Feb. 1972.

124National Center for Health Statistics, E. E. Bryant, M. G. Kovar,

and H. Miller: A study of the effect of remuneration upon response

in the Health and Nutrition Examination Survey, United States.

Vital and Health Statistics. Series 2, No. 67. DHEW Pub. No.

(HRA) 761341, Health Resources Administration. Washington.

U.S. Government Printing Office, Oct. 1975.

‘25J, S. Findlay and W. L. Schaible: A Study of the Effect of

Increased Remuneration on Response in a Health and Nutrition

Examination Survey. Paper presented at the American Statistical

Association Meeting, Survey Research Methods Section. Houston,

Aug. 1980.

‘26National Center for Health Statistics: J, R. Landis, J. M. Lepkowski, S. A. Eklund, and S. A, Stehouwer: A statistical methodology for anal yzing data from a complex survey, the First National

Health and Nutrition Examination Survey. Vital and Health Statistics.

Series 2, No. 92. DHHS Pub. No. (PHS) 82–1 366. Public Health

Service, Washington. U.S. Government Printing Office, Sept. 1982.

‘27M. H. Hansen, M. G. Madow, and B. J. Tepping: An evaluation

of model-dependent and probability-sampling inferences in sample

surveys. J. Am. Statis. A, 78(384):776807, 1983.

128M, G. Kovar: A methodological study of factors associated with

whether children receive adequate medical care. Institute of Statistics

Mimeo Series, No. 1428, Chapel Hill, N.C. Department of Biostatistics, University of North Carolina, 1982.

66
I29D H Freeman and D. B. Brock: The role of covariance matrix .

estimation in the analysis of complex sample survey data, in N.

Krishnan Namboodiri, ed.: Survey Sampling and Measurement. Symposium on Survey Sampling, 2d, University of North Carolina,

New York, Academic press, 1978.

131 A Jordan, s, A. Hams, K, M. Maurer, and J. Wellisch:

Design Effects for a National Study of School Children. Paper

presented at the Annual Meeting of the American Educational Research Association. March 20, 1982.

‘3’Survey Research Center Computer Support Group: OSIRIS IV

User’s Manual, Institute for Social Research. University of Michigan,

Ann Arbor, 1979.

‘32J. T. Helnig and K. A. Council, eds,: SAS Users Guide, 1982

edition. SAS Institute, Inc. Raleigh, N.C.

‘33J. E. Higgens and G. G. Koch: Variable selection and generalized

chi-square analysis of categorical data applied to a large cross-sectional occupational health survey. Int. Stat. Rev. 45( I):5 1–62, 1977.

134J R .Landis, M, M. Cooper, T. Kennedy, and G. Koch: A

computer program for testing average partial association in three-way

contingency tables (PARCAT). Biostatistics Technical Report No.

18. University of Michigan, May 1978.

135National Center for Health Statistics, P. J. McCarthy: Replication,

an approach to the analysis of data from complex surveys. Vital

and Health Statistics. Series 2, No. 14. PHS Pub. No. 1000.

Public Health Service. Washington. U.S. Government Printing Office, Apr. 1966.

IS6M M, HoIt: .$IJRREGR: Standard Errors of Regression Coefficients from Sample Survey Data, Research Triangle Park, N. C.,

Research Triangle Institute, 1977. (Revised April 1982 by B.V.

Shah)

‘s’M. A, Hidiroglou, W. A. Fuller, and R. D. Hickman: Super

Carp., Sixth edition. Survey Section, Statistical Laboratory. Iowa

State University. Ames, Oct. 1980.

13SK Maurer G, Jones, and E, Bryant: Relative COMpUMiOXd

efficiency of the linearized and balanced repeated replication procedures for computing sampling variances. Proceedings of the Survey

Research Methodology Section. American Statistical Association,

1978.

13~ H Freeman, J, L. Freeman, D, B, Brock, and G. G. Koch:

Strategies in the multivariate analysis of data from complex surveys

II: An application to the United States National Health Interview

Survey. Int. Stat. Rev. 44(3):317-330, 1976.

‘@J. W. Choi: A further study on the analysis of categorical data

from weighted cluster sample surveys. Proceedings of the Social

Statistics Section. American Statistical Association, 1981.

141s Lemeshow and A, M, Stoddard: A comparison of akemative

variance estimation strategies for estimating the slope of a linear

regression in sample surveys. Commun. Statist .—Simula. Computa.

13(2): 153–168, 1984.

‘42E. J. Stanek and S. Lemeshow: The behavior of balanced half-sample variance estimates for linear and combined ration estimates

when strata are paired to form pseudo-strata. Estadistica. XXXII

(1 19):71-79, NOV. 1978.

’43J. L. Annest, J. L. Pirkle, D. Makuc, et al.: Chronological

trend in blood lead levels between 1976 and 1980. N. Engl. .I.

Med. 308(23):1373–1377, 1983.

144J E (j~zzle, c. F, Starmer, and G. G. Koch: Analysis of

categorical data by linear models, Biometrics. 25(3):489–504, 1969.

145J R Landis W. M, Stanish, J. L. Freeman, et a].: A COmpUter

.,

program for the generalized chi-square analysis of categorical data

using weighted least squares (GENCAT). Comput. Programs

Biomed. 6:196-231, 1976.

!46J J Shuster and D, J. Downing: Two-way contingency tables

for complex sampling schemes. Biomerrika. 63(2):27 1–276, 1976.

147R N Fofihofer and R. G. Lehnen: Public program Analysis:

.,

A New Categorical Data Approach. Belmont, Cal if. Lifetime LearningPublications, 1981.

14~M c M~re, B, C, Jud]in, and P. Kennemun: Using graduated

food “models in taking dietaty histories. J. Am. Diet. Assoc. 51 :447–

453, 1967.

‘49Consumer and Food Economics Institute: Manual of Food Codes

and Conversions of Measures to Gram-Weight for Use With lrrdividual Food Intake Data From 1977–78 Nationwide Food Consumption Survey. USDA, Science and Education Administration. Working

copy. Hyattsville, Md., Nov. 1, 1979.

““Agricultural Research Service, Consumer and Food Economics

Institute: Expansion of data published in Nutritive Values of American Foods in Common Units. Agriculture Handbook No. 456, Data

Sets 456-1, 4562. U.S. Department of Agriculture, Hyattsville,

Md., May 1977.

67
Appendixes

I.

II.

111.

IV.

v.

VI.

VII.

Persons and agencies involved in the planning, development and operation

of the Hispanic Health and Nutrition Examination Survey . . . . . . . . . . . . . . . .

Summary of data collection instruments and procedures . . . . . . . . . . . . . . . . . . .

Questionnaires administered in the household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questionnaires administered in the mobile examination center . . . . . . . . . . . .

Examination by physician . . . . . . . . . . . . . . . . . . . . . . . . . . .

Special clinical procedures and tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X-ray s, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Urine tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tests on blood samples, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Examination components by age groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Description of food models, food coding manual, and nutrient data base . . . . . . . . . . . . . . . . . . .

Blood and urine assessments by specimen types and age groups . . . . . . . . . . . . . .

Laboratories for blood and urine assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Criteria for inclusion in the special hematological subsample . . . . . . . . . . .

VIII. Pesticide target compounds, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IX.

x.

XI.

XII,

Consent forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reports of findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Report of findings I,...,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Report of findings II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Report of dental findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Examples of analytic approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Example one . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Example two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data collection forms for the Hispanic Health and Nutrition Examination Survey . . . . . . . . . . . . . . .

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

69

72

72

72

72

72

73

73

73

75

76

77

78

79

80

81

81

82

83

83

85

86

87

87

92

95

95
Appendix I

Persons and agencies involved

in the planning, development

and operation of the Hispanic

Health and Nutrition

Examination Survey

Members of the National Academy of

Public Administration panel to review the

Health and Nutrition Examination Survey

Harold Orlans, Project Director

Dale R. Lindsay, Project Director

Sol H. Chafkin, The Ford Foundation

Wilbur J. Cohen, University of Texas

Jean-Pien-e Habicht, Cornell University

David Mark Hegsted, Harvard University

Brian MacMahon, Harvard University

Hamish N. Munro, Massachusetts Institute of Technology

Richard D. Remington, University of Michigan

William H. Stewart, Louisiana State University Medical

Center

James L. Sundquist, The Brookings Institute

Subcommittee of the National Academy

of Public Administration panel to make

recommendations on HHANES

E.L. Aguilar, Tucson Clinic

David Bayse, Centers for Disease Control

Maria D. Burgos, Cornell University Cooperative Extension

Blaine W. Glad, University of California

J. Michael Lane, Centers for Disease Control

Jane Neese, Centers for Disease Control

Siobhan Openheimer-Nicolau, The Ford Foundation

Richard Remington, University of Michigan

Robert E. Roberts, University of Texas Medical School

Catherine Rodriguez, Arizona Department of Health Services

Cecil G. Sheps, University of North Carolina Medical School

Michael P. Stern, University of Texas Health Science Center

Barbara Underwood, Massachusetts Institute of Technology

Carlos Vallbona, Baylor College of Medicine

Institutional Review Board

Henrietta Villaescusa, Health Services Administration

Juan Carlos Rodriguez, National Institutes of Health

Samuel M. Myers, National Center for Health Services

Research

Roderick G. Rodriguez, National Council of La Raza

John R. Anderson, National Center for Health Statistics

Nancy Pearce, National Center for Health Statistics

Ronald Wilson, National Center for Health Statistics

Patricia A. Golden, National Center for Health Statistics

Edward Bryant, WESTAT

Consultants to Institutional Review Board

Michael C. Hill, University of Miami

Nancy Jacobs Goldberg, Temple University Hospital

Gordon C. Johnson, Food and Drug Administration

Joel Kavet, Office of the Assistant Secretary for Health

Robert C, Backus, National Institutes of Health

Consultants in planning and development

Planning Task Forces

Jaime Salazar, Project Director

Health Services Task Force

Pedro Lecca, University of Texas

Emil Berkanovic, University of California

Angela Rodriguez, University of Miami School of Medicine

Marilyn Aguirre, Rutgers University

Jack Elinson, Columbia University

David Hayes-B autista, University of California

Dietary Task Force

Reynaldo Martorell, Stanford University

Juliet Bringas, Nutrition Consultant

Marta Alfonso, North Shore Hospital, Miami, FI.

Elizabeth Sanchez, University of Puerto Rico

Outreach Task Force

Guarione Michael Diaz, Cuban National Planning Council

Amalie G. Ramirez, Baylor College of Medicine

Maria Burgos, Cornell University

Transiatbn Task Force

John Landsverk, University of California

Jose Soto, Rio Grande Federation of Health Centers, Inc.

Marta Alfonso, North Shore Hospital, Miami, FI.

Marilyn Aguirre, Rutgers University

Environmental Protection Agency

Frederick Kutz

Sandy Straussman-Sundy

69

—
Madeline O’Neil Dean

Brion Cook

Tom Dixon

U.S. Department of Agriculture

Robert L. Rizek

Eleanor Pao

Sharon Mickel

National Institutes of Health

Clinical Center

Thomas H, Shawker

Andrew Dwyer

National Institute of Arthritis, Diabetes,

Digestive and Kidney Diseases

Jeffrey Cutler

William C. Knowler

Harold P. Roth

Peter H. Bennett

Maureen Harris

Richard Johannes

National Head, Lung and Blood Institute

Manning Feinleib

A. Richy Sharrett

Richard Havlik

Michael Mock

Graham Ward

Gerald H. Payne

National Institute of Dental Research

James P. Carlos

Ann J. Miller

National Institute of Neurological and

Communicative Disorders and Stroke

Earleen Elkins

National Institute of Child Health and Human

Development

Jeffrey Perlman

Alcohol, Drug Abuse and Mental Health

Administration

Joan Rittenhouse

Marta Sotomayor

National Institute on AlcoholAbuse andAkoholism

Charles Kaelber

Henry Malin

Judy Coakley

National Institute of Mental Health

Dan-et Regier

William Eaton

Ben Z. Locke

National Institute on Drug Abuse

Neil Sampson

Edgar Adams

Centers for Disease Control

Ronald St. John

Robert Johnson

David Bayse

Jane Neese

Wayman Turner

Elaine Gunter

Comelia McGrath

Nancy Bridges

Harold Russell

Gary Myers

John Feeley

Onno Van Assendelft

Food and Drug Administration

John Vanderveen

AlIan L, Forbes

Jean Pennington

Other consultants

Paul Haberman, NCHS, Division of Health Interview Statistics

John Whitener, American Optometric Association

Leo Estrada, University of California

Rumaldo Z. Juarez, DHEW, Office of the Secretary

Henry Montes, DHEW, Office of Disease Prevention and

Health Promotion

Luis Salgado, DHEW, Office of the Secretary

Marco Montoya, National Center for Health Services Research

Joseph De la Puente, National Center for Health Services

Research

Carlos Vallbona, Baylor College of Medicine

Israel Cuellar, San Antonio State Hospital

Jean-Pierre Habicht, Cornell University

Barbara Startleld, The Johns Hopkins University

Robert E. Roberts, University of Texas Medical School

Peter Budetti, Health Policy Program, Washington, D.C.

Rene Jahiel, New York University Medical Center

Richard A. Hodder, Uniform Services, University of Health

Sciences

Harry P. Wetzler, Uniform Services, University of Health

Sciences

Victoria Barrera-White, Bureau of Community Health Service

Vince Hutchins, Bureau of Health Care Delivery Assistance

70
Edward Duffy, Bureau of Health Care Delivery Assistance Irma Wheelock, Johns Hopkins University

Paul S. Bachorik, Johns Hopkins University Hospital Anthony Zavaleta, Texas Southernmost College

Cameron Chumlea, Fels Research Institute Frank Leo, The Johns Hopkins University

Anita Pikus, National Institutes of Health Roger Sanders, The Johns Hopkins University

Kenneth Stewart, Environmental Acoustic Research Company Frank Goodwin, DHEW, Office of Public Affairs

NOTE: This appendix shows organizational affiliation as of the

time of the survey.
Appendix II

Summary of data collection

instruments and procedures

Questionnaires administered in the household

Household Screener Questionnaire

This questionnaire was used in each household to

determine household composition and eligibility (that is,

appropriate Hispanic ethnicity) and for the selection of sample

persons.

Family Questionnaire

This form was administered to each eligible family and

contained 5 sections: a) a family relationship chart which

determined kinship for sample persons under 20 years of

age; b) a family characteristics section, which obtained for

heads of families and all sample persons basic demographic

information, such as race, education, place of birth,

occupation, and marital status; c) a section on Medicare

and health insurance coverage; d) questions on participation

in income assistance programs; and e) selected housing

characteristics, family income, and participation in food stamp

programs.

Chtid Sample Person Questionnaire

This questionnaire, for persons 6 months through 1I

years of age, included sections on birth characteristics,

congenital and other chronic conditions, infant feeding,

functional impairment, weight status, pesticide exposure,

school attendance, language use, participation in meal

programs, and medicine and vitamin usage. Detailed data

relating to health status assessment and health care needs

were collected in sections on health services utilization, dental

care, anemia, vision, hearing, TB exposure, and immunization

status. A few questions obtaining self-reports of ability to

see and hear at school and perceived weight status were

included for children 611 years of age.

Adult Sample Person Questionnaire

For sample persons 12–74 years of age, this questionnaire

included items on health habits, tuberculosis, anemia,

smoking, weight status, functional impairment, chronic

conditions, pesticide exposure, acculturation, meal programs,

and medicine and vitamin usage. To address the issues of

health care needs and health status assessment, detailed

sections on health services, dental care, diabetes, vision,

hearing, hypertension, digestive disease, and cardiovascular

conditions were included. Finally, the full name, father’s

name, and social security number were obtained to facilitate

linkage with the National Death Index.

Questionnaires administered in the

mobile examination center

Dietary Questionnaire

For each sample person, a trained dietary interviewer

recorded the quantity of every item of food or drink consumed

during the previous day, thus enabling estimates to be made

of calories, protein, carbohydrates, fat, unsaturated fats,

cholesterol, and specific vitamins and minerals consumed

during the recall period. A food frequency section ascertained

usual patterns of food consumption measured by daily and/or

weekly frequency of consumption of foods within a number

of groupings, including milk, meat, fish, eggs, fats and

oils, legumes and nuts, cereals, fruits, vegetables, and

alcoholic beverages. Additional questions on special diets

and dietary practices were included in this questionnaire.

Adult Sample Person Supplement

This questionnaire was administered to examined persons

12–74 years of age. It contained sections on recent pesticide

exposure, cigarette smoking for persons 12–1 9 years of age,

reproductive history for females, alcohol consumption, drug

abuse, and, for persons 2tY74 years of age, depression.

Examination by physician

A physician performed and recorded a medical

examination giving special attention to specified findings

related to hearing, vision, gallbladder disease, and the

cardiovascular, neurological, and musculoskeletal systems.

The physician also assessed overall health status, nutritional

status, and weight status and noted diagnostic impressions

and related health care needs.

Special clinical procedures and tests

Ultrasound examination of the gallbladder

For the purpose of estimating the prevalence of gallstones,

an ultrasound examination was conducted on a specified

subsample of examinees 2W74 years of age.

Dental examination

All examined persons received an examination that included the following measures of dental health: 1) a decayed,

missing, filled (DMF) surface index, 2) a dental restorative

72
treatment needs index, 3) a simplified oral hygiene index,

4) a periodontal index, 5) an assessment of need for and

quality of full dentures, and 6) an assessment of malocclusion.

Vision screening

Examined persons 6-74 years of age were tested for

visual acuity. The near vision and distance vision tests

involved reading test cards with Sloan letters or Landolt

rings set at standard distances from the eyes. Binocularity

of vision was tested by using the Random Dot E (RDE)

test.

Tympanic impedance

For the purpose of assessing levels of effusive and

noneffusive middle ear disease, impedance tympanometry

was performed on all examined persons. In this procedure,

the mobility of the tympanic membrane is induced and

recorded electronically under varied air pressures in the ear

canal.

Puretone audiometry

This test, conducted on examined persons between the

ages of 6 and 74, permitted determination of threshold levels

of hearing for frequencies of 500, 1000, 2000, and 4000

hertz for each ear.

Electrocardiograms

Electrocardiographic signals, for examined persons 2&74

years of age, were digitized and recorded on magnetic tape.

This provided normative data on amplitude, duration, interval

and axis measurements, and permitted interpretations of heart

disease according to the Minnesota classification code.

Body measurements

Measurements were made on all examinees and included

standing height and/or recumbent length, depending on age;

body weight; triceps and subscapular skinfolds; and various

other measurements.

Hair collection

A small sample of hair was collected from each examined

person 12–74 years of age and analyzed for selected trace

elements. These data, which were collected for the Centers

for Disease Control for methodological purposes, can be

related to body burdens or stores of the elements and to

overall nutritional and health status.

Tuberculin skin test

In the California and Dade County, Fla. PSU’S, examinees

were injected with 5 tuberculin units of purified protein

derivative (PPD) to test for exposure to tuberculosis.

Examinees were examined at the examination center or at

home 2 to 3 days later by a trained nurse who read and

recorded the test results.

X-rays

Posterior-anterior (PA)

This X-ray of persons 2W74 years of age was used

for the determination of heart size and diagnosis of

cardiovascular conditions, lung and chest conditions, and

structural deformities.

Lateral

Taken of persons 45–74 years of age, this X-ray provided

an additional parameter for the determination of heart size.

No X-rays were taken of pregnant women.

Urine tests

The following tests were performed on casual samples

of urine:

N-Multistix tests

These urinary dipstick tests for qualitative protein, glucose, ketones, bilirubin, blood, urobilinogen, pH, and bacteriuria (nitrite test) were done for examined persons 6-74

years of age.

Urinary sediments

Sediments including red cells, white cells, and casts

were measured for persons 6-74 years of age.

Analysis for pesticide levels

Urine samples from a half-sample of examined persons

12–74 years of age were tested for the presence of alkyl

phosphate residues and metabolizes, carbamate residues,

phenolic compound residues, and malathion metabolizes. Appendix VIII contains a complete listing of the pesticide residues

and metabolizes that were determined.

Tests on blood samples

Tests on blood samples provide a broad range of information related to health and nutrition. The particular tests performed varied with the specific target condition and age

group (see chapter 2 for discussions of target conditions

and appendix V for a summary of tests performed by age

group).

Oral glucose tolerance test (OGIT)

This test involved the collection of blood specimens

from examined persons while they were in a fasting state

as well as at 1 and 2 hours after the glucose challenge.

The test was performed on a specified half sample of examined

adults 20-74 years of age to provide estimates of the prevalence of diabetes and impaired glucose tolerance.

Liver function tests

Biochemical liver tests, performed on examined persons

20-74 years of age, included bilirubin, SGOT, SGPT, and

alkaline phosphatase.

Two chest X-rays were made, as follows:

73
Anemia-related laboratory tests

For the diagnosis of anemia, tests on blood samples

included protoporphyrin, iron, total iron-binding capacity,

red cell folates, serum folates, serum ferritin, and abnormal

hematological indices.

Other biochemical nutritional tests

These tests included albumin and vitamin A.

Serum lipids

Because of their relevance to cardiovascular disease, determinations were made of serum cholesterol, triglycerides,

and high density lipoprotein (HDL).

Bmchemicai tests for body burden

from environmental exposures

Levels of lead (all persons) and organochlorine pesticide

residues and metabolizes (half-sample of persons 12–74 years

of age) were determined. Tests for carboxyhemoglobin and

thiocyanate were performed on a half sample of persons

3–74 years of age for the first 12 examination sites only.

Hematology

The hematological determinations included hemoglobin,

hematocrit, red blood cell count, white blood cell count

and differential analysis, and red blood cell morphology.

Kdney function

The serum creatinine test for kidney function was performed on blood samples.

Syphilis serofogy

The serology determinations for syphilis for examined

persons 12–74 years of age included qualitative and quantitative ART, a FTA-ABS, and MHA-TP.

74
Appendix Ill

Examination components by age

groups

6 months-5 years 6-11 years 12– t9 years 20-74 yeara (nonfastirrg) 20-74 years (fasting)

Physician exam Physician exam Physician exam Physician exam Physician exam

Dental exam Dental exam Dental exam Dental exam Dental exam

Dietary interview Dietary intetview Dietary interview Dietary interview Dietary interview

Body measurements Body measurements Body measurements Body measurements Body measurements

TB skin test’ TB skin test’ TB skin test’ TB skin test’ TB skin test’

Tympanic impedance Tympanic impedance Tympanic impedance Tympanic impedance Tympanic impedance

Audiometry Audiometry

Vision test

Audiometry .

Vision test Vision test

Venipuncture2

.

Venipuncture Venipuncture Venipuncture Venipuncture

Urine Urine Urine Urine

,.. Hair collection Hair collection

Posterior-anterior chest X.ray Posterior-anterior chest X-ray

,.. Lateral chest X-ray3 Lateral cheat X-ray3

,.. Electrocardiogram Electrocardiogram

,.. Oral glucose tolerance test

. Ultrasound examination

‘Conducted under special arrangements in the California and Dada County, F!orida sites.

2Fingemtlckonly for 6 mmlhs+ years of age.

3For@raons 46-74 years of age.

NOTE: = category not applicable

75
Appendix IV

Description of food models,

food coding manual, and

nutrient data base

Food models

The data collection tools used by the HHANES dietary

field staff included those used in the previous NHANES

programs: A revised set of abstract food models similar to

those developed at Tulane University 14* and a food coding

manual developed by the NCHS staff. The abstract models

offered advantages of minimal cost, minimal display and

storage space requirements, and, compared with the models

used in the previous NHANES surveys, reduced bias in

the reporting of types of food eaten and improved accuracy

of food quantification.

A major shortcoming of the food models used in the

previous NHANES programs was that they were not designed

to be used interchangeably. For example, dietary interviewers

observed that if a respondent could not equate the food

container with a food model selection, he or she had difficulty

in reporting amounts of foods consumed. In the revised food

model system, each model used in the interview had universal

application across foods. Respondents were able, for example,

to quantify the amount of string beans they had consumed

using a model representing a coffee cup, if this model seemed

best to represent the actual amount of that food. The model

set included abstract mounds, squares, discs, spheres, wedges,

and thickness sticks, as well as the typically used plastic

serving utensils and dishes. Accurate volume measurement

was determined for each model and all models were labeled

with unique identifiers. The food model changes simplified

coding procedures during the 24-hour recall interview,

minimized the need for interviewers to perform calculations,

and expedited data processing.

Dietary Task Force, the data collection contractor’s staff,

and others concerning the specificity of the food coding

manual. Both the detail with which a respondent could be

expected to describe a food and the practicality of attempting

to maintain accurate brand name nutrient data over the course

of a long survey were issues considered during the discussion

of the manual. It was finally decided to use a condensed

and reorganized version of the coding manual developed

by the U.S. Department of Agriculture (USDA) for its 1977–

78 Nationwide Food Consumption Survey (NFCS). 149 The

HHANES coding manual began with a core of food items

and, as new items were reported, was updated using codes

and verbatim descriptions from the USDA manual. A small

number of codes for food items came from other sources

as identified in the following section.

Nutrient data base

The nutrient data base consisted of foods corresponding

to those in the food code manual, with nutrient levels expressed

in 100-gram edible portions. The nutrient composition data

were obtained from the following sources: The USDA’s 1977–

78 NFCS nutrient data base, the special data base developed

by USDA for use in Puerto Rico as part of the 1977–78

survey; nutrient composition from USDA’s ~a~~~o~ 456150;

commercial data obtained during NHANES II; and data derived from recipe calculations. This almost total reliance

on the USDA data bank will provide comparability between

the HHANES and NFCS programs.

NOTE: A Ikt of references follows the text,

Food code manual

A great deal of emphasis was placed on developing

and pretesting the food code manual for HHANES. There

was much discussion between NCHS staff members, the

76

.—
Appendix V

Blood and urine assessments by

specimen types and age groups

Age

Test $ monfha-5 yearn’ 6-11 years 12–19 yeara +74 years (nonfasting) 2574 years (fasting)

Lead . . . . . . . . . . . . . . . . . .

Protoporphyrin, . . . . . . . . . . .

Red blood cell folate2 .

Complete blood counts (CBC)3

Iron . . . . . . . . . . . . . . . . . .

Total iron binding capacity

Ferritin ..,.........,,.. . .

Folatez, . . . . . . . . . . . . .

Differential countz

Vitamins Aand E . . . . . . . . .

Glucose . . . . . . . . . . . . . . . .

Cholesterol, . . . . . . . . . . . .

Triglycerides . . . . . . . . . . .

High density Iipprotein

Pesticides (organic) . .

Syphilis serology . . . . . . . . . .

Albumin . . . . . . . . . . . . .

Total protein . . . . . . . . . . .

Alkaline phosphatsee

LDH ..,.........,,,,.

SHOT . . . . . . . . . . . . . . . . .

Phosphorus . . . . . . . . . . . . .

Uric acid.........,,.. .

Total bilirubin . . . . . . . . . . .

Calcium . . . . . . . . . . . . . . . . .

Urea Nitrcgen . . . . . . . . . . . .

Creatinine . . . . . . . . . . . . . .

Total C02 . . . . . . . . . . . . .

Chloride . . . . . . . . . . . . . . .

Sodium . . . . . . . . . . . . . . . .

Potassium . . . . . . . . . . . . .

SGPT . . . . . . . . . . . . . . . .

Tetanus . . . . . . . . . . . . . .

Selected trace metals6.

Oral glucose tolerance teat . .

N-Mulfistix . . . . . . . . . . . . . .

Pesticides . . . . . . . . . . . . . . .

x

x

x

x

4X

‘x

4X

4X

4X

4X

,..

,..

.

,..

,..

“x

.,.

.

.

Whole biocd

x

x

x

x

Serum

x

x

x

x

x

x

,..

,..

.,.

x

Serum and hair samples

Plasma

Urine

x

.,.

x

x

x

x

x

x

x

x

x

x

x

x

.

.

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

.,.

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

.,.

x

x

x

.,.

‘FingerStickonly for pereom 6 months+ ysare of age.

2SPCial hematobgicel subearnpleonly (See appendix Vll for explenetii of the inclusion criteria).

31ncludes hemalocrit, hemqlokh, redandwhlte oellcounte, mean wrpuscular volume, maanmrpuscular hemogbbin, and mean w~usdarhen wgloblncwc entration.

44-5 years of age.

5Perf0rmad om a subsel of the aamplas cdlacfsd ss a pilot test only,

NOTE:X = categotyeppliile.

NOTE:... =categoryndapplice.ble,

77
Appendix VI

Laboratories for blood

and urine assessments

Laboratory component

Biochemistry and

hematology]

Chemistry profilez

Cholesterol, triglycerides,

and HDL

Pesticides

Trace metals (hair)

Laboratory

Center for Environmental

Health and Center for

Infectious Disease, Centers

for Disease Control, Atlanta,

Ga.

Primate Research Institute,

New Mexico State

University, Holloman AFB,

N.Mex.

Lipid Research Center,

Johns Hopkins University,

Baltimore, Md.

Toxicant Analysis Center,

Environmental Protection

Agency, Bay Saint Louis,

Miss.

Center for Environmental

Health, Centers for Disease

Control, Atlanta, Ga.

‘Protoporphyrin, RBC folate, serum folate, lead, oral glucose tolerance,

vitamin A, vitamin E, iron, total iron binding capacity, syphilis, tetanus,

ferritin.

‘Tests performed on the Centrifichem 500: Albumin, total protein, alkaline

phosphatase, cholesterol, LDH, SGOT, uric acid, total bilirubin,

creatinine, glucose, calcium, urea nitrogen, total carbon dioxide, chloride,

SGPT, inorganic phosphorus.

Tests performed on the IL 343 Flame Photometer Sodium, potassium.

78
Appendix Vll

Criteria for inclusion in the

special hematological subsample

[On the basis of theas hsmatolcgicsi indices, a sample person was selected for the apscial

hematological subssmple, for which eerum and red cell folste and differential smeer

snsiyaea were performed. A control group cimsistsd of those normal sample persons

whose identiition numbm endad in 8. In sddtion, all femalee 1B-44 years of age

were irwluded}

Value

Assessment according to sex and age Less than Greater than

White cell count (number x 10g per liter) 3.5 13.0

Red cell count (number x 10’2 per liter)

Males, 16 years of age and over 4.0 6.0

Females, 16 years of age and over 3.8 6.0

Both eexes, under 16 years of age 3.6 6.0

Hemoglobin (g/dL — grams per deciliter)

Malee, 16yearsof age and over 13.5 18.5

Females, 16years ofage and over 11.5 16.5

Both sexes, under 16yeareof age . 11.0 (’)

Hematocrit (percent)

Males, 16years of age and over 36.0 56.0

Females, 16yeare ofage and over 32.0 50.0

Both sexes, under 16 years of age 31.0 (’)

Mean corpuscular volume (fkfemtoliter)

Both sexee, 16years of age and over 79.5 105.0

Both sexes, under 16 years of age 74.5 100.0

1Uppsr value not specified

79
Appendix Vlll

Pesticide target compounds

Serum

Aldrin

a@a-BHC

beta-BHC

gammcz-BHC

delta-BHC

q-DDD

pp’-DDD

op’-DDE

pp’-DDE

op’-DDT

pp’-DDT

Dieldnn

Endrin

Heptachlor Epoxide

Hg~tachlor

I-&xachlorobenzen.

Mirex

Oxychlordane

PCB’S

trans-Nonachlor

80

d

Urine

Carbofuranphenol

2,4-D

Dicamba

Isopropoxyphenol

3-Ketocarbofiran

Malathion Dicarboxylic Acid

Malathion Monocarboxylic Acid

alpha-Naphthol

para-Nitrophenol

Pentachlorophenol

Silvex

2,4,5-T

2,4,5 -Trichlorophenol

3,5 ,6-Trichloro-2-pytidinol
Appendix IX

Consent forms —siTe-NmTq7 U@No. : 0937-0078

PIIS # 6219

Approval Expires: 2/85

9/81 CONSRiTTO EXAMINATI~ ANDREQUESTTO FURNISHRESULTS

Please read the following information and sign your name to indicate that YOU have read and

understand this important information about the examination procedures used in our survey.

You can expect to be in the Examination Center about 3 hours. You will receive a medical

examination by a physician and a dental examination by a dentist. We will measure your

height and weight. A nutritionist will ask you about the food you eat. We will also take

blood and urine specimens for laboratory tests and give you a test for tuberculosis.

Depending on your age, we may give you a chest x-ray, an electrocardiogram, tests for

hearing, vision, diabetes, gallstones, venereal disease, and liver disease. In addition,

you will be asked questions about your mental well-being and use of alcohol and other

drugs.

We use standard medical procedures administered by doctors, dentists, nurses and trained

technicians. We would like to point out that as during any similar physical examination,

there my be some discomfort or soreness resulting from the collection of a blood

specimen or from the administration of the tuberculin skin test. If you are chosen to

receive a chest x-ray, this will add to your total lifetime exposure to x-rays.

The intent of the survey is to provide a pictureof the health and nutritional statusof the

Hispanic population. We will not be able to provide any medical treatment or medication to

you . However, in the course of our examination, we will determine important health

information about you and with your permission we will provide this information to your

doctor or clinic. The medical information and other personal data obtained in this survey

are kept in the strictest of confidence. The individual findings collected on each person

in the survey are combined and used only for research and statistical purposes. By law, the

information you provide cannot be used for any other purpose without your written

permission.

If you have any questions about the surveyor your participation in it, or have any problems

as a result of the examination, you should contact either our staff at the Mobile

Examination Center or at our headquarters in the Washington. D.C. area. The Mobile

Examination Center will be in your area from

.,,

to The

office is open from 9 a.m. to 5 p.m., Tuesday through Saturday. You may also call

Mr. David L. Larson at our headquarters at (301) 436-b267 after the Mobile Examination

Center has left your area. ‘

Remember, your participation in this survey and any part of the examination is completely

voluntary. l%ere is no penalty if you refuse to take part in the survey or in any of the

procechm=e involved in the examination.

I HAVERE4DAND UNDHLSTANDTHE INFORMATI(14PRESHITEJJ ANDC(N%NT TO PARTICIPATE

IN THE EXAMINATION.

Signature of sample person If Dat e

12 years of age or over

PNUNTORMIANFUSTALSOSIG4 IFSAMPLEPERSCN ISI.JNIER 1BYE4.RSOFAGE.

Signature of parent or guardian Dat e

Interviewer Date Wltness[lf requlredJ Date

I WUJIJ) LIKE lHE 9JIWWARYOF MY EXAMINAIICNRESULTSTO BE SINT TO THE ADDRESSES

BELCW:

Name of Physicianor Cllnlc Name of Dentist or Dent a1 cl-mlc

Street Address Street Address

City State Zip Code City State Zlp Code

81
——-. ——— SAMPLE NUMBER

PHS No. 6219 OMB No.: 0937-0078

9/8 1 Approval Expires: 2/85

CONSENTIMIENTO PARA EL EXAMEN Y SOLICITUD PARA PROVEER LOS RESULTADOS

Por favor lea la informaci6n siguiente y firme su nombre para indicar que usted ha Ieldo y entiende esta

informaci6n importance sobre Ios procedimientos del examen que se usan en nuestro estudio.

Usted puede contar con estar en e] Centro de Examen alrededor de 3 horas. lJn rrkdico Ie har~ un

examen m6dico y un dentista le harS un examen dental. Mediremos su altura y peso. Una

nutricionista Ie harfi preguntas sobre la comida que usted come. Tambi6n tomaremos muestras de

san re y orina para hater pruebas del Iaboratorio y le haremos una prueba para la tuberculosis.

Segi n su edad, puede ser que le bar% una radiograffa de! pecho, un electrocardiogram, pruebas

de oldo y visifm, la diabetes, el C6ICU1Obiliar, enfermedad ven6rea, y enfermedad de] hfgado.

Adem%, le bar% preguntas sobre su estado mental y su uso de alcohol y otras drogas.

I Isamos procedimientos m.$dicos corrientes administrados PO; m6dicos, dentistas, enfermeras y t6cnicos

entrenados. Quisi&amos advertirie que asl como en cualquier examen flsico, puerfe ser que haya un

poco de malestar como resultado de la coleccifm de la muestra de sangre. Si usted es escogido para

recibir un rayo X del pecho, &to se Ie agregar~ a su exposicifm total de viola a las radiograflas.

El prop6sito de este estudio es presentar un cuadro del estado de la salud y nutrici6n de la poblaci6n

hispana. No podremos facilitarle ningfin medicamento o tratamiento m6dico. Sin embargo, en el curso

de nuestro examen, determinaremos importance informaci6n de salud sobre usted y con su permiso

facilitaremos esta informaci6n a su m<dico o clinics. La informaci6n m$dica y otros dates personages

obtenida en este estudio serSn guardados estrictamente crmfidencial. Los resultados individuals

recopilados sobre cada persona en la encuesta se combinaran y se usaran S61Opara propi%itos de

estudios y estadisticas de salud. Por ley no podemos entregar la in formacifm que usted nos d6 a

nadie sin su permiso escrito.

Si necesita m% informaci6n sobre la encuesta o su participaci6n en ells, o si usted tiene algunos

problemas como resultado del examen m6dico. por favor comuniquese con nuestro personal en e] Centro

de Examen M&il o en nuestra oficina principal en Washington, D.C. El Centro de Examen M6vil estar~

en su Srea el al La oficina est5 abierta de 9 a.m. a 5 p.m., martes a s~bado.

Tambi6n puede Ilamar al Seiior David L. L&son en nuestra oficina principal al tel&fono (301) 436-8267

despu6s de que se haya ido el Centro de Examen M6vil de su Srea.

Recu6rdese que su participaci6n en esta encuesta y cualquier parte de] examen es completamente

voluntarla. No hay ninguna obligaci6n si no quiere participar en la encuesta o en cualquier

procedimiento del examen.

YO HE LEIDO Y ENTIENDO LA INFORMAC1ON PRESENTADA Y CONSIENTO PARA

PARTICIPAR EN EL EXAMEN.

PRIMER Y SEGUNDO NOMBRE Y APELLIDO DE PERSONA MUESTRA

Firma de 1a persona muestra si F echa

12 ahos de edad o m~s

PADRE, MADRE, O GUARDIAN TAMBIEN TIENE QUE FIRMAR S1 LA PERSONA MUESTRA

TIENE MENOS DE 18 A~OS DE EDAD.

Firma del padre, madre o guardi% Fecha

Entrevistador Fecha Testigo (si se requiere) Fecha

QUIERO QUE UN SUMARIO DE LOS RESULTADOS DE MI EXAMEN SEA MANDADO A LA

DIRECCION SIGUIENTE:

Nombre de] M6dico o Cllnica Nombre del Dentista o Cfinica Dental

Direcci6n Direcci6n

Ciudad Estado Zona Postal Ciudad Estado Zona Postal

82

—
Appendix X

Reports of findings

Form PUS 6214-12

9882

Department of Health and Human Services

Public Health Service

Office of Health Research, Statiatica, and Technology

National Center for Health Statistics

Hyattsville, MD 20782

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

REPORT OF FINDINGS I

Doctor’s

Name

and

Address

Dear Doctor:

Recently the person named on the enclosed page was a sample person who voluntarily participated as an examinee in the

Hispanic Health and Nutrition Examination Survey conducted at special facilities of the U.S. Public Health Service. The

objectives of the Survey are to obtain information on the health and nutrition status of the U.S. Hispanic population, 6

months to 74 years of age, The examination is not, and was not intended to be, a substitute for a visit to the examinee’s

physician, nor was it intended to be a complete examination. No attempt has been made by our staff physician to diagnose

those conditions dependent on a thorough review of findings from the various components of the examination. At the

request of the examinee, however, we do send a report of findings from certain selected procedures to the physician he or

she indicates.

Enclosed is a report which notes any physical findings which our physician thought were significant and should be

brought to your attention (i.e., for which no treatment had been sought or no history given), Also reported are some test

results and laboratory data, and a copy of a chest X-ray and an ECG tracing are enclosed. Although we are not engaged in

follow-up treatment of our findings, we appreciate the cooperation of our examinees and hope that we can contribute to

their medical care by making this information available to you.

In addition to the blood and urine analyses performed on all survey participants, certain examinees are selected to receive

other tests, such as serum levels of cholesterol, trace elements, and certain pesticide compounds. Some of these tests

require more time than others to process. If any of these tests were performed for this person, findings will be forwarded

as soon as they are available.

Sincerely yours,

-w

Arnold Engel, M.D.

Medical Advisor

KS
Department of Haalth and Human Services

Public Heelth Service

Nationel Centar for Health Statistics

Hyattsville, MD 20782

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

NOTES ON TESTS AND PROCEDURES

Medical examination—A physician examined each sample person. The physician’s examination Included the head and neck, chest (cardiopulmonary), abdomen, and extremities (musculoskeletal and neurological), however, a rectal examination was excluded. X-Rays and EKG—A 12-lead

EKG and A - P chest X-ray (unless contraindicaterJ were done for examinees 25-74 years.

HEMATOLOGY—SCREENING LIMITS—***

Determmation

Age group Micro-hematocrit Cyanmet-hemoglobin Coulter counter Coulter counter

vol. % Hgb Gm% RBC/cc WBC/cc

Age 1 31 10.0 3. B-5 2 mill. 7.0-16.0 thou.

Ages 2-11 34 11.0 3.8-5.2 mill. 6.0- 15.0 thou ‘*

Males 12-16 years’ 39 13.0 4.5-5.5 mill. 4.5-10 .Othou.

Females 12-16 36 11.5 4.2-5.2 mill. 4.5-10 .Othou.

Adult Males 41-52 14.0-165 4.6-62 mill. 4.3-10 .Othou

Adult Females 36-46 12.0 -14.5 4.2-5.4 mill 4.3-10.0 thou.

Pregnant Females 33-42 10.5-140 37-4.9 mill 50-12.0 thou.

●Marked variation with age for hematocrit, hemoglobin, and red blood cells for males m puberty.

‘*Marked variation with age for white blood cells in age group 2-11.

“*’Results outside the screening limits are considered to warrant further Investlgatlon of the examinee

Urinalysis - Dip and read method using the Ames Clini-Tek A standard microscopic procedure was also used.

Audiometry - Air conduction readings are reported in decibels with respect to audiometric zero (ANSI), which IS considered normal

ROUGH GUIDELINES FOR dB REPORT AT 500-2000 CPS

25 dB or less - Hearing normal or more acute 60-70 dB - Moderate (difficulty with loud speech)

30-40 dB - Near normal (difficulty with faint speech) 75-100 dB - Severe (hears only amplified speech)

45-55 d~ - Mild (difficulty with normal speech) 105 or more - Profound (usually cannot understand amplifted speech}

BLOOD PRESSURE

First reading ~ Second reading ——f———— ❑ Not done

IMPEDANCE AUDIOMETRY SCREENING TEST AUDIOGRAM - Decibels

CPS 500 1000 2000 4000

•l Positive ❑ Negative ❑ Not done Right

(See attached letter for indication of

positive results.) Left

URINE •l Not done

--------------------------------— -

Albumin ❑ Neg •l 30 mg/dl

❑ 100mg/dl ❑ >300mg/dl ❑ Not done

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

Sugar ❑ Neg ❑ Trace ❑ .25g/dl HEMATOLOGY ❑ Not done

❑ .5g/dl •1 >1 .Og/dl

--------------------------------- - Hematocrit Volvo

Nitrite (Bacteriuria) •1 Pos ❑ Neg Hemoglobin gm%

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

Blood ❑ pos ❑ Neg RBC count mill/cc

WBC count thou/cc

OTHER CLINICAL FINDINGS

VISION

)istance Vision

R Eye L Eye

20/ 20/

❑ Without

correction

❑ With

correction

❑ Not done

Near Vision

20/

Acuity at 40cm

Worse than

20/333 ❑

❑ Not done

CHEST X-RAY

❑ Enclosed ❑ Not done

ECG

❑ Enclosed C Not done

TUBERCULIN TEST

—mm ❑ Negative

❑ Not done ❑ Not read

DATE OF AGE

EXAMINEE’S

HEIGHT (cm)

NAME AND

EXAMINATION

ADDRESS SEX WEIGHT (kg)

84
-r, *.,+

*

4

DEPARTMENT OF HEALTH AND HUMAN SERVICES $

c

Public Health Se.rvica

s

*

% Hispanic Health and Nutrition Examination Survey

%’%

National Center for Health Statistics

3700 East-West Highway

%,,,, Hyattsville MD 20782

REPORT OF FINDINGS

Doctor’s

Name and

Address

Dear Doctor:

Earlier we forwarded to you a report of clinical findings obtained during the Hispanic Health and Nutrition Examination Survey on

the examinee named below. At that time we explained that results from certain other tests would take longer to obtain and would

be sent when available. The enclosed findings report contains these results.

Please be reminded that the objectives of the Survey are to obtain information on the health and nutrition status of the U.S.

Hispanic population, 6 months to 74 years of age. The examination is not, and was not intended to be, a substitute for a visit to

the examinee’s physician, nor was it intended to be a complete examination. At the request of the examinee, however, we do send

a report of certain selected procedures to his or her physician.

EXAMINEE’S NAME& ADDRESS

Sincerely youra,

Arnold -w Engel, M.D.

Medical Advisor

Date of Examination

TEST RESULT NORMAL LIMITS

GLUCOSE TOLERANCE TEST

FASTING mg% <115

1 HOUR mg% <200

2 HOUR mg% <140

IRON (SERUM) Ug% 50-175

IRON BINDING CAPACITY (IBC) (SERUM) Ug% 290-500

PROTOPORPHYRIN (WHOLE BLOOD) Ug% 33.90

LEAD (WHOLE BLOOD) Ug% <30

VITAMIN A (SERUM) 20-80- Adults

Ug% 20-50- Children

CHOLESTEROL (SERUM) mg% <300

TRIGLYCERIDES (SERUM) mg% <300

A VALUE OF XXX IN THE RESULTS FIELD INDICATESTHATTHE TEST WAS NOT DONE FOR THIS PERSON.

OTHER LABORATORY FINDINGS ARE ATTACHED WHEN APPLICABLE.

OTHER SIGNIFICANT BLOOD AND URINE RESULTS OTHER SIGNIFICANT EXAMINATION FINDINGS

Form PHS 6214-12 11/83)

—— —— —-—

NCHS sample numbar
FmnPHS6214-13

9 882

Confidentiality has been assurad examlnees as set forth In 22 F.R 1687

Department of Heelth end Human Services

Public Heelth Service

National Center for Health Statistics

Hyattsville, MD 20782

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

REPORT OF DENTAL FINDINGS

Dentist’s

Name and

Address

Dear Doctor:

Recently the person named in this report was among those who had voluntary examinations at special mobile facilities

operated by the Public Health Service.

The dental examination of the Hispanic Health and Nutrition Examination Survey is not, and is not intended to be, a

substitute for the examination usually given to persons seeking care from their own dentist. Neither a dental history nor

X-rays are taken, and therefore the findings are solely the result of what can be seen at the time of the examination. The

examinee named in this report requested that it be sent to you.

If you have any questions about the Survey, please write

Sincerely,

(Examining Dentist)

Examinee’s name and address Age Date of examination

THE INDEX ASSESSMENTS USED IN THE SURVEY REVEAL:

❑ No conditions which suggest that the examinee should be seen by you before the next regular appointment.

❑ One or more of the following conditions that suggest a clinical examination is desirable to determine whether or not

treatment is needed before the next regular appointment.

❑ Decayed teeth ❑ Oral debris and/or calculus

❑ Gingivitis and/or periodontal disease ❑ Malocclusion

❑ Other conditions — Specify

86
Appendix XI

Examples of analytic

approaches

Example one

Definition of the model

In the blood lead trend analysis, a mixed model was

used to compute the predicted percent reduction in average

blood lead levels from the beginning (February 1976) to

the end (February 1980) of NHANES II. SURREGR was

used for this model with a continuous dependent variable

and both categorical and continuous independent variables.

SURREGR was also useful for obtaining age-adjusted

means by regressing the response variable on the continuous

variable “age.”

Definition of population subgroups of interest

(control vafibles)

In the blood lead trend analysis, population groups of

interest were all persons 6 months through 74 years of age,

males, females, whites, blacks, preschool-aged children (6

months through 5 years), children aged 6-17 years, and

adults aged 18–74 years.

Selection of demograph~ covariates (main

effects)

Prior information about the distribution of the dependent

variable was used to define categories. The magnitude of

the association to account for with the dependent variable

and the sample sizes were both taken into account.

Determination of the complete model used for

regression

Prescreening using ordinary least squares, SAS PROC

STEPWISE, OPTIONS/MXR, STEPWISE, FORWARD,

BACKWARD (attachment A)

. In the blood lead analysis, the objective was to obtain

a model with all of the main effects and the most important

first-order interaction terms.

. Using this prescreening process reduced the number of

variables and gave a model that was manageable using

SURREGR. It also circumvented some of the problem

of having insufficient observations in each of the paired

pseudo-PSU’s.

Additional screening using Taylor Linearization, SAS

PROC SURREGR, OPTION/TAYWLS (attachment B).

. Each variable in the model obtained from the prescreening

process was initially checked to make sure there were

enough observations in pairs of pseudo-PSU’s.

● In the blood lead analysis, the model obtained from

the prescreening process was used as a starting point

to eliminate additional variables deemed as making no

significant contribution to the overall variability in blood

lead levels. In this process, the criterion used was that

the F-statistic of the main effect or first-order interaction

term had to be significant at p = 0.10 to remain in

the model.

Determination of the reduced model used for

computing predicted values

The complete model obtained through the screening process using SURREGR was then used as a starting point

for determining the reduced model within each of the population subgroups.

. In the blood lead trend analysis, main effects and firstorder interactions were eliminated from the model if

the F-statistic was not statistically significant at p =

0.05. However, main effects were left in the model

if they were involved in a significant interaction term

regardless of the significance level of their F-statistics.

Also the variables set up to define the downward trend

(ORDER and ORDER I ) always remained in the model.

. After the reduced model had been determined, the intercept, mean values, and regression coefficients from the

SURREGR output were used to compute the predicted

values.

87
ATTACHMENT A

1.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

// JOB AND SETUP CARDS

//SYSIN DD ;

DATA ;

INFILE IN;

INPUT SAMNUM 1-5 STAND 1-2 URBAN 11 SMSA 12 PSU 13-15

SEGMENT 16-19 EXAMINED 36 AGEMO 45-46 AGEYR 47-48

SEX 55 RACE 56 EDUC 62-63 WORK 65 INDUST 73-75

OCCUP 76-78 INCOME 107-108 MO 184-185 DA 186-187 YR 188-189

INTRVWED 208 REGION 209 STRATUM 324-325 PAIR 326

WEIGHT 300-305 SAMPLE 397 LEAD 701-703

LEADDATA 704;

* RECODES ARE AS FOLLOWS;

IF LEAD = O OR LEAD GE 70 OR SAMPLE = 1 OR LEADDATA = o

THEN LEAD = .;

AGE1 = .;

IF AGEYR GE O AND AGEYR LE 5 THEN AGE1 = 1;

IF AGEYR GE 6 AND AGEYR LE 17 THEN AGE1 = 2;

IF AGEYRGE 18 AND AGEYR LE 74 THEN AGE1 = 3;

CHILD = O;

IF AGEl = 1 THENCHILD = 1;

TEEN = O;

IF AGEl = 2 THEN TEEN = 1;

SEX1 = O;

IF SEX = 1 THEN SEX1 = 1;

IF URBAN LE 2 THEN URBAN = 1;

IF URBAN GE 3 AND URBAN LE 7 THEN URBAN = 2;

IF URBAN = 8 THEN URBAN = 3;

RURAL = O;

IF URBAN = 2 OR URBAN = 3 THEN RURAL = 1;

IF INCOME GE 11 AND INCOME LE 18 THEN INCOME = 1;

IF INCOME GE 19 AND INCOME LE 22 THEN INCOME = 2;

IF INCOME= 88 THEN INCOME= .;

INC1 = O;

IF INCOME = 2 THEN INC1 = 1;

IF INCOME= . THEN INC1 = .;

SOUTH= O;

IF REGION = 3 OR REGION = 4 THEN SOUTH = 1;

IF MOD(M0,3)=0 AND DA GE 21 THEN MON=MOD(MO+1,12);

ELSE MON=MO;

SEASON = INT((MON-1)/3);

IF SEASON = . THEN SEASON1 = 1;

ELSE SEASON1 = SEASON + 1;

WINTER = O;

IF SEASON1 = 1 OR SEASON1 = 2 THEN WINTER = 1;

ORDER = (MDY(MO,DA, YR)-MDY(2,20,76 ))/28;

IF ORDER LE 34 THEN ORDER1 = O;

ELSE ORDER1 = ORDER-34;

88
55.1

55.2

56.

57.

57.01

57.02

57.03

57.04

57.05

57.06

57.07

57.08

57.09

57.1

57.11

57.12

57.13

57.14

57.15

57.16

57.17

57.18

57.19

57.2

57.21

57.22

57.23

60.

61.

62.

63.

64.

65.

66.

67.

68.

69.

RACE1 = O;

IF RACE = 2 THEN RACE1 = 1;

AS1 = CHILD*SEX1;

AS2 = TEEN*SEX1;

AR1 = CHILD*RACE1;

AR2 = TEEN*RACE1;

AU! = CHILD*RURAL;

AU2 = TEEN*RURAL;

AI1 = CHILD*INC1;

A12 = TEEN*INC1;

AhJl= CHILD*WINTER;

AW2 = TEEN*WINTER;

AN1 = CHILD*SOUTH;

AN2 = TEEN*SOUTH;

SR1 = SEX1*RACE1;

SU1 = SEX1*RURAL;

S11 = SEX1*INC1;

Swl = SEX1*WINTER;

SN1 = SEX1*SOUTH;

RI1 = RACE1*INC1;

RU1 = RACE1*RURAL;

RW1 = RACE1*WINTER;

RN1 = RACE1*SOUTH;

UI1 = RURAL*INC1;

UW1 = RURAL*WINTER;

UN1 = RURAL*SOUTH;

WN1 = WINTER*SOUTH;

LNLEAD = LOG(LEAD);

IF LEAD = . THEN LNLEAD = .;

KEEP ORDER ORDER1 LEAD WINTER SEX1 CHILD TEEN

RURAL INC1 SOUTH RACE1 LNLEAD AS1 AS2 AR1 AR2

AUI AU2 AI1 A12 AW1 AW2 AN1 AN2 SRI SU1 S11 SW1

SN1 RI1 RU1 RW1 RN1 UI1 UW1 UN1 WN1

PROC STEPWISE;

MODEL LNLEAD=ORDER ORDER1 CHILD TEEN SEX1 RACE1 RURAL INC1

WINTER SOUTH AS1 AS2 AR1 AI1 A12 RU1 RW1 UN1/MAXR;

//

89

—
ATTACHMENT B

1.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

// JOB AND SETUP CARDS

{~:~SIN DD ;

.

INFItE IN;

INPUT SAMNUM 1-5 STAND 1-2 URBAN 11 SMSA 12 PSU 13-15

SEGMENT 16-19 EXAMINED 36 AGEMO 45-46 AGEYR 47-48

SEX 55 RACE 56 EDUC 62-63 WORK 65 INDUST 73-75

OCCUP 76-78 INCOME 107-108 MO 184-185 DA 186-187 YR 188-189

INTRVWED 208 REGION 209 STRATUM 324-325 PAIR 326

WEIGHT 300-305 SAMPLE 397 LEAD 701-703

LEADDATA 704;

* RECODES ARE AS FOLLOWS;

IF LEAD = O OR LEAD GE 70 OR SAMPLE = 1 OR LEADDATA = O

THEN LEAD = .;

AGE1 = .;

IF AGEYR GE O AND AGEYR LE 5 THEN AGEl = 1;

IF AGEYR GE 6 AND AGEYR LE 17 THEN AGE1 = 2;

IF AGEYR GE 18 AND AGEYR LE 74 THEN AGEl = 3;

CHILD= O;

IF AGEl = 1 THEN CHILD = 1;

TEEN = O;

IF AGEl = 2 THEN TEEN = 1;

SEX1 = O;

IF SEX = 1 THEN SEX1 = 1;

IF URBAN LE 2 THEN URBAN = 1;

IF URBAN GE 3 AND URBAN LE 7 THEN URBAN = 2;

IF URBAN = 8 THEN URBAN = 3;

RURAL = O;

IF URBAN = 2 OR URBAN = 3 THEN RURAL = 1;

IF INCOME GE 11 AND INCOME LE 18 THEN INCOME = 1;

IF INCOME GE 19 AND INCOME LE 22 THEN INCOME = 2;

IF INCOME = 88 THEN INCOME = .;

INC1 = O;

IF INCOME = 2 THEN INC1 = 1;

IF INCOME = . THEN INC1 = .;

SOUTH = O;

IF REGION = 3 OR REGION = 4 THEN SOUTH = 1;

IF MOD(M0,3)=0 AND DA GE 21 THEN MON=MOD(MO+1,12);

ELSE MON=MO;

SEASON = INT((MoN-1)/3);

IF SEASON = . THEN SEASON1 = 1;

ELSE SEASON1 = SEASON + 1;

MINTER = O;

IF SEASON1 = 1 OR SEASON1 = 2 THEN WINTER = 1;

ORDER= (MDY(MO,DA,yR)-MDy(2,20,76))/28;

IF ORDER LE 34 THEN ORDER1 = O;

ELSE ORDER1 = ORDER-34;

90
55.1

55.2

56.

57.

57.01

57,05

57.06

57.17

!57.18

57.22

60.

61.

62.

63.

64.

65.

66.

66.1

67.

68.

69.

70.

71.

72.

73.

74.

75.

RACE1 = O;

IF RACE = 2 THENRACE1 = 1;

AS1 = CHILD*SEX1;

AS2 = TEEN*SEX1;

AR1 = CHILD*RACE1;

AI1 = CHILD*INC1;

A12 = TEEN*INC1;

RU1 = RACE1*RURAL;

RW1 = RACE1*WINTER;

UN1 = RURAL*SOUTH;

LNLEAD = LOG(LEAD);

IF LEAD = . THEN LNLEAD = .;

KEEP ORDER ORDER1 LEAD WINTER SEX1 CHILD TEEN

RURAL INC1 SOUTH AS1 AS2 RACE1 LNLEAD STRATUM PAIR WEIGHT

AR1 AI1 A12 RU1 RW1 UN1;

* FOR WEIGHTEDHANESII DATA ANALYSIS, ONE MUSTFIRST

SORT BY STRATUM AND PSEUDO-PSU;

PROC SORT; BY STRATUM PAIR;

* THEN PROCEED WITH SURREGR TO OBTAIN REGRESSION COEFFICIENTS

AND STANDARD ERRORS;

PROC SURREGR MISSPSU BETA TAYWLS;

MODEL LNLEAD=ORDER ORDER1 CHILD TEEN SEX1 RACE1 RURAL INC1

WINTER SOUTH AS1 AS2 AR1 AI1 A12 RU1 RW1 UN1;

STRATUM STRATUM1;

PSU PAIR;

WEIGHT WEIGHT;

//

91
Example two

YES MDMA YES PHONE LOGIT

SATURATED NESTED MODEL

// JOB card(s) TIME=15,REGION=1OO8K

//STEP1 EXEC SAS,TIME.SAS=30,REGION.SAS=300K

//SAS.WORK DD UNIT=3350,SPACE= (TRK,(480,160 ),RLSE)

//CHILD DD DSN=STUDY,UNIT= 3400-6,DISP=(OLD, KEEP),

// VOL=SER=OOOOOO

//VAROUT DD DSN=WYL.ACCT.XXX,DISP=(NEW,CATLG) ,UNIT=3350,

//SPACE=(TRK,(15,5) ,RLSE),DCB=RECFM=FB

IISYSIN DD *

*

*

*

*

*

*

DATA;

SET CHILD.STUDY;

KEEP MDADEQ PHONE UNIT FAMSIZE MDMA EDHEAD MDPA T21316

STRATUM PSEUDO;

ALL UNKNOWNS CHANGED TO UNIT UNKNOWN AND

KEPT FOR VARIANCE COMPUTATIONS;

DEFINE POPULATION;

YES MDMA VISIT YES PHONE;

IF MDMA GE 2 THEN UNIT=.;

IF PHONE GE 2 THEN UNIT=.;

DEFINE STRATA;

sTRATuM=PsEuDo/2 + .5;

STRATUM=INT(STRATUM) ;

SORT BY STRATUM AND PSU IF TAPE NOT IN SORT;

PROC SORT;

BY STRATUM PSEUDO;

CALCULATE VARIANCE-COVARIANCE MATRIX;

PROC SURREGR MISSPSU BETA DATAOUT;

CLASSES UNIT FAMSIZE EDHEAD MDPA;

LEVELS 1 4 5 3;

MODEL MDADEQ=UNIT*FAMSIZE*EDHEAD*MDPA/NOINT ;

STRATUM STRATUM;

PSU PSEUDO; WEIGHT

T21316;

DATA NULL_;

SET D~MMYMOl;

FILE VAROUT;

PuT (BoOl-B060) (4*E15.8/);

//STEP2 EXEC LARGEN,TIME=2

//FT05FO01 DD DSN=WYL .ACCT.XXX.MATRIX, DISP=(OLD, KEEP)

//SYSIN DD

535 1 0 YES MDMA,YES PHONE,SATURATED

60 60 1 (4E15.8)

1 (4E15.8)

1 2 120 2 1 (2F2.0)

1

-1

4 1 (60F1.o/60Fl. o)

92
olololololololololololololololololololololololololololololol

olololololololololololololololololololololololololololololol

2 1

126011 (2F2.0)

1-1

7 2 60 15 1 0 (15F2.0) 11 Saturated FAMSIZE

111111111111111

111000000000-1-1-1

000111000000-1-1-1

000000111000-1-1-1

000000000111-1-1-1

1 0-1 1 0-1 1 0-1 1 0-1 1 0-1

0 1-1 0 1-1 0 1-1 0 1-1 0 1-1

10-1000000000-101

00010-1000000-101

00000010-1000-101

00000000010-1-101

01-10000000000-11

00001-10000000-11

00000001-10000-11

00000000001-10-11

814 (60F1.0) FAMSIZE

1

Ooooooooooooorlol

0000000000000000000000000000001

0000000000000000000000000000000000000000000001

8 1 16 (60F1.0) EDHEAD

01

001

0001

00001

00000000000000001

000000000000000001

0000000000000000001

00000000000000000001

00000000000000000000000000000001

000000000000000000000000000000001

0000000000000000000000000000000001

00000000000000000000000000000000001

00000000000000000000000000000000000000000000001

000000000000000000000000000000000000000000000001

ooooooooooooooooooooooooooooooooooooooooooooooool

oooooooooooooooooooooooooooooooooooooooooooooooool

818 (60F1.0) MDPA

000001

0000001

000000000000000000001

0000000000000000000001

0000000000000000000000000000000000001

00000000000000000000000000000000000001

ooooooooooooooooooooooooooooooooooooooooooooooooooool

oooooooooooooooooooooooooooooooooooooooooooooooooooool

93
818 (60 F1.0) INTERACTION1

00000001

000000001

0000000001

00000000001

000000000001

0000000000001

00000000000001

000000000000001

818 (60 F1.0) INTERACTION2

00000000000000000000001

000000000000000000000001

0000000000000000000000001

00000000000000000000000001

000000000000000000000000001

0000000000000000000000000001

00000000000000000000000000001

000000000000000000000000000001

818 (60 F1.0) INTERACTION3

00000000000000000000000000000000000001

000000000000000000000000000000000000001

0000000000000000000000000000000000000001

00000000000000000000000000000000000000001

000000000000000000000000000000000000000001

0000000000000000000000000000000000000000001

00000000000000000000000000000000000000000001

000000000000000000000000000000000000000000001

8 18 (60 F1.0) INTERACTION4

ooooooooooooooooooooooooooooooooooooooooooooooooooool

oooooooooooooooooooooooooooooooooooooooooooooooooooool

ooooooooooooooooooooooooooooooooooooooooooooooooooooool

oooooooooooooooooooooooooooooooooooooooooooooooooooooool

oooooooooooooooooooooooooooooooooooopoooooooooooooooool

oooooooooooooooooooooooooooooooooooooooooooooooooooooooool

ooooooooooooooooooooooooooooooooooooooooooooooooooooooooool

oooooooooooooooooooooooooooooooooooooooooooooooooooooooooool

//

For reanalysis of the data when the variance-covari ance matrix is

on disk, the first lines are the following;

// JOB card(s) TIME=2,REGION=1OO8K

/*SETUP PROGRAMMER,2,,,INP=NONE

// EXEC LARGEN,TIME=l

//FTo5Foool DD DSN=WYL .DHES.XXX.MATRIX,DISP= (OLD,KEEP)

94
Appendix X11

Data collection forms for the

Hispanic Health and Nutrition

Examination Survey

Contents

Household Screener Questionnaire

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Family Questionnaire

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Child Sample Person Questionnaire, Ages 6Months–11 Years

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Adult Sample Person Questionnaire, Ages 12–74 Years

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . 260

Adult Sample Person Supplement, Ages 12–74 Years

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329

Dietary Questionnaire, English and Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353

Control Record. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371

Physician’s Examination,Ages 6Months–74Years, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

BodyMeasurements, Ages6Months–74 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386

Tympanic Impedance,Ages6 Months–74Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387

Audiometry (Air), Ages&74Years . . . . . . . . . . . . . . . . . . . . . . . . . . . 389

VisionTest, Ages&74Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390

Glucose Challenge Questionnaire, Ages 2&74 Years

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . . 394

Hair Collection Questionnaire, Ages 12–74 Years

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398

Ultrasound Examination of the Gallbladder, Ages 2&74 Years . . . . . . . . . . . . . . . . . . . . . . . . . 400

Dental Examination, Ages6Months–74 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406

FlashcardBooklet, Household Interview . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . 409

English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409

Spanish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416

Flashcards, Adult Sample Person Supplement (English and Spanish) . . . . . . . . . . . . . . . . . . , . . . . 423

95
I

0

ol

I Book of — _books. I

PHS = 6216

OMB 0937-0078

Approval Expires 2/85

Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics and Technology

National Center for Health Statistics

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

HOUSEHOLD SCREENER QUESTIONNAIRE (528)

LANGUAGE OF

INTERVIEW

o106 1 ~ English

2 U Spamsh

o100

STAND SEGMEN

o108

ADDRESS:

SERIAL

NOTICE: Information contained on this form which would permit identification of any individual or establishment

has been collected with a guarantee that it will be held in strict confidence, will be used only for purposes stated for this

study, and will not be disclosed or released to others without the consent of the individual or the establishment in accordance with Section 308(d) of the Public Health Service Act (42 USC 242 m).
I

I

INTRODUCTION: Hello, I’m and we are conducting a survey for the U.S. Public Health

Service (SHOW I D CARD). A letter was sent to you recently explaining the survey, which is called the Health and Nutrition Examination Survey and is about your family’s health. [IF RESI DENT DOES NOT REMEMBER LETTER, HAND

NEW COPY.] All the information that You give us will be kept in the strictest confidence. Your name will not ~ attached

to any of your answers without your specific permission.

a. Before we begin I would like to verify your address.

CATION AND ZIP CODE.)

o109

(INCLUDE HOUSE NO., APT. NO., OR OTHER

State Zi~ Code

b. Is this also your mailing address? o110 I ❑ same as a,

(MARK BOX OR SPECIFY IF

DIFFERENT. INCLUDE ZIP CODE.)

,

0

111

City State Zip Code

w

*
HOUSEHOLD COMPOSITION

la. To begin, how many people live in this household? o114

Number

b. What is the name of the person or one of the persons who owns or rents this home?

(ENTER NAME ON FIRST LINE OF FAMILY TABLE 1.)

IF ONLY ONE PERSON LIVES IN HOUSEHOLD, GO TO If.

OTHERWISE CONTINUE.

c. What is the name of (REF. PER SON)’S spouse, if any, who lives in this household?

(ENTER NAME ON SECOND LINE OF FAMILY TABLE 1.)

d. And the other members of this household who are related to (REF. PERSON): What are their names? Let’s begin with

the oldest. (ENTER NAME(S) IN AGE ORDER IN FAMILY TABLE 1.)

e. Are there any other persons not related to (REF. PERSON) living in this household?

o115 1 ❑ Yes 20N0

(IF YES: ENTER NAMES IN ADDITIONAL FAMILY TABLES, ESTABLISHING A HEAD OF HOUSEHOLD

AND ORDERING EACH FAMILY BY SPOUSE AND THEN FAMILY MEMBERS IN AGE ORDER.)
I

f. I have listed (READ ALL NAMES). Have I missed: Yes*

Any babies or small children? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0116ID

Any lodgers, boarders, or persons in your employ who live here? . . . . . . 011710

Anyone who usually lives here but is now away from home? . . . . . . . . . 011810

Anyone else staying here? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0119 10

9. Do any of the persons in this household have a home anywhere else? . . . . . . . 012010

*APPLY HOUSEHOLD MEMBERSHIP RULES. PROBE IF NECESSARY:

Where does –– usually live and sleep; here or somewhere else?

h. Are any of the persons in this household now on full-time active duty with the Armed Forces of the

United States?

I O Yes (GO TO Ii) oIZI2❑ No (GO TO PAGE3)

i. Who is this? Anyone Else? (DELETE PERSON FROM FAMILY TABLE BY DRAWING LINE THROUGH NAME. )

i. FOR EACH PERSON IN ARMED FORCES, ASK: Where does –- usually live and sleep; here or somewhere else?

(SPECIFY “Living at home” OR “Not living at home” IN PERSON’S LINE.)

F SCREENER REFUSAL, ASK:

i) What is the national origin or ancestry of the persons living in this household?

o122

specify

ii) (IF “DK” OR REFUSED IN i): Is the national origin or ancestry of any of the persons

living in this household (Mexican/Puerto Rican/Cuban)?

o123 1 El Yes 20N0 9 ❑ Don’t Know

No

20

20

20

213

20
HOUSEHOLD COMPOSITION TABLE

STEPS:

1. After listing household, ask Questions 2b and 2C as appropriate for (first/next) family listed.

2. Determine if eligible Hispanic household member in family unit, and mark 2d.

3. If eligible family unit, complete 2e, f and g. Complete 2h after Sample Person Selection.

4. Repeat Steps 2 and 3 for second family in household; if three or more families, use additional Household Screener Questionnaires.

5. If any eligible family unit in household, proceed to Sample Person Selection on page 4. If no eligible family in household,

go to Question 3 on page 4.

6. Complete 2i after exam appointment has been made.

2a. NAME

FIRST, MIDDLE, LAST

o124

2b. IF NOT

COMPLETED

ASK: What is

——‘s relationship to (REF.

PERSONF

o125

REF.

PERSON

@j FAMILY =1

2c. HAND CARD S1. Please give me the number of the group or

groups that represents -– ‘s national origin or ancestry.

2d. ELIGIBLE FAMILY?

ml U ‘f’es (2e) 20 No (NEXT FAMILY OR Q.3)

w

2e. What is ––’s 2f .

date of birth? AGE:

USE

CHT.

MO I DAY YR

@ @ @ @

2g. MA RK ONE

61

blos.

20-44 45-74

YRS. YRS, YRS.

;

132 o133 0134

2h. SAMPLE PERSO-N #

k~

(NUMBER ALL SP’S

SEQUENTIALLY

WITHIN FAMILY)

2i. NCHS #

135

0

101

1

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

HAN D CARD S1. Please give me the number of the group or

2a. NAME

@ ? 12 : : : ! i : ; ‘r ‘~+’

groups that represents ––’s national origin or ancestry.

FIRST, MIDDLE, LAST

HEAD
SAMPLE PERSON SELECTION GUIDE

● Using the table below select Sample Person(s) following the pattern circled for each age category,

L_-For each Sample Person selected, circle mark in column 2g and complete column 2h on page 3.

I

SAMPLE PERSON SELECTION TABLE

PERSONS

6 months – 19 years

A

lst, 2nd, 3rd, 5th, 6th, 7th, 9th, 10th, 1 lth

6

2nd, 3rd, 4th, 6th, 7th, 8th, 10th, 1 lth, 12th

c

lst, 3rd, 4th, 5th, 7th, 8th, 9th, llth, 12th

D

lst, 2nd, 4th, 5th, 6th, 8th, 9th, 10th, 12th

E

All

PERSONS PERSONS

20 years – 44 years 45 years – 74 years

F

I

K

lst, 2nd8 5th, 6th, 9th, All

10th

J

lst, 3rd, 4th, 6thr 7th,

9thr 10th, 12th

NOTE: . Sample selection patterns E, H, I and J are to be used only in Dade County, Florida.

. Sample selection patterns A, B, C, D, F and G are to be used only outside of Dade

County, Florida.

. Sample selection pattern K is to be used in all locations.
ASK EVERYONE:

3. Would you give me your telephone number in case my office wants to check my work?

o136Telephone No. ~

)

o130

Area Code

o137 I ❑ No telephone

7 •l Refused

o139 0140

4. DATE OF INTERVIEW: Ill Ill Ill

MONTH DAY YEAR

5, CHECK ONE:

o141 1 •l NO eligible families. THANK RESPONDENT AND TERMINATE INTERVIEW.

2 ❑ Eligible family (ies), no Sample Person(s). THANK RESPONDENT AND

TERMINATE INTERVIEW,

3 ❑ Eligible family (ies), with Sample person(s). COMPLETE SAMPLE PERSON

QUESTIONNAIRE(S) FOR EACH SAMPLE CHILD (AGE 6 MONTHS –

11 YEARS) AND EACH AVAILABLE SAMPLE ADULT (AGE 12 – 74

YEARS) ;THEN COMPLETE APPROPRIATE FAMILY QUESTIONNAIRES(S).
i Book of books. I

PHS # 6216

OMB : 0937-0078

Approval Expires: 2/85

Department of Health and Human Sarvioss

Public Health Service

Off ice of HeaIth Research, Statisticsand Technology

National Canter for Health Statistics

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

HOUSEHOLD SCREENER QUESTIONNAIRE (528)

LANGUAGE OF

INTERVIEW

o

106 I ❑ English

2 E Spanish

cm TIME BEGAN –._:__

lElam

zClpm

@-@

I

TIME ENDED ––:––

1 •l am

zClpm

o100

STAND SEGMENT SERIAL

o

108

ADDRESS:

NOTICE: La information contenida en este formulario que permitir(a identificar a cualquier individuo o establecirniento ha

sido recogida con la garantia que sera mantenida en la mtis estricta confidencialidad, serti usada s610 para Ios propositos establecidos para este estudio, y no ser~ divulgada o entregada a otros sin el consentimiento del individuo o del establecimiento

de acuerdo con la Seccion 308(d) de la Ley del Servicio de Salud Publics - Public Health Service Act (42 USC 242m).
INTRODUCTION: Hola, soy y estamos haciendo una encuesta para el Servicio de Salud Prlblica

de Ios EE.UU.A (SHOW I D CARD). Recientemente se Ie mandb una carta explic~rrdole la encuesta, parte del Estudio de

Salud y Nutricibn y que se trata sobre la salud de su familia. (IF RESIDENT DOES NOT REMEMBER LETTER, HAND

NEW COPY,) Tor.la la informacibn que usted nos d6 ser5 mantenida en la m% estricta confidencialidad. Su nombre no

ser5 juntado con ninguna de sus respuestas sin su expreso permiso.

am Antes de comenzar quisiera verificar su direccibn. (INCLUDE HOUSE NO., APT, NO., OR OTHER IDENTI FICA.

TION AND ZIP CODE.)

oI 09

City I State I Zip Code I

b. LEs eita tambhln su direccihn postal? o110 1 ❑ same as a.

(MARK BOX OR SPECIFY IF DIFFERENT.

INCLUDE ZIP CODE.)

o ‘

111

City State Zip Code

u

Interviewer Name: No.

Reviewer’s Name:

w

No,
HOUSEHOLD COMPOSITION

I

la. Para comenzar, Zcuantas personas viven en esta casa? o114 _

number

b. ZComo se llama la persona o una de Ias personas que es dueho o que (rents/alquila) esta casa?

(ENTER NAME ON FIRST LINE OF FAMILY TABLE 1.)

IF ONLY ONE PERSON LIVES IN HOUSEHOLD, GO TO If.

OTHERWISE CONTINUE.

c. ZComo se llama et esposo(a) de (REF. PERSON), si tiene esposo(a), que vive en esta casa?

(ENTER NAME ON SECOND LINE OF FAMILY TABLE 1.)

d. ZComo se Ilaman Ios otros miembros de esta casa que son parientes de (REF. PERSON)? Vamos a empezar con

et mayor. (ENTER NAME(S) IN AGE ORDER IN FAMILY TABLE 1.)

e, ZHay algunas personas que no son parientes de (REF. PERSON) pero que viven en esta casa?

o115 10s( 2UN0

(IF YES: ENTER NAMES IN ADDITIONAL FAMILY TABLES, ESTABLISHING A HEAD OF HOUSEHOLD

AND ORDERING EACH FAMILY BY SPOUSE AND THEN FAMILY MEMBERS IN AGE ORDER.)

f. Yo he puesto en la Iista (READ ALL NAMES). ZHe dejado: SI’* No
Algtinbeb60 niiiospequeiios? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0116 In

Algunos hu6spedes, alojados o personas en su empleo que viven aqui’? . . . 0117 10

Alguicn que vive aqu~ usualmente pero est5 fuera de la casa ahora? . . . . 0

Ile 10

Algunotro quesequedaaqui? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0119 10

9. lTienen algunas de Ias personas en este hogar un hogar en cualquier otro Iugar? o120In

*APPLY HOUSEHOLD MEMBERSHIP RULES. PROBE IF NECESSARY:

LDCmde vive y duerme -- usualmente; aqui o en otro Iugar?

20

20

20

20

20,

h, ZEst5rr algunas de Ias personas en este hogar en servicio activo de Ias Fuerzas Armadas de Ios Estates Unidos a

horario completo?

o121 I ❑ Si(GOTOli) 2 •l No (GO TO PAGE 3)

i. LQui6n es? ZAlgtirr otro? (DELETE PERSON FROM FAMILY TABLE BY DRAWING LINE THROUGH NAM E,)

i. FOR EACH PERSON IN ARMED FORCES, ASK: LD6nde vive y duerme –- usualmente; aqu~ o en otro Iugar?

(SPECIFY “Living at home” OR “not living at home” IN PERSON’S LINE.)

IF SCREENER REFUSAL, ASK:

i) ZCU41 es el origen national o ascendencia de Ias personas que viven en este hogar?

o122

specify

ii) IF “DK” OR REFUSED IN i): tEs el origen national o ascendencia de cualquiera de Ias

personas que viven en este hogar (mexicano/puertorriqueiio/cubano)?

o123 Iosi 211N0 9 ❑ No Sabe
I HOUSEHOLD COMPOSITION TABLE

STEPS:

1. After listing household, ask Questions 2b and 2C as appropriate for (first/next) family listed.

2. Determine if eligible Hispanic household member in family unit, and mark 2d.

3. If eligible family unit, complete 2e, f and g. Complete 2h after Sample Person Selection.

4. Repeat Steps 2 and 3 for second family in%ousehold; it three or more persons, use additional Household Screener Questionnaires.

5. If any eligible family unit in household, proceed to Sample Person Selection on page 4. If no eligible family in household,

go to Question 3 on page 4.

6. ComDlete 2i after exam appointment has been made.

1

— 1

2a. NAME

2c. HAND CARD S 1. Por favor, ddme el numero del grupo o grupos que

2b. IF NOT

‘: i i i f i ;( ; : ‘! $~?’

COMPLETED

represents (n) el origen national o ascendencia de ——.

FIRST, MIDDLE, LAST

o

124

REF.

PERSON
fi FAMlLY#2

2c, HAND CARD S1. Por favor, d6me el rrtimero del grupo o grupos que

2a. NAME

@ ! i ““: i : !! : ; : ‘y! =’?:

representa (n) el origen national o ascendencia de -–.

FIRST, MIDDLE, LAST

HEAD
‘1

SAMPLE PERSON SELECTION GUIDE

. Using the table below select Sample Person(s) following the pattern circled for each age category.

● For each Sample Person selected, circle mark in column 2g and complete column 2h on page 3.

II

SAMPLE PERSON SELECTION TABLE

NOTE: . Sample selection patterns E, H, I and J are to be used only in Dade County, Florida.

● Sample selection patterns A, B, C, D, F and G are to be used only outside of Dade

County, F Iorida.

. Sample selection pattern K is to be used in all locations.
ASK EVERYONE:

3. ZPodria darmesu ntimero dete16fono encasode quemioficina quisiera verificar mitrabajo?

o136 NLmero de teldfono

( )

Cifra de iirea

o137 I •l No hay teldfono

T ❑ No quiso darlo

o13e o139 0140

4. DATE OF INTERVIEW: Ill

MONTH

Ill

DAY

Ill

YEAR

5. CHECK ONE:

o141 I ❑ NO eligible families. THANK RESPONDENT AND TERMINATE INTERVIEW.

2 ❑ Eligible family (ies), no Sample Person(s). THANK RESPONDENT AND

TERMINATE INTERVIEW.

3 ❑ Eligible family (ies), with Sample Person(s), COMPLETE SAMPLE PERSON

QUESTIONNAIRE(S) FOR EACH SAMPLE CHILD (AGE 6 MONTHS –

11 YEARS) AND EACH AVAILABLE SAMPLE ADULT (AGE 12 – 74

YEARS); THEN COMPLETE APPROPRIATE FAMILY QUESTIONNAIRES(S).
II

Oepertment of Health and Human services

Public Health service

Office of Heekh Research, Statisticsand Technology

Netional Center fcwHealth Stetisti=

PHS #6215 9/82

OMB No. 0937-0078

Approval Expires: 2/85

HISPANIC HEALTH AND NUTRITtON EXAMINATION SURVEY

FAMILY QUESTIONNAIRE (520)

NOTICE: Information contained on this form which would permit identification of any individual or establishment has been collected with a guarantee that it will be held in strict confidence, will be used only for purposes

stated for this study, and will not be disclosed or released to others without the consent of the individual or the

establishment in accordance with Section 308(d) of the Public Health Service Act (42 USC 242m).

WESTAT o100

lD#:

STAND # SEGMENT # SE RIAL# m

I I I I

i
Q.9

ADDRESS:

Apt. No, City

State Zip Code

INTERVIEWER NAME: NO:o109 REVIEWER NAME: No:o110

LANGUAGE OF INTERVIEW

o106

R English

•l Spanish

cm lClam

TIME BEGAN __ _—2D pm
A. FAMILY RELATIONSHIPS

A-1. ENTER SP #AND FIRST NAME

OF EACH SP IN FAMILY AGED 19

OR UNDER. IF NO SUCH Sp’s, GO

TO A-2.

o111

0112

0113

/

I

sP# “ FIRST NAME

I

SP # FIRST NAME

I

SP # FIRST NAME

A-2. CHECK ITEM:

o121 I ❑ No SP’S aged 19 or under (B-1)

2 El Two or more children in A-1 (A-5)

3 ❑ One child in A-1 (A-3)

A-3. Does ––’s natural father live in this household?

(IF YES, SPECIFY WHICH PERSON)

3022-IZ3 la Nota HH member

2 ❑ Sample Person – SPECIFY SP # _

3 ❑ HH member, not a SP

A4. Does ––’s natural mother live in this household?

(IF YES, SPECIFY WHICH PERSON)

30Z4IZEI loNota HH member

2 ❑ sample Person – SPECIFY SP #_

}

(B-1]

3 ❑ HH member, not a SP

A-5. Do (Names in A-1) (all) have the same natural

o126father?

1 ❑ Y (A-6) 2 ❑ N(A-7)

ASK FOR EACH CHILD BEFORE GOING

TO A-11.

A-10. Does ––’s natural father live in this household?

(IF YES, SPECIFY WHICH pERSON) (pROBE

IF NECESSARY: Is this the same as for ––?)

m

33 134 I •l Not a HH member

2 ❑ Sample Person – SPECIFY SP #_

3 ❑ HH member, not a SP

m

13s 1ST o El same as other child – CHILD’S SP #_

I II Not a HH member

2 ❑ Sample Person – SPECIFY Sp #_

3 ❑ HH member, not a SP

30138 140 00 Same as other child – CHILD’S SP #—

1 El Not a HH member

2 II .Sample Person – SPECIFY SP #—

3 H HH member, not a SP

A-6. Does their natural father live in this household?

