x0000x0000Wave 2 InPerson Questionnaire Page - PDF document

1 ��Wave 2 InPerson Question
��Wave 2 InPerson Questionnaire | Page NSHAP W2 INPERSON QUESTIONNAIRE (IPQ) DefinitionsINTRODUCTIONS, SETUP AND CONSENTBASIC BACKGROUND INFORMATIONII.A. IV.H.Health Related BehaviorsBIOMEASURE BREAK ��Wave 2 InPerson Questionnaire | Page VIII.SAQ VERSION FOR MALE RESPONDENTSIX.FERTILITY/MENOPAUSECHILDREN AND GRANDCHILDRENXI.MENTAL HEALTHXI.A.HappinessXI.B.DepressionXII.EMPLOYMENT AND FINANCESXII.A.EmploymentXII.B.Household IncomeXII.C.Household AssetsXIII.RELIGIONXIV.INTERNET USEDEBRIEFINGXVI.INTERVIEWER COMMENTSXVI.A.Characteristics and Location of the InterviewXVI.B.Respondent’s Functional Health and Behavior during the InterviewXVI.C.Description of the RespondentXVI.D.Description of the Interview LocationXVI.E.Respondent’s Home and His/ Her Neighborhood EnvironmentXVI.F.Interview Logistics and Other InformationDEFINITIONSFI:FieldInterviewerRespondentALLCAPS:Indicatesshouldreadtextloud[BRACKETEDEXT]:CAPIfillerbasedpreloadedmaterial [NAME]:CAPIfillforspecificname.Usuallyusedsocialnetworkrosterandrefersthenametheindividualrostermember.[CURRENTPARTNER]:CAPIfillfornameR’scurrentpartner.Thecurrenpartnertheromantic/intimatepartnerthetheinterview.Currentpartneridentifiedthenetworkrosternamegeneratorquestionsand[RECENTPARTNER]:CAPIfillfornameR’smostrecentromantic/intimate/sexualpartnerthatpartnershipwithinthepastyears.Onlyus

2 eddoeshavecurrentpartner.recentpartnermu
eddoeshavecurrentpartner.recentpartnermustpartnershipthepastyears. ��Wave 2 InPerson Questionnaire | Page INTRODUCTIONS,SETUPCONSENTJustconfirm,yourname[FILLFIRSTANDLASTNAMEFROMPRELOAD]andyouryearbirth[FILLYEARBIRTHFROMPRELOAD]?BOTHNAMEYEARBIRTHARECORRECT(GOQUESTIONSMALLCHANGESNEEDED(GOQUESTIONWRONGPERSON(TERMINATEINTERVIEW)PLEASETYPETHECORRECTEDRESPONDENTINFORMATION,WHERENEEDED.FIRSTNAME:________________CHANGENEEDEDLASTNAME:________________CHANGENEEDEDYEARBIRTH:________________CHANGENEEDEDhaveconsentformthatdescribesthestudyprocedures,risks,andbenefitsparticipationandconfidentiality.wouldlikereadthisformyou.youprefer,however,youmayreadyourself.Mayreadtheformyouwouldyoulikereadyourself?CHOOSEREADFORM(GOQUESTIONREADFORM(GOQUESTIONTakeyourandafteryou’refinishedI’llaskyousigntheform.PRESSCONTINUEWHENCOMPLETESFORM. CONTINUE(GONEXTSECTION)READFORMPRESSCONTINUEWHENCOMPLETEFORM.CONTINUE(GONEXTSECTION)SICBACKGROUNDINFORMATIONASKTHISSECTIONONLYNEWRESPONDENTS(PARTNERSNIRs)GENDERPLEASEINDICATETHEGENDERTHERESPONDENT.UNCLEAR,ASK:requiredaskyouthefollowing:areyoumalefemale?MaleFemale ��Wave 2 InPerson Questionnaire | Page IV.AGEFirst,wouldlikegetsomebasicbackgroundinformationaboutyou.whatmonth,day,andyearwereyouborn?MONTH) _____ (DAY) _____ (YEAREDUCATIONNowI'dlikeaskyousomequestionsaboutyourschooling.Haveyoureceivedhighschdiplomapassedhighscho

3 olequivalencytest?YES,DIPLOMAYES,EQUIVAL
olequivalencytest?YES,DIPLOMAYES,EQUIVALENCY:HowmanygradesschooldidyoufinishpriorgettingyourGED?(CODEEXACTYEARS)No:Howmanygradesschooldidyoufinish?(CODEEXACTYEARS)Didyouattendcollegeuniversity?YESHowmanyyearsdidyoucompletecollegeuniversity?youdidgraduatework,pleaseincludethisalso.(CODEEXACTYEARS)Whatthehighestdegreecertificationyouhaveearned?Noneigh school diploma/equivalencyAssociate's (2year college) or postigh choolvocational certificateBachelor's (4year college) degreeMaster's degree/MBALaw or OTHER (SPECIFY) VI.RACE/ETHNICITYyouconsideryourselfprimarilywhiteCaucasian,BlackAfricanAmerican,AmericanIndian,Asiansomethingelse?White/CaucasianBlack/African AmericanAmericanIndian orAlaskan NativeAsianPacific IslanderOTHER (SPECIFY) _________ ��Wave 2 InPerson Questionnaire | Page youconsideryourselfHispanictino?YESVII.SOCIALCONTEXTASKALLRESPONDENTSTHISSECTIONVIII.ROSTER VIII.A.1.NameGenerator RE:QUESTIONSHAVERESPONDENTUSEROSTERLISTPERSONSIDENTIFIEDTHISSECTIONNowaregoingaskyousomequestionsaboutyourrelationshipswithothepeople.willbeginidentifyingsomethepeopleyouinteractwithregularbasis.Youmayreferthesepeopleanywayyouwant;forexample,youmayusejusttheirfirstnamesnicknames.areinterestedtheidentitiesesepersons;justneedhavesomewayreferthemthatwhenaskyousomefollowquestionsbothwhomaretalkingabout.Fromtime,mostpeoplediscussthingsthatareimportantthemwithothers.Forexam

4 ple,esemayincludegoodbadthingsthathappen
ple,esemayincludegoodbadthingsthathappenyou,problemsyouarehaving,importantconcernsyoumayhave.Lookingbackoverthelastmonths,whoarethepeoplewithwhomyoumostoftendiscussedthingsthatwereimportantyou?PleaselistthesepeopleSectionyourroster.(PROMPTDON’TThiscouldpersonyoutendtalkaboutthingsthatareimportantyou.) ENTERNAMESROSTERTHEORDERWHICHTHEYAREIDENTIFIEDRESPONDENT(SECTIONA).ROMPTONCEWHENRESPONDENTFINISHEDSHENAMEDFEWERTHANPEOPLE:Arethereanymore?IF THE ANSWER IS "NO", DO NOT PUSH FURTHER.1a.WhichthefollowingbestdescribesesNAMErelationshipyou?(PROMPTNEEDED:thispersonyour . . .(HAND CARD)SpousespouseRomantic/SexualpartnerParentParentlawChild ��Wave 2 InPerson Questionnaire | Page StepchildBrothersisterGrandchildOtherrelativeyoursOtherlawFriendNeighborworkerbossMinister,priest,otherclergyPsychiatrist,psychologist,counselor,therapistCaseworker/SocialworkerHousekeeper/HomehealthcareproviderOTHER (SPECIFY________________IF SPOUSE IS SELECTED IN QUESTION 1A, 24 WILL BE SKIPPEDAreyoucurrentlymarried,livingwithpartner,separated,ivorced,widowed,haveyouneverbeenmarried?MARRIEDLIVINGWITHPARTNERSEPARATEDDIVORCEDWIDOWEDNEVERMARRIEDASK QUESTION 3 ONLY IF RESPONDENT ANSWERED "SEPARATED", "DIVORCED", "WIDOWED", OR "NEVER MARRIED" TO Q2youcurrentlyhavemantic,intimate,sexualpartner?YESASK QUESTION 4 ONLY IF RESPONDENT ANSWERED "LIVING WITH A PARTNER" TO QUESTION 2, OR "YES" TO

5 QUESTION 3RESPONDENTANSWERED“MARRI
QUESTION 3RESPONDENTANSWERED“MARRIED”QUESTIONASKTHEBRANCHQ4A(ROSTERB).your[CURRENTPARTNER]someonewrotedownyourrosterearlier?YESPleasetellthelinenumberwhichthispersonappearsRECORDLINENUMBERWouldyoupleaseaddthispersonSectionNAME respondentmarriedcohabitingandreportshavingmorethancurrentpartner,askhimherpickthepartnersheconsidersthemostimportant. ��Wave 2 InPerson Questionnaire | Page (Besidesthepeoplewrotedownyourrosterearlier),thereanyone(else)whoveryimportantyou,perhapssomeonewithwhomyoufeelespeciallyclose?YESWouldyoupleaseaddthispersonSectionRECORDNAME(SKIPQUESTIONONLYCANADDPERSONROSTERSKIPTHERESPONDENTDOESANYONESECTION5A.Whichthefollowingbestdescribes[NAME]relationshipyou?(PROMPTNEEDED:thispersonyour(HAND CARD)SpousespouseRomantic/SexualpartnerParentParentlawChildStepchildBrothersisterGrandchildOtherrelativeyoursOtherlawFriendNeighborworkerbossMinister,priest,otherclergyPsychiatrist,psychologist,counselor,therapistCaseworker/SocialworkerHousekeeper/HomehealthcareproviderOTHER (SPECIFY________________(Excludingthepeoplewrotedownyourrosterearlier,)arethere(other)peoplewholiveyourhouseholdwithyou? YESPleaseaddthesepeopleyourlistSectionRECORDALLNAMESSECTIONROSTER.SKIP6A IF THERESPONDENTDOESANYONESECTION6a.WhichfollowingbestdescribesesNAMErelationshipyou?(PROMPTNEEDED:thispersonyour(HAND CARD)SpousespouseRomantic/SexualpartnerParentParentlaw �

6 000;�Wave 2 InPerson Questionnair
000;�Wave 2 InPerson Questionnaire | Page ChildStepchildBrothersisterGrandchildOtherrelativeyoursOtherlawFriendNeighborworkerbossMinister,priest,otherclergyPsychiatrist,psychologist,counselor,therapistCaseworker/SocialworkerHousekeeper/HomehealthcareproviderOTHER (SPECIFY) ________________Arethereanymore?READLISTLOUDMAKE CERTAIN THERE ARE NO DUPLICATES. IF THERE ARE DUPLICATES, CLICK THE BOX NEXT TO THE PERSON’S NAME TO REMOVE THEM AND CLICK NEXT. IF THERE ARE NO DUPLICATES, CHOOSE ‘NO DUPLICATES’ AND CLICK NEXT.BEFORE GOING ON, REVIEW THE ENTIRE LIST WITH THE RESPONDENT TO MAKE CERTAIN THAT THERE ARE NO DUPLICATES (I.E., THE SAME PERSON LISTED TWICE). IF R DOES NOT LIST ANYONE IN THEIR ROSTER, SKIP TO SOCIAL SUPPORT VIII.A.2.RosterFollowQuestions (LOOP)FOLLOWQUESTIONS:REPEATFOREACHINDIVIDUALNAMESOCIALNETWORKROSTER.Nextaregoingaskyousomequestionsaboutthepeopleyouhavejustlisted.We'llstartwith[NAME][NAME]malefemale?MALEFEMALESKIP[NAME]LISTEDSECTION(OTHERHOUSEHOLDMEMBERS)DoesesNAME]livethesamehouseholdwithyou?(INTERVIEWERNOTE:LIVESSAMERESIDENCEWITHRESPONDENT,NOTSAMEAPARTMENTCOMPLEX.)YES livesthesamehouseholddoeslivehousehold ��Wave 2 InPerson Questionnaire | Page VOLUNTEEREDLIVESWITHRESPONDENTPARTTHEYEARONLYASKNEWRESPONDENTS.ASKONLYROSTERMEMBERLIVESWITHRESPONDENT.What[NAME]age?(PROMPTNEEDED:It'sokayyoudon'ttheexactage,justgiveyourb

