Questionnaire Public Report12/03/2012 02:00:22 PM
Cohort:National Longitudinal Survey of Youth 1979
Round:NLSY79 Round 17
Instrument :NLSY7996 release
  1. Health



Q11-A []Section: Health

INTERVIEWER: ENTERING SECTION 11: HEALTH.

Default Next:Q11-2


Q11-2 [R56165.00]Section: Health

If Answer >= 1 AND Answer <= 10 Then Go To
Q11-4

Default Next:Q11-3
Lead-In:Q11-A [Default]


Q11-3 [R56166.00]Section: Health

Would your health keep you from working ON A JOB FOR PAY NOW?

 1   YES    ...(Go To Q11-5A)
 0   NO

Default Next:Q11-4
Lead-In:Q11-2 [Default]


Q11-4 [R56167.00]Section: Health

(Are you/Would you be) limited in the KIND of work you (could) do on a job for pay because of your health?

 1   YES
 0   NO

Default Next:Q11-5
Lead-In:Q11-2 [1:10], Q11-3 [Default]


Q11-5 [R56168.00]Section: Health

(Are you/Would you be) limited in the AMOUNT of work you (could) do because of your health?

 1   YES
 0   NO

Default Next:Q11-5A
Lead-In:Q11-4 [Default]


Q11-5A [R56169.00]Section: Health

If Answer = 1 Then Go To
Q11-5B

Default Next:Q11-9
Lead-In:Q11-3 [1:1], Q11-5 [Default]


Q11-5B [R56170.00]Section: Health

If Answer = 1 Then Go To
Q11-7

Default Next:Q11-5C
Lead-In:Q11-5A [1:1]


Q11-5C [R56171.00]Section: Health

If Answer = 1 Then Go To
Q11-6

Default Next:Q11-7
Lead-In:Q11-5B [Default]


Q11-6 [R56172.00]Section: Health

Is your limitation ENTIRELY due to your current pregnancy?

 1   YES    ...(Go To Q11-9)
 0   NO

Default Next:Q11-7
Lead-In:Q11-5C [1:1]


Q11-7 [R56173.00]Section: Health

Since what month and year have you had this limitation (other than your pregnancy)?

 1   SELECT TO ENTER DATE   ...(Go To Q11-8)
 0   IF VOLUNTEERED: 'ALL MY LIFE'

Default Next:Q11-9
Lead-In:Q11-5B [1:1], Q11-5C [Default], Q11-6 [Default]


Q11-8 [R56174.00]Section: Health

INTERVIEWER: ENTER DATE FROM WHICH R HAS HAD THIS LIMITATION.

Enter Date:  
MonthYear 

Default Next:Q11-9
Lead-In:Q11-7 [1:1]


Q11-9 [R56175.00]Section: Health

How much do you weigh?



(ENTER POUNDS)

Enter Number: 

Default Next:Q11-10
Lead-In:Q11-6 [1:1], Q11-5A [Default], Q11-7 [Default], Q11-8 [Default]


Q11-10 [R56176.00]Section: Health

If Answer = 0 Then Go To
Q11-78
If Answer >= 1 AND Answer <= 10 Then Go To Q11-11

Default Next:Q11-78
Lead-In:Q11-9 [Default]


Q11-11 []Section: Health

Now, I would like to ask you a few questions about any injuries and illnesses you might have received or gotten WHILE you were working on a job.

Default Next:Q11-12B
Lead-In:Q11-10 [1:10]


Q11-12B [R56178.00]Section: Health

First, since [!lintdate], have you had an incident at any job we previously discussed that resulted in an injury or illness to you?

 1   YES    ...(Go To Q11-13)
 0   NO

Default Next:Q11-78
Lead-In:Q11-11 [Default]


Q11-13 [R56179.00]Section: Health

What is the name of the employer you were working for when the MOST RECENT incident that resulted in an injury or illness to you occurred?

(INTERVIEWER: MOVE OR TO THE EMPLOYER R HAS NAMED AND PRESS <ENTER>. IF THERE IS NO MATCH, ASK R WHICH EMPLOYER LISTED IS THE SAME AS THE ONE FOR WHICH R IS REPORTING A WORK-RELATED INJURY OR ILLNESS.)