(IF YES, SPECIFY WHICH PERSON)

0-027 128 1❑ Not a HH member

2 ❑ Sample Person – SPECIFY SP #_

3 ❑ HH member, not a SP

A-7. Do (Names in A-1) (all) have the same natural

mother?

o129 lDY 20 N (A-9)

A-6. Does their natural mother live in this household

30

(IF YES, SPECIFY WHICH PERSON)

130 131 1 ❑ Nota HH member

2 ❑ Sample Person – SPECIFY SP # _

3 ❑ HH member, not a SP

A-9. CHECK ITEM:

o1321❑ “Y”in A-5 and A-7 (B-1)

2 ❑ “Y” in A-5 and “N” in A-7 (A-11)

3 ❑ “N” in A-5 (A-IO)

IF “Y” IN A-7, GO TO B-1.

A-1 1. Does ––’s natural mother live in this household

(IF YES, SPECIFY WHICH PERSON) (PROBE

IF

?0

62 163 1❑

20

30

x)

164 166 on

10

20

30

0-0

167 16900

In

20

NECESSARY: Is this the same as for ––?)

Not a HH member

Sample Person – SPECI FY SP #_

HH member, not a SP

Same as other child – CHI LD’s Sp # _

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

Same as other child – CHILD’S SP # _

Not a HH member

Sample Person – SPECIFY SP #_.—

3 ❑ HH member, not a SP
o114 I

5P * FIRST NAME

o115 /

5P : FIRST NAME

o116 I

5P = FIRST NAME

o117 I

SP = FIRST NAME

o110 I

SP * FIRST NAME

o119 I

5P # FIRST NAME

o120 I

5P # FIRST NAME

m141 143~D

In

20

30

S@”

In

20

30

@-@::

20

30

O(ID

150 15200

20

30

m

153 155 “n

10

20

30

00

156 158 on

In

20

30

(m::

20

30

I

I

1

I

Same as other child – CHILD’S 5P #_

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a 5P

Same as other child – CHILD’S 5P #_

Not a HH member

Sample Person – SPECIFY SP #—_

HH member, not a 5P

Same as other child – CHILD’S 5P #_

Not a HH member

Sample Person – SPECIFY 5P #—

HH member, not a 5P

Same as other child – CHILD’S 5P #_

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

Same as other child – CHILD’S 5P #_

Not a HH member

Sample Person – SPECIFY 5P #_

HH member, not a SP

Same as other child – CHILD’S SP #_

Not a HH member

Sample Person – SPECIFY Sp #_

HH member, not a SP

Same as other child – CHILD’S SP #_

Not a HH member

Sample Person – SPECIFY 5P #—

HH member, not a Sp

30170 1720H

10

20

30

30

173 175 On

In

20

30

m

176 17Bo D

10

20

30

Emu

In

20

3U

10

20

30

Goon

In

20

30

Same as other child – CHILD’S 5P # _

Not a HH member

Sample Person – SPECIFY’ 5P #_

HH member, not a 5P

Same as other child - CHILD’S 5P #—

Not a HH member

Sample Person – SPECI FY 5P #—

HH member, not a SP

Same as other child – CHILD’S 5P #_

Not a HH member

Sample Person – SPECIFY 5P #_

HH member, not a SP

Same as other child – CHILD’S 5P #

Not a HH member

Sample Person – SPECIF’f Sp #_

HH member, not a SP

Same as other child – CHILD’S 5P #_

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SPSame as other child – CHILD’S SP #_

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

00IEB 190 0 ❑ same as other child – CHILD’S Sp #—

I ❑ Not a HH member

2 ❑ .Sample Person – SPECIFY 5P #_

30 HH member, not a 5P

3
‘1

R-.. FAMII-V . ..-.---—CHARACTERISTICS --------—

‘o101 NCHS USE ONLY

FILL FIRST COLUMN FOR HEAD OF FAMILY, THEN COMPLETE

REMAINING COLUMN(S) FOR (OTHER) SAMPLE PERSON(S) IN

FAMILY.

B-1. Name (TRANSCRIBE FROM PAGE 3 OF SCREENER) B-1

B-2. SP number (TRANSCRIBE FROM PAGE 3 OF SCREENER; USE 99 FOR HEAD, IF NOTSP) B-2 o191 (HEAD OF FAMILY)

B-3. Age (TRANSCRIBE FROM PAGE 30F SCREENER) B-3 o

MONTHS

o

YEARS

192 193

B-4. Sex B-4 o194 1 ❑ Male z •l Female

B-5. ENTER OBSERVED RACE FOR EACH PERSON WHOM YOU ARE ABLE TO OBSERVE. B-5 o1951fl W 2DB 300 9 ❑ Not ohs.

B-6. In what state or foreign country was –– born? (ENTER THE NAME OF THE STATE OR

FOREIGN COUNTRY) B-6 @ [~ State or foreign country

Io197

IF UNDER 5 YEARS OLD, MARK “NEVER ATTENDED.”

B-7

OOU Never attended or

Kindergarten only (B-9)

Elem . . . ..l 2345678

B-7. What is the highest grade or year of regular school –– has ever attendad? High . . . . . 9 10 11 12

(CIRCLE APPROPRIATE NUMBER) College . . . 12345+

B-8. Did –– finish (number in B-7) (grade/year)? B-8 o1981 ❑ Yes 2CIN0

B-9 o199 oCi Under 14

I ❑ Married – spouse in HH

B-9. IF UNDER 14, MARK FIRST BOX AND GO TO B-10. OTHERWISE ASK: 2 •l Married – spouse not in HH

Is –– now married, widowed, divorced, separated or has –– never been married? 3 ❑ Widowed

4 ❑ Divorced

(IF MARRIED, REFER TO HOUSEHOLD COMPOSITION AND MARK ACCORDINGLY.) 5 ❑ Separated

6 El Never married

B-10. CHECK ITEM B-10 o200 1 •l under 17 yrs. old (NEXT SP)

2U 17+yrs. old (B-n)

B-1 1. Did –– ever serve in the Armed Forces of the United States? B-11 @ 1 •l Yes 2UN0
.4

B-12, During the past 2 weeks, did -– work at any time at a job or business, not counting work around

~he house? (INCLUDE UNPAID WORK IN THE FAMILY (FARM/BUSINESS).)

B-13. Even though –– did not work during those 2 weeks, did –- have a job or business?

B-14. Was -- looking for work or on layoff from a job?

B15, Which, looking for work or on layoff from a job?

6-16. CHECK ITEM; MARK A BOX ONLY IF “NO” IN B-14.

B-17. For whom did –– work? ENTER NAME OF COMPANY, BUSINESS, ORGANIZATION, OR

OTHER EMPLOYER,

B-18 For whom did -– work at –– last full-time civilian job or business lasting 2 consecutive weeks or

more? ENTER NAME OF COMPANY, BUSINESS, ORGANIZATION, OR OTHER EMPLOYER,

B-19. What kind of business or industry is this? (For example, TV and radio manufacturing, retail shoe

storer State Labor Department, farm.)

8-20. What kind of work was –– doing? (For eNample, electrical engineer, stock clerk, typist, farmer.)

6-21. What were -–’s most important activities or duties at that job? (For example, types, keeps

account books, files, sells cars, operates printing press, finishes concrete,)

COMPLETE FROM ENTRIES IN B-17 THRU 6.21; ‘-

IF NOT CLEAR ASK:

B-22. Was –– an employee of a private company,

business or individual for wages, salary

or commission? . . . . . . . . . . . . . . . P

—— a Federal government employee? . . . F --

-— a State government employee?. . , . . S

—- a local government employee? . , . . . L -—

self+ mployad in ~ business,

professional practice, or farm?

IF NOT FARM, ASK: Is the

business incorporated?

Yes. ... ... ,.. . . ..nl

No, . . . . . . . . . . . . ..sE

working without pay in family

business or farm?. . . , . . . . . . WP

never worked or never worked

at a full-time civilian job lasting

2weeks or more . . . . . . . . . . NEV

4

B-12

B-13

B-14

6-15

B-16

6-17

&

B-18

B-19

B-2o

B-21

B-22

o201

I ❑ Yes (B-17) 2Ci No

pj ICIY,S 211No

3

204 1 ❑ Yes 2 ❑ No (B-I6)

3

I H Looking (B-IB)

205 2 •l Layoff (6-17)

3 •l Both (B-17)

o206 I ❑ “Yes” in B-13 (6-17)

2 •i “No” in B-13 (NEXT SP)

Employer

Industry

(=)

Occupation

o2oe

Duties

o209

Class of worker

lCIP

2i3F

30s

40L

501

6 USE

71JWP

011 NEV
0)

MONTHS YEARS MONTHS YEARS

B-3 B 3 MONTHS YEARS

o 0 0 0

B-3

192 193 192 193 0192 0193

B-4 o194 I ❑ Male 2 •l Female B-4 o194 1 ❑ Male 2 ❑ Female B-4 o194 1 ❑ Male 2 ❑ Female

B-5 o195 lDW 2CIB 300 gCINotobs. B-5 o195 low 2CIB 3CICI gtl Notobs. B-5 o195 lUW 2UB 3C10 gCINotobs.

‘-6 @m State or foreign country ‘-6 @m State or foreign country ‘-6 @m State or foreign country

o197 0197 0197

OOCI Never attended or 000 Never attended or 000 Never attended or

B-7 Kindergarten only (B-9) B-7 Kindergarten only (B-9) B-7 Kindergarten only (B-9)

Elem . . . ..l 2345678 Eiem . . . ..l 2345678 Elem . . . ..l 2345678

High . . ...9 10 11 12 High . . . . . 9 10 11 12

College . . .1

High . . . . .9 10 11 12

2 3 4 5+ College . . . 1 2 3 4 5+- College . . . 1 2 3 4 5+

B-8 o198 1 ❑ Yes 20 No B-8 o198 1 ❑ Yes 2CIN0 B-8 o198 1 ❑ Yes 2C!N0

o199 0 ❑ Under 14 0

199 0 ❑ Under 14 0199 0 El Under 14

I ❑ Married – spouse in HH 1 ❑ Married – spouse in HH 1 ❑ Married – spouse in HH

B-9 z •l Married – spouse not in HH B-9 2 II Married – spouse not in HH B-9 2 •l Married – spouse not in HH

3 •! Widowed 3 ❑ Widowed 3 •l Widowed

4 El Divorced 4 ❑ Divorced 4 ❑ Divorced

5 ❑ Separated 5 El Separated 5 ❑ Separated

6 ❑ Never married 6 ❑ Never married 6 ❑ Never married

o200

B-10

1UUnder 17 yrs. old (NEXT SP) B-lo o200 1•lUnder 17 yrs. old (NEXT SP) B-lo 0200 I ❑ Under 17 yrs. old (NEXT SP)

20 17+yrs. old (B-II) 2 ❑ 17+ yrs. old (B-n) 2 R 17+yrs. old (B-n)

B-11 @ 1 ❑ Yes 2UN0 B-1 1 o201 1 ❑ Yes 2CIN0 B-n @ 1 ❑ Yes 2UN0

o202 0202

1 •l Yes (B-17) o202

B-12

20N0 B-12 1 ❑ Yes (B-17) 2JN0 B-12 1 ❑ Yes (B-17) 20N0

B-13 @ 1 Cl Yes 2CIN0 B-13 o203 1 ❑ Yes 2CIN0 B-13 @ 1 ❑ Yes 2CIN0
B-14 @ 1 II Yes 20 No (B-16) B-14 o204 1 IJ Yes 20 No (B-16) B-14 o204 1 •l Yes 2 El No (B-1

1 D Looking (B-18)

B-15 @ 2 ❑ Layoff (B-17)

3 •l Both (B-17)

I ❑ Looking (B-l B)

o205 z •l Layoff (B-17)

3 •l Both (B-17)

I ❑ Looking (B-18)

o205 2 ❑ Layoff (B-17)

3 •l Both (B-17)

B-15 B-15

B-16 @ B-16

10 “Yes” in B-13 (B-17)

z ❑ “No” in B-13 (NEXT SP) o206

I El “Yes” in B-13 (B-17)

2 ❑ “No” in B-13 (NEXT SP) o206

1 •l “Yes” in B-13 (B-17)

z ❑ “No” in B-13 (NEXT SP)

B-16

Employer Employer Employer

B-17

&

B-18

B-17

&

B-18

B-17

&

B-18

Industry

B-19

o207

Industry

m

Industry

o207

B-19

B-20

B-19

Occupation

B-20

o200

Occupation

o208

Occupation

B-20 (a

I Duties Duties Duties

B-21 B-21 B-21

o B-22 B-22

209

Class of worker

o209 0209

B-22 Class of worker

lCIP

2CIF

30s

4CIL

501

6CISE

7nwP

OCI NEV

Class of worker

lCIP

zIJF

30s

4CIL

501

6CISE

70WP

oCI NEV

lnP

zUF

3US

4CIL

501

6nsE

7CIWP

o ❑ NEV

5
w

0

c. HEALTH INSURANCE

Medicare isa Social SecuriW health insurance program fordisabled persons and forpersons 65years old and over. People covered by Medicare have acard I

that looks likethis. (SHOW CAR DF-1)

c-1. (is/Are) (name(s) of all SP’S in family) now ❑ Yes, oneormore SP’s covered

covered by Medicare? ❑ No, no SP’scovered (C-6)

ASK FOR EACH SP. MARK BOX IN EACH COLUMN BEFORE ASKING C-3.

c-2. Is –– now covered by Medicare?

—.

................................................................. ....................................

~EACH PERSON WITH “COVERED” IN C-2, ASK C-3 AND C-4,

c-3. Is –– now covered by the part of Social Security Medicare which pays for hospital bills?

c-4. Is –– now covered by that part of Medicare which pays for doctor’s bills? This is the Medicare plan for

which –– or some agency must pay a certain amount each month.

ASK C-5 FOR EACH PERSON WITH “DK” IN C-3 AND/OR C-4.

c-5. May I please see the Social Security Medicare card(s) for -– (and --) to determine the type of

coverage? TRANSCRIBE THE INFORMATION FROM THE CARD OR MARK THE “CARD

NOT AVAIL. ” BOX.

..................

C-6. We are interested in all kinds of health insurance plans except those which pay only for accidents.

(Not counting Medicare) (is/Are) (name(s) of all SP’S in family)

now covered by a health insurance plan which pays-any part ❑ Yes

of a hospital, doctor’s, or surgeon’s bill? ❑ No (C-12)

c-7. What is the name of the plan? (RECORD IN TABLE H. I.; RETURN TO C-8.)

C-8. (is/Are) (names of all SP’S) now covered by any other health

insurance plan which pays any part of a hospital, doctor’s, ❑ Yes (REASK C-7& C-8)

or surgeon’s bill? ❑ No (C-9)

c-3 ~lEI Yes 20N0 9C!DK

C4 @l Cl Yes 20N0 9CIDK

c-5 o213 1 ❑ tioSp.

2 ❑ Med.

I s ❑ Card not avail. ~~
TAD ICU1 I I

,H” LL ,, .,.

PLAN 1

C-10. Does this plan pay any part of doctor’s or surgeon’s

bills for operations?

c-9. Does this (name) plan pay any

part of hospital expenses? o

2!5 1 ❑ Yes 20 NO 90 DK

o

21J 1 U Yes ZO No 9D I)K C-1 1. Is –– covered under this (name) plan?

(MARK BOX FOR EACH SPJ c-1 1 @ ‘rEl Cov. 2 ❑ Not COV, 9nDK

PLAN 2 C-10. Does this plan pay any part of doctor’s or surgeon’s

bills for operations?

C-9. Does this (name) plan pay any

part of hospital expenses? o

21H ID Yes 21J No 90DK

v w

o

.217 ~n DK C-II. Is –- covered under this (name) plan?

1❑ Yes ZONO (MARK BOX FOR EACH SP.) c-1 1 ~ 1 Q Cov, 2 ❑ Not COV. 9CIDK

PLAN 3

C-10. Does this plan pay any part of doctor’s or surgeon’s

bills for operations?

c-9. Does this (name) plan pay any

_o

.

22 I 10 Yes 2D No 9U DK

part of hospital expenses?

o

C-1 1. Is –- covered under this (name) plan?

-/20 1❑ Yes 2CIN0 90 DK (MARK BOX FOR EACH SP,) c-1 1 @ 1 ~ c@J- 2 ❑ Not COV, 9UDK

C-12. CHECK ITEM: REVIEW C-2 AND C-11, AND MARK BOX FOR EACH SP. IF ALL COVERED,

o

223 1 ❑ Covered

GO TO SECTION D. IF NOT, CONTINUE. C-12 2 El Not covered, under 65 yrs. old

3 ❑ Not covered, 65+ yrs, old

ASK C-13 – C-15 FOR EACH PERSON “NOT COVE RED.”

o

224 1 23456789

C.13, Many people do not carry health insurance for various reasons. (SHOW CARD F-2) 7

C-13 IQ

Which of these statements describes why –– is not covered by any”health insurance? (IF 65+): SPECIFY

or Medicare?

C-14, Any other reason?

o

1 •l Yes (REASK C-13 & C-14)

C-14 215 ~ ❑ No

MARK BOX IF ONLY ONE REASON GIVEN; OTHERWISE ASK:

o

226 000 Only one reason in C-13

C-15. What is the main reason -- is not covered by any health insurance? (IF 65+): or Medicare? c-15

OR 123456789 7

10

sPECIFY

6
c-3 ~lCIYes 2CIN0 9CIDK c-3 o211 I El Yes zLINo 9UDK c-3 @l Ryes 2CIN0 9EIDK

C4 @llJ Yes 2Ci No 9LIDK c-4 o212 1 ❑ Yes 2GN0

I .>.>~,.:.: ....~.............* ..................................y..............~.~.................................>~

I

o2!3 1 ❑ Hosp.

o

213 I •l HOSP.

o

213 1 ❑ HOSP.

c-5 2 •l Med. c-5 2 ClMed. c-5 2 •l Med.

3 ❑ Card not avail. 3 0 Card not avail. 3 El Card not avail.
— i

C-11 o216 1 ❑ cov. 2 ❑ Not COV, 9EIDK c-1 1

0

216 1 ~ cov. 2 ❑ Not COV,

o

9CIDK c-1 1 216 1 ❑ COV, 2 ❑ Not COV. 9CIDK

— — m . m

c-1 1 @ 1 ❑ Cov. 2 ❑ Not COV. 90 DK c-1 1 @ 1 ❑ Cov. 2 H Not COV. 9CIDK c-1 1 @ 1 ❑ Cov, 2 ❑ Not COV. 9ci DK

—

2-11 @ 1 ❑ Cov. 2 ❑ Notcov. 90 DK C-11 @ 1 ❑ Cov. 2 ❑ Not COV. 9CIDK c-1 1

0

222 1 ❑ Cov, 2 ❑ Not COV. 9EIDK

o

223 1 ❑ Covered

o

223 1 H Covered

o

223 I ❑ covered

:-12 2 ❑ Not covered, under 65 yrs. old C-12 2 ❑ Not covered, under 65 yrs. old c-1 2 z ❑ Not covered, under 65 yrs. old

3 ❑ Not covered, 65+ yrs, old 3 ❑ Not covered, 65+ yrs. old 3 ❑ Not covered, 65+ yrs, old

—

:-13 o224 1 234 56789 C-13 o

22d I

7

23456789 7

C.13 0224 1 23456789

10 10 10 7

SPECIFY SPECIFY SPECIFY

o

:-14 225

I II Yes (R EASK C-13 & C-14)

o

I ❑ Yes (R EASK C-13 & C-14)

C-14 225 ~ ❑ No

o

1 ❑ Yes (R EASK C-13 & C-14)

C-14 IIS z ❑ No

2UN0

o

226 00 ❑ Only one reason in c-13

o

226 00 ❑ only one reason in C-13

o

226 00 ❑

2-15 C-15

Only one reason in C-13

OR 123456789 OR 123456789

c-1 5

7 1

OR 123456789

10 10 10 ?

SPECIFY SPECIFY SPECIFY

7
D. INCOME ASSISTANCE

D-l. (Does/Do) (game(s) of a~’s in family) now receive assistance through the “Aid to Families with

Dependent Children” Program, sometimes called “AFDC” or “ADC”?

❑ Yes ❑ No (D-3) •l DK (D-3)

D-2, ASK FOR EACH SP: IS -- included in the AF DC assistance payment? D-2

D-3, (Doss/Do) (nama(s) of all SP’S) now receive tha “Supplamantal Security Income” or “SSi”

gold.colorad chack?

❑ Yes ❑ No (D-5) El DK (D.5)

6’210Yes 2Df$jcI aICIDK

D.4. ASK FOR EACH SP: Does -- rocaiva this chack?

D*6 There is a national program caliad Nladloaid which payg for haalth oara for parsons in naad,

(in this Steta it is also caiiad — J During the past 12 months,

(has/hava) (~ame(s) of SP’S) received haalth cara which has been or wili ba paid for by

Medicaid (or )? ,,,,,,,~ ,,

❑ Yes ❑ No (D.7) ❑ DK (D-7)

,,, ,,,,,,,’ ,,

,,,,,, ,., ,,

,,,,,,,,,,, ,

D-6, ASK FOR EACH SP: Did -- raceive this cera? ID-6 IO-J 2nN0 eCIDK

D-8, ASK FOR EACH SP: Does -- have a Medicaid (or ) card? D-8 @l Cl Yes 2CIN0 DCIDK

ASK FOR EACH SP WITH “YES” IN D-8, D-9 G •l Medicaid card seen=

D-9. May I pleasa see --’s (and --’s . . J card(s)? MARK APPROPRIATE BOX(ES) IN EACH SP’S I

Iw

1 ❑ Current t

COLUMN, BEFORE ASKING D-10, 2 •l Expired

3 El No card seen

4 ❑ Other card saen 7 5

SPECIFY
D-10. (is/Are) (name(s) of all SP’S)now covered by any other public assistance program that pays for

health care?

❑ Yes ❑ No (D-12) •l DK (D-12)

D-11, ASK FOR EACH SP: Is -- covered?

..... ...........4..

D-12. (Does/Do) (name(s) of all SP’S) now receive military retirement payments from any branch of the

Armed Forces or a pension from the Veteran’s Administration? Do not include VA disability

compensation.

❑ Yes ❑ No (D-15) ❑ DK (D-15)

D-1 1 o232 1 n ‘fes ZUNO 9CIDK

,:.“+:.:.“.“.:.‘.“+:.:.:.:.:.:.:.: +:+:+:-:.:.:.:.:.:.:.: +:.:.:.:.:.:.:.:.:.:.: .:.:.:...:.:.:.:.:.: .:.x.x.:+:+:.x.:.:.:.:.:.:.:.:.:.:.

D-13. ASK FOR EACH SP: Does –– receive these payments or the pension? D-13 o233 1 ❑ ‘fW zCINO 9CIDK

ASK FOR EACH PERSON WITH “YES” IN D-13.

D-14. Which does -- receive; the Armed Forces retirement, the VA pension, or both?

D-15. (is/Are) (name(s) of all SP’S) now covered by CHAMP-VA, which is medical insurance for dependents

or survivors of disabled vaterans?

•i Yes ❑ No (D-17) ❑ DK (D-17)

D-16. ASK FOR EACH SP: Is –– covered by CHAMP-VA?

.................. . ......................................................................,. . ,, ,, . . . . .. ,,,,,,,,, ....... . . ...,. . . . ... ,,,,,............................................................................ . .. .. .,.,.,.,.,.,., ,,,.. , . . ................................................................................................................................................................................................... .. . .. . .. . .,. ,, ,,,, ,

D-17. (is/Are) (name(s) of all SP’S) now covered by any other program that provides health care for military

dependents or survivors of military persons?

0234 1 ❑ AF zDVA 3 ❑ Botl

,+.:.:, +,:.:,:,:,:,:,:, y.,:,:,:,:,:,:.:,:.:. +.y,.:. >:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.x.;.:.x

D-1 6 o235 1 ❑ YW 2Ci No 9nDK

,:,7.,:,:,:,:,:,:,:,:.:. :.>}:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.x.:...........

I

❑ Yes ❑ No (D.19) ❑ DK (D-19) ‘

D-18. ASK FOR EACH SP: Is -- covered?

.,, ,,, .........

D-19. CHECK ITEM: REFER TO B-3 AND B-11 AND MARK FIRST APPLICABLE BOX.

D-20. Does –– have a disability related to -– service in the Armed Forces of the United States?

D-21. Does –– now receive compensation for this disability from the Veteran’s Administration?

D-19 o237 I ❑ under 17 years (NEXT 5P)

2 ❑ “No” in B-11 (N EXTSP)

3 ❑ “Yes” in B.11 (D-20)

~

D-20 ZM I ❑ Yes (D-21) z ❑ No (NEXTSH

N

m

B
I

Iv

0)

B-1

D-9

o101 NCHS USE ONLY I

I B-1

I

I

B-2

4 I

3

2291 ❑ YF?S 211N0 9CIDK ID-6

3

2301 ❑ yf3S 211No 9CIDK ID -8

3

231 ❑

30

40

Medicaid card seen ~ I D-9

1 ❑ Current t

2 •l Expired

No card seen

Other card seen

7

5

SPECIFY

o101 NCHS USE ONLY I

I

B-1

2

191 B-2

%1 •l Yes 21JN0 91JDK ID-2

o2281 ❑ Yes 2CIN0 90DK D4

3229 1 ❑ yeS 2UN0 9CIDK I

D-6

3

230 1 ❑ YE!S 2CIN0 9ci DK

fi •l Medicaid card seenw

1 ❑ Current {

2 ❑ Expired

3 ❑ No’card seen

4 ❑ Other card seen 7

5

SPECIFY

D-8

D -9

0101 NCHS USE ONLY

o191

92271 ❑ yeSL

2CIN0 9!ZIDK

o2281 ❑ Yes 2CIN0 9CIDK

o2291 ❑ Yes 2CIN0 9DDK

9

2301 ❑ YFX 2CIN0 91-JDK

o231 ❑

30

40

Medicaid card seen

1 ❑ Current 7

2•lExpired

No card seen

Other card seen 7

5

SPECIFY
D-1 1 lmI ❑ Yes 2Ci No 9nDK

D-13 o2331 ❑ yf3S 20N0 9CIDK

L ,,,, _

D-14 2341 ❑ ~~ 2CIVA 3 •l Both

...........................................................................................................................................~.........~

~_

D-16 2351 ❑ yeS zCINO 9nDK

.............................................................................................................................................................

D-18 102361 H Y!3S 2CIN0 91JDK

,...................... ..............................................................................................................................................................

I

D-19 @I ❑ Under 17 years (NEXT SP)

2 II “No” in 8-11 (N EXTSP)

3 ❑ “Yes” in B.11 (D.ZO)

D-20 oZ3E I ❑ Yes (D-21) z ❑ No (NEXT SP)

D-21 102391 ❑ yes 2CIN0

D-11

-

.....................

D-13

D-14

D-16

~—

D-18

—~

D-19

D-20

D-21

o2321 ❑ Yes ZUNO 9CIDK

~.:.:.~.:.:.:.:.:.:.:,:,:.:.:.:.:.;.:.:.:,:.:,:,:.:#:!:t:.:,:,:.:.:.:.:,:,:l:!:.::.......................-:.:-:.:.:.:.:.:.:.:.:.:.:-:.:.:.:.:.:.:

o233 1 ❑ YeS 2UN0 9CIDK

o234 1 ❑ AF 2CIVA 3 •l Both

:.:.:.:.:.: .:.>.:. Y..:.:.:. !w:.:.:.:,: !:.:,:,:.7., x.:,:.:.>:.: .:.:.: .:.:.:.!.:.:,!.:.:,:.:.:.:.:.:.:.:.:.:.:-:.:.:.:,:.:,:.:,:.:.:.:.:.:,

~,

2351 ❑ YeS 2UN0 9CIDK

.>:,:,:.:. },,:.:.:.:,:. }:,:.:.:.:,:.:, x!:,:,:,:,:.:,:,:,:,:,:,:.:.:.:.:,=,:,:.:,+.:.~.~.:.:.x::::::::::::~

o236 1 ❑ YeS zCINO 9nDK

o

2371❑ Under 17 years (NEXT SP)

z ❑ “No” in B-11 (NEXT SP)

3 ❑ “Yes” in B-11 (D-20)

o23e 1 II Yes (D-21) z ❑ No (NEXT SP)

o239 1 ❑ YeS zCINO

D-1 1

D-13

D-14

D-18

-WL&ku

D-19

D-20

D-21

o233 1 ❑ YeS ZONO 9nDK

o2341 ❑ AF 2UVA 3 ❑ Both

:.:.w..:.:.:.:.:,:.:,:,:,:,:,:,:,:,:,:{.:.:.:.:.?..:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.: m

o235 1 ❑ ‘feS 2CIN0 9nDK

(G)1O Yes 2LIN0 9nDK

o2371 ❑ Under 17 years (NEXT SP)

2 •l “No” in B-11 (NEXT W)

3 ❑ “yes” in B.1 I (D.ZO)

oz3e 1 •l Yes (D-21) 2 ❑ No (N EXTSP)

,0239 1 H yes 2CIN0

9
‘1

I

m

E. HOUSING AND INCOME

m

I

E-1. How many rooms are in this ––? Count the kitchen but not the bathroom.

E-2. Do you have access to complete kitchen facilities in (this house/these living quarters); that is, a kitchen

sink with piped water, a refrigerator and a range or cookstove?

E-3. What is the main fuel used for heating this home?

E4. What is the main heating equipment for this home?

E-1

E-2

E-3

E-4

2

240 Rooms

number

2

24! 1 •l Yes 2J No

01 ❑ Oil

w

02 ❑ Natural gas

03 El Electricity

04 El Bottled gas (propane)

05 •l Kerosene

06 ❑ Wood

07 ❑ coal

OE R Other w

SPECIFY

00 •l No fuel used

o243

01 •l Steam or hot water with radiators or

connectors

02 •l Central warm air furnace with ducts

to individual rooms, or central heat

pump

03 ❑ Built-in electric units (permanently

installed in wall, ceiling, or baseboard)

04 •l F Ioor, wall or pipeless furnace

05 •l Room heaters with flue or vent,

Ixsm”mg oil, gas, or kerosene

06 U Room heaters without flue or vent,

burning oil, gas, or kerosene

07 ❑ Heating stove burning wood, coal,

or coke

0ss ❑ Fireplace(s)

0ss ❑ Portable electric heater(s)

10 •l Other (SPECIFY)l’

00 •l NO heating equipment used (E-7)

99 El Don’t know
&

E-5. Are any other types of equipment used for heating this home? (1F MORE THAN ONE TYPE IS

MENTIONED, MARK ONLY THE ONE USED MOST.)

E-6. What is the main fuel used by this additional equipment?

10

E-5

E-6

3

!44

01 •1

02 •1

03 ❑

04 El

05 ❑

06 ❑

07 ❑

08 ❑

090

Steam or hot water with radiators or

connectors

Central warm air furnace with ducts

to individual rooms, or central heat

pump

Built-in electric units (permanently

installed in wall, ceiling, or baseboard)

Floor, wall or pipeless furnace

Room heaters with flue or vent,

burning oil, gas, or kerosene

Room heaters without flue or vent,

burning oil, gas, or kerosene

Heating stove burning wood, coal,

or coke

Fireplace(s)

Portable electric heater(s)

10 ❑ Other (SPECIFY) 11

00 ❑ No other heating equipment used (E-7)

o245 01 ❑

02 •1

03 ❑

04 ❑

05 ❑

06 ❑

07 ❑

Oe ❑

00 •1

Oil

Natural gas

Electricity

Bottled gas (propane)

Kerosene

Wood

Coal

Other 09

SPECIFY

No fuel used
E-7. What is the main fuel used for cooking in this home?

E-8. Do you have air-conditioning - either individual room units, a cantral systam or avaporativa cooling?

E-9. Which do you have?

E-10. Was the total combined family incoma during the past 12 months – that is, yours, (read names of all

family members, including Armed Forces members living at home) more or less than $20,000? Include

money from jobs, Social Security, retirement income, unemployment payments, public assistance,

and so forth. Also include income from interest, dividends, net income from business, farm or rent,

and any other money income received.

READ PARENTHETICAL PHRASE IF ARMED FORCES MEMBER LIVING AT HOME OR IF

NECESSARY.

E-1 1. Of those income groups, which letter best represents the total combined family income during the

past 12 months (that is, yours, (read names, including Armed Forces members living at home))?

include wages, salaries, and the other items we just talked about.

E-7

E-8

E-9

E-10

E-1 1

0240 01 ❑ Oil

02 ❑ Natural gas

03 ❑ Electricity

04 ❑ Bottled gas (propana)

os El Kerosane

oe ❑ Wood

07 ❑ coal

06 ❑ Clther m

SPECIFY

00 ❑ No fuel used

o247 1 ❑ Yes ZU No(E-1O)

o248 I ❑ Individual room unit

2 ❑ Central air-conditioning

3 ❑ Evaporative cooling

o249 1 ❑ $20,000 or more

(HAND CARD F-3)

2 ❑ Less than $20,000

(HAND CARD F-4)

o250 CARD F-4

o1OA IIIJK

02CIB 12UL

03cic 13DM

04Ci D 141JN

I)50E 1500

06n F 16DP

070(3 170Q

oeEIH 180R

0901 190s

IoEi J 2011T

CARD F-3

21DU

22UV

23DW

240)(

25DY

2602

27 ❑ 22
E-12, Did any members of this family receive any Government food stamps in any of the past 12 months?

(That is, from (name of month) last year, up through (name of month) this year.)

E-12 @ lCI Yes 2 ❑ No (E-20)

E-13. In how many months of the past 12 months did any member of this family receive food stamps? E-13 o252 Months

NUMBER

E-14. Did this family receive any Government food stamps in (name of last month)? E-14 @ 10 Yes (E-16)2CI No

E-15. [n which month did any member of this family@ receive foal stamps?

SPECIFY NAME OF MONTH,

E-15 @

MONTH

E-16, For how many persons were those food stamps authorized? E-16 @ Persons

NUMBER

E-17. What was the total face value of those food stamps received by this family in (last month/month E-17 o256 $ , 00

in E-15]?

E-18. Did this family spend more for food (last month/month in E.15) than the value of your food stamps? E.18 @ 1 ❑ Yes ZD No (E-20)

.—

E-19. How much more? E.19 @$ , 00

E-20. Is your family receiving fod stamps at the present time? E-20 @ 1 ❑ Yes 2CIN0

11
I

Dopwtmont of Health and Human Swvicos

Public Health Service

Offico of Health Rowwch, Statistics and Technology

National C@nter for Hmlth Statistics

PHS s6215 9/82

OMB ftO. 0937-0078

Approval Expire,: 2/85

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

FAMILY QUESTIONNAIRE (520)

WESTAT

ID*:

NOTICE: La informaci6n contanida an asta formulario qua parmitiria idantificar a cualquiar individuo o astablecimianto ha sido recogida bajo la garant(a que ser6 mantenida en Ias mh astricta confidencialidad, sard usada

sblo para Ios propbsitos establecidos para aste estudio, y no sar~ divulgada o entragada a otros sin et consantimianto dal individuo o dai establecimiento da acuardo con la Secci6n 308(d) da la Lay dal Servicio da Salud

Pfiblica - Public Health Service Act (42 USC 242m).

10100 ~1

I

—STAND # SEGMENT # SE RIAL# I I

FAMILY ~ I

I J I I
o108

Apt. No. City

State Zip Code

INTERVIEWER NAME: 1

NO: 0109

LANGUAGE OF INTERVIEW

o106

❑ English

•!J Spanish

REVIEWER NAME: NO: ~

cm Illam

TIME BEGAN __ :__

20 pm

@-@ 10am TIME ENDED : _2n ~m
lx. G

PARENTESCOS FAMILIARS

*

A-1. ENTER SP #AND FIRST NAME

OF EACH SPIN FAMILY AGED 19

OR UNDER. IF NO SUCH Sp’s, GO

TO A-2.

I o111 ,

SP # ‘FIRST NAME

o112 I

SP # FIRST NAME

o113 I

SP # FIRST NAME

_——

A-2. CHECK ITEM:

o121 ILI No SP’S aged 190r under (B-1)

2 ❑ Two or more children in A-1 (A-5)

3 ❑ One child in A-1 (A-3)

A-3. ~Vive en este hogar el padre biologico de –-?

(IF “S1”, SPECIFY WHICH PERSON)

20

22 123 lo Nota HH member

2 ❑ Sample Person – SPECIFY SP z _

3 ❑ HH member, not a SP

A-4. ZVive en este hogar la madre biologica de ––?

(IF “S1”, SPECIFY WHICH PERSON)

30124 125 In Nota HH member

2 ❑ Sample Person – SPECIFY SP fi_

I

(B-1

3 ❑ HH member, not a SP

A-5. iTienen (todos) (names in A-1) ei mismo

padre biologico?

o126 1 ❑ s (A-6) 2 •l N (A-7)

ASK FOR EACH CHILD BEFORE GOING

TO A-11.

A-10. ZVive en este hogar et padre biologico de ––?

(IF “S1”, SPECIFY WHICH PERSON) (PROBE

lr2-0 133 134 10

20

30

10

20

30

30

138 140 on

10

20

3D

i~tt,txw+n 1 : cm el mwmp ue ——TI

Not a HH member

Sample Person – SPECI Fy Sp #_

HH member, not a SP

Same as other child – CHILD’S SP #_

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

Same as other child – CHI LD’s SP #_

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

A-6. ZVive en este hogar su padre biologico?

(IF YES, SPECIFY WHICH PERSON)

)-027 128 1 ❑ Nota HH member

2 U Sample Person – SPECIFY Sp #_

3 ❑ HH member, not a SP

A-7. ZTienen (todos) (names in A-1) la misma

madre biologica?

o129 lo s 20 N (A-9)

A-8. ZVive en este hogar su madre biologica?

)-0

(IF “SI’’,SPECIFYWHICH PERSON)

30 131 1 ❑ Nota HH member

2 ❑ Sample Person – SPECIFY SP #—

3 ❑ HH member, not a SP

A-9. CHECK ITEM:

o1321❑ “S”in A-5 and A-7 (B-1)

2 ❑ “S” in A-5 and “N” in A-7 (A-1 1)

3 ❑ “N” in A-5 (A-1O)

IF “S” IN A-7, GO TO B-1

A-1 1. ZVive en este hogar la madre biologica de ––?

(IF “S1”, SPECIFY WHICH pERsoN) (PROBE

IF

)-0

52 163 1❑

203D

64m166 on

10

2U

30

NECESSARY: LEs la misma de ––?)

Not a HH member

Sample Person – SPECIFY SP +$_

HH member, not a SP

Same as other child – CHILD’S Sp # _

Not a HH member

Sample Person – SPECIF’f SP ++—

HH member, not a SP

)Q67 leg o ❑ !jame as other child – CHILD’S SP # _

I ❑ Not a HH member

2 ❑ Sample Person – SPECIFY SP #_

3 El HH member, not a SP
o114 I

SP # FIRST NAME

o115 I

SP # FIRST NAME

o1!6 I

SP # FIRST NAME

o117 J

SP # FIRST NAME

o118 I

SP # FIRST NAME

o

119 —— /

SP # FIRST NAME

o120 -

/

SP $ FIRST NAME

00141 143.0

In

20

30

E@”

la

2U

3U

m::

20

30

m“”

10

20

30

30

153 155 on

10

20

30

0-0

156 )58 on

In

Same as other child – CHILD’S SP #_

Not a HH member

Sample Person – SPECIFY W #_

HH member, not a SP

Same as other child – CHILD’S SP #_

Not a liH member

Sample Person – SPECIFY SP #_

HH member, not a SP

Same as other child – CHILD’S SP #—

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

Same as other child – CHILD’S SP ~_

Not a HH member

Sample Person - SPECIFY SP =_

HH member, not a SP

Same as other child – CHILD’S SP =—

Not a HH member

SamPie person - SPECIFY SP =

HH member, not a SP

Same as other child - CHILD’S Sps

Nota HH member

20 Sample Person – SPECIFY SP fi_

30 HH member, not a SP

w

161 OU Same as other child — CHILD’S SP v_

I ❑ Not a HH member

2 rJ Sample person – SPECIFY SP u—

3 ❑ HH member, not a SP

lU

2U

30

o-on

173 175 “n

20

30

10

2U

30

@@”u

IQ

2CI

30

w::

20

30

@@”u

10

20

3C!

Same as other child – CHILD’S SP # _

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

Same as other child – CHI LD’s SP #_

Not a HH member

Sample Person – SPECIFY SP #_

HH member, not a SP

Same as other child – CHILD’S SP #_

Not a HH member

Sample Person – SPECIFY SP #_

Hi-l member, not a SP

Same as other child – CHILD’S SP #

Not a HH member

Sample Person – SPECIFY SP fi_

HH member, not a SP

Same as other child - CHILD’S SP #—

Not a HH member

Sample Person - SPECIFY SP #_

HH member, not a SP

Same as other child – CHILD’S Sp #_

Not a HH member

Sample person – SPECIFY SP #_

HH member, not a SP

0-0 188 190 0 ❑ same a5 other child – CHILD’S Sp #—

1 ❑ Not a HH member

20 Sample Person – SPECIFY SP #_

30 HH member, not a SP
I ~ B. CARACTERISTICAS DE LA FAMILIA

FILL FIRST COLUMN FOR HEAD OF FAMILY, THEN COMPLETE

REMAINING COLUMN(S) FOR (OTHER) SAMPLE PERSON(S) IN

FAMILY.

B-l. Name (TRANSCRIBE FROM PAGE 30F SCREENER)

B-2. SP number (TRANSCRIBE FROM PAGE 30F SCREENER; USE 99 FOR HEAD, IF NOTSP)

B-3. Age (TRANSCRIBE FROM PAGE 30 F SCREENER)

B-4. Sex

B-5, ENTER OBSERVED RACE FOR EACH PERSON WHOM YOU ARE ABLE TO OBSERVE,

B-6. ZEn cdal estado o pars extranjero naci6 --? (ENTER THE NAME OF THE STATE OR

FOREIGN COUNTRY)

IF UNDER 5 YEA RS OLD, MARK “NEVER ATTENDED. ”

B-7. ZCU41es el grado m&salto de la escuela regular que -- haya asistido en su viola?

(CIRCLE APPROPRIATE NUMBER)

B-8. LTermin6 –- el (number in B-7) (grado/afio)?

B.9. IF UNDER 14, MARK FIRST BOX AND GO TO B-10. OTHERWISE ASK:

lEsti -- ahora casado, es viudo, divorciador separado o msnca se case?

(IF MARRIED, REFER TO HOUSEHOLD COMPOSITION AND MARK ACCORDINGLY.)

B-10. CHECK ITEM

B-1 1. tSirvio –– en Ias Fuerzas Armadas de Ios Estados Unidos?

——

B-1

B-2

B-3

B-4

B.5

B-6

B-7

B-8

B-9

B-10

B-II

n

(10!) NCHS USE ONLY

YIIII

fn

~lnw 2EIB 300 ‘aEINotobs

9 m] Estado o pa(s extranjero

o197

IOU Nunca asistio o solo

“Kindergarten” (B-9)

Primaria 1 2345678

Secundaria 9 10 11 12

Universidad 1 2 3 4 5+

9

198 10s( 2UN0

o

199 OU Menos de 14

1 ❑ Casado – spouse in HH

2 ❑ Casado – spouse not in HH

3 ❑ Viudo

4 ❑ Divorciado

5 ❑ Separado

6 ❑ Nunca casado

o200 1 ❑ under 17 yrs. old (NEXT SP)

20 17+yrs, old (B-n)

o201 10s( 20N0
I

B-12. tDurante Ias 2 semanas pasadas, Ltrabajo –– por cualquier tiempo en algtin trabajo o negocio, sin B-12 o202

1 ❑ S( (6-17)

contar trabajo alrededor de la casa? (INCLUDE WORK “SIN PAGO” IN THE FAMILY

2DN0

(FARM/BUSINESS).)

n

6-13. Aunque -– no trabajo durante esas 2 semanas, itenia —— un trabajo o negocio? ]B-131~ ICISI’ 2EIN0

B-14. /Estaba –– buscando trabajo o estaba en “lay off” (desempleado por falta de trabajo)

de un trabajo?

B.14 @ lEISI’ 2 Cl NO (B-16)

B 15. <Cual, buscando trabajo o en “lay off” de un trabajo? B-15 o

1 D Buscando (B-18)

205 2 [.1 “Lay off” (B-17)

3[ 1 Ambos (617)

B-16. CHECK ITEM: MARK A BOX ONLY IF “NO” IN 814 B-16 o206

I ( I “SI’” in B-13 (B-17)

2 n “N” in B-13 (N EXTSP)

B-17. iPara quien trabajo –-? ENTER NAME OF COMPANY, BUSINESS, ORGANIZATION, OR

Patron

OTHER EMPLOYER, B-17

7

6-18 ~Para qui~n trabaj~ –– en WI (s}timo trabajo o negocio civil, a tiempo completor que duro 2

&

B-18

semanas seguidas o mas? ENTER NAME OF COMpANy, BUSINESS, ORGANIZATION,

OR OTHER EMPLOYER,

B-19. tQu6 tipo de negocio o industria es esto? (Per ejemplo, fabrica de televisors y radios, zapater(a de Industria

venta al por menor, Departamento de Trabajo del Estado, finca. )

B-19 o207

6-20. LQu6 tipo de trabajo hacia ––? (Per ejemplo, ingeniero electrico, vendedor de tienda, Ocupacion

mecanografo, agricultor. )

B-20 o208

6-21, LCutiles eran Ias actividades o deberes mtis importances de –– en ese trabajo? (Per ejemplo, escribe

a rnaquina, mantiene Ios Iibros de contaduri’a, achiva, vende autos, mantiene la operation de

imprenta, mezcla concrete. )

COMpLETE FROM ENTRIES IN 6.17 THRU ––empleado en su ProPio ne90ciot

B-21; IF NOT CLEAR ASK: practica professional o finca?

B-22. tEra –– empleado de una compafiia privada

IF NOT FARM, ASK: ZEst6 el

-

un negocio, o un individuo por

negocio incorporado?

page, sueldo, o comision?. . . . . P

Sr. ... . . . . . . . . . . . ..l

——empleado del gobierno federal? . . . F

No. .,, .,, .. SE . . . . . ..SE

—— empleado del gobierno estatal? . S ‘– trabajando sin pago en un negocio

—- empleado del gobierno local? . . L

de familia o en una finca? . . . . WP

—— nunca trabajo o nunca trabajo en

un trabaio civil a tiemDo completo

que duro 2 semanas o mas?. . . . . . NE\

B-21

B-22

D ?beres

o209

Tipo de empleado

lDP

2UF

30s

40L

5DI

6ns E

70WP

OD NEV

4
MONTHS

o192

0194 I ❑ Male

B-3 YEARS

o193

MONTHS YEARS

o192 0193

MONTHS YEARS

o192 ,0193

B-3

B-4

B-3

B-4 B-4 (a IEI Male 2 ❑ Female

B-5

B-6

2 El Female w 1 ❑ Male 2 ❑ Female

o195 10 W2El B 300 gUNotobs. B-5 o195 low 2DB 3d(j gCINotobs. B-5

B-6

(a low 20 B 3g0 gCi Notobs.

@~] Estado o pais extranjero @rIn Estado o pa(s extranjero WIEl Estado o pais extranjero

n

B-6

o197 0197

)Ou Nunca asistio o solo DOD Nunca asistio o solo

“Kindergarten” (B-9)

Primaria 1 234567E

Secundaria 9 10 11 12

Universidad 1 2 3 4 5+

MD Nunca asistio o solo

“Kindergarten” (B-9)

Primaria 1 2345678

Secundaria 9 10 11 12

Universidad 1 2 3 4 5+

“Kindergarten” (B-9) B-7

B-8

B-7

B-8

B-9

B-7

Primaria 1 2345678

Secundaria 9 10 11 12

Universidad 1 2 3 4 5+

o198 lUSi 20 No

o199 0 ❑ Menos de 14

1 II Casado – spouse in HH

2 D Casado – spouse not in HH

3 ❑ Viudo

4 ❑ Divorciado

5 ❑ Separado

60 Nunca casado

o198 lCISi 2CIN0 o198 lCISi 2CIN0

o199 0 U Menos de 14

1 ❑ Casado – spouse in HH

2 II Casado – spouse not in HH

3 ❑ Viudo

4 ~ Divor~iado

5 ❑ Separado

6 ❑ Nunca casado

B-8

B-9

o199 0 ❑ Menos de 14

1 ❑ Casado – spouse in HH

2 ❑ Casado – spouse not in HH

3 •l Viudo

4 ❑ Divorciado

5 ❑ Separado

6 ❑ Nunca casado

B-9

B-10

B-1 1

B-12

o200 1 •l Under 17 yrs. old (NEXT SP

2 ❑ 17+yrs. old (B-n)

m lCISi 2CIN0

w 1 El Under 17 yrs. old (NEXT SP)

2CI 17+yrs. old (B-II)

Q9 1 ❑ Under 17 yrs. old (NEXT SP

2 ❑ 17+ yrs. old (B-n)

B-10 B-lo

o20 t lCISi 20No

o202

1 ❑ Si (B-17) 2EIN0

B-1 1 o201 10S( 2CIN0 B-n

B-12

o202

lU Si (B-17) 2EIN0

w 1 ❑ Sr’ (B-17) 27N0

B-12
B-13

B-14

B-15

B-16

B-17

&

B-18

B-19

B-20

B-21

B-22

[

o203 Icisl’ 2nrvo

o204 lCISi 20 No (B

1,] Buscando (6-18)

o205 20 “Layoff’’(B-l7)

3 ❑ Ambos (B-17)

o206

IIZ “S(’’inB-l3(B-l7)

z II “No” in B-13 (N EXTSP)

Patron

I ndustria

o207

Ocupacion

In

I Deberes

o209

Tipo de empleado

IUP

2CIF

3CIS

41JL

5iJt

6 USE

7CIWP

o Cl NEV

B-13

B-14

B-15

B-16

B-17

&

B-18

B-19

B-20

B-21

B-22

o203 10s( 2CIN0 B-13

o204 lclsr’ 20 No (B-16) B-14

1 •l Buscando (B-18)

o205 2 ❑ “Lay off” (B-17) B-15

3 El Ambos (B-17)

o206

1 ❑ “SI’” in B-13 (B-17)

B-16

2 II “No” in B-13 (NEXT SP) ,

Patron I

B-17

&

B-18

~

o

B-20

208

Deberes

B-21

I

o209

Tipo de empleado B-22

10P

2CIF

30s

4DL

501

6CISE

7EIWP

o ❑ NEV

1

(_) 203 10s( 2UN0

o204 10S( 2~ No (B-1

I ❑ Buscando (B-18)

o205 2 ❑ “Lay off” (B-17)

3 fl Ambos (B-17)

o206

1 U “Sr’” in B-13 (B-17)

2 ❑ “No” in B-13 (N EXTSP)

Patron

I ndustria

Ocupacion

o200

Deberes

o209

Tipo de empleado

lnP

2iZF

3ns

4CIL

501

eCISE

7CIWP

oCI NEV

5

I
C. SEGURO DE SALUD

Medicare es un programa de seguro de salud del Segu ro Social para personas incapacitadas y para personas de 65 aiios o mas. Personas que est~n

aseguradas por Medicare tienen una tarjeta que se parece a r$sta (SHOW CARD F-1).

c-1. ZEsta(n) (name(s) of all SP’S in family) •l Si, uno o mas asegurado

asegu rado(s) por Medicare ahora? ❑ No, ningtin SP asegurado (C-6)

ASK FOR EACH SP. MARK BOX IN EACH COLUMN BEFORE ASKING C-3.

c-2. ZEsta —- asegurado por Medicare ahora? c-2 ~ I G Aseg. 2 ❑ No aseg. 9CINS

FOR EACH PERSON WITH “COVERED” IN C-2, ASK C-3 AND C-4.

c-3. ZEst5 –— asegurado ahora por la parte de Medicare del Seguro Social que paga Ias cuentas C-3 @jl Dsr 2CIN0 90NS

de hospital?

C-4. LEsta –– asegurado ahora por esa parte de Medicare que paga Ias cuentas de m6dico? Este es el

plan de Medicare por el cuai –– o una agencia tiene que pagar una cierta cantidad cada roes.

C4 o212 , ❑ s; 2EIN0 9DNS

,~ -_:.:.:.:,:.~.:.:.:.=.:,~,~.:,:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:,:.:.:.:.:,~.:.:.:.:

ASK C-5 FOR EACH PERSON WITH “DK” IN C-3 AND/OR C-4.

C-5. tMe puede mostrar por favor la tarjeta(s) del Seguro Social de Medicare de –– (y ––) para determiner c-5 o213 1 ❑ Hosp.

el tipo de aseguranza? TRANSCRIBE THE INFORMATION FROM THE CARD OR MARK THE

2 ❑ Med.

“CARD NOT AVAIL.” BOX. 3 ❑ Tarjeta no obtenible

...............................................................................................................................

C-6. Nos interesa todo tipo de seguros de salud excepto Ios que pagan solo por accidents.

(Sin contar Medicare) tEst4(n) (name(s) of all SP’S in (family)

asegurado(s) ahora por algfin plan de seguro m6dico que paga El Si

cualquier parte de la cuenta de hospital, m6dico, o cirujano? •l No (C-12)

I

c-7. ZComo se Ilamael plan? (RECORD IN TABLE H. I.; RETURN TO C-8. )

I

C-8. ZEst5(n) (name(s) of all SP’S) asegurado(s) ahora por algun otro

plan de seguro m6dico que paga cualquier parte de la cuenta de D S( (R EASK C-7 & C-8)

hospital, m6dico o cirujano? El No (C-9)
I

TABLE H.1. —.

PLAN 1

C-10. iPaga este plan por cualquier parte de la

cuenta de medico o cirujano para operaciones?

c-9. Este plan (name), Lpaga por

cualquier parte de la cuenta

k

o215 In 5( 2U No 90 NS

de hospital?

o214 lclsr’ 2Cl No 9DNS C-1 1. ZEsta –– asegurado por este plan (-)?

(MARK BOX FOR EACH SP,)

PLAN 2 C-10. tPaga este plan por cualquier parte de la

cuenta de medico o cirujano para operaciones?

c-9.

- ,..s~

Este plan (name), Zpaga por

cualquier parte de la cuenta

de hospital?

o211 lEISi

{Esta –– asegurado por este plan (name)?

2Cl No

C-10. ZPaga este plan por cualquier parte de la PLAN 3

cuenta de medico o cirujano para operaciones?

c-9. Este plan (w), Zpaga por .0121lrl Si 20 No 9U NS

cualquier parte de la cuenta

de hospital?

o

C-1 1. ZEst5 –– asegurado por este plan (name)?

220 ID 5( 2DN0 90 NS (MARK BOX FOR EACH 5P.)

C-12. CHECK ITEM: REVIEW C2AND Cll, AND MARK BOX FOR EACH 5P. IF ALL COVERED,

GO TO SECTION D, IF NOT, CONTINUE.

AS KC-13 –C-15 FOR EACH PERSON “NOTC OVER ED.”

C-13. Hay muchas personas que no tienen seguro de salud por varias razones. (SHOW CAR D F-2)

ZCutil de esas razones describe por que –– no estti asegurado por cualquier seguro medico?

(1F 65+): o Medicare?

C-14. ZCualquier otra razon?

MARK BOX IF ONLY ONE REASON GIVEN; OTHERWISE ASK:

C-15. ZCual es la razdn principal por la cual –– no estii asegurado por cualquier seguro m6dico?

(1F 65+): o Medicare?

6

L 4

c-l1 @) I D Aseg. 2 ❑ No aseg. 9LINS

!

C.11 @ I D Aseg. 2 ❑ No aseg. 9LINS

I

C-Ii @) 1 ~ Aw 2 D No aseg. 9LNS

o223 1 ❑ Covered

C-12 z ❑ Not covered, under 65 yrs. old

3 ❑ Not covered, 65+ yrs. old

o224 1 23456789 7

C-13 10

ESPECIFIQUE

C-14 o225

1 ❑ Si (R EASK C-13&C-14)

213N0

o22fj ~n %10 Ufla razonen C-13

C-15 ‘R ‘

23456789 7

10

ESPECIFIQUE
C4 ~lnsr 21JN0 9EINS c-4 o212 lEISi 2DN0 9CINS c-4 ~lCISi 2CIN0 sUNS

o213 1 n HOSP.

o

213 1 ❑ HOSP.

o

213 1 ❑ HOSP.

c-5 2 El Med. c-5 2 Q Med. c-5 2 ❑ Med.

3 G Tarjeta no obtenible 3 •l Tarjeta no obtenible 3 ❑ Tarjeta no obtenible
c-1 1 o215 I ❑ Aseg. 2 ❑ No aseg, 91JNS C-11 o216 1 D Aseg. 2 ❑ No aseg. gCINS c-1 1 @ I ❑ Aseg. 2 0 No aseg. 90NS

c-1 1 @ I •l Aseg, 2 ❑ No aseg, 90 NS C-II @) I ❑ Aseg. 2 •l No aseg, 9CINS c-1 1 @ I ❑ Aseg. 2 •l No aseg. 9 ❑ NS,

L

c-1 1 o222 I ❑ Aseg. 2 Cl No aseg. 90 NS C-11 @ 1 ❑ Aseg. 2 •l No aseg, 9CINS C-11 o2221•lAseg, 2 ❑ No aseg. 9CINS

o223 1 ❑ Covered ‘o223 I •l Covered o223 1 ❑ cowered

C-12 z ❑ Not covered, under 65 yrs, old C.lz 2 ❑ Not covered, under 65 yrs. old C-12 z El Not covered, under 65 yrs, old

3 ❑ Not covered, 65+ yrs, old 3 ❑ Not covered, 65+ yrs, old 3 D Not covered, 65+ yrs, old

234 56789 7

C-13 @l 23456789 7

C.13 0224 1 23456789

10 10 10 7

ESPECIFIQUE ESPECIFIQUE ESPECIFIQUE

1 ❑ si’ (R EAsKc.13 &c-14) 1 Ii Si (R EASK C-13&C-14) C-14 @2n No C-14 o225 z ❑ No

o

1 ❑ sr (R EAs Kc-138r c-14)

C-14 225 * ❑ No

o226 000 S1510una razbn en C-13 o226 w ❑ s~[o Urrarazon en c.13 o226 00 ❑ SOIO una razh en C-13

C-15

OR 123456789

C-15

OR 123456789

C-15

7 1

OR 123456789

7

10 10 10

ESPECIFIQUE ESPECIFIQUE ESPECIFIQUE

7
D. ASISTENCIA DE INGRESO

D-1. ZRecibe(n) (name(s) of all SP’S in family) ahora asistencia a trav6s del programa “Ayuda a Familias

con Hijos Dependientes” algunas veces Ilamado “AFDC” or “ADC”?

•1 Si ❑ No (D-3) ❑ NS (D-3)

D-2. ASK FOR EACH 5P: ZEst5 –– inclu(do en el pago de asistencia de AFDC?

......................................................................................... .. ,, . ..-- -.

D-3. ZRecibe(n) (name(s) of all SP’S) ahora el cheque de color dorado del “Ingreso de Seguros

Suplementarios” (Supplemental Security Income – “SS1”)?

•l Si ❑ No (D-5) ❑ NS (D-5)

D-4. ASK FOR EACH SP: ZRecibe –- este cheque?

. .................................................... . .. .. .. .,.,.,,,/,...,.,

...........................,., ,,.,,,

D-5 Hay un programa national Ilamado Medicaid que paga por el cuidado de salud para Ios necesitados.

(En este estado tambien se llama .) Durante Ios 12 mese~

pasadosr Lha(n) recibido (name(s) of SP’S) cuidado de salud que ha sido o ser5 pagado por

Medicaid (o )?

❑ S( ❑ No (D-7) ❑ NS (D-7)

D-6, ASK FOR EACH SP: ZRecibio –- este cuidado?

D-7 ZTiene(n) (name(s) of all SP’S) ahora una tarjeta de Medicaid (o ) que se parecc

a 6sta? SHOW MEDICAID CARD,

❑ S( ❑ No (D-IO! ❑ NS (D-IO)

D-8. ASK FOR EACH SP: ZTiene –– una tarjeta de Medicaid (o )?

ASK FOR EACH SP WITH “Sir’ IN D-8.

D-9. ~Me permite ver la tarjeta(s) de -- (y de –– . .

.)? MARK Appropriate Box(ES) IN EACH

SP’SCOLUMN, BEFORE ASKING D-10.

D-2 10227 1 ❑ Si 2CIN0 9DNS

D-6 10229 1 ❑ S( 2UN0 9UNS

D -8 10230 1 ❑ S( 2UN0 9DNS

D-9 oz31❑ Medicaid card seen

1 ❑ Current 7

z ❑ Expired

3 II No card seen

4 ❑ Other card seen 7 5

SPECIFY
D-10. tEst5(n) (name(s) of all SP’S) asegurado(s) ahora por cualquier otro programa de asistencia

ptiblica que paga por el cuidado de salud?

•l Si ❑ No (D-12) •l NS (D-12)

D-11. ASK FOR EACH Sp: ZEst5 -- asegurado?

D-12, ~Recibe(n) (name(s) of all SP’S] ahora pages de retiro militar de cualquier rama de Ias Fuerzas Armadas

o de una pensitm de la Administraci6n de Veteranos? No incluya compensaci6n del VA (Administracitm de Veteranos) por incapacitacibn.

II Si ❑ No (D-15) •l NS (D-I5)

D-13. ASK FOR EACH SP: tRecibe -– estos pages o la pensibn?

ASK FOR EACH PERSON WITH W’” IN D-13.

D-14. LCU41 recibe ––, la pensibn de retiro de Ias Fuerzas Armadas, la pensibn del VA o ambas?

. ...............................................................................! :,:,:, ~,:,:,:,:.:.~:.:.:.::.:. y,, :.*

. . . . . . . . . . . . . . . . . . . . . . . . . . ... ,,,

D-15. ZEst5(n) (name(s) of all SP’S) ahora asegurado(s) por CHAMP. VA, que es seguro m~dico para

dependientes o sobrevivientes de veteranos incapacitados?

❑ Si ❑ No (D-17) ❑ NS (D-17)

D-16. ASK FOR EACH SP: ZEst5 –– asegurado por CHAMP-VA?

...........................................................

............................... —

D.17. ZEst~(n) (name(s) of all SP’S) ahora asegurado(s) por cualquier otro programa que provee

cuidado de salud para dependientes o sobrevivientes de personas militares?

•l Si ❑ No (D-19) ❑ NS (D-19)

D-18, ASK FOR EACH SP: tEst5 –– asegurado?

D.19. CHECK ITEM: REFER TO B-3 AND 6-11 AND MARK FIRST APPLICABLE BOX.

D-20. ZTiene -- una incapacitaci6n relacionada a su servicio en las Fuerzas Armadas de Ios Estados Unidos?

D-21. tRecibe –- ahora compensacibn de la Administraci6n de Veteranos por esta incapacitaci6n?

D-n

D-13

D-14

............ .

D-16

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

D-IB

-,.,.,,,,.,. ..

D-19

D-20

D-21

o232 1 ❑ Si 2il No 90NS

...................................................................................................

3 ❑ Ambas

(43)10Si 2CIN0 911NS

w

o237 I IJ Under 17 years (NEXT 5P)

2 ❑ “No” in B-n (NEXT SP)

3 ❑ “Si” in B-11 (D20)

1023E 1 IJ S;(D-ZI) 2 H No (N EXTSP)

lo239 1 ❑ Si 2CIN0

8
i o 1) NCHS USE ONLY NCHS USE ONLY u101 NCHS USE ONLY

w

TIIII

B-1 B-1

B-2

B-1

2

191 B-2 3

191 B-2 0191

D-2

>

227 1 ❑ Si 21JN0

\

9EINS

..,...,.,.,., .............................................................................................................. ...

......!.!!..... ............,,.,,,,,.,,.......... .............. .......

?2al n Si’ 2CIN0 9CINS 7

/271 ❑ Si’ 21JN0 9CINS

..,..,,,,,,.. ......................

.. . ...!...,.,.,.,., ........................

D-2

D -4

D-6

—,:.:.:.:.:.:.:.:.:.:.:

D-8

d

3

!28 1 c! s~ 20N0 9CINS 322el ❑ Si’ 2CIN0 90NS

..,,,,,!.,. ,,,..., .;.,.:.:.+..:.,.,,,.,.,...,................. ....................................................................!.!.!.!. ...!...,.,.,. ........................................................!......

...........,,.,,,.,,,. .........

D-4 3

22el ❑ s; 2CIN0 9UNS

—,

D-6 32291 ❑ Si’ 2CIN0 9CINS

—.:+:+:+:...:

D-8

D-9

2UN0 D-6

‘n2301 H Si’ 2 ❑ ’NO 9CINS $1 ❑ sr 2Ei No 9CINS 3

D-8 2301 ❑ sr 20N0 9CINS

2

23! •l Medicaid card seen

1 ❑ Current 7

D-9 o231 ❑ Mqljcajdcardseen

1 ❑ Cutrent 7

2•lExpired

3 ❑ No card seen

4 ❑ Other card seen 7

0

231 ❑

317

40

Medicaid card seen

I ❑ Current 7

20Expired

No card seen

Other card seen 7

D-9

z •l Expired

3 ❑ No card seen

4 •l Other card seen

?

5 5

SPECIFY

5

SPECIFY SPECIFY
o232 1 ❑ S~ .21JN0 917NS

,.:.x.: .;.;.;.:. :.:.:.;.:.;.:.:.: .;.:.: .:.:.:.:.:.:.:.:.:.:.: .:.:.:.:.:.:.:.:.:.: .:.:.:.:.:.:.:.:.:.:.:.:. :.:.;.;.;.:. ::.;.:.:.:. :.:.:.:.:.:.:.:.:.:

~,.

2321 n Si 2UN0 9CINS

. ..... ,...,... .

..........................:.,:.:.:.:.:.:... w:.::.:...:.:.:.:.:.:,:.Y.,:.:,:,:.x.:.:.:.;

D-1 1

-

....................

D-13 o2331 ❑ Si 2il No 90NS o233 1 ❑ ,Sr 2DN0 9UNS o233 1 ❑ Si’ zIJNo 9CINS

o2341 ❑ FA 2CIVA 3 ❑ Ambas

.................................................................................................................,,..!. ...!., ...................................... ...!.,. ,.,.!.!. . m

D-13 D-13

o234 1 ❑ FA 2CIVA 3 ❑ Amba!

.:.:.:.:.:. Y..x:.:.:.:.:.:.:.:.:.:.!.:.:.:.:.:.:.:.:.!.:.:.!.!.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;

D-14

m.. ... .

D-16 102351 ❑ Si 2UN0 9CINS o2351 ❑ Si 2CIN0 9CINS

. .

......................................................................................................:.7.+:.:.-0:, :+:0:,X,:0:+:.

D-16 o235 1 ❑ Si’ 2CIN0 9CINS

-—

o236 1 ❑ Si 2CIN0 9CINS

..........................................................l.l...l.l.l .l.!!.l.l.l... !.!..!.......!.!.l.l... !l....l.l.l.

o

z3?1❑ Under 17 years (N EXTSP)

2 II “No” in B-n (NEXT 5P)

3 ❑ “W’ in B-11 (D20)

~ ~

D-18 2361 ❑ Si 2CIN0 9CINS

P-..................... ........................................................................................................... .... ................

D-19 02371 •l Under 17 years (NEXT SP)

2 •l “No” in B-11 (NEXT SP)

3 ❑ “Si’” in B-11 (D20)

o236 1 ❑ Si 2CIN0 9CINS

:.}:,:,:,:,:,:,:,:,:, *,:,}:,:,:,:,:,:,:,:,:,:,:, +,:,:,:,:, ~.,:.:,:,:,:.:.:.:,:,: !:!:!.,:.:,:,:,:,:,:,:, +.:,~ :..........................

D-18

-

JLLu2xu

D-19

D-18

-

~

D-19 o2371 ❑ Under 17 years (NEXT 5P)

z ❑ “No” in B-11 (N EXTSP)

I 3 •l “Si” in B-1 1 (D20)

D-20 fil •l Si(D-21) 2 •l NO (NEXT SP) L o2381 ❑ S~(D-21) 2 II No (N EXTSP) D-20 Z3B1 ❑ Si (D-21) ) 2 ❑ No (N EXTSP)

D-21 102391 ❑ Si 2CIN0 o239 1 ❑ Si 2Ci No D-21 E?EL’”No D-21

9
g E. VIVENDA E INGRESO

E-1. LCuiintos cuartos hay en esta –– ? Cuente la cocina pero no el cuarto de baiio.

E-2. ZTiene facilidades completas para cocinar en esta (casa/vivienda), es decir, un fregadero

de cocina con agua de tuberfa, un refrigerator y una estufa u hornillo?

E-3. ZCU51 es el combustible principal que se usa para calentar esta casa?

E-4. ZCU61 es el sistema de calefaccion principal de esta casa?

E-1

E-2

E-3

E-4

3

240 Cuartos

numero

3

241 lCi Si 20 No

2

242 03 ❑ Aceite

02 ❑ Gas natural

03 ❑ E Iectricidad

04 •l Gas butano (propano)

06 ❑ Kerosina

06 ❑ Lefia

07 ❑ carbon

0s ❑ Otro oe

ESPECIFIQUE

00 ❑ No se uso combustible

3

i43

01 ❑

02 ❑

03 ❑

04 ❑

05 ❑

06 u

07 ❑

oe ❑

Oecj

10 ❑

00 ❑

e9 ❑

Sistema de vapor o agua caliente

con radiadores

Homo central de aire caliente con

tubes a cuartos individuales, o

bombs central de calor

Unidades eldctricas instaladas

permanentemente en la pared, el

cielo o en el “baseboard”

Homo de piso, pared u horno sin

tuber(a

Calentadores de cuarto ~ tubo de

caldera o cafion de chimenea, que

queman aceite, gas o kerosina

Calentadores de cuarto ~tubo de

caldera o cafitm de chimenea, que

queman aceite, gas o kerosina

Estufas que queman carbon, Ieiia o

coque

Chimenea(s)

Calentadores e16ctricos portatiles

Otro (ESPECIFiQUE) 11

NO se uso ningun equipo de

calefaccitm (E-7)

No sabe
I

E 5. LSe usa cualquier otro tipo de equipo para calentar esta casa? (1F MORE THAN ONE TYPE

IS MENTIONED, MARK ONLY THE ONE USED MOST.)

I

E-6. LCU61 es el combustible principal que usa este equipo adicional?

10

E-5

E-6

3

t44

01 ❑

02 •1

03 •1

040

05 ❑

06 ❑

07 ❑

Sistema de vapor o agua caliente

con radiadores

Homo central de aire caliente con

tubes a cuartos individuals, o

bombs central de calor

Unidades eldctricas instaladas

permanentemente en la pared, el

cielo o en el “baseboard”

Homo de piso, pared u horno sin

tuber~a

Calentadores de cuarto ~ tubo de

caldera o caii6n de chimenear que

queman aceiter gas o kerosina

Calentadores de cuarto ~tubo de

caldera o caiitrn de chimenea, que

queman aceite, gas o kerosina

Estufas que queman carbtm, Iefia o

coque

os ❑ Chimenea(s)

w II Calentadores eldctricos port~tiles

10 ❑ Otro (ESPECIFIQUE) 11

w fl No se uso ningfin otro equipo de

calefaccibn (E-7)

o245 01 II Aceite

02 ❑ Gas natural

03 ❑ Electricidad

04 ❑ Gas butano (propano)

05 ❑ Kerosina

06 ❑ Lefia

07 ❑ CarbLm

oe ❑ Otro 09

ESPECIFIQUE

00 IJ NO se uso combustible
E-7. ZCU51 es el combustible principal que se usa para cocinar en esta casa?

E-8. iTiene aire acondicionado – ya sea unidades individuals de cuarto, un sistema central o

abanico evaporative?

E-9. LCU51 tiene usted?

E-IO. Durante Ios 12 meses pasados, ?fue el ingreso combinado total de familia, es decir, el suyo, (read

names of all family members, including Armed Forces members living at home) m~s de $20,0~o

menos de $20,000? Incluya dinero de empleos, Seguro Social, ingreso de retire, pages de desempleo,

asistencia pfiblicar etc. Tambi&r incluya ingreso de interds, dividends, ingreso neto de negocio, finca

o renta, y cualquier otro ingreso de dinero recibido,

E-11.

READ PARENTHETICAL PHRASE IF ARMED FORCES MEMBER LIVING AT HOME OR IF

NECESSARY.

De esas categories de ingreso, ZCU51 Ietra mejor representa el ingreso combinado total de familia

durante Ios 12 meses pasados (es decirr el suyo (read names, including Aimed Forces members living

at home))? Incluya pages, sueldos, y Ias otras fuentes de ingreso que acabamos de mencionar.

E-7

E-8

E-9

E-I(

E-11

o246 01 fl Aceite

02 •l Gas natural

03 n E Iectricidad

CM 0 Gas butano (propano)

06 0 Kerosina

06 ❑ Lefia

07 n carbon

080 otro 09

ESPECIFIQUE

00 Cl No se uso combustible

o247 lclsr 2 ❑ No (E-1O)

o24e 1 ❑ Unidad individual de cuarto

2 •l Sistema central de aire

acondicionado

3 !3 Abanico evaporative

o249 1 0 $20,000 or more

(HAND CARD F-3)

z ❑ Less than $20,000

(HAND CARD F-4)

o25o CARD F-4

o1OA IICIK

02UB 12Ci L

03DC 13DM

04EID 14DN

g5Cl E 151qo

06DF 16DP

070(3 17EIQ

OECIH 18EIR

Oecil 1905

IOUJ 20UT

CARD F-3

21D(J

22DV

23DW

24DX

25DY

26tjz

27 ❑ ZZ
E-12. ZRecibi6 algfin miembro de esta familia algunas (estampillas para la comida/cupones de alimento) E-12 @ lCi Si 2 ❑ No (E-20)

del Gobierno en cualquier de IOS 12 meses pasados? (Es decir, dasde (name of month) del afio pasado,

hasta (name of month) de este aiio.)

E-13. LEn cu~rrtos de IOS 12 meses pasados recibib cualquier miembro de esta familia (estampillas para E-13 @ Months

la comida/cupones de alimento)? Ntimero

E-14. ZRecibi6 esta familia (algurras estampillas para la comida/algunos cupones de alimento) del Gobierno E-14 @ la !3(E.16) ZU No

en (name of last month)?

E-15. ~En qu~ Mes recibi6 a[gtin miembro de esta familia (estampillas para la comida/cupones de E-15 @

alimentos) por tiltima vez? SPECIFY NAME OF MONTH. MONTH

E-16, ZPara cu~ntas personas fueron autorizadas esas (estampillas para la comida/cupones de alimentos)? E-16 @ Personas.

Ntimero

E-17. ZCUAI fue el (valor nominal/’’face value”) total de esas (estampillas para la comida/cupones de E-17 o256 $ 00

alimentos) que recibi6 esta familia en (last month/month in E-15)?

E-18. LGast6 esta familia m5s por la comida de (last month/month in E-15) que el (valor nominal/’’face E-18 @ llJSi 2i3 No (E-20)

value”) de sus (estampillas para la comicfa/cupones de alimentos)?

——

E-19. ZCu5rrto miis? E.19 @$ 00

E.20. ZEst6 recibiendo w familia (estampillas para la comida/cupones de alimentos) actualmente? E-20 @ lCISI’ zCINO

11

I

m
Form PHS 620S

9/82

OMB No. 0937-0070

Approval Expiras 2/05

Department of Health and Human Services

Public Haalth Sarvice

Office of Health Research, Statistics,

and Technology

National Canter for Health Statistics

CHILD SAMPLE PERSON

QUESTIONNAIRE (522)

(Ages 6 Mos.-l 1 Years)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

(_) 100

W ESTAT

ID No:

Stand No. Segment No. Serial No.

NCHS u

ID No: ——— ——— —

NAME (First, Middle, Last)

o109

INTERVIEWER NAME: NO. @

LANGUAGE OF INTERVIEW

Q

Ioe

R English

20 Spanish

DATE OF INTERVIEW

Do

_/ _l _

Month Day Year

NOTICE – Information contained on this form

which would permit identification of any individual or establishment has been collected with a

guarantee that it will be held in strict confidence,

will be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the

establishment in accordance with section 30B(d)

of the Public Health Service Act (42 USC 242m).

II I

~ SEX Q’J AGE

In Male

20 Female

REVIEWER NAME: NO. o113

TIME BEGAN

@@ lUam

——: —— 2Clpm

TIME ENDED

O-G z. am

——. _ _ 2Clpm

DATE OF EXAMINATION

—1 —1 —

Month Day Year

TIME

❑ am

––:–—D pm

TRANSPORTATION

❑ Taxi

❑ Self

153
CHILD SAMPLE PERSON QUESTIONNAIRE

Aqes6 Months-11 Years

Topic Page Topic Page

A. Birth 1 N. Medicine/Vitamin MEC 29

G. Condition List 14 L. Respondent for Sample Child 28

C, Dental and Anemia 7 M. Sample Child Self-response 28

F. Functional Impairment 12 H. School Attendance & Language Use 16

B. Health Services 2 E. TB/Weight/immunizations/Pesticides 10

J. Meal Programs 17 D. Vision and Hearing 8

K, MediCine/Vitamin Usage 21

154
BIRTH

Al. How old (was ––’ s biological mother/were you) when i@ years old

—— was born? number

I

I

99 ❑ DK

A2. How old (was ––’ s biological father/were you) when

@

years old

—— was born? number

I

I

99 ❑ DK

A3. Was –- born in a hospital or some other place? I I •l hospital (A4)

I @ zU other1 3 (A6)

I

specify

A4. How many nights (was ––’s biological mother/were

you) in the hospital during this stay? o121 00 ❑ none

nights

number

I

I

99 ❑ DK

A5. How many nights was –– in the hospital during this stay? o122 00 ❑ none

nights

number

99 ❑ DK

A6. How much did –– weigh at birth?

PROBE FOR OUNCES IF NOT REPORTED; ENTER

RESPONSE IN POUNDS AND OUNCES OR IN GRAMS.

o123 9 ❑ DK(A7)

@@ number “S’ “umber ‘z ‘A’)

OR

o126 grams (A9)

number

A7. Did –- weigh more than 5’% pounds (2500 grams) or less? o127 I ❑ 5% Ibs (2500g) or more (A8)

2 ❑ less than 5% Ibs (2500g) (A9)

9 ❑ DK (A9)

A8. Did –– weigh more than 9 pounds (4100 grams) or less? o128 1 ❑ 9 Ibs (4100g) or more

2 ❑ less than 9 Ibs (4100g)

9ci DK

A9. Was –– born about when expected, or was it earlier or

later? o129 I ❑ earlier than expected

2 •l when expected (Al 1)

3 ❑ later than expected

9 ❑ DK(AI1)

AlO. About how much (earlier/later) than expected was –– I

born?

{

I m “umber :: %,5

I

sO months

All. Was –– born with any physical or mental problem or

:@

10Y 2 ❑ N(A13)

defect?

1

155
A12. Did ––’s problem or defect involve (his/her)

Heart? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eyes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ears? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mouth orthroat? . . . . . . . . . . . . . . . . . . . . . . .

Stomach or intestines? . . . . . . . . . . . . . . . . . . .

Kidneys or urinary system?.. . . . . . . . . . . . . . .

Muscles, bones, orjoints? . . . . . . . . . . . . . . . . .

Brain ornervous system?.,.. . . . . . . . . . . . . .

0133 lCIY 2CIN 9CIDK

o134 lEIY 2CIN 9DDK

o135 lEIY 2EiN 90DK

o136 lnY 2DN 9nDK

o137 ICIY 20N 9CIDK

o13810Y 2CiN 9UDK

o139 lEiY 2EIN 9EIDK

o140lIJY 2EIN 9EIDK

A13. Did –– receive any newborn care in an intensive care

unit, premature nursery, or any other type of special

care facility?

o141 10Y 2 ❑ N(A15)

A14. How many nights did –– stay in the special care

facility? o142 I ❑ less than 1 week

2 ❑ 1 week — 1 month

3 ❑ more than 1 month

A15. Was––ever breastfed? m ‘Uy 2 ❑ N(A18)

A16. Howoldwas ––when–– completely stopped

breastFeeding? m 00 ❑ still breastfeeding

{

10 days

number 2U weeks

3U months

A17. How old was –– when –– was first fed formula or

regular milk on a daily basis? m 00 II never on a daily basis

{

10 days

number 2 ❑ weeks

3 ❑ months

A18. How old was –– when –– started eating solid food

(such as strained foods or any other non-liquid foods)

on a daily basis?

HEALTH SERVICES

@-@

00 ❑ never on a daily basis

{

1!2 days

number 2 ❑ weeks

3 ❑ months

B1. Would you say ––’s health in general is excellent, very

good, good, fair, or poor? oI50 1 ❑ excellent

2 ❑ very good

3 ❑ good

4 ❑ fair

5 ❑ poor

B2. Now I would like to ask you about ––’s visits for health

care. First I will ask about routine care, including rou- ~ @ ~ ~ ~ssmo.than 1 month less than 6 mos.

tine checkups and immunizations when nothing is

I

3 ❑ 6 mos., less than 1 yr.

wrong. 4 ❑ 1 yr., less than 5 yrs.

I

5 ❑ 5 or more years

How long has it been since –-’s last visit to a clinic, 9CIDK

health center, hospital, doctor’s office or other place for I o ❑ Never (65)

routine health care? I

2
B3. Is there a particular clinic, health center, hospital, doc-

~ @ ‘0’

2 ❑ N(B5)

tor’s office or other place that -– usually goes to for

routine health care?

I

B4. What kind of place is it – a clinic, a health center, a hospi- I

o

15301 ❑ home

tal, a doctor’s office, or some other place?

I

02 ❑ doctor’s office or private clinic

03 ❑ company or school clinic

PROBE IF CLINIC: Is this a hospital outpatient clinic, I w ❑ hospital outpatient clinic

a company or school clinic, a migrant clinic, or some

I

05 ❑ migrant clinic

other kind of clinic? 06 ❑ other clinic 07

I

specify

I

os ❑ hospital emergency room

PROBE IF HEALTH CENTER: Is this a community

-09 ❑ community, neighborhood, or family

I

health center

health center, neighborhood health canter, a family

health center, a rural health center, or some other I

10 ❑ rural health center

I I ❑ HMO/prepaid 9rouP

kind of health center?

I

12 ❑ other place13

specify

PROBE IF HOSPITAL: Is this an outpatient clinic or I

emergency room?

I

Now I will ask about ––’s visits for health care

I

when –— is sick or injured.

I

B5. Is there a particular clinic, health center, hospital,

~@ ‘0’

2 ❑ N (B19)

doctor’s office or other place that –– usually goas to

when —— is sick or injured?

B6. IF “Y” IN B3, ASK: I

10

1 ❑ same place

Is this the same (place in B4) or is it somewhere else?

I

2 ❑ somewhere else

IF “SAME PLACE” IN B6, REFER TO B4 AND MARK

RESPONSE WITHOUT ASKING. OTHERWISE ASK: I

B7. What kind of place is it - a clinic, a health center, a hos1 @ ~~ ~ &SGr’s office or private clinic (B9) pital, a doctor’s office, or some other place? I 03 ❑ company or school clinic

PROBE IF CLINIC: Is this a hospital outpatient clinic,

I

0.4 •l hospital outpatient clinic

a company or school clinic, a migrant clinic, or some

I

05 ❑ migrant clinic

other kind of clinic? os ❑ other clinic”’

I

specify

os ❑ hospital emergency room

PROBE IF HEALTH CENTER: Is this a community I

09 ❑ community, neighborhood, or family

health center, neighborhood health center, a family

I

health center

health center, a rural health center, or some other kind 10 ❑ rural health center

of health center? I

11 ❑ HMO/prepaid grou P

I

12 •l other place13

PROBE IF HOSPITAL: Is this an outpatient clinic

specify

or emergency room? I

I

B8. Is there a particular person –– usually sees at the 2CIN

(place in B7) when –– is sick or injured? ~@ ‘n’

B9. Now I would Iike to ask you some questions about ––’s 10150 I ❑ less than 1 month

last visit to (place in B7) when –– was sick or injured.

I

2 ❑ 1 mo. less than 6 mos.

How long has it been since that visit? 3 ❑ 6 mos.r less than 1 yr.

I

4 ❑ 1 yr., less than 5 yrs.

I

5 ❑ 5 or more years

9nDK

I

6 ❑ never (B18)

3

157
BIO. About how long did it take –– to get to the (place in I

B7) for that visit?

minutes

— ,@ number

PROBE IF NECESSARY: Would you say it took more I OR

than 30 minutes or less than 30 minutes?

I

I ❑ more than 30 minutes

I @ z ❑ less than 30 minutes

611. Did –– have an appointment for that visit? lo toy 20 N(B13)

I

B12. About how long was it between the time an appointment was made and the time —— actually went for that

visit?