7 estguess.)ASKONLYDOESREFUSES[NAME]oldert
estguess.)ASKONLYDOESREFUSES[NAME]olderthanyou,youngerthanyou,aboutthesameage?OlderthanyouYoungerthanyouAboutthesameageSKIPFORTHOSELISTEDROSTERHowoftenyoutalkthisperson?IF RESPONDENT ASKS, SAY THAT TALKING OVER THE TELEPHONE AND PERSONAL EMAIL (I.E., EMAIL BACK AND FORTH BETWEEN THE TWO OF YOU) MAY BE INCLUDED(HAND CARD)EverydaySeveraltimesweekOnceweekOnceeverytwoweeksOncemonthcoupletimesyearOnceyearLessthanonceyearHowcloseyoufeelyourrelationshipwith[NAME]Wouldyousay not very close, somewhat close, very close, or extremely close?NotverycloseSomewhatclose VerycloseExtremelycloseSupposeyouhadhealthproblemthatyouwereconcernedabout,neededmakeimportantdecisionaboutyourownmedicaltreatment.Howlikelythatyouwouldtalkwith[NAME]aboutthis:wouldyousayverylikely,somewhatlikely,likely?VerylikelySomewhatlikelyNotlikely VIII.A.3.NetworkDensity LOOPNETWORKDENSITY:REPEATFOREACHPAIRINDIVIDUALSLISTEDSECTIONSSOCIALNETWORKROSTER. ��Wave 2 InPerson Questionnaire | Page thenextsetquestions,I'mgoinggiveyoutwothenamesyoulistedearlier,andaskyouindicatehowfrequentlythesetwopeopletalkotherusingthecategoriesthiscard.Oncegetstarted,thinkyou'llseethatthisworksprettyeasily.Let'sstartwithithNAME1anddNAME2HowfrequentlyyNAME1anddNAME2talkother?RESPONDENTASKS,SAYTHATTALKINGOVERTHETELEPHONEPERSONALEMAILMAYINCLUDED.(HAND CARD)EverydaySeveraltimesweekOnceweekOnceeverytwoweeksOncemonthcoupletime

8 syearOnceyearLessthanonceyearHaveneversp
syearOnceyearLessthanonceyearHaveneverspokeneachother VIII.A.4.NetworkChange ASKSECTIONONLYWAVERESPONDENTSLOOPFORALLNAMESNEWROSTERPRESENTWITHWAVEWAVEROSTERBeforeconcludethissectionthesurvey,I’dlikeverifyanychangesbetweenthelistyou’vecreatedtodayandthelistyoucreatedthelastwereinterviewed.DIDLISTANYONEROSTERSKIP[NAME]includedthefirstlistyoucreated?YES:whichlinedoes[NAME]appear?(RECORDLINENUMBER)1a.Q1.Howlonghaveyouknown[NAME](HAND CARD)Less than a year1 to 3 years3 to 6 yearsMore than 6 yearsIF NO TO Q1 AND ROSTER MEMBER LIVES WITH RESPONDENT: What is [NAME]'s age? (PROMPT: It's okay if you don't know the exact age;just give us your best guess.) ��Wave 2 InPerson Questionnaire | Page ASK ONLY IF R DOES NOT KNOW OR REFUSES Q1b: Is [NAME]older than you, younger than you, or about the same age?Older than youYounger than youAbout the same ageIF YES to Q1, ROSTER MEMBER IS HOUSEHOLD MEMBER AND R DID NOT PROVIDE AGE IN W1: What is [NAME]'s age? (PROMPT IF NEEDED: It's okay if you don't know the exact age, just give us your best guess.)ASK ONLY IF R DOES NOT KNOW OR REFUSES Q1D: Is [NAME]older than you, younger than you, or about the same age?Older than youYounger than youAbout the same agenoticedthatlastinterview(YEARINTERVIEW),youalsolisted[NAMEfromWAVEsomeonewithwhomyoudiscussimportantmatters,youdidlist[NAME]thistime.[NAME]stillliving?YESWhatth

9 emainreasonyouarelongertouchwith[NAME]I
emainreasonyouarelongertouchwith[NAME]I MOVED[NAME]MOVED[NAME]DIEDI BECAME ILL OR HAD A HEALTH PROBLEM[NAME]BECAME ILL OR HAD A HEALTH PROBLEMOTHER (SPECIFY)WHENFINISHED,SAY"Thatcompletesquestionsabouttherelationshipsamongthepeopleyoulisted.Thankyouforbearingwithus."IX.SOCIALSUPPORT IX.A.1.Supportfromartner ASK THIS SECTION ONLY IF RESPONDENT HAS CURRENT PARTNERForthisnextsetquestions,I'dlikeyouthinkaboutyourrelationshipwith[CURRENTPARTNER].kingallthingstogether,wouldyoudescribeyour(marriage/relationship)with[CURRENT/RECENTPARTNER]scalefromwithbeingveryunhappyandbeingveryhappy?(HAND CARD)Very unhappy ��Wave 2 InPerson Questionnaire | Page Neither happy or unhappy7 Very happySomecoupleslikespendtheirfreedoingthingstogether,whileotherslikedifferentthingstheirfreetime.Whataboutyouand[CURRENTPARTNER]?youlikespendfreedoingthingstogether,doingthingsseparately?getherSometogether,somedifferentDifferent/separatethingsHowoftencanyouopen[CURRENTPARTNER]youneedtalkaboutyourworries?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD)NeverHardlyeverrarelySometheOftenHowoftencanyourely[CURRENTPARTNER]forhelpyouhaveproblem?Wouldyousaynever,hardlyeverrarely,somethetimeoften?(HAND CARD)NeverHardly ever or rarelySome of the timeOftenHowoftendoes[CURRENTPARTNER]maketoomanydemandsyou?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD) NeverHardly ever or rarelyS

10 ome of the timeOftenHowoftendoes[CURRENT
ome of the timeOftenHowoftendoes[CURRENTPARTNER]criticizeyou?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD)NeverHardly ever or rarelySome of the timeOften IX.A.2.SupportfromFamily ASKTHISSECTIONALLRESPONDENTS ��Wave 2 InPerson Questionnaire | Page Thesenextquestionsaskaboutyourrelationshipswithmembersyouramilyrelatives.RESPONDENTMARRIEDCURRENTPARTNERansweringthesequestions,we'dlikeyouexclude[CURRENTPARTNER].Howoftencanyouopenmembersyourfamilyyouneedtalkaboutyourworries?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD)NeverHardly ever or rarelySome of the timeOftenVOLUNTEEREDFAMILY(SKIPIII.B.3SUPPORTFROMFRIENDS)HowoftencanyourelythemforhelpyouhaveproblemWouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD)NeverHardly ever or rarelySome of the timeOften(Notincluding[CURRENTPARTNER]),oftenmembersyourfamilymaketoomanydemandsyou?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD)NeverHardly ever or rarelySome of the timeOftenHowoftentheycriticizeyou?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD) NeverHardly ever or rarelySome of the timeOften(Otherthan[CURRENTPARTNER]),manyfamilymembersrelativesyouhavewhomyoufeelcloseto?Wouldyousay .(HAND CARD)NoneOneMorethan ��Wave 2 InPerson Questionnaire | Page IX.A.3.Supportfromriends ASKTHISSECTIONALLRESPONDENTSNowwe'dlikeaboutyourrelationshipswithfriends,includ

11 ingthefamilymembersrelativeswerejusttalk
ingthefamilymembersrelativeswerejusttalkingabout.Somepeopleseethemselveshavinggreatmanyfriends.Othersseethemselveshavingfewer.Thinkaboutthepeopleyouconsideryourfriends,bothyourclosestfriendsandpeoplewithwhomyouareprettygoodfriends.Howoftencanyouopenyourfriendsyouneedtalkaboutyourworries?Wouldyousaynever,hardlyeverrarely,somethetimeoften?(HAND CARD)NeverHardlyeverrarelySometheOftenVOLUNTEEREDFRIENDS(SKIPSECTIONIV.A.)Howoftencanyourelythemforhelpyouhaveproblem?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD)NeverHardlyeverrarelySometheOftenHowoftenyourfriendsmaketoomanydemandsyou?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD) NeverHardly ever or rarelySome of the timeOftenHowoftentheycriticizeyou?Wouldyousaynever,hardlyeverrarely,sometheoften?(HAND CARD)NeverHardly ever or rarelySome of the timeOftenAboutmanyfriendswouldyouthatyouhave?that(HANDCARD)NoneOneMorethan ��Wave 2 InPerson Questionnaire | Page PHYSICALHEALTHXI.SELFEPORTEDEALTHThissectionaboutyourphysicalhealth.First,wouldlikeaskyousomegeneralquestions.Wouldyousayyourhealthcellent,verygood,fair,poor?(HAND CARD)ExcellentVerygoodGoodFairPoorWhataboutyouremotionalmentalhealth?excellent,verygood,good,fair,poor?(HAND CARD)ExcellentVery goodGoodFairPoorToday,youhavheadcoldchestcold?YES(Today)youhavestomachflu?YESXII.SENSORYUNCTIONWithyourglassescontactlensesyouwearthem,youreyesighte

12 xcellent,verygood,good,fair,poor?(HAND C
xcellent,verygood,good,fair,poor?(HAND CARD)ExcellentVery goodGoodFairPooryourhearingwithhearingaidyouwearone,excellent,verygood,good,fair,poor?(HAND CARD) ExcellentVery goodGood ��Wave 2 InPerson Questionnaire | Page FairPoorHowoftenyouwearhearingaid?Never/Don't have oneSometimesMosttheAlwaysDoeshearingproblemcauseyoufeelfrustratedwhentalkingmembersyourfamily?YESyouhavedifficultyhearingwhensomeonespeakswhisper?YESDoeshearingproblemcauseyoudifficultywhenvisitingfriends,relatives,neighbors?YESyoufeelthatanydifficultywithyourhearinghampersyourpersonalsociallife?YESXIII.SURGERIESROCEDURESNow we would like to ask about different tests or procedures you may have had done. For each item, please tell me if you had it done within the past year, between one and five years ago, more than five years ago, or if you have never had it done.About how long has it been since you hadWOMEN ONLY Q1A pelvic examination? (HAND CARD)Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever2. A Pap smear test? (A pap smear is a routine medical test in which the doctor examines the cervix (internal female organ) and sends a cell sample to the lab) (HAND CARD)Within the past yearBetween 1 and 5 years ago ��Wave 2 InPerson Questionnaire | Page More than 5 years agoNever(SKIP TO Q3)2a. IF YES TO PAPSMEAR: Have you ever been told you have precancer or dys

13 plasia of the cervix?YES3. A tubal ligat
plasia of the cervix?YES3. A tubal ligation? (tubes tied, cut, or burned)? (HAND CARD)Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever4. A hysterectomy? (PROMPT: A hysterectomyis an operation to remove the uterus) (HAND CARD)Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever5. IF RESPONDENT HAD HYSTERECTOMY: Was the entire uterus removed including the cervix?YES6. IF RESPONDENT HAD HYSTERECTOMY: Did you have your hysterectomy after your last menstrual period, that is, after you went through menopause?YES7. Your ovaries removed? (FOR RESPONDENTS WHO HAD A HYSTERECTOMY: This may or may not have happened during a hysterectomy.) (HAND CARD)Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever(SKIP TO BREASTR)DON’T KNOW (SKIP TO BREASTR)REFUSED (SKIP TO BREASTR)8. IF RESPONDENT HAD OVARIES REMOVED: Was it the left, right, or both ovaries?LEFTRIGHTBOTH ��Wave 2 InPerson Questionnaire | Page 9. IF RESPONDENT HAD OVARIES REMOVED: Did you have your ovaries removed after your last menstrual period, that is, after you went through menopause? YES10. How long has it been since you had a mammogram?Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever (SKIP TO QUESTION 26)DON’T KNOW (SKIP TO QUESTION 26)REFUSED (SKIP TO QUESTION 26)11. IF RESPONDENT HAD A MAMMOGRAM: Have you had a