If Answer = 1 Then Go To
Q11-15A

Default Next:Q11-15
Lead-In:Q11-12B [1:1]


Q11-15 []Section: Health

INTERVIEWER: YOU HAVE SELECTED THE EMPLOYER LISTED BELOW AS THE SAME ONE
R IS REPORTING A WORK-RELATED INJURY OR ILLNESS FOR. IF THIS
IS NOT CORRECT, RETURN TO THE PREVIOUS QUESTION BY PRESSING
THE <PAGE-UP> KEY AND SELECT THE CORRECT EMPLOYER.
EMPLOYER: [Employer for whom respondent was working when most recent incident resulting in illness/injury occurred (includes those for whom no match was made with employer worked for since last interview)].

Default Next:Q11-17
Lead-In:Q11-13 [Default]


Q11-15A []Section: Health

INTERVIEWER: NO EMPLOYER MATCH WAS FOUND. RECORD THE EMPLOYER FOR WHICH R IS REPORTING A WORK RELATED ILLNESS.

Enter: 

Default Next:Q11-17
Lead-In:Q11-13 [1:1]


Q11-17 [R56180.00]Section: Health

In what month and year did the most recent incident occur that resulted in an injury or illness to you?

Enter Date:  
MonthYear 

Default Next:Q11-18
Lead-In:Q11-15 [Default], Q11-15A [Default]


Q11-18 [R56181.00]Section: Health

(HAND CARD DD) Which one category on this card best describes the activity you were engaged in at the time of the incident? (CODE ONE ONLY).

 1   Employer-directed travel
 2   Employer-directed training
 3   Meal break
 4   Rest break
 5   Personal business
 6   Normal work activity
 7   Other activity (SPECIFY)

Default Next:Q11-19
Lead-In:Q11-17 [Default]


Q11-19 [R56182.00]Section: Health

Did the incident result in an injury or an illness?

 1   injury
 2   illness

Default Next:Q11-20
Lead-In:Q11-18 [Default]


Q11-20 [R56183.00]Section: Health

What part of the body was hurt or affected?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-21
Lead-In:Q11-19 [Default]


Q11-21 [R56184.00]Section: Health

(PROBE:) What other part of the body was hurt or affected?

 1   SELECT TO ENTER VERBATIM   ...(Go To Q11-22)
 0   NO OTHER PART OF THE BODY WAS HURT OR AFFECTED

Default Next:Q11-25
Lead-In:Q11-20 [Default]


Q11-22 [R56185.00]Section: Health

INTERVIEWER: ENTER BELOW THE SECOND PART OF THE BODY THAT WAS HURT OR
AFFECTED.

Enter Number: 

Default Next:Q11-23
Lead-In:Q11-21 [1:1]


Q11-23 [R56186.00]Section: Health

(PROBE:) What other part of the body was hurt or affected?

 1   SELECT TO ENTER VERBATIM   ...(Go To Q11-24)
 0   NO OTHER PART OF THE BODY WAS HURT OR AFFECTED

Default Next:Q11-25
Lead-In:Q11-22 [Default]


Q11-24 [R56187.00]Section: Health

INTERVIEWER: ENTER BELOW THE THIRD PART OF THE BODY THAT WAS HURT OR
AFFECTED.

Enter Number: 

Default Next:Q11-25
Lead-In:Q11-23 [1:1]


Q11-25 [R56188.00]Section: Health

(INTERVIEWER: FOR ([First body part hurt or affected in most recent work-injury incident]) ASK:) What kind of [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-26
Lead-In:Q11-21 [Default], Q11-23 [Default], Q11-24 [Default]


Q11-26 [R56189.00]Section: Health

If Answer = 1 Then Go To
Q11-27

Default Next:Q11-30
Lead-In:Q11-25 [Default]


Q11-27 [R56190.00]Section: Health

(INTERVIEWER: FOR ([Second body part hurt or affected in most recent work-injury incident]) ASK:) What kind of [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-28
Lead-In:Q11-26 [1:1]


Q11-28 [R56191.00]Section: Health

If Answer = 1 Then Go To
Q11-29

Default Next:Q11-30
Lead-In:Q11-27 [Default]


Q11-29 [R56192.00]Section: Health

(INTERVIEWER: FOR ([Third body part hurt or affected in most recent work-injury incident]) ASK:) What kind of [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-30
Lead-In:Q11-28 [1:1]


Q11-30 [R56193.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you to miss one or more scheduled days of work, not counting the day of the incident?

