Routing for UAS158
intro2
This survey will ask you questions about your physical and emotional health. Some of these questions may look familiar to you, but we are interested in your response to them today.
Group of questions presented on the same screen
date_intro
What is your date of birth?
dateofbirth_month (R DATE OF BIRTH MONTH)
Month
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December
dateofbirth_day (R DATE OF BIRTH DAY)
Day
RANGE 0..9223372036854775807
dateofbirth_year (R DATE OF BIRTH YEAR)
Year
RANGE 0..9223372036854775807
End of group of questions
minage := strtotime("1954-01-15 00:00:01")
maxage := strtotime("1955-06-15 23:59:59")
if dateofbirth_month = empty OR dateofbirth_year = empty then
notfull
Thank you for your interest, but we could not determine your eligibility for this study. Please click "Next" to return your panel member page.
Exit the survey
elseif dateofbirth_month = response AND dateofbirth_day = empty AND dateofbirth_year = response then
if strtotime(dateofbirth_year . "-" . dateofbirth_month . "-15 00:00:01") < minage then
noteligible
Thank you for your interest, but right now we are not interviewing people in your age range.
Exit the survey
elseif strtotime(dateofbirth_year . "-" . dateofbirth_month . "-15 00:00:01") > maxage then
noteligible
Thank you for your interest, but right now we are not interviewing people in your age range.
Exit the survey
End of if
elseif strtotime(dateofbirth_year . "-" . dateofbirth_month . "-" . dateofbirth_day . " 00:00:01") < minage then
noteligible
Thank you for your interest, but right now we are not interviewing people in your age range.
Exit the survey
elseif strtotime(dateofbirth_year . "-" . dateofbirth_month . "-" . dateofbirth_day . " 00:00:01") > maxage then
noteligible
Thank you for your interest, but right now we are not interviewing people in your age range.
Exit the survey
End of if
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
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
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
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
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
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
Group of questions presented on the same screen
q015 (chronic diseases)
Has a doctor ever told you that you had (check all that apply)?
1 Diabetes
2 Heart disease
3 Arthritis
4 Asthma
5 Cancer
6 Other, please specify:
7 None of the above
q015_other (other chronic disease)
STRING
End of group of questions
q013_a (past 12 months received any social security income)
In the past 12 months, have you received any social security income?
1 (YES) Yes
2 (NO) No
q013_b (past 12 months received any disability benefits)
In the past 12 months, have you received any disability benefits?
1 (YES) Yes
2 (NO) No
q014_intro
Now we will present you with several statements. Please indicate for each statement whether you think it is true or false.
q014_a (Most working age individuals in the US receive health insurance through their or their spouse's employer )
Most working age individuals in the US receive health insurance through their or their spouse's employer.
1 True
2 False
q014_b (Medicare is a health insurance program for those ages 65 and older or with certain disabilities )
Medicare is a health insurance program for those ages 65 and older or with certain disabilities.
1 True
2 False
q014_c (Medicare is only available to those individuals who are receiving social security retirement benefits)
Medicare is only available to those individuals who are receiving social security retirement benefits.
1 True
2 False
q014_d (The share of individuals with any health insurance coverage in the US has decreased since 2010)
The share of individuals with any health insurance coverage in the US has decreased since 2010.
1 True
2 False
q014_e (Medicaid is a health insurance program for certain individuals with low income)
Medicaid is a health insurance program for certain individuals with low income.
1 True
2 False
if q012_a = empty OR q012_b = empty then
q012_intro
Before we finish, we have just a few more questions.
End of if
if q012_b = empty then
q012_b (R SPANISH HISPANIC LATINO)
Are you Spanish, Hispanic or Latino?
1 (YES) Yes
2 (NO) No
End of if
if q012_a = empty then
Group of questions presented on the same screen
q012_a (R RACE)
What is your race? Please check all that apply.
1 White
2 Black or African American
3 American Indian or Alaska Native
4 Asian
5 Native Hawaiian or Other Pacific Islander
6 Other, please specify:
q012_a_other (other race)
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