14 breast biopsy? YES12. IF BIOPSY: Was th
breast biopsy? YES12. IF BIOPSY: Was the biopsy normal?YES (SKIP TO QUESTION 26)DON’T KNOW (SKIP TO QUESTION 26)REFUSED (SKIP TO QUESTION 26)13. All or most of a breast removed? (HAND CARD)Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever (SKIP TO QUESTION 26)DON’T KNOW (SKIP TO QUESTION 26)REFUSED (SKIP TO QUESTION 26)14. IF RESPONDENT HAD ALL OR MOST OF BREAST REMOVED: Have you ever had breast reconstructive surgery?YESMEN ONLY15. A ProstateSpecific Antigen test, also called a PSA test? (PROMPT: A PSA test is a blood test used to check men for prostate cancer) (HAND CARD)Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever ��Wave 2 InPerson Questionnaire | Page 16. A digital rectal exam, also called a DREWithin the past yearBetween 1 and 5 years agoMore than 5 years agoNever17. IF PSA OR DIGITAL RECTAL EXAM: Have you ever had a biopsy of your prostate? (PROMPT: A biopsy is a procedure in which several needles are inserted into the prostate through the rectum to check for cancer)YESNO (SKIP TO Q24)18. IF BIOPSY: Did the biopsy indicate you had prostate cancer?YESNO (SKIP TO Q24)DON’T KNOW (SKIP TO Q24)19. IF BIOPSY INDICATED CANCER: Did you receive therapy for prostate cancer? YESNO (SKIP TO Q24)DON’T KNOW (SKIP TO Q24)20. IF TREATED FOR CANCER: Did you have a prostatectomy? (PROMPT: a comple

15 te removal of the prostate gland? (HAND
te removal of the prostate gland? (HAND CARD)YESIF R HAD A PROSTATECTOMY (“YES TO Q21)a. When did you have a prostatectomy?Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever. IF TREATED FOR CANCER: Did you receive radiation therapy, either from an external beam or from radioactive “seeds” placement? YES: did you have external beam or “seeds” placement? EXTERNAL BEAM“SEEDS” PLACEMENT ��Wave 2 InPerson Questionnaire | Page 22. IF TREATED FOR CANCER: Did you receive androgen deprivation therapy (ADT) or “hormone therapy”? (PROMPT: ADT or hormone therapy include receiving injections every 3months) YES: Are you still receiving the therapy? YES23. About how long has it been since you had a vasectomy? (PROMPT: A vasectomy is a surgical procedure on the testicles to stop a man’s fertility. ADDITIONAL PROMPT IF NEEDED: Sometimes referred to as “getting snipped”) (HAND CARD)Within the pastyearBetween 1 and 5 years agoMore than 5 years agoNever 24. Are you circumcised? YES25. About how long has it been since you had a colonoscopy? Within the past yearBetween 1 and 5 years agoMore than 5 years agoNever XIV.ACCESSEALTHDuringthepastmonths,manytimeshaveyouseendoctorotherhealthcareprofessionalaboutyourhealthdoctor'soffice,clinic,hospital,homesomeotherplace?(DOREADRESPONSES)About oncemont(A

16 bout twicemonth)more1a.“NONE”Q
bout twicemonth)more1a.“NONE”Q1:Aboutlonghasbeensinceyoulastsawtalkeddoctorotherhealthcareprofessionalaboutyourhealth?Includedoctorsseenwhileyouwerepatientspital.Hasbeen monthslessMorethanmonths,morethanyearagoMorethanyear,morethanyearsago ��Wave 2 InPerson Questionnaire | Page MorethanyearsNeverthereplacethatyouusuallywhenyouaresickneedadviceaboutyouralth?YESTHERE IS MORE THAN ONE PLACE2a.YESQ2:Whatkindplaceclinic,doctor'soffice,emergencyroom,someotherplace?Clinic or health centerDoctor's office or HMOHospital emergency room [SKIP TO Q3Hospital outpatient departmentSome other placeI DON'T GET ROUTINE OR PREVENTATIVE CARE ANYWHERE'THEREMORETHANPLACE'Q2:Whatkindplaceyoumostoftenclinic,doctor'soffice,emergencyroom,someotherplace?Clinic or health centerDoctor's office or HMOHospital emergency room [SKIP TO Q3Hospital outpatient departmentSome other placeDoesn't go to one place most oftenI DON'T GET ROUTINE OR PREVENTATIVE CARE ANYWHERESKIP'HOSPITALEMERGENCYROOM'Q2A.Howoftenareyouablegetappointment[fillplacefromabove/theseplaces]quicklyyouthinkyouneedNeveralmostneverSometimesUsuallyAlwaysalmostalwaysYESQ2:that[fillplacefromabove]thesameplace ''THEREMORETHANPLACE'Q2:Arethesethesameplaces"NO"Q2:thereplaceusuallywhenyouneedroutinepreventativecare,suchphysicalexaminationcheckYESTHERE IS MORE THAN ONE PLACE ��Wave 2 InPerson Questionnaire

17 | Page THEREMORETHANPLACEQ3:Whatkindplac
| Page THEREMORETHANPLACEQ3:Whatkindplaceyouusuallywhenyouneedroutinepreventativecare,suchphysicalexaminationcheckClinic or health centerDoctor's office or HMOHospital emergency room [SKIP TO Q4Hospital outpatient departmentSome other placeDoesn't go to one place most oftenI DON'T GET ROUTINE OR PREVENTATIVE CARE ANYWHEREHowoftenareyouablegetappointment[fillplacefromabove/theplacesyouquicklyyouthinkyouneedNever or almost neverSometimesUsuallyAlways or almost alwaysMORBIDITYHasmedicaldoctorevertoldyouthatyouhaveanythefollowingconditions?(PROMPT:Medicaldoctorsincludespecialistssuchdermatologists,psychiatrists,ophthalmologists,wellgeneralpractitionersandosteopaths.includechiropractors,dentists,nurses,nursepractitioners.)DOCTOREVERTOLDTHAThighbloodpressurehypertension?YESREFUSEDDON’T KNOWDOCTOREVERTOLDTHATosteorheumatoidarthritis? YESsteo or rheumatoid arthritis?OSTEOARTHRITISRHEUMATOID ARTHRITISREFUSEDDON’T KNOWDOCTOREVERTOLDTHATheartcondition?YES ��Wave 2 InPerson Questionnaire | Page YES:DOCTOREVERTOLDYOUTHATYOUheartattackmyocardialinfarction?YESREFUSEDDON’TKNOWYES:Haveyoueverhadproceduretreatcoronaryarterydisease,suchcardiacpasssurgeryplacementcoronaryarterystent?(INTERVIEWERINSTRUCTION:RESPONDENTASKS,THISINCLUDESBALLOONANGIPLASTYFORTREATMENTCORONARYARTERYDISEASE.DOESINCLUDEANGIOGRAM,WHICHDIAGNOSTICPROCEDURE)YESREFUSEDDON’T KNOWYES:DO

18 CTOREVERTOLDYOUTHATYOUcongestiveheartfai
CTOREVERTOLDYOUTHATYOUcongestiveheartfailure“CHF”?YESREFUSEDDON’TKNOWDOCTOREVERTOLDTHATskincancer(includingmelanomaother)?YESWhattypeskincancerwereyoudiagnosedwith?CARCINOMAMELANOMAOTHERREFUSEDDON’T KNOWDOCTOREVERTOLDTHATcancer(otherthanskincancer)? YESREFUSEDDON’T KNOWASKONLYRESPONDENTHADCANCER(OTHERTHANSKINCANCER):Howmanysuchcancershaveyouhad?Number ��Wave 2 InPerson Questionnaire | Page MORETHANCANCER,ASKQUESTIONFORFIRSTCANCERFORMOSTRECENTCANCER(LOOPTWOTIMES).LOOPONLYONCEONECANCERREPORTED.LOOPFORSKINCANCER.ASKONLYRESPONDENTHADCANCER:MORETHANCANCER:FORFIRSTLOOP,INTROTEXTSHOULDREAD:NowthinkingaboutyourfirstcancerFORSECONDLOOP,INTROTEXTSHOULDREAD:Nowthinkingaboutyourmostrecentcancer6a.Whendidthecancerbegin?(PROMPTNEEDED:Howoldwereyou?) INTERVIEWERINSTRUCTION:_____MONTH/_____ YEAR OR _____ AGEDON’TKNOWASKONLYRESPONDENTCANCER:Sometimes,cancerwillstartplaceandspreadotherpartsthebody.Rightareinterestedknowingaboutprimarycancer,or,otherrds,whereyourcancerbegan.whichorganpartyourbodydidthecancerstart?(DOREADLIST)BLADDERBONEBRAINBREASTCERVIX(WOMENONLY)COLONESOPHAGUSGALLBLADDERKIDNEY LARYNXWINDPIPELEUKEMIALIVERLUNGLYMPHOMAMOUTH,TONGUE,LIPOVARY(WOMENONLY)PANCREASPERITONEALPROSTATE(MENONLY)RECTUMRENALSOFTTISSUE(MUSCLEFAT)STOMACHTESTES(MENONLY) ��Wave 2 InPerson Questionnaire | Page THROATPHARYNXTHYROIDUTERUS(WOMENO

19 NLY)VULVA(WOMENONLY)OTHER:(SPECIFY)_____
NLY)VULVA(WOMENONLY)OTHER:(SPECIFY)________________6c.ASKONLYRESPONDENTCANCER:Hasthiscancerspreadotherpartsyourbody?YESDOCTOREVERTOLDTHATdiabeteshighbloodsugar?YES7a.YESQ7:whatmonthandyeardidyourdoctorfirsttellyouthatyouhavediabetesMellitushighbloodsugar?MONTHYEARDON’T KNOWEFUSEDDOCTOREVERTOLDTHATEmphysema,asthma,chronicbronchitis,chronicobstructivepulmonarydisease?YESREFUSEDDON’T KNOWDOCTOREVERTOLDTHATosteoporosis?YESREFUSEDDON’T KNOWTHELASTYEARS,DOCTOREVERTOLDTHATHADstroke,cerebrovascularaccident(CVA,bloodclotbleedingthebrain,transientischemicattack(TIA YESREFUSEDDON’T KNOWDOCTOREVERTOLDTHATHAVEhipfracture?YES ��Wave 2 InPerson Questionnaire | Page REFUSEDDON’T KNOWDOCTOREVERTOLDTHATHAVEAlzheimer'sdisease?YESREFUSEDDON’T KNOW12a.QUESTIONDOCTORTOLDTHATHAVEdementia(includingvasculardementia,mixeddementia,MildCognitiveImpairment)?YESREFUSEDDON’T KNOWDOCTOREVERTOLDTHATHAVEParkinson’sdisease?YESREFUSEDDON’T KNOWArethereanyothermedicaldiseasesconditionsthatareimportantyourhealthnow,thathavetalkedabout?YESWhatarethey?Haveyoueverdiscussedwithdoctorthechangesyoursexlifethatmayresultfrommedicalcondition?YESXVI.FUNCTIONALEALTHareinterestedwhatactivitiesareeasydifficultforyou.Pleaselooktheanswercategoriesthehandcardandtellmuchdifficultyyouhavewithactivity.Excludeanydifficultiesthatyouexpectlastlessthanthreemonths.(HAND