I @ 000 ❑ less than 1 day

I days

number

B13. After –– got to the (place in B7), about how long did

;@@

I

{

1 ❑ minutes

–– have to wait before –– was taken care of at that

number

visit? 2 •l hours

DO NOT READ

B14. What was the main reason for that visit? ~ @ I ❑ A SICKNESS OR ILLNESS

2 ❑ AN INJURY

3 ❑ A FOLLOW-UP VISIT

I

4 ❑ AN INJECTION

I

5 ❑ FOR A PRESCRIPTION

6 ❑ SOME OTHER REASON –7

specify

BI 5. In general, how satisf ied were you with the care –– I@ I ❑ very satisfied (B17)

received at that visit? Would you say you were very I

2 ❑ somewhat satisfied

satisfied, somewhat satisfied, or not at all satisfied? 3 ❑ not at all satisfied

I

BI 6. Why weren’t You completely satisfied with the health I

DO NOT READ.

care —- received at that visit?

PROBE FOR MAIN REASON. ~ @ ~~ ~ fiOST AD TOTOOWAITMUCHTOO LONG

03 ❑ LANGIJAGE PROBLEM – COULDN’T

I

COMMUNICATE

I

04 ❑ DR. DIDN’T SPEND ENOUGH TIME

WITH SP

I

05 ❑ MISTREATED BY DR. OR OTHER

I

STAFF

06 ❑ CoNDITl ON DID NOT IMPROVE AFTER

I

TREATMENTOR MEDICATION

I

07 ❑ DR. DID NOT DIAGNOSE OR TREA-T

CONDITION

I

os ❑ OTHER – og

I

eg ❑ DK SPECIFY

B17. Who took –– to the (place in B7) for that visit? I

@

DO NOT READ. MARK ALL THAT APPLY.

o II CHILD WENT ALCjNE

I

1 ❑ MOTHER

I

z ❑ FATHER

4 ❑ OTHER HOUSEHOLD MEMBER ~

I

specify

6 ❑ PERSON NOT IN HOUSEHOLD

B18. Has–– visited any other clinic, health center, doctor’s office or other place for health care when -–

~ @ 1 ❑ Y(B22) 2D N(B32)

was sick or injured since that visit to the (place in

B7)? I

4

158
HAND CARD CSPI I

B19, Many people do not have a particular place they l@1234”~

usually go when they are sick or injured. Could you

please give me the number of the statement which is I

7

specify

the main reason –– does not have a particular place

I

-— usually goes?

I

1. Has two or more usual doctors or places depending

I

on what is wrong.

2. Has not needed a doctor. I

3. Previous doctor no longer available.

4. Have not been able to find the right doctor.

I

5. Recently moved to area. I

6. Other reason – please specify.

I

B20. Although you said –– has no particular place for health 2 ❑ N(B22)

care, is there a particular person —— usually sees if —— ~ @ ‘“y

is sick or injured?

I

B21. Where does –– usually see this person — at home, at a

I @ ~~ ~ l~~rzs office or private clinic clinic, a health center, a hospital, a doctor’s office,

or some other place? I 03 ❑ company or school clinic

I

04 ❑ hospital outpatient clinic

PROBE IF CLINIC: Is this a hospital outpatient clinic, 05 ❑ migrant clinic

a company or school clinic, a migrant clinic, or some I oa m other clinic C7

other kind of clinic?

I

specify

oe ❑ hospital emergency room

I

IM ❑ community, neighborhood, or family

PROBE IF HEALTH CENTER: Is this a community I

health center

health center, neighborhood health center, a family 10 ❑ rural health center

health center, a rural health center, or some other kind I

II ❑ HMO/prepaid group

of health center? I

12 ❑ other placela

specify

PROBE IF HOSPITAL: Is this an outpatient clinic I

or emergency room?

I

B22. Now I would like to ask you some questions about @

I ‘d less than 1 month

-- ‘s last visit to any clinic, health center, doctor’s office 2 ❑ 1 me., less than 6 mos. —

or other place for%alth care when —— was sick or I

3 ❑ 6 mos.r less than 1 yr.

injured. How long has it been since that visit?

I

4 ❑ I yr. r less than 5 Yrs.

5 ❑ 5 or more years

I

9CIDK

o ❑ never (B32)

,

B23. What kind of place did –– visit that time – was it a

clinic, a health center, a doctor’s office, or some I @ ~1~ !~~~rs office or private clinic

other place? I

03 ❑ company or school clinic

I

04 ❑ hospital outpatient clinic

PROBE IF CLINIC: Was this a hospital outpatient 05 ❑ migrant clinic

clinic, a company or school clinic, a migrant clinic, or I

06 ❑ other clinic 07

some other kind of clinic? specify

I 08 ❑ hospital emergency room

I

09 ❑ community, neighborhood, or family

PROBE IF HEALTH CENTER: Was this a community

I

health center

health center, a neighborhood health center, a family 10 ❑ rural health center

health center, a rural health center, or some other I

11 ❑ HMO/prepaid grou P

kind of health center? I

12 ❑ other placels

specify

PROBE IF HOSPITAL: Was this an outpatient clinic

I

or emergency room?

I

I

5

159
B24. About hcw long did it take –– to get to the (place in

;@

minutes

B23) for that visit? number

PROBE IF NECESSARY: Would you say it took more I OR

than 30 minutes or less than 30 minutes?

I

I ❑ more than 30 minutes

I @ z ❑ less than 30 minutes

I

B25. Did –– have an appointment for that visit? @ lnY 2 ❑ N (B27)

I

I

B26. About how long was it between the time an appointment

I@

000 ❑ less than 1 day

was made and the time —— actually went for that visit?

I

days

I

number

B27. After –– got to the (place in B23), about how long did

‘o-o

{

I ❑ minutes

–– have to wait before –– was taken care of at that visit? I

179 lEO

number

I

20 hours

1

B28. What was the main reason for that visit? DO NOT READ

I @ 1 ❑ A SICKNESS OR ILLNESS

I

2 ❑ AN INJURY

I

3 ❑ A FOLLOW-UP VISIT

4 ❑ AN INJECTION

I

5 ❑ FOR A PRESCRIPTION

G ❑ SOME OTHER REASON7

specify

1

B29. 1n general, how satisfied were you with the care ––

~ @ z ❑ somevvhat satisfied

I ❑ very satisfied (B31 )

received at that visit? Would you say you were very

satisfied, somewhat satisfied, or not at all satisfied? 3 ❑ not at all satjsified

I

B30. Why waren’t you (completely) satisfied with the health

I

DO NOT READ.

care —— received at that visit?

10

I B3

01 ‘d COST TOO MUCH

PROBE FOR MAIN REASON,

I

02 ❑ HAD TO WAIT TOO LONG

I

03 ❑ LANGUAGE PROBLEM – COULDN”T

COMMUNICATE

I

04 ❑ DR. DIDN’T SPEND ENOUGH TIME

I

WITH SP

05 ❑ MISTREATED BY DR. OR OTHER

I

STAFF

06 ❑ CONDITION DID NOT IMPROVE AFTER

I TREATMENT OR MEDICATION

I

07 ❑ DR. DID NOT DIAGNOSE OR TREAT

CONDITION

I oe ❑ OTHER — 09

I

specify

99 ❑ DK

B31. Who took –– to the (place in B23) for that visit?

~ @ MARK ALL THAT APPLY.

DO NOT READ.

oiZ CHILD TOO KSELF

I

I ❑ MOTHER

I

ZU FATHER

4 ❑ OTHER HOUSEHOLD MEMBER~

I

specify

I

6 ❑ PERSON NOT IN HOUSEHOLD

6

160
B32. There are some providers of health care that we some- 1

times go to, such as curanderos, sobadores, herbalists, I @ ‘0’ ‘UN

spiritualists, and others. Has —— seen any of these

persons for health care during the past 12 months? I

I

B33. Sometimes people have difficulties in getting medical I

I B34. Did this problem

care. Have you had any difficulties getting medical

I

l—

prevent you from

care for ——

I

I

getting medical

care for -—?

I

1. Because care was not available when –– I @ IUY(B34)2DN ,@ lUY 2UN

needed it? I

2. Because of how much it cost? I

I

@

1 ‘d Y(B34) 2~ N

@ ‘n’

2UN

3. Because you didn’t know whereto go?

I@

I’C!Y(B34) 2UN I @ lCIY 2nN

4. Because you didn’t have a way to get there? I@ lnWB34)2n”!@ TOY 21ZN

5. Be=use the hours were not convenient? I I

,@

1 ❑ Y(B34) 20 N

,@ 70’

2Ei N

6. Because you had to wait too long to get an @

1DY(B34)2DN @ lUY

2UN

appointment?

I

(7. Because You needed someone to take care of I @ ID Y(B34)2DN ~@ 10’ 20N

your other children?)

I I

8. Because you would lose pay from work? @ lDY(B34)2n N@ lUY 2EIN

9. Because you had to wait too long in the ~@ lD’f(B24)20Nl@ IOY 20N

office or clinic?

I

10. Because the staff at the office or clinic was I@ In Y(B34)2a N@ lo’ 2EIN

disrespectful?

I I

11. Because you had no confidence in the staff? @ ID’(B34)2DNI@ ,0’ 2UN

12. Because they did not speak Spanish? I@ 1 ❑ Y(B34) 20 N

;@

I

10Y 2CIN

13. Because there were no (Hispanic) staff

@

1 ❑ Y(B34) 20 N

@

10Y 21JN

members at the office or clinic?

I

I

B35. About how long has it been since –– had a routine phy- I o212 I ❑ less than 1 year ago

sical examination; that is, not for a particular illness,

I

2 ❑ I yr., less than 2 yrs.a90

but for a general checkup? 3 ❑ z yrs.r less than 5 yrs.ago

I

4 ❑ 5 or more yrs. ago

I

5 ❑ never

9UDK

I

B36. Since –– was born, how many different times has ——

10

times

stayed in the hospital overnight or longer? Do not number

include the hospitalization when —— was born. I

DENTAL AND ANEMIA

cl. How old was –– when –– first saw someone for

dental care? ~ @ ‘ ~ :nder 4 yrs. old

2 yrs. old or older

I

9C!DK

3 ❑ never (C5)

7

161
C2. About how long has it been since –– —last saw someone for dental care? o

I ❑ 6 months ago or less

215

2 ❑ over 6 mos. to 12 mos.

3 ❑ over 12 mos. to 2 yrs.

4 ❑ over 2 yrs. to 5 yrs.

5 ❑ more than 5 years

9CIDK

C3. On the average, about how many times a year does –– 1 ❑ less than once a year

see someone for dental care? @ 200nce

I

3 ❑ twice

4 ❑ s or more times

I

5 ❑ no regular schedule

I

9nDK

C4. Has –– ever received fluoride treatments that were

10 ‘n’

20N 9UDK

applied to —— teeth during a visit to a dentist or someone else —— saw for dental care? I

1

C5. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD.

I

1 ❑ under 5 yrs. old (C8)

I 0 2 ❑ 5+ y,S. old (C6)

I

C6. Does –– go to school? I

I o ‘n’

2 ❑ N(C8)

I

C7. Does –– participate in a fluoride program at school?

I @ ‘n’

20N 9CIDK

This is a program in which fluoride tablets or rinses are

given to children to use at school. I

C8. Is –– covered by health insurance that pays for dental i O lo’ 2DN ~ODK

care?

I

I

C9. Has –– e~ had anemia, sometimes called “tired

~ @ ‘0’

2 ❑ N(DI) 9 ❑ DK(DI)

blood” or “low blood”?

I

CIO. Did a doctor ever say that –– had anemia?

; @ ‘0’

2 ❑ N(DI)

I

Cl 1. Does –– still have anemia?

C12. Was -– treated for this condition by a doctor?

VISION AND HEARING

D1. Has –– u had trouble seeing with one or both eyes

~ @ ‘n’

2 ❑ N(D1O)

when —not wearing glasses or contact lenses?

D2. How old was -– when —— first began having 10227 1 ❑ under 1 year old

trouble seeing?

I

2 ❑ 1-4 years old

1

3 IT 5-11 years old

D3. Did –– ever see a doctor about it? I @ 10’ zON

I

D4. Does –- wear glasses or contact lenses? I @ ,,gy 2 ❑ N(D6)

I

8

162
D5. Does –– have trouble with –- vision even when I @ ‘1 ❑ Y(D8) 2 ❑ N(D8)

wearing glasses or contact lenses? I

D6. Has –– ever worn glasses or contact lenses?

D7. Why did —— stop wearing them?

D8. What (are/were) ––’s glasses or contact lenses prescribed for?

D9. How often (does/did) –– use –– glasses or contact

lenses: all of the time, most of the time, hardly ever, or

never?

DIO. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD

AND TO QUESTION C6.

o231 IUY 2 ❑ N(DIO)

MARK ALL THAT APPLY.

DO NOT READ.

o232 I ❑ NO LONGER NEED THEM

o233 1 II DID N’TSEEM TO HELP

m I ❑ INCONVENIENT

5235 I •l 0THER2

specify

MARK ALL THAT A;PLY.

DO NOT READ.

o236 I ❑ READING/CLOSE WORK

o237 I ❑ SEEING DISTANT OBJECTS

o23E I ❑ 0THER2

specify

0239 1 ❑ all of the time

2 ❑ most of the time

3 ❑ hardly ever

4 ❑ never

o240 1 ❑ under 5 yrs. old (D13)

2 ❑ 5+ yrs. old, goes to school (D11)

3 ❑ 5+ yrs. old, doesn’t go to school (D12)

D1l. lS–– able to read the blackboard from the back of the I u lnY 2UN 9!ZDK

classroom (when wearing glasses or contact lenses)?

I

1

D12. Were you ever told by a doctor that –– had learning or I @ lnY 2DN 9nDK

developmental problems related to –– vision? I

D13. When was the last time –– had –– vision tested? I @ I ❑ 6 months ago or less

I

2 ❑ over 6 mos. to 12 mos.

I

3 ❑ over 12 mos. to 2 yrs.

4 •l over 2 yrs. to 5 yrs.

I

5“ ❑ more than 5 yrs.

I

6 ❑ never

9CIDK I

D14. Did –– ever have an ear infection or an earache? i @ ,Uy 2 ❑ N(D18) 9n. DK(D18)

I

D15. How many times has –– had an ear infection or I @ I ❑ only 0.c-3

an earache?

I

2 ❑ twice

3 ❑ 3-5 times

I

4 II 6 or more times

I

9CIDK

I

D16. Was -– ever treated by a doctor for (any of) —— ear l@ ,UY 2 0 N(D18) 90 DK(D18)

infection(s) or earache(s)? I

t G!

I

D17. Did a doctor ever treat an ear infection or earache –– I@ ICIY 2CIN 90 DK

had by placing tubes in -- ear?

I

9
D18. Has –– ever had a ruptured eardrum? I @ lci Y 2EIN 90 DK

I

D19. Has –– ever had a running ear or any discharge from

~ @ ‘0’

2 ❑ N(D22) 90 DK(D22)

—— ears,= counting wax in the ears?

D20. How many times has –– had a running ear or any I o250 1 ❑ only once

discharge from –– ear? I

2 ❑ twice

I

3 ❑ 3-5 times

4 ❑ (5 or more times

I 9nDK

D21. Did -– ever see a doctor because of this condition?

; o lDY

2UN 9nDK

I

D22. Has –– ever had trouble hearing with one or both ears?

; @ ‘0’

2 ❑ N(D27)

Do not i=de any problems which lasted just a short

period of time such as during a cold. I

D23. How old was –- when –– first began having trouble I @ I •! under 1 year old

hearing? I

2 ❑ 1-4 years old

I

3 II 5-11 years old

D24. Since this trouble began, has it gotten worse, gotten

better, or stayed about the same?

~ @ I ❑ gotten worse

2 ❑ gotten better

I

3 ❑ stayed the same

D25. Did –– ~ see a doctor about it? I @ In’ 2Ci N

I

D26. Does, -– still have trouble hearing with one or both ears? i

, @ ‘n’ 2UN

D27. Has –– ever used a hearing aid?

~ @ 10’

2UN

I

D28. How would you describe -– hearing (without a hearing

aid) – good, -- has a little trouble, –– has a lot of I @ 1 B !~~~tro.ble

trouble, or –- is deaf?

I

3 ❑ lot of trouble

4 ❑ deaf

D29. Has –– ~ had an operation on –– ears? i @ IOY zUN

EXCLUDE HAVING TUBES PLACED IN THE I

EARS. I

D30. When was the last time -– had –– hearing tested? I @ I ❑ 6 months ago or less

I

2 ❑ over 6 mos. to 12 mos.

3 ❑ over 12 mos. to 2 yrs.

I

4 ❑ over 2 yrs. to 5 yrs.

I

5 ❑ never

I

9DDK

TB/VVEIGHT/iMMUNIZATION/PESTICIDES

I

I

El. Were You ever told by a doctor that –– had , @ ICIY 2UN

tuberculosis?

I

10

164
E2. Has –– ever lived in a household with a person who

I@ ‘n’

zCIN 9CIDK

had active tuberculosis?

I

E3. About how tall is –– without shoes? 10263 9CIDK

loo feetl inches

264 — 265 number number

OR

,@

number centimeters

I

E4. About how much does -— weigh without clothes or

@

9CIDK

shoes?

@

pounds

number

I@

OR

kilograms

I

number

E5. For –– height, would You say –– is underweight, about

~ @ 1 ❑ underweight

the right weight, or overweight? 2 ❑ about the right weight (E9)

3 ❑ overweight

I

E6. Has –– ever seen a doctor about —— weight? I @ lCIY 2 ❑ N(E9)

I

E7. Did the doctor ever recommend any treatment for –– l@my 2 ❑ N(E9)

weight?

I

E8. What type of treatment did the doctor recommend?

MARK ALL THAT APPLY.

I

DO NOT READ.

@

I ❑ MEDICATION

@

I ❑ REDUCING DIET

@

1 ❑ HIGH CALORIE DIET

@

I ❑ EXERCISE

@

1 ❑ OTHER– Z

specify

E9. Has –– ever received a DPT shot? A DPT shot is to 10278 10Y 20 N(E121 9 ❑ DK(E12)

prevent diphtheria, tetanus, and pertussis or I

whooping cough.

I

EIO. How many DPT shots has -– ever had? I@ 101

I

2D2

I

303

404

I

505+

En. How old was –– when —— had the (first) DPT shot? ~ @@oo ❑ under 1 mo.

I

[ }

10months old (E16)

number 2U years old

I

I

E12. Has — ever received a shot to prevent tetanus?

@lDy

2 ❑ N(E16) 90 DK(E16)

El 3. How many tetanus shots has –– ever had? @::;

1

303

4n4

I

505+

11

165
El 4. How old was –– when –– had the (first) tetanus I 00 ❑ under 1 mo.

shot?

~w

+

I ❑ months old

I

number z ❑ years old

1

E 15. Why did –– receive the tetanus shot(s)? (Was it/Were

10

1 ❑ routine immunization

they) routine immunization(s), or did –– receive the 2 ❑ injury or illness

shot(s) because of an injury or illness that —— had at I 3 ❑ other 4

the time?

I

specify

IF MORE THAN ONE SHOT RECEIVED, MARK ALL

APPLICABLE BOXES. I

E 16. Has –– ever lived with anyone who was working in ;@; oY 2Ci N

farming?

I

E17. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD. i@ 1 ❑ under 6 yrs. old (E20)

2 ❑ f5 yrs. old or older (E18)

I

E18. Has –– ever worked or helped out in farming, for ex- @,o Y 2 ❑ N(E20) 9 ❑ DK(E20)

ample in the fields or orchards?

I

E19. Has –– worked or helped out in farming during the past 10290 10Y 2UN

year? I

E20. (During the past five years/Since -– was born), has the

;O’ny 2DN

SJODK

prescription medication, Kwell, been used on –– to

control head or body lice? I

FUNCTIONAL IMPAIRMENT

F1. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD, ‘o292 1 ❑ under 5 yrs. old (F2)

I 2 ❑ 5+ yrs. old (F4)

F2.’I IS –– able to take part at all in the usual kinds of ‘o293 lnY 2 ❑ N(FIO)

play activities done by most (children/babies) -– I

age?

F3. Is –– limited in the kind ox amount of play activities I@ I ❑ Y(FIO) 2 ❑ N(F8)

—— can do because of an impairment or health problem? I

--

F4. Does any impairment or health problem now keep –– I @ 1 ❑ Y(Flo)2cl N

from attending school?

I

\

F5. Does –– attend a s~cial school or special classes 10296 1 ❑ Y(F1O)2 ❑ N

because of any impairment or health problem? I

F6. , Does -– need to attend a special school or special @

1 ❑ Y(F1O)2 ❑ N

classes because of any impairment or health problem?

I

~,F7] IS –– limited in school attendance because of ––

health?

@

1 ❑ Y(FIO)2 ❑ N

F8. Is –– limited in any way in any activities because of an i@,oY 2 ❑ N(GI)

“ impairment or health problem?

I

F9. In what way is –– limited? RECORD LIMITATION,

;@’

\

NOT CONDITION. [imitation

12

166
F 10. What condition causes this limitation? I

I condition

F11. When did you first notice ––’s (condition in FIO)?

I

,@ lnrn ore than”3 months ago (G I )

PROBE IF NECESSARY: Was it within the past 3 I ❑ 3 months ago or less –

months or was it more than 3 months ago?

I SPECIFY IF 3 MONTHS OR LESS:

I

2 ❑ CONDITION IS ON CARD CSP 2 (Gl)

I

3 ❑ CONDITION NOTON CA RDCSP2 (F12)

F12. Is this limitation caused by any other condition? I o302 lD%

I

z •l N(G1)

F13. What other condition causes this limitation? i

I condition

F14. When did you first notice ––’s (condition in F13)? ;@ I D more than 3 months ago (Gl)

I

❑ 3 months ago or less –

I SPECIFY IF 3 MONTHS OR LESS:

I

2 ❑ CONDITION ISON CARD CSP2 (Gl)

I

3 ❑ CONDITION NOTON CARD CSP2

(REASK F12-F14) ~

13

167
CONDITION LIST

Gl, Did a doctor ever say that –– had -

IF “YES’’ASKG2 -G4 BEFORE GOING G2. Howoldwas ––when first had...?

TO NEXT CONDITION.

1- ———— ———— ———— ———— -——- ———— ——— + ———— ———— ———— ————

a. Asthma? 0304 1 ❑ Y(G2) 2CIN o305 _ mos. o306 — yrs.

b, Other lung disease? o309 1 ❑ Y(G2) 2UN

o

310 — mos. o311 _ yrs.

c. Mental retardation? o314 1 ❑ Y(G4) 2CIN

MAE +

d. Coordination problems? o3161❑ Y(G2) zCIN

. 0317 _ mos. o31e — yrs.

. e. Muscle weakness/paralysis? o321 1 ❑ Y(G2) 20N o322 _ mos, o323 _ yrs.

f. Rheumatic fever? o326 1 ❑ Y(G2) 20N o327 _ mos. o32.9 _ yrs.

——

9. Rheumatic heart disease? o33 I 1 ❑ Y(G2) 2iZNo332 _ ITIOS. o333 — yrs.

~ h. Other heart condition? o

3361❑ Y(G2) 2EINo337 _ mos. o33e _ yrs,

i. Urinary infection? 0341 1 ❑ Y(G2) 20N o342 _ mos. o343 — ylrs.

j, Convulsions? o346 1 ❑ Y(G2) 2CINo347 _ mos. o346 — yl’s.

k: Eczema? o351 1 ❑ Y(G2) 2CINo352 _ ITIOS. o353 — yrs.

1. Speech problems? o356 1 ❑ Y(G2) 20N o357 _ mos. o350 — yrs.

m. Psychological or o3611❑ Y(G2j 2CINo362 — MOS. o363 — yrs.

behavioral problems?

n. Poisoning? o366 1 ❑ Y(G2) 2DN o367 _ mos, o368 _ yrs.

166

14
G3. Does –– still have ...? G4. Has –- ever been treated by a

doctor for –– ...?

..— —— ———— ———— ———— .—— — —.—— —— —————— —————— ———— —.

o307 lDY 20N 9C!DK o300 lCIY 2EIN 9EIDK

o,312 lCIY 2CIN 9CIDK o313 10Y 2UN 9nDK

y

y/y//y/ /#g&jgg#y///////~ o315 lUY 2UN 9EIDK

o319 lEIY 2EIN 9EIDK o320 lCIY 2Ci N 9CIDK

o324 10Y 2UN 9DDK o325 lCIY 2iZ” N 9CIDK

o329 lIZIY 2CIN 9EIDK o330 10Y 2CIN 9nDK

o334 ICIY 2CIN 9CIDK o335 lCIY 2CIN 9nDK

o339 lCIY 2nN 9EIDK o340 lny 2nN 9iZDK

o344 lny 2nN 9CIDK o345 lny 2nN 9UDK

o349 Iny 2nN 90DK o350 Iny 2nN, 9CIDK

o354 lny 2nN 9CIDK o355 lny 2nN 9CIDK

o359 lny 2nN 9CIDK o360 lny 2nN 91ZDK

o364 Iny 2nN 90DK ,. 0365 lny 2nN 9CIDK

:P’p ‘i;;vlY//~~~/~/~A’ ‘ “ ~ ‘ ‘/5&;?i’’’”,:&4 1.4 ~

A?L,,.,,

,yj @ lny 2nN 90DK

m

$15 169
SCHOOL ATTENDANCE AND LANGUAGE USE i

I

H1. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD

@

I ❑ under 5 yrs. old (H17)

AND TO QUESTION C6. 2 ❑ 5+ yrs. old, goes to school (H3)

I

3 II 5+ yrs. old, not in school (H2)

H2. Has -– ever attended school?

H3. Is –- ~either going to school or on vacation I ❑ going to school

from school? ~ @ z ❑ on vacation from school

I

3 ❑ neither (H5)

H4. What grade (is –– in now/will –– be in)? I @ 00 ❑ nursery school

I

77 ❑ kindergarten

}

(H7)

I

grade

number

H5. Why did –– stop going to school?

@

I ❑ health problem

2 ‘d family needs child at home

I

3 ❑ dropped out

i

4 El other 5

specify

H6. How long ago did -— stop going to school?

i

8

S75 00 ❑ less than 1 month ago

I

376

+

I ❑ months

number

I

2 ❑ years

.

IF MORE THAN 12 MONTHS AGO IN H6, GO TO I

H8. OTHERWISE ASK: I

>7. During the past 12 months, about how many days

I ~000 ❑ none

-l was -— absent from school because of illness? I

days

number

H8. Has –– repeated any grades for any reason?

H9. Has –– ever skipped any grades for any reason?

H 10. When –-first began to talk, what language did -– i@ I ❑ Spanish

speak?

I

2 ❑ English (H13)

3 ❑ other 4

specify

I

HI 1. Can –– speak English now?

H 12. How old was –– when –– first began to speak

English?

i@

years old

number

HI 3. What language does –– mainly speak at home now?

~ @ 1 ❑ Spanish

2 •l English

I

3 II both equally

4 ❑ other language 5

1

specify

16

170
I

H14. What language do (––’s parents/you) mainly speak at

lo

1 ❑ Spanish

home now? 2 ❑ English

3 •l both equally

I

d ❑ other language s

I

specify

H15. What language (does/did) –– mainly speak at school

in —-

;63

1 ❑ Spanish

classes? 2 •l English

I

3 ❑ both equally

}

(Jl)

I

4 ❑ depends on subject matter

5 ❑ other language — 6

I

specify

I

I

MARK ALL THAT APPLY.

DO NOT READ.

H16. Why has ––

I

never attended school?

,B

306

I

I ❑ TooYOUNG–NoSCHOOLS AROUND FOR

387 CHILDREN THAT AGE

I

I ❑ HEALTH PROBLEfvl

38a

I

I ❑ FAMILY NEEDS CHILD AT HOME

309 1 ❑ OTHER—2

I

specify

H17. When –– first began to talk, what language did ––

10

I •l Spanish

speak ? z ❑ English (H20)

I

3 ❑ other — 4

I

specify

5 ❑ doesn’t talk yet (H21 )

I

H18. Can –– speak English now? I @ toy 2 ❑ N(H20)

H19. How old was –– when –– first began to speak I

English? @

years old

numbw

I

H20. What language does -- mainly speak at home now?

~ @ 1 ❑ Spanish

2 •l English

I

3 ❑ both equally

4 ❑ other language — 5

I

specify

H21. What language do (––’s parents/you) mainly speak 1 ❑ Spanish

1 @ ~ B Mi&ally

at home now?

I

I

4 ❑ other language —s

specify

MEAL PROGRAMS

J1. Has –– ever received food or health care under the @ lny 2 ❑ N(J4) 9 ❑ DK(J41

Women, Infants, and Children WC) program?

I

J2. IS –– now receiving food or health care under the

Women, Infants, and Children (WIC) program? I@ ‘ny 2nN

9C!DK

17

171
J3. How long (did –- receive/has –– been receiving) I

397

1~

-(

I ❑ months

food or health care from WIC? number 2 ❑ years

I

390

J4. CHECK ITEM: REFER TO ITEM H3 I@ 1 ❑ now going to school or on

I vacation (J5 )

I

2 •l neither (K1 )

#

J5, Does the school that -– attends serve a complete

~@ ‘n’ 2nN breakfast?

1

J6. How many times a week does –– usually eat breakfast

served by the school?

~ @ o ❑ None (J1O)

times

I

number

I

I 9DDK

I

J7. During this (past) school year did ( ––’s parents/you)

I @ ‘n’

2 ❑ N(J9)

fill out a form to enable -– to eat breakfast at school

for free or at a reduced price? I

J8.

I

Does -– eat breakfast at school for free or at a

reduced price? ! @ ; ~ ~~ not eligible

I

3 ❑ No, other reason

I

J9. How much does -- pay for -– breakfast per day?

;@ cents

number

I

I

000 ❑ free

1

JIO. Does the school that –– attends serve a complete I

,@ ‘n’

2Ci N

lunch?

I

I

J11. How many times a week does –- usually eat lunch

@

0 ❑ None (J15)

served by the school?

I

times

number

I

I

9CIDK

I

J12. During this (past) school year did ( ––’s parents/you)

lo ‘0’

2 ❑ N(J14)

fill out a form to enable –– to eat lunch at school

for free or at a reduced price?

I

I

18

172
J13. Does –– eat lunch at school for free or at a reduced

@

1 ❑ Yes

price?

I

2 ❑’Nor not eligible

3 ❑ No, other reason

I

J14. How much does –– pay for –– lunch per day?

lo

cents

number

I

000 ❑ free

J15. Does –– ever bring –– lunch from home? I

1 ❑ Yes, always

I @ 2 ❑ ‘t’es, sometimes

I

3 ❑ No(KI)

J16. On days that –– does not buy lunch at school, does

@

1 ❑ Yes, always

–– buy milk? 2 ❑ Yesr sometimes

I

3 ❑ No(K1)

J17. How much does –– pay for –– milk per day?

10

I

cents

number

I 000 ❑ free

“>-M

19 173
MEDICINE/VITAMIN USAGE

KI. During the past 2 weeks, has –– taken or used any vitamins

or minerals? o413 1 ❑ Y(K2) 2❑ N(K5)

K2. May I see the mntainer(s) K3. How much of the K4. How often does ––

of ––’s vitamins and (vitamin/mineral) take this (vitamin/

minerals? does –– take each mineral)?

RECORD BRAND NAME time –– uses it?

o414o@

[

00

{

I ❑ day

I ❑ tablet/capsule 2 ❑ week

2 ❑ teaspoon per

—— times 3 ❑ month

number 3 El tablespoon 4 ❑ other —

4 G other 5

specify

o414

o@

-i

Go

{

1 ❑ day

I ❑ tablet/capsule z ❑ week

z ❑ teaspoon times

per

3 ❑ month

number 3 ❑ tablespoon 4 ❑ other —

4 ❑ other 5

specify

o414

@@ o@

{

1 ❑ day

+

1 ❑ tablet/capsule 2 ❑ week

2 ❑ teaspoon times

per

3 ❑ month

number 3 ❑ tablespoon 4 ❑ other —

4 ❑ other 5

specify

❑ Continuation booklet

K5. We are interested in all kinds of medicines that people take or use. First I will ask about –- use of medicines that can be

obtained without a doctor’s prescription.

During the past 2 weeks, has –– taken or used any of the following types of medicines?

a) Cough, throat, cold or congestion medicine? o419 lnY zUN

b) Pain relievers, such as aspirin or Tylenol? o420 lnY zCIN

c) Sleeping tablets, sedatives, or tranquilizers? o421 lIZY 2UN

d) Anti-depressants, stimulants, or pep pills? o422 lCIY 2CIN

e) Diet pills or dieting aids? o423 lCIY zUN

f) Laxatives? o424 10Y 2nN

g)Medicines for diarrhea? o425 Iny 2nN

h) Medicines for indigestion? o426 lny 2UN

i) Suppositories? o427 lUY 7-UN

j) Eye drops? o420 lUY zUN

k) Any other medicines, pills, or ointments for which a o429 Iny 2nN

doctor’s prescription is not needed?

IF YES, SPECIFY: 1

21 175
K6. During the past 2 weeks has –– taken or used ahy medicines for which a doctor’s prescription is needed?

o

432 1 ❑ Y(K7) 2 ❑ N(K14)

K7. Maylsee thecontainer(s) of themedicine(s) –-took? KS. What isthe health K9. Did-–take (dos~

RECORD SPECIFIED INFORMATION FOR EACH, problem -- had for reported in K7~per

THEN ASK QUESTIOh4SK8 THROUGH 13 FOR EACH. which -- took the (frequency reporl~

(medicine)? PROBE in K7)?

FOR SYMPTOM OR

CONDITION.

Label printed in: o433

0

442

I ❑ English z ❑ Spanish 3 ❑ Both

——— ——— ——— —-— —.+ .—

Name: 0434

0

443 1 U Y (K12)

.-— — ———— ———— ——— ,— —_,

Prescribed for SP?

211N

o

435 10Y 2EIN

——— ——— ———— ——— ———— —

o

Strength: 435

.—— — ——— ——— ——. —+— ——

Dosage:

w

.—— — ——— ——— ——— ——— —

.—— — ——— ——— ——— ——— ——

IF “AS NEEDED,’’ ASK K8 AND GO TO NEXT

MEDICATION

l——— ——— -—— ——— ——— —

1 ❑ Container not seen-information

o

441 furnished by respondent

o

Label printed in: 433

0

442

1 II English z ❑ Spanish 3 •l Both

-——— ——— ——— ——— ——— —

o

Name: 434

0

443 1 ❑ Y (K12)

.—— — —— ——— ——— —— —— —

20N

Prescribed for SP?

o

4351Ei Y 2UN

- ——— ——— ——— ——— ——— ——

0

Strength: 436

——— ——— ——— ———— .—— ——

O@

Dosage: 437

.—— — ——— —,—— ——— ——— —

.—— ——— ——— ——. ——— —

[F “AS NEEDED,’’ ASK K8 AND GO TO NEXT

MEDICATION

——— ——— ——— ——— ——— —

1 ❑ Container not seen-information

o

441 furnished by respondent

176

22
K1O. How much of the K1l. Did a doctor advise K12. Does the (medicine) K13. What does –– do

(medicine) did –– -- to take (dosage in make —— feel bad or when this happens?

take? KIO)/(frequency in cause any side effects?

m)?

m

4

1 ❑ tablet/capsule o440 0449 0450

2 ❑ teaspoon 1 ❑ Yes I ❑ Yes – SPECIFY DO NOT READ

numbar

PROBLEM

2UN0 $

3 ❑ tablespoon 3 I ❑ QLllTIJSING MEDICINE

4 ❑ other 2 ❑ DECREASE USE

20N0

I

3 ❑ CONSULT DOCTOR

w

GO TO NEXT

MEDICATION 4 ❑ cONTINUE TAKING AS

{

1 ❑ day 9nDK PRESCRIBED

per 2 ❑ week

times 3 ❑ month 5 ❑ CITHER–

4 ❑ other — 6

5 sPECIFY

specify

+

m

1 ❑ tablet/capsu Ie o44B o449 0450

2 ❑ teaspoon 1 ❑ Yes 1 ❑ Yes – SPECIFY DO NOT READ

number PROBLEM

3 ❑ tablespoon 2UN0 3 ? 1 ❑ QUIT USING MEDICINE

4 ❑ other 2 ❑ DECREASE USE

2CIN0

}

3 ❑ CONSULT DOCTOR

m

GO TO NEXT

{

1 El day MEDICATION 4 ❑ CONTINUE TAKING AS

per z Cl week 9UDK PRESCRIBED

times 3 D month

4 El other –

5 ❑ OTHER–

5 6

specify SPECIFY

23

177
1-

—

u uonllnuatl Ofl DOOKlet

—

K7. May I see the container(s) of the medicine(s) –– took? K8. What is the health K9. Did –– take (dosage

RECORD SPECIFIED INFORMATION FOR EACH, problem –– had for

-—

reported in K7) pelr

THEN ASK QUESTIONS K8 THROIJGH 13 FOR EACH. which —— took the (frequency reported

(medicine)? PROBE in K7)?

FOR SYMPTOM OR

CONDITION.

—

Label printed in:

o

442

I ❑ English z ❑ Spanish 3 ❑ Both

.— —. ._ __

o

Name: 434

0

443 1 Cl Y (K12)

——— ———— ——— ——— ——— —

Prescribed for SP?

zON

o

435 lC1% 2UN

————. ——— ——— _____ _

o

Strength: 436

.—— —— __ ___ ___ ___

‘oSage’ @ @

.—— _ ___ __ ___ ___ __

‘requenc” @ @

————— ——— ——— ——— ——.

IF “AS NEEDED,’’ ASK K8 AND GO TO NEXT

MEDICATION.

.—— ——— ——— ——— ——_ ——

1 fl Container not seen-information furnished

—

Label printed in:

o

442

1 ❑ English 2 ❑ Spanish 3 ‘d Both

.—— —_ ___ _______ __

o

Name: 434

0

443 1 ❑ Y (K12)

.—— — —— —— __ ——— ___ _

Prescribed for SP?

2UN

o

435 lCIY 2Ci N

.—— ——— ____ ___ ___ _

Strength: @

—— —_____ ——. — ___ _

Dosage: @@

-—— ————— ———— ——— —_

‘re’’Je+$@

.— —— —— __ _— ______

IF “AS NEEDEDr’’ASK Kg AND GO TO NEXT

MEDICATION.

—————— ——— —— —— ———

1 ❑ Container not seen-information furnished

o

44, by respondent.

m- . . . . . .

—

24
K1O. How much of the K 11. Did a doctor advise K12. Does the (medicine) K13. What does –- do

(medicine) did –– —— to take (dosage in make —— feel bad or

take?

when this happens?

KIO)/(frequency in cause any side effects?

K1O)?

O@

i

1 ❑ tablet/capsule o440 0449 0450

2 ❑ teaspoon 1 ❑ Yes I •l Yes – SPECIFY DO NOT READ

number

PROBLEM

3 ❑ tablespoon 2Ci No 3 ? I ❑ QUIT USING MEDICINE

J ❑ other 2 ❑ DECREASE USE

20N0

}

3 ❑ CONSULT DOCTOR

@@

GO TO NEXT

{

1 ❑ day

MEDICATION 4 ❑ CO NT IN UE TAKING AS

9CIDK PRESCRIBED

2 ❑ week

times

per

3 ❑ month

4 ❑ other –

5 ❑ OTHER–

5

6

specify

sPECIFY

-(

@@

1 ❑ tablet/capsule o448 0449 0450

2 ❑ teaspoon 1 ❑ Yes 1 ❑ Yes - SPECIFY DO NOT READ

number PROBLEM

3 ❑ tablespoon 2DN0 3 ? 1 ❑ QUIT USING MEDICINE

4 ❑ other 2 ❑ DECREASE USE

2DN0

1

3 ❑ CONSULT DOCTOR

@@

GO TO NEXT

{

1 ❑ day

MEDICATION 4 II CONTINUE TAKING AS

2 ❑ week

9 ❑ DKJ PRESCRIBED

per

times 3 ❑ month

4 ❑ other –

5 ❑ OTHER –

5

6

specify

SPECIFY

25

179
K 14. Has –– been told by a doctor to take any medicines during the past 6 months that –– did ~ take during

that period?

o451 1 ❑ Y(K15) 21zrq(Ll)

K15. What are the names of the medicines that -- K 16. What was the health problem

did not take? (PROBE FOR BRAND NAMES, –– had for which the doctor

ENTER EACH ON SEPARATE LINE. THEN recommended the (medicine)?

ASK K16AND K17 FOR EACH,)

o452

0

453

0

452

0

453

0452

0

453

0

452

0

453

0

452

0

453

0452 04s3

❑

.

26

180
K 17. What was –– main reason

for not taking the (medicine)?

o

454 I ❑ SIDE EFFECTS 3 •i DIDNT THINK IT WOULD WORK 5 ❑ OTHER –SPECIFY

2 ❑ COST TOO MUCH 4 ❑ HAVEN’T YET OBTAINED MEDICINE

o

454 I ❑ SIDE EFFECTS 3 ❑ DIDN7THINK IT WOULD WORK 5 ❑ OTHER – SPECIFY

2 ❑ COST TOO MUCH 4 ❑ HAVEN~ YET OBTAINED MEDICINE

o

454 I ❑ SIDE EFFECTS 3 ❑ DIDN’T THINK IT WOULD WORK 5 ❑ OTHER –SPECIFY

2 •l COST TOO MUCH 4 •l HAVEN’T YET OBTAINED MEDICINE

o

454 1 ❑ SIDE EFFECTS 3 ❑ DIDN7THINK IT WOULD WORK 5 ❑ OTHER – SPECIFY

2 ❑ COST TOO MUCH 4 ❑ HAVEN’T YET OBTAINED MEDICINE

o

454 I II SIDE EFFECTS 3 •l DIDN7 THINK IT WOULD WORK 5 ❑ OTHER – SPECIFY

2 ❑ COST TOO MUCH 4 ❑ HAVEN7 YET OBTAINED MEDICINE

o

454 1 ❑ SIDE EFFECTS 3 ❑ DIDNTTHINK IT WOULD WORK 5 ❑ OTHER –SPECIFY

2 ❑ COST TOO MUCH

6

4 ❑ HAVEN’T YET OBTAINED MEDICINE

27

181
I

RESPONDENT FOR SAMPLE CHILD I

I

I

L1. CHECK ITEM: MARK ONE BOX,

@

I ❑ MOTHER

2 ‘d FATHER

INDICATE MAIN RESPONDENT’S RELATIONSHIP I

3 ❑ SISTER OR BROTHER

TO SAMPLE CHILD.

I

4 ❑ OTHER –5

SPECIFY

1

SAMPLE CHILD SELF-RESPONSE

Ml. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD ;@

I ❑ under 6 yrs. old (END)

I

2 ❑ 6+ years old (M2)

I

M2. Now I hava a few questions I would like to ask –– directly. I @ I II Y(M3) 2 ❑ N (END)

Is –– available now?

~,::.:.-.$:$:$ ,.:,.-+>.:;-?:5::+ ,:-:,:.:-.*, y:;~<;;,:~,,..,,-..,,.....,<.:,...:< ......-,-,~y. .......,..5 .,-...~.........}-. .. ..j.+.,.:..,..,. ~...;

...

-.,..,. ...~..,..,: ~......... .:;;-::~-.fi,x.,,:~.,,. ~.:,<...:j..,;j-j,..~ ,:,..,..+, .,,.. ~..,,..~.:.. , ~,. , .,,.....,.+ .-.-... .... ,..,............, -.,.... ..,..,..,..,.

,...,,.,,:,.,,.,,.,.., ....,.,<-.,.;.., ~.->- ...- :,-., .......+.... .t.y.: j:,,..:..:.: ,.~,::~“..;.,,.,. :+.,.+:,:!::.-{: ,..,,,..,. K:.:;..:j;:j,:;.::.:j:...jj ,JJ<&:.::,,; :..:.,::.,,,.. ; .,, ,,.-,-,-.. ,

...............,.,,.,-. fi.,.,..,... . ............,..,, .x,,...,..,,......,,..,,.........;,.,,,.:,,.,,,:, ,+>.,... ...,:.,.,.,.’,.,,..fi.,j.:!:.:

M3. INTRO DU CT 10 N : I would Iike to ask you a few questions <.,,. ‘~~~~’-~”~J;~~”EI:;~-~::’+ i: -,?:, $.>;<.; --;.,.,, ,.--,.=...-:..,,--*:....>. ...~-.: .-,...-;-~~fi;-.:,;T: .....-.........f-!...--,,+ ..,- ,.T,...,.,,..,.,,.. <->,..,.>.: ............:,:..,*.:, ....).:.,:j,;.~kj/,;;2~ ......,.,.,,X.<.:.: ,.j:,,,.::.::l+,i::..:::i :,:;~~T~~-~~n,"xJJ~~~~T-~--fi'~ ,:,:,.,,.:<..,,..w, ~,.:,,..,:.{,.xj ,,:,,,.

,,;-,.:x.,p?.,,.x.: .....5...,>,:,,,.,<.x..<.x., ,,>..,..,., ..........,..,...............-. .,,......>..;,.,.,j.:,.,;.7.,. ~...; ,... .... ,.,.,, ,:.,,,,....

about your health.

~K.x,;.j,.,.,:.,::.,.,.,,,..,.w:<,.,,:.,::.,.,,.*,.,.,.y,,.,. .,., > ,.. .-.f...:.,..-... ......%..--p..--,-..,,,..,,.,,.>.,,.. .................-..:A::-;,,: ~,.,..%,, ,..,.,.,.,.,... ,,,;.!.,,\.*.:., :,:<*,:..,..,.,..,,.,,,,... .. .....,..,,,.. ,. ,-,::.:,,. ~.:.,.j,,,:.~,.f,>. .....,,.....<,,.. ..,~y;: ,..:.:f,<i~ ~.:.J;:..;:;:;;: +..,.,.,. -.,,.,.....-,:.y.,..y.: ~..,..,..>, ..,.,,,,.,,.,.,,.Y. ................-<..... .,......

“’““‘“’“’::.::”;””::::~:”’ p:{’’’”~:’’’’’>/:.;.>. ix.~.<;*;;j;j::,,,;:y,:,.,yw,.:

I

M4. Do you have any trouble seeing (with your glasses on)?

I @ 10’

20N

M5. When you are at school, can you read the blackboard 2CIN

from the back of the classroom (with your glasses on)? ~ o ~ ~ ~oesn’t go m school

!

M6. Do you have any trouble hearing? ] @ In’ 2Ci N

n

M7. When you are at school, can you hear the teacher 10461 10’ 2CIN

from the back of the classroom? 3 ❑ doesn’t go to school

I

M8. Do you think that you are underweight, about the right I@ 1 ❑ underweight (M9)

weight, or overweight?

I

z ❑ about the right weight (M13)

3 ❑ overweight (M 11 )

I

M9. Would you like to weigh more?

I@’ny

2 ❑ N(M13)

MIO. Are you trying to gain weight? ;@ 1 ❑ Y(M13) 2 ❑ N(M13)

Ml 1. Would you like to weigh less?

~ @ lny

2 ❑ N(M13)

M12. Are you trying to lose weight? o46610Y 2DN

M13. Would you say your health in general is excellent, very good I @ 1 ❑ excellent

good, fair or poor?

I

2 ❑ very good

I

3 •l good

4 ❑ fair

I

5 ❑ poor

‘182

28
MEDICINE/VITAMIN MEC

DO NOT ASK IN HOUSEHOLD

N1. REFER TO MEDICINE/VITAMIN USAGE

o

473 I ❑ No-medicine or vitamin reported (N3)

SECTION. MARK ONE BOX.

2 ❑ Medicine or vitamin repotted (N2)

N2. When an interviewer spoke with you a few weeks ago, you mentioned –– had taken (medicine/vitamins/

minerals in questions K2, K5, and K7). Has -- taken any of these medicines during the past 24 hours?

o

460 Iny 2C!N

N3. Has –– taken any (other) medicines, vitamins or minerals during the past 24 hours?

o

46glny 2CIN

IF “YES” IN EITHER N1 OR N2, GO TO N3. OTHERWISE, END QUESTIONNAIRE.

N4. What are the names of all medicines, N5. How much of the (medicine/vitamin/

vitamins and minerals —— took during the mineral) did –– take during the past

past 24 hours? Any others? 24 hours?

o

470

@o

+

I ❑ tablet/capsule

2 ❑ teaspoon

number 3 II tablespoon

4 ❑ other

o

470

o@

-+

1 ❑ tablet/capsule

2 ❑ teaspoon

number 3 •l tablespoon

4 ❑ other

o

470

00

-+

I •l tablet/capsule

2 ❑ teaspoon

number 3 •l tablespoon

4 ❑ other

o

470

@@

-+

1 •l tablet/capsule

2 ❑ teaspoon

number 3 El tablespoon

4 ❑ other

29

103
Form PHS 6208

9f82

OMB No, 0!337-007B

Approval Expires 2/05

Department of Heelth and Human Services

Public Health Service

Office of Health Research, Statistics,

and Technology

National Center for Haakh Statistics

SPANISH VERSION

CHILD SAMPLE PERSON

QUESTIONNAIRE (522)

(Ages 6 Mos. – 11 Years)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

WESTAT

ID No:

NCHS

ID No:

NOTICE: La informacidn contenida en este

formulario que permitir{a identificar a cualquier

individuo o astablecimiento ha sido recogida con

la garant(a que ser~ mantenida en la mds estricta

confidencialidad, seri usada s610 pam Ios prop6sitos establecidos para esta estudio v no sari

divulgada o entregada a otros sin el consentimiento del individuo o del establecimianto de

acuerdo con la Secci6n 308(d) de Iii Ley del

Servicio de Salud Pdblica – Public Health Service

Act (42 USC 242 m).

o100

n

o

107

Stand No, Segment No. Serial No. Family No.

I

— .—— ——.

SP No. I

NAME (First, Middle, Last)

o109

El

INTERVIEWER NAME: NO. @ REVIEWER NAME: NO,

~

113

LANGUAGE OF INTERVIEW

o

106

In English

I ZE Sp&ish I

DATE OF INTERVIEW

Do

mm’d%=

TIME BEGAN

@@ ,~am

20 pm

——:— —

TIME ENDED

@-@ ~ ❑ am

——:— — 2Clpm

DATE OF EXAMINATION

—1 —1 .—

Month Day Year

TIME

❑ am

--:--0 pm

TRANSPORTATION

•1 Taxi

❑ Self

104
CHILD SAMPLE PERSON QUESTIONNAIRE

Ages 6 Months – 11 Years

(SPANISH VERSION)

H.

M,

c.

F.

D.

G.

N.

A.

J.

L.

B.

E,

K.

Topico

Asistencia a la escuela y uso del idioms

Auto-respuesta del nifio ejemplar

Dental y anemia

Impediment funcional

La vista y el oido

Lista de condiciones

Medicina/vitamina MEC

Nacimiento

Programas de alimento

Respondedor para nifio ejemplar

Servicios de salud

Tubercu losis/peso/inmu nizacion/pesticides

Uso de medicina/vitamina

P5gina

18

30

9

13

10

16

31

1

20

28

2

12

23

185
NACIMIENTO

Al. LQu6 edad tenia (la madre bio16gica de –- /usted)

@

afios de edad

rxando —- nacib? nfimero

I

99 ❑ NS

A2. iQu6edad tenia(el padre biologico de––/usted)

cuando —— naci6?

i~ atios de edad

I

n~mero

i

99 ❑ NS

A3. LNacio–– enunhospital oenalgtin otrolugar? ~ @ lClhospital(A4)

2 ❑ otro —

13 (A6)

especifique

I —

A4. 2Cu6ntas nochesestuvo (lamadre biologicade––/ I @ O. Uninguna

usted) enelhospital durante esteperiodo?

I

noches

n~mero

I

I

99 ‘d NS

A5. LCu~ntas noches paso –– en el hospital durante

este periodo?

m 00 ❑ ninguna

I

noches

n6mer0

I

99 ❑ NS

I —

A6. ZCui%to pes6 –– al nacer?

I

I o123 9 ❑ NS (A7)

i@-@

Iibras/ onzas (A9)

PROBE FOR OUNCES IF NOT REPORTED; n~mero nLmerO

ENTER RESPONSE IN POUNDS AND OUNCES

I

OR

OR IN GRAMS.

I@

gramos (A9)

nhmero

I

A7. tPeso —— m~s de 5’% Iibras (2500 gramos) o menos? @ 1 ❑ 5% Iibras (2500g) o mas (A8)

2 ❑ menos de 5% Iibras (2500 d(A9)

I 9 ❑ NS (A9)

I

AS. ZPeso –– mis de 9 Iibras (4100 gramos) o menos?

i@

I ❑ 9 Iibras (4100g) o mas

I

2 ❑ menos de 9 Iibras (4100g)

9UNS

,

A9. lNaci6 –– m~s o menos cuando se esperaba, o nacio

;@ I ❑ m~s temprano de cuando se esperaba

antes o despu& que se esperaba?

I

2 ❑ cuando se esperaba (Al 1)

3 ❑ mas tarde de cuando se esperaba

AIO. k o menos, lcu~nto tiempo (antes/despuds) de 10

que se esperaba naci6 –– ?

i ‘“+i::l:as -

All. ZNaci6 -– con algfin problems o defecto fisico o

mental? ~ @ ‘Os 2 ❑ N (A13)

1
A12. ZEI problems o defecto de –– tuvo que ver con –

I

elcorazbn? . . . . . . . . . . . . . . . . . . . . . . . . . .

I

Iosojos? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

Iosoidos? . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

Iabocaolagarganta? . . . . . . . . . . . . . . . . . . .

I

el est6mago o 10s intestines? . . . . . . . . . . . . . . . I

10s riiiones o el sistema urinario? . . . . . . . . . . . .

I

Ios mkculos, [OS huesos o Ias coyunturas? . . . . . .

I

el cerebro o el sistema de nervios? . . . . . . . . . . .

I

o133 10s 2DN 9UNS

oI*4 Ins 20N 90NS

o135 10s 2LIN 9iZNS

o136 10s 2Ci N 9CINS

o137 10s 2CIN 90NS

o13e 10s 2CIN 9EINS

o139 Ins 20N 9CINS

o140Ins 2EIN 90NS

A13. tRecibi6 –- algfin cuidado de reci6n nacido en una

i @ 1°S

2 •1 N(A15)

unidad de cuidado intensive, en una sala de reci6n

nacidos prematuros, o en algun otro tipo de facilidad

de cuidado especial?

I

A14. ZCuiintas noches se quedo -– en la facilidad de i@ 1 ❑ menos de 1 semana

cuidado especial? 2 ❑ 1 semana — 1 mes

I 3 ❑ m& de un mes

I

A15. &Se Ie dib alguna vez pecho a –- ? , @ 10s 20 N(A18)

A16. ZQU6 edad tenia -– cuando Ie dejaron de dar pecho I

00 ❑ afin se Ie da pecho

por completo? pm+

1 ❑ alias

2 ❑ semanas

n fimero

I

3 ❑ meses

A17. ZQUE edad tenia -– cuando se Ie di6 por primers vez I m El nunca diariamente

formula o Ieche fresca diariamente? I

(

I ❑ d~as

@@ - 2 •l semanas

3 ❑ meses

I

A18. ZQU15edad tenia —— cuando empez6 a comer comida I

00 •l nunca diariamente

s61ida tal como comidas coladas u otras comidas no I

Iiquidas diariamente?

I

-+

[ @@ “timero ~ ~ ~~~anas

3 ❑ meses

SERVICIOS DE SALUD

B1. i@ 1❑ excelente

ZDiria usted que la salud de —— en general es excelente,

muy buena, buena, regular, o mala? 2 ❑ muy buena

I

3 ❑ buena

I

4 ❑ regular

5 ❑ mala

B2. Ahora quisiera preguntarle sobre Ias visitas de –– para

el cuidado de salud. Primero voy a preguntarle sobre

cuidado rutinario, incluyendo ex5menes rutinarios y

vacunas cuando nada esti real.

ZCu6nto tiempo hate desde la tiltima visita de —— a

una clinics, un centro de salud, un hospital, una oficina

de m6dico o algtin otro Iugar para cuidado de salud

rutinario?

1

@

I ❑ meno. yde un mes

I

2 ❑ I roes, menos de 6 meses

3 ❑ 6 meses, menos de un afio

I

4 ❑ I afio, menos de 5 afios

I

5 ❑ 50 mas afios

9CINS

I o ❑ nunca (B5)

2

187
B3. ZHay una clinics, un centro de salud, un hospital, una I@ II-J, 2 ❑ N(B5)

oficina de m6dico, u otro Iugar en particular a que -— I

va usualmente para cuidado de salud rutinario?

I

] @ 01 ❑ casa

B4. ZOU15clase de Iugar es – una clinics, un centro de saludr 02 ❑ oficina de medico o cl(nica privada

un hospital, una oficina de mddico o algfin otro Iugar? I

PROBE IF CLINIC: ZES cl(nica de paciente externo de I

03 ❑ cl(nica de compafi(a o escuela

hospital, una clinics de compaiiia o escuelar una clfnica

I

04 ❑ CI (nica de paciente externo

para trabajadores m igrantes o alguna otra clase de de hospital

clinics? I

05 ❑ cl(rlica para trabajadores

I

migrantes

06 ❑ otra cl(nica 07

I

especifiq ue

PROBE IF HEALTH CENTER: ZES un centro de salud

I

0S ❑ sala de emergencia de hospital

de la comunidad o del vecindario, un centro de salud 09 ❑ centro de salud de la comunidad,

familiar, un centro rural de salud o alguna otra clase de I

del vecindario, o familiar

centro de salud?

I

PROBE IF HOSPITAL: ZES una clinics para paciente I

10 ❑ centro rural de Salud

externo o sala de emergencia? I

11 ❑ HMO (Organization para el

Mantenimiento de la Salud)/

I

grupo prepagado

I

12 ❑ otro Iugar

especifiq ue

B5. Ahora voy a preguntarle sobre Ias visitas de –– para i @ 10S 2 ❑ N(B19)

cuidado de salud cuando esta enfermo o herido.

ZHay una clinics, un centro de salud, un hospital, I

una oficina de m6dico, u otro Iugar en particular a

I

que –– va usualmente cuando esta enfermo o herido?

/

B6. IF “S” in B3, ASK: I@ 1 ❑ mismo Iugar

2 ❑ otro Iugar

ZES este el mismo (place in B4) o es otro Iugar? I

IF “MISMO LUGAR” IN B6, REFER TO B4 AND I

MARK RESPONSE WITHOUT ASKING. OTHERWISE ASK:

I

I @ 01 ❑ casa

B7. ZQU6 clase de Iugar es – una clinics, un centro de I

02 ❑ oficina de mddico o cl(nica privada (B9)

salud, un hospital, una oficina de m6dico o algtin

I

otro Iugar?

PROBE IF CLINIC: ZES clinics de paciente externo I 03 IJ CI (niCa & compaiila o escuela

de hospital, una clinics de compaii~a o escuela, una I

04 ❑ cl (nica de paciente externo

clinics para trabajadores migrantes o alguna otra clase I

de hospital

de clinics? 05 ❑ cl (nica para trabajadores

I migrantes

I

06 ❑ otra clinics 07

especifiq ue

PROBE IF HEALTH CENTER: ZES un centro de salud I

oe ❑ sala de emergencia de hospital

de la comunidad o del vecindario, un centro de salud I os ❑ centro de salud de la comunidad,

familiar, un centro rural de salud o alguna otra clase

I

del vecindario, o familiar

de centro de salud?

I

PROBE IF HOSPITAL: ZES una clinics para paciente

I

10 ❑ centro rural de salud

externo o sala de emergencia? 11 ❑ HMO (Organization para el

I

Mantenimiento de la Salud)/

I

grupo prepagado

12 ❑ otro Iugar 13

I

especifique

3

188
68. iHay alguna persona en particular que -– ve usual- l@ Ins 2EIN

mente en (place in 67) rxsando est6 enfermo o herido? I

I 1❑ menosde un mes

69. Ahora quisiera hacerle algunas preguntas sobre la tiltima I @ 2 •l I roes, rnenos de 6 mese.s

visita de —— a (place in B7) cuando estuvo enfermo o

I

3 ❑ G meses, menos de Un afio

herido. ZCu6nto tiempo hate desde esa visita?

I

4 ❑ 1 afio, meno~ de 5 afios

5 ❑ 5 afios o m&

I

6 ❑ Nunca (B18)

9Ci NS

I

BIO. iCu5nto tiempo Ie tom6 m5s o menos para Ilegar a (place I @ minutes

in B7) para esa visita?

I

niimero

OR

PROBE IF NECESSARY: LDiria usted que Ie tomo I

m~s de 30 minutes o menos de 30 minutes?

@

I ❑ mas de 30 minutes

2 •l menos de 30 minutes

I

BII. ZTUVO (una cita/un turno) para esa visita?

10 ‘Os

7- ❑ N(B13)

B12. 2Cuanto tiempo pasb m~s o menos entre cuando se hizo ‘o162 000 ❑ menos de un dia

la cita y cuando –– fue a esa visita? I

I

dfas

niimero

B13. Despu& de que lleg6 –– a (place in B7) para esa visits,

ZcuAnto tiempo tuvo que esperar m~s o menos antes I =%+;: :;’:’0s

que Ie atendieran? I

614. ZCU51 fue la raz6n principal por esa visita?

I DO NOT READ.

;@

1 ❑ UNA EN FE RMEDADO UN MALESTAR

2 ❑ UNA HER IDA

I

3 ❑ UNA VISITA DE SEGUIMIENTO/

“FOLLOW-UP”

I 4 ❑ IJNA lNYECCl ON

I

5 ❑ PARA UNA RECETA

6 ❑ ALGUNA OTRA RAZ(jN 7

Es PECIFIQUE

B15. En general, Zqu6 satisfecho estuvo usted con el servicio ~@ lDmu

que –– recibi6 en esa visita?

y satisfecho (B 17)

2 ❑ algo satisfecho

iDiria usted que estuvo muy satisfecho, algo satisfecho 3 ❑ nada satisfecho

o nada satisfecho? I

I

I

DO NOT READ.

616. iPor qu6 no estuvo (completamente) satisfecho con I @ 01 ❑ CUESTA DEMASIADO

el cuidado de salud que —— recibi6 en esa visita?

I

02 ❑ TUVO QUE ESPERAR DEMASIADO

03 II PROBLEMA DE LEN GUAJE – NO

PROBE FOR MAIN REASON. I

PUDO COMUNICARSE

I

04 ❑ EL M~DICO NO LE DIO

SUFICIENTE TIEMPO AL “SP”

I

05 ❑ EL MEDICO U OTRO PERSONAL

I

NO LO TRAT6 BIEN

Oe ❑ LA CON DICION NO MEJORd DESPUES

I

DE L~RATAMIENTO O MEDICAMENTO

I

07 ❑ EL MEDICO NO DIAGNOSTIC

NI TRATd LA CON DICl(jN

I

Oe ❑ OTRO –09

I

ESPECIFIQUE

99 ❑ NS

4

189
I

B17. ZQui6n llev6 a ––

DO NOT READ.

a (place in B7) paraesa visita?

I MARK ALL THAT APPLY.

I

, @ o, ❑❑ MADRE EL NlfiO FUE SOLO

I

2 ❑ PADRE

I

4 ❑ OTRO MI EMBRO DE LA CASA ~

I

5 —

ESPECIFIQUE

I

6 ❑ PERSONA NO MI EMBRO DE LA CASA

IB18. ZHa visitado -– cualquier otra cl inica, centro de salud,

@

1 II S (B22) 2 ❑ N (B32)

oficina de m6dico, u otro Iugar para el cuidado de salud

cuando estaba en fermo o herido desde esa visita a

(place in B7)?

I

HAND CARD CSP 1

;@ 1 23456 7

IB19. Muchas personas no tienen un Iugar en particular donde

I

7

ustialmente van cuando est6n enfermos o heridos. especlfique

ZPodria usted darme el numero de la frase que mejor

explica la raz6n principal por la cual –– no tiene un

I

Iugar en particular donde usualmente va? I

1 – Tiene dos o m~s mddicos o lugares a Ios que I

usualmente va depend iendo del problems

que tenga. I

3 – No ha necesitado medico. I

3 – El mddico que Ie atend(a ya no est~

disponible. I

4 – No ha podido encontrar el m~dico apropiado. I

5 – Acaba de mudarse al area.

6 – Otra raz6n-especifique por favor. I

1320. Aunque usted dijo que –– no tiene un Iugar en parti- I @ 10S 2 ❑ N(B22)

cular donde recibe cuidado de salud, Zhay alguna

persona en particular a quien –– ve usualmente cuando I

est6 enfermo o herido?

IB21. ZDonde ve –– a esta persona usualmente - en casa,

I @ OI ❑ casa

en una clinics, en un centro de salud, en un hospital, I

02 ❑ oficina de medico o clinics privada

en una oficina de m6dico o en algtin otro Iugar?

I

03 ❑ cl(nica de compafi l’a o escuela

PROBE IF CLINIC: ZES una clinics para paciente I

04 ❑ clinics para paciente externo de

externo de hospital, una clinics de compaiiia o escuela, hospital

una cl(nica para trabajadores migrantes o alguna otra I

05 ❑ cli’nica para trabajadores

clase de clinics? I

migrantes

05 ❑ otra cl l’nica 07

PROBE IF HEALTH CENTER: ZES un centro de salud I

especlf iq ue

de la comunidad o del vecindario, un centro de salud I

familiar, un centro de salud rural o alguna otra clase 0S ❑ sala de emergencia de hospital

de centro de salud? I cm❑ central de salud de la comunidad,

I

del vecindario, o familiar

PROBE IF HOSPITAL: ZES una clinics para paciente

externo o sala de emergencia? I

I

10 ❑ Centro rural de salud

11 ❑ HMO (Organ izaci6n para el

I Mantenimiento de la Salud)/

I

grupo prepagado

12 ❑ otro Iugar 13

I

especifiq ue

5

190
622. Ahora me gustaria hacede unas preguntas sobre la ~ @ I ❑ rnenosde 1 rnes

ultima visita de –– a cualquier ciinica, centro de salud, 2 ❑ 1 roes, menos de 6 meses

oficina del mi$dico u otro Iugar para el cuidado de salud

I

3 ❑ 6 meses, menos de 1 afio

cuando estuvo enfermo o herido. lCuanto tiempo hate

I

4 ❑ I arlo, menos de 5 aiios

desde esa visita? 5 ❑ 5 ahos o mas

I

9DNS

I

o •l nunca (B32)

623. ZQue ciase de Iugar visito –– para esa visita – era una I @ 01 ❑ casa

cli_nica, un centro de salud, un hospital, una oficina de I

02 ❑ oficina de medico o clinics privada

medico o algun otro Iugar?

I

PROBE IF CLINIC: ZEra una clinics de paciente I

os •l cll’nica de compafil’a o escuela

externo de hospital, una clinics de compafir’a o escuela, I

04•l clinics de paciente externo

u na cl inica para trabajadores m igrantes o alguna otra de hospital

clase de cl(nica?

I

05 II cl (nica para trabajadores

I

migrantes

06 ❑ otra cl~nica 07

I

especif iq ue

PROBE IF HEALTH CENTER: ZEra un centro de

I

08 ❑ sala de emergencia de hospital

salud de la comunidad o del vecindario, un centro de oe ❑ centro de salud de la comunidad,

salud familiar, un centro rural de salud o alguna otra I del vecindario, o familiar

clase de centro de salud? I

PROBE IF HOSPITAL: ZEra una clinics para paciente I

10 ❑ centro rural de salud

externo o sala de emergencia? II ❑ HMO (Organization para el

I Mantenimiento de la Salud)/

I

grupo prepagado

I

12 ❑ otro Iugar 13

especifique

624. ZCuanto tiempo Ie tomo mas o menos para Ilegar a

;@ minutes

(place in B23) para esa visita? n(imero

I OR

PROBE IF NECESSARY: iDiria usted que Ie tomo

mas de 30 minutes o menos de 30 minutes? I @ I •! mas de 30 minutes

I

2 ❑ menos de 30 minutes

625. ZTUVO (una cita/un turno) para esa visita? 1 @ Ins

I

2 ❑ N (B27)

626. ZCuanto tiempo paso mas o menos entre cuando se

hizo la cita y cuando –– fue para esa visita?

~ @“oo ❑ ‘enosde ‘n :~5

I

numero

627. Despu6s de que Ilego a (place in B23) para esa visita, I

Zcuantotiempo tuvo que esperar mas o menos antes I @_{’ ❑ minutes

n6mer0 2 G horas

que Ie atendieran?

I

I

628. ZCU51 fue la razon principal por esa visita? DO NOT READ.

I

@

1 ❑ UNA EN FE RMEDAD O UN MALESTAR

2 ❑ UNA HER IDA

I

3 ❑ IJNA VISITA DE SEGUIMIENTO/

I

“FOLLOW-UP”

4 •l UNA lNYECClbN

I

5 ❑ PARA UNA RECETA

I

6 ❑ ALGUNA OTRA RAZON 7

ESPECIFIQUE

6

191
B29. En general, Zque satisfecho estuvo usted con el servicio 1 @ 1 II rnuy satlsfecho (B31)

que –– recibio en esa visita? I 2 ❑ algo satisfecho

ZDiria usted que estuvo muy satisfecho, algo satisfecho 3 ❑ nada satisfecho

o nada satisfecho?

B30. ZPor qu6 no estuvo (completamente) satisfecho con I

DO NOT READ

MARK ONE BOX ONLY.

el cuidado de saiud que recibio en esa visita? I

PROBE FOR MAIN REASON. @

01 ❑ CUESTA DE MASIADO

I

02 ❑ TUVO QUE ESPERAR DEMASIADO

03 ❑ PROBLEMA DE LEN GUAJE – NO

I

PUDO COMUNICARSE

04 II EL M; DICONO LE Dlb

I SUFI,CIENTE TIEMPO AL “SP”

I

05 ❑ EL MEDICO U OTRO PERSONAL

NO LO TRAT6 BIEN

06 H LA CONDITION NO MEJOR6 DESPU~S

DEL TRATAMIENTO O MEDICAMENTO

07 ❑ EL MfDICO NO DIAGNOS,TICO

I NI TRAT6 LA CON DICION

08 ❑ OTRO – 09

EsPEc IF IQUE

99 ❑ NS

B31. ZQuien Ilevo a –– a (place in B23) para esa visita? DO NOT READ.

I

MARK ALL THAT APPLY.

@

o ❑ EL Nl~OFUE SOLO

I ❑ MADRE

I

z ❑ PADRE

I

4 ❑ OTRO MI EM EIRO DE LA CASA -q

I

5

ES? EC IF IQUE

I 6 Cl PERSONA NO MI EMBRO DE LA CASA

I

I

B32. Hay algunas personas que vemos algunas veces que I(RJ1DS 20N

proveen cuidado de salud, tat como curanderos, sobadores, (herbolarios/hierberos), (espiritualistas/espiritistas), y otros. En Ios ultimos 12 mesas, Zha visto ––

a cualquiera de estas personas para el cuidad de salud?

7

192
I

B33. A veces Ias personas tienen dificultad I

B34. ZEste problems

en obtener cuidado m~dico. ZHa tenido

I

[e impidi6 obtener

usted alguna dificultad en obtener cuidado cuidado m~dico

m~dico para -— I

para ––?

1. Porque el cuidado no estaba disponible I

cuando 10 necesitaba? I @@ ID S(B34)ZDN I 10S 2CIN

2. Por 10 que costaba? [ @@ IO S(B34)2UN I

10s

I

213N

3. Porque no sabfa a donde ir? 1 @@10 S(634)20N I 10s ‘ON

4. Porque no ten (a como Ilegar? I @-@l DS@34)ZON I IOS

~ @@10 S(B34)20N ‘

zCIN

5. Porque el horario no era convenience?

I

10s 2CIN

6. Porque tenfa que esperar demasiado

para obtener (una cita/un turno)? I @@ 1US(B34) zDN ‘ Ins

I

I

2i3N

(7. Porque necesitaba a alguien que Ie

cuidara sus otros niiios?) ~ @@10 S(634)20N ~ 10s zUN

8. Porque perderia sueldo por faltar

al trabajo? I @@ Ius(B34)2cIN ~ 10s

I

2UN

9. Porque ten(a que esperar demasiado

en la oficina o cl fnica? ~ @@10 S(B34)2UN I 10s

I

2CIN

10. Porque el personal de la oficina o la

cl inica Ie falt6 el respeto? I @j@ IuS(B34)2UN ~ 10s

I

2CIN

11. Porque no ten ia conf ianza en el

personal? ~ @@10 S(B34)20N i 10s 2UN

12. Porque no hablaban espafiol? , @@llns(B34)’DN ~ ‘Os 2UN

13. Porque no habian empleados (hispanos) I I

en la oficina o cl(nica? I@@ 1 ❑ S(B34) 2 ❑ N

I

10s 2CIN

I

I

B35. ZCu3nto tiempo hate m& o menos desde que @

1 ❑ hate menosde un aho

—— tuvo un examen fisico rutinario; es decir, z ❑ 1 aiio, menos de 2 afios

no para una enfermedad en particular, sino I

3 ❑ 2 aFios, menos de 5 afios

para un examen en general?

I

4 ❑ 5 arios o mAs

5 ❑ nunca

I

90NS

B36. Desde que naci6 ––, ZcuAntas veces diferentes I

estuvo internado una noche o m~s en el hospital? 10

No incluya la hospitalization cuando –– nacio.

veces

I

numero

8

193
DENTAL Y ANEMIA

I

I

cl. tQue edad tenia —— cuando —— vib por primers vez a 1 ❑ menos de 4 silos de edad

alguien para cuidado dental? @ Z ❑ 4 afios de edad o mayor

I

9DNS

3 ❑ nunca (C5)

C2. M5s o menos, Zcu5nto tiempo hate desde la tiltima I @ 1 ❑ hate 6 meses o menos

vez — que —— vi6 a alguien para cuidado dental?

I

z ❑ mds de 6 meses a 12 meses

I

3 ❑ m~s de 12 r-ne~es a z afios

4 El m~s de 2 afios a 5 afios

I

5 ❑ m~s de 5 afios

9DNS

I

1

C3. En promedio, mi% o menosr icu~ntas veces al aiio @ 1 ❑ menos de una vez al afio

ve —— a alguien para cuidado dental? Z ❑ una vez

I a ❑ dos veces

I

4 ❑ 3 veces o mas

5 ❑ no tiene programa regular

I

9CINS

I

C4. ZHa recibido –– alguna vez tratamientos de fluoruro

I

que fueron aplicados a Ios dientes de –– durante una @ lDS ZUN 9CINS

visita al dentista o por otra persona a quien —— vio I

para cuidado dental?

C5. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD.

lo

I ❑ under 5 yrs. old (C8)

z ❑ 5+ yrs. old (C6)

!

C6. tAsiste -—

I

a la escuela? @ ‘us 2 ❑ N(C8)

I

C7. ZParticipa —— en un programa de fluoruro en la @ IIJs zON 9EINS

escuela? Este es un programa en el cual se Ies dan a

Ios niiios tabletas o enjuagues de fluoruro para uso en I

la escuela. I

C8. ZEst6 asegurado —— por una p61iza de salud que paga

@ ‘Us

zUN 9CINS

por cuidado dental?

I

C9. ZHa tenido —— alguna vez anemia? ~@ IUs 2 H N(D1) 9 ❑ NS(D1)

I

C1O. ZDijo alguna vez un m~dico que –– tenia anemia? @ lDS 2 ❑ N(DI)

I

Cl 1. ZTiene –- anemia todav(a? I@ 10s ZON

I

C12. ZFue atendido –– para esta condicion por un I@ 1~~ ZUN

mddico? I

194

9
I

LA VISTA YE LOIDO

I

D1. ZHa tenido —— alguna vez problemas para wer con uno @ 10s z ❑ N(D1O)

o con ambos ojos cuando n~ usa (lentes/anteojos/ I

espejuelos) o Ientes de contacto?

I

I

1 @ s g ;~;lag;;&~;gd

D2. ZQU6 edad teni_a –– cuando —- empez6 a tener 1 ❑ menos de 1 atio de edad

dificultades con la vista?

I

I

D3. ZVi6 alguna vez –– a un m6dico para eso? I @ Ins 2i3N

!

D4. lUsa –– (lentes/anteojos/espejuelos) o Ientes de I @ IDs 2 ❑ N(D6)

contacto?

I

D5. ZTiene –– problemas con la vista atin cuando usa ‘o230 I ❑ S(D8) z ❑ N(D8)

(lentes/anteojos/espejue[os) o Ientes de contacto? I

D6. tHa usado –– alguna vez (lentes/anteojos/espejuelos)

@ lUS z ❑ N(D1O)

o Ientes de contacto?

D7. LPor qud dej6 –– de usarlos?

I MARK ALL THAT APPLY.

@

DO NOT READ.

I ❑ YA NO LOS NECESITABA

233

18

1❑ NO LE AYUDABAN

234

;@

I ❑ INCONVENIENCES

1 ❑ OTRO z

EsPECIFIQUE

D8. ZPara qu6 Ie recetaron a –– 10s (lentes/anteojos/ I MARK ALL THAT APPLY.

espejuelos) o Ientes de contacto?

I

DO NOT READ.

8

I 236 1 ❑ LEE R/HACER TRABAJOS DE CERCA

I

237 -i ❑ VER OBJETOS LEJANOS

I@ I ❑ OTRO z

EsPECIFIQUE

D9. LCon qu6 frecuencia (usa/usaba) –– sus (lentes/ I •l todo el tiempo i @ 2 ❑ k mayor(a del tiempo anteojos/espejuelos) o Ientes de contacto: todo el

tiempo, la mayoria del tiempo, casi nunca, o nunca? I

3 ❑ casi nunca

4 ❑ nunca

DIO. CHECK ITEM: REFER TO AGE OF SAMPLE CHILD

AND TO QUESTION C6. I@ I ❑ under5 yrs. old (D13)

I

2 ❑ 5+ yrs. old, goes to school (Dll)

3 ❑ 5+ yrs. old, doesn’t go to school (D12)

DI 1. 2Puede –- leer el pizarron desde atr5s de la sala de ] @ lns 2nN 9nNs

clase (cuando usa Ios (Ientes/anteojos/espejuelos) o

Ientes de contacto)? I

I

I

D12. ZLe ha dicho alguna vez un m6dico que –– tenia I @ ins 2nN 9CINS

problemas de aprendizaje o de desarrollo relacionados

a la vista de —– ? I

I

10

195
013. LCuando fue la ultima vez que Ie hicieron un examen I @ I ❑ hace6 mews o rnenos

de la vista a -– ? I

z ❑ mtis de 6 meses a 12 meses

I

3 ❑ mas de 12 meses a 2 afios

4 ❑ mA de 2 afiosa 5 aiios

I 5❑ m&de 5 aiios

I

6 ❑ nunca

9EINS

1

D14. ZTUVO alguna vez –- una infeccion de oido o dolor

de oido?

I @ Ins Z ❑ N(D18)9 ❑ NS(D18)

1

D15. ZCu5ntas veces ha tenido –– una infecci6n de ofdo o

I@

1 ❑ solamente una vez

dolor de oido?

I

2 ❑ dos veces

3 ❑ 3-5 veces

I

4 ❑ 6 veces o m~s

9UNS

I

D16. tHa sido -- atendido alguna vez por un mddico por ~ @ Ins 2 ❑ N(D18)9 •1 NS(D18)

(alguna(s)) infection o dolor(es) de oido?

D17. tLe ha tratado alguna vez un m~dico una infeccitrn o

I

I @ ‘Us

zEIN 9UNS

un dolor de oido a -– poniendole tubes en el oido?

I

D18. ZHa tenido –– alguna vez un timpano roto? I @ ,~s 20N 91JN!3

I

D19. LTUVO –– alguna vez un oido supurante o cualquier

derrame del oido no tomando en cuenta la cera en ~ @ 10s 2 ❑ N(D22) 9 ❑ NS(D22)

Ios o ides? I

D20. ZCu&rtes veces ha tenido -– un o ido supurante o I @ 1 ❑ solo una vez

cualquier derrame del oido? I

2❑ dos veces

3 ❑ 3-5 veces

I

4 ❑ 6 veces o mas

I

9CINS

D21. iVib -- alguna vez a un m6dico debido a esta lo Ins ZUN 9UNS

condici6n? I

D22. tHa tenido –– alguna vez problemas para oir con uno I @ IDs 2 ❑ N(D27)

o Ios dos oidos? No incluya ningunos problemas que

duraron s610 un periodo corto tal como cuando ten ia I

catarro. I

D23. ZQU6 edad tenia –- cuando —— empezo a tener ;@ I ❑ menos de un aiio de edad

problemas en oir? 2 ❑ 1-4 arios de edad

I

3 ❑ 5-11 atlos de edad

D24. Desde que este problems empezo, Zse ha puesto peer, I@ lElpeor

mejor, o se he quedado igual? I

2 ❑ mejor

I

3 ❑ igual

D25. ZVi6 –– alguna vez a un m6dico sobre eso?

I

I@ ‘n’ 7-UN

D26. ZTodavia tiene –– problemas en oir con uno o [OS I@ 10s zCIN

dos oidos?

I

196

11
I

027. ZHa usado –– alguna vez un (aparato auditivo/aparato

para oir/’’hearing aid”)? I @ 10s 2DN

1

D28. ~Como describir(a usted la capacidad de –– en os’r

(sin aparato para oir) – buena, tiene poca dificultad, ; o ; ~ ~~~~;ific.[tad

tiene mucha dificultad o est~ sordo? I

3•l mucha dificultad

4 ❑ sordo

D29. zHa tenido –– alguna vez una operation de Ios or’dos? @ 10’ zEIN

EXCLUDE HAVING TUBES PLACED IN THE EARS.

I

D30. 2Cuando fue la tiltima vez que Ie examinaron el 10260 1 Cl hate 6 meses o menos

oidoa —— ? I

z El mas de 6 meses a 12 meses

I

3 U mas de 12 meses a 2 afios

4 0 mas de 2 afios a 5 ar?os

I

5 U nunca

9CINS

I

TUBERCULOSIS/PESO/l NMUNIZACiON/PESTICI DAS I

I

El. iLe ha dicho alguna vez un medico que —— tenia

@ 10s

zON

tuberculosis?

1

E2. LHa vivido –– alguna vez en un hogar con una persona I @ 10s 2DN 9UNS

que ten ia tuberculosis activa?

I

E3. Mas o menos, Lque estatura tiene –– sin zapatos? @

9UNS

I @@ -n=pieS/ .Lm,,o pulgadas

I OR

l@ cms

I

n;mero

E4. Mas o menos, ~cuanto pesa –– sin ropa o zapatos? @9UNS

I

I @ “,mero “bras

1

OR

~ @ ‘nGm,rO kilos

E5. Para su estatura, Zdiria usted que –– esta bajo peso, ;@

I U bajo peso

mas o menos a su debido peso o sobre peso? z ❑ mas o menos a su debido peso (E9)

3 U sobre peso

I

E6. iHa visto –— alguna vez a un medico con relation lo 10s 2 ❑ N(E9)

a su peso?

!

E7. ZRecomendo el m6dico alguna vez cualquier trata- l@lns 2 ❑ N(E9)

miento para el peso de –— ?

I

E8. iQu6 tipo de tratamiento recomendo el medico?

I

MARK ALL THAT APPLY.

DO NOT READ.

I @ 1 U MEDICINA

I @ 1 ❑ DIETA PARA REDUCIR

1 @ I D DIETA DE ALTACALORI’A

I

,8

276 I U EJERCICIO

277 lCIOTRO-2 EsPEc IF IQUE

12

197
E9. .lHa recibido –– alguna vez una inyeccion de DPT? l@los z u kI(E12)9 ❑ rw(E12)

La inyeccion de DPT es para prevenir la difteria, el I

t6tano y la tos ferina?

I

E 10. ZCuantas inyecciones de DPT ha recibido -– en su WI;:;

viola? I 303

I

404

5D5+ I

En. .?Que edad tenia –– cuando recibio la (primers) 00 0 menos de 1 mes

I

inyeccion de DPT? Im \(E16)

I

I {

1 ❑ meses de edad

n~mero z ❑ ar?os de edad J

E12, ZHa recibido –– alguna vez una inyeccion para prevenir @lDS

2 ❑ N(E16)9 ❑ NS(E16)

el t6tano?

I

E 13. ZCuantas inyecciones ha recibido –– contra el tetano I@::;

en su viola?

I 303

1

404

I

5C15+

E14. ZQU6 edad tenia –– cuando recibio la (primers)

inyeccion contra el tetano?