 1   YES    ...(Go To Q11-31)
 0   NO

Default Next:Q11-32
Lead-In:Q11-26 [Default], Q11-28 [Default], Q11-29 [Default]


Q11-31 [R56194.00]Section: Health

Not counting the day of the incident, how many days was this?

Enter Number: 

Default Next:Q11-32
Lead-In:Q11-30 [1:1]


Q11-32 [R56195.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you ...

to be assigned to another job on a temporary basis?

 1   YES
 0   NO

Default Next:Q11-33
Lead-In:Q11-30 [Default], Q11-31 [Default]


Q11-33 [R56196.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you ...

to work at your regular job less than full time?

 1   YES
 0   NO

Default Next:Q11-34
Lead-In:Q11-32 [Default]


Q11-34 [R56197.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you ...

to work at your regular job, but be unable to perform all of the
normal duties of the job?

 1   YES
 0   NO

Default Next:Q11-35
Lead-In:Q11-33 [Default]


Q11-35 [R56198.00]Section: Health

If Answer = 1 Then Go To
Q11-36

Default Next:Q11-37
Lead-In:Q11-34 [Default]


Q11-36 [R56199.00]Section: Health

Not counting the day of the incident, how many days altogether was this?

Enter Number: 

Default Next:Q11-37
Lead-In:Q11-35 [1:1]


Q11-37 [R56200.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to be laid off?

 1   YES
 0   NO

Default Next:Q11-38
Lead-In:Q11-35 [Default], Q11-36 [Default]


Q11-38 [R56201.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to quit?

 1   YES
 0   NO

Default Next:Q11-39
Lead-In:Q11-37 [Default]


Q11-39 [R56202.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to be fired?

 1   YES
 0   NO

Default Next:Q11-40
Lead-In:Q11-38 [Default]


Q11-40 [R56203.00]Section: Health

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to change occupations?

 1   YES
 0   NO

Default Next:Q11-41
Lead-In:Q11-39 [Default]


Q11-41 [R56204.00]Section: Health

Did you lose any wages because of the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

 1   YES
 0   NO

Default Next:Q11-42
Lead-In:Q11-40 [Default]


Q11-42 [R56205.00]Section: Health

Did you or your employer fill out a worker's compensation form for this [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

 1   YES    ...(Go To Q11-43)
 0   NO

Default Next:Q11-45
Lead-In:Q11-41 [Default]


Q11-43 [R56206.00]Section: Health

Have you collected any worker's compensation benefits for this [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

 1   YES    ...(Go To Q11-45)
 0   NO

Default Next:Q11-44
Lead-In:Q11-42 [1:1]


Q11-44 [R56207.00]Section: Health

Is there a worker's compensation claim pending for this [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

 1   YES
 0   NO

Default Next:Q11-45
Lead-In:Q11-43 [Default]


Q11-45 [R56208.00]Section: Health

Is the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] we've just discussed the MOST SEVERE injury or illness that you have received or gotten since [!lintdate] while you were working at any job we have already talked about?

 1   YES
 0   NO    ...(Go To Q11-46)

Default Next:Q11-78
Lead-In:Q11-43 [1:1], Q11-42 [Default], Q11-44 [Default]


Q11-46 [R56209.00]Section: Health

What is the name of the employer you were working for when the MOST SEVERE incident that resulted in an injury or illness to you occurred?

(INTERVIEWER: MOVE OR TO THE EMPLOYER R HAS NAMED AND PRESS <ENTER>. IF THERE IS NO MATCH, ASK R WHICH EMPLOYER LISTED IS THE SAME AS THE ONE FOR WHICH R IS REPORTING A WORK-RELATED INJURY OR ILLNESS.)