20 CARD) Preparingmeals?difficultySomediffi
CARD) Preparingmeals?difficultySomedifficultyMuchdifficultyUnableIF VOLUNTEEREDHAVE NEVER DONE ��Wave 2 InPerson Questionnaire | Page Takingyourmedications?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEManagingyourmoneysuchwritingchecksandkeepingtrackbills?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEShoppingforgroceries?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEPerforminglighthouseworksuchdishes,lightvacuuming,dusting?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEUsingtelephone?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEWalkingacrossroom?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEWalkingblock?No difficultySome difficultMuch difficulty ��Wave 2 InPerson Questionnaire | Page Unable to doIF VOLUNTEEREDHAVE NEVER DONEDressing,includingputtingshoesandsocks?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEBathingshowering?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEEating,suchcuttingyourfood?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEGettingbed?No difficultySome difficultyMuch difficultyUnable to

21 doIF VOLUNTEEREDHAVE NEVER DONEUsingthet
doIF VOLUNTEEREDHAVE NEVER DONEUsingthetoilet,includinggettinganddown?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONEDrivingcarduringtheday?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONE ��Wave 2 InPerson Questionnaire | Page Drivingcarduringthenight?No difficultySome difficultyMuch difficultyUnable to doIF VOLUNTEEREDHAVE NEVER DONECurrently,youeveruseequipmentdevicessuchcane,walkerwheelchairwhenwalkingYESYESQUESTIONWhatequipmentdevicethat?READLOUD.CHOOSEALLTHATAPPLYWALKERCANECRUTCHESWHEELCHAIR/CARTRAILINGORTHOPEDIC SHOESBRACE (LEG OR BACK)PROSTHESISOXYGEN/RESPIRATORFURNITURE/WALLSOTHERXVII.ECEIVINGASKSECTIONONLY“SOMEDIFFICULTY”“MUCHDIFFICULTY”“UNABLEDO”FORFUNCTIONALHEALTHITEMYoumentionedthatyouhavedifficultywithsometheaboveitems.DoesanyoneeverhelpyouwithLOOPFOREACHITEMWHICHRESPONDEND“SOMEDIFFICULTY”“MUCHDIFFICULTY”“UNABLEDO”YES1a.YESQ1:Thinkingthepersonwhohelpsyoumostoften,thissomeonewrotedownyourosterearlier? YESRECORDLINENUMBERWhichthefollowingbestdescribesthisperson'srelationshipyou?SpousespouseRomantic/SexualpartnerParentParentlaw ��Wave 2 InPerson Questionnaire | Page ChildStepchildBrothersisterGrandchildOtherrelativeyoursOthlawFriendNeighborworkerbossMinister,priest,otherclergyPsychiatrist,psychologi

22 st,counselor,therapistCaseworker/Socialw
st,counselor,therapistCaseworker/SocialworkerHousekeeper/HomehealthcareproviderOTHER (SPECIFY________________XVIII.HEALTHELATEDEHAVIORSNowwillaskingyouaboutphysicalactivitiesyoumayregularbasis.averageoverthelastmonthsoftenhaveyouparticipatedvigorousphysicalactivityexercise?vigorousphysicalactivity,meanminutes or more thingslikesports,exerciseclasses,heavyhousework,jobthatinvolvesphysicallabor.moretimesperweektimesperweektimesperweektimespermonthLessthanpermonthNeverNOTES:WALKSFORMORETHANMINUCANCOUNTNowlet’stalkaboutyoursleepinghabits Whatyouusuallybedandstarttryingfallasleep?weekdaysworkdays?_____am/pmweekendsdaysoff?_____am/pmWhatyouusuallywakeweekdaysworkdays?_____am/pmweekendsdaysoff?_____am/pmHowoftenyoufeelreallyrestedwhenyouwaketheorning?MosttheSometimesRarelyNever ��Wave 2 InPerson Questionnaire | Page Next,wouldlikeaboutyourusealcoholandtobaccoyoueverdrinkanyalcoholicbeveragessuchbeer,wine,liquor?YESQ5:Haveyoueverdrunkalcohol?YESHaveyoudrunkalcoholthelastthreemonths?YESASKQUESTIONONLYTHEYCURRENTLYDRINKHAVEDRUNKTHEPASTMONTHS:thelastthreemonths,average,howmanydaysperweekhaveyouhadanyalcoholdrink?(Forexample,beer,wine,anydrinkcontainingliquor)(DOREADRESPONSES)Every day)(None orlessthanonceweek)ASKQUESTIONONLYTHEYCURRENTLYDRINKHAVEDRUNKTHEPASTMONTHS:thelastthreemonththedaysyoudrink,abouthowmanydrinksyouhave? DRINKSASKQUESTIONONLYTHEYCURRENTLYDRI

23 NKHAVEDRUNKTHEPASTMONTHS:thelastthreemon
NKHAVEDRUNKTHEPASTMONTHS:thelastthreemonths,manydayshaveyouhadfourmoredrinksoccasion?(USEZEROFORNONE)yousmokecigarettes,cigarspipenow?(INTERVIEWERINSTRUCTION:DOESINCLUDESNUFF,CHEWINGTOBACCOOTHERFORMSTOBACCOYES“NO”Q11:Didyoueversmokecigarettescigarspiperegularly?YESSKIPNEXTSECTION ��Wave 2 InPerson Questionnaire | Page “YES”average,manyperdaydidyouusuallysmokePACKCIGARETTESCIGARETTES“YES”Howoldwereyouwhenyoulastsmokedcigarettescigarspiperegularly?“YES”Howoldwereyouwhenyoufirstsmokedcigarettescigarspiperegularly?“YES”theaverage,howmanycigarettescigarspipesperdayyouusuallysmoke?(NOTE:PACKCIGARETTES)“YES”Howoldwereyouwhenyoufirstsmokedcigarettescigarspipesregularly?XIX.BIOMEASUREBREAKSee the “Biomeasure Questionnaire” for details.SEXANDPARTNERSHIPXXI.PARTNERHISTORYASK QUESTIONS 1F W1 MARITAL STATUS= MARRIEDYou mentioned during our first INTERVIEW IN [MONTH/YEAR W1INTV] THAT YOU WERE MARRIED [W1 PARTNER]. Are you still married [W1 PARTNER]? YES (SKIP TO QUESTION 22)2. Did your marriage to [W1 SPOUSE] end in divorce or were you widowed?WidowedDivorcedVOLUNTEERED: SEPARATED 2a. IF WIDOWED: In what month and year did your (husband/wife) die?MONTHYEAR_ DON’T KNOW ��Wave 2 InPerson Questionnaire | Page EFUSED2b. IF DIVORCED OR SEPARATED: In what month and year did you stop liv

24 ing together?MONTHYEAR_ DON’T KNOWE
ing together?MONTHYEAR_ DON’T KNOWEFUSEDIF VOLUNTEERED: STILL LIVING TOGETHER CONTINUE TO QUESTION 22 AFTER R ANSWERS QUESTION 2ASK QUESTIONS 39 IF W1 MARITAL STATUS=LIVING WITH PARTNER3. You mentioned during our first interview in [MONTH/YEAR W1INTV] that you were living with [W1 PARTNER]. Are you still living with [W1 PARTNER]?YES (SKIP TO QUESTION 6)4. IF NO TO QUESTION 3: In what month and year did you stop living with [W1 PARTNER]?MONTHYEAR_ DON’T KNOWEFUSED5. IF NO TO QUESTION 3: Did [W1 PARTNER] die during the time you were living together?YES (SKIP TO QUESTION 8)6. Did you and [W1 PARTNER] marry?YES7. IF NO TO QUESTION 6: Are you still in a romantic, intimate, or sexual relationship with [W1 PARTNER]?YES8. IF YES TO QUESTION 6: In what month and year were you married?MONTHYEARDON’T KNOWEFUSED9. IF YES TO QUESTION 6: Are you and [W1 PARTNER] still married?YES(SKIP TO QUESTION 22)NO (SKIP TO QUESTION 16) ��Wave 2 InPerson Questionnaire | Page ASK QUESTIONS 1021 IF RESPONDENT W1 MARITAL STATUS=SEPARATED, DIVORCED, WIDOWED, NEVER MARRIED AND HAD A W1 SEX/ROMANTIC PARTNER.10. You mentioned during our first interview in [MONTH/YEAR W1INTV] THAT YOU WERE IN A ROMANTIC, INTIMATE, OR SEXUAL RELATIONSHIP WITH [W1 PARTNER]. Are you still in a romantic, intimate, or sexual relationship with [W1 PARTNER]?YES11. Did you and [W1 PARTNER] marry?YE

25 S(SKIP TO QUESTION 17)In what month and
S(SKIP TO QUESTION 17)In what month and year were you married?MONTHYEAR_ DON’T KNOWEFUSED13. Many couples live together before they get married. Did you and your (husband/wife) live together before you got married?MONTHYEAR_ DON’T KNOWEFUSED14. IF YES TO QUESTION 13: In what month and year did you begin living together?MONTHYEARDON’T KNOWEFUSED15. Are you and [W1 PARTNER] still married?YES(SKIP TO QUESTION 22)16. Did your marriage to [W1 SPOUSE] end in divorce or were you widowed?WidowedDivorcedIF VOLUNTEERED: SEPARATED 16a. IF WIDOWED: In what month and year did your (husband/wife) die?MONTHYEAR ��Wave 2 InPerson Questionnaire | Page _ DON’T KNOEFUSED16b. IF DIVORCED OR SEPARATED: In what month and year did you stop living together?MONTHYEARDON’T KNOWEFUSEDIF VOLUNTEERED: STILL LIVING TOGETHERCONTINUE TO QUESTION 22 AFTER R ANSWERS QUESTION16B17. Did you and [W1 PARTNER] ever live together in a romantic relationship for a month or more?YES(SKIP TO QUESTION 22)18. In what month and year did you begin living together?MONTHYEARDON’T KNOWEFUSE19. Are you and [W1 PARTNER] still living together?YES (SKIP TO QUESTION 22)20. In what month and year did you stop living with [W1 PARTNER]?MONTHYEARDON’T KNOWEFUSED21. Did [W1 PARTNER] die during the time you were living together?YESCONTINUE TO QUESTION 22 AFTER R ANSWERS QUESTION 2

26 1Now, we would like to ask you some ques
1Now, we would like to ask you some questions about your sexual relationship. By “sex” or “sexual activity,” we mean any mutually voluntary activity with another person that involves sexual contact, whether or not intercourse or orgasm occurs.In what month and year did you most recently have sexual activity with [W1 PARTNER]?MONTHYEAR ��Wave 2 InPerson Questionnaire | Page DON’T KNOWEFUSED22a. IF RESPONDENTANSWERED DON’T KNOW OR REFUSED TO QUESTION 22. Was it sometime within the last month?YES (SKIP TO Q23)DON’T KNOWEFUSED22b. Was it sometime within the last three months?YES (SKIP TO Q23)DON’T KNOWEFUSED22c. Was it sometime in the last yeaYES DON’T KNOWEFUSED23. SKIP IF PERSON DECEASED: Do you expect to have sexual activity with him/her again?YES IF RESPONDENT IS STILL WITH THEIR W1 PARTNER, SKIP TO QUESTION 31ASK QUESTIONS 2430 IF RESPONDENT IS A NEW W2 RESPONDENT, IS NO LONGER WITH W1 PARTNER, OR DID NOT HAVE SEX/ROMANTIC PARTNER IN W1. ASK QUESTIONS 2426 IF MARITAL STATUS= MARRIED24. In this interview, you mentioned that you were currently married to [W2 PARTNER]. In what month and year were you married?MONTHYEARDON’T KNOWEFUSED25. Many couples live together before they get married. Did you and your (husband/wife) live together before you got married?YESNO (SKIP TO QUESTION 28) ��Wave 2 I