I 00 0 menos de 1 mes

~ @@ {1 ❑ mews de edad

.~m,,o 2 ❑ afios de edad

E15. ZPor que recibio –– la(s) inyeccion(es) contra el

i@ 1 ❑ vacuna(s) rutinaria(s)

tdtano? Z(Era/Eran) vacuna(s) rutinaria(s) o la(s) z O herida o enfermedad

recibio debido a una herida o enfermedad que —- 1 3 •l otro 4

tuvo en ese tiempo?

I

especifique

IF MORE THAN ONE SHOT RECEIVED MARK

ALL APPLICABLE BOXES.

I

I

E16. ZHa vivido –– alguna vez con alguien que hacia trabajo l@l Ds

(agricola/de campo/de fincal)?

2DN

I

E17. CHECK ITEM: REFER TO AGE OF SAMPLE lo

CHILD.

1 ❑ under 6 yrs. old (E20)

I

2 •l 6 yrs. old or older (E18)

E18. LTrabajo –– alguna vez o ayudo en trabajo (agricola/

‘@’~s z ❑ N(E20)9 ❑ Ns(E20)

del campo/de finca), por ejemplo en Ios campos o laS

huertas? I

E 19. ZHa trabajado o ayudado –– en trabajo (agricola/del i@lnS 2CIN

campo/de finca) durante el afio pasado?

I

E20. (Durante [OScinco afios pasados/Desde que nacio –– )

io lUS 2DN ‘nNs

Zie han puesto la medicina recetada, Kwell, para et

control de piojos de la cabeza o cuerpo? I

,

IMPEDIMENT FUNCIONAL

I

F1. CHECK ITEM: REFER TO AGE OF SAMPLE I@ 1 ❑ Under 5 yrs. old (F2)

CHILD. I

2 ❑ 5+ yrs. old (F4)

13
F2. LPuede –– participar en algtin modo en Ias actividades @

I

Ins 7.❑ N(FIO)

de juegos tipicos de la mayorfa de (niiios/beb&) de su

edad?

F3. LEst6 —— Iimitado en el tipo Q la cantidad de juegos en @ I ❑ S(FIO) 2 ❑ N(F8)

que puede participar –– debido a un impediment o

I

problems de salud?

F4. ZHay algfin impediment o problems de salud que

@ I ❑ S(FIO) 20 N

ahora Ie impide que —— asistir la escuela? I

F5. LAsiste -— a una escuela especial, o a clases especiales @ 1 ❑ S(FIO) 20 N

debido a algfin impediment o problems de salud?

I

F6, ZNecesita —- asistir a una escuela especial o a clases 10297 I ❑ S(FIO) 7-CI N

especiales debido a algtin impediment o problems de I

salud? I

F7. ZEst6 Iimitado —— en su asistencia a la escuela debido @ I ❑ S(FIO) 20 N

a su salud? I

F8. ZEstti Iimitado —— en alguna forma en cualquier acti- 10299 10s 20 N(G1)

vidad debido a un impediment o problems de salud? I

F9. ZEn qu6 forma est5 Iimitado -— ?

RECORD LIMITATION, NOT CONDITION.

i@ I

Iimitacion

I

F 10. .ZQU6 condicion causa esta Iimitacion? I

I

condici6n

F1l. ZCu6ndo notb por primera vez (condition in F 10) @

1 ❑ m% de 3 meses (Gl)

de –– ?

I

❑ 3 meses o menos –

PROBE IF NECESSARY: ZFue durante Ios 3 meses

pasados o hate m& de 3 meses? I SPECIFY IF 3 MONTHS AGO OR LESS –

I

I

2 ❑ CONDITION IS ON CARD CSP 2 (Gl)

3 ❑ CONDITION NOT ON CARD CSp 2 (F12)

F 12. .ZEsta Iimitacion es causada por alguna otra condici6n? I@ ,~~

I

2 ❑ N(GI)

I

F13. tQu6 otra condici&r causa esta limitaci6n?

I condici6n

F14. ZCu5ndo noto por primers vez (condition in F13) ‘@ 1 ❑ masde3 meses (Gl)

de –- ? I

I

❑ 3 meses o menos –

I SPECIFY IF 3 MONTHS AGO OR LESS –

I

I

2 •l CONDITION IS ON CARD CSP 2 (Gl)

I

3 •l CONDITION NOT ON CARD CSP 2

I

(REASK F12-F14)

14

199
LISTA DE CON DICIONES

G1. ZLe dijo un m6dico alguna vez que -—

tenia – IF “S’’ASKG2-G4 BEFORE G2. ZQU6 edad terria –– la primers vez

GOING TO NEXT CONDITION. que tuvo.., ?

-—— .—— ——— ——— ——— ———

a. Asma?

———— ———— —

1 Cl S(G2) 20N

b. Otra enfermedad del Dulmon? m 1 ❑ S(G2) 2CIN

c. Retraso mental? 63 1 H S(G4) 2UN

‘t------------

0306

(=)

,—— — -.

o305 _ meses _ afios

o310 _ meses

w ~%%

d. Problemas en la coordination? o3161❑ S(G2) 20N o317 — meses o310 _ aiios

—

e. Debilidad muscular/par51 isis? o3211❑ S(G2) 213No322 _ meses o323 _ afio:s

—

f, Fiebre reumatica? o326 1 ❑ S(G2) 2CINo327 _ meses o328 _ atio!$

—— 9.Enfermedad reumatica del coraz6n? 033 I 1 ❑ S(G2) 2CINo332 _ meses o333 _ aiios

o

— h. Otra condici6n del coraz6n? 336 I ❑ S(G2) 2!3No337 _ meses o338 _ afios

—

i. Infeccitm urinaria? o341 1 ❑ S(G2) 20N o342 _ meses o343 _ afio$

—

j. Convulsions? o346 1 ❑ S(G2) 213No347 _ meses o340 _ aiiosi

o

—

k.Eczema? 35T 1 ❑ S(G2) 2!3No352 _ meses o353 _ afios

o

—

1.Problemas con el hablar? 356 1 ❑ S(G2) 20N o357 _ meses o35a _ afios

o

—

m. Problemas psicoldgicos o problemas 361 1 ❑ S(G2) 2i3No362 — MeSeS o363 _ afiOS,

de comportamiento?

—

n. Envenenamiento? o366 1 ❑ S(G2) 20N o367 _ meses o36E _ afi OS

—

16
G3. Tiene –– todaw’a ...? G4. lFue alguna vez –– atendido

por un m6dico debido a ...?

——— —.— ——— ——— ———— ——— - .—— — ———— ——— ——— ———— ————

0307 10s 2UN 9CINS

0

300 10s 20N 9CINS

(=)10s 2EIN 9Cl NS 0

313 10s 2CIN 9DNS

u — /

/“””’””” “:$:: “,. ,g”;”::’

/

‘ ‘,;$~+$:,;,7:/’~~(y?+ / /. o315 10s 2CIN 9UNS

o319 10s 2ci N 9DNS o320 10s 2CIN 9Ci NS

o

324 lns 2Ci N 9CINS o325 10s 2CIN 9UNS

o329 10s 211N 9DNS o330 Ins. 2CIN 9CINS

o334 10s 2DN 9CINS o335 10s 2CIN 9CINS

o339 10s 2UN 9CINS o340 Ins 2CIN 9CINS

o344 10s 2CIN 90NS o345 10s 20N 9UNS

o349 10s 213N 9CINS .0350 Ins 2nN 9nNs

o354 lns 2Ci N 9UNS o355 Ins 2nN 9UNS

o359 Ins 2nN 9UNS o360 Ins 2nN 9UNS

o364 10s 2nN 9UNS o365 lns 2nN 9Ci NS

17

201
ASISTENCIA A LA ESCUELA Y USO DEL IDIOMA

H1. CHECK ITEM: REFER TO AGE OF SAMPLE ;0

I ❑ Under 5 yrs, old (H17)

CHILD AND TO QUESTION C6.

2 II 5+ yrs. old, goes to school (H3)

I 3 ❑ 5+ yrs. old, not in school (H2)

H2. ZHa asistido alguna vez –– a la escuela? lo Ins 2 ❑ N(H16)

I@ 1 ❑ asiste a la escuela

H3. ZEst5 ahora –– asistiendo a la escuela o est5 de vaca1

2 ❑ de vacaciones de la escuela

ciones de la escuela? 3 ❑ ninguno (H5)

H4. tEn qu6 grado (est5 –– ahora/estar5 –– )? I@ 00 ❑ “nursery”

I

77 ❑ kinder/’’k indergarten”

}

(H7)

I

grado

ntimero

H5. ZPor que dejb –- de asistir a la escuela?

I

I

DO NOT READ.

10

1 ❑ PROBLEMA DE SALUD

I

z ❑ LA FAMILIA NECESITAAL Nl~O EN

LA CASA

I

I

3 ❑ ABANDON(j LA ESCUELA

4 ❑ OTRO 5

I

EsPEcIFIQu E

1

H6. lCu6nto tiempo hate que –– dejo de asistir a la escuela?

I

00 ❑ hate menos de un mes

I@-@ [

1❑ meses

I

n(imero 2 ❑ atios

IF MORE THAN 12 MONTHS AGO IN H6, GO

TO H8. OTHERWISE ASK: I

H7. Durante Ios 12 meses pasados, m% o menos, Zcu5ntos

d fas estuvo --

I @ ooo ❑ ninguno

ausente de la escuela debido a enfer- 1

d(as

medad?

I

n6mer0

I

H8. ZHa repetido –– cualquier grado de la escuela por

10 ‘Us

21JN

cualquier razon?

I

H9. tHa saltado –– alguna vez cualquier grado por cual-

~ @ ‘Us

2Ci N

quier razbn?

1

H’IO. Cuando –– empezo a hablar, ZCU51 idioms hab16? ;@ 1 ❑ espafiol

I

2 ❑ ing16s (H13)

3 ❑ otro 4

I

especifique

HI 1. ZPuede –– hablar ingk ahora?

I @ 10s

2 ❑ N(H13)

I

202

Ie
H12. tZQu6 edad tenia –– cuando empezo a hablar el ing16s? I@

I

aiios de edad

nCimerO

H13. ZQU6 idoma principalmente habla –– ahora en casa?

@ 1 ❑ espaiiol

I

2 ❑ ingl&

3 ❑ Ios dos igualmente

I

4 II otro idioms 5

especifiq ue

1

H 14. ZQU15 idioms principalmente (hablan Ios padres de I@ 1 II espafiol

-– /habla usted) en la casa ahora?

I

Z ❑ ingl&

3 ❑ IOS dos igualmente

I

4 ❑ otro idioms 5

I

especifique

H15. ZQU6 idioms principalmente (habla/hab16) –– en sus

I 1 ❑ espaiiol

‘ o ~ B l~~!;s igualmente

clases en la escuela?

I

}

(Jl)

1

4 •l depende del t6pico

I

5 ❑ otro idioms 6

especif iq ue

H16. lPor qu6 nunca ha asistido –– a la escuela? I

MARK ALL THAT APPLY.

I

DO NOT READ.

I @ 1 ❑ DEMASIADO JOV~N - NO HAY ESCUELAS

@

CERCA PARA NINOS DE SU EDAD

I ❑ PROBLEMA DE SALUD

I@ 1 ❑ LA FAMILIA NECESITA AL Nl~O EN

I

LA CASA

10 1 •l OTRO z

EsPECIFIQUE

H 17. Cuando –– empez6 a hablar, ZCU51 idioms hablo?

;@

1 ❑ espaflol

2 ❑ ingl& (H20)

I

3 ❑ otro 4

especifique

I

I

5 ❑ todavia no habla (H21)

HIS. ZPuede –– hablar ingk ahora?

~~ lns 2n N(H20)

I

H19. LQU6 edad tenia –– cuando empez6 a hablar el ingli%?

I@

afios de edad

n~mero

I

H20. ZQU6 idioms principalmente habla –– ahora en casa?

l@

1 ❑ espafiol

I

2 ❑ ing16s (H20)

3 ❑ Ios dos igualmente

I

4 ❑ otro idioms 5

especifique

w

I ❑ espatiol

H21. ZQU6 idioms principalmente (hablan Ios padres de 2 •l inglf%

–– /habla usted) en la casa ahora? I 3 ❑ Ios dos igualmente

I

4 ❑ otro idioms 5

especifique

19

203
PROGRAMAS DE ALIMENTO

J1. ZHa recibido ––alguna vezcomida oserviciosm6dicos I

j @ 10s

2 ❑ N(J4) 9 ❑ NS(J4)

bajo el programa (WIC) Mujeres, Infantes y Niiios?

,

J2. ZRecibe —— ahora comida o servicios m6dicos bajo

i @ 10’

2UN

el programa (WIC) Mujeres, Infantes y Nirios?

9Ci NS

1

J3. ~pOr cu~nto tiempo (recibi6 —— /ha estado recibiendo

–– ) comida o servicios mddicos del programa WIC?

I@@

I {

I ❑ meses

nfimero 2 ❑ ahos

1

J4. CHECK ITEM: REFER TO ITEM H3, 10

1 ❑ Now going to school or on vacation (J5)

I

z ❑ Neither (Kl)

I

J5. ZLa escuela a que —— asiste sirve un (desayuno/ I @ 10s

almuerzo/’’breakfast”) completo?

2Ci N

I

I

J6. Usualmente, Zcu%tas veces por semana come –– el

(desayuno/almuerzo/’’breakfast”) servido por la escuela? lo veces

nimero

I

o ❑ ninguna (J IO)

9Ei NS

I

J7. Durante este afio (pasado) escolar, Z(llenaron Ios padres

I @ ‘Us

2 ❑ N(J9)

de ––/lleno usted) un formulario para que –– pudiera

comer el (desayuno/almuerz o/’’breakfast”) en la escuela I

a un precio reducido o gratis?

I

I

J8. ZCome –– el (desayuno/almuerzo/’’breakfast”) a un I @ ‘Os’

precio reducido o gratis?

I

2 ❑ No, no elegible

3 ❑ No, otra razon

I

J9. iCuinto paga –- por su (desayuno/almuerzo/’’breakfast”) por dia?

@ centavos

numero

I 000 ❑ gratis

JIO. La escuela a que –– asister isirve una comida de

I @ Ins mediodia completa? 2UN

I

JI 1. Usualmcnte, Zcu5ntas veces por semana come ––

I

la comida de mediodia servida por la escuela? I @ “,mero

veces

I o ❑ ninguna (J15)

I

9UNS

I

J12. Durante este aiio (pasado) escolar, Z(llenaron Ios padres I @ Ins

de –- /llen6 usted) un formulario para que –– pudiera

2 ❑ N (J14)

comer la comida de mediodr’a en la escuela a un precio I

reducido o gratis? I

20

204
I

J13. ZCome –– la comida de mediodi_a a un precio reducido I @ ; : :~ “o ,Iegible

o gratis?

1’ s ❑ Nor otra razon

I

J14. ZCui4nto paga –– por su comida de mediodia por d(a? ,@ centavos

n 6mer0

I 000 ❑ gratis

I

J15. ZTrae –– alguna vez su comida de mediod~a de casa? @

1 ❑ Sir siempre

2 ❑ sir algunas veces

I

3 ❑ No(KI)

J16. En alias que –– no come la comida de mediod(a en la 1

escuela, Zcompra Ieche? I 0 1 B ~1 r ~[l~veces

I

3 ❑ No(KI)

I

J 17. ZCu6nto paga –– por su Ieche por dia? I @ ~,mero centavos

I

I 000 !3 gratis

I

21

205
EL USO DE MEDICINA/VITAMINA

K1. Durante las 2 semanas pasadas, Zha tornado o usado algunas vitaminas o minerales? o41S I ❑ S(K2) 2 ❑ N (K5)

K2. ZMe permite ver el (envase(s)/ K3. ZQUE cantidad del (vitamin/ K4. ZCon qu~ frecuencia toma –– este

botella(s) de vitaminas y mineral) toma —— cada vez (vitamin/mineral)?

minerales de —— ? que 10 usa?

RECORD BRAND NAME

o

414

0-0

/

1 ❑ tableta/capsula

@@ I ❑ d~a

[

2 ❑ semana

2 ❑ cucharadita por

veces 3 ❑ mes

nhmero 4 ❑ otro —

3 ❑ cucharada

5

especifique

4 U otro

o

414

0-0

!

I ❑ tableta/capsu la

@-@$ , ❑ d(a

2 ❑ cucharadita por

{

2 ❑ semana

veces 3 ❑ mes

nimero

3 ❑ cucharada 4 ❑ otro —

5

❑ Continuation booklet \ 4 ❑ otro especifique

K5. Estamos interesados en todas clases de madicinas que la gente toma o usa. Primero Ie preguntar6 sobre el uso de medicinas

que se pueden obtener sin — receta de m6dico.

Durante Ias 2 semanas pasadas, Zha tornado o usado –– algunas de Ias siguientes clases de medicinas:

a) Medicina contra la tos, dolor de garganta, catarro o congestion? o419 10s 20N

b) Calmantes para el dolor, tal como la aspirina o Tylenol?

o

420 Ins 2Ci N

c) Tabletas para dormir, sedatives o tranquilizantes?

o

421 10s 20N

d) Antidepresivos, estimulantes o pildoras animadoras? o422 10s 2Ei N

e) Pildoras o productos que Ie ayudan a bajar de peso?

o

423 10s 20N

f) Laxantes?

o

424 10s 2CIN

g) Medicinas para la diarrea?

o

425 Ins 2UN

h) Medicinas para la indigestion?

o

426 10s 20N

i) Supositorios?

o

427 10s 2DN

j) Gotas para Ios ojos?

o

420 10s 2DN

k) Algunas otras medicinas, pildoras o (pomadas/ungiientos) o429 10s 2CIN

para Ias cuales no se necesita una receta del m~dico?

o

S1 S1, ESPECIFIQUE: 43o

23

207
KG. Durante Ias 2 semanas pasadas, Zha tornado o ha usado -– algunas medicinas para Ias cuales se necesita una receta de m6dico?

o

432 1 ❑ S(K7) 2❑ N(K14)

K7. ZMe permite ver el (envase(s) K8. tCual es el problems de K9. ZTom6 –– (dosage re-

/botella(s)) de la medicinal sahsd por el cual tomo ——

—.

ported in K7) por (freque tom6 –– ? RECORD la (medicine)? quency reported in ~;)?

SPECIFIED lNFORMA- PROBE FOR SYMPTOM

TION FOR EACH, THEN OR CONDITION.

ASK QUESTIONS K8

THROUGH 13 FOR

EACH.

Etiqueta impress en:

o

0442

0

443

433 1 ❑ ingles 2❑ espafiol 3 ❑ ambos 1 ❑ S(K12)

.—— — ——— ——— ——— ——— ——— ——-

0

434 Nombre:

211N

-————————————————_____

o

ZRecetada para la SP?

435 Ins 20N

-——————_____________

o436 Potencia:

.—— —— — ________________

@’@ ‘“’is:

-———————— —____ ________

WI

Frecuencia:

-——————— —________ _____

IF “SEGUN SE NECESITE,’’ASK K8 AND

GOTO NEXT MEDICATION.

.—— — —— __ ____ ___ ———————

o

I II No se vio el envase — la information

441 fue dada por el respondedor

Etiqueta impress en:

o4331❑ ingles o

442

2 ❑ espatiol 3 ❑ ambos o

443

1 ❑ S(K12)

-———————————————————— .

0

434 Nombre:

21ZN

-——— ——— —————————— ——— —.

ZRecetada para la SP?

o

435 10s 2UN

-————___________————_

o436 Potencia:

-———— —— ____ ___________

WI ‘osis’

-——— —————————— ———— ————

WI

Frecuencia:

-——— ———— — ___________ —.

IF “SEGUN SE NECESITE,’’ASK K8 AND

GO TO NEXT MEDICATION.

-————— — — _________ —————

1 ❑ NO se vio el envase — la information

o441 fue dada por el respondedor

—

24

200
KIO. ZCu6nto de la K 11. 2Le aconsej6 K12. LLa (medicine) Ie K13. LQu6 es 10 que hate ––

(medicine) tom6 –-? un mddico a —— hate sentirse mal cuando esto sucede?

que tomara o Ie causa a ——

(dosage in KIO)/ algunos (real

por (frequency efectos/” side

in KIO)? effects”) ?

@l-@ o440 0449 0450

I ❑ tableta/capsula lElsi I ❑ Si– ESPECIFIQUE DO NOT READ.

PROBLEMA

z ❑ cucharadita 2CIN0 I ❑ DEJA DE USAR LA

3 MEDICINA

nhmaro

3 ❑ cucharada 2 ❑ DISMINUYE ELUSO

4 ~ otro 3 ❑ CONSULTA AL MEDICO \

}

2UN0 GOTO

0-0 , ❑ ,,a

NEXT

[

4 ❑ CONTINUA TOM~NDOLA

9 ❑ NS MEDICATION SEG~N LA RECETA

._ por 2 ❑ semana

veces 3 ❑ mes 5 ❑ OTRO

4 ❑ otro -

5

‘6

especifique ESPECIFIQUE

@-@ o440 0449 0450

I

I ❑ tableta/cApsula lclsi I ❑ sI’– ESPECIFIQUE DO NOT READ.

PROBLEMA

2 ❑ cucharadita 21ZIN0 3

I ❑ DEJA DE USAR LA

ndmaro

MEDICINA

3 ❑ cucharada 2 ❑ DISMINUYE EL USO

4 •l otro

}

3 ❑ CONSULTAAL M:DICO

2CIN0 GOTO

@$-@ , ❑ d,a

NEXT

[

4 ❑ CONTINti A TOM~NDOLA

9 ❑ NS MEDICATION SEGtiN LA RECETA

_ por

2 ❑ semana

veces 3 II mes 5 ❑ OTRO

: ❑ otro –

5

especif ique

6

ESPECIFIQUE

I

25

209
K7. ZMe permite ver el (envase(s) K8. ZCU51 es el problems de K9. tTgm6 -- (d~je re-

/botella(s)) de la medicinal salud por el cual tom6 -— ported in K7) por (&-

que tomo ––? RECORD SPECl - Ia (medicine)? PROBE quency reported in K7)?

FIED INFORMATION FOR FOR SYMPTOM OR

EACH, THEN ASK QUES- CONDITION,

TIONS K8 THROUGH 13

FOR EACH.

Etiqueta impress en:

o

0442

433 1 ❑ ingles o443

2 ❑ espafiol 3 ❑ ambos I ❑ S(K12)

.—— — ——— ——— ——— ——— —-— _—.

o434 Nombre:

2CIN

..— —— —___ _____ _____ ___

o

ZRecetada para la SP?

435 10s 20N

..—————_______

o436 Potencia:

.—— — —______ —_

@-@ ‘Os’s:

.. —— _______ ___ ___ __

WI

Frecuencia:

.. ——— — —— —__ _— __ ____ ____

IF “SEGUN SE NECESITE,” ASK K8 AND

GOTO NEXT MEDICATION.

.,— —— _— __ ___ ___ ___ ___ __

o

I ❑ No se vio el envase — la information

441 fue dada por el respondedor

Etiqueta impress en:

o433 1 ❑ ing16s 2 ❑ espafiol 3 ❑ ambos o442 0443 1 ❑ S(K12)

..— —— ———— ————— ———— —_—— .

0434 Nombre:

211N

.————————____—___—

o

ZRecetada para la SP?

435 Ills 213N

..————______—____

o436 Potencia:

..——— — ———_ ____ ____ ———— _

@-@ ‘Os’s:

.—— — ———— ————— ———— ———— —

@-@

Frecuencia:

-.——— ———— ———_ ______ —___

IF “SEGUN SE NECESITE,” ASK KS AND

GO TO NEXT MEDICATION.

-,——— ———_ ____ ____ ____ __

I II No se vio el envase — la information

o441 fue dada por el respondedor

❑ Continuation booklet

26

210
———— _——. —_

K1O. tCuanto de la K11. ZLe aconsejb K12. ZLa (medicine) Ie K13. ZQue es 10 que hate ––

(medicine) tom6 ––? un mddico a —— hate sentirse mal cuando esto sucede?

que tomara o Ie causa a ——

(dosage in K1 0)/ algunos (mat

por (frequency efectoslr’ side

in K1O)? effects”)?

@-@ o440 0449 0450

I ❑ tableta/capsula lEISI’ I ❑ Si– ESPECIFIQUE DO NOT READ.

PROBLEMA

z ❑ cucharadlta 20No 1 ❑ DEJA DE USAR LA

3

nhmaro

MEDICINA

3 ❑ cucharada 2 G DISMINUYE EL USO

4 d otro 3 ❑ CON SULTA AL M~DICO

)

2UN0 GOTO

@-@ , ❑ dja

[

NEXT 4 II CON TIN~A TO M~NDOL#

9 ❑ NS MEDICATION SEGti N LA RECETA

_por 2 •l semana

veces 3 II mes 5 ❑ OTRO

4 ❑ otro –

5

especifique

6

ESPECIFIQUE —

@-@ o440 0469 0450

I

I ❑ tableta/capsula lDSi 1 •l Sj– ESPECIFIQUE DO NOT READ,

PROBLEMA

2 ❑ cucharadita 2CIN0 3

1 ❑ DEJA DE USAR LA

ntimero MEDICINA

3 ❑ cucharada 2 ❑ DISMINUYE EL USO

4 ❑ otro

I

3 ❑ CON SULTAAL M:DICO

2CIN0 GOTO

@~ , ❑ d,a

[

NEXT

4 ❑ CON TINti A TOM~NDOLA

9 ❑ NS MEDICATION

2 ❑ semana

SEGti N LA RECETA

— por

Veces 3 ❑ mes

--- •l otro –

5 ❑ OTRO

5

6

especifique

ESPECIFICSUE

27

211
K14. ZLe ha dicho un mbdico a –- que tome algunas medicinas durante Ios 6 meses pasados que –- no tom6

durante ese periodo?

—

o

461 1 ❑ S (K15) 20 N (Ll)

K15. tCu61es son Ios nombres de Ias medicinas que –– K 16. tCu51 fue el problems de saiud que tenfa -– por

notomo? PROBE FOR BRAND NAMES, ENTER el cual el m6dico recomend6 la (medicine)?

EACH ON SEPARATE LINE. THEN ASK K16

AND K17 FOR EACH.

o

452

0

453

0

452

0

453

0

452

0

453

0

452

0

453

0

452

0

453

0

452

0

453

RESPONDENT FOR SAMPLE CHILD

I

L1. CHECK ITEM: MARK ONE BOX. I@

I ❑ MOTHER

2 ❑ FATHER

INDICATE MAIN RESPONDENT’S RELATION1 3 ❑ SISTER OR BROTHER

SHIP TO SAMPLE CHILD. I

40 OTHER 5

I

SPECIFY

28

212
K17. ZCU.41fue la razon principal por la cual no

tomo la (medicine) –- ?

o454 I ❑ MAL EFECTO 3 ❑ PENS~QUE NO LE IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE

?

2 ❑ CUESTA DEMASIADO 4 ❑ NO LA HE CONSEGUIDO TODAV(A 6

0454

1 ❑ MAL EFECTO 3 ❑ PENS#QUENO LE IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE7

t’

2 ❑ CUESTA DEMASIADO 4 II NO LA HE CONSEGUIDO TODAV;A 6

0454 I ❑ MAL EFECTO 3 ❑ PENS~ QUE NO LE IBAASERVIR 5 •l OTRO – ESPECIFIQUE

?

2 ❑ CUESTA DEMASIADO 4 ❑ NO LA HE. CONS EGUIDO TO DAV~A 6

I ❑ MAL EFECTO 3 ❑ PENSE QUE NO LE IBAASERVIR 5 •l OTRO – ESPECIFIQUE 7

2 ❑ CUESTA DEMASIADO

i

4 ❑ NO LA HE CONSEGUIDO TO DAVIA 6

I ❑ MAL EFECTO 3 ❑ PENSEQUE NO LEIBAASERVIR 5 •l C)TRO – ESPECIFIQUE

2 ❑ CUESTA DEMASIADO

7 4 ❑ NO LA HE CONSEGUIDO TO DAVIA 6

I ❑ MAL EFECTO 3 ❑ PENSE QUE NO LE IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE

❑ CUESTA DEMASIADO

7 4 ❑ NO LA HE CONSEGUIDOTODAVIA 6

29

213
AUTO-RESPUESTA DEL NINO EJEMPLAR

Ml, CHECK ITEM: REFER TO AGE OF SAMPLE

CHILD,

‘@ I ❑ Under 6 yrs. old (END)

I

I

2 ❑ 6+ years old (M2)

M2. Ahora tengo unas pocas preguntas que me gustaria I

@

1 II S(M3) ZO N (END)

hacerle a –– directamente. LEst6 –– disponible ahora?

M3. INTRODUCTION: Me gustaria hacerte unas cuantas I

preguntas sobre tu salud. I

M4. ZTienes cualquier dificultad para ver (con tus (lentes/

anteojos/espejuelos) puestos)?

o45s 10s 20N

M5, Cuando est~s en la escuela, Zpuedes leer el pizarr6n

desde atr~s de la sala de clase (con tus (lentes/anteojos/

espejuelos) puestos)?

o459 Ins 20 N

3 ❑ no va a la escuela

M6. ZTienes algun problems para oir?

M7. Cuando estds en la escuela, Zpuedes o(r a la maestra

desde atr~s de la sala de clase?

o401 Ins 2EIN

3 ❑ no va a la escuela

M8. ~piensas que estfis bajo peso, m~s o rnenos a tu debido

peso, o sobre peso? o482 I ❑ bajo peso (M9)

2 ❑ mas o menos a su debido peso (M13)

3 ❑ sobre peso (M 11)

M9. ZTe gustarr’a pesar mis?

I

,@ 10s 20 N(M13)

MIO. ZEst6s tratando de aumentar de peso? I @ lo S(M13) 20 N(M13)

— I

Ml 1. ZTe gustaria pesar menos? WI 10s

20 N(M13)

I

M 12. ZEst5s tratando de perder peso? I o406

I

Ins 2EIN

M13. ZDirias que tu salud en general es excelente, muy

buena, buena, regular o mala? o487 1 ❑ excelente

2 ❑ muy buena

3 II buena

4 ❑ regular

5 ❑ mala

30

214
MEDICINA/VITAMINA MEC

DO NOT ASK IN HOUSEHOLD

N1. REFER TO MEDICINE/VITAMIN USAGE SECTION.

MARK ONE BOX. @

I•lNo medicine or vitamin reported (N3).

I

2❑ Medicine or vitamin reported (N2).

I

I

N2. Cuando un entrevi.stador hab16 con usted hate unas cuantas semanas, usted [e mencion6 que -– habia tornado (~

vitamins/minerals in K2 K5, and K7). Ll+a tornado —- a[guna de estasmedicinas durante Ias ultimas 24 horas?

o4ae Ins 20 N

N3. ZHa tornado —— algunas (otras) rnadicinas, vitaminas o minerales durante Ias tiltimas 24 horas?

o409Ins 2Ci N

IF “S” IN EITHER N2 OR N3; G0 TO N4. OTHERWISE, END QUESTIONNAIRE.

N4. ZCu41es son Ios nombres de todas Ias medicinas, vitaminas N5. tCuAnto de la (medicine/vitamin/mineral)

y minerals que tom6 -- durante Ias dltimas 24 horas? tom6 –– durante Ias tiltimas 24 horas?

o470

m

(

I ❑ tableta/c5psu la

2 ❑ cucharadita 3❑ cuchara

4 El otro

o470

{

I ❑ tableta/c5psula

—— 2 ❑ cucharadita

s ❑ cuchara

4 •l otro

o470

(

I ❑ tableta/capsula

z ❑ cucharadita

3 •l cuchara

4 ❑ otro

o470

O-@

[

1 ❑ tableta/c5psula

2 El cucharadita

3 ❑ cuchara

4 ❑ otro

—

31

215
Form PHS 6206

9/82

Department of Health and Human services

Public Health Service

Office of Health Research, Statistics,

and Technology

National Canter for Health Statistics

ADULT SAMPLE PERSON

QUESTIONNAIRE (521)

(Ages 12-74 Years)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

OMB No, 0937-0078

Approval lExpires 2/85

NOTICE – Information contained

which would permit identification

onl this form

of any individual or establishment has been collected with a

guarantee that it will be held in strict confidence,

will be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the

establishment in accordance with section 308(d)

of the Public Health Sarvice Act (42 USC 242m).

o100

WESTAT

ID No:

Stand No. Segment No. Serial No.

~ mm

NCHS o101

ID No:

—

——— ——

NAM E (Firstr Middle, Last)

o109

m!

INTERVIEWER NAME: NO. @

~zl

LANGUAGE OF INTERVIEW

o106

Im English

20 Spanish

DATE OF INTERVIEW

@o

—1 —1 — Month Day Year

TIME BEGAN

@@ lUam

—. :__ 20 pm

TIME ENDED

0-0 I ❑ am

—— :__ 20pm

DATE OF EXAMINATION

—1 —1 .—

Month Day Year

TIME

__ :__ ❑ am

❑ pm

TRANSPORTATION

❑ Taxi

❑ Self

216
ADULT SAMPLE PERSON QUESTIONNAIRE

Ages 12-74 Years

M.

G.

K.

c.

J.

F.

A.

E.

Topic Page

Acculturation . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Cardiovascular Conditions. . . . . . . . . . . . . . . . . . 18

Condition List . . . . . . . . . . . . . . . . . . . . . . . . . 25

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Functional Impairment . . . . . . . . . . . . . . . . . . . . 22

Digestive Disease .,...,... . . . . . . . . . . . . . . 14

Health Services . . . . . . . . . . . . . . . . . . . . . . . . . 1

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Topic Page

N. Meal Programs . . . . . . . . . . . . . . . . . . . . . . ..3 I

P. Medicine/Vitamin Usage ..,.... . . . . . . . . . . . 35

R. Medicine/Vitamin MEC . . . . . . . . . . . . . . . ...43

L. Pesticide Exposure . . . . . . . . . . . ., . . . . . . ...26

Q. Name/SSAN . . . . . . . . . . . . . . . . . . . . . . . ...42

H. Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . ..2o

B. Selected Conditions . . . . . . . . . . . . . . . . . . . . . 6

D. Vision and Hearing . . . . . . . . . . . . . . . . . . . .. It)

217
HEALTH SERVICES

Al. Would you say your health in general is excellent, very

I

I ❑ excellent

good, good, fair, or poor? I 0 2 ❑ very good

I

3 ❑ good

I

4 ❑ fair

5 ❑ poor

I

A2. How much control do you think you have over your

~ 0 1 ~ ~~~~deal

future health: a great deal, some, very little, or none?

3 ❑ very little

I

4 ❑ none

I

9nDK

A3. On the average, about how many hours of sleep do you

I

I@

hours

get each day, that is, during a 24-hour period? number

A4. In your job or housework, how much of the time do I

I

Most of Some of Hardly

you have to use lots of arm, leg, or back muscles, as in the the ever or

lifting, pulling, carrying, digging, and so on? Would YOU

I

time time never

say: most of the time, some of the time or hardly ever

or never?

@ ‘n ‘n 30

A5. Outside of your job or work around the house, how often I Hardly

do you take part in activities which require a lot of body I

Freq. Sometimes ever or

movement or energy, like ball games, cycling, dancing, never

and so on? Would you say: frequently, sometimes, or I

hardly ever or never? ,@ 10 2D 30

A6. Now 1 would like to ask you some questions about your

I

use of health care services. I

Is there a particular clinic, health center, doctor’s office

I

,@ 10Y 20 N (A18)

or other place that you usually go to if you are sick or

need advice about your health?

I

A7. What kind of place is it - a clinic, a health center, a

hospital, a doctor’s office, or some other place?

PROBE IF CLINIC: Is this a hospital outpatient

clinic, a company or school clinic, a migrant

clinic. or some other kind of clinic?

PROBE IF HEALTH CENTER: Is thisa

community health center, neighborhood health

canter, a family health canter, a rural health

center, or some other kind of health center?

PROBE IF HOSPITAL: Is this an outpatient

clinic or meergency room?

i@:;:

I

I

03 ❑

I

04 ❑

I

05 ❑

06 ❑

I

I oe ❑

I

09 ❑

I

I

I

10 ❑

11 ❑

I

12 ❑

I

home

doctor’s office or private clinic (A9)

company or school clinic

hospital outpatient clinic

migrant clinic

other clinic 07

specify

hospital emergency room

community, neighborhood, or family

health center

rural health center

HMO/prepaid group

other place 13

specifv
A8. Is there a particular person you usually see at the

‘G

lnY 2EIN

(place in A7)?

I

A9. Now I would like to ask you some questions about @

I ❑ lass than 1 month

your last visit to the (place in A7). How long has it

I

2 ❑ 1 me., less than 6 mos.

been since that visit? 3 ❑ 6 mos. r less than 1 yr.

I 4 ❑ 1 yr., less than 5 yrs.

I

5 ❑ 5 or more years

9nDK

I

AlO. About how long did it take You to get to the (place

10

minutes

in A7) for that visit?

number

I OR

PROBE IF NECESSARY: Would You say it took more

than 30 minutes or less than 30 minutes? I

I ❑ more than 30 minutes

I @ 2 ❑ less than 30 minutes

Al 1. Did you have an appointment for that visit? o129 lny 2 ❑ N(A13)

A12. About how long was it between the time you made

the appointment and the time you actually went

I @ 000 ❑ less than 1 day

for that visit? I days

number

A13. After you got to the (place in A7), about how long

/ @-@

I

{

1 ❑ minutes

did you have to wait before you were taken care of

at that visit?

number

2 ❑ hours

A14. What was the main reason for that visit? I

DO NOT READ.

10

01 ❑ A SICKNESS OR ILLNESS

I

02 ❑ AN INJURY

03 ❑ A FOLLOW-UP VISIT

I

04 ❑ A GENERAL CHECKUP

I

05 ❑ AN INJECTION

06 ❑ FOR A pRESCRlpT]ON

I

07 ❑ PRE- OR pOST-NATAL CARE

I

oa ❑ SOME OTHER REASON –

Oe

specify

A15. In general, how satisfied were you with the care you

10

I ❑ very satisfied (A17)

received at that visit? Would you say you were very

I

2 II somewhat satisfied

satisfied, somewhat satisfied, or not at all satisfied? 3 ❑ not at all satisfied

Al 6, Why weren’t you (completely) satisfied with the health

I

I

DO NOT READ.

mre you received at that visit?

I

PROBE FOR MAIN. REASON.

I @ ~ g ~;;;;fl;~OO LONG

I

03 ❑ LANGUAGE PROBLEM – COULDN’T

I

COMMUNICATE

04 ❑ DR. DIDN’T SPEND ENOUGH TIME

I

WITH SP

I

05 U MISTREATED BY DR. OR OTHER

STAFF

I

oe ❑ CONDITION DID NOT IMPROVE

I

AFTER TREATMENT OR

MEDICATION

I

07 ❑ DR. DID NOT DIAGNOSE OR

I

TREAT CONDITION

oa ❑ OTHER –09

I

SPECIFY

99 ❑ DK

2

219
A17. Have you visited any other clinic, health center, l@

I

I ❑ Y(21) 2 ❑ N(A30)

doctor’s office or other place for health care since

your last visit to the (place in A7)? I

I

I

HAND CARD ASP 1

I

A18. Many people do not have a particular place they usually ;@ 1

234567

go when they are sick or need advice about their health. 7

Could you please give me the number of the statement I

specify

which is the main reason you do not have a particular

place you usually go? I

1. Have two or more usual doctors or places depending I

on what’s wrong. I

2. Haven’t needed a doctor,

3. Previous doctor no longer available. I

4. Haven’t been able to find the right doctor. I

5, Recently moved to area.

6. Other reason - please specify. I

I

I

A19. Although you said you have no particular place for

lo ‘ny

2 ❑ N(A211

health care, is there a particular person you usually

see when you are sick and need health care?

I

I

A20. Where do you usually see this person - at home, at a

I

clinic, a health center, a hospital, a doctor’s office, or I @ ~1 B l~~rrsoffice or private clinic

some other place? I

I

PROBE IF CLINIC: Is this a hospital outpatient clinic, I

03 ❑ company or school clinic

a company or school clinic, a migrant clinic, or some

I

04 ❑ hospital outpatient clinic

other kind of clinic? 05 ❑ migrant clinic

I

06 ❑ other clinic”’

specify

I

PROBE IF HEALTH CENTER: Is this a community I oe ❑ hospital emergency room

health center, neighborhood health center, a family I

09 ‘H community, neighborhood, or family

health center, a rural health center, or some other

I

health center

kind of health center?

PROBE IF HOSPITAL. Is this an outpatient clinic

I

I

10 ❑ rural health center

or emergency room? 11 fJ HMO/prepaid 9rou P

I

12 ❑ other place13

specify

I

A21. Now I would like to ask you some questions about ;@ I ❑ less than 1 month

your last visit to any clinic, health center, doctor’s 2 ❑ 1 me., less than 6 mos.

office or other PI= for health care. How long has it I 3 ❑ 6 mos. r less than 1 yr.

been since your last visit for health care?

I

4 II 1 yr., less than 5 yrs,

I

5 ❑ 5 or more years

6 ❑ never (A30)

I

gUDK

220

3
I

A22. What kind of place did you visit that time - was it a clinic, I @ 01 •l home

a health center, a hospital, a doctor’s office, or some

I

02 El doctor’s office or private clinic

other place?

I

PROBE IF CLINIC: Was this a hospital outpatient

I

03 ❑ company or school clinic

clinic, a company or school clinic, a migrant clinic, 04 ❑ hospital outpatient clinic

or some other kind of clinic? I

05 ❑ migrant clinic

I

06 ❑ other clinic ‘7

specify

I

PROBE IF HEALTH CENTER: Was this a community

I

0S ❑ hospital emergency room

health center, neighborhood health center, a family 09 ❑ community, neighborhood, or family

health center, a rural health center, or some other I

health center

kind of health center?

I

PROBE I F HOSPITAL: Was this an outpatient I

IO ❑ rural health center

clinic or emergency room? I

11 ❑ HMO/prepaid grou P

12 ❑ other place 13

I

specify

I

A23. About how long did it take you to get to the (place

I@

minutes

in A22) for that visit?

I

number

OR

PROBE IF NECESSARY: Would you say it took more I

than 30 minutes or less than 30 minutes? 10143 I ❑ more than 30 minutes

2 ❑ less than 30 minutes

1

A24. Did You have an appointment for that visit? I @ ID’T’ zUN(A26)

I

A25. About how long was it between the time you

made the appointment and the time you actually I @ 000❑ ‘ess‘ban‘ ‘ay

went for that visit? I days

I

number

I

A26. After You got to the (place in A22), about how long

/ @-o

{

1❑ minutes

did you have to wait before you were taken care of at

that visit?

number

I

20 hours

I

A27. What was the main reason for that visit? I DO NOT READ.

I

01 ❑ A SICKNESS OR ILLNESS

I o 02 ❑ AN INJURY

I

03 ❑ A FOLLOW-UP VISIT

I

04 ❑ A GENERAL CHECKUP

05 ❑ AN INJECTION

I

06 ❑ FOR A PRESCRIPTION

I

07 ❑ PRE- OR POST-NATAL CARE

OSI❑ SOME OTHER REASON –

I

09

specify

I

A28. In general, how satisfied were you with the care you

10

1 ❑ very satisfied (A30)

received at that visit? Would you say you were very 2 IJ somewhat satisfied

satisfied, somewhat satisfied, or not at ail satisfied? I 3 ❑ not at all satisfied

4

221
A29. Why weren’t you (completely) satisfied with the health I DO NOT READ.

care you received at that visit? I

PROBE FOR MAIN REASON. ~ @ Oln

02 ❑

I

03 ❑

I 04 ❑

I

I

05 ❑

I

06 ❑

I

I

07 ❑

I 08 ❑

I

99 ❑

COST TOO MUCH

HAD TO WAIT TOO LONG

LANGUAGE PROBLEM – COULDN’T

COMMUNICATE

DR. DIDN’T SPEND ENOUGH TIME

WITH SP

MISTREATED BY DR. OR OTHER

STAFF

CONDITION DID NOT IMPROVE

AFTER TREATMENT OR

MEDICATION

DR. DID NOT DIAGNOSE OR TREAT

CONDITION

OTHER – ~

DK Specify

A30. There are some providers of health care that we some- 1

times go to, such as curanderos, sobadores, herbalists, I

spiritualists, and others. Have you seen or talked to any , @ ‘O’ 20 N

of these persons for health care during the past 12

months? I

A31. Sometimes people have difficulties in getting

medical care. Have you had any difficulties getting

medical care -

1.

2.

3.

4.

5.

6.

(7.

8.

9.

10.

11.

12.

13.

Because cara was not available when you needed

it?

Because of how much it cost?

Because you didn’t know where to go?

Because you didn’t have a way to get there?

Because the hours were not convenient?

Because you had to wait too long to get an

appointment?

Because you needed someone to take care of

your children?)

Because you would lose pay from work?

Because you had to wait too long in the office or

clinic?

Because the staff at the office or clinic was

disrespectful?

Because you had no confidence in the staff?

Because they did not speak Spanish?

Because there were no (Hispanic) staff members

at the office or clinic?

A32. Did this problem

prevent you fralm

getting medical

care for yourself?

I o152 11ZY(A32) 20N ‘

I

, @ln Y

i. I

1 ❑ Y(A32) 20 N

I

I @’Dy

@

IDY(A32)2UNI @lDY

10158 1 ❑ Y(A32) 20 N

~ @lny

I @ 1UY(A32)ZDN, &nY

I

@

1UY(A32)ZDNI @In Y

n

I

I

@

IUY(A32)ZDNI @IDY

1

I

I

,@ 1 ❑ Y(A32) 20 N

10

167 lCIY

I@

1DY(A32)2UNI @lDY

1

I

I

211N

211N

2EIN

2[7N

211N

21d N

21ZN

21ZN

211N

21ZN

2[3N

2[3N

211N

5

222
A33. About how long has it been since you had a routine

physical examination; that is, not for a particular

illness, but for a general checkup?

o178 I II less than 1 year ago

2 ❑ 1 yr., less than 2 yrs.ago

3 •l 2 yrs., less than 5 yrs.ago

4 El 5 or more yrs. ago

5 ❑ never

91ZDK

A34. During the past 12 months, that is, since (date) I

a year ago, were you a patient in a hospital over-

, @ ‘n’

2 ❑ N(B1)

night or longer?

I

A35. During the past 12 months, how many different times

@

times

did you stay in the hospital overnight or longer? number

SELECTED CONDITIONS

B1. Were you ever told by a doctor that you had

~ @ In’

tuberculosis?

2UN I

B2. Have you ever lived in a household with a person who I

had active tuberculosis? ] @ ‘O’ 2Ei N 9CIDK

B3. Have you aver had anemia, sometimes called “tired

blood” or%w blood”? ~ @ lnY 2 ❑ N(B7) 9 ❑ DK(B7)

B4. Did a doctor ever tell you that you had anemia? i @ ,OY 2 •1 N(B7)

B5. Do you still have a ‘arnia? I @ 10’ 20N 9ci DK

B6. Were you treated for this condition by a doctor?

~ @ ‘ny 2CIN

B7. About how tall are you without shoes? @

I

I@

feet inches

I

B8. About how much do you weigh without shoes? i

current weight: I

IF NOW PREGNANT, RECORD CURRENT @

pounds

number

WEIGHT. THEN ASK:

I weight before pregnant:

About how much did you weigh just before you

became pregnant?

~ @ ~Umber

pounds

B9. Do you now mnsider yourself to be overweight,

underweight, or about right? o191 I •l overweight

2 ❑ underweight

3 •l about right

9CIDK

BIO. CHECK ITEM o192 I ❑ Age 25 or younger (B12)

2 ❑ Age 26+ (Bll)

BI 1. About how much did you weigh when you were 25? I@

I

pounds

number

6

223
B12. Do you have trouble biting or chewing any kinds of I@ 10’/ 20N

food, such as firm meats or apples? I

B13. How would you describe the condition of your teeth:

excellent, very good, good, fair or poor?

; @ :: ‘a:;; go;

I

3 ❑ good

I

4 ❑ fair

5 ‘U poor

I 6 ❑ has no teeth

B14. How would you describe the condition of your

gums: excellent, very good, good, fair or poor?

~ @ :: ::;;~o:

I

3 ❑ good

I

4 ❑ fair

5 ❑ poor

I

615. About how long has it been since you ~ saw a

I@

I ❑ 6 months ago or less

dentist or dental hygienist for dental care? 2 ❑ over 6 months to 12 months

I 3 ❑ over 12 months to 2 years

I

4 ❑ over 2 years to 5 years

I

5 ❑ more than 5 years

6 ❑ never (B20)

I

9ci DK

B16. What was the main reason for your last visit for I DO NOT READ.

dental care ? I

,@ 01 ❑ REGULAR CHECKUP

02 ❑ FOR CLEANING TEETH

I

03 ❑ TO HAVE TEETH FILLED

I

04 ❑ TROUBLE WITH GUMS

05 ❑ TO HAVE TEETH PULLED OR

I OR OTHER SURGERY

I 06 ❑ TOOTHACHE

I

07 ❑ ADJUSTMENT OR REPAIR OF

I

DENTAL PLATE

I

os ❑ TO HAVE A DENTAL PLATE MADE

I

m❑ FOR A PRESCRIPTION

IO ❑ SOME OTHER REASON –

I

11

SPECIFY

IF “FOR CLEANING TEETH” IN B16, SKIP TO I

B19.

B17. Have you ever had your teeth cleaned by a dentist

I

I @ ‘n’

2 ❑ N(B20)

or dental hygienist?

I

618. When was the last time they were cleaned?

10

I ❑ 6 months ago or less

2 ❑ over 6 months to 12 months

I

3 ❑ over 12 months to 2 years

I

4 ❑ over 2 years to 5 years (B20)

I

5 ❑ more than 5 years (B20)

9 ❑ DK (B20)

619. During the past 2 years, how many times have you 1 ❑ once

had your teeth cleaned by a dentist or a dental @ 2 ❑ twice

hygienist?

I

3 ❑ three times

4 ❑ four or more times

I

9CIDK

7

224
B20. Are you covered by health insurance that pays for

~ @ ‘n’

2UN 9nDK

dental care?

I

DIABETES 1

!

cl. Do you have diabetes or sugar diabetes?

~ @ ‘n’

2 ❑ N(C6)

C2. Did a doctor tell you that you have it? I 1CIY(C4) 20N

,0

C3. Did any other health professional, such as a nurse 2 ❑ N(C6)

or physician’s assistant, tell you that you have it? ~ @ ‘n’

I

C4. How long ago did the (doctor/health professional)

10

years ago

first tell you that you had diabetes? number

I

C5. How old were you then? I

@

years old

number

I

C6. Have you ever been told by a doctor or other health C7 . How old were

professional that you have – you then?

(IF YES,” ASK C7)

Borderline diabetes? . . . . . . . . . . . . . . . . . . . . . .

I@

1UY(C7) 2CIN 10 yrs. old

;0

n umber

Potential diabetes? . . . . . . . . . . . . . . . . . . . . . . . ID’(C7)2DN @ yrs. old

;@

number

Prediabetes? . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 1CIY(C7) 20N yrs. old

number

C8. CHECK ITEM. MARK F[RST APPLICABLE I II Diabetes — “Y” in

BOX ONLY. [0 either C2 or C3

I 2 •l Borderline diabetes

I

3 ❑ Potential diabetes

I

4 ❑ Prediabetes

5C6

I

specify type

7 ❑ none of these (Dl)

IN QUESTIONS C9-C27 ASK ABOUT CONDITION I

MARKED IN C8. I

C9. When you were first told by a (doctor/health I

professional) that you had (diabetes/. . .), were any I

of the following tests done?

I

a. The oral glucose tolerance test, in which I

you drink a sweet drink and samples of your

blood are taken from your arm for a few I

hours afterwards? . . . . . . . . . . . . . . . . . . . . @ ICIY 21JN 9CIDK

b. A test for sugar or glucose in your urine? . . . . I ~ In’

I

20N 9nDK

c. A test for sugar or glucose in your blood? . . . . I @ 10’ 2UN 9nDK

8

225
CIO. Were you a patient in a hospital at the time a

1 0 ‘Dy

2DN

(doctor/health professional) first told you that you

had (diabetes/ . . .)? I

I

Cl 1. (Not counting that first time) Have you ever been 10 ‘ny 20N

hospitalized because of your (diabetes/. . .)? +

C12. About how much did you weigh when you first were

told you had (diabetes/. . .)? ;@

pounds

number

C13. Have you ever taken insulin injections?

~ @ ‘n’

2 ❑ N (C18)

A

C14. Have you baen taking insulin injections for most of I o222 lnY 2CIN

the past 12 months? I

C15. Ara you now taking insulin injections?

I

+

Cl 6. About how many units per day do you take?

@

units per day

number 1

C17. How many years (have you been taking/did you take)

insulin injections?

1 @ 00 ❑ Less than 1 year

years

i

number

1

C18. Have you ever taken diabetes pills? I

I @ ‘ny 2nN(c23)

Cl 9. Have you been taking them most of the past 20N

12 months? ; @ ‘“y

I

--l

C20. Are You now taking diabetes pills? I @ IOY 2 ❑ N(C22) I

C21. What is the name of the medicine you are taking? i@l

I

specify

C22. How many years (have you been taking/did you take)

diabetes pills?

I @ oo ❑ Less than 1 year

, I

I years

I

number

C23. Has a doctor, nurse, or other health professional ever

given you a diet or instructions on what foods to eat

i @ ID” z’DN(C25)

for your (diabetes/. . .)? I i

I i

C24. Do you now follow the diet or instructions?

;@ ‘Uy

2DN

C25. Do you carry or wear anything which identifies you as

; @ ‘ny

2EIN

having (diabetes/. . .)? I

I

C26. When did you last see or talk to a doctor or othar I ❑ during past 2 weeks

health professional about your (diabetes/. . .)? I @ 2 ❑ o.er2 weeks to 6 months

I

3 ❑ over 6 mos. to 12 mos.

I

4 II over 12 mos. to 2 yrs.

5 ❑ over 2 yrs. to 5 yrs.

I

}

(Dl)

6 ❑ over 5 yrs. ago

9

226
C27. About how many times a year do you see a doctor or

;@

I ❑ less than once a year

other health professional about your (diabetes/. . .)? 2 ❑ once

3 •l twice

I 4 •l 3-4 times

I

5 ❑ 5 or more times

6 ❑ no regular schedule

VISION AND HEARING

1

D1. Have You ~r had trouble seeing with one or both

10 ‘u’

2 ❑ N(DIO)

eyes when —not wearing glasses or contact lenses?

1

D2. How old were you when you first began having

;@

01 El O-4 years old

trouble seeing? 02 ❑ 5-9 years old

123 ❑ 10-19 years old

I 04 ❑ 20-29 years old

I

05 •l 30-39 years old

I

06❑ 40-49 years old

07 •l 50-59 years old

I

os❑ 60-64 years old

m ❑ 65 years old or older

D3. DId you ever see a doctor about it? 1, 2CIN

, @ ‘u’

D4. Do You wear glasses or contact lenses? I

I @ ‘n’ 2 ❑ N(D6)

D5. Do You have trouble with your vision even when I

@

1 0 Y(D8) 2 ❑ N(D8)

wearing glasses or contact lenses?

I

D6. Have you ever worn glasses or contact lenses? j @ l~y 2 ❑ N(D1O)

I

D7. Why did you stop wearing them?

I

MARK ALL THAT APPLY.

DO NOT READ.

I @ I ❑ NO LONGER NEED THEM

I @ I ❑ DIDN~SEEM TO HELP

I@ -r!3INCONVENIENT

@

I •l OTHER z

SPECIFY

D8, What (are/were) your glasses or contact lenses 1 MARK ALL THAT APPLY.

prescribed for? I

DO NOT READ.

I @ I •l READING/CLOSE WORK

1 @ I ❑ SEEING DISTANT OBJECTS

I

@ I ❑ OTHER z

SPECIFY

I

D9, t+OW often (do/did) you use your glasses or contacts: 10 I ❑ all of the time

All of the time, most of the time, hardly ever, or 2 •l most of the time

never? 1 3 El hardly ever

I

4 ❑ never

10

227
DIO. When was the last time you had your vision tested? ~ @ I ❑ 6 rnos. ago or less

2 ❑ over 6 mos. to 12 mos. I

I

3 ❑ over 12 mos. to 2 yrs.

4 ❑ over 2 yrs, to 5 yrs.

I

5 ❑ more than 5 yrs.

I

6 ❑ never

9nDK

1

DI 1. Have you ever had trouble hearing with one or both

@ ‘ny

20 N(EI)

ears? Do n~nclude any problems which lasted just a

short period of time such as during a cold. I

D12. Did you q@’ see a doctor about it? I

2Ci N

,@ ‘0’

D13. How old were you when you first began having trouble II ‘d O-4 years old

‘ o ~ ~ ;;;;~~a;!old

hearing?

1

4 ❑ 20-29 years old

I 5 ❑ 30-39 years old

I

6 ❑ 40-49 years old

7 II 50 years old or older

D14. Since this trouble began, has it gotten worse, gotten

better, or stayed about the same?

I @j ~ ~ 9otten worse

I

gotten better

3 ❑ stayed the same

D15. Have you —ever had an operation on your ears?

@ ‘n’ ‘UN

INCLUDE HAVING TUBES PLACED IN THE EARS.

I

D16. Have you ~r used a hearing aid? I o256 In’ 2UN

I

D17. How would you describe your hearing (without a hearing

la

1 ❑ good

aid) - good, you have a little trouble, you have a lot of 2 ❑ little trouble

trouble, or you are deaf? 3 ❑ lot of trouble

I 4 ❑ deaf

HYPERTENSION

I

El. About how long has it been since you last had your

lo

I ❑ 6 months ago or less

blood pressure taken?

I

2 ❑ over 6 mos. to 1 yr. ago

3 ❑ over 1 year ago

I A❑ never (E6)

E2. Who took your blood pressure the —last time? DO NOT READ.

I

@oIUME DICAL DOCTOR

02 ❑ NURSE

I

03 ❑ OTHER HEALTH PROFESSIONAL –

I

04

SPECIFY

I

I

05 ❑ FAMILY MEMBER

06 ❑ FRIEND

I 07 ❑ YOURSELF (E4)

I

os ❑ OTHER 09

SPECIFY

I

99 ❑ DK

11

228
E3. What were you told when you last had your blood I

pressure taken?

I

That it was: I

A little high, and it needs to be treated? . . . . . . . 1

A little high, and it needs to be watched? . . . . . . I

A little high, but there is no need to worry?. . . .

.1

Normal? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Something else? . . . . . . . . . . . . . . . . . . . . . . . I

I

I

I

I

o260 01 ❑

02 ❑

03 ❑

04 •1

05 ❑

07 ❑

08 ❑

99 ❑

)

high, needs treatment

high, needs to be watched

high, no worry

normal

something else —

06

I

(E6)

specify

TOLD NUMBERS BUT

NO EXPLANATION

NOT TOLD ANYTHING

DK I

I

IF “YOURSELF” MARKED IN E2, ASK: i

E4. The last time you took your blood pressure, did you

10

I ❑ coin operated

use a coin operated unit or some other equipment?

I

2 ❑ other equipment — 3

specify

E5. Was your reading high, low, or normal? ; @ ;:)$

I

3 ❑ normal

9nDK

I

E6. Do you think that people with high blood pressure can I@ ‘ny 20N 90DK

tell when their blood pressure is high?

I

DO NOT PROBE IF “DON’T KNOW. ”

E7. Have you ever been told by a doctor that you had high

@

1 ❑ Y(EIO)2 ❑ N

blood pressure?

I

Es. Another name for high blood pressure is hypertension.

Have you e~r been told by a doctor that you had

hypertension?

I @ 1UY(E1O)2UN

I

I

E9. Have You ~r been told by any other health professional,

such as a nurse or a physician’s assistant, that You had

, @ ,C!Y 2CIN(F1)

high blood pressure or hypertension? I

E 10. How many times were you told that You had (high

~@

1 ❑ once

blood pressure/hypettension): once, or two or more 2 ❑ two or more times

times?

I

E11. Have you ~r been advised by a doctor or other

@ ‘ny

2 ❑ N(E17)

health professional to lose weight because of your

(high blood pressure/hypertension)? I

El 2. Did you lose as much weight as you were advised

to lose? ~@ ‘Uy 2UN

E13. Are you now at the weight that was recommended

@

1 ❑ Y(E?7)2 ❑ N

for you b=use of your (high blood pressure/

hypertension)? I

E 14. Are you now trying to lose weight because of your

@

1 ❑ Y(E17)2 ❑ N

(high blood pressure/hypertension) ?

1 --- - - ,.--, E15. Are You trving to maintain your current weight? lG lny 2nN

I

12

229
El 6. Why aren’t you trying to lose weight? I

I

MARK ALL THAT APPLY.

DO NOT READ.

I

@

I ❑ DIDN’T DO ANY GOOD

@

1 ❑ M.D. SAID TO STOP

! o275 i ❑ DON’T NEED TO ANYMORE

; @ I ❑ TOO MUCH TROUBLE

I @ I ❑ OTHER REASON 2

~ @ 9 ❑ DK/NO REAsON

sPECIFY

E17. Have you ever been advised by a doctor or other

@ ‘“y

2 ❑ N(E22)

health pro~ional to use less salt because of your

(high blood pressure/hypertension)?

!

E18. Did you ever reduce your use of salt after you were adl@

1 ❑ Y(E20) 2 ❑ N

vised to do so because of your (high blood pressure/

hypertension)? I

E19. Why didn’t you ever reduce your use of salt? I

I

MARK ALL THAT APPLY.

DO NOT READ.

~ @ I ❑ DIDN’T DO ANY GOOD

\

@

1 ❑ DIDN’T THINK IT WOULD WORK

@

1 ❑ TOO MUCH TROUBLE

,@

>

1 ❑ OTHER REASON –

(E22)

I

2

SPECIFY

I

@

9 ❑ DK/NO REASON /

E20. Do you now use more salt, less salt, or about the

@

1 ❑ more

same amount of salt as you did when you were 2 ❑ less (E22)

advised to use less salt? 3 ❑ same

I

E21. Why don’t you use less salt now? I MARK ALL THAT APPLY.

I

DO NOT READ.

I @ 1 •l DIDN’T DO ANY GOOD

I @ ‘ ❑ DIDN’TTHINK IT WOULD WORK

I @ 1 ❑ M.D. SAID COULD USE MORE SALT

I @ 1 ❑ TOO MUCH TROUBLE

~ @ 1 ❑ OTHER REASON ‘

I @ 9 ❑ DK/NO REASON

SPECIFY

I

E22. Has a doctor ~r prescribed medicine for your

(high blood pressure/hypertension) ?

I@ 10’ 2 ❑ N(E26)

E23. Are you ~w taking any medicine prescribed by a

lo ‘“y

2 ❑ N(E25)

doctor for your (high blood pressure/hypertension) ?

13

230
E24. A good many people have trouble remembering to take

:@

I D exactly every day

their medicine regularly. Would you say that you take 2 ❑ miss sometimes

your medicine exactly as you should every day, that you 3 El miss a lot

)

(E26)

miss sometimes but not often, that you miss a lot, that I

4 ❑ hardly ever take as should

you hardly ever take your medicine as you should, or I

5 ❑ never take as should

that You never take your medicine as You should?

I

E25. Why did you stop taking your medicine? I MARK ALL THAT APPLY.

I

DO NOT READ.

! @ I ❑ ONLY TAKE WHEN NEEDED

‘@ I ❑ MD. SAID TO STOP

;@

I ❑ DID N’T NEED IT ANYMORE

,@ I ❑ TOO MUCH BOTHER

,0 I II MEDICINE RAN OUT

@

1 ❑ COSTS TOO MUCH

@

1 ❑ SIDE EFFECTS z

SPECIFY

p

1 ❑ OTHER —z

SPECIFY

@

9CIDK

I

E26. Do you see a doctor or other health professional reguI @ ‘ny

2CIN

Iarly about your (high blood pressure/hypertension) ?

I

E27. About how many times a year do you see a doctor or

@

I ❑ less than once a year

other health professional about your (high blood 2 ❑ once

pressure/hypertension)? I 3 1 twice

I

4 ❑ 3-4 times

I

5 ❑ 5 or more times

G ❑ no regular schedule

1

E28. About how long ago did you last see a doctor 10307 I ❑ less than 1 month ago

or other health professional about your (high blood 2 ❑ one month ago

pressure/hypertension)? I

3 •l more than 1 month, to 6 months ago

I

4 ❑ more than 6 months, to 1 year ago

5 ❑ more than 1 year ago

DIGESTIVE DISEASE

F1. CHECK ITEM

;@

1 ❑ Age under20 (Jl)

2 ❑ Age 20+ (F2)

F2. Has a doctor ever told you that you had gallstones?

I

I @ ‘n’

2CIN

F3. Have you ever had an x-ray of your gallbladder? For a

I @ ‘“y

2UN

gallbladder x-ray you take some pills the night before

the x-ray and you are not allowed to eat anything

until after having the x-ray done. I

1

F4. Have you ever had surgery or an operation for gall1 @ ‘ny

2 ❑ N(F6)

stones or gallbladder disease?

I

14

231
F5. How long ago did you have your (last) surgery I I ❑ lessthan 5 years ago

or operation for your gallbladder? I @ 2 ❑ 5 or more years ago

I

F6. During the past year have you had any attacks of I o313 ICIY 2 ❑ N(F17)

nausea and/or vomiting lasting more than 2 hours? I

I

F7. About how many days in the past year have you had ~@9990DK

this trouble? days

number

I

F8. What was the longest period that this trouble lasted during I o3,5000 ❑ less than 1 day (F IO)

the past year? I

days

number

I

IF ENTRY IN F8 1S3 OR MORE DAYS, ASK:

I

F9. How many times in the past year did you have this ~ @990DK

trouble for 3 days or longer? times

n umber

I

FIO. In the past year, what is the longest period of time you

went without having this trouble?

I @ : ~ less than 1 month

I

1 me., less than 3 mos.

3 ❑ 3 mos., less than 6 mos.

I

4 ❑ 6 mos, or longer

I

9CIDK

FI 1. How old were you the first time you had this sick feell@ years old

ing that lasted more than 2 hours? number

I

I

F12. Do you get this feeling while you are eating, after

@

I •l while eating (F14)

eating, or is it not related to eating?

I

2 ❑ after eating (F13)

3 ❑ not related to eating (F14)

I

9 ❑ DK(F14)

I

F13. How long after eating do you start to feel sick? I @ I ❑ 1 hour or less

I

2 ‘d more than 1, less than 2 hrs.

3 ❑ 2 or more hours

I

9nDK

I

F14. Have you ever seen a doctor about this sick feeling?

@ ‘0’

2 ❑ Y(F16)

I

FI 5. What did the doctor say it was? I

@l (F17)

specify

I

F16. What was the cause of this sick feeling?

;@’ speclfv

F17’. During the past five years, have you had pain in your I

abdomen or lower chest which lasted a half hour or I o ~ : !;(r::;)

more? I

15

232
I

I

MARK AREA(S) SHOWN

F18. Please show me where the pain was located. I

front back

I

I

I

I

I

I

I

I

I

I

I

F19. When was the last time you had this pain? i~ 1 ❑ 6 months ago or less

2 ❑ over 6 mos. to 1 year

I 3 ❑ more than 1 yr. ago (F31)

1

F20. How long does the pain usually last? I ❑ 1 hr. or less

I @ z ❑ more than 1, UptOEI hrs.

I

3 ❑ more than 5, up to 24 hrs.

I

4 ❑ more than 24 hrs.

9EIDK

I

F21. While you are having the pain, is it steady or does

I@

I ❑ steady

it come in waves?

I

2 ❑ comes in waves

3 •l both

I

F22. When you have the pain, do you move around or do I@ 1 ❑ move around

you lie still? I

2 ❑ lie still

I

3 ❑ both

F23. At about what hour does the pain usually start?

~ @@_o’clock (:: $:

I

OR

I

cm II no particular time

99 II DK

F24. Have you ever been awakened from sleep by this pain?

~@’n’

2CIN 90DK

F25. Do you get this pain while you are eating, after eating, I @ I ❑ while eating (F27)

or is it not related to eating? I

2 ❑ after eating (F26)

I

3 ❑ not related to eating (F27)

9 ❑ DK (F27)

F26. How long after eating do you get this pain? ! @ I ❑ 1 hour or less

I

2 ❑ more than 1, up to 2 hrs.

I

3 ❑ more than 2 hrs.

91TDK

16

233
F27, Do you usually feel sick to your stomach either before

I

I @ ‘n’ 20N 9 El DK

or after you get this pain?

I

I

F28, Within a day or two of having the pain, have you had

any of the following: I

I

Fever orchillls? . . . . . . . . . . . . . . . . . . . . . . . I @ lnY 2CJN 9UDK

Itching? . . . . . . . . . . . . . . . . . . . . . . . . . . . . I @ 7DY 2UN 9EIDK

Yellow jaundice? . . . . . . . . . . . . . . . . . . . . . . I @ TOY 2LIN 9 [.1 DK

Unusually dark colorcd urine?. . . . . . . . . . . I @ IDY 2EIN 9DDK

Unusually light colored bowel movements? . . . . I @ ICIY 2UN 9 H DK

I

F29, About how many days in the past year have you had

;0

days

this pain in the abdomen or lower chest? number

!

9990 DK

F30. In the past year, what was the longest period of days,

~ @-@

{

I II days

weeks, or months in which you did not have this

I

2 El weeks

number

pain? 3 ❑ months

I

I

F31. How old were you when you had your first attack of

the pain? I ,,, ,0 —-. . years old

number

F32. Have you ever seen a doctor about this pain? ~@ ,nY 2 [1 N (F34)

~—

F33. What did the doctor say it was?

10’ ——. (F35)

5peclfy

F34. What was the cause of this pain?

‘ @ 1 ----,P,C,’V —

—

F35. Have you ever received an injection of medication to ~@luY 2LIN 9 U DK

relieve the pain?

I —

F36. Have you ever been hospitalized for the pain? [@,r]y 21JN 911DK

—

F37. During the past year have you had any of the

following kinds of distress after eating? I

I

Fullness or bloating . . . . . . . . . . . . . . . . . . . . .

@’ny

2CIN 9UDK

Belching . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@’uy 2nN ‘“DK

Sickness to your stomach or throwing up . . . . . . ,@, uY 2UN 9 U DK

Bitter taste in your mouth . . . . . . . . . . . . . . . . @,n Y 2UN 9 [3 DK

Heartburn or burning pain . . . . . . . . . . . . . . . . l@lu Y 2UN 9LIDK

Stomach cramps . . . . . . . . . . . . . . . . . . . . . . . l@IOY 2UN 90DK

I .

234
IF “NO” OR “DK’’TO&,SKlP TO QUESTION F40.

I

I

F38. During the past year, how often have you had (this io 1❑ once or twice

feeling/any of these feelings)? —

I

2 ❑ 3+ times, but less than once

per month

I

3 ❑ about once per month

i

4 ❑ weekly or almost weekly

5 ❑ daily or almost daily

I

F39. Is the distress caused by any of the following foods?

Milk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

Fatty foods . . . . . . . . . . . . . . . . . . . . . . . . . .

,@’uy 2UN ‘D”’

Green vegetables . . . . . . . . . . . . . . . . . . . . . . .

@’Dy ‘UN ‘n”’

[@’Dy 2nN

90”’

Seafood . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@ ‘ny ‘UN ‘n”’

Any other food 3

l@’ny 2CIN 9DDK

specify

I

F40. How often do you have a bowel movement? i@ I ❑ 3 or more times per day

2 ❑ twice per day

I

3 •l once per day

I

4 •l every other day

5 ❑ less often than every other day

I

9CI” K

CARDIOVASCULAR CONDITIONS

G1. Have you ever had any pain or discomfort in your

@

ICI Y(G3)2UN

chest?

I

G2. Have you ever had any pressure or heaviness in your ; @ ICIY 2 ❑ N(G13)

chest?

I

G3. Do you get it when you walk uphill or hurry?

~ @ ‘ny 2nN(G1’) 3 G’ never hurries or walks uphill

G4. Do you get it when you walk at an ordinary pace on

the level? ; @ ‘n’ ‘UN

I

G5. CHECK ITEM: MARK ONE BOX.

@

I •l “Y” in G3 AND/OR G4 (G6)

I

2 ❑ Other (Gil)

G6, What do you do if you get the (pain or discomfort/

;@

1 ❑ stop or slow down

pressure or heaviness) while you are walking? Do you 2 ❑ continue at same pace (G11)

stop, slow down, continue at the same pace, or take

I

a ❑ take medicine

medicine?

G7. If you stand still, what happens to the (pain or dis-

:@

1 ❑ relieved

comfort/pressure or heaviness)? Is it relieved or not? 2 ❑ not relieved (G I 1) .

18

235
I

G8. How soon is it relieved?

p

minutes

number

,

G9. Where is the (pain or discomfort/pressure or heaviness) :@-@

MARK AREA(S) SHOWN.

located?

PROBE IF NECESSARY: I

Please show me where it is located. I

I

I

I

I

I

I

I

I

I

I

GIO. Do you feel it anywhere else?

I

@

I ❑ Y(MARK 20N

AREA IN

I

G9)

I

Gil. Did you see a doctor because of your (pain or dis- l@ ‘n’ 2 ❑ N(G13)

comfort/pressure or heaviness)?

G12. What did the doctor say it was?

:@ ‘ Specify

G 13. Have you ever had a severe pain across the f rent of

~@ ‘n’

2 ❑ N(HI)

your chest lasting for half an hour or more?

I

G 14. How many of these attacks have you had?

I@

01 ❑ One (G17)

I

attacks

number

G 15. What was the date of your first attack? I 9999 •l D K

~ @@ m.. ‘yr.

G16. What was the duration of the pain during your first I @ I ❑ 30-59 min.

attack? I

z ❑ 1-2 hrs.

I

3 ❑ 3-5 hrs.

4 ❑ 6-11 hrs.

I

5 ❑ 12-23 hrs.

I

6 ‘d 24-47 hrs.

7 ❑ 2 days or more

I

9nDK

9999 ❑ D K

G17. What was the date of your (last) attack?

! m ‘0 ‘ vr

19

236
I

G18. What was the duration of the pain during your @

I ❑ 30-59 min.

(last) attack?

1

2 ❑ 1-2 hrs.

3 ❑ 3-5 hrs.

I

4 ❑ 6-11 hrs.

5 ❑ 12-23 hrs.

I

6 ❑ 24-47 hrs.

I

7 II 2 days or more

9nDK

G19. Did you see a doctor because of this pain?

:@ ‘n’

2 ❑ N(G21)

1

G20. What did the doctor say it was?

;@ ‘ specify

I

G21. Have you ever had an electrical recording of your @’D’

2Ci N

heart, also called an ECG, performed? This involves

placing wires on the chest and arms. I

SMOKING

I

H1. Have you smoked at least 100 cigarettes in your

I@ “n’

2 ❑ N(H13)

entire life?

I

I

H2. About how old were you when you first started smoking

I@

years old

cigarettes fairly regularly? number

I

00 ❑ never smoked regularly

H3. Do you smoke cigarettes now? I@ 1UY(H6)211N

H4. About how long has it been since you last smoked

;@

years (H8)

cigarettes (fairly regularly)? number

I

00 ❑ less than 1 year

H5. About what date was that? I @-@~

1

H6. We are interested in the actual number of cigarettes I@ oo ❑ less than 1 per day

people smoke in a day. How many cigarettes a day (do/

did) You smoke (when You last smoked regularly)? I

I

cigarettes

number

IF ANSWERS IN PACKS, ASK:

I

@

packs

Could you give me the actual number of cigarettes? number

H7. Was there ever a period when you smoked more than

~@’D’

2 ❑ N (H9)

(number in H6) cigarettes a day?

I

H8. During the period when you were smoking the most, ~ @ 00 ❑ less than 1 per day

about how many cigarettes a day did you usually

smoke?

I

cigarettes

number

@

packs

number

20

237
I

IF 1 YEAR OR MORE IN H4, GO TO H13. I Brand name(s)

H9. What brand of cigarette (do/did) you usually I

smoke? ,@

!0409

IF MORE THAN ONE BRAND, ASK: I Brand name

HI(3. Which brand (do/did) you smoke the most? @

CHECK CARD ASP 2, BRAND LIST. IF I

BRAND(S) NAMED APPEAR(S) ON LIST, I

ASK: I

H1l. Isthat —~—X Y ,or —Z?

[0

INCLUDE ALL NAMES FOR THE BRAND

I

H12. What type of cigarettes are the (~d) that I

you (smoke/smoked)? Are they:

I

a. Filter tip or non-filter tip? . . . . . . . , . . . . . . l@ ICi FT 2DNFT9DDK

b. Menthol or plain? . . . . . . . . . . . . . . . . . . . . l@ ICi M 2DP eEIDK

c. Hardpack or softpack? . . . . . . . . . . . . . . . . ~ ~ ICI HP ZCISP ~ODK

d. Regular, Kingsize, 100 or 120 millimeter? . . . . 0415 IOR 20K 3n1004nlz09[~DK

e. High, medium, or low tar and nicotine? . . . . .

I

,0416 IUH zOM 30L 9CIDK

H13. Do you smoke cigars now?

~ o ‘ny 2nN(H15)

H14. About how many cigars a day do you smoke?

;0 cigars per day

number

I

❑ less than 1 per day –

I

specify ~

I

eG ❑ 3-6 per week

77 ❑ less than 3

I per week

I

H15. Do you smoke a pipe now?

@ ‘Dy

2 ❑ N(H17)

H16. About how many pipefuls of tobacco e day do you

I

usually smoke? I@

pipefuls per day

number

I

I

❑ less than 1 per day –

I

specify

7

I

Ge ❑ 3-6 per week

i’7 ❑ less than 3

I per week

I

H 17. Does anyone (else) in your household smoke cigarettes,

10 ‘“y

2EIN

cigars, or a pipe inside your home?

I

21

238
HIS. Do you share an office with or work near someone

I

@ ‘0’

2CIN

(else) who smokes cigarettes, cigars, or a pipe in your

presence? I

FUNCTIONAL IMPAIRMENT

#

J1. CHECK ITEM. I@ I •l Age under 18 (J28)

I

2 ❑ Age 71 or older (J25)

3 ❑ Age 18-70 (J2)

J2. What was your major activity during most of the

past 12 months; working at a job or business, ~ @ ~ ~ [~e%i’~~l&!e (J5)

keeping house, going to school, or something else?

I

3 ❑ going to school (J12)

4 ❑ something else (Jl 2)

I

J3. Does any impairment or health problem now keep

@

1 ❑ ‘T’(J17)2 ❑ N

you from working at a job or business? —

!

J4. Are you limited in the kind or amount of work you can I @ 1 ❑ Y(J17) z ❑ N(J15)

do because of any impairment or health problem?

I

J5. Does any impairment or health problem now com- l@ 1CIY(J7)2CIN

pletely keep you from doing any housework?

I

J6. Are you limited in the kind or amount of housework

I@

1 ❑ Y(J7) 2 ❑ N(J12)

you can do because of any impairment or health

problem? I

I

J7. What condition causes this limitation?

I condition

I

J8. When did you first notice your (condition in J7)?

I@

I El more than 3 months ago (J12)

I

❑ 3 months ago or less —

PROBE IF NECESSARY: Was it within the past 3

months or was it more than 3 months ago?

I

SpECIFY IF 3 MONTHS AGO OR LESS –

I 2 ❑ CONDITION IS ON CARD ASP 3 (J12)

I

3 ❑ CONDITION NOT ON CARD ASP 3 (J9)

J9. Is this limitation caused by any other condition?

;@

lnY 2 ❑ N(J12)

JIO. What other condition causes this limitation? I

I

condition

JI 1. When did you first notice your (condition in J1O)? ‘o431

I

I •l more than 3 months ago (J12)

•l 3 months ago or less —

I

I

SPECIFY IF 3 MONTHS AGO OR LESS–

1

2 ❑ CONDITION IS ON CARD ASP 3 (J12)

I

3 ❑ CONDITION NOT ON CARD ASP 3

(REASKJ9-JI1)

J12. Does any impairment or health problem keep you

;@ 1 ❑ Y(J17) 2 ❑ N

from working at a job or business?

J13. Are you limited in the kind ~r amount of work you ‘o433 1 ❑ Y(J17) 2 ❑ N(J14)

could do because of any impairment or health

problem?

I

22

239
J14. CHECK ITEM, it9 1 ❑ “Yes” in J5 ~ J6 (J22)

z ❑ Other (J15)

I

J15. Are you limited in any way in any activities because

—

@ln Y 2 ❑ N(J22)

of an impairment or health problem?

I

J16. In what way are you limited? RECORD LIMITATION, I@’

NOT CONDITION,

I

limitation

J17. What condition causes this limitation? I

I condition

—

J’18. When did you first notice your (condition in JI 7)? I ❑ more than 3 months ago (J22)

~ @ ❑ 3 months ago or less -

PROBE IF NECESSARY: Was it within the past 3

I months or was it more than 3 months ago? SPECIFY IF 3 MONTHS AGO OR LESS–

I

i

2 ❑ CONDITION IS ON CARD ASP 3 (J22)

I

3 ❑ CONDITION NOT ON CARD ASP 3 (J19)

I —

J“19. Is this limitation caused by any other condition? @ln Y 2 ❑ N(J22)

J20. What other condition causes this limitation? I

i

condition

J21. When did you first notice your (condition in J20)?

~@

I ❑ more than 3 months ago (J22)

❑ 3 months ago or less –

I SPECIFY IF 3 MONTHS AGO OR LESS –

I

I

2 ❑ CONDITION IS ON CARD ASP 3 (J22)

3 ❑ CONDITION NOT ON CARD ASP 3

I

(REASK J19-J21)

—

J22, CHECK ITEM.

I

1 ❑ Age 60-70 (J23)

‘ @ 2 ❑ A;e;::-::’&ytiOn

I

I

3 ❑ Other (J39)

I

J23. Because of any impairment or health problem, do you

—

I @ ID Y(J39)z CIN

need the help of other persons with your personal

care needs, such as eating, bathing, dressing, or getting 1

around this home? I

J24. Because of any impairment or health problem, do you I @ -r II Y(J39) z ❑ N(J39)

—

need the help of other persons in handling your routine

needs, such as taking care of this place, doing necessary

I

business, shopping, or getting around for other purposes? I

ASK FOR AGES 71+ ONLY: I

—

1 n

J25. What was your major activity during most of the past ‘w I ❑ working

12 months; working at a job or business, keeping house, I

2 ❑ keeping house

going to school, or something else?

I

3 •l going to school

4 ❑ something else 1

J26. Because of any impairment or health problem, do you ;@ 1 ❑ Y(J34) 2 ❑ N

need the help of other persons with your personal care

needs, such as eating, bathing, dressing, or getting I

around this home?

23

240
J27. Because of any impairment or health problem, do you ‘o445

I

1 ❑ Y(J34) 2 ❑ N(J32)

need the help of other persons in handling your routine

needs, such as taking care of this place, doing necessary

business, shopping, or getting around for other

I

purposes? I

ASK FOR AGES 12-17 ONLY: I

I

J28. Does any impairment or health problem UW keep you I @ 1DY(J34)2CIN

from attending school?

!

J29. Do you attend a special school or special classes be- I @ 1CIY(J34)2CIN

cause of any impairment or health problem? I

J30. Do you need to attend a special school or special I @ ICI Y(J34)20N

classes because of any impairment or health problem?

I

J31. Are you limited in school attendance because of your I @ IO Y(J34)2DN

health? I

J32. Are you limited in ~ in any activities because of ‘o450 10Y 2 ❑ N(J39)

an impairment or health problem? I

J33. In what way are you limited? RECORD LIMITATION,

NOT CONDITION. @ 1

limitation

I

J34. What condition ~uses this limitation? I

I

condition

I

J35. When did you first notice your (condition in J34)? @

1 ❑ more than 3 months ago (J39)

❑ 3 months ago or less —

PROBE IF NECESSARY: Was it within the past 3

I

months or was it more than 3 months ago?

I

SPECIFY IF 3 MONTHS AGO OR LESS –

I

2 ❑ CONDITION IS ON CARD ASP 3 (J39)

3 II CONDITION NOT ON CARD ASP 3 (J36)

J36. Is this limitation caused by any other condition?