If Answer = 1 Then Go To
Q11-48A

Default Next:Q11-48
Lead-In:Q11-45 [0:0]


Q11-48 []Section: Health

INTERVIEWER: YOU HAVE SELECTED THE EMPLOYER LISTED BELOW AS THE SAME ONE
R IS REPORTING A WORK-RELATED INJURY OR ILLNESS FOR. IF THIS
IS NOT CORRECT, RETURN TO THE PREVIOUS QUESTION BY PRESSING
THE <PAGE-UP> KEY AND SELECT THE CORRECT EMPLOYER.
EMPLOYER: [Employer for whom respondent was working when most severe incident resulting in illness/injury occurred (includes those for whom no match was made with employer worked for since last interview)].

Default Next:Q11-50
Lead-In:Q11-46 [Default]


Q11-48A []Section: Health

INTERVIEWER: NO EMPLOYER MATCH WAS FOUND. RECORD THE EMPLOYER FOR WHICH R IS REPORTING A WORK RELATED ILLNESS.

Enter: 

Default Next:Q11-50
Lead-In:Q11-46 [1:1]


Q11-50 [R56210.01]Section: Health

In what month and year did the incident occur that resulted in the most severe injury or illness to you?

Enter Date:  
MonthYear 

Default Next:Q11-51
Lead-In:Q11-48 [Default], Q11-48A [Default]


Q11-51 [R56211.00]Section: Health

(HAND CARD DD) Which one category on this card best describes the activity you were engaged in at the time of the incident? (CODE ONE ONLY.)

 1   Employer-directed travel
 2   Employer-directed training
 3   Meal break
 4   Rest break
 5   Personal business
 6   Normal work activity
 7   Other activity (SPECIFY)

Default Next:Q11-52
Lead-In:Q11-50 [Default]


Q11-52 [R56212.00]Section: Health

Did the incident result in an injury or an illness?

 1   injury
 2   illness

Default Next:Q11-53
Lead-In:Q11-51 [Default]


Q11-53 []Section: Health

What part of the body was hurt or affected?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-54
Lead-In:Q11-52 [Default]


Q11-54 [R56213.00]Section: Health

(PROBE:) What other part of the body was hurt or affected?

 1   SELECT TO ENTER VERBATIM   ...(Go To Q11-55)
 0   NO OTHER PART OF THE BODY WAS HURT OR AFFECTED

Default Next:Q11-58
Lead-In:Q11-53 [Default]


Q11-55 [R56214.00]Section: Health

INTERVIEWER: ENTER BELOW THE SECOND PART OF THE BODY THAT WAS HURT OR
AFFECTED.

Enter Number: 

Default Next:Q11-56
Lead-In:Q11-54 [1:1]


Q11-56 [R56215.00]Section: Health

(PROBE:) What other part of the body was hurt or affected?

 1   SELECT TO ENTER VERBATIM   ...(Go To Q11-57)
 0   NO OTHER PART OF THE BODY WAS HURT OR AFFECTED

Default Next:Q11-58
Lead-In:Q11-55 [Default]


Q11-57 []Section: Health

INTERVIEWER: ENTER BELOW THE THIRD PART OF THE BODY THAT WAS HURT OR
AFFECTED.

Enter Number: 

Default Next:Q11-58
Lead-In:Q11-56 [1:1]


Q11-58 []Section: Health

(INTERVIEWER: FOR ([First body part hurt or affected in most severe work-injury incident]) ASK:) What kind of [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-59
Lead-In:Q11-54 [Default], Q11-56 [Default], Q11-57 [Default]


Q11-59 [R56216.00]Section: Health

If Answer = 1 Then Go To
Q11-60

Default Next:Q11-63
Lead-In:Q11-58 [Default]


Q11-60 [R56217.00]Section: Health

(INTERVIEWER: FOR ([Second body part hurt or affected in most severe work-injury incident]) ASK:) What kind of [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-61
Lead-In:Q11-59 [1:1]


Q11-61 [R56218.00]Section: Health

If Answer = 1 Then Go To
Q11-62

Default Next:Q11-63
Lead-In:Q11-60 [Default]


Q11-62 []Section: Health

(INTERVIEWER: FOR ([Third body part hurt or affected in most severe work-injury incident]) ASK:) What kind of [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Enter Number: 

Default Next:Q11-63
Lead-In:Q11-61 [1:1]


Q11-63 [R56219.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you to miss one or more scheduled days of work, not counting the day of the incident?