27 nPerson Questionnaire | Page 26. IF YES
nPerson Questionnaire | Page 26. IF YES TO QUESTION 25: In what month and year did you beginliving together?MONTHYEARDON’T KNOWEFUSEDCONTINUE TO QUESTION 28 AFTER RESPONDENT ANSWERS QUESTION 26ASK QUESTION 27 IF W2 MARITAL STATUS=LIVING WITH PARTNER27. In this interview, you mentioned you were currently living with [W2 PARTNER] in a romantic relationship. In what month and year did you begin living together?MONTHYEARDON’T KNOWEFUSEDCONTINUE TO QUESTION 28 AFTER RESPONDENT ANSWERS QUESTION 27ASK SEXUAL ACTIVITY QUESTIONS IF R HAS A W2 PARTNER. IF RESPONDENT DOES NOT HAVE A WAVE 2 PARTNER, SKIP TO QUESTION 33Now we would like to ask you some questions about your sexual relationship. By “sex” or “sexual activity” we mean any mutually voluntary activity with another person that involves sexual contact, whether or not intercourse or orgasm occurs.29. In what month and year did you most recently have sexual activity with [W2 PARTNER]?MONTHYEARDON’TKNOWEFUSED29a. IF RESPONDENT ANSWERED DON’T KNOW OR REFUSED TO QUESTION 29: Was it sometime within the last month?YES (SKIP TO Q30)DON’T KNOWEFUSED29b. Was it sometime within the last 3 months? YES (SKIP TO Q30)DON’T KNOWEFUSED ��Wave 2 InPerson Questionnaire | Page . Was it sometime in the last year?YES DON’T KNOWEFUSED30. How many years older or younger is (he/

28 she)?_YEARSDON’T KNOWEFUSED31. How
she)?_YEARSDON’T KNOWEFUSED31. How long did you know him/her prior to having sexual activity for the first time?DON’TKNOWEFUSED32. SKIP IF PERSON DECEASED: Do you expect to have sexual activity with him/her again?YESCONTINUE TO QUESTION 33 AFTER RESPONDENT ANSWERS QUESTION 32Now we would like to ask you some questions about other relationships you may have had [W1 RESPONDENT: since your last interview in [MONTH/YEAR/W1INTV]]]W1 RESPONDENT: Other than [W1 SPOUSE] (and nd WAVE 2 SPOUSE]) have you been married since your last interview? [NEW W2 RESPONDENT: have you ever been married?]YESNO (SKIP TO QUESTION 46)34. [W1 RESPONDENT: Other than [W1 SPOUSE], how many times have you been married since your last interview?]_____ # OF MARRIAGES (SHOULD ALWAYS BE 1 OR MORE)REPEAT MARRIAGE LOOP (QUESTIONS 3545) FOR ALL REMAINING MARRIAGES STARING/ENDING SINCE [MONTH/YEAR/W1INTV]. IF ANY MARRIAGE LOOP DATES OVERLAP WITH CURRENT PARTNER, ASK IF SAME PERSON. 35. Thinking of your (first/next) marriage [since your last interview]. Is this person someone you identified earlier in the roster? (SHOW R ROSTER)YES35a. IF YES: Please tell me the line number on which this person appears.LINE NUMBER (SKIP TO QUESTION 38) ��Wave 2 InPerson Questionnaire | Page 35b. Please tell me the first name or some other way to refer to this person._____(CONTINUE TO QUESTION 36)36.

29 Is [PERSON] male or female? MaleFemale 3
Is [PERSON] male or female? MaleFemale 37. What is [NAME]’s age? (PROMPT IF NEEDED: It’s okay if you don’t know the exact age, just give us your best guess.)_AGEDON’T KNOWREFUSED37a. ASK IF RESPONDENT ANSWERED “DON’T KNOW” OR “REFUSED:” Is [NAME]older than you, younger than you, or about the same age? OlderYoungerSame age38. In what month and year did your marriage to [NAME] begin? MONTHYEARDON’T KNOWEFUSED39. Did you and your (husband/wife) live together before you were married? YESNO (SKIP TO QUESTION 41)40. In what month and year did you begin living together?MONTHYEARDON’T KNOWEFUSED41. Did that marriage end in divorce or were you widowed?WidowedDivorcedIF VOLUNTEERED: SEPARATED 41a. IF WIDOWED: In what month and year did your (husband/wife) die?MONTHYEARDON’T KNOWEFUSED ��Wave 2 InPerson Questionnaire | Page 41b. IF DIVORCED OR SEPARTED: In what month and year did you stop living together? MONTYEARDON’T KNOWEFUSEDIF VOLUNTEERED: STILL LIVING TOGETHER42. In what month and year did you most recently have sexual activity with [NAME]MONTHYEARDON’T KNOWEFUSED42a. IF RESPONDENT ANSWERED DON’T KNOW OR REFUSED TO QUESTION 42. Was it sometime within the last month? YES (SKIP TO Q44)DON’T KNOWREFUSEDb. Was it sometime within the last 3 months?YES (SKIP TO Q44)DON’T KNOWREFUSE

30 Dc. Was it sometime in the last year? YE
Dc. Was it sometime in the last year? YES. How long did you know him/her prior to having sexual activity for the first time?. SKIP IF PERSON DECEASED: Do you expect to have sexual activity with him/her again?YES[Since your last interview in [MONTH/YEAR W1INTV]], have you lived with anyone [else] in a romantic relationship for a month or more? (PROMPT: ithout marrying the person(PROMPT: ot including W1 PARTNER or W2 PARTNERYES(SKIP TO QUESTION 58) ��Wave 2 InPerson Questionnaire | Page 46. With how many other people have you lived in a romantic relationship for a month or more (since your last interview)?(PROMPT: ot including W1 or W2 PARTNER.)_____# OF COHABS (SHOULD ALWAYS BE 1 OR MORE)REPEAT COHAB LOOP (4756) FOR ALL REMAINING COHABS STARTING/ENDING SINCE [MONTH/YEAR W1INTV]. IF ANY LOOP DATES OVERLAP WITH CURRENT PARTNER ASK IF SAME PERSON. 47. Thinking of your (first/next marriage (since your last interview), is this person someone you identified earlier in the roster? (SHOW R ROSTER) YES47a. Please tell me the line number on which this person appears. _____ LINE NUMBER (SKIP TO QUESTION 51)47b. Please tell me the first name or some other way to refer to this person.(CONTINUE TO QUESTION 48)48. Is [PERSON] male or female?MaleFemale49. What is [NAMEs age? (PROMPT IF NEEDED: It’s okay if you don’t know the exact age, just give us your best gu

31 ess.)_____ AGE_____ DON’T KNOWEFUSE
ess.)_____ AGE_____ DON’T KNOWEFUSED49a. ASK IF RESPONDENT ANSWERED “DON’T KNOW” OR “REFUSED: Is [NAME]older than you, younger than you or about the same age?OlderYounger Same age50. In what month and year did you begin living with [NAME]?MONTHYEARDON’T KNOWEFUSED51. In what month and year did you stop living with [W1 PARTNER]?MONTHYEARDON’T KNOWEFUSED ��Wave 2 InPerson Questionnaire | Page 52. Did this person die during the time you were living together?YES53. In what month and year did you first have sexual activity with [NAME]?MONTHYEARDON’T KNOWEFUSED54. In what month and year did you most recently have sexual activity with [NAME]?MONTHYEARDON’T KNOWEFUSED54a. IF RESPONDENT ANSWERED DON’T KNOW OR REFUSED TO QUESTION 39: Was it sometime withinthe last month?YESDON’T KNOWREFUSED54b. Was it sometime within the last three months? YES (SKIPT TO Q56)DON’T KNOWEFUSED54c. Was it sometime in the last year?YESDON’T KNOWREFUSED55. How long did you know him/her prior to having sexual activity for the first time?56. SKIP IF PERSON DECEASED: Do you expect to have sexual activity with him/her again?YES57. Other than those we have just talked about, is there anyone else that you had sexual activity with [since[MONTH/YEAR/W1INTV]]? By “sex” or “sexual activity” we mean any mutually v

32 oluntary activity with another person th
oluntary activity with another person that involves sexual contact, whether or not intercourse or ��Wave 2 InPerson Questionnaire | Page orgasm occurs. (PROMPT: Without marrying the person) (PROMPT: Not including W1 PARTNER or W2 PARTNERYESNO (SKIP TO SEXUAL INTEREST AND MOTIVATION)58. With how many other people have you had sexual activity (since your last interview]? (PROMPT: WITHOUT MARRYING THE PERSON) (PROMPT: NOT INCLUDING W1 PARTNER OR W2 PARTNER) _____# OFSEX PARTNERS (SHOULD ALWAYS BE 1 OR MORE)REPEAT SEX LOOP (QUESTIONS 5964) FOR ALL REMAINING PARTNERS STARTING/ENDING SINCE [MONTH/YEAR/W1INTV].IF ANY LOOP DATES OVERLAP WITHCURRENT PARTNER ASK IF SAME PERSON. 59. Thinking of the (first/next) personsince your last interview, is this person someone you identified earlier in the roster? (SHOW R ROSTER)YES59a. Please tell me the line number on which this person appearsLINE NUMBER (SKIP TO QUESTION 63)59b. Please tell me the first name orsome other way to refer to this person.(CONTINUE TO QUESTION 60)60. Is [PERSON] male or female?MaleFemale61. What is [NAMEs age? (PROMPT: It’s okay if you don’t know the exact age;just give us your best guess.)DON’T KEFUSED61a. ASK IF RESPONDENT ANSWERED “DON’T KNOW” OR “REFUSEDIs [NAME] older than you, younger than you, or about the same age? OlderYoungerSame age62. In what month

33 and year did you first have sexual activ
and year did you first have sexual activity with [NAME]?MONTHYEARDON’T KNOWEFUSED ��Wave 2 InPerson Questionnaire | Page 63. In what month and year did you most recently have sexual activity with [NAME]?MONTHYEARDON’T KNOWEFUSED63a. IF RESPONDENT ANSWERED DON’TKNOW OR REFUSED TOQUESTION 63:Was it sometime within the last month?YES (SKIP TO Q64)ON’T KNOWREFUSED63b. Was it sometime within the last 3 months?YES (SKIP TO Q64)ON’T KNOWREFUSED63c. Was it sometime in the last year?YESON’T KNOWREFUSED64. How long did you know him/her prior to having sexual activity for the first time? 65. SKIP IF PERSONDECEASED: Do you expect to have sexual activity with him/her again? YESXXII.SEXUALINTERESTMOTIVATIONAboutoftenyouhinkaboutsex?LessthanoncemonthOnefewtimesmonthOnefewtimesweekEverydaySeveraltimesdayRESPONDENTSTATES:NEVERHowoftenyoufindsomeoneyoudon’tknowsuchpeoplemovies,television,books,strangersthestreetphysicallyattractive?Morethanonceday ��Wave 2 InPerson Questionnaire | Page EverydaySeveraltimesweekOnceweekLessthanonceweekNeverASKONLYRESPONDENTHASHADSEXPASTMONTHS:Youmentionedbeforethatyoulasthadsex(month/year).Whatarethereasonsyouhaven’thadsexualactivitysincethen?CHOOSEALLTHATAPPLY.USEHANDCARDCURRENTSPOUSECOHABSEXUALPARTNER;OTHERWISEUSE HAND CARD H.CARD(CHOOSEALLTHATAPPLY):YouareinterestedYourpartnerinterest

34 edPhysicalhealthproblemsphysicallimitati
edPhysicalhealthproblemsphysicallimitationsyouhavePhysicalhealthproblemsphysicallimitationsyourpartnerhasOtherSPECIFYCARD(CHOOSEALLTHATAPPLY)YouareinterestedYouhavemettherightpersonreligiousbeliefsallowsexoutsidemarriageOther(DOSPECIFY)Whenyourpartnerwantshavesexwithyou,oftenyouagreeAlways UsuallySometimeRarelyNeverIF VOLUNTEERED: MY PARTNER HAS NOT WANTED TO HAVE SEX WITH E IN THE PAST 12 MONTHS NOTE: 3 POSSIBLE INTRODUCTIONS: OPTION A, B, OR C (WITH SUBSECTIONS * **OPTION A. IF WE HAVE A NAME AND DATE OF MOST RECENT SEXUAL PARTNER: Now we’d like to ask you some questions about your relationship with (NAME OF MOST RECENT SEXUAL PARTNER).**OPTION B. IF WE HAVE NOT ALREADY GOTTEN THIS PERSON’S NAME: Now we’d like to ask you some questions about your relationship with your most recent sexual partner. Since we will be asking some questions about this partner, please tell me the first name or some other way to refer to this person:NAME ________________NEVER HAD SEX ��Wave 2 InPerson Questionnaire | Page REFUSES TO GIVE NAMEIF PROVIDE NAME OR REFUSED TO GIVE NAME ASK: Is this person male or female?MALEFEMALE**OPTION C. IF HAVE NAME, BUT CANNOT FIGURE OUT FROM THE BOXES WHICH PERSON IS THE MOST RECENT SEXUAL PARTNER:Now we’d like to ask you some questions about your relationship with your most recent sexual partner. You mentioned you had s