~ @ lny

2 ❑ N(J39)

J37. What other condition causes this limitation? I

I condition

J38. When did you first notice your (condition in J37) ? i@ 1 ❑ more than 3 months ago (J39)

❑ 3 months ago or less –

I

I

SPECIFY IF 3 MONTHS AGO OR LESS–

I 2 ❑ CONDITION IS ON CARD ASP 3 (J39)

I

3 II CONDITION NOTON CARD ASP 3

(REASK J36-J38)

J39. CHECK ITEM. @1 ❑ Age 18 or older (J40)

I

2 ❑ Age 12-17 (Kl)

J40. Have you ever changed your job, stopped working or I @ IDY 2 ❑ N(KI)

made any changes in your housework because of a

disability or health problem? I

24

241
I

J41. What was the health problem?

I@ ‘

specify

I

J42. Did you -

Retire because of a disability? . . . . , . . . . . . . . . @ llJy 2CIN

Change permanently to an easier job? . . . . . . . . . @ 10’ 2EIN

Change temporarily to an easier job? . . . . . ., . . @ ‘ny 2DN

Cut down to part-time work only? . . . . . . . . . . . @ ‘n’ 2nN

Have to stop working for a few months? . . . . . . .

I@ ‘ny 21ZN

Have to cut down on housework? . . . . . . . . . . .

@ ‘n’

2CIN

Stopdoing all housework? . . . . . . . . . . . . . . . . I@ IDY 20N

Makesome other change? . . . . . . . . . . . . . . . . .

~@ ‘Dy ‘UN

3

specify

I

CONDITION LIST

K1. Has a doctor ~r told you that K2. Do you still have . . . ? K3. How many

you had: (IF “YES” ASK K2 & K3 years ago did

BEFORE GOING TO NEXT CONDITION). you —- first

have ...?

Emphysema? 0486 1 ❑ Y(K2) 20No467 10Y 2UN 9UDK o468

Chronic bronchitis?

o

469 1 ❑ Y(K2) 20N

o

470 10% 2Ci N 9nDK

o

471

Rheumatic fever? o472 1 ❑ Y(K2) 2EIN

o

473 lCIY 2EIN 9ci DK

o

474

Rheumatic heart disease? o475 1 ❑ Y(K2) 20N o476 lDY 2CIN 9Ei DK o477

Heart murmur? o470 1 ❑ Y(K2) 20N o479 ICIY 2CIN 9nDK o4B0

Heart failure? o481HY(K2) 2CIN

o

402 lCIY 20N 9ci DK

o

483

Heart attack?

o

484 1 ‘d Y(K3)

2nN w#%%%///////////B @—

Kidney problems? o406 1 ❑ Y(K2) 2UN o487 10’ 20N 9nDK o488

Cirrhosis of the liver? o409 1 ❑ Y(K2) 2EIN

o

490 10’ 20N 9nDK o491

Hepatitis?

o

492 1 ❑ Y(K2) 20N @ ID’ 2UN eUDK @

Yellow jaundice? o495 1 ❑ Y(K2) 2EIN o496 In’ 2UN 9nDK @

Stroke?

o

498 1 ❑ Y(K3)

o

2 “N %%%%////%///////% @–

G Iaucoma? 500 1 ❑ Y(K2) 2CIN

o

501 lDY 2UN 9nDK

o

502

Cataracts? o503 1 ❑ Y(K2) 2UN o504 lCIY 2DN 9ci DK o505

Strabismus or crossed eyes? 0506 1 H Y(K2) 2CIN o507 10Y 2il N 9CIDK o508

An eye injury? o509 I ❑ Y(K2) 2CIN o510 10Y 21JN 9EIDK o511

Goiter?

o

512 1 ❑ Y(K2) 2CIN

o

513 10’ zON 9nDK @

Other thyroid disease?

o

515 ‘r ❑ Y(K2) 2CIN

o

516 10Y 20N 91ZDK

o

517

25

242
PESTICIDE EXPOSURE

L1. Have you ~r done farm work, either paid or unpaid?

~ @ ‘n’

2 ❑ N(L27)

Some examples of farm work are working with crops

or animals and supervising other workers on farms or I

orchards.

I

L2. Approximately how many years have you worked in

;0 99 ❑ DK

farming?

I

years

number

I

I

L3. Are You a migrant farmworker? I @ IUY(L5)20N

I

L4. Have you ever worked in farming away from your usual I @ 10’

I

2 ❑ N(L6)

home for more than two weeks at a time?

L5. How many months per year are or were You away I @99n DK

from your usual home working in farming? I

00 •l less than 1 month per year

I months per year

I

number

I

L6. Have You worked in farming at any time during the I @ In’ 2 Ig N(L14)

past year?

I

I

L7. During the past year, have you worked on any of the .— ___

following types of farms:

I

I

Animal or dairy farm? . . . . . . . . . . . . . . . . . . .

I @ ‘n’

2DN

Poultry farm? . . . . . . . . . . . . . . . . . . . . . . . . I @ lnY 2CIN

Vegetable or truck farm? . . . . . . . . . . . . . . . . . I @ lnY 2EIN

Fruit orchard? . . . . . . . . . . . . . . . . . . . . . . . .

‘ @ lUY 2nN

Cotton farm? . . . . . . . . . . . . . . . . . . . . . . . . .

‘ @ ‘ny

2Ei N

Tobacco I @ 10’ farm? . . . . . . . . . . . . . . . . . . . . . . . .

I

2UN

Grain farm? . . . . . . . . . . . . . . . . . . . . . . . . . .

Ie’n’

2iZN

Some other kind of farm? 3

I @ ‘ny

2UN

specify

I

L8. During the past year, what agricultural crops have you I@ ~CiDK

mainly worked with?

I

0 ❑ none

lee

I

I

26

243
L9. During the past year, have you performed any of the

following jobs:

Picker or harvester? . . . . . . . . . . . . . . . . . . . . .

Cultivator? . . . . . . . . . . . . . . . . . . . . . . . . . .

Planter? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sorter? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Packer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pesticide sprayer? . . . . . . . . . . . . . . . . . . . . . .

Pesticide mixer; . . . . . . . . . . . . . . . . . . . . . . .

Pesticide flagman? . . . . . . . . . . . . . . . . . . . . .

Field foreman?, . . . . . . . . . . . . . . . . . . . . . . .

Anyotherfarmjob? 3

specifv

I

I

I

I

I

I

I

I

I

I

I

I

I

o530

0539

0540

0

541

0

542

0543

0

544

0

545

0

546

0

547

11-JY 2CIN

113Y 2EiN

lCIY 2CIN

lnY 2CIN

lUY 2EIN

10Y 2DN

lDY 2UN

lnY 2DN

lDY 2EIN

10Y 2CiN

—

LIO. How many months ofthe year do you usuallyworkin 00 ❑ less than 1 mo. peryr.

farming?

@

I

mos. per year

number

1

LI 1. When working in farming, do you usually eat any meals in

; @ lUY 2 ❑ N(L13)

or near the fields during the working day?

L12, When working in farming, where does the water you use -

for washing your hands come from?

Is It: Brought to the fields from somewhere else? . . . . .

From awellin the fields? . . . . . . . . . . . . . . . . .

Irrigation water or standing water at the field? . . .

0550 lci Y 213N

o

551 lDY 211N

o552 lDY 2CIN

From some other source? 3 553 lnY 2EIN

specifv

,48

< 554 0 ❑ DOESN’T WASH HANDS

L13. When working in farming, where does your drinking

water come from?

Is It: Brought to the fields from somewhere else? . . . . .

Fromawell in the fields? . . . . . . . . . . . . . . . . .

Irrigation water or standing water at the field? . . .

From some other source? 3

specify

(a 10Y 2Ei N

w

o

556 lnY 2EIN

o

557 10% 2DN

o558 10Y 2CIN

Y@

o ❑ DOESN’T DRINK WATER

LI 4. Pesticides are chemicals used to kill insects, weeds, plant

diseases, and rodents. When working in farming, to your

knowledge, have pesticides ~r been applied to an area

while you were working in it?

L15. How many times?

‘(G) ,Ciy 20 N(L16) 9 ❑ DK(L16)

(G) I ❑ l-~titnes

1- 2 ❑ 3-5 times

3 ❑ 6-10 times

I

4 ❑ more than 10 times

9CIDK

27

2a
LI 6. Have you ever mixed, handled, or applied pesticides

; @ ‘n’

2 ❑ N(L20) 9 ❑ DK(L20)

while working in farming?

I

L17. Approximately how many times per year have you I ❑ less than once per year

usually mixed, handled, or applied pesticides while i o 2❑ l-12 times pm-year

working in farming? I

3 ❑ more than 12 times per yr.

L18. Have you ever used any of the following items of

protective equipment while mixing, handling, or I

applying pesticides:

I

Gloves? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I @ ‘n’ 2UN

Special suit over clothes? . . . . . . . . . . . . . . . . .

I @ ‘n’

2CIN

Mask? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I @ ‘0’

20N

Goggles? . . . . . . . . . . . . . . . . . . . . . . . . . . . . I @ 10Y 2UN

Rubber boots? . . . . . . . . . . . . . . . . . . . . . . . .

‘ @ ‘n’

2CIN

Head covering? . . . . . . . . . . . . . . . . . . . . . . . .

‘ @ ‘ny ‘UN

Any other item? 3

~ @ ‘O’

2UN

specify

IF ALL “N” in L18, SKIPT0 L20. OTHERWISE ASK: 1

I

L19. How often have @u used any protective equipment @

I ❑ always

while mixing, handling, or applying pesticides: Always,

I

2 ❑ sometimes

sometimes, or never? 3 ❑ never

L20. While working in farming, have any pesticides ever been 10572 1 ❑“Y

spilled or sprayed on any part of your body? I

2 II N (L26)

9 ❑ DK (L26)

L21. How many times have pesticides been spilled or sprayed [ @999u DK

on you? I times

I

number

L22. Did you ever become ill because pesticides were spilled

~ @ ‘ny

2CIN

or sprayed on you?

L23. Did you ever see a doctor because pesticides were spilled I @ ,OY zUN

or sprayed on you? I

L24. Did you ever lose any work time as a result of having

~ @ 10’

2UN

pesticides spilled or sprayed on you?

L25. What specific pesticides were spilled or sprayed on you?

‘o

9nDK

~F NAME(S) NOT KNOWN, ENTER WHAT

PESTICIDE IS USED FOR OR ON. ~m

L26. Besides while working in farming, have you mixed, @

1 ❑ Y (L28) zO N (L28)90 DK (L28)

applied or handled any pesticides during the past year?

I

L27. Pesticides are chemicals used to kill insects, weeds, plant i @ L=’ 2CIN 9nDK

diseases and rodents. Have you mixed, applied or

handled any pesticides during the past year? I

I

28

245

—
I

L28. During the past five years, have you used the I (3 ‘n’ 2EIN

prescription medication, Kwell, to control body

or head lice? I

L29. Have youe~r worked inapesticide processing plant? I @ ICIY

I

20N 9nDK

I

L30. Have you ~ worked as a pesticide applicator or I @ 10’ 2DN 9CIDK

sprayer, for example, an exterminator or a pest control

specialist? I

.—

ACCULTURATION

Ml. Do you speak any Spanish?

I

, @ ‘ny 2DN(M4)

I

M2. Would you say that you speak mostly Spanish, or mostly @

I •l mostly Spanish

English, or do you speak Spanish and English about the 2 ❑ mostly English

same? I

3 ❑ both about the same

I

M3. What language do you prefer: Spanish only, mostly

I@

I ❑ Spanish only

Spanish, mostly English, English only, or Spanish and

I

2 ❑ mostly Spanish

English about equally? 3 ❑ mostly English

I

4 ❑ English only

5 ❑ both equally

M4. Can you read Spanish?

I

I @ “n’

20N

I

M5. Can you read English? I @ IEly 211N

I

IF “YES” TO BOTH M’ AND M5, ASK: I

I

M6. Which do you read better?

10

1 ❑ Spanish

I

2 ❑ English

3 ❑ both the same

M7. Can you write in Spanish?

I

, @ ‘ny

2’ON

I

M8. Can you write in English? I @ ,nY” 20N

I

IF “YES” TO BOTH M7 AND ME), ASK: I

I

M9. In which language do you write better?

@

I ❑ Spanish

2 ❑ English

I

3 ❑ both the same

29

24e
HAND CARD ASP 4

I

I

MIO. Which ofthose groups best describes your ethnic

I@

01 ❑ Boricuan

identification?

I

02 ❑ Puerto Rican

03 •l Cuban

I

04 ❑ Cuban-American

I

05 El Mexican/Mexicano

06 ❑ Chicano

I

07 ❑ Mexican-American

——————.———————

I

08 ❑ Hispano

I

09 ❑ Latin American

10 ❑ Other Spanish or other Hispanic

I

11 ❑ American

I

12 ❑ Anglo-American

13 ❑ other group la

specify

IF ANY BOX BELOW THE LINE IN MIO IS I

CHECKED, ASK:

I

M1l. What is your country of origin?

~w speciti

I

M12. Which of those groups ~ describes your mother’s

ethnic identification?

~ @ ol ❑ Boric.an

02 ❑ Puerto Rican

I

03 ❑ Cuban

04 ❑ Cuban-American

I

05 ❑ Mexican/M exicano

I

06 ❑ Chicano

07 •l Mexican-American

I

os El Hispano

I

09 ❑ Latin American

10

I

specify country

I

11 ❑ other Spanish or other Hispanic

12

I

specify country

13 ❑ American

I 14 ❑ Anglo-American

I

15 ❑ other group 16

spacify

I

Ml 3. Which of those groups ~ describes your father’s

I

01 ❑ Boricuan

ethnic identification? I 002 ❑ Puerto Rican

I

03 ❑ Cuban

w El Cuban-American

I 05 ❑ Mexican/Mexicano

I

06 ❑ Chicano

07 ❑ Mexican-American

I os ❑ Hispano

i

IM❑ Latin American

10

I

specify country

I

1 I •l other Spanish or other Hispanic

12

I

specify country

I

13 ❑ American

I

14 ❑ Anglo-American

15 ❑ other group 16

specify

30

247
M14. In what country or State was your father born? if3 I ❑ U. S., except Puerto Rico

2 ❑ Puerto Rico

I

3 ❑ Cuba

1 4 ❑ Mexico

5 ❑ other G

specify

M15. In what country or State was your mother born?

:@ I ❑ U. S., except Puerto Rico

2 ❑ Puerto Rico

I

3 ❑ Cuba

4 ❑ Mexico

5 ‘d other G

specify

MEAL PROGRAMS

I

N1. CHECK ITEM: , @ I ❑ under 19 (N2)

2 ❑ 19-59 (Pi)

I

3 ❑ 60+ (N16)

I

N2, Are you now attending school?

I @ ‘n’

2 ❑ N(PI)

N3. Does the school that you attend serve a complete ; @ ICIY 2CIN

breakfast?

I

N4. How many times a week do you usually eat breakfast

;@

times

served by the school?

I

o II none (N8)

9nDK

N5. During this (past) school year did your parents fill out i @ IOY 2 ❑ N(N7)

a form to enable you to eat breakfast at school for free

or at a reduced price? I

I

N6. Do you eat breakfast at school for free or at a reduced

‘ @ ! ~ ~; ~;;e?!~;~n

price?

I

N7. How much do you pay for your breakfast per day? I

@

cents

number

I

ooo ❑ free

N8. Does the school that you attend serve a complete I @ 10’ 20N

lunch? I

I

N9. How many times a week do you usually eat lunch served

@

times

by the school? number

I o ❑ none (N13)

I

9CIDK

NIO. During this (past) school year did your parents fill out I @ In’ 20 N(N12)

a form to enable you to eat lunch at school for free or at I

a reduced price?

I

NI 1. Do you eat lunch at school for free or at a reduced

10

I ❑ yes

price? 2 •l no, not eligible

I

3 ❑ no, other reason

31

248
N12. How much do you pay for your lunch per day? ;@ cents

number

I

000 ❑ free

I

N13. Do you ever bring your lunch from home? @I ❑ yes, always

2 ❑ yes, sometimes

I

30 no(Pl)

N14. On days that you do not eat lunch served by the school, I ❑ yes, always

do you buy milk? I 0 2 ❑ yes, sometimes

I

3n no(Pl)

N15. How much do you pay for your milk per day?

@

cents

I

number

I

(Pi)

I

000 ❑ free

1

N16. Do you participate in any program in which prepared I @ ‘n’

2 ❑ N(N20)

meals or groceries are delivered to your home on a

regular basis? I

I

N17. Are prepared meals or groceries delivered to your home? @

I ❑ prepared meals only

I

2 ❑ groceries only

3 ❑ both

I

4 ❑ other — 5

specify

N18. Is the sponsor of the program – I

A local health department? . . . . . . . . . . . . . . . .

I o620 lny

I

2CIN

Another department of local government? . . . . . . @ lny

2nN

A State government? . . . . . . . . . . . . . . . . . . . . 10622 lny 2nN

A church group? . . . . . . . . . . . . . . . . . . . . . . .

I @ ‘n’ 2nN

Some other voluntary organization?

WI “Uy 2UN

3

I

specify

I

N19. About how often is the food brought to your home?

;@

01 ❑ two or three times a day

02 ❑ once a day

03 ❑ four to six times a week

I 04 ❑ two or three times a week

I

05 ❑ once a week

I

o13 ❑ two or three times a month

07 ❑ once a month

I

os •l less than once a month

I

09 ❑ other — 10

specify

N20. Do you participate on a regular basis in any program ~ @ 10% 2 ❑ N(P1)

in which you go out to a place where meals are served

to groups of people? I

32

249
N21. Is the sponsor of the program – I

I

A local health department?. . . . . . . . . . . . . . . .

@ 10’ ‘n”

Another department of local government? . . . . . .

I@’ny

zUN

A State government? . . . . . . . . . . . . . . . . . . . .

I@’ny ZCIN

A church group? . . . . . . . . . . . . . . . . . . . . . . . I@ ICIY ZCIN

Some other voluntary organization? . . . . . . . . . .

I

3

I@ ’D’

20”

Specify

N22. About how often do you go out for these meals? ~ @ .1 ❑ two orthnxtinres a day

02 ❑ once a day

I

03 •l four to six times a week

04 ❑ two or three times a week

I

05 ❑ once a week

I

06 ❑ two or three times a month

07 ❑ once a month

I oa ❑ less than once a month

I

09 ❑ other — 10

specify

I

33

250
MEDICINE/VITAMIN L&AGE

PI. During the past 2 weeks, have you taken or used any

vitamins or minerals? o633 1 El Y(P2) 2 ❑ N(P5)

P2 . May I see the container(s) P3. How much of the P4. How often do you

of your vitamins and (vitamin/mineral) take this (vitamin/

minerals? do you take each mineral)?

RECORD BRAND NAME time you use it?

o

634

@-@

(

@-@

{

1 ❑ day

I ❑ tablet/capsule z ❑ week

z ❑ teaspoon per

times 3 D month

number 3 ~ tablespoon

4 G other

4 ❑ other —

5

specify

o634

WI

-+

m

{

1 ❑ day

I ❑ tablet/capsule

2 ❑ teaspoon

2 ❑ week

times

per

number 3 ❑ tablespoon

3 ❑ month

4 0 other —

4 ❑ other

❑ Continuation booklet

5

specify

P5. We are interested in all kinds of medicines that people take or use. First 1 will ask about your use of medicines that can be

obtained without a doctor’s prescription.

During the past 2 weeks, have you taken or used any of the following types of of medicines?

a) Cough, throat, cold or congestion medicine? o6391DY2CIN

b) Pain relievers, such as aspirin or Tylenol? o64010Y 2CIN

c) Sleeping tablets, sedatives, or tranquilizers? o641 lCIY 2UN

d) Anti-depressants, stimulants, or pep pills? o642 lDY 20N

e) Diet pills or dieting aids? o643 10Y 2EIN

f) Laxatives? o644 lnY zEIN

g) Medicines for diarrhea? o6451UY zON

h) Medicines for indigestion? o6461n Y 2CIN

i) Suppositories? o647 lUY zDN

j) Eye drops? o64E11DY zCi N

k) Any other medicines, pills, or ointments for which a o6491DY 2UN

doctor’s prescription is not needed?

IF YES, SPECIFY: o650

35

251
P6. During the past 2 weeks have you taken or used any medicines for which a doctor’s prescription is needed?

o

651 1 ❑ Y(P7) 2 ❑ N(P14)

P7. May I see the container(s) of the medicine(s) you took? P8. What is the health P9. Did you take (dosage

RECORD SPECIFIED INFORMATION FOR EACH,

,—

problem you had for reported in P7) per

THEN ASK QUESTIONS P8 THROUGH 13 FOR EACH. which you took the (frequency reported

(medicine)? PROBE in P7)?

FOR SYMPTOM OR

CONDITION.

o

Label printed in: 65z

o

653

1 •l English 2 ❑ Spanish 3 ❑ Both

——— ___ _ ——— —— __ ___

o

Name: 655

0

654 1 IJ Y (P12j

-—— ————— ——— ——— —— ——

Prescribed for SP?

2CIN

o

6561OY 20N

————— ——— ——— _____ _

o

Strength: 657

.—— ——_ — ——— —___ ___ _

O-@

Dosage: 658

——— —— ——— —— —— ——— ——

.—— —— ——— —— —— _

IF “AS NE EDED,’’ASK P8 AND GO TO NEXT

MEDICATION

-—— ——_ ___ ___ ___ __

o

662 I ❑ Container not seen-information furnished by respondent

D

~5z Label printed in:

o

653

I ❑ English z ❑ Spanish 3 ❑ Both

-—— ——— —— —- ___ ____

o

Name: 655 0

654I ❑ Y(p12)

.—— — ——— ——_ _____

Prescribed for SP?

2UN

o

656 lCIY ZUN

——— ——— —— _______ __

o

Strength: 657

——— ————— ——.—— ——— ——

.—— ——— ——— .—— _

—— —— —_ ___ ——— ____

IF “AS NEEDED,’’ ASK P8 AND GO TO NEXT

MEDICATION

—— ——— ——— ——— ———— _

o

662 1 ❑ Container not seen-information furnished by respondent

252

36
PIO. How much of the PI 1. Did a doctor advise P12. Does the (medicine) P13. What do you do

(medicine) did you you to take (dosage in make you feel bad or when this happens?

take? KIO)/(frequency in cause any side effects?

KIO)?

9e

{

1 ❑ tablet/capsule o667 0668 0669DO NOT READ.

2 ❑ teaspoon 1 ❑ Yes I ❑ Yes – SPECIFY

number

PROBLEM 1 ❑ QUIT USING MEDICINE

3 ❑ tablespoon 2UN0 3 2❑ DECREASE USE

-I ❑ other

$@

3E’CONSULT DOCTOR

2CIN0

{

I ❑ day

}

GO TO NEXT 4 ❑ CONTINUE TAKING AS

2 ❑ week MEDICATION PRESCRIBED

times

per

3 ❑ month 9CIDK

4 ❑ other —

5 II OTHER–

5

6

5pecifv

sPEcIFY

Y

0

1 ❑ tablet/capsule o667

663 664 0668 0669 Do NOT READ2 ❑ teaspoon 1 ❑ Yes I ❑ Yes –SPECIFY

number PROBLEM 1 ❑ QUIT USING MEDICINE

3 ❑ tablespoon 2DN0 3

2 ❑ DECREASE USE

4 ‘V other

@@

3 •l CONSULT DOCTOR

2DN0

{

1 ❑ day

I

GO TO NEXT 4 ❑ CONTINUE TAKING AS

—per

2 ❑ week MEDICATION PRESCRIBED

rimes 3 ❑ month 9ci DK

4 ❑ other – 5 ❑ OTHER–

5 6

specifv sPECIFY

37

253
P7. May I see the container(s) of the medicine(s) you took? P8. What is the health P8. Did you take (dosage

RECORD SPECIFIED INFORMATION FOR EACH, problem you had for reported in K?) per

THEN ASK QUESTIONS P8 THROIJGH 13 FOR EACH. which you took the (frequency reported

(medicine)? PROBE in P7)?

FOR SYMPTOM OR

CONDITION.

o

Label printed in: 652

0

653

I ❑ English 2 ❑ Spanish 3 ❑ Both

——— ——— ——— —_— —.— —_

o

Name: 655

0

654 1 u Y (p12)

——— ———— ——— ——— —— ——

2DN

Prescribed for SP?

o

6561DY 2Ei N

————— ——— ——— ———— .—

0

Strength: 657

.—— ——— —— ——— .—— ————

‘oSage’ @@

.—— ——— ———— ——— ————

Frequency: @@

.—— —— ——— —— —— —— ———

IF “AS NE EDED,’’ASK P8 AND GO TO NEXT

MEDICATION.

——— —— ——— ——— —— ———

3

162 1 ❑ container not seen-information furnished by respondent

~z Label printed in:

>

0

653

1 ❑ English 2 ❑ Spanish 3 ❑ Both

-—— ——— —— —— ——— ————

0

Name: 655

0

654 1 •1 Y (P12)

——— ——— ——— ——— ——— —

2UN

Prescribed for SP?

o

656 10Y 2UN

-—— ——— ——————— ——— —

o

Strength: 657

———— ———— ——, . ——— .——

Dosage: @@

.—— ——. ——— ——— ——— ——

m

Frequency: 660

.—— — ——— ——— ———— ——

IF “AS NEEDED,r’ ASK P8 AND GO TO NEXT

MEDICATION

— ——— —.——— ——— ————

3

i62 1 ❑ container not seen-information furnished by respondent

❑ Continuation booklet

30

254
P1O. I+OW much of the PI 1. Did a doctor advise P12. Does the (medicine) P13. What do you do

(medicine) did you you to take (dosage in make you feel bad or when this happens?

take? PIO)/(frequency in cause any side effects?

Plo)?

i

m

1 U tablet/capsule

o

667

0

660

0

669

DO NOT READ

z D teaspoon 1 El Yes I ❑ Yes – SPECIFY

number

PROBLEM 1 ❑ QUIT USING MEDICINE

3 ❑ tablespoon 20N0 3

2 El DECREASE USE

4 n other

m

3 C! CONSULT DOCTOR

{

1 ❑ day 2Ei No

2 ❑ week per

}

GO TO NEXT 4 ❑ Continue TAKi NG AS

times 3 •l month Medication PRESCRIBED

4 ❑ other – 90DK

5

5 ❑ OTHER–

specify 6

sPEcIFY

m

{

1 ❑ tabiet/capsule

o

667

0

66B

o

669

DO NOT READ

2 ❑ teaspoon I ❑ Yes 1 ❑ Yes – SPECIFY

number PROBLEM I ❑ QUIT USING ME DiCINE

3 0 tablespoon 2UN0 3

2 ❑ DECREASE USE

4 ❑ other

@-@

{

3 ❑ “CONSULT DOCTOR

1 ❑ day 20No

2 0 week per

I

GO TO NEXT 4 ❑ Continue TAKi NG AS

v mes 3 Cl month Medication PRESCRIBED

4 ❑ other — 9nDK

5

5 ❑ OTHER --

specifv 6

SPECIFY

39

255
plq. Have YOU been told by a doctor to take any medicines during the past 6 months that you did —not take during

that period?

o

67o 1 ❑ ‘T’(p15) 2 ❑ N(QI)

P15. What are the names of the medicines that you

did not take? (PROBE FOR BRAND NAMES,

ENTER EACH ON SEPARATE LINE. THEN

ASK P16 AND P17 FOR EACH.)

o671

0671

0671

0671

P16. What was the health problem

you had for which the doctor

recommended the (medicine)? —-

0672

0672

0672

0672

0

672

0

672

40

256

.
P17. What was your main reason

for not taking the (medicine)?

o673 1 ❑ SIDE EFFECTS 3 ❑ DID N’TTHINK IT WOULD WORK 5 ❑ OTHER – SPECIFY

6

2 ❑ COST TOO MUCH 4 ❑ HAVEN’T YET OBTAIN ED MEDICINE

o673 1 ❑ SIDE EFFECTS 3 U DIDN’T THINK IT WOULD WORK 5 ❑ OTHER – SPECIFY

6

2 ❑ COST TOO MUCH 4 ❑ HAVE N’T YET OBTAINED MEDICINE

o673 1 ❑ SIDE EFFECTS 3 ❑ DID N’TTHIN KIT WOULD WORK 5 ❑ OTHER – SPECIFY

2 ❑ COST TOO MUCH 4 ❑ HAVE N’T YET OBTAINED MEDICINE

6

0673 I ❑ SIDE EFFECTS 3 ❑ DIDN’T THINK IT WOULD WORK 5 ❑ OTHER –SPECIFY

2 ❑ COST TOO MUCH 4 ❑ HAVE N’T YET OBTAINED MEDICINE 6

0

673 1 ❑ SIDE EFFECTS 3 ❑ DIDN’T THINK IT WOULD WORK 5 ❑ OTHER –SPECIFY

z ❑ COST TOO MUCH 4 ❑ HAVEN’T YET OBTAIN ED MEDICINE 6

0573 1 ❑ SIDE EFFECTS 3 ❑ DID N’TTHINK IT WOULD WORK 5 ❑ OTHER–SPECIFY

2 ❑ COST TOO MUCH 4 ❑ HAVEN’T YET OBTAINED MEDICINE 6

41

257
NAM EISSAN

We would like to know how people’s health practices and conditions relate to how long they live. The following information

will be used to check against the vital statistics records maintained by the National Center for Health Statistics of the

U.S. Public Health Service. The results will only be used for statistical purposes and no individual identification will be

shown in any analysis. To make sure that our records are complete:

I

Q1. What is your full name, including middle name?

@

I

first

VERIFY SPELLING.

I@

I middle 10676

I last

1

Q2. What is your date of birth?

;@@ / /

mo. dav

I

yr,

Q3. What is your father’s last name? I

VERIFY SPELLING. DO NOT WRITE “SAME.” @

I

father’s last name

Q4. We would like to have your Social Security Number.

This will have no effect in any way on your benefits.

i~

This information is voluntary and is collected under the I

authority of the Public Health Service Act (42 U.S.C. I

242K Section 306).

-,

I

What is your Social Security number?

I

— —

—— —— —— —.. —

Social Security Number

I

Q5. CHECK ITEM: RESPONDENT

~ @ ~ ~ ~o~H:RpERsoN

MARK MAIN RESPONDENT 3 ❑ FATHER

I

4 ❑ SISTER OR BROTHER

I

5 •l OTHER– G

SPECIFY

I

Q6. IF OTHER THAN SAMPLE PERSON, EXPLAIN I

REASON FOR ACCEPTING PROXY RESPONDENT, @ 1

I

250

42
MEDICINE/VITAMIN MEC

DO NOT ASK IN HOUSEHOLD

R1. REFER TO MEDICINE/VITAMIN USAGE SECTION. o695

MARK ONE BOX.

I ❑ No medicine or vitamin reported (R3).

20 Medicine or vitamin reported (R2).

R2. When an interviewer spoke with you a few weeks ago, you mentioned you had taken (medicine/vitami ns/minerals in

questions P2, P5, and P7). Have you taken any of these medicines during the past 24 hours?

o683 10Y 20N

R3. Have you taken any (other) medicines, vitamins or minerals during the past 24 hours?

o684 lay 2CIN

IF “Y” IN EITHER R20R R3 GO TO R4, OTHERWISE, END QUESTIONNAIRE.

R4. What are the names of all medicines, vitamins and R5. How much of the (medicine, vitamin/

minerals you took during the past 24 hours? mineral) did you take during the past

Any others? 24 hours?

o685

@@

+

I ❑ tablet/capsule

2 ❑ teaspoon

number 3 ❑ tablespoon

4 ❑ other

o685

@-@

+

1 ❑ tablet/capsule

2 0 teaspoon

number 3 ❑ tablespoon

4 ❑ other

o685

@“@

+

I ❑ tablet/capsule

2 ❑ teaspoon

number 3 ❑ tablespoon

4 ❑ other

o

685

@-@

+

I ❑ tablet/capsule

2 ❑ teaspoon

number 3 •l tablespoon

4 ❑ other

43

259
Form PHS 6212 OMB No, 0937-0078

9/82 Approval Expires 2/85

Department of Health and Human services

Public Health Service

Office of Health Research, Statistics,

and Technology

National Center for Health Statistics

SPANISH VERSION

ADULT SAMPLE PERSON

SUPPLEMENT (523)

(Ages 12-74 Years)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

WESTAT

ID No:

NCHS

ID No:

NOTICE: La informacibn contenida en este

formulario que permitirlb identificar a cualquler

individuo o establecimiento ha sido recogida con

la garanr(a que ser~ mantenida en la m& estricta

confidencialidad, serd usada s610 p,Ira Ios Prop6sltos establecidos para este estudio v no serd

divulgada o entregada a otros sin el consentimiento del individuo o del estable(simiento de

acuerdo con la Secci6n 308(d) de la Ley del

Servicio de Salud P(iblica – Public Health Service

Act (42 USC242 ml.

o100

Stand No. Segment No. Serial No.

mm

o101

—

——— ——.

NAME (First, Middle, Last)

o109

WE

I I 1

INTERVIEWER NAME: NO. @

‘ ~zl

I 1

LANGUAGE OF INTERVIEW

o106

10 English

2!X Spanish

DATE OF INTERVIEW

@@ ! I

Month’ x’ Year

TIME BEGAN

@@ 10am

——:— —

2Clpm I

I

i

TIME ENDED

@-@ lCiam

—–,–— 2 ❑ pm

DATE OF EXAMINATION

—r —f ~=

Month Day

TIME

❑ am

❑ pm

TRANSPORTATION

❑ Taxi

❑ Self

260
ADULT SAMPLE PERSON QUESTIONNAIRE

(SPANISH VERSION)

Ages 12-74 Years

Topico

M. Aculturacion

G. Condiciones Cardiovasculares

B. Condiciones Seleccionadas

C. Diabetes

H. El Fumar

P. El Uso de Medicina/Vitamina

F. Enfermedad Digestiva

L. Exposition al Pesticida

P6gina

30

18

6

8

20

37

15

26

Topico

E. Hypertension

J. Impediment Funcional

D. La Vista y el O(do

K. Lists de Condiciones

R. Medicina/Vitamina MEC

Q. Nombre/SSAN

N. Programas de Alimento

A. Servicios de Salud

Pagina

11 .

22

10

26

45

44

33

1

261
SERVICIOS DE SALUD

1

Al. ~Diria usted que su salud en general es excelente,

muy buena, buenar regular, o mala?

I @ 1 ❑ excelente

I

z ❑ muy buena

9 ❑ buena

I 4❑ regular

I 5 ❑ mala

A2. ~Cu5nto control piensa usted que tiene sobre su

@

I ❑ mucho

salud futura: mucho, algo, muy POCO o nada? 2 ❑ algo

3 ❑ muy POCO

I

4 ❑ nacia

90NS

A3. En promedior ~ cu~ntas horas duerme mas o’menos al I@ —horas

dia, es decir, durante un periodo de 24 horas? n6mer0

A4. En su trabajo o quehaceres domestics, ~que parte i~ la mayon’a parte del casi nunca

del tiempo mas o menos usa gran cantidad de mkulos del tiempo o

de braze, pierna o espalda, como para Ievantarr estirar, I

tiempo nunca

cargar, escarbar, u otras cosas? ~Diria usted: la

mayoria del tiempo, parte del tiempo, o casi nunca I In 2EI 3U

o nunca? I

A5. Fuera de su empleo o trabajo alrededor de la casar I m frecuente- algunas casi nunca

icon qu6 frecuencia participa usted en actividades

I

u mente veces o

que requieren gran movimiento del cuerpo o nunca

energia, como juegos de pelota, montar en bicicleta, I

bailar, o actividades similares? ~Dir~a usted: frecuente1

10 20 30

mente, algunas veces, o casi nunca o nunca?

A6. Ahora me gustar~a hacerle unas preguntas sobre su

uso de servicios para el cuidado de salud.

i@

I

~Hay una cli’nica, un centro de saludr una oficina de

I

10s z ❑ N(A18)

medico, u otro Iugar en particular a que usted va

usualmente cuando esta enfermo o necesita consejos

sobre su salud? I

A7. ZQU15clase de Iugar es — una clt’nica, un centro de iGholn

salud, un hospital, una oficina de m6dico o algun

otro Iugar?

PROBE 1F CLINIC: ~Es cl~nica de paciente externo

de hospital, una cl(nica de compaii(a o escuela, una

clinics para trabajadores migrantes o alguna otra

clase de cl(nica?

PROBE IF HEALTH CENTER: ~Es un centrode

salud de la comunidad o del vecindario, un centro de

salud familiar, un centro rural de salud o alguna otra

clase de centro de salud?

PROBE IF HOSPITAL: ~Es una clihica para paciente

externo o sala de emergencia?

iv%

I

04 ❑

05 ❑

I

06 ❑

I

08 ❑

I

09 ❑

I

10 ❑

I

11 ❑

I 12 ❑

I

I

I

casa

oficina de m6dico o cl(nica privada (A9)

cl~nica de compafi;a o escuela

cl(nica de paciente externo de hospital

clinics para trabajadores migrantes

otra cl~nica 97

especifique

sala de emergencia de hospital

centro de salud de la comunidad, del

vecindario, o familiar

centro rural de salud

HMO (Organizaci6n para el Mantenimiento de la

Salud)/grupo prepagado

otro Iugar la

especiflque

AS. ~Hay alguna persona en particular que usted ve usual- I o125 10s 2DN

mente en (place in A7)? I

1

262
A9. Ahora quisiera hacerle algunas preguntas sobre su l@ I ❑ menosde 1 mes

tiltima visita a (place in A7). j,Cu5nto tiempo hate

I

2 ❑ 1 roes, menos de 6 meses

desde esa visita? 3 ❑ 6 meses, menos de I aiio

I

4 ❑ 1 afio, menos de 5 arlos

I

5 ❑ 5 aiios o mas

9,0 NS

AlO. ~Cuanto tiempo Ie tomo mas o menos para Ilegar a I

(place in A7) para esa visita? I @ niirnero ‘inu’os

PROBE IF NECESSARY: ~Dir~a usted que Ie tomo I OR

mas de 30 minutes o menos de 30 minutes? I

I •l mas de 30 minutes

I o 2 ❑ rnenos de 30 minutes

Al 1. ~Tuvo (una cita/un turno) para esa visita? 129 10s ❑ N(A13)

A12. ~Cu5nto tiempo paso m~s o menos entre cuando hizo o130 000 ❑ menos de un d{a

la cita y cuando usted fue a esa visita?

I

I

d(as

nimero

A13. Desprk de que Ilego a (place in A7) para esa visita, 1 ❑ minutes

~cu~nto tiempo tuvo que esperar m& o menos antes ;:

ntimero

que Ie atendieran?

I

132 { 2 II horas

A14. ~Cual fue la razon principal por esa visita?

@

DO NOT READ.

I 01 ❑ UNA EN FERMEDAD O UN MALESTAR

I

02 ❑ UNA HER IDA

I

03 ❑ UNA VISITA DE SEGUIMIENTO/

“FOLLOW-UP”

I

04 ❑ UN EXAMEN GZENERAL

I

05 ❑ UNA IN YECCION

oa ❑ PARA UNA RECETA

I

07 ❑ CUIDADO pRE- o POST-NATAL

I

os •l ALGUNA OTRA RAZ6N 09

ESPECIFIOUE

A15. En general, ~que satisfecho estuvo usted con el servicio o134 1 •l muy satisfecho (Al 7)

que recibio en esa visita? ~Diri’a usted que estuvo muy 2 ❑ algo satisfecho

satisfecho, algo satisfecho o nada satisfecho? 3 ❑ nada satisfecho

A16. i,Por qu6 no estuvo (completarnente) satisfecho con el I@ DO NOT READ.

cuidedo de salud que recibio en esa visita?

I 01 ❑ CUESTA DEMASIADO

PROBE FOR MAIN REASON. I

02 ❑ TLIVO QLJE ESpERAR DEMASIADO

I

03 ❑ PROBLEMA DE LEN GUAJE – NO PUDO

COMUNICARSE

I w ❑ EL M#DICO NO LE D16 SUFICIENTE

I

TIEMPO AL “SPr’

05 ❑ EL MtDICO u OTRO pERSONAL No Lo

I

TRATO BIEN

I

06 ❑ LA cONDlc[~N NO MEJOR~ DESPUES

DE L,TRATAMIENTO O MEDICAMENTO

I

07 ❑ EL MEDICO NO DIAGNOSTIC~ NI TRAT~

I

LA CON DICION

oeCIOTRO-~

I

ESPECIFIQUE

99 ❑ NS

A17. j,Ha visitado cualquier otra cl(nica, centro de salud,

oficina de medico, u otro Iugar para el cuidado de salud

I @ I ❑ S(A21) 20 N(A30)

desde su tiltima visita a (place in A7)? I

I

2

2s3
I

HAND CARD ASP 1. I

I

A18. Muchas personas no tienen un Iugar en particular donde

usualmente van cuando estan enfermos o necesitan I

consejos sobre su salud. ~Podr(a usted darme el nfimero I

de la frase que mejor explica la razon principal por

la cual usted no tiene un Iugar en particular donde I

usualmente va? I

I

1 – Tengo dos o mas medicos o lugares a Ios ,@ 1 234563

que usualmente voy dependiendo del probIema que tenga. 1’ especifique

2 – No he necesitado medico.

3 – El medico que me atendi’a ya no esta I

disponible. I

4 – No he podido encontrar el medico

apropiado. I

5 – Acabo de mudarme al area. I

6 – Otra razon-especifique por favor.

I

I

I

A19. Aunque usted dijo que no tiene un Iugar en particular I@ 10s

20 N(A21)

donde recibe cuidado de salud, j,hay alguna Persona

en particular que usualmente ve cuando esta enfermo I

y necesita cuidado de salud? I

I

I

A20. ~D6nde ve usualmente a esta persona – en casa, en una ;@

01 ❑ casa

clhsica, en un centro de salud, en un hospital, en una 02 ❑ oficina de medico o cl(nica privada

oficina de medico o en algun otro Iugar?

I

03 ❑ cl(nica de compaiiia o escuela

04 ❑ cl(nica para paciente externo de hospital

PROBE IF CLINIC: ~Es una clfnica para paciente I

05 ❑ cl(nica para trabajadores migrantes

externo de hospital, una clihica de compah(a o escuela,

I

06 ❑ otra cl(nica 07

una clinics para trabajadores migrantes o alguna otra especifique

clase de cl(nica? I

08 ❑ sala de emergencia de hospital

I

09 ❑ centro de salud de la comunidad o de,!

PROBE IF HEALTH CENTER: LES un centrode salud vecindario, o familiar

de la comunidad, o del vecindario, un centro de salud I

IO !2 centro rural de salud

familiar, un centro de salud rural o alguna otra clase

de centro de salud? I

II ❑ HMO (Organ izaci&m para el Marytenimiento

I

de la Salud)/ grupo prepagadm

12 ❑ otro Iugar 13

PROBE IF HOSPITAL: ~Es una clilrica para paciente I

especifique

externo o sala de emergencia?

I

!

I

A21. Ahora me gustar(a hacerle unas preguntas sobre su

I@

1 ❑ menos * un mes

(rItima visita a cualquier clkrica, centro de salud, oficina 2 •l 1 roes, menos de 6 meses

de medico u otro Iugar para el cuidado de salud. I 3 ❑ 6 rrieses, menos de un afio

~Cu5nto tiempo hate desde su irltima visita para el I

4 El 1 arlo, menos de 5 aiios

cuidado de salud? 5 ❑ 5 aiios o mas

I G ❑ Nunca (A30)

I

9C!NS

3

264
I

A22. ~Qu6 clase de Iugar visito para esa visits – fue una I@ 01 ❑ casa

clinics, un centro de salud, un hospital, una oficina de

I

02 ❑ oficina de mddico o cl(nica privada

mbdico o algun otro Iugar? 03 ❑ cl~nica de compafi(a o escuela

I

04 ❑ cl(nica de paciente externo de hospital

PROBE IF CLINIC: ~Fue una cl(nica de paciente

I

05 •l cl inica para trabajadores migrantes

externo de hospital, una clinice de compafiia o escuela, 06 ❑ otro clinics 07

una clinics para trabajadores migrantes o alguna otra I

especifique

clase de clinics?

I

u ❑ sala de emergencia de hospital

IX ❑ centro de salud de la comunidad, del vecinPROBE IF HEALTH CENTER: ~Fue un centro de I dario, o familiar

salud de la comunidad o del vecindario, un centro de

I

10 ❑ centro rural de salud

salud familiar, un centro rural de salud o alguna otra

clase de centro de salud? I

11 ❑ HMO (Organizaci6n para el Mantenimiento

de la Salud)/ grupo prepagado

PROBE IF HOSPITAL: ~Fue una clinics para paciente I

12 •l otro Iugar 13

externo o sala de emergencia?

especif iq ue

I

I

A23. ~Cu5nto tiempo Ie tomo mas o menos para Ilegar a I@ minutes

(place in A22) para esa visita? I

n timero

PROBE IF NECESSARY: ~DirIa usted que Ie tomo I

OR

mas de 30 minutes o menos de 30 minutes?

@

1 ❑ m~s de 30 minutes

I

2 ❑ menos de 30 minutes

I

A24. ~Tuvo (una cita/un turno) para esa visita?

1 @ ‘Us

2 ❑ N(AL716)

I

A25. ~Cu6nto tiempo paso mas o menos entre cuando hizo

@

000 ❑ menos de un d~a

la cita y cuando usted fue para esa visita?

I

d l%

I

nfimero

1

A26. Despu& de que IIego a (Place in A22) Para esa visits, I

~cuanto tiempo tuvo que esperar m~s o menos antes @@

{

1 ❑ minutes

que Ie atendieran? n~mero

I

2iJ floras

I

I

DO NOT READ.

A27. &Cual fue la raz6n principal por esa visita?

MI

01 ❑ IJNA ENFI=RMEDAD O IJN MALESTAR

I

02 ❑ UNAHERIDA

‘3 ❑ UNA VISITA DE SEGUIMIENTO/’’FOL LOWI UP”

I

04 ❑ UN EXAMEN GENERAL

I

05 ❑ UNA IN YECC16N

06 ❑ PARA UNA RECETA

I

07 ❑ CUIDADO pRE. O pOST-NATAL

I

OS ❑ ALGUNA OTRA RAZ~N 09

especifiq ue

I

A28. En general, ~que satisfecho estuvo usted con el servicio

que recibio en esa visita? ‘ o :: :;:::;;~::;: ‘A30)

~Dir(a usted que estuvo muy satisfecho, algo satisfecho I 3 ❑ nada satisfecho

o nada satisfecho? I

4

265

—
A29. ~Por quk no estuvo (completamente) satisfecho con ;@ DO NOT READ.

el cuidado de salud que recibi6 en esa visita?

I 01 ❑ CUESTA DEMASIADO

PROBE FOR MAIN REASON. I

02 ❑ TUVO QUE ESPERAR DEMASIADO

I

03 ❑ PROBLEMA DE LEN GUAJE – NO PUDIO

COMUNICARSE

I

04 ❑ EL M~DICO NO LE Dld SUFICIENTE

I

TIEMPO AL “SP”

05 ❑ EL MEDICO U OTRO PERSONAL NO LO

I

TRATd BIEN

I

os ❑ LA CON DICldN NO MEJORb DESPU&

DEL TRATAMIENTO O MEDICAMENTO

I

07 ❑ EL M;DICO NO DIAGNOSTICd NI TRATb

I

LA CON DIClbN

08 ❑ OTRO –09

I

EsPECIFIQUE

I

99 ❑ NS

A30. Hay algunas personas que vemos algunas veces que pro-

~o

10s 20N

veen cuidado de salud, tal como curanderos, sobadores

(herbolarios/hierberos), (espiritualistas/espiritistas),

y otros. En Ios 12 meses pasados, ~ha visto o hablado I

con cualquiera de estas personas sobre el cuidado

de sah.rd?

A31. A veces Ias personas tienen dificultad en obtener cuidado I I A32, ~Este problems Ie irnpidio

m6dico. ~Ha tenido usted alguna dificultad en obtener

I I

obtener cuidado me!dico

cuidado m6dico1

para usted mismo?

I

1. Porque el cuidado no estaba disponible cuando

10 necesitaba? I@ IUS(A32), DN@In S

I

2UN

I

2. Por 10 que costaba? ,@ I ❑ IS(A32) 2UN@ IUS 2iJN

3. Porque no sab~a adonde ir?

;@

IUS(A32)zUN@lnS 2CIN

4. Porque no ten(a como Ilegar? laS(A32)2nN~@lnS

@

20N

5. Porque el horario no era convenience?

I@

IUS(A32)ZUN@OS 20N

6. Porque ten(a que esperar demasiado para obtener I I

(una cita/un turno)? 10 I ❑ S(A32) 2 ~ N ,070s 163 2CJN

(7. Porque necesitaba a alguien que Ie cuidara sus I I

nihos?)

@

10 S(A32)zn N@ IDS

I

2UN

8. Porque perderia sueldo por faltar al trabajo?

w

InS(A32)2nN@ 10S 20N

9. Porque tem’a que esperar demasiado en la oficina I

I

o clihica? WI

lDS(A32)zDN@ lDS 2CIN

10. Porque el personal de la oficina o la cliltica Ie

I I

falt6 el respeto?

;@

IUS(A32)2n N@ IUS 20N

11. Porque no tenfa confianza en el personal? I

@

lUS(A32)znN@lUS

I

2CIN

12. Porque no hablaban espaiiol?

I@

In S(A32)ZUNl@IOS 21ZIN

13. Porque no hab~a empleados (hispanos) en la i I

oficina o ch’nica? @

lUS(A32)ZCl N@ IUS

I

2UN

5

266
A33. ~.Cu&to tiempo hate mas o menos desde que tuvo

:@

I •l hate menosde 1 afio

un examen ffsico .—rutinario; es decir, no para una 2 E! I afio, menos de 2 afios

enfermedad en particular, sino para un examen en

I

3 •l 2 ahos, menos de 5 silos

general? 4 Cl 5 afios o m~s

I

5 El nunca

911NS

A34. Durante Ios 12 meses pasados, es decir, desde (d~)

10 ‘Us

20 N(BI)

hate un aiio, i,paso usted una noche o m5s internado

en un hospital’? I

1

A35. Durante Ios 12 meses pasadosr ~ cuantas veces diferentes I veces

fue internado una noche o mas en el hospital? ,@ n6mer0

CONDICIONES SE LECCIONADAS

B1. ~Le ha dicho alguna vez un medico que usted tenia

@ ‘“s 2UN

tuberculosis?

B2. ~Ha vivido alguna vez en un hogar con una persona

~@ ‘Us ‘UN

9CINS

que terr(a tuberculosis activa?

B3. ZHa tenido alguna vez anemia?

@

10s 2 ❑ N (B7) 90 NS (B7)

B4. ~Le dijo alguna vez un m6dico que tenr’a anemia?

B5. ~Todav(a tiene anemia? !@ Ins 2CIN 9Ci NS

1

w

B6. ~Fue atendido para esta condicion por un mddico? @ ‘us 2UN

B7. Mas o menos, /,que estatura tiene usted sin zapatos? ;00

1B7 lae

I

pies pulgadas

B8. Mas o menos, ~cuanto pesa sin zapatos? i@

peso actual:

i

Iibras

IF NOW PREGNANT, RECORD CURRENT nti mero

WEIGHT, THEN ASK: I

M5s o menos, Zcuh-rto pesaba inmediatamente antes

10

peso antes de quedar em barazada:

de quedar embarazada?

I

Iibras

n(imaro

I

B9m ~Considera usted que ahora estii sobre peso, bajo peso, i@ I •l sobre peso

o mas o menos bien?

I

2 •l bajo peso

3 a mas o menos bien

I 9CINS

BIO. CHECK ITEM 10192 1 ❑ Age 25 or younger (B12)

I

2 H Age 26+ (Bll)

El 1. Mds o menosr Zcuanto pesaba cuando tenia 25 aiios I

,@

Iibras

de edad? n &mero

B12. zTiene usted dificultad en reorder o en masticar cual- @ 10s 2CIN

quier tipo de comida, tal como carries firmes, o

manzanas?

I

6

267
B13. ~Como describiria la condicion de sus dientes: excelente,

;@

1 ❑ excelente

muy buena, buena, regular o mala? 2 ❑ muy buena

3 ❑ buena

I 4 ❑ regular

I

5 ❑ mala

6 ❑ no tiene dientes

B14. ~Como describiria la condicion de sus enc~as: excelente, ;@ 7 ❑ excelente

muy buena, buena, regular o mala?

I

2 ❑ muy buena

3 ❑ buena

I

4 ❑ regular

5 ❑ mala

B15. Mas o menos, ~cudnto tiempo hate desde la filtima vez

@

I ❑ hate 6 meses o menos

que vi6 a un dentista o higienista dental para cuidado

dental?

2 ❑ rnijs de 6 meses a 12 meses

I

3 ❑ m& de 12 meses a 2 aifos

4 ❑ mas de 2 afios a 5 afios

I

5 ❑ m~s de 5 afios

I

6 ‘d nunca (B20)

913NS

i

B16. ~Cual fue la razon principal por su tiltima visits para

@

DO NOT READ

cuidado dental?

I

01 ❑ EXAMEN REGULAR

I

02 II PARA LIMPIAR LOS DIENTES

03 ❑ PARA EM PASTAR LOS DIE,NTES

I

04 ❑ PRO BLEMA CON LAS ENCIAS

I

05 ❑ PA RASACAR DIENTES U OTRACIHUG~A

06 ❑ DOLOR DE DIENTE

I

07 ‘d AJIJSTE O REpARAClbN DE LA PLACA DE

I

DIENTES/DENTADURA POSTIZA

I

oa •l PARA QUE HICIERAN UNA PLACA

DENTAL/DENTADURA POSTIZA

I

09 II PARA UNA RECETA

I

10 ❑ ALGUNA OTRA RAZ6N 11

ESPECIFIQUE

I

IF “PARA LIMPIAR LOS DIENTES” IN B16, SKIP i@

TO=B 19,

I

B17. ~Le ha Iimpiado alguna vez Ios dientes un dentista o

I

Ins 2 ❑ N (B20)

higienista dental?

B18. ~Cuando fue la tiltima vez que se Ios Iimpiaron? ;@

I ❑ hate 6 meses o menos

2 ❑ mas de 6 meses a 12 meses

I

3 •l mas de 12 meses a 2 afios

4 ❑ miis de 2 aiios a 5 aitos (620)

I

5 ❑ m& de 5 atios (B20)

I

9 ❑ NS (B20)

B19. Durante Ios 2 silos pasados, Zcu5ntas veces Ie ha lim- I ❑ una vez

piado Ios dientes un dentists o higienista dental’? I 0 z ❑ dos veces

I

3 II tres veces

I

4 ❑ cuatro o mas veces

9C!NS

B20. ~Tiene seguro de salud que paga por el cuidado dental? /@ 10s 2Ci N 9UNS

7

266
DIABETES

cl. ~Tiene usted diabetes oazdcaren Iasangre? j @ 10s 2 ❑ N (C6)

I

C2. ~Le dijo un m6dico que la tiene? @

lDS(C.4)2DN

C3. ~Le dijo algun otro professional de salud, tal como una ~@ ‘us

2 II N (C6)

enfermera o un “physician’s assistant,”’ que la tiene?

I

C4. ~Cuanto tiempo hate que el (medico/profesional de I @ hate “,mero afios

salud) Ie dijo por primers vez que ten~a diabetes?

C5. ~Qub edad ten(a entonces? ;@ afios de edad

n~mero

—-——.———— —.—-—————.——————

C6. ~Le ha dicho alguna vez un m6dico u otro professional

I

de salud que usted tiene – I

I

I

C7. ~Qu15 edad tenia

(IF “S,” ASK C7)

I

I

usted entonces?

Diabetes marginal/en el I(mite de diabetes/

@

lns(cT)2nN120g o afios de edad

“borderline diabetes’?”

I

I

n~mero

Diabetes potential/la posibilidad de diabetes/

w

lUS(C7)Zn Nl@ ahos de edad

“potential diabetes’?” n6mer0

I I

Prediabetes?

10 I ~ S (C7) z ❑ N I @ .Lmero afios de edad

1

C8. CHECK ITEM. MARK FIRST APPLICABLE BOX

i 1❑ Diabetes — “S” in either C2 or C3

ONLY. I 0 z IZ Borderline diabetes

I

a ❑ Potential diabetes

I

4 ❑ Prediabetes

5136

I

specify type

I

7 ❑ none of these (Dl)

I

IN QUESTIONS C9-C27 ASK ABOUT CONDITION

MARKED IN C8.

1

C9. Cuando el (medico/profesional de salud) Ie dijo por I

primers vez que usted ten(a (diabetes/...), ~le hicieron

cualquiera de Ias siguientes pruebas? I

I

a. ~,Prueba oral de tolerancia a la glucosa, en

la cual usted toma una bebida dulce y [e

[0 lUS

(tomardsacan) muestras de sangre del brazo I

pot varias horas despu&?

I

b. ~Una prueba para el azticar o la glucosa en 10 10s 2CIN 9CINS

la orina?

I

c. ~Una prueba para el azhcar o la glucosa en I@ Ins 2UN 9CINS

la sangre? I

2UN 9CINS

8

269
CIO. ~Era usted paciente en un hospital cuando un (medico/

w

Ins 2EIN

professional de salud) Ie dijo por primers vez que usted

I

teni’a (diabetes/...)?

Cl 1. (Sin contar la primers vez) ~Ha estado hospitalizado

@ 10s 2UN

alguna vez debido a su (diabetes/...)?

1

1

C12. M5s o menos, ZcuAnto pesaba usted la primers vez que

Ie dijeron que ten(a (diabetes/...)? @ Iibras

nhmero

I

C13. LHa recibido alguna vez inyecciones de insulins? 1‘m Ins 2 ❑ N (C18)

C14. ~Ha estado recibiendo inyecciones de insulins durante i@ lo’ 20N

la mayor parte de Ios 12 meses pasados? n

C15. ~Est6 recibiendo inyecciones de insulins ahora? i@ ICIS 21Z N (C17)

...— -———.—- ...— —.

C16. Mas o menos, ~cuantas unidades de insulins toma

por d(a? ;@ unidades por di’a

nimero

C17. ~Por cuantos atios (ha estado tomando/tomaba) inyecciones de insulina?

~ @ 00 ❑ rnenos de 1 afio I

i

arios

nbmero

C18. ~Ha tornado alguna vez plldoras para la diabetes? I@ 10s 2 ❑ N (C23)

C19. ~Las ha estado tomando durante la mayor parte de

@

Ins 20N

Ios 12 meses pasados?

I

1

C20. ~Ahora toma plldoras para la diabetes? I@ 10s 2 ❑ N (C22) I

C21. ~Cual es el nombre de la medicina que est~ tomando?

i @ :,pecifique

I

C22. ~Por cuantos aiios (ha estado tomando/tomaba) pildoras

@

00 ❑ menos de 1 aho

para la diabetes?

I

aiios

nhmero

C23. ~Le ha dado alguna vez un m6dicor enfermera u

@

Ins 2 0 N (C25)

otro professional de salud una dieta o instrucciones

sobre cuales alimentos debe comer para su (diabetes/...)?

I

C24. ~Sigue usted ahora la dieta o Ias instrucciones? I@ IDS 21JN

, I

C25. ~Lleva o trae puesto algo que Ie identifique como

@

10s 2Ci N

alguien que tiene (diabetes/...)?

C26. ~Cuando fue la ultima vez que vio o hablo con un 1 II durante Ias 2 semanas pasadas

medico u otro professional de salud acerca de su i o 2 ❑ t-rk de 2 semanas a 6 meses

(diabetes/...)? I

3 ❑ mas de 6 meses a 12 meses

I

4 •l rnas de 12 meses a 2 afios

5 ❑ mas de 2 aiios a 5 afios

I

(Dl)

I

6 ❑ hate m& de 5 aiios

C27. M% o menos, ~cuantas veces por aiio ve usted a un ‘o235 1 ❑ menos de una vez por afio

m6dico u otro professional de salud acerca de su I

2 ❑ una vez

(diabetes/...)?

I

3 ❑ dos veces

4 ❑ 3-4 veces

I

5 ❑ 5 veces o mas

I

6 ❑ no tiene plan regular

9

270
LA VISTA Y EL Oi_DO

D1. ~Ha tenido usted alguna vez problemas para ver con uno @ 10s 2U N (D1O)

o ambos ojos cuando lo usa (lentes/anteojos/espejuelos)

I

o Ientes de contacto?

I

D2. ~Que edad tem’a cuando empezo a tener dificultades @

of ❑ 0-4 aiios de edad

con la vista? 02 ❑ 5-9 afios de edad

I

03 •l 10-19 afios de edad

I

04 ❑ 20-29 ahos de edad

05 ❑ 30-39 atios de edad

I

06 ❑ 40-49 aiios de edad

I

07 ❑ 50-59 afios de edad

os •l 60-64 afios de edad

I

oe •l 65 aiios de edad o mayor

—- —— . .

D3. ~Vio usted alguna vez a un medico para eso?

w “n’ 20N

D4. ~Usa (lentes/anteojos/espejuelos) o Ientes de contacto? o239 Ins 2 ❑ N (D6)

D5.

w

~Tiene problemas con la vista aun cuando usa (lentes/ ICI S(D8)2CIN(D8)

anteojos/espejuelos) o Ientes de contacto?

I

D6. ~Ha usado alguna vez (lentes/anteojos/espejue los) o ~~ ,ns 2 ❑ N (D1O)

Ientes de contacto?

I

I

MARK ALL THAT APPLY. DO NOT READ

D7. ~Por que dejo de usarlos? I@

I ❑ YA NO Los NECESITO

I

@

I ❑ NO ME AYUDABAN

I @ I El SON INCONVENIENCES

;@

I El OTR02

EsPECIFIQUE

,

I

I MARK ALL THAT APPLY. DO NOT READ

D8. I

~Para qu6 Ie recetaron 10s (lentes/anteojos/espejuelos)

,@

I ❑ LEE R/HACER TRABAJOS DE CERCA

o Ientes de contacto?

ID 1❑ VER OBJETOS LEJANOs

IO

I ❑ OTRO –2

ESPECIFIQUE

D9. ~Con que frecuencia (usa/usaba) sus (lentes/anteojos/

lo

I •l todo el tiempo

espejuelos) o Ientes de contacto: todo el tiempo, la 2 ❑ la mayor~a del tiempo

mayor(a del tiempo, casi nunca, o nunca?

I

3 ❑ casi fiunca

4 ❑ nunca

DIO. ~Cuando fue la filtima vez que le examinaron la vista? i@ 1 ❑ hate 6 meses o menos

2 ❑ mas de 6 meses a 12 meses

I

3 ❑ mas de 12 meses a 2 afios

I

4 ❑ mas de 2 atios a 5 afios

5 •l mik de 5 atios

I

6 n nunca

9nNs

10

27!
DI 1. ~Ha tenido usted alguna vez problemas para oir con uno

@ ‘Us

20 N(EI)

O 10s dos o~dos?

No incluya ningunos problemas que duraron solo un

periodo corto, tal como cuando tiene un catarro. I

D12. ~Vio alguna vez a un medico sobre eso? I

@ ‘n’ 2DN

D13. zQu15 edad tenia usted cuando primero empez6 a tener

problemas para oh?

i@::

.

D 14, Desde que empezo este problems, ~se ha puesto peer,

mejor, o se ha quedado mas o menos igual?

30

40

50

60

O-4 afios de edad

5-9 atios de edad

10-19 atios de edad

20-29 arios de edad

30-39 afios de edad

40-49 afios de edad

50 afios de edad o mayor

o254 1 El peer

2 ‘d mejor

3 ❑ igual

D15. ~Ha tenido alguna vez una operation de Ios or’dos?

INCLUDE HAVING TUBES PLACED IN THE EARS.

o255 10s 20N

1

D16. ~Ha usado alguna vez un (audifono/aparato para oil/ @ Ins 2EIN

“hearing aid”)?

I

9

D 17. ~Como describir(a su capacidad para o(r (sin aparato I @ I ❑ buena

para ok) – buena, tiene un poco de dificultad, tiene

I

2 ❑ poco de dificultad

mucha dificultad o est~ sordo?

I

3 ❑ mucha dificuitad

4 ❑ sordo

,

I

HYPERTENSION I

I

El. ~Cu5nto tiempo hate mas o menos desde la tiltima

vez que le tomaron la presion?

I @ I ‘d hate 6 meses o menos

I

2 ❑ mA de 6 meses a un afio

3 ❑ mas de un afio

I

4 ❑ nunca (E6)

1

E2. ~Quien Ie tomo la presion la ultima vez?

1

0259

I

I

I

I

I

I

I

I

01

02

03

05

06

07

03

99

DO NOT READ.

M:DICO

EN FERMERA

OTRO PROFESSIONAL DE SALUD –

04

especifique

MI EMBRO DE LA FAMILIA

AMIGO

USTED MISMO (E4)

OTRO m

especifique

NS

11

?72
E3.

I

~Que Ie dijeron la tiltima vez que Ie tomaron la presion? ol 0 altar necesita tratamiento

I 00, ❑ alta necesita obser.scion

\

r

~Que estaba:

I

03 ❑ alta, ninguna preocupacibn

Un poco alta, y necesita tratamiento? I 04 ❑ normal

Un POCO altar y necesita observarse?

I

05 ❑ otra cosa —

Un Poco a[ta, pero no hay necesidad

depreocuparse? . . . . . . . . . . . . . . . . . I

06

, (E6)

Normal? . . . . . . . . . . . . . . . . . . . . . . . . .

I

especif iq ue

Otra cosa?

especifique I 07 0 TOLD NUMBERS BUT NO

I

EXPLANATION

I oa ❑ NOT TOLD ANYTHING

I

99 •! DK

I

[F “LISTED MISMO” MARKED IN E2, ASK:

I @ 1 ❑ accionado por monecla

E4. La ultima vez que se tomo la presion, ~uso un aparato I

2 ❑ otro aparato —

3

accionado por monedas u otro aparato? I

especif iq ue

E5. ~Estaba la presion altar baja o normal? ; @ ‘lIk;

I

3 ❑ normal

9iZNS

I

E6. ~Cree usted que personas con la presion alta pueden I @ 10s 21ZN 9UNS

darse cuenta cuando tienen la presion alta?

I

DO NOT PROBE IF “NO SABE.” I

E7. ~Le ha dicho un medico alguna vez que usted tenfa @

lns(Elo)2n N

la presion alta?

I

E8. Otro nombre para la presion alta es hypertension. @1! ZS(EIO)2CIN

~Le ha dicho un mddico alguna vez que us-ted tenia

hipertension? I

E9. ~Le ha dicho alguna vez algfin otro professional de salud,

;0 10s

2 ❑ N(FI)

tal como una enfermera o un “physician’s assistant,”

que usted tenia alta presibn o hipertension? I

E 10. ~Cu5ntas veces Ie dijeron que usted tenia (alta presion/ I ❑ una vez

hypertension): una vez, o dos o mas veces? ~ @ 2 ❑ dos o mas .eces

I

E 11. ~Ha sido aconsejado alguna vez por un m~dico u otro

I @ ‘Os

❑ N (E17)

professional de salud que bajara de peso debido a su

(alta presion/hipertensi6 n)? I

E12. ~Bajo la cantidad de peso que se Ie aconsejo? o269 10s ❑ N

E13. ~Pesa ahora [o que Ie recomendaron debido a su (alta 10 270 1CIS(E17) ❑ IN

presion/hipertension)?

I

E14. ~Est5 ahora tratando de bajar de peso debido a su

;@

1CIS(E17) ❑ N

(alta presion/hipertension )?

E15. ~Esta tratando de mantener su peso actual? 10272 10s

I

❑ N

12

273
,

I MARK ALL THAT APPLY. DO NOT READ.

E 16. ~Por que no esta tratando de bajar de peso? 1 @ I ❑ NO TUVO BUEN RESULTADO

I

m

I ❑ EL M<DICO DIJO QUE LO DESCONTINUARA

I

10 ‘I❑ YA NO NE CESITO PERDER M&i

I @ I H MUCHA MOLESTIA

1 @ I ❑ OTRA RAZiNZ

I

ESPECIFIQUE

p

9 ❑ NS/NO RAZ6N

E 17. ~Le ha aconsejado alguna vez un medico u otro proi @ 1°s

2 ❑ N (E22)

fesional de salud que use menos sal debido a su (alta

presion/hipertension)?

I

I

E 18. ~Redujo alguna vez su uso de sal despu& que le I o280 1OS(E2O)2ON

aconsejaron que 10 hiciera debido a su (alta presion/ I

hypertension)?

I

I MARK ALL THAT APPLY. DO NOT READ,,

I

E19. ~Por que no redujo usted alguna vez su uso de sal? @

I ❑ NO TUVO BUEN RESULTADO

! @ lDPENS~Q

UE NO TUVIERA EFECTO

I @ 1 ❑ MUCHA DIFICULTAD

I @ 1 ❑ OTRA RAZbN z

I

(E22)

ESPECIFIQUE

I

I @ 9 ❑ NS/NO RAZON

I

E20. ~Usa ahora mi% sal, menos sal o mds o menos la misma I@ 1❑ m~s

cantidad de sal que usaba cuando Ie aconsejaron que

I

2 ❑ menos (E22)

usara menos sal? 3 ❑ 10 mismo

I

I MARK ALL THAT APPLY. DO NOT READ.

I

E21. ~Por qu6 no usa menos sal ahora? @1 ❑ NO TUVO BUEN RESULTADO

I @ 1 ❑ PENS6 QUE NO TUVIERA EFECTO

I

@

1 II MEDICO DIJ() QUE PGD~A USAR M~S SAL

I

~ @ I ❑ MUCHADIFICULTAD

@

I ❑ OTRA RAZ6N 2

ESPECIFIQUE

I

@

9 ❑ NS/NO RAZbN

13

274
I

E22. ~Le ha recetado un mddico alguna vez madicina para su I @ Ins

(aka presion/hypertension)?

2 •l N (E26)

I

E23. ~Est6 tomando ahora alguna medicina recetada por un

I

I @ 10s

2 ❑ N (E25)

mtfdico para su (alta presion/hipertension)?

I

E24. Muchas personas tienen dificultad en acordarse de tomar ~ @ lClex actamente todos Ios d(as

su medicina regularmente. ~Dirfa usted que toma su 2 ❑ a veces se Ie pasa

madicina exactamente como debe todos Ios d(as, que a

I

3 II se Ie pasa muy seguido

}

E (26)

veces se Ie pasa pero no frecuentemente, que se Ie pasa 4 ❑ raramente la toma como debe

muy seguido, que raramente toma la medicina como I 5 ❑ nunca la toma como debe

debe, o que nunca toma la medicina como debe?

I

I

I

MARK ALL THAT APPLY. DO NOT READ.

E25. ~Por qu6 dejo de tomar su medicina? 10

I ❑ SOLO TOMA CUANDO NECESITA

I @ I ❑ MEDICO DIJO QUE PARARA

I

@

1 ❑ YA NO LA NECESITABA

;@

I ❑ MUCHA MO LESTIA

,0

I ❑ SE TERM IN(j LA MEDICINA

10

1 ❑ CUESTA MUCHO

l@

I ❑ MALOS EFECTOS 2

ESPECIFIQUE

I

I

@ 1❑ 0TRO–2

ESPECIFIQUE

I

@

9CINS

I

I

E26. ~Ve a un m6dico u otro professional de salud regularw 10s

2UN

mente sobre su (alta presion/hipetiension)?

I

E2i’. Mas o menos, ~cuantas veces por ario ve a un m6dico

o

306 I ❑ menos de una vez por afio

u otro professional de salud sobre su (alta presion/ I 2 •l una vez

hypertension)?

I

3 El dos veces

I

4 ❑ 3-4 veces

5 ❑ 5 veces o mas

I

6 ❑ no tiene programa regular

I

E28. Mas o menos, ~cuanto tiempo hate desde la bltima vez I@ 1 ❑ hate menos de un mes

que vio a un m6dico u otro professional de salud

I

2 ❑ hate un mes

sobre su (aka presi6n/hipetiension)?

I

3 ❑ hate m5s de un mes a 6 meses

4 ❑ haca mas de 6 meses a un afio

I

5 ❑ hate masde un afio

14

275
EN FERMEDAD DIGESTIVA

F1. CHECK ITEM

i@ I ❑ Age under 20 (Jl)

I

2 •l Age 20+ (F2)

F2. ~Le ha dicho un medico alguna vez que usted tenia @ 10s 2CIN

piedras en la ves~cula? I

F3. ;.Le han tornado alguna vez rayos X de la ves(cula

biliar? Para rayos X de la vesicula biliar, usted toma

pildoras la noche antes de Ios rayos X, y no se permite

comer nada hasta despues que Ie hagan Ios rayos X.

F4. ~Le han hecho alguna vez cirugia o una operation

para Ias piedras o para una enfermedad de la vesi’cula

biliar?

F5. ~Cuanto tiempo hate que tuvo su (filtima) cirugia u .

2UN

o311 10s 2 ❑ N (F6)

(a 1 ❑ hate menos de cinco afios

. .

operation de la ves~cula? 1- 2 ❑ hate cinco ahos o m&

1

F6. Durante el aiio pasado, ~ha tenido algfin ataque de

iO ‘Us

2 ❑ N (FI7)

niusea yjo vomito que duro mds de 2 horas?

I

F7. Mas o manes, j.cu~ntos d(as durante el aiio pasado tuvo

,@9990NS

usted este problems?

d(as

nfimero

F8. ~Cual fue el periodo mas Iargo que Ie duro este

problems durante el afio pasado?

i ~ 00CI ‘d menosde un cl(a (FIO)

I d (as

1

ndmero

IF ENTRY IN F8 IS30R MORE DAYS, ASK: I

w

99 ❑ NS

F9. ~Cuantas veces durante el aho pasado tuvo este

problems por 3 d~as o mas? I veces

I

n(imero

F 10. Durante el aiio pasado, ~cual fue el per(odo de tiempo I @ I H rnenosde 1 mes

m~s Iargo que estuvo sin tener este problems? I

2 ❑ 1 roes, menos de 3 meses

I

3 ❑ 3 meses, menos de 6 meses

4 ❑ 6 meses o mas

I

9UNS

1

Fll. ~Qu6 edad ten(a la primera vez que se sintio mal y que

Ie haya durado miis de 2 horas?

i@ aiios de edad

,

nLmerO

F 12. ~Tiene este malestar cuando estd comiendo, despu6s I @ I ❑ cuando est~ comiendo (F14)

de comer, o no esta relacionado con comer?

I

z ❑ despues de comer (F13)

I

s ❑ no est~ relacionado con comer (F 14)

9 n NS(F14)

1

F 13. ~Cu6nto tiempo despu& de comer empieza a sentirse

i@

I ❑ 1 hors o menos

real?

I

2 ❑ mas de 1, menos de 2 horas

3 U 2 horas o mas

I

9UNS

15

276
F 14. ~Ha visitado alguna vez a un medico acerca de este

~e 10’

2D N (F16)

malestar?

F15. ~Que Ie dijo el mtkfico que era? :@ ‘

(F17)

especif iq ue

F 16. ~Que fue la causa de este malestar? ~@ ‘ especifique

F 17. Durante IOS 5 aiios pasados, ~ha tenido dolor en el I@ lDS

abdomen o en la parte baja del pecho que duro media I

2 ❑ N (F37)

hors o mas? I

9 ❑ NS (F37)

F 18. Por favor, ens6iieme donde estaba Iocalizado I MARK AREA(S) SHOWN

el dolor.

I

I

I

I

I

I

I

I

I

I

I

F 19. ZCu6ndo fue la ultima vez que usted tuvo este dolor? I ❑ hate 6 meses o menos

I

3 ❑ hate masde 1 afio (F31)

F20. ZCu5nto tiempo Ie dura este dolor, usualmente?

~ @ ; B LlS~Olrn;a~;~5 horas

I

3 ❑ mas de 5, hasta 24 horas

I

4 ❑ mas de 24 horas

90NS

F21. Mientras tiene el dolor, Zes constante o va y viene? 1 ❑ constante

i @ 2Dvayviene

I

3 ❑ ambos

F22. Cuando tiene el dolor, Zse mueve o se acuesta y se

10

334 1 ❑ se mueve

queda quieto? I

2 ❑ se acuesta y se queda quieto

3 ❑ ambos

1

F23. Mas o menos, .Za qud hors Ie empieza et dolor I = ala (Ias)

(

10 AM

usualmente?

I

2D PM

I

OR

00 ❑ no hay tiempo en particular

I

99 Cl NS

F24. ZLe ha desperado alguna vez este dolor?

lo ‘Us

2Cl N 90NS

F25. ZLe viene este dolor cuando esta comiendo, despues

@

1 ❑ cuando estacomiendo (F27)

de comer o no est~ relacionado con comer?

I

2 El despues de comer (F26)

3 ❑ no esta relacionado con comer (F27)

I

9 D NS (F27)

16

277
F26. ZCu6nto tiempo despu& de comer Ie viene el dolor? I ❑ 1 hors o menos

! @ 2 ❑ mascle 1 hors, a 2 horas

I

3 ❑ m& de 2 horas

9UNS

F27. Usualmente, Zse siente mal del estomago antes o

~o

Ins 2UN 9Ci NS

despu6s que le viene el dolor?

>

F28. Entre un dia o dos despu& de que Ie viene el dolor, I

Zha tenido alguno de Ios siguientes: I

Fiebreo escalofr(os? . . . . . . . . . . . . . . . . . . . .

lo 10s 2CIN 9UNS

Comez6n/picazon? . . . . . . . . . . . . . . . . . . . . . 0342 IDS 20s 9CINS

Ictericia Amarillo? . . . . . . . . . . . . . . . . . . . . . .

I

@ ‘Os

2UN 9UNS

Orina extremadamente oscura? . . . . . . . . . . . . .

10 ‘Us

2UN 9Ci NS

(Evacuaciones/excrementos) de un color

extremadamente claro?. . . . . . . . . . . . . . . . I@ Ins 2CIN 9iZNS

I

F29. M5s o menosr tcu~ntos d (as durante el aiio pasado ha

tenido usted este dolor en el abdomen o en la parte @

d (as

n6mer0

baja del pecho? I 999 ❑ NS

F30. En el aiio pasado, Zcual fue el per(odo miis Iargo de ;@@

I

{

ICI d(as

alias, semanas, o meses en que no tuvo este dolor? 2 ❑ semanas

n~mero 3 ❑ meses

F31. ZQU6 edad tenia cuando tuvo el primer ataque de

@

afios de edad

este dolor? I

n6mer0

F32. ZHa visitado alguna vez a un m6dico acerca de

kl “s

❑ N (F34)

este dolor?

I

F33. ZQU6 Ie dijo el mddico que era? o691 1 (F35)

especif iq ue

—

F34. ZQU15fue la causa de este dolor?

@ ‘

especifique

F35. ZHa recibido alguna vez una inyeccibn de medicina para

[o 10s

21JN 9UNS

aliviar el dolor?

——_

F36. ZHa sido hospitalizado alguna vez por el dolor?

I

,0352 lUS zUN 9Ci NS

F37. Durante el aiio pasado, Zha tenido cualquiera de Ias I

siguientes clases de trastornos despu& de comer? I

Llenura . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:@ 10s 2UN 9UNS

Erutaci6n . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@

10s 2DN 9UNS

(Malestar del est6mago/estomago

revuelto) ov6mito, . . . . . . . . . . . . . . . . . . I@ IDS 2UN 9UNS

Saboramargo enlaboca . . . . . . . . . . . . . . . . . .

I

@

Ins 2UN 91JNS

(Acedi_a/acidez) oardor . . . . . . . . . . . . . . . . . .

@ ‘Us

21JN 90NS

Calambres enelest6mago . . . . . . . . . . . . . . . . .

@ ‘Us

2UN 9UNS

17

278
IF “Nr’ OR “NS”TO A&, SKIP TO

QUESTION F40. ;@

I ❑ una o dos veces

2 ❑ 3 veces o mas, pero menos de una

i

vez por mes

F38. Durante el silo pasado, icon que frecuencia ha tenido

(este trastorno/cualqu iera de estos trastornos)?

3 ❑ como una vez por mes

I

4 ❑ semanalmente o casi semanalmente

I

5 ❑ diariamente o casi diariamente

F39. ZES causado el trastorno por cualquiera de Ios

siguientes alimentos? i

Leche r . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

@ 10s

2UN 9EINS

Alimentos grasosos . . . . . . . . . . . . . . . . . . . . . @ lns

20N 9i3NS

Vegetales verges . . . . . . . . . . . . . . . . . . . . . . . ,@ IQs 2CIN 9(3NS

Mariscos opescado . . . . . . . . . . . . . . . . . . . . . i@ IDS 2DN 9EINS

Algtin otro alimento 3

w ‘n’

2CIN 9CINS

espechfique

I

F40. ZCon que frecuencia (elimina/evacua/obra/mueve el

I@

I ❑ 3 0 mas veces al d(a

vientre/’’hace numero dos”) ?

I

2 ❑ dos veces al d(a

3 D una vez al dia

I

4 D cada otro dia

5 ❑ menos de cada otro d(a

I 9EINS

I

CON DICIONES CARDIOVASCULARES I

G1. ZHa tenido alguna vez algun dolor o molestia en i@ 1DS(G3) 20N

el pecho?

I

G2. ZHa tenido alguna vez alguna presion o pesadez en

WI lDS

20 N(G13)

el pecho? I

G3. ZLe viene esto cuando camina cuesta arriba ~@l 10s

2nN(Gll)

o de prisa?

I

3 ❑ nunca camina cuesta

arriba o de prisa

?

G4. ZLe viene cuando camina a un paso normal en i@ IDS 2DN

nivel piano?

I

1 J

G5. CHECK ITEM: MARK ONE BOX. I@ 1 ❑ “S” IN G3 AND/OR G4 (G6)

I 2 ❑ OTHER (Gil)

1

G6. ZQU6 hate usted si Ie da (el dolor o molestia/la presion

i@l

I •l se detiene o se va despacio

o pesadez) cuando esta caminando? ZSe detiene usted, 1 2 ❑ continua al mismo paso (Gl 1)

camina mas despacio, continua al mismo paso o toma I 3 El toma medicina

medicina? I

G7. Si usted se detiene, Zqu6 Ie pasa (al dolor o molestia/

:@

1 ❑ sealivia

a la presion o pesadez)? ZSe Ie alivia o no? 2 ❑ nose alivia (Gil)

G8. ZQU6 tan pronto se alivia? p

minutes

nhmero

le

279
I MARK AREA(S) SHOWN

G9. ZDonde est~ Iocalizado (el dolor o molestia/la presion

I

o pesadez) ? I

PROBE IF NECESSARY:

, @-@

Por favor ens6rieme donde est~ Iocalizado. I

I

I

I

1-

1

I

I

I

I

I

GIO. ZLO siente en algtin otr6 Iugar? I @ In S(~.$AREA 2DN

GI 1. Zvib a un mddico a causa de w (dolor o moleStia/

p ‘n’ presiEm o pesadez)?

ZU N (G13)

G12. zQu15 Ie dijo el mddico que era? I

@ 1 especifique

G13. ZHa tenido alguna vez un dolor fuerte a trav& del I

@ ‘Us

20 N(HI)

frente del pecho que dur6 por media hors o m%.?

1

G 14. ZCu5ntos de estos ataques ha tenido?

@

01 ❑ uno (G17)

I

ataques

nimero

I

G15. tCu51 fue la fecha de su primer ataque?

@wNs ,

I

mes atio

G 16. ZCu5nto Ie durb el dolor durante su primer ataque? 1 ❑ 30-59 minutes

~ o 2 ❑ l-2horas

I

3 ❑ 3-5 horas

4 ❑ 6-11 horas

I

5 ❑ 12-23 horas

I

6 ❑ 24-47 horas

7 ❑ 2 d(aso mds

I

9’d NS

G17. ZCU51 fue la fecha de su (ultimo) ataque? I

, @999 ❑ ‘s /, ,,0

@

mes

280

19
G18. ZCuanto Ie duro et dolor durante su (tiltimo) ataque?

;@

1 •l 30-59 minutes

2 D 1-2 horas

I

3~ 3.5 horas

4 El 6-11 horas

I

5 D 12-23 horas

~

I

6 U 24-47 horas

7 D 2 diaso mas

I

9DNS

I

G19. tVio a un medico debido a este dolor? I@ lDS 2n N(G21)

G20. ZQue Ie dijo el medico que era?

;@ ‘ espectflque ‘-

G21. ZHa tenido alguna vez una grabacion eiectrica hecha dei

@

IDS 2 KIN

corazon que tambien Ie Ilaman un electrocardiogram

(ECG)? Esto requiere poner alambres sobre el pecho y

en Ios brazes. I

I

t

EL FUMAR

H1. i Ha fumado por 10 menos 100 cigarrillos en toda

~@ in’ su viola?

