Routing for UAS163
intro2
In this survey we will ask you questions about your physical and emotional health.
q006 (cantril ladder)
Please imagine a ladder with steps numbered from zero at the bottom to ten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?
10 10 Best possible
9 9
8 8
7 7
6 6
5 5
4 4
3 3
2 2
1 1
0 0 Worst possible
q007 (how satisfied with life you lead)
On the whole are you very satisfied, fairly satisfied, not very satisfied, or not at all satisfied with the life you lead?
1 Very satisfied
2 Fairly satisfied
3 Not very satisfied
4 Not at all satisfied
q004 (overall health)
In general, would you say your health is:
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
q005 (mental health)
In general, would you say your mental health is:
1 Excellent
2 Very good
3 Good
4 Fair
5 Poor
q008_questions := array(1 => "q008_a", 2 => "q008_b", 3 => "q008_c", 4 => "q008_d", 5 => "q008_e", 6 => "q008_f", 7 => "q008_g")
if sizeof(q008_order) = 0 then
q008_order := shuffleArray(array(1 => 1, 2 => 2, 3 => 3, 4 => 4, 5 => 5, 6 => 6, 7 => 7))
End of if
Loop from 1 to 7
Value of question 'q008_questions[q008_order[cnt]]' asked as question
End of loop
q009 (worry about money)
Did you worry about money yesterday?
1 (YES) Yes
2 (NO) No
if q009 = 1 then
q009_2 (how worried)
Were you very worried or just somewhat worried?
1 Very worried
2 Just somewhat worried
End of if
Group of questions presented on the same screen
q002_intro
The following two questions ask about how you have been feeling in the past 2 weeks.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Subgroup of questions
q002_a (Little interest or pleasure in doing things)
Little interest or pleasure in doing things
1 Nearly every day
2 More than half the days
3 Several days
4 Not at all
q002_b (feeling down, depressed, or hopeless)
Feeling down, depressed, or hopeless
1 Nearly every day
2 More than half the days
3 Several days
4 Not at all
End of subgroup of questions
End of group of questions
Group of questions presented on the same screen
q003_intro
The following questions ask about how you have been feeling during the past 30 days. For each questions, please check the box that best describes how often you had this feeling.
During the past 30 days, about how often did you feel...
Subgroup of questions
q003_a (feeling nervous)
...Nervous
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
q003_b (feeling hopeless)
...Hopeless
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
q003_c (feeling restless or fidgety)
...Restless or fidgety
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
q003_d (feeling so sad that nothing could cheer you up)
...So sad that nothing could cheer you up
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
q003_e (feeling that everything was an effort)
...That everything was an effort
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
q003_f (feeling worthless)
...Worthless
1 All of the time
2 Most of the time
3 Some of the time
4 A little of the time
5 None of the time
End of subgroup of questions
End of group of questions
q010 (confident card)
In the next month, are you confident you will have access to quality medical care?
1 (YES) Yes
2 (NO) No
q011a (have health insurance coverage)
Do you have health insurance coverage?
1 (YES) Yes
2 (NO) No
if q011a = 1 then
Group of questions presented on the same screen
q011b (type of coverage)
Which of the following best describes your current health insurance or health coverage plan?
Please check all that apply.
1 Insurance through my or my spouse’s/partner’s employer/union
2 Retiree Insurance through my or my spouse’s/partner’s former employer/union
3 Private insurance purchased directly from an insurance company or through a state or federal exchange marketplace
4 Medicare
5 Medicaid, Medical Assistance or any kind of government assistance plan for those with low incomes or a disability
6 Tricare or other military health care
7 VA, including CHAMPVA or VA Care
8 Other program:
q011b_other (other type of coverage)
STRING
End of group of questions
End of if
CS_001 (HOW PLEASANT INTERVIEW)
Could you tell us how interesting or uninteresting you found the questions in this interview?
1 Very interesting
2 Interesting
3 Neither interesting nor uninteresting
4 Uninteresting
5 Very uninteresting
CS_003 (comments)
Do you have any other comments on the interview? Please type these in the box below.(If you have no comments, please click next to complete this survey.)
STRING