 1   YES    ...(Go To Q11-64)
 0   NO

Default Next:Q11-65
Lead-In:Q11-59 [Default], Q11-61 [Default], Q11-62 [Default]


Q11-64 [R56220.00]Section: Health

Not counting the day of the incident, how many days was this?

Enter Number: 

Default Next:Q11-65
Lead-In:Q11-63 [1:1]


Q11-65 [R56221.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you ...

to be assigned to another job on a temporary basis?

 1   YES
 0   NO

Default Next:Q11-66
Lead-In:Q11-63 [Default], Q11-64 [Default]


Q11-66 [R56222.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you ...

to work at your regular job less than full time?

 1   YES
 0   NO

Default Next:Q11-67
Lead-In:Q11-65 [Default]


Q11-67 [R56223.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you ...

to work at your regular job, but be unable to perform all of the
normal duties of the job?

 1   YES
 0   NO

Default Next:Q11-68
Lead-In:Q11-66 [Default]


Q11-68 [R56224.00]Section: Health

If Answer = 1 Then Go To
Q11-69

Default Next:Q11-70
Lead-In:Q11-67 [Default]


Q11-69 [R56225.00]Section: Health

Not counting the day of the incident, how many days altogether was this?

Enter Number: 

Default Next:Q11-70
Lead-In:Q11-68 [1:1]


Q11-70 [R56226.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to be laid off?

 1   YES
 0   NO

Default Next:Q11-71
Lead-In:Q11-68 [Default], Q11-69 [Default]


Q11-71 [R56227.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to quit?

 1   YES
 0   NO

Default Next:Q11-72
Lead-In:Q11-70 [Default]


Q11-72 [R56228.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to be fired?

 1   YES
 0   NO

Default Next:Q11-73
Lead-In:Q11-71 [Default]


Q11-73 [R56229.00]Section: Health

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to change occupations?

 1   YES
 0   NO

Default Next:Q11-74
Lead-In:Q11-72 [Default]


Q11-74 [R56230.00]Section: Health

Did you lose any wages because of the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

 1   YES
 0   NO

Default Next:Q11-75
Lead-In:Q11-73 [Default]


Q11-75 [R56231.00]Section: Health

Did you or your employer fill out a worker's compensation form for this [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

 1   YES    ...(Go To Q11-76)
 0   NO

Default Next:Q11-78
Lead-In:Q11-74 [Default]


Q11-76 [R56232.00]Section: Health

Have you collected any worker's compensation benefits for this [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

 1   YES
 0   NO    ...(Go To Q11-77)

Default Next:Q11-78
Lead-In:Q11-75 [1:1]


Q11-77 [R56233.00]Section: Health

Is there a worker's compensation claim pending for this [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

 1   YES
 0   NO

Default Next:Q11-78
Lead-In:Q11-76 [0:0]


Q11-78 []Section: Health

Now we have a few questions about health care and hospitalization plans.

Default Next:Q11-79
Lead-In:Q11-10 [0:0], Q11-10 [Default], Q11-12B [Default], Q11-45 [Default], Q11-75 [Default], Q11-76 [Default], Q11-77 [Default]


Q11-79 [R56235.00]Section: Health

First, are you covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans? (PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, (Medicaid/Medi-Cal/Medical
Assistance/Welfare/Medical Services).

 1   YES    ...(Go To Q11-80A)
 0   NO

Default Next:Q11-81C
Lead-In:Q11-78 [Default]


Q11-80A []Section: Health

(HAND CARD EE) What is the source of your health or hospitalization plan? Is it from a policy from your current or previous employer, ...