20 N (H13)

H2. Mas o menosr Zque edad tenr’a usted cuando empezo ;@

aiios de edad

nfimero

a fumar cigar rillos bastante regularmente?

~—

00 ❑ nunca fumo regularmente

H3. ZFuma cigarrillos ahora?

I@

,

1OS(H6) 2UN

I

H4. Mas o menos, Zhace cuiinto tiempo que dejo de fumar

cigar rillos (bastante regularmente)? @l ahos (H8)

nbmero

I w El menos de un aho

H5. ZEn que fecha fue eso mas o menos?

@l@ m,. -’ .,. ‘ .60

H6. Estamos interesados en el numero actual de cigarrillos que Ias personas fuman en un dia. ZCuantos

cigar rillos por d(a (fuma/fumaba) usted (cuando

fumaba regularmente la tiltima vez)?

IF ANSWER IN PACKS, ASK:

ZMe podria dar el numero exacto de cigarrillos? I

I

o403 00 •l menos de uno por d(a

cigar illos

n~mero

o404 cajetillas

nhmero

H7. ZHubo alguna vez un periodo cuando fumaba mas

@ G

2 El N (H9)

de (number in H6) cigarrillos por dr’a?

I

H8. Durante el per(odo cuando fumaba mas, Zcuantos I@ Ootlm enos de uno por d(a

cigar rillos mas o menos fumaba por dia usualmente?

I cigar illos

I

nGmer O

@

cajetillas

I

n6mer0

20

2e I
I

IF 1 YEAR OR MORE IN H4, GO TO H13, I

Nombre(s) de la marca(s)

H9. ZQU6 marca de cigarrillos (fuma/fumaba) usted I o408

usualmente? I o409

IF MORE THAN ONE BRAND, ASK:

I

I

Nombre de la marca

H 10. ZQU6 marca (fuma/fumaba) usted m~s? I o410

I

CHECK CARD ASP 2, BRAND LIST.

IF BRAND(S) NAMED APPEAR(S) ON

I

LIST, ASK: I

H1l. ZEsos son ~, ~,o ~ ?

I o411

I

INCLUDE ALL NAMES FOR THE BRAND.

I

H12. ZQU6 clase de cigarillos (Brand) son Ios que usted

(fuma/fumaba)? ZSon: I

a. Cigarrillos con filtro o sin filtro? . . . . . . . . . . .

I

,0

ICICF ZIZISF 9UNS

b. Mentolado osinmentol? . . . . . . . . . . . . . . . .

@ ‘nM 2DSM ‘nNs

c. Cajaopaquete suave? . . . . . . . . . . . . . . . . . .

~g lUC 20’ ‘DNS

d. Regular, king sizer 100 or 120 mil(metros? . . . . 415 ICIR 20KS 3 ❑ 100 4D120 9CINS

e. Altos, medianos o bajos en nivel de brea y

nicotine? . ..m . . .. m...... . . . . . . . . . . lo IDA 2Ci M 3DB 9DNS

H 13. ZFuma (puros/tabacos/cigarros) ahora? I o417 10s

I

2 ❑ N(H15)

I

H 14. tZCu5ntos (PU ros/tabacos/cigarros) fuma por d ia I o418

mis o menos?

puros tabacos/cigarros por d(a

I

n6mer0

I ❑ menos de 1 por dia –

I

especif ique

3

I

66 ❑ 3-6 por semana

I

i’7 ❑ menos de 3 por

semana

1

H15. LFuma pipa ahora? I o419 10s 20 N(H17)

1

H16. Usualmente, tcu~ntas pipas Ilena”s de tabaco fuma,

I o420

I

pipas Ilenas de tabaco por dl(a

m~s o menos, por dia? numero

I

•l menos de una por di’a –

I especif ique

I

3

I

66 ❑ 3-6 por semana

77 ❑ menos de 3 por

I

semana

21

282
H17. ZFuma alguna (otra) persona de su hogar cigar-

~o ‘D’ 2UN

rillos, (puros/cigarros/tabacos), o pipa dentro de

su casa?

I

H 18. ZComparte su oficina con o trabaja cerca de alguien ;@ 10s 2i3N

(otro) que fuma cigarrillos, (puros/cigarros/tabacos),

o pipa en su presencia?

I

IMPEDIMENT FUNCIONAL

;@

I ❑ Age under 18 (J28)

J1. CHECK ITEM 2 ❑ Age 71 or older (J25)

I

3 ❑ Age 18-70 (J2)

I

J2. ZCual fue su actividad principal durante la mayor parte @

I ❑ trabajar (J3)

de Ios 12 meses pasados; trabajar en un empleo o

z El quehaceres de la casa (J5)

negocio, hater Ios quehaceres de la casa, asistir a la I

3 •l asistir a la escuela (J12)

escuela o alguna otra cosa? I

4❑ alguna otra cosa (J12)

J3.

I

ZLe impide ahora trabajar en un empleo o negocio ,@

1 ❑ S(J17) 2 ❑ N

algun impediment o problems de saiud?

I

J4.

I

ZEst4 Iimitado en la clase o cantidad de trabajo que

@

1 ❑ S(J17) 2 u N(J15)

puede hater debido a algun impediment o problems

de salud?

I

I

J5. ZLe impide por completo el hater Ios quehaceres de la I @ ICIS(J7) 2CIN

casa algtin impedimento o problems de salud ahora?

I

I

J6. ZEst6 Iimitado en la clase Q cantidad de quehaceres de 10428 1 ❑ S(J7) 2 ❑ N(J12)

la casa que puede hater debido a algtin impediment o

problems de salud? I

.

I

J7. ZQU6 condicion causa esta Iimitacitm?

I

condicidn

I

J8. ZCu5ndo noto por primers vez su (condition in J7)? I@ I ❑ hate mas de 3 meses (J12)

I

PROBE IF NECESSARY: ZFue durante Ios 3 meses I Cl hate 3 meses o menos –

pasados o hate mas de 3 meses? I

I

SPECIFY IF 3 MONTHS AGO OR LESS –

I

2 ❑ CONDITION IS ON CARD ASP3 (J12)

I

3 ❑ CONDITION NOT ON CARD ASP 3 (J9

I

J9. ZEsta Iimitacion es causada por alguna otra condicion?

lo ‘Us

2 •1 N(J12)

J1O. tQue otra condicion causa esta Iimitacion?

I condici6n

22

283
J1l. ZCu5ndo not6 por primers vez su (condition in JIO)? ~ @ 1 ❑ hate ma, de 3 mews (J12)

I

❑ hate 3 meses o menos –

I SPECIFY IF 3 MONTHS AGO OR LESS –

I

I

2 ❑ CONDITION IS ON CAR DASP3 (J12)

I

3 II CONDITION NOT ON CA RDASP3

(REASKJ9-11)

1

J12. ZLe impide trabajar en un empleo o negocio algtin

w

1 ❑ S(J17) 2 ❑ N

impediment o problems de salud?

J13. ZEst5 usted Iimitado en la clase o cantidad de trabajo

;@

1 ❑ S(J17) 2 ❑ N(J14)

que podria hater debido a algfin impedimento o

problems de salud?

I

J14. CHECK ITEM @

I ❑ “S” in J5 OR J6 (J22)

I z ❑ Other (J15)

J15. .ZEst6 Iimitado en alguna forma en cualquier actividad

debido a un impediment o problems de salud? I@ 10s 2 El N(J22)

J16. ZEn qu6 forma est~ Iimitado? RECORD LIMITATION,

~w NOT CONDITION, llmitac)6n

J17. ZQU.5 condicitm causa esta Iimitacion? I

condic16n

I

J18. ZCu~rrdo not6 por primers vez su (condition in J17)?

w

I ❑ hate mas de 3 meses (J22)

PROBE IF NECESSARY: LFue durante Ios 3 meses I ❑ hate 3 meses o menos –

pasados o hate mds de 3 meses? I SPECIFY IF 3 MONTHS AGO OR LESS –

I

I

2 ❑ CONDITION IS ON CARD ASP 3 (J22)

I

3 ❑ CONDITION NOT ON CARD ASP :3 (J19)

I

1

J19. tEsta Iimitacirh es causada por alguna otra condicibn? @ ‘Us 2 ❑ N(J22)

J20. ZQU6 otra condicion causa esta Iimitacion? I

I

cond)ci6n

J21. ZCu5ndo not6 por primers vez su (condition

in J20)? @

1 ❑ hate mas de 3 m“eses (J22)

I ❑ hate 3 meses o menos –

I

I

SPECIFY IF 3 MONTHS AGO OR LESS –

I

2 ❑ CONDITION IS ON CARD ASP 3 (-122)

I

3 ❑ CONDITION NOT ON CARD ASP :3

I

(REASK J12-J21)

I

23

284
1 @ I ❑ Age 60-70 (J23) J22. CHECK ITEM

I

2 ❑ Age 18-59, limitation reported (J23)

I

3 ❑ Other (J39)

J23. Debido a algfin impediment o problems de salud, @ IDS(J39)ZDN

Lnecesita la ayuda de otras personas para sus

necesidades del cuidado personal, tal como comer,

I

baiiarse, vestirse, o moverse en este hogar? I

I

J24. Debido a algfin impediment o problems de salud,

I@

1 ❑ S(J39) 2 ❑ N(J39)

Lnecesita la ayuda de otras personas en el manejo de

sus necesidades rutinarias, tal como el atender de este I

Iugar, hater asuntos necesarios, compras, o movilizarse

para otros propositos? I

ASK FOR AGES 71+ ONLY: I

J25. LCU51 fue su actividad principal durante la mayor

I

parte de Ios 12 meses pasados; trabajar en un empleo I @ ~ ~ ~g!~eres de la casa

o negocio, hater Ios quehaceres de la casa, asistir a la

I

3 ❑ asistir a la escuela

escuela o algu na otra cosa? 4 ❑ alguna otra cosa

J26. Debido a algtin impedimento o problems de salud,

lo

1 ❑ S(J34) 2 ❑ N

Znecesita la ayuda de otras personas para sus necesidades del cuidado personal, tal como comer, baiiarse,

vestirse, o moverse en este hogar? I

J27. Debido a algtin impedimento o problems de salud, ;@ I ❑ S(J34) 2 ❑ N(J32)

Znecesita la ayuda de otras personas en el manejo de

sus necesidedes rutinarias, tal como el atender de este I

Iugar, hater asuntos necesarios, compras, o movilizarse

I

para otros propositos?

ASK FOR AGES 12-170NLY: I

J28. ZLe impide ahora asistir a la escuela algun impedilo

1 ❑ S(J34) 2 ❑ N

mento o problems dc salud?

w

J29. ZAsiste a una escuela especial o a clases especiales @

1 ❑ S(J34) 2 ❑ N

debido a al@n impediment o problems de salud?

I

J30. ZNecesita asistir a una escuela especial o a clases 10 1 ❑ S(J34) 2 ❑ N

especiales debido a algtin impedimento o problems

de salud? I

J31. ZEst5 Iimitado en su asistencia a la escuela debido a

I

su salud? @

1 ❑ S(J34) 2 ❑ N

J32. ZEst5 Iimitado en alguna forma en cualquier actividad ;@ 10s 2 ❑ N(J39)

debido a un impedimento o problems de salud?

I

J33. ZEn qu6 forma esti Iimitado? RECORD LIMITA-

;61 ‘ TION, NOT CONDITION. Iimltacio’n

I

J34. ZQU6 condicion Ie causa esta Iimitacion?

I condici6n

24

2S5
J35. lCuiindo not6 por primers vez su (condition in J34)? @

I ❑ hate mas de 3 meses (J39)

—

PROBE IF NECESSARY: ZFue durante 10s3 meses i

❑ hate 3 meses o menos –

pasados o hate mas de 3 meses? i

SPECIFY IF 3 MONTHS AGO OR

I

LESS -

I

2 ❑ CONDITION IS ON CARD ASP 3 (J39)

I

I

3 ❑ CONDITION NOT ON CARD ASP 3 (J

J36. ZEsta Iimitacirjn es causada por alguna otra condicion?

~@ 10s 2 ❑ N(J39)

J37. ZQU6 otra condici6n causa esta limitaci6n? I

1

condici6n

J38. ZCu6ndo not6 por prkera vez su (condition in J37)? o454 I ❑ hate m~s de 3 meses (J39)

❑ hate 3 meses o menos –

SPECIFY IF 3 MONTHS AGO OR

LESS -

2 ❑ CONDITION IS ON CARD ASP 3 (J39

3 ‘7 CONDITION NOT ON CARD ASP 3

(REASK J36-38)

J39. CHECK ITEM I @ 1 ❑ Age 18 or older (J40)

I

z ❑ Age 12-17 (Kl)

J40. ZHa cambiado alguna vez de trabajo, dejado de trabajar

o hecho algunos cambios en sus quehaceres de casa a

causa de un impediment o problems de salud?

o456 10s 2 ❑ N(KI)

J41. LCU51 fue el problems de salud? I

@ ‘ especifique

J42.

ZSe retir6 por un impedimento?. . . . . . . . . . . . . @

ZCambi6 permanentemente a un trabajo

m% fticil? m. . . .. m........ . . . . . . . . . .

@

ZCambi6 temporalmente a un trabajo m~s ;@

f~cil? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2Reduj6 su trabajo a tiempo (parciaI/ 10

“part-time’’) ?. . . . . . . . . . . . . . . . . . . . . .

ZTUVO que dejar de trabajar por unos meses? . . . .

I@

I

ZTUVO que reducir la cantidad de trabajo @

en Iosquehaceres decasa?. . . . . . . . . . . . . . ,

tDejo de hater todos Ios quehaceres

decasa? . . . . . . . . . . . . . . . . . . . . . . . . . .

;@

ZHizoalgfi notrocambio? . . . . . . . . . . . . . . . . I@

3

especif iq ue I

I

Ins 2Ci N

10s 2UN

Ins 2CIN

Ins zUN

10s 2UN

lCIS 2DN

10s 2DN

Ins 2DN

25

25

?86
LISTA DE CON DICIONES

K1. ZAlguna vez Ie dijo un

mddico que tenia: (IF

‘*S{ ASK K2 AND K3

BEFORE GOING TO

NEXT CONDITION)

n

Enfisema? w

Bronquitis cronica?

Fiebre reumiitica?

Enfermedad

reumatica del corazon?

Soplo/murmullo?

Fallo del corazon?

Ataque de corazon?

Problemas de Ios

riilones?

Cirrosis del higado?

Hepatitis?

lctericia/piel

amarilla?

Derrame cerebral/

em bolia cerebral?

Glaucoma?

Cataratas?

Estrabismo u ojos

bizcos?

Una herida en el

ojo?

Bocio?

Otra enfermedad

de la tiroide?

o469

0

472

(-a

w

o

478

0481

0

484

0

486

0489

0

492

0

495

0

498

0

500

0

503

0

506

0509

0

512

0

515

EXPOSITION AL PESTICIDA

1 ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K3)

1 El S(K2)

1 U S(K2)

1 ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K3)

1 ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K2)

I ❑ S(K2)

1 ❑ S(K2)

1 ❑ S(K2)

2EIN

2DN

2CIN

2CIN

20N

2UN

213N

2EIN

2DN

2CIN

2EIN

20N

20N

2DN

2EIN

2EIN

2CIN

2EIN

K2. ZTodavia tiene... ?

o467 Ins 20N 913NS

o470 10s 2CIN 9CINS

3

473 Ins 213N 90NS

o476 10s 2EIN 9CINS

o

479 10s 2DN 9CINS

o

4a2 ?Us 2CIN 9CINS

o487 10s 2i3N 9CINS

o

490 10s 2CIN 90NS

o

493 Ins 2UN 9CINS

o

496 10s 2DN 91JNS

o501 lns 2CIN 9UNS

o

504 10S 2UN 9DNS

o507 10S 2Ci N 90NS

o510 lns 2UN 9C!NS

o

5;3 lUS 2EIN 9EINS

o516 lcis 2DN 9EINS

K3.

ZHace cuantos aiios

que tuvo por primers

vez... ?

o

468

0

471

0474

0477

0

400

0483

0

485

0

488

0

491

0

494

0

497

0

499

0

502

(aw

o

508

0

511

0

514

0

517

L1. ZHa trabajado usted alguna vez, bien sea pagado o sin

@ ‘OS

2 •l N(L27)

pago, en trabajo (agricola/del campo/de finca)? Algunos

ejemplos de trabajo (agricoia/del campo/de finca) son I

trabajos con cosechas o animales y supervisando otros

trabajadores en fincas o huertas. I

I

26

287
I

L2. ZCutintos afios aproximadamente ha hecho trabajo

(agr (cola/del campo/de f inca)?

I @990Ns

I ar?os

I

ni-fmero

I

L3. ZEs usted trabajador migrante (de agr (cola/del campo/ I

de finca)? ,@

lEi S(L5) 21JN

I

I

L4. ZHa hecho alguna vez trabajo (agri’cola/del campo/ lo Ins 2 ❑ N(L6)

de finca) fuera de su hogar habitual por mas de dos

semanas a la vez? I

I

I

L5. ZCuantos meses al aho esta o estuvo usted fuera de su ~@990NS

hogar habitual haciendo trabajo (agricola/del campo/ 00 ❑ menos de 1 mes por aho

de finca)?

I

meses por afio

nfimero

I

L6. .ZHa hecho trabajo (agri_cola/del campo/de finca) durante I@ IDS 2 •1 N(L14)

cualquier parte del silo pasado?

I

I

I

L7. Durante el silo pasado, tha trabajado en cualquiera

de Ias siguientes clases de trabajo (agricola/del campo/ I

de finca)? I

Finca de animales o Iecheria?. . . . . . . . . . . . . . . lo 524 10s 20N

Finca de (aves de corral/pollos)?. . . . . . . . . . . . .

I 2CIN

Fincade vegetales? . . . . . . . . . . . . . . . . . . . . .

,@ :::

@

2CIN

Huertade fruta? . . . . . . . . . . . . . . . . . . . . . . .

@ ‘as

2CIN

Fincade algodon? . . . . . . . . . . . . . . . . . . . . . .

@ 10s

2UN

Fincade tabaco? . . . . . . . . . . . . . . . . . . . . . . .

@ 10s

213N

Fincade (grano/cereal)? . . . . . . . . . . . . . . . . . . ,@ IDS 2EIN

Alguna otra clase de finca? 3 I@ 10s 2DN

especifique

I

L8. Durante el afio pasado, .Zcon que cosechas agricolas @ 9CINS

ha trabajado principalmente?

I

o ❑ ninguna

~m

I

I

I

27

288
L9. Durante el afio pasado, Zha hecho cualquiera de Ios

I

siguientes trabajos: I

(Piscador/recogedor) o cosechador? . . . . . . . . . .

I

I @ ‘Os

2UN

Cultivator? . . . . . . . . . . . . . . . . . . . . . . . . . .

I @ ‘Us

2Ci N

Sembrador? . . . . . . . . . . . . . . . . . . . . . . . . . .

I @ ‘Os

213N

(Surtidor/clasif icador)?. . . . . . . . . . . . . . . . . . .

I o ‘Os

2CIN

Empacador? . . . . . . . . . . . . . . . . . . . . . . . . . .

I @ 10s

2iZN

Rociador depesticidas? . . . . . . . . . . . . . . . . . .

I @ ‘Us

2CIN

Mezclador depesticidas?. . . . . . . . . . . . . . . . . .

I @ ‘Os

2UN

(Abanderado de pesticides/”flagman”)?. . . . . . . . ~ @ IDS 2CIN

(Mayordomo de campo/’’foreman”/

capataz)?, . . . . . . . . . . . . . . . . . . . . . . . .

I @ ‘Os

2UN

Algu n otro trabajo de finca?3

~ o ‘n’

2CIN

especifique

I

L 10. ZCuintos meses por afio acostumbra usted hater

trabajo (agrr’cola/del campo/de finca)?

I @ oo ❑ rnenos de 1 rnes al a?io

I meses por ar70

n~mero

LI 1. Cuando est~ haciendo trabajo (agri_cola/del camPo/ I @ 10s

de finca) tacostumbra usted a comer alguna de Ias

2 ❑ N(L13)

comidas en o cerca de [OScampos durante el dia de I

trabajo? I

I

L 12. Cuando estii haciendo trabajo (agri_cola/del campo/ I

de finca), Zde dbnde viene el agua que usa para Iavarse

Iasmanes? I

I

ZES: Traido a Ios campos desde otro Iugar? . . . . . . . . .

I @ ‘Us

2nN

De (una noria/un pozo] en Ios campos?. . . . . . . . , @ ID’ 2nN

Agua de riego o estancada en el campo?. . . . . . . .

I @ ‘Us

2nN

De alguna otra fuente?3 I @ Ins 20s

especifique

1 @ o ❑ NOSE LAVA MANOS

I

I

L13. Cuando est5 haciendo trabajo (agri_cola/del campo/ I

de finca), lde d6nde viene el agua que toma?

I

ZES: Trai_do a Ios campos desde otro Iugar?. . . . . . . . .

‘@ 10s

2nN

De (una noria/un POZO) en IOScampos?. . . . . . . . I@ lUS

I@ Ins

2nN

Agua de riego o estancada en el campo?. . . . . . . .

~@ Ins

2CIN

De alguna otra fuente? 3 20N

especifique

I @ o ❑ NO TOMA AGUA

1

28

289
L14. Los pesticides son quimicos usados para matar insectos, I@ 10s 2 ❑ N(L16) 90 NS(L16)

mala hierba, enfermedades de plantas, y roedores.

Mientras trabajando en trabajo (agr(cola/del camPo/

I

de finca), segtin su conocimiento, &e aplicaron alguna I

vez pesticides a un area mientras usted trabajaba

en ells?

I

I

L 15. ZCu6ntas veces? I

1 ❑ 1-2 veces

‘ o ; : w:c:s I

I

4 ❑ mas de 10 veces

9UNS

1

L16. ZHa mezclado, manejado o aplicado pesticides alguna @ ‘Os

2 ❑ N(L20) 9 ❑ NS(L20)

vez mientras haciendo trabajo (agri_cola/del campo/

de finca)? 1

L17. Aproximadamente, tcuiintas veces por aho ha usted

I

@

1 ❑ menos de una vez por afio

mezclado, manejado o aplicado pesticides usualmente 2 ❑ 1-12 veces por afio

mientras trabajando en trabajo (agricola/del campo/ I

3 ❑ mas de 12 veces por afio

de finca)?

I

I

L18 ZHa usado alguna vez cualquiera de Ios siguientes

art~culos de equipo protective mientras mezclando, I

manejando o aplicando pesticides: I

Guantes? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

I@ ‘Os

2EIN

Traje especial sobre la ropa? . . . . , . . . . . . . . . .

,@ 10s

2UN

Mascara? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@ ‘Us

2UN

(Espejuelos/gafas protectivas)?. . . . . . . . . . . . . .

@ ‘Us

2CIN

Botasde hale? . . . . . . . . . . . . . . . . . . . . . . . . ,@ 10s 2DN

Cubierta paralacabeza? . . . . . . . . . . . . . . . . . . 10 10s 2UN

Algfin otro articulo? 3

I@ lUS 2UN

especifique

I

IF ALL “N” IN L18, SKIPT0 L20. I

OTHERWISE ASK:

I

L19. ZCon qud frecuencia ha usado alghn equipo protective

;@

1 ❑ siempre

mientras mezclando, manejando o aplicando pesti- 2 ❑ algunas veces

cidas: siempre, algunas veces, o nunca? 3 ❑ nunca

I

L20. Mientras haciendo trabajo (agr(cola/del campo/de

I

, @ J~~(L26)

finca) Zse Ie derramaron o Ie rociaron con algfin

pesticida alguna vez en cualquier parte del cuerpo?

I

9 ‘d N’ (L26)

I

L21. ZCuantas veces Ie han derramado o rociado Ios pesti- 1@“’HNs cidas encima?

I

veces

nhmero

I

L22. ZSe enfermo alguna vez debido a que Ie derramaron I@ ‘Os 2Ci N

o rociaron pesticides por encima?

I

29

290
L23. LVi6 a un m~dico alguna vez debido a que pesticides

I

@ ‘Us 2CIN

fueron derramados o rociados por encima?

I

L24. ZPerdi6 algfin tiempo de trabajo alguna vez como I@ Ins 2C!N

resultado de tener pesticides derramados o rociados !

por encima?

I

I

L25. iQu6 pesticides espec~ficos se Ie derramaron o se Ie

rociaron encima a usted? 1F NAME(S) NOT KNOWN,

@ 9CINS

ENTER WHAT PESTICIDE IS USED FOR OR ON.

~ @@-

I

I

L26. Adem& de cuando hate trabajo (agricolaldel campof

de finca), durante el aiio pasado, Zha mezclado,

~@ I ❑ S(L28) 2 ❑ N(L28) 9 •i NS(L28)

aplicado o manejado algunos pesticides? 1

I

L27. Los pesticides son qu fmicos usados para matar insectos,

@ ‘n’

2EIN 9DNS

mala hierba, enfermedades de plantas, y roedores.

Durante el afio pasado, ~ha mezclado, aplicado, o I

manejado algunos pesticides?

L28. Durante Ios cinco aiios pasados, Zha usado la medi-

~o 10s 2UN

cina recetada, Kwe[l, para el control de piojos en el

cuerpo o en la cabeza?

I

L29. ZHa trabajado alguna vez en una fabrica que process

;@ 10s 2UN 9CINS

pesticida?

I

L30. ZHa trabajado alguna vez como aplicador o rociador @ Ins 2CIN 9Ci NS

de pesticida, por ejemplo, un exterminator o un

especialista de (control de insecto/control de insecto I

daiiino/’’pest control”)?

I

ACULTURAC16N

1

Ml. ZHabla un Poco de ingh%? I@ ‘us 2 ❑ N(M4)

I

M2. tDiri_a usted que habla principalmente espaiiol, o @l

1 ❑ principalmente espafiol

principalmente ingk, o habla espafiol e ingk m~s 2 ❑ principalmente ingl&

o menos igual?

I

3 ❑ ambos igual

I

M3. ZQU6 idioms prefiere; solamente espafiol, principalmente espaiiol, principalmente inglds, solamente inglds, I @ ~ ~ $~;;j%~nte espaiiol

o espaiiol e ing16s mtis o menos igual? I

3 ❑ principalmente ingl&

I

4 ❑ solo ingh%

5 ❑ ambos igual

I

30

2el
I

M4. ZPuede leer espafiol? 10 ‘Os 2CIN

#

M5. iPuede leer ingh%? I

,@ ‘n’ 2Cl N

I

IF “S” TO BOTH M4 AND M5, ASK: I

M6. ~CU51 lee mejor?

@

1 ❑ espafiol

2 ❑ inglds

I

3 G Ios dos igual

I

M7. ZPuede escribir espaiiol?

I@ 10s 2CIN

1

M8. lPuede escribir ingk? @ IDS 211N

I

IF “S” TO BOTH M7 AND M8, ASK: I

M9. ZEn qu6 idioms escribe mejor?

;@

1 ❑ espafiol

2 ❑ ingles

I

3 ❑ Ios dos igual

I

HAN DCARDASP4 I

I

Ml O. ZCui51 de esos grupos mejor describe su identification hica? I(-J597 01 ❑ boricua

I

02 ❑ puertorriquefio

I

03 ❑ cubano

04 ❑ cubano-americano

I

05 ❑ mexicano

I

06 ❑ chicano

07 ❑ mexico-americano

I

——. ——— ___ __

I

06 ❑ hispano

09 ❑ Iatino americano

I

IO ❑ otro espafiol u otro hispano

I

11 D americano

12 ❑ anglo-americano

I

13 ❑ otro grupo14

especifique

I

I

IF ANY BOX BE LOW THE LINE IN MIOIS I

CHECKED, ASK:

I

M1l. ZCU51 es su pars de origen?

~o~ especifique

I

31

292
I

I

M12. IZCU41de esos grupos mejor describe la identifi- l@ 01 ❑ boricua

cacion 6tnica de su madre?

I

02 ❑ puertorriquer7a

03 ❑ cubana

i

04 ❑ cubana americana

I

05 ❑ mexicana

06 ❑ chicana

I

o~ •l mexico-americana

I

OB ❑ hispana

09 ❑ Iatino americana -

I

10

I

especifique pafs

11 ❑ otra espafiola, u otra hispana —

I

12

I

especifique pa(s

13 •l americana

I

14 ❑ anglo-americana

I

15 ❑ otro grupo —

16

I

especifique

I

I

M 13. ZCU5[ de esos grupos mejor describe la identificacih 6tnica de su padre?

~ @ ol ❑ boricua

02 ❑ puertorriquefio

I

03 •! cubano

04 ❑ cubano americano

I

05 ❑ mexicano

06 ❑ chicano

I 07 ❑ m6xico-americano

I

oe ❑ hispano

I

09 ❑ Iatino americano —

10

I

especifique pafs

I

11 ❑ otro espafiol u otro hispano —

12

I

especifique pa(s

13 •l americano

I

14 •l anglo-americano

I

15 ❑ otro grupo —

16

I

especifiq ue

I

M14. ZEn qud pais o estado naci6 w padre?

@

1 •! Estados Unidos, excepto

Puerto Rico

I

2 ❑ Puerto Rico

I

3 ❑ Cuba

4 ❑ Mdxico

I

5 ❑ otro 6

I

especifique

M15. ZEn qu6 pais o estado nacicl su madre?

[(!I

I •l Estados Unidos, excepto

Puerto Rico

I

2 ❑ Puerto Rico

I

3 ❑ Cuba

4 ❑ M6xico

1

5 ❑ otro 6

I

especifique

32

293
PROGRAMAS DE ALIMENTO

I

N1. CHECK ITEM

, @ 1 ❑ Under 19(N2)

I

2 n 19-59 (Pi)

3 •1 60+(N16)

N2. lAsiste usted a la escuela ahora?

WI ‘Us

2 ❑ N(P1)

N3. La escuela a que usted asiste Zsirve un (desayunol

~@ ‘Us

2CIN

almuerzo/’’breakfast”) completo?

N4. Usualmenter Zcuantas veces por semana come I@ veces

nhmero

usted el (desayuno/almuerzo/’’breakfast”) servido

1-

por la escuela? O ❑ ninguna (N8)

I

9UNS

N5. Durante este aiio (pasado) escolar Zllenaron sus padres ‘o607

I

❑ s 2 ❑ N (N7)

un formulario para que usted pudiera comer et (desayuno/almuerzo/’’breakf ast”) en la escuela a un precio

I

reducido o gratis?

I

N6. ZCome el (desayuno/almuerzo/’’breakfast”) en la ~@ “Us”

escuela a un precio reducido o gratis? 2 ❑ no, no es eligible

I

3 ❑ no, otra razon

N7. lCuanto paga por su (desayuno/almuerzo/’’break-

:@

centavos

fast”) por dia? niimero

I

000 Cl gratis

N8. La escuela que usted asiste, &irve una comida de 10610 Ins 20N

mediod (a completa? 1

N9. Usualmente, Zcuantas veces por semana come usted lo veces

la comida de mediodia servida por la escuela? I

n6mer0

i

o ❑ ninguna (N13)

9CINS

N 10. Durante este aho (pasado) escolar, Lllenaron sus padres I

,(3 10s 20 N(N12)

un formulario para que usted pudiera comer la comida

de mediodia en la escuela a un precio reducido o gratis? I

Nil. ZCome usted la comida de mediodfa en la escuela a

i@ IC!SI’

un precio reducido o gratis?

2 •l no, no es elegible

I

3 ❑ no, otra razon

N12. ZCuanto paga por su comida de mediodia por dia?

Ml centavos

I

n6mer0

I 000 ❑ gratis

I

33

294
N13. tTrae de casa alguna vez su comida de mediod(a? I

1 ❑ s(, siempre

‘ o :: :; ;$:;= “e’es

I

I

I

N14, En alias que no come la comida de mediodia servida

‘o

1 ❑ s(, siempre

por la escuela, Zcompra Ieche?

I

2 ❑ si, algunas veces

I

3 ❑ no(Pl)

I

N15. ZCu&rto paga por su Ieche por dia? lo centavos

ntimem

I

}

(Pi)

I

000 ❑ gratis

N16. tParticipa usted en algtin programa en el cual Ie entre1

I @ 10s

2 ❑ N(N20)

gan en su casa comidas ya preparadas Q (comestibles/

viveres] regularmente?

I

N 17. iLe entregan a su casa comidas ya preparadas o @ 10 SI5Io comidas preparadas

(comestibles/v iveres)?

I

2 ❑ S1510comestibles

3 ❑ ambos

I

4 •l otro —5

I

especifique

N18. LPatrocina el programa –

I

Un departamento local de salud? . . . . . . . . . . . .

I

,(3 ‘n’ 2CIN

Otro departamento del gobierno local? . . . . . . . . @ 10s

2CIN

Ungobierno estatal? . . . . . . . . . . . . . . . . . . . . 10622 lns 2nN

Ungrupo delaiglesia? . . . . . . . . . . . . . . . . . . . @ ‘n’

2EIN

Alguna otra organizacibn voluntaria?. . . . . . . . . .

I

Especifique 3 I@ Ins 2nN

I

N 19. LCu5ntas veces mds o menos se Ie trae esta comida

@

01 ❑ dos o tres veces por dr’a

a su casa?

I

02 ❑ una vez por dia

03 ❑ cuatro a seis veces por semana

I

04 ❑ dos o tres veces por semana

I

05 ❑ una vez por semana

06 ❑ dos o tres veces por mes

I

OT ❑ una vez por mes

I

os ❑ menos de una vez por mes

09 ❑ otro —10

I

especif ique

I

N20. ZParticipa regularmente en algfin programa en el cual ~@ Ins 2 ❑ N(P1)

usted va a un Iugar donde se Ie sirve comidas a grupos

de personas?

I

I

34

295
N21. LPatrocina el programa –

I

I

Un departamento local de salud? . . . . . . . . . . . .

J@ 10s

2UN

Otro departamento del gobierno local? . . . . . . . . @ 10s 2CIN

Ungobierno estatal? . . . . . . . . . . . . . . . . . . . . I@ Ins 2CIN

Ungrupo delaiglesia? . . . . . . . . . . . . . . . . . . .

I@ Ins 2CIN

Alguna otra organization voluntaria?. . . . . . . . . . I

Especifique 3

10 ‘Os

2CIN

I

I

N22. MA o menos, icon qu6 frecuencia sale usted para I(3

01 ❑ dos o tres veces por d(a

estas comidas?

I

02 ❑ una vez por d~a

03 II cuatro a seis veces por semana

I

04 ❑ dos o tres veces por semana

I

05 ❑ una vez por semana

06 ❑ dos o tres veces por mes

I

07 ❑ una vez por mes

os •l menos de una vez por mes

I

09 ❑ otro —’0

I

especifique

35

296
EL USO DE MEDICINA/VITAMINA

P1. Durante Ias 2 semanas pasadas, Zha tornado o usado algunas vitaminas o minerales? o633 1 ❑ s(pz) 2 ❑ N!P5)

P2. ZMe permite ver el (envase(s)/ P3. ZQU6 cantidad del (vitamin/ P4. tCon qu6 frecuencia toma este

botella(s)) de sus vitaminas y mineral) toma cada vez que (vitamin/mineral)?

minerales? 10 usa?

RECORD BRAND NAME

o634

@-@

/

I ❑ tableta/c5psu la

@-@ I ❑ d~a

[

2 ❑ semana

2 U cucharadita por

veces 3 ❑ mes

n6mer0 4 ❑ otro —

3 ❑ cucharada

5

especif ique

\ 4 ❑ otro

o634

@-@

/

I ❑ tableta/capsula

@-@ I ❑ d(a

2 ❑ cucharadita

I

2 ❑ semana

por

vecas 3 ❑ mes

nfimero

3 ❑ cucharada 4 •l otro —

5

\ 4 ❑ otro especifique

❑ Continuation booklet

P5. Estamos interesados en todas clases de medicinas que la gente toma o usa. Primero Ie preguntar+ sobre su uso de medicinas

que se pueden obtener —sin receta de mddico.

Durante Ias2 semanas pasadas, iha tornado o usado algunas de Ias siguientes clasesde medicinas:

a) Medicina contra la tos, dolor de garganta, catarro o congestion? ;0639 Ins 2CIN

b) Calmantes para el dolor, tal como la aspirina o Tylenol? I @ 10s 2CIN

c) Tabletas para dormir, sedatives o tranquilizantes? o641 10s 2CIN

d) Antidepresivos, estimulantes o pildoras animadoras?

~ @ 10s

2Ci N

e) Pildoras o productos que Ie ayudan a bajar de peso? I @ lUS

zUN

f) Laxantes?

~ @ 10s

2EIN

g) Medicinas para la diarrea? I @ ‘Os zEIN

h) Medicinas para la indigestion? o646 10s 2CIN

i) Supositorios? I @ 10s 2CIN

j) Gotas para Ios ojos? o640 Ins 2nN

k) Algunas otras medicinasr pildoras o (pomadas/un@entos)

para Iascuales no se necesit a receta del mddico? ~ @ ‘ns

2nN

S1 S1, ESPECIFIQUE

I

37

297
P6. Durante Ias 2 semanas pasadas, Zha tornado o ha usado algunas medicinas para Ias cuales se necesita una receta de m6dico?

o

651 1 ❑ S(P7) 2 ❑ S(P14)

P7. ZMe permite ver el (envase(s) P8. ZCual es el problems de P9. ZTomo [dosage! reported

/botella(s)) de la medicinal salud por el cual tom6 in P7) por (frequency

que tomb? RECORD SPECl - usted la (medicine)? reported in P7)?

FIED INFORMATION FOR PROBE FOR SYMPTOM

EACH, THEN ASK QUES- OR CONDITION.

TIONS P8 THROUGH 13

FOR EACH.

Etiqueta impress en:

o

652 1 ❑ ing16s 2 ❑ espafiol 3 •l ambos

o

653

0

654 1 ❑ S(P12)

.—— — ———— ———— ———— ———— —.

o

655 Nombre:

2’d N

.—— — ———— ———— ———— ———— __

ZRecetada para la SP?

o

656 lDS 20N

.—— — ———_ ——_ ___ __— __— —

o

657 Potencia:

.—— — —— —_____ ___ ___ ___ .

% DOsis:

.—— — ——— ——— ——— ——— —_— ——.

w

Frecuencia:

.—— — ——— ——— ——— ——— —__ ___

IF “SEGUN SE NECESITE,’’ASK P8 AND

GOTO NEXT MEDICATION.

.—— —— ——_— —___ ____ _—— — —

o

I ❑ No se vio el envase — la informacitm 662

fue dada por el respondedor

o

Etiqueta impress en:

652 1 •l inglds 2 ❑ espaiiol 3 ❑ ambos

o

653

0

654 1 •1 S(P12]

.—— — —————— ——— ——— ——— ———

0

655 N ombre:

21ZIN

.—— — ———— ———— ——— ———— ———

0

LRecetada para la SP?

656 70s 20N

.—— — ——— ——— ——— ——— ——— ——

0

657 Potencia:

.—— — ___ ____ ___ ___ ___ __

M DOsis:

.—— — ———— ———— ————— ———— —

m

Frecuencia:

-——— ——— ——— —————— ——— ———

IF “SEGUN SE NECESITE,” ASK P8 AND

GO TO NEXT MEDICATION.

.—— — —— —__ —__ ___ —___ —_—

0

I ❑ No se vi6 el envase — la informaci6n

662 fue dada por el respondedor

38

298
PIO. ZCuanto de la PI 1. i Le aconsej6 P12, ZLa (medjcine) Ie P13. ZQU6 es 10 que hate cuando

(medicine) tom6? un medico hate sentirse mal esto sucede?

que tomara o Ie causa algunos

(dosage in PI 0)/ (real efectos/’’side

por (frequency effects”)?

in P1O)?

m o

667

0

660

0

669

I ❑ table ta/capsula Iclsl’ I ❑ Si– ESPECIFIQUE DO NOT READ

PROBLEMA

z ❑ cucharadita 2CIN0 1 ❑ DEJA DE USAR LA

3

ntimero M~DICINA

3 0 cucharada 2 ❑ DISMINUYE ELUSO

4 d otro 3 ❑ CONSULTA AL M<DICO

I

2CIN0 GOTO

@-@ ‘“d”a I

NEXT 4 ❑ CONTINtiATOM~NDOLA

9 ❑ NS MEDICATION SEGiJN LA RECETA

2 ❑ semana

5 ❑ OTRO

_por

veces 3 ❑ mes

6

4 I_J Otro —

ESPECIFIQUE

5

especifique

* o

667

0

660

0

669

t

1 ❑ tableta/c5psula 10s( I ❑ SI’– ESPECIFIQUE DO NOT READ.

PROBLEMA

2 ❑ cucharadita 2UN0 3

1 ❑ DEJA DE USAR LA

MEDICINA nCmerO

3 ❑ cucharada 2 ❑ DISMINUYE EL USO

4 ❑ otro

}

2UN0 GOTO 3 ❑ CONSULTA AL M~DICO

NEXT

m ““’”a

I

9 ❑ NS MEDICATION 4 ❑ CONTINtiA TOMliNDOLA

SEG(JN LA RECETA

2 I_J Semana

5 ❑ OTRO

_ por

veces 3 ❑ mes 6

ES PECIFIQUE

4 ❑ otro —

5

especifique

39

299
P7. ZMe permite ver el (envase(s) P8. ZCU51 es el problems de P9. ZTomo (dosage reported

/botella(s)) de la medicinal salud por el cual tomo ~7) por (freq=

que tom6? RECORD SPECl - usted la (medicine)? reported in ~?

FIED INFORMATION FOR PROBE FOR SYMPTOM

EACH, THEN ASK QUES- OR CONDITION.

TIONS P8 THROUGH 13

FOR EACH,

o

Etiqueta impress en:

652 I ❑ ing16s z ❑ espatiol 3❑ ambos o653 0654 1 ❑ S(P12)

.—— — ———— ———— ———— ———— —.

o655 Nombre:

20N

.——————————————_____

o

LRecetada para la SP?

656 Ins 2DN

.—— ——— ———————————— ———

0

657 Potencia:

-— ——— —___ — ____________

o650 Dosis:

-———_—————— ———— —————— —

m

Frecuencia:

.—— — ——— ———— ——— __— ——— __

IF “SEGUNSE NECESITE,’’ ASK P8 AND

GOTO NEXT MEDICATION.

.—— ——— — ——— —_— _—_— ——— ——

0

1❑ No se vio el envase — la information

662 fue dada por el respondedor

o

Etiqueta impress en:

652 1 •l ing16s 2 ❑ espaiiol 3 •l ambos o653 0654 1 ❑ S(P12)

-—————.————— ——————————

0655 Nombre:

2UN

-——— ——— ——— ——— ——— ——————

ZRecetada para la SP?

o656

10s 2CIN

-—— ——— ——— ——_— ————————

0

657 Potencia:

-——— ——— ———————— ——— ———.

-——— ——— ——— ——— ——— ——— ——.

m Frecuencia:

,-— —— ——— ——— ——— ————— ——— .

IF “SEGUN SE NECESITE,” ASK P8 AND

GO TO NEXT MEDICATION.

.—— — ———— ———_ ____— ———— —

o

I❑ No se vio el envase – la information

662 fue dada por el respondedor

O Continuation Booklet

40

300
PIO. ZCuanto de la PI 1. ZLe aconsejb P12. tLa (medicine) Ie P13. ZQU6 es 10 que hate cuando

(medicine) tomr5? un m6dico hate sentirse mal esto sucede?

que tomara o Ie causa algunos

(dosage in PI 0)/ (real efectos/’’side

por (frequency effects”)?

in PIO)?

m o667 0660 0669

i

I ❑ tableta/c5psula Ins( I ❑ SI’-ESPECIFIQUE DO NOT READ.

PROBLEMA

z ❑ cucharadita 2UN0

3

, ❑ DEJA DE USAR LA

MEDICINA

n~mero

3 ❑ cucharada 2 ❑ DISMINUYE EL USO

\

4 L1 otro 3 ❑ CONSULTAAL M~DICO

}

9- CINO GOTO 4 ❑ CONTINtiA TOM~NDOLA

m ‘“d”a

I

NEXT SEGti N LA RECETA

9 ❑ NS MEDICATION

5 ❑ OTRO

2 •l semana

por

veces

3 ❑ mes 6

ESPECIFIQUE

4 ❑ otro —

5

especifique

@-@ o667 066e o669

DO NOT READ.

!

1 ❑ tableta/capsula 10s( 1 ❑ S(– ESPECIFICIUE

PROBLEMA I IJ DEJA DE USAR LA

2 ❑ cucharadita 2Ci No MEDICINA “

3

2 ❑ DISMINUYE USO

ndmero

3 ❑ cucharada

3 II CONSULTA AL MEDICO

/

4 II otro

4 ❑ CONTINUA TOM~NDOLA

@@ ‘“dia

[

I

2CIN0 GOTO SEGtiN LA RECETA

NEXT

9 ❑ NS MEDICATION 5 ❑ OTRO

z ❑ semana

_ por

veces

3 ❑ mes 6

EsPECIFIQUE

4 ❑ otro —

5

especifique

41

301
P14. ZLe ha dicho un medico que tome algunas medicinas durante Ios 6 meses pasados que usted no tomo

durante ese pet iodo?

—

o670 1 ❑ S(P15) 2nN(Ql)

P15. 2Cuales son Ios nombres de Ias medicinas que no P16. zCual era el problems de salud que tenia pm el

tom6? PROBE FOR BRAND NAMES, ENTER cual el m6dico recomendb la (medicine)?

EACH ON SEPARATE LINE. THEN ASK P16

ANDP17 FOR EACH.

o

671

0

672

0

671

0

672

0

671

0

672

0

671

0

672

0

671

0

672

0

671

0

672

42

302
P17. ZCU51fue la razon principal por la cual no tom6 la (medicine)?

o673 I ❑ MAL EFECTO 3 ❑ PENSE QUE NO ME IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE

2 ❑ CUESTA DEMASIADO 4 II NO LA HE CONSEGUIDO TODAViA 6

0673

I ❑ MAL EFECTO 3 •l PENSk QUE NO ME IBAASERVIR 5 •l OTRO – ESPECIFIQUE

2 •l CUESTA DEMASIADO 4 ❑ NO LA HE CONSEGUIDO TODAVjA 6

0673

I ❑ MAL EFECTO 3 ❑ PENS~ QUE NO ME IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE

2 ❑ CUESTA DEMASIADO 4 ❑ NO LA HE CONS EGUIDO TODAViA 6

0673

I ❑ MAL EFECTO 3 ❑ PENSg QUE NO ME IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE

2 ❑ CUESTA DEMASIADO 4 ❑ No LA HE CONSEGUIDO TODAViA 6

0673

I ❑ MAL EFECTO 3 II PENSk QUE NO ME IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE

2 ❑ CUESTA DEMASIADO 4 ❑ NO LA HE CONSEGUIDO TODAViA 6

w

1 IJ MAL EFECTO 3 ❑ PENSk QUE NO ME IBAASERVIR 5 ❑ OTRO – ESPECIFIQUE

2 ❑ CUESTA DEMASIADO 4 ❑ NO LA HE CO NSEGUIDO TODAVfA 6

43

303
NOMBRE/SSAN

Quisi6ramos saber c6mo Ias costumbres y Ias condiciones

de salud de Ias personas est5n relacionadas con el nfimero

de silos que viven. La informacibn que nos d6 se usar%

solamente para comparar con Ias estadisticas vitales que

se mantienen en el Cenjro National de Estadisticas

de Salud del Servicio de Salud Ptiblica de Ios Estados

Unidos. Los resultados ser~n usados finicamente para

propositos estadisticos y no se utilizara identif icaci6n

individual en cualquier an61isis. Para asegurar que

nuestros dates esth completos:

Q1. ZCU51es su nombre completo, incluyendo su segundo

nom bre?

VERIFY SPELLING.

o674

primer

o675

Segundo

o676

apell ido

I

Q2. ZCU51 es la fecha de su nacimiento?

,0 / /

I @ ‘es d fa a~o

Q3. ZCU51 es el apellido de su padre? VERIFY SPELLING, I

DO NOT WRITE “SAME. ”

@ apellido del padre

I

Q4. Quisi6ramos saber su ntimero de (Seguro Social/’’Social I

Security”). Esto no tendr~ ningtin efecto sobre sus I

beneficios. Esta informacih es voluntaria y es recogida

bajo la autoridad de Ie Ley de Servicio Pfiblico (42 I

U.S.C.242K, Secci6n 306). I

zCu61 es su numero de I

(Seguro Social/’’Social Security”)? I @ – y,~r:z.-:ro-.n,- –

I

;@ Q5. CHECK ITEM: RESPONDENT I ❑ SAMPLE PERSON

2 ❑ MOTHER

MARK MAIN RESPONDENT I

3 ❑ FATHER

I

4 ❑ BROTH ER OR SISTER

5 ❑ OTHER –6

I

sPECIFY

I

Q6. IF OTHER THAN SAMPLE PERSON, EXPLAIN

REASON FOR ACCEPTING PROXY RESPONDENT. ;(ZI ‘

44

304
MEDICINA/VITAMINA MEC

DO NOT ASK IN HOUSEHOLD.

R1. REFER TO MEDICINE/VITAMIN USAGE o696❑ No medicine or vitamin reported (R3)

SECTION, MARK ONE BOX. ❑ Medicine or vitamin reported (R2)

R2. Cuando un entrevistador hablo con usted hate unas cuantas semanas, usted menciono que habia tornado (medicine/

vitamin/mineral in P2, P5, and P7, ) ZHa tornado alguna de estas medicinas durante Ias ultimas 24 horas?

10s 2CIN

R3. tHa tornado algunas (otras) medicinas, vitaminas o minerales durante Ias ultimas 24 horas?

o604 Ins 2UN

IF “S” IN EITHER R20R R3, GO TO R4. OTHERWISE END QUESTIONNAIRE.

R4. Cuales son IOS nombres de todas Ias medicinas, vitaminas R5. ZCuanto de la (medicine, vitamin or mineral) tomo

y minerales que tomrfr durante Ias Oltimas 24 horas? durante Ias ultimas 24 horas?

LNingunas otras?

o6e5

Cm

{

1 ❑ tableta/capsula

2 ❑ cucharadita

nbmero 3 ❑ cuchara

4 •l otro

o6e5 @-@

[

1 •l tableta/capsula

z •l cucharadita

3 ❑ cuchara

4 •l otro

o685

@-@

{

1 ❑ tableta/capsula

2 ❑ cucharadita

3 ❑ Cuchara

4 ❑ otro

o685

@-@

{

1 II tableta/capsu la

2 ❑ cucharadita

3 ❑ cuchara

4 ❑ otro

45

305

—.
Form PHS 6212

9/82

Department of Health and Human Sarvicsrs

Public Health Sarvica

office of Hmlth Rewerch, s~ti~ti~s,

and Technology

National Canter for Haalth Statistics

ADULT SAMPLE PERSON

SUPPLEMENT (523)

(Ages 12-74 Years)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

WESTAT

ID No:

NCHS

ID No:

o100

I I

I Stand No. Segment No. Serial No. I

J——————

OMB No. 0937-0078

Approval Expires 2/85

NOTICE – Information contained on this form

which would permit identification of any individual or establishment has been collected with a

guarantee that it will be held in strict confidence,

will be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the

establishment in accordance with section 308(d)

of the Public Health Sarvice Act (42 USC 242m),

Family No. Iu

100

SP No.

NAME (First, Middle, Last)

o109

~

INTERVIEWER NAME: NO. @

LANGUAGE OF INTERVIEW

Q

106

H English

2D Spanish

DATE OF INTERVIEW

@o I I

TIME BEGAN

@@ lCiam

2LI pm

TIME ENDED

0-0 z ❑ am

——:—— 2D w

REVIEWER NAME: NO. o113

DATE OF EXAMINATION

_l —1 —

Month Day Year

TIME

•l am

El pm

TRANSPORTATION

•1 Taxi

•1 Self

306

——
ADULT SAMPLE PERSON SUPPLEMENT

(Ages 12-74 Years)

Page

D.

G.

F.

E.

A.

c.

B.

Alcohol Consumption 6

Depression Scale 21

Diagnostic Interview Schedule 16

Drug Abuse 12

Pesticide Exposure 1

Reproductive History 2

Smoking 1

307

—
SECTION A

Al. During the past seven days, have any weed killers or

I

@ ‘n’

2CIN 9nDK

products to control plant disease been applied to your

garden or to the area immediately around your home? I

A2. During tha past seven days, have any insecticides bean 10115 10Y 2CIN 9CIDK

applied to your home, garden, yard, pets, or houseplants? Some examples of insecticides are mosquito I

repellents, roach and ant killers, no-pest strips, flea I

powders and collars, and insecticide dust.

I

I

A-3. During the past seven days, has any pesticide spilled or @ lUY

2CIN

been sprayad on any part of your body accidentally

or for any reason? I

1

A4. During the past seven days, have you worked in any of I

the following occupations or businesses:

I

Pesticide processing plant? . . . . . . . . . . . . . .

W ‘Dy

2CIN

Pesticide application or spraying? . . . . . . . . .

‘o ‘0’

2CIN

Farmwork or agriculture? . . . . . . . . . . . . . . . 10119 10’ 2CIN

SECTION B

I

B1. CHECK ITEM I@ 1 ❑ Age 12-19 (B2)

I

2 ❑ Age 20+ (Cl)

I

62. Have you smoked at least 100 cigarettes in your entire ;@ 10’ 2 •1 N(B14)

life?

I

I

B3. About how old were you when you first started smoking

IB

years old

cigarettes fairly regularly? I

number

00 ❑ never smoked regularly

I

64. Do you smoke cigarettes now?

[@

IUY(B7) 2Ci N

65. About how long has it been since you last smoked

I

@

years (69)

cigarettes (fairly regularly) ?

number

I

00 ❑ less than 1 year

I

66. About what date was that? I @-@ + yr.

1

308

—
B7. We are interested in the actual number of cigarettes I

@

00 El less than 1 per day

people smoke in a day. How many cigarettes a day

(do/did) You smoke (when You last smoked regularly)? I

cigarettes

number

IF ANSWERS IN PACKS, ASK: I

Could you give me the actual number of cigarettes? ]0

129 packs

number

B8. Was there ever a period when you smoked more than I@ IDY ZU N(BIO)

(number in B7) cigarettes a day? I

B9. During the period when you were smoking the most, ;@ 00 ❑ less than 1 per day

about how many cigarettes a day did you usually smoke?

I cigarettes

I

number

@

packs

number

I

IF 1 YEAR OR MORE IN B5, GOT0 B14.

I

Brand name(s)

BIO. What brand of cigarette (do/did) you usually smoke? I@

I@

I

IF MORE THAN ONE BRAND, ASK:

I

Brand name

BI 1. Which brand (do/did) you smoke the most? @

I

CHECK CARD SUP-1, BRAND LIST. I

IF BRAND(S) NAMED APPEAR(S) ON

LIST, ASK: I

I

B12. Is that ~ , ~ ,or —Z ?

@

INCLUDE ALL NAMES FOR THE BRAND. I

I

B13. What type of cigarettes are the (brand) that you

(smoke/smoked)? Are they: I

I

a. Filter tip or non-filter tip? . . . . . . . . . . . . . .

@

ICIFT 2DNFT9DDK

b. Menthol or plain? . . . . . . . . . . . . . . . . . . . .

@ ‘nM 20’ ‘nDK

c. Hardpack or softpack? . . . . . . . . . . . . . . . . ,@ 11JHP20SP 9CIDK

d. Regular, Kingsize, 100 or 120 millimeter? . . . .

I@ ‘DR 2nK 30100 4D1209n DK

e. High, medium, or low tar and nicotine? . . . . . @ IDH 20M 3CIL 9CIDK

1

BI 4. Does anyone (else) in your household smoke cigarettes, i@ ICIY 2UN

cigars, or a pipe inside your home?

I

SECTION C

I

Cl. CHECK ITEM @

1 ❑ Female (C2)

I

2 ❑ Male (Dl)

2

309
The next questions ask about health conditions of females I

andabouthirth history. I

C2. How old were you when your periods or menstrual cycles

I

@

00 ❑ haven’t started yet (D I )

started?

I

years old

number

C3. Have your periods stopped entirely–not counting during I@ I ❑ Y(C5) 20 N

pregnancy?

I

C4. How many days ago did your last period or menstrual

cycle end?

i @ 000 ❑ having it now

I days ago 1

(C8)

I

number J

C5. How old were you when they stopped? I@ years old

I number

C6. Have you had a hysterectomy?

@

lUY 2 ❑ N(C8)

DEFINE IF NECESSARY:

Has your uterus been removed? I

I

C7. How old were you when you had your (hysterectomy/

@

years old

uterus removad) ?

I

number

C8. Have you ever had one or both of your ovaries removed i@ IOY 20 N(C1l) 90 DK(CII)

(either when You had your uterus removed or at another

time)? I

I

C9. Were both ovaries removed or only one?

10

1 ❑ both

I

2 ❑ one

9EIDK

I

Cl 0. How old were you when you had the (ovary/ovaries) i@ years old

removed? number

I

Cl 1. Have you had a tubal ligation-that is, an operation to tie, I @ lIJY 2 ❑ N(C13) 90 DK(C13)

cut or burn your tubes so you couldn’t get pregnant?

I

1

Cl 2. How old were you when you had this operation?

@

years old

number

C13. Have you ever taken birth control pills? i@ luY 2❑ N(C22)

C14. How old were you when you began taking birth control

;@

years old

pills? number

1

310

3
C15. Are you taking birth control pills now?

I

@

1 II Y(C18) 20 N

1

C16. How long ago did you stop taking them? I

•(

I •l days

, @-@ 2 ❑ weeks

number 3 ❑ months

I

4 •l years

I

I

DO NOT READ.

I

C17. Why did you stop taking them? @

1 ❑ NORMAL CYCLE (C18)

@

1 ❑ DEPRESSION

;~

I ❑ OTHER MENTAL SIDE EFFECTS

163 1 ❑ PHYSICAL SIDE EFFECTS

}

(C22)

@

1 ❑ PHYSICIAN RECOMMENDATION

I@

1 ❑ 0THER2

I

sPECIFY

C18. SHOW CARD SUP-2, ORAL CONTRACEPTIVES 10166

CHART. I

number

Please look at this chart and show me the brand of pills I 999 ❑ DK

you are using.

I

777 ❑ other ~15G

specify

I

C19. How long have you been taking this brand of pill?

~ 00 {

1•ldays

167 - 168

2 II weeks

number 3 ❑ months

4 ❑ years

I

C20. Have you taken any other brand in the past year? @ ‘ny

2 ❑ N(C22)

C21. What other brands have you taken in the past year?

/ @-@ number ‘ number ‘ number

999 ❑ DK

!

DO NOT ASK IF “Y” IN C3. I

C22. Have you had a birth control shot within the last I@ ‘ny 2nN

6 months?

I

I

C23. About how long has it been since you had a Pap smear

test for cancer?

, @ ::: ::er

I

00❑ less than 1 year

years

number

C24. About how long has it been since you had your breasts @99n DK

examined by a doctor or other health professional?

I

98 ❑ never

00 ❑ less than 1 year

I

I

years

number

I

C25. Have you ~r been pregnant? @ lny

ZCI N(DI)

4

311
~ (@ I ❑ “Y’r in any of C3, C6 or Cll (C29)

C26. CHECK ITEM: REFER TO C3, C6, C9, AND C1l.

MARK FIRST APPLICABLE BOX.

2 ❑ “Both” in C9 (C29)

I

3 ❑ Other (C27)

C27. Are you now pregnant? l@ln Y z ❑ N(C29)

C28. Which month of pr~gnancy are you in? I

@

month

number

IF AGE60+J SKIP TO C32. OTHERWISE ASK: I

C29. (Besides this pregnancy) Have you been pregnant during @’ny

2 ❑ N(C32)

the last 12 months? I

C30. How many months ago did that pregnancy end? I @ I ❑ less than 4 months ago

I

2 ❑ 4 mos. -less than 7 mos. ago

I

3 ❑ 7 mos. -less than 10 mos. ago

a ❑ IO-12 months a90

C31. Are you now breastfeeding a child? I@ ’n’ 2CIN

I

C32. How many times have you been pregnant? Be sure to

I

,@

pregnancies

count all your pregnancies whether they ended in number

miscarriage, stillbirth, abortion, or live birth.

I

C33. What is the total number of miscarriages you have had? l@ 00 ❑ none

I miscarriages

I

number

C34. What is the total number of stillbirths you have had?

I

,@

00 ❑ none

I

stillbirths

number

C35. What is the total number of live births you have had? I @ 00 ❑ none (Dl)

I

01 ❑ one live birth (C36)

I

live births (C38)

number

C36. Did this child weigh less than 5% pounds (2500 grams)

;@ ’D’

2UN 9nDK

at birth?

C37. Was this child born with any physical or mental problem I @ I D Y(C40) ZU N(D1)

or defect? I

C38. How many of your children (who were born alive) ~ @ 00 ❑ none

weighed less than 51A pounds (2500 grams) at birth? I

I

children

number

C39. How many of your children (who were born alive) were

born with any physical or mental problem or defect?

; @ 00 ❑ ‘one ‘D1)

I

children

number

5

312
C40. Now 1 will ask about the kinds of problems your (child/children)

had at birth. Please tell me the name(s) of your (child/children) who

(was/were) born with a problem (starting with the first child born

with a problem).

LIST NAMES OF CHILDREN BELOW.

Did ––’s problem or defect involve (his/her)–

READ LIST, MARK RESPONSE FOR EACH CATEGORY FOR FIRST CHILD.

THEN, IF ANOTHER CHILD WITH A PROBLEM, SAY:

Now think about (INSERT NAME OF (SECOND/ . . . ) CHILD WITH pROBLEM).

Did this child’s problem or defect involve (his/her)–

Did ––’s problem or First or Only Child Second Child Third Child

defect involve with Problem with Problem with Problem

(his/her)–

name name name

heart? . . . . . . . . . . . . . . . @Iny 20N 90DK 01991UY 2UN 9Ci DK @lny 20N 90DK

eyes?. . . . . . . . . . . . . . . . @IUY2DN9DDK @ln Y 2DN9DDK o2oe1El Y 2CIN 90DK

ears? . . . . . . . . . . . . . . . . @10 Y2UN90DK @l UY20N90DK @lny2n N 9UDK

mouth or throat?. . . . . . . .

0 0 0

1941 UYzi3N 9UDK 2021n Y2n N9n DK 2101OY 20N 9nDK

stomach or intestines? . . . . 01g51ny2n N 9UDK 02031n Y2n N9n DK o2111ny2n N 91ZDK

kidneys or urinary system? . 0 0 0

1961OY2ON9UDK 2041n Y2n N9n DK 2121OY 2Li N 913DK

muscles, bones, or joints? . . @l UYz UN9iZDK @l UYz UN9UDK @ln Y2n N9n DK

brain or nervous system?. . . @lOY 20N 9UDK @n Y2n N9n DK O1OY 2L!N 90DK

SECTION D

I

D2. In you entire life have you had at least 12 drinks of any I O’ny 2n N(D4)

kind of alcoholic beverage?

I

I

D3. In any one year have you had at least 12 drinks of any

I

,0

lnY(D5) 2nN

kind of alcoholic beverage?

I

I

6

313
I

DO NOT READ.

D4. What isyourmain reason fornot drinking? I ~ ol ❑ NO NEED/NOT NECESSARY

I

02 ❑ DON’T CARE FOR/DISLIKE IT

03 ❑ MEDICAL/HEALTH REASONS

I

04 ❑ RELIGIOUS/MORAL REASONS

I

05 ❑ BROUGHT UP NOT TO DRINK

/

(El)

06 ❑ COSTS TOO MUCH

I

07 ❑ FAMILY MEMBER ALCOHOLIC

I

os •i INFREQUENT DRINKER

09 ❑ OTHER

I

7

10

specify

D5. Not counting small tastes, how old were you when you

@

years old

started drinking alcoholic beverages? number

!

HAND CALENDAR CARD.

I

D6. Did you have a drink during the period outlined in red? I @ 1CIY(D8)2CIN

I

D7. When was your last drink?

_/ —/_

220 - 222

/ 00 Month Day Year 7

ENTER DATE AND CHECK BOX I @ lClbef ore 4-week reference period, less than 1 year

I

from end of reference period (D32)

2 ❑ 1 or more years ago from end of reference

I

period (D64)

—–t-–..__.

D8. During that period, when did you last have a drink?

I @-@ -&&+-

1

D9. Let’s talk about the 4 weeks outlined in red. @

00 ❑ none or never (D13)

During that 4-week period, on how many days did you I

days

drink any beer?

I

number

DIO, During that 4-week period, on the day(s) when you drank

@

beers

beer, about how many beers did yOLI drink (a day)? number

I

I

DI 1. During those four weeks, what was the total number of

@

beers

beers you drank? number

I

I

D12. How many ounces were in a typical can or bottle or glass

@

ounces

that you drank during that period? number

I

I

+

D13. During that 4-week period, on how many days did you

drink any wine?

1 @ 00 •l none or never (D17)

i 7uidays I

D14. During that 4-week period, on the day(s) when you drank

;@ —

__glasses

wine, about how many glasses of wine did you drink

number

(a day)?

I

7

314
I

D15. During those four weeks, what was the total number of ,@ —–—glasses

glasses of wine that you drank?

number

I8

1

DI 6, How many ounces were in a typical glass that you drank

@

ounces

during that period?

number

I

D17. During ~ @ 00 ❑ none or never (D21) that 4-week period, on how many days did you

drink any liquor, such as whiskey, rum, gin, vodka, or

tequila? I

days

number

D18. During that 4-week period, on the day(s) when you drank

:@

drinks

liquor, such as whiskey, rum, gin, vodka, or tequila, about

number

how many drinks did you have a (day)?

I

D19. During those four weeks, what was the total number of

drinks of liquor you drank? ;@ number ‘rinks

I

I

D20. How many ounces of liquor were in a typical glass that

10

ounces

you drank during that period?

number

I

D21. CHECK ITEM: REFER TO QUESTIONS D9, D13, AND I ❑ only one beverage type (D24)

D17 AND MARK i o z ❑ drank every day (D24) FIRST APPROPRIATE BOX.

I

3 ❑ other (D22)

I number ‘ays I

D24. During those 4 weeks, did you have more than (largest @ ,UY 2 ❑ N(D29)

number in D1O, D14, or D18) drink(s) of any kind of

alcoholic beverage on a single day? —

I

I

D25. During those 4 weeks, on how many days did you have I @ 01 ❑ one day only (D28)

more than (largest number in D1O, D14, or D18) drinks(s) I

of any kind of alcoholic beverage, that is, beer, wine, or

Iiqti? I

n.rnb.r ‘ays

D26. What was the largest number of drinks you had on any I

one of those days? ,@ “umber ‘rinks

1

I

D27. On how many days during those 4 weeks did you have

10

days (D29)

(number in D26) drinks? number

I

B

315
D28. How many drinks did you have on that day? I@ drinks

number

D29. Was your drinking during those four weeks typical of i@ 1❑ Y(D31)2EI N

your drinking over the past 12 months?

I

D30. Did you drink more or less than usual during those

4 weeks?

@

)

:: ;“ (D51)

I

D31. For how many years has this been typical of your itl years (D51)

drinking?

number

I

D32. Let’s talk about the 4-week period ending the day you

had your last drink,

During those 4 weeks, on how many days did you drink

any beer? ozw 00 ❑ none or never (D36)

“umber ‘ays

D33. During that 4-week period, on the day(s) when you drank

;@ number beers

beer, about how many beers did YOU drink (a day)?

D34. During those four weeks, what was the total number of

@

beers

beers you drank?

number

I

D35. About how many ounces were in a typical can or bottle

~@

ounces

or glass of beer that you drank during that period?

number

1

D36. During those 4 weeks, on how many days did you drink

any wine?

1 @ 00 ❑ none or never (D40)

I

number ‘ays

I

D37. During that 4-week period, on the day(s) when you drank

;@

glasses

wine, about how many glasses of wine did you drink

number

(a day)? I

D38. During those four weeks, what was the total number of

glasses of wine that you drank? o255 glasses

number

D39. About how many ounces were in a typical glass that you

drank during that period? o256 ounces

number

D40. During those 4 weeks, on how many days did you drink I

any liquor, such as whiskey, rum, gin, vodka or tequila?

, @ 00 ❑ ‘one ‘r ‘ever ‘D44)

I

davs

number

9

316
I

D41. During that 4-week period, on the day(s) when you drank

10

drinks

liquor, such as whiskey, rum, gin, vodka or tequila, about

number

how many drinks did you have (a day)? I

m

D42. During those four weeks. what was the total number of I

drinks you had? @ ““rnber ‘rinks

I

I

D43. About how many ounces of liquor were in a typical drink

@

ounces

you had during that period?

number

I

D44. CHECK ITEM: REFER TO QUESTIONS D32, D36, AND I @ I ❑ only one beverage type (D47)

D40 AND MARK FIRST APPROPRIATE BOX.

I

2 ❑ drank every day (D47)

I

3 El other (D45)

D45. I have asked you about beer, wine, and liquor separately.

Now I want you to think about them combined.

D46. During those 4 weeks, on how many days altogether did ~@ 01 ❑ one day only

you drink any kind of alcoholic beverage, that is, beer,

or wine, or~uor? I OR

I

I

__days

number

D47. Was your drinking during those 4 weeks typical of your

@

1 ❑ Y(D49) 2 ❑ N

drinking during the 12 months before your last drink?

I

D48. Did you drink more or less than usual during those ~@

1 ❑ more

4 weeks? 2 ❑ less }

(D50)

I

D49. For how many yaars did you drink the same as you did

@l

years

in the 4 weaks before your last drink?

number

I

D50. What is your main reason for not drinking since (date

in D7)?

~ @ 01 ❑ ;: l~lVN%NEcESSARY

02 II DON’T CARE FOR/DISLIKE IT

I

03 ❑ MEDICAL/HEALTH REASONS

I

M❑ RELIGIOUS/MORAL REASONS

05 ❑ ALCOHOLIC/PROBLEM DRINKING (SELF)

I

06 ❑ COSTS TOO MUCH

I

07 D FAMILY MEMBER AN ALCOHOLIC OR

PROBLEM DRINKER

I

oa ❑ INFREQUENT DRINKER

m ❑ OTHER

1 10

I

specify

D51. Now think back over the 12-month period before your

~@

months

last drink. In how many of those months did you have at

number

least one drink of any alcoholic beverage, that is, either

beer or wine or liquor? I

I

10

317
I

D52. During those months, on how many days did you have

9 or more drinks of any alcoholic beverage? I@

—

I

days

number

D53. On how many days did you have at least 5 drinks of any

alcoholic beverage?

— i@1

days

number

D54. The next few questions are about drinking during your

lifetime beginning with the age you started drinking and i

ending with your last drink. I

M/as there ever a period in your life when you considered I zzo

c?

In)’ 2 ❑ N (D57)

yourself to be a heavy drinker? I

D55. How many years were you a heavy drinker? years

number

D56. When you were a heavy drinker, how many drinks of

lo

drinks

alcoholic beverages did you have in a typical week?

number

I

D57. Was there ever a period in your life when you considered I @ lCIY 2 ❑ N (D60)

yourself to be a moderate drinker?

I

D58. How many years were you a moderate drinker?

i@ years

number

D59. When you were a moderate drinker, how many drinks

lo

drinks

of alcoholic beverages did you have in a typical week?

number

.

D60. Was there ever a period in your life when you considered I @ lDY 2 •l N (D63)

yourself to be a light drinker?

I

D61. How many years were you a light drinker? @

years

number

1

D62. When you were a light drinker, how many drinks of

~@ alcoholic beverages did You have in a typical week?

drinks

number

D63. Do you now consider yourself to be a light, moderate, @

I ❑ abstainer

or heavy drinker? 2 El light

I

a ❑ moderate

I

(El)

I

4 0 heavy

I

I

D64. The next few questions are about drinking during your

lifetime beginning with the age You started drinking and i

ending with your last drink. I

Was there ever a period in your life when You considered

p

lCIY 2 ❑ N (D67)

yourself to be a heavy drinker?

11

318
D65. How many years were you a heavy drinker?

I

@

years

number

I

D66. When you were a heavy drinker, how many drinks of

~@

drinks

alcoholic beverages did you have in a typical week? number

D67. Was there ever a period in your life when you considered

yourself to be a moderate drinker? ~ @ ‘ny 2nN(D70)

1

D68. How many years were you a moderate drinker?

lo

years

number

1

D69. When you were a moderate drinker, how many drinks of

@

drinks

alcoholic beverages did you have in a typical week? number

I

D70. Was there ever a period in your life when you considered

lo lUY

2 ❑ N (D73)

yourself to be a light drinker?

n

D71. How many years were you a light drinker? 10287 years

number

1

D72. When you were a light drinker, how many drinks of

lo

drinks

alcoholic beverages did you have in a typical week? number

1

DO NOT READ.

I

D73. What is your main reason for not drinking since (date I @ S; S B~l;%&%’15%~L%IT

in D7)?

I

03 ❑ MEDICAL/HEALTH REASONS

04 ❑ RELIGIOUS/MORAL REASONS

I

05 Cl ALCOHOLIC/PROBLEM DRINKING (SELF)

I

06 •l CC)STS TOO MUCH

07 ❑ FAMILY MEMBER AN ALCOHOLIC OR

I

PROBLEM DRINKER

I

os O INFREQUENT DRINKER

09 ❑ OTHER

I

10

specify

SECTION E

12

319
I

E2. Did you ever take any of these kinds of pills just to see ,@ IIqy 20N 9nDK

what it wfike an~ow it would work?

I ——

E3. Did you ever take ~ of these kinds of pills just to :@ lCIY 2CIN 9nDK

enjoy the feeling they give you?

I

E4. Did you ever take any of these pills for some -r

@ ‘0’

2UN 91JDK

nonmed ical reason~nd not because you needed it?

I

E5. CHECK ITEM

I

I ❑ “N” or “DK” in E2, E3 AND E4 (E7)

I @ 2 ❑ Other (E6)

I

E6. When was the most recent time you took any of these

;@

I ❑ within the past week

.—

for nonmedical reasons? z ❑ within the past month

I

3 ❑ within the past 6 months

4 ❑ 6 months to a year ago

I

5 ❑ more than a year ago

I

e ❑ more than two years ago

7 ❑ more than 5 years ago

I

9CIDK

I

E7. How old were you when you first had a chance to try ~@

years old

marijuana or hash if you wanted to?

number

I

9e ❑ DK

00 ❑ never had chance (E12)

ES. About how old were you the first time you tried :@ years old

marijuana or hash?

number

I

99 ❑ DK

I

00 ❑ never used (E12)

E9. When was the most recent time you used marijuana

or hash? — —

@

I ❑ within the past week

2 ❑ within the past month

I

3 ❑ within the past 6 months

I

4 ❑ 6 months to a year ago

s ❑ more than a year ago

I

}

(En)

6 ❑ more than two years ago

I

7 ❑ more than 5 years ago

9CIDK

1

EIO. In the past 30 days, on how many different days did you

;@

_ days

use marijuana or hash? number

I

El 1. In your entire life, about how many times have you used i@ 1 ❑ 1-2 times

marijuana or hash?

I

2 ❑ 3-10 times

3 II 11-99 times

I

4 ❑ 100 times or more

E12. CHECK ITEM 10300 I ❑ Age 12-44 (E13)

I

2 ❑ Age45+(Fl)

320

13
E14. How old were you when you first had a chance to try

I

@

years old

one of these inhalants if you wanted to?

number

I

99 •l DK

I

00 ❑ never had chance (E18)

E15. About how old were you the first time you used one 143 years old

of these inhalants?

number

I 99 ❑ DK

I

00 ‘d never used (E18)

I

E16. Have you ever used any of the following inhalants for

kicks or to get high?

I

I

Gasoline or lighter fluid . . . . . . . . . . . . . . . . . .

,@ 10Y 20N

Spray paint . . . . . . . . . . . . . . . . . . . . . . . . . .

I@ lUY 2Ci N

Other aerosol sprays . . . . . . . . . . . . . . . . . . . .

I@ IOY 2DN

“Shoe shiner” glue, or toluene. , . . . . . . . . . . . . I@ lCIY 2UN

Lacquer thinner, other paint solvents . . . . . . . . . I@ lCIY 213N

Amylnitrite or poppers . . . . . . . . . . . . . . . . . .

I@ 10Y 2iZN

Halothane, ether, or other anesthetics . . . . . . . . . @ lnY zUN

Nitrous oxide, whippets . . . . . . . . . . . . . . . . . .

I

@

lnY 2CIN

“Locker Room” odorizers . . . . . . . . . . . . . . . .

@

10Y 2Ci N

1

E17. When was the most recent time that you used one of ;@ I ❑ within the past week

.—

these inhalants to get high or to feel good?

I

2 ❑ within the past month

3 ❑ within the past 6 months

I

4 ❑ 6 months to a year ago

I

5 ❑ more than a year ago

G ❑ more than two years ago

I

T ❑ more than 5 years ago

I

9CIDK

I

E 18. How old were You when you first had a chance to try @ years old

cocaine if you wanted to?

number

I

99 ❑ DK

I

00 ❑ never had a chance (Fl)

E19. About how old were you the first time you tried lo years old

cocaine?

number

I

99 ❑ DK

I

OO ❑ never used (Fl)

14

321
E20. When was the ——most recent time that you used cocaine? 0315 I El within the past week

2 ❑ within the past month

3 ❑ within the past 6 months

4 ❑ 6 months to a year ago

5 ❑ more than a year ago

6 ❑ more than two years ago

7 ❑ more than 5 years ago

9CIDK

15

322
SECTION F

F1. CHECK ITEM ; @ I ❑ Age .nder20 (END)

I

2 ❑ Age 20+ (F2)

o321 I El APPETITE SUMMARY: CHECK BOX IF CODE ‘5” IN F3, F4, or F5.

o322

F6. Have you ever had a period of

[~

Y~pROBE ❑ 3 F37. Did you have trouble falling asleep, staying adeep or

two weeks or more when you waking up too early?

had trouble falling asleep, ❑ 4 5

staying asleep or with waking ION o

lCIY

up too early?

363 2CIN

------- ------ ------ ------ ------ ------ ------ ---- ------ ------ ------ ------ ------ ----- ,

0323

F7. Have you ever had a period of

[

‘Y’+pROBE i_J3 F38. Were you sleeping too much?

two weeks or longer when you ❑ 4 ❑ 5

were sleeping too much? o364 lCIY

ION 2CIN

16

323
o324 1 •l SLEEP SUMMARY: CHECK BOX IF CODE ‘5’ IN F6 or F7.

o

325

FS. Has there ever been a period

[

Y+pROBE ❑ 3 F39. Were you tired out all the time?

lasting two weeks or more when H5

you felt tired out all the time? ❑ 4

o

365 lci Y

ION 2UN

o

326 I ❑ TIRED OUT SUMMARY: CHECK BOX IF CODE ‘5’ IN F8.

o

2.27

F9. Has there ever been a period

[

‘f+pROBE ❑ 3

F40. Did you talk or move more slowly than is normal

Of tlWJ weeks or more when I-J5 for you?

you talked or moved more ION ❑ 4

slowly than is normal for you?

I

o366 lnY

2CIN

------ ------ -------- -----_ -----_ -_---- ------ ------ ------ ------ ------ ------ -----., ------

0

328

F70. Has there ever been a period

[

y+pROBE ❑ 3 F41. Did you have to be moving all the time–that is you

of two weeks or more when ❑ 5 couldn’t sit still and paced up and down?

you had to be moving all the ❑ 4

time–that is, you couldn’t sit ION

o

367 lnY

still and paced up and down? 2CIN

o

329 10 SLOW, RESTLESS SUMMARY: CHECK BOX IF CODE ‘5’ IN F9 or FIO.

o

330

FI 1. Was there ever a period of

[

Y+ASK A ❑ 2 F42. Was your interest in sex a lot less than usual?

several weeks when your interest

in sex was a lot less than usual?

:: 0 5

0

IDY

❑ 8

368

20N

1 ❑ N(F12)

IF VOLUNTEERS NO INTEREST

EVER, MARK BOX8 AND SKIP

TO F12.

A. Did you tell a doctor or any other professional

about your decreased interest in sex?

o

Y+ROBE

331 ION

B. Did you take medication more than once for your

decreased interest in sex?

o

Y+ROBE

332 lCIN

C. Did your decreased interest in sex interfere with your

life or activities a lot?

YES+PROBE

o

333 I ❑ N+MARK BOX 2.

324

17
o334 I ❑ sEX SUMMARY: CHECK BOXIF CODE ’5’ IN F1l.

o335 F43. Did you feel worthless, sinful, or guilty?

F12. Has there ever been a period of y+ IJ5

o

lci Y

two weeks or more when you felt

369

2CIN

worthless, sinful or guilty? ION

o

336 1 ❑ WORTHLESS SUMMARY: CHECK BOX IF CODE ‘5’ IN F12.

o337

F13. Has there ever been a period of

[

Y+p ROBE ❑ 3

F44. Did you have a lot more trouble concentrating than is

two weeks or more when you IJ5

normal for you?

had a lot more trouble concen- ❑ 14

tratirqthan is normal for you? lCIN

1

0370 lCIY 20N

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

o

330

F14. Have you ever had a period of

[

Y+PROBE ❑ 3

F45. Did your thoughts come much slower than usual or seerr

two weeks or more when your ❑ 5

mixed up?

thoughts came much slower ❑ 4

than usual or seemed mixed up? 1 ❑ N

o

371 TOY

2CIN

o

S39 1 ❑ TROUBLE THINKING SUMMARY: CHECK BOX IF CODE ‘5’ IN F13 or F14.

o

340 F46. Did you think a lot about death–either your own,

F15. Has there ever been a period of y+

1

someone else’s or death in general?

5

two weeks or more when you o thought a lot about death– lUN

3721UY

2Ci N

either your own, someone else’s

or death in general?

------ ------ ------ ------ ------ ------ ------ ----- ------ ------ ------ ------ ------ ------ --- 0341

F47. Did you feel like you wanted to die?

F16. Has ihere ever been a period of y+

i

5

0

10Y

two weeks or more when you

373

2CIN

felt like you wanted to die? lCIN

------ ------ ------ ------ ------ ------ ------ ----- ------ ------ -_---- -_---- ------ _----- ___

o342

F48. Did you feel so low that you thought of

committing suicide?

F17. Have you ever felt so low you y+ ❑ 5

thought of committing suicide?

~

o

~74lnY

ION 2CIN

,----- ----- ----- ----- ----- ------ ----- ----- --- ------ ------ ------ ---_-- ______ ------ -_ --_,

o343 F49. Did you attempt suicide?

F18. Have you ever attempted suicide? y+ 5

0

lCIY

375 2nN lUN

o

344I❑ DEATH SUMMARY : CHECK BCX IF ANY ‘5’

CODED IN F15-F18. GO TOG1.

18

325
F19. CHECK ITEM. REFER TO SUMMARY BOXES ON

PAGES 16-18.

0345 I ❑ FEWER THAN 4 SUMMARY BOXES

CHECKED (Gl)

z ❑ 40R MORE SUMMARY BOXES CHECKED,

ND “N” IN F2 (F22)

3 ❑ 4 OR MORE SUMMARY BOXES CHECKED,

MD “Y” IN F2 (F20)

F20, You said you’ve had a period of feeling (depressed/ I

1 ❑ Y(F24)2 ❑ N

RESPONDENT’S EQUIVALENT) and also said ,@

you’ve had some other problems (MENTION ALL

QUESTIONS CODED ‘5’ IN F3-F18). Has there ever

I

been a time when the feelings of (depression/ I

RESPONDENT’S EQUIVALENT) and some of these

I

other problems occurred together, that is within the

same month? I

I

F21, So there’s never been a period when you felt (depressed/

;@

1 ❑ has been a period (F24)

RESPONDENT’S EQUIVALENT) at the same time you z ❑ never been a period (Gl)

were having some of these other problems?

I

I

F22. You said you have had periods when (MENTION ALL I@ ‘ny

7- ❑ N(GI)

QUESTIONS CODED ‘5’ IN F3-F18. ). Was there ever a

time when several of these problems occurred together– I

that is, within the same month?

F23. When you were having some of these problems at about

I@ I •l okay(Gl)

the same time, were you feeling okay, or were you feeling 7- ❑ low or equivalent

low, gloomy, blue or uninterested in everything? I

I

F24. What’s the longest spell you’ve ever had when you felt I@@

{

1 ❑ weeks

(depressed/R ESPONDENT’S EQUIVALENT) and had

I

a ❑ months number

several of these other problems at the same time? 3 ❑ years

I

F25. CHECK ITEM @

1 •l less than 2 weeks in F24 (Gl)

a ❑ other (F26)

I

F26. Have you had more than one spell when you felt

I

@ ‘Uy

zON

(depressed/R ESPON DENT’S EQUIVALENT) and had

several of these other problems at the same time?