35 exual activity with [NAME OF MOST RECENT
exual activity with [NAME OF MOST RECENT SEXUAL PARTNER FROM Q13,ARCTSEXM] in [DATEand have not provided a date for your last sexual activity with [ME OF PERSON FROM Q20 OTHERSEXM].You have not provided a date for your last sexual activity with h NAME OF PERSON FROM Q13 ARCTSEXM, and mentioned you had sexual activity with NAME OF MOST RECENT SEXUAL PARTNER FROM Q20 OTHRSEXMin n DATE[IF MOST RECENT SEX DATES THE SAME] You mentioned you had sexual activity with [NAME]in [DATEand with [NAME]in [DATEYou have not provided a date for your last sexual activity with [NAME]or with [NAME]Which person is your most recent sexual partner?YESXXIII.CURRENT(OROSTECENT)ARTNERSHIP XXIII.A.1.Assessmentandatisfactionwithurrentelationship ASKTHISSECTIONRESPONDENTHASCURRENTPARTNER.DOESCURRENTPARTNER,ASKSECTIONREGARDSMOSTRECENTPARTNER.RECENTPARTNERDEFINEDPARTNERSHIPTHATOCCURREDTHEPASTYEARS.Howphysicallypleasurabledid/doyoufindyourrelationshipwith[CURRENT/RECENTPARTNER]be:extremelypleasurable,verypleasurable,moderatelypleasurable,slightlypleasurable,allpleasurable?(HAND CARD)ExtremelyVeryModeratelySlightlyNotall ��Wave 2 InPerson Questionnaire | Page Howemotionallysatisfyingdid/doyoufindyourrelationshipwith(him/her)be?Extremelysatisfying,verysatisfying,moderatelysatisfying,slightlysatisfying,allsatisfying?(HAND CARD)ExtremelyVeryModeratelySlightlyNot at allXXIV.BEHAVIORWITHART

36 NERThenextsetquestionsaboutyoursexualrel
NERThenextsetquestionsaboutyoursexualrelationshipwithithPARTNERthelastmonths.Youmayrefuseansweranyquestion,interviewerforthissurveyrequiredaskallthequestions.Duringthelastmonths(IFCURRENTPARTNER:Duringyourrelationship),aboutoftendidyousexwith[CURRENT/RECENTPARTNER]?Was(HAND CARD)OncedaymoreweekOncetwiceweektimesmonthOncemonthlessNoneall(SKIPQUESTIONWhenyouhadsexwith[CURRENT/RECENTPARTNER]thelastmonths,oftendidyourpartnertouchyourgenitalswith(his/her)hands?Was(HAND CARD) AlwaysUsuallySometimesRarelyNeverWhenyouhadsexwith[CURRENT/RECENTPARTNER]thelastmonths,oftendid(he/she)performoralsexyou?WasPROMPT:oralsexmeanstimulatingthegenitalswiththemouth;thatyourpartnerlickingkissingyourgenitals.) (HAND CARD)AlwaysUsuallySometimesRarelyNeverSKIPTHISMALE/MALEFEMALE/FEMALEPARTNERSHIPWhenyouhadsexwith[CURRENT/RECENTPARTNER]thelastmonths,howoftendidyouractivitiesincludevaginalintercourse?PROMPT:vaginalintercourse,meanwhenman’spenisinsidewoman’svagina.) (HAND CARD) ��Wave 2 InPerson Questionnaire | Page waysUsuallySometimesRarelyNeverthelastmonths,oftendidyoufeelsexuallyaroused(“turnedon”)duringsexualactivitywith[CURRENT/RECENTPARTNER]?(HAND CARD)AlwaysUsuallySometimesRarelyNeverWomen only: thelastmonths,oftendidhavesensationpulsatingtinglingyourvagina/genitalareaduringsexualactivitywith[CURRENT/RECENTPARTNER]?(HAND CARD)AlwaysUsuallySometimesRarelyN

37 everSEXUALBEHAVIORFUNCTIONEGARDLESSOFART
everSEXUALBEHAVIORFUNCTIONEGARDLESSOFARTNERSHIP)ASKTHISSECTIONALLRESPONDENTSSometimespeoplethroughperiodswhichtheyareinterestedsexarehavingtroublewithsexualgratification.havejustfewquestionsaboutwhetherduringthelastmonthstherehaseverbeenperiodseveralnthsmorewhenyou. . . (READBELOW).lackedinteresthavingsex?YESwereunableclimax(experienceorgasm)? YEScameclimax(experiencedorgasm)tooquickly?YESexperiencedphysicalpainduringintercourse ��Wave 2 InPerson Questionnaire | Page YESdidfindsexpleasurable(evenwaspainful)?YESfeltanxiousjustbeforehavingsexaboutyourabilityperformsexually?YESFORMALER’sONLY:hadtroublegettingmaintainingerection?YESFORFEMAR’sONLY:hadtroublelubricating?YES(IFRESPONDENTDOESTHEMEANINGLUBRICATING,USETHEFOLLOWINGPROMPT:Whenthevaginafeltdryduringsexualactivityor,otherwords,didbecomesmoothwetduringsexualactivityRESONDENTHADPROBLEMS:Howmuchdidthis/theseproblemsbotheryou?ExtremelyVeryModeratelySlightlyNot at allSKIPDIDNOTPROBLEMSDuringthepastmonths,haveyoueveravoidedsexbecausetheproblem(s)youmentioned?YES SKIPDIDNOTPROBLEMSHaveyouevertalkedwith[CURRENTPARTNER]abouttheproblem(s)youmentioned?YES ��Wave 2 InPerson Questionnaire | Page XXVI.PREUBERTALSEXUALEXPERIENCEASKALLRESPONDENTSTHISSECTIONNext,wouldlikeaskyousomemorequestionsaboutyourchildhood.FEMALE:Howoldwereyouwhenyoureachedpuberty?pubertymeanwhenyouhadyourfirstmenstrualpe

38 riod?_____ AGERESPONDENTDOESAGE:Was(HAND
riod?_____ AGERESPONDENTDOESAGE:Was(HAND CARD)thebeginningelementaschoolyounger)At theendelementaryschool(10During middleschooljuniorhigh(1214)At thebeginninghighschool(15At theendhighschoollater(17older)MALE:Howoldwereyouwhenyoureachedberty?pubertymeanwhenyouvoicechangedyoufirstnoticedyoursemenRESPONDENTDOESAGE:Was(HAND CARD)the beginning of elementary school (9 or younger)?At the end of elementary school (10 or 11)?Duringmiddle school or junior high (1214)?At the beginning of high school (1516)?At the end of high school or later (17or older)?Beforeyouwereyearsold,didanyonetouchyousexually? YES3a.Withmanypeopledidthishappen?PEOPLE Howoldwereyouwhenyoufirsthadsexwithanotherperson?INTERVIEWER NOTES: BY SEX WE MEAN VAGINAL INTERCOURSE OR ANAL INTERCOURSE IF MALEMALE RELATIONSHIP._____ AGEthisfirstoccasion,thissomethingyouwantedthetime,wentalongwith,wereforcedinto?WantedWentalongwithWereforcedinto ��Wave 2 InPerson Questionnaire | Page XXVII.VERSIONFORFEMALERESPONDENTSSometimespeoplefindeasierentertheiranswerssomequestionsthecomputerinsteadsayingthemanotherperson.Pleaseanswerthefollowingquestionsthiscomputerenteringyouranswers.WILLUSECOMPUTERWILLUSEPAPERVERSIONyourentirelifefar,aboutmanymenhaveyouhadsexwith,evenonlyonetime?“sex”sexualactivity,”meananymutuallyvoluntaryactivitywithanotherpersonthatinvolvessexualcontact,whetherintercourseorgasm

39 occurs._____ NUMBERyourentirelifefar,abo
occurs._____ NUMBERyourentirelifefar,aboutmanywomenhaveyouhadsexwith,evenonlytime?“sex”“sexualactivity,”meananymutuallyvoluntaryactivitywithanotherpersonthatinvolvessexualcontact,whetherintercourseorgasmoccurs._____ NUMBERMasturbationverycommonpractice.masturbation,meanstimulatingyourgenitals(sexorgans)forsexualpleasure,notwithsexualpartner.average,thepastmonthsoftendidyoumasturbate? (HAND CARD) (Pleaseselectansweronly MorethanoncedayEverydaySeveraltimesweekOnceweektimesmonthOncemonthEveryothermonthtimesyeartimesyeaNotallthisyearThenextsetquestionsaboutincontinence.thismighteasytalkabout,incontinencequitecommonhealthproblem.thepastmonths,haveyouhaddifficultycontrollingyourbladder,includileakingsmallamountsurine,leakingwhenyoucoughsneeze,beingablemakethebathroomtime?YES6a.“YES”Q6:Howfrequentlydoesthisoccur?(HAND CARD)Everyday ��Wave 2 InPerson Questionnaire | Page fewtimesweekfewtimesmonthfewtimesyearthepastmonths,haveyouhadotherproblemswithurinating,suchincompleteemptying,weakurinarystream,strainingbeginurination,difficultypostponingurination?YES7a.“YES”Q7:Howfrequentlydoesthisoccur?(HAND CARD)EverydayfewtimesweekfewtimesmonthfewtimesyearNowwouldlikeyouhaveexperiencedstoolincontinence.thepastmonths,haveyoulostcontrolyourbowels(stoolincontinenceanalincontinence)?YES8a.“YES”Q8:Howfrequentlydoesthisoccur?(HA

40 ND CARD)Every dayA few times a weekA few
ND CARD)Every dayA few times a weekA few times a monthA few times a yearThankyouforyourcooperation.Pleasegivethelaptopbackyourinterviewer.XXVIII.VERSIONORMALERESPONDENTS Sometimespeoplefindeasierentertheiranswerssomequestionsthecomputerinsteadsayingthemanotherperson.Pleaseanswerthefollowingquestionsthiscomputerenteringyouranswers.WILLUSECOMPUTERWILLUSEPAPERVERSIONyourentirelifefar,aboutmanywomenhaveyouhadsexwith,evenonlytime?“sex”“sexualactivity,”meananymutuallyvoluntaryactivitywithanotherpersonthatinvolvessexualcontact,whetherintercourseorgasmoccurs._____ NUMBER ��Wave 2 InPerson Questionnaire | Page yourentirelifefar,aboutmanymenhaveyouhadsexwith,evenonlyonetime?“sex”“sexualactivity,”meananymutuallyvoluntaryactivitywithanotherpersonthatinvolvesxualcontact,whetherintercourseorgasmoccurs._____ NUMBERMasturbationverycommonpractice.masturbation,meanstimulatingyourgenitals(sexorgans)forsexualpleasure,notwithsexualpartner.average,thepastmonthsoftendidyoumasturbate?(HAND CARD) (Please select one answer onlyMore than once a dayEvery dayeveral times a weekOnce a week3 times a monthOnce a monthEvery other month5 times a year2 times a yearNot at all this yearThenextsetquestionsaboutincontinence.thismighteasytalkabout,incontinencecommonhealthproblem.thepastmonths,haveyouhaddifficultycontrollingyourbladder,includingleakingsma