Default Next:Q11-80B
Lead-In:Q11-79 [1:1]


Q11-80B [R56237.03]Section: Health

... [a policy from (your) [Spouse/partner's name]'s current or previous employer], a policy bought directly from a medical insurance company, is it (Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some other source?

(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)

 1   1. Policy from your CURRENT employer
 2   2. Policy from a PREVIOUS employer
 3   3. Policy from spouse's or partner's CURRENT employer
 4   4. Policy from spouse's or partner's PREVIOUS employer
 5   5. Policy bought directly from medical insurance company
 6   6. Medicaid/Medi-Cal/Medical Assist/Welfare/Medical Service
 7   7. Other (SPECIFY)

Default Next:Q11-81A
Lead-In:Q11-80A [Default]


Q11-81A [R56238.00]Section: Health

In 1995, were there any months when you were NOT covered by health insurance?

 1   YES    ...(Go To Q11-81B)
 0   NO

Default Next:Q11-82
Lead-In:Q11-80B [Default]


Q11-81B [R56239.09]Section: Health

Which months?

(MARK ALL THAT APPLY)
(ENTER MONTHS IN 1996 ON NEXT SCREEN)

 1   JANUARY 1994 2   FEBRUARY 1994
 3   MARCH 1994 4   APRIL 1994
 5   MAY 1994 6   JUNE 1994
 7   JULY 1994 8   AUGUST 1994
 9   SEPTEMBER 1994 10   OCTOBER 1994
 11   NOVEMBER 1994 12   DECEMBER 1994
 13   JANUARY 1995 14   FEBRUARY 1995
 15   MARCH 1995 16   APRIL 1995
 17   MAY 1995 18   JUNE 1995
 19   JULY 1995 20   AUGUST 1995
 21   SEPTEMBER 1995 22   OCTOBER 1995
 23   NOVEMBER 1995 24   DECEMBER 1995
 0   NO MONTHS IN 1994 OR 1995

Default Next:Q11-81BA
Lead-In:Q11-81A [1:1]


Q11-81BA [R56240.01]Section: Health

(Which months?)

(MARK ALL THAT APPLY)
(ENTER MONTHS IN 1996 BELOW)

 25   JANUARY 1996
 26   FEBRUARY 1996
 27   MARCH 1996
 28   APRIL 1996
 29   MAY 1996
 30   JUNE 1996
 31   JULY 1996
 32   AUGUST 1996
 33   SEPTEMBER 1996
 34   OCTOBER 1996
 35   NOVEMBER 1996
 36   DECEMBER 1996
 0   NO MONTHS IN 1996

Default Next:Q11-82
Lead-In:Q11-81B [Default]


Q11-81C [R56241.00]Section: Health

When was the most recent time you were covered by insurance?

 1   SELECT TO ENTER DATE   ...(Go To Q11-81D)
 0   NEVER COVERED BY HEALTH INSURANCE
 2   DK, PRECEDES DATE OF MARRIAGE/PARTNERSHIP

If Answer = -2 Then Go To
Q11-81E

Default Next:Q11-82
Lead-In:Q11-79 [Default]


Q11-81D [R56242.00]Section: Health

(When was the most recent time you were covered by insurance?)

(ENTER MONTH AND YEAR)

Enter Date:  
MonthYear 

Default Next:Q11-82
Lead-In:Q11-81C [1:1]


Q11-81E [R56243.00]Section: Health

Can you tell me how long ago the most recent time you were covered by insurance was?


(ENTER AMOUNT BELOW AND TIME UNIT - "WEEKS", "MONTHS", ETC. IN NEXT SCREEN.)

Enter Number: 
If Answer >= -2 AND Answer <= -1 Then Go To
Q11-82

Default Next:Q11-81F
Lead-In:Q11-81C [-2:-2]


Q11-81F [R56244.00]Section: Health

(Can you tell me how long ago the most recent time you were covered by insurance was?)