1

1

F27. Did (this spell/any of those spells) occur just after

I

a H N(F29)

someone close to you died?

,@’ay

IF VOLUNTEERS BEGAN MORE THAN 2 MONTHS I

AFTER DEATH, MARK “N” AND SKIP TO F29. I

I

19

326
F28. Have you had any spell of depression along with these i@ 1❑ only due to death

other problems (such as MENTION SOME PROBLEMS 7+ ❑ other times or not due to death

CODED ‘5’ IN F3-F18) at times when it wasn’t due to I

a death? I

F29. Are you in one of these spells of feeling low or 10 356 1 ❑ Y(F31)

disinterested and having some of these other problems I

2CIN

now?

I

F30. When did your last spell like that end? : @ 1 ❑ within last 2weeks

z •l within last month

I 3 •l within last 6 months

I

4 ❑ within last year

I

s ❑ more than 1 year ago

F31. CHECK ITEM. i @ 1 ❑ “Y” in F26 (F32)

I

z •l more than 52 weeks or

more than 1 year in F24 (F32)

I

3 ❑ other (F33–page 16)

F32. Now I’d like to know about the time when you were i@

years old

feeling (depressed/R ESPONDENT’S EQUIVALENT)

number

I

(F33–page 16)

for at least 2 weeks and had the largest number of these

problems at the same time. How old were you at that I

time? (IF CAN’T CHOOSE: Then pick one bad spell.) 1

20

327
SECTION G

G1. I am going to read a list of ways you may have felt. Please tell me how often you have felt this way during the past

week; rarely or none of the time; some or a little of the time; occasionally or a moderate amount of time; or most ,3r all

of the time.

--------- ------ -------- _________ ------ _----- ------ ------ ------ ------ ------ ------ -m-------

Occasionally

HAND RESPONDENT CARD

SUP-5 FOR QUESTION G1.

a.

b.

c.

d.

e.

f.

9.

h.

i.

j.

k.

1.

m.

n.

o.

P.

q.

r.

s.

t.

During the past week,

that would be from (date)

through today:

I was bothered by things that usually

don’t bother me . . . . . . . . . . . . . . .

1 did not feel like eating; my appetite

was poor . . . . . . . . . . . . . . . . . . . .

I felt that 1 could not shake off the

blues even with help from my family

or friends . . . . . . . . . . . . . . . . . . .

I felt that 1 was just as good as other

people . . . . . . . . . . . . . . . . . . . . .

I had trouble keeping my mind on

what lwas doing . . . . . . . . . . . . . .

I felt depressed . . . . . . . . . . . . . . . .

1 felt that everything 1 did was an

eifort. m. . . . . . . . . . . . . . . . . . . .

I felt hopeful about the future . . . , .

I thought my life had been a

failure . . . . . . . . . . . . . . . . . . . . .

I felt fearful . . . . . . . . . . . . . . . . . .

Mysleep was restless . . . . . . . . . . . .

I was happy . . . . . . . . . . . . . . . . . .

I talked less than usual . . . . . . . . . . .

I felt lonely . . . . . . . . . . . . . . . . . .

People were unfriendly . . . . . . . . . .

I enjoy ed life . . . . . . . . . . . . . . . . .

had crying spells, . . . . . . . . . . . . ,

feltsad, . . . . . . . . . . . . . . . . . . .

felt that people disliked me . . . . . .

could not get “going” . . . . . , . . . .

Rarely or

None of

the Time

(Less than

1 Day)

o376 00

0377 00

0370 00

0379 00

0380 on

o301 00

0382 on

o383 00

0304 00

0385 on

o3e6 00

0387 00

03ee on

o

3e9 00

0390 on

o391 fJo

o392 on

o393 00

0394 00

0395 on

Some or a

Little of

the Time

(l-2 Days)

In

In

10

10

In

In

10

10

10

10

10

10

In

10

10

10

10

10

10

10

or a

Moderate

Amount of

Time

(3-4 Days)

Zn

20

20

Zn

20

Zlg

20

20

20

20

20

20

20

20

20

20

20

20

20

20

Most or

All of

the Time

(5-7 Days)

3D

30

3H

30

30

30

30

30

30

30

30

30

3 ❑

30

:3 ❑

:3 ❑

:3 ❑

:3 ❑

3 ❑

:1 ❑

21

328
Form PHS 6206

9182

OMB No. 0937-0078

Approval Expires 2/85

Department of Health and Human Sarvices

Public Health Service

office of Health Research, stitisti~s,

and Technology

National Center for Health Statistics

SPANISH VERSION

ADULT SAMPLE PERSON

QUESTIONNAIRE (521)

(Ages 12-74 Years)

HEALTH AND NUTRITION EXAMINATION SURVEY

WESTAT

ID No:

NCHS

ID No:

o100

Stand No. Segment No. Serial No.

o101

—

——— ———

NOTICE: La informaci6n contenida

formulario aue permitir~a identificar a

en este

-— cualguier

individuo o establecimiento ha sido recogida con

la garantia que serd mentenida en la m~s estricta

confidencialidad, ser~ usada s610 para Ios prop6sitos establecidos para este estudio y no ser~

divulgada o entregada a otros sin el consentimiento del individuo o del establecimiento de

acuerdo con la Seccibn 308(d) de la Ley del

Servicio de Salud Pdblica – Public Health Service

Act [42 USC 242 m).

bin&-1k-1

NAME (First, Middle, Last)

o109

EEIil!a

INTERVIEWER NAME: NO. @ REVIEWER NAME: NO. o113

I

I J II 1

LANGUAGE OF INTERVIEW

o106 In English

2!X Spanish

TIME BEGAN

@@ ,D

am

—-.—— ‘2 ❑ pm

TIME ENDED

@-@ lClam

——.—— 2!Jpm

DATE OF EXAMINATION

_l —1 —

Month Day Year

TIME

——.—— ❑ am

❑ pm

TRANSPORTATION

❑ Taxi

❑ Self

329
SPANISH VERSJON

ADULT SAMPLE PERSON SUPPLEMENT’

(Ages 12-74 Years)

Tbpico Pagina

—. .—

E. Abuso de drogas 13

D. Consumo de alcohol 6

B. El fumar 1

G. Escala de depresion 21

A. Exposition al pesticida 1

C, Historia reproductive 3

F. Programa de la entrevista diagnostic 16

330
SECTION A

Al. Durante Ios siete d(as pasados, Zse ha aplicacfo exter- ~@ 10s 21JN 90NS

minador de hierbas-malas o productos para controlar

Ias enfermedades de Ias plantas en su jard(n o en la Area I

que rodea su casa?

I

I

A2. Durante Ios siete dr’as pasados, Zse han aplicado insecti- ~@ 10s 2CIN 9CINS

cidas a su casa, jardin, patio, animales o plantas de casa?

Algunos ejemplos de insecticidal son repelentes de

mosqu itos, exterminadores de hormigas y cucarachas, I

(tiras contra-insectol”no Pest-strips”), Polvos y collares I

para las pulgas y el polvo insecticidal.

I

I

A3. Durante Ios siete alias pasados, Zse Ie ha derramado o 10 ‘Os 2EIN

rociado algfin pesticida en cualquier parte de cuerpo

ya sea por accidente o por cualquier motivo? I

I

A4. Durante IOS siete d ias pasados, Zha trabajado usted

I

en alguna de estas ocupaciones o negocios: I

Planta procesadora de pesticides? . . . . . . . . . . . .

I

,0 10s 2CIN

Aplicaci6n o rocio de pesticides? . . . . . . . . . . . . @ ‘Us 2CIN

Trabajo de (campo/finca) o en agricultural? . . . . .

@ lUS

2UN

SECTION B

B1. CHECK ITEM 10 120 I •l Age 12-19 (B2)

I

2 ❑ Age 20+ (Cl)

I

B2. ZHa fumado por 10 menos 100 cigarrillos en p IDS 2 ❑ N(B14)

toda su viola?

I

B3. MA o menos, Zqud edad tenia usted cuando empez6 ;@ afios de edad

a fumar cigarrillos bastante regularmente? n6mer0

I

00 ❑ flurlca fumb regularmente

B4. ZFuma cigarrillos ahora? ;@ 1CIS(137) 2CIN

I

B5. M4s o menos, Zhace cu~nto tiempo que dejb de fumar I@ aFios (B9)

cigarrillos (bastante regularmente)?

I

n Gmero

00 ❑ menos de un afio

I

B6. ZEn qu6 fecha fue eso m~s o menos? @@ ~

m es d fa ❑60

I

1

331
B7. Estamos interesados en el ntimero actual de. cigarrillos ;@ 00 ❑ menos de uno por d(a

que Ias personas fuman en un dia. ZCuantos cigarrillos

por dia (fuma/fumaba) usted (cuando fumaba regular- 1

cigarrillos

mente la ultima vez)?

I

n6mer0

IF ANSWERS IN PACKS, ASK: I@ cajetillas

LMe podria dar ei numero exacto de cigarrillos?

I

nilmero

I

B8. ZHubo alguna vez un per(odo cuando fumaba mas de

~@ 10’

2 ❑ N(BIO)

(number in B7) cigarrillos por dia?

I

B9. Durante el perr’odo cuando fumaba mas, Zcuantos ~ @oclrn enos de uno por dt’a

cigarrillos mas o menos fumaba por dia usualmente?

I

cigar rillos

nLmer O

I@ ~ cajetillas

numero

1

IF 1 YEAR OR MORE IN B5, GOT0 614. I

I

Nombre(s) de la marca(s)

B’IO. ZQue marca de cigarriilos (fuma/fumaba) usted

usualmente? w

w

IF MORE THAN ONE BRAND, ASK: I Nombre de la marca

I

BI 1. ZCual marca (fuma/fumaba) usted mas? ,@

1

CHECK CARD SUP-1, BRAND LIST. IF I

BRAND(S) NAMED APPEAR(S) ON

LIST ASK: I

I

B12. LESOS son X , X ,0 Z ?

@

INCLUDE ALL NAMES FOR THE BRAND, I

u

B13. ZQUe clase de cigarillos (brand) son Ios que usted

(fuma/fumaba)? ZSon:

I

I

a. Cigarillos con filtro o sin filtro? . . . . . . . . . . . . . . . I @ ICICF 2CISF ,IJNS

b. Mentolado osinmentol? . . . . . . . . . . . . . . . .. . . . I @ IDM 2Ci SM srCINS

c. Cajaopaquete suave?.. . . . . . . . . . . . . . . . . . . .

1 @ lnc 2nps ‘DNS

d. Regular, king size, 1000120 milimetros? . . . . . .

@l ‘UR 2DKS

30100 4D1Z09DNS

e. Altos, medianos, o bajos en nivel de brea y

nicotine? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I @ ICJA 2CIM 3DB ~EINS

B14. /.Fuma alguna (otra) persona de su hogar cigarrillos, ~@ 10s

20N

(puros/cigarros/tabacos), o pipa dentro de su casa?

1

2

332
SECTION C

cl. CHECK ITEM I @ I ❑ Female (C2)

I

2 ❑ Male (Dl)

Las siguientes preguntas se tratan sobre condiciones I

de salud de Ias mujeres y sobre sus partos. I !

C2. ZQU6 edad tenia cuando empezo su regla o periodos

144 00 ❑ no han empezado todavia (Dl) ;0

menstruates? Iafios de edad

n6mer0

C3. ZSe ha suspendido su regla por completo - sin contar

w

1CIS(C5) 2UN

cuando estaba embarazada?

I

~ @ooo ❑ C4. ZCuantos alias hate que termino su filtima regla o

10 tengo ahora

periodo menstrual? hate d (as

I

(C8)

1

n6mer0

C5. ZQU6 edad tenfa cuando dejo de tener su regla? @

atios de edad

I

n 6mer0

C6. ZLe han hecho una histerectomia? @

10s 2 ❑ N(C8)

DEFINE IF NECESSARY:

ZLe sacaron la matriz?

I

C7. ZQU6 edad tenia cuando le (hicieron la histerectomfa/

10

afios de edad

sacaron la matriz)?

I

n6mer0

1 I

C8. ZLe han sacado uno o ambos ovarios (ya sea cuando

I

@ ‘Us

2 ❑ N(CII) 90 NS(CI1)

Ie sacaron la matriz o en otra ocasibn)?

C9. ZLe sacaron Ios dos ovarios o S1510uno?

‘ @ 1 •l ambos

I

2 ❑ uno

I

90NS

,

C1O. ZQU6 edad tenia cuando Ie sacaron (el ovario/los I

@

afios de edad

ovarios)? n u’mero

1

C1l. ZLe han Iigado ([OS tubes/las trompas)—es decir, Ie

@ ‘us

2 ❑ N(C13) 90 NS{C13)

han hecho una operaci6n donde Ie amarran, cortan o

queman (Ios tubes/las trompas) para que no quede I

embarazada?

I

C12. ZQU15edad ten ia cuando Ie hicieron esta operaci6n?

;@

afios de edad

nimero

C13. ZHa tornado usted alguna vez p ildoras (para el control I@ 10s 2 ❑ N(C22)

de la natalidad/anticonceptivas)?

I

I I

3

333
I

C14. ZQU6 edad tenia cuando empez6 a tomar pildoras (para

el control de la natalidad/anticonceptivas)? I@ aiios de edad

I

nifmero

C75. ZEst5 tomando [as pildoras (para el control de la 1 @ IO S(C18)2CIN

natal idad/anticonceptivas) ahora? I

I

C16. ZHace cu6nto tiempo que dejb de tomarlas? I

{

I •l alias

I @@ “,..,. :: ;::;”

I

4 ❑ atios

I

I DO NOT READ.

C17. tPor qu6 dej6 de tomarlas? I @ 1 ❑ CICLO NORMAL (C18)

1 @ I •l DEPRESION

I

J@ 1 El OTROS MAL EFECTOS ME NTALES/ 1

“MENTAL SIDE EFFECTS”

I @ I U MAL EFECTOS FklCOS

(C22)

I@ I ❑ LO RECOMEND(j UN MEDICO

I @ ICI OTR02

1

ESPECIFIQUE )

SHOW CARD SUP-2, ORAL CONTRACEPTIVE I

o

166

CHART. I

n~mero

C18. Por favor mire esta tarjeta y ens&ieme la marca de

I

999 ❑ NS

Ias pildoras que usted estti usando. 177 ❑ otro 666

especif ;q ue

C?9. ZHace cu&rto tiempo que usted ha estado tomando

I

{

I ❑ d{as

esta marca de p (Idoras?

@@

Z ❑ semanas

~

3 ❑ meses

4 ❑ atios

1

I

C20. ZHa tornado usted cualquier otra marca durante el ,@ ‘us z 0 N(C22)

aiio pasado?

I

C27. <Chr15otras marcas ha tornado usted durante el

@-@ ‘ ‘ -

afio pasado?

n 6mer0 n6mer0 n;mero

!

999 ❑ NS

DO NOT ASK IF “S” IN C3. I

I

C22. lLe han dado una inyeccibn (para el control de la @’Ds 2UN

natal idad/anticonceptiva) en Ios 6 meses pasados?

!

C23. Mds o menos, icu~nto tiempo hate desde que Ie hicieron I @990NS

un (anAlisis Papanicolau/’’pap test”) para c~ncer? I

96 ❑ nunca

I

IJO ❑ menos de un aho

~

aiios

I

334

4
C24 M6s o menos, Zcu6nto tiempo hate desde que un m6dico ;@ 99 ❑ NS

u otro professional de salud Ie exam ino Ios (senos/pechos)? 98 •l nunca

I

00 ❑ menos de un afio

i

afios

niimero

C25. tHa estado usted alguna vez (embarazada/encinta)?

C26. CHECK ITEM: REFER TO C3, C6, C9, AND C1l. ;@ I ❑ “S” in any of C3, C6 or Cl 1 (C29)

MARK FIRST APPLICABLE BOX, 2 ❑ “Ambos” in C9 (C29)

I 3 ❑ Other (C27)

C27. ZEst6 usted (embarazada/encinta) ahora? J@lns a •l N (C29)

I

I C28. ZEn qu6 mes de su em barazo est~ ahora?

I

I@I

m es

I

1

IF AGE 60+, SKIP TO C32. OTHERWISE ASK:

l@ms

C29. (Ademas de este embarazo) ZHa estado embarazada ,

z ❑ N(C32)

I durante Ios 12 meses pasados? I I

I

C30. tHace cu~ntos meses que termin6 ese em barazo?

@

I ❑ hate menos de 4 meses

2 ❑ hate 4 meses — menos de 7 meses

1

3 ❑ hate 7 meses — menos de 10 meses

I

4 ❑ hate 10.IZ meses

C31. ZLe est~ dando pecho a un niiio ahora?

C32. ZCui%tas veces ha estado embarazada? Por favor, no ;@- —embarazos

olvide contar todos sus embarazos, es decir Ios numero

malpartos, nacimientos muertos, abortos, y nacimientos

I

vivos.

I

C33. LCU51 es el numero total de (malpartos/abortos

I

@

00 ❑ ninguno

espont~neos) que ha tenido? malpartos

I

n;mero

C34. ZCu5ntos niiios en total ha tenido que nacieron muertos? ;@

00 IJ ninguno

I

nacimientos muertos

n fimero

1

C35. ZCui%tos niiios en total ha tenido que nacieron vivos? ~ @ oo ❑ ninguno(Dl)

01 ❑ un nacimiento vivo (C36)

I

nacimientos vivos (C38)

n Gmero

.

C36. iPes6 este niiio menos de 5% Iibras (2500 gramo.s) I

, @ ‘n’ 2CIN 9UNS

al nacer?

C37. ZNacio este nirio con algfin problems o defecto fisico i @ 1 ❑ S (C40)2 ❑ N(DT)

o mental? I

C38. ZCu5ntos de sus niiios (que nacieron vivos) pesaron I @ 00❑ ninguno

menos de 5% Iibras (2500 gramos) al nacer?

I

—nirios

niimero

5

335
I

C39. .ZCu5ntos de sus niiios (que nacieron vivos) nacieron con ~ @ 000 ninguno (Dl)

algfin problems o defecto fisico o mental? nifios

n Gmero

I

C40, Ahora Ie VOY a preguntar sobre el tipo de problemas que (SU niiio tuvo/sus niiios tuvieron) al nacer. Por favor digame (el

nombre de su niiio que naci6/los nombres de sus niiios que nacieron) con un problems (comenzando con el Primer

nifio que nacio con un problems).

LIST NAMES OF CHILDREN BELOW,

El problems o defecto de –- , Ztuvo que ver con -

READ LIST, MARK RESPONSE FOR EACH CATEGORY FOR FIRST CHILD. THEN, IF ANOTHER CHILD

WITH A PROBLEM, SAY:

Ahora piense sobre (INSERT NAME OF (SECOND)...) CHILD WITH PROBLEM).

El problems o defecto de este niiio, Ztuvo que ver con -

El problems o Primer o finico nifio Segundo nifio Tercer nifio

defecto de –– , con problems con problems con problems

ituvo que ver con —

nombre nombre nombre

elcorazOn? . . . . . . . . . . . o19110s zUN 9CINS @ins zUN 9CINS @Ios c4UN9CINS

Iosojos? . . . . . . . . . . . . . o1921US 213N 9QNS (@us 2CIN9DNS @Ins20Ns10N5

IosoCdos? . . . . . . . . . . . . o1931CIS 2i3N 90NS @as zCi N 9CINS @10 S2UN9UNS

la boca o la garganta? . . . . o1941ns 7-UN 90NS @IOs zUN90NS 02101ns2aN9DNs

el estrimago o 10s intestines? o19510s 2UN 9UNS @Ios 2oN90NS @ms 2UN9C INS

10s riiiones o el

sistema urinario? . . . . . . . 019510s 213N 90NS @Ins 2UN9UNS @U S2tJNg~NS

Ios miisculos, Ios huesos,

o Ias coyunturas? . . . . . . . 019710s 7-UN 9CINS @IDS 2DN91JNs @us 2nN9UNS

el cerebro o el sistema

denervios? . . . . . . . . . . . o19al!JS zUN 9Ci NS @lm 2ntv9n Ns o21410s ZUN 9CINS

SECTION D

D2. En tocfa su viola, Zha tornado usted por 10 menos 12 I@ Ins 2 ❑ N(D4)

bebidas alcoh61icas de cualquier tipo?

I

D3. En cualquier afio, Zha tornado por 10 menos 12 bebidas ~@ 1CIS(D5) ZCIN

alcoh61icas de cualquier tipo?

I

6

336
D4. iCu51 es su razbn principal por no tomar? I

I

DO NOT READ.

@

1

01 ❑ NO HAY NECESIDAD/NO NECESARIO

I

02 ❑ NO ME GUSTA

I

03 ❑ RAZONES M~DICAS/DE SALUD

I CM❑ RAZONES RELIGIOSAS/MORALES

I 05 ❑ ME ENSE~ARON A NO TOMAR

I

(El)

I

w ❑ CUESTA DEMASIADO

I

07 ❑ MI EMBRO DE FAMILIAALCOHOLICO

I

0s ❑ TOMA CON POCA FRECUENCIA

I

w ❑ OTRO

I

10

especifique

D5. Sin contar probaditas, iquk edad tenfa usted cuando I

empez6 a tomar bebidas alcoh61icas? @

afios de edad

numero

HAND CALENDAR CARD. I

I

D6. ZTom6 una bebida alcoh61ica durante el per(odo @IO S(D8) 2DN

marcado en rojo?

I

D7. iCu5ndo tom6 su tiltima bebida alcoh61ica? iW ..SL,, LF07

ENTER DATE AND CHECK BOX. ;@ 1 ❑ before 4-week reference period, less

than 1 year from end of reference

I

period (D32)

I

z ❑ 1 or more years ago from end of

reference period (D64)

1

D8. Durante ese periodo, Zcu5ndo tom6 una bebida

I @@ I /

alcohdica por irltima vez? m es d b aFO

D9. Vamos a hablar sobre Ias 4 semanas marcadas en rojo. I @ oo ❑ ninguno o nunca (D13)

Durante ese periodo de 4 semanas, ien cu~ntos dfas I d (as

tom6 cerveza? I

n Gmero

DIO, Durante ese periodo de 4 semanas, en (el dfa/los I

d fas) que toms5 cerveza, ZcuAntas cervezas mA

w

cervezas

o menos tomb (per dia)?

I

nfimero

DI 1. Durante esas 4 semanas, iqu~ fue el nfimero total de

;@ cervezas

cervezas que usted tom6? n Cimero

D12. 2Cu5ntas onzas contenia la Iata o botella o vaso tipico I

@

onzas

que tom6 durante ese per(odo? numero

D13. Durante ese periodo de 4 semanas, Zen cu~ntos d(as ‘o23100❑ ninguno o nunca (D17)

tom6 vine? I d (as

ntimero

D14. Durante ese periodo de 4 semanas, en (el dia/los alias)

I@

vases

que tom6 vine, Zcui%tos vases de vino m6s o menos n~mero

tomb (per dia)? I

7

337
D15. Durante esas 4 semanas, Zqud fue el ntimero total de I@ vases

vases de vino que usted tomb?

I

n6mer0

I

D 16. LCuantas onzas conten [a un vaso tipico que usted

tomo durante ese per[odo? io

onzas

ntimero

D17. Durante ese periodo de 4 semanas, ten cu5ntos di_as

W

00 ❑ ninguno o nunca (D21)

tom6 usted Iicor, tal como whiskir ron, ginebra, vodka, j

o tequila? i

d [as

nfimero

D18. Durante ese periodo de 4 semanas, en (el dia/los dr’as)

que tomo Iicor, tal como whiski, ron, ginebra, vodka, i@

o tequila, mas o menos, Zcrxintos (tragos/Pales) tomO

I

tragos

(per dia)? n Cimero

I

D19. Durante esas 4 semanas, Zqu& fue el ntimero total de

@

tragos

(tragos/pales) que usted tom6? n;mero

D20. ~Cu5ntas onzas de Iicor contenr’a un vaso tipico que

WI

onzas

usted tomo durante ese per(odo?

I

n~mero

;@ 1 ❑ onlv one beverage Wpe (D24)

D21. CHECK ITEM: REFER TO QUESTIONS D9, D13

AND D17 AND MARK FIRST APPROPRIATE BOX.

I

z ❑ drank everv day (D24)

I 3 ❑ other (D22)

D23. Durante Ias 4 semanas marcadas en rojo, ZcuAntos d(as w

01 ❑ SOIO en Cjl’a (D29)

en total tom6 cualquier tipo de bebida alcoh61ica, es

decir cerveza, o vino o Iicor?

I

I

OR

I

alias

n 6mer0

D24. Durante esas 4 sernanas, Ztomo m5s de (largest number i~ IDS z ❑ N(D29)

in D1o, D14, o D18) (trago(s)/pale(s)) de cualquier

tipo de bebida alcoholic en su solo dia? I

I

D25. Durante esas 4 semanasr Zen cuantos d(as tom6 mA @

01 ❑ SOIO Un dia (D28)

de (largest number in DIO, D14, or D18) (trago(s)/

pale(s)) de cualquier tipo de bebida alcoh~lica, es

decir, cerveza, vino o Iicor? I

alias

n6mero

I

D26. tCu51 fuel el rirmero m5s grande de (tragos/pales)

@

tragos

que tom6 en cualquier de esos d(as? niimero

1

D27. ZEn cuiintos d(as durante esas 4 semanas tomo ;@ .dias (D29)

(number in D26) bebidas alcoholics? n6mero

I

B

338
D28. ZCu5ntos (tragos/pales) tomo ese dr’a? tragos

nGmerO

D29. tEra su consumo de alcohol durante esas 4 semanas ;@ 1 ❑ S(D31) Z ❑ N

tipico de su consumo durante Ios 12 meses pasados?

1

D30. ZDurante esas 4 semanas, tom6 usted mgs, o tom6 [@ Inr-n:s

menos, de 10 que acostumbra? Z II menos )

(D51)

I

I

D31. ZPor cu~ntos aiios ha sido esto ti_pico de su modo

W

aFios (D51)

de tomar?

I

n(imero

I

D32. Vamos a hablar sobre el per(odo de 4 semanas que

terminb el dia que tom6 su filtimo (trago/pale).

I @ 00 ❑ ninguno o nunca (D36)

Durante esas 4 semanas, Zen cu5ntos dfas tom6 I

alias

usted cerveza? I numero

D33. Durante ese periodo de 4 semanasr en (el d~a/los I

d (as) cuando tom6 cerveza, Zcuantas cervezas mds

@

cervezas

o menos tom6 (per dfa)? ntlmero

D34. Durante esas 4 semanasr Zqu6 fue el ntimero total de I

cervezas que usted tom6? @

cervezas

ntim.3r0

D35. M5s o menos, Zcu5ntas onzas conten ia la Iata, la I

botella o el vaso t(pico de cerveza que tomo @

onzas

durante ese oeriodo?

nimero

D36. Durante esas 4 semanas, ten cu~ntos alias tom6 vine? ~ @ oo ❑ ninguno o nunca (D40)

i

alias

n 6m0ro

I

D37. Durante ese peri_odo de 4 semanas, en (el d ia/los d(as)

que tom6 vine, Zcutintos vases de vino mA o menos ;@ vases

tom6 (per dia)? ntimero

1

D38. Durante esas 4 semanas, Zqfie fue el ntimero total

de vases de vino que usted tom6?

I@ vases

I

n 6mer0

D39. M5s o menos, LcuAntas onzas conten ia el vaso tipico

que usted tomti durante ese per(odo? ~@

onzas

numero

D40. Durante esas 4 semanas, Zen cu~ntos d(as tom6 Iicor ‘o257 00 ❑ ninguno o nunca (D44)

tal como whiski, ronr ginebra, vodka o tequila? I

I

d ias

n 6mer0

D41. Durante ese periodo de 4 semanas, en (el dfa/los alias) I

cuando tom6 Iicor, tal como whiski, ron, ginebra,

vodka, o tequila, m~s o menos, icu~ntos (tragos/pales) ;@

tragos

n 6mer0

tom6 (per dia)?

I

9

339
I

D42. Durante esas 4 semanas, Zqu6 fue el mlmero total de

I@

tragos

(tra90s/pales) que tom6? I

ndm9r0

D43. M5s o menos, .Zcu6ntas onzas de Iicor contenfa un I

(trago/pale) tipico que usted tomo durante ese periodo? ,0

onzas

n6mer0

1

D44. CHECK ITEM: REFER TO QUESTION D32, D36

@

1 ❑ only one beverage type (D47)

AND D40AND MARK FIRST APPROPRIATE BOX,

I

z ❑ drank every day (D47)

~

D46. Durante esas 4 semanas, Len cuantos alias en total I @ o, ❑ solo un dia

tom6 usted cualquier tipo de bebida alcoholic, es

dacir, cerveza, o vine, o Iicor? I OR

I

d{as

n6mer0

I

D47. ZEra su consumo de alcohol durante esas 4 semanas @

1 ❑ S(D49) z ❑ N

tipico de su consumo durante Ios 12 meses antes de su

filtimo (trago/pale)? I

D48, 2Durante esas 4 semanas, tomo usted m&, o tom6 @ 1 n Iilas

menos, de 10 que acostumbra? Z ❑ menos }

(D50)

I

D49, iPor cu~ntos afios tomaba usted igual a 10 que tom6 en

;@

——aiios

Ias 4 semanas antes de su filtimo (trago/pale)? nimero

I

D50. ZCU51 es su razon principal por no tomar desde I

DO NOT READ.

(date in D7)?

I

ol ❑ NO HAY NECESIDAD/NO NECESARI()

I

02 ❑ NO ME GLJSTA

I 03 ❑ RAZONES M#DIC’AS/DE SALUD

I

I

04 ❑ RAZONES RELIGIOSAS/MORALES

I

05 ‘d ALCOHOL ICO/PERSONA TIENE

I

PROBLEMA CON LA TOMADA

I

06 ❑ CUESTA DEMASIADO

I

07 El MI EMBRO DE FAMILIA ALCOH(j LIC()

I OB ❑ TOMA CON POCA FRECUENCIA

I 09 ❑ OTRO

I

10

especiflque

I

D51. Ahora piense sobre el periodo de 12 meses antes I

de su filtima bebida. tEn cu~ntos de esos meses tomo

usted por 10 menos un (trago/pale) de cualquier I@ —

bebida alcoh61ica, es decir, cerveza o vino o Iicor?

___ __meses

I

nGmerO

10

340
D52. Durante esos meses Len cu~ntos d (as tom6 9 (tragos/

kl

——_dias

pales) o mi% de cualquier bebida alcoh61ica? nimero

I

D53. LEn cuantos di’as tomo por 10 menos 5 (tragos/pales) ;@

d{as

de cualquier bebida alcoholic? nimero

D54. Las sigu ientes preguntas se ref ieren a su manera de

“ tomar durante su viola comenzando cuando usted i

empezb a tomar y terminando cuando usted tom6 I

su tiltimo (trago/pale).

I

ZHubo alguna vez un periodo en su viola cuando l@lns 2 ❑ N(D57)

consideraba que tomaba mucho? I

D55. ZPor cuintos aFios tomaba mucho? afios

n6mer0

D56. Cuando usted tomaba mucho, Zcuantos (tragos/

pales) de bebida alcoh61ica tom6 durante una i @ “,mero tragos

semana tipica? I

D57. iHubo alguna vez un periodo en su viola cuando @ 1°’7. ❑ N(D60)

consideraba que tomaba moderadamente?

I

D58. ZPor cu~ntos aiios tomaba moderadamente? aii os

n~mero

D59. Cuando usted tomaba moderadamente, Zcu5ntos I

(tragos/pales) de bebida alcoh61ica tom6 durante @

tragos

n~mero

una semana tipica?

I

D60. ZHubo alguna vez un periodo en su viola cuando i@lns 2 ❑ N (D63)

consideraba que tomaba poco?

I

D61. tPor cu~ntos afios tomaba poco?

; @ – “,me,o “os

D62. Cuando usted tomaba poco, Zcu5ntos (tragos/pales)

de bebida alcoh61ica tom6 durante una semana tipica?

; @ –n,mero ‘rages

I

D63. ZConsidera ahora que usted toma poco, moderado, ;@ 1 ❑ abstinence

o mucho? 2 ❑ poco

I

3 ❑ moderado

)

(El)

I

4 ❑ mucho

D64. Las siguientes preguntas se refieren a su manera de tomar

durante su viola comenzando cuando usted empez6 a

I

tomar y terminando cuando usted tom6 su tiltimo I

(tra90/pale).

I

ZHubo alguna vez un periodo en su viola cuando consiW ‘n’ z ❑ N(D67)

deraba que tomaba mucho?

I

11

341
I

D65. iPor cuhtos aiios tomaba mucho? I@ afios

nGmero

D66. Cuandousted tomabamucho, tcui%tos (tragos/pales) I@ tragos

de bebida alcoholic tom6 durante una semana t~pica?

I

n 6mer0

D67. iHubo alguna vez un per(odo en w viola cuando con- ~@ ID, 2 ❑ N(D70)

sideraba que tomaba moderadamente?

I

I

D68. LPor cui%tos atios tomaba moderadamente? @

atios

n~mero

I

D69. Cuando usted tomaba moderadamenter lcu5ntos I@

(tragos/pales) de bebida alcoholic tomti durante

tragos

I

n6mer0

una semana tipica?

D70. LHubo alguna vez un per(odo en su viola cuando con- l@ ,lJ~ 2U N (D73)

sideraba que tomaba poco? I

D71. tPor cuimtos aiios tomaba poco? iO287 afios

n;mero

1

D72. Cuando usted tomaba poco, icu~ntos (tragos/pales)

de bebida alcoholic tom6 durante una semana tfpica? lo

tragos

ntimero

I DO NOT READ,

D73. ZCuil es su razon principal por no tomar desde

(fecha en D7)? I@ 01 ❑ No HAY NECESIDAD/NO NECESARIID

I

I

02 ❑ NO ME GUSTA

I

03 ❑ RAZONES M~DICAS/DE SALUD

I 04 ❑ RAZONES RELIGIOSAS/MORALES

I

I

05 ❑ ALCOH6LiC0/PERSONA TIENE

PROBLEMA CON LA TOMADA

I

I

06 @ CUESTA DE MASIADO

I

07 ❑ MI EMBRO DE FAMILIAALCOH6LICC)

I os ❑ TOMA CON POCA FRECUENCIA

I

I

09 II OTRO

I

10

espedifique

12

342
SECTION E

El. INTRODUCTION.

Ahora tengo algunas preguntas sobre pildorm y otras

drogas que usted pueda haber usado.

SHOW CARD SUP-4, SEDATIVE CHART.

Por favor mire bien w Ias pildoras en esta tarjeta.

Estas p ildoras son barbittiricos y otros sedantes.

PAUSE WHILE RESPONDENT LOOKS

AT CARD,

Algunas veces Ios mddicos recetan estas pildoras para

calmar a Ias personas durante el dfa o ~ara ayudarles a

dormir durante la noche. Pero aparte de su uso m6dico,

algunas veces hay personas que toman estasp(ldoras

por si mismo para relajarse o para sentirse bien.

E2. ZHa tornado usted alguna vez cual~uiera de estos tipos

de p(ldoras s610para ver c6mo era y como Ie afectaba?

I

E3. ZHa tornado usted alguna vez cualquiera de estos tipos @ Ins

I

zUN 9UNS

de pildoras s610 para disfrutar la sensaciEmque Ie

producen? I

E4. ZHa tornado usted alguna vez cualquiera de estas @ 10s ZUN 9CINS

pildoras por~ raztm que no fue m6dica y no

porque la necesitaba? I

E5. CHECK ITEM i @ 1 ❑ “N” OR “NS” in E2, E3,~ E4 (E7)

I z ❑ Other (E6)

E6. ZCu5ndo fue la vez mA reciente en que usted tom6 I @ 1 ❑ dentro de la sernana pasada

cualquiera de estaspor razones que no fueran m6dicas?

I

z ❑ dentro del mes pasado

3 ❑ dentro de Ios tiltimos seis meses

I

4 ❑ seis meses a un afio

I

5 ❑ hate m& de un afio

G •l hate m& de dos ahos

~

7 ❑ hate m5s de 5 afios

9CINS

E7.

I

ZQU6 edad tenia cuando tuvo la primers ocasi6n de

@

afios de edad

probar la marijuana o el “hashish” si hubiera querido n imero

hacerlo?

I

99 ❑ Ns

1

00 ❑ nunca tuvo ocasi6n (E12)

I

ES. M5s o menos, Zqu6 edad tenia la primers vez que prob6

/ @ ‘n6t-nero “osdee dad la marijuana o el “hashish”?

I

99 ❑ Ns

00 ❑ nunca ljsij (E12)

I

13

343
E9. ZCu5ndo fue la vez m~s reciente en que usted US6 la I @ I ❑ dentro de la sernana pasada

marijuana o el “hashish”? I

z ❑ dentro del mes pasado

I

3 ❑ dentro de Ios tiltimos seis meses

4 ❑ sei~ meses a Ljn afio

I

5 ❑ hate mas de un afio

}

(En)

I

G ❑ hate m~s de dos afios

7 ❑ hacemasde 5 afios

I

9DNS

I

E 10. En Ios 30 alias pasados, Zen cu~ntos d(as distintos uso

10

alias

marijuana o “hashish”?

I

nilmero

E 11. En su viola entera, Zcu6ntas veces miis o menos ha usado I @ 1 ❑ l-2veces

usted la marijuana o el “hashish”? I 2 ❑ 3-10 veces

I

3 ❑ 11-99 veces

4 ❑ 100 veces o mas

E12. CHECK ITEM I@ 1‘UAge 12-44 (E13)

I

z ❑ Age45+(Fl)

~

I

00 ❑ nunca tuvo ocasitm (E18)

E15. M5s o menos, ~qu~ edad ten(a la primers vez que usted

w

uso uno de estos inhalants?

I

atios de edad

n6mer0

I

99 ❑ NS

I

00 ❑ nunca uso (E18)

E16. ZHa usado alguna vez cualquiera de Ios siguientes inhalants para disfrutar la sensation que producen o para I

ponerse “high”?

I

Gasolina o fluido para encendedores . . . . . . . . . . @ 10s 2UN

Pinturas aerosoles . . . . . . . . . . . . . . . . . . . . . . I@ 10s 2UN

Otrosaerosoles . . . . . . . . . . . . . . . . . . . . . . . . w ‘Us

2UN

“Shoe Shine,” goma, toluene. . . . . . . . . . . . . . . I@ Ins 2UN

Solventes para Iacas y pinturas . . . . . . . . . . . . . .

I @ Ins 2DN

Nitrito amilico o “poppers” . . . . . . . . . . . . . . .

I

, @ ‘Us

2UN

“Halothane, “ alter, u otros anest&icos . . . . . . . . .

, 0 10s

2UN

Oxido nitroso, “whippets” . . . . . . . . . . . . . . . .

I @ 10s

20N

“Locker Room Odorizers” . . . . . . . . . . . . . . . .

I @ ‘Us

2CIN

14

344
E17. ZCu5ndo fue la vez mas reciente que uso uno de estos /0 1 ❑ dentro de la semana pasada

inhalants para disfrutar la sensation que producen 2 ❑ dentro del mes pasado

o para ponerse “high”?

I

3 ❑ dentro de Ios Ultimos Seis ryleses

I

4 ❑ Seis meses a Un afio

5 ❑ hate mas de un afio

I

6 ❑ hate mas de dos afios

I

7 ❑ hate mas de 5 afios

90NS

E 18. ~Que edad tenia usted cuando tuvo la primers ocasion I

@

aiios de edad

de probar la cocaina si hubiera querido hacerlo? n6mer0

I

99 ❑ Ns

00 •l nunca tuvo la ocasion (Fl)

I

E19. MA o menos, Zque edad tenia usted la primers vez @

arlos de edad

que probo la cocaina? n(tmero

I

99 ❑ Ns

I

00 •l nunca probo (Fl)

E20. ZCuando fue la vez mas reciente que U$O la cocaina? @

I •l dentro de la semana pasada

2 ❑ dentro del mes pasado

I

3 ❑ dentro de Ios ultimos seis meses

I

4 ❑ Seis mews a un aiio

5 U hate mas de un afio

I 6 ❑ hate mas de dos afios

I

7 ❑ hate mas de 5 afios

9UNS

I

15

345
SECTION F

I

F1. CHECK ITEM I @ ❑ Age under 20 (END)

I

❑ Age 20+ (F2)

N

t ia

‘),

~emplo,

.------

dos Iibras

:omo 10

------- ,

mentr5

‘ias

o

321 1 ❑ APPETITE SUMMARY: CHECK BOX IF CODE ‘5’ IN F3, F4, OR F5.

F6. ZAlguna vez ha tenido un

o

322 S~PROBE

[

I-J3 F37. .ZTuvo usted dificultades en conciliar el sueilo, en

per~odo de dos semanas ❑ 5 permanecer dormido, o en despertarse demasiado

o m~s en el cual tuvo ❑ 4 temprano?

dificultades en conciliar ION

el sueiio, en permanecer

o

36310s

dorm ido o en despertarse zUN

demasiado temprano?

------------ ------ ------ ------ ------ ------ -- ------ ------ _______ ______ -------- -------- --l

F7. ZAlguna vez ha tenido un

o

323 S+-PFIOBE

[

❑ 3 F38. ZEstaba usted durmiendo demasiado?

periodo de dos semanas lq5

o mA en el cual dormia ❑ 4

o

10s

demasiado? ION

3642n N

16

346
o324 1 ❑ SLEEP SUMMARY: CHECK BOX IF CODE ‘5’ IN F60R F7.

F8. .!Alguna vez Iwbo un o

[

325S-+PROBE ❑ 3 F39. tSe senti~ usted agotado todo el tiempo?

periodo de dos semanas ❑ 5

o m& en el cual se sent(a I-J4 o

Ins

agotado todo el tiempo? lCIN 36520N

o326loTIRE D OUT SUMMARY: CHECK BOX IF CODE ‘5’ IN F8.

F9. lAlguna vez hubo un o

[’

327S+PROBE ❑ 3 F40. ZHablaba o se movia usted mas despacio de 10

periodo de dos semanas ❑ 5 normal para usted?

o m& en el cual habiaba ❑ 4

o se movr’a m% despacio IUN

1

0

36610s

de 10 normal para usted? z’UN

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

F1O. LAlguna vez hubo un o

[

328!+PROBE ❑ 3 F41. ZSentia usted que tenia que estar en continuo moviperiodo de dos semanas I-J5miento, es decir no pod(a sentarse y quedarse quieto y

o m~s en el cual tenia que ❑ 4 tenia que andar de un Iado para otro?

estar en continuo movi- lCIN

miento, es decir no podia o

10s

sentarse y quedarse qu ieto

3672DN

y tenia que andar de un

Iado para otro?

o32910SLOW, RESTLESS SUMMARY: CHECK BOX IF CODE ‘5’ IN F9 OR F1O.

F1l. ZHubo alguna vez un o33o S+ASK A

[

❑ 2 F42. ZSU inter& en el sexo era mucho menos que 10

periodo de varias semanas ❑ 3 acostumbrado?

en el cual su interes sexual !74‘5 era mucho menos de 10 ❑ 8 o36810s

acostum brado? 10 N(F12) ZCIN

IF VOLUNTEERS NO INTEREST EVER,

MAR KBOX8ANDSKIPTOF12.

A. ZLe ha (dicholcontado)

a un medico u otro professional acerca de la disminucion de su interes

sexual?

o331

❑ S+PROBE

ION

B. ZHa tornado medicina miis

de una vez para la disminucion de su inter& sexual?

o332

❑ S+PROBE

lIIN

C. ZLa disminucion de su

interes sexual Ie ha (estorbado/molestado) demasiado

en su viola o en sus actividades?

o333

❑ S+PROBE

I II N+MARK BOX 2.

17

347
o334 10 SEX SUMMARY: CHECK BOX IF CODE ‘5’ IN F1l.

F43. ZSe sintio usted que no valia nada, que era unla persona

F12. iAlguna vez hubo un periodo o335 pecadora, o culpable?

de dos semanas o m~s en el cual s+ ❑ 5

se sentia que no val (a nada, que o369 Ins

era u na persona pecadora, o

ZON

ION

culpable?

o336 lo WORTHLESS SUMMARY: CHECK BOX IF CODE 15/ IN F12.

o

[

F13. ZAlguna vez hubo un per(odo 337 S+ PROBE ❑ 3 F44. ZTUVO usted mucha m~s dificultad en concentrarse

de dos semanas o mtis en el ❑ 5 de 10 que es normal para usted?

cual tenfa mucha m~s dificultad ,g4

en concentrarse de 10 que es ION o370 10s

normal para usted? zUN

------ ------ ------ ------ ------ ------ ------ --* ------ ------ ------ ------ ------ _----- ---p-- ,

0

[

F14. ZAlguna vez hubo un periodo ase S+PROBE ❑ is F45. ZLe vinieron sus pensamientos mucho mds despacio de

de dos semanas o mtis en el ❑ 5 10 acostumbrado o Ie parecian confusos?

cual sus pensamientos venian ❑ 4

mucho m& despacio de 10 ION o

Ins

acostumbrado o Ie parec~an 371z ON

con fuses?

o339 l’d TROUBLE THINKING SUMMARY: CHECK BOX IF CODE ‘5’ IN F13 OR F14.

F15. ZAlguna vez hubo un perr’odo o340 F46. ZPensb usted mucho sobre la muerte - ya sea en la

de dos semanas o m~s en el cual s+ lg5 suya, en la de alguien m6s o en la muerte en gelneral?

pensaba mucho sobre la muerte-ya

sea en la suya, en la de alguien ION

I

o

37210s

m% o en la muerte en general? zCIN

------- ------ ------- ------ -------- --------- - --_--- ----- ----- ----- ------ ----- ----,- -----

F16. lAlguna vez hubo un periodo o341 F47. &Se sinti6 usted como que querr’a morirse?

de dos semanas o m5s en el cual s+ I-J5

se sent(a como que queria morirse?

I

o

3731ns

ION 2!JN

------ ------ ----- ----- ------ ------ ------ ------ ----- --------- ----- ----- ----- ----- ,------

F 17. tAlguna vez se ha sentido tan o342 F48. ZSe sintitr tan decaido que ha pensado en suicidarse?

deca(do que ha pensado en s+ l-J~

suicidarse?

1

0

~741ns

lCIN zCIN

------ ------ ------ ------- ------ ------ ------ ----- ------- ------ ------ ------ ------- !------

F18. ZAlguna vez ha intentado o343 F49. Zlntent6 suicidarse?

suicidarse? s+ ❑ 5

o

375 10s

lIIN zCIN

o3441 ❑ DEATH SUMMARY: CHECK Box IF ANY

‘5’ CODED IN F15-F18. GO TOGI.

1.9

34e
F19. CHECK ITEM. REFER TO SUMMARY BOXES

ON PAGES 16-18.

0345 I ❑ FEWER THAN 4 SUMMARY BOXES

CHECKED (Gl)

2 ❑ 4 OR MORE SUMMARY BOXES CHECKED,

AND “N” IN F2 (F22)

3 ❑ 4 OR MORE SUMMARY BOXES CHECKED,

~ “S” IN F2 (F20)

F20. Usted ha dicho que tuvo una temporada cuando se

I

habr’a sentido (deprimido/RESPON DENT’S EQU lVA- 1

~T) y tambidn dijo que habia tenido otros problemas @

1 ❑ S(F24) ZCIN

como (MENTION ALL QUESTIONS CODED ‘5’ IN

F3-F 18). ZAlguna vez hubo una temporada en la cual I

ei sentirse (deprimido/RESPON DENT’S EQUIVALENT) I

y algunos de estos otros problemas Ie ocurrieron

juntos, es decir, dentro del mismo roes? I

F21. ZAsi es que nunca hubo una temporada en la cual se ] @ 1 ❑ ha habido un per(odo (F24)

sintio (deprimido/R ESPONDENT’S EQUIVALENT)

I

y a la vez tenia algunos de estos problemas?

I

z ❑ nunca ha habido un per(odo (Gl)

F22. Usted dijo que ha tenido temporadas en Ias que (~- @ ‘us 7- ❑ N(G1)

TION ALL QUESTIONS CODED ‘5’ IN F3-F18).

ZHubo alguna ocasion cuando varies de estos problemas I

Ie ocurrieron juntos dentro del mismo roes?

I

F23. Cuando tenia algunos de estos problemas mas o menos ~ @ 1 ❑ sentia bien (Gl)

al mismo tiempo, Zse sentia bien, o se sentia decaido,

triste, deprimido o desinteresado en todo?

I

z ❑ decaido o equivalence

F24. ZCual ha sido la temporada mas Iarga en que se ha i @@

{

1 ❑ semanas

sentido (deprimido/RESpON DENT’S EQUIVALENT) I

2‘Dmeses

y en la que al mismo tiempo ha tenido varies de estos ntimero

3 ❑ ar?os

otros problemas?

I

I

F25. CHECK ITEM i @ 1 ❑ less than 2 weeks in F24 (Gl) I

I I 2 ❑ other (F26) I

F26. ZHa tenido mas de una temporada en la que se sentia i@ IDS 20N

(deprimido/R ESPONDENT’S EQUIVALENT) y tenia

varies de estos otros problemas al mismo tiempo? I

F27. .Z(Este episodio ocurrio/Cualquiera de estos episodios

I

,@ 10s 2UN(F29)

ocurrieron) POCO despues de que alguien cercano a

usted murio?

I

IF VOLUNTEERS BEGAN MORE THAN 2 MONTHS I

AFTER DEATH, MARK “N’’ANDSKIPTO F29.

I

19

349
F28, ZHa tenido algdn episodio de depresion al mismo i@

1 ❑ solamente debido a muerte

tiempo que ten ia estos otros problem as (tales como

MENTION SOME PROBLEMS CODED ‘5’ IN F3- 1 2 ❑ otros tiempos o no debido a muerte

~) en ocasiones en que no fue debido a la muerte

de alguien? I

I

I

F29. tEsta pasando usted ahora por uno de estos episodios ;@

1 ❑ S(F31) zUN

en el cual se siente deca(do o desinteresado y tiene

algunos de estos otros problemas?

I

.

F30. tCu5ndo termin6 el irltimo episodio como ese? I @ 1 ❑ dentro de Ias tiltimas 2 sernanas

I

2 ❑ dentro del dltimo mes

3 •l dentrm de Ios tiltimos 6 meses

I

4 Cl dentro del ultimo afio

I

5 ❑ hate mas de Un aho

F31. CHECK ITEM i@ 1 ❑ “S” in F26 (F32)

z ❑ more than 52 weeks or more

I

than 1 year in F24 (F32)

I

3 ❑ other (F33 – page 16)

F32. Ahora quisiera saber acerca de la temporada en la cual

se sintio (deprimido/R ESPONDENT’S EQUIVALENT)

i@ afios de edad

por 10 menos 2 semanas y tenia al mismo tiempo el

I

nGmer O (F33 – page 16)

mayor numero de estos otros problem as. ZQU6 edad

tenia en ese tiempo? (1F CAN’T CHOOSE: Entonces I

escoja uno de Ios peores episodios. )

I

350

20
SECTION G

G 1. Le voy a leer unas frases que describen como usted podr(a haber sentido. Por favor d(game con que frecuencia se ha sentido

de esta manera durante la semana pasada: raramente o ninguna vez; alguna o poca vez; ocasionalmente o una cantidad de

tiempo moderada; o la mayor parte o todo el tiempo.

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

HAND RESPONDENT CAR DSUP-5

FOR QUESTION G1.

Durante la semana pasadar

eso es desde (f-a) hasta

el presente:

am

b.

c.

d.

e.

f.

9.

h.

i.

L

k.

1.

m.

n.

o.

Pm

r.

s.

t.

Me molestaron cosas que usualmente

nome molestan. ..,..... . . . . . .

No me sentia con ganas de comer;

teniamal apetito . . . . . . . . . . . . . .

Me sentia que no podr’a quitarme

de encima la tristeza atin con la

ayuda de mi familia o amigos. . . . . .

Sentia que yo era tan bueno como

cualquiera otra persona. . . . . . . . . .

Tenia dificultad en mantener mi

mente en 10 que estaba haciendo . . .

Me sentia deprimido . . . . . . . . . . .

Sentia que todo 10 que hacia era

unesfuerzo . . . . . . . . . . . . . . . . .

Me sentia optimists sobre

elfuturo . . . . . . . . . . . . . . . . . . .

Pens6 que mi viola habia sido

unfracaso . . . . . . . . . . . . . . . . . .

Mesentia conmiedo . . . . . . . . . . .

Mi sueiio era inquieto. . . . . . . . . . .

Estabacontento . . . . . . . . . . . . . .

Hab16 menos de 10 usual . . . . . . . . .

Mesenti solo . . . . . . . . . . . . . . . .

La gente no era amistosa. . . . . . . . .

Disfrut6de lavida . . . . . . . . . . . . .

Pas6 rates Ilorando. . . . . . . . . . . . .

Mesenti triste . . . . . . . . . . . . . . . .

Sentia que no Ie caia bien a

Iagente . . . . . . . . . . . . . . . . . . . .

No tenia ganas de hater nada. . . . . .

Raramente o

ninguna vez

(Menos de un

dia)

o376 on

o

377 on

o

378 00

0

379 00

0

3 BO 00

03e I 00

0

302 on

o303 on

o384 oi-J

o3e5 00

0306 on

o387 on

o3B8 on

o3EB on

o3eo 00

0391 on

o

392 on

o

393 00

0394 on

o

395 on

Alguna o

poca vez

(l-2 Dias)

In

10

Ocasionalmente

o una cantidad

moderada

(3-4 Dias)

20

20

20

20

20

20

2U

20

20

20

20

20

20

20

20

La mayor parte

o todo el

tiempo

(5-7 Dias)

30

30

30

30

30

3D

30

30

30

31-J

30

31-J

31-J

21

351
PHS #6209 9/8/s2 OMB NO. 0937-0078 APPROVAL EXPIRES 2/E5

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics

and Technology

National Center for Health Statistics

NOTICE: Information contained on this form which would NOTICE: La inform aci6n contenida en este formulario que

permit identification of any individual or establishment permitiria identificar a cualquier individuo o establehas been collected with a guarantee that it will be held in cimiento ha sido recogida con la garant~a que ser~ manstrict confidence, will be used only for purposes stated for tenida en la m~s estricta confidencialidad, serd usada S1510

this study, and will not be disclosed or released to others para Ios prop6sitos establecidos para este estudio, y no

without the consent of the individual or establishment in ser~ divulgada o entregada a otros sin el consentimiento

accordance with section 308(d) of the Public Health Serv- del individuo o del establecimiento de acuerdo con la

ice Act (42 USC 242m). Seccion 308(d) de la Ley del Servicio de Salud PublicaPublic Heaith Service Act (42 USC 242m).

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

DIETARY QUESTIONNAIRE (525)

cIll

WESTAT

ID #:

NCHS

ID #:

o100

Stand # Segment # Serial # I

10101 —

j__—— —— I

NAME (First, Middle, Last)

o109

0107

Family # I

o108

SP #

o110

SEX

,0 Male

20 Female

I

I

Respondent Code

(Mark all that apply)

1 ❑ -

2 cl3n -

4 cl60-

Sample Person

Spouse

Parent

Grandparent

Other 7

TIME BEGAN

Date of Recall

Mo. Day

o103

7 Clam [o.P1

I

2i3pml Day of Recall (Mark One)

o

11.91❑ -

2 clTIME ENDED o105

0104

l13am

2Upm

3 ❑-

4 ❑-

5 cl6 ❑-

7 ❑-

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

1

353
:!4.,HOUR

TIME

OF

DAY

o

FOO

01.:

02. -

03. -

04, -

05. -

06. -

07. -

08. -

FOOD AND BEVERAGES CONSUMED

:

Pa

~o

rJE FOOD DESCRIPTION

<y ITEM

@

SOURCE CODES INGESTION PERIOD CODES

Iome 1.-Breakfast

School 2.- Lunch

Restaurant 3.- Between meals

Fast Food Restaurant 4, - Dinner

Cafeteria 5.- Total Day

Vending machine

Someone e“se’s home

Other 09

SPECIFY

354

2
RECALL

PRIMARY

SECONDWORK AREA

SIZE OF EDIBLE

ARY PORTION

FOOD FOR LINE

FOOD

CODE COMPUTATIONS CARD

CODE (IF NEEDED) NO.

Ill

@ o123 & b @ @

01

I

— 02

— 03 !

1

04

~ : 05

-i, , –,

06

— 07

— 08

— 09

— 10

— 17

— 12 —

— 13

— 14

— 75

— 16

— 17

— 18

— 19

— 20 —.

— 21

— 22

— 23

— 24

— 25 —

3

355
24-HOUR

TIME

OF

DAY

FOOD AND BEVERAGES CONSUMED

FOOD

ITEM DESCRIPTION

I

1

FOOD SOURCE CODES INGESTION PERIOD CODES

ol.-

02. -

03. -

04. -

05. -

06. -

07. -

08. -

Home 1.- Breakfast

School 2.- Lunch

Restaurant 3.- Between meals

Fast Food Restaurant 4.- Dinner

Cafeteria 5.- Total Day

Vending machine

Someone else’s home

Other 09

SPECIFY

A

356
RECALL

SECOND- WORK AREA SIZE OF EDIBLE

PRIMARY ARY FOR PORTION LINE

FOOD FOOD COMPUTATIONS CARD

CODE CODE (IF NEEDED) NO.

Ill

@ o123

6 b @ @

— 26

— 27

— 28

29

— 30

— 31

— 32

— 33

— 34

— 35

— 36

— 37

— 38

— 39

— 40

— 41

— 42

— 43

— 44

— 45

— 46

— 47

— 48

— 49

— 50

5

357
1. Is what you ate yesterday the way you 1. LLO que comio ayer es como normalmente

normally eat? come?

o’28 Yes T El Si

No 2iZNo

IF “YES” SKIP TO 3.

2. In what way was what you ate yesterday 2. LEn que manera es 10 que comio ayer

different from usual? diferente de 10 come normalmente?

o129 1

3. 24-HOUR RECALL COMPLETION CODE (MARK ONE)

o‘3o I ❑ - SATISFACTORY

2 ❑ - UNSATISFACTORY

3 ❑ - REFUSAL

o131 COMMENTS 1 ❑

2

4. Are you on a special diet? 4. LEsta usted en una dieta especial?

o13z Yes I •l Si

No 2 ❑ No (Skip to Question 10)

6

350

.
5. What is the purpose of this diet? CHECK ALL

THAT APPLY.

To lose weight . . . . . . . . . . . . . . . . . . . . . o133 ID

To gain weight . . . . . . . . . . . . . . . . . . . . . o134In

For diabetes . . . . . . . . . . . . . . . . . . . . . . . . o135In

For kidney failure . . . . . . . . . . . . . . . . . . o13GlQ

For ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . o’37ICI

For diverticulitis . . . . . . . . . . . . . . . . . . . . 013B,❑

For allergies . . . . . . . . . . . . . . . . . . . . . . . olag lD

For heart trouble . . . . . . . . . . . . . . . . . . . o140 10

For high blood pressure . . . . . . . . . . . . 0141,I-J

For pregnancy . . . . . . . . . . . . . . . . . . . . . o’421❑

Other, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o143 la

5. LCual es el proposito de esta dicta? CHECK

ALLTHATAPPLY.

Para bajarde peso

Paraaumentar depeso

Porla diabetes

Porla insuficienciadel rifionlfallo renal

Porla ulcers

Por la diverticulitis

Por Ias alergias

Porenfermedaddel corazon/problemas cardiacos

Por la presi6n alta (alta presion de la sangre)

Porel embarazo

Otra

IF’’OTHER’’ DESCRIBE: 2

6. What kind ofdiet is it?

CHECK ALL THAT APPLY.

High protein . . . . . . . . . . . . . . . . . . . . . . .

High calorie . . . . . . . . . . . . . . . . . . . . . . . .

Lowfat . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Low protein . . . . . . . . . . . . . . . . . ,....,.

Lowsalt . . . . . . . . . . . . . . . . . . . . . . . . . . .

Low carbohydrates . . . . . . . . . . . . . . . . .

Low sugar . . . . . . . . . . . . . . . . . . . . . . . . .

Low calorie . . . . . . . . . . . . . . . . . . . . . . . .

Low cholesterol . . . . . . . . . . . . . . . . . . . .

Vegetarian with eggs, milk, etc. . . . . .

Vegetarian with noeggs, milk, etc. .

A bland diet . . . . . . . . . . . . . . . . . . . . . . . .

Some other type . . . . . . . . . . . . . . . . . . .

@la

@la

@lo

@ln

@lcl

o149 , ❑

o150 , a

@lo

o152 , ❑

o15310

0154 , I-J

o’551❑

o’561❑

6. ~Quetipodedieta es?

CHECKALLTHAT APPLY.

Altaen proteinas

Alta en calorias

Baja engrasas

Bajaen proteinas

Baja ensal

Baja en carbohidratos

Baja enazticar

Baja encalorias

Baja encolesterol

Vegetariana con huevos, leche, etcetera

Vegetariana sin huevos, Ieche, etcetera

Una dieta blanda—sin condimentos

Alguna otra clase

IF’’OTHERTYPE” DESCRIBE: 2

7 359
7. How long have you been on this diet? Specify

how many weeks, months, or years.

Weeks o157

Months 015E

Years o159

7. LCuanto tiempo ha estado usted en esta

dicta? Especifique cuantas semanas, meses o

anos.

Semanas

Meses

Atios

8. Was this diet prescribed by a health profes- 8. ~Le dio la dieta un professional de salud,

sional, such as a doctor, dietitian or nurse? como un medico, una dietista o enfermera?

No 2iZNo

9. Do you go off this diet often, once in a while, 9. LDiria usted que se sale de esta dieta

rarely or never? (seguido/a menudo), de vez en cuando,

raramente o nunca?

o161

Often 1 II Seguido/a menudo

Once in a while 2 ❑ De vez en cuando

Rarely or never 3 ❑ Raramente o nunca

10. Has your way of eating changed in the past 10. LHa cambiado su manera de comer en Ios tres

three months? meses pasados?

o’62 Yes I •l Si

No 2Ci No

IF “NO” SKIP TO INSTRUCTION BOX FOR DIETARY FREQUENCY.

11. How has your way of eating changed?

o163 1

11. LComo ha cambiado su manera de corner?

12. How long ago was this change? 12. &Hacecuanto tiempo que ocurrio estlecambio?

Weeks oI64 Semanas

Months o165 Meses

360

8
DIETARY FREQUENCY

INSTRUCTION BOX FOR DIETARY FREQUENCY

INTERVIEWER: SEE Q. 7 AND Q. 12 AND MARK ONE BOX ONLY.

o166 1, ❑

*2, ❑

*3. ❑

SP HAS HAD NO DIET CHAN~ RECALL PERIOD IS PAST 3 MONTHS.

SP DIET CHANGE IS 2 MONTHS OR MORE. RECALL PERIOD IS PAST 2 TO 3 MONTHS.

SP DIET CHANGE IS LESS THAN 2 MONTHS. RECALL PERIOD IS 3 MONTHS PRIOR TO

OF DIET.

*CHANGE TO APPROPRIATE INTRODUCTION FOR TIME PERIOD COVERED.

I

START

INTRODUCTION: Next, I’m going to ask you how often you usually eat certain foods. When answering

think about your diet over the past 3 months, r

Tell me if you ate these foods daily, weekly, less than once a week or ne;er during that

time.

INTRODUCTION: Ahora, me gustaria preguntarle con que frecuencia usualmente usted come ciertos

alimentos. Cuando me conteste, piense sobre 10 que usted ha comido durante Ios 3 meses

pasados, . Digame, por favor, si usted comio estos

alimentos diariamente; semana~n’te, menos de una vez por semana o nunca durante ese

tiempo.

CODING NUMBER OF TIMES CODE INTERVAL CODE

OO—NONE OR NEVER O—NEVER

99—UNKNOWN I—DAILY

77—LESS THAN ONCE A WEEK 2—WEEKLY

7—LESS THAN ONCE A WEEK

9—UNKNOWN

9

361
No. of Times Interval

13. Now I’m going to ask you about milk used as a beverage and on cereal, and

milk products.

Ahora, me gustaria preguntarle sobre Ieche que usted bebe y que usa con el

cereal, y productos Iacteos.

a.

b.

cm

d.

e.

f.

Skim milk, Iowfat milk, or buttermilk-Leche descremada, Ieche baja en

grasa, o Ieche agria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Whole milk—Leche (sin descremar/enters) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ice cream, ice milk—(Helado/nieve/mantecado), “icemilk’’. . . . . . . . . . . . . . . . .

Puddings made with milk—Pudines hechos con Ieche . . . . . . . . . . . . . . . . . . . .

Cheese including cottage cheese— Queso incluyendo “cottage cheese” . . . .

Yogurt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14.

No. of Times Interval

Mixed dishes prepared with meat, fish, poultry, or cheese, combined with rice,

pasta or vegetables, such as spaghetti with meat sauce, tacos, pizza,

“burritos,” enchiladas, tamales, or paella.

Platillos mixtos preparados con came, pescado, aves o queso, combinados con

arroz, pasta o vegetales, tales como spaghetti con salsa de came, tacos, pizza,

burritos, enchiladas, tamales, opaella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @~l@n

15. a.

b.

Shellfish, such as shrimp, clams, or oysters, fresh, frozen or canned—

Mariscos de conchs, tales como camarones, almejas, u ostiones, fresCOS,congelados o enlatados . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fish including tuna, fresh, frozen, canned, smoked, or salted—

Pescado incluyendo stun, fresco, congelado, enlatado, ahumado, o salado .

No. of Times hnterval

@~l@n

@mGm

10

362
No. of Times Interval

16. Organ meats, such as tripe, liver, brain, tongue, heart, kidney—

Carries de organos, como tripa, higado, seso, Iengua, corazon, rinon . . . . . . ...0 m @n

No. of Times Interval

17. Poultry, such as chicken, turkey, duck—

Aves, tales comopollo, (guajolote/pave), pate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @~l @n

18. a.

b.

c.

No. of Times

Luncheon meats and processed meats, for example, salami, sausages, and

hot dogs—

Carries (procesadas/frias), por ejemplo, “salami,” chorizos, “hot dogs” . . . . . em

Pork orham—Carne depuercoo Jason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @m

Beef, including hamburger, lamb or veal—

Carrie de res, incluyendo hamburguesa, carnero, o ternera . . . . . . . . . . . . . . . . @m

Interval

(EKI

@n

No. of Times Interval

19. Eggs—Huevos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @m@In

20.

No. of Times Interval

Soups—(Caldos/sopas) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ml @cl

11

363
No. of Times Interval

21. How often do you eat these fats and oils not including use in cooking?

LCon que frecuencia come usted estas grasas y aceites sin incluir el uso en

cocinar?

a.

b.

c.

d.

e.

f.

9.

h.

Margarine, vegetable oil—Margarina, aceite vegetal. . . . . . . . . . . . . . . . . . . . . . . @m @cl

Butter, cream cheese—Mantequilla, queso crema . . . . . . . . . . . . . . . . . . . . . . . . .@m@K1

Non dairy coffee creamer—Crema anific’ial para elcafe . . . . . . . . . . . . . . . . . . . . emoo

Cream, including sour cream and half and half—

Crema de Ieche, incluyendo (crema agria/’’sour cream”) y “half and half” ..@ml @a

Bacon, salt pork—Tocino (puerco salado/’’salt pork”) . . . . . . . . . . . . . . . . . . . . . . @m @El

Mayonnaise, salad dressing—Mayonesa, salsa de ensa[ada . . . . . . . . . . . . . . . . @moo

Peanut butter-( Mantequilla de cacahuate/mantequilla de mani) . . . . . . . . . . @l~J@n

Avocado, olives—Aguacater aceitunas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . omon

No. of Times Interval

22. a. Cold cereals or hot cereals such as oatmeal, cream of rice or wheat—

Cereales fries o cereales calientes como avena, crema de arroz o de

b. Rice and pastas, such as spaghetti or macaroni, and other pastas—

Arroz y pastas, tales como spaghetti o macarrones, y otras pastas ,

c. Bread, corn bread, rolls, crackers,and other grain products—

Pan, pan de maiz, panecillos, galletas saladas y otros productos

d. Corn tortillas-Tortillas de maiz .

e. Flour tortillas-Tortillas de harina

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

trigo . . @moo

. . . . . . . @lTl@--J

de grano . . @~j@n

. . . . . . . . . . . omen

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OO..@rll@)cl

364

12
No. of Times Interval

23. Legumes, such as pinto or refried beans, white, red, or black beans, blackeyed

peas, garbanzos, or nuts, including peanuts or seeds—

Legumbres, tales como (frijoles/habichuelas), garbanzos, nueces, incluyendo

(cacahuates/mani) o semillas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@~[ @D

24. a,

b.

c.

d.

e.

f.

9.

h.

No. of Times

All kinds of fruits, fresh, dry, canned, or juices—

Todo tipo de frutas, frescas, secas, enlatadas o jugos . . . . . . . . . . . . . . . . . . . . .

@m

Citrus fruits or juice, such as oranges or grapefruits—

Frutas or jugos citricos, tales como (naranjas/chinas) o toronjas . . . . . . . . . . .

@ ml

Deep yellow or orange fruits such as peaches, apricots, melon, cantaloupes,

mangos, or papaya—

Frutas amarillas o anaranjadas tal como (duraznos/melocotones),

(chavacanes)albaricoques), melones, mangos, (papayadfrutas bombas) . . . . .@m

All kind of vegetables, fresh, frozen, canned, pickled, or juices—

Todo tipo de vegetales, frescos, congelados, enlatados, en vinagre, o jugos

devegetales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@ml

Bright orange or dark green vegetables such as carrots, squash, hot red

peppers, greens, spinach, broccoli—

Vegetales de color naranja o verde oscuro, tales como zanahorias,

calabazas, (chiIes/ajis) rojos picantes, espinaca, brocoli . . . . . . . . . . . . . . . . . . . .

@ [~~

Vegetables such as peppers, tomatoes, salsas, cabbage—

Vegetales tal como (chiles/ajis), tomates, salsas, repollo . . . . . . . . . . . . . . . . . . . @m

Potatoes—papas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

........@m

Bananas or plantains—(bananas/guineos) o platanos . . . . . . . . . . . . . . . . . . . . . . Q’ m

13

365
25. a,

b.

c.

Candy, syrup, jelly, honey or molasses—

(Dulces/caramelos), siropes, jaleas, miel o (melaza/melado

Sugar added on foods and to all beverages—

No. of Times

de cant) . . . . . . . . @m

El azticar anadido a Ias comidas y a todas Ias bebidas . . . . . . . . . . . . . . . . . . . . o245

Sodas excluding diet sodasSodas excluyendo sodas de dietas . . . . . . . . . . . . . . . . . 0247

. . . . . . . . . . . . . . . . . . . . .

I I I

I 1 I

Interval

@) •1

@ ❑

(G) m

26. a,

b.

Cake, cookies, doughnuts, or pastries—

(Queque/biscocho), galletas dulces, “donuts:’ empanadas

dolce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pies, fruit puddings, jello or sherbets—

dulces, o pan o249

. . . . . . . . . . . . . . .

No. of Times Interval

Pasteles dulces, pudines de fruta, (“jello’’/gelatina), o (sorbetes/nieves) . . . . o251

I I I

I I 1

@) lg

@ ❑

27. a.

b.

c.

No. of Times Interval

Beer—Cerveza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @in@u

Wine, sangria-Vine, sangria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@~l@n

Liquor, such as rum, tequila, cognac, whiskey, gin, vodka, etc.—

Licor, tal como ron, tequila, conac, whiski, ginebra, vodka, etcetera . . . . . . . . @~J@u

28. a.

b.

c.

d.

e.

f.

No.

Decaffeinated coffee-Cafe descafeinado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o259

Coffee-Cati . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0261

Herbal teas—Tedehierba . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0263

Tea—Te . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0265

Diet sodas—Sodas de dietas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0257

Water—Agua . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0269

of Times

I I I

I 1

I

I I I

I I I

I

Interval

—

14

366

,
No. of Times Interval

29. Potato chips, tortilla chips, crackling, popcorn, pretzels—

(Papitas fritas/’’potato chips”), (tostadad’’tortilla chips”), chicharrones,

(palomitas/rositas de maiz/’’popcorn”), “pretzels” . . . . . . . . . . . . . . . . . . . . . . . . . . . .

@n@n

30. a.

b.

c.

d.

Cocoa or chocolate added to drinks—

Cocoa o chocolate agregado a bebidas o

273

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mustard, soy sauce, tabasco sauce, worcestershire or steak saucaMostaza, salsa de soya, salsa tabasco, salsa inglesa o salsa para bistec . . . . 0275

No. of Times

Fruit flavored drinks such as Koolaid, Hi-C or Hawaiian Punch—

Bebidas que tienen saber a fruta tal como “Koolaid, Hi-C o

Punch” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Artificial sweeteners—

Endulsadores artificiales (sacarina) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hawaiian

o

277

. . . . . . . . . .

0279

. . . . . . . . . .

I I

I I I

I I

I I I

Interval

on

00

(ml

31. DIETARY FREQUENCY COMPLETION CODE (MARK ONE)

o

26’ I ❑l- SATISFACTORY

2 ❑- UNSATISFACTORY

3 ❑ REFUSAL

o

2’2 COMMENTS 1❑

2

15

367
No. of Times Interval

32, How often do you salt your food at the table?

LCon que frecuencia Ie agrega sal a su comida en la mesa? @[= @]u

No. of Times Interval

33. Including lunch how often do you buy a meal outside the home?

Incluyendo la comida de mediodia, &con que frecuencia compra una comida

fuera de la casa? @ m C]n

No. of Times Interval

34. How often do you eat frozen or canned ready-fixed meals such as TV dinners?

~Con que frecuencia come comidas congeladas o enlatadas preparadas de

antemano tal como “n/ dinners”? @ m on

35. Do you drink any type of herb tea when you 35. ~Toma alguna clase de te de hierba cuando

don’t feel well? no se siente bien?

o2B9 Yes I •! Si

No 20No

(Q37) (Q37)

36. For what kind(s) of illness do you take herb 36. &Para que tipo(s) de enfermedad(es)

tea? te de hierba?

SPECIFY: I o290 SPECIFY: 1

toma el

16
37. Who usually prepares the food at your house? 37. LQuien prepara usualmente la comida en su

casa?

RELATIONSHIP TO SAMPLE PERSON

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

Self and other . . . . . . . . . . . . . . . . . . . . . .

Mother . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Father . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Husband . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mother-in-law . . . . . . . . . . . . . . . . . . . . . .

Daughter . . . . . . . . . . . . . . . . . . . . . . . . . . .

Daughter-in-law . . . . . . . . . . . . . . . . . . . . .

Other 11

SPECIFY

o291

01 •1

02 ❑

03 ❑

04 ❑

05 ❑

06 ❑

07 •1

OB ❑

09 ❑

10 ❑

Persona misma

Persona mkmayotro

Madre

Padre

Esposo

Esposa

Suegra

Hija

Nuera

Otro 11

SPECIFY

38. Whatdoyou usuallyusewhenyou fryfoods?

Lard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Butter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Margarine . . . . . . . . . . . . . . . . . . . . . . . . . .

Shortening . . . . . . . . . . . . . . . . . . . . . . . . .

Other 7

SPECIFY

DO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0292

10

2CI

30

40

50

38. LQue es 10 que usualmente usa cuando frie

comidas?

Manteca

Aceite

Mantequilla

Margarina

Mantecavegetal

Otro 7

90

SPECIFY

NS

17

369
39. How often do you eat breakfast-almost ev- 39. ~Con que frecuencia come (desalyuno/aleryday, sometimes, rarely or never?

Everyday .,,..,...,......,,,.,.,,. ,,

Sometimes ...,....,...,,..,,.. . . . . .

Rarely or never . . . . . . . . . . . . . . . . . . . . .

Other 5

SPECIFY

muerzo/’’breakfas) ’’)-casi todos 10S alias,

algunas veces, raramente o nunca?

o293

10 Todos Ios alias

2CI Algunas veces

30 Raramente o nunca

4n Otro 5

SPECIFY

40. Including evening snacks, how often do you

eat between meals—almost everyday, sometimes, rarely or never?

mw

Everyday, .,, ,, . . . . . . . . . . . . . . . . . . . . . 10

Sometimes, . . . . . . . . . . . . . . . . . . . . . . . . 20

Rarely or never . . . . . . . . . . . . . . . . . . . . . 30

Other 5 40

SPECIFY

40. ~Con que frecuencia come entre comidas,

incluyendo bocadillos de noche—casi todos

Ios alias,algunas veces, raramente o nunca?

Todos Ios alias

Algunas veces

Raramente o nunca

Otro 5

SPECIFY

41. IANGUAGE OF INTERVIEW. MARK ONE BOX

o106

, ❑- ENGLISH

2 ❑l- SPANISH

3 ❑l- MIXED

I

MAKE SURE COVER PAGE INCLUDING “TIME ENDED” IS COMPLETE. I

INTERVIEWER NAME NO.

o112

REVIEWER NAME NO.

o113

I I

o295

USE REVERSE FOR COMMENTS I ❑

370

18
Form PHS 6214-1

Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

CONTROL RECORD (500)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

OMB No, 0937-007a

Approval Exwes 12/B4

NOTICE — Information contained on this form

which would permit identification of any individual

or establishment has been collected with a guarantee that it will be held in strict confidence, will

be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the estaba. Age b. Sex c. Coordinator 1

Iishment in accordance with section 308(d) of the

@.@ I ❑ Yrs. q : ~:ale

2 ❑ Mos. —— 0.–.

d. Reviewer e. Examination Date f. Date of Birth

@Mo. @Da. @Yr. @Mo. @Da. @yr.

@.–– –– –– –– –– –– ––

i. Name (First, Middle, Last)

Procedure Age

Group

(1) (2)

1. Physician’s Exam. All

2. Nutrition Quest. All

3. Body Measurements All

4. Venipuncture I All

5. Dental Exam. All

6. Tympanic Impedance All

Time

#--H- —— .—— ——” ——

@ o ————“——

& “ @ . ——.————“ ——

a @ ——.————“——

G @

——.————“ ——

@ (9

——. ———— ——

Staff

(5)

o

—— —

@

———

@

G–– ———

@

———

@ @ @

7. Audiometry (air) 6-74 —— ——

G– @ “–– G––

8. Vision Test 6-74 ——, —— —— “—— —— —

@ y @

9. Casual Urine Specimen 6-74 / —— —

G–”–– @ @

10. Sample Person S Jpp. 12-74 ——. —— —— “—— ———

11. Hair Collection—PM 12-19 @ @ @

FAST 20-74 —— .—— —— .—— — ——

@ @ @

12. ECG 20-74 —— —— —

13. Chest X-ray: PA M/F 20-74 @–”–– G– - @

Lat. M/F 45-74 — — — — ——. —— ———

G D @

16. Venipuncture III-FAST 20-74 —— ———

17. Gallbladder 20-74 G– ‘– G– @

Ultrasound-FAST — — —— ——” —— ———

TIME IN @ TIME OUT @

Public Health Service Act (42 USC 242rn).

g. Temperature h. GIT Priority

@ 0

—— —,—

Procedure or part of overall

procedure not done

(Enter reason for noncompletion)

(6)

@

@

In home T ❑ Yes 2UN0

@

@

@

@

@

@

@

@

@

@

@ Pregnant 1❑ Yes—DON’T X-RAY

2i3No
Form PHS 6214-9 OMB No. 0937 -007E

9/B/62 Approval Expires 12/a4

Department of Health and Human Services NOTICE — Information contained on this form

Public Health Service which would permit identification of any individual

Office of Health Research, Statistics, and Technology or establishment has been collected with a guarNational Center for Health Statistics antee that it will be held in strict confidence, will

be used only for purposes stated for this study,

PHYSICIAN’S EXAMINATION (509) and will not be disclosed or releasecl to others

(AGES 6 MONTHS -74 YEARS) without the consent of the individual or the establishment in accordance with section 308(d) of the

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY Public Health Service Act (42 USC 242m).

a. Examiner b. Reviewer c. Age: d. Sex:

{

•l Yrs. IDM

@––– @––– —— ❑ Mos. @znF

EXAMINEE SEATED

A. SKULL AND EARS Yes

l, Bossing of skull . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @jlln

No

40

40

40

No

4U

40

40

40

40

4U

40

4a

40

40

40

2. Auditory Canal Right

a. Otitisexterna, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @--@ 10

b. Purulent discharge,.,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@j ,0

Left

. . . . . . . . . . . .

10 ,,..,,. . . . . .

3. Ear Drums Right Left

Not visualized, canal completely occluded . . . . . . . . . . . . . . . . . . @-@

Not visualized, other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dull (opaque) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Transparent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Bulging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Retracted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @)-@

Calcium plaques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Reddened . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Other discolorations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Fluid, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Scars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@

Perforated

a. 20 20

b.

c.

d.

e.

f.

9.

h.

i.

jk.

1.

In In

10 10 . . . . . . . . . . . .

,,,,... . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

,..,... . . . . .

10 10

10 in

10

10

In

10

10

10 10

10 10

10 10

(a) With discharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ In

(b) Without discharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ 10

10 ,,..,,......

10 ............

4. Other, describe (@ 1

1

372
EXAMINEE SEATED

B, NARES

Right Left No

I. Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ 1 ❑ . . . . . . . . . . . . . . 1 •1 .............. 40

2. Deviated septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ 1 •1 . . . . . . . . . . . . . . 1 ❑ . . . . . . . . . . . . . . 40

3. Swollen turbinates . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ 10 . . . . . . . . . . . . . . 1 ❑ . . . . . . . . . . . . . . 4CI

4.inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ 10 . . . . . . . . . . . . . . 1 •1 . . . . . ...<<.... 4n

5. Polyps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ la ““”””””””””””” la . . . . ..4 . . . . . . . 4D

6. Other, describe @ 1

C. LIPS AND PHARYNX Yes No

l. Cheilosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n 40

2. Cyanosis oflips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lo 40

3. Enlarged tonsils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lo 40

4. Other, describe @ 1

D. EYES Yes No

I. Strabismus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lo 4CI

2. Conjunctival injection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ la 40

3. Pale conjunctiva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n 40

4, Xerophthalmia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lU 4CI

5. Keratomalacia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ la 40

6. Pterygium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lo 40

Right Left No

7. Corneal lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ In . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . . . 4n

Right Left Equal

8. Unequal pupils—Check larger . . . . . . . . . . . . . . . . . . . . . @ lo ..””” ””””””’”” ‘a ““”””’””””’””””””” 40

Abnormal Normal

9. Papillary light reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n 40

2

373
EX.AMINEE SEATED

10. Ocular Fundi

Left No

I ❑ I(DI1)

10 . . . . . . . . . . . . . .

10 . . . . . . . . . . . . . .

I ❑ (D1l)

a.

b.

c.

d.

e.

f.

9,

1-1.

i.

J

k.

1.

Globe absent . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Red reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lens opacities . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fundus notvisualized . . . . . . . . . . . . . . . . . . . .

Narrow arterioles . . . . . . . . . . . . . . . . . . . . . . . .

Tortuous arterioles . . . . . . . . . . . . . . . . . . . . . . .

AV compression . . . . . . . . . . . . . . . . . . . . . . . . .

Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exudate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Venous engorgement . . . . . . . . . . . . . . . . . . . .

Papiiledema . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disc abnormal ..,,.... . . . . . . . . . . . . . . . . . . .

@-@

@-@

@.@

@-@

@-@)

@-@

@-@

@-@

@J-@

@-@

@-@

@-@

1

1

1

1

1

1

1

1

1

1

1

1

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .

. .

. .

. .

. .

. .

. .

. .

. .

,,

. .

. .

.,.

. . .

.,.

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

4U

40

40

4U

40

4C!

4CI

4U

40

4U

❑

❑

❑

❑

❑

❑

❑

❑

❑

. . . . . . . . . . . . .,

. . . . . . . . . . . . . .

. . . . . . . . . . . . . .

. . . . . . . . . . . . . .

. . . . . . . . . . .,,,

. . . . . . . . . . . . . .

. . . . . . . . . . . . . .

. . . . . . . . . . . . ,.

11. Other, describe @ 1 —

E. NECK

l. Enlarged lymph nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Yes

in

in

No

an

an

o

❑

2. Tender lymph nodes . . .

3. Thyroid evaluation

a. WHO Classification

b. Tenderness . . . . . . .

c. Nodule . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . .

. . . .

. . . . .

. . . . . . .

,.

. . . . . . . .