41 llamountsurine,leakingwhenyoucoughsneeze
llamountsurine,leakingwhenyoucoughsneeze,beingablemakethebathroomtime? YES6a.“YEQ6:Howfrequentlydoesthisoccur?(HAND CARD)Every dayA few times a weekA few times a monthA few times a yearthepastmonths,haveyouhadotherproblemswithurinating,suchincompleteemptying,weakurinarystream,strainingbeginurination,difficultypostponingurination?YES7a.“YES”Q7:Howfrequentlydoesthisoccur?(HAND CARD)Every dayA few times a weekA few times a monthA few times a year ��Wave 2 InPerson Questionnaire | Page Nowwouldlikeyouhaveexperiencestoolincontinence.thepastmonths,haveyoulostcontrolyourbowels(stoolincontinenceanalincontinence)?YES8a.“YES”Q8:Howfrequentlydoesthisoccur?(HAND CARD)Every dayA few times a weekA few times a monthA few times a yearThankyouforyourcooperation.Pleasegivethelaptopbackyourinterviewer.XXIX.FERTILITY/MENOPAUSE (ASKALLFEMALERESPONDENTSTHISSECTION) NowI’mgoingtoaskyoufewquestionsaboutyourreproductivehistory.Howmanyhaveyoubeenpregnantaltogether?(PROMPT:Pleaseincludelivebirths,miscarriages,stillbirths,tubalpregnancies,andabortions.)_____ NUMBER (RANGE 0PREGNANCIES,SKIPTHISQUESTION(BIRTHS):Howmanyyourpregnanciesresultedlivebirths?(PROMPT:“livebirth,”meanthebirthlivingnewborn.)NTERVIEWERINSTRUCTIONS:BIRTHCONSIDERED“LIVE”EVENTHEINFANTONLYLIVEDSHORTTIME._____ NUMBER (RANGE 0Howoldwereyouwhenyouhadyourlastenstrualper

42 iod?(PROMPTRESPONDENTREFERSMENOPAUSE:are
iod?(PROMPTRESPONDENTREFERSMENOPAUSE:aretryingunderstandwhenwomenthroughmenopause.Thebestwaymeasurethemenopauserecordwhenyouhadyourlastmenstrualperiod.)ANSWEREDLASTMENSTRUALPERIODANSWEREDSTILLMENSTRUATINGHAVINGPERIODSCHILDRENGRANDCHILDRENNext,wouldlikeaskyousomequestionsaboutanychildrenyoumayhave.Forthesequestions,youmanyincludechildrenwhoarebiologicallyrelatedyou,suchstepchildrenadoptedchildren. ��Wave 2 InPerson Questionnaire | Page Howmanylivingsonsyouhave?(IFASKED,SAY:"Youmayincludestepsonsyouwish.")_____ NUMBERHowmanylivingdaughtersyouhave?(IFASKED,SAY:"Youmayincludestepdaughterswish.")_____ NUMBERHowmanylivinggrandchildrenyouhave?(IFASKED,SAY:"Youmayincludegrandchildrenfromstepsonsstepdaughters,stepgrandchildren,youwish.")_____ NUMBERXXXI.MENTALHEALTHXXXII.HAPPINESSNowwillturnthoughtsandfeelingsyoumayhaveaboutyourlifeyourself.askingaboutyourthoughtsandfeelingsadditionyourphysicalhealth,canpaintmorecompletepictureyourlife.youwereconsideryourlifegeneralthesedays,happyunhappywouldyousayyouare,thewhole . . .(HAND CARD)ExtremelyhappyVeryhappyPrettyhappyUnhappysometimesUnhappyusuallyXXXIII.DEPRESSIONNowlet’stalkaboutthoughtsandfeelingsyoumayhavehadduringthepastweek.willeadseriesstatements.Telloftenduringthepastweekyoufeltlikethis;rarelythetime,somethetime,occasionally,mostthetime?Don’ttaketoolongoveryourreplies;yourimmediatereactioneachitemwi

43 llprobabmoreaccuratethanlongthoughtrespo
llprobabmoreaccuratethanlongthoughtresponse.(HAND CARD) Duringthepastweek. . . didfeellikeeating;appetitewasRarelytheSometheOccasionallyMostthe ��Wave 2 InPerson Questionnaire | Page feltdepressedRareor none of the time Someof the timeOccasionallyMostof the timefeltthateverythingdidwaseffortRarelyor none of the time Someof the timeOccasionallyMostof the timesleepwasrestlessRarelyor none of the time Someof the timeOccasionallyMostof the timewashappyRarelyor none of the time Someof the timeOccasionallyMostof the timefeltlonelyRarelyor none of the time Someof the timeOccasionallyMostof the timePeoplewereunfriendlyRarelyor none of the time Someof the timeOccasionallyMostof the timeenjoyedlifeRarelyor none of the time Someof the timeOccasionallyMostof the timefeltsadRarelyor none of the time Someof the timeOccasionally ��Wave 2 InPerson Questionnaire | Page Mostof the timefeltthatpeopledislikedRarelyor none of the time Someof the timeOccasionallyMostof the timecouldget"going"Rarelyor none of the time Someof the timeOccasionallyMostof the timeXXXIV.EMPLOYMENTFINANCESareinterestedthefinancialcircumstancesthatmightaffectthehealtholderAmericans,I’dlikeaskyousomequestionsaboutyouremploymentandyourfinances.XXXV.EMPLOYMENTAreyouCHOOSEALLTHATAPPLYTHESEAPPLIES,SELECTOTHER.(HAND CARD)Currentlyworking?Ret

44 iredDisabledandunablework?Unemployedlaid
iredDisabledandunablework?Unemployedlaidoffandlookingforwork?homemaker?OTHERSPECIFY)Pleasetellwhattypeotheremploymenthold. ASKONLYRESPONDENTNOTCURRENTLYWORKINGAND RETIRED:Haveyoueverworkedforpay? YESDON’TKNOWREFUSED ASKONLYRESPONDENTANSWERED‘OTHER’QUESTIONAreyou workingforpay,eitherfullparttime,thepresenttime? YESDON’T KNOWREFUSEDASKALLRESPONDENTS ��Wave 2 InPerson Questionnaire | Page firstgoingaskfewquestionsaboutworkrelatedactivitiesthelastweek.lastweek,meantheweekbeginningSunday,,DATEandendingSaturday,,DATELastweek,didyouanyworkforpay?YESDON’T KNOWREFUSEDYES:Howmanyhoursperweekyouusuallyworkthisjob?_____ HOURS PER WEEKXXXVI.HOUSEHOLD INCOMENow,I’dlikeaskyouabouttheincomeyourhousehold.together,whatwouldyousaywasapproximatelytheincomeyourhousehold[CURRENTYEARMINUSbeforetaxesdeductions?(PROMPTRESPONDENTASKSFORDEFINITIONHOUSEHOLD:Householdmeanspeoplelivingtogetherunderroofincludingdependentslikeyoungchildren,elderlyparents,adultchildrenwhohavereturned.doesincludeplatonicroommates.)(NOTEFOR INTERVIEWER: R SHOULD INCLUDE EARNINGS, GOVERNMENT BENEFITS LIKE SOCIAL SECURITY, VETERANS BENEFITS AND SSI,AND PAYMENTS FROM PENSION PLANS OF ALL MEMBERS OF THE HOUSEHOLD. R SHOULD NOT INCLUDE ANY INTEREST PAYMENTS FROM SAVINGS, PAYMENTS FROM IRAS, DIVIDENDS FROM STOCKS, BONDS, OR MUTUAL FUNDS, OR ANY MONETARY GIFTSRE: QUESTION XI.B.2: A

45 SK THIS QUESTION ONLY IF RESPONDENT ANSW
SK THIS QUESTION ONLY IF RESPONDENT ANSWERS "DON'T KNOW" OR "REFUSED" TO ABOVE QUESTIONASKONLYANSWERSDON’TKNOW/REFUSEDABOVEQUESTION:WouldyousaytheincomeyourhouseholddCURRENTYEARMINUSwasmorethanlessthan MoreSKIPQUESTIONAboutLessthan(GOQUESTIONDON’TKNOWREFUSEDASK QUESTION XI.B.3. ONLY IF RESPONDENT ANSWERED "LESS THAN $50,000" TO QUESTION XI.B.2. ��Wave 2 InPerson Questionnaire | Page WouldyousaytheincomeyourhouseholddCURRENTYEARMINUSwasmorethanlessthan$25,000?MorethanAboutLessthanDON’TKNOWREFUSEDASKQUESTIONXI.B.4.ONLYRESPONDENTANSWERED"MorethanQUESTIONXI.B.2.WouldyousaytheincomeyourhouseholddCURRENTYEARMINUSwasmorethanlessthan$100,000?MorethanAboutLessthanDON’TKNOWREFUSEDXXXVII.HOUSEHOLDASSETSNowI'dlikeyouthinkaboutalltheassetsyourhousehold.Thesearethingslikeyourhouse(ifyouownit),yourcars,otherrentalpropertiesandbusinessesyouown,andfinancialassetslikesavingsaccounts,stocks,bonds,mutualfunds,andpensions.Altogether,muchwouldyousaythatamountedto,approximately,aftercountingfortheloansyoumighthavepayoff?(IFRESPONDENTASKSTHISREFERSNETWORTH,CONFIRMTHATDOES.) RE: QUESTION 2. : ASK THIS QUESTION ONLY IF RESPONDENT ANSWERS "DON'T KNOW" OR "REFUSED" TO ABOVE QUESTION.WoulyousaythatallyourassetscombinedamountmorelessthanMorethanSKIPQ4)AboutLessthan(GOQ3)DON’TKNOWREFUSEDASK QUESTION 3 ONLY IF RESPONDENT ANSWERED "LESS THAN $50,000" TO QUESTION

46 uldyousaythatallyourassetscombinedamount
uldyousaythatallyourassetscombinedamountmorelessthanMorethanAboutLessthan ��Wave 2 InPerson Questionnaire | Page DON’TKNOWREFUSEDASKQUESTIONSONLYRESPONDENTANSWERED"MorethanQUESTIONWouldyousaythatallyourassetscombinedamountmorelessthanMorethanAboutLessthan(GODON’TKNOWREFUSEDASKQUESTIONONLYRESPONDENTANSWERED"Lessthan$500,000"QUESTIONWouldyousaythatallyourassetscombinedamountmorelessthanMorethanAboutLessthanDON’TKNOWREFUSEDyouuandPARTNERownyourhome,rentwhat?RentIF VOLUNTEERED: LIVES RENT FREE WITH SOMEONEOTHER (SPECIFYthepastyears,howmanytimeshaveyoumoved?_____ NUMBER7a. IF 'DON’T KNOW' OR 'REFUSED' TO Q7: Was it more than onetime?YES: Was it more than 5 times?YESXXXVIII.RELIGIONWhatyourcurrentreligiouspreference(PROBENECESSARY:Protestant,Catholic,Jewishsomeotherreligionreligionall?NOTE:CODE“GREEKORTHODOX“RUSSIANORTHODOX“EASTERNORTHODOXCATHOLIC PROTESTANT(PROMPTDENOMINATIONALCHRISTIANCATHOLIC ��Wave 2 InPerson Questionnaire | Page JEWISHOTHERPECIFY)_____ASKONLYRESPONDENTANSWERED“PROTESTANT”RELIGION:Whatspecificdenominationbranchthat,any?BAPTISTEPISCOPALIANLUTHERANMETHODISTMORMONPRESBYTERIANUNITEDCHURCHCHRIST(CONGREGATIONAL)OTHER(SPECIFYVERBATIM)___________ASKONLYRESPONDENTANSWERED“PROTESTANT’“CATHOLIC”RELIGION:Wouldyousaythatyouhavebeen“bornagain”havehad“bornaga