(ENTER TIME UNIT BELOW)

 1   WEEKS
 2   MONTHS
 3   YEARS
 4   OTHER (SPECIFY)

Default Next:Q11-82
Lead-In:Q11-81E [Default]


Q11-82 [R56245.00]Section: Health

If Answer = 1 Then Go To
Q11-83

Default Next:Q11-86
Lead-In:Q11-81E [-2:-1], Q11-81A [Default], Q11-81BA [Default], Q11-81C [Default], Q11-81D [Default], Q11-81F [Default]


Q11-83 [R56246.00]Section: Health

Is [Spouse/partner's name] covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans? (PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, (Medicaid/Medi-Cal/Medical
Assistance/Welfare/Medical Services).

 1   YES    ...(Go To Q11-84A)
 0   NO

Default Next:Q11-86
Lead-In:Q11-82 [1:1]


Q11-84A []Section: Health

(HAND CARD EE) What is the source of [Spouse/partner's name]'s health or hospitalization plan? (READ AS NECESSARY) Is it from a policy from your current or previous employer, ...

Default Next:Q11-84B
Lead-In:Q11-83 [1:1]


Q11-84B [R56248.06]Section: Health

... a policy from [Spouse/partner's name]'s current or previous employer, a policy bought directly from a medical insurance company, is it (Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some other source?

(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)

 1   1. Policy from your CURRENT employer
 2   2. Policy from a PREVIOUS employer
 3   3. Policy from spouse's or partner's CURRENT employer
 4   4. Policy from spouse's or partner's PREVIOUS employer
 5   5. Policy bought directly from medical insurance company
 6   6. Medicaid/Medi-Cal/Medical Assist/Welfare/Medical Service
 7   7. Other (SPECIFY)

Default Next:Q11-86
Lead-In:Q11-84A [Default]


Q11-86 [R56249.00]Section: Health

If Answer = 1 Then Go To
Q11-87

Default Next:Q11-86A
Lead-In:Q11-82 [Default], Q11-83 [Default], Q11-84B [Default]


Q11-86A [R56250.00]Section: Health

If Answer = 1 Then Go To
Q11-87

Default Next:Q11-86B
Lead-In:Q11-86 [Default]


Q11-86B [R56251.00]Section: Health

If Answer = 1 Then Go To
Q11-87

Default Next:Q11-86C
Lead-In:Q11-86A [Default]


Q11-86C [R56252.00]Section: Health

If Answer = 1 Then Go To
Q11-87

Default Next:Q11-86D
Lead-In:Q11-86B [Default]


Q11-86D [R56253.00]Section: Health

If Answer = 1 Then Go To
Q11-87

Default Next:Q11-86E
Lead-In:Q11-86C [Default]


Q11-86E [R56254.00]Section: Health

If Answer = 1 Then Go To
Q11-87

Default Next:Q13-1A
Lead-In:Q11-86D [Default]


Q11-87 [R56255.00]Section: Health

(Is/Are) your (child/children) covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans? (PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services).

 1   YES    ...(Go To Q11-88A)
 0   NO

Default Next:Q13-1A
Lead-In:Q11-86 [1:1], Q11-86A [1:1], Q11-86B [1:1], Q11-86C [1:1], Q11-86D [1:1], Q11-86E [1:1]


Q11-88A []Section: Health

(HAND CARD EE) What is the source of your (child/children)'s health or hospitalization plan? (READ AS NECESSARY) Is it from a policy from your current or previous employer, ...

Default Next:Q11-88B
Lead-In:Q11-87 [1:1]


Q11-88B [R56256.05]Section: Health

... [a policy from (your) [Spouse/partner's name]'s current or previous employer], a policy bought directly from a medical insurance company, is it (Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some other source?

(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)

 1   1. Policy from your CURRENT employer
 2   2. Policy from a PREVIOUS employer
 3   3. Policy from spouse's or partner's CURRENT employer
 4   4. Policy from spouse's or partner's PREVIOUS employer
 5   5. Policy bought directly from medical insurance company
 6   6. Medicaid/Medi-Cal/Medical Assist/Welfare/Medical Service
 7   7. Other (SPECIFY)

Default Next:Q13-1A
Lead-In:Q11-88A [Default]