3 2 1

Groups @ ❑ ❑ ❑

Yes

in

in

No

an

qn

. . . . . . . . . . . . .- @

. . . . . . . . . . . . . . @

. . . . . ,.

. . . . . . . .

. . . . . . .

. . .

. .

. . . ,.

. .

.,. . .

. .

. . .

. . . .

. . . . . . . . . . . . .

4. Other thyroid, describe @ 1

3
EXAMINEE SEATED

IF EXAMINEE LESS THAN AGE 6 YEARS, GO TO SECTION G

F. PULSE AND BLOOD PRESSURE

1.

2.

3.

4.

5.

Pulse Rate (beats per minute) @ — — —

Irregular Regular

Pulse Regularity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘u 2U

Infant Child Adult Large Thigh

Cuff Width . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n....’ ‘n.... ‘ 0 ---- 40.... ‘n

Blood Pressure Reading @ _ _ _ / @ _ _ _

Systolic Diastolic

Comments @ I

G. CHEST AND CVA

1, Inspection

a.

b.

c.

d.

e.

Beading ofribs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Asymmetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Funnel breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Pigeon breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

increased A.P. diameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

2. CVAtenderness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

3. Auscultation

Circle number(s) for area(s):

a)

b)

c)

d)

e)

f)

9)

Diminished breath

sounds . . . . @-@

Absent breath

sounds . . . . @.@

Bronchial breath

sounds . . . . @.@

Rales . . . . . @-@

Rhonchi . . . @-@

Wheeze . . . @-@

Other (@ 1

Areas

1234

1234

1234

1234

1234

1234

Yes

In

10

10

lU

la

No

40

40

40

4U

40

40

No

56 4 ❑@

56 4 ❑@

56 4 ❑@

56 4 ❑@

56 4 ❑@

56 4 ❑@

4. Other, describe @ 1

4

375
FEMALE EXAMINEE SEATED AND SUPINE

MALE EXAMINEE SUPINE ONLY

H. Breast mass(es) (age 10 and over) Yes No

a. Right . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n 4 [1

b. Left . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @’D’ 4 [1

c, Other, describe @ 1

EXAMINEESUPINE

1. HEART

1. Carotid Arteries

a.

b.

c.

d.

Right carotid pulsations . . . . . . . . . . . . . . @ I ❑ Absent 2 ❑ Diminished 4 [1 Normal

Right carotid bruit . . . . . . . . . . . . . . . . . . . @ IEI Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 [~ No.

Left carotid pulsations . . . . . . . . . . . . . . . @ I ❑ Absent 2 ❑ Diminished 4 [1 Normal

Left carotid bruit . . . . . . . . . . . . . . . . . . . . @ lIZ Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 [~ No

2. P.M.l. (Age 18 and over) . . . . . @ 1 ❑ Felt 2 ❑ Not felt (l-3)

a.interspace . . . . . . . . . . . . . . @ Jo ““’”-”””50 ““’””---60 ““””””””70

b. Midclavicular line . . . . . . . . a

lDAt 2 ❑ Inside 3 ❑ Outside

3. Thrills Yes No

a. Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n 4 [3

Base Apex

b. Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n 20

4. Heart sounds

a. lst heart sound . . . . . . . . . . . . . . . . . . . . . @ I ❑ Accentuated 2 El Diminished 4 [3 Normal

b. 2nd heartsoundaortic. . . . . . . . . . . . . . . @ 1 •l Accentuated 2 ❑ Diminished 4 [q Normal

c, 2nd heart sound pulmonic . . . . . . . . . . . . @ 1 ❑ Accentuated 2 ❑ Diminished 4 [3 Normal

d. 3rd heart sound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 1 ❑ Yes 2 ❑ Maybe 4 [g No

f. Systolic click . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 1 •l Yes 4 [~ No

5

376
EXAMINEE SUPINE

5. Murmurs Yes No

a.

b,

c.

d.

Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @7n 40

Systolic Diastolic

1 2 3 4

Location @ @ @ @l

1) Mitral 1 1 1 1

2) Aortic 2 2 2 2

3) Tricuspid 3 3 3 3

4) Pulmonic 4 4 4 4

Type @l @ @ @

1) Functional 1 1 1 1

2) Organic 2 2 2 2

3) Don’tknow 3 3 3 3

Grade @ @ @ @

1) 1 1 1 1 1

2) 2 2 2 2 2

3) 3 3

+

3 3 3

4) 4 4 4 4 4

5) 5 5 5 5 5

6) 6 6 6 6 6

6. Other, describe@ 1

1. Surgical scars . . . . . . . . . . . . . . .

Yes

..@lD

234

\

Circle areas(s) number(s)@-@ 1

2, Ascites . . . . . . . . . . . . . . . . . . . . . . . . .@ln

\

3. Bruit . . . . . . . . . . . . . . . . . . . . . . . . . . .@ln

1

Circle area(s) number(s)@-@ 1 2 3

4, Hepatomegaly . . . . . . . . . . . . . . . .

.-B

5. Splenomegaly . . . . . . . . . . . . . . . . ..@

6. Uterine enlargement . . . . . . . . . .

..@

7. Tenderness on palpation . . . . . . . . .@

Circle areas(s) number(s)@-@ 1 2 3

4

•1

•1

•1

•1

.4

8. Mass(es) . . . . . . . . . . . . . . . . . . . . . . .@ln

Circle areas(s) number(s)@-@ 1 2 3 4

9. Other findings, describe

No

4CI

56

40

40

56

40

40

40

4cl

56

40

56

7

7

7

7

89

89

89

89

@l

6

377
JIO. COMPLETE QUESTIONS 10a-c AND 11 FOR FASTING GROUP ONLY (Sample Numbers 800-999):

a. During the past year has this examinee had any attacks of @ lCIYes 20No 9 ~] DK

nausea and/or vomiting lasting more than 2 hours?

b. During the past five years has this examinee had pain in @ llZYes 20No 9 ~] DK

the gallbladder area which lasted a half hour or more?

IF “Yes” IN 10b, COMPLETE 10c:

c, Does this examinee usually feel sick to his/her stomach @ lUYes 20No 9 ~] DK

either before or after getting this pain?

11. What is your opinion of the likelihood of this examinee having @ 1❑ Definitely has gallstones

gallstones? 2❑ Probably has gallstones

3 ❑ Probably does not have gallstones

4 ❑ Definitely does not have gallstones

5❑ Unable to form opinion

378

7
EXAMINEE SUPINE

K. TANNER STAGING (Ages 10 through 17)

l, Hair —Male and Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 10 20 30 40 50

2. Genitals —Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ In 2D 3D 40 50

3. Breasts — Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 10 20 3EI 40 50

4. Other findings @ 1

L. EXTREMITIES

1, Legs

a. Abduction of hips (underage 3only) Abnormal Normal

Ortolani’s maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lU 4U

b.

c.

d.

e.

Pulsations

(1)

(2)

(3)

(4)

(5)

(6)

Right femoral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ I ❑ Absent zR Diminished 40 Normal

Rightfemoral bruit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @la Yes..... . . . . . . . . . . . . . . ..40No

Leftfemoral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ I ❑ Absent zU Diminished 4UNormal

Leftfemoral bruit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @la Yes..... . . . . . . . . . . . . . . ..40No

Right dorsalispedis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 1❑ Absent undiminished 40 Normal

Left dorsalis penis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ 1❑ Absent zDDiminished 4aNormal

Leg ulceration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @j-@ lQRight... lnLef4U None. . ..4 UNone

Severe Moderate Mild None

Edema . . . . . . . . . . . . . . . . . . . . Right . . . . . . . . . . . . . @lo . . . . ...20 . . . . ...30 . . . . ...40

Left . . . . . . . . . . . . . . . @lo . . . . ...20 . . . . . ..3CI . . . . ...40

Straight leg-raising test (Age 18and over)

(1)

(2)

(3)

Right leg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Leftleg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Pain with ankle dorsiflexion

(a) Right leg

(b) Left leg .

2. Other, describe@

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Abnormal Normal

10 4D

10 40

Yes No

In 40

la 40

8

379
EXAMINEE SEATED

M. JOINTS (Age 10 and over)

MANIFESTATIONS

1. Joints I

Tender

Right Left

Swelling

Right Left

@4@

la

@lnzl , ❑

Deformity

Right Left

Limitation of motiol

Right Left

Normal

a. Hips @ln@ ,❑ (i@-(#)

In

q-p , ❑

b. Knees

@-6& ✠✎✠ ✌❑

In

@Jn@

10

@&

10

c. Ankles @jnij

in

?-(II ,❑

@ju@

Tn

d. Feet

@J-J--

10

e. Shoulders

@&

10

?.-(3

10

@i-&

In

f. Elbows

*

g. Wrists

h. Hands @$n@

10

@6i& @6@

10 10

Epiphysial enlargement, wrists (under ageleonly) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lo

Other, specify 1

2. 40

3.

N. NEUROLOGICAL EVALUATION

Abnormal

. . . . . . . . . . . . . . . . @- @loRight .,l Cleft.... 40

Arms Legs

Normal

Coordination

Hand-wrist pronation-supination . . . . . . . . . . . . .

1

2.

3.

Sensory

Vibration . . . . . . . .

Muscles

. . . . @-@ I ❑ Right ..ln Left 1❑ Right ..llZ Left.... 4n

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. .

. .

Yes

. . . . . . . . . . . . . . . . . . . . . ,. @ ‘u

No

Weakness . . . . . . 40

Paralysis

(l) Arms . . . . . . . .

a,

b.

.. ?,.... . . . . . . . . .

. . . @-@I ❑ Right lDLeft . . . . . . . . . . . . . . . . . . . . . . . 40 . . . . . . . . .

In Left . . . . . . . . . . . . . . . . . . . . . . . . 40 (2) Legs . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@I ❑ Right

9
EXAMINEE SEATED

4. Speech evaluation

a. Stuttering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0. -

b. Other, specify @ 1

5. Kneejerks absent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Othe, describe @ I

40

0. SKIN EVALUATION

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15,

16,

Follicular hyperkeratosis

a. Arms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...........

b. Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . - . . . . . . . . . . . . . . . . . . . . .

Hyperpigmentation, hands and face . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dry or scaling skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Perifolliculitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..OO. .<...o......-

Petechiae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If present, describe @ ‘

Mosaic skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Pellagrous dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... @

Ecchymoses . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . - - . .“. . . . . . . . 0. . . . . . . . . . . . . . @

Ifyes, describe @ 1

Spider angioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -. @

Eczema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Impetigo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Scars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Urticaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Infestation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Other, describe @’

Yes

10

10

10

10

10

lIJ

10

10

in

10

10

In

10

in

10

10

No

40

40

4U

40

4CI

40

40

40

40

4n

40

40

40

40

4CI

40

10

3el
EXAMINEE SEATED

IF EXAMINEE LESS THAN AGE 6 YEARS, RECORD PULSE ONLY

P. PULSE AND BLOOD PRESSURE

1.

2.

3.

4.

5.

Pulse Rate (beats

Pulse Regularity .

per minute) @ — — —

Irregular Regular

. . . . 20

Adult Large Thigh

30. . . . 40. . . . 50

. . . . . . . . . . . . . . . . . . . . . . . @ ‘n”””” . . . .

Infant

10. . . .

Child

Cuff Width ❑ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

Blood Pressure Reading @ –Sys-ic- / @––

Diastolic

—

Comments @ 1

EXAMINEE STANDING

Q. BACK Yes

10

10

10

Left

10. ...

1 cl ....

No

4n

40

40

4n

40

No

40

40

40

40

40

40

No

40

40

1.

2.

3.

4.

Scoliosis . . . . . . . . . .

Kyphosis . . . . . . . . . .

. . . . . . . . . . . . . . . . . . “@

. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “@

Lordosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

. . . . . . . .

Tenderness Right

Sciatic notch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@j 10. . . .

Sacroiliac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @-@ 10. . . .

a.

b.

c. Other—describe @ 1

limitation of motion Yes

10

10

10

in

10

In

Yes

10

10

5. Lumbar spine

Flexion . . .

Extension .

a.

b.

c.

d.

e.

f.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Right lateral bending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Left lateral bending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Right rotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Left rotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @

6 Cervical spine limitation

a. Flexion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b, Extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I

11

382
EXAMINEE STANDING

R. GAIT Abnormal Normal

1. Simple walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ‘n “n

2.

3.

4.

5.

Bowed legs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Knock knees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . .

. . . . . . . . . . . . .

Yes

. . . . . . @ ‘n

...... @ ‘ri

Varicose Veins . . . . . . . . . . . . Right . . . . .

Left . . . . .

Other, describe @ 1

Severe Moderate Mild

@ 10. . . . . 20 . . . . . . 3CI . . . .

@ 10. . . . . 20 . . . . . . 31J . . . .

S. HEALTH STATUS

Wouldyou say the health ofthis sample person

is in general excellent, very good, good, fair,

or poor?

63 ‘n

2U

30

40

50

T. NUTRITIONAL STATUS

1.

2.

Normal nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ lo

Abnormal nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

No

40

40

None

“n

40

excellent

very good

good

fair

poor

U. WEIGHT STATUS

l. Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ la

2. Normal weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

3. Underweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

12
EXAMINEE SEATED

U. DIAGNOSTIC IMPRESSIONS AND HEALTH CARE NEEDS None T ❑

a. Condition

(List suspected

conditions and answer

questions b-e for

each condition)

b. Basis

for

Judgment

c. Confidence

in

Assessment

@ I •l Certain

2 ❑ Likely

3 •l Uncertain

d. Severity of

Condition

e. Has a Physician

been Consulted

Regarding this

Condition within

the last year?

@ I ❑ History @ I ❑ Mild (@I ❑ Y

2UN

3CIDK

2 ❑ Phy’s

Exam 2 ❑ Moderate

3 II Severe

lCD— ——-—

3 ❑ Both

@ln Y

20N

3nDK

@ @ 1 ❑ Histw’ @ 1 •l Certain

2 ❑ Likely

3 •l Uncertain

491 ❑ Mild

2 ❑ Phy’s

Exam 2 ❑ Moderate

3 ❑ Both 3 ❑ Severe

lCD— ——. —

@ @ 1 ❑ History @ I •l Certain

2 ❑ Likely

3 II Uncertain

@j) I ❑ Certain

2 ❑ Likely

3 •l Uncertain

@ I •l Certain

2 ❑ Likely

3 •l Uncertain

@ I ❑ Mild

2 ❑ Phy’s

Exam 2 ❑ Moderate

3 ❑ Both 3 ❑ Severe

lCD— ——” —

@ I ❑ History @ 1 ❑ Mild

2 ❑ Phy’s

Exam 2 ❑ Moderate

3 ❑ Both 3 ❑ Severe

lCD— ——. —

@l [ZIY

2[1N

3 [~ DK

@ 1 ❑ History

2 ❑ Phy’s

Exam 2 ❑ Moderate

3 ❑ Both 3 ❑ Severe

lcD_——.—

334

13
V. SUBSTANTIATING COMMENTS ON DIAGNOSTIC IMPRESSIONS AND HEALTH CARE NEEDS

Level of referral: @ 1 ❑ Level 1

2 ❑ Level II

3 ❑ Level Ill

14

385
Form PHS 6214-2 OMB INo, 0937-0078

9/8/82 Approval Expires 12/84

I

Departmern of Health and Human Services NOTICE — Information contained m this form

Public Health Service which would permit identification of any individual

OffIce of Health Research, Statistics, and Technology or establishment has been collected with a guarNational Center for Health Statistics antee that it will be held in strict confidence, will

BODY MEASUREMENTS (501)

(AGES 6 MONTHS -74 YEARS)

be used only for purposes stated fc~r this study,

and will not be disclosed or released to others

without the consent of the individual or the establishment in accordance with section 308(d) of the

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY Public Health Service Act (42 USC 242m).

a. Age

{

b. Sex c. Examiner No. d. Recorder No.

•l Yrs. ❑ M

— — ❑ Mos. ❑ F @––– @----

NOTE - Measure left side also if the last digit of examinee’s sample number is 3 or 6.

l. Biacromial breadth (cm),..,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ ––”–

2. Biiliac crest breadth (cm)... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G ––’–

3. Bitrochanteric breadth (cm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

..@ ––-–

4.

5.

6.

7.

8.

9.

10.

Right Side Left Side

Elbow breadth (cm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

-e –

Upper armgirth (cm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

..@ –

Triceps skinfold (mm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.@ –

Subscapular skinfold (mm) . . . . . . . . . . . . . . . . . . . . . . . . . .

..@ –

Iliac crest skinfold (mm) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

..@ –

Medial calf circumference (cm)...,. . . . . . . . . . . . . . . . . . .

.@ –

Medial calfskinfold (mm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 019–

—-— (3 ––-–

—.— @ ‘–”–

—._ o ––-– —.— 0 ‘–”–

—.— (9 ––”–

—.— @ ‘–-–

—-— D ‘–”–

11. Examinee right/lefthanded @ In Right 20 Left 3 ❑ Both 4 [1 Not sure

12. Weight (kilograms) @–––-––

13. Sitting height (cm) (ages 2 and over) @ ‘–”–

14. Standing height (cm) (ages 2 and over) @–––”–

15. Chest circumference - Midpoint

a. Chest erect (cm) (ages 2 through 7) @ ‘–”–

b. Chest supine (cm) (ages 3 and under) @ ––-

16. Head circumference (ages 7 and under) (cm) @ ‘–”–

17. Recumbent length (ages 3 and under) (cm) @–––”–

18. Crown rump length (ages 3 and under) (cm) @ ––”–

386
Form PHS 6214.4

Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

TYMPANIC IMPEDANCE (503)

(AGES 6 MONTHS -74 YEARS)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

a. Age

{

b. Sex

❑ Yrs. ❑ M

—— ❑ Mos. ❑ F

START HERE IF SAMPLE NUMBER EVEN

1. RIGHT EAR

a. EARTIP USED

@ 1❑ Rock

2 •l Conventional

b. TYMPANOGRAM

@ I ❑ Obtained

2 ❑ Not obtained - Give reason

. . Physical Volume Test@ – – - –..

d. Acoustic reflex

(@ 1•l Present

2 ❑ Absent

e. Curve shape descriptor

@ I ❑ Normal

2 ❑ Rounded peak

3 ❑ Truncated curve

4 ❑ No peak

IF “NORMAL” OR “ROUNDED PEAK,” COMPLETE

3a-b. OTHERWISE GO TO 5.

OME! No 0937.0078

APDrOVal Ewres 12/84

NOTICE — Information contained on this form

which would permit identification of any individual

or establishment has been collected with a guarantee that it will be held in strict confidence, will

be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the estab.

Iishment in accordance with section 308(d) of the

Public Health Service Act (42 USC 242m).

1

c. Tympanometer No. d. Examiner No.

@––. –__ @ ‘––

START HERE IF SAMPLE NUMBER ODD

2. LE17 EAR

a. EARTIP USED

@ 1❑ Rock

2 •l Conventional

b. TYMPANOGRAM

@ I ❑ Obtained

2 ❑ Not obtained - Give reason

c. Physical Volume Test@ – – – cc

d. Acoustic reflex

(@I ❑ Present

2 ❑ Absent

e. Curve shape descriptor

(@ I ❑ Normal

2 ❑ Rounded peak

3 ❑ Truncated curve

4 ❑ No peak

F “NORMAL” OR “ROUNDED PEAK,” COMPLETE

la-b. OTHERWISE GO TO 6.

1

387
RIGHT EAR LEFT EAR

3a. Pressure at maximum compliance (mm H20) I

4a. Pressure at maximum compliance (mm H20)

@n+

— ——

cl-

@n+

—— —

❑ -

b. Maximum compliance (cc)

@–-

b. Maximum compliance (cc)

@–-

5. Condition Affecting Test Results

Mark all that apply

@ 1❑ None

@ I ❑ Cold or sinusitis now

@ 1❑ Ear discharge

@ 1❑ Ringing/noises in ear

@ I ❑ Equipment defect

(@J I ❑ Cold/sinusitis within week

@ 1❑ Earache within week

@ I ❑ Hearing aid worn

@ I •l Patent ventilating

tube inserted

(@ I ❑ Other-Describe 2

6. Condition Affecting Test Results

Mark all that apply

@j 1 n None

@ I ❑ Cold or sinusitis now

@ I ❑ Ear discharge

@ I ❑ Ringing/noises in ear

@ I a Equipment defect

@ 1❑ Cold/sinusitis within week

@ 1❑ Earache within week

(@) I ❑ Hearing aid worn

@ I Cl Patent ventilating

tube inserted

@ I ❑ Other-Describe 2

3.98
Form PHs 6214-3

9/8/82

OMB No, 0937 -007B

Approval Expires 12/84

Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

NOTICE — Information contained on this form

which would permti identification of any individual

or establishment has been collected with a guarantee that it will be held in strict confidence, will

be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the establishment in accordance with section 308(d) of the

Public Health Service Act (42 USC 242m).

AUDIOMETRY (AIR) (502)

(AGES 6-74 YEARS)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

1

c. Audiometer No. d. Examiner No.

@––––– @–––

START HERE IF SAMPLE NUMBER ODD

a. Age

—— Yrs.

b. Sex

W

START HERE IF SAMPLE NUMBER EVEN

1. AIR CONDUCTION - RIGHT EAR 2. AIR CONDUCTION - LEH EAR

Frequency

(Hz)

(b)

Retest R with

masking on L*

(a)

Frequency

(Hz)

(b)

Hearing level

(c)

Retest L with

masking on R*

(a)

@

Hearing level

(c)

@ 1000 1000 @

2000

4000

2000

4000

500

@

500 @

1000 @ 1000

4. Condition Affecting Test Results

Mark all that apply

@ 1❑ None

@ I ❑ Cold or sinusitis now

3. Condition Affecting Test Results

Mark all that apply

@ I ❑ None

@ I ❑ Cold or sinusitis now

@ 1 H Ear discharge

@ 1❑ Ringing or other noises in ear

@ 1❑ Equipment defect

❑ Ear discharge

❑ Ringing or other noises in ear

❑ Equipment defect

❑ Cold or sinusitis within one week

❑ Earache within one week

❑ Hearing aid worn

❑ Pads out

❑ Other-Describe 2

@ I ❑ Cold or sinusitis within one week

(i@ I ❑ Earache within one week

@ 1❑ Hearing aid worn

@ I ❑ Pads out

@ 1❑ Other-Describe ‘

*Retest poorer ear with A/C masking on better ear only

if differences in A/C-HL between the two ears is 40 dB

or more

389
Form PHS 6214-7 OMB NCI,0937-0078

9/8/82 Approval %lres 12/84

I

Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

VISION TEST (507)

(AGES 6-74 YEARS)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

NOTICE — Information contained oln this form

which would permit identification of any individual

or establishment has been collected with a guarantee that it will be held in strict confidence, will

be used only for purposes statkd for this ~tudy,

and will not be disclosed or released to others

without the consent of the individual cr the estab1

Iishment in accordance with section ~08(d) of the

Public Health Service Act (42 USC 242m).

,

a. Age b. Sex

— ..

c. Examiner No.

❑ M

— — Yrs. ❑ F @–––

CHECK ITEM A: @ I ❑ Sloan Letters Used

2 ❑ Landolt Rings Used

1. DISTANCE VISION

CHECK @ I ❑ Wears glasses for test

ITEM B: 2 •l Wears contact lenses for test

3 ❑ Forgot (glasses, contact “lenses)

4 ❑ Does not wear either glasses or contact lenses for distance vision

1.

2.

3.

4.

—

VISUAL ACUITY

Both eyes without correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

START HERE IF SAMPLE NUMBER IS ODD:

Left eyewith correction if worn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

START HERE IF SAMPLE NUMBER IS EVEN:

Right eyewith correction if worn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . @j20/–– _

Both eyes with correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .-@ 2(3/ – _ _

@20/ –– _

@20/ – _ _

390
Il. BINOCUIAR VISION

Test using Random Dot E with both eyes and with glasses/contact lenses (if examinee wears glasses/contact lenses).

Distance

cm Pass/Fail

50cm . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ln P 2!3F

loo m. . . . . . . . . . . . . . . . . . . . . . . . . . . . G’np 20F

Ill. NEAR VISION

CHECK @ I •! Wears glasses for test

ITEM C:

2 ❑ Wears contact lenses for test

3 ❑ Forgot (glasses, contact lenses)

4 ❑ Does not wear either glasses or contact lenses for near vision

30 cm 40 cm 50 cm 60 cm

1. Both eyes

without correction . . . . . . 020/— — — 4320/––– (i320/––– @2t3/– __

2. Both eyes

with correction . . . . . . . . . 020/— — — @ 20/– – – @ 20/– – – @ 20/–

2

391
Form PHS 6214.10 OMIB No. 0937-0078

,9/0/82 Approval Expires 12/s4

Department of Health and Human Services NOTICE — Information contained on this form

Public Health Service which would permit identification of any individual

Office of Health Research, Statistic, and Technology or establishment has been collected with a guarNational Centar for Health Statistics antee that it will be held in strict confidence, will

GLUCOSE CHALLENGE QUESTIONNAIRE (506)

(AGES 20-74 YEARS)

be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual ortheestabIishment in accordance with sectioln Sr)s(d) of the

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY Public Health Service Act (42 USC 242m).

a. LANGUAGE OF INTERVIEW @ I ❑ English 2 ❑ Spanish

b. Coordinator

@

c. Examiner d. Date

@ @-@ ~–

—. . —— —

e. Age f. Sex g. Not Scheduled h. I ❑ First visit (Go to 1)

— — yrs. ❑ M ❑ F @la (@ 2 •l Second visit (Go to 7)

1 1

.

1. Are you currently taking insulin?

2. Are you currently taking diabetes pills?

3a. At what time did you finish your last meal?

b. Have you had anything at all to eat since (time in 3a)?

c. At what time did you last have anything at all to eat?

4a. Have you had anything to drink, other than water,

after (latest time in 3a or 3c)?

b. At what time did you last have anything at all to

drink, besides water?

c. How many hours ago did you last drink any water?

(Was it less than 10 hours ago or longer?)

CHECK ITEMA: Refer to LATEST TIME specified in 3a, 3c,

or 4b; and refer to Time Chart. MARK APPROPRIATE BOX.

RECORD PRIORITY HERE AND ON CONTROL RECORD.

1

—

@

1❑ Yes (DO NOT GIVE GTT)

2DN0

@ I ❑ Yes

20No

@ 9999❑ DK @-@ 1❑ A.M. I ❑ Yestercjay

{ — —___

20 P.M. 2 ❑ Today

t“ime

@ 1 •l Yes

2 ❑ No (4)

@ ww D DK @-@I I ❑ A.M. I ❑ Yesterday

{ —— 2 ❑ P.M. 2 ❑ Today :——

@ lU Yes 3

2 n No (CHECK ITEM A) ‘pecify

@ 9999 ❑ DK @-@ I ❑ A.M. 1❑ Yesterday

{ — —:—— 2 ❑ P.M. 2 ❑ Today

time

@ hours ago

number

OR

@ I ❑ less than 10 hours ago

2 ❑ 10 or more hours ago

❑ Glucola maybe given (5)

@ GTT Priority 2

4 ❑ Glucola may not be given (6)

NOTES

392
5a. Time fasting specimen drawn. IF NOT DRAWN, GO

TO 6.

IJ. Time glucola given. IF NOT GIVEN, GO TO 6.

... .

c. Time one-hour specimen drawn. IF NOT DRAWN, GO

TO 6.

. . .

d. Time two-hour specimen drawn. IF NOT DRAWN, GO

TO 6.

6. Mark reason for incomplete test:

a.

b.

c.

d.

:“

9.

h.

i.

j.

k.

Arrived late . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Technical error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Didnotfast atleast 10 hours.... . . . . . . . . . . . . . .

Fasted more than 16 hours . . . . . . . . . . . . . . . . . . .

Refused interview . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Refused glucola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Refused specimen . . . . . . . . . . . . . . . . . . . . . . . . . . .

Venipuncture unsuccessful . . . . . . . . . . . . . . . . . . .

Became ill during test . . . . . . . . . . . . . . . . . . . . . . . .

Other reason 12

specify

ASK IF SECOND VISIT:

7a. Atwhattime didyoufinish your last meal?

b. Have you had anything at all to eat since (time in

%J)?

c. At what time did you last have anything at all to

eat ?

8a. Have you had anything to drink, other than water,

after (latest time in 7a or 7c)?

b. At what time did you last have anything at all to

drink, besides water?

c. How many hours ago did you last drink any water?

(Was it less than 10 hours ago or longer?)

CHECK ITEM B: Refer to LATEST TIME specified in 7a, 7

or 8b; and refer to Time Chart. MARK APPROPRIATE BOX

RECORD PRIORITY HERE AND ON CONTROL RECORD.

@ –-e- –

@ –--e– –

First visit

@

. . . . . . . . . . . . . . . .01 •1

. . . . . . . . . . . . . . . .02 ❑

. . . . . . . . . . . . . . . .03 •1

. . . . . . . . . . . . . . . . 04 ❑

. . . . . . . . . . . . . . . .05 ❑

. . . . . . . . . . . . . . . .06 ❑

. . . . . . . . . . . . . . . .07 •1

. . . . . . . . . . . . . . . .08 •1

. . . . . . . . . . . . . . . .09 ❑

. . . . . . . . . . . . . . . . 10 •1

. . . . . . . . . . . . . . . . 11 •1

Second visit

@

. . . . . . . . . . . . . . . . . 01 ❑

. . . . . . . . . . . . . . . . . 02 •1

. . . . . . . . . . . . . . . . . 03 •1

. . . . . . . . . . . . . . . . . 04 ❑

. . . . . . . . . . . . . . . . . 05 •1

. . . . . . . . . . . . . . . . . 06 ❑

................. 07 •1

. . . . . . . . . . . . . . . . . 06 ❑

. . . . . . . . . . . . . . . ‘..090

. . . . . . . . . . . . . . . . . 10CI

. . . . . . . . . . . . . . . . . 11•1

@ 9999 ❑ DK @-@ , IJ A.M I II Yesterday

—._— { — 2UP, M. 2 ❑ Today

time

@ 1 •l Yes

2 ❑ No (8)

(9 I EI Yes 3

specify

2 ❑ No (CHECK ITEM B)

— —. __-’

time

@

hours ago

number

OR

@ I ❑ less than 10 hours ago

2 ❑ 10 or more hours ago

@ ❑ Glucola maybe given (5)

GTT Priority 1

4 •l Glucola may not be given (6)

NOTES

2

393
Form PHS 6214-10 OMB No. 0937-0078

9/8/82 Approval EIpires 12/84

I

Department of Health and Human Services

Public Health Service

Office of Health Rasearch, Statistics, and Technology

National Center for Health Statistics

SPANISH VERSION

GLUCOSE CHALLENGE QUESTIONNAIRE (506)

(AGES 20-74 YEARS)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

a. LANGUAGE OF INTERVIEW (@ I ❑ English

NOTICE — La inform aci6n contenida en este formulario que permitir~a identificar a cual,quier individuo o estableoimiento ha sido recogida con la

garant;a que ser6 mantenida en la mfis estricta

confidencialidad, ser~ usada solo para ICISprop6sitos establecidos para este estudio, y no ser~ divulgada o entregada a otros sin el consent imiento

del individuo o del establecimiento de acuerdo con

la Secci6n 308(d) de la Ley del Servicicl de Salud

P6blica-Public Service Act (42 USC 242m).

2 ❑ Spanish

b. Coordinator c. Examiner

@ @ —. _ —— .

d. Date

@-@ ~.

e. Age f. Sex g. Not Scheduled h. I ❑ First visit (Go to 1)

—— yrs. ❑ M ❑ F (@In @ 2 •l Second visit (Gc~to 7)

1. ZActualmente est5 usando insulins?

2. ZActualmente est5 tomando pfidoras para la

diabetes?

3a. ZA qutl hors termin6 su rltima comida?

b. tHa comido cualquier cosa desde (hors en 3a)?

c. LA qu6 hors comi6 usted cualquier cosa por filtima

vez ?

4a. ZHa tornado cualquier bebida, no incluyendo agua,

despu& de (hors m~s tarde en 3a o 3c)?

b. LA qu6 hors tom6 cualquier cosa por ikima vez,

adem~s de agua?

4c. ZHace cu%tas horas tom6 agua por dltima vez?

(ZHace menos de 10 horas o mik?)

CHECK ITEM A: Refer to LATEST TIME specified in 3a, 3C

or 4b; and refer to Time Chart. MARK APPROPRIATE BOX.

RECORD PRIORITY HERE AND ON CONTROL RECORD.

NOTES

0 1❑ S;(DO NOT GIVE GTT)

20No

@

10s;

20No

@) wwa NS @-@ I ❑ A.M. I ❑Ayer

—.—— { — 20 P.M. 2 ❑ Hoy

hors

@ 10s;

2 ❑ No (4)

@ 9999U NS @-@ I ❑ A,M. 1❑Ayer

{ — —,—— 20 P.M. 2 ❑ Hoy

hors

@ lnsr 3

especifique

2 ❑ No (CHECK ITEM A)

@ 99990 NS @-@ 1❑ A.M. I ❑Ayer

{

20 P.M. 2 ❑ Hoy — —.—_

hors

@ hate horas

ntimero

OR

I ❑ hate menos de 10 horas

2 ❑ hate 10 horas o m&s

❑ Glucola may be given (5)

@ GTT Priority 1

4 ❑ Glucola may not be given (6)

1
5a. Time fasting specimen drawn. IF NOT DRAWN, GO

TO 6,

b. Time glucola given. IF NOT GIVEN, GO TO 6.

.. . ........... . . . ......... . . . . . . .

c. Time one-hour specimen drawn. IF NOT DRAWN, GO

TO 6.

d. Time two-hour specimen drawn. IF NOT DRAWN, GO

TO 6.

6. Mark reason for incomplete test:

a.

b.

c.

d.

;“

9.

h.

i.

j.

k.

Arrived late . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Technical error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Didnotfast atleast 10 hours... . . . . . . . . . . . . . . .

Fasted more than 16 hours . . . . . . . . . . . . . . . . . . .

Refused interview . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Refused glucola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Refused specimen . . . . . . . . . . . . . . . . . . . . . . . . . . .

Venipuncture unsuccessful . . . . . . . . . . . . . . . . . . .

Became ill during test . . . . . . . . . . . . . . . . . . . . . . . .

Other reason 12

Specify

ASK IF SECOND VISIT:

7a. ZAqu6hora termin6su tiltimacomida?

. . . . . . . . . . . .

b. LHa comido cualquier cosa desde (hors en 7a)?

. ... ... ... . ... . . . . . . . . . . .. . . . . . . . . .

c. 2A qu6 hors comi6 cualquier cosa por la Gltima vez?

8a. ZHa tornado cualquier bebida, no incluyendo agua,

despu& de (hors mzfs tarde en 7a o 7c) ?

b. LA qu~ hors tom6 cualquier cosa por hltima vez,

adem~s de agua?

c. LHace cu~ntas horas tom6 agua por tiltima vez?

(ZHace menos de 10 horas o mi%?

CHECK ITEM B: Refer to LATEST TIME specified in 7a, 7C

or 8b; and refer to Time Chart, MARK APPROPRIATE BOX,

RECORD PRIORITY HERE AND ON CONTROL RECORD.

NOTES

First visit

@

. . . . . . . . . . . . . . . .01 •1

. . . . . . . . . . . . . . . .02 ❑

. . . . . . . . . . . . . . . . 03 •1

. . . . . . . . . . . . . . . . 04 ❑

. . . . . . . . . . . . . . . . 05 •J

. . . . . . . .. . . . . . . . . 06 ❑

. . . . . . . . . . . . . . . . 07 •1

. . . . . . . . . . . . . . . . 08 •1

. . . . . . . . . . . . . . . . 09 •1

. . . . . . . . . . . . . . . . 10U

. . . . . . . . . . . . . . . . 11 •1

Second visit

@

. . . . . . . . . . . . . . . . . 01 •1

. . . . . . . . . . . . . . . . . 02 •1

. . . . . . . . . . . . . . . . . 03 •1

. . . . . . . . . . . . . . . . . 04 •1

. . . . . . . . . . . . . . . . . 05 ❑

. . . . . . . . . . . . . . . . . 06 ❑

. . . . . . . . . . . . . . . . . 07 ❑

. . . . . . . . . . . . . . . . . 08 ❑

. . . . . . . . . . . . . . . . . 09 •1

. . . . . . . . . . . . . . . . . 10 ❑

. . . . . . . . . . . . . . . . . 110

@wwCINS@J@ ,OAM. lCi Ayer

{ — _ 2H P.M. 2 ❑ Hoy

‘her=

@ 10s;

2 ❑ No (8)

@ 9999U NS @-@ I ❑ A.M. I ❑Ayer

— — { 20 P.M. 2 ❑ Hov

—L

@ 10s;3

est3ecifique

2 ❑ No (CHECK iTEM B)

{

@ 99990 NS @-@ 1❑ A.M. 1❑Ayer

20 P.M. 2 ❑ Hoy —

...hor~ ..... .....................................................

@ hate horas

n~mero

OR

@ 1❑ hate menos de 10 horas

2 ❑ hate 10 horas o m~s

❑ Glucola maybe given (5)

@

GTT Priority )

4 ❑ Glucola may not be given (6)

2

395
Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

HAIR COLLECTION QUESTIONNAIRE (514)

AGES 12-74 YEARS

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

OMB No. 0937-0078

Approval Expmes 12/84

NOTICE — Information contained on this form

which would permit identification of any individual

or establishment has been collected with a guar -

antee that it will be held in strict confidence, will

be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the establishment in accordance with section 308(d) of the

Public Health Service Act (42 USC 242m).

a, Name (First, Middle, Last) b. Sex c. Age

❑ M

❑ F — — Yrs.

d. Examiner

@ — — —

1. When was the last time your hair was washed?

2. The last time your hair was washed, was it washed

at

3. The last time your hair was washed, what brand of

shampoo was used ?

4a. Is this your regular brand of shampoo?

b. If no —

5a. When washing your hair do you ever use a conditioner or cream rinse on your hair?

b. If yes —

6. How often do you use a conditioner or cream rinse?

@ I ❑ Today or yesterday

2 ❑ Two through six days ago

3 ❑ Seven days ago or longer

@ I ❑ Home

2 ❑ Beauty shop or barber shop

@ Specify brand 01

99 ❑ Don’t know

(j@ li3Yes

2UN0

@ Specify brand I

@ ,UYes

2 ❑ No - SKIP TO QUESTION

@ Specify brand 1

7a

@ I •l Occasionally

2❑ Almost always

1

396
7a. When washing your hair do you ever use a dandruff shampoo?

b. If yes—

8. How often do you use a dandruff shampoo?

9a. Do you use any color treatment on your hair?

b. If yes—What?

10. How often do you color treat your hair?

11. When was the last time your hair was color

treated?

12a. Have you had a permanent wave in the last six

months?

b. If yes—When?

13. LANGUAGE OF INTERVIEW.

@l Cl Yes

2 ❑ No—SKIP TO QUESTION 9a

@ Specify brand I

(@ I •l Occasionally

2 ❑ Almost always

@’Dyes

2❑ No—SKIP TO QUESTION 12a

(@J I ❑ Tint

2 •l Color rinse

3 ❑ Bleach

4 ❑ Frost

@ Specify brand I

@ I ❑ Weekly

2 ❑ Two or three times a month

3 ❑ Once a month

4 ❑ Less than once a month

@ 1❑ Less than one week ago

2 ❑ Two or three weeks ago

3 ❑ One month ago

4 •l More than one month ago

@l ElYes

20No

@ I ❑ Within the last month

2 •l Two to three months ago

3 ❑ Four to six months ago

@ I ❑ English

2 ❑ Spanish

2

397
Form PH.S 6214-11

9/6/62

Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

SPANISH VERSION

HAIR COLLECTION QUESTIONNAIRE (514)

AGES 12-74 YEARS

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

a. Name (First, Middle, Last)

OMB No. 0937007B

Approval Expires 12/S4

NOTICE — La informaci6n contenida en este formulario que permitir(a identificar a cualquier indi -

viduo o establecimiento ha sido recogida con la

garantfa que ser~ mantenida en la m6s estricta

confidencialidad, ser~ usada solo para Ios prop6sl -

tos establecidos para este estudio, y no ser5 divulgada o entregada a otros sin el consentimiento

del individuo o del establecimiento de acuerdo con

la Seccion 308(d) de la Ley del Servicio de Salud

Ptiblica Public Health Service Act (42 USC 242m).

b. Sex c. Age

❑ M

❑ F — — Yrs.

d. Examiner

@ — — —

1. tCu6ndo fue la filtima vez que se lav6 el cabello?

2. La filtima vez que su cabello fue lavado, tfue

Iavado en ?

3. La dltima vez que su cabello fue lavado, tque

marca de champil se US6? “

4a. ?Es esta la marca de champii que uss regularmente

b. Si no—

5a. Cui$kdo se lava el cabello, Zusa alguna vez un

acondicionador o enjuague de crema en el cabello’

b; Si si—

6. ZCon qu6 frecuencia usa un acondicionador o

enjuague de crema?

@ I ❑ Hoy o ayer

2 ❑ De dos a seis d[as

3 ❑ Siete d(as o m~s

@ I H Casa

2 ❑ Sa16n de belleza o barber(a

@ Especifique la marca L

99 ❑ No sabe

@ Especifique la marca

@ iOS(

2 ❑ No - SKIP TO QUESTION 7a

@ Especifique la marca 1

@) I •l Ocasionalmente

2 •l Casi siempre

1

398
7a, Cu6ndo se lava el cabello, D!usa alguna vez un

champti para la caspa?

b. Si sf—

8. LCon qu6 frecuencia usa un champiipara la caspa?

9a. LUsa algtin tratamiento de color en el cabello?

b. Si s(— L cual?

10. LCon qu6 frecuencia se da tratamiento de color

en el cabello?

11. ZCu6ndo fue la filtima vez que se di6 tratamiento

de color en el cabello?

12a. LSe ha hecho un permanente en Ios tiltimos seis

meses?

b. Si s(–icu6ndo7

13. LANGUAGE OF INTERVIEW.

@’Ds~

2 ❑ No—SKIP TO QUESTION 9a

@ Especifique la rnarca I

@ I El Ocasionalmente

2 ❑ Casi siempre

@lnsf

2 ❑ No—SKIP TO QUESTION 12a

@ I ❑ Tinte

2 ❑ Enjuague de color

3 ❑ Blanqueador/de-colora nte

4 ❑ “Frost”

(@ Especifique la marca I

@ I ❑ Semanalmente

2 ❑ Dos o tres veces por mes

3 ❑ Una vez por mes

4 ❑ Menos de una vez por mes

@ 1❑ Hate menos de una semana

2 ❑ Hate dos o tres semanas

3 H Hate un mes

40 Hate m% de un mes

(@Ins;

20No

@ I ❑ Dentro del tiltimo mes

2❑ Hate dos a tres meses

3 ❑ Hate cuatro a seis meses

@ I ❑ English

2 ❑ Spanish

2

399
Form PHS 6214-5

9/8/82

Department of Health and Human Services

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

ULTRASOUND EXAMINATION OF THE GALLBLADDER (504)

(AGES 20- 74)

HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY

OMa No 0937 -oo7a

Approvsl Expmes 12/a4

NOTICE — Information contained cm this form

which would permit identification of any individual

or establishment has been collected with a guarantee that it will be held in strict confidence, will

be used only for purposes stated for this study,

and will not be disclosed or released to others

without the consent of the individual or the establishment in accordance with section :gOg(d) of the

Public Health Service Act (42 USC 242m).

a. Examiner No.

@ —— —

b. Sex

❑ M

❑ F

c. Age

— — years

‘1. Has sample person been given Glucose Questionnaire (506)?

TRANSCRIBE RESPONSES OR ASK SAMPLE PERSON:

2a. At what time did you. finish your last meal?

b. Have you had anything at all to eat

since (time in 2a)?

c. At what time did you last have anything at all to eat?

3a. Have you had anything to drink, other than water,

after (latest time in 2a or 2c)?

b. At what time did you last have anything at all to

drink, besides water (EXCLUDE GLUCOLA)?

CHECK ITEM A: REFER TO LATEST TIME SPECIFIED IN

2a, 2c, OR 3b,

@ 1❑ Yes - TRANSCRIBE RESPONSES TO 2a–c AND

3a-b BELOW FROM GLUCOSE CHALLENGE

QUESTIONNAIRE ITEMS 3a-c AND 4a-b.

2 ❑ No - ASK QUESTIONS 2a–c AND 3a–tt.

@

9999 ❑ DK @-@

J

I ❑ A.M.

~20 P.M. z — —,——

time

❑ Yesterday

❑ Today

@ I ❑ Yes

2 ❑ No (SKIP TO QUESTION 3)

@ ,m~ •l DK @-@ I ❑ A.M. I ❑ Yesterday

{

2 ❑ P.M. 2 ❑ Today — — — —

time

@ Ill Yes 3

specify

2 ❑ No (GO TO CHECK ITEM A)

@ 9999 ❑ DK @-@ I ❑ A.M. I ❑ Yesterday

{

20 P.M. 2 ❑ Today — —.——

time

@ 1❑ 6 hours ago or longer

(GO TO QUESTION 4)

2 ❑ less than 6 hours ago (END EXAM)

400

1
4. Was sample person given glucola? (SEE @l UYes

GLUCOSE CHALLENGE QUESTIONNAIRE 20No

QUESTION 5b).

5. Is gallbladder visible within the examinee in I

Yes No Not Done

the following positions?

a. Supine flat . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Left side down . . . . . . . . . . . . . . . . . . . . . . .

c. Upright (if necessary) . . . . . . . . . . . . . . . . . .

@lo 20 30

@lo 20 30

@’n ‘n 30

CHECK ITEM B

I

@ I ❑ & “NO” IN 5 (SKIP TO QUESTION 12)

2 ❑ ANY “YES” IN 5 (TAKE PICTURES OF

GALLBLADDER AND PROCEED WITH

QUESTIONS 6-1 1)

6. Dimensions—RECORD FROM A SINGLE

POSITION AND ALONG THE TRUE AXIS OF

GALLBLADDER.

a. Maximal length . . . . . . . . . . . . . . . . . . . . . .

b. Maximal anterior-posterior diameter. . . .

c, Thickness of anterior wall . . . . . . . . . . . . .

mm Picture Number

@––– @––

@––– @––

@l–– @––

7. Morphology:

a. Is the gallbladder “folded”? (USUALLY @ •l yes, Picture number _ _

PROXIMAL TWO-THIRDS) 00❑ No

b, Does the gallbladder have a “septum”? @ •l Yes, Picture number _ _

(USUALLY DISTAL ONE-THIRD) 00 ❑ No

8. Is there an area of wall contour irregularity? I

Irregularity:

DO NOT INCLUDE A “FOLD” OR “SEPTUM”

AS A WALL CONTOUR IRREGULARITY.

DO NOT INCLUDE PARTIAL VOLUME EFFECT,

@ I ❑ Definitely absent

2 ❑ Probably absent

3 ❑ Probably present

}

Picture

4 ❑ Definitely present number — —

401

-.
9a. Are there internal echoes in the lumen?

DO NOT INCLUDE “FOLD,” “SEPTUM,”

OR CONTOUR IRREGULARITY.

DO NOT INCLUDE NOISE, ESPECIALLY

ANTERIOR THIRD OF LUMEN.

b. If present, indicate structure.

c. If clump(s) present and can be measured, record maximal diameters of each.

CHECK ITEM C: REFER TO QUESTIONS

8 AND 9.

10a.

.

b.

Is there movement of (wall contour irregularity/internal echoes within the

lumen) with change in examinee position?

If present, record rapidity of movement.

Echoes:

@ I ❑ Definitely absent

}

CHECK ITEM C

2❑ Probably absent

3❑ Probably present

}

Picture @

4 ❑ Definitely present number _ _

@lu

Zn

Sn

an

Solitary clump

1

9C

Multiple clump

Diffuse layered

Diffuse non-layered }

CHECK ITEM C

. . . . . ................ . . . . . . . ................................. . ......................

mm Picture Number

@a. – – @– –

@b. _ _ @– –

@c. _ _ @– –

Definitely or probably absent in both

8 and 9 (SKIP TO 11)

Other (TAKE PICTURE WITH

EXAMINEE’S POSITION DIFFERENT

FROM POSITION FOR QUESTIONS

8 AND 9, AND PROCEED WITH

QUESTION 10).

~ln

Zn

30

an

Movement:

Definitely absent

Probably aosent }

11

Probably present 1

Picture @

Definitely present number _—

~ln

2n

Fast (within one minute)

Slow (more than one minute)

3

402

—
Shadowing:

11. Is there any shadowing originating from within the

gallbladder?

INCLUDE DENSELY PACKED GALLBLADDER WITH

SHARP ACOUSTIC SHADOW AND LITTLE TO NO

GALLBLADDER LUMEN FLUID.

IF PROBABLY OR DEFINITELY PRESENT, TAKE 2

PICTURES, EACH IN A DIFFERENT TRANSDUCER

POSITION.

@la

20

30

Definitely absent

Probably absent

Probably present

Definitely present

@ @

}

Picture numbers

— — and _ _

SKIP TO QUESTION 14

QUESTIONS 12-13 AND CHECK ITEM D APPLY ONLY IF GALLBLADDER IS NOT VISIBLE (ALL “NO” IN QUESTION 5).

! 2, Can you see:

a,

b.

c.

d.

Liver margin on longitudinal scan, 4 cm. to right of

midline ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Portal vein at liver hilum on transverse scan? . . . . . . . .

Intrahepatic right portal vein? . . . . . . . . . . . . . . . . . . . . . .

Is there any visible evidence of a right subcostal

cholecystectomy scar? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHECK ITEM D: MARK FIRST APPLICABLE BOX,

13. Was visualization hampered by:

@ •l Yes, Picture no. _ _

WDNO

@ •l Yes, Picture no. _ _

WDNO

@ ❑ Yes, Picture no. _ _

NDNO

@01 ❑ y=

MONO

“Yes” in 12d (SKIP TO QUESTION 14, MARK

BOX 4)

ALL “Yes” in 12a-c (SKIP TO QUESTION 14,

MARK BOX 3)

ANY “No” in 12a-c (GO TO QUESTION 13)

@ I ❑ Obesity?

20 Gas?

3 •l Scars?

4 ❑ Liver not seen or high liver?

5 ❑ Other? B

explain

MARK BOX 6 IN QUESTION 14

4

403
14. Final conclusions. MARK FIRST APPLICABLE BOX OR MARK AS INSTRUCTED IN PREVIOUS QUESTIONS.

2U

30

40

5U

Abnormal gallbladder, galLstones present (if shadowing from gallbladder or if there is movement c)f intragallbladder echoes).

Abnormal gallbladder, no definite stones (if wall contour irregularity or internal echoes are present; exclude

folds or noise),

Abnormal non-filled gallbladder (gallbladder not found or very small, barely visible gallbladder).

Probable cholecystectomy.

Normal gallbladder.

Inadequate visualization of right upper quadrant.

15. Observations and comments about study or sample

person:

a. Tenderness noted in gallbladder area during exam?

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

b. Other comments.

16.

ASK SAMPLE PERSON QUESTIONS 16-18.

During the past year have you had any attacks of

nausea and/or vomiting lasting more than 2 hours?

17. During the past five years have you had pain in this

area (GALLBLADDER AREA) which lasted a half

hour or more?

IF “YES” IN 17, ASK:

18. Do you usually feel sick to your stomach either

before or after you get this pain?

19, LANGUAGE OF INTERVIEW.

43::;.s

..............................................................................................................

@ln

W:os

9CIDK

@:::os

9nDK

@l ClYes

2DN0

9nDK

@ ‘ ❑ English

2 •i Spanish

5

404
ULTRASOUND EXAMINATION (SPANISH VERSION)

2a. LA qu6 hors termin6 su filtima comida?

b. tHa comido cualquier cosa

desde (hors en 2a)?

c. LA qu6 hors comi6 usted cualquier

cosa por filtima vez?

3a. LHa tornado cualquier bebida,

no incluyendo agua, despu6s

de (hors m~s tarde en 2a o 2c)?

b. LA qu6 hors tom6 usted cualquier

cosa por tiltima vez, adem% de agua

(NO INCLUYA GLUCOLA)?

16. Durante RI a?io pasado, Zha

tenido cualquier ataque

de rkusea y/o v6mito

que haya durado m& de

2 horas?

17. Durante Ios cinco afios pasados, Lha

tenido dolor en esta iirea

(GALLBLADDER AREA) que dur6

media hors o mi%?

IF “S1” in 17, ASK:

18. Usualmente, Lse siente usted mal del

est6mago antes o despu6s que Ie viene

este dolor?

6

405
PHS 6214-6

8/81

OMB No.: 0937-0078

Approval Expires: 8/82

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Researchr Statistics and Technology

National Center for Health Statistics

Hispanic Health and Nutrition Examination Survey

DENTAL EXAMINATION

NOTICE: Information contained on this form which would permit identification of any individual or

establishment has been collected with a guarantee that it will be held in strict confidence, will be used only for

purposes stated for this study, and will not be disclosed or released to others without the consent of the

individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42

USC 242m).

NCHS SAMPLE NO.

1

406
15317

SAMPLE

;7; “.”

““”

012 u.”

.“”

012 .=”

HISPANIC HEALTH AND NUTRITION

EXAMINATION SURVEY

DENTAL EXAMINATION

II NAME

II II ZY;zzgz?;! AU S- UUUUUU UUG

11 1I

E.m-. -.. n. .

0123456789

.“” .”.. “.”

I

DECK NUMBER 505 I

NO TE~H PRESENT

o I

SEX @ ~

u

US GOVERNMENTPRlNTlt4G0FFlCE19B2-35Ei.604

407
HISPANIC HEALTH AND NUTRITION

EXAMINATION SURVEY

DENTAL EXAMINATION

NAME

PHS-6214-6 (8/81)

CENTRALINCIS LATERALINCIS lSTBICUSPID lSTMOLAR 2NDMOIAR
PHS Form 6207 OMB No.0937-0078

Approval Expires: 2/85

English

Flashcards

S1 - National Origin and Ancestry

1 Mexican/Mexicano

2 Mexican-American

3 Chicano

4 Puerto Rican

5 Boricua

6 Cuban

7 Cuban-American

8 Hispano - specify

9 Other Latin American or Other Spanish - specify

O Other - specify
F1

Sample Medicare Card

AGR VERIFICATION CHAnT FOn 19S3

INSTRUCTIONS

In using lh!s chain, dot- w M Maws: Locate Ihn bmh year of tha parson on Ihe chart If the pnrsun

has M1 nod a bmhdav u of tfm dav of inmrwew m 1983, [ha cmmcl aqu WIII be shown m [ha “’r40 column.

If h pm3ml has hti ● bird!dav, lb corrmx aga WIII ba m (ha “Ym”’ column.

i3irrhdw m 1983? Birrhdav m 19E37

YaH of k-rh Yam .af birth

NO AGE Yam NO AGE Yam

1

F

1

1

1

1

1

1

1

1

I

1

12 90 91 1930 A4 45

13 09 1939 43 44

14 se %’ 1940 42 43

15 07 aa 1941 41 42

M 86 07 1942 40 41

)7 85

)0 04

)9 03

)0 02

)1 al

.96

.9E

04

83

02

1943

1944 ::

I 945 37

1946 36

1947 35

40

36

1902 00 .91 194.9 34 35

1903 80 1949

1904 H 79 1950 :; ::

I 905 77 78 1951 31 32

1906 70 77 1952 30 31

1907 75

190.9

1909 ;:

1910 72

1911 71

76 1953 29 30

75 1954 29

74 1955 ;: ze

73 1956 26 27

72 I 957 25 26

1912

1913 ::

1914 60

1915 67

1916 66

71

70

69

80

07

1958 24

1959 23

1960 22

1961

1962 ::

1917 65 66 1963 19 20

1918 64 65 1964 la 19

1919 63 1965 17 18

1920 62 :: 1966 16 17

1921 61 62 1967 15 16

1922 60

1923 59

1924 50

1925 57

1926 56

61 1968 ld

60 1969 13

59 I 970 12

5a 1971 11

57 1972 10

15

1d.

13

12

11

1927 55

1920 54

1929 53

1930 52

1931 51

56 1973 9

55 1974 a

54 1975 7

53 1976 6

52 1977 5

91 10

;i

1932 50

1933 43

1934 Ja

1935 47

I 93a 46

1937 45

51

50

49

4a

a7

46

1970 4

1979 3

19ao 2

19al 1

19a2 under I

1903 NA

51

4

3

21

uncle, ‘1 ,

8ack
1.

2.

3.

4.

5.

6.

7.

8.

9.

F2 - Reasons for not having Health Insurance Coverage

Care received through Medicaid or Welfare

Unemployed, or reasons related to unemployment

Can’t obtain insurance because of poor health,

illness, or age

Too expensive, can’t afford health insurance

Dissatisfied with previous insurance

Don’t believe in insurance

Have been healthy, not much sickness in the

family, haven’t needed health insurance

Military dependent, (CHN4PUS), Veteran’s benefits

Some other reason - Specify

F-3

U . . . . . 20,000 - 24,999

V . . . . . 25,000 - 29,999

w . . . . . 30,000 - 34,999

x . . . . . 35,000 - 39,999

Y . . . . . 40,000 - 44,999

z . . . . . 45,000 - 49,999

Zz . . . . . 50,000 and over
A. . . . .

B. . . . .

c. . . . .

D. . . . .

E. . . . .

F. . . . .

G. . . . .

H. . . . .

I. . . . .

J. . . . .

K. . . . .

L. . . . .

M. . . . .

N. . . . .

o. . . . .

P. . . . .

Q . . . . .

R. . . . .

s. . . . .

T. . . . .

F-4

Less than 1,000 (including loss)

1,000- 1,999

2,000- 2,999

3,000- 3,999

4,000- 4,999

5,000- 5,999

6,000- 6,999

7,000- 7,999

8,000- 8,999

9,000- 9,999

10,000- 10,999

11,000- 11,999

12,000- 12,999

13,000- 13,999

14,000- 14,999

15,000- 15,999

16,000- 16,999

17,000- 17,999

18,000- 18,999

19,000- 19,999

ASP-1

1. Have two or more usual doctors

or places depending on what’s

wrong.

2. Haven’t needed a doctor.

3. Previous doctor no longer available.

4. Haven’t been able to find the right

doctor.

5. Recently moved to area.

6. Other reason - please specify.
ASP-Z

CLqar@tte Erud L lot

1. ArcLIc Llqht9 &rCt,C L,qVd~, 4rct,c Llqht, 100

2. E91n1r Bn181r, Oel~lr 100

5. c-l C-l, c-[ L,qlIts, Cmwl Lonq ll@t,

6. [mrltm= Carlton, Cmrlton 100. Cmrllnn 1211

7. Chm[erflald rhamerfl~ld. Cksterfl Pld 1~

.5. 0RCW9 kad~, hC0d9 1~

‘J, Chrml IJor.1. I)orml II

10. CVm [we !00. [w 120

11. Go1dmI L lqhi~ ralti L@N., kk. L@d 10U

12. Kid Kent, Kmt lm, KBnt Mlcranltm 11,

K.m 11[, Kant 111 100

lY, Xoal Kc.YI, Kmal I“ternmt 101,.1, Koo: Uild3,

KOO1 Hlldn 100, KOO1 L1qht,

Kool Liqhl 100, k!wl S-r L@t,

Kool 5qmr Llqht 100, Kwl Ultrm,

Kml lUll Tm 1110, K“ul <UPC( lurq 10II

10. Lnrd H L WMJH, L mdMLI@ts, L mdHLIqvIl 11111

——. —.—

15. Lnrk Lark, Lark Ltqhts, Lmrk 11, Lark 100,

Lmrk LIqht 100

16. lucky Strlkm (“lwklen”) L-kv 5tr1ke, Lucky Ien, Lucky 1012

17. HmrlbOrO U.clbnro, tt. rLbora L iqhl,

%rlbaro 1011, M.rlbm 1 lqht 10fl

18. mr, t Her It. &rll Illtrm LIqnt,

MOrlt 100

—

19. tbra I%re L Iqht !Olt, tbnre !20

—

20. N9wmrt f4e~rt , N*worl LIqhl,

U? WCIrl IUO, N-.warl 1 tqht 100,

Nc~ort Red

—. _ —.

21, !knrthul.d tkorthwlrwl, Northwlrd 100

22, h. No., NO”Ino

——

ZJ. Old Gold Old Cald 5trnh@Il, Old Gold flltmr,

Old Gold Ltqht, Old Gold flltcr 100

IQ. P.L1 I%L1 Pall Mall, Pill Mnll LIqhl,

Pall Mall 100, Pwl %11 [.[ro Llqhl.

Pwl H~ll LIqht 100

25. Parlllnerli Pnrlbment L!cJW, Parllwnl LIqhL !00

26. Ph, l,o Hoer,, phkll Ip mIrr I*, rl,llllp H0rr13 Crm*rj

Phllllp M0rr13 Int. rnatlunal tnn

—.—— ——

21. Ralrlqll RJ1e IqII, Ral. IqII 100, RIIlrIC#T LIW,

lisle, + I Iqhl 100

——.

28. 5nl-m Snlem, $al.m I lqhL, 5alc9 1 tqht 100,

Salem Lonq Llqht, 5alcm 10n,

5nlem Illtrn, Salem lJllrn Inn

zq. I mre”t nn Imrevlon, Imreylon LIqht, Ic. revlon 10tZ,

I mravtwi IJII ra LOW Inr,

lnrevlc+I Lomq L Iq+IL 100

J1 . I rue Irt,m, Iruc lno

— —

JZ. VMILW vu,! OIF, v~.lwvT 1110, VMTICW Ultrm LIqlI1 s

Vant ●y lJ1trm L Iqhl 100

.—

31. VlcFroV VlcErOy, Vlcerny Rich Ltqht ,

VlceruV Rich L Iqhl Ion,

V\ceroy Supr Lanq 100

X4. Vlr811ntm 511m Vtrqtntm >JImm, Vlrqlnlm 511m LLqht

J!.. Mimtm Hn”aton, ltm~lon l. Iqht, W1rWan lJILrn,

!4nn9ton 100, Wlnstan I lqht lno,

HInqton IIltra 11)0, Mtnslmn lnt *rn“t Ionnl lnu

—— -—
AS-3

O’uonic Cmditim List

Allergy, any Tuberculosis

Arthritis or rhemacism ~r, qyst, or grtih

Ast.tma varicose veins, trnuble with

Cancmr

Cleft palare

Club Emt

Corditim present sime birth

Dsafness or serious trouble with hearing

Diabetes

Epilepsy

Hardening of the arteries

Hey fever

Heart trmble

Ikaorrhoids or piles

Hensia or mpture

High blind pressure

Kidney StOIKS

Mental illness

Missing fingers, hand or arm; cces, fmc or leg

Palsy

Paralysis of any kind

Permanent stiffness or deformity of r,he fret, leg, fingers, arm or back

Prostate trouble

Repeated trouble uich back or spine

Rh-tic Fever

Sericue trouble seeing, ●ven when wearing glasses

Sims trouble, repeated attacks of

Speeth defect, any

St- ulcer

Stroke

Thyroid trotble or goiter

ASP-4

Ethnic Identification

Boricuan

Puerto Rican

Cuban

Cuban -lunerican

Mexican/Mexicano

Chicano

Mexican-Americm

Hispano

Latin American

Other Spanish or Other Hispanic

American

Anglo-American

Other group - ~~ify
m-l C4-2

Ouonic Cmiitim List

1. Has two or more usual doctors

or places depending on what’s

wrong.

2. Hasn’t needed a dcctor.

3. Previous doctor no longer available.

4. Hasn’t been able to find the right

doctor.

5. Recently moved to area.

6. Other reason - please specify.

Allerw, my IUerculosis

Arthritis or rh-tiem Tumr, cyst, or growth

kttm Varicose veins, trouble with

Cmxer

aeft pelate

CM fmt

Cuwiitim present sirce birth

tineas or serious trouble with he-ring

Diabetes

Epilqay

Hardming of the arteries

Hay fever

Heart trasble

brrliuids or piles

Hernia or rqmrre

High blind pressure

Kidney stones

Mrtel illness

Missing fingers, hard or arm; toes, foot or leg

Pmlsy

Paralysis of eny kind

Pe~t stiffness or deformity of the fret, leg, fingers, arm or back

Proswte trouble

Repeemd trmble with back or spine

Rh4nmtic fever

.%ricu trouble 5eaing, even Am waring glasses

Sinus trouble, repeated attecks of

Speech defat, any

Stmsch ulcer

Strcke

‘Itryroid trouble or goiter
.5

m

PHS Form 6207 OMB No. 0937-0078

Approval Expires: 2/85

Tarjetas Para Mostrar

En Espanol

1

2

3

4

5

6

7

8

9

0

S1 - Origen National o Ascend encia

14exicano

M4xico-tbnericano

Chicano

Puertorriqueiio

Boricua

Cubano

Cubano-Americano

Hiapano - e9pecifique

Otro Latino-hericano u Otro EspaFiol - especifique

Otro - especifique
AGE VERIFICATION CHART FOR 19133

I

INSTRUCTION

InUSIW Ihls chail, Momma age as folbws: LOCaICIha bitlh year of l.he parson on (he than. II he person

has rq[ hmia bmhday as Of[ha day of imarviaw in 1903, Iha eomct egewfflba shownm IIM “No”’ column,

II !ha pm.on hm hti a birthday, lha coneci qs WINk inIha “Yes” cohm’m.

Elrthday In 1983?

Year Of binh

Blmhdsyin 1983?

Year of birlh

No AaE Ycm No AGE 799

10

18

10

18

Ie

—

10

18

18

19

19

12 90 91 1938

13 89

44

90

45

1939 43

14 Be 89

44

1940

15 E7

42

En

43

1941

10 Be

41

87

42

1942 40 41

17 85 80 1943

la

39 40

9 ::

1944

1%

39

1945

0 82

%

II

1940

B1

39

H

:!

1947 35 !38 --

1902 80 01

1903

1940

79 80

34 35

1904

1949

79

1905 ;;

1950 :; ;:

1906 70

1951

;;

31 :;

1962 30

1907 75

I 90!3 74

1909 73

1910

1911 ;:

70 1953

75

29

1954

74”

20

I 955 27

1950

H

26

1957 25

---

959 ii

1900 22

1961

1902 H

1917 es 80

1910 04

1983 19

65

20

1919 63

1964 18

64

19

1920

1905 17 la

1921 H

1966 Ie

1%

17

1907 15 16

1

1922 60

1923 69

1924 50

1925

1926 U

1920 54

1929 53

1930 52

1931 51

19ee

%

5s

1969 ;:

58

1970 12

57

1971 11

1972 10

15

14

13

12

II

1927 55 50 1973 9 10

9

6

7

55

54

1974 6

53

1975

1976 ;

52 1977 s 6

I

60 51 1970 A G

I

1932

1933 49

1934 4e

1935 47

1936

50

49

40

47

46

1979 3

1960 2

19el I

1962 under 1

1963 NA

i

under 1

Fl

Tarjeta Muestra de Medicare

Health !.JL.. Insurance

Frente
F2 - Razones por no tener p61iza de Seguro de Sa.lud

1. El cuidado ●s recibido a trav& del Medicaid o del Welfare

(Bienestar PGblico).

2. Desempleado, o raz6nes relacionadas al desempleo.

3. No puede obtener seguro debido a mala salud, enfermedad o edad.

4. Muy care, no puede pagar seguro de salud.

5. No satisfecho con ●l seguro previo.

6. No tree en el seguro.

7. Ha ●stado bien de salud, no ha habido mucha ●nfermedad ●n la

familia, no ha necesitado seguro de salud.

8. Dependiente militar, (CHAMPUS), beneficios de Veterano.

9. Alguna otra raz6n - Especifique

1 I I 111 2

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

418
1- Tengo dos o mla mddicos o lugares a 10S que usualmente voy

dependiendo del problems que tenga.

2- No he nacasitado mddico.

3- E1 mddico que me atendfa ya no estd disponible.

4- No he podido encontrar el m4dico ●propiado.

5- Acabo de mudarme ●l Area,

6- Otra r8z6n. Eapecifique por favor.

m

m

m

om

m

m

m1

E

m“

m

m

m

*-

I

0

0

0-

*

.

.

.

.

.

0

mmm

mm

m

m

F.i1

0

0

0

m-

.

.

.

.

.

w

m

mm

m1

0

0

0

m-

.

.

.

.

.

n

m

mm.

*

I

0

0

0-

*

.

.

.

.

.

IA

m

mm

m1

E

m-

.

.

.

.

.

IL

m

mm.

w

I

E

m-

.

.

.

.

.

u

m

m

m

o!5-

1

0

0

0

0

0

0-

1 I

Eo-

.

.

.

.

.

Y

I

0

0

0-

1

0

0

0

w1

0

0

0

m“

I

0

0

0.

f% .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

A

.

.

.

.

.

.

.

.

.

.

z

.

.

.

.

.

L

.

.

.

.

.

0’

.

.

.

.

.

W

.

.

.

.

.

m

.

.

.

.

.

< u b

419
ASP-2

Clqarette Brti LLst

CIqar.Lto Brand L13t (ccmtlnued)

[r thm Clqarcttm EIrmxt N- IS fhen pr~. “1s th, s ,, y, or ZT

qlwn in rasmae to either a or b lnclu& ●ll ktnds ror thm bruwl)

(n) (b)

1. ArCt ,C Llqhts Arct, c L,qht9, Arct LC Llqhts IOU

z, Bala Lr Eelmlr, Oelalr 100

h. C*rld~ Crmbrldqe, Ctirldqa 100

5. Cml C-1, C-l Llqhta, C-l Lonq L1qht,

6, Cmrltcn Carlton, Cnrlton 100, Cnrlton 120

7. Ckaterfield Chest crfleld, C&sterrl?ld 100

8. Oacti Oecadm , kCOdS 100

9. 00rol Oorml, Ihr.1 1[

10. [“0 [we 100, [w 120

Il. Goldm L qhts Caldan L1@mm, 1231&n LIqht IOU

12. Umnt K-t, Kent 100, Kmnt Hkcranntm [1,

Kent III, Kant 11[ lCn3

IJ, KM1 Kool, Ko.al lntemmthor,. i, Kool Hilds,

Kool M,ldo 100, Kcml L1@,

Mml L1qht 100, Uual Swwr L1@t,

Ktml S-r L@t 100, Koal Ullr.,

Koal UILr. !(70, Kool Super Lunq 100

581mm Ultrm, Smlcm Ultrm 100

14. Lmd M L ord M, L uwJHLIqht3, 1 mdt4L1qht 100

15. L mrk Lmck, Lark LL@d E, Lmrk 11, lark 100,

Lnrk Llqht 100

16. Luky Strlko (“Luklos”) Lucky 5tr1ke, Lucky [en, Lucky 100

17. Hmrltmro Harlboro, timrltmro L Iqt,

Harlbaro 100, Hmrlbro I lqht 1012

IB. &rlt Herxt, %ril Ultrm Li@,

&rlt 100

Iv. bre f’bre Llqht 100, Nare 12!2

20. NOqlart Neqort , Nmqmrl L,+t,

Nr”Part 100, Ne.qm,l L ,ghl 100,

~Tort Red

21. tbrthwlnd F4nrthwmd, North. trrl 100

———

12. Fhw NW, w- Irto

----

21. Old Gold Old Gold 5Lrnlqhl, Old Gold rllter,

Old Gold Llqht. Old GoId FIILer 1017

— —.

26. Pall Hall Pall Hnll, Pmll Mmll L,qht.

Pmll !4s1! 100, Pm,l %11 fnlrm L,qht,

Paul Mall L,qhl 100

—.

25. Pmrl, mt Pmrll-nf l,qht, Parl 1~”1 L ,,+1 I(IO

——-

26, Ph, l,p t40rr, q Phllltp Hwrr I,, PI, IIIIP t40r I Is Cmnamkr,

Phbll,p Morris Intern atl.#nal 1011

—

21 RalE I*,I, Rale, qh, Iiale, qh 100, Rmle, qh L ,qhl ,

Rale, qh I ,qhl 100

——.—— .

28. ?nlmm Salem, Salem I lqht, ;alem I Iqhl III(I,

Salem Loriq L,qht, 5al=m lrlfl.

S.l=m Illtra, falem Ultr. lot:

29. lareyt”r, I.reyton, Iarqlon I tqhl . Imreylon IC!17,

Imre”ton Illtrm Low Imr,

[mrqlom Lonq I lqht 1043

—-- ——-

JO. lr, m’l@l Irluw. Ir, mph lCKt

—— ——

Il. I rue Iru., Irw 100

Jz. Vnri *,? Va,)l “q?, Vrml nq” 1.10, Vm-.l aqr Ul:ra I., ql,t

VAnt aqm lIILra L ,,,t,l 100

—— —— —-

IJ. Vlcerny VIcProy, Vncerny R,ch L8qhl ,

V, Crr”y Il,,h L,qhl 10IJ.

Vlc. ro” 5“ger L“”q 100

—. —

J&. V,rq, n,m -ii, m Vlrqlnln tllmq. Vtrqmnlm 511m I Iqt,t

15. Wlmton )tln,tm, W,n, ta,, L,qht, W,qSt”” I)[trm,

hln,ton lLOJ, Mlnston LIc@2 100,

Itl”. t”” Illtrm 1[10, Wlml”n [nl?r -

n“t ,0””1 II-II]
ASP-3

Chronic Condition List

ASP-4

1dentificaci6n Etnica

alergia, cualquiera

artritis o reumatismo

asma

cheer

pafadar hendido/fisura palatina

pie de[orme, tong.5nito

cond1c16n presente desde ●l nacimiento

aordera o problems (dilicuJtad] seria con el ofr

diabetes

epilepsia

●ndurecimiento de Ias arterisss

fiebre del heno/hayfever

problems del coraz6n/problems cardiaco

hemorroides o afmorrarsas

hernia o quebradura

al ta presi 6n

CSICU1OS (o piedras) renales (en el ritin)

●nfermedad mental/maf de IOS nervios

faita de dedos, mano o braze; dedos de Ios pies,

pie o pierna

perlesia (o paralisis) C.P,

par~lisis de cualquier tipo

rigidez (Tksura) permanence o de formidad del pie, pierna, dedos, brazo

o espalda

problems de la pr6stata

problems repetido cdn la espalda o la ●spina/columns vertebral

fiebre reum~tica

problems serio con la vista, aGn cuando tiene lentes/espejueios puestos

sinusitw con repitidos ataques

defecto del habla, cuaiquier

(dcera del est6mago

ataque de parSlisis, apopiejia, ●mbole

problems de la tlroldes, bocio

tdmrcuiosis

tumor o qulste

venas varicosas, problems con

Boricua

PuertorriqueFio

Cubano

Cubano-Americano

Mexicano

Chicano

M6xico-Americano

Hispano (o Hisp%ico)

Latinoamericano

Otro Espafiol u otro Hispano (Hisp%ico)

Americano

Angloamericano

Otro grupo - especifique

$.

N
CSP-1

1- Tiene dos o m~s mddicos o lugares a Los que usualmence va dependiendo

del problems que tenga.

2- No ha necesitado d!dico.

3- E1 m4dico que le atendfa ya no est~ disponible.

4- No ha podido encontrar el ❑edico apropiado.

5- Acaba de mudarse al Area.

6- Otra raz6n. Especifique por favor.

422
FLASHCARDS FOR ADULT SAMPLE PERSON SUPPLEMENT

Sun-l

CiqaretlcIJrd List

II thim Clqarettw Erred N- IS II-ml prm. ‘la !hls ., T, or Z7”

qlvm m rmponrn to elttmr a or h [ml- -11 birnis for the brmdl

(a) (b)

1. ArcL1c Ll@s Arctic LLqht3. ~rctlc Llqhts IOU

12. Mm’It Krnt, Mmt 100. Kmt Hlcrmlla I 1,

Kmt Ill. Kmt Ill 1~

lJ, Kodl Kaa I, Koat Intmmntlwml, Kool Htlds,

Nml Ma Ida 100, Kml L1qht ,

Kml lIqhL lMt, Kml Sqmr LI@t,

Kml -r LI* lm, KDOI Ultrm.

hul UILra lIM, KOO1 SWr L- 100

Sal- lllLra, Smlmn Ullrn 100

I*, L sd H L mdH, L tiHLIqhts, L mdMLlqht 100

1>. Lark Lmh, Lmrh lI@dm, Lnrk 11, Lnrh 100,

Lmrk LI@4 100

!7. Mmltmro lrarlhro, Iwrlkuro L l~t,

*rlhm lm, rnarltmm 1 Iqht 100

18. brlt tknrlt, ~rlt Ultrs Ll@t,

F&rlt Im

Cl~rattm Brti Ll~t (cmtlti)

—.

19. mre tbrc Llqht 100, Nero IZIJ

- ———- .

20. tkmqmrt f@wrl o ~wrl LI+LI

+wParl IUO, Me~[l L ,qht IMI.

Ww+mrt fled

—. _. —. -.-—

21. Mrtlwld Norttw&tul, Norttmtrrt IIXI

—.—

21. h. ?40., NaW Itrd

.-. .

z). Old Gold Old Cold 5trmlqht, Old Gold rlllar,

Old Cold LI@l. Old Gold filter 10CI

— —.

24. Pmll Mmll Pall H~ll. Pall Mnll L,qht,

P.11 Hall 1011, Pwl Hall [.lra 1 Iqht,

Paul Mml I I tqhl lf10

—-— . .

z~. POrllawlll PIJr I,rmmt I., qi,t, pnrllmnt Llqhl If10

— ——-

26. Phlllp M“rr,3 Phllllp Herr IY, PIIIll Ip Horl13 Crmoan+r.

Phl[llp Morris Int. rnatlcuml 10II

—.— ---

27 *alcl@ Rale Iqh, tlal~lqh IOU, Rmlelqh 1 Iqhl.

Ralelqh I Iqllt Ino

28. Cml. m 5elem,5akeM I Iqhl . $altm 1 Ir$d 100,

5alm Lmq Llqhl. 5alcIE Iflfl,

S,nlcm Illtra. $alern 1111 rm 101:

———.

29. Imrcylnll Iareyton, Inreylm I Iqht , I nrerlon 100,

Inreyton 1111 r. LOOI 1■r,

Imre”toll lolwg I Iqht 100

— -- -----

Jom lrlut@ Irtwp, Iridqrh 100

—— —— —.

J1. Irue Iru”, Iru? 100

.——

Jz. Vvmmr vslllnqP, V.”lwp I 10, Vmlaqn Ul:rb Llqlll

VU-II .qe Ullrn L IW 100

JJ. Vlmrnv Vm+roV. Vbcemy Rich LIqhl ,

Vflcerny filch Llqhl Irlo,

Vtceroy 5uwr lonq 1110

—— . .—

la. Vlrqtnlm <I]m Vnrqlnla 511wI. V)rq#nlm 511M Llqlst

..— — .—— — . .

J$, Ulml 00 Wlml on, ttun~tan L1qM , Mlnst Un Ultrn,

Uln~tOn 100, Mlnslon Licpt 100,

MImtrm lllfrm 11)0, WIrnlnI-I lnl *rn“l Ionml Inil

——— -—
,;

,,

,.3

— “-. ., -~

424
425
—
SLIII-q –sEDATIVES

L

4Qi9”dh

E8KA8Aw

L

544

LUUMWRC

L

6>4>4

mE8ARAr _

7 M#MR81TAL

8 PHEMMWTAL

9 ALURATE”

10

11 WAABud

I UMMiEN*

12 ~+&#

lwLulMR” .—

“~dL———— 8oPofr

.

14

Id

Ad)

MLUDE” —.

L

ls~~

PARE8r _

!

“,9

?mw

17lwHA@ALoNE

18CHLORALHYMATE

t

. -—-..—

23lwYmAmTM

248EmhlmT&

427
Revised 10/29/Bl

PRoBES FOR OIAGWOSTIC INTSRVIEW SCHSDUSJI

l’~an(5x) ever the remult of a phynical illnenm or injuq~

Wo —- ‘Wam (SIC) war the result of using mdlcmtmn,

drugs or ~hol?”

YES Wo

-:*

no —> HASX mx 5.

v

YEs~Mxxsox3.

‘Wan (5x) ~ the rewlc of ● physical illnam~ or injury? (such ●m )7”

VEs —-MARX Wx 6.

tm~

“Uhen (5x) was nnc due to a phynicml illnec# or injury,

~ result of uming medication, drugm

or ●lcohall

IF RESPONDENTVOLUNTEERS

H

!Jl

—

VsS

STRESS,

~ HAIUCUO XL.

DEPRESSIONOR E(WJlVIILENT,MARK 90X 5.

420
.. .. . .

S1.TP-5 SLIP-5

g

-4 Rarely or None of the Time (less than 1 da,y)

g

=

!2e

w Some or a Little of the Time (l-2 days)

m

H

2

c1

0 Occasionally or a Moderate Amount of Time

2H (3-4 days)

nm

m.

y

g

Most or All of the Time (5-7 days)

.

0 Rarmente o nimyma vez (menos de m dia)

o Alguna o pxa vez (l-2 dia)

o Ocasionalmente o ma cantidad mdera3a (3-4alias)

o La mayor parte o todo el tienp (5-7alias)

4=.

I&
Vital and Health Statistics 

series descriptions 

SERIES 1. 

SERIES 2. 

SERIES 3. 

SERIES 4. 

SERIES 5. 

Programs and Collection Procedures-Reports describing 

the general programs of the National Center for Health 

Statistics and its offices and divisions and the data collection methods used. They also include definitions and 

other material necessary for understanding the data. 

Data Evaluation and Methods Research-Studies of new 

statistical methodology including experimental tests of 

new survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to 

statistical theory. Studies also include comparison of 

U.S. methodology with those of other countries. 

Analytical and Epidemiological Studies-Reports presenting analytical or interpretive studies based on vital 

and health statistics, carrying the analysis further than 

the expository types of reports in the other series. 

Documents and Committee Reports-Final reports of 

major committees concerned with vital and health statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

Comparative International Vital and Health Statistics 

Reports-Analytical end descriptive reports comparing 

U.S. vital and health statistics with those of other countries. 

SERIES 10. Data From the National Health Interview Survey-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other 

health-related topics, all based on data collected in the 

continuing national household interview survey. 

SERIES 11. Data From the National Health Examination Survey and 

the National Health and Nutrition Examination SuweyData from direct examination, testing, and measurement 

of national samples of the civilian noninstitutionalized 

population provide the basis for (I) estimates of the 

medically defined prevalence of specific diseases in the 

United States and the distributions of the population 

with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships 

among the various measurements without reference to 

an explicit finite universe of persons. 

SERIES 12. Data Frdm the Institutionalized Population Suweys-Discontinued in 1975. Reports from these surveys are included in Series 13. 

SERIES 13. Data on Health Resources Utilization-Statistics on the 

utilization of health manpower and facilities providing 

long-term care, ambulatory care, hospital care, and family 

planning services. 

SERIES 14. Data on Health Resources: Manpower and FacilitiesStatistics on the numbers, geographic distribution, and 

characteristics of health resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

SERIES 15. Data From Special Surveys-Statistics on health and 

health-related topics collected in special suweys that 

are not a part of the continuing data systems of the 

National Center for Health Statistics. 

SERIES 20. Data on Mortality-Various statistics on mortality other 

than as included in regular annual or monthly reports. 

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; 

and statistics on characteristics of deaths not available 

from the vital records based on sample surveys of those 

records. 

SERIES 21. Data on Natality, Marriage, and Divorce-Various statistics on natality, marriage, and divorce other than as 

included in regular annual or monthly reports. Special 

analyses by demographic variables; geographic and time 

series analyses; studies of fertility; and statistics on 

characteristics of births not available from the vital 

records based on sample surveys of those records. 

SERIES 22. Data From the National Mortality and Natality SurveysDiscontinued in 1975. Reports from these sample surveys 

based on vital records are included in Series 20 and 21, 

respectively. 

SERIES 23. Data From the National Survey of Family GrowthStatistics on fertility, family formation and dissolution, 

family planning, and related maternal and infant health 

topics derived from a periodic survey of a nationwide 

probability sample of ever-married women 15-44 years 

of age. 

For answers to questions about this report or for a list of titles of 

reports published in these series, contact: 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Public Health Service 

Hyettsville, Md. 20782 

301-436-8500 
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Pubfii Health Service 

Nathrtal Center for Health Statistics 

3700 East-West Highway 

Hyattsville, Maryland 20782 

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $36300 

, 

r 

PRESORTED 

SPECIAL 4TH CLASS RATE 

POSTAGE & FEES PAID 

PHS/NCHS 

PERMIT No. G-281 

DHHS Publication No. (PHS) 85-i 321, Series 1, No. 19