47 in”experience?YESThinkingaboutthepa
in”experience?YESThinkingaboutthepastmonths,aboutoftenhaveyouattendedreligiousservices?(HAND CARD)SeveraltimesweekEveryweekAboutoncemonthSeveraltimesyearAboutoncetwiceyearNeverXXXIX.INTERNETyouhaveaccesstheWorldWideWeb,theInternetyourhomeanotherlocation?YESWhereyoumostoftenusetheinternet:yourhomeanotherlocation?Home Another locationyouregularlyusetheWorldWideWeb,theInternet,forsendingandreceivingmailforanyotherpurpose,suchmakingpurchases,searchingforinformation,makingtravelreservations?YES ��Wave 2 InPerson Questionnaire | Page XL.DEBRIEFINGThankyouforyourtime.Because people move from time to time, please give us the name, address and telephone number of a person who will always know where you canbe reached (even if you should move or change your phone number).1. What is this person'sFIRST & LAST NAME: ________________ STREET ADDRESS: ________________CITY, STATE & ZIP: ________________ PHONE NUMBER: ________________ 2. UNDER WHAT NAME IS THIS PHONE NUMBER LISTED: NAME: ________________3. We would like to confirm your home address. Is your home address [INSERT RESPONDENT ADDRESS FROM PRELOAD HEREYES (SKIPTO Q5)DON’T KNOW REFUSED4. IF NO, DON’T KNOW, OR REFUSED TO Q3:Please tell us your correct home address. STREET ADDRESS: ________________ CITY: ________________STATE: _______________ZIPCODE: _____________5. IF PHONE NUMBERS AVAILABLE: We

48 would like to confirm your phone number
would like to confirm your phone number(s). We have yourphone number(s) as [INSERT RESPONDENT PHONE NUMBERS FROM PRELOAD HERE. Is that correct? YES (SKIPTO Q7)DON’T KNOW REFUSED6. IF NO, DON’T KNOW, OR REFUSED TO Q5: Please tell us your correct phone numbers. PHONE NUMBER 1 ________________PHONE NUMBER 2 ___PHONE NUMBER 3 ________________7. IF LESS THAN 3 PHONE NUMBERS LISTED IN PRELOAD: Are there any other phone numbers we can reach you at?YES(GO TO Q8) ��Wave 2 InPerson Questionnaire | Page SKIPTO QDON’T KNOW REFUSED8. IF Q7=YES OR NO PHONE NUMBERS AVAILABLE TO PRELOAD: Please tell us up to three telephone numbers we can reach you at in the future, if necessary. PHONE NUMBER 1 ________________PHONE NUMBER 2 ________________PHONE NUMBER 3 ________________9. IF EMAIL ADDRESS AVAILABLE: We would like to confirm youremail address. Is your email address [INSERT RESPONDENT EMAIL ADDRESS FROM PRELOAD HEREYESDON’T KNOW REFUSED10. IF NO, DON’T KNOW, OR REFUSED TO Q9: Please tell us your correct email address. EMAIL ADDRESS: SKIPTO Q12)VOLUNTEERED DOES NOT HAVE EMAIL ADDRESSDON’T KNOW REFUSED11. We would also like to keep in touch with you through email, if necessary. Please give us your email address if you currently have one. EMAIL ADDRESS: (GO TO Q12)IF VOLUNTEERED DOES NOT HAVE EMAIL ADDRESSDON’T KNOW REFUSED. PLEASE

49 GIVE RESPONDENT FOLLOWUP QUESTIONNAIRE (
GIVE RESPONDENT FOLLOWUP QUESTIONNAIRE (1 OR 2) PPROPRIATE ENVELOPE. WRITE SU_ID WHERE INDICATED ON BACK COVER. Thank you for your participation.Our survey is almost completone of the last steprequires that you fill out this questionnaire, seal it in this postagepaid envelope, and drop it in the mail. XLI.INTERVIEWERCOMMENTSINTERVIEWER: PLEASE COMPLETE THESE QUESTIONS AS SOON AS POSSIBLE AFTER YOU LEAVE THE INTERVIEW ��Wave 2 InPerson Questionnaire | Page XLII.CHARACTERISTICSANDOCATIONTHENTERVIEWWheredidtheinterviewtakeplace?RESPONDENT’S HOMERESPONDENT’S FAMILY MEMBER’S HOMERESPONDENT’S FRIEND’S HOMERESPONDENT’S WORKPLACE DON’T KNOWREFUSEDOtherpersonswerepresent:DURING NONE OF THE INTERVIEW (GO TO QUESTION 4)OCCASIONALLY PASSING THROUGH THE INTERVIEW AREADURING 1/4 OF THE INTERVIEWDURING HALF OF THE INTERVIEWDURING 3/4 OF THE INTERVIEWFOR THE ENTIRE INTERVIEWDON’T KNOWREFUSEDANSWERQUESTIONQUESTIONNOTERO.ANSWER QUESTION 3 IF QUESTION 2 IS NOT ZERO: Whatotherpersonswerepresentduringtheinterview?CHOOSEALLTHATAPPLY.SPOUSE/PARTNERRESPONDENT’S CHILD/CHILDREN UNDER 12 YEARS OF AGERESPONDENT’S CHILD/CHILDREN OVER 12 YEARS OF AGEOTHER RELATIVE(S)FRIENDCAREGIVEROTHER ADULT NONRELATIVEOTHER CHILD NONRELATIVEUNABLE TO DETERMINE RELATIONSHIPDON’T KNOWREFUSEDHowcandidwastherespondent?PROBABLY NOT CANDID AT ALLS

50 OMEWHAT CANDIDMOSTLY CANDIDENTIRELY CAND
OMEWHAT CANDIDMOSTLY CANDIDENTIRELY CANDIDDON’T KNOWREFUSED ��Wave 2 InPerson Questionnaire | Page XLIII.RESPONDENT’SUNCTIONALEALTHEHAVIORDURINGTHENTERVIEWPleaseratetherespondent’sfunctionalhealthandbehaviorduringtheinterviewthefollowingscales: 1 2 3 4 5 DK R Practically deaf Normalhearing Practically blind Normalvision Unable read Normaladultliteracy XLIV.DESCRIPTIONOFTHEESPONDENTDescribetherespondentusingthefollowingscales: 1 2 3 4 5 DK R Physically attractive Notphysicallyttractive 2. Attractive personality Not attractive personality 3. Well - dressed Poorly dressed 4. Hygienic Not hygienic 5. Straight posture Stooped/slouching 6. Flat stomach Pot belly 7. Thin Obese 8. Spoke clearly Did not speak clearly Didtherespondenthaveanythefollowingnotableaspectshis/herappearance?CHOOSEALLTHATAPPLYBAD/MISSING TEETHHEAVY MAKEOBVIOUSLY DYED HAIOBVIOUS TOUPEEPHYSICAL HANDICAP (SPECIFY) _______________PROSTHESIS AND/OR MISSING LIMB(S) (SPECIFY) ________________GLASSES ��Wave 2 InPerson Questionnaire | Page BALD, BALDING, OR THINNING HAIRGOLD OR SILVER TOOTH OR TEETHNO NOTABLE ASPECTSOTHER (SPECIFY) ________________ DON’T KNOWREFUSEDXLV.DESCRIPTIONOFTHENTERVIEWOCATIONDescribetheroom(s)whichtheinterviewwasconducted,usingthefollowingscales: 1 2 3 4 5

51 DK R 1. Cold Hot 2. Dark Lig
DK R 1. Cold Hot 2. Dark Light 3. Clean Dirty 4. Neat and T idy Messy 5. Quiet Noisy 6. Cramped Spacious 7. Very cluttered Notclutteredall 8. No smell SKIPStrongsmell 9. Pleasant smell Unpleasantsmell XLVI.RESPONDENT’SMEANDHIS/ HEIGHBORHOODNVIRONMENT(SKIPQUESTIONS)INTERVIEWWASRESPONDENT’SHOME)Typestructurewhichrespondentlives:TRAILERDETACHED SINGLE FAMILY HOUSETWOFAMILY HOUSE, TWO UNITS SIDESIDETWOFAMILY HOUSE, TWO UNITS ONE ABOVE THE OTHERDETACHED 34 FAMILY HOUSEROW HOUSE (3 OR MORE UNITS IN AN ATTACHED ROW)APARTMENT HOUSE (5 OR MORE UNITS, 3 STORIES OR LESS)APARTMENT HOUSE (5 OR MORE UNITS, 4 STORIES OR MORE)APARTMENT IN A PARTLYCOMMERCIAL STRUCTUREASSISTED LIVING FACILITY OR GROUP HOMENURSING HOMEOTHER (SPECIFY) ________________ DON’T KNOW ��Wave 2 InPerson Questionnaire | Page REFUSEDHowwellkeptthebuildingwhichtherespondentlives?VERY POORLY KEPT (NEEDS MAJOR REPAIRS)POORLY KEPT (NEEDS MINOR REPAIRS)FAIRLY WELL KEPT (NEEDS COSMETIC WORK)VERY WELL KEPT DON’T KNOWREFUSEDHowwellkeptaremostthebuildingsthestreet(oneblock,bothsides)wheretherespondentlives?VERY POORLY KEPT (NEEDS MAJOR REPAIRS)POORLY KEPT (NEEDS MINOR REPAIRS)FAIRLY WELL KEPT (NEEDS COSMETIC WORK)VERY WELL KEPT DON’T KNOWREFUSEDComparedotherhouses/apartmentstheneighborhood,wouldyousaythattherespondent’shous

52 e/apartmentwas:FAR BELOW AVERAGEBELOW AV
e/apartmentwas:FAR BELOW AVERAGEBELOW AVERAGEAVERAGEABOVE AVERAGEFAR ABOVE AVERAGEDON’T KNOWFUSEDDescribethestreet(oneblock,bothsides)wheretherespondentlives,usingthefollowingscales: 1 2 3 4 5 DK R 5. Clean Fulllitterrubble 6. Quiet Noisy trafficthestreet Heavy traffic on the street Buildings/housesareclose together Buildings/housesarefarapart smellairpollution Strong smell or air pollution ��Wave 2 InPerson Questionnaire | Page XLVII.INTERVIEW LOGISTICS AND OTHER INFORMATION 1. Counting this case, how manyinterviews have you completed for this survey so far? THIS IS MY FIRST CASE SECOND CASE THIRD CASE FOURTH CASE FIFTH CASE SIXTH CASE SEVENTH CASE EIGHTH CASE NINTH CASE TENTH CASE ELEVENTH CASE OR MORE DON’T KNOW REFUSED 2. How difficult was this case to get? VERY DIFFICULT SOMEWHAT DIFFICULT NOT VERY DIFFICULT NOT AT ALL DIFFICULT DON’T KNOW REFUSED 3. Finally, please add additional information that would help us better understand the respondent as a person or the conditions under which the interview took place. DON’T KNOW REFUSED 
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105 -�16��87;)/-8)1,�-6က-4
-�16��87;)/-8)1,�-6က-478-�7��" �"=:e-A\t�7:�")-�"--�\t�477:01+)/7���\b\b\n !-+-18  %-:1.1+) ,2=,1+) 61) )- 61) )- 61) )- 61) )- �$"�' " �\b\f\n\b\t\b WAVE 2 DATA COLLECTION INSTRUMENTS Suggested CitationWaite LJ, Cagney KA, Cornwell B, Dale W, Huang E, Laumann EO, McClintock MO’Muircheartaigh C, Schumm P. (2011). National Social Life, Health, and Aging Project (NSHAP) Wave 2 InPerson and LeaveBehind Questionnaires. Chicago, IL: NORC at the University of Chicago.NSHAPInvestigatorsLinda J. Waite, Principal InvestigatKathleen A. CagneyBenjamin CornwellWilliam DaleElbert HuangwardO. LaumannMartha K. McClintockColm A. O'MuircheartaighL. Phil SchummAcknowledgmentsNSHAPWave 2is supported by the National Institutes of Health, including the National Institute on Aging R37AG030481and R01AG 034679, the Office of Research on Women's Health, and the Office of AIDS Research. Additional financial and material support is provided by NORC at the University of Chicago. Contact InformationNORC at the University of Chicago1155 East 60th StreetChicago, Illinois 60637Phone: (773) 256Fax: (773) 256http